Publications by authors named "Ralph B Blasier"

6 Publications

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Reply to the Letter to the Editor: The Problem of the Aging Surgeon: When Surgeon Age Becomes a Surgical Risk Factor.

Authors:
Ralph B Blasier

Clin Orthop Relat Res 2020 05;478(5):1139

R. B. Blasier, Orthopaedic Surgeon (Retired), Department of Orthopaedic Surgery, OSF St. Francis Hospital, Escanaba, MI.

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http://dx.doi.org/10.1097/CORR.0000000000001224DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170688PMC
May 2020

Is a Physician "Provider Tax" the Solution to Michigan's Medicaid Woes?

HSS J 2013 Oct 29;9(3):257-63. Epub 2013 Aug 29.

Orthopaedic Surgery, OSF St Francis Hospital and Medical Group, Escanaba, MI 49829 USA.

Background: Michigan is facing a Medicaid budget shortfall. Evidence suggests that the underlying factors causing reliance on Medicaid and cost of treatment to increase are getting worse. A tax on Michigan physicians has been proposed by legislators to meet the budget demands of Michigan's Medicaid program.

Questions/purposes: This paper looks at the legal basis of such a tax, studies the successes and failures of other states that have implemented similar taxes, and attempts to assess the effect this tax would have on Michigan doctors and patients.

Conclusion: With current Medicaid rules, such a tax would increase federal matching funds and potentially reimbursement rates. However, the cost of a tax on physicians would not be born equally, and there are no guarantees that the revenue would provide a funding solution.
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http://dx.doi.org/10.1007/s11420-013-9348-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3772163PMC
October 2013

The problem of the aging surgeon: when surgeon age becomes a surgical risk factor.

Authors:
Ralph B Blasier

Clin Orthop Relat Res 2009 02 31;467(2):402-11. Epub 2008 Oct 31.

Department of Orthopaedic Surgery, Wayne State University, 6071 West Outer Drive, Detroit, MI 48235, USA.

The question of when a surgeon should retire has been the subject of debate for decades. Both anecdotal evidence and objective testing of surgeons suggest age causes deterioration in physical and cognitive performance. Medical education, residency and fellowship training, and technology evolve at a rapid pace, and the older a surgeon is, the more likely it is he or she is remote from his or her initial education in his or her specialty. Research also shows surgeons are reluctant to plan for retirement. Although there is no federally mandated retirement age for surgeons in the United States, surgeons must realize their skills will decline, a properly planned retirement can be satisfying, and the retired surgeon has much to offer the medical and teaching community.
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http://dx.doi.org/10.1007/s11999-008-0587-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628499PMC
February 2009

External rotation of the glenohumeral joint: ligament restraints and muscle effects in the neutral and abducted positions.

J Shoulder Elbow Surg 2005 Jan-Feb;14(1 Suppl S):39S-48S

Department of Orthopaedics and Rehabilitation, Vanderbilt Shoulder Center, 2601 Jess Neely Drive, Nashville, TN 37212, USA.

External rotation of the glenohumeral joint is important in a variety of pathologic states, yet the ligamentous restraints to external rotation have not been thoroughly investigated and the muscle effects have received even less attention. The purpose of this study was to investigate the ligamentous restraints and muscle effects limiting external rotation of the glenohumeral joint in a biomechanical cadaveric model. External rotation torque was applied to the humeri of 15 shoulders mounted in the supine position in a custom fixture while varying rotator cuff and biceps loads in 15 degrees and 60 degrees of glenohumeral abduction. A randomly chosen ligament (coracohumeral ligament [CHL], combined superior and middle glenohumeral ligaments [S+M], anterior band of the inferior glenohumeral ligament [AB], entire inferior glenohumeral ligament [IGHL], or posterior capsule [PC]) was cut, and testing was repeated (n = 3 for each ligament). Torque data were collected every 3 degrees through the entire range of external rotation. Individual muscles were loaded with 22.2 N (designated as a standard state) and were compared with loads of 0, 11.1, and 44.5 N. Alterations in muscle loads were analyzed with a residual maximum likelihood-based repeated-measures model. Ligament effects were analyzed by use of analysis of variance with Tukey correction. In the neutral position, each ligament except the PC significantly affected the torque required for external rotation, with IGHL > CHL > AB > S+M. In this position, loading the subscapularis to 44.5 N significantly increased the torque required to externally rotate the shoulder whereas unloading it significantly decreased the torque required. In the 60 degrees abducted position, each ligament except the PC significantly affected the torque required for external rotation, with IGHL > AB > S+M > CHL. In this position, loading the biceps or subscapularis to 44.5 N significantly increased the torque required to externally rotate the shoulder as rotation increased whereas unloading it significantly decreased the torque required as rotation increased. This work demonstrates that the glenohumeral joint capsule behaves as a cylinder with many regions serving as restraints to external rotation. In addition, the long head of the biceps has an important role as a dynamic restraint to external rotation in the abducted shoulder. This is a new function attributed to the biceps and reinforces the role of external rotation in the generation of biceps and superior labral pathology.
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http://dx.doi.org/10.1016/j.jse.2004.09.016DOI Listing
June 2005

Failure of the biceps superior labral complex: a cadaveric biomechanical investigation comparing the late cocking and early deceleration positions of throwing.

Arthroscopy 2003 Apr;19(4):373-9

University of Michigan Shoulder Group, Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, the University of Michigan, Ann Arbor, Michigan, USA.

Purpose: The goal of the study was to determine which position of the throwing motion, late-cocking or early deceleration, was more likely to produce lesions of the biceps superior labral complex.

Type Of Study: Cadaveric biomechanical model.

Methods: Ten paired cadaver shoulders were prepared and mounted on a custom testing apparatus in 60 degrees glenohumeral abduction with the humerus in the plane of the scapula. All specimens were loaded with 100 cycles of subfailure external rotation torque (7.9 N-m) with 22 N applied to the rotator cuff tendons and long head of the biceps tendon. One of each pair of specimens was randomly tested in a late cocking position for throwing (>125 degrees external rotation, 60 degrees glenohumeral abduction, in the plane of the scapula). The other was tested in a position of early deceleration (80 degrees external rotation, 60 degrees glenohumeral abduction, 16 degrees horizontal adduction). The biceps was loaded to failure with the shoulder fixed in these positions. The specimens were then examined by 2 experienced shoulder surgeons, blinded to the test protocol, to assess for the presence of a type II SLAP lesion.

Results: Failure of the biceps superior labral complex occurred at the superior glenoid in 9 of 10 specimens in the late cocking position and in 2 of 10 specimens in the early deceleration position (P =.055). Five specimens developed type II SLAP lesions, with more in the late cocking position (4 of 10) than in the early deceleration position (1 of 10; P =.12). Load to failure was significantly less for the late cocking position (289 +/- 39 N) than for the early deceleration position (346 +/- 40 N; P =.004).

Conclusions: These results suggest that the late cocking position may contribute to biceps-superolabral complex injuries in the thrower's shoulder.
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http://dx.doi.org/10.1053/jars.2003.50044DOI Listing
April 2003

Glenoid inclination is associated with full-thickness rotator cuff tears.

Clin Orthop Relat Res 2003 Feb(407):86-91

Orthopaedic Research Laboratories and University of Michigan Shoulder Group, University of Michigan, Ann Arbor, MI, USA.

Anatomic factors, such as a hooked acromion, have been associated with rotator cuff disorders. Orientation of the glenoid relative to the scapula has been implicated in shoulder instability, but it has not been linked to rotator cuff disorders. The purpose of the current study was to test the hypothesis that superior inclination of the glenoid is associated with full-thickness rotator cuff tears. Glenoid inclination angles were measured from 16 shoulder radiographs of a convenience sample of eight cadavers in which one shoulder had an intact rotator cuff and the other shoulder had a full-thickness rotator cuff tear. Glenoid inclination angles for shoulders with rotator cuff tears were compared with contralateral normal shoulders using nonparametric statistical analysis. The glenoid inclination angle was greater in cadaver shoulders having full-thickness rotator cuff tears (98.6 degrees ) than in shoulders without tears (91.0 degrees ). A second experiment was done to assess the reliability of using 34 Grashey view radiographs from a clinical population to measure glenoid inclination angle. A method to measure the glenoid inclination on Grashey views was tested and was found to correlate with the inclination angles measured on cadaveric scapulae. Intrarater reliability of measurements from clinical Grashey views was 0.93, and interrater reliability was at least 0.88.
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http://dx.doi.org/10.1097/00003086-200302000-00016DOI Listing
February 2003
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