A comparison of two treatment protocols in the management of exercise-associated postural hypotension (EAPH) : a randomised clinical trial

Includes bibliographical references (p. 79-83).The aim of this study was to compare which of the two commonly used treatment protocols for Exercise Associated Postural Hypotension (EAPH) (Trendelenburg with oral fluids ad libitum or intravenous fluids) result in quicker recovery and earlier discharge from the medical facility

Assessment and management of shoulder pain at primary care level

Most patients with shoulder pain will initially visit their community health centre, private general practitioner or family physician, with various levels of experience in the assessment and management of shoulder conditions. Shoulder conditions will range from early, simple ailments that can be treated in the primary care setting, to post-traumatic injuries and complex pathologies requiring the expertise of an orthopaedic surgeon or a fellowship-trained shoulder surgeon. Correct assessment of the patient’s shoulder condition at the index consultation is a prerequisite for appropriate management. This article sets out straightforward guidelines to help general practitioners confidently identify the patient’s source of shoulder pain and initiate an appropriate management plan at primary care level. Criteria for urgent and elective referral for specialist care are also outlined

An analysis of the biomechanics of interference screw fixation and sheathed devices for biceps tenodesis

Background This study aimed to evaluate the differences in biomechanical properties of biceps tenodesis when performed with sheathed versus unsheathed screws and also to investigate the effect of altering the pre-tension. Methods Tenodesis was performed in an in vitro model using biomechanical test blocks and ovine tendons. Blocks were allocated to 1 of 5 groups which varied by method of tenodesis and cyclical loading protocol: Group A, Biosure PK screw (10-100 N), Group B: 7-8 mm Biosure Sync and Biosure PK screw (10-100 N), Group C: Biosure PK screw (10-70 N), Group D: Biosure PK (20-100 N), and Group E: custom sheath and Biosure PK screw (10-100 N). If tenodeses remained intact after 500 cycles maximum load to failure testing was performed. Findings 30% of tenodeses in Group A failed prior to 500 cycles whereas none failed in the sheathed device groups (P = 0.02). Using a sheathed device prevented mal-rotation. However, tenodeses in Group B were more likely to fail immediately distal to the tenodesis at a load below the anticipated maximum load to failure suggesting tendon damage during fixation. Using the custom sheath, which did not have sharp edges, resulted in a statistically significant increased maximum load to failure in Group E (348 N) when compared to Group A (228 N, mean difference 120 N, P = 0.01) and Group B (253 N, mean difference 95 N, P = 0.0007). Interpretation Sheathed devices prevent mal-rotation and increase stiffness and maximum load to failure. This is further improved by reducing tendon damage at the time of tenodesis.This study was supported by funding from The Royal Orthopaedic Hospital Research Grant Committee, The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, West Midlands, B31 2AP, UK. This studywas also supported by an Educational Grant of Equipmentfor Study by Smith and Nephew, Cardinal Park, Godmanchester, Huntingdon, Cambridgeshire, PE29 2SN. No funding was received. This grant provided Ultrabraid Suture, Biosure PK screws, Biosure Sync Devices and the instrumentation required for these implants only