ls -la /home/daytona/workspace/ 2>/dev/null || echo "workspace empty or not foun…

mkdir -p /home/daytona/workspace/upper-limb-guide && echo "dir created"

~/upper-limb-guide/generate_pdf.py

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm, mm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, PageBreak, KeepTogether
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import BaseDocTemplate, Frame, PageTemplate
from reportlab.lib.colors import HexColor

OUTPUT = "/home/daytona/workspace/upper-limb-guide/Upper_Limb_Exam_Guide.pdf"

# ── Colour palette ──────────────────────────────────────────────────────────
C_NAVY   = HexColor("#1B3A5C")
C_TEAL   = HexColor("#1A7A8A")
C_LTBLUE = HexColor("#D6EAF8")
C_MINT   = HexColor("#E8F8F5")
C_GOLD   = HexColor("#F0A500")
C_WHITE  = colors.white
C_BLACK  = colors.black
C_LGREY  = HexColor("#F4F6F7")
C_DGREY  = HexColor("#555555")
C_RED    = HexColor("#C0392B")
C_GREEN  = HexColor("#1E8449")

# ── Page numbering ───────────────────────────────────────────────────────────
def on_page(canvas, doc):
    canvas.saveState()
    w, h = A4
    # Header bar
    canvas.setFillColor(C_NAVY)
    canvas.rect(0, h - 22*mm, w, 22*mm, fill=1, stroke=0)
    canvas.setFillColor(C_WHITE)
    canvas.setFont("Helvetica-Bold", 10)
    canvas.drawString(15*mm, h - 13*mm, "UPPER LIMB ORTHOPAEDIC EXAMINATION GUIDE")
    canvas.setFont("Helvetica", 9)
    canvas.drawRightString(w - 15*mm, h - 13*mm, "Clinical Reference")
    # Footer
    canvas.setFillColor(C_NAVY)
    canvas.rect(0, 0, w, 12*mm, fill=1, stroke=0)
    canvas.setFillColor(C_WHITE)
    canvas.setFont("Helvetica", 8)
    canvas.drawString(15*mm, 4*mm, "Sources: Bailey & Love 28th Ed | Miller's Review of Orthopaedics 9th Ed | Campbell's Operative Orthopaedics 15th Ed 2026")
    canvas.drawRightString(w - 15*mm, 4*mm, f"Page {doc.page}")
    canvas.restoreState()

# ── Document setup ───────────────────────────────────────────────────────────
doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    topMargin=28*mm,
    bottomMargin=18*mm,
    leftMargin=18*mm,
    rightMargin=18*mm,
    title="Upper Limb Orthopaedic Examination Guide",
    author="Orris Medical Reference",
)

styles = getSampleStyleSheet()

# Custom styles
def S(name, parent="Normal", **kwargs):
    return ParagraphStyle(name, parent=styles[parent], **kwargs)

sTitle    = S("sTitle",    "Title",   fontSize=26, textColor=C_WHITE,   alignment=TA_CENTER, spaceAfter=4)
sSubtitle = S("sSubtitle", "Normal",  fontSize=12, textColor=HexColor("#AED6F1"), alignment=TA_CENTER, spaceAfter=6)
sH1       = S("sH1",       "Heading1",fontSize=14, textColor=C_WHITE,   spaceAfter=4, spaceBefore=2, leading=18)
sH2       = S("sH2",       "Heading2",fontSize=12, textColor=C_NAVY,    spaceAfter=3, spaceBefore=8, leading=16)
sH3       = S("sH3",       "Heading3",fontSize=10, textColor=C_TEAL,    spaceAfter=2, spaceBefore=6, leading=14)
sBody     = S("sBody",     "Normal",  fontSize=9,  textColor=C_BLACK,   spaceAfter=3, leading=13, alignment=TA_JUSTIFY)
sBullet   = S("sBullet",   "Normal",  fontSize=9,  textColor=C_BLACK,   spaceAfter=2, leading=12, leftIndent=12, bulletIndent=0)
sNote     = S("sNote",     "Normal",  fontSize=8,  textColor=C_DGREY,   spaceAfter=2, leading=11, leftIndent=6, fontName="Helvetica-Oblique")
sCaption  = S("sCaption",  "Normal",  fontSize=8,  textColor=C_DGREY,   alignment=TA_CENTER, spaceAfter=4)
sTH       = S("sTH",       "Normal",  fontSize=8,  textColor=C_WHITE,   fontName="Helvetica-Bold", leading=11)
sTD       = S("sTD",       "Normal",  fontSize=8,  textColor=C_BLACK,   leading=11)
sTD2      = S("sTD2",      "Normal",  fontSize=8,  textColor=C_BLACK,   leading=11, fontName="Helvetica-Bold")
sAlert    = S("sAlert",    "Normal",  fontSize=9,  textColor=C_RED,     fontName="Helvetica-Bold", spaceAfter=3, leading=12)
sGreen    = S("sGreen",    "Normal",  fontSize=9,  textColor=C_GREEN,   fontName="Helvetica-Bold", spaceAfter=3, leading=12)

# ── Helpers ──────────────────────────────────────────────────────────────────
def section_header(title, subtitle=""):
    """Navy banner heading."""
    w = A4[0] - 36*mm
    data = [[Paragraph(title, sH1)]]
    t = Table(data, colWidths=[w])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), C_NAVY),
        ("TOPPADDING",    (0,0), (-1,-1), 6),
        ("BOTTOMPADDING", (0,0), (-1,-1), 6),
        ("LEFTPADDING",   (0,0), (-1,-1), 10),
        ("RIGHTPADDING",  (0,0), (-1,-1), 10),
        ("ROUNDEDCORNERS", [4,4,4,4]),
    ]))
    items = [t]
    if subtitle:
        items.append(Paragraph(subtitle, sNote))
    items.append(Spacer(1, 3*mm))
    return items

def subsection(title):
    return [Paragraph(title, sH2), HRFlowable(width="100%", thickness=1, color=C_TEAL, spaceAfter=3)]

def sub2(title):
    return [Paragraph(title, sH3)]

def bullet(text, bold_prefix=""):
    if bold_prefix:
        full = f"<b>{bold_prefix}</b> {text}"
    else:
        full = text
    return Paragraph(f"\u2022  {full}", sBullet)

def note(text):
    return Paragraph(f"<i>{text}</i>", sNote)

def alert(text):
    return Paragraph(f"&#9888;  {text}", sAlert)

def tip(text):
    return Paragraph(f"&#10003;  {text}", sGreen)

def make_table(headers, rows, col_widths=None, alt_rows=True):
    w = A4[0] - 36*mm
    if col_widths is None:
        n = len(headers)
        col_widths = [w/n]*n
    header_row = [Paragraph(h, sTH) for h in headers]
    table_data = [header_row]
    for r in rows:
        table_data.append([Paragraph(str(c), sTD) for c in r])
    t = Table(table_data, colWidths=col_widths, repeatRows=1)
    style = [
        ("BACKGROUND",    (0,0), (-1,0), C_NAVY),
        ("ROWBACKGROUNDS",(0,1), (-1,-1), [C_WHITE, C_LGREY] if alt_rows else [C_WHITE]),
        ("GRID",          (0,0), (-1,-1), 0.4, HexColor("#CCCCCC")),
        ("TOPPADDING",    (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING",   (0,0), (-1,-1), 6),
        ("RIGHTPADDING",  (0,0), (-1,-1), 6),
        ("VALIGN",        (0,0), (-1,-1), "TOP"),
    ]
    t.setStyle(TableStyle(style))
    return t

def highlight_box(text, bg=C_LTBLUE, border=C_TEAL):
    w = A4[0] - 36*mm
    t = Table([[Paragraph(text, sBody)]], colWidths=[w])
    t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), bg),
        ("LINEABOVE",     (0,0), (-1,0), 2, border),
        ("LINEBELOW",     (0,-1),(-1,-1),2, border),
        ("LEFTPADDING",   (0,0), (-1,-1), 10),
        ("RIGHTPADDING",  (0,0), (-1,-1), 10),
        ("TOPPADDING",    (0,0), (-1,-1), 6),
        ("BOTTOMPADDING", (0,0), (-1,-1), 6),
    ]))
    return t

# ── Content builder ──────────────────────────────────────────────────────────
story = []

# ── COVER PAGE ───────────────────────────────────────────────────────────────
w_page, h_page = A4

# Title block
story.append(Spacer(1, 20*mm))
cover_title = Table([[Paragraph(
    "<font color='white'><b>UPPER LIMB</b></font>", 
    S("CT", fontSize=36, textColor=C_WHITE, alignment=TA_CENTER, leading=42))
]], colWidths=[A4[0]-36*mm])
cover_title.setStyle(TableStyle([
    ("BACKGROUND", (0,0),(-1,-1), C_NAVY),
    ("TOPPADDING",    (0,0),(-1,-1), 14),
    ("BOTTOMPADDING", (0,0),(-1,-1), 4),
    ("LEFTPADDING",   (0,0),(-1,-1), 10),
]))
story.append(cover_title)

cover_sub = Table([[Paragraph(
    "<font color='white'>Orthopaedic Examination Guide</font>",
    S("CS", fontSize=18, textColor=C_WHITE, alignment=TA_CENTER))
]], colWidths=[A4[0]-36*mm])
cover_sub.setStyle(TableStyle([
    ("BACKGROUND", (0,0),(-1,-1), C_TEAL),
    ("TOPPADDING",    (0,0),(-1,-1), 8),
    ("BOTTOMPADDING", (0,0),(-1,-1), 8),
    ("LEFTPADDING",   (0,0),(-1,-1), 10),
]))
story.append(cover_sub)

story.append(Spacer(1, 8*mm))

# Cover info box
cover_info = [
    ["JOINT", "CONDITIONS COVERED"],
    ["Shoulder", "Frozen shoulder, Rotator cuff tears, Dislocation, Impingement"],
    ["Elbow", "Tennis elbow, Golfer's elbow, Supracondylar fracture, OA"],
    ["Wrist", "Colles' fracture, Scaphoid fracture, De Quervain's"],
    ["Hand", "Carpal tunnel syndrome, Dupuytren's contracture"],
]
cw = [(A4[0]-36*mm)*0.25, (A4[0]-36*mm)*0.75]
ct = Table(cover_info, colWidths=cw)
ct.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), C_TEAL),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [C_LTBLUE, C_WHITE]),
    ("TEXTCOLOR",     (0,0), (-1,0), C_WHITE),
    ("FONTNAME",      (0,0), (-1,0), "Helvetica-Bold"),
    ("FONTNAME",      (0,1), (0,-1), "Helvetica-Bold"),
    ("FONTSIZE",      (0,0), (-1,-1), 9),
    ("GRID",          (0,0), (-1,-1), 0.5, HexColor("#AAAAAA")),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
]))
story.append(ct)
story.append(Spacer(1, 8*mm))

# Exam framework reminder
story.append(highlight_box(
    "<b>UNIVERSAL EXAMINATION SEQUENCE</b>  \u2192  "
    "<b>LOOK</b> (inspect) \u2192 <b>FEEL</b> (palpate) \u2192 <b>MOVE</b> (active \u2192 passive \u2192 resisted) \u2192 <b>SPECIAL TESTS</b> \u2192 <b>NEUROVASCULAR</b>",
    bg=C_MINT, border=C_GREEN
))
story.append(Spacer(1, 5*mm))
story.append(note("Sources: Bailey & Love's Short Practice of Surgery 28th Ed | Miller's Review of Orthopaedics 9th Ed | Campbell's Operative Orthopaedics 15th Ed 2026 | S Das Manual on Clinical Surgery 13th Ed"))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════
# SECTION 1 – SHOULDER
# ═══════════════════════════════════════════════════════════════════════════
story += section_header("SECTION 1 — THE SHOULDER", "Glenohumeral joint examination & common conditions")

story += subsection("Anatomy Reminders")
story.append(bullet("Ball-and-socket joint — greatest ROM, least intrinsic stability"))
story.append(bullet("Rotator cuff: <b>S</b>upraspinatus, <b>I</b>nfraspinatus, <b>T</b>eres minor, <b>S</b>ubscapularis (SITS)"))
story.append(bullet("Pain anterolateral; referred pain from cervical spine, heart, mediastinum, diaphragm"))
story.append(bullet("Axillary nerve supplies deltoid + 'regimental badge area' of lateral arm"))
story.append(Spacer(1, 3*mm))

story += subsection("LOOK")
story.append(bullet("Strip to waist. Inspect front, side, back — compare both sides"))
story.append(bullet("Attitude: Clavicle fracture / anterior dislocation → patient supports flexed elbow with other hand"))
story.append(bullet("Deformity: Flattening = dislocation (greater tuberosity displaced medially); step deformity at ACJ"))
story.append(bullet("Muscle wasting: Deltoid wasting = axillary nerve palsy; supraspinous/infraspinous fossa wasting = rotator cuff"))
story.append(bullet("Scars: Anterior (deltopectoral) | Lateral (deltoid-splitting) | Posterior ports (arthroscopy)"))
story.append(Spacer(1, 3*mm))

story += subsection("FEEL")
story.append(bullet("Test 'regimental badge area' sensation (upper lateral arm) — loss = axillary nerve injury"))
story.append(bullet("Palpate: Sternoclavicular joint → clavicle → AC joint → acromion → coracoid → greater tuberosity → bicipital groove"))
story.append(bullet("Localised ACJ pain = acromioclavicular pathology; diffuse = glenohumeral or referred"))
story.append(Spacer(1, 3*mm))

story += subsection("MOVE")
story.append(bullet("Stabilise scapula: thumb on coracoid + fingers on scapular spine — prevents scapulothoracic compensation"))
story.append(bullet("Start: arms at sides, elbows extended, palms forward (anatomical position)"))
story.append(bullet("Note pain throughout range — painful arc 60°–120° = supraspinatus/impingement"))
story.append(Spacer(1, 2*mm))

rom_data = [
    ["Movement", "Normal Range", "Clinical Note"],
    ["Flexion", "0–180°", "Loss = adhesive capsulitis, GHJ OA"],
    ["Extension", "0–60°", ""],
    ["Abduction", "0–180°", "Painful arc 60–120° = impingement"],
    ["Adduction", "0–50°", ""],
    ["External Rotation", "0–60°", "FIRST lost in frozen shoulder"],
    ["Internal Rotation", "0–90°", "Test: thumb to spine level"],
]
story.append(make_table(rom_data[0], rom_data[1:], col_widths=[(A4[0]-36*mm)*0.28,(A4[0]-36*mm)*0.22,(A4[0]-36*mm)*0.50]))
story.append(Spacer(1, 4*mm))

story += subsection("SPECIAL TESTS — SHOULDER")
story.append(Spacer(1, 2*mm))

story += sub2("Impingement / Rotator Cuff")
imp_data = [
    ["Test", "Technique", "Positive Finding & Meaning"],
    ["Impingement sign (Neer)", "Passive forward flexion >90°", "Pain = subacromial impingement"],
    ["Hawkins' test", "Passive FF 90° + internal rotation", "Pain = impingement syndrome"],
    ["Jobe's test (Empty can)", "Resisted pronation/FF at 90° in scapular plane", "Pain/weakness = supraspinatus lesion"],
    ["Drop-arm test", "Arm placed in abduction then released", "Cannot maintain = supraspinatus rupture"],
    ["Hornblower sign", "Resisted ER at 90° abduction", "Pain = infraspinatus / teres minor lesion"],
    ["Lift-off test (Gerber)", "Arm in IR behind back; lift off", "Cannot lift = subscapularis tear"],
    ["Bear-hug test", "Hand on opposite shoulder; examiner tries to lift", "Cannot maintain = subscapularis lesion"],
    ["Belly-push test", "Elbow held forward with abduction pressure", "Cannot hold elbow forward = subscapularis"],
]
story.append(make_table(imp_data[0], imp_data[1:],
    col_widths=[(A4[0]-36*mm)*0.28,(A4[0]-36*mm)*0.35,(A4[0]-36*mm)*0.37]))
story.append(Spacer(1, 4*mm))

story += sub2("Instability Tests")
inst_data = [
    ["Test", "Technique", "Positive Finding & Meaning"],
    ["Apprehension test", "Supine: 90° abduction + ER", "Apprehension = anterior instability"],
    ["Relocation test", "Posterior force during apprehension", "Relief = anterior instability confirmed"],
    ["Load-and-shift test", "Ant/post force on humeral head", "Degree of translation = laxity"],
    ["Sulcus sign", "Inferior traction on arm at side", "Gap below acromion = inferior laxity"],
]
story.append(make_table(inst_data[0], inst_data[1:],
    col_widths=[(A4[0]-36*mm)*0.28,(A4[0]-36*mm)*0.35,(A4[0]-36*mm)*0.37]))
story.append(Spacer(1, 4*mm))

story += sub2("Labrum / Biceps Tests")
lab_data = [
    ["Test", "Technique", "Positive Finding & Meaning"],
    ["O'Brien (Active compression)", "10° adduction, 90° FF, max pronation; resist", "Pain = SLAP lesion / ACJ pathology"],
    ["Speed's test", "Resisted FF, elbow extended, forearm supinated", "Pain in bicipital groove = biceps tendinopathy"],
    ["Yergason's test", "Resisted supination with elbow at 90°", "Pain in groove = biceps tendinopathy / SLAP"],
]
story.append(make_table(lab_data[0], lab_data[1:],
    col_widths=[(A4[0]-36*mm)*0.28,(A4[0]-36*mm)*0.38,(A4[0]-36*mm)*0.34]))
story.append(Spacer(1, 3*mm))

story.append(alert("Always obtain X-rays before diagnosing frozen shoulder — exclude GHJ osteoarthritis and locked posterior dislocation (both cause selective ER loss)."))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════
# SECTION 2 – SHOULDER CONDITIONS
# ═══════════════════════════════════════════════════════════════════════════
story += section_header("SECTION 2 — SHOULDER CONDITIONS")

story += subsection("Frozen Shoulder (Adhesive Capsulitis)")
story.append(bullet("Age 40–70 years; female predominance; nondominant side more common"))
story.append(bullet("Associations: Diabetes mellitus (disproportionately affected, worse outcomes), thyroid disease, post-breast/chest surgery, prolonged immobilisation"))
story.append(bullet("Pathology: Fibrosis of CHL and rotator interval capsule; type III collagen + myofibroblasts (resembles Dupuytren histology)"))
story.append(Spacer(1, 2*mm))

stage_data = [
    ["Stage", "Name", "Duration", "Features"],
    ["1", "Pre-adhesive", "Weeks–months", "Nocturnal pain; ROM initially preserved"],
    ["2", "Freezing", "3–9 months", "Pain + progressive ROM loss"],
    ["3", "Frozen", "9–15 months", "Stiffness dominates; pain decreases"],
    ["4", "Thawing", "15–24 months", "Gradual ROM recovery"],
]
story.append(make_table(stage_data[0], stage_data[1:],
    col_widths=[(A4[0]-36*mm)*0.08,(A4[0]-36*mm)*0.20,(A4[0]-36*mm)*0.22,(A4[0]-36*mm)*0.50]))
story.append(Spacer(1, 3*mm))

story.append(Paragraph("Key Examination Findings", sH3))
story.append(bullet("Global loss of all shoulder movements — active ROM = passive ROM"))
story.append(bullet("External rotation is FIRST and MOST affected movement"))
story.append(highlight_box(
    "<b>KEY DISTINGUISHER:</b>  Active ROM = Passive ROM \u2192 Frozen shoulder  |  Active &lt; Passive ROM \u2192 Rotator cuff tear",
    bg=C_LTBLUE, border=C_TEAL
))
story.append(Spacer(1, 2*mm))
story.append(Paragraph("Investigations & Treatment", sH3))
frozen_rx = [
    ["Modality", "Detail"],
    ["X-ray", "Normal — mandatory to exclude GHJ OA and posterior dislocation"],
    ["Arthrography", "Reduced joint volume (<10 mL vs normal 35 mL); loss of axillary recess"],
    ["MRI", "Capsular thickening, CHL thickening, obliterated subcoracoid fat triangle"],
    ["Conservative (90%)", "NSAIDs + physiotherapy (pendulum/Codman exercises) + intraarticular steroid injection"],
    ["Distention arthrography", "Hydrodistention — inflates and stretches capsule"],
    ["Surgical", "Closed manipulation under anaesthesia; arthroscopic capsular release (if 12–16 wks conservative fails)"],
]
story.append(make_table(frozen_rx[0], frozen_rx[1:],
    col_widths=[(A4[0]-36*mm)*0.30,(A4[0]-36*mm)*0.70]))
story.append(Spacer(1, 5*mm))

story += subsection("Rotator Cuff Tears")
story.append(bullet("Supraspinatus most commonly torn (exits supraspinous fossa, passes under coracoacromial arch — 'critical zone' of poor vascularity)"))
story.append(bullet("Presentation: Painful arc, weakness on abduction/ER, nocturnal pain; may be acute (trauma) or degenerative (gradual)"))
story.append(bullet("Drop-arm test positive in complete supraspinatus rupture"))
story.append(bullet("No restriction of passive ROM — distinguishes from frozen shoulder"))
story.append(bullet("Investigations: X-ray (superior head migration in massive tear), Ultrasound (dynamic, good for tears), MRI (gold standard — size, retraction, fatty atrophy)"))
story.append(bullet("Treatment: Physiotherapy + subacromial steroid injection; arthroscopic/open cuff repair for full-thickness tears"))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════
# SECTION 3 – ELBOW
# ═══════════════════════════════════════════════════════════════════════════
story += section_header("SECTION 3 — THE ELBOW", "Hinge joint examination & common conditions")

story += subsection("Anatomy Reminders")
story.append(bullet("Hinge (trochleoulnar) + pivot (radioulnar) joint combined"))
story.append(bullet("Normal carrying angle: 9–14° valgus (physiological cubitus valgus); greater in females"))
story.append(bullet("Hueter's triangle: Medial epicondyle + lateral epicondyle + olecranon tip = equilateral triangle at 90° flexion"))
story.append(bullet("Normal range: −5° (hyperextension) to 150° flexion | Pronation 70° | Supination 90°"))
story.append(Spacer(1, 3*mm))

story += subsection("LOOK")
story.append(bullet("Attitude: Elbow held in flexion after most injuries. Child with swollen flexed elbow = supracondylar fracture until proven otherwise"))
story.append(bullet("Inspect from FRONT: Carrying angle, position (extended/flexed, pronated/supinated)"))
story.append(bullet("From BEHIND: Olecranon prominence posteriorly"))
story.append(bullet("From THE SIDE: Anteroposterior broadening = posterior dislocation or supracondylar fracture"))
story.append(Spacer(1, 2*mm))
carrying_data = [
    ["Deformity", "Definition", "Common Cause", "Complication"],
    ["Cubitus valgus", "Increased carrying angle >15–20°", "Malunion lateral condyle fracture (child)", "Tardy ulnar nerve palsy"],
    ["Cubitus varus\n(gun-stock deformity)", "Reversed/decreased carrying angle", "Malunited supracondylar fracture", "Mainly cosmetic"],
]
story.append(make_table(carrying_data[0], carrying_data[1:],
    col_widths=[(A4[0]-36*mm)*0.25,(A4[0]-36*mm)*0.25,(A4[0]-36*mm)*0.27,(A4[0]-36*mm)*0.23]))
story.append(Spacer(1, 3*mm))

story += subsection("FEEL")
story.append(bullet("Cross-fluctuation test for joint effusion"))
story.append(bullet("Ulnar nerve: Roll under fingers between medial epicondyle and olecranon; assess distal ulnar sensation"))
story.append(bullet("Radial head: Palpate with thumb while pronating/supinating — feel for rotation, tenderness, irregularity"))
story.append(bullet("Springing the radius: Squeeze radius + ulna together distally → referred pain at upper radius = fracture head/neck radius"))
story.append(highlight_box(
    "<b>Hueter's Triangle Rule:</b> Equilateral triangle at 90° = preserved in <b>supracondylar fracture</b> "
    "(distal fragment moves as one). Triangle DISRUPTED in <b>posterior elbow dislocation</b> "
    "(olecranon displaced posteriorly relative to epicondyles).",
    bg=C_MINT, border=C_GREEN
))
story.append(Spacer(1, 3*mm))

story += subsection("MOVE")
story.append(bullet("Flexion–Extension: −5° to 150°"))
story.append(bullet("Pronation: 70° | Supination: 90° — tested with elbows at 90°"))
story.append(Spacer(1, 3*mm))

story += subsection("Elbow Conditions")
story += sub2("Lateral Epicondylitis (Tennis Elbow)")
story.append(bullet("Degenerative tendinopathy at origin of extensor carpi radialis brevis (ECRB) — NOT true inflammation"))
story.append(bullet("Peak: 5th decade; more common in non-athletes; risk factors: female, smoking, manual labour, statins"))
story.append(bullet("Mechanism: Repetitive supination/pronation with elbow near full extension"))
story.append(bullet("Tenderness: 5 mm distal and anterior to midpoint of lateral epicondyle"))
story.append(bullet("Pain: Exacerbated by resisted wrist dorsiflexion and forearm supination, gripping objects"))
story.append(Spacer(1, 2*mm))

te_tests = [
    ["Test", "Technique", "Positive"],
    ["Cozen's test", "Resisted wrist extension, elbow extended", "Pain at lateral epicondyle"],
    ["Mill's test", "Passive wrist flexion, elbow extended", "Pain at lateral epicondyle"],
    ["Middle finger test", "Resisted extension of middle finger", "Pain at ECRB origin (most specific for ECRB)"],
]
story.append(make_table(te_tests[0], te_tests[1:],
    col_widths=[(A4[0]-36*mm)*0.25,(A4[0]-36*mm)*0.43,(A4[0]-36*mm)*0.32]))
story.append(Spacer(1, 2*mm))
story.append(bullet("X-ray: Usually normal (occasionally calcific tendinitis). MRI: Tendon thickening, increased T1/T2 signal at ECRB"))
story.append(bullet("Treatment: Conservative (84–95% respond): rest, ice, counter-force brace, physio, steroid injection"))
story.append(bullet("Surgical: Débridement/release of ECRB origin (open or arthroscopic) if conservative fails at 6 months"))
story.append(Spacer(1, 3*mm))

story += sub2("Medial Epicondylitis (Golfer's Elbow)")
story.append(bullet("Flexor-pronator origin tendinopathy at medial epicondyle (flexor carpi radialis, pronator teres)"))
story.append(bullet("Tenderness at medial epicondyle; pain with resisted wrist flexion + forearm pronation"))
story.append(bullet("Must exclude ulnar nerve entrapment at elbow (coexists in ~60% of cases)"))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════
# SECTION 4 – WRIST
# ═══════════════════════════════════════════════════════════════════════════
story += section_header("SECTION 4 — THE WRIST", "Examination and FOOSH injuries")

story += subsection("Anatomy Reminders")
story.append(bullet("Wrist ROM: Flexion 75–80° | Extension 70–75° | Radial deviation 15° | Ulnar deviation 30–40°"))
story.append(bullet("Normal parameters (X-ray): Volar tilt 11° | Radial inclination 22° | Radial height 12 mm"))
story.append(bullet("Lister's tubercle: Palpable on dorsal distal radius; 1 cm distal = scaphoid"))
story.append(bullet("Anatomical snuffbox: Between APL/EPB (radial border) and EPL (ulnar border) — SCAPHOID lies below"))
story.append(Spacer(1, 3*mm))

story += subsection("Colles' Fracture")
story.append(bullet("Transverse fracture of distal radius within 2.5 cm of wrist"))
story.append(bullet("Commonest fracture in adults >40 years; elderly osteoporotic women after FOOSH most typical"))
story.append(Spacer(1, 2*mm))

colles_data = [
    ["Feature", "Description"],
    ["Displacement (5Ds)", "Dorsal displacement, Dorsal angulation, radial Deviation, Dinner-fork Deformity, impacteD"],
    ["Examination", "Dinner-fork deformity on lateral view; radial deviation; local swelling and bruising"],
    ["X-ray (AP + Lateral)", "Confirm fracture; measure volar tilt, radial inclination, radial height"],
    ["Acceptable reduction", "Volar tilt ≥0°, radial inclination ≥15°, radial height shortening ≤3 mm"],
    ["Treatment", "Undisplaced: Below-elbow cast 6 wks. Displaced: Closed reduction (haematoma block or Bier's) + cast. Unstable: K-wires or volar locking plate (ORIF)"],
    ["Complications", "CRPS (Sudeck's atrophy), malunion, median nerve injury, EPL rupture, carpal tunnel syndrome"],
]
story.append(make_table(colles_data[0], colles_data[1:],
    col_widths=[(A4[0]-36*mm)*0.28,(A4[0]-36*mm)*0.72]))
story.append(Spacer(1, 5*mm))

story += subsection("Scaphoid Fracture")
story.append(alert("Most commonly MISSED fracture — 30% have normal initial X-ray. Normal X-ray does NOT exclude scaphoid fracture."))
story.append(bullet("Mechanism: FOOSH with wrist in dorsiflexion and radial deviation"))
story.append(bullet("Blood supply enters distally — proximal pole fractures risk avascular necrosis (AVN)"))
story.append(Spacer(1, 2*mm))

scaph_tests = [
    ["Clinical Test", "Technique", "Positive Finding"],
    ["Anatomical snuffbox tenderness", "Palpate dorsal snuffbox with wrist in ulnar deviation", "Tenderness = scaphoid # until proven otherwise"],
    ["Scaphoid tubercle tenderness", "Palpate volar tubercle at wrist crease", "Tenderness (more specific than snuffbox)"],
    ["Scaphoid compression test", "Axial compression along axis of thumb", "Pain at wrist"],
    ["Telescoping test", "Telescoping the thumb proximally", "Pain at scaphoid"],
]
story.append(make_table(scaph_tests[0], scaph_tests[1:],
    col_widths=[(A4[0]-36*mm)*0.30,(A4[0]-36*mm)*0.38,(A4[0]-36*mm)*0.32]))
story.append(Spacer(1, 3*mm))

scaph_rx = [
    ["Investigation", "Role"],
    ["X-ray (AP, lateral, scaphoid views)", "First line; may be NORMAL acutely — repeat at 10–14 days if clinical suspicion"],
    ["MRI", "Most sensitive and specific — detects fracture within 24–48 hours"],
    ["CT", "Best for assessing displacement and union"],
    ["Bone scan", "Sensitive but non-specific; use if MRI unavailable"],
]
story.append(make_table(scaph_rx[0], scaph_rx[1:],
    col_widths=[(A4[0]-36*mm)*0.38,(A4[0]-36*mm)*0.62]))
story.append(Spacer(1, 3*mm))

story += sub2("Treatment")
story.append(bullet("Undisplaced waist: Thumb spica cast 8–12 weeks"))
story.append(bullet("Displaced (>1 mm) or proximal pole: Surgical fixation (Herbert screw)"))
story.append(bullet("Non-union/AVN: Bone grafting + fixation; vascularised bone graft (1,2-ICSRA graft)"))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════
# SECTION 5 – HAND
# ═══════════════════════════════════════════════════════════════════════════
story += section_header("SECTION 5 — THE HAND", "Carpal tunnel syndrome, Dupuytren's, De Quervain's")

story += subsection("Carpal Tunnel Syndrome (CTS)")
story.append(bullet("Most common entrapment neuropathy — median nerve compressed under flexor retinaculum"))
story.append(bullet("Anatomy: Carpal tunnel = carpal bones (3 sides) + transverse carpal ligament (floor). Contains 9 flexor tendons + median nerve"))
story.append(bullet("Epidemiology: More common in women; ~3% of adults; common in pregnancy"))
story.append(Spacer(1, 2*mm))

cts_aet = [
    ["Category", "Causes"],
    ["Inflammatory", "Rheumatoid arthritis, tenosynovitis (most common cause)"],
    ["Metabolic/Endocrine", "Hypothyroidism, diabetes mellitus, acromegaly, pregnancy"],
    ["Space-occupying", "Ganglion, lipoma, carpal fracture malunion, amyloidosis"],
    ["Occupation", "Repetitive wrist flexion/extension, vibrating tools"],
]
story.append(make_table(cts_aet[0], cts_aet[1:],
    col_widths=[(A4[0]-36*mm)*0.28,(A4[0]-36*mm)*0.72]))
story.append(Spacer(1, 3*mm))

story.append(Paragraph("Clinical Features", sH3))
story.append(bullet("Pain, numbness, paraesthesia in radial 3½ digits (thumb, index, middle, radial half of ring)"))
story.append(bullet("Worse at night and with repetitive hand motion — 'flick sign' (shaking hand relieves symptoms)"))
story.append(bullet("Thenar wasting = late sign indicating chronic compression"))
story.append(bullet("Weakness of thumb abduction (abductor pollicis brevis)"))
story.append(Spacer(1, 2*mm))

cts_tests = [
    ["Test", "Technique", "Sensitivity / Significance"],
    ["Tinel's sign", "Tap over carpal tunnel at wrist flexor retinaculum", "Paraesthesia in median nerve distribution"],
    ["Phalen's manoeuvre", "Wrist fully flexed for 60 seconds (dorsal surfaces back to back)", "Symptom reproduction — most specific"],
    ["Carpal compression test", "Direct pressure over tunnel for 30 seconds", "Most sensitive clinical test"],
    ["Reverse Phalen", "Wrists extended back to back", "Symptom reproduction"],
    ["Abductor pollicis brevis test", "Resisted thumb abduction against resistance", "Weakness = thenar denervation"],
]
story.append(make_table(cts_tests[0], cts_tests[1:],
    col_widths=[(A4[0]-36*mm)*0.27,(A4[0]-36*mm)*0.40,(A4[0]-36*mm)*0.33]))
story.append(Spacer(1, 3*mm))

story.append(Paragraph("Investigations & Treatment", sH3))
cts_rx = [
    ["Step", "Detail"],
    ["NCS / EMG", "Confirms diagnosis; prolonged sensory latency before motor latency; mandatory before surgery; 25% false-negative rate"],
    ["Conservative", "Night wrist splinting in neutral; activity modification; nerve gliding exercises; corticosteroid injection"],
    ["Surgical", "Carpal tunnel decompression — open or endoscopic division of flexor retinaculum. Equivalent long-term outcomes. Excellent results."],
    ["Indication for surgery", "Failed conservative measures OR thenar wasting (indicating muscle denervation)"],
]
story.append(make_table(cts_rx[0], cts_rx[1:],
    col_widths=[(A4[0]-36*mm)*0.28,(A4[0]-36*mm)*0.72]))
story.append(Spacer(1, 5*mm))

story += subsection("Dupuytren's Contracture")
story.append(bullet("Progressive palmar fascial fibrosis → flexion contracture (ring and little fingers most common)"))
story.append(bullet("Pathology: Myofibroblast proliferation, type III collagen — histologically similar to frozen shoulder capsule"))
story.append(bullet("Associations: Male sex, Northern European descent, diabetes, alcohol, phenytoin, vibration exposure, HIV"))
story.append(bullet("Examination: Palmar pitting/dimpling, palpable nodules along fascial bands, MCPj and PIPj flexion deformity"))
story.append(bullet("Hueston tabletop test: Cannot place palm flat on table = significant contracture"))
story.append(bullet("Treatment: Observation if mild | Needle fasciotomy, collagenase injection (Xiaflex) | Fasciectomy (surgical)"))
story.append(bullet("Surgery indicated: MCP contracture ≥30° OR any degree of PIP contracture"))
story.append(Spacer(1, 5*mm))

story += subsection("De Quervain's Tenosynovitis")
story.append(bullet("Stenosing tenosynovitis of 1st dorsal extensor compartment: APL (abductor pollicis longus) + EPB (extensor pollicis brevis)"))
story.append(bullet("Common in new mothers (lifting infant); repetitive pinch-grip activities"))
story.append(bullet("Tenderness over radial styloid and 1st dorsal compartment; crepitus on movement"))
story.append(highlight_box(
    "<b>Finkelstein's test:</b> Patient makes a fist with thumb inside fingers. "
    "Examiner passively ulnar deviates the wrist. "
    "Sharp pain at radial styloid = POSITIVE (De Quervain's).",
    bg=C_LTBLUE, border=C_TEAL
))
story.append(Spacer(1, 2*mm))
story.append(bullet("Treatment: Thumb spica splint + NSAIDs → corticosteroid injection → surgical release of 1st compartment"))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════
# SECTION 6 – QUICK REFERENCE SUMMARY TABLE
# ═══════════════════════════════════════════════════════════════════════════
story += section_header("SECTION 6 — QUICK REFERENCE SUMMARY")

story.append(Spacer(1, 3*mm))

summary_data = [
    ["Condition", "Site", "Key Sign/Test", "Investigation", "1st-Line Tx", "Surgical Tx"],
    ["Frozen shoulder", "GHJ", "Equal active=passive loss; ER first", "X-ray (normal), MRI", "Physio, steroid inj", "Arthroscopic capsular release"],
    ["Rotator cuff tear", "Shoulder", "Drop-arm, painful arc, Jobe's", "MRI", "Physio, subacromial inj", "Arthroscopic repair"],
    ["Shoulder dislocation (ant)", "GHJ", "Flattening, anterior bulge", "X-ray AP + lateral", "Reduction (Kocher/Hippocratic)", "Latarjet / Bankart repair (recurrent)"],
    ["Tennis elbow", "Lateral epicondyle", "Cozen's, Mill's test", "Clinical ± MRI", "Brace, steroid inj", "ECRB release"],
    ["Golfer's elbow", "Medial epicondyle", "Resisted wrist flexion", "Clinical", "Brace, steroid inj", "Flexor-pronator release"],
    ["Supracondylar # humerus", "Elbow", "Posterior displacement; Hueter's intact", "X-ray", "MUA + K-wires", "ORIF if NV compromise"],
    ["Colles' fracture", "Distal radius", "Dinner-fork deformity", "X-ray", "Closed reduction + cast", "Volar locking plate ORIF"],
    ["Scaphoid fracture", "Wrist", "Snuffbox tenderness", "MRI (gold)", "Thumb spica 8–12 wks", "Herbert screw"],
    ["Carpal tunnel", "Wrist", "Phalen's, Tinel's, thenar wasting", "NCS/EMG", "Night splint, steroid inj", "CTD (open/endoscopic)"],
    ["Dupuytren's", "Palm", "Tabletop test", "Clinical", "Observation if mild", "Fasciectomy / Collagenase"],
    ["De Quervain's", "Radial styloid", "Finkelstein's test", "Clinical ± USS", "Splint + NSAID + inj", "1st compartment release"],
]
story.append(make_table(
    summary_data[0], summary_data[1:],
    col_widths=[
        (A4[0]-36*mm)*0.16,
        (A4[0]-36*mm)*0.10,
        (A4[0]-36*mm)*0.20,
        (A4[0]-36*mm)*0.16,
        (A4[0]-36*mm)*0.18,
        (A4[0]-36*mm)*0.20,
    ]
))
story.append(Spacer(1, 5*mm))

story += subsection("Classic Examination Mnemonics & Key Rules")

rules = [
    ("Regimental badge area", "Upper lateral arm sensation → axillary nerve. Loss after shoulder dislocation = axillary nerve palsy."),
    ("Active = Passive ROM loss", "Frozen shoulder (capsular contracture)"),
    ("Active < Passive ROM loss", "Rotator cuff tear (muscle/tendon discontinuity)"),
    ("Hueter's triangle INTACT", "Supracondylar fracture (distal fragment moves as one unit)"),
    ("Hueter's triangle DISRUPTED", "Posterior elbow dislocation (olecranon displaced)"),
    ("Anatomical snuffbox tenderness", "Scaphoid fracture until proven otherwise — treat + investigate even with normal X-ray"),
    ("Normal X-ray ≠ No fracture", "Scaphoid: 30% missed on initial films. Get MRI if clinically suspected."),
    ("Equal active = passive ROM", "Frozen shoulder — capsular disease"),
    ("Dinner-fork deformity", "Colles' fracture — dorsal displacement + angulation of distal radius"),
    ("Radial 3½ digits + night sx", "Carpal tunnel syndrome (median nerve)"),
    ("Ring + little finger contracture", "Dupuytren's contracture (ulnar palmar fascia)"),
    ("Finkelstein positive", "De Quervain's stenosing tenosynovitis"),
]

for rule, explanation in rules:
    story.append(bullet(f"<b>{rule}:</b> {explanation}"))

story.append(Spacer(1, 5*mm))
story.append(highlight_box(
    "<b>NEUROVASCULAR CHECK — Always at end of upper limb examination:</b>  "
    "Radial pulse | Capillary refill | Sensation in median / ulnar / radial nerve distributions | "
    "Motor function of intrinsic hand muscles",
    bg=C_MINT, border=C_GREEN
))

story.append(Spacer(1, 8*mm))
story.append(Paragraph(
    "Sources: Bailey & Love's Short Practice of Surgery 28th Ed | Miller's Review of Orthopaedics 9th Ed | "
    "Campbell's Operative Orthopaedics 15th Ed 2026 | S Das Manual on Clinical Surgery 13th Ed | "
    "Textbook of Family Medicine 9th Ed",
    sNote
))

# ── Build ────────────────────────────────────────────────────────────────────
doc.build(story, onFirstPage=on_page, onLaterPages=on_page)
print("PDF generated:", OUTPUT)

cd /home/daytona/workspace/upper-limb-guide && python generate_pdf.py 2>&1

ls -lh /home/daytona/workspace/upper-limb-guide/Upper_Limb_Exam_Guide.pdf

~/upper-limb-guide/generate_lower_limb_pdf.py

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm, mm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, PageBreak, KeepTogether
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.lib.colors import HexColor

OUTPUT = "/home/daytona/workspace/upper-limb-guide/Lower_Limb_Exam_Guide.pdf"

# ── Colour palette ──────────────────────────────────────────────────────────
C_NAVY   = HexColor("#1B3A5C")
C_TEAL   = HexColor("#1A7A8A")
C_LTBLUE = HexColor("#D6EAF8")
C_MINT   = HexColor("#E8F8F5")
C_GOLD   = HexColor("#F0A500")
C_WHITE  = colors.white
C_BLACK  = colors.black
C_LGREY  = HexColor("#F4F6F7")
C_DGREY  = HexColor("#555555")
C_RED    = HexColor("#C0392B")
C_GREEN  = HexColor("#1E8449")

def on_page(canvas, doc):
    canvas.saveState()
    w, h = A4
    canvas.setFillColor(C_NAVY)
    canvas.rect(0, h - 22*mm, w, 22*mm, fill=1, stroke=0)
    canvas.setFillColor(C_WHITE)
    canvas.setFont("Helvetica-Bold", 10)
    canvas.drawString(15*mm, h - 13*mm, "LOWER LIMB ORTHOPAEDIC EXAMINATION GUIDE")
    canvas.setFont("Helvetica", 9)
    canvas.drawRightString(w - 15*mm, h - 13*mm, "Clinical Reference")
    canvas.setFillColor(C_NAVY)
    canvas.rect(0, 0, w, 12*mm, fill=1, stroke=0)
    canvas.setFillColor(C_WHITE)
    canvas.setFont("Helvetica", 8)
    canvas.drawString(15*mm, 4*mm, "Sources: Bailey & Love 28th Ed | Miller's Review of Orthopaedics 9th Ed | Campbell's Operative Orthopaedics 15th Ed 2026 | S Das 13th Ed")
    canvas.drawRightString(w - 15*mm, 4*mm, f"Page {doc.page}")
    canvas.restoreState()

doc = SimpleDocTemplate(
    OUTPUT, pagesize=A4,
    topMargin=28*mm, bottomMargin=18*mm,
    leftMargin=18*mm, rightMargin=18*mm,
    title="Lower Limb Orthopaedic Examination Guide",
    author="Orris Medical Reference",
)

styles = getSampleStyleSheet()

def S(name, parent="Normal", **kwargs):
    return ParagraphStyle(name, parent=styles[parent], **kwargs)

sH1    = S("sH1","Heading1",fontSize=14,textColor=C_WHITE,spaceAfter=4,spaceBefore=2,leading=18)
sH2    = S("sH2","Heading2",fontSize=12,textColor=C_NAVY,spaceAfter=3,spaceBefore=8,leading=16)
sH3    = S("sH3","Heading3",fontSize=10,textColor=C_TEAL,spaceAfter=2,spaceBefore=6,leading=14)
sBody  = S("sBody","Normal",fontSize=9,textColor=C_BLACK,spaceAfter=3,leading=13,alignment=TA_JUSTIFY)
sBullet= S("sBullet","Normal",fontSize=9,textColor=C_BLACK,spaceAfter=2,leading=12,leftIndent=12)
sNote  = S("sNote","Normal",fontSize=8,textColor=C_DGREY,spaceAfter=2,leading=11,leftIndent=6,fontName="Helvetica-Oblique")
sTH    = S("sTH","Normal",fontSize=8,textColor=C_WHITE,fontName="Helvetica-Bold",leading=11)
sTD    = S("sTD","Normal",fontSize=8,textColor=C_BLACK,leading=11)
sAlert = S("sAlert","Normal",fontSize=9,textColor=C_RED,fontName="Helvetica-Bold",spaceAfter=3,leading=12)
sGreen = S("sGreen","Normal",fontSize=9,textColor=C_GREEN,fontName="Helvetica-Bold",spaceAfter=3,leading=12)

def section_header(title, subtitle=""):
    w = A4[0] - 36*mm
    data = [[Paragraph(title, sH1)]]
    t = Table(data, colWidths=[w])
    t.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1),C_NAVY),
        ("TOPPADDING",(0,0),(-1,-1),6),("BOTTOMPADDING",(0,0),(-1,-1),6),
        ("LEFTPADDING",(0,0),(-1,-1),10),("RIGHTPADDING",(0,0),(-1,-1),10),
    ]))
    items = [t]
    if subtitle:
        items.append(Paragraph(subtitle, sNote))
    items.append(Spacer(1,3*mm))
    return items

def subsection(title):
    return [Paragraph(title, sH2), HRFlowable(width="100%",thickness=1,color=C_TEAL,spaceAfter=3)]

def sub2(title):
    return [Paragraph(title, sH3)]

def bullet(text):
    return Paragraph(f"\u2022  {text}", sBullet)

def note(text):
    return Paragraph(f"<i>{text}</i>", sNote)

def alert(text):
    return Paragraph(f"&#9888;  {text}", sAlert)

def tip(text):
    return Paragraph(f"&#10003;  {text}", sGreen)

def make_table(headers, rows, col_widths=None):
    w = A4[0] - 36*mm
    if col_widths is None:
        n = len(headers)
        col_widths = [w/n]*n
    table_data = [[Paragraph(h, sTH) for h in headers]]
    for r in rows:
        table_data.append([Paragraph(str(c), sTD) for c in r])
    t = Table(table_data, colWidths=col_widths, repeatRows=1)
    t.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,0),C_NAVY),
        ("ROWBACKGROUNDS",(0,1),(-1,-1),[C_WHITE,C_LGREY]),
        ("GRID",(0,0),(-1,-1),0.4,HexColor("#CCCCCC")),
        ("TOPPADDING",(0,0),(-1,-1),4),("BOTTOMPADDING",(0,0),(-1,-1),4),
        ("LEFTPADDING",(0,0),(-1,-1),6),("RIGHTPADDING",(0,0),(-1,-1),6),
        ("VALIGN",(0,0),(-1,-1),"TOP"),
    ]))
    return t

def hbox(text, bg=C_LTBLUE, border=C_TEAL):
    w = A4[0] - 36*mm
    t = Table([[Paragraph(text, sBody)]], colWidths=[w])
    t.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1),bg),
        ("LINEABOVE",(0,0),(-1,0),2,border),("LINEBELOW",(0,-1),(-1,-1),2,border),
        ("LEFTPADDING",(0,0),(-1,-1),10),("RIGHTPADDING",(0,0),(-1,-1),10),
        ("TOPPADDING",(0,0),(-1,-1),6),("BOTTOMPADDING",(0,0),(-1,-1),6),
    ]))
    return t

# ────────────────────────────────────────────────────────────────────────────
story = []

# ── COVER ────────────────────────────────────────────────────────────────────
story.append(Spacer(1,18*mm))
ct = Table([[Paragraph("<font color='white'><b>LOWER LIMB</b></font>",
    S("CT",fontSize=36,textColor=C_WHITE,alignment=TA_CENTER,leading=42))]],
    colWidths=[A4[0]-36*mm])
ct.setStyle(TableStyle([("BACKGROUND",(0,0),(-1,-1),C_NAVY),
    ("TOPPADDING",(0,0),(-1,-1),14),("BOTTOMPADDING",(0,0),(-1,-1),4),
    ("LEFTPADDING",(0,0),(-1,-1),10)]))
story.append(ct)
cs = Table([[Paragraph("<font color='white'>Orthopaedic Examination Guide</font>",
    S("CS",fontSize=18,textColor=C_WHITE,alignment=TA_CENTER))]],
    colWidths=[A4[0]-36*mm])
cs.setStyle(TableStyle([("BACKGROUND",(0,0),(-1,-1),C_TEAL),
    ("TOPPADDING",(0,0),(-1,-1),8),("BOTTOMPADDING",(0,0),(-1,-1),8),
    ("LEFTPADDING",(0,0),(-1,-1),10)]))
story.append(cs)
story.append(Spacer(1,8*mm))

cover_info = [
    ["JOINT","CONDITIONS COVERED"],
    ["Hip","NOF fracture, Dislocation, OA, Perthes', SCFE, Developmental dysplasia"],
    ["Knee","ACL/PCL tears, Meniscal tears, OA, MCL/LCL, Patellofemoral syndrome"],
    ["Ankle","Ankle sprain (lateral ligament), Achilles tendon rupture"],
    ["Foot","Hallux valgus, Pes planus, Pes cavus, Plantar fasciitis, Metatarsalgia"],
]
cw = [(A4[0]-36*mm)*0.20,(A4[0]-36*mm)*0.80]
ci = Table(cover_info, colWidths=cw)
ci.setStyle(TableStyle([
    ("BACKGROUND",(0,0),(-1,0),C_TEAL),
    ("ROWBACKGROUNDS",(0,1),(-1,-1),[C_LTBLUE,C_WHITE]),
    ("TEXTCOLOR",(0,0),(-1,0),C_WHITE),
    ("FONTNAME",(0,0),(-1,0),"Helvetica-Bold"),
    ("FONTNAME",(0,1),(0,-1),"Helvetica-Bold"),
    ("FONTSIZE",(0,0),(-1,-1),9),
    ("GRID",(0,0),(-1,-1),0.5,HexColor("#AAAAAA")),
    ("TOPPADDING",(0,0),(-1,-1),5),("BOTTOMPADDING",(0,0),(-1,-1),5),
    ("LEFTPADDING",(0,0),(-1,-1),8),
]))
story.append(ci)
story.append(Spacer(1,8*mm))
story.append(hbox(
    "<b>UNIVERSAL EXAMINATION SEQUENCE</b>  \u2192  "
    "<b>LOOK</b> (inspect) \u2192 <b>FEEL</b> (palpate) \u2192 "
    "<b>MOVE</b> (active \u2192 passive \u2192 resisted) \u2192 "
    "<b>SPECIAL TESTS</b> \u2192 <b>GAIT &amp; NEUROVASCULAR</b>",
    bg=C_MINT, border=C_GREEN
))
story.append(Spacer(1,5*mm))
story.append(note("Sources: Bailey & Love's Short Practice of Surgery 28th Ed | Miller's Review of Orthopaedics 9th Ed | "
    "Campbell's Operative Orthopaedics 15th Ed 2026 | S Das Manual on Clinical Surgery 13th Ed | "
    "Rheumatology 2022 Elsevier"))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════════════════
# SECTION 1 – HIP
# ════════════════════════════════════════════════════════════════════════════
story += section_header("SECTION 1 — THE HIP",
    "Ball-and-socket joint — examine spine, abdomen, pelvis, groin, thigh & consider gynaecological causes in women")

story += subsection("Anatomy Reminders")
story.append(bullet("Ball-and-socket synovial joint: femoral head + acetabulum"))
story.append(bullet("Key bony landmarks: ASIS, iliac crest, greater trochanter, ischial tuberosity, pubic tubercle"))
story.append(bullet("Femoral artery: palpated at midpoint of inguinal ligament (ASIS to pubic tubercle)"))
story.append(bullet("Nerve supply: femoral nerve (L2–L4), obturator nerve (L2–L4), sciatic nerve (L4–S3)"))
story.append(Spacer(1,3*mm))

story += subsection("GAIT (Observe First — Before the Patient Lies Down)")
story.append(bullet("<b>Trendelenburg gait (gluteus medius lurch):</b> Pelvis drops to contralateral side during stance; trunk leans to ipsilateral side to compensate. Causes: hip OA, NOF fracture, superior gluteal nerve palsy, DDH"))
story.append(bullet("<b>Antalgic gait:</b> Short stance phase on painful side — minimises time weight-bearing on affected hip"))
story.append(bullet("<b>Scissors gait:</b> Spastic hip adductors — knees cross midline (cerebral palsy)"))
story.append(Spacer(1,3*mm))

story += subsection("LOOK (Standing → Supine)")
story.append(Paragraph("<b>Standing — inspect front, side, back:</b>", sBody))
story.append(bullet("Pelvic tilt: One ASIS higher than the other (true/apparent leg length discrepancy)"))
story.append(bullet("Rotational deformity: foot progression angle (in-toeing vs. out-toeing)"))
story.append(bullet("Gluteal wasting: abductor weakness; scoliosis secondary to pelvic tilt; lumbar lordosis"))
story.append(Paragraph("<b>Supine:</b>", sBody))
story.append(bullet("Scars and sinuses (previous surgery, septic arthritis)"))
story.append(bullet("Rotational deformity: patellae pointing outward/inward"))
story.append(bullet("Fixed adduction deformity (OA, cerebral palsy) → apparent shortening due to pelvic tilt"))
story.append(Spacer(1,3*mm))

story += subsection("FEEL")
story.append(bullet("Greater trochanter: tenderness = trochanteric bursitis or abductor enthesopathy"))
story.append(bullet("ASIS, iliac crest, pubic tubercle (bony landmarks for measurements)"))
story.append(bullet("Inguinal ligament: lymphadenopathy, hernia"))
story.append(bullet("Femoral pulse: palpate at midinguinal point. Absent in posterior dislocation (head of femur no longer supports artery from behind)"))
story.append(bullet("Posterior hip: ischial tuberosity tenderness (hamstring origin)"))
story.append(Spacer(1,3*mm))

story += subsection("MOVE")
story.append(Paragraph("<b>Passive Hip Movements (normal ranges):</b>", sBody))
hip_rom = [
    ["Movement","Normal Range","How to Test"],
    ["Flexion","0–120°","Supine; flex hip+knee. Modified Thomas' test for fixed flexion."],
    ["Extension","0–10°","Prone; lift leg off couch. (Or Thomas' test)"],
    ["Abduction","0–45°","Supine; stabilise contralateral ASIS; slide leg out"],
    ["Adduction","0–30°","Supine; cross leg over midline"],
    ["Internal rotation","0–45°","Hip+knee at 90°; swing foot outward"],
    ["External rotation","0–45°","Hip+knee at 90°; swing foot inward"],
]
story.append(make_table(hip_rom[0],hip_rom[1:],
    col_widths=[(A4[0]-36*mm)*0.22,(A4[0]-36*mm)*0.18,(A4[0]-36*mm)*0.60]))
story.append(Spacer(1,2*mm))
story.append(alert("First movement lost in hip OA: Internal rotation — always test this!"))
story.append(Spacer(1,3*mm))

story += subsection("SPECIAL TESTS — HIP")
story.append(Spacer(1,2*mm))
hip_tests = [
    ["Test","Technique","Positive Finding & Meaning"],
    ["Thomas' test\n(fixed flexion deformity)","Patient supine. Flex both hips fully. Hold one hip flexed (flattens lumbar lordosis). Allow other leg to drop to couch.",
     "Leg unable to reach couch = fixed flexion deformity of that hip. Angle = degree of FFD"],
    ["Trendelenburg test\n(abductor integrity)","Patient stands on one leg. Examiner stands behind.",
     "Pelvis drops on contralateral (unsupported) side = POSITIVE. Weak abductors on standing leg (gluteus medius)"],
    ["Leg length measurement\n(True LLD)","ASIS to medial malleolus",
     "Difference indicates true shortening (femoral/tibial). Compare both sides."],
    ["Apparent LLD","Xiphisternum to medial malleolus",
     "Difference due to pelvic tilt/adduction contracture, not actual bone shortening"],
    ["Bryant's triangle","Patient supine. Vertical line from ASIS. Horizontal line from GT to meet it. Measure horizontal limb.",
     "Shortened horizontal limb = upward displacement of GT (NOF #, posterior dislocation)"],
    ["Nelaton's line","Line from ASIS to ischial tuberosity in lateral decubitus",
     "GT lies above line = upward displacement (NOF #, dislocation)"],
    ["FABER/Patrick test","Flex, Abduct, Externally Rotate hip (figure-of-4 position)",
     "Anterior hip pain = hip joint pathology. Posterior pain = SI joint / L5–S1 referred"],
    ["FADIR/Impingement test","Flex hip 90°, Adduct, Internally Rotate",
     "Anterior groin pain = femoroacetabular impingement (FAI) or labral tear"],
    ["Stinchfield test","Active straight-leg raise ~20 cm against mild resistance",
     "Anterior hip pain = hip joint pathology (contracts iliopsoas and compresses joint)"],
    ["Ober's test","Lateral decubitus: lower leg flexed. Extend and abduct upper leg then let drop.",
     "Leg fails to adduct below horizontal = tight iliotibial band (ITB)"],
    ["Log roll (Roll test)","Supine: rotate leg in/out gently at calf level",
     "Stiffness or pain = hip joint irritability (useful in acute hip pathology)"],
]
story.append(make_table(hip_tests[0],hip_tests[1:],
    col_widths=[(A4[0]-36*mm)*0.22,(A4[0]-36*mm)*0.38,(A4[0]-36*mm)*0.40]))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════════════════
# SECTION 2 – HIP CONDITIONS
# ════════════════════════════════════════════════════════════════════════════
story += section_header("SECTION 2 — HIP CONDITIONS")

story += subsection("Hip Osteoarthritis (OA)")
story.append(bullet("Most common joint disease. Primary (idiopathic) or secondary (DDH, Perthes', SCFE, trauma)"))
story.append(bullet("Presentation: Groin pain (referred to knee), stiffness worse in morning/rest, antalgic or Trendelenburg gait"))
story.append(Paragraph("<b>Examination Findings:</b>", sBody))
story.append(bullet("Antalgic/Trendelenburg gait"))
story.append(bullet("Fixed flexion deformity (Thomas' test positive)"))
story.append(bullet("Internal rotation FIRST lost; then all movements restricted"))
story.append(bullet("Shortening of limb (advanced OA with superior/posterior head migration)"))
story.append(Paragraph("<b>Investigations:</b>", sBody))
story.append(bullet("X-ray (AP pelvis + lateral frog-leg): Loss of joint space (superolateral), subchondral sclerosis, osteophytes, subchondral cysts (LOSS)"))
story.append(bullet("MRI: Early cartilage loss, avascular necrosis, labral tears"))
story.append(Paragraph("<b>Treatment:</b>", sBody))
oa_rx = [
    ["Stage","Treatment"],
    ["Mild","Analgesia (paracetamol, NSAIDs), physiotherapy, weight loss, activity modification, walking aids"],
    ["Moderate","Intraarticular steroid injection, hyaluronic acid injection, bracing"],
    ["Severe / Failed conservative","Total Hip Replacement (THR) — gold standard; excellent long-term outcomes"],
]
story.append(make_table(oa_rx[0],oa_rx[1:],col_widths=[(A4[0]-36*mm)*0.18,(A4[0]-36*mm)*0.82]))
story.append(Spacer(1,5*mm))

story += subsection("Neck of Femur (NOF) Fracture")
story.append(alert("Elderly patient lying helplessly with externally rotated, shortened lower limb = NOF fracture until proven otherwise"))
story.append(Spacer(1,2*mm))
story.append(bullet("Commonest serious fracture in elderly; high morbidity/mortality (1-year mortality ~30%)"))
story.append(bullet("Mechanism: Low-energy fall in osteoporotic patients; high-energy trauma in young"))
story.append(Paragraph("<b>Garden Classification (Subcapital):</b>", sBody))
garden = [
    ["Grade","Description","Blood Supply"],
    ["I","Incomplete/impacted — valgus impaction","Usually intact"],
    ["II","Complete, non-displaced","Usually intact"],
    ["III","Complete, partial displacement — head partially rotated","Disrupted"],
    ["IV","Complete, full displacement — head rotated, trabeculae not aligned","Disrupted — HIGH AVN risk"],
]
story.append(make_table(garden[0],garden[1:],
    col_widths=[(A4[0]-36*mm)*0.12,(A4[0]-36*mm)*0.55,(A4[0]-36*mm)*0.33]))
story.append(Spacer(1,3*mm))
story.append(Paragraph("<b>Examination Findings:</b>", sBody))
story.append(bullet("Lying helpless; cannot weight bear; extreme pain on any movement"))
story.append(bullet("Lower limb: <b>shortened, externally rotated</b> (sternomastoid + iliacus/iliopsoas retract and rotate fragment)"))
story.append(bullet("Bony tenderness on attempted rotation of shaft of femur (transcervical/subcapital)"))
story.append(bullet("Bryant's triangle: horizontal limb shortened (upward GT displacement)"))
story.append(bullet("Nelaton's line: GT above line"))
story.append(Paragraph("<b>Investigations:</b>", sBody))
story.append(bullet("X-ray (AP pelvis + lateral): Always obtain both views. Shenton's line disrupted."))
story.append(bullet("MRI: Most sensitive — detects occult fractures within 24–48 hours (superior to bone scan)"))
story.append(Paragraph("<b>Treatment (operative for almost all):</b>", sBody))
nof_rx = [
    ["Fracture Type","Patient","Treatment"],
    ["Intracapsular undisplaced (Garden I/II)","Young + elderly","DHS or cannulated screws"],
    ["Intracapsular displaced (Garden III/IV)","Elderly (>65)","Hemiarthroplasty (cemented Austin Moore/Thompson) or THR"],
    ["Intracapsular displaced (Garden III/IV)","Young (<65)","Reduction + internal fixation (preserve head)"],
    ["Extracapsular (intertrochanteric)","Any age","Dynamic Hip Screw (DHS)"],
    ["Subtrochanteric","Any","Intramedullary nail (e.g. PFNA)"],
]
story.append(make_table(nof_rx[0],nof_rx[1:],
    col_widths=[(A4[0]-36*mm)*0.34,(A4[0]-36*mm)*0.22,(A4[0]-36*mm)*0.44]))
story.append(Spacer(1,5*mm))

story += subsection("Hip Dislocation")
story.append(Paragraph("<b>Posterior Dislocation (90% of hip dislocations):</b>", sBody))
story.append(bullet("Mechanism: Dashboard injury (knee hits dashboard forcing femoral head posteriorly) — high-energy RTA"))
story.append(bullet("Attitude: <b>Flexion, adduction, internal rotation</b> of the thigh"))
story.append(bullet("Limb: Shortened; fixed in above posture"))
story.append(bullet("Femoral pulse: Difficult to palpate (head absent from acetabulum)"))
story.append(bullet("Complications: Sciatic nerve injury (10–20%), avascular necrosis of femoral head, post-traumatic OA"))
story.append(Spacer(1,2*mm))
story.append(Paragraph("<b>Anterior Dislocation (rare):</b>", sBody))
story.append(bullet("Attitude: <b>Extension, abduction, external rotation</b> of the thigh"))
story.append(bullet("Femoral head palpable in groin (pubic/obturator type)"))
story.append(bullet("Treatment: Emergency closed reduction under GA; post-reduction CT to check for fragment"))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════════════════
# SECTION 3 – KNEE
# ════════════════════════════════════════════════════════════════════════════
story += section_header("SECTION 3 — THE KNEE",
    "Three compartments: medial, lateral, patellofemoral | Ligaments: ACL, PCL, MCL, LCL, posterolateral corner")

story += subsection("Anatomy Reminders")
story.append(bullet("Synovial hinge joint (+ slight rotation in last 15° of extension — 'screw-home mechanism')"))
story.append(bullet("ACL: Primary restraint to anterior tibial translation (resists anterior draw + rotational instability)"))
story.append(bullet("PCL: Primary restraint to posterior tibial translation (90°)"))
story.append(bullet("MCL (medial): Resists valgus stress + external rotation forces"))
story.append(bullet("LCL (lateral): Resists varus stress"))
story.append(bullet("Menisci: Shock absorption, load distribution, joint stability, lubrication"))
story.append(bullet("Extensor mechanism: Quadriceps → quadriceps tendon → patella → patellar tendon → tibial tuberosity"))
story.append(Spacer(1,3*mm))

story += subsection("LOOK")
story.append(bullet("<b>Standing:</b> Alignment — varus ('bow-legged', medial compartment OA) or valgus ('knock-knee'); measure intermalleolar/intercondylar distance"))
story.append(bullet("Fixed flexion deformity (FFD) from the side; recurvatum (hyperextension)"))
story.append(bullet("Quadriceps wasting — universal sign of chronic knee pathology"))
story.append(bullet("Gait: Antalgic (OA), varus thrust (medial compartment collapse), high-stepping (foot drop)"))
story.append(bullet("<b>Supine:</b> Swelling pattern — prepatellar bursa, Baker's cyst (popliteal), diffuse effusion"))
story.append(bullet("Scars (previous arthroscopy, ligament reconstruction, TKR)"))
story.append(Spacer(1,3*mm))

story += subsection("FEEL")
story.append(Paragraph("<b>Effusion Tests:</b>", sBody))
story.append(bullet("<b>Fluid displacement (stroke/bulge test):</b> Stroke fluid from medial side into suprapatellar pouch; press pouch inferiorly; fluid returns to medial side as a visible bulge — SMALL effusion"))
story.append(bullet("<b>Patellar tap test:</b> Compress fluid into joint; tap patella; floats off the trochlea — LARGE effusion"))
story.append(Spacer(1,2*mm))
story.append(Paragraph("<b>Palpation Points:</b>", sBody))
story.append(bullet("Joint line (medial and lateral) — tenderness = meniscal pathology or compartment OA"))
story.append(bullet("Tibial tuberosity — Osgood-Schlatter disease (adolescents); patellar tendon insertion"))
story.append(bullet("Inferior pole of patella — patellar tendinopathy ('jumper's knee')"))
story.append(bullet("Medial epicondyle of femur — MCL origin"))
story.append(bullet("Popliteal fossa — Baker's cyst (communicating with joint via posterior capsule); popliteal aneurysm"))
story.append(Spacer(1,3*mm))

story += subsection("MOVE")
story.append(bullet("Flexion–Extension: −5° (hyperextension) to 135°"))
story.append(bullet("<b>Lag test (extensor mechanism):</b> Ask patient to lift straight leg off bed (SLR). Then flex knee and try to straighten against gravity. Cannot re-straighten = extensor mechanism failure"))
story.append(bullet("Fixed flexion deformity: Patient prone — measure angle of FFD or height of heel off couch"))
story.append(Spacer(1,3*mm))

story += subsection("SPECIAL TESTS — KNEE")
story.append(Spacer(1,2*mm))

story += sub2("Cruciate Ligaments")
cr_tests = [
    ["Test","Technique","Positive Finding"],
    ["Lachman test (best for ACL)","Knee at 15–30° flexion; pull proximal tibia anteriorly",
     "Excessive anterior translation with soft/absent end-point = ACL rupture. Most sensitive ACL test."],
    ["Anterior draw test (ACL)","Knee at 90°; sit on foot; draw tibia forward. Grade I <5 mm, II 5–10 mm, III >10 mm",
     "Anterior translation = ACL injury. Also check for posterior sag before drawing."],
    ["Posterior draw test (PCL)","Knee at 90°; push tibia posteriorly. >10 mm = combined PCL + PLC",
     "Posterior translation = PCL rupture"],
    ["Posterior sag sign (PCL)","Knees flexed 90°; look from side at tibial tuberosity level",
     "Posterior sag of tibia = PCL rupture"],
    ["Pivot shift test (ACL)","Valgus + internal rotation force on flexed knee; then extend",
     "Clunk as lateral tibial plateau reduces at ~30° = rotatory instability (ACL deficiency)"],
]
story.append(make_table(cr_tests[0],cr_tests[1:],
    col_widths=[(A4[0]-36*mm)*0.27,(A4[0]-36*mm)*0.40,(A4[0]-36*mm)*0.33]))
story.append(Spacer(1,3*mm))

story += sub2("Collateral Ligaments")
col_tests = [
    ["Test","Technique","Positive Finding"],
    ["Valgus stress test (MCL)","Apply valgus force at 0° and 30° flexion",
     "Laxity/pain at 30° = MCL tear. Laxity at 0° = complete MCL + cruciate injury."],
    ["Varus stress test (LCL)","Apply varus force at 0° and 30° flexion",
     "Laxity/pain at 30° = LCL tear. Laxity at 0° = severe posterolateral corner injury."],
]
story.append(make_table(col_tests[0],col_tests[1:],
    col_widths=[(A4[0]-36*mm)*0.27,(A4[0]-36*mm)*0.40,(A4[0]-36*mm)*0.33]))
story.append(Spacer(1,3*mm))

story += sub2("Menisci")
men_tests = [
    ["Test","Technique","Positive Finding"],
    ["Joint line tenderness","Flex knee 90°; palpate joint line with thumb + index",
     "Tenderness = most sensitive clinical test for meniscal tear"],
    ["McMurray's test","Supine. Fully flex knee. Externally rotate + extend (medial); internally rotate + extend (lateral).",
     "Palpable/audible click or pain at joint line = meniscal tear"],
    ["Thessaly test","Patient stands on one leg, flexes knee 20°, rotates body medially + laterally 3 times",
     "Joint line pain or sensation of locking = meniscal tear (good sensitivity/specificity)"],
    ["Apley grind test","Prone; flex knee 90°; compress + rotate (grind) then distract + rotate",
     "Pain with compression + rotation = meniscal tear; pain with distraction = ligament injury"],
]
story.append(make_table(men_tests[0],men_tests[1:],
    col_widths=[(A4[0]-36*mm)*0.27,(A4[0]-36*mm)*0.40,(A4[0]-36*mm)*0.33]))
story.append(Spacer(1,3*mm))

story += sub2("Patellofemoral Joint")
pf_tests = [
    ["Test","Technique","Positive Finding"],
    ["Patellar apprehension\n(Fairbank's) test","Attempt to push patella laterally with knee extended. Also at 30° flexion.",
     "Patient contracts quads / grabs examiner / complains of pain = lateral patellar instability"],
    ["J-sign / Patellar tracking","Patient extends knee slowly from 90° — observe patella path",
     "Lateral jump at end of extension = maltracking (VMO weakness)"],
    ["Clarke's test (patellar grind)","Push patella distally; patient tenses quads",
     "Pain = patellofemoral syndrome / chondromalacia patellae"],
]
story.append(make_table(pf_tests[0],pf_tests[1:],
    col_widths=[(A4[0]-36*mm)*0.27,(A4[0]-36*mm)*0.40,(A4[0]-36*mm)*0.33]))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════════════════
# SECTION 4 – KNEE CONDITIONS
# ════════════════════════════════════════════════════════════════════════════
story += section_header("SECTION 4 — KNEE CONDITIONS")

story += subsection("ACL Rupture")
story.append(bullet("Most common serious knee ligament injury; young athletic population (pivoting sports)"))
story.append(bullet("Mechanism: Non-contact deceleration + valgus collapse + internal rotation (most common); direct blow"))
story.append(bullet("Presentation: Haemarthrosis within 2 hours, 'pop' heard, immediate inability to continue sport"))
story.append(Paragraph("<b>Examination:</b>", sBody))
story.append(bullet("Lachman test positive (most sensitive, best performed acutely)"))
story.append(bullet("Anterior draw test positive (less sensitive acutely — hamstring guarding at 90°)"))
story.append(bullet("Pivot shift test positive (pathognomonic of rotatory instability but difficult acutely)"))
story.append(Paragraph("<b>Investigations:</b>", sBody))
story.append(bullet("X-ray: Segond fracture (avulsion of lateral tibial plateau = pathognomonic for ACL rupture)"))
story.append(bullet("MRI: Gold standard — shows ligament signal change/discontinuity, bone bruising, meniscal tears"))
story.append(Paragraph("<b>Treatment:</b>", sBody))
story.append(bullet("Conservative: Physiotherapy, quadriceps strengthening — for low-demand patients"))
story.append(bullet("Surgical: ACL reconstruction (hamstring/patellar tendon/quadriceps tendon graft) — for young, active patients or those with instability; arthroscopic"))
story.append(Spacer(1,5*mm))

story += subsection("Meniscal Tear")
story.append(bullet("Medial meniscus more commonly torn than lateral (less mobile; attached to MCL)"))
story.append(bullet("Mechanism: Twisting injury in young; degenerative in elderly"))
story.append(bullet("Presentation: Joint line pain, swelling, locking (bucket-handle tear), giving way"))
story.append(Paragraph("<b>Examination:</b>", sBody))
story.append(bullet("Joint line tenderness (most sensitive)"))
story.append(bullet("McMurray's test, Apley grind test positive"))
story.append(bullet("Locked knee (cannot achieve full extension) = bucket-handle meniscal tear"))
story.append(Paragraph("<b>Investigations:</b>", sBody))
story.append(bullet("MRI: Grade I = intrameniscal signal; Grade II = signal not reaching surface; Grade III = tear reaching articular surface (surgical)"))
story.append(Paragraph("<b>Treatment:</b>", sBody))
story.append(bullet("Conservative: RICE, physiotherapy for stable peripheral tears"))
story.append(bullet("Surgical: Arthroscopic meniscal repair (peripheral vascular zone — red zone) or partial meniscectomy (avascular — white zone)"))
story.append(Spacer(1,5*mm))

story += subsection("Knee Osteoarthritis")
story.append(bullet("Most common: medial compartment (varus knee → medial compartment loading)"))
story.append(bullet("Presentation: Insidious onset pain, crepitus, stiffness, deformity, functional limitation"))
story.append(Paragraph("<b>Examination:</b>", sBody))
story.append(bullet("Varus/valgus deformity; fixed flexion deformity; quadriceps wasting"))
story.append(bullet("Joint line tenderness; bony enlargement (osteophytes); crepitus on movement"))
story.append(bullet("Reduced ROM — flexion most affected"))
story.append(Paragraph("<b>Investigations:</b>", sBody))
story.append(bullet("Weight-bearing X-ray: Loss of joint space (medial > lateral), subchondral sclerosis, osteophytes, varus/valgus alignment (Kellgren-Lawrence grading)"))
story.append(Paragraph("<b>Treatment:</b>", sBody))
knee_oa_rx = [
    ["Stage","Treatment"],
    ["Mild–moderate","Analgesia, NSAIDs, physiotherapy, weight loss, activity modification, knee brace (unloader brace for unicompartmental OA)"],
    ["Moderate","Intraarticular steroid injection; hyaluronic acid injection"],
    ["Severe","Total Knee Replacement (TKR) or Unicompartmental Knee Replacement (UKR) — for isolated compartment disease in lower-demand patients"],
]
story.append(make_table(knee_oa_rx[0],knee_oa_rx[1:],
    col_widths=[(A4[0]-36*mm)*0.18,(A4[0]-36*mm)*0.82]))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════════════════
# SECTION 5 – ANKLE & FOOT
# ════════════════════════════════════════════════════════════════════════════
story += section_header("SECTION 5 — ANKLE & FOOT",
    "Hindfoot (talus, calcaneus) | Midfoot (navicular, cuboid, cuneiforms) | Forefoot (metatarsals, phalanges)")

story += subsection("Anatomy Reminders")
story.append(bullet("Ankle (talocrural joint): Mortise joint — tibia, fibula, talus. Plantarflexion/dorsiflexion."))
story.append(bullet("Subtalar joint: Inversion/eversion of hindfoot"))
story.append(bullet("Lateral ligament complex: ATFL (anterior talofibular) + CFL (calcaneofibular) + PTFL (posterior talofibular)"))
story.append(bullet("ATFL: Most commonly torn in lateral ankle sprain (plantarflexion + inversion mechanism)"))
story.append(bullet("Medial deltoid ligament: Strong; rarely torn in isolation"))
story.append(bullet("Achilles tendon: Gastrocnemius + soleus → calcaneal insertion. 'Watershed zone' 2–6 cm above insertion"))
story.append(Spacer(1,3*mm))

story += subsection("LOOK (Standing → Supine)")
story.append(Paragraph("<b>Standing (weight-bearing assessment):</b>", sBody))
story.append(bullet("Overall limb alignment: Pelvic obliquity → LLD → knee valgus/varus → foot posture"))
story.append(bullet("Hindfoot (from behind): Achilles + calcaneus angle. Normal heel valgus 5–7°. Too many toes sign (>2 toes visible from behind = pes planus + forefoot abduction)"))
story.append(bullet("Medial longitudinal arch (from side): Absent = pes planus (flat foot); Exaggerated = pes cavus (high arch)"))
story.append(bullet("Forefoot: Hallux valgus (bunion), hallux rigidus; hammer/claw/mallet toe deformities"))
story.append(Spacer(1,2*mm))
toe_table = [
    ["Deformity","MTPj","PIPj","DIPj"],
    ["Claw toe","Hyperextension","Flexion","Flexion"],
    ["Hammer toe","Normal","Flexion","Extension or flexion"],
    ["Mallet toe","Normal","Normal","Flexion"],
    ["Hallux valgus","Valgus (lateral deviation)","Normal","—"],
]
story.append(make_table(toe_table[0],toe_table[1:],
    col_widths=[(A4[0]-36*mm)*0.28,(A4[0]-36*mm)*0.24,(A4[0]-36*mm)*0.24,(A4[0]-36*mm)*0.24]))
story.append(Spacer(1,3*mm))
story.append(Paragraph("<b>Gait:</b>", sBody))
story.append(bullet("High-stepping gait = foot drop (common peroneal nerve palsy, L4 radiculopathy)"))
story.append(bullet("Antalgic gait = ankle/foot joint pain; short propulsive phase = forefoot pain"))
story.append(Paragraph("<b>Footwear inspection:</b>", sBody))
story.append(bullet("Normal wear: posterolateral heel (heel strike) + under big toe ball (toe-off)"))
story.append(bullet("Medial heel wear = hindfoot valgus/pes planus; lateral = hindfoot varus/pes cavus"))
story.append(Spacer(1,3*mm))

story += subsection("FEEL")
story.append(bullet("Skin: Reduced sensation in glove-and-stocking distribution = diabetes peripheral neuropathy"))
story.append(bullet("Pulses: Dorsalis pedis (dorsum of foot) + posterior tibial (behind medial malleolus)"))
story.append(bullet("Medial malleolus, lateral malleolus, base of 5th metatarsal, navicular: Specific bony tenderness points"))
story.append(bullet("Ottawa Rules tender points: Posterior 6 cm of fibula/tibia; base 5th MT; navicular → X-ray required"))
story.append(bullet("Achilles tendon: Palpate for defect, tenderness 2–6 cm above insertion (watershed zone)"))
story.append(bullet("Plantar fascia: Tenderness at calcaneal origin (plantar fasciitis)"))
story.append(Spacer(1,3*mm))

story += subsection("MOVE")
ankle_rom = [
    ["Movement","Joint","Normal Range"],
    ["Dorsiflexion","Talocrural","0–20°"],
    ["Plantarflexion","Talocrural","0–50°"],
    ["Inversion","Subtalar","0–35°"],
    ["Eversion","Subtalar","0–15°"],
    ["Toe extension/flexion","MTP/IP joints","Individually assessed"],
]
story.append(make_table(ankle_rom[0],ankle_rom[1:],
    col_widths=[(A4[0]-36*mm)*0.30,(A4[0]-36*mm)*0.30,(A4[0]-36*mm)*0.40]))
story.append(Spacer(1,3*mm))

story += subsection("SPECIAL TESTS — ANKLE & FOOT")
ankle_tests = [
    ["Test","Technique","Positive Finding & Meaning"],
    ["Anterior draw test (ATFL)","Stabilise distal tibia; pull heel anteriorly in slight plantarflexion",
     "Anterior translation of talus > 3–5 mm (or > other side) = ATFL tear"],
    ["Talar tilt test (CFL)","Invert heel with ankle in neutral; compare with other side",
     "Increased tilt = CFL tear (combined ATFL + CFL = severe lateral ligament complex injury)"],
    ["Thompson (Simmonds') test\n(Achilles tendon integrity)","Patient prone, knee at 90°. Squeeze calf (gastrocnemius bulk).",
     "No plantarflexion = POSITIVE = complete Achilles tendon rupture"],
    ["Single heel rise test","Stand on one foot; rise up onto tiptoe",
     "Unable to rise = tibialis posterior dysfunction / Achilles weakness"],
    ["Silfverskiold test","Dorsiflexion measured with knee extended vs. flexed",
     "Improved DF with knee flexed = gastrocnemius tightness (not combined gastrosoleus)"],
    ["Ottawa ankle rules","Bony tenderness at: posterior 6 cm fibula/tibia; base 5th MT; navicular",
     "Any positive point = X-ray required to exclude fracture"],
]
story.append(make_table(ankle_tests[0],ankle_tests[1:],
    col_widths=[(A4[0]-36*mm)*0.25,(A4[0]-36*mm)*0.38,(A4[0]-36*mm)*0.37]))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════════════════
# SECTION 6 – ANKLE/FOOT CONDITIONS
# ════════════════════════════════════════════════════════════════════════════
story += section_header("SECTION 6 — ANKLE & FOOT CONDITIONS")

story += subsection("Lateral Ankle Sprain")
story.append(bullet("Most common musculoskeletal injury. Inversion + plantarflexion mechanism"))
story.append(bullet("Lateral ligament complex: ATFL (first), then CFL, then PTFL (most severe)"))
story.append(Paragraph("<b>Examination:</b>", sBody))
story.append(bullet("Swelling + bruising over lateral malleolus + ATFL territory"))
story.append(bullet("Anterior draw test + talar tilt test positive (acute = difficult due to guarding)"))
story.append(bullet("Apply Ottawa rules — X-ray if bony tenderness present"))
story.append(Paragraph("<b>Treatment:</b>", sBody))
story.append(bullet("RICE in acute phase; early functional rehabilitation; ankle brace"))
story.append(bullet("Chronic instability: Bröstrom repair (anatomical ligament reconstruction)"))
story.append(Spacer(1,5*mm))

story += subsection("Achilles Tendon Rupture")
story.append(alert("Thompson's test: Absence of plantarflexion on calf squeeze = complete Achilles rupture"))
story.append(bullet("Peak age: 30–50 years; 'weekend warriors'; fluoroquinolone use increases risk"))
story.append(bullet("Mechanism: Sudden explosive push-off (squash, tennis, basketball)"))
story.append(Paragraph("<b>Examination:</b>", sBody))
story.append(bullet("Sudden pain ('felt like being shot/kicked')"))
story.append(bullet("Palpable gap in tendon 2–6 cm above insertion (watershed zone)"))
story.append(bullet("Thompson's (Simmonds') test POSITIVE — most important clinical test"))
story.append(bullet("Patient can weakly plantarflex using long toe flexors (do not be falsely reassured)"))
story.append(Paragraph("<b>Investigations:</b>", sBody))
story.append(bullet("USS: Confirms tear, gap size, apposition in equinus"))
story.append(bullet("MRI: Detailed anatomy, partial vs. complete"))
story.append(Paragraph("<b>Treatment:</b>", sBody))
story.append(bullet("Non-operative: Functional bracing in equinus (progressive rehabilitation) — similar outcomes to surgery in some studies"))
story.append(bullet("Surgical: End-to-end repair — preferred in young, active patients; lower re-rupture rate"))
story.append(Spacer(1,5*mm))

story += subsection("Foot Conditions Summary")
foot_conds = [
    ["Condition","Typical Patient","Key Finding","Treatment"],
    ["Plantar fasciitis","Middle-aged, overweight, runners","Heel pain worst in morning 1st steps; tenderness at calcaneal origin of plantar fascia","Stretching, orthotics, steroid injection, ESWT"],
    ["Hallux valgus (bunion)","Middle-aged women; tight shoes","Lateral deviation of hallux; medial prominence; MTPj bursa","Shoes modification; osteotomy (scarf/chevron) if symptomatic"],
    ["Hallux rigidus","Adults 30–60","Stiff, painful 1st MTPj; dorsal osteophyte; reduced dorsiflexion","Stiff-soled shoes, orthotics; 1st MTPj fusion or cheilectomy"],
    ["Pes planus (flat foot)","All ages","Collapsed medial arch; too many toes sign; tibialis posterior tenderness","Physiotherapy, orthotics; corrective surgery for rigid flat foot"],
    ["Pes cavus","Neurological cause (CMT, spina bifida)","High arch; clawing of toes; calluses under metatarsal heads","Assess neurological cause; orthotics; corrective osteotomy"],
    ["Morton's neuroma","Middle-aged women","Burning/shooting pain 3rd–4th web space; Mulder's click","Wide shoes, metatarsal dome pad, steroid injection; surgical excision"],
    ["Ankle OA","Post-traumatic (recurrent sprains/fractures)","Reduced ankle ROM; joint line tenderness; varus/valgus deformity","Physiotherapy, bracing; ankle fusion (arthrodesis) or total ankle replacement"],
]
story.append(make_table(foot_conds[0],foot_conds[1:],
    col_widths=[(A4[0]-36*mm)*0.18,(A4[0]-36*mm)*0.18,(A4[0]-36*mm)*0.31,(A4[0]-36*mm)*0.33]))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════════════════
# SECTION 7 – QUICK REFERENCE SUMMARY
# ════════════════════════════════════════════════════════════════════════════
story += section_header("SECTION 7 — QUICK REFERENCE SUMMARY")
story.append(Spacer(1,3*mm))

summary = [
    ["Condition","Site","Attitude/Deformity","Key Test","Investigation","Treatment"],
    ["Hip OA","Hip","Fixed flexion (Thomas'+)","IR first lost","X-ray: LOSS","Analgesia → THR"],
    ["NOF fracture","Hip","Short, ER, helpless","Bryant's triangle short","X-ray ± MRI","DHS/Hemiarthroplasty/THR"],
    ["Post. dislocation hip","Hip","Flex, adduct, IR","Head in buttock; posterior","X-ray (AP + lateral)","Urgent closed reduction"],
    ["Ant. dislocation hip","Hip","Extend, abduct, ER","Head in groin","X-ray","Closed reduction"],
    ["ACL rupture","Knee","Haemarthrosis","Lachman + pivot shift","MRI","Physio / ACL recon"],
    ["PCL rupture","Knee","Posterior sag","Posterior draw","MRI","Bracing / PCL recon"],
    ["Meniscal tear","Knee","Joint line pain","McMurray, joint line TTP","MRI","Repair or partial meniscectomy"],
    ["Knee OA","Knee","Varus; FFD","Crepitus, reduced ROM","WB X-ray","Analgesia → TKR/UKR"],
    ["Lat. ankle sprain","ATFL/CFL","Swelling lateral malleolus","Anterior draw, talar tilt","X-ray if Ottawa +","RICE, rehab, brace"],
    ["Achilles rupture","Tendo-Achilles","Palpable gap","Thompson + (no PF)","USS/MRI","Functional brace / repair"],
    ["Plantar fasciitis","Heel","Morning pain","Calcaneal origin TTP","Clinical ± USS","Stretching, steroid inj"],
    ["Hallux valgus","1st MTPj","Lateral hallux deviation","Bunion; MTPj ROM","X-ray (WB)","Shoes; osteotomy"],
]
story.append(make_table(summary[0],summary[1:],
    col_widths=[
        (A4[0]-36*mm)*0.18,
        (A4[0]-36*mm)*0.08,
        (A4[0]-36*mm)*0.19,
        (A4[0]-36*mm)*0.18,
        (A4[0]-36*mm)*0.16,
        (A4[0]-36*mm)*0.21,
    ]))
story.append(Spacer(1,5*mm))

story += subsection("Classic Rules & Mnemonics")
rules = [
    ("<b>Trendelenburg gait</b>", "Pelvis drops CONTRALATERAL to weak abductor. Trunk leans IPSILATERAL to compensate."),
    ("<b>Thomas' test positive</b>", "Fixed flexion deformity of hip — hip cannot reach neutral extension."),
    ("<b>First movement lost in hip OA</b>", "Internal rotation."),
    ("<b>NOF fracture attitude</b>", "Shortened, externally rotated lower limb — helpless on floor."),
    ("<b>Posterior hip dislocation attitude</b>", "Flexion + adduction + internal rotation (FAIR)."),
    ("<b>Anterior hip dislocation attitude</b>", "Extension + abduction + external rotation."),
    ("<b>Haemarthrosis within 2 hours</b>", "ACL rupture, osteochondral fracture, peripheral meniscal tear (vascular zone), tibial plateau fracture."),
    ("<b>Lachman test</b>", "Most sensitive clinical test for ACL rupture. Perform at 15–30° flexion."),
    ("<b>Fluid displacement test</b>", "Small effusion. Patellar tap: large effusion."),
    ("<b>Joint line tenderness</b>", "Most sensitive clinical test for meniscal tear."),
    ("<b>Thompson's test positive</b>", "No plantarflexion on calf squeeze = complete Achilles rupture."),
    ("<b>Too many toes sign</b>", "Forefoot abduction + hindfoot valgus = pes planus."),
    ("<b>Ottawa ankle rules</b>", "Bony tenderness posterior fibula/tibia, base 5th MT, or navicular → X-ray."),
    ("<b>Segond fracture</b>", "Lateral tibial plateau avulsion on X-ray = pathognomonic ACL rupture."),
    ("<b>Shenton's line disrupted</b>", "Hip fracture or dislocation (smooth arc from inferior femoral neck to superior obturator foramen)."),
]
for rule, explanation in rules:
    story.append(bullet(f"{rule}: {explanation}"))

story.append(Spacer(1,5*mm))
story.append(hbox(
    "<b>NEUROVASCULAR CHECK — Always at end of lower limb examination:</b>  "
    "Femoral + popliteal + dorsalis pedis + posterior tibial pulses | Capillary refill | "
    "Sensation in femoral / obturator / sciatic (common peroneal + tibial) distributions | "
    "Motor function: hip flexion (L1–L2), knee extension (L3–L4), dorsiflexion (L4), plantarflexion (S1–S2)",
    bg=C_MINT, border=C_GREEN
))
story.append(Spacer(1,8*mm))
story.append(note(
    "Sources: Bailey & Love's Short Practice of Surgery 28th Ed | Miller's Review of Orthopaedics 9th Ed | "
    "Campbell's Operative Orthopaedics 15th Ed 2026 | S Das Manual on Clinical Surgery 13th Ed | "
    "Rheumatology 2-Volume Set 2022 Elsevier"
))

# ── Build ────────────────────────────────────────────────────────────────────
doc.build(story, onFirstPage=on_page, onLaterPages=on_page)
print("PDF generated:", OUTPUT)

cd /home/daytona/workspace/upper-limb-guide && python generate_lower_limb_pdf.py…

ls -lh /home/daytona/workspace/upper-limb-guide/