Music is the most essential ingredient of any entertainment. In order to create successful entertaining event musicians plays an imperative role. Musicians are wizards who spread the fragrance of joy by absorbing woes, in the form of Playing Related Musculoskeletal Disorders (PRMDs), for themselves. Like other occupations, musicians also suffer from work related musculoskeletal disorders which are often disabling

Dupuytren’s Contracture (DC) is a fibro-proliferative tumor according to ICD 10 - fascial fibromatosis of unknown etiology (M 720), accompanied by a stable bending contracture of fingers. In CD in the postoperative period extremely high rate of surgical complications is observed: intraoperative (injury of blood vessels, nerves, tendons), general postoperative (hematoma, necrosis, odema, stiffness, etc.), late postoperative (recurrence, spread, progression). In the last case according to the data of different authors, complications frequency is depend upon the degree (from partial up to the total) and the accuracy of excision of the affected aponeurosis ?almaris. One of the problems in choosing the type of operation and technology is the complexity of the cutoff determination boundaries of the affected CD. Up to now there is no suitable for use in the practical CD surgery algorithm of the affected aponeurosis ?almaris spread non invasive visualization in a particular patient. The most appropriate method for the solution of this problem is a method of MRI. The technology of identifying the boundaries of surgery of the affected aponeurosis palmaris in Dupuytren’s contracture by means of MRI has been elaborated. It has been shown that MRI is a highly informative method in the assessment of topographic anatomy of aponeurosis palmaris in normal and CD states. PD, T1, T2 - weighed images allow objectively to visualize the border areas of the affected aponeurosis in I - III stages of CD. PD fsat (fat tissues signal saturation) MRI mode is not recommended for use.

Metallosis is an aseptic fibrosis, local necrosis, inflammation, or loosening of an implant device secondary to metallic corrosion and release of wear debris. The condition has been highlighted recent years due to the clinical complications caused by metal-on-metal (MoM) hip replacement. Although some major types of MoM hip prostheses have been recalled from the market, metallosis is far from over as not only there are still a million implanted MoM hip prosthetic cases worldwide, but also it has been found in non-MoM hip prostheses and other metal implants. This mini review aims to provide recent findings of implants related metallosisin skeletal tissue.

Osteoarthritis (OA), a degenerative disease of the articular cartilage, is one of the most frequent pathologies of the Temporomandibular Joint (TMJ), characterized by spontaneous pain at rest or in function, decreased range of motion, and articular noise.

Lateral epicondylitis is a common disorder that affects 1% to 3% of the general population. This dysvascular and degenerative condition presents with lateral elbow pain worse with wrist extension against resistance. The primary pathologic tissue is believed to be the tendinous origin of the extensor carpi radialis brevis. The condition is self-limited in 70% to 80% of patients; therefore conservative management is first line. Surgery may be considered in persistent cases of lateral epicondylitis refractory to conservative therapy and is required in 4% to 11% of patients. The three common surgical modalities for treatment are open, percutaneous, and arthroscopic, all with good results thus far. This article aims to summarize arthroscopic treatment of lateral epicondylitis and discuss its advantages, techniques, rehabilitation, outcomes, and complications.

Objective:
To assess the usefulness of superficial ultrasonography of median nerve in accurate differentiation between neuropathic nerve and normal nerve measurement in Egyptian population.

Material and Methods:
The study was conducted on thirty patients with CTS; twelve males and eighteen females with mean age 43.93±4.51 (range 35-52y), and another thirty normal subjects; fifteen males and fifteen females, with their mean age 36.7±4.86 (range 29-45y). The Cross Sectional Area (CSA) and Flattening Ratio (FR) at different levels on both groups. Data from the study and control groups were compared. The accuracy of the ultrasonographic diagnostic criteria for CTS was evaluated using Receiver Operating Characteristic (ROC) analysis.

Results:
All measurements showed significant differences between CTS and normal groups except the CSA at pronator quadrates. Using the ROC curve, a cutoff value of CSA >10 mm2 at the level of pisiform and CSA difference > 1 between pisiform and pronator quadrates provided a 100% specificity and high overall diagnostic accuracy 98.89%.

Conclusion:
The sonographic cutoff values of the median nerve dimensions in Egyptian population could yield an accurate differentiation between neuropathic and normal median nerve.

Temporomandibular joint (TMJ) dislocations, which occur as a result of an excess of muscle activity/ spasticity in the protractor masticatory muscles, were defined as neurogenic dislocations of the TMJ. We report a case of a 36-year-old woman with sequelae of haemorrhagic stroke, which developed recurrent episodes of TMJ dislocation, interfering with the rehabilitation program and her well-being/quality of life. Conservative measures were implemented but 2 months later, TMJ dislocation episodes continued (2-3 daily). Then, type A botulinum toxin (BTX-A) injections were applied to both lateral pterygoid muscles, and these episodes ceased to happen for more than seven months. While conservative treatment is often not sufficient, surgical procedures are invasive and involve more risk, BTX-A injections, were an effective treatment option during for a longer than expected period of time.

The article presents the results of comprehensive approach to the treatment of temporomandibular dysfunction (TMD, which consisted in combination of occlusal therapy and muscle status correction with Botulinum Toxin A (BTX-A) injections or using centrally acting muscle relaxants. The study included 111 patients, 81 women and 30 men aged 18 to 45 years. According to the results of the clinical examination all patients were divided into two groups. The main group (91 patients) included patients with clinical signs of TMD. The control group (20 patients) consisted of patients without clinical signs of dysfunction and without malocclusion. The groups were comparable in sex and age. Patients of the main group were divided into 2 subgroups: in the first sub group the patients received centrally action muscle relaxants (71 people), in the second the patients were treated with BTX-A injections into masticatory muscles (20 people). In both subgroups the treatment included occlusal therapy. All patients were subjected to Magnetic Resonance Imaging (MRI) of the TMJ and masticatory muscles, as well as ultrasonography and surface Electromyography (EMG) of the masticatory muscles before and after treatment. As a result, a significant reduction in the pain syndrome, an improvement in the interrelation of intraarticular TMJ elements and a change in the structure of the masticatory muscles was revealed. The best results were achieved in the group with injections of BTX-A into the masticatory muscles. Electromyographic indexes have approached the values of the norm. The clinical signs of TMD decreased or reduced.

A 46 year old, healthy weight female patient visited our outpatient clinic with complaints of the right knee. Since a few months she experienced symptoms of a locked knee without explainable cause and localized pain on the lateral side.

A case of acute compartment syndrome is described in an old woman following branch stuck to her forearm. She just displayed a little wound with no fractures. The ulnar artery was punctured by a branch and caused a large forearm hematoma and eventually lead to an acute forearm compartment syndrome. Prompt diagnosis and surgical management bring a successful consequence. The written informed consent was obtained from the patient to publicate this case, including the following pictures.

Synovial and ganglion cysts are fluid-filled lesions within joints, most often occurring in the periarticular areas of the wrist, knees, and feet.

We present two cases of symptomatic avascular necrosis of distal femur in two multiple sclerosis patients who received Methylprednisolone (15 and 10 grams respectively) for relapses treatment over a period of 28 and 29 months. Both complained knee pain after steroid treatment, in both cases we diagnosed avascular necrosis of distal femur only one year later. These cases illustrate how important is not to underestimate the event of avascular bone necrosis after steroid pulse treatment, even with low cumulative dosages, after a long time interval and in unusual necrosis sites.

Juvenile Idiopathic Arthritis (JIA) is an autoimmune disease that may lead to inflammation of multiple joints at a young age, often complicated by destruction and growth disturbances, including the craniofacial region. The annual incidence is reported as 0.008–0.226 per 1000 children.

Arthroscopic treatment for ankle diseases has proven to be successful as multiple articles describe favorable outcomes, low complication rates and cost-effectiveness [1]. Nonetheless, these articles are most often from North America, Europe and Pacific nations, thus there is a lack of literature supporting these outcomes in the Latin American patient population. The purpose of this study was to describe the early outcomes of a commonly performed procedure focusing in the Latin patient population. We conducted the study on a case series of patients who underwent arthroscopic treatment of Hagelund lesions at a tertiary care center in Medellin, Colombia Outcomes were measured by previously trained personnel decrease bias.

The goal of this study was to report the short-term outcomes of these patients and thus our focus was on the f irst 12 months after surgery. A total of 6 patients had available data for the follow up.

The mean age was 43.1 (SD 21.6), 66.7% of patients were males and all cases had unilateral surgeries. Mean follow up was 10.9 months (range 3- 24.3). 100%of patients stated they would undergo the operation again, with the mean satisfaction on the 10-point scale being 9 (range 7-10). No patient had undergone a second procedure for the same indication. One patient had instability symptoms, but this was not reproducible during the examination. In summary, arthroscopic treatment of Haglund deformity in a Latin patient population yielded satisfactory results.

Anatomic reduction of ankle fractures does not ensure a normal ankle function. This might be related to chondral damage during the fracture or other intra-articular pathology. Arthroscopy in the setting of acute operative management of ankle fractures provides a means to completely assess intra-articular pathology and sometimes even direct therapeutic intervention. To date there is no consensus in the literature regarding the indications for arthroscopy in the setting of ankle fractures. It is our practice to perform an arthroscopic assessment of all ankle fractures requiring surgical intervention. The current study retrospectively evaluated a consecutive series of twenty-two adult patients who underwent routine arthroscopy performed during open reduction and internal fixation of ankle fractures and its correlation with the clinical results at a follow-up of 2 years. The clinical results at 2 year follow-up results demonstrated an average AOFAS score of 82±8. Patients with grade 4 talar damage fared significantly worse (70±8) than both patients with grade 3 talar damage (83±7) and with normal talus structure during arthroscopy 87±9 (5.42, p<0.001).

In conclusion the findings of this limited series seem to indicate that final clinical results at 2 years follow-up correlate with the presence of chondral damage observed during arthroscopy. A randomized clinical trial should be performed in order to assess the possible advantages of ankle arthroscopy as compared with open reduction technique in improving treatment outcomes in ankle fracture fixation.

Background:
The clinical syndrome of “tennis leg” is often associated with a calf hematoma and was originally ascribed to a ruptured plantaris tendon. Recent publications have demonstrated a much higher association of myotendinous injuries of the Medial Head of the Gastrocnemius (MHG), with infrequent injuries to the plantaris, in the setting of calf hematoma. Nevertheless, a purported association between plantaris tendon rupture and calf hematoma persists in some literature and clinical discussions.

Hypothesis/Purpose:
The purpose of our study is to evaluate whether a hematoma or fluid collection between the soleus and MHG muscles after trauma may be caused by an isolated plantaris tendon tear.

Study Design:
Cross-sectional study.

Methods:
IRB approval was obtained for this retrospective review. An institutional radiology database search for MRI examinations of the calf performed over a ten year period returned 710 MRI examinations, 67 of which demonstrated an interfascial hematoma, fluid collection or edema between the MHG and soleus muscles. Each MRI was scrutinized by two fellowship trained musculoskeletal radiologists for integrity of the plantaris, gastrocnemius, and soleus myotendinous structures and intervening fascia. Discrepancies were resolved by consensus.

Results:
62 of the 67 cases demonstrated a visible plantaris tendon and hematoma, fluid collection, or edema interposed between the soleus and MHG muscles. The plantaris was not visible and was presumed to be congenitally absent in five cases. Of the remaining 62 cases, the MHG was abnormal in 62/62 (100%) cases and the plantaris tendon was abnormal in 3/62 (4.8%) cases. Isolated injury to the MHG was observed in 59/62 (95.2%) cases; isolated injury to the plantaris tendon was not observed in any cases (0%).

Conclusion:
Our results demonstrate no association between a hematoma, fluid collection, or edema between the soleus and MHG muscles and a plantaris tendon tear. In concert with previous studies, our results support gastrocnemius injuries as the causative etiology of a calf hematoma in this location following acute trauma.

Clinical Relevance:
A hematoma interposed between the soleus and MHG muscles following acute trauma is not associated with plantaris tendon tears; this historical association should be abandoned.

What is known about this subject:
Medial head gastrocnemius muscle injury is more common than plantaris tendon injuries in cases of “tennis leg.”

What this study adds to existing knowledge:
A hematoma between the soleus and MHG muscles following trauma is not attributable to isolated plantaris tendon injury. In cases of tennis leg, even when the plantaris tendon is injured, a hematoma between the soleus and MHG muscles is attributable to concurrent gastrocnemius injury.