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PubMed2005

Development of a portable 3D ultrasound imaging system for musculoskeletal tissues.

3D ultrasound is a promising imaging modality for clinical diagnosis and treatment monitoring. Its cost is relatively low in comparison with CT and MRI, no intensive training and radiation protection is required for its operation, and its hardware is movable and can potentially be portable. In this study, we developed a portable freehand 3D ultrasound imaging system for the assessment of musculoskeletal body parts. A portable ultrasound scanner was used to obtain real-time B-mode ultrasound images of musculoskeletal tissues and an electromagnetic spatial sensor was fixed on the ultrasound probe to acquire the position and orientation of the images. The images were digitized with a video digitization device and displayed with its orientation and position synchronized in real-time with the data obtained by the spatial sensor. A program was developed for volume reconstruction, visualization, segmentation and measurement using Visual C++ and Visualization toolkits (VTK) software. A 2D Gaussian filter and a Median filter were implemented to improve the quality of the B-scan images collected by the portable ultrasound scanner. An improved distance-weighted grid-mapping algorithm was proposed for volume reconstruction. Temporal calibrations were conducted to correct the delay between the collections of images and spatial data. Spatial calibrations were performed using a cross-wire phantom. The system accuracy was validated by one cylinder and two cuboid phantoms made of silicone. The average errors for distance measurement in three orthogonal directions in comparison with micrometer measurement were 0.06+/-0.39, -0.27+/-0.27, and 0.33+/-0.39 mm, respectively. The average error for volume measurement was -0.18%+/-5.44% for the three phantoms. The system has been successfully used to obtain the volume images of a fetus phantom, the fingers and forearms of human subjects. For a typical volume with 126 x 103 x 109 voxels, the 3D image could be reconstructed from 258 B-scans (640 x 480 pixels) within one minute using a portable PC with Pentium IV 2.4 GHz CPU and 512 MB memories. It is believed that such a portable volume imaging system will have many applications in the assessment of musculoskeletal tissues because of its easy accessibility.

Equipment Design↗

PubMed2006

Development of a taxonomy to describe massage treatments for musculoskeletal pain.

BACKGROUND: One of the challenges in conducting research in the field of massage and bodywork is the lack of consistent terminology for describing the treatments given by massage therapists. The objective of this study was to develop a taxonomy to describe what massage therapists actually do when giving a massage to patients with musculoskeletal pain. METHODS: After conducting a review of the massage treatment literature for musculoskeletal pain, a list of candidate techniques was generated for possible inclusion in the taxonomy. This list was modified after discussions with a senior massage therapist educator and seven experienced massage therapists participating in a study of massage for neck pain. RESULTS: The taxonomy was conceptualized as a three level classification system, principal goals of treatment, styles, and techniques. Four categories described the principal goal of treatment (i.e., relaxation massage, clinical massage, movement re-education and energy work). Each principal goal of treatment could be met using a number of different styles, with each style consisting of a number of specific techniques. A total of 36 distinct techniques were identified and described, many of which could be included in multiple styles. CONCLUSION: A new classification system is presented whereby practitioners using different styles of massage can describe the techniques they employ using consistent terminology. This system could help facilitate standardized reporting of massage interventions.

Body Image↗

PubMedDate not supplied

[Work-related musculoskeletal disorders in dentistry professionals. 2. Prevention, ergonomic strategies and therapeutic programs].

In dental professionals the risk of developing work-related musculoskeletal disorders (WMSD) can be minimized through a combination of prevention, ergonomic strategies, and specific therapeutic programs. Prevention includes early identification of symptoms, analysis of working posture and activity, and the evaluation of equipment (such as dental instruments, position of the dental unit, patient and operator chairs, and lighting). The ergonomic strategies are based on identifying the best daily timetable (including periodic pauses) and most efficient team organization, as well as establishing the correct position that should be held at the patient chair. Finally specific therapeutic programs are very important in preventing or treating WMSD. In fact, fitness exercises such as mobilization, stretching or muscular and cardiovascular training are recognized as fundamental for dental professionals, and when WMSD occurs physiatric care and physical therapy are recommended.

Dental Equipment↗

PubMedDate not supplied

Early identification of patients at risk of developing a persistent back problem: the predictive validity of the Orebro Musculoskeletal Pain Questionnaire.

OBJECTIVE: To test the predictive utility of the Orebro Musculoskeletal Pain Screening Questionnaire in identifying patients at risk for developing persistent back pain problems. DESIGN: Prospective, where participants completed the questionnaire and their cases were followed for 6 months to assess outcome with regard to pain, function, and absenteeism due to sickness. PARTICIPANTS: One hundred seven patients, recruited from seven primary care units. RESULTS: Discriminant analyses showed that the items on the questionnaire were significantly related to future problems. For absenteeism due to sickness, 68% of the patients were correctly classified into one of three groups, whereas an even distribution would have produced 33%. The analyses for function correctly classified 81%, and for pain 71%, into one of two groups, compared with a chance level of 50%. A total score analysis demonstrated that a cutoff score of 90 points had a sensitivity of 89% and a specificity of 65% for absenteeism due to sickness, and a sensitivity of 74% and a specificity of 79% for functional ability. CONCLUSIONS: The results underscore that psychological variables are related to outcome 6 months later, and they replicate and extend earlier findings indicating that the Orebro Screening Questionnaire is a clinically reliable and valid instrument. The total score was a relatively good predictor of future absenteeism due to sickness as well as function, but not of pain. The results suggest that the instrument could be of value in isolating patients in need of early interventions and may promote the use of appropriate interventions for patients with psychological risk factors.

Acute Disease↗

PubMedDate not supplied

American Nurses Association position statement on elimination of manual patient handling to prevent work-related musculoskeletal disorders.

In order to establish a safe environment for nurses and patients, the American Nurses Association (ANA) supports actions and policies that result in the elimination of manual patient handling. Patient handling, such as lifting, repositioning, and transferring, has conventionally been performed by nurses. The performance of these tasks exposes nurses to increased risk for work-related musculoskeletal disorders. With the development of assistive equipment, such as lift and transfer devices, the risk of musculoskeletal injury can be significantly reduced. Effective use of assistive equipment and devices for patient handling creates a safe healthcare environment by separating the physical burden from the nurse and ensuring the safety, comfort, and dignity of the patient.

American Nurses' Association↗

PubMed1998

A three-dimensional musculoskeletal database for the lower extremities.

A three-dimensional musculoskeletal database of the lower extremities has been developed for use in human musculoskeletal models. The locations of idealized muscle attachments on the pelvis, both femurs, both tibias and fibulas, and both feet were accurately digitized for 52 dried skeletal specimens. The mean specimen heights were 177.5 cm (male) and 166.2 cm (female) and the mean specimen age at the time of death was 48.8 yr. Statistical accumulation and scaling techniques were used to generate highly representative normative models, which were divided into groups and tested for differences based on gender and race. From the test results, the pelvis was divided into a male model (RMS = 8.6 mm), a black female model (RMS = 7.0 mm) and a white female model (RMS = 7.3 mm). The foot was separated into black (RMS = 3.7 mm) and white models (RMS = 3.6 mm). Single models were used for the femur (RMS = 6.5 mm) and the tibia/fibula (RMS = 3.7). Containing over 12000 anatomical landmarks digitized from 52 dried skeletons, this study represents an improvement over previous databases by an order of magnitude.

Black People↗

PubMed2001

Effects of computer monitor viewing angle and related factors on strain, performance, and preference outcomes.

A model of visual and musculoskeletal strain associated with computer monitor placement was developed. The main premise of which is that monitor placement decisions must take into consideration development of both visual and musculoskeletal strains. Certain factors in the model that were thought to affect one or both types of strain. or that were considered important to rule out for effect, were tested in a lab setting. These factors were viewing angle (eye level, midlevel, low level), monitor size (14 in., 19 in.), keyboard familiarity (touch typist, nontouch typist), and task (reading, mousing, typing). Outcomes included indicators of visual and musculoskeletal strain, preference, and performance. Muscle activity was generally greater for the low viewing angle, for the standard monitor (14 in.), and for non-touch typists. Participants preferred the midlevel placement. Task performance was slightly diminished with eye-level placement. Results are interpreted in relation to the model and to several hypotheses that were formed to focus the inquiry. Actual or potential applications of this research include monitor placement decisions in the design or modification of computer workstations.

Adult↗

PubMed1995

The effects of exercise on growth.

The way in which exercise influences statural, hypertrophic and reparative growth is examined from the perspective of the human lifespan. Statural growth depends on a neuroendocrine programme which channels nutrient energy towards increments in lean body mass. Exercise can facilitate statural growth and is a necessary stimulus for reparative growth through its stimulatory effects on secretion of growth hormone (GH) and other anabolic hormones. An exercise-associated increase in GH secretion is a response to acute or prolonged exercise-induced fuel shortage that directs metabolism towards utilisation of lipids and promotes growth. Exercise can transiently block the expression of statural growth by competitively removing the necessary nutritional support for growth. Statural growth retardation can be corrected by catch-up growth, but stunting may also be permanent (depending on the timing and magnitude of the energy drain). Hypertrophic growth is less dependent on hormonal and nutritional support than statural growth, and exercise provides the necessary mechanical stress for growth and remodelling of the musculoskeletal system. Excessive mechanical strain may suppress hypertrophic growth. The intermittent nature of exercise provides temporal organisation that is necessary for the normal operation of cellular growth process. Exercise by pregnant women does not appear to influence fetal growth. Evaluation of the effect of exercise on growth of children and adolescents is complicated by nonrandom selection of individuals for participation in organised sports, and by lack of information on the magnitude of exercise-induced energy drain. Exercise is essential for regulation of body composition in adulthood. It provides mechanical and metabolic stimuli that are necessary for hypertrophy of the musculoskeletal system and increased GH secretion for reparative growth.

Adolescent↗

PubMedDate not supplied

[Musculoskeletal disorders caused by repetitive trauma of the upper limbs: a paradigm of the development of occupational diseases and industrial medicine].

The work related musculoskeletal disorders (WMSDs) are a wide range of inflammatory and degenerative disease and disorders that result in pain and functional impairment. All available definitions for WMSDS are non consistent and require in each individual case and in each group study careful identification of symptoms, signs and findings. WMSDs, as a mutifactorial work related disease, are associated to physical and psychosocial factors at work and other individual, sociocultural factors. They are therefore good paradigm for the changing occupational risks and illness and for the new methods that the occupational medicine and the preventive disciplines have to set up. The research and standardization needs appear to be more evident for framing pathogenesis, biological response and pathology of WMSDs and mainly for risk factors assessment, since suitable analytical methods are still not available. The agreement of valid standardised methods (guide lines) for the evaluation of working conditions and assessment of risk factors is required, taking due regard to the multidisciplinary approach both in biological and medical areas and in poly technical ones. Finally attention would be paid to the strategy for prevention, implementing ergonomic programmes, health surveillance, adequate training to work, aimed to primary prevention of WMSDs.

Arm Injuries↗

PubMed2003

Musculoskeletal pain in the obese: a comparison with a general population and long-term changes after conventional and surgical obesity treatment.

Obesity is associated with musculoskeletal pain and osteoarthritis. This study compares the prevalence of work-restricting musculoskeletal pain in an obese and a general population and investigates changes in the incidence of and recovery from musculoskeletal pain after bariatric surgery or conventional obesity treatment. A random sample of 1135 subjects from a general population was compared with 6328 obese subjects in the Swedish obese subjects (SOS) study. For the obese subjects, information about musculoskeletal pain was also collected 2 and 6 years after obesity surgery or the start of non-surgical treatment. In both sexes, self-reported work-restricting pain in the neck and back area and in the hip, knee and ankle joints was more common in the obese subjects than in the general population (odds ratios (ORs) ranging from 1.7 to 9.9, P<0.001). Operated obese women had a lower incidence of work-restricting pain in the knee and ankle joints compared with the conventionally treated control group over 2 and 6 years (ORs 0.51-0.71). Among subjects reporting symptoms at baseline, the recovery rate for pain in the knee and ankle joints in men and pain in the neck and back and in the hip, knee and ankle joints in women improved in the surgical group compared with the control group after 2 years (ORs 1.4-4.8). Obese subjects have more problems with work-restricting musculoskeletal pain than the general population. Surgical obesity treatment reduces the long-term risk of developing work-restricting musculoskeletal pain and increases the likelihood of recovering from such pain.

Adult↗

PubMed1998

Education in rheumatology.

The increasing burden of arthritis and musculoskeletal conditions in both developed and developing societies is shown by national and community-based surveys. Many complaints are sufficiently severe to cause disability and loss of time from work. Medical care is provided most often by primary health care physicians who are often inadequately trained to handle these conditions. Better medical student education that focuses on common community problems remains crucial. Strong rheumatology units with a commitment to teaching and research are necessary to redress any imbalance as new curricula are developed. Such units also have to take responsibility for primary health care physician and nurse education in how to manage common musculoskeletal problems. Arthritis Foundations and patient support groups have a role in public education and in increasing community knowledge on the causes and prevention of some common conditions so as to assist in improving overall care. New initiatives in professional and public education have given encouraging results, but further changes in community attitudes and perceptions of chronic conditions are necessary and are within the scope of most Arthritis Foundations' key objectives.

Arthritis, Rheumatoid↗

PubMed2026

DNA methylation signatures in skeletal muscle associated with physical function in healthy older adults.

Despite the substantial variability in physical function among older adults, the molecular mechanisms remain poorly characterized, particularly within skeletal muscle. This study aimed to determine the patterns of DNA methylation in skeletal muscle associated with physical function in healthy older adults. We analyzed DNA methylation (EPIC v2 array; 875,554 CpG sites) in skeletal muscle from 92 healthy older adults (median age 74; 62% female). Associations were examined across five phenotypes: Short Physical Performance Battery (SPPB), 6-min walk test (6MWT), handgrip strength, perceived disability (PAT-D), and lifestyle health (modified Life's Essential 8). Linear regression models adjusted for age, sex, race, BMI, and muscle fiber composition. Genomic inflation corrected via the BACON method (FDR < 0.05). Gene set enrichment analysis was performed on suggestive hits (FDR < 0.1). We identified significant differentially methylated probes (DMPs) and regions (DMRs) across all phenotypes: SPPB (70 DMPs, 22 DMRs), 6MWT (16 DMPs, 566 DMRs), handgrip strength (2 DMRs), PAT-D (19 DMPs, 1 DMR), and lifestyle health (2 DMPs). DMRs largely overlapped promoters. Identified genes overlapped known musculoskeletal and neurological GWAS hits, including RUNX2 and FOXL1 (bone mineral density), IGFBP3 (muscle mass), and NEK1 and SHANK1 (neurological function). Enrichment analysis revealed that 6MWT-associated genes relate to nervous and skeletal system development, while handgrip-associated genes involve cytoskeletal dynamics and protein assembly. Epigenetic variation in aging skeletal muscle is associated with physical function. The enrichment of pathways related to nervous and musculoskeletal development suggests specific epigenetic mechanisms underlying functional decline, offering potential targets for intervention in older adults.

DNA methylation↗

PubMed2006

Comparison of musculoskeletal ultrasound practices of a rheumatologist and a radiologist.

OBJECTIVE: There is considerable debate regarding the role of the rheumatologist ultrasonographer and how this development will impact on musculoskeletal ultrasound (MSUS) performed by radiologists. We compared the MSUS practices of a rheumatologist and a radiologist working within the same National Health Service Trust. METHODS: A retrospective review of MSUS reports of consecutive scans performed by a consultant rheumatologist with a special interest in MSUS and a consultant musculoskeletal radiologist. Reports were analysed for referring specialties, indications for MSUS, joint regions scanned, MSUS findings, frequency with which patients were referred for injection and how often injection was performed. RESULTS: A total of 170 patients were referred to the rheumatologist for MSUS of 282 joint regions (91% referred by rheumatologists). Of those, 84 (49%) patients had MSUS examination of more than one joint region, with up to five regions scanned per sitting. One hundred patients were referred to the radiologist for MSUS of 111 joint regions (49% referred by orthopaedic surgeons). The most frequently requested primary indication for MSUS performed by the rheumatologist was detection of synovitis [74 (44%) patients] while MSUS performed by the radiologist was most frequently for assessment for major structural changes [44 (44%) patients]. The rheumatologist performed MSUS-guided injection in 59 of 170 (35%) patients scanned and the radiologist in 13 of 100 (13%). CONCLUSION: MSUS performed by the rheumatologist was predominantly requested by rheumatologists to aid diagnosis of synovial and tendon inflammation and to guide injections, while MSUS performed by the radiologist was predominantly requested by orthopaedic surgeons to aid diagnosis of structural pathology. Curriculums in MSUS designed for rheumatologists may need to place appropriate emphasis on the identification of synovial and tendon inflammation, and injection guidance.

England↗

PubMed1990

Sonography of the musculoskeletal system.

Improved technology and the development of high-resolution transducers have made sonography of the structures of the musculoskeletal system possible. The vast majority of scientific reports on the value of sonography for imaging musculoskeletal abnormalities have been written only in the last decade. Sonography has several inherent advantages: it is relatively inexpensive, allows comparison with the opposite normal side, uses no radiation, and can be performed at bedside or in the operating room if necessary. The advent of MR imaging has revolutionized musculoskeletal imaging and may be used in many instances rather than sonography for evaluating the same abnormalities or anatomic structures. It is important, however, to keep in perspective what the different imaging techniques have to offer, and, if one is just as efficacious as the other, the least invasive and least expensive should be chosen whenever possible. The goal of this article is to review the applications of sonography to the evaluation of musculoskeletal disorders including tendon disease, soft-tissue masses, identification of foreign bodies, osteomyelitis, cellulitis, and certain joint abnormalities.

Aneurysm↗

PubMedDate not supplied

Deep vein thrombosis associated with pediatric musculoskeletal sepsis.

Deep vein thrombosis (DVT) is uncommon in children but can occur given certain circumstances. The authors describe four children in whom DVT developed in association with musculoskeletal sepsis. One child died. Prothrombotic screens were performed on the three surviving children, showing normal hematologic parameters. The severity of DVT complicating musculoskeletal sepsis is emphasized, particularly the potential for septic embolic complications. Deep vein thrombosis should be considered in any child with musculoskeletal sepsis, particularly when a limb is severely swollen or when there are pulmonary septic emboli.

Bone Diseases, Infectious↗

PubMed1998

Do psychological factors predict changes in musculoskeletal pain? A prospective, two-year follow-up study of a working population.

Our aim was to determine the predictive value of some psychometric instruments for the development and persistence of musculoskeletal pain. In 452 subjects, pain in the shoulder, neck, and low back during the preceding year was assessed at baseline, one year, and two years' follow-up. Psychological distress, depression, self-efficacy beliefs, subjective work prognosis, disability, and work characteristics were assessed at baseline. The best predictor of future pain was disability. The psychometric measures did not predict changes in pain. The explanatory power of the variables in the multivariate analyses was low. Perceived disability in persons with musculoskeletal symptoms should be acknowledged early. The traditional research paradigm focusing on a few hypothetically relevant variables does not take into account the reflective, dynamic, reciprocal nature of human behavior during the process of recovery from or development of a pain problem.

Adult↗

PubMed2006

Sex differences in the rate of fatigue development and recovery.

BACKGROUND: Many musculoskeletal injuries in the workplace have been attributed to the repetitive loading of muscle and soft tissues. It is not disputed that muscular fatigue is a risk factor for musculoskeletal injury, however the disparity between gender with respect to muscular fatigability and rate of recovery is not well understood. Current health and safety guidelines do not account for sex differences in fatiguability and may be predisposing one gender to greater risk. The purpose of this study was to quantify the sex differences in fatigue development and recovery rate of lower and upper body musculature after repeated bouts of sustained isometric contractions. METHODS: Twenty-seven healthy males (n = 12) and females (n = 15) underwent bilateral localized fatigue of either the knee extensors (male: n = 8; female: n = 8), elbow flexors (male: n = 8; female: n = 10), or both muscle groups. The fatigue protocol consisted of ten 30-second sub-maximal isometric contractions. The changes in maximum voluntary contraction (MVC), electrically evoked twitches, and motor unit activation (MUA) were assessed along with the ability to control the sustained contractions (SLP) during the fatigue protocol using a mixed four-factor repeated measures ANOVA (gender x side x muscle x time) design with significance set at p < 0.05. RESULTS: There was a significant loss of MVC, MUA, and evoked twitch amplitude from pre- to post-fatigue in both the arms and legs. Males had greater relative loss of isometric force, a higher rate of fatigue development, and were less capable of maintaining the fatiguing contractions in the legs when compared to the females. CONCLUSION: The nature of the induced fatigue was a combination of central and peripheral fatigue that did not fully recover over a 45-minute period. The results appear to reflect sex differences that are peripheral, and partially support the muscle mass hypothesis for explaining differences in muscular fatigue.

Journal Article↗

PubMed2003

Aging or osteoarthritis: which is the problem?

OA is not an inevitable consequence of aging, but aging-related changes in the musculoskeletal system increase the risk of developing OA if other risk factors are also present. The joint is a functioning biomechanical unit of the neuromuscular system. Factors that contribute to the development of joint pain and loss of joint function include those associated with aging, those associated with underuse or misuse of the musculoskeletal system, and those associated directly with the development of OA. Complex interactions exist among many of these factors such as strength, balance, and proprioception, which are affected by aging, underuse, and OA. Many older adults who have joint pain and loss of function do not exhibit structural changes of OA that can be detected by standard radiography. When structural damage is present, its contribution to pain and disability is not always clear. In the absence of pharmacologic agents that can prevent the progression of structural damage in OA, management of older adults who have joint pain and loss of function should focus on improving neuromuscular function and preventing further declines.

Aged↗