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Introduction: Hemangiopericytoma is a rare tumor arised from the pericytes, contractile spindle cells that surround the capillaries and post-capillary venules. The tumor was found equally among males and females. Case report: We report a case of a 63-year-old female who presented a giant painful mass on her right shoulder that occurred one year before admission. Limited range of motion and a sense of tingling along the affected arm was present also. An irregular, oval-shaped mass, colored dark-red, with signs of necrosis was the maximal diameter of 14cm. Routine laboratory analyzes showed results within the range of referenced values. Lung X-ray and ultrasonographic examination of the abdomen showed no signs of secondary tumor deposits, and no osteo-muscular lesions in the affected region. Ultrasonographic examination of the neck and right axillary region showed no signs of regional metastases. The surgical excision of the entire tumor was performed, with the associated subcutaneous tissue and a part of fascia underneath. Results of the histopathological analysis confirmed the diagnosis of hemangiopericytoma. The specimen showed no signs or elements of the neoplastic tissue on the edges of the resection lines. 3 years after the operation, there was found no signs of tumor relapses, regional or systemic metastases. Conclusion: Considering that there are no official clinical guides and protocols for hemangiopericytoma management, as well as the occurrence of cutaneous and subcutaneous hemangiopericytomas is exceptionally rare, more extensive research in this field and more described cases are need to gain a better understanding of that issue.

BACKGROUND: Many statistics reveal that violin players suffer most often from musculoskeletal disorders compared to musicians of other instrument groups. A common phenomenon, especially observed in violin beginners, is the tendency to elevate the right shoulder during playing the violin. This can probably lead to serious disorders in long-term practice with repetitive movements. OBJECTIVE: For this reason, this study investigated the relationship between the right shoulder elevation and the force in the right glenohumeral joint during violin playing. It was hypothesized that the forces in the right glenohumeral joint are higher during playing with the right shoulder raised compared to playing in normal posture. METHODS: Motion capture data from four experienced violinists was recorded and processed by means of musculoskeletal simulation to get the force and elevation angle while playing with raised shoulder and in normal position. RESULTS: The results indicate that the absolute values of the resulting force, as well as the forces in the mediolateral, inferosuperior, and anteroposterior directions, are higher in playing the violin with the shoulder raised than in a normal posture. CONCLUSIONS: Elevating the right shoulder while playing the violin may pose a potential problem.

OBJECTIVE: Clarinetists often report discomfort of the right wrist and thumb and note that it is likely the result of the constant force applied to the area from the instrument’s weight and the musician’s technique. One preventative measure to reduce this discomfort is the use of a neck strap. The objective of the current study was to document the biomechanical impacts of this intervention. METHODS: Eight experienced clarinetists played a series of three etude pieces while playing both with and without a neck strap. For each condition, the force between the right thumb and clarinet was measured, electromyographic (EMG) data were collected from seven muscle groups, and subjective assessment of perceived effort was obtained. RESULTS: The results showed that when the neck strap was used, there was a significant decrease in the average force between the thumb and clarinet (p

OBJECTIVE: First and second violinists in orchestras use identical instruments, but the motor patterns used to execute the different notes may vary between the two groups and the biomechanical gestures may influence musculoskeletal complaints. The primary objective of this study was to compare the pain intensity and interference in musical performance of first and second violinists of professional youth chamber orchestras. Second, to investigate the correlation between pain and the musical practice profile in this population. METHODS: This cross-sectional study enrolled 74 violinists, aged 12 to 17 years, from three professional youth chamber orchestras in Brazil. Participants completed a validated self-administered questionnaire, the Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians–Brazilian version (MPIIQM-Br). Variables related to musical practice profiles were also recorded. Data analysis applied t-tests for independent samples and Pearson’s correlation coefficient. RESULTS: The sample of first violinists (n=39) presented 23 males and 16 females, and the second violinists (n=35) included 23 females and 12 males. The mean age was 13.9 yrs (SD 1.1) and 14.1 yrs (1.0) for the first and second violinist groups, respectively. Most participants (n=66, 89%) reported pain in at least one moment of their career, and 54 (76%) reported pain at the time of data collection. A higher pain prevalence was identified in the right shoulder (37.7%), in 28.2% of the second violinists and 9.4% of the first. The second violinists presented higher scores for most variables related to pain intensity and pain interference in performance (p < 0.05). A correlation was observed between time working at a professional level and the number of affected areas on the body pain map (r=0.30; 95% CI 0.23–0.42) and between the hours of daily practice and the number of affected areas on the body pain map (r=0.39; 95% CI 0.29–0.45). CONCLUSION: Second violinists had more complaints of pain and difficulty in playing their instrument compared to the first violinists. The study also found a correlation between the number of body areas with pain complaints and variables linked to the violinists’ practice profile.

Arteriovenous malformations (AVMs) are congenital high flow pathologic linkages between arteries and veins of different sizes that may occur in any part of the body. The clinical presentation is largely dependent on the size and location of AVMs and can range from an asymptomatic birthmark to congestive heart failure in extreme cases. In this report, we describe a 20-year-old male who presented with a large AVM of the right shoulder that resulted in significant cosmetic and physical impairment and treated with several sessions of endovascular embolization with good clinical outcomes. This case highlights the complexity of diagnosing and managing these AVMs. Most of these anomalies require a multi-disciplinary approach that integrates both trans-catheter and surgical interventions with trans-arterial lesion embolization being the cornerstone of the treatment.

The risk of Musculoskeletal Disorders (MSDs) can occur in a variety of occupations including in traditional jewelers. The complaint is caused by an awkward position during work activities. The study aims to identify complaints of Musculoskeletal Disorders (MSDs). This study used qualitative approach through in-depth interviews on 5 key informants and 2 key expert informants and ergonomic risk determination referring to the BRIEF method. The results showed that all informants experienced complaints of the upper neck, lower neck, right shoulder, back, right elbow, right upper arm, and right forearm. Measurements through the BRIEF sheet show that complaints on the left and right elbows, left and right shoulders, neck, and back include high category ergonomic hazards while complaints on the hands and wrists of the right include moderate category ergonomic hazards. High risk of Musculoskeletal Disorders (MSDs) is found at all stages of work (smelting, grinding, posturing, jewelry formation, and gilding). Therefore, workers are recommended to perform muscle relaxation for (8-12 seconds) every half hour.

BACKGROUND Neurofibromatosis type 1 (NF1) is an inherited autosomal dominant disorder affecting many parts of the body with cafe au lait spots, skeletal deformity, and scoliosis. A familial case of NF1 with scoliosis and a painless mass had not yet been reported. CASE SUMMARY We describe the case of a 15-year-old male patient with a painless lump on the left side of his neck for 10 years and scoliosis. His right shoulder was about 5 cm lower than the left, the left side of his face was deformed, and the left submandibular skin was relaxed. The folding and drooping were obvious and movement was poor. Computed tomography revealed the involvement of the neck, upper chest wall, and surrounding left shoulder, accompanied by bone changes and scoliosis. Histological evaluation showed subepidermal pale blue mucoid degeneration, fibrous fusiform cells in the dermis in a fascicular, woven arrangement. His mother had the same medical history. The diagnosis was neurofibromatosis of the left neck. Various parts of the tumor tissue were serially resected during several visits. Eight months after surgery, there was a slight tendency to regrow. CONCLUSION This case of slow-progressing NF1 highlights the importance of early diagnosis and treatment to reduce its impact on the patient's growth and development.

Kegiatan fisik yang berhubungan dengan aktivitas kerja pada operator produksi merupakan salah satu pekerjaan perlu diperhatikan. Aktifitas operator pada CV. Primavera yang bergerak di bidang garment terutama bagian cutting laser kain adalah proses pemotongan kain yang menggunakan teknologi sinar laser berdaya tinggi yang dipancarkan dari generator mengenai benda kerja, pergerakan pemotongan dikontrol melalui komputer sehingga kemungkinan melesetnya kecil. Pada saat proses cutting laser, pekerja berdiri didepan mesin cutting laser dan membungkuk saat penyetingan ukuran kain sesuai keranjang. Keluhan tersebut muncul disebabkan postur tubuh kerja yang tidak ergonomi menyebabkan timbulnya rasa sakit pada beberapa bagian tubuh yang dirasakan pekerja. Tujuan dari penelitian ini adalah untuk mengetahui tingkat resiko dan persentase keluhan yang dirasakan selama cutting laser. Metode yang digunakan adalah Rapid Entire Body Assessment (REBA) dan Nordic Body Map (NBM), berdasarkan metode REBA resiko kerja yang di hadapi pekerja dalam cutting laser kain dengan level tinggi skor yang dihadapi dikisaran 8-10, kategori tindakan tinggi sehingga perlu segera dilakukan perbaikan postur kerja. Nordic Body Map menunjukan segmen tubuh yang pertama pada bagian punggung dengan skor 9, segmen tubuh kedua pada bagian kanan bahu dengan skor 8, segmen tubuh ketiga bagian pinggang skor 8, segmen tubuh keempat pada bagian pantat skor 8, dan segmen tubuh kelima pada bagian kaki kanan dengan skor 8, disebabkan postur kerja yang membungkuk saat proses cutting laser dan penyetingan ukuran kain serta faktor umur dan lama bekerja ikut mempengaruhi kuesioner.

Disinfectant tunnels have attracted attention as a potential measure to prevent the spread of COVID-19, but their safety and effectiveness are questionable. Disinfectants such as sodium hypochlorite were used, yet no scientific evidence is available on its effectiveness to eliminate SARS-CoV-2 on the human body through spraying, although this chemical is effective in the elimination of the virus on inanimate surfaces. Since safety issues are of importance, countries have halted the operation of these tunnels. Available literature has suggested several effective disinfectants against SARSCoV-2, including iodine-based solution, such as povidone-iodine (PVP-I). This report describes the evaluation of the bactericidal activity of PVP-I in comparison to sodium hypochlorite, both in vitro and following spraying under a model tunnel. Two bacteria strains (Pseudomonas aeruginosa ATCC 27853 and Staphylococcus aureus ATCC 12600) were used as model microorganisms. The spraying pattern and droplets distribution from the tunnel are also being described and were correlated with the effectiveness of the disinfectant droplets to eliminate the model bacteria. Results showed that 0.5 % v/v PVP-I and 0.5% v/v sodium hypochlorite are bactericidal (>5 log10 reduction) in vitro. However, sprayed disinfectants did not show similar activity. Bacterial growth was seen in all cloth samples for 0.5% v/v PVP-I and all cloth samples except right shoulder for 0.5 % v/v sodium hypochlorite. Hence, the design of any disinfectant tunnel is important, and with an effective disinfectant to justify its efficacy. © 2021 Penerbit Universiti Kebangsaan Malaysia. All rights reserved.

Close your eyes and imagine that you are in an art museum. You look over your right shoulder and see a painting of a lush garden landscape. Try to investi- gate it further. Observe the abundance of pastel-colored flowers, engaging van- tage points and mystical partially hidden pathways.a Then, consider how the landscape makes you feel. Now, keep your eyes closed and imagine another scenario. You are sitting in the front row of Christian Dior’s “The Garden of Earthly Delights” fashion show.b Try to concentrate on the clothing. Observe the plethora of delicate, soft-hued, floral-print gowns. Finally, consider how the fashions make you feel.

All names and places have been changed to protect innocent victims in this case report. A young woman was returning home after work when she was accosted by a man wielding a knife. She was dragged into a nearby bush where the suspect attempted to rape her. She put up a substantial fight and was able to flee the scene. She went directly to the nearest police station to report the case. She was asked by the police to accompany them in the hope that she might recognise the suspect at the local taxi rank, which was near the scene of the crime. She did in fact recognise the suspect who was duly arrested. He denied any knowledge of the crime for which he was being apprehended. The victim informed the police that she had remembered biting the suspect on his right shoulder during the attack and ensuing struggle. The suspect was asked to roll up his right sleeve where a possible bitemark wound was observed. The suspect was taken into custody for further investigations. Fortunately, the police officer in charge of the case had attended a lecture on bitemarks given by the second author some weeks before the incident and was therefore well-versed in the protocol for the collection of evidence in a bitemark case. The officer arranged that photographs and impressions of the possible bitemark were taken for forensic analysis. Unfortunately, swobs of the bitemark were not conducted, therefore DNA and ABO blood group antigen analysis could not be performed. Impressions of the victim’s dentition were also taken from which plaster models were constructed. All dental materials used in this case were mixed according to the manufacturer’s instructions and were within their expiry dates. This evidence was submitted to the forensic odontology unit at the University of Pretoria for examination and comparative analysis

espanolEl sindrome HELLP es una complicacion de los trastornos hipertensivos del embarazo, principalmente observado en pacientes con preeclampsia severa y eclampsia; sin embargo, puede diagnosticarse en pacientes con preeclampsia agregada y en mujeres con hipertension gestacional (preeclampsia sin proteinuria). Generalmente el sindrome se manifiesta en el tercer trimestre. Se ha senalado que 2 tercios de las pacientes eran diagnosticadas antes del parto, el 70 % entre las 27-37 semanas, el 20 % despues de las 37 semanas y el 10 % restante antes de las 27 semanas. El sindrome HELLP se observa entre el 0,5 y 0,9 % de todas las gestaciones y del 4 al 14 % de todas aquellas con preeclampsia/eclampsia. La edad promedio de las que padecen este sindrome es de 25 anos. La metodologia de la investigacion, es una revision bibliografica, que se apoyo en medios electronicos para la busqueda de la informacion. Entre las conclusiones relevan-tes estan que Las manifestaciones clinicas son variadas y entre las que se menciona estan: dolor en cuadrante superior derecho, ictericia, nauseas y vomitos, cefalea, dolor en hombro derecho y cuello, alteraciones visuales, manifestaciones hemorragicas. Este sindrome pone en riesgo la vida de la madre, por las complicaciones que se pueden presentar como: hemorragia cerebral, insuficiencia renal, ruptura hepatica y mayor posibilidad de muerte asociada con eclampsia, principalmente cuando coexiste hipertension severa. Esta condicion reviste de gran importancia durante el embarazo, ya que debe ser tratada lo mas rapido posible, ya que dentro del abanico de tratamientos que pueden existir, la interrupcion del embarazo es una de las mas comunes y realizadas, esto con la finalidad de preservar la vida de la madre EnglishHELLP syndrome is a complication of hypertensive disorders of pregnancy, mainly observed in patients with severe pre-eclampsia and eclampsia; however, it can be diagnosed in patients with added pre-eclampsia and in women with gesta-tional hypertension (pre-eclampsia without proteinuria). The syndrome usually manifests itself in the third trimester. It has been reported that 2 thirds of the patients were diagnosed before delivery, 70% between 27-37 weeks, 20% after 37 weeks, and the remaining 10% before 27 weeks. HELLP syndrome occurs in 0.5% to 0.9% of all pregnancies and 4% to 14% of all pre-eclampsia / eclampsia. The average age of those with this syndrome is 25 years. The research methodology is a bibliographic review, which relied on electronic means to search for information. Among the relevant conclusions are that the clinical manifestations are varied and among those mentioned are: pain in the right upper quadrant, jaundice, nausea and vomiting, headache, pain in the right shoulder and neck, visual disturbances, hemorrhagic manifestations. This syn-drome puts the life of the mother at risk, due to complications that can occur such as: cerebral hemorrhage, kidney failure, liver rupture and a greater possibility of death associated with eclampsia, mainly when severe hypertension coexists. This condition is of great importance during pregnancy, since it must be treated as quickly as possible, since within the range of treatments that may exist, the interruption of pregnancy is one of the most common and carried out, this in order to preserve the life of the mother.

A 60 year married female from Chennai presented with pain and restricted abduction, adduction, external rotation and flexion of right shoulder both in active and passive movements for 2 months. She was diagnosed to be affected by adhesive capsulitis which is equated to Kumbavatham, one of the vatha diseases mentioned in Siddha system of medicine. She was treated with Siddha Varmam therapy and thokkanam with Vathakesari thylam. After 15 days of hospital stay the patient was discharged and was followed for 6 months. There were no adverse reactions/events observed during the course of treatment. The combination therapy has provided the reduction in pain and restricted movements which was measured using goniometer and SPADI index.

Wardenaar, FC, Ortega-Santos, CP, Vento, K, Beaumont, JS, Griffin, SC, Johnston, C, and Kavouras, SA. A 5-day heat acclimation program improves heat stress indicators while maintaining exercise capacity. J Strength Cond Res 35(5): 1279-1286, 2021-This study aimed to evaluate whether a daily 60 minutes isothermic biking protocol during a 5-day period could improve physiological heat acclimation and exercise performance capacity in partially acclimated subjects. A quasi-experimental study consisted of an intervention (INT, n = 7) and control (CON, n = 7) group completing 2 12 minutes Cooper tests (pre-CT on day 1 and post-CT on day 7) and a heat stress test (HST, on day 9). INT performed additional intensive exercise 1 hour per day on days 1-5, whereas CON did not. During CTs and HST, core temperature (Tc, telemetric capsule), skin temperature (Tsk, sensors at neck, right shoulder, left hand, and right shin), and heart rate (HR, chest strap) were continuously monitored and baseline, average, peak, and increment were calculated. During the HST, the INT group showed a smaller baseline-peak Tc increment (INT 0.88 ± 0.27 vs. CON 1.64 ± 0.90° C, p = 0.02), a lower HR peak (150.2 ± 12.6 vs. 173.0 ± 16.8 b·min-1, p = 0.02), and lower Tsk peak (36.47 ± 0.62 vs. 36.54 ± 0.46° C, p = 0.04). There was a nonsignificant, but practical difference based on a moderate effect size for change in pre-CT to post-CT performance of nearly +2.7 ± 12.3% in INT and -3.0 ± 8.5% in CON (p = 0.32 and d = 0.51), and HST distance covered resulting in a nonsignificant difference of 464 ± 849 m between INT and CON (p = 0.38 and d = 0.44). In conclusion a short-term 5-day heat acclimation program including 300 minutes of extra exercise resulted in positive physiological adaptions to heat stress, as indicated by lower core temperature and HR in comparison with a control group.

PurposeThe COVID-19 pandemic lockdown has caught many educational institutions by surprise and warranted an abrupt migration from offline to online learning. This has resulted in an education change, without any time for due consideration, as regards its impact on musculoskeletal disorders (MSD) on students. The purpose of this study is to investigate MSD related to online learning during the COVID-19 pandemic lockdown.Design/methodology/approachA cross-sectional study was conducted on undergraduate students in India. In total, 261 students participated in this online survey.FindingsThe study finds that around 80% of students have reported some symptom in the head, neck and eyes since they started online learning. In total, 58% have reported MSD symptom in the right shoulder and 56% in the right hand fingers. Besides, more than 40 % of students experienced some MSD symptoms, in almost all the body parts studied, due to online learning. Correlation analysis is conducted between time spent on online learning per day and MSD symptoms.Originality/valueThis is the first study conducted on MSD and online learning during COVID-19 pandemic.

OBJECTIVES: The objective of the study is to evaluate the effectiveness and safety of shoulder reduction developed by Prakash. METHODOLOGY: This descriptive study was carried out at Rehman Medical and Surgical Center District Buner and Naseer Teaching Hospital Peshawar from June 2017 to December 2019. All patients with a history of trauma to either shoulder were subjected to anterior-posterior shoulder radiograph. Those having shoulder dislocation were enrolled in the study. Data including age, gender, previous dislocation history, duration of dislocation and associated fracture, and fracture type were recorded in patient case sheet. Patients having recurrent dislocation, polytrauma, low GCS, fracture-dislocations, and more than a week history of dislocation were excluded from the study. RESULTS: This study was performed on 30 patients. The mean age of the patients was 36.46±11.58 years. Among them, 83.3% (n=25) were male and 16.7% (n=5) were female. While dislocation occurred on the right shoulder in 63.3% (n=19) and in 36.7% (n=11) on the left side. All the patients have dislocation for the first time. The reduction was performed using Prakash’s method. The success rate was 90% (n=27) and 10% (n=3) the reduction failed, which was then reduced under anesthesia using the Hippocratic method. CONCLUSION: The Prakash's method for reducing anterior shoulder dislocation requires minimum assistance with no anesthesia, it is safe, less time consuming, has a high success rate, less pain, and has minimal complications.

Based on calculations by the Directorate General of Food Plants (Ditjen TP), Ministry of Agriculture. Corn production in the last 5 years has increased by an average of 12.49% per year. According to the Secretary of the Directorate General of Food Crops of the Ministry of Agriculture (Kementan) Maman Suherman in 2019 maize production is estimated to reach 33 million tonnes of dry shell (PK) in an interview with Republika on January 6, 2019. Cepiring sub-district, Kendal district, apart from being planted with rice in the rainy season, rice fields also planted with maize. After harvesting, the corn that has been plucked is separated from the cob using a corn sheller. The shelling machine is used using diesel fuel and electricity, with workers standing for long periods of time, causing fatigue in the arms, waist, thighs and back. The data processing of the nordic body map questionnaire was carried out to determine the complaints on the skeleton and muscles of the workers. From the results of the questionnaire above, most Sido Rejo farmers feel complaints on their right shoulder, left upper arm, back, right upper arm, back, waist, left elbow, right elbow, left forearm, right forearm, left wrist, wrist right, left hand, right hand, left thigh, right thigh, left calf, right calf, left leg to right leg. With anthropometric measurements, the dimensions of the body used are the height of the sitting shoulders and the data used are the average data or the 50th percentile. With this solar sheller, it can save fuel and be environmentally friendly and reduce the complaints of the frame and muscles of farmers

Introduction: Dysbaric osteonecrosis (DON) in people working under increased atmospheric pressure is well documented. It is generally less common in military and commercial divers than in caisson workers, except in some high-risk groups, such as in many indigenous diving industries where workers have little or no understanding of decompression principles. With the increasing popularity within the recreational diving community of deep air and mixed-gas decompression diving (‘technical diving’), it is likely that diving physicians may see an increase in the prevalence of DON in this group in the future. Methods: The case report is presented of a technical diving instructor, with a 30-year history of deep diving, who developed bilateral humeral head DON and required a right shoulder hemi-arthroplasty. A focused literature search was also undertaken to identify published cases of DON in recreational divers. Results: The frequency, duration and depth of exposure to pressure, inadequate decompression, the occurrence of DCS and increasing age have been common features associated with DON in both divers and caisson workers. Many of these features were present in this technical diver. Conclusions: Whilst DON is uncommon in recreational air scuba divers, all the above risk factors are present to a greater degree in technical diving. It is suggested that medical review for DON is merited from time to time in this potentially high-risk group of recreational divers.

A 16-year-old male patient presented with 48-hour history of a painful swelling over the right sternoclavicular joint. He had recently returned from holiday in Turkey but gave no history of trauma. Palpation over the swelling was very tender and he was noted to be feverish at 38.2 ° C. There was no medical history of note and no history of unwell contacts. Initial radiography of the right shoulder is shown in …

Positional anterior sternoclavicular joint (SCJ) dislocation is relatively rare and needs careful treatment. We report our course of treatment and tips for surgery in a case. The patient was a 16-year-old male outfield baseball player. Three years ago, he had 3 recurrent episodes of right shoulder dislocation. During these injuries, there were forward dislocations of the proximal right clavicle edge accompanied by a creaking sound during the throw acceleration period. Thereafter, the anterior dislocation of the SCJ occurred during the acceleration phase of throwing, and the SCJ naturally repositioned on the shoulder resting position. This situation lingered and he often felt shoulder apprehension during throws, so he opted for surgical treatment just 1 month after the first injury. We performed a modified version of the figure-of-8 technique reported by Wang et al, using the ipsilateral palmaris longus (PL) tendon. The bilateral edge of the PL was attached to a Krackow suture and passed through the bone tunnels opened at the proximal clavicle and proximal sternum so that it became a figure of 8 on the anterior of the SCJ. The stability of the SCJ was confirmed after the surgery.

The medical manufacturing industry is currently one of the sectors with great potential growth in Malaysia, which offers numerous job opportunities to local and foreign workers. The growing proportion of workers in this industry means that a large number of workers are potentially exposed to ergonomic risk factors at the workplace, which may consequently affect their health. Thus, this study was carried out is to investigate the ergonomic risk factors and the prevalence of musculoskeletal disorders among male workers in a medical manufacturing company in northern Malaysia. Eight industrial workers (n = 8) were recruited from two Plastic Technology (PT) departments to participate in this study. Observations were made by recording the participants performing two tasks (manual lifting of containers and bags of chemicals) using a video camera at the PT1 and PT3 departments. The participants’ personal information and their job-related characteristics were first collected using a demographic questionnaire. Next, the Cornell Musculoskeletal and Hand Discomfort Questionnaire (CMDQ) was used to evaluate the prevalence of musculoskeletal disorders among workers while Manual Handling Assessment Charts (MAC) were used to assess the most common risk factors during the lifting operations. The results showed that the highest prevalence of musculoskeletal disorders among the male workers at the medical manufacturing company was at the lower back (83.17%), upper back (4.38%), right shoulder (3.49%), and left shoulder (3.49%). Based on the results of the MAC, 100% of the participants were at high risk of injury from postures in the vertical lift zones, torso twisting, and sideways bending. In addition, 87.5 and 62.5% of the participants were at high risk of injury based on their hand distance from the lower back and grip on the load, respectively. The results of this study can serve as a guideline to implement interventional ergonomics programmes at the workplace and improve the musculoskeletal health of workers in the medical manufacturing industry in Malaysia.

Background: The calcific tendinitis of the shoulder is a dysfunction conservatively treated by shock waves, iontophoresis, and phonophoresis, associated or not with the use of acetic acid. Objective: To check the effects of phonophoresis with acetic acid in the treatment of calcific tendinitis of the shoulder in resorption stage. Methods: Measurements of ROM, muscle strength and functionality of the shoulder (SPADI) were made pre and post-physiotherapeutic treatment. The treatment protocol consisted of 10 sessions of therapeutic ultrasound with acetic acid (frequency = 3 MHz; intensity = 1.4 W/cm2; pulsed mode of 1:4), for 10 minutes, 3 times a week. The data were analyzed using the SPSS software (20.0), through the Student’s t-test (paired) considering a significance level of 5%. Results: There was significant improvement regarding the ROM, muscle strength and functionality of the right shoulder (SPADI) comparing pre vs. post-treatment (P0.05), in the comparison between the shoulders (right X left) in the post-treatment. Conclusion: According to the results of this case study, the protocol used (10 sessions of therapeutic ultrasound + 5% acetic acid) was effective in the treatment of calcific tendinitis of shoulder, improving the ROM, muscle strength and functional capacity, in addition to eliminating the pain of the shoulder affected.

Lateral exercises are commonly practiced in equitation. Studies on the influence of these exercises on horses' emotional responses are scarce. This study investigated equine behavioral and physiological responses to lateral exercises. Forty horses (11 ± 4 years old) and two riders (one professional and one amateur) were involved in the research. Two sessions of approximately 10 minutes each were performed. In session 1, longitudinal exercises were performed at three gaits: walk, trot, and canter. In session 2, horses performed a lateral exercise (shoulder-in) at the three gaits. To study autonomic nervous system activity, heart rate variability was assessed using heart rate (HR), low-frequency/high-frequency ratio (LF/HF), and very-low-frequency (VLF) data. Behaviors previously associated with a horse's lack of attention (looking around frequency [LAF]) and relaxation (playing with/chewing the bit duration [PCB]) were collected. LAF was significantly highest in session 1 (P

Purpose: This study was to evaluate several tasks performed at a high intensity in terms of their ability to elicit EMG activity in the ser ratus anterior by comparing the EMG activities of the serratus anterior, upper trapezius, and lower trapezius muscles during six tasks combined shoulder flexion with rotation. Methods: Fifteen healthy males were recruited to this study. Each subject was instructed to assume a sitting position without back sup port and asked to flex (90° or 120°) the right shoulder and protract the scapula in the sagittal plane with maximal external rotation; to assume a neutral position; or to internally rotate the glenohumeral joint. The EMG data were collected from the serratus anterior (SA), upper trapezius (UT), and lower trapezius (LT) muscles were normalized to maximum voluntary isometric contraction. The UT/LT and UT/SA muscle activity ratios in each task were assessed by calculating the surface EMG. Data were analyzed by two-way repeated-measures analysis of variance, with the level of significance set at p

Background: Occupational injuries and work-related disabilities are among the most factors contributing to the creation of musculoskeletal disorders (MSDs) in industry. Improper workstation and poor posture increase fatigue load and, eventually, the appearance of MSDs. In addition to reducing physical strength, MSDs mitigate accuracy, augment the accidents, and reduce job productivity. Hence, the purpose of this research was to assess the risk factors for MSDs in electrical devices assembly workers utilizing Muscle Fatigue Assessment (MFA) and Novel Ergonomic Pos­tural Assessment (NERPA). Methods: This study was one cross-sectional descriptive study in the year … and was conducted in one electrical device manufacturing workshop in Khuzestan province along with 84 female workers. 13 jobs and 32 postures were selected in this workshop. Nordic Questionnaire was used to determine the frequency of MSDs. Then, the risk levels were specified in the studied individuals with the use of MFA and NERPA. The obtained data were analyzed in SPSS software version 16. The statistical methods applied in this study were mean, standard deviation, frequency, frequency percentage, t-test of two independent samples, and correlation coefficient assessment. Furthermore, the significance level of statistical tests was considered to be P

Background Cutibacterium acnes is the most common pathogen in shoulder prosthetic joint infections. Short-contact benzoyl peroxide (BPO) solutions effectively reduce C acnes loads on the shoulder preoperatively. It is unknown how long the effect of BPO lasts. We evaluated C acnes counts 1 week after BPO application. We hypothesized that BPO would decrease C acnes burden with a rebound after 1 week. Methods Screening of 102 healthy volunteers with no history of shoulder surgery or C acnes infection was performed to establish bacterial counts. Thirty-four participants were selected based on an established threshold. Each was given BPO 5% for 3 consecutive days of application on either the left or right shoulder as indicated by a random number generator. Deep sebaceous gland cultures were obtained with a detergent scrub technique before BPO application, after 3 days of use, and 1 week after BPO treatment commenced. Results The differences between the logarithmic reduction and the logarithmic rebound at the anterior, lateral, and posterior sites were statistically significant. Anteriorly, the average log reduction was −0.44 and the average log rebound was 0.69 (P = .003). Laterally, reduction was −0.64 and rebound was 0.74 (P = .003). Posteriorly, reduction was −0.63 and rebound was 0.78 (P = .008). At the axilla, reduction was −0.40 and rebound was 0.31 (P = .10). The differences in C acnes burden between pretreatment and 1-week counts at all sites were not statistically significant. Conclusion A significant decrease in C acnes burden occurred after BPO application but was not permanent. Significant rebound occurred just 1 week later.

En este estudio se analiza la relación entre el espesor de grasa subcutánea (EGS), espesor muscular (EM) y espesor de grasa subcutánea y espesor muscular juntos (EGSM), medidos con ultrasonido en un solo punto anatómico de cerdos vivos y los parámetros más importantes de la canal . En nuestro experimento utilizamos cerdos híbridos de las razas Pietrain, Landrace y Yorkshire en cantidad de 25 animales de ambos sexos. Los resultados del estudio sugieren que los parámetros de la composición de la canal aquí analizados están altamente correlacionados con el espesor de la grasa subcutánea medida con el ultrasonido en la última costilla del musculo longuísimo dorsal en el lado izquierdo del cerdo vivo (r = 0.53 - 0.67). La correlación múltiple del modelo de predicción de regresión lineal entre los parámetros de la canal y el espesor de grasa dorsal fue (0.74) y el coeficiente de determinación mostró suficiente capacidad de predicción (R2 = 0.55). Los modelos de predicción de regresión lineal de los componentes de la canal con el espesor muscular obtuvieron baja capacidad de predicción (R2 = 0.23). Igualmente en el modelo de regresión del espesor de grasa subcutánea y espesor muscular juntos ( R2= 0.25). Entre las correlaciones más importantes encontradas están: lomo derecho, carne clase A (r = 0.80), peso vivo y canal entera (r = 0.85) paleta derecha y carne clase B (r = 0.88) siendo este patrón repetitivo en todas las correlaciones de las mediciones ultrasonografica y los componentes de la canal.

After an acupuncture treatment 24 times, the symptoms are recovered right shoulder both active and passive full range of movement in all directions, and pain‐free. Furthermore, no adverse effects were observed., After an acupuncture treatment 24 times, the symptoms are recovered right shoulder both active and passive full range of movement in all directions and pain‐free. Furthermore, no adverse effects were observed.

Thermal burns from therapeutic modalities have previously been reported in East Asian and Australasian literature. However, there is a paucity of similar cases reported in Western populations of burns secondary to therapeutic modalities and given the increasing popularity of such therapies, we think it important to highlight some of the potential risks. Here we present a case of full thickness burn to the right shoulder in an adult male requiring tangential excision and skin grafting after receiving Thai Herbal Hot Compress Massage Ball Therapy four days earlier. We aim to raise awareness of thermal burns secondary to such therapeutic modalities and remind clinicians and therapists the proportional time-temperature relationship in such low-moderate burns causing significant burn injuries. Traditional or alternative medical practitioners should be aware and trained in the first aid of burns and remain highly vigilant to the possibility of contact burns in these patients. Future work will involve undertaking a telephone survey of massage therapists to understand their practices regarding training in the identification, prevention and first aid management of burns.

Since one of the most crucial elements in crashes is related to human factors, driver behavior significantly impacts road safety. Driver behavior is influenced by many factors, including driving characteristics, experience, and the road environment. In this study, the effect of combining different elements including shoulder width (left shoulder width up to 0.6 m and more than 0.6 m as well as right shoulder width up to 1 m and more than 1 m), type and height of barriers (guardrail with a height 0.7 m, New Jersey with a height of 1.1 m, and retaining walls with heights of 5 and 10 m) on driver behavior on urban highways (in both upgrade and downgrade scenarios) was investigated. For this purpose, 20 urban highway segments were selected for filming and speed recording using the laser gun camera. The results revealed that New Jerseys on the left shoulders had caused driver workload and concentration more than guardrails. An average of 5% reduction in speed and a 25% increase in the lateral offset of the barriers were recorded to reduce the driver's workload. A 10-m retaining wall has caused more driver workload and concentration on the right shoulder than the curbs. An average of 8% reduction in speed and a 36% increase in the lateral offset of the barriers were recorded to reduce the driver's workload. It was also concluded that increasing the shoulder width can reduce the driver's workload. Finally, the movement methods model was predicted by using the nonlinear regression model for different car wheel positions from lateral lanes to various road barriers.

The rapid progress in the industrial sector has an important role in growing the economy. Without the industrial sector, growth in developing countries will be slower than in previous years. UD. Berkah Alam is one of the informal industrial sectors that focuses on coconut management. The types of jobs available at UD. The blessings of Nature are the pacak part, the scrap part, the daily part and the copra part. This type of work has a risk of musculoskeletal disorders. The study was conducted with the aim of knowing the prevalence of complaints of Musculoskeletal Disorders (MSDs) in each work section. The method used is a survey using a nordic body map using a questionnaire. The results showed that 59% of all workers experienced complaints of pain or pain, especially in the musculoskeletal system. Workers who experience complaints on the musculoskeletal system are highest in the copra (100%). Complaints of disorders experienced by workers of the right shoulder, left shoulder, buttocks, buttocks, right forearm and left forearm.

BACKGROUND Acromioclavicular joint (ACJ) injuries are among the most common injuries in contact and non-contact sports. As winter sports become more popular, there has been an increase in shoulder injuries among recreational skiers and snowboarders. METHODS This was a retrospective analysis of all patients who presented to the Denver Health Winter Park Medical Center with ACJ injury from 2012 to 2017. We examined the incidence of ACJ injuries, the injury mechanism, demographics, and type of ACJ injuries among skiers and snowboarders treated at the clinic. RESULTS A total of 341 ACJ injuries (6.7% of total visits) were encountered during the study period. The majority of ACJ injures were type I (41.3%) and mainly occurred in men (86.5%). Most (96.8%) of the cases were primary ACJ injuries on the right shoulder (56.9%). The average age of patients with ACJ injuries was 30.0 years (range 10-72). More than half (62.2%) of ACJ injuries occurred while snowboarding. The most common mechanism of injury (93.5%) was fall to the snow while skiing/snowboarding. Women were more likely to have a type I ACJ injury than men (80.4% vs 35.4%; P

Purpose—This study aimed to estimate the prevalence and risk factors of MSD pain in various anatomical regions among nurses. Method—A cross-sectional study involving a self-administered questionnaire by registered nurses with clinical experience. Data was collected using convenience sampling after obtaining informed consent. The results were drawn from a total of 300 nurses. Results—The nurses presented with occasional mental exhaustion (44.3%) and often physical exhaustion (44.0%). Almost all (97.3%) the nurses complained of having work-related pain during the last 12 months. Body parts with the most pain were the lower back (86.7%), ankles (86.7%), neck (86.0%), shoulders (85.0%), lower legs (84.7%) and upper back (84.3%). The pain frequency was rated as occasional pain for the neck and upper back, pain was often felt for the rest of the parts. Nurses complained of severe pain in the lower back (19.7%), right shoulder (29.7%) and left shoulder (30.3%). The frequency of having musculoskeletal symptoms in any body region was increased with age, lower education level, female gender, high BMI, job tenure and lifestyle. Conclusions—Nurses’ WRMSD complaints should be taken seriously to curb further risk and musculoskeletal hazards.

The purpose of this study was to assess the effect of using a combination of stretching and Brain Gym®(BG) + Touch for Health (TfH) movements to reduce fatigue and musculoskeletal complaints (MSCs) in garment-sewing operators. A quasi-experimental study was performed on 53 respondents with two sessions of stretching movements and BG + TfH movements of 5 min duration, three times a week for four weeks. Fatigue was measured using a reaction timer and MSCs were measured using a Nordic Body Map questionnaire. Wilcoxon and Mann–Whitney U tests were performed to examine the differences of pre/post and between the intervention group (IG) and control group (CG). A significant difference was found in IG for pre- and post-fatigue (p &lt, 0.001) and MSCs (p &lt, 0.001), while in CG there was no difference in fatigue (p = 0.200) and MSCs (p = 0.086). Significant differences were found between the IG and CG groups in terms of fatigue (p = 0.046), as well as in MSCs (p &lt, 0.001). A significant decrease in MSCs per part body in IG was found on the left wrist, left hand, and left knee. The percentage of MSC severity decreased in all parts of the body, except the right shoulder, left elbow, and right thigh.

We present the case of a giant bronchogenic cyst (BC) that appeared just within the right diaphragm. A 51‐year‐old man was referred to our hospital with a chief complaint of pain from the lumbar area to the right shoulder. Computed tomography images showed a cystic mass measuring 18.0 × 17.5 × 12.8 cm in the right thoracic cavity. Right posterolateral thoracotomy from the eighth intercostal space was performed, and the cyst wall and diaphragm were resected together. The defect of the diaphragm was repaired using a 2‐mm‐thick Gore‐Tex™ expanded polytetrafluoroethylene patch. It is embryologically rare for a giant BC to develop within the right diaphragm. As BCs may be associated with malignant tumours or infection, complete resection of the cyst wall is required. Literature review revealed no consensus on the best surgical procedure. Therefore, it is important to consider the appropriate surgical procedure for each case., We present an exceedingly rare case of a giant bronchogenic cyst that had developed within the right diaphragm. The cyst was successfully surgically resected.

The presence of metaplastic ossification within a atypical lipomatous tumour /well differentiated Liposarcoma (ALT/WDLPS) is a rare occurrence. We report a case ALT/WDLPS with unusual extensive metaplastic bone formation in a 30 years female who complained of swelling in the right shoulder for the past one and a half years. Bangladesh Journal of Medical Science Vol.20(1) 2021 p.197-199

There are few case reports of hepatocellular carcinoma (HCC) metastasis to the skeletal muscle. A 78-year-old man developed a mass in the right shoulder. Washout of contrast medium during contrast-enhanced ultrasonography (CEUS) in both the primary HCC and the metastatic site was detected. Several nodules were scattered throughout the liver on an autopsy. In addition, the moderately differentiated HCC had metastasized to the right teres major muscle. Rare muscular metastasis should be considered if a hepatic tumor is moderately or poorly differentiated HCC. Early washout during CEUS is consistent with a pathological diagnosis of moderately or poorly differentiated HCC.

While dental pulp calcifications and root anomalies may be inconsequential incidental findings in dental radiographs, they can, especially in combination, represent a clue, hidden in plain sight, for the diagnosis of hyperphosphatemic familial tumoral calcinosis (HFTC). HFTC is an autosomal recessive disease of mineral metabolism characterized by sometimes massive, painful calcification around large joints, systemic inflammation, dental pulp calcification, and thistle-shaped roots. This paper describes a woman with HFTC who endured not only the symptoms of HFTC for decades, but also the frustration of not knowing the cause. The diagnosis was finally made at the age of 73 years, when the connection between a large right shoulder calcification and hyperphosphatemia was made. The dental findings were likely present on her initial radiographs taken in childhood. Increased awareness of the association between characteristic dental findings and HFTC may allow for earlier diagnosis and interventions to improve the care of patients with this rare condition.

Introduction After a vaccination, patients frequently have clinical symptoms of pain and swelling over the injection area which usually resolve 2–3 days after the injection. If the symptoms do not improve, a shoulder injury related to vaccine administration (SIRVA) will be considered, perhaps related to an improper injection technique. Herein we report our first case of a SIRVA after a Sinovac COVID-19 vaccination which occurred due to deep penetration and direction of the needle. The clinical symptoms of the patient improved after treatment with combined oral non-steroidal anti-inflammatory drugs and a short course of intravenous antibiotic. Case presentation A 52-year-old Thai male without prior shoulder pain had a Sinovac COVID-19 vaccination at his right shoulder. The injection was given by a nurse using a 27-gauge needle, 1.5 inches in length. The injection landmark was 3 finger breadths below the midlateral edge of the acromial process. The direction of the needle was 45° to the skin cephalad. Three days after receiving the vaccine the patient began to have right shoulder pain with limited range of motion and acute fever. He was admitted for medical treatment which his clinical symptoms gradually improved. Conclusion We report a case of subacromial-subcoracoid-subdeltoid bursitis following a Sinovac COVID-19 vaccine injection. This condition is rare, and usually related to an incorrect vaccination technique. To avoid this complication, nurses should identify the correct landmark, use an appropriate needle length, and point the needle in the correct direction., Highlights • After a vaccination, if the symptoms do not improve, SIRVA will be considered. • There is a risk of SIRVA if the direction of the needle was pointed to the skin cephalad. • Before diagnosis SIRVA, septic arthritis of shoulder should be ruled out.

Angiomatoid fibrous histiocytoma (AFH) is a rare, slow-growing soft tissue tumor with an intermediate biologic potential and uncertain line of differentiation, and minimal metastatic potential. AFH may mimic both the clinical, histological, and radiological findings of several tumors; therefore, it is frequently misdiagnosed. Three cases of AFH were included in this study. A six-year-old male and two females with an age of 12 and 17 years are presented. The primary locations were in the right shoulder (case 1), left medial proximal thigh (case 2), and left lateral knee (case 3). Two cases (cases 2&3) were presented with a painful mass. In the three patients, the masses were firm, mobile, and not attached to the skin. Magnetic resonance imaging (MRI) was done, illustrating unspecific findings to reach a diagnosis. Needle biopsies were performed in all patient, and the diagnosis of AFH was reached. All three patients underwent wide surgical excision of the tumor. Patients were followed up routinely every three to four months with imaging studies to rule out recurrence and metastasis, for a period of 15 months (case 1), 26 months (case 2), and 19 months (case 3), which all resulted negatively.

Introduction and importance The ossifying fibromyxoid tumor of soft tissue is a rare tumor of intermediate differentiation and uncertain lineage that occurs in adults mostly in the extremities and the trunk. Presentation of case we present a case of 57 year-old man presenting with a right scapular mass. It was a subcutaneous and painless mass that was largely excised. The diagnosis of ossifying fibromyxoid tumor of the right shoulder was made. The follow up of 1 year was without recurrence and metastasis. Clinical discussion The ossifying fibromyxoid tumor of soft tissue is exceptional, microscopic diagnosis and management is challenging, considering the scarcity of the tumor. Conclusion More cases and retrospective studies are needed to understand the pathogenesis and to determine optimal treatment regimens., Highlights • Clinical, gross and microscopic examinations of ossifying fibromyxoid tumor.

Case We describe the case of a 38-year-old woman, a yoga instructor, who had pain in the right shoulder and scapular region of 4 months' duration while performing yoga. Radiography and computed tomography diagnosed delayed union of a first rib stress fracture. The delayed union of stress fracture of the first rib was successfully treated with the limiting of yoga activity and low-intensity pulsed ultrasound (LIPUS). Conclusions Physicians should be aware that even yoga posing can cause stress fractures of the first rib. LIPUS therapy may be effective for delayed union in addition to rest.

A 35-year-old man with a swelling over the right shoulder and right anterior chest wall was referred to our hospital. The swelling had been present for over 2 months and was mildly painful. No history of trauma was present. On examination, there was limitation of shoulder movements. Swelling was

A 40-year-old woman presented to the neuromuscular clinic for evaluation of chronic right shoulder weakness of 1-year duration. During that time, she noticed progressive difficulties lifting her right arm overhead and reaching for objects on the back seat of her car. Around 3 months after the onset of shoulder weakness, she started to develop an intermittent achy sensation behind the right ear and hoarseness of her voice. She noted difficulty talking over loud noises and in phone conversations. She denied vision, taste, or hearing changes, dysphagia, dyspnea, numbness, or weakness in other limbs.

A modified transaxillary approach for aortic valve disease to obtain the same exposure as the anterior minithoracotomy approach and to preserve the pectoralis major muscle is presented. When the patient's right shoulder is adducted horizontally, or the right arm is flexed anteriorly 90 degrees and adducted to the left, the right axilla comes close to the chest midline. That means that a right anterior thoracotomy can be made through the right axilla when the arm position is adjusted appropriately. The modified new approach is safe and faster than the conventional transaxillary approach, and it provides cosmetic advantages to the patient.

Calcific Tendinitis is a condition characterized by abnormal deposition of hydroxyapatite crystals in the tendons with secondary inflammation. However, complication like intraosseous migration is rare. Hereby we present a case of 58-year-old female patient who presented with pain in the right shoulder along with restricted movements. The MRI scan revealed features of intraosseous migration of calcification in addition to the detailed evaluation of calcific tendinitis. Furthermore, the patient was treated with ultrasound guided aspiration & percutaneous irrigation post which the pain subsided indicating promising therapeutic role of ultrasonography in such cases. Thus multimodality approach can help in complete diagnosis & treatment of this condition.

Introduction: Echocardiography is essential in the evaluation of patients with cardiovascular disease. Repetitive movements, however, expose ultrasound operators to a high risk of musculoskeletal strain injuries. Aim: We investigated to what extent a probe stabilizer could reduce repetitive movements. Materials and methods: The study population consisted of 31 male patients referred for routine transthoracic echocardiography. A good apical acoustic window was prerequisite for inclusion. Standard apical views and measurements were first recorded without using the probe stabilizer. Afterwards, the same apical views and measurements were acquired with utilization of the probe stabilizer. During the entire procedure, shoulder abduction and muscle activity of right forearm flexor and extensor muscles were recorded. To this purpose, an EMG-sensor was attached to the right lower arm and a gyroscope to the right shoulder blade. Results: Extreme right arm abduction (>30˚) occurred in 58% of the time with use of the stabilizer and in 98% of the time without (p