Orthopaedics
My Coping Plan
Orthopaedics
Dr Ash Chehata
sleep and contact with the pillow and bed sheets. This theory is supported by the significant symptomatic improvement seen when taping or shielding the eye at night.
All patients with FES should be considered for a sleep study to diagnose underlying OSA. Treating the patient for obesity and OSA is thought to have a beneficial effect on the progression of FES.
Besides weight loss and continuous positive airway pressure, treatment should be conservative initially and consist of supportive therapies such as lubricants and eyelid taping or an eye shield at night to keep eyelids closed during sleep.
This treatment may be poorly tolerated in patients using a CPAP mask because an ill-fitting mask with a leak directed toward the ocular surface may exacerbate keratoconjunctivitis. If tolerated by the patient, however, it may be both a therapeutic and diagnostic intervention.
My Coping Plan
App of the Week
WHAT started as a suicide prevention strategy for university students has expanded into an app that is free for all patients to download.
Developed at the University of South Australia, My Coping Plan allows users to plan positive coping steps in advance and refer to them in times of crisis.
KEY POINTS
The steps are divided into five stages, starting with actions that users can perform on their own, and moving into interpersonal support strategies.
The final stage involves contacting health professionals.
Psychologist Dr Helen Stallman( PhD), who developed the app, suggests it’ s particularly useful for young people approaching a
• Consider floppy eyelid syndrome in any overweight middle-aged male with recalcitrant conjunctivitis with mucous discharge.
• The most sensitive physical sign is hyper-laxity of the upper lid, which is easily everted.
• Consider referral for sleep study if not already diagnosed with OSA.
• Treatment is conservative initially with lid taping or shield and lubricants, but surgery may be required.
Persistent symptoms or other problems such as lash ptosis, epiphora or dermatochalasis may require surgery to address horizontal eyelid laxity, lid margin malposition and excess periocular skin. ● stressful time, such as Year 12 students.
However, she says the app is suitable for everybody, not just young adults.
Specifications
COST: FREE COMPATIBLE WITH: IOS 9.0 or Android 4.4
A pressing issue
TERRY is a 32-year-old office worker. He presents with left shoulder weakness. He reports having pulled a muscle in his chest while doing bench presses at the gym several weeks earlier.
He heard a pop, experienced pain in his left anterior chest and was unable to keep the bar elevated.
THE QUIZ
Q. What is the most likely diagnosis? a. Pectoralis minor muscle strain b. Pectoralis major muscle rupture c. Acute coronary syndrome d. Costochondritis A. The answer is b. Patients often give a history of performing a maximal lift and feeling something in the shoulder giving or ripping, often accompanied by an audible‘ snap’ or‘ pop’.
Q. What clinical features would support this diagnosis? a. Chest wall asymmetry with muscle contraction b. Bruising of the medial arm c. Bruising and swelling of the anterior chest d. Loss of the anterior axillary fold A. The answer is all of the above. Asking the patient to press their hands together in a‘ prayer’ position, eliciting
an isometric contraction, will reveal chest wall asymmetry. This can be easily confirmed by looking for medial movement of the nipple.
If pectoralis major is ruptured, a distinct deformity or hollow will be seen, as the muscle moves medially and bunches in the chest.
The pectoralis major has insertions at the humerus, sternum and clavicle, so rupture can lead to bruising affecting the medial arm and chest wall. The anterior axillary fold is formed by the pectoralis muscle and will therefore be absent in rupture.
Q. Which of the following is true about pectoralis major rupture? a. It is typically seen in people aged 50-70 b. Males are more commonly affected than females c. Swimming is the most common sport
The bruising( pictured) emerged the following day and was associated with localised swelling. He is concerned that he is still unable to perform a bench press due to weakness. Dr Chehata is an orthopaedic surgeon specialising in upper limb surgery of the shoulder, elbow and wrist, who practises in Melbourne, Vic.
associated with this injury d. Bench press is the most common precipitating activity A. The answers are b and d. This injury is most commonly seen in males aged 20-40, typically following a bench press, with arm abducted and extended in eccentric contraction( deep part of bench press).
It is also seen in sports that lead to sudden forceful overload in the eccentric phase( for example, rugby league).
Q. What is the investigation of choice to help define the injury? a. X-ray b. Ultrasound c. CT chest d. MRI chest A. The answer is d. An MRI is the most helpful investigation and can assist in defining where the tear has occurred and whether early surgical intervention is required.
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