Arm Wrestling Can Lead to Humerus Fracture

A clip posted recently on Google Video shows a serious injury associated with arm wrestling: spiral fracture of the humerus. These fractures often require open reduction and internal fixation with a metal plate and screws, and recovery can take months.

British Journal of Sports Medicine has an excellent case report which describes a Broken arm wrestler:

"Usually the musculotendinous structures are the limiting factor in arm wrestling, but in this particular case they were not, either because the proprioceptive awareness of the patient was reduced because of the alcohol and late night and/or he wasovermuscular for his bony size, in the sense that, although he was generally muscular, he did not have the humeral cortical bone hypertrophy to match his muscularity because he was not a regular arm wrestler.

This type of arm wrestling injury tends to occur when one arm wrestler tries to force the match in an effort to win or to change the tide of the contest. As the offensive wrestler continues with the attack, the defender's internalrotator shoulder muscles suddenly and passively stretch and change from their maximally concentric contraction to an eccentric compensatory contraction, resulting in an intense rotational force with subsequent humeral fracture."


Video: An arm wrestler breaks his arm during a match at the Empire State Golden Arm Tournament of Champions in New York City. There is a clearly audible snap in the video when the humerus breaks.

John Brzenk, who is considered the best arm wrestler in the world, responds to a fan question regarding how often (professional) arm wrestling leads to fractures:

"To be honest over the last 15 years of arm wrestling I’ve seen maybe a handful of broken arms and all of them in the upper arm."

Any fracture is serious. If you engage in arm wrestling, please have the cases above in mind, exercise properly and take every precaution to prevent similar injury from happening to you.

References:
Broken arm wrestler. Br J Sports Med 2000; 34:461-462.
Interview with John Brzenk. ArmWrestling.com.
Image source: Arm wrestling from Wikipedia, the free encyclopedia.

Related:

Ed Goljan, M.D., professor of pathology and top notch arm wrestler

Updated: 07/23/2010

A "Killer" Cookie?

Family Medicine Notes links to the nutrition info a "killer" cookie offered by Dunkin' Donuts: it contains 65% of your daily allowance of saturated fat.

And not only that, the "killer" cookie is loaded with 48 g of sugar AND 550 mg of sodium. Is sodium there to temper the sweetness, or just to increase blood pressure? The recommended total daily intake of sodium is 2000 mg, so this cookie certainly goes a long way in ensuring that everybody who eats it hits the maximum daily dose of sodium they can take...

References:
Illegal food? Family Medicine Notes
Image source: Wikipedia

Using a Blog to Build an Educational Portfolio in Academic Medicine

What is an "educational portfolio"?

Let me explain. I am an academic hospitalist at the Cleveland Clinic. The goal of our section is to be the best academic hospitalist group in country. "Academic" means that we devote a significant amount of our time to research and teaching. This time has to be accounted for and for that purpose each of us builds an educational portfolio -- a collection of research ideas, projects, presentations, manuscripts and published articles. A blog can be the perfect solution to building an electronic educational portfolio.

Collecting your research ideas (and asking for feedback) is actually a very valuable exercise not dependent on your current position -- a medical student, resident, academic or private practice physician. Medicine is all about life-long learning, isn't it?

How to use a blog to build an educational portfolio?

All blogs place a time stamp on the posts and are in a reverse chronological order, thus placing the newest ideas on top. Reading a recent Scoble post, I realized that Google makes it really easy to find what you have written weeks or even months ago: just search for a particular topic adding your blog name to it: example. Scoble's example is naturally not related to medicine at all but the idea is what is important there:

One of the first things I learned about blogging back in 2000 was it is an awesome way to stick things into Google. If you find a new restaurant, for instance, and they don’t yet exist in Google, if you write about it on your blog invariably it’ll be there within a week.

I regularly write about things for the SOLE purpose of putting them on Google. Same thing with my link blog.

It’s very easy to pull them back out, too. Just add your blog’s name to a Google search.

For instance, I remember I wrote about a coffee place in Redmond. Forget the name? Just ask Google for it back out. This works consistently well.

You can choose whether to make you blog accessible to everyone (recommended, since it invites feedback) or confidential. Currently, the best and easiest service to start a blog seems to be Blogger.com, owned by Google.

Related reading:

"One of the best decisions I’ve made in my career was to start a blog and a wiki, leaving a paper trail of ideas" http://bit.ly/GX7Z6C
The power of blogging on Google. Scobleizer.
Blogs Are Increasingly Venues for Scholarship. Open Medicine Blog, 01/2008.
Developing a virtual personal network. BMJ Career Focus 2007;334:13-15.
Web 2.0 in Medicine 2006-2007 (PowerPoint file).
Feature: 5 Reasons to Use WordPress as CMS. BloggingPro, 2007.
How To Use Your Blog To Make 2008 Your Best Year Ever! LifeHack.org.
Video presentations: Novel concepts and easy-to-use web tools for researchers. European Molecular Biology Laboratory, 2006.

Blogs as Web-Based Portfolios Part 2. Thinking Stick, 2010.

Blogs as Web-Based Educational Portfolios - free eBook PDF http://goo.gl/BXCF

As A Busy Physician, Why Do I Even Bother Blogging? http://goo.gl/fSF3 - Excellent summary.
Beautiful example of how blogs can disseminate medical information much more efficiently than journals, NEJM included (http://goo.gl/rOvNq).

Note: After working at the Cleveland Clinic and Case Western Reserve University as a Clinical Assistant Professor for Medicine for 3 years, I moved to Creighton University to complete an Allergy and Immunology fellowship. I now work as an Allergist/Immunologist and Assistant Professor of Medicine and Pediatrics at the University of Chicago. This blog post was written during my work at the Cleveland Clinic.

"Medical Breakthrough" in Treatment of Seborrheic Keratosis

Medscape's MedGenMed eJournal features an amusing video editorial by his Editor-in-Chief, George D. Lundberg:

I Use Fingernail Surgery to Remove My Seborrheic Keratoses (free registration required):

"So, now I take my seb keratoses off while they are still small with my fingernails, usually the one on the third finger of my right hand. Am I kidding you? No."

A very special dog: Skidboot

A heart-warming segment from Texas Country Reporter (8 min). There may never be another Skidboot -- the smartest dog in the world, according to Jay Leno, at least.

Related:
See more videos at Skidboot.com.
Link via FatDoctor.

How a Doctor Almost Killed Her Dog - ibuprofen, the key ingredient in Motrin, poisons dogs. NYTimes.

Schmedley is Another Web 2.0 Start Page

I thought Netvibes was probably the slickest Web 2.0 start page (web desktop?) until I saw Schmedley.

As you can see from the screen shot on the right, Windows Live Search still has some catching up to do when you search for "clinical cases"...

Read the full review complete with useful screen shots on Go2web2.

References:
Schmedley: More Than Just A StartPage. Go2web2.
NetVibes is an example of what a web 2.0 desktop might look like
Pageflakes: The Teacher Edition. ScienceRoll, 12/2007.

Updated: 12/08/2007

Something you have never seen before -- a rare central line complication in NEJM

A man had a central line inserted by a cardiologist through the left subclavian vein. Six months later, the patient presented with posterior neck pain. A guide wire was protruding from the back of his neck... Continue reading: Complication of Central Venous Catheterization. NEJM, 2007.

Our own images of central line complications simply pale in comparison to this NEJM case.

You can get more cases and images if you subscribe to the free NEJM image feed which is syndicated in the right sidebar of this web site: http://rss.nejm.org/imagecast.xml

References:
Complication of Central Venous Catheterization. NEJM, 2007.
Complications of Central Line Placement - Pneumothorax, Arrhythmia, Hematoma

Improper placement of the central venous catheter - case one and case two from the Annals of Emergency Medicine