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Upper trapezius muscle activity patterns during repetitive manual material handling and work with with a computer mouse.

Firstly, upper trapezius EMG activity patterns were recorded on the dominant side of 6 industrial production workers and on the side operating a computer mouse of 14 computer-aided design (CAD) operators to study differences in acute muscular response related to the repetitiveness of the exposure. The work tasks were performed with median arm movement frequencies ranging from 5 min(-1) to 13 min(-1) and were characterized by work cycle times ranging from less than 30 sec to several days. However, the static and median EMG levels and EMG gap frequencies were similar for all work tasks indicating that shoulder muscle loads may be unaffected by large variations in arm movement frequencies and work cycle times. An exposure variation analyses (EVA) showed that the EMG activity patterns recorded during production work were more repetitive than during CAD work, whereas CAD work was associated with more static muscle activity patterns, both may be associated with a risk of developing musculoskeletal symptoms. Secondly, upper trapezius EMG activity patterns recorded on the mouse side of the CAD operators were compared with those recorded on the non-mouse side to study differences in muscular responses potentially related to the risk of developing shoulder symptoms which were more prevalent on the mouse side. The number of EMG gaps on the mouse side were significantly lower than the values for the upper trapezius on the non-mouse side indicating that more continuous activity was present in the upper trapezius muscle on the mouse side and EVA analyses showed a more repetitive muscle activity pattern on the mouse side. These findings may be of importance to explain differences in the prevalence of shoulder symptoms.

Adult↗

Ergonomic evaluation of winegrape trellis systems pruning operation.

The winegrape industry suffers from high incidence rates of work-related musculoskeletal disorders. Pruning of dormant vines is a significant task, requiring long periods of highly repetitive and physically demanding work. The purpose of this study is to quantitatively evaluate five commonly used winegrape trellis systems with regard to the risk of developing musculoskeletal injuries to the wrist and lower back while pruning. Eleven subjects participated in this study. Subjects performed a simulated pruning task as wrist and trunk postures were gathered using electrogoniometers. The results showed significant postural differences among the trellis systems. Compared to the other systems, the VSP was determined to be the optimal system in terms of decreasing relative MSD risk. These results will assist vineyards in the selection process of suitable trellis systems that will include the worker health aspect in conjunction with other trellis-related parameters such as grape quality and productivity.

Adult↗

The association between children's computer use and musculoskeletal discomfort.

UNLABELLED: As American children spend more time working at computers, they may be putting themselves at risk for musculoskeletal disorders and other conditions that can result from overuse. There is little research that describes the home computer use of American middle school children or that describes the prevalence of musculoskeletal discomfort in this population. This study provides a general description of the computer set-up and home use of 152 6th grade children and looks at the association between overall musculoskeletal discomfort and various ergonomic variables. METHOD: 152 6th grade children completed the Musculoskeletal Discomfort Questionnaire and a survey of home computer use. RESULTS: More than half of the children reported some musculoskeletal discomfort within the last year. This pain could be made worse by computer use. Students reported that they had three computers in their house, and that they generally did not have furniture specifically designed for computer use. There was a significant association between the number of hours on the computer and overall musculoskeletal discomfort (r = 0.19, p = 0.05). The odds ratios between having furniture designed for the computer and touch typing and musculoskeletal discomfort were borderline significant, but suggested that students without proper furniture were more likely to have musculoskeletal discomfort (OR = 1.89, 95% CI = 0.94-3.84) and that those who could touch type were less likely to have musculoskeletal discomfort (OR = 0.54, 95%, CI = 0.26-1.10), OR). CONCLUSION: American children are reporting moderate amounts of musculoskeletal discomfort and this discomfort can be associated with computer use. Risk factors associated with computer use and discomforts are similar to those reported in the adult literature. Further study is necessary to understand the similarities and differences between adult and children computer use and how to protect both from developing musculoskeletal discomfort.

Child↗

Nonrheumatic conditions in children including infectious diseases and syndromes.

Often, a child is referred for evaluation to a pediatric rheumatologist and found to have a nonrheumatologic disorder. Infections constitute an important group of disorders with potential musculoskeletal system involvement. Reactive arthritis subsequent to infection with Yersinia is discussed, as well as reactive arthritis seen in the course of cystic fibrosis. Musculoskeletal manifestations of tuberculosis and brucellosis are reviewed. The continued presence of acute rheumatic fever in the United States has been documented, but the clinical spectrum of the disease appears to be changing over time. A variety of inherited syndromes may involve the musculoskeletal system, either primarily or as a minor manifestation. The bony dysplasias, another group of disorders, result from abnormal collagen structure and affect musculoskeletal development; clinical findings and new genetic information is reviewed. Descriptions of several rare syndromes (eg, hyaline fibromatosis and hypertrophic osteoarthropathy) also are reviewed here.

Arthritis, Reactive↗

Adverse events associated with pyrazinamide and levofloxacin in the treatment of latent multidrug-resistant tuberculosis.

BACKGROUND: The current Canadian and US guidelines for the treatment of multidrug-resistant latent tuberculosis infection advocate the use of pyrazinamide and a fluoroquinolone as a first-line treatment option. However, there is very little information in the literature that describes the use of these agents together. This case series describes the probable association between multiple adverse events and the use of pyrazinamide and levofloxacin in the treatment of individuals with suspected latent multidrug-resistant tuberculosis infection. METHODS: We studied a case series of 17 individuals with suspected latent multidrug-resistant tuberculosis infection in Hamilton, Ont., who were being treated with pyrazinamide and levofloxacin. The Naranjo scale was used to assess patients for musculoskeletal, central nervous system, gastrointestinal and dermatological adverse events. Hepatocellular events were assessed and defined using criteria established by the Council for International Organizations of Medical Sciences. Laboratory abnormalities and adverse events that were documented during combination drug therapy were evaluated to determine the likelihood of an association. RESULTS: Fourteen individuals developed musculoskeletal adverse effects (11 were deemed to be probably related to combination therapy). There were 8 reports of central nervous system effects (5 of which were assessed as being probably associated with therapy). Hyperuricemia and gastrointestinal and dermatological effects were also common; the use of pyrazinamide and levofloxacin was believed to be probably responsible for the emergence of these adverse effects. There were 5 cases of hepatocellular injury. Therapy was discontinued in all individuals. INTERPRETATION: The combination of pyrazinamide and levofloxacin appears to be a poorly tolerated regimen. The mechanism of a possible interaction is not yet understood. Given the severity of some of the adverse events, a better understanding of dosing and clearer guidelines for monitoring therapy are imperative if these drugs are to be prescribed together.

Adolescent↗

Behavioral development in the absence of neural activity: effects of chronic immobilization on amphibian embryos.

Embryos of Xenopus laevis and Ambystoma mexicanum were continually immobilized from premotile stages of development to stages at which normally reared embryos were swimming well. Immobilization was achieved through exposure to solutions of chloretone, lidocaine, or alpha-bungarotoxin. At a number of stages after recovery from the drugs, spontaneous and stimulated behaviors were extensively quantified. Immobilization of Ambystoma embryos resulted in temporary defects in musculoskeletal development. In contrast, treated Xenopus embryos could not be distinguished from controls by simple visual observation within minutes to hours after removal from the drug solutions. Quantifications of behavior revealed, however, a transient period of 24-48 hr during which treated embryos exhibited consistently reduced measures of stimulated swimming, while showing an increase in frequency of spontaneous movements. Detailed behavioral testing could detect no permanent effects of chronic immobilization in either species after this initial period of recovery. The results are discussed in reference to the classic works of Harrison (1904), Carmichael (1926, 1927), and Matthews and Detwiler (1926).

Ambystoma↗

Postnatal development of the fore- and hindlimbs in the grey short-tailed opossum, Monodelphis domestica.

Marsupials are good experimental animals for developmental studies as their offspring are born at a stage comparable to embryonic stages of eutherian species. The South American opossum, Monodelphis domestica, is particularly useful because of its small size and easy maintenance. This study was carried out to compare development of opossum fore- and hindlimbs during postnatal life, using light microscopy and whole mount alizarin staining. At birth, well-developed mobile forelimbs show cartilage models of bones and myotubular striated muscle fibres. However, hindlimbs are relatively underdeveloped paddle-like outgrowths. Two days later mesodermal condensations form models of the future hindlimb bones and mononucleate myoblast aggregates are present; by 6 days post partum (dpp) the hindlimb has reached a stage of development similar to that of the forelimb at birth. At this stage, periosteal buds have invaded forelimb long bones and nuclei in forelimb muscle fibres have become displaced to the periphery. The 16 dpp hindlimb shows long bones invaded by periosteal buds and closely packed, striated muscle fibres. Epiphyseal plates are now seen in the forelimb long bones and forelimb muscle fibres show mature characteristics. Musculoskeletal development is well correlated with the functional demands of the limbs during postnatal development in the opossum, which provides an excellent model for investigations into the genes and molecules controlling limb development.

Animals↗

Repeated survey on changes in musculoskeletal complaints relative to age and work demands.

OBJECTIVES: To examine changes in musculoskeletal complaints over four years in groups of employees relative to age and work demands. METHODS: Repeated questionnaire data of male employees in heavy physical work (exposed group, n = 7324) and mental work (control group, n = 4686), stratified for age (20-9, 30-9, 40-9, 50-9), were analysed. For each employee, data on the occurrence of musculoskeletal complaints from two surveys with a mean interval of around four years were available. Changes in prevalences over the follow up interval were analysed. Proportions of new, recovered, and chronic cases as well as those free of complaints at both surveys were studied. RESULTS: For most complaints, there were significantly greater increases in prevalences in the exposed group compared with the control group over the follow up interval particularly within the group aged 40-9 for back, neck, and several sites of the upper and lower limbs. The 20-9 year age group also had significantly greater changes for several musculoskeletal complaints. Within the oldest age group (50-9) exposure to heavy physical work demands only affected changes in prevalences of neck and upper arm complaints. After four years in the cohort free of complaints at the start of the follow up the group aged 40-9 had the highest prevalence of complaints of the back, neck, and the upper and lower limbs. CONCLUSIONS: Middle aged and younger employees develop musculoskeletal complaints as a result of exposure to heavy physical work. In the oldest age group health related selection seems to mask the occupational health risks under study. To prevent the expected increase in musculoskeletal disorders and related work disability in our aging workforce, preventive measures should be taken at all stages of a working life.

Adult↗

Pseudosyndactyly and musculoskeletal contractures in inherited epidermolysis bullosa: experience of the National Epidermolysis Bullosa Registry, 1986-2002.

Mitten deformities of the hands and feet occur in nearly every patient with the most severe subtype (Hallopeau-Siemens) of recessive dystrophic epidermolysis bullosa, and in at least 40-50% of all other recessive dystrophic epidermolysis bullosa patients. Smaller numbers of patients with dominant dystrophic, junctional, and simplex types of epidermolysis bullosa are also at risk of this complication. Surgical intervention is commonly performed to correct these deformities, but recurrence and the need for repeated surgery are common. Higher numbers of epidermolysis bullosa patients also develop musculoskeletal contractures in other anatomic sites, further impairing overall function. Lifetable analyses not only better project the cumulative risk of mitten deformities and other contractures but also emphasize the need for early surveillance and intervention, since both of these musculoskeletal complications may occur within the first year of life.

Adolescent↗

Effects of space flight on Xenopus laevis larval development.

Fifty-three fertilized Xenopus laevis embryos at early tail bud stage were launched into orbit aboard a Biocosmos satellite and remained in microgravity for 11.5 days. During this period, the embryos hatched and continued to develop as free-living larvae. Forty-eight individuals survived the mission. Upon recovery these tadpoles had smaller heads/bodies and proportionately longer tails than ground controls. Almost all the flight animals had caudal lordosis and consequently swam in backward somersaults. Compared to ground-based controls, their notochords were significantly larger in cross-sectional area and were deformed. Caudal muscle fibers were less dense and involuted in a fashion indicative of degeneration. In contrast, cranial muscles associated with buccal pumping did not differ between the flight and control animals. Upon landing, the flight larvae were found to be negatively buoyant and lay on the bottom when they were not swimming. They had significantly smaller lungs than controls, suggesting that they had failed to inflate their lungs in microgravity. Additionally, the branchial baskets, gill filters and thymuses all showed signs of retarded development or degeneration. The caudal deformity that we observed in the flight X. laevis has been independently observed in three other space flight experiments where embryos were launched then hatched in space. In contrast, Xenopus larvae from another orbital experiment that were raised from fertilization through hatching in space did not exhibit any caudal abnormalities. These divergent results suggest that either features of the launch itself (i.e., high acceleration and vibration) or an abrupt decrease in gravity during the tail bud stage detrimentally affects musculoskeletal development in anurans.

Animals↗

Job demands, muscle activity and musculoskeletal symptoms in relation to work with the computer mouse.

OBJECTIVES: This study assessed work postures, movements, psychosocial job demands, and shoulder and wrist extensor muscle activity and registered the prevalence of musculoskeletal symptoms of computer-aided design (CAD) operators. METHODS: A questionnaire survey was used to study the use of the computer mouse, psychosocial work factors, and musculoskeletal symptoms among 149 CAD operators. A workplace study was performed using observations, electrogoniometers on the wrists, and electromyography to measure exposures and physiological responses during CAD work among a subgroup of the CAD operators. RESULTS: Musculoskeletal symptoms were far more prevalent for the arm or hand operating the mouse than for the other arm or hand, and women were more affected than men. The symptoms may be related to such risk factors as repetitive movements, static postures (eg, ulnar-deviated and extended wrist on the mouse side), and static muscular activation patterns. The risk factors were present due to continuous mouse use and possibly also due to high demands for mental attentiveness, precision, and information processing. CONCLUSIONS: Exposure during work with a computer mouse may present a risk for developing musculoskeletal symptoms. Improvements should focus on introducing more variation.

Adult↗

Strength training and the immature athlete: an overview.

The developing musculoskeletal structures of the immature athlete are uniquely susceptible to injury, particularly at the physes. These growth plates are present in arm and leg bones, and some may not close until the late teen years. Early literature suggested that weight training might be inappropriate for these athletes. However, recent evidence suggests that, properly done, strength/resistance training may not only be safe, it may also help reduce the risk of injury for the young athletes. Nurses are often called upon to advise coaches of formal and community athletic programs, and need to know the underlying physiology of developing bone and muscle as well as the current recommendations related to training.

Adolescent↗

Musculoskeletal injuries among ERCP endoscopists in Canada.

BACKGROUND: There are few reports in the literature describing musculoskeletal complaints among endoscopists, and none are specific to those who perform endoscopic retrograde cholangiopancreatography (ERCP). PURPOSE: To examine the current practices of ERCP endoscopists and the prevalence of musculoskeletal injuries. METHODS: A self-report survey was sent to physicians practising ERCP across Canada identified through a pre-existing database. A second mailing was sent six weeks later to those who did not respond to the first mailing. RESULTS: Of 162 surveys sent, 122 responses were received, with five respondents indicating that they no longer performed ERCP and three declining to participate. Of the 114 participants, 67% reported at least one musculoskeletal complaint, and 58% reported two or more complaints. Seventy-four per cent attributed their symptoms to endoscopy and/or ERCP, and 79% reported that their condition was aggravated by performing ERCP. The most frequently reported pain symptoms were back pain (57%), neck pain (46%) and hand pain (33%), which are all consistent with the physical risks involved in performing ERCP. Only 51% reported taking regular breaks, and only 25% reported having fluoroscopy tables with adjustable heights. The room designs of the respondents' ERCP facilities were analyzed for ergonomic considerations: 67% had poor ergonomics and 33% had good ergonomics. Sixty-four per cent reported that they were interested in learning preventive strategies. CONCLUSIONS: Physicians who perform ERCP develop musculoskeletal injuries and are interested in learning about risk factor modification.

Canada↗

Development of a musculoskeletal examination skills course for a physical medicine and rehabilitation residency program.

This article describes the development of a musculoskeletal physical examination skills course for a physical medicine and rehabilitation residency training program. Course objectives, structure, and modification over time based on experience and resident feedback are discussed. The current course design is adaptable to meet the needs and resources of most residency programs.

Clinical Competence↗

Computer use increases the risk of musculoskeletal disorders among newspaper office workers.

BACKGROUND: Our objectives were to estimate prevalence of musculoskeletal disorders among office workers at a newspaper in Mexico City, analyze the relationship between musculoskeletal disorders and use of the personal computer (PC) and associated ergonomic factors in the aforementioned population, and to analyze the modifying effect that psychosocial factors have on the relationship between ergonomic factors and musculoskeletal disorders and extant jobs at the newspaper. METHODS: A total of 73% (218 of 298) of office workers at a newspaper were studied. Information was collected by a questionnaire completed by participants. Cases for work-related musculoskeletal disorder in hands (WMSD-H), upper extremity (WMSD-UE), and back (WMSD-B) were established. Working conditions, computer use, and ergonomic and psychosocial factors were studied as independent variables. To study the relationship between musculoskeletal disorders and independent variables, prevalence ratios adjusted for potential confounders (sex, age, educational level, and marital status) were estimated. RESULTS: Risk of musculoskeletal disorders was greater among workers at the newspaper who used computers, those involved in editing work, and those who adopted uncomfortable positions. The modifying effect of psychosocial factors was observed only in the relationship between ergonomic factors and WMSD-B because among workers with control over work, WMSD-B risk was reduced by the greater number of work breaks. Among workers without social support, increase in number of postures and rotation/inclination of the neck was associated with substantial risk increase, while amid workers under psychological demand number of PC tasks and number of rest pauses were associated with increase in WMSD-B risk. CONCLUSIONS: The findings of our study showed that PC use increased risk of developing musculoskeletal disorders (WMSD-H and WMSD-UE). Such an increase is mediated by ergonomic factors such as mouse use, remaining seated for prolonged periods, adoption of inadequate or uncomfortable postures, performing certain PC tasks, and psychosocial factors.

Adult↗

The Football Association medical research programme: an audit of injuries in academy youth football.

OBJECTIVES: To undertake a prospective epidemiological study of the injuries sustained in English youth academy football over two competitive seasons. METHODS: Player injuries were annotated by medical staff at 38 English football club youth academies. A specific injury audit questionnaire was used together with a weekly return form that documented each club's current injury status. RESULTS: A total of 3805 injuries were reported over two complete seasons (June to May) with an average injury rate of 0.40 per player per season. The mean (SD) number of days absent for each injury was 21.9 (33.63), with an average of 2.31 (3.66) games missed per injury. The total amount of time absent through injury equated to about 6% of the player's development time. Players in the higher age groups (17-19 years) were more likely to receive an injury than those in the younger age groups (9-16 years). Injury incidence varied throughout the season, with training injuries peaking in January (p<0.05) and competition injuries peaking in October (p<0.05). Competition injuries accounted for 50.4% of the total, with 36% of these occurring in the last third of each half. Strains (31%) and sprains (20%) were the main injury types, predominantly affecting the lower limb, with a similar proportion of injuries affecting the thigh (19%), ankle (19%), and knee (18%). Growth related conditions, including Sever's disease and Osgood-Schlatter's disease, accounted for 5% of total injuries, peaking in the under 13 age group for Osgood-Schlatter's disease and the under 11 age group for Sever's disease. The rate of re-injury of exactly the same anatomical structure was 3%. CONCLUSIONS: Footballers are at high risk of injury and there is a need to investigate ways of reducing this risk. Injury incidence at academy level is approximately half that of the professional game. Academy players probably have much less exposure to injury than their full time counterparts. Areas that warrant further attention include the link between musculoskeletal development and the onset of youth related conditions such as Sever's disease and Osgood-Schlatter's disease, the significant number of non-contact injuries that occur in academy football, and the increased rates of injury during preseason training and after the mid season break. This study has highlighted the nature and severity of injuries that occur at academy level, and the third part of the audit process now needs to be undertaken: the implementation of strategies to reduce the number of injuries encountered at this level.

Adolescent↗

Symposium on the musculoskeletal aspects of Marfan syndrome: meeting report and state of the science.

The National Marfan Foundation sponsored a symposium in August 2005 to review recent progress in the area of Marfan-related musculoskeletal research. Orthopaedic surgeons, molecular geneticists, medical geneticists, and pain specialists met to review a variety of topics. This report reviews and summarizes the proceedings of the symposium, with emphasis on future directions for study that were identified in the course of the meeting. Areas covered include clinical detection, diagnosis, growth, spine deformity, molecular mechanisms, dural ectasia, protrusio acetabuli, and pain in Marfan syndrome.

Acetabulum↗