An electromyographic analysis of the shoulder during cones and planes of arm motion.

Shoulder motion has traditionally been described in reference to arbitrarily defined planes of motion (e.g., sagittal/flexion, coronal/abduction). This study examined shoulder muscle recruitment during conical arm movements, which include all planes of motion. Electromyographic (EMG) data was collected with intramuscular wire electrodes from ten muscles in five normal volunteers. Each muscle showed peak EMG activity in association with a direction of action consistent with its anatomic alignment. These findings were similar for movements in both the sagittal and coronal planes, calling into question conventionally held designations of shoulder muscles as flexors and abductors. Muscle recruitment was as follows: Clavicular pectoralis major, to move the arm medially along the horizontal; anterior deltoid, to move the arm obliquely upward inclined toward the midline; middle deltoid, to move the arm obliquely upward inclined away from the midline; posterior deltoid, to move the arm laterally along the horizontal; and teres major and latissimus dorsi, to move the arm obliquely downward away from the midline. Rotator cuff muscles were maximally active during elevation, consistent with the concept of a force couple.

Intravascular monitoring via the axillary artery.

Axillary artery cannulation was performed in 31 patients in whom the radial arteries were unavailable or unsuitable for cannulation. The artery was first cannulated with an 18-gauge needle, after which a Seldinger guide wire (0.032-inch diameter) was passed, which was used to introduce a 6-inch, 18-gauge Teflon catheter. The mean duration of cannulation was 3.2 days (range 19 hours to 8 days). All patients were assessed for complications of the procedure up to 72 hours after decannulation. No serious complications were encountered. It is concluded that the axillary artery is a safe alternative in the absence of an available radial artery when arterial cannulation is indicated.

Alternative sites for continuous arterial monitoring.

During a 13-month period, we studied 148 patients who had percutaneous arterial cannulation for continuous intraoperative, postoperative, and intensive care monitoring. In all patients, alternative arteries were cannulated, which included the brachial (43%), axillary (19%), femoral (28%), dorsalis pedis (8%), and superficial temporal artery (1%). No patient sustained any functionally significant or serious complication requiring surgical intervention. Eighteen patients (12%) had minor, clinically insignificant complications. We conclude that in the absence of an available radial artery, there are at least five other reliable arterial sites that may be cannulated and safely used when direct arterial monitoring is required.

A review of supernumerary thumb and its surgical management.

Type II polydactyly is relatively easy to treat by simple ablation. Central wedge resection is an alternative treatment, providing sufficient bone and soft tissue are excised. Duplication at the MP joint may be difficult to treat because of the frequently associated problems of joint deviation and limited motion, which may produce unacceptable results. MP joint deviation in the ulnar direction of less than 30 degrees does not require treatment. Treatment may be necessary for ulnar deviation greater than 50 degrees. Metacarpal osteotomy, arthrodesis, and central wedge resection are methods of treatment. Collateral ligament reconstruction and tendon transfer were unsuccessful in one patient. IP joint deviation of greater than 15 degrees may need treatment. If there is less than 10 degrees of motion associated with it, arthrodesis is indicated when the joint is skeletally mature. When opposition is impaired thenar muscle tendon transfer is an effective treatment.

Assessing the development of daily living skills in patients with spina bifida.

The development of independence in daily living skills of 256 patients with spina bifida was assessed by means of a new Functional Activities scoring system. The score was derived from nine categories of activity; five are to do with self-care, three with locomotion and one with social interaction. The reasons for the variation in achievement between individuals with the same degree of paralysis are discussed, as are the differences in learning curves for single activities. The scoring system enables a quantitative assessment to be made of the current status of an individual patient, and enables more realistic therapeutic goals to be set.

Myelodysplasia: the natural history of kyphosis and scoliosis. A preliminary report.

The results of this study support the concept that the levels of the bifid vertebral arch and of functional motor activity are significant influences on the development of scoliosis and kyphosis in patients born with myelodysplasia. 'Significant' degrees of scoliosis and kyphosis may appear at any time during life, but most frequently occur during late childhood or adolescence. Not all 'significant' curvatures require treatment, nor do all children with myelodysplasia and factors predisposing to kyphosis and scoliosis develop these complications. It is believed that the preliminary cumulative percentage curves presented in this study will be of value in counselling parents of afflicted newborn infants, and in planning the management of patients born with myelodysplasia.