A Review of Slipping Rib Syndrome: Diagnostic and Treatment Updates to a Rare and Challenging Problem.

Slipping rib syndrome (SRS) is a disorder that occurs when one or more of the eighth through tenth ribs become abnormally mobile. SRS is a poorly understood condition leading to a significant delay in diagnosis and therapeutic management. History and a physical exam are usually sufficient for a diagnosis of SRS. The utility of dynamic ultrasounds has also been studied as a useful diagnostic tool. Multiple surgical techniques for SRS have been described within the literature. Cartilage rib excision (CRE) has been the most common technique utilized. However, the literature has shown a high rate of recurrence and associated risks with the procedure. More recently, minimally invasive rib fixation and costal cartilage excision with vertical rib plating have been shown as successful and safe alternative techniques. This may be an effective, alternative approach to CRE in adult and pediatric populations with SRS.

Robotic First Rib Resection in Thoracic Outlet Syndrome: A Systematic Review of Current Literature.

Thoracic outlet syndrome (TOS) involves the compression of neurovascular structures in the thoracic outlet. TOS subtypes, including neurogenic (nTOS), venous (vTOS), and arterial (aTOS) are characterized by distinct clinical presentations and diagnostic considerations. This review explores the incidence, diagnostic challenges, and management of TOS with a focus on the innovative approach of Robotic First Rib Resection (R-FRR). Traditional management of TOS includes conservative measures and surgical interventions, with various open surgical approaches carrying risks of complications. R-FRR, a minimally invasive technique, offers advantages such as improved exposure, reduced injury risk to neurovascular structures, and shorter hospital stays. A comprehensive literature review was conducted to assess the outcomes of R-FRR for TOS. Data from 12 selected studies involving 397 patients with nTOS, vTOS, and aTOS were reviewed. The results indicate that R-FRR is associated with favorable intraoperative outcomes including minimal blood loss and low conversion rates to traditional approaches. Postoperatively, patients experienced decreased pain, improved function, and low complication rates. These findings support R-FRR as a safe and effective option for medically refractory TOS.

Reliability and Validity of the Modified Heckmatt Scale in Evaluating Muscle Changes With Ultrasound in Spasticity.

OBJECTIVES: To determine the reliability and validity of the Modified Heckmatt scale in assessing muscle echotexture in spasticity. DESIGN: Prospective, observational, 2-center study. Two residents and 2 ultrasound experienced staff physicians each rated 100 ultrasound images that were also analyzed using quantitative gray-scale. SETTING: Academic ambulatory spasticity clinic. PARTICIPANTS: Participants (N=50) included 45 patients with upper or lower extremity spasticity and 5 healthy references. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Modified Heckmatt scale ratings and quantitative gray-scale scores. RESULTS: Inter- and intra-rater intraclass correlation coefficients were 0.76 and 0.81, respectively (P<.001), indicating good to excellent reliability. A significant relationship was found between Modified Heckmatt scores and quantitative gray-scale scores (r=0.829; P<.001). CONCLUSIONS: The Modified Heckmatt scale demonstrated good reliability and validity to assess the pathologic muscle changes that occur in patients with spasticity.

Sleep deprivation potentiates HPA axis stress reactivity in healthy adults.

OBJECTIVE: This article describes an experiment that was designed to investigate the effects of sleep deprivation on physiological stress responses in healthy adults. METHOD: Twenty-six participants, ages 22-49, completed a 3-night laboratory experiment with randomization to one night of sleep-deprivation or a normal-sleep control condition. After a night of baseline sleep, 12 participants were sleep deprived and 14 were not. After the sleep manipulation, each participant completed the Trier Social Stress Test, a task that requires delivering a speech and performing difficult arithmetic in front of a stern, three-person panel. The stressor was administered from 5:00 p.m.-5:30 p.m. and saliva samples were collected 20 and 5 min before (baseline) and 5, 20, and 40 min after the stressor. Samples were assayed for cortisol (a biomarker for the HPA axis) and alpha-amylase (a putative biomarker for the sympatho-adrenal medullar system). RESULTS: Sleep deprivation was associated with higher cortisol levels at baseline (p < .0001) and an amplified cortisol response to the stressor relative to control participants (pinteraction = 0.0039). Alpha-amylase showed a significant main effect of the stressor (p = .0026), but there was no effect of sleep loss at baseline or in response to the stressor. CONCLUSIONS: Sleep deprivation is associated with both elevated resting cortisol release and with an exaggerated cortisol response to a stressor indicative of elevated HPA axis responses in healthy adults. Individual differences in the magnitude of this response may represent a risk factor for psychological and physical health consequences associated with heightened cortisol exposure.

Sleep deprivation and stressors: evidence for elevated negative affect in response to mild stressors when sleep deprived.

Stress often co-occurs with inadequate sleep duration, and both are believed to impact mood and emotion. It is not yet known whether inadequate sleep simply increases the intensity of subsequent stress responses or interacts with stressors in more complicated ways. To address this issue, we investigated the effects of one night of total sleep deprivation on subjective stress and mood in response to low-stress and high-stress cognitive testing conditions in healthy adult volunteers in two separate experiments (total N = 53). Sleep was manipulated in a controlled, laboratory setting and stressor intensity was manipulated by changing difficulty of cognitive tasks, time pressure, and feedback about performance. Sleep-deprived participants reported greater subjective stress, anxiety, and anger than rested controls following exposure to the low-stressor condition, but not in response to the high-stressor condition, which elevated negative mood and stress about equally for both sleep conditions. These results suggest that sleep deprivation lowers the psychological threshold for the perception of stress from cognitive demands but does not selectively increase the magnitude of negative affect in response to high-stress performance demands.