Case Presentation for Suprascapular Neuropathy

CASE HISTORY: The patient is an 18-year-old female collegiate volleyball player who has suffered progressive shoulder pain in her right shoulder. She states that the pain has progressively gotten worse over the past 3-4 years. The sharp pain began when she would raise her right arm above 90 degrees when hitting an overhand serve. Over time, the pain progressed and became noticeable in additional movements. The patient had noted significant weakness in both her right arm and right shoulder. The patient states when she sleeps on her right arm/shoulder she wakes up in severe pain. She has tried sleeping with the right elbow in extension which has helped in alleviating the pain. PHYSICAL EXAM: The patient’s vital signs were all within normal ranges. A physical exam was performed and identified pain with Hawkins-Kennedy and empty can. Manual muscle testing demonstrated infraspinatus (2/5) and supraspinatus (3/5) weakness. Upper Quarter Y Balance Test revealed right and left composite scores of 85.7 and 96.1, respectively. DIFFERENTIAL DIAGNOSES: Suprascapular nerve palsy; Ulnar nerve palsy; Infraspinatus atrophy; Subacromial impingement syndrome; and rotator cuff injury. TESTS & RESULTS: An X-ray for the right arm and shoulder was also preformed which did not show any pathologies. The patient had a magnetic resonance imaging (MRI) of the right arm and shoulder revealing two lesions in the head of the humerus. An MRI of the cervical spine without contrast was preformed and revealed a mild disk bulge at C5 and C6 with no significant Neural Foraminal Stenosis (NF) narrowing. There was straightening and very slight reversal of the normal cervical lordosis. A nerve conduction study was performed and identified a right sided suprascapular neuropathy at the spinoglenoid notch with significant motor axon loss. Lastly, electrophysiologic testing was done which identified right sided ulnar neuropathy. FINAL DIAGNOSIS: Right sided suprascapular neuropathy at the spinoglenoid notch. Right sided ulnar neuropathy. DISCUSSION: Suprascapular neuropathy is a very uncommon cause for shoulder pain and is often times misdiagnosed. Frequently the diagnosis of suprascapular neuropathy is mistaken for subacromial impingement syndrome, rotator cuff injuries, etc. Common signs and symptoms of suprascapular neuropathy are pain and weakness in the shoulder, atrophy, and often burning and aching. Suprascapular neuropathy is reported to only be found in 0.4% of patients with shoulder pain. The compression of the suprascapular nerve at the spinoglenoid notch is often due to repetitive use and space-occupying lesions. Athletes that perform sports like tennis, weight-lifting, and volleyball are more likely to experience a suprascapular neuropathy injury. OUTCOME OF THE CASE: The patient has been diagnosed with suprascapular neuropathy caused by compression of the suprascapular nerve at the spinoglenoid notch. This patient has been prescribed a rehabilitation program involving the throwers ten to strengthen her rotator cuff muscles along with improving her scapular and glenohumeral stabilization and proprioception. The athlete is participating in normal practice and play and has been told to take over the counter anti-inflammatory medications such as ibuprofen, as needed. RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: The patient is to remain in normal practice and play and continue her basic rehabilitation program. She has been referred to a surgical doctor and has been asked to seek a surgical consultation in the future

Gender Differences in Incremental Force Production Accuracy Following a 3-, 6-, or 12-Week Strength Training Course

Subjective muscular force production is a commonly used psychophysiological method in resistance training and physical rehabilitation. However, limited research is available regarding whether differences exist in match-force production accuracy between male and female adults. PURPOSE: The purpose of this study was to examine the gender differences in perceived force production accuracy following participation in a strength training course. METHODS: Participants (20 males, 26 females) were sampled from an undergraduate strength training course. Using a hand-grip dynamometer, maximal and incremental force production measurements were collected with the participants in a seated position with their dominant forearm resting on a table. Participants were asked to produce a maximal force on the hand-grip dynamometer followed by two sets of incremental force measures at 25%, 50%, 75%, and 100% of maximal effort with adequate rest in between bouts. Incremental hand-grip measurements were repeated following a 3-, 6-, or 12-week strength training course. A linear regression analysis was used to examine the relationship between gender and hand-grip force error for the increments of force. RESULTS: Results indicated that the most variance in error was at the submaximal muscular force production of 25%, whereas the most accurate increment was at 100%, regardless of duration (3-, 6-, or 12-weeks) of participation in the strength training course (r2 = 0.046, p \u3c 0.001). For increments of lower exertion (i.e., 25% and 50%), there was no significant differences between male and female participants. However, for higher incremental force exertion (i.e., 75% and 100%), approximately 23% of variance (r2 = 0.230, p \u3c 0.001) and 32% of variance (r2 = 0.322, p \u3c 0.001) in force production accuracy, respectively, can be accounted for by gender. CONCLUSION: Following exposure to strength training instruction, physically active female adults are more accurate in force production at incremental exertion levels (i.e., 25%, 50%, 75% of maximal force), whereas males have greater match-force accuracy at 100% of maximal force production

Loneliness and sleep: A systematic review and meta-analysis

Despite the mounting evidence linking loneliness with health, the mechanisms underlying this relationship remain obscure. This systematic review and meta-analysis on the association between loneliness and one potential mechanism—sleep—identified 27 relevant articles. Loneliness correlated with self-reported sleep disturbance (r = .28, 95% confidence interval (.24, .33)) but not duration, across a diverse set of samples and measures. There was no evidence supporting age or gender as moderators or suggesting publication bias. The longitudinal relationship between loneliness and sleep remains unclear. Loneliness is related to sleep disturbance, but research is necessary to determine directionality, examine the influence of other factors, and speak to causality

A Large Catalog of Homogeneous Ultra-Violet/Optical GRB Afterglows: Temporal and Spectral Evolution

We present the second Swift Ultra-Violet/Optical Telescope (UVOT) gamma-ray burst (GRB) afterglow catalog, greatly expanding on the first Swift UVOT GRB afterglow catalog. The second catalog is constructed from a database containing over 120,000 independent UVOT observations of 538 GRBs first detected by Swift, the High Energy Transient Explorer 2 (HETE2), the INTErnational Gamma-Ray Astrophysics Laboratory (INTEGRAL), the Interplanetary Network (IPN), Fermi, and Astro-rivelatore Gamma a Immagini Leggero (AGILE). The catalog covers GRBs discovered from 2005 Jan 17 to 2010 Dec 25. Using photometric information in three UV bands, three optical bands, and a `white' or open filter, the data are optimally co-added to maximize the number of detections and normalized to one band to provide a detailed light curve. The catalog provides positional, temporal, and photometric information for each burst, as well as Swift Burst Alert Telescope (BAT) and X-Ray Telescope (XRT) GRB parameters. Temporal slopes are provided for each UVOT filter. The temporal slope per filter of almost half the GRBs are fit with a single power-law, but one to three breaks are required in the remaining bursts. Morphological comparisons with the X-ray reveal that approximately 75% of the UVOT light curves are similar to one of the four morphologies identified by Evans et al. (2009). The remaining approximately 25% have a newly identified morphology. For many bursts, redshift and extinction corrected UV/optical spectral slopes are also provided at 2000, 20,000, and 200,000 seconds.Comment: 44 pages, 14 figures, to be published in Astrophysical Journal Supplementa

Facing the River Gauntlet: Understanding the Effects of Fisheries Capture and Water Temperature on the Physiology of Coho Salmon

An improved understanding of bycatch mortality can be achieved by complementing field studies with laboratory experiments that use physiological assessments. This study examined the effects of water temperature and the duration of net entanglement on physiological disturbance and recovery in coho salmon (Oncorhynchus kisutch) after release from a simulated beach seine capture. Heart rate was monitored using implanted electrocardiogram biologgers that allowed fish to swim freely before and after release. A subset of fish was recovered in respirometers to monitor metabolic recovery, and separate groups of fish were sacrificed at different times to assess blood and white muscle biochemistry. One hour after release, fish had elevated lactate in muscle and blood plasma, depleted tissue energy stores, and altered osmoregulatory status, particularly in warmer (15 vs. 10°C) and longer (15 vs. 2 min) capture treatments. A significant effect of entanglement duration on blood and muscle metabolites remained after 4 h. Oxygen consumption rate recovered to baseline within 7–10 h. However, recovery of heart rate to routine levels was longer and more variable, with most fish taking over 10 h, and 33% of fish failing to recover within 24 h. There were no significant treatment effects on either oxygen consumption or heart rate recovery. Our results indicate that fishers should minimize handling time for bycatch and maximize oxygen supply during crowding, especially when temperatures are elevated. Physiological data, such as those presented here, can be used to understand mechanisms that underlie bycatch impairment and mortality, and thus inform best practices that ensure the welfare and conservation of affected species

Phenotypic and Genotypic Characterization of Escherichia coli Isolated from Untreated Surface Waters

A common member of the intestinal microbiota in humans and animals is Escherichia coli. Based on the presence of virulence factors, E. coli can be potentially pathogenic. The focus of this study was to isolate E. coli from untreated surface waters (37 sites) in Illinois and Missouri and determine phenotypic and genotypic diversity among isolates. Water samples positive for fecal coliforms based on the Colisure® test were streaked directly onto Eosin Methylene Blue (EMB) agar (37°C) or transferred to EC broth (44.5°C). EC broth cultures producing gas were then streaked onto EMB agar. Forty-five isolates were identified as E. coli using API 20E and Enterotube II identification systems, and some phenotypic variation was observed in metabolism and fermentation. Antibiotic susceptibility of each isolate was also determined using the Kirby-Bauer Method. Differential responses to 10 antimicrobial agents were seen with 7, 16, 2, and 9 of the isolates resistant to ampicillin, cephalothin, tetracycline, and triple sulfonamide, respectively. All of the isolates were susceptible or intermediate to amoxicillin, ciprofloxacin, polymyxin B, gentamicin, imipenem, and nalidixic acid. Genotypic variation was assessed through multiplex Polymerase Chain Reaction for four virulence genes (stx1 and stx2 [shiga toxin], eaeA [intimin]; and hlyA [enterohemolysin]) and one housekeeping gene (uidA [-D-glucuronidase]). Genotypic variation was observed with two of the isolates possessing the virulence gene (eaeA) for intimin. These findings increase our understanding of the diversity of E. coli in the environment which will ultimately help in the assessment of this organism and its role in public health

Reduction in the population prevalence of hepatitis C virus viraemia among people who inject drugs associated with scale-up of direct-acting anti-viral therapy in community drug services:REAL WORLD DATA

BACKGROUND AND AIMS: There has been little empirical evidence to show the 'real-world' impact of scaling-up direct-acting anti-viral (DAA) treatment among people who inject drugs (PWID) on hepatitis C virus (HCV) viraemia at a population level. We aimed to assess the population impact of rapid DAA scale-up to PWID delivered through community services-including drug treatment, pharmacies, needle exchanges and prisons-in the Tayside region of Scotland, compared with Greater Glasgow and Clyde (GGC) and the Rest of Scotland (RoS). FINDINGS: Uptake of HCV therapy (last year) among PWID between 2013-14 and 2017-18 increased from 15 to 43% in Tayside, 6 to 16% in GGC and 11 to 23% in RoS. Between 2010 and 2017-18, the prevalence of HCV viraemia (among antibody-positives) declined from 73 to 44% in Tayside, 67 to 58% in GGC and 64 to 55% in RoS. The decline in viraemia was greater in Tayside [2017-18 adjusted odds ratio (aOR) = 0.47, 95% confidence interval (CI) = 0.30-0.75, P = 0.001] than elsewhere in Scotland (2017-18 aOR = 0.89, 95% CI = 0.74-1.07, P = 0.220) relative to the baseline of 2013-14 in RoS (including GGC). Per-protocol SVR rates among PWID treated in community sites did not differ from those treated in hospital sites in Tayside (97.4 versus 100.0%, P = 0.099). CONCLUSIONS: Scale-up of direct-acting anti-viral treatment among people who inject drugs can be achieved through hepatitis C virus (HCV) testing and treatment in community drug services while maintaining high sustained viral response rates and, in the Tayside region of Scotland, has led to a substantial reduction in chronic HCV in the population

Refinement of Saliva MicroRNA Biomarkers for Sports-Related Concussion

Purpose Recognizing sport-related concussion (SRC) is challenging and relies heavily on subjective symptom reports. An objective, biological marker could improve recognition and understanding of SRC. There is emerging evidence that salivary micro-ribonucleic acids (miRNAs) may serve as biomarkers of concussion; however, it remains unclear whether concussion-related miRNAs are impacted by exercise. We sought to determine whether 40 miRNAs previously implicated in concussion pathophysiology were affected by participation in a variety of contact and non-contact sports. Our goal was to refine a miRNA-based tool capable of identifying athletes with SRC without the confounding effects of exercise. Methods This case-control study harmonized data from concussed and non-concussed athletes recruited across 10 sites. Levels of salivary miRNAs within 455 samples from 314 individuals were measured with RNA sequencing. Within-subjects testing was used to identify and exclude miRNAs that changed with either: (a) a single episode of exercise (166 samples from 83 individuals) or (b) season-long participation in contact sports (212 samples from 106 individuals). The miRNAs that were not impacted by exercise were interrogated for SRC diagnostic utility using logistic regression (172 samples from 75 concussed and 97 non-concussed individuals). Results Two miRNAs (miR-532-5p, miR-182-5p) decreased (adjusted p \u3c 0.05) after a single episode of exercise, and 1 miRNA (miR-4510) increased only after contact sports participation. Twenty-three miRNAs changed at the end of a contact sports season. Two of these miRNAs (miR-26b-3p, miR-29c-3p) were associated (R \u3e 0.5; adjusted p \u3c 0.05) with the number of head impacts sustained in a single football practice. Among the 15 miRNAs not confounded by exercise or season-long contact sports participation, 11 demonstrated a significant difference (adjusted p \u3c 0.05) between concussed and non-concussed participants, and 6 displayed moderate ability (AUC \u3e 0.70) to identify concussion. A single ratio (miR-27a-5p/miR-30a-3p) displayed the highest accuracy (AUC = 0.810, sensitivity = 82.4%, specificity = 73.3%) for differentiating concussed and non-concussed participants. Accuracy did not differ between participants with SRC and non-SRC (z = 0.5, p = 0.60). Conclusion Salivary miRNA levels may accurately identify SRC when not confounded by exercise. Refinement of this approach in a large cohort of athletes could eventually lead to a non-invasive, sideline adjunct for SRC assessment