Anatomical plane and transverse axis of the scapula: Reliability of manual positioning of the anatomical landmarks

Background The aim of our study was to evaluate the accuracy of manual determination of the three key points defining the anatomical plane of the scapula, which conditions the reliability of planning software programs based on manual method. Method We included 82 scapula computed tomography scans (56 pathologic and 26 normal glenoid), excluding truncation and major three-dimensional artifact. Four observers independently picked the three key points for each case. Inter- and intra-observer agreement was calculated for each point, using the intraclass correlation method. The mean error (mm) between the observers was calculated as the diameter of the smallest sphere including the four chosen positions. Results Lower inter-observer agreement was found for the trigonum superoinferior position and for the glenoid center anteroposterior position. The mean positioning error between the four observers was 6.9 mm for the trigonum point, and error greater than 10 mm was recorded in 25% of the cases. The mean positioning error was 3.5 mm for the glenoid center in altered glenoid, compared to 1.8 mm for normal glenoid. Discussion Manual determination of an anatomical plane of the scapula suffers from inaccuracy especially due to the variability in trigonum picking, and in a lesser extent, to the variability of glenoid center picking in altered glenoid.

The Reliability and Validity of a Clinical Assessment Tool to Measure Scapular Motion in All Three Anatomical Planes

Context: A single clinical assessment device that objectively measures scapular motion in each anatomical plane is not currently available. The development of a novel electric goniometer affords the ability to quantify scapular motion in all three anatomical planes. Objective: Investigate the reliability and validity of an electric goniometer to measure scapular motion in each anatomical plane during arm elevation. Design: Cross-sectional. Setting: Laboratory setting. Patients or Other Participants: Sixty participants (29 females, 31 males) were recruited from the general population. Intervention(s): An electric goniometer was used to record clinical measurements of scapular position at rest and total arc of motion (excursion) during active arm elevation in two testing sessions separated by several days. Measurements were recorded independently by two examiners. In one session, scapular motion was recorded simultaneously with a 14-camera three-dimensional optical motion capture system. Main Outcome Measures: Reliability analysis included examination of clinical measurements for scapular position at rest and excursion during each condition. Both the intra-rater reliability between testing sessions and the inter-rater reliability recorded within the same session were assessed using Intraclass Correlation Coefficients (ICC2,3). The criterion-validity was examined by comparing the mean excursion values of each condition recorded by the electric goniometer to the 3D optical motion capture system. Validity was assessed by evaluating the average difference and root mean square error (RMSE). Results: The between session intra-rater reliability was moderate to good (ICC2,3: 0.628–0.874). The within session inter-rater reliability was moderate to excellent (ICC2,3: 0.545–0.912). The average difference between the electric goniometer and 3D optical motion capture system ranged from −7° to 4° and the RMSE was between 7–10°. Conclusions: The reliability of scapular measurements is best when a standard operating procedure is used. The electric goniometer provides an accurate measurement of scapular excursions in all three anatomical planes during arm elevation.

Anterior hyaloid membrane dissection using the conventional surgical microscope: a novel surgical approach in 2 patients

Background To describe the dissection and removal of the anterior hyaloid membrane using the conventional surgical microscope. Case presentation This microscopic surgical approach involves dissecting the anterior hyaloid at the natural anatomical plane. A 30-gauge needle mounted on a 3.0 cc syringe is used to inject filtered air anterior to the anterior hyaloid membrane. Two patients needed this procedure; the first patient was pseudophakic with proliferative diabetic retinopathy, tractional retinal detachment, and vitreous hemorrhage. The second patient was phakic with proliferative diabetic retinopathy, anterior proliferative vitreoretinopathy, and recurrent vitreous hemorrhage. Both patients tolerated the procedure well with no complications. Conclusion Pneumatic dissection of the anterior hyaloid membrane is previously thought to be only possible with the aid of ophthalmic endoscopy. This novel surgical approach provides surgeons with the option to perform pneumatic dissection of the anterior hyaloid when ophthalmic endoscopy is not available. Prospective studies are needed to reveal possible additional benefits or risks associated with this approach.

Upright posture and the meaning of meronymy: A synthesis of metaphoric and analytic accounts

Cross-linguistic strategies for mapping lexical and spatial relations from body partonym systems to external object meronymies (as in English ‘table leg,’ ‘mountain face’) have attracted substantial research and debate over the past three decades. Due to the systematic mappings, lexical productivity, and geometric complexities of body-based meronymies found in many Mesoamerican languages, the region has become focal for these discussions, prominently including contrastive accounts of the phenomenon in Zapotec and Tzeltal, leading researchers to question whether such systems should be explained as global metaphorical mappings from bodily source to target holonym or as vector mappings of shape and axis generated “algorithmically.” I propose a synthesis of these accounts in this paper by drawing on the species-specific cognitive affordances of human upright posture grounded in the reorganization of the anatomical planes, with a special emphasis on antisymmetrical relations that emerge between arm-leg and face-groin antinomies cross-culturally. Whereas Levinson argues that the internal geometry of objects “stripped of their bodily associations” (1994: 821) is sufficient to account for Tzeltal meronymy, making metaphorical explanations entirely unnecessary, I propose a more powerful, elegant explanation of Tzeltal meronymic mapping that affirms both the geometric-analytic and the global-metaphorical nature of Tzeltal meaning construal. I do this by demonstrating that the “algorithm” in question arises from the phenomenology of movement and correlative body memories — an experiential ground that generates a culturally selected pair of inverse contrastive paradigm sets with marked and unmarked membership emerging antithetically relative to the transverse anatomical plane. These relations are then selected diagrammatically for the classification of object orientations according to systematic geometric iconicities. Results not only serve to clarify the case in question but also point to the relatively untapped potential that upright posture holds for theorizing the emergence of human cognition, highlighting in the process the nature, origins and theoretical validity of markedness and double scope conceptual integration.

Diabetes-related lower extremity amputations in Singapore

Background: Lower extremity amputation (LEA) is defined as the complete loss in the transverse anatomical plane of any part of the lower limb. The objective of this study is to look at the trend and mortality trend of LEA performed in diabetes patients from 2008 to 2013. Methods: All patients age 15 and above with diabetes mellitus who had undergone LEAs (both major and minor) in Tan Tock Seng Hospital, Singapore from 1 January 2008 to 31 December 2013 were included. The outcomes of interest were deaths from all causes within 30 days and within 1 year. Results: Major LEA rate has increased from 11.0 per 100,000 population in 2008 to 13.3 per 100,000 population in 2013. The 30-day mortality rate ranges from 6.0% to 11.1% and the 1-year mortality rate ranges from 24.3% to 30.6%. Minor LEA rate has increased from 10.8 per 100,000 population in 2008 to 13.9 per 100,000 population in 2013. The 30-day mortality rate ranges from 1.5% to 3.7% and the 1-year mortality rate ranges from 9.7% to 18.3%. Conclusions: The trends in major and minor LEA are increasing. The 30-day and 1-year mortality for both major and minor LEA are comparable to figures reported worldwide. There is a need to re-look at preventive strategies to reduce LEA in diabetes patients in Singapore.

The Number of Trials Required to Obtain a Representative Movement Pattern During a Hurdle Hop Exercise

When reporting a subject’s mean movement pattern, it is important to ensure that reported values are representative of the subject’s typical movement. While previous studies have used the mean of 3 trials, scientific justification of this number is lacking. One approach is to determine statistically how many trials are required to achieve a representative mean. This study compared 4 methods of calculating the number of trials required in a hopping movement to achieve a representative mean. Fifteen males completed 15 trials of a lateral hurdle hop. Range of motion at the trunk, pelvis, hip, knee, and ankle, in addition to peak moments for the latter 3 joints were examined. The number of trials required was computed using a peak intraclass correlation coefficient method, sequential analysis with a bandwidth of acceptable variance in the mean, and a novel method based on the standard error of measurement (SEMind). The number of trials required across all variables ranged from 2 to 12 depending on method, joint, and anatomical plane. The authors advocate the SEMind method as it demonstrated fewer limitations than the other methods. Using the SEMind, the required number of trials for a representative mean during the lateral hurdle hop is 6.