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At one time, women who had delivered by cesarean section in the past would usually have another cesarean section for any future pregnancies. The rationale was that if allowed to labor, many of these women with a scar in their uterus would rupture the uterus along the weakness of the old scar. Over time, a number of observations have become apparent: Most women with a previous cesarean section can labor and deliver vaginally without rupturing their uterus. Some women who try this will, in fact, rupture their uterus. When the uterus ruptures, the rupture may have consequences ranging from near trivial to disastrous. It can be very difficult to diagnose a uterine rupture prior to observing fetal effects (eg, bradycardia). Once fetal effects are demonstrated, even a very fast reaction and nearly immediate delivery may not lead to a good outcome. The more cesarean sections the patient has, the greater the risk of subsequent rupture during labor. The greatest risk occurs following a “classical” cesarean section (in which the uterine incision extends up into the fundus.) The least risk of rupture is among women who had a low cervical transverse incision. Low vertical incisions probably increase the risk of rupture some, but usually not as much as a classical incision. Many studies have found the use of oxytocin to be associated with an increased risk of rupture, either because of the oxytocin itself, or perhaps because of the clinical circumstances under which it would be contemplated. Pain medication, including epidural anesthetic, has not resulted greater adverse outcome because of the theoretical risk of decreasing the attendant’s ability to detect rupture early. The greatest risk of rupture occurs during labor, but some of the ruptures occur prior to the onset of labor. This is particularly true of the classical incisions. Overall successful vaginal delivery rates following previous cesarean section are in the neighborhood of 70 This means that about 30of women undergoing a vaginal trial of labor will end up requiring a cesarean section. Those who undergo cesarean section (failed VBAC) after a lengthy labor will frequently have a longer recovery and greater risk of infection than had they undergone a scheduled cesarean section without labor. Women whose first cesarean was for failure to progress in labor are only somewhat less likely to be succesful in their quest for a VBAC than those with presumably non-recurring reasons for cesarean section. For these reasons, women with a prior cesarean section are counseled about their options for delivery with a subsequent pregnancy: Repeat Cesarean Section, or Vaginal Trial of Labor. They are usually advised of the approximate 70successful VBAC rate (modified for individual risk factors). They are counseled about the risk of uterine rupture (approximately 1in most series), and that while the majority of those ruptures do not lead to bad outcome, some of them do, including fetal brain damage and death, and maternal loss of future childbearing. They are advised of the usual surgical risks of infection, bleeding, anesthesia complications and surgical injury to adjacent structures. After counseling, many obstetricians leave the decision for a repeat cesarean or VBAC to the patient. Both approaches have risks and benefits, but they are different risks and different benefits. Fortunately, most repeat cesarean sections and most vaginal trials of labor go well, without any serious complications. For those choosing a trial of labor, close monitoring of mother and baby, with early detection of labor abnormalities and preparation for
Shoulder Clinical Examination - Medical School Clinical Skills - Dr Gill
Personally, I find the shoulder examination the most complex examination possibly as there are so many variations and special tests. Some of which overlap and some will relate specifically to a patients presentation.
Often in a medical school syllabus, only select special tests will be used. In this shoulder exam demonstration, we include the Hawkins-Kennedy Test looking for impingement. This is dovetailed with examination for bicipital tendonitis as this is another possible cause of impingement type symptoms.
This shoulder upper limb exam follows the standard "Look, Feel, Move" orthopaedic exam approach, and overall order as set out in MacLeods Clinical Examination
Watch further orthopaedic examinations for your OSCE revision:
The Spine Examination:
https://youtu.be/pJxMHa6SCgU
Knee Examination
https://youtu.be/oyKH4EYfJDM
Hip Joint Clinical Examination
https://youtu.be/JC9GKq5nSdQ
________
Please note that there is no ABSOLUTE way to perform a clinical examination. Different institutions and even clinicians will have differing degrees of variations - the aim is the effectively identify medically relevant signs.
However during OSCE assessments. Different medical schools, nursing colleges, and other health professional courses will have their own preferred approach to a clinical assessment - you should concentrate on THEIR marks schemes for your assessments.
The examination demonstrated here is derived from Macleods Clinical Examination - a recognized standard textbook for clinical skills.
#ShoulderExamination #ClinicalSkills #DrGill
We will show you what a sports hernia examination (aka athletic pubalgia, gilmore's groin, lower abdominal pain) and rule out a diagnosis of hip impingement. Rehab exercises are suggested based on the results.
If you're experiencing any of these symptoms, don't hesitate to schedule a sports hernia examination. I can help you determine the best treatment plan to promote your recovery and avoid future injury. Subscribe to my channel to stay updated on the latest medical news and tips!
If you would like to know more about sports hernias and other diagnoses for front of hip, groin, adductor and lower abdominal strain, watch our detailed webinar here: https://bit.ly/37thtNF
For treatment, come visit us or schedule a virtual session. www.p2sportscare.com
Costa Mesa CA 715-502-4243
#sportshernia #abdominal #hippain
Sports Hernia Diagnosis
What Is A Sports Hernia?
A sports hernia is tearing of the transversalis fascia of the lower abdominal or groin region. A common misconception is that a sports hernia is the same as a traditional hernia. The mechanism of injury is rapid twisting and change of direction within sports, such as football, basketball, soccer and hockey.
The term “sports hernia” is becoming mainstream with more professional athletes being diagnosed. The following are just to name a few:
Torii Hunter
Tom Brady
Ryan Getzlaf
Julio Jones
Jeremy Shockey
If you follow any of these professional athletes, they all seem to have the same thing in common: Lingering groin pain. If you play fantasy sports, this is a major headache since it seems so minor, but it can land a player on Injury Reserve on a moments notice. In real life, it is a very frustrating condition to say the least. It is hard to pin point, goes away with rest and comes back after activity, but is hardly painful enough to make you want to stop. It lingers and is always on your mind. And if you’re looking for my step-by-step sports hernia rehab video course here it is.
One the best definitions of Sport hernias is the following by Harmon:
The phenomena of chronic activity–related groin pain that it is unresponsive to conservative therapy and significantly improves with surgical repair.”
This is truly how sports hernias behave in a clinical setting. It is not uncommon for a sports hernia to be unrecognized for months and even years. Unlike your typical sports injury, most sports medicine offices have only seen a handful of cases. It’s just not on most doctors’ radar. The purpose of this article is not only to bring awareness about sports hernias, but also to educate.
Will you find quick fixes in this article for sports hernia rehab?
Nope. There is no quick fix for this condition, and if someone is trying to sell you one, they are blowing smoke up your you-know-what.
Is there a way to decrease the pain related to sports hernias?
Yes. Proper rehab and avoidance of activity for a certain period of time will assist greatly, but this will not always stop it from coming back. Pain is the first thing to go and last thing to come. Do not be fooled when you become pain-free by resting it. Pain is only one measure of improvement in your rehab. Strength, change of direction, balance and power (just to name a few) are important, since you obviously desire to play your sport again. If you wanted to be a couch potato, you would be feeling better in no time. Watching Sports Center doesn’t require any movement.
Why is this article so long?
There is a lot of information on sports hernias available to you on the web. However, much of the information is spread out all over the internet and hard for athletes to digest due to complicated terminology. This article lays out the foundational terminology you will need to understand what options you have with your injury. We will go over anatomy, biomechanics, rehab, surgery, and even the fun facts. The information I am using is from the last ten years of medical research, up until 2016. We will be making updates overtime when something new is found as well. So link to this page and share with friends. This is the best source for information on sports hernias you will find.
Common Names (or Aliases?) for Sports Hernias
Sportsman’s Hernia
Athletic Pubalgia
Gilmore’s Groin
How Do You Know If You Have A Sports Hernia?
Typical athlete characteristics:
Male, age mid-20s
Common sports: soccer, hockey, tennis, football, field hockey
Motions involved: cutting, pivoting, kicking and sharp turns
Gradual onset
How A Sports Hernia Develops
Chronic groin pain typically happens over time, which is why with sports hernias, we do not hear many stories of feeling a “pop” or a specific moment of injury. It is the result of “overuse” mechanics stemming from a combination of inadequate strength and endurance, lack of dynamic control, movement pattern abnormalities, and discoordination of motion in the groin area.
#SPORTSHERNIAEXAM #california
What is an ingrown hair cyst? An ingrown hair cyst refers to an ingrown hair that turns into a cyst — a large bump that extends between the skin’s surface and deep underneath it. The appearance is a cross between a regular ingrown hair and an acne cyst, though this is a different condition. These types of cysts are common among people who shave, wax, or use other methods to remove their hair. Although you may be eager to get rid of these cysts simply because of their appearance, it’s also important to watch for signs of an infection. Keep reading to learn what causes these cysts to form, plus how to treat them and prevent them from returning.
A hematoma is a collection of blood outside of a blood vessel. There are several types of hematomas and they are often described based on their location. Examples of hematomas include subdural, spinal, under the finger or toenail bed (subungual), ear, and liver (hepatic). Some causes of hematomas are as pelvic bone fractures, fingernail injuries (subungual), bumps, passing blood clots, blood clot in the leg (DVT), blood cancers, and excessive alcohol use. Symptoms of hematomas depend upon their location and whether adjacent structures are affected by the inflammation and swelling associated with the bleeding and may include
Olympus has extended the value of its award-winning combined surgical energy device, THUNDERBEAT, to open surgical procedures. Watch Dr. Francois Blaudeau master use of THUNDERBEAT Open Extended Jaw (OEJ) in a total abdominal hysterectomy.
http://medical.olympusamerica.com/products/thunderbeat?utm_source=youtube&utm_campaign=Total%20Abdominal%20Hysterectomy%20Surgery%20-%20THUNDERBEAT&utm_medium=description&utm_term=energy&utm_content=surgical
Doctors save the life of an unborn baby who was injured along with her mother in a missile attack in the Syrian city of Aleppo. The video shows a team of emergency medical workers delivering the baby by Cesarean section and then treating the newborn for the shrapnel wounds covering her body and one very large gash in her head. “Medics can be seen frantically reviving the baby, after delivering her by emergency cesarean, as she lies motionless,” the article states. “Eventually the tiny newborn begins to cry and seemingly comes to life as she is given an oxygen mask and rubbed vigorously.” “According to Reuters, the woman also has three other children, all of whom were injured in the attack, but are reported by doctors in the hospital to be in a good condition,” the Daily Mirror article states. The article does not provide the gestational age of the baby before it was delivered. The article said the pregnant woman was hit by a barrel bomb – “crude explosives and shrapnel and dropped from helicopters used by [Syrian] President Bashir al-Assad’s regime." The article notes an estimated 7.6 million Syrians have been displaced by the ongoing civil war and that 320,000, including 11,000 children, have been killed in the conflict. The Daily Mirror also reports that the doctors suggested that the tiny girl be named Amal, which means hope in Arabic. UK Daily Mirror: Incredible footage shows Syrian doctors perform lifesaving caesarean after missile strike leaves shrapnel embedded in unborn baby's face
-A finding of ASC on cytology requires further investigation to exclude precancerous lesions. Recommendations differ for women age 21 -24 and those age ;::25. For women age 21 -24 with ASCUS or low-grade squamous intraepitheliallesion (LSIL), current guidelines recommend repeating Pap smear in one year. In this younger patient population, HPV infection is transient and malignant transformation is rare. Therefore, colposcopy is not performed unless the patient demonstrates ASC-US or LSIL on 3
An amputation is the removal of an extremity or appendage from the body. Amputations in the upper extremity can occur as a result of trauma, or they can be performed in the treatment of congenital or acquired conditions. Although successful replantation represents a technical triumph to the surgeon, the patient's best interests should direct the treatment of amputations. The goals involved in the treatment of amputations of the upper extremity include the following : Preservation of functional length Durable coverage Preservation of useful sensibility Prevention of symptomatic neuromas Prevention of adjacent joint contractures Early return to work Early prosthetic fitting These goals apply differently to different levels of amputation. Treatment of amputations can be challenging and rewarding. It is imperative that the surgeon treat the patient with the ultimate goal of optimizing function and rehabilitation and not become absorbed in the enthusiasm of the technical challenge of the replantation, which could result in poorer outcome and greater financial cost due to lost wages, hospitalization, and therapy.
The camera sends images to an external monitor so the doctor can study the inside of your colon. The doctor can also insert instruments through the channel to take tissue samples (biopsies) or remove polyps or other areas of abnormal tissue. A colonoscopy typically takes about 20 minutes to an hour.