Introduction of clerking pro forma for surgical spinal patients at the Royal National Orthopaedic Hospital NHS Trust (London): an audit cycle.

As a tertiary referral centre of spinal surgery, the Royal National Orthopaedic Hospital (RNOH) handles hundreds of spinal cases a year, often with complex pathology and complex care needs. Despite this, issues were raised at the RNOH following lack of sufficient documentation of preoperative and postoperative clinical findings in spinal patients undergoing major surgery. This is not in keeping with guidelines provided by the Royal College of Surgeons.

Risk of Neurological Injuries in Spinal Deformity Surgery.

Study Design: A retrospective study.

Objective: Rate of neurological injuries is widely reported for spinal deformity surgery. However, few have included the influence of the subtypes and severity of the deformity, or anterior versus posterior corrections.

A multicentre retrospective review of muscle necrosis of the leg following spinal surgery with motor evoked potential monitoring: a cause for concern?

Purpose: There are very few reported cases of compartment syndrome of the leg following spinal surgery via a posterior approach. An association between compartment syndrome and muscle over-activity via nerve stimulation during evoked potential monitoring was first suggested in 2003. No further reports have suggested this link.

Intraoperative nerve monitoring during total shoulder arthroplasty surgery.

Background: Nerve injury is an acknowledged complication of total shoulder arthroplasty (TSA). Although the incidence of postoperative neurological deficit has been reported to be between 1% and 16%, the true incidence of nerve damage is considered to be higher. The present study aimed to identify the rate of intraoperative nerve injury during total shoulder arthroplasty and to determine potential risk factors.

Muscle activation patterns in patients with recurrent shoulder instability.

Purpose: The aim of this study is to present muscle patterns observed with the direction of instability in a series of patients presenting with recurrent shoulder instability.

Materials And Methods: A retrospective review was carried out on shoulder instability cases referred for fine wire dynamic electromyography (DEMG) studies at a specialist upper limb centre between 1981 and 2003. An experienced consultant clinical neurophysiologist performed dual needle insertion into four muscles (pectoralis major (PM), latissimus dorsi (LD), anterior deltoid (AD) and infraspinatus (IS)) in shoulders that were suspected to have increased or suppressed activation of muscles that could be contributing to the instability.

Characterization of radiochromic film scanning techniques used in short-pulse-laser ion acceleration.

Radiochromic film (RCF) is increasingly being used as a detector for proton beams from short-pulse laser-matter interaction experiments using the RCF imaging spectroscope technique. The community has traditionally used inexpensive flatbed scanners to digitize and analyze the data, as opposed to more expensive and time-consuming microdensitometers (MicroDs). Often, the RCF densities in some regions exceed an optical density (OD) of 3.

Prospective blinded comparison of surface versus wire electromyographic analysis of muscle recruitment in shoulder instability.

Background: This pilot study assesses level of agreement between surface and fine-wire electromyography (EMG), in order to establish if surface is as reliable as fine wire in the diagnosis and treatment of abnormal muscle patterning in the shoulder.

Method: Eighteen participants (11 female) with unstable shoulders were recruited after written consent and ethical approval. Anthropometric information and mean skinfold size for triceps, subscapular, biceps and suprailiac sites were obtained.

An investigation into EMG activity in the upper and lower portions of the subscapularis muscle during normal shoulder motion.

Background And Purpose: The subscapularis (SSc) muscle is considered to perform a variety of roles during normal shoulder movement. The SSc is innervated by two or more discrete motor nerves and previous studies have indicated some difference in electromyographic (EMG) activity between the upper and lower portions of the muscle. The purpose of the present study was to compare EMG activity between the upper and lower portions of the SSc muscle during voluntary shoulder movements in normal healthy subjects.

Does the removal of pectoralis minor impair the function of pectoralis major?

The treatment of long-standing unilateral facial palsy with cross-facial nerve graft and free pectoralis minor muscle flap to the face has been the elective choice for more than 300 patients during the last 20 years at Mount Vernon Hospital in Northwood, United Kingdom. In this study, the authors assessed the residual donor-site morbidity in the chest after the procedure. During the second stage of the operation, the medial and the lateral pectoral nerves are divided at a proximal level from the plexus.