High Altitude Medicine and Physiology is invaluable for any doctor accompanying an expedition or advising patients on a visit to high altitudes, physicians specializing in illness and accidents in high places, and physiologists who study our dependence on oxygen and the adaptation of the body to altitude. All of which will undoubtedly help doctors stay abreast of this continually changing area of specialism.
Therefore, it is an honor to review and recommend this book. I am particularly appreciative for the innovative discussions of such topics as 'History,' 'Commuting to high altitude for commercial and other activities,' 'Athletes and altitude,' and 'Practicalities of field studies. In my opinion, the answer is a resounding, 'Yes! Paul S. Auerbach, leading authority on wilderness medicine. It should be the first port of call for anyone with medical training and an interest in high-altitude physiology or indeed planning to travel to high altitude, to gain an understanding of the associated physiological changes.
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High Altitude Medicine and Physiology is invaluable for any doctor accompanying an expedition or advising patients on a visit to high altitudes. This pre-eminent and accessible text has developed over five editions in response to man's attempts to climb unaided to higher altitudes and to spend more time.
Stay on CRCPress. Preview this Book. West, Robert B. It helps with medial rotation of the humerus. Muscles from the chest wall that contribute to the shoulder are: . The armpit Latin : axilla is formed by the space between the muscles of the shoulder.
The skin around the shoulder is supplied by C2-C4 upper , and C7 and T2 lower area. Branches of the plexus, in particular from C5-C6, supply the majority of the muscles of the shoulder. The subclavian artery arises from the brachiocephalic trunk on the right and directly from the aorta from the left. The axillary artery also supplies blood to the arm, and is one of the major sources of blood to the shoulder region. The other major sources are the transverse cervical artery and the suprascapular artery , both branches of the thyrocervical trunk which itself is a branch of the subclavian artery.
The muscles and joints of the shoulder allow it to move through a remarkable range of motion , making it one of the most mobile joints in the human body.
This tremendous range of motion also makes the shoulder extremely unstable, far more prone to dislocation and injury than other joints . The following describes the terms used for different movements of the shoulder: . The shoulder is the most movable joint in the body. However, it is an unstable joint because of the range of motion allowed. This instability increases the likelihood of joint injury, which often leads to a degenerative process in which tissues break down and no longer function well.
Fractures of shoulder bones can include clavicular fractures , scapular fractures , and fractures of the upper humerus.
Shoulder problems, including pain , are common  and can relate to any of the structures within the shoulder. When this type of cartilage starts to wear out a process called arthritis , the joint becomes painful and stiff. Imaging of the shoulder includes ultrasound, X-ray and MRI, and is guided by the suspected diagnosis and presenting symptoms. Conventional x-rays and ultrasonography are the primary tools used to confirm a diagnosis of injuries sustained to the rotator cuff.
For extended clinical questions, imaging through Magnetic Resonance with or without intraarticular contrast agent is indicated. Hodler et al. Furthermore, x-rays are required for the planning of an optimal CT or MR image. The conventional invasive arthrography is nowadays being replaced by the non-invasive MRI and ultrasound, and is used as an imaging reserve for patients who are contraindicated for MRI, for example pacemaker-carriers with an unclear and unsure ultrasonography.
Projectional radiography views of the shoulder include:. The body has to be rotated about 30 to 45 degrees towards the shoulder to be imaged, and the standing or sitting patient lets the arm hang.
This method reveals the joint gap and the vertical alignment towards the socket. The arm should be abducted 80 to degrees. This method reveals: . The lateral contour of the shoulder should be positioned in front of the film in a way that the longitudinal axis of the scapula continues parallel to the path of the rays. This projection has a low tolerance for errors and, accordingly, needs proper execution. There are several advantages of ultrasound. Limitations include, for example, the high degree of operator dependence and the inability to define pathologies in bones.
One also has to have an extensive anatomical knowledge of the examined region and keep an open mind to normal variations and artifacts created during the scan. Although musculoskeletal ultrasound training, like medical training in general, is a lifelong process, Kissin et al. After the introduction of high-frequency transducers in the mids, ultrasound has become a conventional tool for taking accurate and precise images of the shoulder to support diagnosis.
Adequate for the examination are high-resolution, high-frequency transducers with a transmission frequency of 5, 7. To improve the focus on structures close to the skin an additional "water start-up length" is advisable.
During the examination the patient is asked to be seated, the affected arm is then adducted and the elbow is bent to 90 degrees. In order to also demonstrate those parts which are hidden under the acromion in the neutral position, a maximum medial rotation with hyperextension behind the back is required. Usually the echogenicity compared to the deltoid muscle is homogeneous intensified without dorsal echo extinction.
Variability with reduced or intensified  echo has also been found in healthy tendons.
Bilateral comparison is very helpful when distinguishing and setting boundaries between physiological variants and a possible pathological finding. Degenerative changes at the rotator cuff often are found on both sides of the body. In addition, a dynamic examination can help to differentiate between an ultrasound artifact and a real pathology.
To accurately evaluate the echogenicity of an ultrasound, one has to take into account the physical laws of reflection, absorption and dispersion.
It is at all times important to acknowledge that the structures in the joint of the shoulder are not aligned in the transversal, coronal or sagittal plane, and that therefore during imaging of the shoulder the transducer head has to be held perpendicularly or parallel to the structures of interest.
Otherwise the appearing echogenicity may not be evaluated. Orthopedics established the MRI early on as the tool of choice for joint- and soft tissue-imaging because of its non-invasiveness, lack of radiation exposure, multi planar slicing possibilities and the high soft tissue contrast. MRIs can provide joint details to the treating orthopedist, helping them to diagnose and decide the next appropriate therapeutic step.
To examine the shoulder, the patient should lay down with the concerned arm is in lateral rotation. For signal detection it is recommended to use a surface-coil. To find pathologies of the rotator cuff in the basic diagnostic investigation, T2-weighted sequences with fat-suppression or STIR sequences have proven value. In general, the examination should occur in the following three main planes: axial, oblique coronal and sagittal. Most morphological changes and injuries are sustained to the supraspinatus tendon.
Traumatic rotator cuff changes are often located antero-superior, meanwhile degenerative changes more likely are supero-posterior. Because of their extreme short T2-relaxation time they appear typically signal-weak, respectively, dark.
About this title Synopsis: A comprehensive update to this preeminent and accessible text, this fifth edition of a bestseller was developed as a response to man's attempts to climb unaided to higher altitudes and to spend more time in these conditions for both work and recreation. Main article: Shoulder problems. Show related SlideShares at end. There is an approximately 4-to-1 disproportion in size between the large head of the humerus and the shallow glenoid cavity. Portable hyperbaric chambers have been in use since the lates . Nancy Langston.
Degenerative changes, inflammations and also partial and complete tears cause loss of the original tendon structure. Fatty deposits, mucous degeneration and hemorrhages lead to an increased intratendinal T1-image. Edema formations, inflammatory changes and ruptures increase the signals in a T2-weighted image.
While using MRI, true lesions at the rotator interval region between the parts of the supraspinatus and subscapularis are all but impossible to distinguish from normal synovium and capsule.