A plea for the use of drawing in human anatomy teaching.

Descriptive human anatomy constitutes one of the main parts of the educational program of the first part of the medical studies. Professors of anatomy have to take into account the exponential evolution of the techniques of morphological and functional exploration of the patients, and the trend to open more and more the contents of the lectures of anatomy to clinical considerations. Basically, teaching requires a series of descriptive and educational media to set up, in front of the student, the studied structures and so to build the human body. More generally, lectures in morphological sciences try to develop three types of knowledge: declarative, procedural, and conditional. Traditionally in France "basic or first" anatomy is taught in amphitheater and in big groups by building each structure or region on a blackboard with colored chalk that allows a relief stake of certain structures and builds in two dimensions a three-dimensional organization. Actually, the blackboard is and stays for us an excellent media of non-verbal expression.

Does bone density of the greater tuberosity change in patients over 70?

INTRODUCTION: There are no published studies on bone density of the greater tuberosity of the humerus, which could influence the stability of reinsertion by suture anchors. The goal of our study was to determine the influence of age, gender and the type of tear on the quality of bone in the greater tuberosity. METHODOLOGY: Ninety-eight patients over the age of 60 were included, 41 without a rotator cuff tear and 57 with an isolated stage 1 or 2 supraspinatus tear and fatty infiltration (FI) ≤ 2. The areas of measurement included cancellous bone located under the cortex of the greater tuberosity. Measurements were obtained either across from the tear or from the middle facet with greater tuberosity if the cuff was not torn. We measured average, maximum and minimum bone density and the standard deviation (SD) in each region with Osirix software. RESULTS: The two groups were similar for age (73), investigated side and mean densities (0.282 g/cm(2) vs 0.210 g/cm(2)). Age over 70 was a predictive factor for osteoporosis of the greater tuberosity whether or not a rotator cuff tear was present (P<0.0001). There was less trabecular bone in women with cuff tears (P=0.009). Stage 2 cuff retraction was predictive of osteoporosis of the greater tuberosity (P=0.0001). CONCLUSION: This is the first study in the literature to evaluate bone density of the greater tuberosity in relation to the presence or not of a rotator cuff tear in an elderly population. Female gender, age over 70 and stage 2 cuff retraction are factors responsible for osteoporosis of the greater tuberosity of the humeral head. The osteoporosis is not severe, and normally the quality of bone of the greater tuberosity should not limit stability of suture anchors. LEVEL OF EVIDENCE: 3.

Immediate passive motion versus immobilization after endoscopic supraspinatus tendon repair: a prospective randomized study.

INTRODUCTION: Rehabilitation programs after rotator cuff repair should allow recovery of shoulder function without preventing tendon healing. The aim of this randomized prospective study was to compare the clinical results after two types of postoperative management: immediate passive motion versus immobilization. PATIENTS AND METHODS: We followed 100 patients, mean age 55 years old, who underwent arthroscopic repair of a non-retracted supraspinatus tear. Patients were randomized to receive postoperative management of immediate passive motion or strict immobilization for 6 weeks. A clinical evaluation was performed in 92 patients, and CT arthrography in 82. Mean follow-up was 15 months. RESULTS: The mean preoperative Constant score improved significantly from 46.1 points to 73.9 at the final follow-up. The rate of intact cuffs was 58.5%. Functional results were statistically better after immediate passive motion with a mean passive external rotation of 58.7° at the final follow-up versus 49.1° after immobilization (P=0.011), a passive anterior elevation of 172.4° versus 163.3° (P=0.094) respectively, a Constant score of 77.6 points versus 69.7 (P=0.045) respectively, and a lower rate of adhesive capsulitis and complex regional pain syndrome. Results for healing seemed to be slightly better with immobilization, but this was not statistically significant: the cuff had a normal appearance in 35.9% of cases after immobilization compared to 25.6% after passive motion, an image of intratendinous addition was found in 25.6% versus 30.2%, punctiform leaks in 23.1% versus 20.9%, and recurrent tears in 15.4% versus 23.3% respectively. DISCUSSION: The rehabilitation program that results in better tendon healing by preventing postoperative stiffness has not yet been identified. Our results suggest that early passive motion should be authorized: the functional results were better with no significant difference in healing.