Background: There is a lack of standardized tests that assess functional performance for sustained upper extremity activity. This study describes development of a new test for measuring functional performance of the upper extremity and neck and assesses reliability and concurrent validity in patients with shoulder pathology.
DIRECT IN6UIt AL HERNIA THE BRI; MDCL ORA indirect inguinal hernia. At operation the condition conformed in every way to that in Case 1, and it was treated in the same manner, except that silk was used to repair the hole in the transversalis fascia, and a silk darning-repair made of the inguinal canal. His recovery was uninterrupted.-,/,rm oLE .. ', HtMIALlC 4 LDn INGWINAL -IOU01 A diagrammatic drawing of the condition described. No attempt has been made to illustrate the bladder that forms part of the medial wall of -the sac. The epigastric vessels are exaggerated in size and clarity in order to point out their relation to the sac. DiscussionThe facts that emerge from a study of these cases are important, and raise points of interest with regard to their anatomy, the type of sac, and their treatment.In the common type-of direct hernia nothing more is usually found than a diffuse bulge of the posterior wall of the inguinal canal, often emerging through the external ring, but possessing no definite peritoneal sac and rarely if ever strangulating. The aetiology is usually quite clear, and represents a weakness of the mtuscles in that region, often due to advancing age, and occasionally secondary to bowel or urinary obstruction. In the rare type described here the inguinal canal is normal in all respects except for a localized opening in the transversalis fascia with qLuite definite edges, and in the cases reported would not admit more than the tip of the index finger. As Ogilvie points out, the aetiology of this condition is not clear, and from a study of so few cases it is impossible even to hazard a guess, but it seems certain that the peritoneal sac has arisen secondarily to the hole in the transversalis fascia. In two cases bladder formed a considerable part of the sac, and in one case actual strangulation had occurred. In all cases a definite tubular peritoneal sac was found which had to be dissected from its surroundings and ligatured as in an indirect hernia. Furthermore, they were all diagnosed as indirect herniae before operation; and, indeed, they are indistinguishable.With regard to treatment, it is important to recognize this type of hernia, which can only be done at operation. The significance of this is borne out by Case 3, for it is possible that the true state of affairs was not recognized at the original operation, and that the diagnosed indirect hernia was really the direct one found at the second operation.The bladder often forms a part of the sac and must, if possible, be stripped off from it. More important, though, is the repair. It is apparent that, whatever type of repair is done on the inguinal canal, unless a direct attack is made on the opening in the transversalis fascia recurrence is apt to occur. In my own particular cases the opening was closed with catgut in two, and silk in the third. In the case which was strangulated no repair of the inguinal canal was made, but-a full repair was effected in the other two, using silk in one and strips of external oblique aponeurosis in the ...
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