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PubMed1984

Epidemiology of musculoskeletal impairments and associated disability.

Data from the US Health and Nutrition Examination Survey (HANES I) of 1971-1975 confirm the high prevalence of musculoskeletal impairments among United States adults. Musculoskeletal impairments tend to be more prevalent among older persons, and persons with less education and with lower annual family incomes. Prevalence rates are slightly higher in females than in males, while Whites and non-Whites are affected with almost equal frequency. Among persons reporting a history of musculoskeletal symptoms, those who have some disability tend to be older, non-White, of lower education and income, and widowed, separated, or divorced. Persons with multiple parts of the body involved, or reporting that their symptoms are due to accident or injury are also especially likely to report disability. Taken as a whole, the data suggest that medical, social, and economic factors all play a role in determining whether a person with musculoskeletal impairment goes on to develop disability related to his or her impairment.

Adult↗
PubMedDate not supplied

Pain in multiple sclerosis: a biopsychosocial perspective.

Clinically significant pain has been found in as many as 65% of persons diagnosed with multiple sclerosis (MS). Acute pain conditions include trigeminal neuralgia, painful optic neuritis, and Lhermitte's syndrome. Chronic pain conditions such as dysesthesias in the limbs, joint pain, and other musculoskeletal or mechanical pain problems develop as a function of spasticity and deconditioning associated with MS. These painful conditions may respond to pharmacological, surgical, rehabilitation, and psychological interventions. However, unresolved pain, associated disability, and affective distress are common. In addition, efforts to manage MS and its associated symptoms, for example, may inadvertently cause osteoporosis and headache or other symptoms that may exacerbate pain and pain-related disability. Conversely, efforts to manage pain may have negative effects on the symptoms of MS (e.g., increased fatigue). A multidimensional approach to assessment and management that is guided by a comprehensive biopsychosocial model is recommended. Such an approach needs to consider the exacerbating nature of MS, MS-related pain, and interventions aimed at their management. Suggestions for future research on MS-related pain conclude the article.

Combined Modality Therapy↗
PubMed2003

Ultrastructural determinants of murine achilles tendon strength during healing.

The mechanisms by which tendon strength is established during growth and development and restored following injury are not completely understood and are likely to be complex, multifactorial processes. Several studies examining the relationship between mechanical behavior and ultrastructural characteristics of tendons and ligaments during growth and maturation suggest that collagen fibril diameter is strongly correlated with tendon strength. Because of the similarities between development and repair processes of musculoskeletal tissues, increases in tendon strength during healing may be related to increases in fibril ultrastructural parameters such as fibril size, numerical density, and area fraction. In this study, we compared murine Achilles tendons at various time points after tenotomy with sham-operated controls in tensile tests to failure and examined tendons using electron microscopy to assess collagen fibril ultrastructure. We found that in the 6-week period following Achilles tenotomy, fibril mean diameter remained significantly smaller than sham-side diameter by a factor of 2-3. Despite the persistently small fibril size, increasing numerical density resulted in a gradual increase in fibril area fraction. Biomechanical strength did not reach that of intact tendons until some time between 5 and 7 weeks, approximately the same time period when fibril area fraction began to approach sham values. These data suggest that parameters other than collagen fibril size are most responsible for increased tendon strength during healing.

Achilles Tendon↗
PubMed2006

Comparison of muscle activity associated with structural differences in dental hygiene mirrors.

PURPOSE: Ergonomic studies suggest that the commonly used pinch grasp, held in a static position, is a contributing factor for dental Hygienists' development of work-related musculoskeletal disorders (WMSDs) such as carpal tunnel syndrome (CTS), Trigger Thumb, de Quervain's stenosing tenosynovitis, and carpometacarpal (CMC) osteoarthritis. The pinch grasp is commonly used by the dental hygienist while holding the dental mirror in the non-dominant hand. In response to this concern, manufacturers are redesigning dental mirror handles. The value of these re-designed products is based solely on anecdotal evidence. To date, minimal research has been done to examine the non-dominant mirror hand. The purpose of this study was to objectively evaluate dental mirror handle design using surface electromyography (sEMG) to compare muscle activity associated with grasping the mirror. METHODS: This randomized controlled clinical trial utilized a two-by-two repeated measures statistical design. Data was collected on a convenience sample of 19 (N=19) healthy dental hygiene students in their last year of study. Data collection was divided into two phases to maintain a balanced study. The independent variables in phase I were diameter and weight. The independent variables in phase II were weight and padding. Muscle activity was measured while grasping various dental hygiene mirrors in 30-second increments using sEMG. Following data collection subjects designated which mirror felt most and least comfortable to compare subjective data with objective data. RESULTS: Three statistically significant results occurred. In phase II, padding (p=.01) demonstrated the largest reduction of muscle activity in the flexor pollicis brevis, by decreasing mean muscle activity by 3.7 microv. The interaction of diameter and weight (p=.01) in phase I reduced the mean muscle activity in the extensor digitorum by .8 microV and weight (p=.02) in phase II decreased the muscle activity in the extensor digitorum by .62 microV. Self-reports of comfort reported by the subjects in this study were not consistent with the measurements of muscle activity using sEMG. CONCLUSION: Ergonomic adaptations to dental hygiene mirror handles were associated with increases and decreases in muscle activity. The clinical impact of this is amplified as force is exerted. Furthermore, it may be possible to reduce WMSDs for dental hygienists by using instrument designs during the workday. Self-reports of comfort by the subjects in this study did not calibrate with the measurements of muscle activity using sEMG. Additional research is needed to further isolate the external variables of the study and to determine what actual reduction in muscle activity is significant for maintaining musculoskeletal health.

Adult↗
PubMed1988

[Clinical aspects of erythema migrans (Lyme) borreliosis].

Erythema migrans or Lyme borreliosis may be classified according to 3 stages. Erythema migrans is the typical initial lesion of the disease, often associated with general symptoms. Carditis, meningitis, musculoskeletal symptoms including arthralgia may develop in stage 2; arthritis (arthralgia), acrodermatitis chronica atrophicans (ACA), and encephalomyelitis may occur in stage 3. Borrelial lymphocytoma may be seen either in the early phase of the disease or along with the ACA. However, there is no definite therapeutical concept, so far. We recommend tetracyclines during the first stage, and high doses of penicillin G during stages 2 and 3 as well as for pregnant women.

Humans↗
PubMed1982

Physical training programs for mass scale use: effects on cardiovascular disease--facts and theories.

A significant increase in the numbers of Americans exercising during the 1970's has occurred, stimulated by an increased desire to improve the quality and, hopefully, the quantity of life. Fitness improvement is associated with an increase in HDL-cholesterol and a reduction in blood pressure, serum total cholesterol, LDL- and VLDL-cholesterol, triglycerides, glucose, uric acid and with weight loss and decrease in percent body fat. Correlations of risk factor changes with weight loss are greater than correlations with fitness improvement. After controlling for weight loss correlation of triglycerides and uric acid and percent body fat fitness improvement remains significant. Risk factor reduction has been shown to occur with fitness improvement without weight loss and with weight loss unaccompanied by fitness change, but the largest risk factor changes occur in the presence of both weight loss and fitness improvement. The aerobics exercise program concentrates on developing cardiorespiratory fitness first and musculoskeletal strength secondarily. Various physical activities can be quantified by means of a point system based on the intensity and duration of the activity. A fitness goal of 30 points per week for men and 24 points per week for women is reasonable and achievable by nearly all, regardless of age or sex. The most beneficial effect of exercise may be a biochemical mediated feeling of well-being.

Adult↗
PubMed1996

Correlation between anatomic features and low-field magnetic resonance imaging of the equine metacarpophalangeal joint.

OBJECTIVE: To expand our current knowledge and to establish limits of correlation between signal intensities of the magnetic resonance (MR) image and actual macroscopic and microscopic anatomic features of the imaged structures of the equine metacarpophalangeal joint (MCPJ). SAMPLE POPULATION: The right MCPJ was obtained from 4 adult horses that were euthanatized for reasons unrelated to the musculoskeletal system. PROCEDURE: The distal portion of the right forelimbs was collected from 4 equine cadavers. The bones were drilled to provide fixed reference points and examined by MR imaging. After imaging, the joints were sectioned for gross and histologic inspection. The MR images were aligned and correlated with digitized gross and histologic images to identify tissue types. RESULTS: Comparison of the images resulted in identification of different bone types, articular cartilage, and soft tissue structures of the equine MCPJ. CONCLUSION: Results provided relevant information regarding the appearance of the imaged tissues of the equine MCPJ. CLINICAL RELEVANCE: Although MR imaging does not have current clinical applications for equine practitioners, its wide acceptance as the imaging modality used for most human musculoskeletal derangements may aid in developing more realistic applications in equine medicine.

Animals↗
PubMed1993

The population health impact of arthritis. POHEM Workshop Group.

The workshop was convened to develop quantitative estimates of the incidence of progressional musculoskeletal diseases in order to estimate the population health impact of arthritis. Estimates were developed for (a) the prevalence of arthritis, (b) a weighting strategy to adjust for the quality of life for the range of health states associated with arthritis, and (c) transition probabilities to represent the likelihood of disease onset and progression through the range of possible health states. A simulation "game" was designed to follow the progression of a cohort of 200 healthy persons or persons with arthritis, creating the basis for the estimation of transition probabilities and thus generating simulated longitudinal data that allow calculation of the quantitative estimate of the burden of illness from musculoskeletal diseases within the Canadian population.

Arthritis↗
PubMed2006

Physical injury assessment of male versus female chiropractic students when learning and performing various adjustive techniques: a preliminary investigative study.

BACKGROUND: Reports of musculoskeletal injuries that some chiropractic students experienced while in the role of adjustor became increasingly evident and developed into the basis of this study. The main objective of this study was to survey a select student population and identify, by gender, the specific types of musculoskeletal injuries they experienced when learning adjustive techniques in the classroom, and performing them in the clinical setting. METHODS: A survey was developed to record musculoskeletal injuries that students reported to have sustained while practicing chiropractic adjustment set-ups and while delivering adjustments. The survey was modeled from similar instruments used in the university's clinic as well as those used in professional practice. Stratified sampling was used to obtain participants for the study. Data reported the anatomical areas of injury, adjustive technique utilized, the type of injury received, and the recovery time from sustained injuries. The survey also inquired as to the type and area of any past physical injuries as well as the mechanism(s) of injury. RESULTS: Data obtained from the study identified injuries of the shoulder, wrist, elbow, neck, low back, and mid-back. The low back was the most common injury site reported by females, and the neck was the most common site reported by males. The reported wrist injuries in both genders were 1% male complaints and 17% female complaints. A total of 13% of female respondents reported shoulder injuries, whereas less than 1% of male respondents indicated similar complaints. CONCLUSION: The data collected from the project indicated that obtaining further information on the subject would be worthwhile, and could provide an integral step toward developing methods of behavior modification in an attempt to reduce and/or prevent the incidence of musculoskeletal injuries.

Journal Article↗
PubMed2005

[Technical R & D and future applications].

Medical imaging is closely related to technological progress. During the last twenty years considerable progress enabled sonography to assess musculoskeletal structures more and more accurately. Development of new high frequency transducers, harmonic imaging, Doppler sonography and contrast agents resulted in better image quality and increased diagnostic accuracy. Nevertheless, future technologies may provide new additional functional and qualitative possibilities. The limitations of musculoskeletal sonography are rather well established. Some are probably due to physical "obstacles" that future technology could resolve. Elastography and heterogeneous tissues focalisation are examples of experimental applications which could push back the limits of our current practice. But the future of sonography cannot be reduced to a purely technological dimension. It also depends on clinical and paraclinical evaluation as well as on widely available education programs directed to promote a wider diffusion and improved clinical use of sonography.

Biomedical Research↗
PubMed2006

Defining the effect and mediators of two knowledge translation strategies designed to alter knowledge, intent and clinical utilization of rehabilitation outcome measures: a study protocol [NCT00298727].

BACKGROUND: A substantial number of valid outcome measures have been developed to measure health in adult musculoskeletal and childhood disability. Regrettably, national initiatives have merely resulted in changes in attitude, while utilization remains unacceptably low. This study will compare the effectiveness and mediators of two different knowledge transfer (KT) interventions in terms of their impact on changing knowledge and behavior (utilization and clinical reasoning) related to health outcome measures. METHOD/DESIGN: Physical and occupational therapists (n = 144) will be recruited in partnership with the national professional associations to evaluate two different KT interventions with the same curriculum: 1) Stakeholder-Hosted Interactive Problem-Based Seminar (SHIPS), and 2) Online Problem-Based course (e-PBL). SHIPS will consist of face-to-face problem-based learning (PBL) for 2 1/2 days with outcome measure developers as facilitators, using six problems generated in consultation with participants. The e-PBL will consist of a 6-week web-based course with six generic problems developed by content experts. SHIPS will be conducted in three urban centers in Canada. Participants will be block-allocated by a minimization procedure to either of the two interventions to minimize any prognostic differences. Trained evaluators at each site will conduct chart audits and chart-stimulated recall. Trained interviewers will conduct semi-structured interviews focused on identifying critical elements in KT and implementing practice changes. Interviews will be transcribed verbatim. Baseline predictors including demographics, knowledge, attitudes/barriers regarding outcome measures, and Readiness to Change will be assessed by self-report. Immediately post-intervention and 6 months later, these will be re-administered. Primary qualitative and quantitative evaluations will be conducted 6-months post-intervention to assess the relative effectiveness of KT interventions and to identify elements that contribute to changing clinical behavior. Chart audits will determine the utilization of outcome measures (counts). Incorporation of outcome measures into clinical reasoning will be assessed using an innovative technique: chart-stimulated recall. DISCUSSION: A strategy for optimal transfer of health outcome measures into practice will be developed and shared with multiple disciplines involved in primary and specialty management of musculoskeletal and childhood disability.

Journal Article↗
PubMed1994

Neurohumoral mediation of exercise-induced growth.

To assess exercise effects on growth, other variables modulating growth need to be taken into account. Endogenous control of growth proceeds from local actions of growth factors and dependence on nutrition abundance through guidance by growth hormone (GH) and other anabolic hormones to neuroendocrine suppression of growth. Nutrient abundance controls the reparative growth of lean body mass in adulthood by coupling it to anabolic endocrine reflexes. Growth is blocked when catabolic endocrine reflexes govern energy expenditure. The relationship between exercise intensity and growth is nonlinear. Growth is an intermittent process. Its expression and stimulation are dependent on ultradian and circadian rhythms of energy metabolism and neurohumoral release. High-resistance exercise selectively stimulates growth of the musculoskeletal system through expression of growth factor genes in the challenged tissues and without the GH guidance or abundant nutritional support. Habitual endurance exercise stimulates reparative growth of lean body mass through the neuroendocrine adaptations including increased pulsatile GH secretion. These also facilitate oxidative utilization of storage lipids thereby contributing to the regulation of body composition in adulthood. In the absence of sufficient high-resistance and endurance exercise regulation of adult body mass is impaired: excess LBM is lost during energy deficit, and excess fat accumulates during energy surplus.

Adaptation, Physiological↗
PubMed2004

Aboriginal health in Aboriginal hands: development, delivery and evaluation of a training programme for Aboriginal health workers to promote the musculoskeletal health of Indigenous people living in a rural community.

CONTEXT: Indigenous Australians living in rural communities suffer from multiple musculoskeletal problems that significantly impair their activities of daily living. They commonly report physical disability and 'having learned to live with their pain'. A pilot, accredited musculoskeletal training program in the form of a sports massage course was designed and implemented in an attempt to address modifiable, commonly-presenting musculoskeletal conditions in this community. ISSUE: Sports massage was taught to 20 participant Aboriginal Health workers (AHWs) and community Elders at Durri Aboriginal Corporation, New South Wales, Australia. Sports massage was chosen as the vehicle for skills development because sport was widely valued in the community. The participants were taught a variety of theoretical and massage skills in the 2 week course using the informal 'round table' techniques developed by Booroongen Djugun College, NSW, Australia. The course was evaluated positively by participants. Because the course was developed according to community guidelines it had high cultural acceptability. LESSONS: Sports massage skills have been adapted for treatment of patients with chronic illness and stress within the community. Development of the course according to community needs was essential for acceptance, as was the active involvement of AHWs in all phases. For sustainability, such courses require appropriate funding.

Journal Article↗
PubMed1998

Power Doppler Sonography: Applications in Musculoskeletal Imaging.

Power Doppler sonography (PDS) is a recently developed technique that depicts moving blood volume within tissues. The enhanced sensitivity of PDS makes it possible to depict soft tissue vascularity, facilitating its role in the evaluation of musculoskeletal inflammatory diseases. A broad range of new and potential applications of PDS in the musculoskeletal system will be described including its use in the setting of bursal, tendon, articular, and muscle diseases, and in the evaluation of fluid collections and soft tissue masses.

Journal Article↗
PubMed2001

Pharmacologic pain treatment of musculoskeletal disorders: current perspectives and future prospects.

OBJECTIVE: The authors aimed to provide an educational update on the current evidence of the effectiveness of drug therapy in the treatment of musculoskeletal pain and to offer a perspective of possible future developments. DESIGN: The authors used a pragmatic review of data provided by available systematic reviews and seminal controlled studies pertaining to the treatment of regional musculoskeletal pain problems. RESULTS: Epidural steroids may offer limited, short-term benefit for sciatica. Local injections of steroids are either ineffective or provide short-lasting benefits. Nonsteroidal anti-inflammatory drugs and opioids reduce pain, but the effect size is modest. The literature does not support convincingly the use of antidepressants. Certain muscle relaxants may be useful in the treatment of back pain. Hyaluronic acid, neutraceutical agents, avocado-soybean unsaponifiable agents, oxaceprol and diacerein may be effective in the treatment of osteoarthritis, but the information regarding these new agents does not allow wholesale endorsement of these substances. Selective epidural injection of steroids at a target nerve root approached through the intervertebral foramin has the potential to replace the traditional epidural approach. Long-acting, C--fiber-specific local anesthetics are under investigation and could provide long-lasting pain relief without motor or sensory impairment. In the future, central hypersensitivity in chronic musculoskeletal pain might be treated using antagonists of the N-methyl-D-aspartate receptor. Cannabinoid agents produce antinociception and prevent experimentally induced hyperalgesia in animals, and they may find a role in pain management. Methods to optimize drug combinations are available. CONCLUSIONS: The effectiveness of the currently available drugs in the treatment of musculoskeletal pain conditions is disappointing. Recent developments may open new perspectives in this area of pain medicine.

Animals↗
PubMed2005

Orthopedic disorders in neonatal foals.

The first month of life is a vulnerable time for foals. They must adjust to their environment while they are still compromised immunologically, and their musculoskeletal system is rapidly growing and adjusting to stresses from an increasing amount of exercise. Therefore, if a foal is born with or acquires an abnormality or disease related to the musculoskeletal system, rapid adjustments must be made to allow the foal to grow and respond so that future athletic performance will not be compromised. Problems must be identified early, which requires thorough examinations. This article summarizes treatment options for orthopedic disorders that present or become clinically evident within the first month of life.

Age Factors↗
PubMed1991

Curriculum for musculoskeletal radiology.

Although general suggestions have been made regarding a radiology residency curriculum, no specific list of entities has been offered. Over the past ten years, we have developed a resident-run morning conference in musculoskeletal radiology that is supervised by faculty and covers a specific curriculum. We offer our curriculum as an example that may assist other departments in developing their own curricula.

Curriculum↗