فهرست مطالب greg gallant

This study examines the pattern of muscular contraction and the intensity of this contraction of the biceps and triceps following elbow surgery. We performed a prospective electromyographic study of 16 patients undergoing 19 surgical procedures on the elbow joint. We measured the resting EMG signal intensity of the biceps and triceps of the operated and the normal sides at 90 degrees. We then calculated the peak EMG signal intensity during passive elbow flexion and extension of the operated side. Seventeen of 19 elbows (89%) displayed a co-contraction pattern of the biceps and triceps near the end of flexion and extension during the passive range of motion. The co-contraction pattern was observed near the end of the range of motion in both flexion and extension. In addition to the observed co-contraction patterns, we detected higher contraction intensities for the biceps and triceps muscles in all patients in both flexion and extension for the elbows, which had been treated surgically. Further analysis suggests an inverse correlation between the biceps contraction intensity and the arc of motion measured at the latest follow-up. The co-contraction pattern and increased contraction intensity of periarticular muscle groups may result in internal splinting mechanisms, contributing to the development of elbow joint stiffness, which is frequently observed following elbow surgery. Level of evidence: III

The median artery is an embryonic structure that typically regresses during gestation. Occasionally, the artery remains and is then termed a persistent median artery (PMA). A PMA can be associated with other anatomic anomalies, and has been known to contribute to carpal tunnel syndrome (CTS). Recent literature has observed an increase in PMA prevalence, speculated to indicate microevolutionary change. We performed a prospective observational study to investigate the current prevalence rate of PMA in patients undergoing carpal tunnel release (CTR).  Institutional review board approval was obtained. From October 2020 to January 2021, patients ≥18 years old undergoing open CTR by 9 orthopaedic hand surgeons were included in analysis. Patients undergoing endoscopic CTR were excluded. Intraoperatively, the carpal tunnel was evaluated for the presence of a PMA, median nerve anomalies, or any other anatomic anomalies. If a patient underwent bilateral CTR during the study, only one side was included in analysis as determined randomly.  Three hundred and sixty open CTRs in 327 patients were performed during the study. Twenty-seven PMAs were identified, for an overall prevalence rate of 8.3%. The average age of patients with a PMA was 63.6 years (SD 13.3 years), consisting of 15 men and 12 women. There were no statistical differences in age, gender, or laterality between patients that did and did not have a PMA. Thirty-three patients underwent bilateral CTR during the study, with 3 being found to have a PMA unilaterally, and zero having a PMA bilaterally. Two bifid median nerves (0.6%) were also identified. This study represents the highest prevalence rate of PMA directly observed in CTR patients reported to date (8.3%). A PMA is not a rare finding, and it should be recognized and protected during CTR. Occasionally, a PMA can be the cause of an acute presentation of CTS. Level of evidence: IV

Distribution of radiographic images in the outpatient setting on compact discs-recordable (CD-R) iscommonplace. Opening, manipulating and interpreting these can be challenging. This study evaluated the availabilityand ease of use of CD-R to evaluate digital images in an outpatient orthopedic setting. 118 CD-R containing diagnostic studies were evaluated by seven board certified orthopaedic surgeons.Surgeon age and self-perceived “tech savvy” scores were tabulated using a visual analog scale (VAS). Surgeonsevaluated: ability and number of computers to open, autorun, and specific reader software. Time to load was recordedin seconds, type of study, presence of “not for diagnostic use”, and if the disc required additional software. Studies weregraded using a VAS for ease of opening, ability to move from image to image and/or between series, to manipulatethe image, and to zoom and pan. There were 79 radiographs, 29 MRI’s, and 10 CT scans. Seven (6%) had to be manually opened andfour (3%) required software installation. Thirteen (11%) contained a warning that the studies should not be used fordiagnostic purposes. Six (5%) of the studies could not be opened. For the opened studies, average time from diskinsertion to image was 43.7 seconds overall (range 3-350), 65.3 seconds (range 21-191) for MRI and CT, and 35.2seconds (range 5-177) for radiographs. The present digital imaging systems include different software types and a variety of interfaces.Improving this would decrease time and effort necessary to open and evaluate these studies, and improveefficiency.Level of evidence: III