REHABILITATION OF A CONSERVATIVELY MANAGED CLAVICULAR FRACTURE

The collarbone, or wishbone, is a thin, S-shaped bone about 6 inches (15 cm) long and serves as a support between the shoulder blade and the sternum (sternum). Clavicle fracture so occur as a result of injury or trauma. The most common site of fracture is the junction between the two curvatures of the bone, which is the weakest point. The displacement post fracture is most common in clavicular fracture because the attachment of the muscle sternocleidomastoid pulls the Sternal head upwards and the pectoral muscle pulls the distal clavicle downwards. After a distal clavicle fracture, radiographic nonunion has been identified in 10% to 44% of patients. Most of clavicular fractures are managed non-surgically by physical therapy which consists of a rehabilitation program without hampering the fracture healing, the rehabilitation consists of pain reduction, improving strength and range of motion of the shoulder, Scapular and neck muscles and postural correction exercises in addition to a brace to support the upper limb as the clavicle is the bone connecting the Axilla to the shoulder girdle. And the patient is started with medical management which usually consist of analgesics. 62 year old male patient with left clavicle fracture was diagnosed on x-ray after a hit from a bullock cart. Following this incident the patient underwent a prompt series of physical rehabilitation which included strengthening exercises, thoracic expansion exercises, breathing exercises. The case report suggests that a physiotherapy treatment procedure led to the improvement of functional goals progressively and significantly.

Reaching higher: External scapula assistance can improve upper limb function in humans with irreversible scapula alata

Background Scapular dyskinesis, i.e., the deviant mobility or function of the scapula, hampers upper limb function in daily life. A typical sign of scapular dyskinesis is a scapula alata—a protrusion of the shoulder blade during arm elevation. While some reversible causes of scapula alata can be treated with therapy, other, irreversible causes require invasive surgical interventions. When surgery is not an option, however, severe limitations arise as standard approaches for assisting the scapula in daily life do not exist. The aim of this study was to quantify functional improvements when external, i.e., non-invasive, scapula assistance is provided. Methods The study was designed as a randomized controlled crossover trial. Eight participants with a scapula alata due to muscular dystrophy performed arm elevations in shoulder flexion and abduction while unassisted (baseline), externally assisted by a trained therapist, and externally assisted by a novel, textile-based scapula orthosis. Results With therapist assistance, average arm elevation increased by 17.3° in flexion (p < 0.001, 95% confidence interval of the mean $$C{I}_{95\%}=\hspace{0.17em}\left[9.8^\circ , 24.9^\circ \right]$$ C I 95 % = 9 . 8 ∘ , 24 . 9 ∘ ), and by 11.2° in abduction (p < 0.01, $$C{I}_{95\%}=\left[4.7^\circ , 17.7^\circ \right]$$ C I 95 % = 4 . 7 ∘ , 17 . 7 ∘ ), constituting the potential of external scapula assistance. With orthosis assistance, average arm elevation increased by 6.2° in flexion ($$C{I}_{95\%}=\left[0.4^\circ ,11.9^\circ \right]$$ C I 95 % = 0 . 4 ∘ , 11 . 9 ∘ ) and by 5.8° in abduction ($$C{I}_{95\%}=\left[3.0^\circ ,8.5^\circ \right]$$ C I 95 % = 3 . 0 ∘ , 8 . 5 ∘ ). Remarkably, in three participants, the orthosis was at least as effective as the therapist. Moreover, orthosis assistance reduced average perceived exertion by 1.25 points (Borg Scale) when elevating a filled bottle during a simulated daily living task. Conclusion These findings indicate a large potential for future advancements in orthotics. Already now, the textile-based scapula orthosis presented here is a feasible tool for leveraging the benefits of external scapula assistance when a therapist is unavailable, as encountered in daily life scenarios. Trial Registration ClincalTrials.gov (ID NCT04154098). Registered: November 6th 2019, https://clinicaltrials.gov/ct2/show/NCT04154098?term=scapula+orthosis&draw=2&rank=1 Graphic abstract

Indigenous Slaughter Techniques: Effects on Meat Physico-Chemical Characteristics of Nguni Goats

To improve goat meat quality in rural communities, it is important to evaluate the effects of indigenous slaughter methods used by resource-limited farmers when performing traditional ceremonies on the meat physico-chemical characteristics. The current study assessed the effects of the meat physico-chemical characteristics of Nguni goats slaughtered with the transverse neck incision (TNI), suprasternal notch piercing (SNP) and the under shoulder blade piercing at the chest floor point of elbow (CFP) to the direction of the heart methods. Thirty Nguni weathers were randomly assigned to three slaughter treatments (10 goats/treatment). Musculus longissimus thoracis et lumborum (LTL) was sampled at post-mortem for physico-chemical characteristic measurements. Meat from wethers slaughtered with the SNP method had greater ultimate pH values than meat from wethers slaughtered with TNI and CFP slaughter methods. Wethers slaughtered with the SNP method had lower meat redness (a*), yellowness (b*), and chroma (C*) values than those slaughtered with TNI and CFP slaughter methods. Goat slaughter method did not affect meat drip loss, water holding capacity, cooking loss and shear force. Overall, Nguni wethers slaughtered with the TNI and CFP methods produced chevon with fresher meat appearance than those slaughtered using the SNP method.

Cave finds indicate elk (<i>Alces alces</i>) hunting during the Late Iron Age in the Bavarian Alps

The finding of a partially preserved elk skeleton from the Bavarian Alps is reported. Remnants of an adult male were found, together with skeletal elements of juvenile moose calves, at the base of a talus cone in the pit cave Stiefelschacht, next to Lenggries (southern Germany). The adult's bones exhibited anthropogenic traces like cut marks and were radiocarbon-dated to the Late Iron Age. A projectile hole in the left shoulder blade and cut marks on the bones are indicative of hunting and meat usage. The elk remains were associated with several wild and domestic species such as ungulates and hare but were not, however, accompanied by archaeological artefacts. Other archaeological sites of the Late Iron Age are so far not known within a distance of less than 30 km to the Stiefelschacht. While the presence of elk during prehistoric times in the Alps has already been known before, the finds and the location are unique in that they are the first evidence of elk hunting during the Late Iron Age in the northern Alps.

Analysis of roentgenologic parameters of the articular process of the scapula in children with instability of the shoulder joint

Background. The frequency of occurrence of dislocation of the shoulder joint is the highest among that for all other limb joints. Simultaneously, recurrent instability of the shoulder joint develops majorly in children and adolescents, which, in the future, lead to the development of persistent pain syndrome. Past evidence indicate that the features of the spatial positioning of the articular process of the scapula can be considered as a risk factor toward the development of instability in the shoulder joint among adult patients. However, there is no reliable data in the literature regarding the influence of tilt and rotation of the shoulder blade glenoid on the occurrence of instability in the shoulder joint among children and adolescents. Encouraged, we undertook this subject for our study. Aim. To clarify the impact of changes in the version and inclination of the glenoid on the instability of the shoulder joint among children. Materials and methods. We analyzed the survey data of 42 children with a habitual dislocation of the shoulder of traumatic and atraumatic origins. The average ages of the examined children were 15.57 1.75 and 15.07 1.64 years, respectively, for those with shoulder instability of traumatic and atraumatic origins, respectively. Results. Statistical data processing revealed no significant differences in the versioning and inclination of the glenoid process between the groups with traumatic and atraumatic instabilities of the shoulder joint. Notably, the average values of versioning and inclination indicators were in the normal range. Conclusion. Based on our results, we suggest that, in the childhood, the dynamic and static soft tissue stabilizers of the shoulder joint play the leading role in the formation of instability of the shoulder joint.

Give Me Back My Bones! by K. Norman

Norman, Kim. Give Me Back My Bones! Illustrated by Bob Kolar. Candlewick Press, 2019. This book is a blend of fun and education. A pirate skeleton, whose bones have been spread across the ocean floor, wants to reclaim them. He “claim[s] his clavicle” and “hanker[s] for [his] humerus.” The text is a poem filled with surprising and creative descriptions of what the individual bones do: “Who can spot my shoulder blade, / my shrugging jacket-holder blade, / my shiver-when-I’m-colder blade? / Oh, scapula, come back!” The text is printed on Bob Kolar’s simple, bright, two-dimensional illustrations. There are some fun things to find in the illustrations. For example, when the pirate is looking for his hand-bones, we see them in the sand, hidden among hand-shaped corals. A squid returns his arm-bones. In some images fish peer at him suspiciously as he slowly collects his missing parts. As an educational work, this book is excellent. The front end papers show all of the disconnected bones with their names. The back end papers show the whole skeleton together with the bones named. Because it is a jaunty poem and fun to read, children will want to re-read it and will eventually memorize it. As a by-product of fun, they will learn what metacarpals and phalanges are. This book is highly recommended for pediatricians’ offices, as well as public and school libraries. Highly Recommended: 4 out of 4 starsReviewer: Sean C. Borle Sean C. Borle is a University of Alberta student in the Faculty of Medicine and Dentistry who is an advocate for child health and safety.

Influence of Slaughter Methods That Are Indigenous to Nguni People on Meat Physico-Chemical Characteristics of Goat Meat

Background:Resource-limited households in smallholder farming systems slaughter goats use indigenous methods for performing traditional ceremonies and meat consumption. Although extensive research has been done to determine the effect of slaughter methods on meat physico-chemical characteristics, there is paucity of informationon methods which are indigenous to Nguni people. Therefore,the objective of the study was to determine meat quality of Nguni goats slaughtered using indigenous slaughter methods. Methods:Thirty 15-18-month old wetherswere randomly assigned to three slaughter methods; transverse neck incision (TNI), suprasternal notch piercing (SNP) and under shoulder blade chest floor point of elbow piercing (CFP) to the direction of the heart. Post-mortem, them. longissimus thoracis et lumborum(LTL) was sampled for meat quality measurements. Results:Wethersslaughtered using the SNP method had greaterultimate pH values when compared with TNI and CFP slaughter methods. Wethers slaughtered using SNP method had greater rate of pH decline when compared with TNI and CFP slaughter methods. Whethers slaughtered using the SNP method had lower meat redness (a*), yellowness (b*), and chroma (C*) values when compared with TNI and CFP slaughter methods.Slaughter method had no effect (P≥ 0.05)on drip loss, water holding capacity,cooking lossand shear force. Conclusions:Overall, Nguni wethersslaughtered using theTNI and CFP methods produced chevonwithfresh meatappearance.

Development of shirt pattern for wheelchair tennis players through 3D avatars

This study is to develop the wheelchair tennis pattern to improve comfort by reducing garment strain in a CAD program by analyzing seven body movements related to garment strain during play. The bodice was subdivided into surface zones in the present study to efficiently develop 2D patterns that can later be transferred into 3D virtual garments and draped onto 3D avatars. The 2D patterns were developed based on morphological analysis that provided different possible solutions to enhance comfort by releasing garment strain at each surface zone. The structural lines and wearing ease grade points were utilized to adjust a tennis shirt block pattern when developing this 2D pattern at morphological analysis step. In this study, 3D body scanner was used to create 3D avatars with postures based on the determined seven body movements. The drafted pattern was used to drape the virtual garments on the each movement of 3D avatars in the CAD program, and then the stain areas of the pattern design were identified using the tension map. In all of the movements, the majority of garment strain appeared on the shoulder surface and around the neck within the surface zone of bodice shoulder angle. The majority of other strain found was on the shoulder blade as the bodice bust zone during movements in the forehand swing, backhand swing, serve toss, and serve follow through postures. Based on these strain results obtained from 3D scanner, the first pattern was developed to release strains in shoulder as seen by the significant decrease in strain during both forehand movements. The second pattern was constructed to release other maximized strain on the back surface zone of the shoulder blade. Based on the results of this study, it should be noted that the shoulder and the shoulder blade areas are important during development of patterns in terms of decreasing strain for comfort during wheelchair tennis play movements.