Achievements

Research Abstract for Pediatric Hand Study Group 2024 Meeting Title: Biceps Area Ratios (BAR) Can Predict Need for Surgery in Brachial Plexus Birth Palsy: a pilot study Authors with degrees (please bold presenting author): Authors: Elspeth Jane Rose Hill, MB ChB, MRes, PhD, MRCS, Jennifer Hankenson MD, Lisa L. Lattanza MD, Rey N. Ramirez MD Body: Indicating nerve surgery in brachial plexus birth palsy (BPBP) remains controversial. Existing guidelines are largely based on antigravity elbow flexion, which is difficult to examine and subjective. We suggest that ultrasound measurements of biceps cross-sectional area ratios (BAR) could provide data that is 1) predictive 2) reliable and 3) objective to guide treatment of BPBP. In this pilot study our preliminary data shows patients who need nerve surgery 1) show differences in BAR and 2) that BAR can show the need for surgery earlier than serial physical examination. Methods: The biceps were examined using ultrasound in clinic. At the midpoint between the acromion and the elbow flexion crease, bilateral cross-sectional area of the biceps (bCSA) was measured. The ratio of these two bCSA measurements (BPBP bCSA/normal bCSA) was taken to give the value for the biceps area ratio (BAR). 1) To decide if BAR could predict recovery, we looked to see if there was a difference in BAR between patients who needed nerve reconstruction and patients who didn’t. 2) To see if BAR was an accurate measurement of biceps recovery, we compared BAR measurements to the elbow flexion AMS measurements. Results: Improvement in BAR correlates with not needing nerve surgery. In the one patient (A) who required nerve reconstruction, the BAR reached a ceiling of 0.85 by 6 m.o. (at which time he had surgery). In four patients who did not require surgery, the BAR reached a minimum of 0.94 by 2 m.o. (average 1.03, range 0.94-1.15). BAR scores showed recovery a month earlier than physical exam. Patient B had a BAR of 1.09 with elbow flexion AMS of 2 at 3 m.o., then a BAR of 0.97 with elbow flexion AMS of 6 at 4 m.o. BAR seems to correlate with physical exam. Elbow flexion AMS score of >=6 was correlated with a BAR of >=0.94, and an AMS score of 1-2 was correlated with a BAR of <= 0.85. The appearance of the biceps on ultrasound is also markedly different between the BPBP side and the unaffected side (Figure). Conclusion: Early results show that BAR correlates with physical exam and may be predictive of the need for nerve reconstruction at an earlier age. Significance: BAR is easier and more objective than current criteria for indicating surgery in BPBP. Development of a scoring system based on BAR could allow earlier and more confident decisions to perform surgery. Figure 1 – BAR (Biceps Area Ratio) Measurements for Patient A. a) the BPBP affected side b) the non-BPBP side. The BAR is 0.85 for this patient. The echogenicity of the BPBP affected muscle is markedly increased. Figure 2 – BAR (Biceps Area Ratio) Measurements for Patient B. a) the BPBP affected side b) the non-BPBP side. The BAR is 0.97 for this patient. The echogenicity of the BPBP affected muscle is similar to the normal side.

Objectives: Efforts to boost gender diversity in medicine saw women comprising 50.6% of 2021 U.S. medical school graduates. This representation sharply drops within orthopaedic surgery where only 18.3% of residents and 5.6% of active orthopaedic surgeons in 2021 were women. This is contrasted to physical medicine and rehabilitation (PM&R), where 34.3% of residents and 35.8% of active physiatrists in 2021 were women. This study compares factors impacting women’s decision to pursue their respective fields to identify opportunities for systemically promoting fair representation. Design: A 48-question survey was distributed to women practicing orthopaedics and a 51-question survey was distributed to women practicing PM&R. Questions included close-ended, open-ended, and identifiers on a 4-point modified Likert scale. Study data were collected using REDCap electronic data capture tools. Results: There were 299 responses to the orthopaedics survey and 102 responses to the PM&R survey. Regarding negative experiences, 7.3% of PM&R respondents versus 28.2% of orthopaedics respondents reported experiencing sexual harassment. 11.5% of PM&R respondents versus 79.2% of orthopaedics respondents reported witnessing sexist comments or behaviors. Furthermore, 13.7% of PM&R respondents versus 60.6% of orthopaedics respondents reported an unwelcoming environment. Regarding positive experiences, 68.6% of PM&R respondents versus 71.6% of orthopaedics respondents found exposure to the field encouraging. 69.6% of PM&R respondents versus 87.4% of orthopaedics respondents reported that having a mentor in the field was encouraging. Conclusions: Stark differences were reported especially with sexist behaviors or comments, illustrating a dichotomous environment between orthopaedic surgery and PM&R, despite both being predominantly male-dominated fields. This high degree of pervasive behavior readily experienced within orthopaedics is not present within other specialties, necessitating further investigation into the toxicities which discourage and prevent women from entering the field.

Objectives: Efforts to enhance gender diversity in medicine have led to 50.6% of U.S. medical school graduates and 34.3% of physical medicine and rehabilitation (PM&R) residents and fellows in 2021 being women. This study aims to uncover shared factors influencing women's choice to pursue PM&R, highlighting opportunities for systemic changes to achieve gender equity in this male-dominated field. Design: A 51-question survey was distributed through verbal channels and personal referrals within the field of physiatry. 38 questions were closed-ended, two were open-ended, and 11 were identifiers using a 4-point modified Likert scale. Study data were collected and managed using REDCap electronic data capture tools. Results: There were 102 survey responses. In terms of potential negative factors, 7.3% of respondents reported experiencing sexual harassment, 11.5% reported witnessing sexist comments or behaviors, and 13.7% reported an environment that was uninviting. Additionally, 20.4% felt discouraged by the perceived level of prestige of the field. In terms of potential positive factors, 87.1% of respondents felt encouraged by quality of life in the field, 69.6% felt encouraged by having a mentor in the field, and 68.6% felt encouraged by having prior knowledge or exposure to the field. Additionally, 19.4% were encouraged by current gender diversity, while 76.3% felt that it did not impact their decision. Conclusions: With PM&R being a male-dominated field, there was a surprisingly low rate of sexist comments or behaviors that either were witnessed or experienced from our respondents. In addition, the factors which were commonly noted as being encouraging - such as quality of life, early exposure, and adequate mentorship - are areas of further exploration for institutions to provide young trainees to not only garner more interest in PM&R, but also help equilibrate the gender discrepancy within the field.