Shoulder examination: a systematic approach

2021 ◽  
pp. 1-15
Author(s):  
Akib M Khan ◽  
Angelos Assiotis ◽  
Mazin S Ibrahim ◽  
Andrew R Sankey
Keyword(s):  
Rotator Cuff ◽  
Systematic Approach ◽  
Healthcare Professionals ◽  
Full Range ◽  
Range Of Movement ◽  
Systematic Examination ◽  
Complex Joint ◽  
Different Levels ◽  
Shoulder Examination

The shoulder is a complex joint with static and dynamic stabilising structures working synchronously. These allow a full range of movement while preserving stability of the joint. Patients may present with pain, stiffness, weakness, deformity or instability. The authors suggest a systematic examination sequence to ensure that important pathology is not overlooked. Adopting this approach allows common pathologies, including tears of the rotator cuff, impingement and tendinopathy, to be easily identified. This shoulder examination sequence may be used by all healthcare professionals and can also act as a revision aid for those undergoing exams in this field, at different levels of training.

scholarly journals Controversies In The Surgical Management Of Shoulder Instability: Associated Soft Tissue Procedures

2017 ◽  
Vol 11 (1) ◽  
pp. 989-1000 ◽  
Author(s):  
Santos Moros Marco ◽  
José Luis Ávila Lafuente ◽  
Miguel Angel Ruiz Ibán ◽  
Jorge Diaz Heredia
Keyword(s):  
Soft Tissue ◽  
Rotator Cuff ◽  
Shoulder Instability ◽  
Full Range ◽  
Rotator Interval ◽  
Range Of Movement ◽  
Slap Repair ◽  
Rotator Cuff Injuries ◽  
Complex Anatomy ◽  
Pubmed Database

Background:The glenohumeral joint is a ball-and-socket joint that is inherently unstable and thus, susceptible to dislocation. The traditional and most common anatomic finding is the Bankart lesion (anterior-inferior capsule labral complex avulsion), but there is a wide variety of anatomic alterations that can cause shoulder instability or may be present as a concomitant injury or in combination, including bone loss (glenoid or humeral head), complex capsule-labral tears, rotator cuff tears, Kim´s lesions (injuries to the posterior-inferior labrum) and rotator interval pathology.Methods:A review of articles related to shoulder anatomy and soft tissue procedures that are performed during shoulder instability arthroscopic management was conducted by querying the Pubmed database and conclusions and controversies regarding this injury were exposed.Results:Due to the complex anatomy of the shoulder and the large range of movement of this joint, a wide variety of anatomic injuries and conditions can lead to shoulder instability, specially present in young population. Recognizing and treating all of them including Bankart repair, capsule-labral plicatures, SLAP repair, circumferential approach to pan-labral lesions, rotator interval closure, rotator cuff injuries and HAGL lesion repair is crucial to achieve the goal of a stable, full range of movement and not painful joint.Conclusion:Physicians must be familiarized with all the lesions involved in shoulder instability, and should be able to recognize and subsequently treat them to achieve the goal of a stable non-painful shoulder. Unrecognized or not treated lesions may result in recurrence of instability episodes and pain while overuse of some of the techniques previously described can lead to stiffness, thus the importance of an accurate diagnosis and treatment when facing a shoulder instability.

scholarly journals SLAP Tears

2021 ◽  
Vol 1 (3) ◽  
pp. 263502542110007
Author(s):  
Steven B. Cohen ◽  
John R. Matthews
Keyword(s):  
Rotator Cuff ◽  
Shoulder Arthroscopy ◽  
Biceps Tendon ◽  
Full Range ◽  
Contralateral Side ◽  
Highly Active ◽  
Slap Repair ◽  
Biceps Tenotomy ◽  
Labral Tears ◽  
Anterior Posterior

Background: Superior labral tears are frequently encountered during shoulder arthroscopy. Outcomes following superior labral anterior-posterior (SLAP) repairs in young athletes have been well documented. Superior labral repairs in older patient population continue to remain controversial due to concerns of postoperative complications including persistent preoperative symptoms, pain, stiffness, and higher rates of revision surgery. Indications: We present a case of a highly active 38-year-old woman who failed 1½ years of nonoperative management of a type IIB SLAP tear with extension to the posterior labrum. Her symptoms continued to limit her hobbies and work. Technique: A knotless single-anchor SLAP repair was performed along with debridement of the posterior frayed labrum. No biceps tenotomy or tenodesis was performed after full evaluation of the tendon failed to demonstrate evidence of synovitis, tendinopathy, or tear. The patient also did not have any concomitant shoulder pathology, including a rotator cuff tear or chondral lesion. Results: At 6 months, the patient had regained full range of motion similar to the contralateral side. She had returned to her normal activities and sports, including tennis. Discussion/Conclusion: Successful outcomes following SLAP repairs in patients over 35 years can be achieved, but treatment should be individualized with particular attention to concomitant pathology involving the rotator cuff, chondral surface, or biceps tendon which may require tenodesis or tenotomy.

scholarly journals State of the Science in Dried Blood Spots

2018 ◽  
Vol 64 (4) ◽  
pp. 656-679 ◽  
Author(s):  
Jeffrey D Freeman ◽  
Lori M Rosman ◽  
Jeremy D Ratcliff ◽  
Paul T Strickland ◽  
David R Graham ◽  
...  
Keyword(s):  
Systematic Approach ◽  
Full Range ◽  
Dried Blood Spots ◽  
Blood Spots ◽  
Highly Sensitive ◽  
Wide Range ◽  
Potential Applications ◽  
Review Of Reviews ◽  
Near Term ◽  
State Of The Science

Abstract BACKGROUND Advancements in the quality and availability of highly sensitive analytical instrumentation and methodologies have led to increased interest in the use of microsamples. Among microsamples, dried blood spots (DBS) are the most well-known. Although there have been a variety of review papers published on DBS, there has been no attempt at describing the full range of analytes measurable in DBS, or any systematic approach published for characterizing the strengths and weaknesses associated with adoption of DBS analyses. CONTENT A scoping review of reviews methodology was used for characterizing the state of the science in DBS. We identified 2018 analytes measured in DBS and found every common analytic method applied to traditional liquid samples had been applied to DBS samples. Analytes covered a broad range of biomarkers that included genes, transcripts, proteins, and metabolites. Strengths of DBS enable its application in most clinical and laboratory settings, and the removal of phlebotomy and the need for refrigeration have expanded biosampling to hard-to-reach and vulnerable populations. Weaknesses may limit adoption in the near term because DBS is a nontraditional sample often requiring conversion of measurements to plasma or serum values. Opportunities presented by novel methodologies may obviate many of the current limitations, but threats around the ethical use of residual samples must be considered by potential adopters. SUMMARY DBS provide a wide range of potential applications that extend beyond the reach of traditional samples. Current limitations are serious but not intractable. Technological advancements will likely continue to minimize constraints around DBS adoption.

User identification across online social networks in practice: Pitfalls and solutions

2016 ◽  
Vol 44 (3) ◽  
pp. 377-391 ◽  
Author(s):  
Azadeh Esfandyari ◽  
Matteo Zignani ◽  
Sabrina Gaito ◽  
Gian Paolo Rossi
Keyword(s):  
Social Networks ◽  
Online Social Networks ◽  
Full Range ◽  
Application Programming Interface ◽  
User Identification ◽  
Application Programming ◽  
Test Sets ◽  
Set Up ◽  
Different Levels ◽  
Programming Interface

To take advantage of the full range of services that online social networks (OSNs) offer, people commonly open several accounts on diverse OSNs where they leave lots of different types of profile information. The integration of these pieces of information from various sources can be achieved by identifying individuals across social networks. In this article, we address the problem of user identification by treating it as a classification task. Relying on common public attributes available through the official application programming interface (API) of social networks, we propose different methods for building negative instances that go beyond usual random selection so as to investigate the effectiveness of each method in training the classifier. Two test sets with different levels of discrimination are set up to evaluate the robustness of our different classifiers. The effectiveness of the approach is measured in real conditions by matching profiles gathered from Google+, Facebook and Twitter.

scholarly journals Nurses’ Perspectives About Reasons for Not Reporting Medical Errors in Educational Hospitals, Ahvaz, Iran

2021 ◽  
Author(s):  
Zahra Rahsepar ◽  
Farzad Faraji-Khiavi ◽  
Mansour Zahiri ◽  
Mohammadhosein Haghighizadeh
Keyword(s):  
Medical Errors ◽  
Health Care Quality ◽  
Analytical Study ◽  
Systematic Approach ◽  
Care Quality ◽  
Error Reporting ◽  
Measurement Tool ◽  
Work Experiences ◽  
Process Factors ◽  
Different Levels

Background: Reporting of medical errors is an approach to identify and prevent errors in hospitals. Objectives: The purpose of this study was to determine the barriers to error rError Reporting; Nurse; Hospital; Ahvazeport from the nurses’ viewpoints in Ahvaz Educational hospitals. Methods: This descriptive-analytical study was done on 206 nurses working in educational hospitals of Ahvaz selected by stratified random sampling. The measurement tool used in this study was a researcher-made questionnaire, which its validity was confirmed by content validity, and its reliability using Cronbach’s alpha was calculated to be 0.84. Data collection was performed from April to June 2019. Results: The causes of failure to error reporting included educational, attitudinal, process, structural, and managerial factors. The total mean score of the factors causing non-reporting of errors was 3.88 ± 0.53, which was between 3 and 4 (“important”). Also, educational, attitudinal, and process factors were reported as “very important” for nurses. Structural and managerial factors were rated reported “important” by nurses over 90% of nurses rated educational, attitudinal, and process factors as important and very important, and more than 70% of them rated structural and managerial factors as important and very important. Nurses with different levels of education or work experiences had different scores in reasons for not reporting errors. Conclusions: Some educational, attitudinal, process, structural, and managerial factors were critical reasons for not reporting errors. In order to reduce same errors in the future and promoting health care quality, officials need to develop strategies to remove barriers and consider the reasons for not reporting errors in nurses’ educational programs using team-based and forward-looking approaches, adopting an impersonal and systematic approach, and finally, modifying error reporting rules.

scholarly journals A GIS-Based Cultural Heritage Study Framework on Continuous Scales: A Case Study on 19th Century Military Industrial Heritage

2015 ◽  
Vol XL-5/W7 ◽  
pp. 215-222 ◽  
Author(s):  
J. He ◽  
J. Liu ◽  
S. Xu ◽  
C. Wu ◽  
J. Zhang
Keyword(s):  
Systematic Approach ◽  
Spatial Scales ◽  
Heritage Conservation ◽  
Archaeological Sites ◽  
Historical Buildings ◽  
Gis Technology ◽  
Industrial Heritage ◽  
Natural Settings ◽  
Different Levels

This paper presents a framework of introducing GIS technology to record and analyse cultural heritages in continuous spatial scales. The research team is developing a systematic approach to support heritage conservation research and practice on historical buildings, courtyards, historical towns, and archaeological sites ad landscapes. These studies are conducted not only from the property or site scales, but also investigated from their contexts in setting as well as regional scales. From these continues scales, authenticity and integrity of a heritage can be interpreted from a broader spatial and temporal context, in which GIS would contribute through database, spatial analysis, and visualization. The case study is the construction of a information indexing framework of Dagu Dock industrial heritage to integrate physical buildings, courtyards, natural settings as well as their intangible characteristics which are affiliated to the physical heritage properties and presented through historical, social and culture semantics. The paper illustrates methodology and content of recording physical and social/cultural semantics of culture heritages on different scales as well as connection between different levels of database.

scholarly journals Dynamics of the IFT machinery at the ciliary tip

eLife ◽  
2017 ◽  
Vol 6 ◽  
Author(s):  
Alexander Chien ◽  
Sheng Min Shih ◽  
Raqual Bower ◽  
Douglas Tritschler ◽  
Mary E Porter ◽  
...  
Keyword(s):  
Basal Body ◽  
Full Range ◽  
Intraflagellar Transport ◽  
Feedback Mechanism ◽  
Conventional Imaging ◽  
Range Of Movement ◽  
Anterograde Transport ◽  
Traffic Jam ◽  
Negative Feedback Mechanism ◽  
Cilia And Flagella

Intraflagellar transport (IFT) is essential for the elongation and maintenance of eukaryotic cilia and flagella. Due to the traffic jam of multiple trains at the ciliary tip, how IFT trains are remodeled in these turnaround zones cannot be determined by conventional imaging. Using PhotoGate, we visualized the full range of movement of single IFT trains and motors in Chlamydomonas flagella. Anterograde trains split apart and IFT complexes mix with each other at the tip to assemble retrograde trains. Dynein-1b is carried to the tip by kinesin-II as inactive cargo on anterograde trains. Unlike dynein-1b, kinesin-II detaches from IFT trains at the tip and diffuses in flagella. As the flagellum grows longer, diffusion delays return of kinesin-II to the basal body, depleting kinesin-II available for anterograde transport. Our results suggest that dissociation of kinesin-II from IFT trains serves as a negative feedback mechanism that facilitates flagellar length control in Chlamydomonas.

Challenges faced by nurses in complying with aseptic non-touch technique principles during wound care: a review

2020 ◽  
Vol 29 (5) ◽  
pp. S28-S35 ◽  
Author(s):  
Temi Sonoiki ◽  
Julie Young ◽  
Obrey Alexis
Keyword(s):  
Systematic Approach ◽  
Healthcare Professionals ◽  
Wound Care ◽  
Integrated Approach ◽  
Nurse Education ◽  
Wound Management ◽  
Inclusion Criteria ◽  
Healthcare Associated Infection ◽  
Wound Site ◽  
Healthcare Associated

Background: Surgical and wound site infections (SWSIs) are the second most frequent type of healthcare-associated Infection. One way of preventing SWSIs is by adhering to the principles of asepsis. However, many nurses struggle to apply the principles of aseptic non-touch technique (ANTT) during wound management. Aim: To identify the barriers and enablers that influence nurses' adherence to the principles of ANTT during wound care. Method: A literature search using a systematic approach was carried out. Four databases were searched to identify relevant studies published between January 1993 and December 2018. Titles and abstracts were reviewed. Studies that met the inclusion criteria were reviewed for quality. The extracted data were then synthesised. Findings: A total of seven studies fulfilled the requirements for inclusion. Three themes emerged and were found to be the most dominant factors influencing adherence to the principles of ANTT: material and resources, nurse education, and nurses' behaviour. Conclusion: Nurses' compliance with aseptic practice is directly influenced by environmental and psychological factors. Ensuring compliance to ANTT may require an integrated approach involving local, national and worldwide organisations, in collaboration with higher education institutions that teach nurses and similar healthcare professionals.

scholarly journals Reverse geometry shoulder replacement for proximal humeral metastases

2014 ◽  
Vol 96 (7) ◽  
pp. e32-e35 ◽  
Author(s):  
RA Kapur ◽  
PA McCann ◽  
PP Sarangi
Keyword(s):  
Rotator Cuff ◽  
Symptomatic Relief ◽  
Skeletal Metastases ◽  
Loss Of Function ◽  
Rotator Cuff Disease ◽  
Shoulder Replacement ◽  
Range Of Movement ◽  
Upper Limb Function ◽  
Effective Option ◽  
Metastatic Involvement

The management of skeletal metastases can be challenging for the orthopaedic surgeon. They represent a significant source of pain and disability for cancer patients, adding to the morbidity of their condition. Treatment is directed at the alleviation of symptoms and the restoration of function. Metastatic involvement of the proximal humerus can be especially debilitating, having the potential to cause severe pain and loss of function. We present a report of three such cases where reverse geometry proximal shoulder replacement was used to provide a pain free functional range of movement in patients with concomitant rotator cuff disease. In all cases, significant symptomatic relief was achieved postoperatively with preservation of upper limb function. No surgical complications were noted. It is our belief that this novel surgical strategy provides a valuable and effective option for the management of proximal humeral metastatic disease in the rotator cuff deficient patient.

Condylar fractures of the proximal and middle phalanges

2013 ◽  
Vol 40 (1) ◽  
pp. 51-58 ◽  
Author(s):  
D. J. Shewring ◽  
A. C. Miller ◽  
A. Ghandour
Keyword(s):  
Internal Fixation ◽  
Full Range ◽  
Day Surgery ◽  
Nonoperative Treatment ◽  
Lateral Approach ◽  
Close Monitoring ◽  
Range Of Movement ◽  
Distal Interphalangeal ◽  
Condylar Fractures ◽  
Extensor Lag

We describe the treatment of 74 patients with phalangeal condylar fractures. Twelve patients presenting with undisplaced fractures were initially treated nonoperatively; of these, five displaced, requiring fixation. The remaining seven patients, all children, united uneventfully. Sixty-two patients presenting with displaced fractures were treated with internal fixation using a single lag screw through a lateral approach. The patients were treated semi-electively on a day surgery unit. Twenty-seven patients with unicondylar fractures, all operated on within 2 weeks of injury, regained full range of movement. Thirty-eight patients had loss of extension (range 10–35°) with fixed flexion contractures at the proximal interphalangeal and thumb interphalangeal joints and extensor lag at the distal interphalangeal joints (overall mean extension loss 10°). Although fixation was technically easier during the first week, a delay of 2 weeks before fixation made little difference to the outcome. In our experience, fractures can be taken down and fixed internally even 8 weeks after injury. If nonoperative treatment is initially embarked upon, close monitoring is required with weekly radiographs up to 3 weeks, as these fractures will frequently displace.

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