Fractured Knowledge: Making Sense of Exercise in Patients With Bone Metastases.

PURPOSE: Traditional dogma suggests that individuals with cancer-related bone metastases should restrict their physical activity, potentially engaging cautiously in isometric exercises. However, occurrences of adverse skeletal events during supervised exercise in patients with known metastatic bone lesions are exceedingly rare, contrasting with the substantial risks of inactivity. Recent studies advocate for well-designed exercise regimens for individuals with bone metastases, highlighting the potential benefits of enhanced mental well-being, fatigue mitigation, enhanced physical function, and an overall improved quality of life. As cancer rehabilitation physicians, it falls within our scope of practice to diagnose, assess, and manage risk while emphasizing the role of exercise and rehabilitation therapies, accompanied by necessary precautions, for individuals with metastatic cancer. This review aims to explore the safety and feasibility of exercise interventions for individuals affected by metastatic bone disease.

Anatomical landmarks to avoid injury to the great auricular nerve during rhytidectomy.

BACKGROUND: An estimated 116 086 facelifts were performed in 2011. Regardless of the technique employed, facial flap elevation carries with it anatomical pitfalls of which any surgeon performing these procedures should be aware. Injury to the great auricular nerve (GAN) is the most common of these injuries, occurring at a rate of 6% to 7%. OBJECTIVES: We report our findings on the location of the GAN on the basis of anatomical landmarks to aid surgeons with planning their surgical approach for safe elevation of rhytidectomy skin flaps in the lateral neck region. METHODS: Sixteen fresh cadaveric heads were dissected under loupe magnification. All specimens were dissected in a 45-degree (facelift) position in which a mid-sternocleidomastoid (SCM) incision was used for exposure. Measurements from the bony mastoid process, bony external auditory canal, external jugular vein, and anterior border of the SCM to the GAN were taken in each cadaver. RESULTS: The GAN follows a consistent course over the mid-body of the SCM before bifurcating into anterior and posterior branches and terminal arborization. Regardless of the length of the SCM, the GAN at its most superficial location was found to be consistently at a ratio of one-third the distance from either the mastoid process or the external auditory canal to the clavicular origin of the SCM. CONCLUSIONS: Knowledge of the anatomy, course, and location of the GAN along the surface of SCM muscle based on anatomic landmarks and distance ratios can facilitate a safer dissection in the lateral neck during rhytidectomy procedures.

The lumbar facet joint: a review of current knowledge: part 1: anatomy, biomechanics, and grading.

We present a two-part review article on the current state of knowledge of lumbar facet joint pathology. This first article discusses the functional anatomy, biomechanics, and radiological grading systems currently in use in clinical practice and academic medicine. Facet joint degeneration is presented within the larger context of degenerative disc disease to enable the reader to better understand the anatomical changes underlying facet-mediated lower back pain. Other less-common, but equally important etiologies of lumbar facet joint degeneration are reviewed. The existing grading systems are discussed with specific reference to the reliability of CT and MR imaging in the diagnosis of lumbar facet osteoarthritis. It is hoped that this discussion will stimulate debate on how best to improve the diagnostic reliability of these tests so as to improve both operative and non-operative treatment outcomes.

The lumbar facet joint: a review of current knowledge: Part II: diagnosis and management.

This article is the second article in a two-part review on lumbar facet joint pathology. In this review, we discuss the current concepts and controversies regarding the proper diagnosis and management of patients presenting with presumed facet-mediated lower back pain. All efforts were made to include the most relevant literature from the fields of radiology, orthopaedics, physiatry, and pain management. Our focus in this article is on presenting the evidence supporting or refuting the most commonly employed injection-based therapies for facet-mediated lower back pain.

Avoiding the medial brachial cutaneous nerve in brachioplasty: an anatomical study.

OBJECTIVE: With more patients undergoing bariatric surgery procedures, there has been an increased demand on plastic surgeons to manage excess skin around the body from massive weight loss. The upper arm is one of the areas that require surgical attention. One of the complications of brachioplasty is injury to cutaneous nerves of the arm. We report our findings of the location of the medial brachial cutaneous nerve on the basis of anatomical landmarks to aid the reconstructive surgeon in planning his or her operative approach and procedure. METHODS: Eight fresh cadaver arms were dissected under loupe magnification. The brachial plexus was dissected from proximal to distal to evaluate the branching points of the cutaneous nerves. Measurements were taken from the medial epicondyle to cutaneous branches off the main nerve. RESULTS: At about 7 cm proximal to the medial epicondyle, there is an arborization of 2 to 3 cutaneous branches. This nerve sends 3 to 4 branches through the muscular fascia across the ulnar nerve to skin of the medial arm at about 15 cm proximal to the medial epicondyle. In most cadavers, this was found in the midportion of the arm. CONCLUSIONS: The plastic surgeon will be challenged to effectively manage excess skin from weight loss. Placing the incisions more posteriorly on the arm will help avoid morbidity associated with injury to these nerves, while still providing an acceptable aesthetic outcome. Knowledge of the anatomy of the course of the medial brachial cutaneous nerve can help the surgeon better plan his or her operative approach to maximize aesthetic benefit and limit nerve injury.

Rehabilitation of orthopaedic and neurologic boxing injuries.

Clinical decision making for injured boxers follows the same therapeutic principles as the treatment plan for other injured athletes. Just as surgical techniques have improved, so has the scientific basis for implementing therapeutic exercises progressed to return the athletes to their former level of competition.