Rotator Cuff Essays - Shoulder, Synovial Bursae, Free Essays

Rotator Cuff Essays - Shoulder, Synovial Bursae, Free Essays Rotator Cuff It is often difficult to tell where concepts actually begin. It is certainly not obvious who first used the term rotator or musculotendinous cuff. Credit for first describing ruptures of this structure is often given to J. G. Smith, who in 1834 described the occurrence of tendon ruptures after shoulder injury in the London Medical Gazette. (Smith, 1834) In 1924 Meyer published his attrition theory of cuff ruptures. (Meyer, 1924) In his 1934 classic monograph, Codman summarized his 25 years of observations on the musculotendinous cuff and its components and discussed ruptures of the supraspinatus tendon. (Codman, 1934b) Beginning 10 years after the publication of Codman's book and for the next 20 years, McLaughlin wrote on the etiology of cuff tears and their management. (McLaughlin, 1944, McLaughlin and Asherman, 1951) Oberholtzer first carried out arthrography in 1933 using air as the contrast medium. (Oberholtzer, 1933) Lindblom and Palmer (Lindblom and Palmer, 1939) used radio-opa que contrast and described partial-thickness, full-thickness, and massive tears of the cuff. Codman recommended early operative repair for complete cuff tears. He carried out what may have been the first cuff repair in 1909. (Codman, 1934b) Current views of cuff tear pathogenesis, diagnosis, and treatment are quite similar to those that he proposed over 50 years ago. Pettersson has provided an excellent summary of the early history of published observations on subacromial pathology. Because of its completeness, his account is quoted here. (Pettersson, 1942) As already mentioned, the tendon aponeurosis of the shoulder joint and the subacromial bursa are intimately connected with each other. An investigation on the pathological changes in one of these formations will necessarily concern the other one also. A historical review shows that there has been a good deal of confusion regarding the pathological and clinical observations on the two. The first to observe morbid processes in the subacromial bursa was Jarjavay, (Jarjavay, 1867) who on the basis of a few cases gave a general description of subacromial bursitis. His views were modified and elaborated by Heineke (Heineke, 1868) and Vogt. (Vogt, 1881) Duplay (Duplay, 1872) introduced the term periarthritis humeroscapularis to designate a disease picture characterized by stiffness and pain in the shoulder joint following a trauma. Duplay based his observations on cases of trauma to the shoulder joint and on other cases of stiffness in the shoulder following dislocation, which he had studied at autopsy. The pathological foundation for the disease was believed by Duplay to lie in the subacromial and subdeltoid bursa. He thought that the cause was probably destruction or fusion of the bursa. Duplay's views, which were supported by his followers, Tillaux (Tillaux, 1888) and Desch, (Desche, 1892) were hotly disputed. His opponents, Gosselin and his pupil Duronea (Duronea, 1873) and Desplats, (Desplats, 1878) Pingaud a nd Charvot, (Pinguad and Charvot, 1879) tried to prove that the periarthritis should be regarded as a rheumatic affection, neuritis, etc. In Germany, Colley (Colley, 1899) and Kuster (Kuster, 1882) were of practically the same opinion regarding periarthritis humeroscapularis as Duplay. Roentgenography soon began to contribute to the problem of humeroscapular periarthritis. It was not long before calcium shadows began to be observed in the soft parts between the acromion and the greater tuberosity. (Painter, 1907) The same finding was made by Stieda, (Stieda, 1908) who assumed that these calcium masses were situated in the wall and in the lumen of the subacromial bursa. These new findings were indiscriminately termed bursitis calcarea subacromialis or subdeltoidea. The term bursoliths was even used by Haudek (Haudek, 1911) and Holzknecht. (Holzknecht, 1911) Later, however, as the condition showed a strong resemblance to humeroscapular periarthritis, it became entirely identified with the latter. In America, Codman(Codman, 1984) made a very important contribution to the question when he drew attention to the important role played by changes in the supraspinatus in the clinical picture of subacromial bursitis. Codman was the first to point out that many cases of inability to abduct the arm are due to incomplete or complete ruptures of the supraspinatus tendon. With Codman's findings it was proved that humeroscapular periarthritis was not only a disease condition localized in the subacromial bursa, but that pathological changes also occurred in the tendon aponeurosis of the shoulder joint. This

What Makes a Compelling Romance Novel

What Makes a Compelling Romance Novel What Makes a Compelling Romance Novel? Ann Leslie Tuttle worked at Harlequin Books - a division of HarperCollins - for over 20 years, most recently as a Senior Editor. During her tenure, she acquired and edited NYT and USA Today bestselling authors in romance, women's fiction, and mystery, including Sylvia Day, Julia London, Lisa Renee Jones, and Hank Phillippi Ryan.If you know how a story will end, why would you want to read the book? That’s the question that romance writers constantly struggle to answer. Readers come to the genre knowing they will (almost) always get a happy ending in which the protagonists find and profess their love.To entice readers, writers must therefore deliver a fresh premise with strong, evocative prose and pacing that gets to the heart of the story - usually beginning with the protagonists meeting in the first chapter. These will be the elements that usually prompt someone to pick up the book and start reading. Most importantly, the writer’s crafting of the two main characters and their emotional journeys is what will keep the reader hooked.Having been an editor working on romance titles for well over 20 years, I’ve seen both debut and experienced authors struggle to create compelling characters whose emotional push-and-pull is strong enough to sustain the length of the story. Over the years, I’ve pulled together my own list of trouble spots - and ways to surmount them - that I’d like to share with you now. See what makes a compelling romance novel here! Trouble Spot #1: CharacterizationThe best lesson I ever received in characterization was at a writers’ conference, where an author who was pitching me told me that she wrote horoscopes for a living. The writer took that skill and developed such detailed horoscopes for the hero and heroine in her story that she knew precisely who they were regarding their tastes and personalities, what obstacles they faced, what had occurred in their past or backstory, etc.While I wouldn’t recommend that every romance writer start building astrological charts, I would encourage you to make sure you really know who your protagonists are. Delve deeply into their stories so that they’re not just one-dimensional stereotypes. Indeed, the more (believable) hardships they’ve endured in the past, the more material you will have to mine.Keep in mind that while stories featuring large families are popular with readers, it can often be a challenge to write about a presumably tortured hero who comes from such a loving, happy home. But if he’s served in the military or lost a close friend in a childhood accident, he may have other emotional reserves upon which you can draw. id=attachment_15175 style="width: 910px" class="wp-caption aligncenter">"Oh, Mr. Darcy!" (image: BBC)In the end, it’s all about the emotional conflict our romantic leads must surmount that makes their story so compellingThe emotional conflict is not to be confused with the external one. The external conflict usually revolves around an issue of miscommunication, perhaps differing career and money goals - or if you want to kick it up a notch, an external threat. (This is particularly effective when one of the main characters is on the run, or in hiding.)For example, the heroine might have left town eight years ago, believing her high school boyfriend didn’t love her simply because he never got her note or phone call - this is the external conflict they must resolve if they want to patch things up. Or maybe the protagonists believe they can’t be together because one lives on the East Coast and the other on the West Coast. These kinds of conflicts can usually be o vercome by a heartfelt conversation or compromise, but it sometimes involves uncovering the main players in a global threat and taking them down.A strong emotional conflict boils down to either a question of trust or fear. For instance, if your hero lost his first wife to cancer, it’s understandable that he won’t want to run the risk of ever experiencing that all-consuming pain again. Or if the heroine shared her deepest secret with an ex who betrayed her trust, she’s probably reluctant to open up to a new partner.In each of these emotionally fraught cases, the conflict is deep and will require some growth on the part of your hero and heroine to recognize that, despite high stakes involved, love is worth putting oneself on the line.Even if one of your characters first realizes and even confesses their love, the resolution of the conflict should take up most of the book (Elizabeth and Darcy, anyone?). If you’ve created a conflict that is sufficiently compe lling, there should not be an instance where both the protagonists confess their love, only to be driven apart again by some external threat or unsolved thread.Yes, readers may know how your story ends. But with multi-faceted protagonists, emotional appeal, great plotting, and a strong conflict, they will still want to travel with the characters as they overcome each milestone on their journey to finding love.For more help with writing great romance, you can also take inspiration from any of the books on these lists:The 10 Best Historical Romance Novels Like OutlanderThe 25 Best Romance Authors and Their Must-Reads30+ Best Young Adult Romance Books That You Can't Miss Out On40+ Paranormal Romance Books with BiteWhat are some of your experiences writing romances? Share your thoughts in the comments below!