How would you treat the partially torn biceps tendon?

Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 6 (July-August), 2001: pp 636–639     

A historical vignette. "How do you like your labyrinth: straight or mixed"?

Usually, people think that a precise date, that of Cotugno's publication concerning the aqueducts of the ear, is the interface between the concept of a labyrinth full of air and the concept of a labyrinth full of fluids. However, there is then a period of doubt lasting about a century! This paper endeavours to demonstrate that, in historical terms, dates are useful, but artificial, markers. It also provides an analysis of this period based on the types of criticism directed against the doctrine of the implanted air of the ear.     

If you could see what we see,would it bother you?

Objective

The purpose of our study was to determine whether the anatomic threshold for pelvic organ prolapse (POP) diagnosis and surgical success remains valid when the patient sees what we see on exam.

Methods

Two hundred participants were assigned, by computer-generated block randomization, to see one of four videos. Each video contained the same six clips representative of various degrees of anterior vaginal wall support. Participants were asked questions immediately after each clip. They were asked: “In your opinion, does this patient have a bulge or something falling out that she can see or feel in the vaginal area?” Similarly, they were asked to give their opinion on surgical outcome on a 4-point Likert scale.

Results

The proportion of participants who identified the presence of a vaginal bulge increased substantially at the level of early stage 2 prolapse (1 cm above the hymen), with 67 % answering yes to the question regarding bulge. The proportion of participants who felt that surgical outcome was less desirable also increased substantially at early stage 2 prolapse (1 cm above the hymen), with 52 % describing that outcome as “not at all” or “somewhat” successful.

Conclusion

Early stage 2 POP (1 cm above the hymen) is the anatomic threshold at which women identify both a vaginal bulge and a less desirable surgical outcome when they see what we see on examination.

     

How well do you know the back of your hand? Toward evidence-based knowledge

Familiarity with the back of one's hand has long been used as a reference criterion for knowledge despite a lack of supporting evidence. The present study prospectively tests normal subjects' knowledge of dorsal hand features. Sixty surgical, medical, and allied hospital employees (30 men, 30 women) were asked 5 questions with binary answers about features on the dorsum of their dominant hands while their hands were concealed. The proportion of correct answers to each question ranged from 0.45 to 0.65, and none was significantly different from 0.50. Similarly, the mean percentage of correct answers for all subjects and all questions was 54%, which was not significantly different from 50%. Thus, the accuracy of the answers approximated random guesses. Hand specialists scored significantly higher (75%) than other occupation groups. Men and women scored equally as a whole. These data refute the use of the hand idiom as a reference criterion for knowledge.     

What would you do? Challenges in shoulder surgery

Anatomic total shoulder and reverse total shoulder arthroplasties are excellent treatment options for various glenohumeral joint pathologies. Specific shoulder conditions require a tailored approach with each presenting unique technical challenges. Although infrequent, complications in shoulder arthroplasty can be complex to manage and the cause of significant patient morbidity. The presented cases provide a brief overview of the diagnostic dilemmas and treatment options for common and uncommon disorders encountered in shoulder arthroplasty.     

What would you do? Challenges in shoulder surgery

Dr. Evan Flatow moderates a panel of experts and discusses complex shoulder arthroplasty cases. The panel includes Dr. Gerald Williams, Dr. Leesa Galatz, Dr. William Seitz, Dr. Anthony Romeo, Dr. Joseph Iannotti, and Dr. Charles Jobin.Dr. Flatow: These cases are picked to give illustrative points to talk about.     

What would you do? Challenges in shoulder surgery

The treatment of glenohumeral joint disorders presents a challenge to the orthopedic provider. The adept shoulder surgeon must be facile with the management of both primary and complex shoulder pathologies. The cases presented are represented for their complexity and to present management principles that are fundamental to appropriate treatment of both simple and complex glenohumeral diseases. Furthermore, these cases are presented in the light of complex decision making regarding arthroplasty and the older active patient.     

What would you do? Challenges in shoulder surgery

Dr. Evan Flatow moderates a panel of experts and discusses complex shoulder arthroplasty cases dealing with bone loss, malunions, arthroplasty revision, implant failure, and more. Panel includes Dr. Jon P. Warner, Dr. Gerald Williams, Dr. William Levine, Dr. William Seitz, and Dr. Evan Lederman.