How dirty is your duck?

Ugly ducklings—the dark side of plastic materials in contact with potable water

Bath todays are in common use (see this link).

They pose an interesting insight into biofilm formation and flexible plastic materials, water, external microbial and nutrient contamination,

These authors characterized biofilm communities inside 19 bath toys used under real conditions. All examined bath toys revealed slimy biofilms on their inner surface.

Total bacterial numbers averaged 5.5 million cells/cm2 (clean water controls), 9.5 million cells/cm2 (real bath toys), and 74  million cells/cm2 (dirty water controls). Bacterial community compositions were diverse, showing many rare taxa in real bath toys and rather distinct communities in control bath toys, with a noticeable difference between clean and dirty water control biofilms.

The authors argue that bath toy biofilms are influenced by (1) the organic carbon leaching from the plastic material, (2) the chemical and biological water quality, (3) additional nutrients from care products and human body fluids in the bath water, as well as, (4) additional bacteria from dirt and/or the end-users’ microbiome.

They conclude that toys from real households are colonized by dense biofilms with complex bacterial and fungal communities.

Comment: The purpose of this post is to remind us that biofilms form on plastic as well as metal. Of interest is that the biofilm did not come off the plastic easily - it had to be removed using an electric toothbrush (Oral-B®, Advanced Power).

These findings may have relevance in the revision of the plastic components of a total shoulder when infection is suspected.

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Supporting progress in shoulder surgery

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How to stretch and how not to stretch

Some patients have had difficulty maintaining their range of motion after shoulder arthroplasty.

Sometimes the issue is that they are not correctly monitoring their range of elevation.

Ideally the range should be monitored weekly by a consistent physical therapist for the first 6 to 12 weeks after surgery. The therapist can report to the surgeon if there is any question about the onset of stiffness or the loss of range of motion.

Alternatively, the patient may use photos taken from the side to compare to those shown in this link to make sure they are attaining at least 150 degrees of elevation (the angle between the body and the arm).

Some very motivated patients still need coaching on the best stretching technique. We like to avoid a lot of quick stretches because they result in temporary 'elastic' lengthening of the tissue that returns immediately to the pre stretching length as illustrated by stretching the bungee in the video below.

Other well motivated patients stretch their shoulder too roughly, so that tissue is torn giving rise to pain and additional scar tissue. This is illustrated by pulling on a stick of cold chewing gum in the video below.

Ideally, stretches should be comfortable and held for a long time (one or two minutes for each repetition) so that 'plastic' or permanent lengthening of the tissues is achieved. This is shown in the video below as I stretch some bubble wrap (note that I had to take out some of the stretching time so the video would fit). Note also that the amount of lengthening achieved was definite, but not large. But if a bit of permanent lengthening is achieved each time, the shoulder motion will increase. To prevent 'backsliding' the stretches should be done frequently through the day.

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