The document discusses arthroscopic Bankart repair surgery for recurrent shoulder dislocations in young football players. It provides background on shoulder dislocation rates and the types of injuries that often occur. It then describes a study of 28 football players who underwent arthroscopic Bankart repair surgery using suture anchors, followed by a rehabilitation program. Results found the mean Constant shoulder score was excellent, most players returned to their pre-injury sport level, and only one player suffered a re-dislocation, demonstrating the procedure is a reliable treatment option.
Rotator Cuff Update 2022 for Medbelle Len Funk.pptxLennard Funk
the common questions patients will ask once they have had a scan and a tear has been reported, particularly if they have had no injury of trauma, they ask what caused my tear. If I have a tear what can you do to fix it, it’s got to be fixed. How can I get better if it is not fixed. I have already had physiotherapy and that didn’t fix it so how will more physiotherapy. Some patients who are not keen on surgery, do I really need to have an operation. I have not had an injury.
there are multiple options thrown into the mix here which we need to consider for an individual patient.
The below illustration shows a very rough decision making tool that I would use in determining surgical or treatment options for particular patients.
A younger patient who has both pain and weakness with a massive cuff tear, if it is partially repairable a biological augment would be suitable.
If their predominant weakness is external rotation i.e. a positive Hornblower sign but good elevation, a lat dorsi tendon transfer.
For an older patient who has a predominant weakness but no significant pain, deltoid rehabilitation programme is indicated.
If they do have pain, a suprascapular nerve procedure such as an ablation would be beneficial.
For those that have significant pain and weakness with failed non-operative options, a reverse shoulder replacement would be the best option.
The balloon as we said, has a very limited place and this is for the older patient with slight loss of function and pain with higher demands.
For those that have more significant pain and elevation weakness, a superior capsular reconstruction would be my preferred option.
Elbow instability Jill Thomas NWULG may 2018Lennard Funk
Jill Thomas from the Upper Limb Unit at Wrightington Hospital presents on rehabilitation for elbow instability - presented to the North West Upper Limb Group (www.nwulg.org)
Rotator Cuff Update 2022 for Medbelle Len Funk.pptxLennard Funk
the common questions patients will ask once they have had a scan and a tear has been reported, particularly if they have had no injury of trauma, they ask what caused my tear. If I have a tear what can you do to fix it, it’s got to be fixed. How can I get better if it is not fixed. I have already had physiotherapy and that didn’t fix it so how will more physiotherapy. Some patients who are not keen on surgery, do I really need to have an operation. I have not had an injury.
there are multiple options thrown into the mix here which we need to consider for an individual patient.
The below illustration shows a very rough decision making tool that I would use in determining surgical or treatment options for particular patients.
A younger patient who has both pain and weakness with a massive cuff tear, if it is partially repairable a biological augment would be suitable.
If their predominant weakness is external rotation i.e. a positive Hornblower sign but good elevation, a lat dorsi tendon transfer.
For an older patient who has a predominant weakness but no significant pain, deltoid rehabilitation programme is indicated.
If they do have pain, a suprascapular nerve procedure such as an ablation would be beneficial.
For those that have significant pain and weakness with failed non-operative options, a reverse shoulder replacement would be the best option.
The balloon as we said, has a very limited place and this is for the older patient with slight loss of function and pain with higher demands.
For those that have more significant pain and elevation weakness, a superior capsular reconstruction would be my preferred option.
Elbow instability Jill Thomas NWULG may 2018Lennard Funk
Jill Thomas from the Upper Limb Unit at Wrightington Hospital presents on rehabilitation for elbow instability - presented to the North West Upper Limb Group (www.nwulg.org)
Suture anchor Bone Response Validation StudyLennard Funk
Suture anchors are routinely used for shoulder labral reconstruction procedures. There is paucity of literature on how the response of bone to suture anchor should be measured following labral reconstruction. A new system, based on the use of magnetic resonance (MR) imaging, has been developed by Professor Bhatti and his trainee which grades bone signal changes around suture anchors using a five-point scale. This system, however, has not yet been tested on a clinical dataset. We tested the reliability of the grading system in an independent dataset.
This validation study demonstrates that the grading system is feasible and has generally moderate reliability. And, although results could be improved if a training document is added at the beginning of the study, this grading system should undergo further validation testing for use in clinical trials.
Assessment of Femoral Tunnel Placement in ACL ReconstructionJeremy Burnham
This study reviews the literature on tunnel placement in anterior cruciate ligament reconstruction, and assess the ability of experienced physicians and surgeons to evaluate the tunnel position using x-rays.
Ulnar Collateral Ligament Injury in AthletesDikshaTaani
Ulnar collateral ligament or medial collateral ligament injuries are most common in players: baseball pitchers, gymnasts, javelin throwers etc.
It mainly occurs with repetitive throwing motion which causes strain on medial collateral ligament and is known as Thrower's elbow.
Injury can be of two types: overuse & traumatic injury in which overuse ligament injuries are the commonest of all.
Due to muscular imbalance & faulty technique injury occurs.
Common complains are pain, bruising, tenderness over the medial side of elbow and felt during movement.
Arthroscopic Management of Anterior, Posterior, and Multidirectional Shoulder...Peter Millett MD
Arthroscopic treatment of the unstable shoulder has evolved rapidly and significantly in recent years. Better understanding of the pathoanatomy, advancements in technology, and improved surgical techniques have led to dramatic improvements in outcome. An arthroscopic approach includes significant advantages. Arthroscopy provides better identification of concomitant pathology, lower morbidity, less soft tissue dissection, maximal preservation of motion, shorter surgical time, and improved cosmesis. There is less pain, and many patients have an easier functional recovery, with greater returns in motion compared with traditional open techniques. Finally, some of the inherent risks of open procedures, such as postoperative subscapularis rupture, are virtually eliminated. Surgeons can now routinely expect results that are at least comparable, if not better than, those achieved with open techniques. For more shoulder surgery and instability studies, visit Dr. Millett, Orthopedic Surgeon, Vail Colorado http://drmillett.com/shoulder-studies
Suture anchor Bone Response Validation StudyLennard Funk
Suture anchors are routinely used for shoulder labral reconstruction procedures. There is paucity of literature on how the response of bone to suture anchor should be measured following labral reconstruction. A new system, based on the use of magnetic resonance (MR) imaging, has been developed by Professor Bhatti and his trainee which grades bone signal changes around suture anchors using a five-point scale. This system, however, has not yet been tested on a clinical dataset. We tested the reliability of the grading system in an independent dataset.
This validation study demonstrates that the grading system is feasible and has generally moderate reliability. And, although results could be improved if a training document is added at the beginning of the study, this grading system should undergo further validation testing for use in clinical trials.
Assessment of Femoral Tunnel Placement in ACL ReconstructionJeremy Burnham
This study reviews the literature on tunnel placement in anterior cruciate ligament reconstruction, and assess the ability of experienced physicians and surgeons to evaluate the tunnel position using x-rays.
Ulnar Collateral Ligament Injury in AthletesDikshaTaani
Ulnar collateral ligament or medial collateral ligament injuries are most common in players: baseball pitchers, gymnasts, javelin throwers etc.
It mainly occurs with repetitive throwing motion which causes strain on medial collateral ligament and is known as Thrower's elbow.
Injury can be of two types: overuse & traumatic injury in which overuse ligament injuries are the commonest of all.
Due to muscular imbalance & faulty technique injury occurs.
Common complains are pain, bruising, tenderness over the medial side of elbow and felt during movement.
Arthroscopic Management of Anterior, Posterior, and Multidirectional Shoulder...Peter Millett MD
Arthroscopic treatment of the unstable shoulder has evolved rapidly and significantly in recent years. Better understanding of the pathoanatomy, advancements in technology, and improved surgical techniques have led to dramatic improvements in outcome. An arthroscopic approach includes significant advantages. Arthroscopy provides better identification of concomitant pathology, lower morbidity, less soft tissue dissection, maximal preservation of motion, shorter surgical time, and improved cosmesis. There is less pain, and many patients have an easier functional recovery, with greater returns in motion compared with traditional open techniques. Finally, some of the inherent risks of open procedures, such as postoperative subscapularis rupture, are virtually eliminated. Surgeons can now routinely expect results that are at least comparable, if not better than, those achieved with open techniques. For more shoulder surgery and instability studies, visit Dr. Millett, Orthopedic Surgeon, Vail Colorado http://drmillett.com/shoulder-studies
Brief review of Shoulder instability in young athletes.
This ppt includes definition,causes,types of instability, bankart & hill sac's lesion, diagnosis, treatment (both reduction ), and rehabilitation protocol..
Arthrolatarjet (Arthroscopic Latarjet Proc) Dr Sujit Jos keralaSujit Jos
Arthroscopic Latarjet procedure is gaining popularity in every part of the world as it combines the strength of Latarjet procedure while retaining the advantages of Arthroscopy. It is most useful shoulder recurrent dislocation associated with bone loss in the glenoid (Bony Bankart) or humeral head (Hill Sach's defect).
Phased approach of Connecting from posture and movement assessment (1).pdfTomohiro Sawatari
I am a physiotherapist in Japan. I used to work in a conditioning gym and since I got my physiotherapy licence I have been working in an orthopaedic clinic.
The postural and movement assessment as a concept for therapeutic intervention is summarised in this slide.
---------------------------------------------------------
姿勢・動作の評価の考え方について、このスライドにまとめています。
Healing rates of the posterior horn of the lateral meniscus appear to be less favourable than other locations. In part this is due to the loose capsular attachment in this region reducing the success of deployment of anchors on the capsule. Using popliteus as an anchor point is safe and results in a very low rate of re-operation for failure of repair
Similar to Presentation triantafyllou christos (20)
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Couples presenting to the infertility clinic- Do they really have infertility...
Presentation triantafyllou christos
1. “Arthroscopic suture-anchor Bankart repair
for recurrent anterior shoulder dislocations
in young football players”
Triantafyllou Ch.
Kapsampelis Al.
From Euroclinic Hospital in Athens
2. 75% of all shoulder dislocations occur in the
position of external rotation and abduction
during athletic activities
(Baker CL and colleagues Am J Sports Med 1990)
When an anterior shoulder dislocation
happens for first time:
• 100% re-dislocation rate in patients younger than 10 years
• 94% between the ages 10 and 20 years, and…
• 79% between the ages of 20 and 30 years
(Bowe and colleagues J Bone Joint Surg Am 1984)
Basic Facts
3. Bankart lesion occurs in 94% of first time
acute traumatic dislocations in young
patients
(Taylor DC, Arciero RA: Am J Sports Med 1997)
Bony Bankart lesions have been reported
in 22% of primary dislocations
(Rowe CR, Patel D, Southmayd WW J Bone Joint Surg Am
1978)
Basic Facts
4. Hill-Sacks lesions have been reported in 32% to 51%
of initial anterior dislocations and concurrent
glenoid and humeral head bone defects exist
in nearly 100% of cases of repetitive dislocations
(Calandra JJ, Baker CL, Uribe J: Arthroscopy 1989)
HAGL lesions (Humeral Avulsion of the
Glenohumeral Ligaments) have been reported
in 7.5% to 9.3% (generally in an older patient
population)
(Bokor DJ, Conboy VB, Olson C J Bone Joint Surg Br 1999)
(Wolf EM, Cheng JC, Dickson K: Arthroscopy 1995)
Basic Facts
5. The labrum increases the depth of the
glenoid up to 50%
(Bigliani LU, Kelkar R, Flatow EL et al: Clinic Orthop Relat Res
1990)
By reducing the labral height by 80% the
resultant stability of the glenohumeral joint
decreases by 60%
(Lazarus MD, Sidles JA, Harryman DT II, Matsen FAIII J Bone
Joint Surg Am 1996)
Basic Facts
6. 28 football players (10 goalkeepers)
Mean age 24.64 yrs (range 19-33 yrs)
From 2005 to 2010
1-3 unilateral anterior post-traumatic shoulder
dislocations
Mean follow-up period 50 months
(range 27-88 months)
Materials
7. None of the patients had a Hill-Sachs lesion more
than 20% of the humeral head
None of the patients had a bony Bankart lesion
more than 20% of the glenoid width (The width of
the glenoid is about 25mm)
None of them had a traumatic humeral avulsion of
the glenohumeral ligaments (HAGL lesion)
None of them had a serious rupture of the rotator
cuff
Materials
16. Arm on a sling 0-4 wks postop
12 wks, a single upper limb therapist
Two 45min sessions per week
Home exercises according to written &
oral instructions
Gradually advancing ROM exercises
Shoulder muscles’ strengthening with free
weights and elastic bands
Rehabilitation Program
17. Exercises for activation of the glenohumeral
head’s and scapula’s stabilizing muscles
Proprioception training with closed kinetic
chain exercises
Neuromuscular co-ordination training of
scapulohumeral rhythm
Glenohumeral joint’s capsule stretching
exercises
Special Features of the Rehabilitation Program
18. 0-4 wks
4-6 wks
8-12 wks
6-8 wks
Arm on sling, pendulum, shoulder flexion up to 90o,
scapula’s stabilizing muscles’ activation, biceps & triceps
strengthening, deltoid isometric
Shoulder abduction to 90o and external rotation to 0o,
glenohumeral’s stabilizing muscles’ activation (elastic band),
deltoid isotonic strengthening (free weights and elastic band)
Full ROM, isotonic strengthening of rotator cuff muscles
(free weights and elastic band) and scapula’s stabilizers
(free weights and rowing machine), closed kinetic chain
exercises for proprioception
Glenohumeral joint’s capsule stretching, continue of
stabilizing exercises and all shoulder and scapula muscles’
strengthening
Rehabilitation Program
19. Strengthening and stretching at the gym
Gradual return to their team’s training
sessions under close supervision
Check every 2 wks to decide the appropriate
time to return to full sport’s activity
After the 12 wks Postop
20. At the end of the rehabilitation process all
patients were assessed using the Constant
Shoulder Score
At the time of the final follow-up were
contacted by phone and asked to fill in a
self evaluating quality of life questionnaire
for shoulder instability (the Western Ontario
Shoulder Instability Index) send to them
by mail
Evaluation of Patients’ Progress
21. The official score of the European Society of
Shoulder and Elbow Surgery
Combines physical examination tests with subjective
evaluation by the patients
Subjective assessment: 1 item for pain (15 points)
and 4 items for activities of daily living (20 points)
Objective assessment: ROM (forward elevation 10
points, abduction 10 points, ext. rot. 10 points,
int. rot. 10 points), and power (25 points)
Best possible score: 100 points
Constant Shoulder Score
22. Evaluates the patients’ perception of treatment’s success and
feeling of shoulder’s stability
Contains 21 questions in 4 domains: physical symptoms,
sports, recreation and work
The best possible score is 0 (=no decrease in shoulder related
quality of life)
The worst possible score is 2100 (=extreme decrease in
shoulder related quality of life)
The most recommended questionnaire for shoulder instability
evaluation since it has proved highly valid, reliable and
sensitive to change
(Kirkley et al. 1998, Kirkley et al. 2003, Plancher & Lipnick 2009,
Salomonsson et al. 2009)
Western Ontario Shoulder Instability Index (WOSI)
24. The mean Constant score was 97.42 ± 1.95
with all patients scoring excellent
24 patients (85.72%) returned to pre-op
sport’s level and 4 (14.28%) returned to a
lower level after a mean of 7.1 ± 0.87 months
1 patient (a goalkeeper) suffered a traumatic
re-dislocation (rate 3.57%) and underwent
revision arthroscopic operation
Results (at the end of the rehabilitation process)
25. 23 patients had excellent, and
5 had good WOSI scores
Mean WOSI score 104.00 ± 101.50
Results (at the final follow-up)
26. The arthroscopic Bankart repair with the
correct use of suture anchor and when
the appropriate rehabilitation program is
followed it is a reliable treatment with
good clinical outcomes excellent post-
operative shoulder motion and low
recurrent rates even for high level
football players
Conclusion