Management of proximal biceps tendon pathology

The long head of the biceps tendon is widely recognized as an important pain generator,especially in anterior shoulder pain and dysfunction with athletes and working individuals.The purpose of this review is to provide a current understanding of the long head of the biceps tendon anatomy and its surrounding structures,function,and relevant clinical information such as evaluation,treatment options,and complications in hopes of helping orthopaedic surgeons counsel their patients.An understanding of the long head of the biceps tendon anatomy and its surrounding structures is helpful to determine normal function as well as pathologic injuries that stem proximally.The biceps-labral complex has been identified and broken down into different regions that can further enhance a physician’s knowledge of common anterior shoulder pain etiologies.Although various physical examination maneuvers exist meant to localize the anterior shoulder pain,the lack of specificity requires orthopaedic surgeons to rely on patient history,advanced imaging,and diagnostic injections in order to determine the patient’s next steps.Nonsurgical treatment options such as anti-inflammatory medications,physical therapy,and ultrasound-guided corticosteroid injections should be utilized before entertaining surgical treatment options.If surgery is needed,the three options include biceps tenotomy,biceps tenodesis,or superior labrum anterior to posterior repair.Specifically for biceps tenodesis,recent studies have analyzed open vs arthroscopic techniques,the ideal location of tenodesis with intra-articular,suprapectoral,subpectoral,extra-articular top of groove,and extra-articular bottom of groove approaches,and the best method of fixation using interference screws,suture anchors,or cortical buttons.Orthopaedic surgeons should be aware of the complications of each procedure and respond accordingly for each patient.Once treated,patients often have good to excellent clinical outcomes and low rates of complications.

Machine learning in orthopaedic surgery

Artificial intelligence and machine learning in orthopaedic surgery has gained mass interest over the last decade or so.In prior studies,researchers have demonstrated that machine learning in orthopaedics can be used for different applications such as fracture detection,bone tumor diagnosis,detecting hip implant mechanical loosening,and grading osteoarthritis.As time goes on,the utility of artificial intelligence and machine learning algorithms,such as deep learning,continues to grow and expand in orthopaedic surgery.The purpose of this review is to provide an understanding of the concepts of machine learning and a background of current and future orthopaedic applications of machine learning in risk assessment,outcomes assessment,imaging,and basic science fields.In most cases,machine learning has proven to be just as effective,if not more effective,than prior methods such as logistic regression in assessment and prediction.With the help of deep learning algorithms,such as artificial neural networks and convolutional neural networks,artificial intelligence in orthopaedics has been able to improve diagnostic accuracy and speed,flag the most critical and urgent patients for immediate attention,reduce the amount of human error,reduce the strain on medical professionals,and improve care.Because machine learning has shown diagnostic and prognostic uses in orthopaedic surgery,physicians should continue to research these techniques and be trained to use these methods effectively in order to improve orthopaedic treatment.

Analysis of the Effects of Complementary and Alternative Medicine (CAM) Methods to Decrease Body Image Dissatisfaction among Young Women during 2015-2020 and A Research Protocol

Background:Body image dissatisfaction(BID)has garnered global attention.It is significantly correlated with the development of depression,anxiety,eating disorders(EDs)and low self-esteem.BID is increasingly common among adolescents and young women in China,whereas it lacks the effective treatment and prevention programs for BID.Objective:This paper expects to analyze the effective CAMs methods on improving BID,and based on the results,we put forward a feasible and effective study protocol to fill the gap of BID improvement among teenage girls.Methods:Fifty-two studies of CAM in 2015-2020 years in influencing body image and its correlates are col-lected and analyzed,and a study protocol combined“In Favor of Myself”is sent up.This study protocol adds praise,psychological counselling,nutrition education and yoga to the project“In Favor of Myself”,improving BID through group support,shifting attention from focusing on one’s physical appearance to enhancing one’s value,and alleviating pressure and emotions through yoga.Results:Many methods,such as fitness training,psychoeducation,nutritional therapy,music therapy,health promotion programs and internet-based interventions are considered the existing interventions to improve BID.Other CAMs,such as acupuncture,beauty care,Tai chi,and aromatherapy,could be tried in the improvement of BID in further studies.Conclusion:CAM is capable of subjectively changing feelings of bodies,adjusting their cognition of body image,enhancing the body-mind connection,improving self-esteem and relieving negative emotions,but the efficacy and mechanism of CAM working on BID still need more systematic and standardized research.

Soleus muscle flap for reconstruction of lower extremity trauma.Workhorse or glue factory?

Aim:Soleus muscle flaps have traditionally been a reliable tool in the plastic surgeon’s armamentarium for lower extremity reconstruction and limb salvage.In the modern era,many surgeons prefer free flaps.This study sought to evaluate trends and outcomes of soleus flap reconstruction after lower extremity injury in a large cohort at a Level 1 trauma center.Methods:This is an Institutional Review Board-approved,retrospective chart review that was undertaken at Los Angeles County+University of Southern California Medical Center from 2007 to 2021.Patient demographics,Gustilo-Anderson fracture classification,flap characteristics,and outcomes were collected and analyzed.Outcomes of interest included failure rates,postoperative complications,and long-term ambulatory status.Results:Of 187 local leg flaps,68(36.4%)were soleus flaps,with 84% of soleus flaps performed prior to 2016.The flap loss rate was 0.0%.Eighteen(26.1%)flaps demonstrated>1 complication,including osteomyelitis/hardware infection(n=12),flap revision(n=6),and amputation(n=2).Long-term follow-up demonstrated 35.3% of patients ambulating independently after an average of 7.5±7.2 months,with the remainder needing a wheelchair or walking assistance device.Conclusion:Although soleus flap loss rate was 0%,the findings demonstrate more infections than expected;this must be considered in light of pre-existing patient comorbidities possibly deterring free flap placement.Additionally,our results reveal that only 16% of soleus flaps were performed after 2015.As surgeons consider the reconstructive ladder for lower extremity trauma,a rotational soleus muscle flap should not be overlooked in the modern era of free flap tissue transfers and might be a more optimal flap choice in certain patients with multiple comorbidities.