🔴Nice teaching case for the advanced therapeutic fellow ERCP... Teaching Pearl 🧠 | Hock-Pull Technique in Supine Position 🛌 Supine patient = altered orientation → technique matters 🔹 Papilla orientation: In supine ERCP, the papilla often appears more inferior/posterior and less en face, with a tendency for the catheter to fall into the pancreatic duct due to gravity and scope torque. 🔹 Why Hock-Pull helps: • Hockey bow redirects the tip upward toward the biliary axis despite gravity. • Gentle pull-back everts and opens the papillary orifice, counteracting the “downward fall” seen in supine cases. • Improves coaxial alignment (~11 o’clock) without pushing. 🔹 Manoeuvrability advantage: • Pulling back stabilizes the papilla against respiratory motion. • Small rotations become effective—micro-adjustments instead of force. • Reduces repeated pancreatic duct entry and papillary trauma. 💡 Pearl: > “In supine ERCP, gravity favors the pancreas—hock-pull brings you back to bile.” #ERCP #SupineERCP #Endoscopy #GI #TeachingPearls #PatientSafetyshow more

🎯 3 Teaching Pearls from the “Compact Disc” Method... for ERCP Cannulation 1️⃣ Visualize the invisible. Imagine stacked CDs inside the papilla to conceptualize the 3D bile duct axis—especially in long oral protrusion (LOP). 2️⃣ Advance gently, not forcefully. Cannulation should feel like passing through the center hole of each CD. Force bends the axis and increases injury risk. 3️⃣ Alignment is everything. Ensure scope position and catheter axis are “face to face” with the imagined duct axis before advancing. Simple concept. #ERCP #Endoscopy #MedicalEducation #AdvancedEndoscopy #Basics #KFHU #BiliaryCannulationshow more

The pancreas when touched during ERCP 😅

Throwback to a 🔝 downloaded 📼 from 2020: step-by-step... #technique for #supine #PCNL by Guido Giusti and his #ETCE #team. You can find it by clicking the #link below, it’s #OpenAccess!show more

3. Supine butterfly release Lie on your back with... soles of your feet together. Let knees fall open. Raise hips slightly, then lower. Stay in position and allow shaking. Tremors often begin within minutes. Do not resist.show more

Patient came for an ERCP and found to have... copious blood in stomach. Duodenum showed the following findings. What would your next move be? #gitwittershow more

Caleb controls gravity with one hand and somehow manages... to pull all the attention to his fingers...show more

Boris really dropped the greatest insult of the 21st... century, calling them "Great supine protoplasmic invertebrate jellies"show more

Tennessee OL working on reaches with a skip pull... technique 👀 📝 Skip pull gives you room to work off the snap to run and work for outside leverage 📝 Get backside hand and foot through the crotch of the defendershow more

This setup uses pulleys to transfer downward motion into... tension along a rope. Lowering the engine crane increases the force applied through the system. The result is a controlled demonstration of gravity, tension, and mechanical advantage.show more

Bro really called them "great supine protoplasmic invertebrate jellies"... 🤣 Quite possibly the greatest insult of the 21st century.show more

"You may recall doing the pull-ups and the sit-ups... required for the President's Physical Fitness Test back in school. It was phased out in 2013 for a less competitive program — and now, President Trump has brought it back." 💪🏻show more

Lee Hunter, MD, presents the Arthrex Elbow Fracture Plating... System, using a dorsal olecranon fracture plate to reduce the fracture. The elbow is positioned using the ElbowLoc® arm positioner, allowing the surgeon to complete the surgery in supine, as shown in this video, or lateral position. KreuLock™ locking compression screws allow for compression across the fracture and stability in the plate. Visit #Arthrex at Exhibit 409 during #OTA2026 to learn more about our latest innovations: #WhatsNewAtArthrexshow more

golf equivalent: you need to hole out from 275... yards on the 18th hole to force a playoff. you wait for the green to clear, pull 3-wood ... then you drill one off the tree directly in front of you. it ricochets back and hits your caddie square in the faceshow more

Stiffness is often associated with muscle weakness, which stabilizes... the blades and helps keep the shoulders in a more neutral position. Perform each exercise 10 times - you will feel your upper back muscles engage and become easier to control.show more

Ajax U14 Session Plan (Everything in this for creativity)... 🔹 Focus on movement to receive and strong back foot receiving 🔹 Improve effectiveness in 1v1 duels within a directional setup 🔹 Central 1v1 game with neutral players supporting the team in possession 🔹 Creates a 2v1 advantage in the active zone 🔹 Attacker creates space to receive and progress the ball 🔹 Must pass to the opposite neutral player inside the end zone 🔹 If defender wins the ball, roles switch immediately 🔹 Emphasis on quick decision making 🔹 Positive and confident 1v1 play 🔹 Quality first touch under pressure 🔹 Sharp movement and awareness 🔹 Fast transitions when possession is lost or regainedshow more

When a spacecraft leaves Earth, it doesn’t just fire... its engines and head straight to its destination. In many missions, especially those going beyond low Earth orbit, there’s a more subtle and elegant strategy at play, one that uses gravity itself as part of the navigation system. This is often called a gravity assist, or a slingshot maneuver. But in the case of missions like #Artemis II, what’s being used is a closely related idea known as a free-return trajectory. At first glance, it might sound simple: the spacecraft goes to the Moon, loops around it, and comes back. But the physics behind it is anything but simple. Instead of relying on continuous propulsion, the spacecraft follows a carefully calculated path through the gravitational field of the Earth–Moon system. It is launched with just the right speed and direction so that, as it approaches the Moon, the Moon’s gravity bends its trajectory. The spacecraft is effectively flung around the Moon, redirected onto a path that naturally brings it back toward Earth. No major engine burn is needed for the return. Small trajectory corrections may still be required, but gravity does the heavy lifting. That’s the key. This kind of trajectory is not just efficient, it’s also safe. If something goes wrong with the spacecraft’s engines or onboard systems, gravity itself ensures the return. It’s an inherent backup plan, built into the trajectory from the very beginning. The same fundamental idea appears in gravity assists used across the Solar System. When a spacecraft flies past a planet, it can gain or lose speed by exchanging momentum with that planet. From the spacecraft’s point of view, it’s as if it has been accelerated without using fuel. In reality, it has borrowed a tiny amount of orbital energy from the planet itself. That’s how missions like Voyager reached the outer planets, and how probes continue to explore regions far beyond what their onboard fuel alone would allow. But there’s an important distinction. An interplanetary gravity assist is typically used to change speed and direction, often increasing the spacecraft’s energy. A free-return trajectory, like the one used in Artemis II, is designed for something more specific: a path that naturally loops back to Earth without requiring additional propulsion. It’s less about gaining energy, and more about shaping a trajectory that guarantees a return. To understand why this works, it helps to stop thinking in straight lines. In space, motion follows curves defined by gravity. The spacecraft is constantly falling, first toward Earth, then toward the Moon, and then back toward Earth again. What looks like a loop is really a continuous free fall through a changing gravitational landscape. This way of navigating space reveals something deeper. We tend to think of engines as the drivers of motion, but once a spacecraft is on its way, gravity does most of the work. The art of spaceflight is not just about thrust. It’s about knowing when not to use it. #GoodLuck #Artemis NASA Artemisshow more

I like the Hammer Strength iso-lateral chest/back machine as... a change-up for lat pull downs. I keep the weight a little lighter. Go for a big stretch at the top (I don't do this on regular lat pull down) but the weight needs to be light enough you can retract and pull the weight down when you transition. If in doubt, don't go for a big stretch at the top and stick with normal lat pull down movement! Stay Stronk!show more