More than 30 000 people undergo heart surgery in the UK each year. A significant source of long-term morbidity following sternotomy is the tendency to form abnormal scars. Living with scars can be challenging in a social environment that values physical attractiveness. The physiology of wound healing is a complex, dynamic process that results in restoration of anatomical continuity and function. However, where the reparative processes are disrupted, wound healing can be impaired resulting in two pathological extremes: deficient healing leading to chronic wounds or excessive healing leading to hypertrophic or keloid scars. Current post-sternotomy precautions are, at best, supported by indirect evidence and have several limitations. Psychosocial distress is directly related to patient-perceived scar severity and unrelated to clinicians’ ‘objective’ rating. The potential impact of sternal scar formation should be discussed with patients pre-operatively and appropriate support (social skills training, cognitive behavioural therapy) should be offered during recovery.

Back injury is one of the most frequently encountered injuries in the collegiate rower. The differential diagnosis of back pain in the competitive rower includes muscle strain, ligament/tendon injury, stress reaction, stress fracture, and a tear in the annulus fibrosis.Endurance sports, such as rowing, have an increased frequency of stress injury The diagnosis of stress reaction cannot be made with plain radiographs. Many studies have firmly established the efficacy of single photon emission computed tomography (SPECT) bone scans and magnetic resonance imaging in establishing the diagnosis of a stress reaction We present a case of a collegiate rower with mid back pain secondary to a stress reaction of the endplates of the costotransverse articulation at the T8 level diagnosed by a positive positron emission tomogram study in the setting of a negative SPECT scan.

Shoulder pain is a common musculoskeletal ailment. The process of determining the etiology of shoulder pain can be difficult. The differential diagnoses include: both intracapsular and extracapsular lesions; and neurologic, vascular, postural, and visceral causes. We present an unusual case of shoulder pain accompanied by loss of shoulder range of motion (ROM), initially thought to be caused by an intrinsic shoulder disorder. However, it ultimately was determined that a cervical radicular disorder caused both the impaired ROM and the patient's shoulder pain.