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.
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.
Physiotherapist or Physical therapists are important health providers and can contribute to enhanced outcomes in many common musculoseletal disorders including osteoarthritis, ACL injuries, tendinopathies, such as rotator cuff disorders, tennis elbow and achilles tendinopathy and muscle tears
Prof. Anisuddin Bhatti describes spasticity management in Cerebral Palsy patients. Botulinum Toxin (BOTOX) therapy and its application techniques live demonstration given. lectured delivered on zoom.us on 13th September 2020 for Trainees & trainers at Pakistan. Acknowledged for few text material & pictures taken from google.com and E Blecks book on Cerebral Palsy.
Multidirectional instability of the shoulder 2014Lennard Funk
Multidirectional Instability is still a term that is used for a number of patients with shoulder instabiliity. In this lecture I discuss the confusion in definitions, applications and my understanding and management of this complex group of patients.
Corrigendum to “Special surgical technique for knee arthroplasty”Apollo Hospitals
We typically operate more than 1200-1800 cases a year, out of which we have included 300 cases randomly for the study. All these selected cases were local residents and easy to follow-up.
Physiotherapist or Physical therapists are important health providers and can contribute to enhanced outcomes in many common musculoseletal disorders including osteoarthritis, ACL injuries, tendinopathies, such as rotator cuff disorders, tennis elbow and achilles tendinopathy and muscle tears
Prof. Anisuddin Bhatti describes spasticity management in Cerebral Palsy patients. Botulinum Toxin (BOTOX) therapy and its application techniques live demonstration given. lectured delivered on zoom.us on 13th September 2020 for Trainees & trainers at Pakistan. Acknowledged for few text material & pictures taken from google.com and E Blecks book on Cerebral Palsy.
Multidirectional instability of the shoulder 2014Lennard Funk
Multidirectional Instability is still a term that is used for a number of patients with shoulder instabiliity. In this lecture I discuss the confusion in definitions, applications and my understanding and management of this complex group of patients.
Corrigendum to “Special surgical technique for knee arthroplasty”Apollo Hospitals
We typically operate more than 1200-1800 cases a year, out of which we have included 300 cases randomly for the study. All these selected cases were local residents and easy to follow-up.
Presentation on Spinal Metastases Scorng system and Decision making
By
Dr.SHASHIDHAR B K
Bangalore Spine Specialist Clinic
www.spinesurgeonbangalore.com
drshashidharbk@gmail.com
Short Term Analysis of Clinical, Functional Radiological Outcome of Total Kne...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Presentation given by Dr Adnan Saithna, Professor of Orthopedic Surgery, at AAOS 2020, on the relationship between early post-operative extension deficit and subsequent risk of cyclops syndrome following ACL reconstruction
Arthroplasty: Present practices by DR. D. P. SWAMI DR. D. P. SWAMI
COMPARISON OF DIFFERENT APPROACHES FOR HIP REPLACEMENT, DIFFERENT ASPECTS OF OVERLAPPING SURGERIES IN TKR AND TEST FOR CONTAMINATION IN OPERATION THEATER
Presentation delivered at 2020 AAOS annual meeting by Dr Adnan Saithna, Professor of Orthopedic Surgery, Overland Park, Kansas. This randomised controlled study demonstrates that combined ACL and anterolateral ligament reconstruction is not associated with an increased risk of adverse events when compared to isolated ACL reconstruction
Real-life examples of manuscript reviews Comparison and contrast of useful ...OARSI
Aileen Davis, PhD
Senior Scientist and Division Head,
Health Care and Outcomes Research,
Krembil Research Institute,
University Health Network and
Professor, University of Toronto
Real-life examples of manuscript reviews Comparison and contrast of useful ...OARSI
Aileen Davis, PhD
Senior Scientist and Division Head,
Health Care and Outcomes Research,
Krembil Research Institute,
University Health Network and
Professor, University of Toronto
How to write an effective review (and help editors and authors)OARSI
Rik Lories, MD PhD Professor of Experimental Rheumatology
Director of the Laboratory of Tissue Homeostasis and Disease
KU Leuven, Skeletal Biology and Engineering Research Centre and University Hospitals Leuven, Division of Rheumatology
Joel A Block, MD
The Willard L Wood MD Professor, and
Director, Division of Rheumatology, Rush University Medical Center
Editor in Chief, Osteoarthritis and Cartilage
Real-life examples of manuscript reviews Comparison and contrast of useful ...OARSI
Senior Scientist and Division Head,
Health Care and Outcomes Research, Krembil Research Institute,
University Health Network and
Professor, University of Toronto
Professor of Radiology and Medicine
Vice Chair, Academic Affairs
Assistant Dean of Diversity
Director, Quantitative Imaging Center (QIC)
Boston University School of Medicine, Boston, MA
Nuts & Bolts of Systematic Reviews, Meta-analyses & Network Meta-analysesOARSI
Director, Applied Health Research Centre (AHRC)
Li Ka Shing Knowledge Institute, St. Michael’s Hospital
Professor, Department of Medicine & IHPME, University of Toronto
Tier 1 Canada Research Chair in Clinical Epidemiology of Chronic Diseases
Structural Targets for Prevention of Post Traumatic OAOARSI
David Hunter MBBS, PhD, FRACP
Florance and Cope Chair of Rheumatology, Professor of Medicine
University of Sydney and Royal North Shore Hospital
Chair, Institute of Bone and Joint Research
Chair, Musculoskeletal, Sydney Medical Program
Consultant Rheumatologist, North Sydney Orthopedic and Sports Medicine
Building a translational team for impacting public policy Pre-Congress Worksh...OARSI
David Hunter MBBS, PhD, FRACP
Florance and Cope Chair of Rheumatology, Professor of Medicine
University of Sydney and Royal North Shore Hospital
Chair, Institute of Bone and Joint Research
Consultant Rheumatologist, North Sydney Orthopedic and Sports Medicine
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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.
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.
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.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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!
1. Year in Review: Mechanics
Michael A. Hunt PT, PhD
Department of Physical Therapy
University of British Columbia
Vancouver, Canada
2. Disclosure Information
Michael A. Hunt PT, PhD
Associate Professor
University of British Columbia, Vancouver BC Canada
I have no financial relationships with commercial interests to disclose
My presentation does not include discussion of off-label or investigational use
4. Publication Overview
• Approximately 200 relevant papers from 461 unique search
hits
• Vast majority of papers were:
– in living humans (75%)
– focused on the knee joint (69%)
– motion capture-based (56%)
7. Popular areas/themes
• 1. Effects of rate of loading/force development
• 2. Relationships between joint loading and imaging-based
outcomes
• 3. Using mechanics to predict clinical outcomes
8. Effects of rate of load on cartilage damage
• Chondral explants from neonatal
calves
• Razor blade rig used to create
controlled cuts into the tissue
• Critical force needed to cut, depth of cut, and energy of cut were
calculated
9. Effects of rate of load on cartilage damage
• At faster blade speeds, first cut
occurred
– at lower critical force
– at lower blade depth
– with lower required energy
10. Rate of force development – effects on gait
• Longitudinal study of 24 patients
post-TKA
• Used multiple linear regression to
examine factors predictive of knee flexion excursion
- demographic
- clinical
- functional
11. Rate of force development – effects on gait
• Rate of quads torque development,
but not overall strength was predictive
12. Popular areas/themes
• 1. Effects of rate of loading/force development
• 2. Relationships between joint loading and imaging-based
outcomes
• 3. Using mechanics to predict clinical outcomes
15. Loading and compositional MRI - healthy
• Location-specific contact force impulse on
medial condyle:
– Positively correlated (r=0.78) to weight-bearing
cartilage thickness
– Inversely correlated (r=-0.71) to T1ρ relaxation time
• Regional variations in all measures based on load experienced
• Potential adaptations in healthy individuals to load may
include thicker cartilage and higher proteoglycan density
16. Loading and compositional MRI – chronic ACLR
• Longitudinal study up to 3 years post-ACLR
(n=31); Control group (n=16)
• Kinetic data during a drop-landing task
• T1ρ relaxation time
17. Loading and compositional MRI – chronic ACLR
• Reduced loading on ACLR knee; compensated by increased loading on Contralateral knee at 6
months
• No differences in T1ρ at Baseline; higher T1ρ in ACLR at 3 years
18. Loading and compositional MRI – chronic ACLR
• Larger interlimb asymmetry (more negative side-to-side
difference) was correlated with T1ρ increase over time
19. Popular areas/themes
• 1. Effects of rate of loading/force development
• 2. Relationships between joint loading and imaging-based
outcomes
• 3. Using mechanics to predict clinical outcomes
20. Progression of Hip OA
• n = 57 with mild or moderate hip OA
• Motion analysis and MRI grading
– Progression defined as (increase in cartilage, labrum,
BML, or cyst scores)
21. Progression of Hip OA
• 22/57 progressed at 18 months
1.1 times higher risk of progression for every 1° increase in flexion
22. Progression to TKA
• n = 157 with follow-up testing (~6 years
post-TKA)
• Focus on contralateral knee status
23. Progression to TKA
• n = 37 underwent contralateral TKA
At baseline, they exhibited:
- LESS knee flexion during loading
in BOTH knees
- LESS knee extension during
midstance in the initial TKA knee
24. Clinically-available measures
• Single-leg hop tests can be used to:
• Examine PROMs in patients with degenerative
meniscal tears
• Examine risk of post-traumatic OA after
ACL
27. In need of help!
• Area still dominated by the knee joint
28. hand OA:
2 SRs, 2 RCTs
hip OA:
1 SR, 2 RCTs
knee OA:
6 SRs, 23 RCTs
PFP across the lifespanOA regions evaluated
general OA:
1 SR
36 papers included
Compliments of Dr. Natalie Collins
29. In need of help!
• Area still dominated by the knee joint
30. In need of help!
• More longitudinal data to identify mechanical markers relevant
to both clinical and structural progression
• Much larger datasets
– Likely requires multi-centre studies
– From cell to animal to human
– Joint-specific
