Post-stroke shoulder pain is associated with either a peripheral or central pathology. However, most of the time, it is challenging to establish a cause-and-effect relationship between the suggested pathology and shoulder pain reported. We report a 66 year-old man who developed a right hemiplegic shoulder pain two months post stroke with initial investigations suggestive of peripheral pathologies. Pharmacological and non-pharmacological treatment did not improve his shoulder pain. Later he developed complex regional pain syndrome (CRPS) of the right hand and the initial shoulder pain subsequently relieved following resolution of the CRPS.
Epidermoid cyst is a common benign cutaneous swelling frequently encountered in surgical practice. It usually presents as a painless lump frequently occurring in hairbearing areas of the body particularly the scalp, scrotum, neck, shoulder and back. Giant epidermoid cysts commonly occur in hairy areas such as the scalp. We present here the case of a rare occurrence of a giant epidermoid cyst in the less hairy area of the right upper thigh mimicking a soft tissue sarcoma. Steps are highlighted for the management of this unusual cyst.
The aim was to compare the effectiveness of intra-articular lidocaine (IAL) versus intravenous Demerol and Diazepam (IVS) in reduction of acute anterior shoulder dislocation.
Introduction: The anterolateral acromion approach of the shoulder is popular for minimally invasive plate osteosynthesis (MIPO) technique. However, there are literatures describing the specific risks of injury of the axillary nerve using this approach. Nevertheless, most of the studies were done with Caucasian cadavers. So, the purpose of this study was to evaluate the risk of iatrogenic axillary nerve injury from using the anterolateral shoulder approach and further investigate the location of the axillary nerve, associated with its location and arm length in the Asian population that have shorter arm length compared to the Caucasian population. Materials and Methods: Seventy-nine shoulders in fourty-two embalmed cadavers were evaluated. The bony landmarks were drawn, and a vertical straight incision was made 5cm from tip of the acromion (anterolateral approach), to the bone. The iatrogenic nerve injury status and the distance between the anterolateral edge of the acromion to the axillary nerve was measured and recorded. Results: In ten of the seventy-nine shoulders, the axillary nerve were iatrogenically injured. The average anterior distance was 6.4cm and the average arm length was 30.2cm. The anterior distance and arm length ratio was 0.2. Conclusion: Our results demonstrated that the recommended safe zone at 5cm from tip of acromion was not suitable with Asian population due to shorter arm length, compared to Caucasian population. The location of axillary nerve could be predicted by 20% of the total arm-length.
One of the difficulties with bobbin friction stir welding (BFSW) has been the visualisation of microstructure, particularly grain boundaries, and this is especially problematic for materials with fine grain structure, such as AA6082-T6 aluminium as here. Welds of this material were examined using optical microscopy (OM) and electron backscatter diffraction (EBSD). Results show that the grain structures that form depend on a complex set of factors. The motion of the pin and shoulder features transports material around the weld, which induces shear. The shear deformation around the pin is non-uniform with a thermal and strain gradient across the weld, and hence the dynamic recrystallisation (DRX) processes are also variable, giving a range of observed polycrystalline and grain boundary structures. Partial DRX was observed at both hourglass boundaries, and full DRX at mid-stirring zone. The grain boundary mapping showed the formation of low-angle grain boundaries (LAGBs) at regions of high shear as a consequence of thermomechanical nature of the process.
Fracture is common after trauma. Proximal humeral fracture can occur in the elderly after fall and in youngsters after motor vehicle accidents (MVA) and sport injuries. A 37-year-old man was admitted with a fracture of his left proximal humerus following an MVA. He sustained a 3-part fracture and treated surgically using a PHILOS plate. There are few options in managing proximal humerus fracture ranging from conservative to surgical intervention based on its severity. We reminiscent the usage of PHILOS plate as a mode of treatment of such fracture.
This study was conducted to investigate i) while the shoulder was in 180° of flexion and the elbow extended, which of the forearm position (supination, pronation and neutral) can generate the greatest handgrip strength, ii) is there any correlation of the handgrip strength between the dominant hand (right hand) and non-dominant hand (left hand) in each forearm position, and iii) will the dominant hand possessed 10% higher handgrip strength than the non-dominant hand. 100 right handed sedentary active students age 22.20 years old (± 1.03), height 172.83 cm (± 6.37), body mass 68.87 (± 11.52) and grip position 3.77 (± 0.77) were recruited in this study. The result indicated that for both the dominant and non-dominant hand, when the shoulder is in 180˚ flexion of the body with the elbow extended, the greatest grip strength was obtained when the forearm was in neutral position followed by pronation and supination position. Post Hoc analysis showed that for both dominant hand and non-dominant hand, pronation and supination forearm position produced greater strength score compared to supination forearm position (p0.05). In all forearm position, participants were shown to produced significantly greater strength in their dominant hand and all the scores were more than 10% greater compared to when using non-dominant hand. Positive relationships were also found for the strength score between dominant hand and non-dominant hand. As the conclusion, different shoulder, elbow and forearm position can affect handgrip strength.
A new species of Leptostraca, Nebalia terazakii sp. n. is described and figured. The species was sampled from the coral reefs of Pulau Payar Marine Park, Langkawi, Malaysia. There are 32 existing species of Nebalia but Nebalia terazakii sp. n. can be distinguished from the other known species of Nebalia by the following combination of characters: the rostrum is 1.89 times as long as wide and the eyes have no dorsal papilla or lobes. Article 4 of the antennular peduncle has one short thick distal spine. The proximal article of the endopod of maxilla 2 is shorter than the distal, a feature peculiar to Nebalia terazakii sp. n., the exopod of maxilla 2 is longer than article 1 of the endopod, the posterior dorsal borders of the pleonites 6 to 7 are provided with distally sharp denticles, anal plate with prominent lateral shoulder and finally, the terminal seta of the caudal rami is 1.17 times the length of the entire rami.
HyperDSC™(fast scan rate) was used to study the melting behavior of canola (CLO), sunflower (SFO), palm olein (PO), rice bran oils (RBO), and cocoa butter (CB), and was compared to the melting behaviors using conventional DSC. There was an increase in sensitivity with increase in scan rate. Slow scan rate (5 to 20C/min) gave low sensitivity, which increased when the scan rates were increased to 50, 100 and 200C/min. Peak resolution was affected by scan rate depending on the sample weight. Increase in the size of sample coupled with the use of fast scan rate decreased the peak resolution. Generally small sample sizes gave better peak resolution. Results of the effect of scan rate on glass transition (Tg) shows that Tg, which is a weak transition especially in crystalline and low amorphous materials was not detected using conventional scan rates (5 to 20oC/min). It was however detected using of hyperDSC™ scan rates (100 to 200oC/min). Increasing the scan rate resulted in an increase in the peak temperature and the elimination of shoulder peaks, which were caused due to the polymorphic behavior of the triacylglycerols in the oils. The increase in peak temperature caused a shift in the peak position towards a higher temperature value. There is a positive correlation between the peak temperature and scan rate. The correlation coefficients (r) for CLO, SFO, PO, RBO and CB were 0.96, 0.95, 0.97, 0.96 and 0.96 respectively.
Posture is one of the most important factor that need to be considered in any postural analysis. Awkward, extreme,
and repetitive postures can increase the risk of musculoskeletal disorders (MSDs). As observational methods are more
widely used than instrumentation-based methods to assess postural problems, this study reviews and assesses the
scientific literature of observational methods and focused on pen and paper based specifically. In order to identify the
published methods, a list of English or Malay articles dating as far back as 1990 was compiled from PubMed, Science
Direct and Google Scholar. The keywords were ergo*, posture*, method*, observational*, postural problems*, pen and
paper*, posture analysis*, indirect* and macro-ergo*. In addition, a secondary search was also performed using
bibliography of retrieved articles so that additional papers for conducting review and evaluations can be collected. A
total of 121 articles that assessed postural problems in working activities were found. However, after intensive
screening process only 6 articles were selected to be further analyzed. Posture of upper arms/shoulder, lower arms/
elbow, wrist, neck, back/trunk and leg were highlighted in this study. The limitations and the strengths of the
published pen and paper based observational method focusing on those postures were also discussed. The finding of
this review will benefit researchers in the process of understanding unsafe posture in workplace. It could also provide
to researcher on how to improve the current pen and paper based observational method for assessing postural
problems.
In developing ergonomically sound furniture, there is a need in evaluating anthropometrics from various aspect such as gender differences. The objectives of this study was to evaluate anthropometrics differences between genders of children in Malaysia in order to determine the need in having specified chairs for each gender. Represented by four states in Malaysia, a total of 2400 children were involved in the study. A custom made measurer and an anthropometer were used to measure the subjects. Six body measurements, which are, sitting shoulder height, sitting subscapular height, shoulder breadth, buttock popliteal length, popliteal height and hip width were documented for evaluation. From this study, there were some significant differences on some body parts while other body parts were similar to male and female. Therefore, chairs are needed to be made according to the suitability of both gender.
This study on anthropometrics of Primary School children from grade 1 to 5 in Peninsular Malaysia involves 2310 students aged seven to eleven years old. The objectives were to analyze the differentiation of anthropometrics between children of grades 1 to 5 and grouping them to suitable levels in which they are appropriate to propose chair dimensions. A multi-stage sampling method was used, and rural and urban areas were also included in providing anthropometric database that represents the whole Peninsular Malaysia population. There were six dimensions measured in this study, which are sitting shoulder, sitting subscapular height, sitting elbow height, hip width, buttock-popliteal length and popliteal height. All the measurements were chosen to represent dimensions needed to construct ergonomic school chair. From the results, ANOVA showed p-values of
The management of post-radiation wound breakdown over the posterior cervico thoracic region can be a challenging task for a surgeon. The aim of the treatment is to produce a well vascularized and a low tensile flap which will close a large defect. We describe the use of the lower trapezius flap to reconstruct the wound breakdown and to obtain stable tissue coverage in a patient with post- radiation necrosis. This flap minimizes the disruption of the scapula-thoracic function while preserving the range of movement over the shoulder. From the literature review, it was noted that the dorsal scapular artery (DSA) and transverse cervical artery (TCA) aid in the blood supply to the trapezius muscle and prevent local necrosis during rotation of the flap. The trapezius flap is widely accepted because of the minor donor site morbidity, large arc of rotation and adequate blood supply.
Introductions: Call center has been defined as a working environment in which uses telephone and computer for the purpose of marketing and manage communication with prospect clients or existing clients (Rocha, Glina, Morinho and Nakasato, 2005; Sprigg, Smith and Jackson, 2003).
Methodology: The study was conducted via observation of working condition and face to face interview with call center operators. Measurement of anthropometrics was also conducted.
Results: Ergonomics issues found at call center were inappropriate work condition and workstation which lead to awkward sitting posture (sitting with forward leaning posture, raised shoulder, feet not supported on floor). Besides that organizational policy which required high job demand and subsequently lead to prolonged sitting and static posture (very minimal posture changes). Combination all these factors lead to musculoskeletal symptoms and the operators reported of having neck, shoulder, upper back and lower back pain compared to other body parts.
Conclusion: The management should embark on organization wide ergonomics management program and should review the current policy and create safe and healthy working environment by providing suitable workstation for the operators in order to prevent musculoskeletal.
It is very rare indeed in the practice of children's orthopaedics today in Malaysia that the natural history of long bone osteomyelitis is seen. A case is presented where a shoulder abscess in a 3-year-old child developed into septic arthritis of the shoulder and subsequently chronic osteomyelitis of the adjacent humerus. The parents refused active surgical debridement and sequestrectomies. Three years later the child had regenerated a new humerus over the sequestra. Radiographs are presented illustrating the entire natural history of osteomyelitis with the regeneration of a new humerus.
Reported is the first case of syringomyelia and syringobulbia associated with Arnold Chiari I malformation in a Malaysian child. The initial complaint was that of unilateral anhidrosis of the face. The chief presenting features were dissociated sensory loss, asymmetrical weakness of the left upper limb associated with subluxation of left shoulder and signs of upper motor neurone lesion in the left lower limb. One unusual feature was the presence of vesiculation followed by ulceration of the pinnae of both ears. Magnetic resonance imaging (MRI) of the posterior fossa and cervical and thoracic cord facilitated the diagnosis and was the most useful diagnostic procedure in this child.
We report a case of a broken K-wire migrating to the cervical spine from the right clavicle in a 9-year-old child. The initial diagnosis, fracture of the clavicle with an acromioclavicular joint dislocation, was treated by open reduction and K-wiring. One K-wire broke and migrated to the neck, posterolateral to the C6 vertebra. The K-wire was removed percutaneously under image intensification. Acromioclavicular joint dislocation in children is rare since the distal clavicle does not ossify until the age of 18 or 19 years meaning that almost all closed fractures of the clavicle in children can be treated nonoperatively.
A 28-year-old man presented with a chief complaint of rashes all over his body. He had a history of a trip to Langkawi Island, a famous island resort off the west coast of Malaysia, over the Chinese New Year’s weekend. According to him, he had a lot of fun with a group of friends at the sunny beach and the beautiful sea. There were no untoward incidents and they were perfectly well when they returned home after a 2-day trip. On the evening of the second day after his return, he noticed rashes appearing over his body, notably on shoulders and trunk. These rashes were little painful in nature.
Introduction: Degenerative disorder involving the acromioclavicular
joint (ACJ) is quite common especially in the elderly.
One of the surgical modalities of treatment of this disorder is the
Mumford Procedure. Arthroscopic approach is preferred due to
its reduced morbidity and faster post-operative recovery. One
method utilizes the anteromedial and Neviaser portals, which
allow direct and better visualization of the ACJ from the
subacromial space. However, the dangers that may arise from
incision and insertion of instruments through these portals are
not fully understood. This cadaveric study was carried out to
investigate the dangers that can arise from utilization of these
portals and which structures are at risk during this procedure.
Methods: Arthroscopic Mumford procedures were performed
on 5 cadaver shoulders by a single surgeon utilizing the
anteromedial and Neviaser portals. After marking each portals
with methylene blue, dissection of nearby structures were
carried out immediately after each procedure was completed.
Important structures (subclavian artery as well as brachial plexus
and its branches) were identified and the nearest measurements
were made from each portal edges to these structures. Results:
The anteromedial portal was noted to be closest to the
suprascapular nerve (SSN) at 2.91 cm, while the Neviaser portal
was noted to be closest also to the SSN at 1.60 cm. The
suprascapular nerve was the structure most at risk during the
Mumford procedure. The anteromedial portal was noted to be
the most risky portal to utilize compared to the Neviaser portal.
Conclusion: Extra precaution needs to be given to the
anteromedial portal while performing an arthroscopic distal
clavicle resection in view of the risk of injuring the
suprascapular nerve of the affected limb.
This study is aimed at seat design optimization for high-speed train based on the Malaysians sitting anthropometry
data focusing on seat fit parameters. An analysis of anthropometry data composed of 15 dimensions that are
required in seat design was done with 50 male subjects. These data were collected through direct measuring
methods with standard equipment. According to the Malaysian automotive seat fit parameters, the backrest width,
backrest height, cushion width, and cushion length were established based on these anthropometric dimensions:
interscye breadth (5th percentile female and 95th percentile male), hip breadth (95th percentile female), sitting
shoulder height (5th percentile female), and buttock-popliteal length (5th percentile female), respectively. This
study uses the CATIA software to design and analyse the proposed seat design. The fit parameters proposed for the
new design are seat height, 380mm; cushion width, 450mm; backrest width, 450mm and backrest height, 850mm.
The CATIA human activity analysis (based on Rapid Upper Limb Analysis, RULA) was also executed. From the study,
the new conceptual seat design gives the most optimized fit when compared to the current seat.