Neck Position Research Articles

Interventions to prevent visual fatigue during robotic surgery.

The robotic surgeon is at risk of visual fatigue from prolonged viewing of the video display resulting in digital eye strain and use of the three-dimensional binoculars resulting in accommodative stress. Symptoms of digital eye strain include blurred vision, dry eyes, eyestrain, neck and back ache, diplopia, light sensitivity, and headaches. Vergence or accommodation-related symptoms include blurred near or distance vision, difficulty refocusing, and diplopia. Beneficial ergonomic interventions to manage digital eye strain during robotic surgery include appropriate lighting, improved neck positioning, optimal screen positioning, improved image parameters, screen breaks, optimising environmental factors, and eye exercises. Correction of refractive error, use of lubricating eye drops, and blink efficiency training to induce motor memory have been shown to be effective in reducing visual fatigue. Vergence-accommodation mismatch can be reduced with slower movement of the camera, screen breaks, and correction of refractive error. Robotic surgeons should adopt these simple and non-invasive interventions to minimise visual fatigue.

Tactile mechanisms and afferents underlying the rat pup transport response.

Juvenile rodents and other altricial mammals react with calming, immobility, and postural modifications to parental pickup, a set of behaviors referred to as the transport response.1,2,3,4,5 Here, we investigate sensory mechanisms underlying the rat transport response. Grasping rat pups in anterior neck positions evokes strong immobility and folding up of feet, whereas more posterior grasping has lesser effects on immobility and foot position. Transport responses are enhanced by slow (1Hz), and even more so by fast (4Hz), gentle shaking and translation, features consistent with parental transport. With lateral grasping, the forepaw below the grasping position points downward and the forepaw lateral to the grasping position points upward and medially. Such forepaw adjustments put the pup's center of gravity below the grasping point, optimizing pup transportability. Tactile stimuli on the back, belly, tail, whisker, dorsal forepaws, and dorsal hind-paws do not significantly affect behavior of anterior-neck-held pups. Instead, ground contact, or paw stimulation consistent with ground contact, disrupts transport responses. We identify afferents mediating transport response by examining membrane labeling with FM 1-436 following anterior neck grasping. We observe a dense innervation of the anterior-neck-skin region (∼30 terminals/mm2). We find an age-related decrease of cytochrome oxidase reactivity in the rat somatosensory cortical neck representation, a possible correlate to developmental decrease in pup transport response. We conclude that anterior neck grasping and loss of ground contact trigger calming and postural adjustments for parental transport in rat pups, responses putatively driven from the densely innervated anterior neck skin.

Vertigo and dizziness due to vertebrobasilar TIA: a prospective study

PurposeProspective studies on vascular vertigo and dizziness (VVD) due to vertebrobasilar transient ischemic attack (VBTIA) have been sparse. This study aimed to characterize clinical features, response to treatments, and prognostic factors of VVD due to VBTIA using a cohort established in 2021.MethodsWe recruited 103 patients (58 female individuals, 56.3%), with a mean age of 70.9 ± 9.3 years (range = 37–85), between January 2021 and January 2024. All patients met the diagnostic criteria of “Probable transient VVD” published by the Bárány Society. The mean interval from symptom onset to recruitment was 11.8 months (range = 0.5–72). Treatments followed the current American Heart Association–American Stroke Association's Guidelines for Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack. Patients with recurrent strokes among TIAs, and patients who were already taking an antithrombotic agent and should maintain the same regimen were excluded.ResultsImbalance (46.7%) and vertigo (39.8%) were the most frequent symptoms. The duration of attacks was <1 min in 35 patients (33.9%), 1–10 min in 34 patients (33.0%), 10–60 min in 15 patients (14.6%), and >60 min in 19 patients (18.5%). Trigger factors were reported in 20 patients (19.4%), which included eccentric neck position in 12 patients (11.7%), physical exercise in four patients (3.9%), positional changes in three patients (2.9%), and eccentric neck position and physical exercise in the remaining patient (0.9%). The frequency of attacks before the medication was 1 or <1/month in 32 (31.0%) patients, 1–4/month in 44 (42.7%) patients, 4–8/month in 21 patients (20.4%), and daily in six patients (5.9%). The treatment regimens were aspirin in 57 patients (55.3%), clopidogrel in 19 patients (18.5%), aspirin plus clopidogrel in 25 patients (24.3%), and rivaroxaban in two patients (1.9%). The attacks were reduced by 93.2% [IC 95% (88.34, 98.06), number needed to treat: 1] during the median follow-up of 12 months (range = 2–36 months). Only seven (6.8%) patients experienced a new attack with the medication. No prognostic factors could be identified for the recurrences.ConclusionVVD due to VBTIA has a broad clinical spectrum. Secondary stroke prevention is effective in VVD due to VBTIA even though no prognostic factors could be identified for symptom recurrence.

Predictive value of dynamic diffusion tensor imaging for surgical outcomes in patients with cervical spondylotic myelopathy

BackgroundCervical spondylotic myelopathy (CSM) is the most common chronic spinal cord injury with poor surgical and neurologic recovery in the advanced stages of the disease. DTI parameters can serve as important biomarkers for CSM prognosis. The study aimed to investigate the predictive value of dynamic diffusion tensor imaging (DTI) for the postoperative outcomes of CSM.MethodsOne hundred and five patients with CSM who underwent surgery were included in this study. Patients were assessed using the Modified Japanese Orthopedic Association Score (mJOA) before and one year after surgery and then divided into groups with good (≥ 50%) and poor (< 50%) prognoses according to the rate of recovery. All patients underwent preoperative dynamic magnetic resonance imaging of the cervical spine, including T2WI and DTI in natural(N), extension (E), and flexion (F) positions. ROM, Cross-sectional area, fractional anisotropy (FA), and apparent diffusion coefficient (ADC) were measured at the narrowest level in three neck positions. Univariate and multivariate logistic regression were used to identify risk factors for poor postoperative recovery based on clinical characteristics, dynamic T2WI, and DTI parameters. Predictive models were developed for three different neck positions.ResultsForty-four (41.9%) patients had a good postoperative prognosis, and 61 (58.1%) had a poor prognosis. Univariate analysis showed statistically significant differences in diabetes, number of compression segments, preoperative mJOA score, cross-sectional area ((Area-N), (Area-E), (Area-F)), ADC((ADC-N), (ADC-E), (ADC-F)) and FA (((FA-N), (FA-E), (FA-F)) (p < 0.05). Multivariable logistic regression showed that natural neck position: Area-N ([OR] 0.226; [CI] 0.069–0.732, p = 0.013),FA-N([OR]3.028;[CI]1.12–8.19,p = 0.029); extension ne-ck position: Area-E([OR]0.248;[CI]0.076–0.814,p = 0.021), FA-E([OR]4.793;[CI]1.737–13.228,p = 0.002);And flextion neck postion: Area-F([OR] 0.288; [CI] 0.095–0.87, p = 0.027),FA-F ([OR] 2.964; [CI] 1.126–7.801, p = 0.028) were independent risk factors for poor prognosis.The area under the curve (AUC) of the prediction models in the natural neck position, extension neck position, and flexion neck positions models were 0.708[(95% CI:0.608∼0.808), P < 0.001]; 0.738 [(95% CI:0.641∼0.835), P < 0.001]; 0.703 [(95% CI:0.602∼0.803), P < 0.001], respectively.ConclusionDynamic DTI can predict postoperative outcomes in CSM. Reduced FA in the extension position is a valid predictor of poor postoperative neurological recovery in patients with CSM.

Cervical motion analysis using wearable inertial sensors to patients with cervical ossification of posterior longitudinal ligament.

This study aimed to clarify cervical kinematics during daily activities, including level walking and stair ascending, in patients with cervical ossification of the posterior longitudinal ligament (C-OPLL). Eighteen patients with myelopathy caused by C-OPLL and 18 healthy controls were recruited to participate in the study. The sagittal cervical kinematics during level walking and stair ascent were quantitatively assessed using a motion analysis system based on wearable inertial sensors. The Japanese Orthopaedic Association score, Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire, Neck Disability Index, and deep sensation in the lower extremities were assessed in all participants. Nine of 18 patients with C-OPLL presented with deep sensory disturbances. Patients with C-OPLL with deep sensory disturbances exhibited different sagittal plane cervical motion patterns than healthy controls during level walking and stair ascent. During the first phase of stair ascent, both patients with C-OPLL and healthy controls flexed their necks to the same degree; however, during the middle and final phases of stair ascent and all phases of level walking, the mean cervical flexion angle of patients with C-OPLL with deep sensory disturbances was significantly higher than that of patients with C-OPLL without deep sensory disturbance and healthy controls. Our data suggest that patients with C-OPLL presenting with deep sensory disturbances are likely to walk with their necks flexed and gaze downward to observe their steps throughout their daily lives. This habitual neck posture may lead to a vicious cycle of cervical kyphosis and worsening of compressive myelopathy.

A Novel Design of Soft Corrugated Actuator for Creating Precise Head and Neck Positioning System

A Novel Design of Soft Corrugated Actuator for Creating Precise Head and Neck Positioning System

Biomechanics and morphological comparisons of the caudal region of titanosaurs from the Cretaceous of Brazil: Paleobiology and paleoecology inferences.

Biomechanical studies in sauropod dinosaurs are mainly focused on neck posture and feeding strategy. Few works investigate other aspects such as tail movement and function, especially in the clade Titanosauria, the most diverse within Neosauropoda. This study applied biomechanical concepts of neutral pose (cartilaginous neutral pose) and range of motion to verify the shape and direction of the caudal region of the advanced titanosaurs Adamantisaurus mezzalirai and Baurutitan britoi, in addition to comparing it with other titanosaurs (e.g., Arrudatitan maximus, Lirainosaurus astibiae, and Trigonosaurus pricei). As a result, the tails analyzed have a sigmoidal-convex shape, probably close to the ground (but not touching it). The sigmoidal-convex shape could increase the moment arm for the M. caudofemoralis longus, making it possible to use the tail as a fifth stabilizing member. This work expands our knowledge about sauropod dinosaurs by exposing a diversity of shapes for the tails of titanosaur sauropods and brings new possibilities for how these dinosaurs could use their tails.

10 Years of Convergent Neck Implants: A Systematic Review of Clinical Outcomes, Initial Original Concepts, and Changes in Surgical and Prosthetic Protocols

The study reviewed the state of the art of the clinical use of a convergent-neck-designed Prama implant. This implant was introduced approximately 10 years ago and was characterized by a specific and unique convergent neck with a microtextured surface (UTM surface) and Zirconium Titanium (ZirTi) implant body surface. The neck design was developed to adopt the biologically oriented preparation technique (BOPT). A critical analysis of the published clinical studies and an evaluation of the adopted clinical protocols were performed. A total of forty-six articles were eligible to be reviewed. Only sixteen clinical studies reported clinical outcomes on Prama implants, and nine of these were selected having the longest follow-up from different research groups. The clinical follow-up/duration of the studies ranged from 12 months to 6 years. The initially proposed protocols explored neck supracrestal–transmucosal placement and gained interest due to its minimally invasive concept and the ability to proceed without a pre-prosthesis second surgery. The following investigations dedicated attention to the subcrestal or equicrestal implant placement with the conventional flap approach. The clinical studies characterized by the transmucosal exposed neck approach reported high survival rates with a stable bone morphology and reduced bone loss during the follow-up. Further recent implementations included the introduction of different convergent neck heights that need to be evaluated. The use of intraoral scanner technologies and digital workflow resulted in a simpler methodology with control of the marginal crown morphology. The studies support the concept that the hard tissue parameters (such as marginal bone level, MBL) and soft tissue parameters (such as pink esthetic score, PES) were stable or improved during the follow-up. Definitive crowns, designed with low invasiveness for soft tissues, were possible thanks to the morphology of the neck. The clinical studies support the use of the Prama implant with the different neck positions, demonstrating hard tissue preservation and optimal esthetic results in the first years following insertion. However, the current body of evidence is not robust enough to draw definitive conclusions, especially in the long term, and further high-quality research (long-term randomized trials) is required to consolidate these early observations.

Tactile Mechanisms and Afferents Underlying the Rat Pup Transport Response.

Juvenile rodents and other altricial mammals react with calming, immobility and folding up of feet to parental pickup, a set of behaviors referred to as transport response. Here we investigate sensory mechanisms underlying the rat transport response. Grasping rat pups in anterior neck positions evokes strong immobility and folding up of feet, whereas more posterior grasping positions have lesser effects on immobility and foot position. Transport responses are enhanced by slow (1Hz) and even more so by fast (4Hz) gentle shaking and translation of the pup, features consistent with parental transport. In response to lateral grasping, the forepaw below the grasping position points downwards and the forepaw lateral to the grasping position points upwards and medially. Such forepaw adjustments put the pup's center of gravity below the grasping point, optimizing pup transportability along with folding up of feet and tail lifting. Tactile stimuli on the back, belly, tail, whisker, dorsal forepaws and dorsal hind-paws do not significantly affect the behaviour of anterior-neck-held pups. Instead, ground contact or paw stimulation consistent with ground contact disrupts transport responses. We identify afferents mediating the transport response by examining membrane labelling with FM1-43 following anterior neck grasping. We observe a dense innervation of the anterior neck skin region (~30 terminals/ mm2). We also observed an age-related decrease of cytochrome oxidase reactivity in the rat somatosensory cortical neck representation, a possible correlate to the developmental decrease in the pup transport response. We conclude anterior neck grasping and loss of ground contact trigger calming and postural adjustments for parental transport in rat pups, responses putatively driven from the densely innervated anterior neck skin.

The deflection of fatigued neck

The human neck is a unique mechanical structure, highly flexible but fatigue prone. The rising prevalence of neck pain and chronic injuries has been attributed to increasing exposure to fatigue loading in activities such as prolonged sedentary work and overuse of electronic devices. However, a causal relationship between fatigue and musculoskeletal mechanical changes remains elusive. This work aimed to establish this relationship through a unique experiment design, inspired by a cantilever beam mechanical model of the neck, and an orchestrated deployment of advanced motion-force measurement technologies including dynamic stereo-radiographic imaging. As a group of 24 subjects performed sustained-till-exhaustion neck exertions in varied positions-neutral, extended, and flexed, their cervical spine musculoskeletal responses were measured. Data verified the occurrence of fatigue and revealed fatigue-induced neck deflection which increased cervical lordosis or kyphosis by 4-5° to 11°, depending on the neck position. This finding and its interpretations render a renewed understanding of muscle fatigue from a more unified motor control perspective as well as profound implications on neck pain and injury prevention.

Modeling of bonding pressure based on the plastic deformation mechanism of interfacial voids closure in solid-state diffusion bonding

The model of the diffusion bonding pressure was established using the analysis calculation method and further verified by the finite element analysis (FEA) and the experiments. The normalized temperature was defined as the ratio of temperature and the melting point of the base materials. And the normalized bonding pressure was defined as the ratio of the applied bonding pressure and the yield strength at the bonding temperature. The contribution of the plastic deformation to the void closure expressed a linear relationship with the normalized bonding pressure, of which the slope was 3. The relationship was appropriate in TiAl6V4, pure copper C11000, aluminium alloy AA6061, stainless steel SUS 304, and Ni-based alloy Inconel 617 using analysis calculation. The diffusion bonding pressure design range can be summarized as σn = 0.05–0.577. Subsequently, the analytic computational model was verified by FEA. The results showed that the maximum stress was concentrated in the position of the void neck. And the linear relationship between the normalized bonding pressure and the bonded ratio was also tenable. There was a stable static error existed between FEA and the analytic computational analysis. Furthermore, the experimental verification showed the verification and accuracy of the analytic computational analysis results.

Drive away neck pain: Transformative motor control therapeutic neck exercises and tailored programs redefine posture for automotive workers.

Neck discomfort, arising from strained muscles, poor posture, accidents, or underlying medical conditions, significantly impacts daily activities and overall well-being, presenting a substantial healthcare challenge. This study aims to evaluate the efficacy of motor control therapeutic neck exercise and a Structured Exercise Program on neck pain and posture among automobile industrial workers. Using a lottery technique, 106 participants aged 20 to 45 were selected from the vicinity of Chennai's auto industries based on predetermined eligibility and exclusion criteria. Subsequently, participants were randomly assigned to either the motor control therapeutic neck exercise group or the structured exercise program group, each comprising 53 individuals. Participants received a comprehensive overview of the study and respective interventions, and their informed consent was obtained. Demographic details, Neck Injury and Disability scores, and Assessment of Postural and Ergonomic Characteristics data were then collected. Statistical analysis revealed a significant difference between the groups, with the Motor Control Therapeutic Neck Exercise group demonstrating superior outcomes in reducing pain and improving posture, with p-values less than 0.001. This study highlights the efficacy of Motor Control Therapeutic Neck Exercise over Structured Exercise in improving neck pain and posture among automobile industrial workers. These findings contribute valuable insights for the development of targeted interventions in occupational health settings.

Comparison of different head positions for ease of intubation in obese patients using videolaryngoscopy

BackgroundIn direct laryngoscopy ramping is a recommended technique in obese patients to improve success of intubation. Recently 25° back up position has also been described for the same purpose. The effect of change in head neck positions have not been much studied in obese patients, while using videolaryngoscopy (VL). MethodsThis prospective randomized study included 150 adult obese surgical patients (BMI >30 kg/m2), requiring intubation using VL. Patients were randomly assigned one of the three groups: sniffing position, ramped up position and 25° back up position. The time taken for intubation was the primary outcome. Other parameters assessed were Cormack-Lehane grading, time to achieve best glottic view, ease and attempts required for intubation. ResultsThe study shows that, 25° back up position has reduced time taken for successful intubation 161.80 s as compared to ramped up position (172.56 s) and sniffing position (171.84 s) with p value of <0.0001. Mean time for best glottic view was 18.82 s in group C, compared to 38.24 s for group B, and 39.66 s in group A (p < 0.0001). The ease of intubation score was also very easy/easy in 9/28 patients in group C compared to 3/16 and 3/17 patients respectively in groups A and B (p = 0.007). First attempt at intubation was successful in 47 patients in group C compared to 32 and 40 patients in groups A and B respectively (p = 0.001). There was no significant difference in Cormack and Lehane grading in different positions. ConclusionsThe 25° back up position is a simple and useful technique in improving glottic view and intubation success rate with reduction in intubation time compared to ramped up and sniffing positions.

Ultrasonographic assessment of cricothyroid membrane height in a Turkish cohort

Aims: Cricothyrotomy is a life-saving technique utilized in emergency airway management. This study aimed to assess the variability in the height of the cricothyroid membrane (CTM) based on gender, age, and body-mass index (BMI) across different neck positions, neutral and maximally extended. Methods: The study enrolled healthy volunteers aged 18 years and older. Participant baseline characteristics (age, gender, and BMI) were systematically documented. The height of the CTM was measured using, with the participants’ necks positioned in neutral and extended postures. Associations between CTM height and demographic variables, including sex, age, height, and BMI, were evaluated. Results: The study cohort comprised 296 individuals with a mean age of 41.84±15.76 years, ranging from 18 to 75 years. 30.3% of the participants were between 18 and 29 years old. 175 participants (59.1%) were female. The CTM height was significantly greater in the maximum extension position compared to the neutral position (p

Magnetic resonance arthrography with positional manoeuvre for the diagnosis of synovial fold of posterior shoulder joint capsule.

The objective of this study is to prospectively assess the effectiveness of shoulder magnetic resonance (MR) arthrograms with positional manoeuvres in detecting posterior synovial folds. Two radiologists independently assessed all axial MR arthrograms in internal rotation, neutral position, and external rotation for the presence of a posterior synovial fold. The diagnostic performances of the MR arthrograms were then compared, with results validated through arthroscopy. Arthroscopy was performed on 81 of the 150 patients included in the study. A posterior synovial fold was identified arthroscopically in eleven of these patients. Measurements of the posterior synovial fold obtained in external rotation and the neutral position of the arm showed a significant correlation with arthroscopic results (p < 0.05). For detecting the posterior synovial fold with arthroscopic correlation, the sensitivity and specificity values for observer 1 and observer 2 were 100-81.4% and 100-88.6%, respectively, for MR arthrograms in the neutral position; 100-52.9% and 100-62.9% for MR arthrograms in external rotation; and 100-95.7% and 81.8-98.6% for MR arthrograms in internal rotation. There was a fair agreement for MR arthrography in external rotation for detecting posterior synovial folds, while MR arthrograms in internal rotation and neutral position showed near-perfect and significant interobserver agreement. The rotational positions of the humeral neck during MR arthrographic examination can influence the diagnostic specificity and sensitivity of axial MR arthrograms in detecting the posterior synovial fold. The posterior synovial fold can mimic a posterior labral detachment. Therefore, its correct identification is crucial in order to avoid unnecessary surgical procedures. Movement of the shoulder may introduce variability in MR arthrography appearance. Rotation of the humeral neck during MR arthrography can affect diagnoses in posterior synovial fold detection. Given that posterior synovial folds can imitate posterior labral detachment, their correct identification is crucial to avoid unnecessary surgical procedures.

Ventilation quality and fiber optic glottic view of AuraGain laryngeal mask in neutral, moderate, and extreme lateral head and neck positions in anesthetized spontaneously breathing children

BackgroundWe investigated the effects of moderate (45°), and extreme (60°) right lateral rotation of the head and neck on the ventilatory performance of Ambu AuraGain Laryngeal mask airway in generally anesthetized spontaneously breathing children. MethodsFifty-two children (aged 2–9 years) were randomized in this open-label observational cohort, to receive Ambu® AuraGain either in moderate (45°) (Group I, n = 26) or extreme (60°) (Group II, n = 26) lateral rotation of the head and neck. The oropharyngeal leak pressure OLP (primary outcome), ventilation score, exhaled tidal volume, and fiberoptic glottic view score, were recorded with the head and neck in a neutral position, then in lateral position after insertion by 1,15,30 and 45 min., and at end of surgery. ResultsThe mean OLP in group I decreased from 23.81 ± 2.87 cmH2O in the neutral position to 23.77±3.78 cmH2O, (P = 0.941) 1 min. after lateral rotation. Whereas, In group II, it increased from 20.38 ± 4.18 cmH2O to 21.88±3.28 cmH2O, (P = 0.002). Afterward, the OLP was maintained decreased in group I and increased in group II (P < 0.05), with no intergroup differences. The ventilation score did not show significant intra or inter-group differences. After lateral rotation, the fiberoptic glottic score showed a trend towards better values in group II than in group I. ConclusionVentilation with AuraGain LMA can efficiently be implemented while the head and neck are in the neutral and laterally rotated positions in anesthetized spontaneously breathing children. Extreme lateral rotation (60°) was better tolerated than the moderate position (45°).

Smartphone Usage and Postural Stability in Individuals With Forward Head Posture: A Nintendo Wii Balance Board Analysis.

To assess postural stability, specifically center of body sway during single-leg standing balance, among individuals with and without forward head posture (FHP) during smartphone use. The research recruited 53 healthy smartphone users, aged 18-25, and categorized them into FHP group comprising 26 subjects and the normal (control) group with 27 subjects. Participants were assigned the task of maintaining balance while engaged in smartphone typing during single-leg standing. The experiment involved four specific conditions according to neck posture and stable of surface. The study meticulously quantified body center of pressure (COP) sway amplitudes using the Nintendo Wii Balance Board. The research revealed that individuals with FHP exhibited significantly greater body sway compared to the control group when using smartphones. Notably, distinct variations were observed in path length sway, anteroposterior (AP), and mediolateral (ML) sway amplitude, particularly evident when maintaining flexed neck positions on a soft surface while engaged with smartphones. These findings strongly suggest that individuals with FHP encounter deteriorated postural stability during smartphone use, particularly in challenging head positions.

An Extended Neck Position is Likely to Produce Cervical Spine Injuries Through Buckling in Accidental Head-First Impacts During Rugby Tackling

Catastrophic cervical spine injuries in rugby often occur during tackling. The underlying mechanisms leading to these injuries remain unclear, with neck hyperflexion and buckling both proposed as the causative factor in the injury prevention literature. The aim of this study was to evaluate the effect of pre-impact head–neck posture on intervertebral neck loads and motions during a head-first rugby tackle. Using a validated, subject-specific musculoskeletal model of a rugby player, and computer simulations driven by in vivo and in vitro data, we examined the dynamic response of the cervical spine under such impact conditions. The simulations demonstrated that the initial head–neck sagittal-plane posture affected intervertebral loads and kinematics, with an extended neck resulting in buckling and supraphysiologic intervertebral shear and flexion loads and motions, typical of bilateral facet dislocation injuries. In contrast, an initially flexed neck increased axial compression forces and flexion angles without exceeding intervertebral physiological limits. These findings provide objective evidence that can inform injury prevention strategies or rugby law changes to improve the safety of the game of rugby.

Mechanisms for pelvic floor muscle training: Morphological changes and associations between changes in pelvic floor muscle variables and symptoms of female stress urinary incontinence and pelvic organ prolapse-A narrative review.

Today there is Level 1, recommendation A for pelvic floor muscle training (PFMT) to be effective in treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP). However, the mechanisms of action are discussed. The aim of the present overview was to give an update of studies evaluating the effect of PFMT on pelvic floor morphology and associations between changes in PFM strength and symptoms of female SUI and POP. MATERIALS ANDMETHODS: This was a narrative review retrieving studies from systematic reviews of PFMT for SUI and POP. In addition, an open search on PubMed with the search terms PFMT and morphology was conducted. Both randomized controlled trials (RCTs) and pre-posttest design studies were included. PEDro rating scale (0-10) was used to assess risk of bias. Ten studies were found reporting on morphological changes after PFMT. The four RCTs had PEDro score between 5 and 8/10. The studies found significant higher bladder neck position and narrower levator hiatus dimensions, thicker external urethral sphincter, increased cross-sectional area of PFM, improvement in PFM tears and blood flow. Twenty studies analyzed associations between changes in different PFMT variables and SUI and POP. Eleven studies found a positive weak to moderate association and six studies reported no association. Studies comparing responders and nonresponders to PFMT found statistically significant better PFM variables in responders. PFMT can change pelvic floor muscle and external urethral sphincter anatomy. This contributes to the understanding on how PFMT can be effective in prevention and treatment of SUI and POP.

Cervical spine positioning patterns amongst hand surgeons: A critical analysis of surgical posture

AimThis study aims to assess the cervical spine positioning of consultant and trainee hand surgeons during standardised hand surgeries, focusing on the prevalence of sustained end-range postures, particularly cervical spine flexion. BackgroundSurgeons often perform procedures that require maintenance of sustained postures for prolonged periods of time. Hand surgeons may be at increased risk of sustained end of range postures, particularly cervical spine flexion. This can lead to strain on the musculoskeletal structures of the neck. Recent evidence suggests a higher incidence of neck dysfunction in hand surgeons, leading to an associated morbidity. MethodsWe examined hand surgeons of all experience levels during 40 common hand surgery procedures. We used real-time dynamic goniometric measurements of neck flexion using the “UPRIGHT GO 2” device and accompanying smartphone app. Neck flexion exceeding 40° was used as the threshold for defining an acceptable neck position. ResultsAnalysis included 20 total subjects at various levels of medical training (SHO n ​= ​6, Registrar n ​= ​9, Consultant n ​= ​5) performing surgeries under different conditions. Maladaptive neck positions were prevalent, with junior surgeons exhibiting such postures for 71 ​% of procedure time compared to 60 ​% for consultants. This underscores the potential contribution of sustained end-range postures to cervical spine dysfunction in hand surgeons, highlighting an early intervention opportunity. Notably, participants reported varied experiences with neck pain and expressed unanimous interest in integrating biofeedback posture devices into surgical training, with a single consultant expressing reservations.