{"title":"Shoulder impingement and the rotator cuff","authors":"Ryan L Hillier-Smith, Henry B Colaço","doi":"10.1016/j.mpsur.2024.11.005","DOIUrl":"10.1016/j.mpsur.2024.11.005","url":null,"abstract":"<div><div>The rotator cuff muscles include supraspinatus, infraspinatus, subscapularis and teres minor. The action of their tendons enables the complex movement of the shoulder joint. Rotator cuff disorders are common and can result in significant shoulder dysfunction and pain. Supraspinatus is the most frequently affected tendon. Subacromial impingement syndrome (SIS) represents a spectrum of pathology including subacromial bursitis, rotator cuff tendinopathy, partial thickness and full thickness tears. These are investigated using ultrasound or magnetic resonance imaging. Rotator cuff tears are not always related to SIS and can be divided into traumatic and degenerative. Treatment for tendinopathy and partial tears is normally non-operative through physiotherapy and corticosteroid injections. Full thickness and some partial thickness tears may require surgical repair, which is commonly performed arthroscopically. This involves mobilizing the torn or detached tendon and repairing it back to the native footprint with bone anchors or transosseous sutures. Repairs can be achieved using single or double row anchor techniques. Where tendon repair is not possible, other surgical solutions can be considered. These include patch repair augmentation, superior capsular reconstruction or tendon transfers. Cases of chronic rotator cuff tears can lead to cuff tear arthropathy, which ultimately can be treated with reverse total shoulder replacement.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 2","pages":"Pages 74-79"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Forearm fractures in adults","authors":"Niyati Jain, Hari Iyer, Sukhdeep Gill","doi":"10.1016/j.mpsur.2024.12.002","DOIUrl":"10.1016/j.mpsur.2024.12.002","url":null,"abstract":"<div><div>Forearm fractures are seen by the orthopaedic team either in the emergency department or in the fracture clinic. Injuries which include the more proximal or distal joints are rare but can lead to disabling consequences if missed. In this article we discuss the anatomy, classifications systems and management of these less common upper limb fractures.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 2","pages":"Pages 91-95"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Rheumatoid arthritis in the hands","authors":"Rhian Bevan, Kim Pearce, Rebecca Mills","doi":"10.1016/j.mpsur.2024.11.002","DOIUrl":"10.1016/j.mpsur.2024.11.002","url":null,"abstract":"<div><div>Rheumatoid arthritis (RA) is a chronic autoimmune disorder resulting from a T-cell-mediated immune response against soft tissues. Among the various joints affected, the hands are particularly susceptible, leading to joint destruction, deformity, significant disability and decreased quality of life for those affected. In the hands, RA predominantly affects the wrist joint and metacarpophalangeal (MCP) joints. In the early stages signs can be subtle, including joint pain and morning stiffness; however, as the disease progresses more severe symptoms and complications can occur, such as deformities of the hand and tendon ruptures. Significant advances in pharmacological treatments has meant there is less need for surgical intervention. With research still ongoing for pharmacological interventions, there are many promising treatments for RA.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 2","pages":"Pages 109-114"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anatomy of the hand","authors":"Joseph Hanger, Joanna Higgins","doi":"10.1016/j.mpsur.2024.12.006","DOIUrl":"10.1016/j.mpsur.2024.12.006","url":null,"abstract":"<div><div>The anatomy of the hand is a marvel of functional complexity, combining intricate skeletal, muscular, and neurovascular structures to facilitate a wide range of precise and powerful movements. As the primary tool for interaction with the environment, the hand's ability to perform fine motor tasks, from power gripping to delicate dexterity, is essential for daily activities and performing higher cognitive functions such as writing, manipulating tools, and communicating through gestures. This functional versatility is possible due to the unique arrangement of bones, muscles, tendons, and ligaments, and a highly specialized network of sensory and motor nerves. Understanding the detailed anatomy of the hand is crucial not only for the diagnosis and treatment of injuries and disorders, but also for advancing surgical techniques. Moreover, disruptions to its complex structures, whether through trauma, disease, or congenital conditions, can have profound implications on hand function and overall quality of life.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 2","pages":"Pages 115-119"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anatomy of the brachial plexus and upper limb peripheral neuropathies","authors":"Alastair Stephens, Clare Langley","doi":"10.1016/j.mpsur.2024.11.007","DOIUrl":"10.1016/j.mpsur.2024.11.007","url":null,"abstract":"<div><div>The brachial plexus is a complex network of nerves supplying the upper limb. Anatomical knowledge allows correlation between clinical findings diagnosing a neuropathy. We will discuss the brachial plexus anatomy and how clinical assessment permits diagnosis and management of injuries.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 2","pages":"Pages 69-73"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Chronic pancreatitis","authors":"James Lucocq, Michael Hughes","doi":"10.1016/j.mpsur.2024.10.007","DOIUrl":"10.1016/j.mpsur.2024.10.007","url":null,"abstract":"<div><div>Chronic pancreatitis (CP) is a chronic inflammatory condition that results in irreversible morphological changes of the pancreas, including fibrosis and loss of both exocrine and endocrine functions. The aetiology of CP is multifaceted, including genetic, environmental, and autoimmune factors. Chronic alcohol consumption, smoking, and genetic mutations are significant contributors, with mechanisms involving oxidative stress, ductal obstruction, and immune-mediated inflammation. The clinical presentation is variable, with abdominal pain, malnutrition due to exocrine insufficiency, and diabetes mellitus being common presentations. Diagnosis of CP involves clinical evaluation, laboratory tests, and imaging studies, such as CT, MRCP, and endoscopic ultrasound, to assess pancreatic damage and complications. Management is complex and includes pain control, nutritional support, pancreatic enzyme replacement and, in severe cases, surgical interventions. Endoscopic treatment, such as stenting, and surgical procedures, like pancreaticojejunostomy, are used for ductal abnormalities and intractable pain. Emerging therapies, including antifibrotic treatments and stem cell therapy, are being explored. Long-term management requires a multidisciplinary approach, addressing not only medical and surgical needs but also psychological support and patient education. Advances in imaging and molecular biology are enhancing the understanding and treatment of CP, promising improved patient outcomes and quality of life.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 1","pages":"Pages 57-63"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Test yourself: MCQ and Single Best Answer","authors":"Adrian Ben Cresswell","doi":"10.1016/j.mpsur.2024.11.003","DOIUrl":"10.1016/j.mpsur.2024.11.003","url":null,"abstract":"","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 1","pages":"Pages 67-68"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Acute pancreatitis","authors":"James Lucocq, Sanjay Pandanaboyana","doi":"10.1016/j.mpsur.2024.10.005","DOIUrl":"10.1016/j.mpsur.2024.10.005","url":null,"abstract":"<div><div>Acute pancreatitis (AP) is a significant cause of morbidity worldwide, with a steadily rising incidence, particularly in Western nations. This article provides a comprehensive overview of the epidemiology, aetiology, pathophysiology, and management of AP. The various aspects of the Revised Atlanta classification system are emphasized for its utility in defining AP severity, stratifying risk and guiding treatment. Both the role of imaging and the ‘step-up’ approach to guide procedural and endoscopic management are discussed, demonstrating the shift towards minimally invasive techniques. Early recognition of organ dysfunction and supportive care, including judicious fluid management, nutritional support, and appropriate use of antibiotics, are critical to improving outcomes. Specific considerations and recommendations for the management of local and systemic complications are outlined, with recommendations for early referral to specialized centres for optimal care.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 1","pages":"Pages 47-56"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Surgery of the spleen","authors":"Claire Jones","doi":"10.1016/j.mpsur.2024.11.001","DOIUrl":"10.1016/j.mpsur.2024.11.001","url":null,"abstract":"<div><div>The spleen is a solid organ located beneath the left hemidiaphragm. Indications for surgical resection include trauma (blunt or penetrating), haematological diseases, abscesses, hydatid disease, oncological resection or immunosuppression. Surgical approaches include open, laparoscopic and, more recently, robotic; the complications of operative intervention will also be discussed. In patients with an absent spleen there is a significant increased risk of developing overwhelming post-splenectomy infection (OPSI). It is therefore essential to protect patients from infection due to encapsulated organisms through vaccination. This requires a combination of vaccinations, antibiotic prophylaxis and good education.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 1","pages":"Pages 64-66"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cystic neoplasms of the pancreas","authors":"Alistair Rowcroft, Andrew Healey","doi":"10.1016/j.mpsur.2024.10.006","DOIUrl":"10.1016/j.mpsur.2024.10.006","url":null,"abstract":"<div><div>As the use of cross-sectional imaging has become more frequent, there has been an increase in the diagnosis of cystic neoplasms and small non-functioning neuroendocrine neoplasms within the pancreas. Investigation and follow-up of cystic lesions of the pancreas requires a multi-modal approach, of which endoscopic ultrasound with biopsy is becoming an increasingly important component. The main premalignant cystic neoplasms of the pancreas are mucinous-type tumours, intraductal papillary mucinous neoplasm (IPMN) and mucinous cystic neoplasm (MCN). Main-duct IPMN should be resected due to the high incidence of underlying malignancy; however, a selective approach to intervention for side-branch IPMN should be taken (dependent on the presence of symptoms, tumour markers and tumour characteristics). Pancreatic neuroendocrine neoplasms (PanNENs) can also present as cystic lesions. Biochemically confirmed functional PanNEN and non-secreting PanNENs larger than 2 cm in size should be evaluated for surgery.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 1","pages":"Pages 38-46"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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