Biceps Tendon Rupture With Post-operative Complications

Biceps Tendon Rupture With Post-operative Complications Locomotor PBL Experiment Writeup Introduction In this PBL, we observe a case of biceps tendon rupture with post-operative complication of heterotopic ossification. We will first go through the anatomy of the upper limb followed by a discussion of the ruptured biceps tendon, heterotopic ossification and finally mode of action of indomethacin. Learning Objectives 1. Osteology of the upper limb with emphasis on the elbow and wrist 2. The neurovascular supply to the upper limb 3. Movements possible at joints of upper limb and the range of movements possible with regards to the elbow and wrist and the muscles that bring about these actions. 4. Rupture of distal biceps tendon 5. Heterotopic ossification 6. Mode of action of Indomethacin 1. Osteology of the upper limb with emphasis on the elbow and wrist Arm The humerus is the largest and longest bone of the arm region connecting the shoulder to the forearm. Proximally, the head of the humerus articulates with the glenoid cavity of the sca pula forming the glenohumeral joint. Distally the humerus articulates with the two bones of the forearm, the ulna and radius. The humerus is shown in more detail in figure 1 below. Figure 1 Humerus (1) For Anil’s case we will focus several prominent features on the distal region of the humerus which forms part of the elbow. There are two projections on either side of the distal end of the humerus which are the medial and lateral epicondyle. The medial epicondyle protects the ulnar nerve which passes just posteriorly and also serves as the attachment site for the forearm superficial flexor muscles. The lateral epicondyle conversely is the attachment site for the forearm extensor muscles. Anteriorly in between these two epicondyles are two articular surfaces: the round surfaced lateral capitulum which articulates with the radius and the spool shaped medial trochlea which articulates with the ulna. Also anteriorly, the radial fossa directly above the capitulum accommodates the h ead of the radius during flexion of the elbow whereas the coronoid fossa directly above the trochlea accommodates the coronoid process of the ulna during flexion of the elbow. Both the radial and coronoid fossa limit flexion of the elbow. Posteriorly, the olecranon fossa accommodates the olecranon process of the ulna during extension of the elbow. The olecranon fossa prevents hyperextension of the elbow. Forearm The forearm is made up of two bones: ulna and radius. Proximally both of these bones articulate with the humerus whereas distally only the radius directly articulates with the carpals of the wrist thus connecting the arm to the wrist. The ulna and radius are shown in figure 2 below. Figure 2 Radius and Ulna (1) The ulna The ulna is the stabilizing bone of the forearm and is medial and longer of the two bones. There is a projection anteriorly at the proximal end called the coronoid process which fits into the coronoid fossa during elbow extension. Posteriorly on the proximal end of the ulna is the olecranon process (which forms the prominence of the elbow) which fits into the olecranon fossa during elbow extension. The articular surface between the olecranon and the coronoid articulates with the trochlear of the humerus and gives the movements of elbow extension and flexion.

Hospitality and Tourism Industry Essay Example | Topics and Well Written Essays - 2000 words

Hospitality and Tourism Industry - Essay Example (Smith, 2003, p. 17) The term 'sustainable tourism' usually denotes the application of the more general concept of sustainable development to tourism as a specific economic sector. The ethical responsibilities towards code of practice enable the industry to acquire a critical role in protecting the vital needs of not only mainstream population but also the minorities that exist without political backup and economic support. Whether it is political extravaganza targeting masses or be it minorities, the role of legislation and codes should be based on the recognition of human rights and custom values. Hall & Richards (2000) while providing example of sustainable environment highlights the hospitality sector in which there are particular procedures of the installation of state-of-the-art energy-saving technology and waste-management which are followed by most of the hotels. In this context it is better for a hotel to survive thereby adopting 'sustainability'. For example a hotel can almost immediately have an impact on costs and may increase revenue if the organisation advertises its 'green credentials' and so attracts more eco-conscious clients. (Hall & Richards, 2000, p. 64) However, this may well lead to an increase in the level of aggregate demand and consequently an overall rise in total energy use and waste generation. Furthermore, the larger number of visitors puts unintended and increased pressure on the local infrastructure, services and environment, the effect of which is uncertain, especially with regard to the additional financial burden which is likely to fall not onl y on the public sector but the private (business) and personal sectors (perhaps receiving no direct benefit from tourism), because of the increased costs of mitigating the adverse effects of tourism, particularly dealing with waste. Besides characteristics, what matters within the context of tourism, are the characteristics of the natural, cultural and built environments of destinations that attract tourists towards them. All environments are different and have their own unique features, and what makes a particular type of environment attractive for tourism is a function of value judgements and fashions that exist in society. (Holden, 2003, p. 24) Code of Practice from Managerial Aspect The major constraints in today's tourism industry are those approaches, which are adopted by the managers, thereby influencing the hospitality of the product and labour markets, organisational status and structure, including size of workplace, and culture are chief among the factors thought to place constraints on managers. Managers, as much as workers and

Public Law Essay Example | Topics and Well Written Essays - 7000 words

Public Law - Essay Example While the United Kingdom does not have a formal written and codified Constitution, there is an unwritten set of rules comprised of the Acts of Parliament, judicial decisions as well as political practices that form the basis of Constitutional practice within the U.K2. Parliament is sovereign, as articulated by Oxford Professor A.V. Dicey who stated that â€Å"in theory, Parliament has total power, it is sovereign† thereby it is the source of all valid authority.3 Therefore, there is no separation of powers in the U.K., Parliament has been deputed as the supreme authority to make the laws of the land, through the principle of Parliamentary Sovereignty. Further more the Human Rights Act of 1988 incorporated the goals of the European Convention of Human Rights3a within the framework of national law, by including a provision that Parliament legislation is to be interpreted and read in such a manner as to give effect to the goals of the Convention4, while the judiciary has also been given the power under the Act to declare Parliament legislation incompatible with Convention rights5.Wiithin the UK, the European Convention was not directly relevant to statutory interpretation6 until the introduction of the Human Rights Act of 1998.