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The Frequently Forgotten Pediatrics
Published in Christopher M. Hayre, William A. S. Cox, General Radiography, 2020
The World Health Organization (WHO) reports the top five etiologies for unintentional injuries due to road traffic accidents (RTAs): falls, burns, drowning, and poisoning (Chandran et al., 2010). Alarming numbers linked to injuries and deaths are also related to war, disasters, and child abuse. Although the prevalence and type of abuse may vary by location, the signs and symptoms are often similar. Children can present with symptoms such as retinal hemorrhage, subdural hemorrhage, and encephalopathy or evidence of diffuse axonal injury (Gonzalez & McCall, 2018). Additionally, child abuse could be considered when features are not consistent with the history provided, such as rib fractures, bruises of the ears, toes, or in the form of handprints (Kiragu et al., 2018). A helpful mnemonic for assessing which bruises are more concerning is the ‘TEN 4’ rule, which include Torso, Ear, Neck, and 4 Worrisome fractures involving posterior or lateral rib fractures, ‘bucket handle’ fractures, and fractures involving the sternum, spine, and scapula unless the child has been in a major motor vehicle or similar accident. In children, with elevated liver function tests, pancreatic enzymes, or otherwise unexplained hematuria, abuse involving abdominal trauma should be considered. Other signs and symptoms that should trigger a careful exam include unusual scars in the form of hand and belt prints, cigarette burns, burns in an unusual distribution, or swelling that is unexplainable such as swollen painful thigh in a young infant. Each of the seven strategies in the INSPIRE strategies, elucidated later, are important in prevention as well as specific treatment for the injuries sustained (Gonzalez & McCall, 2018). It is also important to differentiate abuse from traditional treatment and practices such as tattooing, cupping, and coining prevalent in many cultures (Lilley & Kundu, 2012; Kiragu et al., 2018). In suspected physical abuse (SPA), skeletal surveys are performed in order to detect bone fractures, which remain the most common clinical presentation of SPA, after soft tissue bruising and burns (Clarke et al., 2012). The current national guidelines presented by the Royal College of Radiologists and Society and College of Radiologists (RCR/SCoR) recommend a full skeletal survey with 25 projections for small children and 34 for large children. It is essential that the diagnosis of abuse is ascertained and not missed, as evidence shows that in 50–80% of fatal or near-fatal abuse cases, there was evidence of prior abusive injuries. Therefore, ensuring that images with optimal image quality for the diagnostic purposes are produced is essential (Hampel & Pascoal, 2018).
Functional and morphological changes in shoulder girdle muscles after repeated climbing exercise
Published in Research in Sports Medicine, 2022
Sebastian Klich, Pascal Madeleine, Krzysztof Ficek, Klaudia Sommer, Cesar Fernández-de-Las-Peñas, Lori A Michener, Adam Kawczyński
A hand-held myotonometer device (MyotonPro, Myoton Ltd, Estonia) was used to measure the stiffness of the pectoralis major, deltoideus anterior and posterior, and infraspinatus muscle. Muscle stiffness is defined as the property that characterizes resistance to the contraction or to a stretching external force that deforms the initial shape of the tissue. Stiffness (N/m) was computed as S = amax.mprobe/Δl, where a is the acceleration of the damped oscillation; mprobe is the mass of the measurement mechanism, and Δl is the probe displacement (Kawczynski et al., 2018). The examiner located the probe perpendicular to the tested area and then the probe generated three impulses exerted on the tested muscles (Kelly et al., 2018). The probe was placed perpendicular to the tested area and generated three impulses exerted on the testing area. The subject was seated with their backs on a chair, arms on the table with the forearms pronated. Measures of stiffness were performed over the shoulder at four locations: (1) infraspinatus – two fingers width below the centre spine of scapula (Kelly et al., 2018), (2) anterior deltoid, (3) posterior deltoid, and (4) pectoralis major – muscle belly halfway between clavicle and humeral bone (Klich et al., 2020). The relative reliability was good to excellent for stiffness of all analysed muscles (ICC2, 1 from 0.86 to 0.94). The absolute reliability showed that SEMs ranged from 10 N/m to 17 N/m, while MDC90% ranged from 28 N/m to 48 N/m.
Critical scapula motions for preventing subacromial impingement in fully-tethered front-crawl swimming
Published in Sports Biomechanics, 2022
Since the error in the measurement of scapular motion was reported to increase when the arm was elevated high (Karduna, McClure, Michener, & Sennett, 2001; Konda, Yanai, & Sakurai, 2011; Meskers, van de Sande, & de Groot, 2007), we adopted two approaches to minimise this error. The first was the use of a mini sensor (RX1-C, 23 mm×13 mm×11 mm, half of the size of a standard sensor) for each scapula. The flat superior surface of the acromion was narrow and a small sensor was stabilised better than the standard sensor and was less affected by the displacement of the Deltoid muscles. The second was a careful judgment on the attachment site. According to the study conducted by Konda et al. (2011) as well as our experience, the sensor on the acromion would be translated and/or rotated by the displacement of the Deltoid muscles when the arm elevation angle was high. We put the sensor on the proximal part of the acromion near the spine of scapula and confirmed for each participant that the sensor was not rotated by the displacement of the Deltoid muscles during several times of arm abduction.
Sex Differences in Rotator Cuff Muscles’ Response to Various Work-Related Factors
Published in IISE Transactions on Occupational Ergonomics and Human Factors, 2021
Hossein Motabar, Ashish D. Nimbarte
The skin over relevant anatomical landmarks was prepared prior to the placement of the surface EMG electrodes based on SENIAM guidelines (Hermens et al., 1991). Guidance from the literature was used to identify the locations of the EMG electrodes (Boettcher et al., 2008; Perotto, 2011; Xu et al., 2014): the upper border of the spine of scapula for supraspinatus; 4 cm below the medial border of the spine of scapula for infraspinatus; and one-third of the distance from the acromion to the interior angle of scapula along the lateral border for teres minor. The Bagnoli-16 Desktop EMG System (Delsys Inc., Boston, USA) was used to collect EMG data at a frequency of 1000 Hz. Parallel bar EMG electrodes made from 99.9% pure silver measuring 10 mm in length, 1 mm in diameter and spaced 10 mm apart were used. The common-mode rejection ratio (CMRR) for the electrodes is 92 dB and input impedance is greater than 1015 Ω.