David Wallis

Using an experimental bicycle seat to reduce perineal numbness

ABSTRACT BACKGROUND: Perineal numbness and erectile dysfunction are emerging as health concerns among bicyclists. Three studies indicate that between 7% and 21% of male cyclists experience genital area numbness after prolonged riding. OBJECTIVE: To evaluate the effect of an experimental seat design on perineal numbness. DESIGN: Fifteen experienced male cyclists exercised for 1 hour on a stationary spin cycle using either an experimental or standard bicycle seat. Several days later they repeated the trial using the other seat type. Before and after each 1-hour exercise session, perineal sensation was tested using the Weinstein Enhanced Sensory Testing (WEST)-hand esthesiometer. Cyclists were also asked to report their perception of numbness after each exercise bout. RESULTS: Cyclists reported more numbness with the standard seat than with the experimental seat (79% vs 14%; P=0.009). Similarly, sensory testing at all perineal sites yielded greater hypoesthesia with the standard seat than with the experimental seat (P=0.05). This difference was most marked at the dorsal penis (P=0.04). CONCLUSION: The experimental bicycle seat produced significantly less subjective and objective numbness than the standard cycle seat in 1 hour of stationary cycling. Bicycle seat design and innovation may decrease or eliminate perineal numbness.

Arthroscopic resection of an anterior calcaneal fracture: a case report.

Fracture of the anterior superior process of the calcaneus is an injury that often is missed clinically and presents a therapeutic challenge. The presenting symptoms often mimic ankle sprains, and they frequently are missed on both clinical and radiographic examinations.1,2,9,10,19–24 Most acute fractures of the anterior process of the calcaneus are successfully treated with cast immobilization; however, delayed diagnosis may lead to nonunion and prolonged disability or chronic pain. Surgical excision of the fracture fragment may be considered for patients who have persistent symptoms after a trial of conservative treatment. Surgical excision of an anterior calcaneal fragment usually is done with an open procedure. Open approaches to the subtalar joint can involve excision of the fat pad, detachment of the extensor digitorum brevis, and transsection of the ligaments of the sinus tarsi. Although the exact morbidity of this dissection is unknown, there are obvious technical advantages to preserving normal anatomy.4,13–15,17 Results have been less than ideal in these settings, as even with appropriate open surgical excision, it is not uncommon for patients to have persistent symptoms postoperatively.2,3,11,12 With recent advances in small instrumentation and surgical technique, it is possible to approach

Wrist Pain After a Fall

A 28-year-old right-handed man tripped down a flight of stairs, landing on his outstretched right hand. He developed immediate pain, swelling, and stiffness but did not seek medical attention. After 1 week without relief, he went to see his primary care provider. The patient did not have numbness or tingling, and he reported no previous injuries to the wrist. X-rays were obtained (figure 1), and the patient was referred to an orthopedist for further evaluation.