Lk Chan

A Systematic Review on Ankle Injury and Ankle Sprain in Sports

AbstractThis article systematically reviews epidemiological studies on sports injury from 1977 to 2005 in which ankle injury was included. A total of 227 studies reporting injury pattern in 70 sports from 38 countries were included. A total of 201 600 patients were included, with 32 509 ankle injuries. Ankle injury information was available from 14 098 patients, with 11 847 ankle sprains. Results show that the ankle was the most common injured body site in 24 of 70 included sports, especially in aeroball, wall climbing, indoor volleyball, mountaineering, netball and field events in track and field. Ankle sprain was the major ankle injury in 33 of 43 sports, especially in Australian football, field hockey, handball, orienteering, scooter and squash. In sports injuries throughout the countries studied, the ankle was the second most common injured body site after the knee, and ankle sprain was the most common type of ankle injury. The incidence of ankle injury and ankle sprain was high in court games and team sports, such as rugby, soccer, volleyball, handball and basketball. This systematic review provides a summary of the epidemiology of ankle injury in sports.

Scapular Position in Primates

Scapular position affects shoulder mobility, which plays an important role in the upper limb adaptations in primates. However, currently available data on scapular position are unsatisfactory because of the failure to simultaneously consider the relative dimensions of all the three skeletal elements of the shoulder girdle, i.e. the clavicle, the scapula and the thorax. In the present study, the clavicular length and the scapular spine length were measured on preserved cadavers, and the dorsoventral thoracic diameter was measured on scaled radiographs of a wide range of primates, permitting a quantitative comparison of scapular position among primates. It was found that arboreal monkeys have a more dorsally situated scapula than terrestrial ones, but the same difference was not found between terrestrial and arboreal prosimians. Hominoids were found to have the most dorsally situated scapula. Contrary to the slow climbing theory of hominoid evolution, which tries to explain most postcranial specializations of hominoids as adaptations for slow climbing, the scapulae of slow-climbing lorines and Alouatta are much less dorsal than those of the hominoids.

Advantages of video trigger in problem-based learning

Background: Traditionally, paper cases are used as ‘triggers’ to stimulate learning in problem-based learning (PBL). However, video may be a better medium because it preserves the original language, encourages the active extraction of information, avoids depersonalization of patients and allows direct observation of clinical consultations. In short, it exposes the students to the complexity of actual clinical problems. Aim: The study aims to find out whether students and facilitators who are accustomed to paper cases would prefer video triggers or paper cases and the reasons for their preference. Method: After students and facilitators had completed a video PBL tutorial, their responses were measured by a structured questionnaire using a modified Likert scale. Results: A total of 257 students (92%) and 26 facilitators (100%) responded. The majority of students and facilitators considered that using video triggers could enhance the students’ observational powers and clinical reasoning, help them to integrate different information and better understand the cases and motivate them to learn. They found PBL using video triggers more interesting and preferred it to PBL using paper cases. Conclusion: Video triggers are preferred by both students and facilitators over paper cases in PBL.

Cadaveric Study of Zone 2 Flexor Hallucis Longus Tendon Sheath

PURPOSE The purpose of this study was to investigate the anatomy of the zone 2 flexor hallucis longus (FHL) tendon sheath. METHODS Dissection of the zone 2 FHL tendon sheath was performed in 12 feet of 6 cadavers. The tendon sheath was subdivided into proximal fibrous (zone 2A) and distal fascial (zone 2B) parts. The lengths of the zone 2A and 2B FHL tendon were measured and represented the length of the corresponding tendon sheaths, and the relation of the medial plantar nerve to each part of the zone 2 FHL tendon sheath was studied. RESULTS In all specimens there were fibrous and fascial components of the zone 2 FHL tendon sheath. The medial plantar nerve crossed the zone 2B tendon sheaths and then became plantar lateral to the sheath in 7 specimens. The distance between the medial plantar nerve and the orifice of the zone 2A tendon sheath averaged 7.6 mm. The distance between the medial plantar nerve and the junction between zones 2A and 2B averaged 3.2 mm. The distance between the medial plantar nerve and the distal end of the zone 2B tendon sheath averaged 4.2 mm. The mean length of the zone 2A tendon sheath was 35.9 mm, and the mean length of the zone 2B tendon sheath was 30.5 mm. CONCLUSIONS The zone 2 FHL tendon sheath can be subdivided into a proximal fibrous zone (2A) and a distal fascial zone (2B). Because of the close proximity of the medial plantar nerve to the tendon sheath, there is a significant risk of iatrogenic nerve injury when surgical procedures are performed in zone 2B. CLINICAL RELEVANCE An understanding of the anatomy of the zone 2 FHL tendon sheath is useful for the safe practice of zone 2 FHL tendoscopy.

Evaluation of small‐group teaching in human gross anatomy in a Caribbean medical school

Although there are a number of medical schools in the Caribbean islands, very few reports have come out so far in the literature regarding the efficacy of small‐group teaching in them. The introduction of small‐group teaching in the gross anatomy laboratory one and a half years ago at St. Matthews University (SMU) on Grand Cayman appears to have had a significant positive impact on the academic achievement of students in anatomy. This study surveyed the responses of the students to the small‐group learning method in gross anatomy at SMU using a structured questionnaire. The results show that our students prefer this small‐group learning method over a completely self‐directed method in the gross anatomy lab because the study materials were carefully chosen and the study objectives were demonstrated by the resource person. However, teacher‐centered teaching was deliberately avoided by fostering problem‐solving skills in the anatomy lab sessions. Another aim of the small‐group teaching at SMU was to develop the interpersonal and communication skills of the students, which are important in their later education and career. Anat Sci Ed 1:19–22, 2008.

Glenohumeral mobility in primates

This study refutes the traditional idea that the glenohumeral joint of hominoids is more mobile than that of other primates, a belief that forms a basis for the two prominent theories of hominoid evolution. According to the brachiation theory, many anatomical features of the hominoid shoulder (including those of the glenohumeral joint) increase shoulder mobility and are interpreted as adaptations for brachiation. The slow climbing theory explains the same set of features as adaptations for slow climbing. The slow-climbing primates should therefore also possess these features, and their glenohumeral mobility should be the same as that of hominoids and be higher than that of other primates. This study presents three-dimensional glenohumeral mobility data, measured using a single video camera method on fresh specimens. The results show that the hominoid glenohumeral joint is actually less mobile than those of non-hominoid primates, including the habitually slow-climbing lorines, but it is characterized by a smooth excursion in the scapulocranial direction.

The Range of Passive Arm Circumduction in Primates : Do Hominoids Really Have More Mobile Shoulders?

Hominoids and lorines are assumed to possess greater shoulder mobility than other primates. This assumption is based on morphological characteristics of the shoulder, rather than on empirical data. However, recent studies have shown that the glenohumeral joint of hominoids is not more mobile than that of other primates (Chan LK. 2007. Glenohumeral mobility in primates. Folia Primatol (Basel) 78(1):1-18), and the thoracic shape of hominoids does not necessarily promote shoulder mobility (Chan LK. 2007. Scapular position in primates. Folia Primatol (Basel) 78(1):19-35). Moreover, lorines differ significantly from hominoids in both these features, thus challenging the assumption that both hominoids and lorines have greater shoulder mobility. The present study aims to test this assumption by collecting empirical data on shoulder mobility in 17 primate species. Passive arm circumduction (a combination of glenohumeral and pectoral girdle movement) was performed on sedated subjects (except humans), and the range measured on the video images of the circumduction. The motion differed among primate species mostly in the craniodorsal directions, the directions most relevant to the animals ability to brachiate and slow climb. Hylobatids possessed the highest craniodorsal mobility among all primate species studied. However, nonhylobatid hominoids did not have greater craniodorsal mobility than arboreal quadrupedal monkeys, and lorines did not have greater craniodorsal mobility than arboreal quadrupedal prosimians. Nonhylobatid hominoids and lorines had similar craniodorsal mobility, but this was due to a longer clavicle, more dorsal scapula, and lower glenohumeral mobility in the former, and a shorter clavicle, less dorsal scapula, and greater glenohumeral mobility in the latter. This study provides evidence for the reexamination of the brachiation, slow climbing, and vertical climbing hypotheses.

The role of regulation in medical student learning in small groups

Computer supported collaborative problem based learning in medicine can lead to high levels of metacognition.High co-regulation in problem based learning co-occurs with levels of Interactive Social Presence.Co-regulatory actions that activate the discussion and metacognitive acts of planning. This study examines the role of regulatory processes in medical students as they learn to deliver bad news to patients in the context of an international web-based problem based learning environment (PBL). In the PBL a medical facilitator and students work together to examine video cases on giving bad news and share their perspectives on what was done effectively and what could be done differently. We examine how regulation occurs within this collaboration. A synchronous computer-supported collaborative learning environment (CSCL) facilitated peer discussion at a distance using a combination of tools that included video-conferencing, chat boxes, and a shared whiteboard to support collaborative engagement. We examine regulation along a continuum, spanning from self- to co-regulation, in situations where medical students learn how to manage their own emotions and adapt their responses to patient reactions. We examine the nature of the discourse between medical students and facilitators to illustrate the conditions in which metacognitive, co-regulation and social emotional activities occur to enhance learning about how to communicate bad news to patients.

Modified Plantar Plate Tenodesis for Correction of Claw Toe Deformity

Background: The purpose of the study was to evaluate the efficacy and safety of the modified plantar plate tenodesis for correction of claw toe deformity. Materials and Methods: Modified plantar plate tenodesis was performed in ten fresh frozen cadaveric feet with claw toe deformity of the second toe. The plantar plate of the second metatarsophalangeal joint was anchored to the extensor digitorum longus tendon by a figure-of-eight suture. The figure-of-eight construct and the relationship of the digital nerve and the suture were studied. A clinical study was conducted to study the operative times, degree of correction and the improvement of AOFAS score between groups with the original plantar plate tenodesis (Group 1) and modified technique (Group 2). Any neural injury if present was also noted. Result: In the cadaveric study, the claw toe deformity was corrected and no nerve injury occurred in any specimen. There was flexor tendon tethering by the suture in 2 specimens. In the clinical study, the average operative time was 51 minutes for Group 1 and 31 minutes for Group 2. The improvement in AOFAS score averaged 44 in Group 1 and 43 in Group 2. The corrective power of the sagittal plane deformity at the metatarsophalangeal joint averaged 25 degrees in Group 1 and 23 degrees in Group 2. Conclusion: Plantar plate tenodesis was effective in correction of flexible claw second toe deformity by stabilization of the attenuated plantar plate. The modified technique allowed easier retrieval of the suture and shorter operative time. However, it may result in tethering of the flexor tendon. Level of Evidence: III, Retrospective, Case Control Therapeutic Study

Zone 2 Flexor Hallucis Longus Tendoscopy: A Cadaveric Study:

BACKGROUND The purpose of this study was to verify the safety and efficacy of zone 2 flexor hallucis longus tendoscopy with the patient in the prone position. MATERIALS AND METHODS The technique was performed in 12 cadaver feet (6 pairs). The endoscopic findings were compared to an anatomic dissection. The locations of the posteromedial and plantar portals were studied. The relationship between the medial plantar nerve and the tract of FHL tendoscopy was also studied. RESULT The average distance of the posteromedial portal above the medial malleolar tip was 10.3 mm. The average distance between the posteromedial portal and the posterior tibial nerve was 9.9 mm. The average distance between the plantar portal and the intermalleolar line was 41.5 mm. The average distance between the rod simulating the tenoscope and the nerve was 4.8 mm. The nerve was medial to the rod in 4 specimens and lateral to the rod in 8 specimens. CONCLUSION Zone 2 flexor hallucis longus tendoscopy was a feasible approach to the deep portion of the flexor hallucis longus tendon in this cadaveric study. There is potential risk of damage to the medial plantar nerve. CLINICAL RELEVANCE These findings can help guide a surgeon who is considering trying this clinically.