On the rotational deformity of the shoulder following an obstetric brachial plexus palsy

An internal rotation deformity of the shoulder occurs very frequently in brachial plexus birth palsy. Even though surprisingly accurate descriptions of the deformity were already published at the beginning of the 1900s, the nature of the deformity is not well understood and there is no consensus regarding surgical treatment. This thesis was aimed at improving the scientific basis for surgical treatment of the deformity. In study I the passive mechanical properties of single cells and muscle bundles were investigated in muscle biopsy specimens harvested from the subscapularis muscle in nine children with birth palsy who had undergone open surgery for shoulder contracture. Biopsy specimens from seven healthy subjects were used as controls. Single muscle fibres from patients with birth palsy displayed a shorter slack sarcomere length and linear deformation of the fibre within a wider zone of sarcomere length. There was a greater relative increase in stiffness for fibre bundles / single fibres compared to the controls. Study II was an investigation of the histopathology of muscle biopsies harvested from the subscapularis muscle in 13 children operated on for brachial plexus birth palsy. The majority of the subscapularis muscle biopsy samples had an essentially normal morphology and showed a predominance of type I myosin heavy chain isoform (slow fibres), while one sample showed signs of fibrosis. The findings of studies I and II are interpreted to be consistent with the theory that the shortening of the subscapularis in a majority of patients is a result of altered muscular balance following the nerve injury. Study III was an evaluation of the results at one year after surgical correction of internal rotational deformities in the shoulders of 270 patients with birth palsy, using open subscapularis elongation and latissimus dorsi-to-infraspinatus transfer, alone or in combination. Open relocation was performed on incongruent joints. Ninety-two per cent (97 of 105) of the incongruent joint could be relocated, with an upper age limit of 12 years for the subluxed joints and 5 years for dislocated joints. There was a substantial overall mean improvement in external rotation and the Mallet score following surgery and a notable decrease in the mean internal rotation for the relocated joints, but not for the congruent joints. The trumpet sign was corrected in 83%. Adding a latissimus dorsi transfer did not result in greater improvement in the mean external rotation compared with elongation of the subscapularis alone. Study IV was an evaluation of the long-term effects in 118 of the patients from study III, using the same protocol. There was an overall moderate decrease in the mean rotational range compared with the results at one year post surgery, while abduction remained unchanged, as did the correction of the trumpet sign. One out of four patients with relocated joints had required additional surgery in order to adjust the range of rotation or to stabilise the joint. In conclusion, the open subscapularis elongation produced a good long-term correction of the deformity with lasting elimination of the trumpet sign and reduction of incongruent joints and with a moderate mean loss of internal rotation. Long-term monitoring of the patients operated on is recommended because of the large individual variations and the need for additional surgery in selected patients

Obstetric brachial plexus injury : expectations before and satisfaction three months after secondary surgery on the shoulder

Introduction: Children affected by obstetrical brachial plexus injury frequently have residual external rotation weakness in the shoulder. Secondary surgical procedures are available for improvement. The aim of this study was to describe and compare children's and parents' expectations, the importance of selected arm/hand function, and performance of activities before and satisfaction after surgical correction of rotation deformity in the shoulder. Method: In the Department of Hand Surgery, Södersjukhuset Sweden, all patients ≥4-year-olds (n = 42) affected by obstetrical plexus injury who underwent secondary surgery to release rotation contracture of the shoulder were included in this study between November 2001 and May 2006. A disease-specific questionnaire was developed and used. Results: The expectations before surgery were that the majority of the activities and functions would be improved. There were some differences between the adolescents’ and their parents’ expectations. After surgery, both children and parents were overall satisfied. Conclusion: This study shows that expectations before surgery were high and both children and parents reported positive experiences three months after surgery. A long-term study is warranted if final conclusions are to be drawn.NoneManuscrip

Kan ett systematiskt arbete med psykosociala riskbedömningar påverka psykosocialt säkerhetsklimat?

Session 8Stress och psykosociala faktorerBeskrivning av en pågående studie: Kan ett systematiskt arbete med psykosociala riskbedömningar påverka psykosocialt säkerhetsklimat?Rachael Berglund, Ulrika Hultgren & Tomas BackströmStressrelaterad ohälsa i arbetslivet kostar Europa €617 miljard om året och påverkar 40 miljoner enligt International Labour Organisation (ILO). Det psykosociala säkerhetsklimatet (PSK) lig-ger till grund för hur en organisation eller arbetsgrupp verkligen mår. Enligt lagstiftningen idag i Europa ska alla arbetsplatser arbeta förebyggande för att eliminera eller minska identifierade riskfaktorer, vilket inkluderar psykosociala risker. Denna studie har som syfte att undersöka om ett systematiskt arbete med riskbedömningar av den psykosociala arbetsmiljön kan påverka det psykosociala säkerhetsklimatet, välbefinnande och arbetets effektivitet i arbetsgrupper. Två glo-bala industriföretag i Sverige ingår i studien. Interventionen riktar sig mot ledare och förväntas påverka cirka 200 medarbetare per företag. Undersökningen har en kvasiexperimentell design med kontrollgrupp. Enkäter som mäter PSK, stressorer, välbefinnande och effektivetet används vid tre tidpunkter: en mätning före interventionen, en efter och en mätning efter ytterligare sex månader. Interventionen innefattar tre faser. Under fas 1 utbildas ledarna i psykosocial säker-het, PSK, riskbedömningar och team-coaching. Vid fas 2 arbetar ledaren tillsammans med sin arbetsgrupp för att upprätta och följa en handlingsplan med syfte att eliminera eller minska arbetsgruppens prioriterade risker. Fas 3 överlappar delvis med fas 2 och innehåller fyra möten med fokus på psykosocial säkerhet där chefen träffar sina peers för chefsstöd och för att stärka coachningsbeteenden. Studien är unik eftersom PSK tidigare inte har används tillsammans med Health and Safety Executives’s management standards och dessutom för att team coachning används i ett systematiskt arbete med psykosociala riskbedömningar

Kan ett systematiskt arbete med psykosociala riskbedömningar påverka psykosocialt säkerhetsklimat?

Session 8Stress och psykosociala faktorerBeskrivning av en pågående studie: Kan ett systematiskt arbete med psykosociala riskbedömningar påverka psykosocialt säkerhetsklimat?Rachael Berglund, Ulrika Hultgren & Tomas BackströmStressrelaterad ohälsa i arbetslivet kostar Europa €617 miljard om året och påverkar 40 miljoner enligt International Labour Organisation (ILO). Det psykosociala säkerhetsklimatet (PSK) lig-ger till grund för hur en organisation eller arbetsgrupp verkligen mår. Enligt lagstiftningen idag i Europa ska alla arbetsplatser arbeta förebyggande för att eliminera eller minska identifierade riskfaktorer, vilket inkluderar psykosociala risker. Denna studie har som syfte att undersöka om ett systematiskt arbete med riskbedömningar av den psykosociala arbetsmiljön kan påverka det psykosociala säkerhetsklimatet, välbefinnande och arbetets effektivitet i arbetsgrupper. Två glo-bala industriföretag i Sverige ingår i studien. Interventionen riktar sig mot ledare och förväntas påverka cirka 200 medarbetare per företag. Undersökningen har en kvasiexperimentell design med kontrollgrupp. Enkäter som mäter PSK, stressorer, välbefinnande och effektivetet används vid tre tidpunkter: en mätning före interventionen, en efter och en mätning efter ytterligare sex månader. Interventionen innefattar tre faser. Under fas 1 utbildas ledarna i psykosocial säker-het, PSK, riskbedömningar och team-coaching. Vid fas 2 arbetar ledaren tillsammans med sin arbetsgrupp för att upprätta och följa en handlingsplan med syfte att eliminera eller minska arbetsgruppens prioriterade risker. Fas 3 överlappar delvis med fas 2 och innehåller fyra möten med fokus på psykosocial säkerhet där chefen träffar sina peers för chefsstöd och för att stärka coachningsbeteenden. Studien är unik eftersom PSK tidigare inte har används tillsammans med Health and Safety Executives’s management standards och dessutom för att team coachning används i ett systematiskt arbete med psykosociala riskbedömningar

Nerve Tracing in Juvenile Rats: A Feasible Model for the Study of Brachial Plexus Birth Palsy and Cocontractions?

Brachial plexus birth injuries cause diminished motor function in the upper extremity. The most common sequel is internal rotation contracture. A number of these patients also suffer from cocontractions, preventing the use of an otherwise good passive range of motion in the shoulder. One theory behind the co-contracture problem is that injured nerve fibers grow into distal support tissue not corresponding to the proximal support tissue, resulting in reinnervation of the wrong muscle groups. To further elucidate this hypothesis, we used rat neonates to investigate a possible model for the study of cocontractions in brachial plexus birth injuries. Five-day-old rats were subjected to a crush injury to the C5–C6 roots. After a healing period of 4 weeks, the infraspinatus muscle was injected with Fluoro-Gold. A week later, the animals were perfused and spinal cords harvested and sectioned. Differences in the uptake of Fluoro-Gold and NeuN positive cells of between sides of the spinal cord were recorded. We found a larger amount of Fluoro-Gold positive cells on the uninjured side, while the injured side had positive cells dispersed over a longer area in the craniocaudal direction. Our findings indicate that the method can be used to trace Fluoro-Gold from muscle through a neuroma. Our results also indicate that a neuroma in continuity somewhat prevents the correct connection from being established between the motor neuron pool in the spinal cord and target muscle and that some neurons succumb to a crushing injury. We also present future research ideas

Nerve Tracing in Juvenile Rats : A Feasible Model for the Study of Brachial Plexus Birth Palsy and Cocontractions?

Brachial plexus birth injuries cause diminished motor function in the upper extremity. The most common sequel is internal rotation contracture. A number of these patients also suffer from cocontractions, preventing the use of an otherwise good passive range of motion in the shoulder. One theory behind the co-contracture problem is that injured nerve fibers grow into distal support tissue not corresponding to the proximal support tissue, resulting in reinnervation of the wrong muscle groups. To further elucidate this hypothesis, we used rat neonates to investigate a possible model for the study of cocontractions in brachial plexus birth injuries. Five-day-old rats were subjected to a crush injury to the C5-C6 roots. After a healing period of 4 weeks, the infraspinatus muscle was injected with Fluoro-Gold. A week later, the animals were perfused and spinal cords harvested and sectioned. Differences in the uptake of Fluoro-Gold and NeuN positive cells of between sides of the spinal cord were recorded. We found a larger amount of Fluoro-Gold positive cells on the uninjured side, while the injured side had positive cells dispersed over a longer area in the craniocaudal direction. Our findings indicate that the method can be used to trace Fluoro-Gold from muscle through a neuroma. Our results also indicate that a neuroma in continuity somewhat prevents the correct connection from being established between the motor neuron pool in the spinal cord and target muscle and that some neurons succumb to a crushing injury. We also present future research ideas

Acute coronary angiography after coronary artery bypass grafting

To access publisher's full text version of this article. Please click on the hyperlink in Additional Links field.Objectives Coronary angiography is the golden standard when myocardial ischemia after CABG occurs. We summarize our experience of acute coronary angiography after CABG. Design All 4446 patients (mean age 68 ± 9 years, 22% women) who underwent CABG 2007 to 2012 were included in this retrospective observational study. Incidence, indications, findings, measures of acute angiography after CABG was assessed. Outcome variables were compared between patients who underwent angiography and those who did not. Results Eighty-seven patients (2%) underwent acute coronary angiography. Patients undergoing angiography had ECG changes (92%), echocardiographic alterations (48%), hemodynamic instability (28%), angina (15%), and/or arrhythmia (13%). Positive findings were detected in 69% of the cases. Only ECG changes as indication for angiography had a moderate association with positive findings, but the precision increased if other sign(s) of ischemia were present. Thirty-day mortality (7% versus 2%, p = 0.002) was higher and long-term-cumulative survival lower (77% versus 87% at five years, p = 0.043) in angiography patients. Conclusions Acute angiography is a rare event after CABG. Postoperative myocardial ischemia leading to acute coronary angiography is associated with increased short-term and long-term mortality.Vastra Gotaland Healthcare Region (ALF/LUA)/ 14628