ImranzamanML/Clinical_Documents_on_Syndromes_Disease

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Type 2 sprain in the medial collateral ligament and type sprain in the lateral collateral ligament.

Joint effusion and bone bruise with suggestion of some minimal overlying chondromalacia and medial patellar facet.
EXAM:

MRI RIGHT FOOT

CLINICAL:

Pain and swelling in the right foot.

FINDINGS:

Obtained for second opinion interpretation is an MRI examination performed on 11-04-05.

There is a transverse fracture of the anterior superior calcaneal process of the calcaneus. The fracture is corticated however and there is an active marrow stress phenomenon. There is a small ganglion measuring approximately 8 x 5 x 5mm in size extending along the bifurcate ligament.

There is no substantial joint effusion of the calcaneocuboid articulation. There is minimal interstitial edema involving the short plantar calcaneal cuboid ligament.

Normal plantar calcaneonavicular spring ligament.

Normal talonavicular articulation.

There is minimal synovial fluid within the peroneal tendon sheaths.

Axial imaging of the ankle has not been performed orthogonal to the peroneal tendon distal to the retromalleolar groove. The peroneus brevis tendon remains intact extending to the base of the fifth metatarsus. The peroneus longus tendon can be identified in its short axis extending to its distal plantar insertion upon the base of the first metatarsus with minimal synovitis.

There is minimal synovial fluid within the flexor digitorum longus and flexor hallucis longus tendon sheath with pooling of the fluid in the region of the knot of Henry.

There is edema extending along the deep surface of the extensor digitorum brevis muscle.

Normal anterior, subtalar and deltoid ligamentous complex.

Normal naviculocuneiform, intercuneiform and tarsometatarsal articulations.

The Lisfranc’s ligament is intact.

The Achilles tendon insertion has been excluded from the field-of-view.

Normal plantar fascia and intrinsic plantar muscles of the foot.

There is mild venous distention of the veins of the foot within the tarsal tunnel.

There is minimal edema of the sinus tarsus. The lateral talocalcaneal and interosseous talocalcaneal ligaments are normal.

Normal deltoid ligamentous complex.

Normal talar dome and no occult osteochondral talar dome defect.

IMPRESSION:

Transverse fracture of the anterior calcaneocuboid articulation with cortication and cancellous marrow edema.

Small ganglion intwined within the bifurcate ligament.

Interstitial edema of the short plantar calcaneocuboid ligament.

Minimal synovitis of the peroneal tendon sheaths but no demonstrated peroneal tendon tear.

Minimal synovitis of the flexor tendon sheaths with pooling of fluid within the knot of Henry.

Minimal interstitial edema extending along the deep surface of the extensor digitorum brevis muscle.
CC:

Right shoulder pain.

HX:

This 46 y/o RHF presented with a 4 month history of right neck and shoulder stiffness and pain. The symptoms progressively worsened over the 4 month course. 2 weeks prior to presentation she began to develop numbness in the first and second fingers of her right hand and RUE pain. The later was described as a throbbing pain. She also experienced numbness in both lower extremities and pain in the coccygeal region. The pains worsened at night and impaired sleep. She denied any visual change, bowel or bladder difficulties and symptoms involving the LUE. She occasionally experienced an electric shock like sensation shooting down her spine when flexing her neck (Lhermitte's phenomena). She denied any history of neck/back/head trauma.

She had been taking Naprosyn with little relief.

PMH:

1) Catamenial Headaches. 2) Allergy to Macrodantin.

SHX/FHX:

Smokes 2ppd cigarettes.

EXAM:

Vital signs were unremarkable.

CN: unremarkable.

Motor: full strength throughout. Normal tone and muscle bulk.

Sensory: No deficits on LT/PP/VIB/TEMP/PROP testing.

Coord/Gait/Station: Unremarkable.

Reflexes: 2/2 in BUE except 2+ at left biceps. 1+/1+BLE except an absent right ankle reflex.

Plantar responses were flexor bilaterally. Rectal exam: normal tone.

IMPRESSION:

C-spine lesion.

Type 2 sprain in the medial collateral ligament and type sprain in the lateral collateral ligament.

Joint effusion and bone bruise with suggestion of some minimal overlying chondromalacia and medial patellar facet.

EXAM:

MRI RIGHT FOOT

CLINICAL:

Pain and swelling in the right foot.

FINDINGS:

Obtained for second opinion interpretation is an MRI examination performed on 11-04-05.

There is a transverse fracture of the anterior superior calcaneal process of the calcaneus. The fracture is corticated however and there is an active marrow stress phenomenon. There is a small ganglion measuring approximately 8 x 5 x 5mm in size extending along the bifurcate ligament.

There is no substantial joint effusion of the calcaneocuboid articulation. There is minimal interstitial edema involving the short plantar calcaneal cuboid ligament.

Normal plantar calcaneonavicular spring ligament.

Normal talonavicular articulation.

There is minimal synovial fluid within the peroneal tendon sheaths.

Axial imaging of the ankle has not been performed orthogonal to the peroneal tendon distal to the retromalleolar groove. The peroneus brevis tendon remains intact extending to the base of the fifth metatarsus. The peroneus longus tendon can be identified in its short axis extending to its distal plantar insertion upon the base of the first metatarsus with minimal synovitis.

There is minimal synovial fluid within the flexor digitorum longus and flexor hallucis longus tendon sheath with pooling of the fluid in the region of the knot of Henry.

There is edema extending along the deep surface of the extensor digitorum brevis muscle.

Normal anterior, subtalar and deltoid ligamentous complex.

Normal naviculocuneiform, intercuneiform and tarsometatarsal articulations.

The Lisfranc’s ligament is intact.

The Achilles tendon insertion has been excluded from the field-of-view.

Normal plantar fascia and intrinsic plantar muscles of the foot.

There is mild venous distention of the veins of the foot within the tarsal tunnel.

There is minimal edema of the sinus tarsus. The lateral talocalcaneal and interosseous talocalcaneal ligaments are normal.

Normal deltoid ligamentous complex.

Normal talar dome and no occult osteochondral talar dome defect.

IMPRESSION:

Transverse fracture of the anterior calcaneocuboid articulation with cortication and cancellous marrow edema.

Small ganglion intwined within the bifurcate ligament.

Interstitial edema of the short plantar calcaneocuboid ligament.

Minimal synovitis of the peroneal tendon sheaths but no demonstrated peroneal tendon tear.

Minimal synovitis of the flexor tendon sheaths with pooling of fluid within the knot of Henry.

Minimal interstitial edema extending along the deep surface of the extensor digitorum brevis muscle.

CC:

Right shoulder pain.

HX:

This 46 y/o RHF presented with a 4 month history of right neck and shoulder stiffness and pain. The symptoms progressively worsened over the 4 month course. 2 weeks prior to presentation she began to develop numbness in the first and second fingers of her right hand and RUE pain. The later was described as a throbbing pain. She also experienced numbness in both lower extremities and pain in the coccygeal region. The pains worsened at night and impaired sleep. She denied any visual change, bowel or bladder difficulties and symptoms involving the LUE. She occasionally experienced an electric shock like sensation shooting down her spine when flexing her neck (Lhermitte's phenomena). She denied any history of neck/back/head trauma.

She had been taking Naprosyn with little relief.

PMH:

1) Catamenial Headaches. 2) Allergy to Macrodantin.

SHX/FHX:

Smokes 2ppd cigarettes.

EXAM:

Vital signs were unremarkable.

CN: unremarkable.

Motor: full strength throughout. Normal tone and muscle bulk.

Sensory: No deficits on LT/PP/VIB/TEMP/PROP testing.

Coord/Gait/Station: Unremarkable.

Reflexes: 2/2 in BUE except 2+ at left biceps. 1+/1+BLE except an absent right ankle reflex.

Plantar responses were flexor bilaterally. Rectal exam: normal tone.

IMPRESSION:

C-spine lesion.