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Heberden’s Nodes

 

Other Known Aliases – none

 

Definition – osteophytic growths on the distal interphalangeal joints of the fingers and toes

 

Heberden-Arthrose.JPG

 

Clinical Significance – Most commonly seen in osteoarthritis and similar to, but much more common than, Bouchard’s nodes of the proximal interphalangeal joints.  They are much more common in women and seem to have a genetic predisposition.

 

History – Named after William Heberden (1710-1801), who was an English physician and received his medical doctorate from St. Johns College in Cambridge in 1739, where he made his name a distinguished medical lecturer at the university.  He received fellowship in the Royal College of Physicians in 1746 and then the Royal Society in 1749.  He njoyed a prolific medical practice in London and Paris for over 30 years.  While semi-retired, he worked on a collection of papers for the Royal College of Physicians to be transcribed into a three volume textbook entitled Medical Transactions.  These were eventually revised and transcribed in English, by his son William Heberden the younger, which included a chapter on arthritis by Heberden the elder describing these findings.

 

William Heberden b1710.jpg

 

References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
  5. Up To Date. www.uptodate.com
  6. https://archive.org/details/2556044R.nlm.nih.gov

PAINE #PANCE Pearl – Musculoskeletal

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Question

 

Thoracic outlet syndrome is constellation of signs and symptoms due to compression of the neurovascular bundle in the upper thorax.

  1. What are the three main classifications?
  2. What structures can compression the bundle?
  3. What are the three physical examination maneuvers you can do at the bedside to help diagnoses?

Answer

 

  • The main classifications of thoracic outlet syndrome are:
    • Neurogenic
      1. Most common
      2. Signs and symptoms include pain, paresthesias, numbness, and weakness
    • Venous
      1. 2nd most common
      2. Signs and symptoms include hand swelling, pain, cyanosis with repetitive activity
    • Arterial
      1. Least common
      2. Signs and symptoms include pain, pallor, paresthesias, and poikilothermia not related to activity
  • There are three anatomic areas that thoracic outlet obstruction can occur in:
    • Scalene Triangle
      1. Most common site of neurogenic
    • Costoclavicular space
      1. Most common site of venous
    • Pectoralis minor space
      1. Most common site for arterial

Image result for thoracic outlet syndrome scalene

Image result for thoracic outlet syndrome scalene

 

  • There are several bedside maneuvers you can perform to help distinguish between these types

 

Ep-PAINE-nym

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Bouchard’s Nodes

 

Other Known Aliases – none

 

Definition – nodular growths on the proximal interphalangeal joints of the fingers and toes

 

 

Clinical Significance – Most commonly seen in osteoarthritis and similar to Heberden’s nodes of the distal interphalangeal joints, though they are less common.

 

History – Named after Charles Jacques Bouchard (1837-1915), a French pathologist who received his medical doctorate in 1866 while studying under the famous Dr. Jean Martin Charcot. He practiced at the Bicêtre Hospital where he was appointed chair of general pathology in 1879.  His seminal work was the Traité de Pathologie Générale, which was a compendium of medical pathology and where the description of his eponymous findings were first recorded.

 

Image result for Traité de Pathologie Générale bouchard

References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
  5. Up To Date. www.uptodate.com
  6. Contrepois A. The clinician, germs and infectious diseases: the example of Charles Bouchard in Paris. Medical history. 2002; 46(2):197-220. [pubmed]
  7. https://www.nature.com/articles/140457c0

PAINE #PANCE Pearl – Musculoskeletal

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Question

 

Thoracic outlet syndrome is constellation of signs and symptoms due to compression of the neurovascular bundle in the upper thorax.

  1. What are the three main classifications?
  2. What structures can compression the bundle?
  3. What are the three physical examination maneuvers you can do at the bedside to help diagnoses?

Ep-PAINE-nym

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Jones Fracture

 

Other Known Aliases – none

 

Definition – fracture of the base of the 5th metatarsal at the metaphyseal-diaphyseal junction

Image result for jones fracture

Clinical Significance – Fairly easy radiographical diagnosis to make, but careful examination must distinguish between acute injuries in Zone 1 and 2 and chronic injuries in Zone 3.

Image result for jones fractureImage result for jones fracture zones

History – Named after Sir Robert Jones (1857-1933), a Welsh orthopaedic surgeon and received his medical doctorate from the Liverpool School of Medicine in 1887 and achieved fellowship in 1889.  Along with his uncle, he was a pioneer in the diagnosis and management of fractures.  He first described the injury that bears his name in 1902 in the Annals of Surgery entitled “Fracture of the Base of the Fifth Metatarsal by Indirect Violence”.  This paper was a six patient case report on the injury pattern and Dr. Jones was patient number one having injured his foot several months prior dancing.  After Wilhem Rontgen published his discovery of x-rays in 1895, Dr. Jones adopted this new modality fully in the practice of orthopaedics and published the first clinical radiograph in 1896 about a 12yo with a bullet lodged in his wrist that could not be found clinically and required a 2hr long exposure.

Robert Jones (surgeon).jpg

scanned image of page 697

 

References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
  5. Up To Date. www.uptodate.com
  6. Jones Fracture.  Wheeless’ Textbook of Orthopaedics. http://www.wheelessonline.com/ortho/jones_fracture
  7. OrthoBullets. https://www.orthobullets.com/foot-and-ankle/7031/5th-metatarsal-base-fracture
  8. Jones R. I. Fracture of the Base of the Fifth Metatarsal Bone by Indirect Violence. Annals of surgery. 1902; 35(6):697-700.2. [pubmed]
  9. Jones R, Lodge O.  The Discovery of a Bullet Lost in the Wrist by Means of the Roentgen Rays.  Lancer. 1896;147(3782):476-477 [article]

PAINE #PANCE Pearl – Infectious Disease

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Question

 

To weave a common theme this week between this post and Wednesday’s eponym:

  1. What are the HACEK bugs?
  2. What disease are they associate with?
  3. Why are they important?

Answer

 

The HACEK pathogens is an acronym for the fastidious, gram-negative bacteria that are implicated in 5-10% of infective endocarditis cases. The bugs are:

  • Haemophilus species
  • Aggregatibacter species
  • Cardiobacterium species
  • Eikenella species
  • Kingella species

 

These pathogens are normal oropharyngeal flora, but can take up to 14 days to grow in the laboratory and are often referred to as
culture-negative” endocarditis cases.  It is important to discuss with your lab if you are worried about HACEK pathogens so they can plate the blood cultures on the appropriate agar plates and keep past the typical 3-5 days if there is no growth.

 

References

  1. Sharara SL, Tayyar R, Kanafani ZA, Kanj SS. HACEK endocarditis: a review. Expert review of anti-infective therapy. 2016; 14(6):539-45. [pubmed]
  2. Chambers ST, Murdoch D, Morris A, et al. HACEK infective endocarditis: characteristics and outcomes from a large, multi-national cohort. PloS one. 2013; 8(5):e63181. [pubmed]
  3. Yew HS, Chambers ST, Roberts SA, et al. Association between HACEK bacteraemia and endocarditis. Journal of medical microbiology. 2014; 63(Pt 6):892-5. [pubmed]
  4. Wassef N, Rizkalla E, Shaukat N, Sluka M. HACEK-induced endocarditis. BMJ case reports. 2013; 2013:. [pubmed]