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At least 631 records · Page 35Linked to original sources
PubMed2001

Fibromyalgia developed after administration of gonadotrophin-releasing hormone analogue.

We report the case of a woman treated with a gonadotrophin-releasing hormone analogue for endometriosis who developed typical clinical features of fibromyalgia, with widespread musculoskeletal pain, sleep difficulties, neuropsychological complaints and tender points on clininal examination. The gonadotrophin-releasing hormone analogue treatment probably induced disturbances in the neuroendocrine system and the secretion of neurotransmitters, and may be suspected to be the cause of this case of fibromyalgia.

Adult↗
PubMed2003

Synthesis of two-dimensional human walking: a test of the lambda-model.

To test the lambda-model version of the equilibrium point hypothesis both for feasibility and validity with respect to the control of terrestrial locomotion, we developed a two-dimensional, eleven-segment musculoskeletal model of the human body including 14 muscle-tendon complexes per leg, three-segment feet, and a physiologically based model of foot-ground interaction. Human walking was synthesized by numerical integration of the coupled muscle-tendon and rigid body dynamics. To this end a control algorithm based on the lambda-model was implemented in the model providing muscle stimulation patterns that guaranteed dynamically stable walking including a balanced trunk. Thus, the timing of the movement is not preset by a central pattern generator but emerges from the interaction of the musculoskeletal system with the control algorithm. The control parameters were found in a trial-and-error approach. The feedforward part of the control scheme consists of just two target configurations each of which is composed of a set of one nominal length per muscle (lambda-model). Variation of gravity reveals that (1) the synthesized walking patterns are close to ballistic walking and (2) this muscularly induced natural walking can only be initiated and maintained in the range between about a tenth and three times earth-bound gravity. Our walking patterns are robust both against parameter variations and shuffling of the swing leg. We discuss our model with respect to gravity scaling, speed control, feedback delay, and the terms "equilibrium point hypothesis" and "central pattern generator."

Algorithms↗
PubMed1988

Reversal of aluminum-related bone disease after substituting calcium carbonate for aluminum hydroxide.

Aluminum-related osteodystrophy, a crippling disease in patients with renal failure, can develop from the long-term ingestion of aluminum hydroxide gels. We present a diabetic patient treated with continuous ambulatory peritoneal dialysis (CAPD) who developed markedly elevated plasma aluminum levels but no musculoskeletal symptoms. Bone biopsy revealed features of the aplastic form of aluminum-related disease with significant aluminum staining, decreased osteoblastic osteoid, and decreased bone formation by double tetracycline labeling, but no excess accumulation of unmineralized osteoid. Aluminum hydroxide gels were discontinued and the patient received calcium carbonate to control hyperphosphatemia; 9 months later, a bone biopsy showed marked improvement of the aluminum-related bone disease, and at 2 to 10 months, plasma aluminum had decreased from 208.7 +/- 10.3 (SE) to 55.7 +/- 3.9 micrograms/L.

Aged↗
PubMedDate not supplied

A brief outpatient functional assessment measure: validity using Rasch measures.

The Medical Rehabilitation Follow Along (MRFA(TM)) is a brief outpatient functional assessment measure that was developed using Rasch analysis. The MRFA currently has musculoskeletal, neurologic, multiple sclerosis, cardiac, and pulmonary forms. Using Rasch scoring and selected scales, the 31-item musculoskeletal form of the MRFA was compared with and contrasted to a measure of general health status, the Medical Outcomes Trust SF-36. Content, construct, and criterion validity were addressed using scale scores before and after outpatient rehabilitation, as well as therapist ratings of improvement. The results supported the validity of inferences made from the MRFA scales using Rasch measures for persons with musculoskeletal problems. Rasch and raw scoring provided similar results with respect to the validity of the MRFA scales. Implications for the use of Rasch and raw scoring approaches with the MRFA are discussed.

Activities of Daily Living↗
PubMed2003

Regional musculoskeletal examination: what the students say.

Confusion exists over which musculoskeletal examination skills medical students should learn. This study aimed to explore the views of third-year medical students. This was a qualitative study to allow in-depth exploration of beliefs and attitudes. Twenty students were randomly assigned to 1 of 2 focus groups. Their attitudes towards musculoskeletal examination were explored and discussed. The groups' discussions were recorded, transcribed, and framework analysis was undertaken with the aid of NUD*IST computer software. The following themes were identified: students dislike eponymous names for clinical tests; students felt there is a need for a more structured approach to musculoskeletal examination; students appeared unaware that many clinical tests were not based on evidence; students complained of a lack of confidence in the use of musculoskeletal clinical tests. Student's confidence in their musculoskeletal examination skills may be improved by the development of an agreed set of so-called core examination skills.

Journal Article↗
PubMed1996

Footfall patterns in the early development of the quadrupedal walking of Japanese macaques.

The development of quadrupedal walking in infant Japanese macaques (Macaca fuscata) was studied on the basis of their footfall patterns. Lateral views of the walking of 5 monkeys were taken by a video-camera and the timing of touchdown and liftoff was recorded. The total number of trials was 435. The change of footfall patterns during development was complicated. Four stages could be discerned, as in behavioural studies. In the first stage, there was a wide variation. The dominant patterns were the diagonal sequence which included any type of couplet in the second stage and trot in the third stage. There were two groups of footfall patterns in the fourth stage which were the diagonal sequence-diagonal couplet and the lateral sequence-lateral couplet. It seems that the stages reflect aspects of the development of both the neural system and the musculoskeletal system.

Animals↗
PubMed2004

Evidence for vascular and enzymatic events in the pathophysiology of acute laminitis: which pathway is responsible for initiation of this process in horses?

To date, there is a substantial amount of data to support the hypotheses that vascular and enzymatic changes are ongoing in experimental laminitis. Furthermore, there is substantial in vitro evidence that the enzymatic changes weaken the dermo-epidermal attachments leading to mechanical failure of the hoof-bone interface of the equine digit. However, investigators of both the vascular and enzymatic theories have, to date, been unable to substantiate the effects of these pathophysiological changes in vivo on laminar tissues of horses afflicted with experimentally induced or naturally acquired laminitis. In addition, the effects of laminitis-inducing treatment have not been prevented or reversed by treatment with an MMP inhibitor or a vasoactive antagonist. It is possible that there is simultaneous activation of the vascular and enzymatic pathways and/or other inflammatory processes. Moreover, the third theory involving mechanical factors cannot be discounted simply because strong evidence for vascular and enzymatic changes exists. It is common for horses with severe musculoskeletal disease affecting weightbearing on a limb to develop laminitis in the contralateral limb. It remains to be determined what factors are responsible for initiation of laminitis in these individuals. Evidence has not been presented that precludes the possibility of coincident occurrence of vascular and enzymatic changes. In fact, many of the inflammatory mediators (e.g. interleukin-1beta) found in laminitic tissues can concurrently stimulate synthesis of vasoactive substances and activate MMPs. Because enzymatic action on proteins is largely dependent on the concentrations of proteins and enzyme, the enzymatic theory is not dependent upon increased delivery of enzymes via increased capillary flow. Likewise, because vascular changes can alter tissue function via increased capillary flow and oedema formation, the vascular theory is not dependent upon decreased capillary flow. It is true that naturally acquired laminitis is widely variable in severity and predisposing diseases. Therefore, most probably there are multiple mechanisms involved in the initiation and propagation of the pathophysiologic cascade(s) and, therefore, successful intervention will necessitate multiple treatment modalities.

Acute Disease↗
PubMed2004

Bone and brain: a review of neural, hormonal, and musculoskeletal connections.

Nerves have been identified in bone. Their function has recently become the focus of intense study. Metabolic control of bone is influenced by the nervous system. Potential transmitters of this influence include glutamate, calcitonin gene-related protein (CGRP), substance P, vasoactive intestinal peptide (VIP), pituitary adenylate cyclase activating polypeptide (PACAP), leptin, and catecholamines. Disorders of nerves - central or peripheral--can have substantial influence on bone health and repair. Specifically considered are the potential neural influences at work in such conditions as osteoporosis, fracture healing, Charcot osteoarthropathy, musculoskeletal pain syndromes, heterotopic ossification, skeletal growth and development, and obesity-related increased bone density. In this article, we review the current state of experimental and clinical evidence implicating the role of nervous tissue in regulating bone biology and discuss the current understanding of molecular signaling between nervous and osseus tissue in the homeostatic maintenance of the skeleton.

Arthropathy, Neurogenic↗
PubMed1991

Recent advances in magnetic resonance imaging of musculoskeletal tumours.

Magnetic resonance imaging (MRI) has become the method of choice, where available, for the evaluation of musculoskeletal neoplasms. Recently, there has been interest and development in a number of areas in this field: (a) gradient-echo (fast-scan) sequences, which may often be substituted for more time-consuming T2-weighted sequences, are useful as localizing sequences and play an important role in intravenous contrast-enhanced scanning; (b) magnetic resonance contrast agents (e.g., gadolinium) improve delineation of tumours on static imaging and may help in estimating tumour aggressiveness with dynamic imaging; (c) STIR (short inversion time inversion recovery) increases lesion conspicuity; (d) spectroscopy, still an investigational area, may help in evaluating tumour response to chemotherapy and radiotherapy.

Bone Neoplasms↗
PubMed1984

The physiology of endurance exercise. The marathon.

The metabolic demands of competitive marathon running require the development and integration of the respiratory, cardiovascular, and musculoskeletal systems. Environmental factors such as ambient temperature, humidity, and wind resistance can affect running performance. In addition to training, racing strategy, fluid ingestion, and dietary manipulation are specific and practical methods that can be used to augment marathon performance.

Adolescent↗
PubMed1984

Toxic epidemic syndrome: musculoskeletal manifestations.

The musculoskeletal manifestations of a new systemic disease that developed after toxic oil consumption are described. Clinically, it was characterized by the presence of arthralgias, sometimes arthritis, extensive muscle atrophy, severe neuropathy and a scleroderma-like skin involvement. Radiologically, different types of osteopenia could be seen in the absence of joint space narrowing or erosions. Neither hypertrophy, nor hyperplasia of synoviocytes were seen on microscopic examination. A non-necrotizing vasculitis and increase in fibrous tissue were observed at different levels.

Adolescent↗
PubMedDate not supplied

Transdermal non-steroidal anti-inflammatory agents.

Concern over the scale of morbidity associated with the use of oral non-steroidal anti-inflammatory drugs (NSAIDs), particularly in the elderly, has led to the development of alternative strategies for the relief of musculoskeletal and joint pain. One such is to explore the possibility of formulations that bypass the gastrointestinal tract that has proved so vulnerable to the prostaglandin inhibitory effects of NSAIDs. The success of transdermal absorption of such drugs as nicotine, oestrogens, nitrates, clonidine and hyoscine into the bloodstream has added a new dimension to drug therapy. Over the past 15 years some six topical non-steroidals (T/NSAIDs) have been licensed in the UK, and a number of others are available in other countries or are under investigation. Unlike the case with the drugs mentioned above, where the aim is to achieve a high blood level, comparable to that obtained with the oral formulation, with T/NSAIDs the desired goal is a high local concentration at the site of the lesion with, at the same time, as low a plasma concentration as possible, in order to minimise adverse GI tract or systemic effects. This paper reviews the pharmacokinetic data and the evidence for efficacy and safety, and attempts to assess the place of T/NSAIDs in current medical practice.

Administration, Cutaneous↗
PubMed2005

Ultrasonography for rheumatologists: the development of specific competency based educational outcomes.

BACKGROUND: A competency based approach to the education of rheumatologists in musculoskeletal ultrasonography (MSK US) ensures standards are documented, transparent, accountable, and defensible, with clear benefit to all stakeholders. Specific competency outcomes will facilitate informed development of a common curriculum and structured programme of training and assessment. OBJECTIVE: To determine explicit competency based learning outcomes for rheumatologists undertaking MSK US. METHODS: International experts in MSK US, satisfying specific selection criteria, were asked to define the minimum standards required by a rheumatologist to be judged competent in MSK US. They reviewed 115 MSK US skills, comprising bone and soft tissue pathology, in seven joints regions of the upper and lower limbs, and rated their relative importance according to specific criteria. These data are presented as specific educational outcomes within designated competency categories. RESULTS: 57 expert MSK US practitioners were identified and 35 took part in this study. Ten generic core competency outcomes were recognised including physics, anatomy, technique, and interpretation. Regarding specific regional competencies, 53% (61/115) were considered "must know" core learning outcomes, largely comprising inflammatory joint/tendon/bone pathology and guided procedures; 45% (52/115) were required at an intermediate/advanced level (18/115 "should know", 34/115 "could know"), and 2% (2/115) were deemed inappropriate/unnecessary for rheumatologist ultrasonographers. CONCLUSIONS: This is the first study to developing a competency model for the education of rheumatologists in MSK US based on the evidence of international experts. A specific set of learning outcomes has been defined, which will facilitate future informed education and practice development and provide a blueprint for a structured rheumatology MSK US curriculum and assessment process.

Clinical Competence↗