The exact mechanical function of synergist muscles within a human limb in vivo is not well described. Recent studies indicate the existence of a mechanical interaction between muscle actuators that ...may have functional significance and further play a role for injury mechanisms. The purpose of the present study was to investigate if intermuscular force transmission occurs within and between human plantarflexor muscles in vivo. Seven subjects performed four types of either active contractile tasks or passive joint manipulations: passive knee extension, voluntary isometric plantarflexion, voluntary isometric hallux flexion, passive hallux extension, and selective percutaneous stimulation of the gastrocnemius medialis (MG). In each experiment plantar- and hallux flexion force and corresponding EMG activity were sampled. During all tasks ultrasonography was applied at proximal and distal sites to assess task-induced tissue displacement (which is assumed to represent loading) for the plantarflexor muscles MG, soleus (SOL), and flexor hallucis longus (FHL). Selective MG stimulation and passive knee extension resulted in displacement of both the MG and SOL muscles. Minimal displacement of the triceps surae muscles was seen during passive hallux extension. Large interindividual differences with respect to deep plantarflexor activation during voluntary contractions were observed. The present results suggest that force may be transmitted between the triceps surae muscles in vivo, while only limited evidence was provided for the occurrence of force transfer between the triceps surae and the deeper-lying FHL.
Background
Minor events that occur in the workplace sometimes are evaluated with MRI, which may reveal age-related changes in the symptomatic body part. These age-related changes are often ascribed ...to the event. However, evidence of similar or worse pathophysiology in the contralateral joint would suggest that the symptoms might be new, but the pathophysiology is not.
Questions/purposes
Using a convenience sample of occupational injury claimants with bilateral MRI to evaluate unilateral knee or shoulder symptoms ascribed to a single event at work, we sought to determine whether MRI findings of the shoulder and knee are more often congruent or incongruent with new unilateral symptoms.
Methods
Two hundred ninety-four occupational injury claimants employed at companies throughout Texas that do not subscribe to workers’ compensation insurance, who were older than 40 years, and with unilateral shoulder or knee symptoms, were studied. Starting in 2012, all patients seen by OccMD Group PA who present with unilateral symptoms ascribed to work undergo bilateral MRI, based on several previous occasions where bilateral MRI proved to be a compelling demonstration that perceived injuries are more likely age-related, previously well-adapted pathophysiology. MRI findings (anything described as abnormal by the radiologist; eg, defect size or signal change) was considered congruent if the abnormality of one or more structures on the symptomatic side was greater than that of the corresponding structures in the asymptomatic joint. Bivariate analysis was used to compare the frequency of MRI findings congruent and incongruent with symptoms. Logistic regression was used to evaluate factors associated with MRI findings of the shoulder or knee.
Results
Less than half of the patients with shoulder (90 of 189; 48%; p = 0.36) or knee (45 of 105; 43%; p = 0.038) symptoms had worse pathologic features on the symptomatic side. Older age was associated with disorders in the infraspinatus tendon (59 ± 8 versus 56 ± 8 years; p = 0.012), glenoid labrum (60 ± 9 versus 57 ± 8 years; p = 0.025), and biceps tendon (60 ± 8 versus 57 ± 8 years; p = 0.0038). Eighty-seven percent of patients (91 of 105) had structural changes in the medial meniscus described by the radiologist.
Conclusions
Occupational injury claimants 40 years of age and older with unilateral knee and shoulder symptoms ascribed to a work event tend to have bilateral age-related MRI changes. Age-related disorders should be distinguished from acute injury.
Level of Evidence
Level IV, diagnostic study.
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FZAB, GEOZS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
J. M. Bernstein argues that to capture the depths of the harm of torture, we need to do away with the idea that we possess intrinsic and inviolable worth. If personhood is inviolable, then torture ...can inflict only apparent harm on our standing as persons. Bernstein claims that torture is a paradigm of moral injury because it causes what he calls “devastation”: The victim experiences an actual degradation of his or her personhood. Bernstein argues that our value is given to us through mutual recognition and hence can be lost. In this paper, I argue that if our human value can be lost, then it first must be built up. If it must be built up, then the question of our status before the building begins must be answered. Bernstein faces a problem of human beings who fall outside relations of mutual recognition and hence are valueless. His best option for answering this problem is to point to the centrality of the body in his account of recognition, but doing so reveals a notion of intrinsic worth implicit in his account. I call for a revision of Bernstein's account that can hold on to devastation without eschewing intrinsic worth.
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DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Ambegaonkar, JP, Schock, CS, Caswell, SV, Cortes, N, Hansen-Honeycutt, J, and Wyon, MA. Lower extremity horizontal work but not vertical power predicts lower extremity injury in female collegiate ...dancers. J Strength Cond Res 32(7): 2018-2024, 2018-Dancers often perform powerful and explosive movements that require adequate lower extremity (LE) activity in horizontal and vertical directions. We examined whether these measures were interrelated and whether they predicted LE injury status in dancers using binary logistic regressions and receiver operator characteristic (ROC) curve analyses. Forty-three collegiate female dancers (18 ± 0.7 years; 162.6 ± 5.9 cm; 59.4 ± 7.1 kg) performed single leg hop (SLH, m) and vertical jump (VJ, cm) tests. Single leg hop and VJ distances were used to calculate SLH norm (as a % of body height) and vertical power (vPower, watts). Lower extremity injuries and dance exposure hours (DEhrs) were recorded for 16 weeks. Dancers had 51 injuries resulting in a 3.7/1,000 DEhr injury incidence rate (95% confidence interval CI: 2.7-4.7). Twenty dancers were injured, whereas 23 remained injury free. Injured dancers had significantly lower SLH norm than noninjured dancers (t = 2.7, p = 0.009, 85.2 ± 11.2% vs. 76.8 ± 8.4%, respectively), but vPower was similar (t = 0.6, p = 0.53, injured = 2,632.0 ± 442.9 watts, noninjured = 2,722.7 ± 480.0 watts). SLH norm, but not vPower significantly predicted injury status χ(1,43) = 5.9, p = 0.02. Specifically, an SLH norm cut-off value of 78.2% identified dancers at injury risk (area under the curve = 0.73, SE = 0.08, p = 0.01, 95% CI = 0.57-0.89, sensitivity = 0.75, specificity = 0.70). However, vPower was not able to identify dancers at risk (p = 0.36). vPower had moderate relationships with SLH norm (r = 0.31, p = 0.04). Compared with injured dancers, noninjured dancers had greater SLH norm but similar vPower. Only SLH norm predicted injury status in female collegiate dancers. Thus, the SLH test may possibly predict LE injury risk in dancers. Strength and conditioning coaches can prospectively use baseline SLH test screenings to identify dancers whose SLH is less than 78.2% of their height because these dancers may have increased probability of LE injury risk. Coaches can then include horizontal direction exercises when designing training programs and examine whether these programs reduce LE injury risk in female collegiate dancers.
Jan Wise, BMA medicolegal committee chair, tells Tom Moberly that the culture of doctors stretching themselves to work beyond their shifts and cover rota gaps has to end
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BFBNIB, CMK, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
Contrast-enhanced whole-body computed tomography (also called "pan-scanning") is considered to be a conclusive diagnostic tool for major trauma. We sought to determine the accuracy of this method, ...focusing on the reliability of negative results.
Between July 2006 and December 2008, a total of 982 patients with suspected severe injuries underwent single-pass pan-scanning at a metropolitan trauma centre. The findings of the scan were independently evaluated by two reviewers who analyzed the injuries to five body regions and compared the results to a synopsis of hospital charts, subsequent imaging and interventional procedures. We calculated the sensitivity and specificity of the pan-scan for each body region, and we assessed the residual risk of missed injuries that required surgery or critical care.
A total of 1756 injuries were detected in the 982 patients scanned. Of these, 360 patients had an Injury Severity Score greater than 15. The median length of follow-up was 39 (interquartile range 7-490) days, and 474 patients underwent a definitive reference test. The sensitivity of the initial pan-scan was 84.6% for head and neck injuries, 79.6% for facial injuries, 86.7% for thoracic injuries, 85.7% for abdominal injuries and 86.2% for pelvic injuries. Specificity was 98.9% for head and neck injuries, 99.1% for facial injuries, 98.9% for thoracic injuries, 97.5% for abdominal injuries and 99.8% for pelvic injuries. In total, 62 patients had 70 missed injuries, indicating a residual risk of 6.3% (95% confidence interval 4.9%-8.0%).
We found that the positive results of trauma pan-scans are conclusive but negative results require subsequent confirmation. The pan-scan algorithms reduce, but do not eliminate, the risk of missed injuries, and they should not replace close monitoring and clinical follow-up of patients with major trauma.
The authors asked college students to rate the importance of a list of barriers to reporting rape and sexual assault among male and female victims. The authors' findings indicate that barriers ...prevalent 30 years ago, prior to efforts by the rape reform movement, continue to be considered important among college men and women. The barriers rated as the most important were (1) shame, guilt, embarrassment, not wanting friends and family to know; (2) concerns about confidentiality; and (3) fear of not being believed. Both genders perceived a fear of being judged as gay as an important barrier for male victims of sexual assault or rape and fear of retaliation by the perpetrator to be an important barrier for female victims.
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DOBA, FSPLJ, IJS, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Abstract
Contractures of the shoulder joint and glenohumeral joint dysplasia are well known complications to obstetrical brachial plexus palsy. Despite extensive description of these sequelae, the ...exact pathogenesis remains unknown. The prevailing theory to explain the contractures and glenohumeral joint dysplasia states that upper trunk injury leads to nonuniform muscle recovery and thus imbalance between internal and external rotators of the shoulder. More recently, another explanation has been proposed, hypothesizing that denervation leads to reduced growth of developing muscles and that reinnervation might suppress contracture formation. An understanding of the pathogenesis is desirable for development of effective prophylactic treatment. This article aims to describe the current state of knowledge regarding these important complications.
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