Introduction Covid-19 has had a significant impact on all aspects of health care. We aimed to characterise the trends in emergency general surgery at a district general hospital in Scotland. Methods A prospective cohort study was performed from 23/03/20 to 07/05/20. All emergency general surgery patients were included. Demographics, diagnosis and management were recorded along with Covid-19 testing and results. Thirty-day mortality and readmission rates were also noted. Similar data were collected on patients admitted during the same period in 2019 to allow for comparison. Results A total of 294 patients were included. There was a 58.3 per cent reduction in admissions when comparing 2020 with 2019 (85 vs 209); however, there was no difference in age (53.2 vs 57.2 years, p = 0.169) or length of stay (4.8 vs 3.7 days, p = 0.133). During 2020, the diagnosis of appendicitis increased (4.3 vs 18.8 per cent, p = \ 0.05) as did severity (0 per cent [ grade 1 vs 58.3 per cent [ grade 1, p = \ 0.05). The proportion of patients undergoing surgery increased (19.1 vs 42.3 per cent, p = \ 0.05) as did the mean operating time (102.4 vs 145.7 min, p = \ 0.05). Surgery was performed in 1 confirmed and 1 suspected Covid-19 patient. The latter died within 30 days. There were no 30-day readmissions with Covid-19 symptoms. Conclusion Covid-19 has significantly impacted the number of admissions to emergency general surgery. However, emergency operating continues to be needed at pre-Covid-19 levels and as such provisions need to be made to facilitate this.

BackgroundIt has been suggested that the quantification of paravertebral muscle composition and morphology (e.g. size/shape/structure) with magnetic resonance imaging (MRI) has diagnostic, prognostic, and therapeutic potential in contributing to overall musculoskeletal health. If this is to be realised, then consensus towards standardised MRI methods for measuring muscular size/shape/structure are crucial to allow the translation of such measurements towards management of, and hopefully improved health for, those with some musculoskeletal conditions. Following on from an original paper detailing methods for measuring muscles traversing the lumbar spine, we propose new methods based on anatomical cross-reference that strive towards standardising MRI-based quantification of anterior and posterior cervical spine muscle composition.MethodsIn this descriptive technical advance paper we expand our methods from the lumbar spine by providing a detailed examination of regional cervical spine muscle morphology, followed by a comprehensive description of the proposed technique defining muscle ROI from axial MRI. Cross-referencing cervical musculature and vertebral anatomy includes an innovative comparison between axial E12 sheet-plastinates derived from cadaveric material to a series of axial MRIs detailing commonly used sequences. These images are shown at different cervical levels to illustrate differences in regional morphology. The method for defining ROI for both anterior (scalenes group, sternocleidomastoid, longus colli, longus capitis) and posterior (multifidus, semispinalis cervicis, semispinalis capitis, splenius capitis) cervical muscles is then described and discussed in relation to existing literature.ResultsA series of steps towards standardising the quantification of cervical spine muscle quality are described, with concentration on the measurement of muscle volume and fatty infiltration (MFI). We offer recommendations for imaging parameters that should additionally inform a priori decisions when planning investigations of cervical muscle tissues with MRI.ConclusionsThe proposed method provides an option rather than a final position for quantifying cervical spine muscle composition and morphology using MRI. We intend to stimulate discussion towards establishing measurement consensus whereby data-pooling and meaningful comparisons between imaging studies (primarily MRI) investigating cervical muscle quality becomes available and the norm.

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Background Persistent symptoms post concussion can arise from a range of sources, including the neck. There is little description of neck assessment findings in people with persistent symptoms post concussion. Objectives To assess people with persistent symptoms following a concussion and determine whether the neck has also been injured, and to evaluate the potential of the neck to contribute to their symptoms. Methods A consecutive series of participants (n = 20) referred for neck assessment were prospectively recruited by 2 providers of a multidisciplinary concussion service for people with persistent symptoms. Data were collected at initial assessment and on completion of neck treatment, which included standard questionnaires (Rivermead Post Concussion Symptoms Questionnaire, Neck Disability Index, Dizziness Handicap Inventory); patient-reported measures of headache, dizziness, and neck pain; physical examination findings; and details of comorbidities. Results Participants were evaluated at a mean of 7.5 weeks post concussion (median, 5 weeks). On neck assessment, 90% were considered by the clinician to have a neck problem contributing to their current symptoms. Multiple findings were consistent with this view, including moderate-to-severe Neck Disability Index scores (mean ± SD, 33.4 ± 9.5 points), frequent neck pain (85%), frequent moderate-to-severe pain on occiput-C4 segmental assessment (85%), a positive flexion-rotation test (45%), and muscle tenderness (50%–55%). Conclusion Multiple findings were indicative of concurrent neck injury, particularly involving the upper cervical spine. These neck-related findings are important to recognize, as they have the potential to contribute to persistent symptoms post concussion and may respond to neck treatment. This study was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616001183471). J Orthop Sports Phys Ther 2019;49(11):845–854. Epub 1 Jun 2019. doi:10.2519/jospt.2019.8547

PurposeThe fascicular morphology of the sternocleidomastoid (SCM) is not well described in modern anatomical texts, and the biomechanical forces it exerts on individual cervical motion segments are not known. The purpose of this study is to investigate the fascicular anatomy and biomechanics of the SCM combining traditional and modern methods. MethodsThis study is comprised of three parts: Dissection, magnetic resonance imaging (MRI), and biomechanical modelling. Dissection was performed on six embalmed cadavers: three males age 73-74 years; and three females age 63-93 years. The fascicular arrangement and morphologic data were recorded. MRIs were performed on six young, healthy volunteers: three males age 24-37; and three females age 26-28). In vivo volumes of the SCM were calculated using the Cavalieri method.Modelling of the SCM was performed on five sets of computed tomography (CT) scans. This mapped the fascicular arrangement of the SCM with relation to the cervical motion segments, and used volume data from the MRIs to calculate realistic peak force capabilities. ResultsDissection showed the SCM has four parts; sterno-mastoid, sterno-occipital, cleidomastoid and cleido-occipital portions. Force modelling shows that peak torque capacity of the SCM is higher at lower cervical levels, and minimal at higher levels.Peak shear forces are higher in the lower cervical spine, while compression is consistent throughout. ConclusionsThe findings provide detailed insight into the structure and function of the SCM with relation to the cervical motion segments, and will help inform models of neck muscle function and dysfunction.3