Recreation. Golf injuries.
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Back Injuries↗
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Modern treatment of injuries to the back.
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Back↗
The management of penetrating injuries of the back.
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Abdomen, Acute↗
Changes in lumbar lordosis modify the role of the extensor muscles.
STUDY DESIGN: Fiber angles of longissimus thoracis and iliocostalis lumborum at L3 were documented in vivo, using high resolution ultrasound, with the lumbar spine in neutral curve and when fully flexed. OBJECTIVES: To evaluate the effect of changes in lumbar curvature on the mechanics of these muscles. BACKGROUND: Full flexion modifies the failure tolerance of the lumbar spine, determines the load distribution among muscle and passive tissues, and modulates the types of tissue damage that occur. Related to this issue are the possible changes in muscle line of action with full flexion which changes the ability of the spine to support shear loads. METHODS: Nine normal men and 5 normal women were scanned in three positions: (1) an upright standing posture; (2) with the hips flexed to approximately 30 degrees and the spine fully flexed; (3) hips flexed but the spine returned to a neutral curvature. RESULTS: Mean longissimus/iliocostalis fiber angles for upright standing, hips flexed-spine flexed, and hips flexed-spine neutral lordosis were 25. 7 degrees, 10.7 degrees and 28.3 degrees, respectively. CONCLUSIONS: Anterior shear load on the lumbar spine has been recently shown to be highly related to the risk of reporting a back injury. Bending forward allowing the spine to fully flex changes the line of action of the largest lumbar extensor muscles compromising their role to support anterior shear forces. Relevance Fiber angles of longissimus thoracis and iliocostalis lumborum were documented with high resolution ultrasound at L3, with the spine in neutral curvature and fully flexed. Full lumbar flexion changes the line of action of these muscle compromising their role to support anterior shear forces on the spine - anterior shear forces have been recently documented to be highly related to the risk of reporting a back injury.
Adolescent↗
Golf injuries and rehabilitation.
There are more than 25 million golfers in the united States, and many have an injury related to golf. Low back injuries are the most common golf injuries, followed by elbow injuries. Successful treatment of golf injuries often includes modification of the golf swing. Adaptations allow many individuals, including those who are physically challenged, to enjoy playing golf.
Adult↗
Is bowling workload a risk factor for injury to Australian junior cricket fast bowlers?
OBJECTIVES: To examine whether bowling workload is a risk factor for overuse injury to Australian junior cricket fast bowlers and to evaluate the appropriateness of current bowling workload guidelines. METHODS: Forty four male fast bowlers (mean (standard deviation) age 14.7 (1.4) years) were monitored prospectively over the 2002-2003 season. Bowlers completed a daily diary to record bowling workloads and self reported injuries, which were validated by a physiotherapist. Bowling workload prior to the first injury (for those bowlers who were injured) was compared to workload across the whole season for uninjured bowlers. RESULTS: Eleven (25%) bowlers reported an overuse-type injury, with seven of these sustaining a back injury. Injured bowlers had been bowling significantly more frequently than uninjured bowlers (median number of days since the previous bowling day: 3.2 v 3.9 days, Mann-Whitney U = 105.0, p = 0.038). Compared with bowlers with an average of > or =3.5 rest days between bowling, bowlers with an average of <3.5 rest days were at a significantly increased risk of injury (risk ratio (RR) = 3.1, 95% confidence interval (CI) 1.1 to 8.9). There were also trends towards an increased risk of injury for those who bowled an average of > or =2.5 days per week (RR = 2.5, 95% CI 0.9 to 7.4) or > or =50 deliveries per day (RR = 2.0, 95% CI 0.7 to 5.4). CONCLUSIONS: This study has identified high bowling workload as a risk factor for overuse injury to junior fast bowlers. Continued research is required to provide scientific evidence for bowling workload guidelines that are age-specific for junior fast bowlers.
Adolescent↗
SPECT in avulsion injury of the multifidus and rotator muscles of the lumbar region.
A 37-year-old man was investigated for a work-related back injury with plain radiography, CT scan, bone scintigraphy, and SPECT. SPECT was able to demonstrate multiple sites of increased isotope uptake not seen on plain radiographs, CT scan, or planar images. Consequently, the diagnosis of avulsion injury of the multifidus and rotator muscles of the lumbar region was made. SPECT appears to have a role in the specific diagnosis of work-related back injuries.
Adult↗
Predictors of returning to work.
An investigation of predictors of returning to work in a sample of physically injured persons who are receiving workers' compensation benefits and vocational rehabilitation is presented. One hundred fourteen injured subjects (86 with back injury; 28, other injury) undergoing vocational rehabilitation and receiving workers' compensation benefits were assessed on demographic, emotional, cognitive, financial incentive, and miscellaneous variables. Predictors for returning to work were identified using stepwise logistic regression. Patients with moderate or severe depression, defined as a score greater than 16 on the Beck Depression Inventory (BDI), were significantly less likely to return to work following vocational rehabilitation efforts than patients with less severe depression (for back-injured patients, odds ratio (OR) = 31, 95% CI [8.8, 108]). BDI scores correctly classified 84 percent of the back-injury and 86% of the other-injury groups with respect to their return to work. The level of workers' compensation benefit was the only variable that added (marginally) to the predictive power of the BDI. In a physically injured population receiving workers' compensation benefits, who are judged to be not clearly permanently disabled, level of depressive symptoms is a strong predictor of returning to work. Caution is warranted in using the BDI as the sole determinant in a forensic situation for making a real-world prediction, as BDI responses are easy to fake. Treatment of concurrent depression is an important component of helping physically injured workers resume gainful employment.
Accidents, Occupational↗
Factors contributing to the development of low back pain in industrial workers.
A survey to elicit information on factors related to the causes of low back pain in industrial workers was made. Questionnaires were sent to 1000 workers in various industrial occupations including hospital workers, and 509 responses were received. In this population, back injuries were more frequent among women, as were absences for other illness. Most employees sustaining back injury subsequently returned to their original job. This survey serves as a pilot study indicating areas from which objective results may be obtained and directions of improvement in future questionnaires.
Absenteeism↗
Persistent medical problems and permanent impairment five years after occupational injury.
In a comprehensive, one year material of 1,785 occupational injuries in the township of Umeå, Sweden. 1985-04-01/1986-03-31, the proportion of persons with persistent medical problems, two years after the event, was 39%. These were investigated again in 1990, five years after the event, and the proportion of persons with persistent medical problems had dropped to 23%. Around 4% of the injured had a definable permanent medical impairment, most often caused by a fracture, luxation or amputation of an upper extremity. Back injuries, however, were the most frequent cause for persistent medical problems, mostly in the form of ache and pain. Persons in health care, social and nursing occupations had a twice as high proportion of persistent problems as the average in the material. Of the persons that reported persistent medical problems when interviewed in 1990, one in three had changed his leisure time activities, one in five had changed jobs, and one in ten had retired early or was on long term sick leave. The group of early retired and persons on long term sick leave had a large proportion of young females and old males. The reader is reminded that conclusions and comparisons must be made with reference to the assessment and benefit structure in the particular systems of social insurance and workers' compensation.
Adult↗
Prediction of injury caused by penetrating wounds to the abdomen, flank, and back.
Controversy about the appropriate evaluation of penetrating abdominal, flank, and back injuries prompted this retrospective review of 311 patients at an urban level 1 trauma center over 5 years. Seventy-five (24%) patients sustained gunshot wounds to the abdomen. All patients with gunshot wounds underwent exploratory laparotomy; results of 67 laparotomies (89%) were positive. Of 236 patients sustaining stab wounds (140 abdominal wounds, 51 flank wounds, 26 back wounds, and 19 wounds to multiple sites), 147 were treated according to a selective protocol, based on results of physical examination, wound exploration, peritoneal lavage, and ancillary diagnostic studies. No injuries were found at celiotomy in three (2%) of these 147 patients. One false-negative result of evaluation of a flank wound occurred. Significant injuries were found in 13 patients (68%) with stab wounds to multiple sites, 61 patients (44%) with abdominal stab wounds, 15 patients (29%) with flank stab wounds, and four patients (15%) with back stab wounds. Mandatory exploration of gunshot wounds is justified. Physical findings of intra-abdominal injury or positive results of peritoneal lavage identify stab wound victims likely to benefit from surgical exploration. A policy of mandatory observation or routine celiotomy for treatment of stab wounds is not justified.
Abdomen↗
Uremia increases gastric mucosal permeability and acid back-diffusion injury in the rat.
The possibility that chronic uremia renders the gastric mucosa more susceptible to acid injury was investigated. A rat model of chronic renal failure was induced by subtotal nephrectomy. [H+] back-diffusion across the mucosa, following intragastric perfusion of 0.15N HCl or 15% ethanol in 0.15N HCl, was significantly greater in uremic than in sham-operated rats. Gastric mucous gel thickness and transmural potential difference were significantly lower in rats with renal insufficiency. Furthermore, a significantly greater acidification rate of the surface epithelial cells was found in uremic rats than in sham-operated rats during superfusion with pH 1.7 buffer. Intragastric administration of acidified ethanol or aspirin solutions markedly increased gastric mucosal blood flow (68% and 89% respectively) in the sham-operated group producing mild injury, in contrast to uremic rats, where a lesser increase in mucosal blood flow (7% and 14% respectively) was associated with more pronounced mucosal injury. It was concluded that enhanced susceptibility to acid injury in uremia is due to a reduction of function of pre-epithelial, epithelial, and postepithelial elements of the gastric mucosal barrier.
Animals↗
New law--old habits. Study day report.
In his introduction to a study day, entitled 'Work Injuries--New Law, Old Habits'. Phil Gray, labour relations director of the RCN, described the background of the potentially alarming rise in reported back injury amongst nurses--1.5 million days per year are lost for this reason. In 1991 an RCN survey found back injury to be an ongoing problem, with a lack of training, assessment or proper care.
Absenteeism↗
Analysis of the convergent and discriminant validity of published lumbar flexion, extension, and lateral flexion scores.
STUDY DESIGN: Articles reflecting the convergent or discriminant validity of the lumbar range of motion tests were reviewed and compared. Mean scores and standard deviations for lumber range of motion from healthy control subjects were plotted against those from patients with low back injuries. OBJECTIVE: To use published research to analyze the convergent and discriminant validity of lumbar range of motion tests for the characterization of low back pain and injury. SUMMARY OF BACKGROUND DATA: Several publications have addressed lumbar range of motion validity. Individual studies suggest that the tests possess convergent validity, but that their discriminant validity is indeterminate. METHODS: English-language journals were searched on Medline using "region," "lumbar," "range of motion," "validity of results," "observer variation," and "low back pain" as title and subject search terms. The study methods approximating the specifications of the American Medical Association Guides to the Evaluation of Permanent Impairment were included in the analysis. RESULTS: Convergent validity research showed inconsistent relations between inclinometric and radiographic lumbar range of motion measurements. Some studies showed strong relation, whereas others showed essentially no relation between the two techniques. Correlations between lumbar range of motion scores and spinal disability and function were similarly inconclusive. Studies reporting mean scores and standard deviations for lumbar range of motion measurements showed a high degree of overlap between the scores of participants with low back injuries and those without such injuries. CONCLUSIONS: Convergent and discriminant validities of the lumbar range of motion tests currently require further substantiation. Absolute lumbar range of motion scores may not be suitable as the sole determinants of low back pathology diagnosis. Implications for using the lumbar range of motion tests to characterize low back injuries in medicolegal situations are discussed.
Humans↗
Disc degeneration of the lumbar spine in relation to overweight.
OBJECTIVE: To study the association between overweight and lumbar disc degeneration. DESIGN: Population-based 4-y follow-up magnetic resonance imaging (MRI) study. SUBJECTS: The subjects were 129 working middle-aged men selected to the baseline magnetic resonance imaging (MRI) study from a cohort of 1832 men representing three occupations: machine drivers, construction carpenters, and office workers. The selection was based on the paticipants' age (40-45 y) and place of residence. MR images of the lumbar spines were obtained at baseline and at 4-y follow-up. MEASUREMENTS: Signal intensity of the nucleus pulposus of the discs L2/L3-L4/L5 was visually assessed by two readers using the adjacent cerebrospinal fluid as an intensity reference. The weight (at age 25 and 40-45 y) and height of the subjects, history of car driving, smoking, and back injuries were assessed by questionnaire. RESULTS: Multiple regression analyses allowing for occupation, history of car driving, smoking, and back injuries showed that persistent overweight (body mass index (BMI) > or =25 kg/m(2) at both ages) associated strongly with an increased risk of the number of lumbar discs with decreased signal intensity of nucleus pulposus at follow-up, adjusted odds ratio (OR) being 4.3 (95% confidence intervals (95% CIs) 1.3-14.3). Overweight at young age (risk ratio (RR) 3.8; 95% CI 1.4-10.4) was a stronger predictor of an increase in the number of degenerated discs during follow-up than overweight in middle age (RR 1.3; 95% CI 0.7-2.7). CONCLUSIONS: The study provides evidence that the BMI above 25 kg/m(2) increases the risk of lumbar disc degeneration. Overweight at young age seems to be particularly detrimental.
Adult↗
Clinical assessment of lumbar impairment.
Assessment of severity in low back injuries may be based on diagnosis, pain, disability, physical impairment, and capacity for work. It is important to distinguish between impairment and disability. Physical impairment is objective structural limitation; disability is the resulting loss of function. Disability can be assessed by the patient's report of restriction in activities of daily living: bending and lifting, sitting, standing, walking, traveling, socializing, sleep, sex, and putting on or taking off footwear. Detailed statistical analysis of 480 patients identified the most important elements of lumbar impairment as the anatomic and time patterns of pain, lumbar flexion, straight leg raising, neurologic signs, previous surgery, and spinal fractures. Methods of examination need to be improved. An anatomic chart is provided to calculate impairment in the individual patient. The patient's report of pain, disability, and capacity for work should then be compared with the physician's objective assessment of the injury, diagnosis, and lumbar impairment.
Absenteeism↗
Lumbosacral spine imaging: physioanatomic method.
Noninvasive evaluation of low back and leg pain has progressed rapidly over the past decade. The development of computed tomography, single-photon emission-computed tomographic bone scan, and magnetic resonance imaging has markedly increased diagnostic accuracy in detecting pathologic conditions. With this increased accuracy has come recognition of a 50% prevalence of underlying abnormalities in patients between 20 and 60 years old who have no symptoms. When such patients have a back injury, subsequent imaging will show in half of the population studied abnormalities that are not related to an acute injury. Degeneration of the spine progresses in all patients throughout their lifetime, and nearly all of the population will have back discomfort at some time. Political- and judicial-based compensation for back injuries related to accidents and on-the-job injuries provides an incentive for patients not to improve on therapy and to exaggerate symptoms, further complicating the clinical evaluation of their condition. The goal of physioanatomic noninvasive and invasive imaging evaluation presented in the following chapters is to increase specificity by differentiating pain generators from asymptomatic underlying pathologic conditions. When used with intensive conservative management and psychologic testing, this physioanatomic approach has resulted in much better treatment outcomes in our experience. The physioanatomic approach is quite simple, consisting of rigorous correlation of pathologic changes demonstrated by noninvasive imaging modalities (computed tomography, single-photon emission-computed tomographic bone scan, and magnetic resonance), or invasive modalities (diskography-enhanced computed tomography, nerve root block and facet block) with the patient's symptoms to evaluate whether the symptoms and the pathologic lesion are concordant or discordant. Patient symptoms and history are evaluated by use of a pain drawing and information sheet. The patient's pain pattern is categorized into a nonspecific pattern or into one of four recognizable pathway patterns (radicular, dorsal ramus, polyneuropathy, and sympathetic). Because each spinal lesion is typically manifested primarily via one of the four symptom pathways, the distribution of expected symptoms from each pathologic feature can be compared with the patient's pain drawing, and an assessment of the significance of imaged lesions can be made. The patient's presenting symptoms are also used to determine the most cost-effective and efficacious use of initial diagnostic imaging evaluation. In a minority of patients the findings on noninvasive imaging either will not correlate with the patient's symptoms or will demonstrate multiple abnormalities that could account for the patient's symptoms. In these patients, invasive techniques are extremely helpful in defining a pain generator or pain generators.(ABSTRACT TRUNCATED AT 400 WORDS)
Absorptiometry, Photon↗
[The range of injuries among back seat passengers].
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Accidents, Traffic↗