News Category: General

Doctors, nurses, and physical therapists are often asked for practical advice. Women with chest pain (angina) may seek help after a heart attack. Is it safe to vacuum the house? Should a different vacuum be purchased?

These are important concerns for women who are doing the household chores. Vacuuming is one task that can bring on chest pain or other symptoms. Vacuuming doesn’t take any more energy than walking on the level, yet it still causes problems. The reason for this is unknown.

Doctors at the University Medical Center in Nebraska looked at this problem. They tried to find out if symptoms occur more often with one type of vacuum cleaner over another. They looked at five different model types, including upright, canister, and self-propelled. Some machines were lightweight and others were heavy-duty.

Researchers found big differences in how much energy is used with certain vacuum cleaners. Heavy-duty upright and canister vacuums require the most energy. As more energy is used, more oxygen is needed. With coronary artery disease (CAD), the heart may not be able to deliver the needed oxygen. Chest pain and other symptoms can then occur.

Patients with CAD or who have to limit physical stress should take a look at their vacuums. Using a light-weight, self-propelled machine or canister model with a power head is advised. Using one of these can reduce oxygen demand. In some cases, women may be advised to slow their pace or to stop vacuuming altogether. These patients may even have symptoms while vacuuming with a power-assisted model.

There’s a new drug treatment to lower the chances of bone fractures from bone disease. These are called bisphosphonates. Bisphosphonates can be used to keep bone cells from being absorbed or destroyed. This is good news for patients with low bone density from osteoporosis, Paget’s disease, cancer, or other bone disease.

There are several different types of bisphosphonates on the market. You may have heard of names that end with the suffix “–ate.” The most commonly known bisphosphonate is probably Fosamax, known to the pharmacist and doctor as alendronate. Others include Actonel (risedronate), Aredia (pamidronate), and Zometa (zolendronate).

Patients taking these drugs must follow the directions carefully. They shouldn’t be taken with antacids that have aluminum or magnesium. Bottled water with minerals should be avoided. This decreases the body’s ability to absorb and use bisphosphonates. Calcium supplements have the same effect.

Food should be avoided for two hours before taking these drugs. There may be some side effects such as stomach pain, nausea, vomiting, constipation, or diarrhea. Less common side effects include taste disorders, joint pain, liver problems, and hallucinations. Patients are advised to report any problems to the physician. Changes in drug or dosage can help.

There may be a way to prevent intestinal problems. Patients are told to stay in an upright or seated position for at least 30 minutes after taking bisphosphonates. The newer drugs only have to be taken once a week. This makes it easier for patients to follow these guidelines.

Why is it that some people who hurt themselves return to work and others don’t? This has puzzled doctors, employers, and worker’s compensation personnel for years. The cost of the injury isn’t as much as the indirect costs of lost work. In fact, lost productivity costs twice as much as the direct health care costs for an injury.

Doctors would like to be able to predict who will have a good recovery. If they can tell who won’t be able to return to work, the patients can be retrained or directed to some other kind of work. The earlier this is done, the better for patients and costs.

A group of doctors in the Netherlands studied this problem. They compared workers with arm injuries who did return to work with those who didn’t. They found that there are some factors that make a difference. For example, if the injury is above the elbow, the chances of returning to the same job are less than if the injury is in the hand.

Having more than one nerve or one tendon injured increases the risk of a poor result. Two nerves in the arm were compared: the median and ulnar nerves. Damage to the ulnar nerve usually has a greater effect on grip strength. Grip strength is an important skill needed to return to most jobs.

Other important risk factors included education level and rehabilitation. Workers with a higher level of education and training go back to work sooner than blue-collar workers or manual laborers. Most of all, workers given a rehab program were 3.5 times more likely to return to work within one year of the injury.

The authors of this study think that compliance with a hand therapy program may be the key to returning workers with arm injuries to the job. Retraining or redirecting workers who have the risk factors outlined above can reduce costs.

The American Heart Association reports that breast cancer is the number one fear of American women. In fact, one in every eight women will have breast cancer over the course of her life. Researchers and women both want to know the risk factors for breast cancer.

Physical activity may help prevent breast cancer. Many groups have studied the benefits of exercise in preventing breast cancer. Some studies report a protective effect of physical activity. Others find no such effect.

Scientists are asking: Does exercise and physical activity prevent breast cancer before or after menopause? Is there a “best time” in life to exercise? A large study to answer these questions was done at the University of Buffalo in New York.

A total of 1550 pre- and post-menopausal women were asked about the time they spent in exercise or sports. This was measured over a lifetime. The amount and type of physical activity was reported at age 16 and for two, 10, and 20 years before the the survey was taken. Activity level on the job was also measured.

The authors of this study say that physical activity does have a protective effect. Exercise that is strong enough to cause a sweat protects pre- and post-menopausal women from breast cancer. This effect was strongest in women who were active at least 20 years before the study. Women who were active throughout their life also had a lower risk of breast cancer.

Most people know to put ice on an injury as soon as possible. This goes for sprains, strains, bruises, and dislocations. Not all of us understand why. Even researchers are still studying this question.

The obvious reason is that ice is thought to keep the swelling down. Of course, the freezing sensation takes our minds off the pain, too. But why does 20 minutes of ice applied in the first 30 minutes of an injury have a continued effect five hours later? What is happening in the blood vessels and in the cells?

Researchers at Wake Forest University School of Medicine (North Carolina) studied injuries in rats to answer this question. They started with the basic idea that cold causes the blood vessels to close down. This is called vasoconstriction. This prevents swelling and damage from bleeding in the injured tissue.

Using high-tech microscopes, the scientists were able to see what happens to an injury. They could watch the response right away and monitor it for minutes to hours. Using a special dye, they could see right down to the white blood cell level.

Normally, white blood cells (WBCs) move to an injured area to help repair the area. These cells move like an amoeba, rolling and sliding along the inner lining of the blood vessels. Swelling or edema occurs when WBCs stick to the wall of the blood vessel. Too many WBCs rolling along the blood vessel also cause damage and edema. Ice applied 15 minutes after the injury reduces this rolling and sticking of the WBCs. The effect is long lasting, sometimes up to several hours later.

So you want to begin a walking program, but you don’t know how to start. Some experts say you need to walk briskly for at least 30 minutes. Others say you can do several shorter walks to add up to 30 minutes. Which advice is right?

The answer is–both. These researchers started middle-aged adults who were not exercising on a six-week walking schedule. Half walked for 30 minutes at a time. The other half walked three times a day, for ten minutes at a time. They all did their walking program five days each week during the study period. None of the participants changed their diets or anything else about their lifestyles.

All the walkers saw similar health benefits, regardless of whether they took long walks or short walks. After completing their six-week walking program, they all had better levels of “good” cholesterol, and lower levels of triglycerol and total cholesterol. Their blood pressure went down, as did their levels of tension and anxiety. Their walking speed also improved. None of the walkers lost any weight, but their waist, hip, and skin-fold measurements decreased slightly. For middle-aged people who haven’t been too active, three ten-minute walks a day are as effective for the heart and mind as walking for 30 minutes.

Alternative treatments for pain are becoming more and more popular, including the use of “static magnet therapy.” This type of treatment involves placing magnets directly on painful areas. There isn’t much science showing that magnet therapy consistently reduces pain. However, some people swear by this form of treatment. They feel that magnets decrease pain and improve function.
There may be something to static magnet therapy. But how does it work? Do magnets improve blood flow? Or do they somehow affect the nervous system? No one, not even true believers, knows for sure.

This study tested the theory that magnets increase blood flow to the painful area. Twenty healthy young men wore magnets on their forearms for 30 minutes. On another day they wore fake magnets for 30 minutes. They didn’t know that some of the magnets were fake. Both times their blood flow and blood pressure was measured. There was no difference in blood flow between using the real or fake magnets.

Static magnet therapy may somehow decrease pain. But if so, it seems clear that it’s not because magnets increase blood flow. The authors caution that this study does not rule out the benefits people report when using magnets to ease pain. Nor does it imply that magnets do not have the potential to help with healing. The main findings do show, however, that the benefits are not achieved through increases in blood flow.

Small areas of local injury with swelling can be helped with steroids, and no needle is required. This is done by a process called iontophoresis. Iontophoresis uses electricity to “push” drugs across the skin and into tissue. Sports injuries are the most common use of iontophoresis.

Iontophoresis is used more often because of the side effects of injected steroids. Sometimes, tendons rupture after the use of these drugs. It is not clear whether this happens because of the drugs or as a result of the first tendon injury.

A group of scientists have studied the effects of steroids on tendons in rabbits. Two kinds of steroid treatment were reviewed. The first is by direct injection and the second, by iontophoresis. Both groups received measurable amounts of the steroid. The levels in the blood were checked after one hour, seven days, and 14 days. In both groups, the blood levels are less over time. By 14 days, there are no measurable amounts of steroid left in the blood for either group.

Giving steroids by needle is faster and only requires one visit. Using iontophoresis to give the drug is less painful but needs to be done with several visits. Injection brings more of the drug to the inflamed area right away. Iontophoresis is a slower process with higher levels of steroid present over a longer period of time. It is a good option for patients who don’t like shots.

You know what to do if you get a bad bump, a sprain, or a strain–you ice it. Doctors, nurses, therapists, and trainers will prescribe icing an injury for 20 to 30 minutes. Putting ice on an injured spot helps lessen inflammation and may have other healing benefits. It’s an effective low-tech treatment.

Scientists don’t know many of the specifics about how icing works. For example, no one knows exactly how cold the injured area needs to be to get the most benefit. And even though everyone recommends a standard 20 to 30 minutes of icing, there is little science to back that up. These researchers wondered how fat tissue affects the cooling of muscle tissue. Fat is a great natural insulator. It keeps warmth in. It also keeps cold out–including cold from an ice pack. It would make sense that people with more fat would need to apply ice longer than thin people to get the same benefit.

The researchers set out to test this theory using 47 volunteers. First, each volunteer’s skin fold thickness was measured. This was an indictor of how much fat tissue they had. Then a tiny temperature probe was inserted one centimeter into the thigh muscle. The probe read the muscle temperature throughout icing. The researchers were looking for a certain “typical” decrease in muscle temperature.

The researchers found that icing times varied dramatically depending on the amount of fat tissue. Twenty minutes with an ice pack was enough for people with skin fold measurements of less than 20 millimeters (mm). However, people with skin folds between 20 mm and 30 mm needed almost 40 minutes to get the same decrease in temperature. And people with skin folds between 30 mm and 40 mm needed a whole hour of icing.

Clearly, the standard prescription of 20 to 30 minutes of icing isn’t for everyone. The authors recommend that health care workers at least estimate the amount of fat tissue a patient has before prescribing the length of time for ice treatments.

Forcing the body to move past the available range of motion usually isn’t a good idea. Ballet dancers are especially likely to do this. However, it can be the cause of pain and injury.

Ballet looks so graceful. The dancers move seemingly without effort, but ballet is very athletic. It requires strength, agility, and endurance. Dance injuries are so common that 90 percent of all professional dancers have had an injury from dancing. More than half of all student dancers have also had injuries.

Dancers use a position called turnout. The hips, legs, and feet are rotated out as much as possible. The ideal turnout is 180 degrees. This means the heels are touching and the toes are pointed out to form a perfectly straight line.

A dancer can rarely achieve this position without compensating somewhere else. Sometimes, the feet and legs are turned out farther than the motion in the hips will allow. This is the most common cause of dance injuries. Full turnout forces the knees and lower legs to twist and move the feet when the hips can go no further.

Another way to get more turnout is to tilt the pelvis. The stomach moves forward and the back increases its swayback position. This increases the risk of low back pain and injury. Dancers may also roll the arches of the feet inward. This puts the feet in a position of being flat-footed. Injuries of the ligaments and soft tissue of the feet can occur.

Physical therapists who study dance injuries have some suggestions. Dancers should only turn the feet and knees out as far as the hips go naturally. This motion may improve with a program of stretching and strengthening–not by forcefully straining to attain ideal turnout. Instructors need to know the potentially harmful results of stressing ideal turnout when hip motion is the limiting factor in its achievement. This may ultimately help reduce pain and injury among dancers. More studies are needed to find strategies to safely increase hip rotation.

Exercise is known to help treat or prevent osteoporosis. Weight-bearing exercise works the best. However, it is tough to recommend that patients who are older or who have arthritis should take up weight-bearing exercise such as running or weight lifting.

Tai Chi Chuan could provide a good alternative for many patients. It is a gentle, fluid form of exercise that involves low and safe amounts of weight bearing. It is practiced by millions of people around the world. It is especially popular in China, where it was developed.

This study, done in Hong Kong, looked at the bone mineral density (BMD) after years of Tai Chi Chuan practice. Researchers focused on 17 postmenopausal women who did Tai Chi Chuan regularly. Their BMD was compared to 17 postmenopausal women who did not exercise. None of the women took calcium, vitamins, or estrogen, and they had never smoked. Their BMD was tested at the beginning of the study and again one year later. During that time, the women who did Tai Chi Chuan continued to do it at least 3.5 hours each week. The other women did no exercise at all.

Results showed that the group who did Tai Chi Chuan had higher BMDs both at the beginning of the study and again in a year. They still showed some bone loss over the year, but the rate of loss was much slower than the group who did not exercise. The authors suggest that Tai Chi Chuan could be a good exercise to recommend to patients at risk for osteoporosis who need a gentle form of exercise.

A major German study is underway to determine how exercise affects several women’s health issues–heart disease, diabetes, menopausal symptoms, quality of life, general physical fitness, back pain, and osteoporosis. This part of the study followed 59 women who were recently past menopause.

All had osteopenia, a diagnosis that describes decreased bone density. The women went through physical exams, questionnaires, and strength and flexibility tests. After 14 months of exercise, their results were compared to results for 41 women who did not exercise. None of the women were getting hormone replacement therapy. All of them took calcium and vitamin D.

This article outlines the complex training program the women followed. The program involved two supervised training sessions each week. The women also did two training sessions at home. Each session was more than an hour long. The sessions had four parts: endurance training, jumping exercises, strength training, and stretching. The specific exercises changed frequently. The sessions were designed to increase in difficulty over time.

The end results were overwhelmingly positive in the exercise group. As expected, the women who exercised were significantly stronger and had better endurance. They also reported an improved quality of life and fewer menopausal symptoms, such as insomnia and mood swings. And it is particularly noteworthy that the exercise group actually saw an improvement in bone mass in the spine.

This study is rare because it focuses on women who are just past menopause, rather than elderly women. With elderly patients, doctors often don’t recommend intense exercise because of the possibility of falls and broken bones. So research has often focused on finding the gentlest forms of exercise to help increase bone mass index. The results of this study suggest that intense exercise might be just the ticket for younger postmenopausal women. They can increase their bone mass while simultaneously improving their health in other ways.

Most of our bone mass is built during the first 20 years of our lives. Weight-bearing activities like walking, running, lifting weights,and jumping rope help build the strongest bones. But medical science has a long way to go before it can figure out which activities are best at building bone.

The authors measured the results of jumping rope on the bone strength of high school girls. The study included 37 girls who were past puberty. They were divided into three groups. The “high volume” group did 10 minutes of jump roping, five days a week. The “low volume” group did five minutes of jump roping. The control group did 10 minutes of walking and stretching. All the girls had measures of bone strength done before starting the program and after four months.

Two separate tests were used for measuring bone density. One was
a simple ultrasound of the heel. The second, called dual energy X-ray absorptiometry involves a broader scan of the skeleton. It is considered the best test, but it is expensive and difficult.

After four months, bone density increased 6.1 percent in the high volume group, 4.1 percent in the low volume group, and 1.1 percent in the control group. These numbers suggest that jumping rope is an effective way to build bone for girls.

The researchers were also interested in how the two measures of bone strength compared. This study showed that both measures showed similar improvements in bone strength, especially in the lower body.

This data supports the idea that heel ultrasound can be an effective way to measure bone strength. However, the authors caution that the data might be different with older women or with other forms of exercise.

Cancer treatment is tough on the body and the mind. Cancer survivors finish chemotherapy and radiation treatment with less strength, stamina, and flexibility. They often feel depressed and fatigued.

Earlier research has shown that exercise programs can help cancer survivors recover physically. This small study tested the physical effects of exercise on cancer survivors. It included low-intensity exercise, which has been increasingly found to have health benefits. The study also tested how exercise affected mental state and quality of life.

Researchers enrolled 18 survivors of breast, colon, and lung cancer for a 10-week study. The survivors were divided into three groups. One group did moderate-intensity exercise. One group did low-intensity exercise. The third group, a control group, did no exercise at all.

The exercise groups did a supervised exercise session three times a week. They used the rower, treadmill, stair-climber, and stationary bicycle. Workouts were 14 minutes long at the beginning of the study. They increased by two minutes a week, so that workouts were 32 minutes long in the tenth week. The moderate-intensity group worked at up to 60 percent of their maximum heart rate, while the low-intensity group worked at up to 40 percent of theirs.

The subjects were all tested for body fat, flexibility, aerobic capacity before and after the 10 weeks. They also filled out a questionnaire on mental state and quality of life.

Both exercise groups showed similar results, which were much better than the control group. The exercisers lost body fat and had better flexibility and increased aerobic capacity. They also reported more energy, less fatigue and anxiety, and an overall better quality of life.

This was a very short-term test. Different exercise intensities could show different results over a longer period of time. But the results are positive. Even low-intensity exercise can help cancer survivors get back to the business of enjoying their lives.

Doctors know that weight-bearing exercise helps build bone mass in women after menopause. Research has shown that strength training can be especially helpful. But nobody knows exactly how it works. If they did, doctors could better design individualized programs to help prevent or treat osteoporosis.

These authors tested whether lifting larger amounts of weight led to higher bone mass. They assigned 140 postmenopausal women to three sessions of strength training a week for one year. The one-hour sessions included two sets of six to eight repetitions of eight different weight lifting exercises. The exercises were meant to strengthen the arms, legs, and body. Some were free weight exercises, and some used machines. The women lifted 70 to 80 percent of their maximum in each exercise. All the women took calcium, and half of them were on hormone replacement therapy.

Their bone mineral density (BMD) was measured at the beginning of the strength training and again one year later. The BMD was measured in three different spots: the femur trochanter (the large bump at the top of the thigh bone), the femur neck (the skinny part of the thigh bone by the hip joint), and the lower spine. The authors found a definite relationship between lifting more weight and increasing the BMD in the femur trochanter. The authors note that this strength training program put the most direct weight load on the femur trochanter. Comparing the different exercises, they found that weighted squats seemed to have the biggest impact on BMD growth.

These results are interesting for many reasons. They suggest that intense strength training programs seem to build more BMD than easy programs. They also open up new questions about the complex ways that bones and muscles interact. The authors also note that many questions remain about how hormone replacement therapy combines with strength training in building BMD. The authors feel that this study will be a good foundation for future research on helping postmenopausal women build stronger bones.

Four-wheeled all-terrain vehicles (ATVs) cause more than their share of injuries. Part of the problem is human: driving while drunk, going too fast, not wearing helmets, or not knowing how to drive ATVs. And ATVs themselves are powerful and, for the most part, unstable. Put all those factors together, and the injuries from ATV accidents can be very serious.

This two-year study covered all ATV injuries seen in a hospital in Puerto Rico. Researchers looked closely at the 33 ATV riders who needed a total of 46 orthopedic surgeries. The data put the spotlight on some interesting facts:

• Bones were injured all over the body, but 63 percent of the injuries were to the legs. No injuries to the head and neck showed up in this study. However, this is probably because most ATV riders who receive head and neck injuries end up dead, not in the operating room.


• About 75 percent of the injured patients were driving the ATVs.


• Only four patients (12 percent) were wearing helmets.


• The average patient was a young man in his 20s, with little experience driving ATVs, who was driving too fast after drinking alcohol.


• The average hospital stay was 11 days. The range was two days to 44 days.


• The average cost of medical care (ambulance, emergency room, hospital stay, intensive care, and operating costs) was almost $12,000. The range went from about $3,300 to almost $55,000.


• Patients were usually disabled for several weeks to several months after the accident.


• About 18 percent of the patients were children, and they had the most severe injuries. Other studies that include more types of injuries show that about half of the ATV accident victims are children.

A small number of patients with a total hip or knee joint replacement can end up with less motion and more pain than before the operation. This is especially true if they develop a condition called heterotopic ossification (HO).

When this rare condition happens, the patient starts to form bone in the soft tissue. Without warning, bone cells start forming in the muscles. When it occurs, HO usually starts within 16 hours of the operation to replace a knee or hip joint. The result is a painful loss of motion. The patient can’t sit, climb stairs, or put on shoes and socks. Signs of inflammation such as redness, swelling, and tenderness usually accompany HO.

Doctors don’t know exactly what causes HO. There are some people who are more likely than others to develop this condition. Risk factors for HO include men with hypertrophic osteoarthritis in both hips or knees. This kind of arthritis causes tissue to increase in size. Anyone who’s had HO before has an increased risk of getting it again. Some diseases, such as ankylosing spondylitis and Paget’s disease, also put a patient at increased risk.

Other risk factors are less common but just as important. For example, certain methods of joint replacement have a higher rate of HO. They include using a cementless implant and replacing the hip joint from the front rather than the side or back. Anyone with a total knee replacement that has knee stiffness afterward and needs to have the knee manipulated by the doctor is at increased risk.

HO can be prevented. Patients at risk can use radiation or drugs, such as nonsteroidal antiinflammatories (NSAIDs). Radiation keeps fast growing cells such as bone cells from forming. These measures can be taken before the joint replacement. Some doctors watch patients at risk carefully and start treatment as soon as any sign of HO appears.

Strange as it may sound, electromyostimulation (EMS) can strengthen muscles. EMS works by sending electrical currents to the nerves that control muscles. The electrical currents make the muscles contract. Carefully designed EMS programs can improve athletic performance.

This study looked at using EMS to increase the vertical jump of high-level Italian volleyball players. EMS was used along with plyometric jump training, a method that uses explosive movements to improve speed and power.

It worked like this. Ten volleyball players went through four weeks of the experimental training. They did three sessions each week. Each session started with a 20-minute warm-up. Then the players got EMS stimulation in specific muscles in the legs for 26 minutes. After a rest, they did five sets of ten jumps. They finished with ten minutes of stretching. They were allowed to play one practice game a week. Meanwhile, the ten players in the control group did regular preseason training.

All 20 volleyball players were tested during the four weeks of training and for two weeks afterwards. Their vertical jump height was measured. So was the strength of their “jump” muscles (the knee extensor and ankle plantar flexor muscles).

Results showed that the players who got EMS and plyometric training jumped higher and had stronger “jump” muscles than before training. Their jump height even improved two weeks after the training program stopped. Meanwhile, the control group saw no improvements in strength or vertical jump.

The authors feel that this combination of EMS and jump training could be a useful preseason program for volleyball players. They suggest that EMS training may cause a nerve response that “programs” the muscles to be more efficient. The authors note, however, that it is possible that either plyometrics or EMS alone caused the gains in strength. More study is needed to find out.

Falls have a major role in fractures for women who are past menopause (postmenopausal). The risk of falling goes up even more as these women get older. When they have osteoporosis, the risk increases again. Until now, it was thought that osteoporosis and falls together led to fractures in older women. Finding out that falling of itself increases fracture is an important piece of the puzzle.

The number of falls found in a group of 2,650 postmenopausal women went up with increasing age. At age 50 years, only nine percent of the women said they fell. By age 80 and older, this had increased to 38 percent.

A history of falling predicts fracture more than having osteoporosis. Osteoporosis means “bones full of holes.” There is less bone mass and damage to the structure of the bone itself.  Osteoporosis raises the chances that a fall will cause a broken bone. Osteoporosis can happen in both men and women at all ages, but it often follows menopause in women and occurs later in life in men.

Programs to teach prevention of falls have been moderately successful. Yet the expense and difficulty of getting the information to women has generally been too much. If falling is so important in causing fractures, then more efforts must be made to find ways to stop falls from happening.

No one wants to be the first patient operated on by a surgeon. This never happens. Doctors-in-training learn their surgery skills first on plastic teaching models and cadavers (human bodies preserved for study). Then they watch expert doctors. The final step is practicing with a teaching surgeon.

Today’s technology has added a new step in this learning process. Enter the computer simulator. The simulator used in this study is a computer and video with a model of the shoulder. The software program makes it possible for the doctors to “touch” parts of the shoulder. With computers, doctors train for surgery without making devastating mistakes. It also saves money in time and supplies by not using an operating room.

Airline pilots have practiced with computer simulation for years. The medical world has been slow to use this kind of technology. Having three-dimensional (3-D) views has changed this for doctors, as they are now able to practice arthroscopic surgery as if on a real body.

Computer technology gives the doctor immediate feedback. For example, if the doctor bumps the virtual joint surface or pulls on a virtual tendon, the camera and probe let the doctor know. The software for this program allows for constant change of the camera image and position. It also allows the doctor to view the patient’s correct size and position.

There is some merit that young people using computer games today could make better surgeons tomorrow. The skills used to play computer games will be helpful in the future. These same hand motions may later be used while practicing and performing operations.