Worker's Compensation Cases Research Articles

Efficacy of Ultrasonic Tenotomy and Debridement and Platelet-Rich Plasma Injections for Lateral Elbow Tendinopathy

To determine the efficacy of treatment of lateral elbow tendinopathy (LET) with platelet-rich plasma (PRP) injection and ultrasonic tenotomy and debridement (USTD) as well as risk factors for treatment failure. This was a retrospective study including patients treated for LET with PRP or USTD between January 2018 and December 2021. The efficacy of both procedures was assessed using pain-related patient-reported outcome measures at the 12-week follow-up. Baseline subject characteristics and diagnostic ultrasound findings were analyzed as risk factors for failure of treatment. Failure was classified as a surgical indication for LET within a year of the PRP or USTD. Ultrasonic tenotomy and debridement and PRP both led to significant improvement in patient pain within the 12-week follow-up period. There was no significant difference in efficacy between the two procedures. Common extensor tendon tearing on ultrasound and Worker's Compensation cases were found to be risk factors for failure of USTD. Lateral collateral ligament complex involvement and injection were found to be risk factors for failure of PRP. Platelet-rich plasma and USTD are both effective interventions for LET. They have separate risk factors for failure that should be taken in consideration while deciding the treatment approach. These procedures are minimally invasive alternatives to some of the more invasive surgical options to treat LET. Therapeutic III.

Outcomes of reverse shoulder arthroplasty following failed superior capsular reconstruction.

Superior capsular reconstruction (SCR) can be used for massive irreparable rotator cuff tears in the absence of significant degenerative changes; however, those who fail an SCR may require reverse shoulder arthroplasty (RSA). The effect of a previously performed SCR on outcomes following RSA remains unknown. Subjects who underwent RSA from May 2015 to January 2021 at 2 separate institutions were retrospectively identified through prospectively collected databases. Patients who underwent RSA after failed SCR were matched to those who underwent RSA after failed rotator cuff repair (RCR) based on the number of previous ipsilateral shoulder procedures (n=1, 2, ≥3) and secondarily by age within 5 years. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS) for pain, and Western Ontario Osteoarthritis of the Shoulder index (WOOS) scores were compared between groups. The minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) thresholds were calculated to determine clinically relevant differences between groups. Forty-five patients were included (32 RSA following RCR, 13 following SCR). There were more smokers (P=.001) and worker's compensation cases (P=.034) in the SCR group. The RCR cohort was older (P=.007) and had a greater incidence of mental health (P>.999) and somatic disorders (P=.698), although these did not reach statistical significance. The mean follow-up for the RCR and SCR groups were 24.2±23.3 and 20.4±14.9 months following RSA, respectively (P=.913). The time from index RCR or SCR to RSA were 94.4±22.2 and 89.2±5.3 months, respectively (P=.003). Pre- and postoperative range of motion were similar between groups, as was the overall change in forward flexion (P=.879), abduction (P=.971), and external rotation (P=.968) following RSA. The RCR group had lower postoperative VAS pain (P=.009), higher SANE (P=.015), higher ASES (P=.008), and higher WOOS (P=.018) scores. The percentage achieving the MCID (P=.676) and SCB (P>.999) were similar; however, 56.7% of the RCR group met the SANE PASS threshold compared with 0.0% in the SCR group (P=.005). There were no differences in postoperative complications (P=.698) or revision rates (P=.308) following RSA between cohorts. When matched for number of previous procedures to the ipsilateral extremity and age, patients who underwent RSA following failed SCR had worse clinical outcome scores than their RSA following failed RCR counterparts. No patient in the SCR group met the SANE PASS threshold, whereas more than half of the RCR group did.

Deconstructing the Way We Use Pulmonary Function Test Race-Based Adjustments

Race is a social construct. It is used in medical diagnostic algorithms to adjust the readout for spirometry and other diagnostic tests. The authors review historic evidence about the origins of race adjustment in spirometry, and recent attention to the lack of scientific evidence for their continued use. Existing reference values imply that White patients have better lung function than non-White patients. They perpetuate the historical assumptions that human biological functions of the lung should be calculated differently on the basis of racial-skin color without considering the difficulty of using self-identified race. More importantly, they fail to consider the important effects of environmental exposures, socioeconomic differences, health care access, and prenatal factors on lung function. In addition, the use of "race adjustment" implies a White standard to which other non-White values need "adjustment." Because of the spirometric guidelines in place, the current diagnostic prediction adjustment practice may have untoward effects on patients not categorized as "White," including underdiagnosis in asthma and restrictive lung disease, undertreatment with lung transplant, undercompensation in workers compensation cases, and other unintended consequences. Individuals, institutions, national organizations, and policymakers should carefully consider the historic basis, and reconsider the current role of an automated, race-based adjustment in spirometry.

Hip arthroscopy with initial access to the peripheral compartment provides significant improvement in FAI patients

This study was designed to evaluate the clinical and radiographic results of arthroscopic treatment of femoroacetabular impingement (FAI) using the technique of initial access to the peripheral compartment. It is based on a single surgeon large case series with a minimum of 2years follow-up. Prospective longitudinal study with consecutive patients. Inclusion criteria were the presence of FAI syndrome that had failed non-operative treatment and had a hip arthroscopy with initial access to the peripheral compartment. Exclusion criteria were previous hip surgery, patients younger than 16 or older than 60years, Tönnis grade ≥ 2 osteoarthritis, hip dysplasia based on radiographic evidence of LCEA less than 25° and workers compensation cases. One hundred and sixty hips met the inclusion criteria, 84 were female and 70 were male patients (six bilateral cases), with a median age of 36years (range 16-59). The median alpha angle correction was 22.6º (range 5.9-46.7) (p < 0.01) and the average LCEA correction when acetabuloplasty was undertaken was 6.5º (range -1.4-20.8) (p < 0.01). The mean NAHS at baseline was 56.1 (range 16-96) and improved to 83.2 at the last follow up (range 44-100) for the patients that had no additional procedure (p < 0.01). The mean average improvement was 27.7º points (range -16-73). No iatrogenic labral perforation and no full-thickness chondral damage were recorded during the arthroscopic procedures. Favourable outcomes are reported for the arthroscopic treatment of FAI with initial access to the peripheral compartment. The technique is protective against iatrogenic chondral and labral damage, more conservative to the joint capsule, but the mean traction time was relatively long when suture anchors were used. The results are comparable to the classic initial central compartment approach. Level IV.

Return to activity following modified brostrom procedure with and without a semimembranosus allograft

Despite the modified Broström Procedure (MBP) being the gold standard for surgical treatment of chronic ankle instability (CAI), there is little data regarding factors that impact rehabilitation time. This retrospective analysis includes 67 consecutive Modified Broström Procedures (MBPs). Records were reviewed to define patient factors associated with increased time to return to activity (RTA). Of the 67 cases reviewed, 23 patients underwent reconstruction of the calcaneofibular (CFL) with a semimembranosus allograft in addition to repair of the anterior talofibular ligament (ATFL) with a suture tape. There were no significant demographic or clinical differences between these two groups. All patients had a minimum follow-up of 12 months. The mean age and body mass index (BMI) of the cohort was 44.7 years and 33.7 kg*m2, respectively, with a ratio of females to males of 2.35:1. Males began weight bearing as tolerated (WBAT) in a walking boot 1.08 weeks earlier than females (p = 0.053). Those with a BMI ≥ 35 kg/m2 RTA in normal shoe gear 0.50 weeks later (p = 0.443). Workers’ compensation cases were correlated with RTA (+0.431, p < 0.001). The number of completed physical therapy (PT) sessions had no significant correlation with time of return to activity (+0.063. p = 0.622). The post-operative complication rate was 7.5% (Five patients). No odds ratios were found to be statistically significant. Overall, these results suggest that semitendinosus allograft is safe, and corroborates prior evidence that worker's compensation cases are independently linked to a delayed return to activity. This data can potentially guide post-operative expectations and preparation of clinical trials.

COVID, Courts, and Other Controversies

Personal Injury cases seeking recovery for contracting coronavirus are proliferating. These fall into four categories: direct exposure, such as on cruise ships, allegedly claiming negligent property management and decision-making, shareholder liability suits for failure to disclose potential loss from lawsuits, workers compensation cases alleging workplace exposure occurring in the course of employment, and bystander exposure from spouses exposed to their husbands’ who contracted the disease on the job. Proving causation, will, however, be difficult. Proving negligence on the ground of flawed sterilization will also be difficult. Claims against cruise ship operators for failing to notify passengers before embarkation of potential exposure, however, I suggest may have some traction, although at present that route is not being.

A Comparison of Minimally Invasive and Open Transforaminal Lumbar Interbody Fusion for Grade 1 Degenerative Lumbar Spondylolisthesis: An Analysis of the Prospective Quality Outcomes Database

It remains unclear if minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is comparable to traditional, open TLIF because of the limitations of the prior small-sample-size, single-center studies reporting comparative effectiveness. To compare MI-TLIF to traditional, open TLIF for grade 1 degenerative lumbar spondylolisthesis in the largest study to date by sample size. We utilized the prospective Quality Outcomes Database registry and queried patients with grade 1 degenerative lumbar spondylolisthesis who underwent single-segment surgery with MI- or open TLIF methods. Outcomes were compared 24 mo postoperatively. A total of 297 patients were included: 72 (24.2%) MI-TLIF and 225 (75.8%) open TLIF. MI-TLIF surgeries had lower mean body mass indexes (29.5±5.1 vs 31.3±7.0, P=.0497) and more worker's compensation cases (11.1% vs 1.3%, P<.001) but were otherwise similar. MI-TLIF had less blood loss (108.8±85.6 vs 299.6±242.2 mL, P<.001), longer operations (228.2±111.5 vs 189.6±66.5 min, P<.001), and a higher return-to-work (RTW) rate (100% vs 80%, P=.02). Both cohorts improved significantly from baseline for 24-mo Oswestry Disability Index (ODI), Numeric Rating Scale back pain (NRS-BP), NRS leg pain (NRS-LP), and Euro-Qol-5 dimension (EQ-5D) (P>.001). In multivariable adjusted analyses, MI-TLIF was associated with lower ODI (β = -4.7; 95% CI = -9.3 to -0.04; P=.048), higher EQ-5D (β = 0.06; 95% CI=0.01-0.11; P=.02), and higher satisfaction (odds ratio for North American Spine Society [NASS] 1/2=3.9; 95% CI=1.4-14.3; P=.02). Though trends favoring MI-TLIF were evident for NRS-BP (P=.06), NRS-LP (P=.07), and reoperation rate (P=.13), these results did not reach statistical significance. For single-level grade 1 degenerative lumbar spondylolisthesis, MI-TLIF was associated with less disability, higher quality of life, and higher patient satisfaction compared with traditional, open TLIF. MI-TLIF was associated with higher rates of RTW, less blood loss, but longer operative times. Though we utilized multivariable adjusted analyses, these findings may be susceptible to selection bias.

How Is Maximum Outcome Improvement Defined in Patients Undergoing Shoulder Arthroscopy for Rotator Cuff Repair? A 1-Year Follow-Up Study

To (1) determine the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and Constant-Murley subjective score thresholds for achieving maximal outcome improvement (MOI) after arthroscopic rotator cuff repair and (2) identify preoperative predictors of reaching the ASES threshold for achieving MOI. A retrospective cohort study was performed to identify patients undergoing rotator cuff repair at a high-volume institution from January 2014 to January 2017 with a 1-year minimum follow-up. Patient characteristics, as well as preoperative and postoperative outcome scores, were analyzed. MOI for the ASES and SANE score were calculated as previously described, and a receiver operating characteristic (ROC) curve analysis was used to determine thresholds for percentage of maximal improvements for each outcome measure based on a satisfaction anchor question. Last, a logistic regression model was used to identify predictors of reaching the ASES threshold for achieving MOI. A total of 220 patients were included in the final analysis. There was a statistically significant increase in score average across all 3outcome measures (P < .001 for all), with 162 (73.6%) patients rating their surgical outcome as satisfactory at 1-year follow-up. The ROC curve analysis demonstrated that ASES, SANE, and Constant-Murley threshold percentages for achieving MOI was 69.5% (area under the curve [AUC], 0.86; 95% confidence interval [CI], 0.81-0.91; P < .001), 75%(AUC, 0.814; 95% CI, 0.758-0.871; P < .001), and 55.1% (AUC, 0.84; 95% CI, 0.783-0.898; P < .001), respectively. Logistic regression demonstrated that workers compensation cases (odds ratio, 0.69; 95% CI, 0.55-0.86; P= .001) and dominant-sided surgery (odds ratio, 0.72; 95% CI, 0.59-0.88; P= .002) were predictors of not achieving maximal improvement on the ASES score. Achieving 69.5% of maximal ASES score improvement or 75% of maximal SANE score improvement is indicative of achieving patient satisfaction after arthroscopic rotator cuff repair. Preoperative variables including workers compensation cases and surgery to the dominant side were predictors of not achieving maximal improvement. IV, case series.

The impact of practice guidelines on opioid utilization for injured workers.

Opioid use is rising in the US and may cause special problems in workers compensation cases, including addiction and preventing a return to work after an injury. This study evaluates a physician-level intervention to curb opioid usage. An insurer identified patients with out-of-guideline opioid utilization and called the prescribing physician to discuss the patient's treatment protocol. This study uses a differences-in-differences study design with a propensity-score-matched control group. Medical and pharmaceutical claims data from 2005 to 2011 were used for analyses. Following the intervention, the use of opioids increased for the intervention group and there is little impact on medical spending. Counseling physicians about patients with high opioid utilization may focus more attention on their care, but did not impact short-term outcomes. More robust interventions may be needed to manage opioid use. While the increasing use of opioids is of growing concern around the world, curbing the utilization of these powerfully addictive narcotics has proved elusive. This study examines a prescribing guidelines intervention designed to reduce the prescription of opioids following an injury. The study finds that there was little change in the opioid utilization after the intervention, suggesting interventions along other parts of the prescribing pathway may be needed.

UI Form design considerations for ergonomists evaluating computer workstations

A professional ergonomist performing a workplace evaluation identifies risk factors and provides recommendations to mitigate these risks. This system involves analysis of the interaction between a human subject and the subject’s computer based work environment. Since the data required to be collected is more than the average person can keep in their short term memory, it is safe to say the ergonomist will need to record observations. This will have to be done while simultaneously interacting with the employee performing work. Human-computer interaction is observed by the ergonomist, but ergonomists themselves also use a computer or tablet to take records and produce a report. The interaction and interface of the data collection form for ergonomic evaluations should cater to the needs and capabilities of the ergonomist in the field (Kim, 2015) and so it is not a surprise that most forms are designed by the ergonomists themselves. These forms are also typically tailored to the type of task being evaluated (i.e. computer, laboratory, industrial) because each of their environments have particular equipment or tools these need to be recorded. For example, a computer workstation will include a chair, desk, displays, etc. while a lap will have a stool chair, bench height seating, rack, flow hood, etc. This paper will describe key user-interface form design considerations for office ergonomic evaluation forms with the purpose of optimizing the user-experience for an ergonomic professional. Applications include the use of a form on a laptop computer, tablet, or phone in a computer workstation environment. This paper will consider factors related to the working environment, reliability, input requirements, form structure and flow, and front end to back end management agents. The goal of any interface is to be intuitive enough that it would require minimal familiarization to be reliably implemented (Norman, 2002). As users gain familiarity with the form entries, the ergonomist can benefit from increased speed, accuracy and consistency of their evaluations. The report generated by these completed forms can be utilized in legal and workers compensation cases and therefore they require special consideration in the way the questions are phrased and ordered to reduce potential for error and opportunities to place blame. This added complexity makes their design more than a simple task. Guidelines are included in this article that will proactively assist ergonomists in designing effective forms.

Patient Understanding, Expectations, and Satisfaction Regarding Rotator Cuff Injuries and Surgical Management

Rotator cuff injuries are among the most common in orthopaedics, with rotator cuff repair surgery consistently reported as one of the most commonly performed orthopaedic procedures. Patient satisfaction is becoming an increasingly important outcome metric as health care continues to evolve with regard to quality measures affecting physician reimbursement. Evidence supports that postoperative patient satisfaction, an important quality outcome metric, is highly influenced by preoperative patient expectations, which are in turn governed by patient knowledge and understanding. Many authors have delineated patient-, injury-, and surgery-specific variables associated with high preoperative expectations and satisfaction after rotator cuff surgery. Specifically, large rotator cuff tears, subscapularis tears, persistence of postoperative pain and dysfunction, worker's compensation cases, lower education level, and preoperative disability have been seen more frequently in patients reporting poor satisfaction. Others have reported variables associated with higher patient satisfaction such as being married, employed, and of older age at the time of surgery (>55 years old) predictive of higher satisfaction. Patient education preoperatively regarding details about the surgery and the postoperative plan both immediately after the procedure and for rehabilitation are critical in helping set patients' preoperative expectations that have a known effect on patients' subjective clinical outcomes.

Arizona Hospital Discharge and Emergency Department Database: Implications for Occupational Health Surveillance.

The objective of the project was to identify trends in emergency department visits and inpatient admissions for occupational injury and disease frequency and describe the financial impact from specific clinical groups known to have occupational risk factors. Workers compensation cases among 19 million records in the Arizona statewide hospital discharge database (HDD) were assessed for seven clinical groups from 2008 to 2014, including back, cardiac, carpal tunnel syndrome, heat-related, psychiatric, pulmonary, and trauma. Cases with cardiac, psychiatric, and pulmonary diagnoses were both frequent and expensive. Although incidence was generally stable, charges per case rose significantly over the time period. Inpatient and emergency department records provide valuable data that complement other surveillance approaches for both occupational illnesses and injuries. Tracking charge as well as incidence data is useful.

Delayed Open Reduction Internal Fixation of Missed, Low-Energy Lisfranc Injuries.

The aim of this study was to determine the outcome of delayed presentation (at least 6 weeks from the time of injury) of low-energy Lisfranc injuries limited to the first and second tarsometatarsal joints treated with open reduction internal fixation. 8 patients with an average age at surgery of 39.8 years were retrospectively reviewed with a mean time to surgery from injury of 15.1 (range of 6.3 to 31.1) weeks. We used radiographic measurements, physical examination, SF-12 scores, Foot and Ankle Ability Measure (FAAM) scores, VAS scores and return to work or sports as outcome measures. Patients were treated with an open reduction and internal fixation as opposed to a formal arthrodesis with a variety of internal fixation. All 8 patients were available for follow-up and outcome reporting at an average of 3.1 years (minimum 2.0) postoperatively. The mean VAS improved from 8.5 to 2.8 postoperatively. The mean postoperative physical and mental SF-12 scores were 46.8 and 57.1, respectively. The mean postoperative overall and sports FAAM scores were 75.4 and 65.9, respectively. There were no radiographic signs of a late diastasis at the Lisfranc joint. All patients including 2 workers compensation cases returned to work and all were able to return to their prior sporting activity. A delayed open reduction internal fixation of patients with missed, low-energy Lisfranc injury was performed and resulted in decreased pain. In this series, a fair to good functional outcome was observed, and the ability to return to work or previous sport was possible for all patients studied. Level IV, retrospective case series.

Autologous Chondrocyte Implantation to Isolated Patella Cartilage Defects.

Background Autologous chondrocyte implantation (ACI) is a durable treatment for patients with chondral defects. This study presents the comprehensive evaluation of patients with patella defects treated with ACI at medium- to long-term follow-up. Methods Thirty consecutive patients with isolated chondral lesions of the patella were enrolled prospectively. Primary outcome measures were validated patient reported outcome measures and objective magnetic resonance imaging. Results Nineteen of 30 patients underwent tibial tubercle osteotomy (TTO) to correct lateral maltracking in combination with soft tissue balancing. The defect sizes were large, averaging 4.7 ± 2.1 cm2 (range 2.2-30.0 cm2). Pidoriano/Fulkerson classification revealed that 3 defects were type II (lateral), 9 were type III (medial), and 18 were type IV (central/panpatella). Age at the time of surgery was 32 ± 10 years. At follow-up of 2 to 14 years, knee function was rated good to excellent in 25 (83%) patients, fair in 4 (13%) patients, and poor in 1 (3%) patient. Three patients failed treatment after a mean of 75 months (6.25 years). All 3 failures were Workers Compensation (WC) cases. They were older than the non-WC patients, 42 ± 6 years compared with the non-WC 28 ± 9 years ( P = 0.0019). Significant increases in all clinical and health utility outcome scores were seen. Magnetic resonance imaging demonstrated that the fill grade, surface and integrity of the repair tissue correlated with clinical scores. Conclusion ACI to isolated patella defects results in significant functional improvement at a minimum of 24 months, with the results remaining durable at latest follow-up of 15 years. Level of evidence Level 4.

Paper #20 - Patient factors influencing return to work and cumulative financial claims after clavicle fractures in workers compensation cases

Background: Workers compensation status is consistently cited as a predictor of poor outcome after orthopaedic procedures. This study analyzes a cohort of all workers compensation patients after surgical or non-operative treatment of clavicle fractures to identify factors that influence the time for return to work and total healthcare reimbursement claims, including a comparison of surgical and non-operative treatments. Operative treatment has been associated with faster time to boney union. We hypothesized that return to work for operative patients would be faster and the reimbursement claims for operative cases would be higher. Methods: The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes and Current Procedural Terminology (CPT) codes were used to retrospectively query the Workers' Compensation national database managed by University of Illinois, Chicago. Claims for clavicular fractures treated surgically and non-operatively were identified from 2003 to 2013. The outcomes of interest were the number of days for return to full work (RTW) following surgery and the total reimbursement for healthcare-related claims. The primary independent variable was treatment modality. Multivariate analysis was performed to control for relevant employee, employer and treatment covariates that were likely to confound associations. We used two-tailed hypothesis tests and P < .05 to indicate statistical significance. Averages are ± standard deviation. Results: There were 169 settled claims for clavicle fractures within the database. Only 20% (n = 34) of these claims related to surgical treatment, while 80% (n = 135) related to non-operative treatment. For claims with complete follow-up, the average time for RTW was 196 ± 287 days for surgical treatment, and 69 ± 94 days for non-operative treatment. The average healthcare claims reimbursed were $29,136 ± 26,998 for surgical management, compared to $8366 ± 14,758 for non-operative treatment. From multivariate RTW analysis, we did not find a significant difference between non-operative and surgical treatment groups in their time to RTW (P = .06) Claims from workers with one or more dependents (Reference Group [RG]: No dependents), from the West (RG: Midwest), from injuries related to athletics/Police/Firefighters (RG: Driving/flying/boating) were significant predicators of earlier RTW. Claims with a higher percentage of impairment, filing of a legal suit, and incident report only claims (RG: Employer's liability) were associated with later RTW. From multivariate reimbursement analysis, total healthcare reimbursement for claims with surgical treatment were 330% higher as compared to claims for non-operative treatment (P < .01). Claims with an associated legal suit, from working professionals (RG: Driving/Flying/Boating related injuries), from workers with at least 20 years of service (RG: < 10 years), and between 180 and 360 lost working days (RG: < 45 days) were predictors of higher healthcare claims. Injuries from pushing/pulling/lifting, and from falls (RG: Motor vehicle related injuries), and incident report only claims (RG: Employer's liability) were significant predictors of lower healthcare claim amount. Conclusion: Contrary to our hypothesis, the patients treated under workers compensation status for clavicle fractures return to work at roughly the same time whether they are treated surgically or non-operatively, when controlling for relevant covariates. Workers compensation patients treated with surgery accumulate significantly higher healthcare claims than those treated without surgery. Although many variables that independently influence return to work timing and cumulative health care claims in this study are non-modifiable, attempting to minimize legal suits may help expedite patients return to work. As the indications for operative treatment of clavicle fractures continues to be elucidated, non-operative treatment of fractures may help reduce overall financial burden in workers compensation patient population.

Ethnic South Asian Radiologists: Their Increasing Prevalence and Geographic Distribution

Since the passage of the Hart-Celler Immigration and Naturalization Act of 1965, the entry of South Asians seeking citizenship into the United States has continued unabated, first predominantly from India, but now also from Pakistan and Bangladesh. Their presence together has become increasingly impo1iant in medicine in general and in radiology in particular. The prevalence of South Asians among American radiologists is assessed by our analysis of the membership panel of image interpreters of One Call Medical, a broker of CT and MRI for workers compensation cases, which encompasses more than 19,000 radiologists. From that list, by analysis of Hindu surnames, Americans of Indian nativity and ancestry constitutes 4.8% of all members. A parallel analysis of Americans having Muslim surnames common in South Asia, including those with familial ties to India, Pakistan, and Bangladesh, yielded another 2.3%. Therefore, collectively South Asians make up 7.1% of all radiologists in this group, which includes nearly half of all American radiologists. Hence, the percentage of South Asians as radiologists in the United States now far exceeds their percentage in the general American population.

Complications following subpectoral biceps tenodesis with interference screw fixation

BackgroundSubpectoral biceps tenodesis is considered an effective and increasingly popular method to manage long head of the biceps tendon pathology and combined lesions of the biceps labral complex. The purpose of this study was to report the complications following this procedure in a large prospective group of patients using a consistent technique.HypothesisSubpectoral biceps tenodesis is a safe and effective method for treating long head of the biceps pathology with a low complication rate.Study designCase series. Level of evidence IV.MethodsThis study had prior Institutional Review Board approval. Over a period of 5 years, 636 patients underwent subpectoral biceps tenodesis by the same surgeon. Patients who underwent subpectoral tenodesis with interference screws using a standardized technique were included in the analysis. Those who underwent biceps tenodesis for a chronic long head biceps rupture, those who underwent concomitant shoulder arthroplasty and those who underwent revision biceps tenodesis were excluded. All patients included in the study also underwent a postoperative physical examination.ResultsFrom November of 2005 to June of 2011, 491 patients met the inclusion criteria, 344 patients were male, 147 female and 39 were worker compensation cases. Out of the 491 patients with subpectoral biceps tenodesis, complications occurred in 12 patients of which 11 were considered minor and 1 was considered a major complication. The major complication was a proximal humerus fracture that occurred through the drill hole 2 weeks postoperatively. This was clearly due to a technical error where the drill hole was placed eccentrically in the humeral shaft. There were 11 minor complications; 5 cases had a rupture at the fixation site, 2 other cases had ruptures at the muscle-tendon junction site (distal to the tenodesis) and 1 patient had a rupture in continuity. Two cases had minor sprains that presented only with mild pain and resolved completely and one other case needed to be revised due to a prominent screw. All of the complications occurred within the first 2 months after surgery and 2 were in worker compensation cases.ConclusionAn overall complication rate of 2.4 % validates the hypothesis of a low complication rate after subpectoral biceps tenodesis. These results support the conclusions from previous biomechanical studies that have shown good bone-tendon-screw interface fixation strength.

The AMA Guides Use in Australia

The AMA Guides Use in Australia

The Neuroethics and Neurolaw of Brain Injury

Neuroethics and neurolaw are fields of study that involve the interface of neuroscience with clinical and legal decision-making. The past two decades have seen increasing attention being paid to both fields, in large part because of the advances in neuroimaging techniques and improved ability to visualize and measure brain structure and function. Traumatic brain injury (TBI), along with its acute and chronic sequelae, has emerged as a focus of neuroethical issues, such as informed consent for treatment and research, diagnostic and prognostic uncertainties, and the subjectivity of interpretation of data. The law has also more frequently considered TBI in criminal settings for exculpation, mitigation and sentencing purposes and in tort and administrative law for personal injury, disability and worker's compensation cases. This article provides an overview of these topics with an emphasis on the current challenges that the neuroscience of TBI faces in the medicolegal arena.

A survey of current policy and practice of surgical exposure for preclerkship medical students at American medical institutions

BackgroundThe goals of this study were to (1) determine the extent of preclerkship surgical participation in American medical colleges; (2) examine policies regarding such surgical participation; and (3) elicit medical school administrators' perceptions about such exposure. MethodsSurveys were sent to 128 accredited medical schools (1 administrator each). The 54 (42%) replies were analyzed using descriptive statistics and Student's t tests, with significance defined as a P value of ≤ .05. ResultsOf the respondents, 55.6% did not permit student surgical participation. Only 22.2% of responding institutions offered preclerkship surgical skills electives. Administrators from the former group of schools perceived significantly greater risk (P = .001) to patient safety with student surgical participation than did administrators at schools permitting such participation, even though no respondents reported malpractice or worker's compensation cases arising from student participation. ConclusionsMedical students have limited opportunities for preclerkship surgical participation at most American medical institutions, possibly because of unsubstantiated concerns for patient safety.