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A. Ben, M.B. B.CH., M.B.B.Ch., Ph.D.

Associate Professor, University of Florida College of Medicine

Also medications zopiclone cheap 4mg zofran, cambered rear wheels whose top distance between the wheels is smaller than the bottom orient the hand rim to more closely resemble the force application treatment quadricep strain discount zofran 8 mg visa. The laws governing the motion of objects were developed Forces may be categorized as noncontact or contact medicine bottle zofran 4 mg discount. The joint reaction force medications lexapro zofran 8 mg line, the net force acting across a joint, has compressive and shear components. Friction results from interaction between two surfaces and is a force that acts parallel to the interface of the two surfaces and in a direction opposite to the motion. The coefficient of friction is the quantification of the interaction of the two surfaces. Fluid resistance refers to the transfer of energy from an object to the fluid through which the object is moving. Drag acts in a direction opposite to the direction of motion, and lift is perpendicular to the drag component. Inertia results from the force applied by one segment on another that is not caused by muscle actions. A muscle force is the pull of the muscle on its insertion, resulting in motion at a joint. Muscle forces are generally calculated as net forces, not individual muscle forces, although intricate mathematical procedures can evaluate individual muscle forces. An elastic force results from the rebound of a material to its original length after it has been deformed. A free body diagram is a schematic illustration of a system with all external forces represented by vector arrows at their points of application. Muscle forces are generally not represented on these diagrams unless the system involves a single segment. In the first technique, the analysis may be a static case (when a = 0) or a dynamic case (when a 0). The static twodimensional linear case is determined using the following equations: Fx = 0 for the horizontal component Fy = 0 for the vertical component 384 Section iii Mechanical Analysis of Human Motion the two-dimensional dynamic case uses the following equations: Fx = max for the horizontal component Fy = may for the vertical component work, has two forms, kinetic and potential. The relationship between work and energy is defined in the workΥnergy theorem, which states that the amount of work done is equal to the change in energy. When this is done segment by segment, internal work or the work done on the segments by the muscles to move the segments is calculated. When the amount of work done is related to the time over which the work is done, the power developed is being evaluated. Special force applications include definitions for centripetal force and pressure. Impulse is defined as the area under the forceδime curve and is thus equal to the change in momentum. This type of analysis has been used in research to evaluate the jump height of the center of mass in vertical jumping in association with the equations of constant acceleration. Work is the product of the force applied and the distance over which the force is applied. A 100 N force is applied to a box at an angle of 60Рto the horizontal via a rope. Using static analysis, solve for the horizontal and vertical forces of C that will maintain this system in equilibrium if A = 331 N, B = 79 N, and W = 50 N. The force parallel to a surface is 380 N and the force perpendicular to the surface is 555 N. In question 4, if the 380 N force is the anterior force applied by a foot on the ground when walking, what will the person do? Fall, because the frictional force causes the foot to "stick" to the ground because it is greater than the anterior force c. Continue walking as normal since the frictional force is sufficient to prevent slipping d. If the static coefficient of friction of a basketball shoe on a particular playing surface is 0. An object is being pushed by a stick horizontally across a table at a constant velocity.

Consider the angular momentum of a gymnast performing an aerial somersault about a transverse axis through the total body center of mass moroccanoil treatment buy zofran 8mg lowest price. The torque applied over time at the point of takeoff determines the quantity of angular momentum medicine quinine discount zofran 4 mg without a prescription. The gymnast symptoms 8 weeks pregnant discount zofran 8mg with visa, however symptoms women heart attack cheap 4mg zofran mastercard, may manipulate the moment of inertia to spin faster or slower about the transverse axis. At takeoff, the gymnast is in a layout position with a relatively large moment of inertia and a relatively small angular velocity or rate of spin. As the gymnast assumes a tuck position, the moment of inertia decreases and the angular velocity increases accordingly because the quantity of angular momentum is constant. Having completed the necessary rotation and in preparation to land, the gymnast opens up, assuming a layout position, increasing the moment of inertia and slowing the rate of spin. Although the total angular momentum is constant, it may be transferred, for example, from a transverse axis through the center of mass to a longitudinal axis through the center of mass. For example, a diver may twist about the longitudinal and initiate actions that produce a somersault about the transverse axis. Researchers have investigated the arm and hip movements to accomplish this change in angular momentum (15,56,64,65). Other activities that use the principles of transferring angular momentum are freestyle skiing and gymnastics. Rotations may be initiated in midair even when the total body angular momentum is zero. A prime example of this is the action of a cat when dropped from an upside-down position. As the cat begins to fall, it arches its back, or pikes, to create two body sections, a front and a hind section, and two distinct axes of rotation. The cat extends its hind limbs and rotates the hind section in the opposite direction to counteract the rotation of the front segment. Because the moment of inertia of the hind section is greater than that of the front section, the angular distance that the hind section moves is relatively small. Throughout the aerial portion of the dive, the total body angular momentum of the diver is constant. When the diver is in a layout position, the moment of inertia decreases and the angular velocity increases in proportion. During the tuck portion of the dive, the angular velocity increases and the moment of inertia decreases in proportion. The reaction of the front portion of the cat to the hind section rotation is small because the cat creates a large moment of inertia by extending its front legs. The use of such actions in sports such as diving and track and field has received considerable attention (12,15). The angular momentum of a segment about its own center of mass is referred to as the local angular momentum of the segment. The angular momentum of a segment about the total body center of mass is referred to as the remote angular momentum of the segment. Expressed algebraically: Htotal = Hlocal + Hremote If the total angular momentum of an individual is calculated, the local aspects of each segment and the remote aspects of each segment must be included. Local angular momentum is expressed as: Hlocal = Icmv where Hlocal is the local angular momentum of the segment, Icm is the moment of inertia about an axis through the segment center of mass, and v is the angular velocity of the segment about an axis through the segment center of mass. The remote aspect of angular momentum is calculated as: Hremote = mdv2 where Hremote is the remote angular momentum, m is the mass of the segment, d is the distance from the segment center of mass to the total body center of mass, and v is the angular velocity of the segment about an axis through the total body center of mass (24). Figure 11-14 illustrates the proportion of local and remote angular momentum of the total angular momentum in a forward two-anda-half rotation dive. In this instance, the remote angular momentum makes up a greater proportion of the total angular momentum than does the local angular momentum. This technique for calculating total body angular momentum has been used in a number of biomechanics studies.

A Vertical Longitudinal B Oblique C Degenerative D Transverse (Radial) E Horizontal Figure 6-4 medications containing sulfa discount zofran 4mg line. Klimkiewicz Evaluation of Common Sports Medicine Injuries the principles involved in the initial evaluation of the injured athlete focus on history and physical examination in combination with auxiliary tests and are similar in comparison to other orthopedic injuries nail treatment buy zofran 4 mg on line. This subspecialty differs from that of a general orthopedic setting in two distinct manners symptoms ruptured spleen buy zofran 8mg line. One large difference in the management of the athlete is the ability to provide prompt "on-the-field" attention as a result of game time coverage by the sports medicine physician; this allows one to often visualize the injury directly and distinguish as to whether the mechanism was a direct result of blunt trauma as compared to a more-indirect mechanism treatment hyperthyroidism discount 8mg zofran visa. Additionally, it provides one with a golden window of time to evaluate the injury before the effects of swelling and subsequent pain and spasm complicate the physical exam. It often allows one the opportunity to make the diagnosis without the need for auxiliary tests that are often required when evaluating these injuries on a more-subacute basis. Furthermore, the sports medicine physician is often asked the safety of returning to play in light of a specific injury. Knowledge of the common injuries as well as the sporting activities themselves is important in making these decisions. The following sections focus on the history as well as physical examination in the sports medicine setting. History the history in many sporting injuries is straightforward and related to acute trauma. Important in this history is the mechanism of injury, as this often relates very closely with the structure injured. When this is more ambiguous on questioning the athlete, input from other players, trainers, and coaches as well as game-time film can be invaluable in determining the mechanism of injury. Other injuries within this field are a result of microtrauma, or overuse, and have no specific mechanism of injury. For these insidious conditions, its important to obtain the specifics of recent activity including change in recent activity, change in shoe wear or other equipment, the surface involved (track to road, flat surface to hills, etc. Other pertinent details include whether this problem has occurred before, and if so, how it happened, what type of treatment was rendered, and what was the outcome. Previous problems may alert the clinician to a different treatment problem to prevent recurrence of the injury. Examples include the management of "first-time" as opposed to recurrent shoulder dislocations. Sports Medicine 267 Symptoms that occur with activity and improve with rest are typical of overuse injuries. Nocturnal awakening usually indicates more serious injury or an underlying systemic disorder. Such a distinction is important in distinguishing shin splints from a stress fracture in a long-distance runner. In the athlete with intermittent knee symptoms, pain in the anterior aspect of the knee that is worse with stair climbing or with prolonged sitting suggests problems related to the patellofemoral joint. Symptoms that occur predictably with cutting and pivoting activities, accompanied by swelling and instability, suggest an internal derangement of the knee such as a meniscus injury or tear of the anterior cruciate ligament. Physical Examination the specific examination depends on the nature of the symptoms and the region affected. All physical examinations, however, should begin with inspection and observation of the extremity. After acute injury one should compare the injured joint in question to its opposite side. Inspection for skin changes such as ecchymoses, abrasions, and associated swelling can be important clues in distinguishing macrotrauma from a microtraumatic event. Range of motion of the joint in question both actively and passively is imperative. First have the athlete move the joint in question and observe for associated pain or asymmetry as compared to the opposite side. Examples include a patient who presents with shoulder pain of insidious onset whose active and passive range of motion is asymmetrical and limited on the affected side suggesting an adhesive capsulitis as a diagnosis; this is compared to a rotator cuff injury where passive range of motion would be full despite a limited active range of motion secondary to pain. Strength assessment is an important component to the exam of any jointrelated injury. During strength assessment, weakness may be the result of direct injury to a musculotendinous unit responsible for joint function. However, pain, guarding, or reflex inhibition of muscular contraction can also be responsible for perceived weakness on examination.

The most common cause of pseudobulbar palsy is a cerebrovascular disease treatment kidney infection discount 8 mg zofran with mastercard, typically after multiple infarcts symptoms before period generic zofran 4 mg without a prescription, but it may also occur in motor neurone disease and multiple sclerosis symptoms 3 months pregnant order 4mg zofran mastercard. Comatose patients may be hypoglycaemic or hyponatraemic keratin smoothing treatment buy zofran 8 mg cheap, and hypocalcaemia may lead to spasms and tetany. Imaging Skull and spinal X-rays are used to identify fractures, metastases, destructive lesions, osteomyelitis and degenerative osteomyelitis. However, small lesions (<1 cm) or lesions with the same attenuation as bone or brain. Patients with pacemakers or metallic fragments in the brain cannot be imaged and claustrophobia is an 740 Neurology issue for some patients. Doppler studies B-mode and colour ultrasound are valuable in the detection of stenosis of the carotid arteries. Its main value is to characterize epilepsy syndromes and it is a sensitive test for encephalopathies; different patterns are seen with different encephalopathies. Evoked potentials record brain responses to sound (auditory evoked potentials), touch (somatosensory) and visual stimuli (visual evoked potentials). Fluid should be sent for microscopy and culture, protein, and glucose concentration with a simultaneous plasma glucose sample. Electromyography is usually performed in conjunction with nerve conduction studies, which measure the speed of conduction of impulses through a nerve. They will differentiate between axonal and demyelination neuropathy and determine whether pathology is focal or diffuse. These tests are used to investigate disease of the muscles, nerves or neuromuscular junction. Muscle biopsy Unconsciousness and coma 741 is performed under local anaesthetic with a small skin incision and muscle biopsy needle. It can image a large bulk of muscle and avoids the sampling error associated with muscle biopsy. It consists of clusters of interconnected neurones throughout the brainstem, with projections to the spinal cord, the hypothalamus, the cerebellum and the cerebral cortex. Serial measurements are used to detect a deterioration which may indicate the need for further investigation or treatment. Aetiology Altered consciousness is produced by four types of processes: נDiffuse brain dysfunction due to severe metabolic, toxic or neurological disorders נBrainstem lesions which damage the reticular formation נPressure effect on the brainstem such as a cortical or cerebellar lesion which compresses the brainstem, inhibiting the ascending reticular activating system נExtensive damage of the cerebral cortex and cortical connections can cause coma. The most common causes of coma are metabolic disorders, drugs and toxins and mass lesions. Assessment In all patients presenting in coma, a history should be obtained from any witnesses and relatives. Assess for cyanosis, respiratory rate (normal 12Ͳ0 breaths/min), use of accessory muscles of respiration (p. Immediate assessment of capillary glucose is essential if the patient has diabetes. Look for evidence of trauma, bruits and neck stiffness (indicating meningitis or subarachnoid haemorrhage). They also occur in deep coma of any cause, but particularly coma caused by barbiturate intoxication or hypothermia. Conjugate lateral deviation of the eyes indicates ipsilateral cerebral haemorrhage or infarction (the eyes look away from the paralysed limbs), or a contralateral pontine lesion (towards the paralysed limbs). Asymmetry of spontaneous limb movements, tone and reflexes indicates a unilateral cerebral hemisphere or brainstem lesion. Investigations In many cases the cause of coma will be evident from the history and examination, and appropriate investigations should then be carried out. Blood and urine tests ננננננBlood glucose by immediate Stix testing and then formal laboratory testing Serum for urea and electrolytes, liver biochemistry and calcium Arterial blood gases Blood cultures Serum and urine for drug analysis. Management the immediate management consists of treatment of the cause, careful nursing, meticulous attention to the airway and frequent observation to detect any Stroke and cerebrovascular disease 745 change in vital function. A cause must be established before decisions are made about withdrawing supportive care. Brain death Brain death means the irreversible loss of the capacity for consciousness, combined with the irreversible loss of the capacity to breathe. Two independent senior medical opinions are required for the diagnosis to be made. The three main criteria for diagnosis are as follows: נIrremediable structural brain damage.