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PubMed2006

Latest developments in the assessment and management of chronic musculoskeletal pain syndromes in children.

PURPOSE OF REVIEW: As many as 25% of new patients in pediatric rheumatology clinics present with idiopathic chronic pain and recent data suggest the prevalence of these conditions is increasing. Knowledge of the latest developments in assessment and treatment is critical for providing optimal clinical care. This review summarizes advances published in the past year forwarding our understanding of chronic musculoskeletal pain syndromes in children. RECENT FINDINGS: Research has recently focused on the impairment associated with chronic pain syndromes in children, issues impacting the diagnosis of these conditions, and the efficacy of pharmacological and psychosocial treatments. No diagnostic criteria have been developed for specific chronic pain syndromes in children; however, data from several studies substantiate the need for thorough assessment of the child and family in multiple domains. In addition, studies have expanded both pharmacologic and psychosocial treatment options for children with these syndromes. SUMMARY: Despite a growing body of research on chronic pain syndromes in children, there are no established standards of care. Data continues to support an interdisciplinary approach for effectively assessing and managing these conditions.

Child↗
PubMed2000

A new approach to applying feedforward neural networks to the prediction of musculoskeletal disorder risk.

A new and improved method to feedforward neural network (FNN) development for application to data classification problems, such as the prediction of levels of low-back disorder (LBD) risk associated with industrial jobs, is presented. Background on FNN development for data classification is provided along with discussions of previous research and neighborhood (local) solution search methods for hard combinatorial problems. An analytical study is presented which compared prediction accuracy of a FNN based on an error-back propagation (EBP) algorithm with the accuracy of a FNN developed by considering results of local solution search (simulated annealing) for classifying industrial jobs as posing low or high risk for LBDs. The comparison demonstrated superior performance of the FNN generated using the new method. The architecture of this FNN included fewer input (predictor) variables and hidden neurons than the FNN developed based on the EBP algorithm. Independent variable selection methods and the phenomenon of 'overfitting' in FNN (and statistical model) generation for data classification are discussed. The results are supportive of the use of the new approach to FNN development for applications to musculoskeletal disorders and risk forecasting in other domains.

Back Injuries↗
PubMed2003

Risk factors for musculoskeletal disorders among nursing personnel in Greek hospitals.

OBJECTIVES: To investigate the relationships between physical, psychosocial, and individual characteristics and different endpoints of musculoskeletal complaints of the lower back, neck and shoulders. METHODS: In this cross-sectional study a questionnaire survey was carried out among 351 nursing personnel (response 84%) in six general hospitals in Athens, Greece. A questionnaire was used on physical and psychosocial workload, need for recovery, perceived general health and (1) the occurrence of musculoskeletal complaints in the past 12 months, (2) chronic complaints during at least 3 months, and (3) complaints which led to sickness absence. In logistic regression analysis odds ratios (ORs) were estimated for all relevant risk factors. RESULTS: Self-reported factors of physical load were associated with the occurrence of back pain (OR=1.85), neck pain (OR=1.88), and shoulder pain (OR=1.87) but these factors were not associated with chronic complaints and musculoskeletal sickness absence. Physical load showed a trend with the number of musculoskeletal complaints with ORs of 2.47 and 4.13 for two and three musculoskeletal complaints, respectively. No consistent influence of psychosocial factors on complaints, chronicity, or sickness absence was observed. A perceived moderate general health was also a risk factor, and strongest associations were observed for sickness absence due to back pain (OR=2.03), neck pain (OR=8.31), and shoulder pain (OR=6.84). CONCLUSIONS: The handling of physical loads among nurses seems to put them at risk for the occurrence of musculoskeletal disorders. The development of these complaints into chronic complaints and associated sickness absence is strongly determined by perceived general health and almost not associated with work-related physical and psychosocial risk factors. When the influence of work-related risk factors on musculoskeletal health is being investigated, the general health status of individual workers should be taken into account.

Adult↗
PubMed2006

[New developments in joint ultrasonography].

Musculoskeletal ultrasonography has become an established imaging technique in rheumatology. The ability of ultrasonography to visualize soft tissue changes provides a possibility for differentiating between exudative and proliferative synovial tissue changes. Superficial cartilage and bone lesions can be detected earlier by ultrasonography than by conventional radiography. The application of Doppler and power Doppler ultrasonography is helpful for the detection of early inflammation. Current studies with ultrasound contrast media demonstrate its benefit in the differentiation of inflammatory processes. Musculoskeletal ultrasonography is helpful in the diagnosis of early arthritis, especially in patients with inconspicuous conventional radiography or suspicious clinical findings. It is a convenient method for follow-up analysis, and therefore has an impact on the monitoring of therapy. It is patient-friendly and is an important tool for the diagnostic work-up of arthritis.

Arthritis, Rheumatoid↗
PubMed2007

Drug-induced musculoskeletal disorders.

Drug-induced musculoskeletal disorders represent a broad clinical spectrum, from asymptomatic biological abnormalities to severe and even life-threatening diseases. Since an increasing number of drugs have been implicated in inducing rheumatic symptoms and/or syndromes, this review is not meant to be exhaustive, bearing in mind that the development of any musculoskeletal disorder should be considered as possibly related to a medication. The purpose of this article is to provide an overview of the more frequent drug-induced musculoskeletal disorders. These include: (i) arthralgias and arthropathies, including chondropathies and inflammatory arthritis; (ii) connective tissue diseases, especially lupus-like syndromes; (iii) periarticular disorders, including tendinopathies, enthesopathies and frozen shoulder; (iii) bone diseases, such as osteoporosis, osteomalacia and osteonecrosis; and (iv) myopathies. Although virtually all drug classes may induce musculoskeletal disorders, a significant part of them are related to corticosteroids, vaccines, antibacterials and lipid-lowering agents. Knowledge of drug-induced musculoskeletal disorders avoids carrying out unnecessary investigations, and allows optimal management of the patients, i.e. early discontinuation of the offending agent, adequate treatment monitoring and/or intervention with appropriate preventive actions.

Adrenal Cortex Hormones↗
PubMed2004

Self reported musculoskeletal symptoms in the neck/shoulders and/or arms and general health (SF-36): eight year follow up of a case-control study.

AIMS: To explore and compare the prevalence after eight years of self reported musculoskeletal symptoms and general health (SF-36) for groups with initially different degrees of severity of symptoms in the neck/shoulders and/or arms. METHODS: A case-control study was performed in 1989 comprising 129 clinically examined cases and 655 survey controls. The study population was followed up in 1997 with a postal survey. The controls, none of which were clinically examined at baseline (1989), were divided into groups according to degree of severity of self reported symptoms in the neck/shoulders and/or arms at baseline: no symptoms, light symptoms, and severe symptoms. Cases were clinically diagnosed with a musculoskeletal disorder of the neck/shoulders and/or arms at baseline. RESULTS: At the 1997 follow up, there was a trend of increasing prevalence of musculoskeletal symptoms, as well as decreasing health status as rated in the SF-36 over the three severity groups among controls. Only small differences were seen between the cases and the controls reporting severe musculoskeletal symptoms or the neck/shoulders and/or arms. CONCLUSION: The degree of questionnaire based self reported musculoskeletal symptoms of the neck/shoulders and/or arms clearly indicate different degrees of future health problems (both in terms of self reported musculoskeletal problems and health in general as captured by the SF-36). Therefore, there is a need for improved intervention and health promotion strategies. Such effort should be implemented before musculoskeletal symptoms have developed to clinical cases, particularly in the realm of the workplace.

Adolescent↗
PubMed1992

[Development of three-dimensional imaging of the musculoskeletal system and its diagnostic capability].

Since 1987 we have studied osseous surfaces reconstructed three-dimensionally (3-D) from CT images with the cooperation from Hitachi Medico Co., Ltd. From these studies we have developed the following method for various clinical use. The method of this 3-DCT system could treat rather noisy images scanned with low radiation exposure because of the high contrast ratio (CT number) between bones and soft tissues, in the CT images. In addition, the 3-D calculation treated only the extracted data instead of all the CT images data, and the high speed processor was used in our system. These were effective to reduce the processing time. Furthermore, the system provided a natural stereoscopic view using a mixture shading method. Subsequently, this 3-DCT system was applied to clinical cases to examine its diagnostic capability. These results indicate that the 3-DCT system is useful in evaluating pathological conditions of bones and joints.

Arthrography↗
PubMed2005

Referrals to hospital-based rheumatology and orthopaedic services: seeking direction.

OBJECTIVES: While both community and hospital-based services strive to cope with the considerable burden posed by musculoskeletal disorders, multidisciplinary-led, integrated approaches are frequently lacking. It has been suggested that referrals to musculoskeletal services are frequently misdirected to an orthopaedic surgeon when non-surgical advice/intervention is warranted, reducing the efficiency of hospital-based services and potentially affecting quality of care. Triage of referrals may help to prevent this, but this system is dependent upon accurate and thorough information being provided in the referral letter. Our aim was to assess the feasibility of triage of musculoskeletal referrals to rheumatology and orthopaedic services at a large teaching hospital. METHODS: One thousand and eighty-seven consecutive referral letters to orthopaedic and rheumatology services were reviewed by a consultant rheumatologist. Letters were assessed for both basic content and the appropriate destination for that referral. In order to evaluate the accuracy of the assessor's prediction of the most appropriate destination of the referrals, the number of patients who were ultimately listed for surgical intervention was calculated in a random sample of orthopaedic referrals, 1 yr after the initial hospital appointment was requested. RESULTS: Six hundred and eighty-two referrals were to orthopaedics and 393 to rheumatology. Referrals relating to spinal pain were excluded. The content of letters was scant and no diagnosis was volunteered in 63.4% of referrals. Fifty-eight per cent of referrals to orthopaedics were considered appropriate; 27% of referrals to orthopaedics were defined as 'should definitely see a rheumatologist' (12%) or 'should probably see a rheumatologist' (15%). Fifteen per cent of referrals to orthopaedics were defined as 'could see either a surgeon or a rheumatologist'. Ninety-four per cent of referrals to rheumatology were defined as appropriate, 2% were not and 4% were defined as 'could see either a surgeon or a rheumatologist'. One year later, in a random sample of 373 of the orthopaedic referrals, 42.2% of those who were categorized as 'should see surgeon' and 9.7% of the 'should see a physician' group were listed for surgical intervention. CONCLUSIONS: Many referrals to hospital-based musculoskeletal services are likely to be misdirected. Integrated referral and care pathways are required for efficient and optimal care of patients with musculoskeletal diseases. The development of such pathways will require significant support, education and training for general practitioners.

Correspondence as Topic↗
PubMed2005

Collagen synthesis in human musculoskeletal tissues and skin.

We have developed a direct method for the measurement of human musculoskeletal collagen synthesis on the basis of the incorporation of stable isotope-labeled proline or leucine into protein and have used it to measure the rate of synthesis of collagen in tendon, ligament, muscle, and skin. In postabsorptive, healthy young men (28 +/- 6 yr) synthetic rates for tendon, ligament, muscle, and skin collagen were 0.046 +/- 0.005, 0.040 +/- 0.006, 0.016 +/- 0.002, and 0.037 +/- 0.003%/h, respectively (means +/- SD). In postabsorptive, healthy elderly men (70 +/- 6 yr) the rate of skeletal muscle collagen synthesis is greater than in the young (0.023 +/- 0.002%/h, P < 0.05 vs. young). The rates of synthesis of tendon and ligament collagen are similar to those of mixed skeletal muscle protein in the postabsorptive state, whereas the rate for muscle collagen synthesis is much lower in both young and elderly men. After nutrient provision, collagen synthesis was unaltered in tendon and skeletal muscle, remaining at postabsorptive values (young: tendon, 0.045 +/- 0.008%/h; muscle, 0.016 +/- 0.003%/h; elderly: muscle, 0.024 +/- 0.003%/h). These results demonstrate that the rate of human musculoskeletal tissue collagen synthesis can be directly and robustly measured using stable isotope methodology.

Adult↗
PubMed1991

Functional status assessment.

Methodology of functional status assessment for musculoskeletal disorders has developed considerably in recent years. Reliability and sensitivity of measurements of physical functions are studied more systematically, and observer tests of activities of daily living functions have been developed with increased accuracy. A major area of interest, however, is reflected in studies of multidimensional assessments of functional limitations and the development of arthritis-specific questionnaires. The importance and difficulties of assessing function in clinical practice have been emphasized. Increasing interest among health planners and health economists in outcome measurements utilizing multidimensional functional assessments is evolving.

Activities of Daily Living↗
PubMed2003

Longer moment arm results in smaller joint moment development, power and work outputs in fast motions.

Effects of moment arm length on kinetic outputs of a musculoskeletal system (muscle force development, joint moment development, joint power output and joint work output) were evaluated using computer simulation. A skeletal system of the human ankle joint was constructed: a lower leg segment and a foot segment were connected with a hinge joint. A Hill-type model of the musculus soleus (m. soleus), consisting of a contractile element and a series elastic element, was attached to the skeletal system. The model of the m. soleus was maximally activated, while the ankle joint was plantarflexed/dorsiflexed at a variation of constant angular velocities, simulating isokinetic exercises on a muscle testing machine. Profiles of the kinetic outputs (muscle force development, joint moment development, joint power output and joint work output) were obtained. Thereafter, the location of the insertion of the m. soleus was shifted toward the dorsal/ventral direction by 1cm, which had an effect of lengthening/shortening the moment arm length, respectively. The kinetic outputs of the musculoskeletal system during the simulated isokinetic exercises were evaluated with these longer/shorter moment arm lengths. It was found that longer moment arm resulted in smaller joint moment development, smaller joint power output and smaller joint work output in the larger plantarflexion angular velocity region (>120 degrees/s). This is because larger muscle shortening velocity was required with longer moment arm to achieve a certain joint angular velocity. Larger muscle shortening velocity resulted in smaller muscle force development because of the force-velocity relation of the muscle. It was suggested that this phenomenon should be taken into consideration when investigating the joint moment-joint angle and/or joint moment-joint angular velocity characteristics of experimental data.

Ankle Joint↗
PubMed2001

Real-time spatial compound imaging: application to breast, vascular, and musculoskeletal ultrasound.

Real-time spatial compound imaging (SonoCT) is an ultrasound technique that uses electronic beam steering of a transducer array to rapidly acquire several (three to nine) overlapping scans of an object from different view angles. These single-angle scans are averaged to form a multiangle compound image that is updated in real time with each subsequent scan. Compound imaging shows improved image quality compared with conventional ultrasound, primarily because of reduction of speckle, clutter, and other acoustic artifacts. Early clinical experience suggests that real-time spatial compound imaging can provide improved contrast resolution and tissue differentiation that is beneficial for imaging the breast, peripheral blood vessels, and musculoskeletal injuries. Future development of real-time spatial compound imaging will help address the bulk of general imaging applications by extending this technology to curved array transducers, tissue harmonics, panoramic imaging, and three-dimensional sonography.

Breast Diseases↗
PubMed1994

Gene encoding a novel murine tissue inhibitor of metalloproteinases (TIMP), TIMP-3, is expressed in developing mouse epithelia, cartilage, and muscle, and is located on mouse chromosome 10.

Remodeling of the extracellular matrix (ECM) is an essential component of normal development and is also involved in the pathogenesis of arthritis and the spread of cancer. The matrix metalloproteinases and their natural inhibitors, the tissue inhibitors of metalloproteinases (TIMPs), play an important role in this context. We have isolated mouse cDNA clones encoding a novel member of the TIMP family, designated TIMP-3. We have assigned the Timp-3 locus to the [C1-D1] region of mouse chromosome 10 using both genetic and cytogenetic methods. The conceptual translation product of the Timp-3 cDNA shows a high degree of similarity with ChIMP-3, a recently cloned chicken metalloproteinase inhibitor, as well as significant structural similarity with the amino acid sequences of the previously isolated members of this family, TIMP-1 and TIMP-2. The pattern of expression of Timp-3 in the developing mouse embryo is distinct from that previously reported for Timp-1. Timp-3 is expressed in cartilage and skeletal muscle, in myocardium, in the skin, oral and nasal epithelium, in the newborn mouse liver, in the epithelium of some tubular structures such as the developing bronchial tree, oesophagus, colon, urogenital sinus, bile duct, in the kidney, salivary glands, and in the choroid plexus of the brain. The patterns of Timp-3 expression in surface epithelia and in the epithelial lining of many tubular organs suggests that TIMP-3 may be involved in regulating ECM remodeling during the folding of epithelia and during the formation, branching, and expansion of epithelial tubes. In the mouse placenta, expression is seen in the trophoblast, raising the possibility that TIMP-3 may be involved in regulating trophoblastic invasion of the uterus. We propose a role for TIMP-3 in musculoskeletal and cardiac development, in the morphogenesis of certain epithelial structures, and placental implantation.

Amino Acid Sequence↗
PubMed1994

Current status of musculoskeletal interventional radiology.

This article details many of the latest developments in the field of musculoskeletal interventional radiology. Some of the topics included in this discussion are percutaneous biopsy of musculoskeletal lesions, automated percutaneous discectomy, facet joint arthrography, percutaneous vertebroplasty, and percutaneous drainage of abscesses.

Biopsy, Needle↗
PubMed2005

How does persistent pain develop? An analysis of the relationship between psychological variables, pain and function across stages of chronicity.

The fear-avoidance model is an attempt to underscore the importance of cognitive and behavioral factors, in a chain of events linking pain to disability. However, it is not clear at what time point the psychological variables within the model begin to be prominent. The aim of this study was to investigate the role of these psychological variables in the development of a chronic musculoskeletal pain problem. Three stages of chronicity, defined by duration of pain, provided a proxy for the developmental process: <1 year (N=48), 1-3 years (N=47) and >3 years (N=89). Subjects completed questionnaires on fear of movement, catastrophizing, depression, pain and function. The results indicate that the relationship between fear of movement and function is moderated by the stage of chronicity. Regression analyses showed that fear of movement did not explain any variance in the group with pain duration <1 year. Fear of movement did explain variance in the groups with pain duration of 1-3 years and >3 years. This suggests that the time point in the development of a musculoskeletal pain problem might be an essential aspect of the importance of the relationship between psychological components and function.

Adult↗
PubMedDate not supplied

Randomised double blind placebo control study of adjuvant treatment with the metalloproteinase inhibitor, Marimastat in patients with inoperable colorectal hepatic metastases: significant survival advantage in patients with musculoskeletal side-effects.

BACKGROUND: A double blind placebo RCT of adjuvant treatment of the matrix metalloproteinase inhibitor, Marimastat, in patients with unresectable colorectal liver metastases showed no significant effect on survival. There was a statistically significant survival advantage for the marimastat-treated patients with musculoskeletal-side effects, (p = 0. < 000). AIM: To assess the effect of adjuvant Marimastat in patients with inoperable colorectal liver metastases (CRCLM). PATIENTS AND METHODS: Patients (n = 121) with CRCLM, stratified by treatments for their liver disease status prior to randomization, received adjuvant oral Marimastat treatment 10 mg b.d. or placebo for up to two years. RESULTS: Prognostic indicators such as number and size of hepatic lesions and percentage of liver replacement were well distributed between the treatment (57) and placebo (64) groups. There was no significant overall survival advantage for MARIMASTAT TREATMENT: 388 days, 95% CI, 277-499 and placebo 410 days, 95% CI 306-514, (p = 0.5) log rank. Musculoskeletal symptoms in hands, wrists and/or shoulders developed in 35 out of 57 Marimastat-treated patients. Median survival for 35 patients with musculoskeletal symptoms was 619 days, 95% CI, 360-878 days vs 184 days, 95% CI, 77-291, (p = 0.000 log rank) for 22 patients without symptoms. Musculoskeletal symptoms developed within three months of study treatment in 28 out of 35 (80%) patients. CONCLUSION: Increased survival in Marimastat-treated patients with musculoskeletal symptoms suggests that these may be biological evidence of tissue effect with resulting importance for dose optimisation of Marimastat. This should now be studied in the other randomized control trials of Marimastat.

Aged↗
PubMed2001

[Overuse injury syndromes in children and adolescents].

More and more children participate in sports competitions. The main difference between children and adults is that the former still grow and develop. An immature musculoskeletal system is less able to cope with repetitive biomechanical stress. Sites of overuse injury are the sites of rapid growth: epiphysis, apophysis, and growth plates. Overuse injuries in children most commonly affect the cartilage where it meets with the tendons (nonarticular chondrosis), cartilage and bone at the joints surfaces (primary and secondary osteochondrosis), or the bone and its physis (stress fractures). The most characteristic overuse injuries in children are physeal stress fracture and osteochondrosis. The basic diagnostic and treatment principles in children greatly correspond to those in adults. The prevention of overuse injuries in children is very important. To minimise the injuries, children should be encouraged to limit the length of exercise, use high-quality equipment properly, cross train, and participate in conditioning programs to develop strength and flexibility.

Adolescent↗