10 research outputs found
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 â„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 adolescentsâ and their parentsâ 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 pÄverka psykosocialt sÀkerhetsklimat?
Session 8Stress och psykosociala faktorerBeskrivning av en pĂ„gĂ„ende studie: Kan ett systematiskt arbete med psykosociala riskbedömningar pĂ„verka psykosocialt sĂ€kerhetsklimat?Rachael Berglund, Ulrika Hultgren & Tomas BackströmStressrelaterad ohĂ€lsa i arbetslivet kostar Europa âŹ617 miljard om Ă„ret och pĂ„verkar 40 miljoner enligt International Labour Organisation (ILO). Det psykosociala sĂ€kerhetsklimatet (PSK) lig-ger till grund för hur en organisation eller arbetsgrupp verkligen mĂ„r. 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 pĂ„verka det psykosociala sĂ€kerhetsklimatet, vĂ€lbefinnande och arbetets effektivitet i arbetsgrupper. TvĂ„ glo-bala industriföretag i Sverige ingĂ„r i studien. Interventionen riktar sig mot ledare och förvĂ€ntas pĂ„verka cirka 200 medarbetare per företag. Undersökningen har en kvasiexperimentell design med kontrollgrupp. EnkĂ€ter som mĂ€ter PSK, stressorer, vĂ€lbefinnande och effektivetet anvĂ€nds vid tre tidpunkter: en mĂ€tning före interventionen, en efter och en mĂ€tning efter ytterligare sex mĂ„nader. Interventionen innefattar tre faser. Under fas 1 utbildas ledarna i psykosocial sĂ€ker-het, PSK, riskbedömningar och team-coaching. Vid fas 2 arbetar ledaren tillsammans med sin arbetsgrupp för att upprĂ€tta och följa en handlingsplan med syfte att eliminera eller minska arbetsgruppens prioriterade risker. Fas 3 överlappar delvis med fas 2 och innehĂ„ller fyra möten med fokus pĂ„ psykosocial sĂ€kerhet dĂ€r chefen trĂ€ffar sina peers för chefsstöd och för att stĂ€rka coachningsbeteenden. Studien Ă€r unik eftersom PSK tidigare inte har anvĂ€nds tillsammans med Health and Safety Executivesâs management standards och dessutom för att team coachning anvĂ€nds i ett systematiskt arbete med psykosociala riskbedömningar
Kan ett systematiskt arbete med psykosociala riskbedömningar pÄverka psykosocialt sÀkerhetsklimat?
Session 8Stress och psykosociala faktorerBeskrivning av en pĂ„gĂ„ende studie: Kan ett systematiskt arbete med psykosociala riskbedömningar pĂ„verka psykosocialt sĂ€kerhetsklimat?Rachael Berglund, Ulrika Hultgren & Tomas BackströmStressrelaterad ohĂ€lsa i arbetslivet kostar Europa âŹ617 miljard om Ă„ret och pĂ„verkar 40 miljoner enligt International Labour Organisation (ILO). Det psykosociala sĂ€kerhetsklimatet (PSK) lig-ger till grund för hur en organisation eller arbetsgrupp verkligen mĂ„r. 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 pĂ„verka det psykosociala sĂ€kerhetsklimatet, vĂ€lbefinnande och arbetets effektivitet i arbetsgrupper. TvĂ„ glo-bala industriföretag i Sverige ingĂ„r i studien. Interventionen riktar sig mot ledare och förvĂ€ntas pĂ„verka cirka 200 medarbetare per företag. Undersökningen har en kvasiexperimentell design med kontrollgrupp. EnkĂ€ter som mĂ€ter PSK, stressorer, vĂ€lbefinnande och effektivetet anvĂ€nds vid tre tidpunkter: en mĂ€tning före interventionen, en efter och en mĂ€tning efter ytterligare sex mĂ„nader. Interventionen innefattar tre faser. Under fas 1 utbildas ledarna i psykosocial sĂ€ker-het, PSK, riskbedömningar och team-coaching. Vid fas 2 arbetar ledaren tillsammans med sin arbetsgrupp för att upprĂ€tta och följa en handlingsplan med syfte att eliminera eller minska arbetsgruppens prioriterade risker. Fas 3 överlappar delvis med fas 2 och innehĂ„ller fyra möten med fokus pĂ„ psykosocial sĂ€kerhet dĂ€r chefen trĂ€ffar sina peers för chefsstöd och för att stĂ€rka coachningsbeteenden. Studien Ă€r unik eftersom PSK tidigare inte har anvĂ€nds tillsammans med Health and Safety Executivesâs management standards och dessutom för att team coachning anvĂ€nds 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 C5âC6 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 68â±â9 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%, pâ=â0.002) was higher and long-term-cumulative survival lower (77% versus 87% at five years, pâ=â0.043) 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)/
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