An evaluation of the anatomical basis of the Biceps Load tests I and II for superior labral anterior and posterior (SLAP) lesions

Both Biceps Load tests I and II rely on an increase in tension in the long head of biceps to identify a superior labral anterior and posterior (SLAP) lesion. This study aimed to evaluate the anatomical basis of Biceps Load tests I and II by measuring activity in the long head of biceps in the two clinical tests. Activity in the long head of biceps was measured in 12 healthy young participants using surface electromyography. Activity was only minimally increased in both Biceps Load I and II compared with the resting position. In the absence of convincing support for the anatomical basis of the test, investigations of diagnostic accuracy need to be replicated in order for the reported high accuracy of Biceps Load I and II tests to be supported with confidence.     

Orientation to dissection: Assisting students through the transition

Human dissection continues to be strongly argued for teaching human anatomy to medical students and is technically and emotionally demanding. An orientation to dissection and the laboratory are provided for students before beginning their work because students' and families' reactions to dissection are often complex. This study explored medical students' experiences of attending an orientation to human dissection and the anatomy laboratory. Students' reactions, feelings, and thoughts were enquired about 1 year after beginning dissection at the University of Auckland, New Zealand. Qualitative research methods, specifically one-on-one semistructured interview were utilized. Third-year medical students self-selected into the study and were interviewed 1 year after entering the laboratory. Transcribed audiotapes of the interviews were analyzed for themes across the interviews. One year after dissection students have vivid memories with differing ways of viewing the body that may help or hinder with dissection. The themes presented include orientation, student anticipation, psychological approach to the body, normalizing-continuing disquiet, and social reference. The orientation eases student entry into the laboratory. There can be ongoing feelings of ambivalence regards the body for some students. Novel findings include that students not only have their own feelings to deal with but also those of friends and family who question them and may feel uncomfortable with the idea of them dissecting. Even one year after beginning dissection, students may emotionally struggle with their work and may require further support, including how they talk about sensitive topics with other people.     

Arthroscopic glenoid retrieval in failed TSA: Search and rescue

Aseptic loosening of the glenoid is one of the most common reasons for revision surgery. Radiographs often demonstrate lucencies, of which only a small percentage are clinically significant. Diagnosing a loose glenoid can therefore be extremely challenging. Arthroscopy may be used to diagnose and remove the polyethylene in select patients where revision surgery is contraindicated. Results demonstrate acceptable outcomes and clinically significant improvements in preoperative pain and function.     

Humeral retroversion and shoulder muscle changes in infants with internal rotation contractures following brachial plexus birth palsy

AIM To examine humeral retroversion in infants who sustained brachial plexus birth palsy(BPBI) and suffered from an internal rotation contracture. Additionally, the role of the infraspinatus(IS) and subscapularis(SSc) muscles in the genesis of this bony deformation is explored.METHODS Bilateral magnetic resonance imaging(MRI) scans of 35 infants(age range: 2-7 mo old) with BPBI were retrospectively analyzed. Retroversion was measured according to two proximal axes and one distal axis(transepicondylar axis). The proximal axes were:(1) the perpendicular line to the borders of the articular surface(humeral centerline); and(2) the longest diameter through the humeral head. Muscle cross-sectional areas of the IS and SSc muscles were measured on the MRI-slides representing the largest muscle belly. The difference in retroversion was correlated with the ratio of muscle-sizes and passive external rotation measurements.RESULTS Retroversion on the involved side was significantly decreased, 1.0° vs 27.6°(1) and 8.5° vs 27.2°(2),(P 0.01), as compared to the uninvolved side. The size of the SSc and IS muscles on the involved side was significantly decreased, 2.26 cm2 vs 2.79 cm2 and 1.53 cm2 vs 2.19 cm2, respectively(P 0.05). Furthermore, the muscle ratio(SSc/IS) at the involved side was significantly smaller compared to the uninvolved side(P = 0.007).CONCLUSION Even in our youngest patient population, humeral retroversion has a high likelihood of being decreased. Altered humeral retroversion warrants attention as a structural change in any child being evaluated for the treatment of an internal rotation contracture.