Comparison Of Early Active Range Of Motion In Primary Reverse Shoulder Arthroplasty Based On Indication: A Single Center Retrospective Review,
2022
Department of Orthopaedics and Rehabilitation Stony Brook University
Comparison Of Early Active Range Of Motion In Primary Reverse Shoulder Arthroplasty Based On Indication: A Single Center Retrospective Review, Michael E. Doany, Kenny Ling, Rosen Jeong, Alireza K. Nazemi, David E. Komatsu, Edward D. Wang
Stony Brook Orthopaedic and Musculoskeletal Journal
Background: Reverse shoulder arthroplasty (RSA) is commonly used in the treatment of rotator cuff arthropathy. Indications for RSA have expanded to include complex proximal humerus fractures. Studies directly comparing outcomes between traumatic and traditional elective indications are limited. The purpose of this study was to compare early active range of motion (aROM) within the first two years postoperatively between traumatic and non-traumatic primary RSA, as well as compare ASES scores, and patient satisfaction at final follow-up.
Methods: A retrospective analysis was conducted of all RSA performed by a single surgeon between January 2000 and December 2018. Patients were grouped by …
Multi-Center, Single-Blind Randomized Controlled Trial Comparing Functional Electrical Stimulation Therapy To Conventional Therapy In Incomplete Tetraplegia,
2022
The Texas Medical Center Library
Multi-Center, Single-Blind Randomized Controlled Trial Comparing Functional Electrical Stimulation Therapy To Conventional Therapy In Incomplete Tetraplegia, Kim D Anderson, Radha Korupolu, Kristin E Musselman, Jacqueline Pierce, James R Wilson, Nuray Yozbatiran, Naaz Desai, Milos R Popovic, Lehana Thabane
Faculty, Staff and Student Publications
BACKGROUND: Loss of upper extremity function after tetraplegia results in significant disability. Emerging evidence from pilot studies suggests that functional electrical stimulation (FES) therapy may enhance recovery of upper extremity function after tetraplegia. The aim of this trial was to determine the effectiveness of FES therapy delivered by the Myndmove stimulator in people with tetraplegia.
METHODS: A multi-center
RESULTS: Between June 2019 to August 2021, 51 participants were randomized to FES (
CONCLUSION: Forty sessions of FES therapy delivered by the MyndMove stimulator are as effective as conventional therapy in producing meaningful functional improvements that persist after therapy is completed. …
Thirty Day Low-Dose Versus Regular-Dose Aspirin For Venous Thromboembolism Prophylaxis In Primary Total Joint Arthroplasty,
2022
Department of Orthopaedics and Rehabilitation Stony Brook University
Thirty Day Low-Dose Versus Regular-Dose Aspirin For Venous Thromboembolism Prophylaxis In Primary Total Joint Arthroplasty, Alexander Duke, Stephen Bowen, Samir Baig, David E. Komatsu, James Nicholson
Stony Brook Orthopaedic and Musculoskeletal Journal
Background: Aspirin (ASA) is an effective chemical prophylaxis for venous thromboembolism (VTE) after total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, the optimal dosage and duration of therapy remains debatable. The main objective of this study was to compare two ASA regimens with regard to the incidence of symptomatic deep venous thrombosis (DVT), pulmonary embolism (PE), bleeding (based on patient’s dressing), and infection within 90 days after primary THA and TKA.
Methods: We retrospectively identified 625 primary THA and TKA surgeries among 483 patients who received aspirin for four weeks post operatively. A total of 301 patients received …
Current Concepts Review: Postoperative Analgesia After Posterior Spinal Fusion For Adolescent Idiopathic Scoliosis,
2022
Department of Orthopaedics and Rehabilitation Stony Brook University
Current Concepts Review: Postoperative Analgesia After Posterior Spinal Fusion For Adolescent Idiopathic Scoliosis, Aadit Shah, Eduard P. Pey, Stephen Bowen, James Barsi
Stony Brook Orthopaedic and Musculoskeletal Journal
Many post-operative analgesic options exist after a posterior spinal fusion for adolescent idiopathic scoliosis, with newer interventions gaining attention. It is unclear which provide the most benefit. The aim of this current concept review is to document efficacy, safety and quality of evidence of analgesic interventions after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Potent analgesia with IV opioids or epidural anesthesia remains the cornerstone of postoperative analgesia following PSF for AIS. A diverse set of analgesic adjuvants are under investigation with promising results, including GABA-analogues, intrathecal anesthesia, nonsteroidal anti-inflammatory drugs and acetaminophen, ketamine, spinal nerve block, alpha …
Level Of Obesity Is Directly Associated With Complications Following Arthroscopic Rotator Cuff Repair,
2022
Department of Orthopaedics and Rehabilitation Stony Brook University
Level Of Obesity Is Directly Associated With Complications Following Arthroscopic Rotator Cuff Repair, Alireza K. Nazemi, Kevin I. Kashanchi, David E. Komatsu, Edward D. Wang
Stony Brook Orthopaedic and Musculoskeletal Journal
Background: The purpose of this study was to investigate the association between increasing levels of obesity and post-operative complications within 30 days of arthroscopic rotator cuff repair (ARCR).
Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program database for all patients who underwent ARCR from 2015 to 2017. Patients were stratified into 3 cohorts according to their body mass index (BMI). Patients with a BMI < 30 kg/m2 were placed in the non-obese cohort, patients with a BMI between 30 and 40 kg/m2 were placed in the obese cohort, and patients with a BMI > 40 kg/m2 were placed in the morbidly obese cohort. Postoperative complications within 30 days of the procedure were collected. Multivariate logistic regression was used to investigate the relationship between increasing levels …
เปรียบเทียบความสัมพันธ์ระหว่างภาวะกล้ามเนื้อล้าที่วัดได้จากกระแสประสาทของกล้ามเนื้อ (Emg) และความรู้สึกล้าขณะออกกำลังกายในท่าดันพื้น ในกลุ่มคนที่มีประสบการณ์ในการออกกำลังกายกับกลุ่มคนที่ขาดประสบการณ์ในการออกกำลังกาย, เกริก บุตรวงศ์โสภา
Chulalongkorn University Theses and Dissertations (Chula ETD)
การออกกำลังกายท่าดันพื้นเป็นท่ามาตรฐานในการออกกำลังกายแบบ compound movement ของกล้ามเนื้อช่วงบน การประเมินความล้าของผู้ปฏิบัติให้รวดเร็วและแม่นยำจะช่วยป้องกันการบาดเจ็บได้ จุดประสงค์ของการวิจัยนี้เพื่อเปรียบเทียบว่าความสัมพันธ์ระหว่างสัญญาณกระแสประสาทและการรับรู้ขณะเกิดภาวะกล้ามเนื้อล้าขณะออกกำลังกายท่าดันพื้นในกลุ่มคนที่มีประสบการณ์ออกกำลังกายในท่าดันพื้น (Well-trained) และกลุ่มคนที่ขาดประสบการณ์ออกกำลังกายในท่าดันพื้น (Un-trained) เพศชายอายุ 20-35 ปี โดยแบ่งกลุ่มละ 30 คน ทำการดันพื้นจนเกิดอาการล้าไม่สามารถดันพื้นต่อได้ ผลการศึกษาพบว่า กลุ่ม Well-trained มีจำนวนครั้งที่ดันพื้นมากกว่ากลุ่ม Un-trained อย่างมีนัยสำคัญ โดยมีค่าเฉลี่ย 27.3±6.3 ครั้ง และ 18.2±4.3 ครั้ง (p=0.001) ตามลำดับ โดยในกลุ่ม Well-trained ความล้าที่วัดได้จากการลดลงของค่าความถี่มัธยฐาน (Delta median frequency, ∆MDF) ในกล้ามเนื้อ Pectoralis Major มีความสัมพันธ์กับ Visual numeric scale of fatigue (VNS-F) ในระดับสูง (r=-0.98, p<0.05) ส่วนกลุ่ม Un-trained การลดลงของ ∆MDF ในกล้ามเนื้อ Triceps Brachialis และกล้ามเนื้อ Upper Trapezius มีความสัมพันธ์กับ VNS-F ในระดับสูง r = -0.93, p<0.05 และ r = -0.86, p<0.05 ตามลำดับ โดยทั้ง 2 กลุ่มพบว่า ∆MDF ลดลงอย่างมีนัยสำคัญเมื่อค่า VNS-F มากกว่า 6 สรุปว่า ในการออกกำลังกายท่าดันพื้น ความสัมพันธ์ของภาวะกล้ามเนื้อล้าที่วัดได้จากกระแสประสาทกล้ามเนื้อกับความรู้สึกล้ามีความสัมพันธ์ในระดับสูงทั้งสองกลุ่ม แต่จะแตกต่างกันที่กลุ่มกล้ามเนื้อ โดยกลุ่ม Well-trained วัดได้ที่กล้ามเนื้อหลักมัดใหญ่ที่ใช้ในท่าดันพื้น ส่วนกลุ่ม Un-trained วัดได้ที่กล้ามเนื้อหลักมัดเล็กและกล้ามเนื้อมัดรองในท่าดันพื้น ดังนั้นในกลุ่ม Un-trained ควรเสริมสร้างความแข็งแรงของกล้ามเนื้อ Triceps Brachialis และ Pectoralis Major ให้แข็งแรงก่อนเพื่อป้องกันการบาดเจ็บจากการใช้กล้ามเนื้อผิดมัดในการออกกำลังกายท่าดันพื้น
ผลของการออกกำลังกายเพื่อลดภาวะกระดูกสันหลังค่อมแบบหลายมิติต่อมุมส่วนโค้งของกระดูกสันหลังระดับอก ความแข็งแรงของกล้ามเนื้อแอ่นหลังและความสามารถการทรงตัวขณะเดิน ในผู้หญิงที่มีภาวะกระดูกสันหลังค่อมจากท่าทางที่ไม่เหมาะสม, ปัญญภรณ์ หมายดี
Chulalongkorn University Theses and Dissertations (Chula ETD)
การพัฒนาการออกกำลังกายเพื่อลดภาวะกระดูกสันหลังค่อมแบบหลายมิติ (MHCE) เพื่อแก้ไขปัญหาที่ครอบคลุมถึงการเปลี่ยนแปลงของความยาวกล้ามเนื้อข้อสะโพกที่ต่อเนื่องมาจากการเกิดภาวะกระดูกสันหลังค่อม ส่งผลให้การส่งต่อข้อมูลประสาทรับรู้ความรู้สึกในข้อสะโพกเพื่อควบคุมการทรงตัวบกพร่อง จึงทำให้ผู้ที่มีภาวะกระดูกสันหลังค่อมสูญเสียการทรงตัวได้ง่าย วัตถุประสงค์ของการศึกษาเพื่อศึกษาความแตกต่างของผล MHCE และการออกกำลังกายเพื่อลดภาวะกระดูกสันหลังค่อมรูปแบบที่แนะนำในปัจจุบัน (CHCE) เป็นเวลา 8 สัปดาห์ ต่อการเปลี่ยนแปลงของมุมส่วนโค้งของกระดูกสันหลังระดับอก (TKA) ความยืดหยุ่นของกระดูกสันหลังระดับอก ความแข็งแรงของกล้ามเนื้อแอ่นหลัง ความยาวของกล้ามเนื้องอสะโพก (Hip flexor) และกล้ามเนื้อเหยียดข้อสะโพกร่วมกับงอเข่า (Hamstrings) การรับรู้ตำแหน่งของข้อสะโพก (JPS) และการทรงตัวขณะเดินในผู้หญิงที่มีภาวะกระดูกสันหลังค่อมจากท่าทางที่ไม่เหมาะสม ผู้เข้าร่วมวิจัยถูกสุ่มแบ่งเป็นกลุ่ม MHCE และกลุ่ม CHCE กลุ่มละ 18 คน ได้รับการตรวจประเมินก่อนและหลังออกกำลังกาย ผลการศึกษาพบว่า ทั้ง 2 กลุ่ม มีค่า TKA ความยืดหยุ่นของกระดูกสันหลังระดับอก ความแข็งแรงของกล้ามเนื้อแอ่นหลัง ความยาวของกล้ามเนื้อ Hamstrings และความสามารถการทรงตัวขณะเดินแตกต่างอย่างมีนัยสำคัญทางสถิติก่อนและหลังออกกำลังกาย ส่วนค่า JPS มีความแตกต่างอย่างมีนัยสำคัญทางสถิติเฉพาะกลุ่ม MHCE (P<.05) และกลุ่ม MHCE มีค่า TKA ลดลงมากกว่ากลุ่ม CHCE อย่างมีนัยสำคัญทางสถิติ (P<.05) สรุปว่า MHCE สามารถลดมุมส่วนโค้งของกระดูกสันหลังระดับอกและพัฒนาการรับรู้ตำแหน่งของข้อสะโพกได้ดีกว่า CHCE ส่วนการเพิ่มความยืดหยุ่นของกระดูกสันหลังระดับอก เพิ่มความแข็งแรงของกล้ามเนื้อแอ่นหลัง เพิ่มความยาวกล้ามเนื้อ Hamstrings และการพัฒนาความสามารถการทรงตัวขณะเดิน การออกกำลังกายทั้ง 2 แบบทำได้ไม่แตกต่างกัน
Safety Of Exercise For Adults With Thoracic Aortic Aneurysms And Dissections,
2022
The Texas Medical Center Library
Safety Of Exercise For Adults With Thoracic Aortic Aneurysms And Dissections, Jesse Li, Alexandra Boyd, Michael Huang, Joshua Berookhim, Siddharth K Prakash
Faculty, Staff and Student Publications
BACKGROUND: Current guidelines for patients with thoracic aortic aneurysms or dissections (TAD) restrict vigorous exertion with the intention to prevent acute aortic dissections. However, a safe threshold for exercise intensity has not been established for TAD patients. In this study, we measured exertional changes in systolic and diastolic blood pressure during isometric and dynamic exercises in a cohort of TAD patients to determine safety of moderate intensity exercise.
METHODS: Thirty-one adults with TAD and 14 controls were recruited from UTHealth outpatient clinics. All participants completed an exercise protocol consisting of two circuits of five moderate intensity exercises: hand grips, leg …
The Lived Experiences Of Sports Retirement Among Elite, Action Sports Athletes,
2022
Antioch University Seattle
The Lived Experiences Of Sports Retirement Among Elite, Action Sports Athletes, Gracie Struthers
Antioch University Dissertations & Theses
This study explored the lived experiences of sports retirement among elite, action sport athletes. This study examined participants’ retirement experiences, their well-being post-retirement, and recommendations participants had for current athletes about retirement. Interviews were conducted remotely with four participants. Participants identified as Caucasian, in the 25–38 age range, had been involved with their sport competitively for 17.75 years, and had been retired for 3.37 years. Data was collected and analyzed utilizing Interpretive Phenomenological Analysis (IPA). Participants’ experiences during retirement illustrated a significant disruption in their lives and the way they lived. This disruption was characterized by significant grief and distress, …
Factors Associated With Intention To Disclose Concussive Symptoms In Active Duty Soldiers,
2022
Georgia Southern University
Factors Associated With Intention To Disclose Concussive Symptoms In Active Duty Soldiers, Carly Beck
College of Graduate Studies: Theses & Dissertations
Background: Concussion disclosure is a heavily researched topic, and while previous literature has explored predictors of concussion disclosure in numerous populations, research within the active duty Soldier population is limited. This study further explored predictors of concussion disclosure to a medical professional or leadership in the active duty Solider population through the lens of the Theory of Planned Behavior. Methods: A cross-sectional electronic survey was distributed to 181 active duty Soldiers. Descriptive statistics were used to report frequency of high intention to disclose concussive symptoms among demographics, and a multivariate regression model was used to assess significant predictors of intention …
Experiences And Perceptions Of Female Athletic Trainers Working With Male Coaches In Male Sports,
2022
Georgia Southern University
Experiences And Perceptions Of Female Athletic Trainers Working With Male Coaches In Male Sports, Sierra Hobday
College of Graduate Studies: Theses & Dissertations
Context: Female athletic trainers are making great strides in a previously male-dominated profession and are also becoming more prevalent in working with male sports teams. Female athletic trainers working within male sports often face gender bias and discrimination which has been found to come from male coaches of these sports. While previous studies have shown male coaches may demonstrate practices of gender bias towards female athletic trainers working in male sports, no studies have focused directly on the male coach and female athletic trainer relationship. Purpose: To examine the experiences and perceptions of female athletic trainers currently working with male …
The Role Of Physical Activity In Older Adults And Practical Intervention,
2021
MountainView Medical Center-Nevada
The Role Of Physical Activity In Older Adults And Practical Intervention, Se Won Lee, Rebecca Patel, Bryan Werner, Ji Won Yoo, Timothy Tiu
HCA Healthcare Journal of Medicine
Physical inactivity (PI), defined as not meeting guidelines for physical activity beyond baseline daily living activities, is common among older adults (age 65 and older) and contributes to increased morbidity, increased mortality and increased health care spending. Understanding the clinical impact of PI on common medical conditions among older adults will help primary care physicians (PCPs) to educate these patients successfully. Physical activity and exercise are effective in the primary and secondary prevention of chronic diseases that can lead to physical impairments, disability and/or premature death. Physical activity and exercise have been shown to improve cognitive dysfunction and painful musculoskeletal …
The Rotator Cuff Tendon-To-Bone Interface: Maturation, Aging, And 3d Bioprinting For Regeneration,
2021
University of Nebraska Medical Center
The Rotator Cuff Tendon-To-Bone Interface: Maturation, Aging, And 3d Bioprinting For Regeneration, Xiping Jiang
Theses & Dissertations
Rotator cuff tendon injuries often occur at the tendon-to-bone interface (i.e., enthesis) area with a high prevalence for the elderly population. In addition, regeneration of the gradient structure of the enthesis is still a significant clinical challenge. Our studies aim to identify the histological, molecular, and biomechanical alterations of the rotator cuff enthesis with maturation and aging, and develop a novel therapeutic method using three-dimensional (3D) bioprinting technique to regenerate a functional enthesis. Striking variations of the entheses were observed both histologically and biomechanically during the maturation process. The histological features did not show many differences at the insertion site …
An Online Educational Resource On Adaptive Sports For People With Spinal Cord Injuries,
2021
University of St. Augustine for Health Sciences
An Online Educational Resource On Adaptive Sports For People With Spinal Cord Injuries, Rachel Morgan, Steven M. Gerardi
Fall 2021 Virtual OTD Capstone Symposium
A spinal cord injury (SCI) has a serious impact on an individual’s participation in everyday life activities, leading to a high risk of a sedentary life-style. There is a paucity of research pertaining to adaptive sport participation post-injury and the role of occupational therapy (OT). Additionally, there are limited resources available that inform people with SCI on the benefits of adapted sports or where to go to engage in them. As such, this paper describes the development of a doctoral capstone project to address this need. The purpose of this capstone project was to create an educational web page that …
The Role Of Pre-Participation Exams In Identifying Student Athletes At Risk For Sudden Cardiac Arrest,
2021
Bowling Green State University
The Role Of Pre-Participation Exams In Identifying Student Athletes At Risk For Sudden Cardiac Arrest, Elizabeth Frey
Honors Projects
Sudden cardiac arrest (SCA) is the leading cause of death in young student athletes (Drezner et al., 2007). With athletes being recognized as some of the healthiest members of society, a catastrophic event like this can stimulate debate over pre-participation screening and appropriate emergency actions. With 55-80% cases of sudden cardiac death (SCD) being asymptomatic before the event (Drezner et al., 2007), looking into how well pre-participation screenings identify at risk individuals becomes much more important. This project investigates to what extent pre-participation physicals (PPE) can be improved to better identify student athletes at risk for sudden cardiac death and …
Treatment Of Full-Thickness Acetabular Chondral Flaps During Hip Arthroscopy: Bone Marrow Aspirate Concentrate Versus Microfracture,
2021
Massachusetts General Hospital
Treatment Of Full-Thickness Acetabular Chondral Flaps During Hip Arthroscopy: Bone Marrow Aspirate Concentrate Versus Microfracture, Michael P. Kucharik, Paul F. Abraham, Mark R. Nazal, Nathan H. Varady, Christopher T. Eberlin, Wendy M. Meek, Sara A. Naessig, Scott D. Martin
Orthopaedic Surgery and Sports Medicine Resident Research
Background: The optimal treatment strategy for patients with full-thickness chondral flaps undergoing hip arthroscopy is controversial.
Purpose: To compare functional outcomes of patients who underwent bone marrow aspirate concentrate (BMAC) application with those of patients who underwent microfracture.
Study Design: Cohort study; Level of evidence, 3.
Methods: This was a retrospective case series of prospectively collected data on patients who underwent arthroscopic acetabular labral repair by 1 surgeon between June 2014 and April 2020. The inclusion criteria for this study were age ≥18 years, preoperative radiographs of the pelvis, arthroscopic acetabular labral repair, exposed subchondral bone with overlying chondral flap …
The Validity Of Using One Force Platform To Quantify Whole-Body Forces, Velocities, And Power During A Plyometric Push-Up,
2021
University of Southern Mississippi
The Validity Of Using One Force Platform To Quantify Whole-Body Forces, Velocities, And Power During A Plyometric Push-Up, Zhanxin Sha, Boyi Dai
Faculty Publications
Background: Previous studies have typically measured velocity and power parameters during the push-up, either using one or two force platforms. The purpose of the study was to compare the force, velocity, and power parameters between the one-force-platform method and the two-force-platform method during plyometric push-ups.
Methods: Thirty-four physically active young adults participated in the study to perform the plyometric push-up. For the two-force-platform calculation method, the forces applied to the feet and hands were both measured. For the one-force-platform calculation method, the forces applied to the feet were assumed to be constant, while the forces applied to hands …
Examination Of Athlete Triad Symptoms Among Endurance-Trained Male Athletes: A Field Study,
2021
University of Virginia
Examination Of Athlete Triad Symptoms Among Endurance-Trained Male Athletes: A Field Study, Erin M. Moore, Clemens Drenowatz, David F. Stodden, Kelly Pritchett, Thaddus C. Brodrick, Brittany T. Williams, Justin M. Goins, Toni M. Torres-Mcgehee
All Faculty Scholarship for the College of Education and Professional Studies
Background: Studies examining the physiological consequences associated with deficits in energy availability (EA) for male athletes are sparse.
Purpose: To examine male athlete triad components; low energy availability (LEA) with or without an eating disorder risk (ED), reproductive hormone [testosterone (T)], and bone mineral density (BMD) in endurance-trained male athletes during different training periods.
Methods: A cross-sectional design with 14 participants (age: 26.4 ± 4.2 years; weight: 70.6 ± 6.4 kg; height: 179.5 ± 4.3 cm; BMI: 21.9 ± 1.8 kg/m2) were recruited from the local community. Two separate training weeks [low (LV) and high (HV) training volumes] were used …
Access To Care, Reporting Behaviors, And Quality Of Athletic Training Service Interactions For Reserve Officers' Training Corps Cadets,
2021
University of South Carolina
Access To Care, Reporting Behaviors, And Quality Of Athletic Training Service Interactions For Reserve Officers' Training Corps Cadets, Mary Catherine Avey, Amy F. Hand, Nancy A. Uriegas, Allison B. Smith, Zachary K. Winkelmann
Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association
Purpose: Reserve Officers’ Training Corps (ROTC) programs prepare student-civilians to become leaders through strenuous physical and leadership training. Unlike their student-athlete counterparts who have direct access to athletic training services, ROTC cadets may or may not have a healthcare provider available. The purpose of this study was to examine the access to care and reporting behaviors of ROTC cadets with a secondary aim exploring the quality of healthcare service interactions relative to patient-centered care.
Methods: An online survey assessed access to care using a self-report tool on the type of medical providers available to the ROTC cadets (n=132, age=20±3 …
A Comparison Of Treatment Options For Carpal Boss: A Critically Appraised Topic,
2021
Indiana State University
A Comparison Of Treatment Options For Carpal Boss: A Critically Appraised Topic, Megan M. Collins, Matthew J. Rivera
Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association
Context: Carpal bossing is a bony growth or mass that typically occurs at the 2nd or 3rd carpometacarpal joint. Carpal bossing is often overlooked placing the patient at an increased risk for pain or injury, such as osteoarthritis or inflammatory joint disease if left untreated. Individuals such as combat sport athletes who experience repetitive trauma to this area are at a high risk to develop carpal bossing. The literature suggests conservative or surgical interventions to manage symptoms. The goal of this systematic review is to synthesize the current literature for clinical knowledge and intervention outcomes for carpal bossing. …
