Change in Driving Performance following Arthroscopic Shoulder Surgery
The current study aimed to measure perioperative changes in driving performance following arthroscopic shoulder surgery using a validated driving simulator.21 patients who underwent arthroscopic surgery for rotator cuff or labral pathology were tested on a driving simulator preoperatively, and 6 and 12 weeks postoperatively. An additional 21 subjects were tested to establish driving data in a control cohort. The number of collisions, centerline crossings, and off-road excursions were recorded for each trial. VAS and SPADI scores were obtained at each visit.The mean number of collisions in the study group significantly increased from 2.05 preoperatively to 3.75 at 6 weeks (p<0.001), and significantly decreased to 1.95 at 12 weeks (p<0.001). Centerline crossings and off-road excursions did not significantly change from preoperative through 12 weeks, although centerline crossings were statistically different from the controls at each time point (p<0.001). Surgery on the dominant driving arm resulted in greater collisions at 6 weeks than surgery on the non-dominant driving arm (p<0.001).Preliminary data shows that driving performance is impaired for at least 6 weeks postoperatively, with a return to normal driving by 12 weeks. Driving is more profoundly affected in conditions that require avoiding a collision and when the dominant driving arm is involved.
Bifurcated distal bicep tendon with an isolated rupture of the distal long head tendon at insertion site: A unique anatomical variant and injury pattern [Meeting Abstract]
Case Description: A 35-year-old man with no significant past medical history presented with a 10-week history of left arm pain. The pain started while pulling a lat-pull bar in a flexed-elbow position followed by a fast eccentric contraction. He felt sudden pain in the left antecubital fossa that persisted for 10 weeks and was associated with weakness. Physical examination revealed pain and weakness with resisted forearm supination and flexion. Hook test and "Popeye" deformity were negative. Setting: Tertiary Care Center. Results or Clinical Course: MRI showed a full thickness tear at the distal insertion of the long head bicep tendon with an intact short head bicep tendon. The patient underwent surgical repair followed by physical therapy and regained full bicep strength with return to pre-injury exercise. Discussion: Bicep tendon ruptures most commonly occur in males between ages 40 to 60 with incidence of 1.2 per 100,000. Mechanism of injury involves eccentric contraction of a flexed forearm, followed by pain and significant weakness in forearm flexion and supination. The two bicep brachii typically unite into one tendon that inserts onto the radial tuberosity. Additional anatomical variations include bifurcation of the distal short and long head tendons at insertion site. Several injury patters at the insertion site have been reported and most commonly include ruptures of the short head tendon with or without a concomitant rupture of the long head bicep tendon. Literature on distal long head rupture with an intact short head component in the setting of a bifurcated bicep tendon is limited. Conclusions: This case demonstrates a patient with a unique anatomical variant at the distal bicep tendon insertion site who sustained a rare injury involving a complete tear of the distal long head bicep tendon with an intact short head component. This was a rather challenging diagnosis to make as this patient presented late after initial injury and did not have typical physical examination findings of a!
Effect of acid-suppressive therapy on narrow band imaging findings in gastroesophageal reflux disease: a pilot study
Standard endoscopy is an insensitive test for gastroesophageal reflux disease (GERD). Narrow band imaging (NBI) endoscopy enhances visualization of the distal esophagus. NBI patterns like intrapapillary capillary loop (IPCL) dilatation, tortuosity, and increased number; microerosions; increased vascularity at the squamocolumnar junction (SCJ); ridge-villous pattern below the SCJ; and presence of columnar islands in the distal esophagus have been suggested as features of GERD. We evaluated the effect of proton pump inhibitor (PPI) therapy on NBI findings in GERD patients. Patients prospectively underwent NBI upper endoscopy before and after PPI therapy. NBI findings were recorded at each endoscopy. Twenty-one patients with GERD symptoms (mean age 60.0 years; males 90.5%; white 90.5%) were studied. After PPI therapy, there was a significant reduction in the proportion of patients with the following NBI features: IPCL tortuosity (90% vs. 4.8%, P < 0.0001), dilated IPCLs (86% vs. 9.5%, P < 0.0001), and increased vascularity at the SCJ (43% vs. 9.5%, P= 0.0082). PPI led to healing of all microerosions (71% vs. 0%, P < 0.0001) and disappearance of ridge-villous patterns below the SCJ (14% vs. 0%, P < 0.0001). There was no significant change in the proportion of patients with increased numbers of IPCLs pre- and post-PPI therapy (71% vs. 48%, P= 0.09) or columnar islands in the distal esophagus (38% vs. 29%, P= 0.31). In patients with GERD symptoms, NBI features suggestive of GERD respond to PPI; suggesting these features are truly acid-mediated. These findings need to be confirmed by randomized controlled trials.