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Jamie's Italian Onboard Symphony of the Seas The term "foodie" is tossed around a lot, and I never thought of myself as one unless it means someone who likes to eat a lot of good food then heck yea I am a "foodie. Of course not, but put a spread in front of me that looks like I am going to be in a food coma in under an hour and I am going to tell the world about it. As a born and raised New Englander, I have dined in some pretty.

JSinapijr March 5, Tuesday Travel Tips. Then your eyes move on to the words "Submit an Offer The big question is, should you submit an offer to upgrade your. Jan February 6, Symphony VS Harmony I know we have been gone for a second but we are back and starting off with a blog that is bound to answer your questions! I am here to te. JSinapijr February 4, The New Ships we Saw in Well, is racing to a close, and it was an incredible year for the industry. Let's take a look back at some of the incredible new ships that debuted in ! New Ships: Every year cruise lines seem to outdo themselves with the incredible ships they debut, and was one of the most incredible!

From the largest ship in the world debut to the most innovative ship of our time. JSinapijr December 29, Prepare for Emergencies with Both a Passport and Trip Insurance I have stressed in previous blogs about the importance of carrying both travel insurance and a passport while on a cruise vacation.

The couple were on a three-night cruise to the Bahamas when a sudden and serious illness necessitated a visit to the cruise ship doctor whi.

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Jan December 19, Group Cruise Misconceptions What exactly is a group cruise? When I offer a group cruise to someone, I often get looks of puzzlement or replies like "I don't like to travel in herds" or "nope, don't like crowds of tourists". What many people - those who have never experienced group cruising - don't realize is that a "group" reservation doesn't mean that you have to follow one another around the entire trip as if you were attached at the hip.

Jan November 27, Most Reliable Airlines for Cruise Travelers After trying multiple new airlines over the last year, I have figured out which ones would be best for getting me to my ship on time and which ones might cost me my entire cruise. Also, tell me what your most unreliable airline for cruise travel is!

JSinapijr November 16, Regal Princess: A Stormy Start and First impressions In attempt to keep the costs down for this cruise, we initially booked an inside cabin. However, the price dropped and we were able to upgrade to a standard balcony at no extra cost. I wondered, would a balcony even be usable on a cruise like this, one in which driving rain and wind kept everyone inside?

First things first We pulled and yanked to no avail, but finally the door slid open so that we could barely see the skyline and Statue of Liberty through the mist. Jan October 29, When I s. Jan October 28, Did you know? Repositioning cruises are a unique and affordable way to vacation and experience a number of ports around the world! Low prices, lots of relaxing sea days and interesting itineraries make a repositioning cruise an attractive vacation option. Most often taking place during the shoulder seasons of fall and spring, this interesting cruise option allows you to sail to unusual and off-the-beaten track locations when a cruise ship relocates to another region for the new season.

Once the patient is able to maximize pectoralis contraction consistently without gravity, he or she is asked to sit up and attempt flexion. Usually two to four sessions are required to produce this effect. Post, M. J Shoulder Elbow Surg. Eight patients with painful, chronic winging of the scapula had an indirect transfer of the pectoralis major with fascia lata autograft.

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Preoperative duration of symptoms averaged Surgery was performed in the lateral decubitus position with the torso tilted backward 35 degrees. A 5 x 20 cm section of the fascia lata was harvested and twisted into a tubular graft. One long incision was made to harvest the sternal portion of the pectoralis major tendon as well as transfer the graft to the inferior scapula. Patients were followed for an average of One patient had continued pain, and one patient did not regain full motion.

Three of four patients had their previous multi-directional instability resolve post-operatively, while one underwent a capsular shift procedure. Two patients had a seroma or hematoma at the graft harvest site requiring aspiration. Clin Orthop Relat Res. Eleven patients with symptomatic scapular winging with duration of symptoms from 12 — 60 months underwent a transfer of the sternal portion of the pectoralis major tendon reinforced with fascia lata autograft. Surgery was performed in a modified beach chair position with a 20 cm incision in the axillary skin crease for both tendon harvest and transfer.

A 4 x 10 cm fascia lata graft was harvested and tubularized and used to reinforce but not be interposed between the pectoralis major and scapula. Patients were followed for an average of 41 months. Ten of the eleven patients had satisfactory results with improvement in function and reduction of pain with no winging. One patient had a full recurrence of winging.

Eight patients with scapular winging due to LTN palsy underwent an indirect pectoralis major tendon transfer with autograft hamstrings through a two-incision technique on the shoulder and a separate incision for graft harvest on the ipsilateral leg. Patients had experienced symptoms for an average of 40 months range 12 — 86 months.

Surgery was performed in the manner described above in the surgical technique portion of this paper. Patients were followed for an average of 32 months range 24 — 40 months post-operatively. There was one patient who reportedly had a deep infection treated at another institution and was lost to follow-up. FF improved to an average of degrees range, degrees , compared with the preoperative average of 97 degrees range, degrees.

All patients were satisfied with the cosmesis of their incisions. J Bone Joint Surg Am. Sixteen patients with scapular winging underwent pectoralis major transfer with fascia lata autograft. Surgery was originally performed with individual strips of fascia lata and then later changed to a rectangular graft that was sewn into a tubular configuration. Surgery was performed in the lateral decubitus position and the entire pectoralis major tendon was used for transfer. Patients were followed for an average of 4 years and 3 months range 2 years and 1 month to 9 years.

Results were graded as excellent in eight patients, good for five and fair for one.

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The two remaining patients both had failures attributed to using individual, small strips of fascia lata graft and were revised to scapulothoracic fusions. Povacz, P, Resch, H. This is an anatomic study performed on 40 cadaver shoulders to measure the size of the pectoralis major muscle and its sternal portion. This study was designed to answer whether the length of the pectoralis major muscle would permit a direct transfixation of the split sternal portion to the inferior pole of the scapula.

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The distance from the origin of the sternal portion of the pectoralis major muscle to its insertion on the humeral shaft was measured and then repeated in abduction of 45 and 90 degrees. This length of the sternal portion was then compared to the distance from its origin to the inferior angle of the scapula.

At 45 degrees of abduction, the lengths of both these measures are near equal, leading the authors to recommend direct transfer of the sternal head without graft.


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Fifteen patients with scapular winging, weakness of arm abduction and fatigue with overhead activities underwent pectoralis major transfer with fascia lata autograft after an average of 25 months of symptoms range months. Details on the surgery were not provided. Patients were followed for an average of 64 months range months. Pain decreased with 11 patients, but no patients were pain-free with all activities.

Two patients had persistent adhesive capsulitis, one patient had persistent muscle bulging on the lateral aspect of her thigh and one patient required chronic narcotics for pain. A correlation was found with post-operative limited external rotation ER and significantly lower outcome scores. Nine patients with LTN paralysis with symptoms for an average of 34 months were followed after indirect pectoralis major tendon transfer with fascia lata autograft.

Surgery was performed in the lateral decubitus position with the head of the table elevated to 20 degrees. The entire pectoralis major was detached and a 5 x 15 cm portion of fascia lata was harvested and sutured to the stump of the pectoralis major tendon to augment the graft.


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    • Five patients were placed in a shoulder spica cast post-operatively. Follow-up averaged 70 months range 12 — months. There were three complications post-operatively with two cases of adhesive capsulitis and a thigh seroma from the fascia lata graft.

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    Direct transfer of the pectoralis major tendon in the lateral decubitus position was performed on twelve patients with LTN palsy that had symptoms for an average of 24 months. The entire tendon was detached with a cortical flake of bone and then the sternal head was transferred to the scapula while the clavicular head was reattached to the insertion.

    One patient had a rupture of the tendon transfer during a fall, resulting in continued winging and underwent a revision.