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PubMed1992

Serum and other calcium fractions in patients after severe musculoskeletal trauma.

Alterations in serum calcium fractions after trauma may be of clinical importance. For investigation of this problem, serum calcium fractions were studied prospectively in 42 patients with severe musculoskeletal injuries. The severity of trauma was assessed with the Apache II severity of disease classification system. Serum ionized calcium, total calcium, pH, albumin, and arterial blood gases were measured daily for the first five days after admission. The fat embolism syndrome developed in eight patients; they were more severely injured than the others, and they had significantly lower levels of serum ionized calcium for all five days of the study. There was a strong negative correlation between the Apache II score and serum ionized calcium. Ionized hypocalcemia has a strong association with development of the complications of severe musculoskeletal trauma, such as the fat embolism syndrome.

Adult↗
PubMed1999

Force and repetition measurement of ham boning. Relationship to musculoskeletal symptoms.

The purpose of this study was to develop a valid methodology for comparing measured torque repetition data along a ham boning line to symptoms reported in an established clinical database, which included history of cumulative stress disorder symptoms. A musculoskeletal stress measurement system was used to measure torque and repetition data associated with boning hams. Twenty-two surveys were conducted across a representative sample of employees performing this task on three different production lines. Two different knife grips were compared in the study to determine if one method produced lower torque. The data were analyzed and work (in-lb) and power (in-lb/sec) calculations were made. Evidence showed an increased rate of reported symptoms by subjects exerting more power as compared to other subjects performing the same task. One method was found to require less power than another. Operators managed a microbreak in the cycle ranging from .88% to 4% of the survey time. Operators not reporting symptoms averaged longer microbreaks than those reporting. The study provided data for structuring a line rotation program for moving people to positions requiring less "power."

Cumulative Trauma Disorders↗
PubMed2006

Developing a musculo-skeletal screening survey for Indigenous Australians living in rural communities.

INTRODUCTION: Indigenous Australians living in rural communities experience high levels of musculoskeletal conditions that significantly impair their daily activities. Aboriginal health workers (AHWs) have a close understanding of their communities' needs and play a central role in the assessment and management of these conditions. To assist in the musculoskeletal assessment process a screening survey was collaboratively developed, trialled and evaluated for use by AHWs. METHODS: A cross-sectional survey was developed following discussions with key community informants, and a literature review for relevant survey instruments. It was piloted before being administered by AHWs and the findings compared with those of a clinical assessment conducted by musculoskeletal health professionals. The participants included 189 members of an Australian rural Indigenous community. RESULTS: The screening survey achieved face and content validity. It provided high sensitivity (above 70%) and moderately high specificity (above 60%) for measuring musculoskeletal conditions in this community. It did not achieve high enough Kappa scores when measuring agreement between the screening tool and clinical assessment. A significant correlation was, however, obtained between the most prevalent musculoskeletal condition and between reported overall pain as assessed by AHWs and chiropractors. CONCLUSIONS: The screening survey has applicability in this community and has the potential to be adapted in similar settings. Incorporating a basic range of motion and palpation assessment to localise painful anatomical sites may help to further improve the sensitivity and specificity of this instrument.

Adult↗
PubMed2000

An update of diagnostic strategies using molecular genetic and magnetic resonance imaging techniques for musculoskeletal tumors.

Rheumatologists may be incidentally confronted by bone and soft tissue lesions presenting in and around joints that require early recognition and appropriate referral. The diagnostic and therapeutic management of patients with musculoskeletal tumors is critically dependent on a multidisciplinary approach. Advances, particularly in the fields of histopathology, molecular (cyto)genetics and radiologic imaging techniques, have resulted in significant improvements in reaching a correct (differential) diagnosis, essential for implementing optimal treatment modalities. Magnetic resonance imaging is becoming increasingly important in planning preoperative and postoperative management strategies, and should precede all invasive procedures. Improvements in the fields of immunohistochemistry, together with the realization that certain tumor groups may be associated with specific genetic alterations, has significantly improved diagnostic accuracy. Additionally, the presence of certain genetic alterations within the tumoral genome have been found to be of prognostic value, and the hereditary context recognized for a number of specific bone and soft tissue tumors should be taken into account in the management of a patient with such a neoplasm. It is envisaged that an increasing understanding of the molecular biology and histogenesis of individual musculoskeletal tumor types will lead to tailor-made therapeutic options and consequently prognostic improvements. This update serves to highlight some important recent developments in fundamental and diagnostic aspects of musculoskeletal tumors.

Biopsy↗
PubMed1996

Musculoskeletal disease research: should we analyze the joint or the person?

OBJECTIVE: To illustrate newly developed statistical methods in analysis of correlated binary outcome data in musculoskeletal (MSK) disease. METHODS: We applied 3 alternative statistical approaches to evaluate the relation of several risk factors to presence of knee osteoarthritis using data from the Framingham Osteoarthritis Study. The methods were (1) an ordinary logistic regression model using each knee as an independent unit of observation; (2) an ordinary logistic regression model treating each person rather than the knee as the unit of analysis; and (3) generalized estimating equation (GEE) and polychotomous logistic regression (PCHLE) using each knee as the unit of analysis but accounting for the correlation between fellow knees. We discuss the advantages and disadvantages of each method with respect to validity, precision, and interpretability. RESULTS: The GEE and PCHLE models had clear advantages. They simultaneously evaluated the effects of person specific and knee specific risk factors, increased precision, enhanced the interpretability of variables, and provided new insights about how risk factors act. CONCLUSION: While the choice of statistical approach depends critically on the scientific question of interest, the GEE and PCHLE approaches will often be optimal in assessments of factors associated with MSK conditions affecting multiple correlated sites within the body, especially when the interest of the study focuses on site specific risk factors.

Age Factors↗
PubMed1993

Fast scanning and fat-suppression MR imaging of musculoskeletal disorders.

Two of the most exciting areas of development in MR imaging in the past several years have been rapid imaging and fat-suppression techniques. This article reviews the most widely available techniques for performing rapid imaging and fat suppression and summarizes current clinical applications in musculoskeletal imaging.

Female↗
PubMed1999

Ganglioneuromas and renal anomalies are induced by activated RET(MEN2B) in transgenic mice.

Multiple endocrine neoplasia type 2B (MEN2B) is an autosomal dominant syndrome characterized by the development of medullary thyroid carcinoma, pheochromocytomas, musculoskeletal anomalies and mucosal ganglioneuromas. MEN2B is caused by a specific mutation (Met918-->Thr) in the RET receptor tyrosine kinase. Different mutations of RET lead to other conditions including MEN2A, familial medullary thyroid carcinoma and intestinal aganglionosis (Hirschsprung disease). Transgenic mice were created using the dopamine beta-hydroxylase promoter to direct expression of RET(MEN2B) in the developing sympathetic and enteric nervous systems and the adrenal medulla. DbetaH-RET(MEN2B) transgenic mice developed benign neuroglial tumors, histologically identical to human ganglioneuromas, in their sympathetic nervous systems and adrenal glands. The enteric nervous system was not affected. The neoplasms in DbetaH-RET(MEN2B) mice were similar to benign neuroglial tumors induced in transgenic mice by activated Ras expression under control of the same promoter. Levels of phosphorylated MAP kinase were not increased in the RET(MEN2B)-induced neurolglial proliferations, suggesting that alternative pathways may play a role in the pathogenesis of these lesions. Transgenic mice with the highest levels of DbetaH-RET(MEN2B) expression, unexpectedly developed renal malformations analogous to those reported with loss of function mutations in the Ret gene.

Adrenal Gland Neoplasms↗
PubMed2005

[Health reasons for work disability among municipal transport drivers].

BACKGROUND: The health condition of public transport drivers is one of the factors playing a role in assuring safety of passengers taking use of this kind of transportation means. Therefore, the assessment of pathologies occurring in this occupational group is essential from the prevention point of view. Drivers employed in the municipal transport system are at particular risk. The aim of the study was to define health reasons of work disability among bus and tram drivers in general and to indicate pathologies responsible for disabilities in particular. MATERIALS AND METHODS: The study covered 940 drivers (including 788 men and 152 women) employed in a municipal transportation enterprise during the years 1996-2000. Bus (30%) and tram (22%) drivers as well as transport service workers (48%), aged over 45 years, but under the retirement age, were eligible for the study. The analysis of temporary work disability during a five-year period was based on sickness absence, sickness absence rate and the average duration of sickness absence. RESULTS: The analysis revealed that diseases of the circulatory system form the major group of pathologies responsible for total sickness absence among bus drivers (43%), tram drivers (27%) and transport service workers (27%). These disease are also a leading cause of earlier retirement. They mostly include ischemic heart disease in bus drivers and hypertension in tram drivers. Cancers (pleura, kidney and eye) were responsible for 9% of sickness absence in the group of male tram drivers, whereas endocrine, nutritional and metabolic diseases and immunity disorders (diabetes, disorders of thyroid gland) in 16% of female tram drivers. Diseases of the musculoskeletal system were major causes of sickness absence among female tram drivers (24%), whereas malignant and benign neoplasms of breast and uterine myoma in 24% of female transport service workers. CONCLUSIONS: The results of the analysis are in agreement with the literature findings and provide explicit evidence that employment in the municipal transport system is the risk factor responsible for the development of serious diseases such as musculoskeletal disorders and neoplasms. Bearing this in mind, this occupational group (bus and tram drivers) should be covered by specially designed prevention programs to protect them against these pathologies, turning special attention to health promotion at and outside workplace.

Aged↗
PubMed2002

Electromagnetic fields for the treatment of osteoarthritis.

BACKGROUND: As the focus for osteoarthritis (OA) treatment shifts away from drug therapy, we consider the effectiveness of pulsed electric stimulation which is proven to stimulate cartilage growth on the cellular level. OBJECTIVES: 1)To assess the effectiveness of pulsed electric stimulation for the treatment of osteoarthritis (OA). 2) To assess the most effective and efficient method of applying an electromagnetic field, through pulsed electromagnetic fields (PEMF) or electric stimulation, as well as the consideration of length of treatment, dosage, and the frequency of the applications. SEARCH STRATEGY: We searched PREMEDLINE, MEDLINE, HealthSTAR, CINAHL, PEDro, and the Cochrane Controlled Trials Register (CCTR) up to and including 2001. This included searches through the coordinating offices of the trials registries of the Cochrane Field of Physical and Related Therapies and the Cochrane Musculoskeletal Group for further published and unpublished articles. The electronic search was complemented by hand searches and experts in the area. SELECTION CRITERIA: Randomized controlled trials and controlled clinical trials that compared PEMF or direct electric stimulation against placebo in patients with OA. DATA COLLECTION AND ANALYSIS: Two reviewers determined the studies to be included in the review based on inclusion and exclusion criteria (JH,VR) and extracted the data using pre-developed extraction forms for the Cochrane Musculoskeletal Group. The methodological quality of the trials was assessed by the same reviewers using a validated scale (Jadad 1996). Osteoarthritis outcome measures were extracted from the publications according to OMERACT guidelines (Bellamy 1997) and additional secondary outcomes considered. MAIN RESULTS: Only three studies with a total of 259 OA patients were included in the review. Electrical stimulation therapy had a small to moderate effect on outcomes for knee OA, all statistically significant with clinical benefit ranging from 13-23% greater with active treatment than with placebo. Only 2 outcomes for cervical OA were significantly different with PEMF treatment and no clinical benefit can be reported with changes of 12% or less. REVIEWER'S CONCLUSIONS: Current evidence suggests that electrical stimulation therapy may provide significant improvements for knee OA, but further studies are required to confirm whether the statistically significant results shown in these trials confer to important benefits.

Clinical Trials as Topic↗
PubMed1991

Role of magnetic resonance imaging in the radiological management of musculoskeletal tumors.

The treatment of bone tumors has developed from amputation surgery to refined methods of therapy in the last 20 years. Limb-preserving operations in particular require exact documentation of the intra- and extraosseous extent of the tumors. Our clinical study showed that magnetic resonance imaging (MRI) is equal to or even superior to computed tomography (CT) in regard to the most important radiological criteria. For this reason, MRI can be considered of great value in the radiological management of bone tumors. While CT is in most cases inferior to MRI, there are still special cases which require angiography.

Adult↗
PubMed1991

[Pain perception during simulated static work].

The purpose of this study was to determine the effect of current design recommendations (additional rest allowances) for static work on the development of temporary musculo-skeletal pains. The subjects were healthy, relatively fit young adults (16 men). Static work at 25% MVC was performed both in a commonly-used working posture and in a nontypical posture (overhead work). The ratios of work-to-rest corresponded to the ergonomical recommendations. Estimates of pain-perceptions concerning the neck, shoulders and back/trunk were recorded during the muscular exercise. The results show that under certain conditions (commonly-used working posture) the additional rest allowances render possible an exercise without musculoskeletal pains. During overhead work the development of temporary pain-perceptions is not inhibited by additional rest allowances. A revision of the current design recommendations for overhead work is suggested.

Adult↗
PubMed2003

A simple questionnaire to detect hypermobility: an adjunct to the assessment of patients with diffuse musculoskeletal pain.

The aim of the study was to develop a simple and reproducible self-reporting questionnaire that identifies individuals with hypermobility. Two hundred and twelve consecutive hypermobile female new attendees to the hypermobility clinic at two London teaching hospitals and a random selection of 57 healthy volunteers completed a 10-part questionnaire. Questions were selected from clinical experience (RG), and assessed musculoskeletal symptoms and past and present physical agility. Of the 212 cases, 30 were hypermobile with no other underlying disorder and 182 fulfilled the 1998 Brighton criteria for benign joint hypermobility syndrome (BJHS). Odds ratios for the presence of hypermobility were calculated for each question. Six questions were found to be significant and the model of 'best fit' for sensitivity and specificity contained five of these. To demonstrate the reproducibility of the five-part questionnaire a second cohort of 170 hypermobile cases with BJHS and 50 controls was surveyed. Analysis demonstrated that a positive answer to any two questions in the five-part questionnaire gave the highest combined sensitivity and specificity for detecting hypermobility. The sensitivity and specificity was 84% and 89% respectively in the first cohort and reproduced with values of 84% and 80% in the second cohort. Overall the questionnaire correctly identified 84% of all cases and controls. This simple and reproducible questionnaire for detecting hypermobility could be of particular use as an adjunct in the clinical assessment of chronic, diffuse pain syndromes where hypermobility is often missed yet is potentially treatable.

Adolescent↗
PubMed1996

Medical problems of adolescent female athletes.

Adolescent female athletes represent unique medical challenges. Although still limited, research and understanding of their particular problems has grown over the past 3 decades as female sports participation has increased dramatically. Despite concerns, however, exercise and athletic activity are safe and beneficial for girls and young women, and may help them develop positive attitudes toward self-image and body satisfaction. Several musculoskeletal injuries fairly common among female athletes may be related to structural development. Iron and calcium deficiencies are frequent nutritional concerns for these girls. Disordered eating, a phenomenon exhibited by many adolescent females, may not be more prevalent in athletes. Amenorrhea is a common problem for female athletes, and may contribute significantly to stress fractures and future osteoporosis. For these and other reasons, physicians must be aware of these issues to better help their female patients safely participate in athletics.

Adolescent↗
PubMed2007

Musculoskeletal fitness and weight gain in Canada.

BACKGROUND: Obesity is a growing health issue in Canada, and identifying the determinants of weight gain is important for the development of appropriate prevention strategies. PURPOSE: To quantify the association between musculoskeletal fitness (MSF) and subsequent weight gain and development of obesity. METHODS: The sample included 606 participants (20-69 yr; 291 men, 315 women) from the Physical Activity Longitudinal Study (PALS), a follow-up of participants from the 1981 Canadian Fitness Survey. Standardized assessments of height, weight, MSF (push-ups, sit-ups, grip strength, and trunk flexibility), and cardiorespiratory fitness were made at baseline (1981). Follow-up data on self-reported height and weight and body mass index (BMI) were collected by survey in 2002-2004. Logistic regression was used to predict obesity and weight gain of > or = 10 kg between 1981 and 2002-2004. RESULTS: During the 20-yr follow-up, the prevalence of obesity (BMI > or = 30 kg.m(-2)) increased from 3.1 to 15.2%, reflecting a mean weight gain of 7.4 kg (men: 6.7 kg; women: 8.1 kg). Further, independent of age, sex, baseline BMI, physical activity, cardiorespiratory fitness, smoking, alcohol consumption, and income, low MSF was associated with significantly higher odds of having gained at least 10 kg during follow-up (OR: 1.78, 95% CI: 1.14-2.79). CONCLUSIONS: The results indicate that MSF is a significant predictor of weight gain during a 20-yr period. Promoting participation in activities that enhance MSF may be beneficial in attenuating age-related weight gain and in preventing obesity among Canadians.

Adult↗
PubMed1997

Comparison of technetium-99m-MIBI and technetium-99m-tetrofosmin uptake by musculoskeletal sarcomas.

UNLABELLED: Technetium-99m-MIBI was initially developed for heart studies but it can also be used to depict tumors, predict multidrug resistance and evaluate chemotherapy. Recently, 99mTc-tetrofosmin, which exhibits similar physical properties, has been launched for heart studies. Tumor uptake and prediction of multidrug resistance have also been reported regarding the latter tracer. A comparison of these two tracers regarding the detectability of musculoskeletal sarcoma has been made. METHODS: Twenty patients with musculoskeletal sarcoma of the extremities or pelvis underwent planar examination after the administration of 99mTc-MIBI and 99mTc-tetrofosmin with an interval of 2-7 days. The tumor activity was compared with one ipsilateral and one contralateral background region. RESULTS: There was a small, but not significant, difference in favor of 99mTc-MIBI with regard to both background regions. CONCLUSION: Technetium-99m-MIBI and 99mTc-tetrofosmin can both be used to visualize musculoskeletal sarcomas. The choice may depend on which agent is used routinely for myocardial studies in the laboratory.

Adolescent↗
PubMed1993

A controlled study of the effects of an early intervention on acute musculoskeletal pain problems.

Current conceptions of chronic pain clearly suggest that proper care at the acute stage should prevent the development of chronic problems. Patients (198) seeking help for acute musculoskeletal pain (MSP), e.g., back and neck pain participated in two studies of the effects of an Early Active intervention which underscored 'well' behavior and function compared to a Treatment as usual control group. The quantity of the Early Active treatment was a median of 1 doctor's appointment and 3 meetings with a physical therapist. Study I concerned patients with a prior history of sick-listing for MSP, while study II involved patients with no prior history of MSP. Treatment satisfaction, pain experience, activities and sickness absenteeism were assessed before, after and at a 12-month follow-up. In study I (patients with a history of MSP), the results showed significant improvements for both groups, but virtually no differences between the groups. Similarly, in study II (no history of MSP) both groups demonstrated significant improvements, e.g., for pain intensity and activity levels. However, the Early Active treatment resulted in significantly less sick-listing relative to the control group. Moreover, the risk of developing chronic (> 200 sick days) pain was 8 times lower for the Early Activation group. This investigation shows that relatively simple changes in treatment result in reduced sickness absenteeism for 'first-time' sufferers only. Consequently, the content and timing of treatment for pain appear to be crucial. Properly administered early intervention may therefore decrease sick leave and prevent chronic problems, thus saving considerable resources.

Absenteeism↗
PubMed1978

Malignant hyperthermia and central core disease in a child with congenital dislocating hips.

We describe a development of a malignant hyperthermia (MH) syndrome, partially aborted by therapy, in a child with central core disease and congenital dislocating hips. Patients with central core disease appear to be more susceptible to MH; possibly those with elevated serum creatine phosphokinase levels, as in our patient, are especially susceptible. We review the clinical and pathologic aspects, possible pathogenesis, and treatment of the MH syndrome. An increased calcium level within the muscle fiber is suggested as the major cytodestructive factor, and that increase could be consequent to a plasmalemmal susceptibility to the provoking drugs hypothesized to be the basic defect in MH. Prevention of the full manifestations of MH is predicated on (1) a high index of suspicion in the search for history of anesthetic complications in the patient and his family, with or without evident neuromuscular disease, (2) recognition that there is a somewhat greater risk of MH developing in a patient who has certain "musculoskeletal" abnormalities or muscle weakness but that is not-except for central core disease-a classic clinicopathologically defined disease, (3) close monitoring of patients during anesthesia, and (4) if the syndrome develops, prompt therapeutic measures, including cessation of anesthesia.

Adult↗
PubMed1998

Musculoskeletal challenges of osteoporosis.

Reduction in the biomechanical competence of the axial skeleton can result in challenging complications. Osteoporosis consists of a heterogeneous group of syndromes in which bone mass per unit volume is reduced in otherwise normal bone, which results in more fragile bone. The geriatric population has an increased risk for debilitating postural changes because of several factors. The two most apparent factors are involutional loss of functional muscle motor units and the greater prevalence of osteoporosis in this population. Obviously, the main objective of rehabilitation is to prevent fractures rather than to treat the complications. These complications can vary from "silent" compression fractures of vertebral bodies, to sacral insufficiency fractures, to "breath-taking" fractures of the spine or femoral neck. The exponential loss of bone at the postmenopausal stage is not accompanied by an incremental loss of muscle strength. The loss of muscle strength follows a more gradual course and is not affected significantly by a sudden hormonal decline, as is the case with bone loss. This muscle loss may contribute to osteoporosis-related skeletal disfigurations. In men and women, the combination of aging and reduction of physical activity can affect musculoskeletal health, and contribute to the development of bone fragility. The parallel decline in muscle mass and bone mass with age is more than a coincidence, and inactivity may explain some of the bone loss previously associated with aging per se. Kyphotic postural change is the most physically disfiguring and psychologically damaging effect of osteoporosis and can contribute to an increment in vertebral fractures and the risk of falling. Axial skeletal fractures, such as fracture of the sacral alae (sacral insufficiency fracture) and pubic rami, may not be found until radiographic changes are detected. Management of chronic pain should include not only improvement of muscle strength and posture but also, at times, reduction of weight bearing on the painful pelvis with insufficiency fractures. Axial skeletal health can be assisted with improvement of muscular supportive strength. Disproportionate weakness in the back extensor musculature relative to body weight or flexor strength considerably increases the risk of compressing porous vertebrae. A proper exercise program, especially osteogenic exercises, can improve musculoskeletal health in osteoporotic patients. Exercise not only improves musculoskeletal health but also can reduce the chronic pain syndrome and decrease depression. Application of a proper back support can decrease kyphotic posturing and can expedite the patient's return to ambulatory activities. Measures that can increase safety during ambulatory activities can reduce risk of falls and fractures. Managing the musculoskeletal challenges of osteoporosis goes hand in hand with managing the psychological aspects of the disease.

Adult↗