Showing papers by "Stephen J. O'Brien published in 2015"

SmileFinder: A Resampling-Based Approach to Evaluate Signatures of Selection from Genome-Wide Sets of Matching Allele Frequency Data in Two or More Diploid Populations

Abstract: Background Adaptive alleles may rise in frequency as a consequence of positive selection, creating a pattern of decreased variation in the neighboring loci, known as a selective sweep. When the region containing this pattern is compared to another population with no history of selection, a rise in variance of allele frequencies between populations is observed. One challenge presented by large genome-wide datasets is the ability to differentiate between patterns that are remnants of natural selection from those expected to arise at random and/or as a consequence of selectively neutral demographic forces acting in the population.

The Genome 10K Project: A Way Forward

Abstract: The Genome 10K Project was established in 2009 by a consortium of biologists and genome scientists determined to facilitate the sequencing and analysis of the complete genomes of 10,000 vertebrate species. Since then the number of selected and initiated species has risen from ∼26 to 277 sequenced or ongoing with funding, an approximately tenfold increase in five years. Here we summarize the advances and commitments that have occurred by mid-2014 and outline the achievements and present challenges of reaching the 10,000-species goal. We summarize the status of known vertebrate genome projects, recommend standards for pronouncing a genome as sequenced or completed, and provide our present and future vision of the landscape of Genome 10K. The endeavor is ambitious, bold, expensive, and uncertain, but together the Genome 10K Consortium of Scientists and the worldwide genomics community are moving toward their goal of delivering to the coming generation the gift of genome empowerment for many vertebrate species.

Genomic legacy of the African cheetah, Acinonyx jubatus.

Abstract: Patterns of genetic and genomic variance are informative in inferring population history for human, model species and endangered populations. Here the genome sequence of wild-born African cheetahs reveals extreme genomic depletion in SNV incidence, SNV density, SNVs of coding genes, MHC class I and II genes, and mitochondrial DNA SNVs. Cheetah genomes are on average 95 % homozygous compared to the genomes of the outbred domestic cat (24.08 % homozygous), Virunga Mountain Gorilla (78.12 %), inbred Abyssinian cat (62.63 %), Tasmanian devil, domestic dog and other mammalian species. Demographic estimators impute two ancestral population bottlenecks: one >100,000 years ago coincident with cheetah migrations out of the Americas and into Eurasia and Africa, and a second 11,084–12,589 years ago in Africa coincident with late Pleistocene large mammal extinctions. MHC class I gene loss and dramatic reduction in functional diversity of MHC genes would explain why cheetahs ablate skin graft rejection among unrelated individuals. Significant excess of non-synonymous mutations in AKAP4 (p 80 %) pleiomorphic sperm. The study provides an unprecedented genomic perspective for the rare cheetah, with potential relevance to the species’ natural history, physiological adaptations and unique reproductive disposition.

Genome-Wide Association and Trans-ethnic Meta-Analysis for Advanced Diabetic Kidney Disease: Family Investigation of Nephropathy and Diabetes (FIND).

Abstract: Diabetic kidney disease (DKD) is the most common etiology of chronic kidney disease (CKD) in the industrialized world and accounts for much of the excess mortality in patients with diabetes mellitus. Approximately 45% of U.S. patients with incident end-stage kidney disease (ESKD) have DKD. Independent of glycemic control, DKD aggregates in families and has higher incidence rates in African, Mexican, and American Indian ancestral groups relative to European populations. The Family Investigation of Nephropathy and Diabetes (FIND) performed a genome-wide association study (GWAS) contrasting 6,197 unrelated individuals with advanced DKD with healthy and diabetic individuals lacking nephropathy of European American, African American, Mexican American, or American Indian ancestry. A large-scale replication and trans-ethnic meta-analysis included 7,539 additional European American, African American and American Indian DKD cases and non-nephropathy controls. Within ethnic group meta-analysis of discovery GWAS and replication set results identified genome-wide significant evidence for association between DKD and rs12523822 on chromosome 6q25.2 in American Indians (P = 5.74x10-9). The strongest signal of association in the trans-ethnic meta-analysis was with a SNP in strong linkage disequilibrium with rs12523822 (rs955333; P = 1.31x10-8), with directionally consistent results across ethnic groups. These 6q25.2 SNPs are located between the SCAF8 and CNKSR3 genes, a region with DKD relevant changes in gene expression and an eQTL with IPCEF1, a gene co-translated with CNKSR3. Several other SNPs demonstrated suggestive evidence of association with DKD, within and across populations. These data identify a novel DKD susceptibility locus with consistent directions of effect across diverse ancestral groups and provide insight into the genetic architecture of DKD.

Diagnostic glenohumeral arthroscopy fails to fully evaluate the biceps-labral complex.

Abstract: Purpose: The purpose of this study was to define the limits of diagnostic glenohumeral arthroscopy and determine the prevalence and frequency of hidden extra-articular “bicipital tunnel” lesions among chronically symptomatic patients Methods: Eight fresh-frozen cadaveric specimens underwent diagnostic glenohumeral arthroscopy with percutaneous tagging of the long head of the biceps tendon (LHBT) during maximal tendon excursion The percentage of visualized LHBT was calculated relative to the distal margin of subscapularis tendon and the proximal margin of the pectoralis major tendon Then, a retrospective review of 277 patients who underwent subdeltoid transfer of the LHBT to the conjoint tendon were retrospectively analyzed for lesions of the biceps-labral complex Lesions were categorized by anatomic location (inside, junctional, or bicipital tunnel) Inside lesions were labral tears Junctional lesions were LHBT tears visualized during glenohumeral arthroscopy Bicipital tunnel lesions were extra-articular lesions hidden from view during standard glenohumeral arthroscopy Results: Seventy-eight percent of LHBT were visualized relative to the distal margin of the subscapularis tendon and only 55% relative to the proximal margin of the pectoralis major tendon No portion of the LHBT inferior to the subscapularis tendon was visualized Forty-seven percent of patients had hidden bicipital tunnel lesions Scarring was most common and accounted for 48% of all such lesions Thirty-seven percent of patients had multiple lesion locations Forty-five percent of patients with junctional lesions also had hidden bicipital tunnel lesions The only offending lesion was in the bicipital tunnel for 18% of patients Conclusions: Diagnostic glenohumeral arthroscopy fails to fully evaluate the biceps-labral complex because it visualizes only 55% of the LHBT relative to the proximal margin of the pectoralis major tendon and did not identify extra-articular bicipital tunnel lesions present in 47% of chronically symptomatic patients Level of Evidence: Level IV, therapeutic case series and cadaveric study

Olfactory receptor subgenomes linked with broad ecological adaptations in Sauropsida

Abstract: Olfactory receptors (ORs) govern a prime sensory function. Extant birds have distinct olfactory abilities, but the molecular mechanisms underlining diversification and specialization remain mostly unknown. We explored OR diversity in 48 phylogenetic and ecologically diverse birds and 2 reptiles (alligator and green sea turtle). OR subgenomes showed species- and lineage-specific variation related with ecological requirements. Overall 1,953 OR genes were identified in reptiles and 16,503 in birds. The two reptiles had larger OR gene repertoires (989 and 964 genes, respectively) than birds (182-688 genes). Overall, birds had more pseudogenes (7,855) than intact genes (1,944). The alligator had significantly more functional genes than sea turtle, likely because of distinct foraging habits. We found rapid species-specific expansion and positive selection in OR14 (detects hydrophobic compounds) in birds and in OR51 and OR52 (detect hydrophilic compounds) in sea turtle, suggestive of terrestrial and aquatic adaptations, respectively. Ecological partitioning among birds of prey, water birds, land birds, and vocal learners showed that diverse ecological factors determined olfactory ability and influenced corresponding olfactory-receptor subgenome. OR5/8/9 was expanded in predatory birds and alligator, suggesting adaptive specialization for carnivory. OR families 2/13, 51, and 52 were correlated with aquatic adaptations (water birds), OR families 6 and 10 were more pronounced in vocal-learning birds, whereas most specialized land birds had an expanded OR family 14. Olfactory bulb ratio (OBR) and OR gene repertoire were correlated. Birds that forage for prey (carnivores/piscivores) had relatively complex OBR and OR gene repertoires compared with modern birds, including passerines, perhaps due to highly developed cognitive capacities facilitating foraging innovations.

Gene loss, adaptive evolution and the co-evolution of plumage coloration genes with opsins in birds

Abstract: The wide range of complex photic systems observed in birds exemplifies one of their key evolutionary adaptions, a well-developed visual system. However, genomic approaches have yet to be used to disentangle the evolutionary mechanisms that govern evolution of avian visual systems. We performed comparative genomic analyses across 48 avian genomes that span extant bird phylogenetic diversity to assess evolutionary changes in the 17 representatives of the opsin gene family and five plumage coloration genes. Our analyses suggest modern birds have maintained a repertoire of up to 15 opsins. Synteny analyses indicate that PARA and PARIE pineal opsins were lost, probably in conjunction with the degeneration of the parietal organ. Eleven of the 15 avian opsins evolved in a non-neutral pattern, confirming the adaptive importance of vision in birds. Visual conopsins sw1, sw2 and lw evolved under negative selection, while the dim-light RH1 photopigment diversified. The evolutionary patterns of sw1 and of violet/ultraviolet sensitivity in birds suggest that avian ancestors had violet-sensitive vision. Additionally, we demonstrate an adaptive association between the RH2 opsin and the MC1R plumage color gene, suggesting that plumage coloration has been photic mediated. At the intra-avian level we observed some unique adaptive patterns. For example, barn owl showed early signs of pseudogenization in RH2, perhaps in response to nocturnal behavior, and penguins had amino acid deletions in RH2 sites responsible for the red shift and retinal binding. These patterns in the barn owl and penguins were convergent with adaptive strategies in nocturnal and aquatic mammals, respectively. We conclude that birds have evolved diverse opsin adaptations through gene loss, adaptive selection and coevolution with plumage coloration, and that differentiated selective patterns at the species level suggest novel photic pressures to influence evolutionary patterns of more-recent lineages.

The first whole genome and transcriptome of the cinereous vulture reveals adaptation in the gastric and immune defense systems and possible convergent evolution between the Old and New World vultures

Abstract: The cinereous vulture, Aegypius monachus, is the largest bird of prey and plays a key role in the ecosystem by removing carcasses, thus preventing the spread of diseases. Its feeding habits force it to cope with constant exposure to pathogens, making this species an interesting target for discovering functionally selected genetic variants. Furthermore, the presence of two independently evolved vulture groups, Old World and New World vultures, provides a natural experiment in which to investigate convergent evolution due to obligate scavenging. We sequenced the genome of a cinereous vulture, and mapped it to the bald eagle reference genome, a close relative with a divergence time of 18 million years. By comparing the cinereous vulture to other avian genomes, we find positively selected genetic variations in this species associated with respiration, likely linked to their ability of immune defense responses and gastric acid secretion, consistent with their ability to digest carcasses. Comparisons between the Old World and New World vulture groups suggest convergent gene evolution. We assemble the cinereous vulture blood transcriptome from a second individual, and annotate genes. Finally, we infer the demographic history of the cinereous vulture which shows marked fluctuations in effective population size during the late Pleistocene. We present the first genome and transcriptome analyses of the cinereous vulture compared to other avian genomes and transcriptomes, revealing genetic signatures of dietary and environmental adaptations accompanied by possible convergent evolution between the Old World and New World vultures.

Recurrent Evolution of Melanism in South American Felids

Abstract: Morphological variation in natural populations is a genomic test bed for studying the interface between molecular evolution and population genetics, but some of the most interesting questions involve non-model organisms that lack well annotated reference genomes. Many felid species exhibit polymorphism for melanism but the relative roles played by genetic drift, natural selection, and interspecies hybridization remain uncertain. We identify mutations of Agouti signaling protein (ASIP) or the Melanocortin 1 receptor (MC1R) as independent causes of melanism in three closely related South American species: the pampas cat (Leopardus colocolo), the kodkod (Leopardus guigna), and Geoffroy’s cat (Leopardus geoffroyi). To assess population level variation in the regions surrounding the causative mutations we apply genomic resources from the domestic cat to carry out clone-based capture and targeted resequencing of 299 kb and 251 kb segments that contain ASIP and MC1R, respectively, from 54 individuals (13–21 per species), achieving enrichment of ~500–2500-fold and ~150x coverage. Our analysis points to unique evolutionary histories for each of the three species, with a strong selective sweep in the pampas cat, a distinctive but short melanism-specific haplotype in the Geoffroy’s cat, and reduced nucleotide diversity for both ancestral and melanism-bearing chromosomes in the kodkod. These results reveal an important role for natural selection in a trait of longstanding interest to ecologists, geneticists, and the lay community, and provide a platform for comparative studies of morphological variation in other natural populations.

Cookiecutter: A Tool for Kmer-Based Read Filtering and Extraction

Abstract: Motivation: Kmer-based analysis is a powerful method used in read error correction and implemented in various genome assembly tools. A number of read processing routines include extracting or removing sequence reads from the results of highthroughput sequencing experiments prior to further analysis. Here we present a new approach to sorting or filtering of raw reads based on a provided list of kmers. Results: We developed Cookiecutter — a computational tool for rapid read extraction or removing according to a provided list of k-mers generated from a FASTA file. Cookiecutter is based on the implementation of the Aho-Corasik algorithm and is useful in routine processing of high-throughput sequencing datasets. Cookiecutter can be used for both removing undesirable reads and read extraction from a user-defined region of interest. Availability: The open-source implementation with user instructions can be obtained from GitHub: https://github.com/ ad3002/Cookiecutter

Genetic Ancestry of the Extinct Javan and Bali Tigers

Abstract: The Bali (Panthera tigris balica) and Javan (P. t. sondaica) tigers are recognized as distinct tiger subspecies that went extinct in the 1940s and 1980s, respectively. Yet their genetic ancestry and taxonomic status remain controversial. Following ancient DNA procedures, we generated concatenated 1750bp mtDNA sequences from 23 museum samples including 11 voucher specimens from Java and Bali and compared these to diagnostic mtDNA sequences from 122 specimens of living tiger subspecies and the extinct Caspian tiger. The results revealed a close genetic affinity of the 3 groups from the Sunda Islands (Bali, Javan, and Sumatran tigers P. t. sumatrae). Bali and Javan mtDNA haplotypes differ from Sumatran haplotypes by 1-2 nucleotides, and the 3 island populations define a monophyletic assemblage distinctive and equidistant from other mainland subspecies. Despite this close phylogenetic relationship, no mtDNA haplotype was shared between Sumatran and Javan/Bali tigers, indicating little or no matrilineal gene flow among the islands after they were colonized. The close phylogenetic relationship among Sunda tiger subspecies suggests either recent colonization across the islands, or else a once continuous tiger population that had subsequently isolated into different island subspecies. This supports the hypothesis that the Sumatran tiger is the closest living relative to the extinct Javan and Bali tigers.

Early surveillance of ceramic-on-metal total hip arthroplasty

Abstract: Ceramic-on-metal (CoM) is a relatively new bearing combination for total hip arthroplasty (THA) with few reported outcomes. A total of 287 CoM THAs were carried out in 271 patients (mean age 55.6 years (20 to 77), 150 THAs in female patients, 137 in male) under the care of a single surgeon between October 2007 and October 2009. With the issues surrounding metal-on-metal bearings the decision was taken to review these patients between March and November 2011, at a mean follow-up of 34 months (23 to 45) and to record pain, outcome scores, radiological analysis and blood ion levels. The mean Oxford Hip Score was 19.2 (12 to 53), 254 patients with 268 hips (95%) had mild/very mild/no pain, the mean angle of inclination of the acetabular component was 44.8 o (28 o to 63 o ), 82 stems (29%) had evidence of radiolucent lines of > 1 mm in at least one Gruen zone and the median levels of cobalt and chromium ions in the blood were 0.83 μg/L (0.24 μg/L to 27.56 μg/L) and 0.78 μg/L (0.21 μg/L to 8.84 μg/L), respectively. The five-year survival rate is 96.9% (95% confidence interval 94.7% to 99%). Due to the presence of radiolucent lines and the higher than expected levels of metal ions in the blood, we would not recommend the use of CoM THA without further long-term follow-up. We plan to monitor all these patients regularly. Cite this article: Bone Joint J 2015;97-B:300–5.

The Genome Russia Project: Closing the Largest Remaining Omission on the World Genome Map

Abstract: We are witnessing the great era of genome exploration of the world, as genetic variation in people is being detailed across multiple varied world populations in an effort unprecedented since the first human genome sequence appeared in 2001. However, these efforts have yet to produce a comprehensive mapping of humankind, because important regions of modern human civilization remain unexplored. The Genome Russia Project promises to fill one of the largest gaps, the expansive regions across the Russian Federation, informing not just medical genomics of the territories, but also the migration settlements of historic and pre-historic Eurasian peoples.

PTCH1 expression at diagnosis predicts imatinib failure in chronic myeloid leukaemia patients in chronic phase

Abstract: The tyrosine kinase inhibitor (TKI) imatinib has revolutionized the management of chronic myeloid leukaemia (CML). However, around 25% of patients fail to sustain an adequate response. We sought to identify gene-expression biomarkers that could be used to predict imatinib response. The expression of 29 genes, previously implicated in CML pathogenesis, were measured by TaqMan Low Density Array in 73 CML patient samples. Patients were divided into low and high expression for each gene and imatinib failure (IF), probability of achieving CCyR, progression free survival and CML related OS were compared by Kaplan-Meier and log-rank. Results were validated in a second cohort of 56 patients, with a further technical validation using custom gene-expression assays in a conventional RT-qPCR in a sub-cohort of 37 patients. Patients with low PTCH1 expression showed a worse clinical response for all variables in all cohorts. PTCH1 was the most significant predictor in the multivariate analysis compared with Sokal, age and EUTOS. PTCH1 expression assay showed the adequate sensitivity, specificity and predictive values to predict for IF. Given the different treatments available for CML, measuring PTCH1 expression at diagnosis may help establish who will benefit best from imatinib and who is better selected for second generation TKI.

Putting Russia on the genome map.

Abstract: In the News story “Who has your DNA—or wants it” (25 September, p. [1475][1]), J. Kaiser listed 17 projects that aim to chart human genetic diversity across the globe in the context of a dozen ongoing national genome sequencing initiatives ([ 1 ][2]). Yet Russia—a country with 1/10th of

The Genome 10K Project: A Way Forward Further

Abstract: The Genome 10K Project was established in 2009 by a consortium of biologists and genome scientists determined to facilitate the sequencing and analysis of the complete genomes of 10,000 vertebrate species. Since then the number of selected and initiated species has risen from ∼26 to 277 sequenced or ongoing with funding, an approximately tenfold increase in five years. Here we summarize the advances and commitments that have occurred by mid-2014 and outline the achievements and present challenges of reaching the 10,000-species goal. We summarize the status of known vertebrate genome projects, recommend standards for pronouncing a genome as sequenced or completed, and provide our present and future vision of the landscape of Genome 10K. The endeavor is ambitious, bold, expensive, and uncertain, but together the Genome 10K Consortium of Scientists and the worldwide genomics community are moving toward their goal of delivering to the coming generation the gift of genome empowerment for many vertebrate species.

The Role of MRI in Diagnosing Biceps Chondromalacia

Abstract: Objectives:Sisterman described the “Biceps Footprint”, Castagna et al reported on “Chondral Imprints,” and Kuhn et al identified “Humeral Head Abrasions.”[1],[2],[3] These can be considered types o...

“Hidden Lesions” of the Extra-articular Biceps After Subpectoral Biceps Tenodesis: Letter to the Editor:

Abstract: Dear Editor: While we commend Moon and colleagues for drawing attention to the extra-articular portion of the long head of the biceps tendon (LHBT), they inadequately define the term ‘‘hidden lesion,’’ offer a limited assessment of lesion distribution, and improperly conclude that open subpectoral biceps tenodesis is a panacea. To accurately define hidden lesions of the LHBT, one must first understand the limits of diagnostic glenohumeral arthroscopy and the anatomy and histology of what we have termed the ‘‘bicipital tunnel,’’ which confines the extra-articular segment of the LHBT. Cadaveric experiments by our group demonstrated that the fibroosseous bicipital tunnel is a closed space from the articular margin through the proximal 3 cm of the subpectoral region in all specimens. We divided the bicipital tunnel into 3 zones. Zone 1 represents the traditional bicipital groove, extending from the articular margin to the inferior margin of the subscapularis tendon. While some lesions affecting the LHBT in this zone remain hidden, it should be noted that 78% of the tendon here is actually visualized during diagnostic arthroscopy. Others have reported similar limits of diagnostic arthroscopy. Zone 2 represents a ‘‘no-man’s-land’’ between the inferior margin of the subscapularis and the proximal margin of the pectorals major tendon. This biologically active zone is particularly relevant because of its invisibility to glenohumeral arthroscopy above and to open subpectoral exposure below. Zone 3 of the bicipital tunnel represents the subpectoral region. Cross-sectional analysis of the bicipital tunnel revealed similarities between zones 1 and 2, including, most important, a dense connective tissue roof and the presence of synovial tissue. Quantitative analysis further demonstrated that zones 1 and 2 had similarly limited percentage empty tunnel, suggesting a vulnerability to a range of space-occupying lesions, such as scar, osteophytes, and loose bodies, as well as hypertrophic tenosynovium. Hidden lesions, in fact, encompass a wide array of objective findings—including loose bodies, osteophytes, cysts, osseous stenosis, soft tissue stenosis, inflamed vinculae, hypertrophic scar, and extra-articular LHBT instability—in addition to the partial tears and tenosynovitis reported by Moon et al. Acknowledgment of these lesions’ existence is critical to our comprehensive understanding of the pathogenesis and diagnosis of biceps tendinitis. In fact, we first reported the diverse nature of these lesions at the March 2013 AAOS annual meeting in a large cohort study of chronically symptomatic patients; the study was later recognized with the J. Whit Ewing Award at the AANA and was published in the journal Arthroscopy. The offending lesions of 277 patients with chronic bicepslabral complex symptoms were categorized as ‘‘inside,’’ ‘‘junctional,’’ or ‘‘bicipital tunnel’’ based strictly on direct intraoperative visualization. Inside lesions were those of the labrum and biceps anchor. Junctional lesions were those of the LHBT that could be visualized by pull test during diagnostic glenohumeral arthroscopy. We defined hidden bicipital tunnel lesions as only those visualized directly from with the subdeltoid space after complete release of the fibrous sheath in zones 1 and 2 of the bicipital tunnel. We determined that 47% of patients had true ‘‘hidden lesions’’ and that hypertrophic scar, extra-articular instability, and stenosis were actually more common than the extension of proximal partial tears reported by Moon et al. Furthermore, nearly half of patients with a normal-appearing LHBT on glenohumeral arthroscopy had 1 of the aforementioned hidden lesions, and 18% of this large clinical cohort had their essential lesion occurring within the bicipital tunnel. There are several merits to the open subpectoral biceps tenodesis technique. We would argue that the most important is its effective decompression of the bicipital tunnel, as the authors pointed out, but one should use caution in concluding that this makes it the optimal technique for all patients. A recent paper by Werner et al, for example, demonstrated equivalence of clinical outcomes for suprapectoral and subpectoral biceps tenodesis techniques. Many patients fare well with tenotomy and proximal tenodesis techniques that do not decompress the bicipital tunnel. They may be quicker, require less hardware, and reduce morbidity. Must we subject the patient with isolated proximal pathology to the infection risk associated with an axillary incision, to the risk of neurovascular injury, or to the risk of fracture? The real question is, how can we determine the location of offending lesions and use that information to select the most appropriate tenodesis technique for a particular patient? For example, age may be a risk factor for bicipital tunnel pathology. We found that patients with tunnel lesions were statistically 6 years older than those without (P = .003). Furthermore, in a large prospective study investigating the comprehensive physical examination of the biceps-labral complex, we showed that tenderness to palpation of the bicipital tunnel and the active compression test (O’Brien sign) had negative predictive values of 96% and 93%, respectively, for the aforementioned hidden lesions. The Speed test and Yergason test were quite specific for presence of these lesions, at 87% and 98%, respectively. Biceps surgery is not a one-size-fits-all strategy; rather, it is our charge as clinicians to select the optimal treatment strategy for an individual patient. In summary, it is imperative that health care providers understand the existence of the bicipital tunnel and full array of ‘‘hidden lesions’’ that are present in chronically symptomatic patients. We must not limit our The American Journal of Sports Medicine, Vol. 43, No. 3 2015 The Author(s)

Open-Access Video-Based Orthopaedic Instructional Content is Inaccurate:

Abstract: Objectives:The internet has an increasing role in both patient and physician education. While several recent studies critically appraised the quality and accuracy of web-based written information available to patients, no studies have evaluated such parameters for open access video content designed for provider use. The present study sought to determine utilization of video resources by orthopaedic residents and assess the quality and accuracy of their contentMethods:Surveys were distributed to orthopaedic surgery residents to to determine their use of open access instructional video content. An assessment of quality and accuracy of said video content was performed using the basic shoulder examination as a suragate for the “best-case scenario” due to its widely accepted components that are stable over time. Three search terms (“shoulder”, “examination” and “shoulder exam”) were entered into the four online video resources most commonly accessed by orthopaedic surgery residents (VuMedi, G9MD, Orthobullets,...

Proximal biceps tendon pain: current trends and philosophy

Abstract: This review outlines recent innovations in the diagnosis and treatment of complex biceps and labral pain. These innovations include advances in the specificity of diagnostic testing to more effectively identifying a patient’s source of pain, as well as surgical methods to reduce the percentage of failed biceps and labral surgeries. The work presented here is clinically important to obtain an accurate diagnosis and effective treatment of bicipital and labral pain.