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Elbow Anatomy

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181. Why off-the-shelf clavicle plates rarely fit: anatomic analysis of the clavicle through statistical shape modeling. (PubMed)

of the clavicle often makes it challenging for the surgeon to make the plate fit adequately. Based on the identified variability in the clavicle's anatomy, it seems unlikely that a clavicle plating system can fit the entire population.Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved. (...) -superior bow, and medial and lateral curvature. Statistically significant differences between male and female clavicles were seen in length, sigmoid shape, and medial curvature. Comparison in men between left and right revealed significant differences in length and medial curvature. For women, a statistically significant difference between left and right was only seen in the length.Although the operative treatment of displaced midshaft clavicular fractures has clear benefits, the variable anatomy

2019 Journal of Shoulder and Elbow Surgery

183. Current Best Peripheral Nerve Transfers for Spinal Cord Injury. (PubMed)

Current Best Peripheral Nerve Transfers for Spinal Cord Injury. After reviewing this article, the participant should be able to: 1. Understand the anatomy and pathophysiology of spinal cord injury and the resulting upper and lower motor neuron syndromes. 2. Recognize who may benefit from nerve transfers. 3. Understand the role of history, examination, imaging, and electrodiagnostics in the determination of time-sensitive lower motor neuron injury versus non-time-sensitive upper motor neuron (...) injury. 4. Outline the surgical options and perioperative care for those undergoing nerve transfer and the expected outcomes in restoring shoulder, elbow, wrist, and hand function.This article outlines how to localize and differentiate upper motor neuron from combined upper and lower motor neuron injury patterns in spinal cord injury by means of detailed history, physical examination, imaging, and electrodiagnostic studies to formulate appropriate surgical plans to restore function in this complex

2019 Plastic and reconstructive surgery

184. Parameterization of proximal humerus locking plate impingement with in vitro, in silico, and in vivo techniques. (PubMed)

to simulate impingement. Second, a dynamic in silico musculoskeletal model modeled changes to implant geometry, surgical techniques, and acromial anatomy, where a collision detection algorithm was used to simulate impingement. Finally, in vivo shoulder kinematics were recorded for 9 activities of daily living. Motions that created a high likelihood of impingement were identified.Of simulated impingement events, 73.9% occurred when the plate was moved proximally, and 84% occurred when acromial tilt was 20 (...) in the likelihood of impingement, whereas plate thickness and humeral head center of rotation should also be considered. Careful preoperative planning that includes these factors could help guide operative decision making and improve clinical outcomes.Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

2019 Journal of Shoulder and Elbow Surgery

185. When depersonalization is necessary in medicine

. My five year old was looking sheepishly down at the carpet, afraid to meet my gaze. Panic was rising in my own chest as an explanation unfolded that my young daughter had pulled him off the couch while twisting his arm in a game of wrestling. After a quick evaluation for any evidence of a broken bone, I was confident that he had “nursemaid’s elbow,” caused by a subluxation of the radial head. As he continued to whimper on the ground, I quickly performed a reduction maneuver and heard a “click (...) . I move fast: Cutting expertly through skin, fat, and fascia into the peritoneum and finally through the thick uterine muscle to deliver the blue, lifeless baby. I am not thinking of anything except precision, speed, and safety during birth. Only when I hear the wail of the baby finally taking its first breath do I look down and see the effects of adrenaline on my hands. A notice a fine tremor while I carefully close the uterus and restore normal anatomy. Only then, do I step back into myself

2019 KevinMD blog

186. Coracoacromial morphology: a contributor to recurrent traumatic anterior glenohumeral instability? (PubMed)

 = .021), had a flatter anterior-posterior radius of curvature (MD, 77 mm; P < .001), and were more anteriorly tilted (MD, 5°; P = .005).Coracoacromial and glenoid anatomy differs between individuals with and without recurrent traumatic anterior shoulder instability. This pathologic anatomy is not addressed by current soft-tissue stabilization procedures and may contribute to instability recurrence.Copyright © 2019 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All

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2019 Journal of Shoulder and Elbow Surgery

187. Percutaneous cubital tunnel release with a dissection thread: a cadaveric study. (PubMed)

and the extent of damage to surrounding structures. The cubital tunnel and deep across the medial elbow were completely transected leaving the ulnar nerve fully decompressed in all cases. There was no evidence of direct injury to the ulnar nerve or adjacent neurovascular structures. A prerequisite knowledge of sonographic anatomy and experience with interventional ultrasound is essential. Future clinical studies should evaluate this technique's safety and efficacy compared with conventional ones. (...) Percutaneous cubital tunnel release with a dissection thread: a cadaveric study. This cadaveric study tested the feasibility of decompressing the ulnar nerve across the elbow percutaneously with a commercially available surgical dissection thread, a guiding needle, hydrodissection and ultrasound guidance. We performed the procedure in 19 fresh-frozen cadaveric upper extremities. Subsequently, we did an anatomical dissection of the specimens to visualize the extent of ulnar nerve decompression

2019 Journal of Hand Surgery - European

188. What Is the Survival and Function of Modular Reverse Total Shoulder Prostheses in Patients Undergoing Tumor Resections in Whom an Innervated Deltoid Muscle Can Be Preserved? (PubMed)

What Is the Survival and Function of Modular Reverse Total Shoulder Prostheses in Patients Undergoing Tumor Resections in Whom an Innervated Deltoid Muscle Can Be Preserved? After proximal humerus resection for bone tumors, restoring anatomy and shoulder function remains demanding because muscles and bone are removed to obtain tumor-free surgical margins. Current modes of reconstruction such as anatomic modular prostheses, osteoarticular allografts, or allograft-prosthetic composites (...) to oncologic protocol. Complications and function were evaluated at final follow-up by the treating surgeon (PR) and shoulder surgeon (AC). Complications were evaluated according to Henderson classification. Functional results were assessed with the Musculoskeletal Tumor Society score (range 0 points to 30 points), Constant-Murley score (range 0 to 100), and American Shoulder and Elbow Surgeons score (range 0 to 100). The statistical analysis was performed using Kaplan-Meier curves.Complications occurred

2019 Clinical Orthopaedics and Related Research

189. Treatment of a Complex Interprosthetic Humerus Fracture. (PubMed)

Treatment of a Complex Interprosthetic Humerus Fracture. Interprosthetic humeral shaft fractures involving shoulder and elbow arthroplasty can be difficult to manage surgically, both due to fracture and patient characteristics. Adequate fixation can be difficult, given the intramedullary nature of the adjacent implants. Careful attention must be paid to regional anatomy, and care must be taken to not damage the radial or ulnar nerve during dissection and mobilization of the fracture, especially (...) hemiarthroplasty and total elbow arthroplasty.

2019 Journal of Orthopaedic Trauma

190. Anatomic shoulder parameters and their relationship to the presence of degenerative rotator cuff tears and glenohumeral osteoarthritis: a systematic review and meta-analysis. (PubMed)

Anatomic shoulder parameters and their relationship to the presence of degenerative rotator cuff tears and glenohumeral osteoarthritis: a systematic review and meta-analysis. Scapular anatomy, as measured by the acromial index (AI), critical shoulder angle (CSA), lateral acromial angle (LAA), and glenoid inclination (GI), has emerged as a possible contributor to the development of degenerative shoulder conditions such as rotator cuff tears and glenohumeral osteoarthritis. The purpose (...) reported on the GI with mixed results on shoulder pathology.Degenerative rotator cuff tears appear to be significantly associated with the AI, CSA, and LAA. There does not appear to be a significant relationship between the included shoulder parameters and the development of osteoarthritis.Copyright © 2019 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

2019 Journal of Shoulder and Elbow Surgery

191. Structural glenoid allograft reconstruction during reverse total shoulder arthroplasty. (PubMed)

preoperatively vs. 10 ± 8 postoperatively, P = .002), the average American Shoulder and Elbow Surgeons score (31 ± 19 preoperatively vs. 70 ± 25 postoperatively, P < .001), and average active forward elevation (71° ± 41° preoperatively vs. 128° ± 28° postoperatively, P < .001) were noted. Coronal-plane radiographic correction was 29° ± 12° as measured with the reverse shoulder arthroplasty angle (P < .001) and 14° ± 11° as measured with the β angle (P < .001). Postoperatively, of 17 patients with a minimum 1 (...) -year radiographic follow-up, 14 (82%) had complete radiographic incorporation of the graft. Acromial fracture nonunions developed in 2 patients and loosening and migration of the baseplate were found in 2 patients, although no patients elected to undergo further surgery.RTSA with allograft reconstruction of severe glenoid defects allows restoration of glenoid anatomy and leads to high rates of bony incorporation with low rates of glenoid loosening or requirement for revision. Structural allograft

2019 Journal of Shoulder and Elbow Surgery

192. Skin Cancer Treatment (PDQ®): Health Professional Version

of Medicare fee-for-service data to the U.S. population, it has been estimated that the total number of persons treated for nonmelanoma skin cancers in 2012 was about 3 million.[ , ] That number exceeds all other cases of cancer estimated by the American Cancer Society for that year, which totaled about 1.6 million.[ ] Although nonmelanoma skin cancer is the most common of all malignancies, it accounts for less than 0.1% of patient deaths caused by cancer. Anatomy Anatomy of the skin showing the epidermis (...) of the fingers and at the ulnar fossa of the elbow, or recurrent carcinomas following surgical excision. Permanent pigment loss at the treatment site is unavoidable, so the treatment is not well suited to dark-skinned patients. Edema is common after treatment, especially around the periorbital region, temple, and forehead. Treated tumors usually exude necrotic material, after which an eschar forms and persists for about 4 weeks. Atrophy and hypertrophic scarring have been reported, as have instances of motor

2017 PDQ - NCI's Comprehensive Cancer Database

193. Radial Head Arthroplasty: A Systematic Review. (PubMed)

Radial Head Arthroplasty: A Systematic Review. Despite the expanding body of literature on radial head arthroplasty, the increasing understanding of elbow anatomy, biomechanics, and kinetics, and the evolution of surgical techniques and prosthesis designs, there is currently no evidence to support one type of radial head prosthesis over another. The purposes of the present report were to review the literature and to explore the association between prosthesis design variables and the timing (...) of follow-up. The revision rate was not significantly affected by prosthesis polarity, material, or fixation technique, nor was it significantly affected by the delay of treatment. There was also no significant effect of prosthesis polarity, material, or fixation technique on postoperative range of motion. The Mayo Elbow Performance Score was only reported for half of the overall patient population, but, among those patients, the combined rate of excellent and good results was 85%. Seven percent

2016 JBJS reviews

194. Ultra-high field upper extremity peripheral nerve and non-contrast enhanced vascular imaging. (PubMed)

Ultra-high field upper extremity peripheral nerve and non-contrast enhanced vascular imaging. The purpose of this study was to explore the efficacy of Ultra-high field [UHF] 7 Tesla [T] MRI as compared to 3T MRI in non-contrast enhanced [nCE] imaging of structural anatomy in the elbow, forearm, and hand [upper extremity].A wide range of sequences including T1 weighted [T1] volumetric interpolate breath-hold exam [VIBE], T2 weighted [T2] double-echo steady state [DESS], susceptibility weighted (...) and quantitatively [SWI was only qualitatively compared]. DSI studio was utilized to identify nerves based on analysis of diffusion weighted derived fractional anisotropy images. Images of forearm vasculature were extracted using a paint grow manual segmentation method based on MIPAV [Medical Image Processing, Analysis, and Visualization].High resolution and high quality signal-to-noise ratio [SNR] and contrast-to-noise ratio [CNR]-images of the hand, forearm, and elbow were acquired with nearly homogeneous 7T

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2017 PLoS ONE

196. AIUM Practice Parameter for the Performance of Peripheral Venous Ultrasound Examinations

with the patient’s clinical situation and should be consistent with relevant legal and local health care facility requirements. V . Specifications of the Examination The requesting health care provider should be encouraged to provide the pretest probability of acute deep venous thrombosis and/or the results of a D-dimer assay if known. 4,10,11 Note: The words proximal and distal refer to the relative distance from the attached end of the limb, per Gray’s Anatomy. For example, the proximal femoral vein is closer (...) assessment of all the accessible portions of the internal jugular, subclavian, axillary, and innominate veins, as well as compression gray scale ultrasound of the brachial, basilic, and cephalic veins in the upper arm to the elbow. All accessible veins should be scanned using optimal gray scale and Doppler techniques as well as appro- priate positioning. Venous compression is applied to accessible veins in the transverse plane with adequate pressure on the skin to completely obliterate the normal vein

2015 American Institute of Ultrasound in Medicine

198. The Second ASRA Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine

with that procedure. | Elbow Surgery Surgery of the elbow is particularly hazardous because of the minimal soft tissue protection available to the multiple nerves that traverse the joint. Ulnar neuropathy persists in up to 10% of elbow replacement patients. Up to 4.2% of elbow arthroscopies are associated with transient iatrogenic nerve injury in part because portals are placed blindly in a nerve-rich area. | Hip Surgery The frequency of nerve injury after total hip arthroplasty (THA) varies widely but generally (...) associated with nerve injury. These injuries often present as diffuse sensorimotor deficits (Class I). Consider delaying placement of regional blocks if assessment of postoperative nerve function is important for the surgeon (Class III). | ANATOMY AND PATHOPHYSIOLOGY OF NEURAXIAL INJURY Since our 2008 practice advisory, we have expanded recommendations on 5 specific topics that relate to the anatomy and pathophysiology of spinal cord injury associated with regional anesthesia and pain medicine: spinal

2015 American Society of Regional Anesthesia and Pain Medicine

199. EANM practice guidelines for lymphoscintigraphy and sentinel lymph node biopsy in melanoma ? SNMMI Endorsement

in a 128×128 matrix in word mode) during the first 10 min after injection is recom- mended for detection of SLNs in head and neck melanoma. Although dynamic images are time consuming, dynamic se- riesshould beacquired wheneverpossible because thisfacil- itates image interpretation [83]. In melanoma of the hand/forearm or foot/leg, dynamic imaging should start over theinjectionsiteandfollowthelymphaticdrainagetotheknee or elbow and axilla or groin to reveal ectopic basins and in- transitlymph nodes (...) .Toreducescatteringartefactfromtheinjectionsite, images with lead shielding of the primary tumour can be Table 2 Recommended regions covered by static images and/or SPECT/CTaccordingtothelocationoftheprimary tumour Tumourlocation Staticimages Trunk Axilla+trunk+groin;orbody scanning fromneck to groin Hand/forearm Elbow+axilla+neck Upperarm Axilla+neck Foot/lowerleg Knee+groin Headneck Neck in multipleprojections Thigh Groin 1756 EurJ NuclMedMolImaging(2015)42:1750–1766added.Thismaybehelpfulespeciallyiftheprimarytumouris located

2015 Society of Nuclear Medicine and Molecular Imaging

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