1) Radial nerve palsy can be classified as high or low lesions, with high lesions demonstrating total loss of wrist extension in addition to finger and thumb losses.
2) Tendon transfers are commonly used to restore wrist, finger, and thumb extension when radial nerve function cannot be recovered. Jones pioneered many tendon transfer techniques still used today.
3) Common tendon transfers include the palmaris longus to the extensor pollicis longus to provide thumb extension and abduction, the flexor carpi ulnaris to the extensors digitorum communis to provide finger extension, and the pronator teres to the extensor carpi radialis brevis to provide wrist
Hand rehabilitation following flexor tendon injuriesAbey P Rajan
hand rehabilitation following flexor tendon injuries include introduction, clinical anatomy, tendon nutrition, tendon healing, post op. management, special cases, summary
Hand rehabilitation following flexor tendon injuriesAbey P Rajan
hand rehabilitation following flexor tendon injuries include introduction, clinical anatomy, tendon nutrition, tendon healing, post op. management, special cases, summary
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
Tendon transfer in neuro-muscular foot jitendra jain
Main etiology of Foot deformity in neuro-muscular disorder is muscular weakness & tone imbalance. Most of time this deformity is progressive so it is very important to have a permanent solution. Tendon transfer plays a very important role in balancing the muscle tone & power around the foot.
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
Tendon transfer in neuro-muscular foot jitendra jain
Main etiology of Foot deformity in neuro-muscular disorder is muscular weakness & tone imbalance. Most of time this deformity is progressive so it is very important to have a permanent solution. Tendon transfer plays a very important role in balancing the muscle tone & power around the foot.
Brachial plexus is one of the tough topic to remember by anyone undergoing MBBS course. This slide gives you in detail about the Origin / Course / Formation / Distribution / Anatomical variations & Applied anatomy & Made so easy to Remember & Draw as well.
Radial Nerve is very important topic for first year MBBS Students and as well as for day today clinical practice. This slide gives you full course & relations with clear diagrams as well as applied anatomy with clinical Co-relation.
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.
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
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
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
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!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Tendon transfer for radial nerve palsy
1. Tendon transfer for Radial Nerve
Palsy
By:
Dr.mohammed Abd-Alhussein Laftah
Plastic surgery resident
Baghdad university –Alkindy college of medicine
2. • Radial nerve losses are divided into high and low
nerve disruptions.
• Low lesions: are essentially posterior
interosseous palsies, without loss of wrist
extension. They demonstrate:
1. loss of thumb extension–abduction and
2. loss finger extension at their
metacarpophalangeal (MCP) joints, the intrinsic
muscles providing interphalangeal extension.
3. • High lesions:
demonstrate the losses of low nerve lesions
with the addition of total loss of active wrist
extension as a result of paralysis of the
extensor carpi radialis longus (ECRL) and
brevis (ECRB).
4. Anatomy
- Innervation Order of Muscles: Radial Nerve
• BR
• ECRL
• Supinator*
• ECRB
• EDC
• ECU
• EDM
• APL
• EPL
• EPB
• EIP
Main radial
nerve
posterior interosseous nerve
5.
6. Requirements in a Patient with Radial
Nerve Palsy
• A patient with irreparable radial nerve palsy
needs to be provided with
(1) wrist extension.
(2) finger (metacarpophalangeal [MP] joint)
extension.
(3) a combination of thumb extension and
abduction.
7. Amplitude of Motion
The surgeon must also have some appreciation of the amplitude of tendon
excursion for each Muscle:
• Wrist flexors and extensors: 33 mm
• Finger extensors and EPL: 50 mm
• Finger flexors: 70 mm
These above-listed values have practical significance because it is impossible
for a wrist flexor with an excursion of 33 mm to substitute fully for a finger
extensor that requires an amplitude of 50 mm. Although the true
amplitude of tendon excursion cannot be increased, two things can be
done to augment its effective amplitude.
First:the natural tenodesis : the effective amplitude of the tendon is increased
significantly by active volar flexion of the wrist, allowing the transferred
wrist flexor to extend the fingers fully
second factor: that can increase amplitude is extensive dissection of the
• muscle from its surrounding fascial attachments. This is particularly true of
the BR.
8. Historical Review
• Jones is credited with being the major
innovator of radial nerve transfers, and all the
article in the post–World War I era
acknowledged his fundamental contributions.
9. Jones Transfers
--
• PT to ECRL and ECRB
• FCU to EDC III-V
• FCR to EIP, EDC II,
• PT to ECRL and ECRB
• FCU to EDC III-V
• FCR to EIP, EDC II, EPL, EPB, and APL
10. Best Combinations of Tendon
Transfers for Radial Nerve Palsy
FCR transfer
• PT to ECRB
• FCR to EDC
• PL to rerouted EPL
Superficialis Transfer :
• PT to ECRL and ECRB
• FDS III to EDC
• FDS IV to EIP and EPL
• FCR to APL and EPB
FCU Transfer
• PT to ECRB
• FCU to EDC
• PL to reroute EPL
12. PT to ECRB transfer. It is
important to take a strip of
periosteum in continuity
with PT insertion
to ensure adequate length
for transfer
13. FCU to EDC transfer. FCU must be
freed up extensively to create a
direct line of pull from its
origin to the new insertion into EDC
tendons just proximal to dorsal
retinaculum. End-to-side juncture is
shown here. Moberg and
Nachemson suggested that 4 to 5
cm of paralyzed EDC tendons be
resected proximal to the juncture,
allowing an end-to-end suture and a
more direct line of pull
14. Draw back of FCU transfer
(1) The FCU is too strong and its excursion is too
short for transfer to the finger extensors.
(2) its function as the prime ulnar stabilizer of
the wrist is too important to sacrifice.
15. PL to rerouted EPL transfer. By
rerouting EPL out of dorsal
retinaculum, the transfer creates a
combination of abduction and
extension force on thumb.
16. CRITICAL POINTS: TENDON TRANSFERS
FCU to EDC
▪ Do not use for tendon transfer in posterior interosseous nerve palsy.
▪ The FCU must be freed up extensively, requiring a long incision.
▪ Generously excise muscle from the distal half of the tendon to reduce bulk.
▪ Free up the muscle sufficiently to allow it to be redirected obliquely across the
forearm.
▪ Protect the muscle's innervation in the proximal muscle belly.
▪ Create a line of pull from the medial epicondyle to the EDC as straight as possible.
▪ Tendon juncture: weave the FCU through the EDC tendons at a 45-degree angle
just proximal to the dorsal retinaculum.
▪ Include the EDM only if there is a lag in extension of the small finger.
▪ Tension:
▪ Wrist in neutral (0 degrees)
▪ MP joints in neutral (0 degrees)
▪ FCU under maximum tension
17. CRITICAL POINTS: TENDON TRANSFERS
PL to Rerouted EPL
▪ Transect the EPL at its musculotendinous junction.
▪ The EPL tendon is rerouted to pass along the radial
border of the thumb metacarpal.
▪ The tendon juncture of PL to EPL is in the snuffbox
superficial to the dorsal retinaculum in line with the
thumb metacarpal.
▪ Tension:
▪ Wrist in neutral (0 degrees)
▪ Maximum tension on distal stump of EPL
▪ PL under maximum tension
18. CRITICAL POINTS: TENDON TRANSFERS
PT to ECRB
▪ Take a strip of periosteum from the radius in continuity with
the PT insertion.
▪ Free up the muscle proximally to gain maximum excursion.
▪ Pass the tendon around the radial border of the forearm
superficial to the BR and ECRL.
▪ Suture only into the ECRB—do not include the ECRL—just
distal to the musculotendinous junction.
▪ Tension:
▪ Wrist in 45 degrees of extension
▪ PT under maximum tension
▪ Reinforce juncture with a strip of free tendon graft.
19. Flexor Carpi Radialis Transfer
FCR to EDC transfer. Brand suggested that EDC
tendons be transected and transposed
superficial to dorsal retinaculum to create a
straight-line, end-to-end juncture with FCR
20. Flexor Carpi Radialis Transfer
• A straight longitudinal incision is made in the distal half of the volar radial aspect of
the forearm between the FCR and PL. Both tendons are identified, transected near their
insertions, and freed up to the middle of the forearm to allow redirection of the tendons to
their new insertions.
• A second longitudinal incision is made on the dorsum, extending from just distal to the
dorsal retinaculum to the mid-forearm.
• The FCR is passed around the radial border of the forearm through a subcutaneous tunnel.
• The juncture between the FCR and EDC can be made by:
1. Leaving the EDC in continuity (similar to the FCU transfer depicted in Figure).
2. the EDC tendons be divided so that a formal end-to-end suture can be done between the
FCR and EDC, as shown in Figure. To avoid the problem of multiple exposed raw tendon
ends, burying each cut tendon end.
• The finger extensor tendons all are tested for extension of the MP joint, and “four good
tendons are chosen.” These are divided at their musculotendinous junctions; withdrawn
distally, superficial to the intact dorsal retinaculum; and redirected to a point over the distal
radius, where they can meet the FCR tendon in a straight line.
21. CRITICAL POINTS: FCR TO EDC
▪ Divide the FCR near its insertion and pass it
subcutaneously around the radial border of
forearm.
▪ Divide the EDC tendons just proximal to the
retinaculum, and reposition the stumps
superficial to the retinaculum.
▪ Tension:
▪ Wrist in neutral (0 degrees)
▪ MP joints in neutral (0 degrees)
▪ FCR under maximum tension
22. Superficialis Transfer
• two finger superficial flexor muscles, not their
tendons, can be brought through the
interosseous membrane, using one for the
thumb and the other for the combined
fingers.
23. Postoperative Management
a long arm splint is applied that
• immobilizes the forearm in 15 to 30degrees of pronation.
• the wrist in approximately 45 degrees of extension.
• the MP joints in slight (10 to 15 degrees) flexion.
• the thumb in maximum extension and abduction.
• The proximal interphalangeal joints of the fingers are left
free.
The cast is removed 4 weeks postoperatively; removable
short arm splints to hold the wrist, fingers, and thumb in
extension are made, which the patient wears for an
additional 2 weeks, removing them only for exercise.