Podcasts about clin orthop relat res

Welcome to the (delayed) 10th & SUMMER BOTOX SPECIAL EPISODE of BSCOS Paediatric Orthopaedic Digest (POD)cast with Caroline Edwards, Head of Childrens Surgery  at Plymouth hospital who started her consultant career at Southampton Childrens Hospital, she set up and developed the neuromuscular service. She proposes a "hub and spoke" model for learning at busy tertiary centres and shared her research on the surgical vulnerability score, a tool to assess the likelihood of early death in patients with neuromuscular disorders. Caroline highlights the challenges faced by young adults transitioning from clinic care for cerebral palsy and suggested district general hospitals could provide dedicated clinics. Listen in to the episode to learn more!   We scoured 35 journals & highlighted the most impactful studies that we feel can change practice or improve outcomes in Paediatric Orthopaedics.  Follow Updates on @BSCOS_UK  REFERENCES: 1.     Skeletal Muscle in Cerebral Palsy: From Belly to Myofibril. Howard JJ &  Herzog W. Front Neurol. Feb 2021. PMID: 33679586 2.     Virtual Reality Distraction Is No Better Than Simple Distraction Techniques for Reducing Pain and Anxiety During Pediatric Orthopaedic Outpatient Procedures: A Randomized Controlled Trial. Fabricant PD et al. Clin Orthop Relat Res. May 2024. PMID: 37939199   3.     Effect of parental touch on relieving acute procedural pain in neonates and parental anxiety (Petal): a multicentre, randomised controlled trial in the UK. Hauck AGV et al. Lancet Child Adolesc Health. April 2024. PMID: 38373429.   4.     REM Sleep Preserves Affective Response to Social Stress-Experimental Study. Halonen et al. eNeuro. June 2024. PMID: 38802242   5.     Functional electrical stimulation during walking in children with unilateral spastic cerebral palsy: A randomized cross-over trial. Moll et al. Dev Med Child Neurol. May 2024. PMID: 37823431.   6.     Clinical Effectiveness of Newborn Screening for Spinal Muscular Atrophy: A Nonrandomized Controlled Trial. Schwartz et al. JAMA Pediatr. June 2024. PMID: 38587854   7.     Surgical management of proximal femoral unicameral bone cyst in children. Maximen et al + SOFOP. Bone Joint J. May 2024. PMID: 38688504   8.     Treatment of Hip Displacement in Children With Cerebral Palsy: A 5-year Comparison of Proximal Femoral Osteotomy and Combined Femoral-Pelvic Osteotomy in 163 Children. Kiapekos N et al. J Pediatr Orthop. July 2024. PMID: 38477355    9.     Impact of Pavlik Harness treatment on motor skills acquisition: A case-control study. Jesus AR et al. J Child Orthop. March 2024. PMID: 39100978   10.  Deep Learning Analysis of Surgical Video Recordings to Assess Nontechnical Skills. Harari RE et al. JAMA Netw Open. July 2024. PMID: 39083274   11.  Single versus double retrograde intramedullary nail technique for treatment of displaced proximal humeral fractures in children: A retrospective cohort study. Samara E et al. J Child Orthop. March 2024. PMID: 38831859   12.  Can the Achilles tendon regenerate completely following percutaneous tenotomy in older children with clubfoot? Aroojis A et al. Int Orthop. June 2024. PMID: 38340143.   13.  Guided Growth With Minifragment Plates for Angular Deformities in the Distal Radius in Skeletally Immature Patients. Preliminary Results. Soler-Jimenez A et al. J Pediatr Orthop. September 2024. PMID: 38767293.   14.  Robot-assisted Temporary Hemiepiphysiodesis With Eight-plates for Lower Extremity Deformities in Children. Liang M et al. J Pediatr Orthop. April 2024. PMID: 38312109    Follow Hosts: @AnishPSangh @AlpsKothari @Pranai_B See as many of you as possible at the BSCOS sessions at the BOA in Birmingham!

Patello-femoral pain is a common, and at times, debilitating condition of the knee that can impact people across the lifespan. Professor Bill Vicenzino is a world leading expert on this topic and to that end I've enticed him onto the show to give us the ins and outs of this tricky condition. This is truly a must listen episode with a real pioneer of physiotherapy about a very common and important musculoskeletal condition. Key Papers: 1. Rathleff MS, Holden S, Krommes K, Winiarski L, Hölmich P, Salim TJ, Thorborg K. The 45-second anterior knee pain provocation test: A quick test of knee pain and sporting function in 10-14-year-old adolescents with patellofemoral pain. Phys Ther Sport. 2022 Jan;53:28-33. doi: 10.1016/j.ptsp.2021.11.002. Epub 2021 Nov 4. PMID: 34775189. 2. Powers CM, Witvrouw E, Davis IS, Crossley KM. Evidence-based framework for a pathomechanical model of patellofemoral pain: 2017 patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester, UK: part 3. Br J Sports Med. 2017 Dec;51(24):1713-1723. doi: 10.1136/bjsports-2017-098717. Epub 2017 Nov 6. PMID: 29109118. 3. Powers CM, Ho KY, Chen YJ, Souza RB, Farrokhi S. Patellofemoral joint stress during weight-bearing and non-weight-bearing quadriceps exercises. J Orthop Sports Phys Ther. 2014 May;44(5):320-7. doi: 10.2519/jospt.2014.4936. Epub 2014 Mar 27. PMID: 24673446. 4. Crossley KM, Stefanik JJ, Selfe J, Collins NJ, Davis IS, Powers CM, McConnell J, Vicenzino B, Bazett-Jones DM, Esculier JF, Morrissey D, Callaghan MJ. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. Br J Sports Med. 2016 Jul;50(14):839-43. doi: 10.1136/bjsports-2016-096384. Epub 2016 Jun 24. PMID: 27343241; PMCID: PMC4975817. 5. Nimon G, Murray D, Sandow M, Goodfellow J. Natural history of anterior knee pain: a 14- to 20-year follow-up of nonoperative management. J Pediatr Orthop. 1998 Jan-Feb;18(1):118-22. PMID: 9449112. 6. Dye SF. The pathophysiology of patellofemoral pain: a tissue homeostasis perspective. Clin Orthop Relat Res. 2005 Jul;(436):100-10. doi: 10.1097/01.blo.0000172303.74414.7d. PMID: 15995427. 7. Holden S, Matthews M, Rathleff MS, Kasza J; Fohx Group; Vicenzino B. How Do Hip Exercises Improve Pain in Individuals With Patellofemoral Pain? Secondary Mediation Analysis of Strength and Psychological Factors as Mechanisms. J Orthop Sports Phys Ther. 2021 Dec;51(12):602-610. doi: 10.2519/jospt.2021.10674. PMID: 34847699. 8. Robertson CJ, Hurley M, Jones F. People's beliefs about the meaning of crepitus in patellofemoral pain and the impact of these beliefs on their behaviour: A qualitative study. Musculoskelet Sci Pract. 2017 Apr;28:59-64. doi: 10.1016/j.msksp.2017.01.012. Epub 2017 Feb 2. PMID: 28171780. The Shoulder Physio Online Course Connect with Jared and guests: Jared on Instagram: @‌shoulder_physio Jared on Twitter: @‌jaredpowell12 Bill on Twitter: @Bill_Vicenzino See our Disclaimer here: The Shoulder Physio - Disclaimer

During this episode I discuss scoliosis. _ I cover the diagnosis of scoliosis, severity of curves, sex differences and structural versus functional scoliosis.  _ I also think about the conservative management of scoliosis including watch and wait strategies, out-patient exercise programs, bracing and in-patient rehabilitation programs. _ Do you have scoliosis and did this episode help clear up any misconceptions ? _ Subscribe to The Concast - New episodes Friday at 9am EST *

Episode Length: 33:30 Welcome to the KeyLIME Holiday Special “re run” series!  We're going to continue our trip down memory lane by sharing our annual Holiday Specials from the last four years.  Last year's KeyLIME Holiday Special (2021) was our fourth edition and featured the following papers:  1) Levy IM et al. Is Teaching Simple Surgical Skills Using an Operant Learning Program More Effective Than Teaching by Demonstration?  Clin Orthop Relat Res. 2016; 474:945–955 (Lara's pick) 2) Han H-C  et al. Predictors of ManuScript Rejection sYndrome (MiSeRY): a cohort study.  Med J Aust. 2019;211(11):511-513 (Linda's pick) 3) Bauer GR. Biased Outcome reporting Guidelines for Underwhelming Studies (BOGUS) statement and checklist. BMJ. 2021;10(375):e067350.(Jason's pick) 4) Lee et. al,. Web-Based Surveys for Data Gathering from Medical Educators: An Exploration of the Efficacy and Impact of Follow-Up Reminders. ERIC. 2002 April (Jon's pick) *No abstracts available for the four Holiday Special articles. Follow our co-hosts on Twitter! Jason R. Frank: @drjfrank  Jonathan Sherbino: @sherbino  Linda Snell: @LindaSMedEd  Lara Varpio: @LaraVarpio Lara Varpio's Disclaimer: The views expressed in this manuscript are solely those of the authors and do not necessarily reflect those of the Uniformed Services University of the Unites States Department of Defense.  Want to learn more about KeyLIME? Click here! Full transcript for this Episode is available upon request.

Nawet do 60% zerwanych ACL może się wygoić, a gdy zastosujemy zachowawczą metodę leczenia „Cross Bracing” to wartość ta może wzrosnąć nawet do 90%! Całość oczywiście oparta o dowody naukowe. Zapewne dokładnie coś takiego chce usłyszeć większość osób, które doznały zerwania więzadła krzyżowego przedniego. Temat gojących się zerwań ACL jest bardzo gorący ostatnimi czasy. Pojawiło się kilka prac, które chętnie były udostępniane i tym samym budowały konkretny pogląd na tytułową tematykę. Taki stan rzeczy to pole minowe dla przekonań zarówno specjalistów jak i pacjentów. Próba omówienia go i nadania właściwego kontekstu to zadanie karkołomne z wykorzystaniem tekstu czy infografik w social media dlatego właśnie razem z lek. Jakubem Liberskim złapaliśmy za mikrofony i podjęliśmy próbę rozprawienia się z tematem i kilkoma innymi ściśle z nim powiązanymi… Celowo piszę „próbę” bo już po zakończeniu nagrania obaj wiedzieliśmy, że odpowiedzi na jedne pytania siłą rzeczy nasuwały nowe. Wierzę, że poczyniliśmy skuteczne starania, aby nośny ostatnimi czasy temat doczekał się pełniejszego kontekstu. Wraz z moimi gośćmi czynimy starania, aby popularyzować wiedzę związaną z utrzymaniem zdrowia, sprawności i pełni możliwości psychofizycznych naszego ciała. Jeżeli uważasz, że takie działania mają sens to udostępnij proszę ten materiał i polub nasze profile w mediach społecznościowych. 1.Costa-Paz M, Ayerza MA, Tanoira I, Astoul J, Muscolo DL. Spontaneous healing in complete ACL ruptures: a clinical and MRI study. Clin Orthop Relat Res. 2012 Apr;470(4):979-85 2. Filbay S, Roemer F, Lohmander S, et al32 Spontaneous healing of the ruptured anterior cruciate ligament: observations from the KANON trialBMJ Open Sport & Exercise Medicine 2022;8

Dr. Laura Certain (@laura_certain) and Dr. Nico Cortes-Penfield (@Cortes_Penfield) join Dr. Julie Ann Justo (@julie_justo) to discuss all things related to prosthetic joint infections. Tune in to learn about what comprises a bacterial biofilm, how it develops, and ways to combat it using the latest evidence-based antibiotic regimens. We also take a look at what's on the horizon for the field of orthopedic infectious diseases. Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/ References: Cortés-Penfield NW, Kulkarni PA. The History of Antibiotic Treatment of Osteomyelitis. Open Forum Infect Dis. 2019 Apr 8;6(5):ofz181. doi: 10.1093/ofid/ofz181. PMID: 31123692. Bernard L, et al. Antibiotic Therapy for 6 or 12 Weeks for Prosthetic Joint Infection. N Engl J Med. 2021 May 27;384(21):1991-2001. doi: 10.1056/NEJMoa2020198. PMID: 34042388. (DATIPO trial) Gallagher C, et al. Impact of Implementing an IV to PO Antibiotic Treatment Protocol for Orthopedic Infections ion Prescribing Habits and Health Utilization Outcomes. IDWeek 2022. Poster 909. Febrile Podcast. Episode #31 – Truth or DAIR. 2022 Feb 28. https://febrilepodcast.com/episode-31-truth-or-dair/ Frank JM, et al. The Mark Coventry, MD, Award: Oral Antibiotics Reduce Reinfection After Two-Stage Exchange: A Multicenter, Randomized Controlled Trial. Clin Orthop Relat Res. 2017 Jan;475(1):56-61. doi: 10.1007/s11999-016-4890-4. PMID: 27387759. Kelly MP, et al. Extended Oral Antibiotics Increase Bacterial Resistance in Patients Who Fail 2-Stage Exchange for Periprosthetic Joint Infection. J Arthroplasty. 2022 Aug;37(8S):S989-S996. doi: 10.1016/j.arth.2022.01.027. PMID: 35074446. Payne J, et al. Inducing Antimicrobial Resistance with Long-term Antibiotics at Stage 2 Revision for Periprosthetic Joint Infection. IDWeek 2022. Poster 981. Frost P, et al. Phototoxic potential of minocycline and doxycycline. Arch Dermatol. 1972 May;105(5):681-3. PMID: 5026677. Lode H, et al. Comparative pharmacokinetics of cephalexin, cefaclor, cefadroxil, and CGP 9000. Antimicrob Agents Chemother. 1979 Jul;16(1):1-6. doi: 10.1128/AAC.16.1.1. PMID: 475366. Sader HS, et al. In vitro activity of cefpodoxime compared with other oral cephalosporins tested against 5556 recent clinical isolates from five medical centers. Diagn Microbiol Infect Dis. 1993 Aug-Sep;17(2):143-50. doi: 10.1016/0732-8893(93)90025-3. PMID: 8243035. Green S & Tsai YV. Precision Dosing of To-Marrow: Linezolid Therapeutic Drug Monitoring. ContagionLive: Bench to Bedside with SIDP. 2022 Nov 3. https://www.contagionlive.com/view/precision-dosing-of-to-marrow-linezolid-therapeutic-drug-monitoring Check out our podcast host, Pinecast. Start your own podcast for free with no credit card required. If you decide to upgrade, use coupon code r-7e7a98 for 40% off for 4 months, and support Breakpoints. Check out our podcast host, Pinecast. Start your own podcast for free with no credit card required. If you decide to upgrade, use coupon code r-7e7a98 for 40% off for 4 months, and support Breakpoints.

Liquid biopsy has emerged as a novel diagnostic tool, enabling rapid, non-invasive molecular testing of thyroid cancers. This episode offers insight into some of the opportunities and challenges that are presented by liquid biopsy in this field. To answer questions on this topic, we have invited Professor Frederique Penault-Llorca to join us. She is Professor of Pathology at the University of Clermont-Ferrand and CEO of the Comprehensive Regional Cancer Institute Centre Jean Perrin in Clermont-Ferrand, France. Funding Information: This episode is supported by an educational grant from Eli Lilly, who have had no influence on the content or choice of faculty. Faculty Disclosures: Professor Frederique Penault-Llorca has disclosures are as follows: Advisory board: Roche, EliLilly, Illumina, Speaker: Roche, EliLilly, Illumina, References 1. Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–1214 2. Albarel F, Conte-Devolx B, Oliver C. From nodule to differentiated thyroid carcinoma: Contributions of molecular analysis in 2012. Ann Endocrinol (Paris). 2012;73:155–164 3. Nylen C, Mechera R, Marechal-Ross I, et al. Molecular markers guiding thyroid cancer management. Cancers (Basel). 2020;12:2164 4. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Thyroid Carcinoma. Version 2.2022. May 5, 2022. Available at: https://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf (accessed June 2022) 5. Pinchot SN, Al-Wagih H, Schaefer S, et al. Accuracy of fine-needle aspiration biopsy for predicting neoplasm or carcinoma in thyroid nodules 4 cm or larger. Arch Surg. 2009;144:649–655 6. Bellevicine C, Sgariglia R, Nacchio M, et al. Molecular testing of thyroid fine-needle aspiration: local issues and solutions. An interventional cytopathologist perspective. J Mol Pathol. 2021;2:233–240 7. Kasraeian S, Allison DC, Ahlmann ER, et al. A comparison of fine-needle aspiration, core biopsy, and surgical biopsy in the diagnosis of extremity soft tissue masses. Clin Orthop Relat Res. 2010;468:2992–3002 8. Lindeman NI, Cagle PT, Aisner DL, et al. Updated molecular testing guideline for the selection of lung cancer patients for treatment with targeted tyrosine kinase inhibitors: Guideline from the College of American Pathologists, the International Association for the Study of Lung Cancer, and the Association for Molecular Pathology. Arch Pathol Lab Med. 2018;142:321–346 9. Pennell NA, Arcila ME, Gandara DR, et al. Biomarker testing for patients with advanced non-small cell lung cancer: Real-world issues and tough choices. Am Soc Clin Oncol Educ Book. 2019;39:531–542 10. Belli C, Penault-Llorca F, Ladanyi M, et al. ESMO recommendations on the standard methods to detect RET fusions and mutations in daily practice and clinical research. Ann Oncol. 2021;32:337–350 11. Li MM, Datto M, Duncavage EJ, et al. Standards and guidelines for the interpretation and reporting of sequence variants in cancer: A joint consensus recommendation of the Association for Molecular Pathology, American Society of Clinical Oncology, and College of American Pathologists. J Mol Diagn. 2017;19:4–23

Brought to you by CSMi – https://www.humacnorm.com/ptinquest Learn more about/Buy Erik's courses – The Science PT Support us on the Patreons! In Orthopaedic Speciality Care, Longer Explanations Are Not More Caring or More Satisfying. van Maren K, Brown LE, Cremers T, et al. Clin Orthop Relat Res. 2021 479:12 – p 2601-2607 doi: 10.1097/CORR.0000000000001860 Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music for PT Inquest: “The Science of Selling Yourself Short” by Less Than Jake Used by Permission Other Music by Kevin MacLeod – incompetech.com: MidRoll Promo – Mining by Moonlight

Kaue e Raíza discutem um caso de monoartrite aguda apresentado pelo Iago. Quais as causas mais importantes no pronto-socorro? Como iniciar a investigação? O que pedir no líquido sinovial? Referências: 1) Margaretten ME, Kohlwes J, Moore D, Bent S. Does this adult patient have septic arthritis? JAMA. 2007;297(13):1478-1488 2) Sack K. Monarthritis: differential diagnosis. Am J Med 1997; 102:30S. 3) Mohana-Borges AV, Chung CB, Resnick D. Monoarticular arthritis. Radiol Clin North Am 2004; 42:135. 4) Shmerling RH, Delbanco TL, Tosteson AN, Trentham DE. Synovial fluid tests. What should be ordered? JAMA 1990; 264:1009. 5) McCutchan HJ, Fisher RC. Synovial leukocytosis in infectious arthritis. Clin Orthop Relat Res 1990; :226. 6) Siva C, Velazquez C, Mody A, Brasington R. Diagnosing acute monoarthritis in adults: a practical approach for the family physician. Am Fam Physician. 2003 Jul 1;68(1):83-90. PMID: 12887114. 7) Becker JA, Daily JP, Pohlgeers KM. Acute Monoarthritis: Diagnosis in Adults. Am Fam Physician. 2016 Nov 15;94(10):810-816. PMID: 27929277. 8) Jeong H, Kim AY, Yoon HJ, et al. Clinical courses and predictors of outcomes in patients with monoarthritis: a retrospective study of 171 cases. Int J Rheum Dis. 2014;17(5):502–510. 9) Ma L, Cranney A, Holroyd-Leduc JM. Acute monoarthritis: what is the cause of my patient's painful swollen joint? CMAJ. 2009;180(1):59–65. 10) Baker DG, Schumacher HR Jr. Acute monoarthritis. N Engl J Med. 1993;329(14):1013–1020. 11) Kienhorst LB, Janssens HJ, Fransen J, Janssen M; British Society for Rheumatology. The validation of a diagnostic rule for gout without joint fluid analysis: a prospective study. Rheumatology (Oxford). 2015;54(4):609–614. 12) Bardin T. Gonococcal arthritis. Best Pract Res Clin Rheumatol. 2003;17(2):201–208. 13) Davis, Benjamin T., and Mark S. Pasternack. "Case 19-2007: A 19-Year-Old College Student with Fever and Joint Pain." New England Journal of Medicine 356.25 (2007): 2631-2637.

REFERENCES 1.Kulshreshtha R, Singh R, Sinha J, Hall S. Anatomy of the distal biceps brachii tendon and its clinical relevance. Clin Orthop Relat Res. 2007;456:117-20.2.Eames MH, Bain GI, Fogg QA, van Riet RP. Distal biceps tendon anatomy: a cadaveric study. J Bone Joint Surg Am. 2007;89(5):1044-9.3.Athwal GS, Steinmann SP, Rispoli DM. The distal biceps tendon: footprint and relevant clinical anatomy. J Hand Surg Am. 2007;32(8):1225-9.4.Konschake M, Stofferin H, Moriggl B. Ultrasound visualization of an underestimated structure: the bicipital aponeurosis. Surg Radiol Anat. 2017;39(12):1317-22.5.Snoeck O, Lefevre P, Sprio E, Beslay R, Feipel V, Rooze M, et al. The lacertus fibrosus of the biceps brachii muscle: an anatomical study. Surg Radiol Anat. 2014;36(7):713-9.6.Negrao JR, Mogami R, Ramirez Ruiz FA, Wagner FV, Haghighi P, Ward SR, et al. Distal insertional anatomy of the triceps brachii muscle: MRI assessment in cadaveric specimens employing histologic correlation and Play-doh((R)) models of the anatomic findings. Skeletal Radiol. 2020;49(7):1057-67.7.Arrigoni P. Distal Biceps Brachii Injury: Springer; 2018.8.Blasi M, De la Fuente J, Perez-Bellmunt A, Zabalza O, Martinez S, Casasayas O, et al. High-resolution ultrasound in the assessment of the distal biceps brachii tendinous complex. Skeletal Radiol. 2019;48(3):395-404.9.Mazzocca AD, Cohen M, Berkson E, Nicholson G, Carofino BC, Arciero R, et al. The anatomy of the bicipital tuberosity and distal biceps tendon. J Shoulder Elbow Surg. 2007;16(1):122-7.10.Schmidt CC, Savoie FH, 3rd, Steinmann SP, Hausman M, Voloshin I, Morrey BF, et al. Distal biceps tendon history, updates, and controversies: from the closed American Shoulder and Elbow Surgeons meeting-2015. J Shoulder Elbow Surg. 2016;25(10):1717-30.11.de la Fuente J, Blasi M, Martinez S, Barcelo P, Cachan C, Miguel M, et al. Ultrasound classification of traumatic distal biceps brachii tendon injuries. Skeletal Radiol. 2018;47(4):519-32.12.Williams BD, Schweitzer ME, Weishaupt D, Lerman J, Rubenstein DL, Miller LS, et al. Partial tears of the distal biceps tendon: MR appearance and associated clinical findings. Skeletal Radiol. 2001;30(10):560-4.13.A. B. Varia: Distal Biceps Tendon Rupture: Springer; 2019.14.Chew ML, Giuffre BM. Disorders of the distal biceps brachii tendon. Radiographics. 2005;25(5):1227-37.15.Wenzke DR. MR imaging of the elbow in the injured athlete. Radiol Clin North Am. 2013;51(2):195-213.16.Festa A, Mulieri PJ, Newman JS, Spitz DJ, Leslie BM. Effectiveness of magnetic resonance imaging in detecting partial and complete distal biceps tendon rupture. J Hand Surg Am. 2010;35(1):77-83.17.Lobo Lda G, Fessell DP, Miller BS, Kelly A, Lee JY, Brandon C, et al. The role of sonography in differentiating full versus partial distal biceps tendon tears: correlation with surgical findings. AJR Am J Roentgenol. 2013;200(1):158-62.18.Giuffre BM, Lisle DA. Tear of the distal biceps branchii tendon: a new method of ultrasound evaluation. Australas Radiol. 2005;49(5):404-6.19.Midtgaard KS, Hallgren HB, Franlund K, Gidmark F, Soreide E, Johansson T, et al. An intact lacertus fibrosus improves strength after reinsertion of the distal biceps tendon. Knee Surg Sports Traumatol Arthrosc. 2020;28(7):2279-84.

REFERENCES 1.Kulshreshtha R, Singh R, Sinha J, Hall S. Anatomy of the distal biceps brachii tendon and its clinical relevance. Clin Orthop Relat Res. 2007;456:117-20.2.Eames MH, Bain GI, Fogg QA, van Riet RP. Distal biceps tendon anatomy: a cadaveric study. J Bone Joint Surg Am. 2007;89(5):1044-9.3.Athwal GS, Steinmann SP, Rispoli DM. The distal biceps tendon: footprint and relevant clinical anatomy. J Hand Surg Am. 2007;32(8):1225-9.4.Konschake M, Stofferin H, Moriggl B. Ultrasound visualization of an underestimated structure: the bicipital aponeurosis. Surg Radiol Anat. 2017;39(12):1317-22.5.Snoeck O, Lefevre P, Sprio E, Beslay R, Feipel V, Rooze M, et al. The lacertus fibrosus of the biceps brachii muscle: an anatomical study. Surg Radiol Anat. 2014;36(7):713-9.6.Negrao JR, Mogami R, Ramirez Ruiz FA, Wagner FV, Haghighi P, Ward SR, et al. Distal insertional anatomy of the triceps brachii muscle: MRI assessment in cadaveric specimens employing histologic correlation and Play-doh((R)) models of the anatomic findings. Skeletal Radiol. 2020;49(7):1057-67.7.Arrigoni P. Distal Biceps Brachii Injury: Springer; 2018.8.Blasi M, De la Fuente J, Perez-Bellmunt A, Zabalza O, Martinez S, Casasayas O, et al. High-resolution ultrasound in the assessment of the distal biceps brachii tendinous complex. Skeletal Radiol. 2019;48(3):395-404.9.Mazzocca AD, Cohen M, Berkson E, Nicholson G, Carofino BC, Arciero R, et al. The anatomy of the bicipital tuberosity and distal biceps tendon. J Shoulder Elbow Surg. 2007;16(1):122-7.10.Schmidt CC, Savoie FH, 3rd, Steinmann SP, Hausman M, Voloshin I, Morrey BF, et al. Distal biceps tendon history, updates, and controversies: from the closed American Shoulder and Elbow Surgeons meeting-2015. J Shoulder Elbow Surg. 2016;25(10):1717-30.11.de la Fuente J, Blasi M, Martinez S, Barcelo P, Cachan C, Miguel M, et al. Ultrasound classification of traumatic distal biceps brachii tendon injuries. Skeletal Radiol. 2018;47(4):519-32.12.Williams BD, Schweitzer ME, Weishaupt D, Lerman J, Rubenstein DL, Miller LS, et al. Partial tears of the distal biceps tendon: MR appearance and associated clinical findings. Skeletal Radiol. 2001;30(10):560-4.13.A. B. Varia: Distal Biceps Tendon Rupture: Springer; 2019.14.Chew ML, Giuffre BM. Disorders of the distal biceps brachii tendon. Radiographics. 2005;25(5):1227-37.15.Wenzke DR. MR imaging of the elbow in the injured athlete. Radiol Clin North Am. 2013;51(2):195-213.16.Festa A, Mulieri PJ, Newman JS, Spitz DJ, Leslie BM. Effectiveness of magnetic resonance imaging in detecting partial and complete distal biceps tendon rupture. J Hand Surg Am. 2010;35(1):77-83.17.Lobo Lda G, Fessell DP, Miller BS, Kelly A, Lee JY, Brandon C, et al. The role of sonography in differentiating full versus partial distal biceps tendon tears: correlation with surgical findings. AJR Am J Roentgenol. 2013;200(1):158-62.18.Giuffre BM, Lisle DA. Tear of the distal biceps branchii tendon: a new method of ultrasound evaluation. Australas Radiol. 2005;49(5):404-6.19.Midtgaard KS, Hallgren HB, Franlund K, Gidmark F, Soreide E, Johansson T, et al. An intact lacertus fibrosus improves strength after reinsertion of the distal biceps tendon. Knee Surg Sports Traumatol Arthrosc. 2020;28(7):2279-84.

REFERENCES 1.Kulshreshtha R, Singh R, Sinha J, Hall S. Anatomy of the distal biceps brachii tendon and its clinical relevance. Clin Orthop Relat Res. 2007;456:117-20.2.Eames MH, Bain GI, Fogg QA, van Riet RP. Distal biceps tendon anatomy: a cadaveric study. J Bone Joint Surg Am. 2007;89(5):1044-9.3.Athwal GS, Steinmann SP, Rispoli DM. The distal biceps tendon: footprint and relevant clinical anatomy. J Hand Surg Am. 2007;32(8):1225-9.4.Konschake M, Stofferin H, Moriggl B. Ultrasound visualization of an underestimated structure: the bicipital aponeurosis. Surg Radiol Anat. 2017;39(12):1317-22.5.Snoeck O, Lefevre P, Sprio E, Beslay R, Feipel V, Rooze M, et al. The lacertus fibrosus of the biceps brachii muscle: an anatomical study. Surg Radiol Anat. 2014;36(7):713-9.6.Negrao JR, Mogami R, Ramirez Ruiz FA, Wagner FV, Haghighi P, Ward SR, et al. Distal insertional anatomy of the triceps brachii muscle: MRI assessment in cadaveric specimens employing histologic correlation and Play-doh((R)) models of the anatomic findings. Skeletal Radiol. 2020;49(7):1057-67.7.Arrigoni P. Distal Biceps Brachii Injury: Springer; 2018.8.Blasi M, De la Fuente J, Perez-Bellmunt A, Zabalza O, Martinez S, Casasayas O, et al. High-resolution ultrasound in the assessment of the distal biceps brachii tendinous complex. Skeletal Radiol. 2019;48(3):395-404.9.Mazzocca AD, Cohen M, Berkson E, Nicholson G, Carofino BC, Arciero R, et al. The anatomy of the bicipital tuberosity and distal biceps tendon. J Shoulder Elbow Surg. 2007;16(1):122-7.10.Schmidt CC, Savoie FH, 3rd, Steinmann SP, Hausman M, Voloshin I, Morrey BF, et al. Distal biceps tendon history, updates, and controversies: from the closed American Shoulder and Elbow Surgeons meeting-2015. J Shoulder Elbow Surg. 2016;25(10):1717-30.11.de la Fuente J, Blasi M, Martinez S, Barcelo P, Cachan C, Miguel M, et al. Ultrasound classification of traumatic distal biceps brachii tendon injuries. Skeletal Radiol. 2018;47(4):519-32.12.Williams BD, Schweitzer ME, Weishaupt D, Lerman J, Rubenstein DL, Miller LS, et al. Partial tears of the distal biceps tendon: MR appearance and associated clinical findings. Skeletal Radiol. 2001;30(10):560-4.13.A. B. Varia: Distal Biceps Tendon Rupture: Springer; 2019.14.Chew ML, Giuffre BM. Disorders of the distal biceps brachii tendon. Radiographics. 2005;25(5):1227-37.15.Wenzke DR. MR imaging of the elbow in the injured athlete. Radiol Clin North Am. 2013;51(2):195-213.16.Festa A, Mulieri PJ, Newman JS, Spitz DJ, Leslie BM. Effectiveness of magnetic resonance imaging in detecting partial and complete distal biceps tendon rupture. J Hand Surg Am. 2010;35(1):77-83.17.Lobo Lda G, Fessell DP, Miller BS, Kelly A, Lee JY, Brandon C, et al. The role of sonography in differentiating full versus partial distal biceps tendon tears: correlation with surgical findings. AJR Am J Roentgenol. 2013;200(1):158-62.18.Giuffre BM, Lisle DA. Tear of the distal biceps branchii tendon: a new method of ultrasound evaluation. Australas Radiol. 2005;49(5):404-6.19.Midtgaard KS, Hallgren HB, Franlund K, Gidmark F, Soreide E, Johansson T, et al. An intact lacertus fibrosus improves strength after reinsertion of the distal biceps tendon. Knee Surg Sports Traumatol Arthrosc. 2020;28(7):2279-84.

Molecular basis of intervertebral disc degeneration and herniations: what are the important translational questions? Kadow T, Sowa G, Vo N, Kang JD. Clin Orthop Relat Res. 2015 Jun;473(6):1903-12. doi: 10.1007/s11999-014-3774-8. PMID: 25024024 --- Send in a voice message: https://anchor.fm/moveman/message

How do diversity, equity, and inclusion contribute to excellence, creativity, competitive advantage, and relevance in both orthopaedic surgery and scientific publishing? How can we achieve greater diversity among authors, editors, and reviewers at top journals? What specific steps can individuals and organizations take to create a more diverse, inclusive, and equitable environment that provides greater opportunities for under-represented groups? We have a mailbag! If you have any feedback or comments about the latest episode or other relevant topics, feel free to send us a line at the OrthoJOE Mailbag: orthojoe@jbjs.org. Talking Points: Equity and inequality in surgery “Getting to excellence” and “being diverse and inclusive” are key targets How can we be more inclusive in the publishing industry and within our fields of expertise? The orthopaedic gender gap What more should we be doing? Rallying the voices of others Being aware of what’s happening in your office Thinking broadly about change Resources/Links: Scholl E, Badwall HK, Bhandari M. Equity in Surgery: Being Diverse and Inclusive, Isn’t Enough. OE Insights. Sept. 5, 2020. https://myorthoevidence.com/Download/5ac93c79-38a3-4e9e-b5bc-ce225882ac75. Okike K, Liu B, Lin YB, Torpey JL, Kocher MS, Mehlman CT, Bhandari M, Biermann JS. The orthopedic gender gap: trends in authorship and editorial board representation over the past 4 decades. Am J Orthop (Belle Mead NJ). 2012 Jul;41(7):304-10. https://pubmed.ncbi.nlm.nih.gov/22893880/ Hiller KP, Boulos A, Tran MM, Cruz AI Jr. What Are the Rates and Trends of Women Authors in Three High-impact Orthopaedic Journals from 2006-2017? Clin Orthop Relat Res. 2020 Jul;478(7):1553-1560. doi: 10.1097/CORR.0000000000001043. https://pubmed.ncbi.nlm.nih.gov/31688211/ Ray GS, Lechtig A, Rozental TD, Bernstein DN, Merchan N, Johnson AH. Gender Disparities in Financial Relationships Between Industry and Orthopaedic Surgeons. J Bone Joint Surg Am. 2020 Feb 19;102(4):e12. doi: 10.2106/JBJS.19.00669. https://jbjs.org/reader.php?id=205772&rsuite_id=2266005&native=1&source=The_Journal_of_Bone_and_Joint_Surgery/102/4/e12/abstract&topics=oe#info

Meredith and Monee open up the closet to Dr. Amy Miller to discuss gratitude. It seems to be a low hanging yet high yield fruit in the realm of wellness. Together, the three are able to put "thank you" in the larger cultural context. Plus a return to definitions and data! Sources referenced in this episode:breathe. Gratitude editionCaste by Isabel WilkersonBuetow SA, Aroll B. Doctor gratitude: a framework and practical suggestions. CMAJ. 2012 Dec 11Rao N, Kemper KJ. Online Training in Specific Meditation Practices Improves Gratitude, Well-Being, Self-Compassion, and Confidence in Providing Compassionate Care Among Health Professionals. J Evid Based Complementary Altern Med. 2017 Kelly JD 4th. Your Best Life: Breaking the Cycle: The Power of Gratitude. Clin Orthop Relat Res. 2016 DecRiskin A, Bamberger P, Erez A, Riskin-Guez K, Riskin Y, Sela R, Foulk T, Cooper B, Ziv A, Pessach-Gelblum L, Bamberger E. Expressions of Gratitude and Medical Team Performance. Pediatrics. 2019 AprHuang CH, Wu HH, Lee YC, Li L. What Role Does Patient Gratitude Play in the Relationship Between Relationship Quality and Patient Loyalty? Inquiry. 2019 Jan-DecMelnyk BM, Kelly SA, Stephens J, Dhakal K, McGovern C, Tucker S, Hoying J, McRae K, Ault S, Spurlock E, Bird SB. Interventions to Improve Mental Health, Well-Being, Physical Health, and Lifestyle Behaviors in Physicians and Nurses: A Systematic Review. Am J Health Promot. 2020 Nov;34(8):929-941. doi: 10.1177/0890117120920451. Epub 2020 Apr 27.Fogarty CT. Compassion, gratitude and awe: The role of pro-social emotions in training physicians for relational competence. Int J Psychiatry Med. 2020 Sep

In Episode 26 of The MSK Minute, I review the infamous "Jones Fracture" of the fifth metatarsal, what it is, how to diagnosis it, and how to treat it!  Enjoy, and I trust that you will find the information valuable.Please subscribe to the podcast and YouTube Channel, and join the Basics of Ortho community at www.basicsofortho.com.  If you would like to get in touch, you can do so through the website or email me at jason@basicsofortho.com.Articles referenced in this episode:Jones R. I. Fracture of the Base of the Fifth Metatarsal Bone by Indirect Violence. Ann Surg. 1902 Jun;35(6):697-700.2. PMID: 17861128; PMCID: PMC1425723.Chuckpaiwong B, Queen RM, Easley ME, Nunley JA. Distinguishing Jones and proximal diaphyseal fractures of the fifth metatarsal. Clin Orthop Relat Res. 2008 Aug;466(8):1966-70. doi: 10.1007/s11999-008-0222-7. Epub 2008 Mar 25. PMID: 18363075; PMCID: PMC2584274.Cheung CN, Lui TH. Proximal Fifth Metatarsal Fractures: Anatomy, Classification, Treatment and Complications. Arch Trauma Res. 2016 Jun 13;5(4):e33298. doi: 10.5812/atr.33298. PMID: 28144601; PMCID: PMC5251206.Wiener BD, Linder JF, Giattini JF. Treatment of fractures of the fifth metatarsal: a prospective study. Foot Ankle Int. 1997 May;18(5):267-9. doi: 10.1177/107110079701800504. PMID: 9167925.https://www.basicsofortho.com/ankle-and-footDisclaimer: The information presented in this podcast is based on Jason Coggins's experience managing orthopedic conditions over a 20 year career as an athletic trainer and physician assistant in orthopedics.It is for informational purposes only and is not intended to be used to diagnose or treat any medical conditions.  If you require medical care, please see your local provider.

This week we're joined by Lisa Cannada, MD. Dr. Cannada is a very accomplished orthopedic traumatologist. She served as the first female chair of the American Academy of Orthopaedic Surgeons Board of Directors' Board of Specialty Societies from 2017-2018 and has published more than 130 research papers and two textbooks. She also is the former president of the Ruth Jackson Orthopedic Society. She has served as a mentor to countless medical students and residents. Most importantly, she has been able to maintain a thriving family life on top of all this. We discuss how she has managed to balance work and family, how to get more women into orthopedics, how men can serve as mentors for women in orthopedic surgery, and how to survive your first few years in practice. You can find Dr. Cannada on Twitter @LisaCannada Like, subscribe, comment on the video. We're also on iTunes, Spotify, and any other podcast platform. Links to all of our episodes as well as our platforms can be found at www.orthotalkpod.com References from this episode: Sexual harassment in orthopedic surgery trainees https://pubmed.ncbi.nlm.nih.gov/32956144/ Whicker E, Williams C, Kirchner G, Khalsa A, Mulcahey MK. What Proportion of Women Orthopaedic Surgeons Report Having Been Sexually Harassed During Residency Training? A Survey Study. Clin Orthop Relat Res. 2020 Aug 26. doi: 10.1097/CORR.0000000000001454. Epub ahead of print. PMID: 32956144. Women do less complex surgeries than their male counterparts? https://pubmed.ncbi.nlm.nih.gov/32941284/ Chen YW, Westfal ML, Chang DC, Kelleher CM. Under-Employment of Female Surgeons? Ann Surg. 2020 Sep 15. doi: 10.1097/SLA.0000000000004497. Epub ahead of print. PMID: 32941284. #medicine #orthopedics #surgery #doctor #medschool #residency

Szczęśliwie jestem daleki od dyskusji światopoglądowych. Dla mnie te skróty różnią się jedną literką. W ortopedii LHBT to ścięgno głowy długiej bicepsa.W odcinku omawiam budowę mięśnia, odmienności budowy mięśnia dwugłowego oraz możliwe patologie tego ścięgna. Dla ciekawych przygotowana jest zagadka: " W ilu stawach biceps ramienia powoduje ruch?"Jeśli wiesz, to napisz w komentarzu. Jeśli nie, to może dowiesz się tego z Podcastu.A na koniec omównienie postepowania pooperacyjnego - interesujące zarówno dla fizjoterapeutów jak i lekarzy i pewnie samych pacjentów. Literatura do statystki:Sturzenegger M, Beguin D, Grunig B, Jakob RP. Muscular strength after rupture of the long head of the biceps. Arch Orthop Trauma Surg. 1986;105:18–23Mariani EM, Cofield RH, Askew LJ, Li GP, Chao EY. Rupture of the tendon of the long head of the biceps brachii.Surgical versus nonsurgical treatment. Clin Orthop Relat Res. 1988:233–9.Deutch SR, Gelineck J, Johannsen HV, Sneppen O. Permanent disabilities in the displaced muscle from rupture of the long head tendon of the biceps. Scand J Med Sci Sports. 2005;15:159–62. Linki do innych opracowańOdcinek 28 – Zerwanie bicepsa w części dalszejOdcinek 31 – Obrąbek, SLAP & moreSzycie mięśnia nadgrzebieniowego – na kanale YT Michal Drwiega

Vi har diskutert muskelskjelettsfagets uspesifikke problemstillinger i gjentatte episoder. I denne episoden tar vi en etterlengtet kikk på én av skulderens spesifikke problemstillinger: nemlig AC-leddsplager. Vi snakker både om traumatiske AC-leddsskader etter for eksempel fall eller taklinger på idrettsbanen, men også de vanligere belastningsrelaterte plagene som kan komme av over- eller feilbelastning. Vi diskuterer også AC-leddsartrose. BLOGG: På JevneHelse ble det nylig publisert en omfattende artikkel om traumatiske AC-leddsskader. Les denne her. REFERANSER:Enger, M., et al.: Shoulder injuries from birth to old age A 1-year prospective study of 3031 shoulder injuries in an urban population. Injury, 2018.Kaplan, L.D., et al.: Prevalence and variance of shoulder injuries in elite collegiate football players. Am J Sports Med, 2005. 33(8): p. 1142-6.Rockwood, C.A., Jr.: Fractures and dislocations of the shoulder. Philadelphia, PA: Lippincott; 1984. pp. 860–910., 1984.Gorbaty, J.D., et al.: Classifications in Brief: Rockwood Classification of Acromioclavicular Joint Separations. Clin Orthop Relat Res, 2017. 475(1): p. 283-287.Chester, R., et al.: Psychological factors are associated with the outcome of physiotherapy for people with shoulder pain: a multicentre longitudinal cohort study. Br J Sports Med, 2016.Chester, R., et al.: Self-efficacy and risk of persistent shoulder pain: results of a Classification and Regression Tree (CART) analysis. Br J Sports Med, 2019. 53(13): p. 825-834.Chester, R., et al.: Predicting response to physiotherapy treatment for musculoskeletal shoulder pain: a systematic review. BMC Musculoskelet Disord, 2013. 14: p. 203.Granville-Chapman, J., et al.: The Rockwood classification in acute acromioclavicular joint injury does not correlate with symptoms. J Orthop Surg (Hong Kong), 2018. 26(2): p. 2309499018777886.Hoffmann, T.C., et al.: The connection between evidence-based medicine and shared decision making. JAMA, 2014. 312(13): p. 1295-6.Littlewood, C., et al.: Physiotherapists' recommendations for examination and treatment of rotator cuff related shoulder pain: A consensus exercise. Physiotherapy Practice and Research, 2019. 40(2): p. 87-94.MUSIKK: Joseph McDade-Mirrors

In this episode Craig is joined by Dr. Jesse Elis, the director of player health and performance for the Portland Trailblazers. Jesse leads all facets of the Trail Blazers medical and performance staff to provide preventative maintenance and rehabilitative health care to Trail Blazers players. Topics from this discussion include Jesse's story, how he positioned himself to take on a very unique and rare role in the NBA, his advice and what it takes for someone to pursue a medical career in pro sports, the origins and true definition of load management, the most common NBA injuries and how they're managed, and understanding the demands of basketball.   Jesse Elis has an extensive history in the realm of high-performance sports model and rehab to performance integration. He is the Director of Player Health and Performance for the Portland Trail Blazers. Elis leads all facets of the Trail Blazers medical and performance staff to collaboratively provide preventative maintenance and rehabilitative health care to Trail Blazers players. In addition, he works closely with the team’s athletic trainers, physicians, strength and conditioning specialists, nutritionists, psychologists and sport performance specialists to integrate rehabilitative concepts into performance training. Prior to Trail Blazers, he was the Director of Physical Therapy for EXOS and managed the rehab teams for all EXOS legacy sites. He received his Doctorate of Physical Therapy from the University of North Dakota (2009) and a 3 year post-doctorate fellowship through Evidence in Motion. His credentials also consist of broad certifications in both sports and orthopedics along with having a CSCS designation. In addition, he is part-owner of a continuing education company, Phoenix Manual Therapy, which specializes in high-level clinical reasoning and manual therapy integration.    Enjoy!   -The Prehab Guys   Guests: Dr. Jesse Elis PT, DPT, FAAOMPT, OCS, SCS Email: jelis313@gmail.com Instagram: @physio_elis Linkedin: https://www.linkedin.com/in/jesse-elis-pt-dpt-ocs-scs-comt-cscs-faaompt-57b96533/   Jesse's Resources: Phoenix Manual Therapy: http://www.phoenixmanualtherapy.com/   Articles mentioned in the podcast: Bittencourt NF, Meeuwisse WH, Mendonca LD, et al. Complex systems approach for sports injuries: moving from risk factor identification to injury pattern recognition-narrative review and new concept. Br J Sports Med 2016;50:1309–14 Dye SF. The pathophysiology of patellofemoral pain: a tissue homeostasis perspective. Clin Orthop Relat Res 2005;100-10. Mueller MJ, Maluf KS. Tissue adaptation to physical stress: a proposed ‘‘Physical Stress Theory’’ to guide physical therapist practice, education, and research. Phys Ther. 2002;82:383-403.   Visit our website: www.theprehabguys.com Follow us on: Instagram | Facebook | Youtube | Twitter   Connect with The Prehab Guys info@theprehabguys.com   Leave feedback, let us know what to talk about next. Did you enjoy this? Don't forget to rate, review, and subscribe.

I denne episoden diskuterer vi problemet rundt spesifisitet. Hvorfor diagnostiseres 90% av korsryggspasienter med "uspesifikke korsryggssmerter" mens vi i andre ledd er mer spesifikke med mindre forskning? Vi tar utgangspunkt i kvalitativ forskning på subakromielt impingement og diskuterer hvordan vi rammer inn budskapet i vår kommunikasjon med pasienten har mye å si for den konteksten vi skaper for behandling og ultimativt hvor vellykket vi er med vår rehabilitering.   Hvordan har den kulturelle bagasjen og finansieringen av intervensjoner formet skulderområdet? AKTUELL LITTERATUR:Cuff, A., et al.: Subacromial impingement syndrome – What does this mean to and for the patient? A qualitative study. Musculoskeletal Science and Practice, 2018. 33: p. 24-28.Neer, C.S., 2nd: Impingement lesions. Clin Orthop Relat Res, 1983(173): p. 70-7.Neer, C.S., 2nd: Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am, 1972. 54(1): p. 41-50.Brox, J.I., et al.: Arthroscopic surgery compared with supervised exercises in patients  with rotator cuff disease (stageII impingement syndrome). BMJ, 1993. 307(6909): p. 899-903.Ketola, S., et al.: Does arthroscopic acromioplasty provide any additional value in the treatment of shoulder impingement syndrome? A TWO-YEAR RANDOMISED CONTROLLED TRIAL. J Bone Joint Surg Br., 2009. 91(10): p. 1326-34.Ketola, S., et al.: Which patients do not recover from shoulder impingement syndrome, either with operative treatment or with nonoperative treatment? Acta Orthop, 2015. 86(6): p. 641-6.Ketola, S., et al.: Arthroscopic decompression not recommended in the treatment of rotator cuff tendinopathy: a final review of a randomised controlled trial at a minimum follow-up of ten years. Bone Joint J, 2017. 99-B(6): p. 799-805.Haahr, J.P., et al.: Exercises may be as efficient as subacromial decompression in patients with subacromial stage II impingement: 4-8-years' follow-up in a prospective, randomized study. Scand J Rheumatol, 2006. 35(3): p. 224-8.Haahr, J.P., et al.: Exercises versus arthroscopic decompression in patients with subacromial impingement: a randomised, controlled study in 90 cases with a one year follow up. Ann Rheum Dis, 2005. 64(5): p. 760-4.Paavola, M., et al.: Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial. BMJ, 2018. 362: p. k2860.Beard, D.: Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. The Lancet, 2017.MUSIKK: Joseph McDade-Mirrors

Links to find the podcast: Look for us on Apple Podcasts, Google Play, Podbean, PlayerFM, RADIO and more. Just Google "the gait guys podcast". Our Websites: www.thegaitguys.com Find Exclusive content at: https://www.patreon.com/thegaitguys doctorallen.co summitchiroandrehab.com shawnallen.net Our website is all you need to remember. Everything you want, need and wish for is right there on the site. Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our websites. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20). Our podcast is on iTunes and just about every other podcast harbor site, just google "the gait guys podcast", you will find us. Where to find us, the podcast Links: Apple podcasts: https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138?mt=2 Google Play: https://play.google.com/music/m/Icdfyphojzy3drj2tsxaxuadiue?t=The_Gait_Guys_Podcast other links for today's show: Clin Orthop Relat Res. 1987 Jun;(219):21-7. Effects of joint pathology on muscle. Young A, Stokes M, Iles JF. https://pdfs.semanticscholar.org/b3ba/35567cbb32fff6cd8088592f9b63bede205b.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571089/ https://www.ncbi.nlm.nih.gov/pubmed/8153825 Rest in Peace, Neil Peart, Jan 7,2020, "The Professor" #RUSHisking, #theprofessor, #neilpeart, #greatestdrummerofalltime

Show notes are linked up below: Links to find the podcast: Look for us on Apple Podcasts, Google Play, Podbean, PlayerFM, RADIO and more. Just type "the gait guys podcast" into your fav search engine. Our Websites: www.thegaitguys.com Find Exclusive content at: https://www.patreon.com/thegaitguys doctorallen.co summitchiroandrehab.com shawnallen.net Our website is all you need to remember. Everything you want, need and wish for is right there on the site. Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our websites. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20). Our podcast is on iTunes and just about every other podcast harbor site, just google "the gait guys podcast", you will find us. Where to find us, the podcast Links: Apple podcasts: https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138?mt=2 Google Play: https://play.google.com/music/m/Icdfyphojzy3drj2tsxaxuadiue?t=The_Gait_Guys_Podcast Show notes: extra videos at: https://www.patreon.com/thegaitguys https://bjsm.bmj.com/content/47/2/93 Doppler ultrasound and tibial tuberosity maturation status predicts pain in adolescent male athletes with Osgood-Schlatter's disease: a case series with comparison group and clinical interpretation Matthieu Sailly, Rod Whiteley, Amanda Johnson https://neurosciencenews.com/learning-optimized-15171/ Learning is optimized when we fail 15% of the time Neuroscience NewsNovember 6, 2019 https://www.mdpi.com/2076-3417/9/19/4176 Patellofemoral Joint Loads during Running Immediately Changed by Shoes with Different Minimalist Indices: A Cross-sectional Study. Chenhao Yang 1, Songlin Xiao 1, Yang Yang 1, Xini Zhang 1, Junqing Wang 1 and Weijie Fu School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai 200438, China Appl. Sci. 2019, 9(19), 4176; https://doi.org/10.3390/app9194176 Clin Orthop Relat Res. 1987 Jun;(219):21-7. Effects of joint pathology on muscle. Young A, Stokes M, Iles JF. Physiother Theory Pract. 2006 Nov;22(5):251-62. A functional model to describe the action of the adductor muscles at the hip in the transverse plane.  Leighton RD1.Department of Physical Therapy, University of New England, Portland, ME 04103, USA.

Brought to you by CSMi Patient reported outcome measures (PROM) are commonly used to assess function in patients. But is that what they are actually measuring? Can we alter those scores in a meaningful way just through practicing the tasks mentioned in the questionnaire? Can the QuickDASH PROM be Altered by First Completing the Tasks on the Instrument? Shapiro LM, Harris AHS, Eppler SL, Kamal RN. Clin Orthop Relat Res. 2019 Apr 27. doi: 10.1097/CORR.0000000000000731. [Epub ahead of print] Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Produced by: Matt Hunter Music for PT Inquest: "The Science of Selling Yourself Short" by Less Than Jake Used by Permission

Brought to you by CSMi What do patients believe about knee osteoarthritis and nonsurgical interventions? Where do they get these beliefs? Can we change these beliefs? Even if we do will that make a difference? Misconceptions and the Acceptance of Evidence-based Nonsurgical Interventions for Knee Osteoarthritis. A Qualitative Study. Bunzli S, O'Brien P, Ayton D, Dowsey M, Gunn J, Choong P, Manski-Nankervis JA. Clin Orthop Relat Res. 2019 Jun 10. doi: 10.1097/CORR.0000000000000784. [Epub ahead of print] Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Produced by: Matt Hunter Music for PT Inquest: "The Science of Selling Yourself Short" by Less Than Jake Used by Permission

Brought to you by CSMi Pain catastrophizing has been shown to have an affect on outcomes specifically after total knee arthroplasty. This article took a good look at the problem and many people interpreted the findings to say that cognitive behavioral therapy (CBT) wasn't effective. Turns out it's much more interesting than that... Pain Coping Skills Training for Patients Who Catastrophize About Pain Prior to Knee Arthroplasty: A Multisite Randomized Clinical Trial. Riddle DL, Keefe FJ, Ang DC, Slover J, Jensen MP, Bair MJ, Kroenke K, Perera RA, Reed SD, McKee D, Dumenci L. JBJS. February 6, 2019 - Volume 101 - Issue 3 - p 218-227 doi: 10.2106/JBJS.18.00621. The effectiveness trial. Pain coping skills training for patients with elevated pain catastrophizing who are scheduled for knee arthroplasty: a quasi-experimental study. Riddle DL, Keefe FJ, Nay WT, McKee D, Attarian DE, Jensen MP. Arch Phys Med Rehabil. 2011 Jun;92(6):859-65. doi: 10.1016/j.apmr.2011.01.003. Epub 2011 Apr 29. The efficacy trial. OPEN ACCESS! Preoperative pain catastrophizing predicts pain outcome after knee arthroplasty. Riddle DL, Wade JB, Jiranek WA, Kong X. Clin Orthop Relat Res. 2010 Mar;468(3):798-806. doi: 10.1007/s11999-009-0963-y. Epub 2009 Jul 8. The validation of the metric. OPEN ACCESS! Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Produced by: Matt Hunter Music for PT Inquest: "The Science of Selling Yourself Short" by Less Than Jake Used by Permission

Join hosts Jeff Nusbaum, MD, and Nachi Gupta, MD on this episode of EMplify as they take you through the June 2018 issue of Emergency Medicine Practice: Managing Shoulder Injuries in the Emergency Department Fracture, Dislocation, and Overuse. This month, Richard Pescatore, director of clinical research at Crozer-Keystone Health System and clinical assistant professor at the Rowan University School of Osteopathic Medicine, along with Andrew Nyce, vice chairman and associate professor at cooper medical school of Rowan University reviewed just over 100 articles to come up with their evidence-based recommendations. Their recommendations were then edited by John Munyak of Maimonides and Mark Silverberg of SUNY Downstate and Kings County Hospital. Most Important References * Ponce BA, Kundukulam JA, Pflugner R, et al. Sternoclavicular joint surgery: how far does danger lurk below? J Shoulder Elbow Surg. 2013;22(7):993-999. (Prospective cohort; 49 patients) * Slaven EJ, Mathers J. Differential diagnosis of shoulder and cervical pain: a case report. J Man Manip Ther. 2010;18(4):191-196. (Case report) * Helfen T, Ockert B, Pozder P, et al. Management of prehospital shoulder dislocation: feasibility and need of reduction. Eur J Trauma Emerg Surg. 2016;42(3):357-362. (Retrospective review; 70 patients) * Lenza M, Belloti JC, Andriolo RB, et al. Conservative interventions for treating middle third clavicle fractures in adolescents and adults. Cochrane Database Syst Rev. 2014(5):CD007121. (Systematic review; 3 trials, 354 patients) * Neer CS, 2nd. Displaced proximal humeral fractures: part I. Classification and evaluation. 1970. Clin Orthop Relat Res. 2006;442:77-82. (Review article) * Sholsberg J, Jackson R. Best evidence topic report. Intra-articular corticosteroid injections in acute rheumatoid monoarthritides. Emerg Med J. 2004;21(2):204. (Systematic review; 1 study, 137 patients)

Join hosts Jeff Nusbaum, MD, and Nachi Gupta, MD on this episode of EMplify as they take you through the June 2018 issue of Emergency Medicine Practice: Managing Shoulder Injuries in the Emergency Department Fracture, Dislocation, and Overuse. This month, Richard Pescatore, director of clinical research at Crozer-Keystone Health System and clinical assistant professor at the Rowan University School of Osteopathic Medicine, along with Andrew Nyce, vice chairman and associate professor at cooper medical school of Rowan University reviewed just over 100 articles to come up with their evidence-based recommendations. Their recommendations were then edited by John Munyak of Maimonides and Mark Silverberg of SUNY Downstate and Kings County Hospital. Most Important References * Ponce BA, Kundukulam JA, Pflugner R, et al. Sternoclavicular joint surgery: how far does danger lurk below? J Shoulder Elbow Surg. 2013;22(7):993-999. (Prospective cohort; 49 patients) * Slaven EJ, Mathers J. Differential diagnosis of shoulder and cervical pain: a case report. J Man Manip Ther. 2010;18(4):191-196. (Case report) * Helfen T, Ockert B, Pozder P, et al. Management of prehospital shoulder dislocation: feasibility and need of reduction. Eur J Trauma Emerg Surg. 2016;42(3):357-362. (Retrospective review; 70 patients) * Lenza M, Belloti JC, Andriolo RB, et al. Conservative interventions for treating middle third clavicle fractures in adolescents and adults. Cochrane Database Syst Rev. 2014(5):CD007121. (Systematic review; 3 trials, 354 patients) * Neer CS, 2nd. Displaced proximal humeral fractures: part I. Classification and evaluation. 1970. Clin Orthop Relat Res. 2006;442:77-82. (Review article) * Sholsberg J, Jackson R. Best evidence topic report. Intra-articular corticosteroid injections in acute rheumatoid monoarthritides. Emerg Med J. 2004;21(2):204. (Systematic review; 1 study, 137 patients)

Goal-setting can support your recovery from back pain and lead you to a better quality of life. Part 2 of this episode shows you proven techniques that help you in achieving what you aim for. + download your personal goal-setting sheet for free!!! Get your free Personal-Goal-Setting-Sheet here   Part 1 was about what you should aim for in your recovery:  Increasing physical activity1,2,3,4 improving sleep quality4,5 managing stress4,6  Now let´s dig in how goal-setting can help us in achieving that.  In their Article from 2002 Edwin Locke from University of Maryland and Gary Latham from Univerity of Toronto sum up the evidence about what science knows about the mechanisms of goal-setting.7 Goals affect performance through four mechanisms: direct attention and effort energizing function goals affect persistence, hard goals prolong effort (important for us, recovery process is a long term comittment) goals affect action indirectly by leading to the arousal, discovery, and/or use of task-relevant knowledge and strategies   To sum it up: "Effects of Goal-Setting are very reliable. Goal-setting theory is among the most valid and practical theories in organizational psychology."7 Those with high specific goals reach higher performance than those who tried to do their best. It´s not always that easy and we will talk about what research tells us, what is important in defining goals that help reaching higher performance. And thats exactly what we are looking for.   They further conclude:7 a goal should be specific, proximal goals should be added, proper use of learning goals should be made. What does this mean?   A general goal would be: Increasing physical activity. A specific goal would be: Increase walking distance up to 20 min a day. Translated into a proximal goal: Walk 20 min every day for one week starting today. And you could also add a strategy: Walk 20 min every day, before a get into the car driving to work starting today, or getting out of the bus-stop one station before my destinantion and walk there. Be creative!   So thinking about activity: Set specific Goals. Add a proximal goal and add a strategy   Be clear about why you are doing this! You are not doing this right now to become instantly pain free, you want to increase physical activity, increase quality of sleep and manage stress because in the long run that is what you will benefit from and as aresult will increase your quality of life.   Start with something that you are confident to achieve.8 No doubt there should be some challenge within your set goals. Sucess in reaching your goals will feed your confidence and step by step you can start set higher goals for your self. Goal setting is also about self efficacy, which means confidence in that you can achieve your goals. So thats a reward on it´s own, and we need that in roder to go on with our recovery.   Goals lead to higher performance when people are committed to their goals and receive summary feedback. And there are several ways you can enhance commitment. Through factors that make goal attainment important for you First of all write your goal down. Put your Goals somewhere where you can see them, so that you stay focused and you reflect upon them. Having an accountability buddy helps in multiple ways. The announcement to another person will raise the importance of xour goals for you and if you hold a weekly conversation where you report about your progress or difficulties you will have a fixed time to reflect upon your situation and this feedback will enable you to find better strategies to overcome difficulties.    Resource Section: Goal-Setting-Sheet Get your free Personal-Goal-Setting-Sheet here Set your goals for each day and at the end of the day reflect on them. Did you made it? Great! If not reflect about the reasons for it. Can you think of any strategy how to achieve your goal the next time you will be in the same situation? Could you ask someone for help if it is a time problem? Any strategy is better than no strategy. And by trying out new things you probably will come along with better and better strategies that will work for you.   If you are short on time, make it a 5 min goal. Maybe some stretching, or mobilisation-technique that you already know that you can do before you go to sleep. Find more information at www.mybackrecovery.com    Literature: Sackett DL, Rosenberg WMC, Gray JAM, et al. Evidence based medicine: what it is and what it isn’t. 1996. Clin Orthop Relat Res. 2007;455:3-5. http://www.ncbi.nlm.nih.gov/pubmed/17340682. Accessed December 16, 2012. Manske RC, Lehecka BJ. Evidence - based medicine/practice in sports physical therapy. Int J Sports Phys Ther. 2012;7(5):461-473. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3474298&tool=pmcentrez&rendertype=abstract. Accessed December 16, 2012. Jette DU, Bacon K, Batty C, et al. Evidence-based practice: beliefs, attitudes, knowledge, and behaviors of physical therapists. Phys Ther. 2003;83(9):786-805. http://www.ncbi.nlm.nih.gov/pubmed/12940766. Accessed October 5, 2012. Hooten W, Timming R, Belgrade M, et al. Assessment and Management of Chronic Pain.; 2013. Pakpour AH, Yaghoubidoust M, Campbell P. Persistent and developing sleep problems: a prospective cohort study on the relationship to poor outcome in patients attending a pain clinic with chronic low back pain. Pain Pract. 2017:1-2. doi:10.1111/papr.12584. Morley S, Williams A. New Developments in the Psychological Management of Chronic Pain. CanJPsychiatry. 2015;6060(44):168-175. Locke E a, Latham GP. Building a practically useful theory of goal setting and task motivation: A 35-year odyssey. Am Psychol. 2002;57(9):705-717. doi:10.1037/0003-066X.57.9.705. Bodenheimer T, Handley MA. Goal-setting for behavior change in primary care: An exploration and status report. Patient Educ Couns. 2009;76(2):174-180. doi:10.1016/j.pec.2009.06.001.  

8.1 Setting Goals to Boost Your Recovery from Back Pain - Part 1 What we should aim for in our recovery process and how setting the right goals can help us with that.   What to aim for The most effective treatments for low back pain include exercise or multidisciplinary rehabilitation (also see Episode 06). Passive treatments, on the other hand, have not been demonstrated to induce long-term improvements.1   Physical Activity and Therapeutic Exercise 2,3,4,5 This is what we know what will help in the long term. Increasing activity. Developing a set of active coping strategies.   Improve Sleep5 Improving sleep also makes total sense, since over 50% of people living with chronic pain suffer from depression and there is a strong correlation between quality of sleep and depression. And depression has an impact on your recovery process.5 "Presenting, persistent, and developing sleep problems have a significant impact on recovery for those with LBP"6  According to the "2015 sleep in america poll", making sleep a priority is linked to better sleep, even among those with pain. Setting the right goals has a direct impact on your life.7    Check out the videos of the national sleep foundation about sleep and chronic pain: Sleep and Pain: Beat the Cycle and Improve Your Sleep Today https://sleep.org/articles/sleep-pain-beat-cycle-improve-sleep/   Chronic Pain and Sleep https://sleepfoundation.org/sleep-disorders-problems/pain-and-sleep   What is Sleep Hygiene https://sleep.org/articles/sleep-hygiene/   Manage Stress5 Relaxation is an integral component of cognitive behavioral treatment programs for chronic pain.8 -formal interventions are for example: therapy, counceling classes, support group, relaxation techniques, meditation, yoga, breathing exercices, autogenic trainingcreative activity....- There is a lot of research how people living with chronic pain can benefit from meditation and relaxation techniques. Watch out for the next episode!   Part 1 of this episode examined what you should be aiming for in your recovery and why this is important. Part-2 will show you proven techniques that help you in achieving what you aim for. find out more on www.mybackrecovery.com  Literature:  Scheermesser M, Bachmann S, Schämann A, et al. A qualitative study on the role of cultural background in patients’ perspectives on rehabilitation. BMC Musculoskelet Disord. 2012;13(5):5. doi:10.1186/1471-2474-13-5. Sackett DL, Rosenberg WMC, Gray JAM, et al. Evidence based medicine: what it is and what it isn’t. 1996. Clin Orthop Relat Res. 2007;455:3-5. http://www.ncbi.nlm.nih.gov/pubmed/17340682. Accessed December 16, 2012. Manske RC, Lehecka BJ. Evidence - based medicine/practice in sports physical therapy. Int J Sports Phys Ther. 2012;7(5):461-473. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3474298&tool=pmcentrez&rendertype=abstract. Accessed December 16, 2012. Jette DU, Bacon K, Batty C, et al. Evidence-based practice: beliefs, attitudes, knowledge, and behaviors of physical therapists. Phys Ther. 2003;83(9):786-805. http://www.ncbi.nlm.nih.gov/pubmed/12940766. Accessed October 5, 2012. Hooten W, Timming R, Belgrade M, et al. Assessment and Management of Chronic Pain.; 2013. Pakpour AH, Yaghoubidoust M, Campbell P. Persistent and developing sleep problems: a prospective cohort study on the relationship to poor outcome in patients attending a pain clinic with chronic low back pain. Pain Pract. 2017:1-2. doi:10.1111/papr.12584. 2015 Sleep in America Poll. Sleep Heal. 2015;1(2):e14-e375. doi:10.1016/j.sleh.2015.02.005. Morley S, Williams A. New Developments in the Psychological Management of Chronic Pain. CanJPsychiatry. 2015;6060(44):168-175.  

Recommendations based on current available evidence helps you combine your personal experience and expectations with research to form an individual treatment plan and find treatments with the most promising results.   What treatment should I consider for my back pain?  There are many guidelines regarding LBP and some even especially for chronic LBP. In this episode you will find information about the treatment options often recommended in these guidelines.   Setting evidence into your personal situation After having examined all the best available evidence from systematic research it is important to know how to apply this information to your individual situation. Evidenced based treatment is more than simply the best available evidence from systematic research alone. It should also take into account the expertise of your clinician(s) as well as your personal expectations, beliefs and preferences!1,2,3   Treatment Recommendations with strong supporting evidence Information, education and self-care "All the guidelines explicitly underline the importance of educating and providing patients with information on LBP with regard to their expected course and the possibility of effective prevention and selfcare options."4 Physical activity and therapeutic exercise "There is strong evidence that physical activity and therapeutic exercise are effective for the management of CLBP, even if it is not clear what kind of exercise is best. An individual, graded and active exercise program supervised by an expert (physical therapist) is almost always recommended."4 Multidisciplinary treatment programs "Combined physical and psychological interventions with cognitive-behavioral therapy and exercise are particularly recommended for people who have received at least one course of less intensive treatment and have high disability and/or significant psychological distress."4   All other forms of treatment are currently categorized using the following descriptions: Might do - recommendations with moderate supporting evidence Don’t know - recommendations with limited or inconclusive evidence Don’t do - recommendations with strong evidence against intervention   For more information of other treatment options please refer to the original article which can be found via the Internet: "An updated overview of clinical guidelines for chronic low back pain management in primary care."4   Find out more: www.mybackrecovery.com   Literature:   Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. 1996. Clin Orthop Relat Res. 2007;455:3–5. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17340682. Accessed December 16, 2012. Manske RC, Lehecka BJ. Evidence - based medicine/practice in sports physical therapy. Int J Sports Phys Ther. 2012;7(5):461–73. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3474298&tool=pmcentrez&rendertype=abstract. Accessed December 16, 2012. Jette DU, Bacon K, Batty C, et al. Evidence-based practice: beliefs, attitudes, knowledge, and behaviors of physical therapists. Phys Ther. 2003;83(9):786–805. Available at: http://www.ncbi.nlm.nih.gov/pubmed/12940766. Accessed October 5, 2012. Pillastrini P, Gardenghi I, Bonetti F, et al. An updated overview of clinical guidelines for chronic low back pain management in primary care. Jt Bone Spine. 2012;79(2):176–185. doi:10.1016/j.jbspin.2011.03.019.    

Johnny has fallen on an outstretched hand, and comes to you with a swollen, painful elbow.   Position of comfort, analgesia, xrays, and now what?   What am I seeing -- or not seeing -- here?     First a refresher on radiographic anatomy of the elbow --   Images courtesy of Radioglypics (Open Access Radiology Education). Used with permission. Now that we have our adult anatomy reviewed, let's go through the development of the elbow in a child. We are all born with primary ossification centers -- the basic shapes of our long bones.  Secondary ossification centers then develop around the ends of our long bones, and make interpretation of films in the context of suspected injury difficult. Elbow Interpretation Roadmap: CRITOE More pragmatic and utilitarian than a prosaic mnemonic, CRITOE helps us to remember the order of ossification of the pediatric elbow. Although children develop at different rates, the order of ossification is programmed into us.  Images courtesy of Radiopaedia.   Capitellum By age one, the capitellum ossifies. On the AP view, imagine a little white oval balloon floating in the darkness between the radius and the humerus.  Radial Head By age three, the capitellum gets another little balloon to join the party. The radial head is a bony little balloon that floats just above the floor.  If you see both little balloons floating on either ends of the space between the humerus and the radius – you know this child is about three years old. Internal Epicondyle By the age of five, the capitellum and radial head are no longer little floating balloons, but now taking on shapes that resemble what they will look like as an adult. By age five, you’ve grown out of balloons, and have moved on to Frisbees.  The internal epicondyle (meaning the medial epicondyle) starts to ossify by age five – a little bony Frisbee.   Trochlea By age seven, another little Frisbee flies around. On the AP view, the trochlea is superimposed on the humerus – if you look at the distal medial humerus, you’ll see the trochlea like a little oval Frisbee taking shape (see combined film below).   Olecranon By age nine, the olecranon of the ulna is ossifying.  In a nine year old, you’ll see a capitellum, radial head, internal epicondyle, trochlea, and olecranon. External Epidondyle By age 11, you start to ossify your external epicondyle (lateral epicondyle).           Pediatric Elbow Films: Putting It All Together Watch this dynamic video by Dr Jeremy Jones from Radiopaedia:   Fracture Saviors: Fat Pads and Drawn Lines These three things can save us: fat pads, the anterior humeral line, and the radiocapitellar line. Non-annotated images courtesy of Heidi Nunn. Normal anterior fat pad                 Sail sign: billowing hypodensity, indicating blood; sometimes the only (indirect) sign of an elbow fracture                 Posterior fat pad: always pathologic                 Radiocapitellar Line: anterior humeral line bisects the capitellum   Baumann’s angle (carrying angle): Normal is 70 to 75 degrees.  A difference between extremities of just 5 degrees or more is abnormal. Supracondylar fractures: Gartland Classification             Compartment Syndrome Pain out of proportion to exam, paresthesias, pallor, poikilothermia, pulselessness, and paralysis                   The 6 Ps of compartment syndrome are not sensitive in children. The only thing that may alert you to increasing compartment pressures in children is an increasing need for analgesics.       Volkmann's ischemic contracture Untreated compartment syndrome results in thrombosis, edema, ischemia, and disabling contracture.     Other Elbow Injuries (Details in podcast audio) Lateral Condyle Fracture Medial Epicondyle Fracture Radial head and radial neck fractures Olecranon fractures Elbow dislocation Radial head subluxation (nursemaid’s elbow) Medial epicondylar apophysitis (Little leager’s elbow)   Test your retention: check out this interactive post from the team at Don't Forget the Bubbles.     Key Points and Summary The most important pediatric elbow injury is the supracondylar fracture. Grade I is minimally displaced and needs a cast; Grade II is displaced, but with the posterior cortex intact; after closed reduction, the child may still need surgery; Grade III fractures all need closed reduction, internal fixation, and close monitoring for compartment syndrome. CRITOE gives us the order of ossification for the pediatric elbow – capitellum, radial head, internal epicondyle, trochlea, external epicondyle, and olecranon -- typically occurring at year 1, 3, 5, 7, 9, and 11 – remember the order is the most important thing – all ossification centers should be accounted for.  Make sure one is not missing – or where one has been “created” traumatically. If you don't see the obvious fracture, you can be "saved" by the sail sign and/or a posterior fat pad.  Also, make sure to look for the anterior humeral line – on the lateral view, a line drawn down the anterior humerus – if it intersects with the middle third of the capitellum, that is normal – it not, suspect a supracondylar fracture. The radiocapetellar line runs along the radial neck through the radial head and should line up nicely with the capitellum. If not, assume a fracture-dislocation. Close communication and coordination with the orthopedist will help us to get the right care at the right time – there is some variability with orthopedic practice, so be open to that – we can make out biggest impact by making the right diagnosis, and aggressively treating pain and effectively providing procedural sedation when needed. References Alton TB et al.  Classifications In Brief: The Gartland Classification of Supracondylar Humerus Fractures. Clin Orthop Relat Res. 2015 Feb; 473(2): 738–741. Hardwick J, S Srivastava S. Volkmann’s contracture of the forearm due to an insect bite: a case report and review of the literature. Ann R Coll Surg Engl. 2013 Mar; 95(2): e36–e37. Kanj WW et al. Acute compartment syndrome of the upper extremity in children: diagnosis, management, and outcomes. J Child Orthop. 2013 Jun; 7(3): 225–233. Krul M, van der Wouden JC, van Suijlekom-Smit LW, Koes BW. Manipulative interventions for reducing pulled elbow in young children. Cochrane Database Syst Rev. 2012 Jan 18;1:CD007759. Leung S, Paryavi E, Herman MJ, Sponseller PD, Abzug JM. Does the Modified Gartland Classification Clarify Decision Making? J Pediatr Orthop. 2016 Mar 11. [Epub ahead of print] Macias CG, Bothner J, Wiebe R. A comparison of supination/flexion to hyperpronation in the reduction of radial head subluxations. Pediatrics. 1998 Jul;102(1):e10. Mallo G, Stanat SJ, Gaffney J. Use of the Gartland classification system for treatment of pediatric supracondylar humerus fractures. Orthopedics. 2010 Jan;33(1):19. Bonus! Watch Larry Mellick Reduce a Nursemaid's Elbow! https://www.youtube.com/watch?v=-0ROu4hCXwQ This post and podcast are dedicated to Andy Neill, MBBS.  Thank you for your humanism and your dogged dedication to connect with the learner and simplify complex concepts.  Welcome back, Andy! Supracondylar Fractures Powered by #FOAMed -- Tim Horeczko, MD, MSCR, FACEP, FAAP