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Hence, the hook test may be more accurate to detect foveal TFCC tears but all together not more important than the trampoline test to establish the correct diagnosis. For once, Captain Hook has won!Predicting future trends in arthroscopic and related surgery can be a challenging task for researchers, authors, editors, and clinicians alike. Analysis of high-citation articles from the past may guide future research. Cartilage had been the most highly cited topic in the arthroscopic literature, but the last 5 years has been overtaken by shoulder and rotator cuff. Following close behind is the hip arthroscopy literature, which is clearly moving up in the citation rankings. As highly cited "classic" articles become common knowledge, their overwhelming impact on citation will lessen, allowing the next generation of articles and topics to flourish. We may benefit from the analysis of arthroscopic topics in smaller time frames to predict future trends to give us a more up-to-date prediction of the future. The sweet spot may be somewhere between 5 to 10 years rather than since the inception of journal metrics to help predict where the literature is going. This is not to say that the classic articles aren't critically important, but they are just that, classic, and not necessarily predictive of the future.The optimal treatment for proximal biceps tendon lesions identified at the time of arthroscopic rotator cuff repair remains a topic for debate. The decision between biceps tenotomy and tenodesis is one in which we will likely never have a clear-cut answer. Proponents of biceps tenotomy and biceps tenodesis will cite the pros and cons of each surgical option to support their treatment of choice. Several meta-analyses have shown no superior outcomes with either treatment. Cost analysis and surgical efficiency may favor biceps tenotomy, whereas the possible development of a Popeye deformity, biceps cramping, and supination strength favor tenodesis. The surgical treatment of choice requires an informed discussion and shared decision making between surgeon and patient to determine patients' expectations and maximize surgical outcomes for each individual patient.Arthroscopic surgery of the shoulder has revolutionized the way we address intra-articular and tendinous injuries about the joint. Nevertheless, despite the apparent minimally invasive nature of our trade, there remain potential long-term consequences to every operation. This is especially true if future arthroplasty is indicated, as the risk of prosthetic joint infection is increased in patients having a previous procedure. True partnership with our patients necessitates that they have a clear understanding of the full implications of any surgery, no matter how small it may seem. True informed consent necessitates that our patients understand not only the immediate implications of the current operation but the potential effects on a future operation. This can only be accomplished by effective and honest communication about the full scope of the risk undertaken when an arthroscopic surgery is performed.Labrum tears involving >270° of the glenoid have been termed "circumferential tears," "panlabral tears," "triple lesions," and "large tears." They are rare injuries that encompass anywhere from 2.4% to 6.5% of traumatic labral injuries. Given their rare nature, the literature has been limited to level IV studies with small patient numbers. Identifying these injuries in the clinical setting can be challenging, as patients can present with signs and symptoms of unidirectional instability, combined instability, or even microinstability. However, we know that magnetic resonance arthrography seems to be more helpful than magnetic resonance imaging, and that these patients will most often present with pain in between multiple instability episodes. Given that the gold standard treatment for these injuries is operative intervention, recognizing them as opposed to an isolated unidirectional injury is critical for surgical planning and patient counseling purposes. Isolating other demographic and historical risk factors in addition to physical examination and imaging may be key in making the diagnosis.Anterior glenohumeral instability with glenoid bone loss is a difficult problem and often requires open procedures with bone block augmentation. The current evidence suggests glenoid bone loss of 20% or more as a cutoff value indicating augmentation. Expert consensus-based techniques, such as the Delphi, clarify evidence-based medicine and allow pooling of expert opinion in a scientific fashion. These methods suggest that 3-dimensional computed tomography should be used to evaluate bone loss, previous dislocations, or failed soft-tissue surgery; Hill-Sachs lesions are poorly quantified by standard imaging; and, in cases with a bone deficit of >20%, glenoid bone graft should be considered. No consensus was reached regarding glenoid track evaluation, magnetic resonance imaging for evaluation of bone loss, safety of arthroscopic Latarjet, remplissage use for Hill-Sachs lesions of less than 30%, indications for a shoulder sling for 4 to 6 weeks after surgery, or postoperative rehabilitation timing and range-of-motion protocols.Diagnostic injections have been used in the workup of many musculoskeletal complaints, especially when a good history and physical examination don't point to a concrete diagnosis. However, the accuracy of blind injections, especially in locations like the biceps sheath, has been called into question. This has led to the use of image guidance to improve injection accuracy, usually with great success. However, even with great accuracy, the diagnostic utility of an injection may still be quite limited because of fluid extravasation.For irreparable rotator cuff tears, superior capsular reconstruction (SCR) has become an option for restoring glenohumeral joint stability and reversing proximal humeral migration. Signs of irreparable rotator cuff tears include pain from subacromial impingement, muscle weakness, and pseudoparalysis. In biomechanical studies, Mihata et al. showed SCR with fascia lata graft and side-to-side suturing to remaining infraspinatus tendon restored superior stability of the shoulder joint. Adding acromioplasty decreased the subacromial contact area without altering the humeral head position, superior translation, or subacromial peak contact pressure. The same research group showed that using an 8-mm thick fascia lata graft attached at 15° to 45° of shoulder abduction optimized superior stability of the shoulder joint. Adams et al. performed SCR using a dermal allograft and found that greater glenohumeral abduction angle (60°) decreased applied deltoid force. SCR can be performed with the patient in the lateral decubinded.Artificial intelligence (AI) and machine learning refer to computers built and programed by humans to perform tasks according to our design. This is vital to keep in mind as we try to understand the application of AI to medicine. AI is a tool with strengths and limitations. The primary strength of AI is that it allows us to assimilate and process unlimited quantities of health care data. The limits of AI include the inability of machines to adapt in a human sense, the reality that machines lack human insight (i.e., clinical judgment or common sense), and the limitation that machine-learning algorithms are subject to the data on which they are trained. Thus, we must adapt to AI and machine learning. Next, because machine learning is a type of AI in which computers are programmed to improve the algorithms under which they function over time, we require insight to achieve an element of explainability about the key data underlining a particular machine-learning prediction. Finally, machine-learning algorithms require validation before they can be applied to data sets different from the data on which they were trained. As computers have become faster and more powerful, and as the availability of digital data has become immense, we can program our machines to analyze data and recognize patterns that, in sum, are a primary basis of medical diagnosis and treatment.

Dysfunctions in the lower esophageal sphincter (LES) and the upper esophageal sphincter (UES) levels can occur owing to poor muscle coordination, contraction, or relaxation. Such condition can possibly be addressed by functional rehabilitation. The aim of this study was to measure pressure changes in the UES and LES at rest and during routine rehabilitation techniques, that is, cervical manual traction and trunk stabilization maneuver.

This study was conducted in a University Hospital Gastrointestinal Endoscopy Center. Cervical manual traction and a trunk stabilization maneuver were performed in a convenient group of 54 adult patients with gastroesophageal reflux disease. High-resolution manometry was used to measure pressure changes in the LES and UES at rest and during manual cervical traction and trunk stabilization maneuver.

Average initial resting UES pressure was 90.91 mmHg. A significant decrease was identified during both cervical traction (average UES pressure = 42.13 mmHg, P < .001) and trunk stabilization maneuver (average UES pressure = 62.74 mmHg, P = .002). The average initial resting LES pressure was 14.31 mmHg. A significant increase in LES pressure was identified both during cervical traction (average LES pressure = 21.39 mmHg, P < .001) and during the trunk stabilization maneuver, (average pressure = 24.09 mmHg, P < .001).

Cervical traction and trunk stabilization maneuvers can be used to decrease pressure in the UES and increase LES pressure in patients with gastroesophageal reflux disease.

Cervical traction and trunk stabilization maneuvers can be used to decrease pressure in the UES and increase LES pressure in patients with gastroesophageal reflux disease.

The purpose of this study was to compare the effects of a 6-week program of pelvic floor muscle training (PFMT) plus connective tissue massage (CTM) to PFMT alone in women with overactive bladder (OAB) symptoms on those symptoms, pelvic floor muscle strength, and quality of life.

Thirty-four participants were randomly divided into PFMT+CTM (n = 17) and PFMT (n = 17) groups. see more PFMT was applied every day and CTM was applied 3 days a week for 6 weeks. Before treatment, at week 3, and after treatment (week 6), we assessed pelvic floor muscle strength (with a perineometer), bladder symptoms (with a urine diary), OAB symptom severity (with the 8-item Overactive Bladder Questionnaire [OAB-V8]), urgency (with the Patient Perception of Intensity of Urgency Scale [PPIUS]), and quality of life (with King's Health Questionnaire [KHQ]). The Mann-Whitney U test, χ

test, Friedman test, and Dunn multiple comparison test were used for analysis.

In both groups, pelvic floor muscle strength increased, whereas OAB symptoms and PPIUS and KHQ scores decreased after treatment (P < .05). Although the OAB-V8, PPIUS, and KHQ scores decreased at week 3, frequency, OAB-V8, and PPIUS scores, in addition to some parameters of the KHQ, decreased after treatment in the PFMT+CTM group compared to the PFMT group (P < .05).

Compared to PFMT alone, PFMT+CTM achieved superior outcomes in reducing OAB symptoms in the early and late periods.

Compared to PFMT alone, PFMT+CTM achieved superior outcomes in reducing OAB symptoms in the early and late periods.