Acute traumatic tear of the latissimus dorsi tendon from its insertion. A case report.
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Acute Disease↗
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Results for “Back Injuries”
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Disability days in major league baseball.
We have examined the injury experience in Major League Baseball as reflected by the disabled list, based on data presented by American Specialty Companies in their publications, to examine any changes in injury rates over the past 11 years. It is reasonable to expect that improvements in training and conditioning, diagnostic methods, and surgical treatment over the last 11 years would have reduced injuries and resulted in fewer players on the disabled list. Yet, such does not appear to be the case. There is no evidence that the number of injuries in Major League Baseball has declined over the last decade; on the contrary, it appears that both the number of players and player days on the disabled list have increased. Team membership, injury location, and position do not appear to be related to the increase. Nor does it appear that the increase in injuries is a result of more sensitive diagnostic tests allowing the diagnoses of previously unrecognized injuries. Whatever the reason, it is significant that publicly available data, when viewed over an 11-year period, reveal a gradual and consistent increase in reported injuries--suggesting a problem that deserves attention.
Absenteeism↗
When to operate on abdominal gunshot wounds.
Historically, penetrating abdominal trauma was managed expectantly until the late 19th century. In World War I, with the high mortality and morbidity associated with penetrating abdominal trauma, operative management replaced expectant management. It was soon realized that not all penetrating abdominal injuries required an operation. Since the 1960's, selective nonoperative management of stab wounds to the anterior abdomen has become the standard of care. However, gunshot wounds to the abdomen are still treated by mandatory exploration based on an allegedly high incidence of intra-abdominal injuries and low rate of complications, if laparotomy turns out negative. A number of series have recently surfaced, reporting successful outcomes, while decreasing morbidity and hospital length of stay, with selective non-operative management of gunshot wounds to the abdomen. This review will address the current controversies surrounding selective nonoperative management of gunshot wounds to the abdomen and will present our experience and current approaches.
Abdominal Injuries↗
Use of leg positioning holders.
Direct Placement Leg Holders (DPLHs) have improved patient care in our hospital for those people requiring lower limb internal fixation for fractures. This brief history of how and why their potential use in orthopaedic trauma came about will describe the benefits for patient care and how they can improve patient positioning. Further suggestions include added benefits for practitioners acting as surgical or first assistants to the surgeon, including highlighting the benefits of preventing back injury to staff.
Equipment Design↗
Influence of static lumbar flexion on the trunk muscles' response to sudden arm movements.
BACKGROUND: Viscoelastic creep of lumbar ligaments (prolonged forward bend) has been shown to negatively influence the spine's muscular reflexive behaviour and spinal stability. No studies to date have investigated the influence of spinal viscoelastic creep on the feedforward response of the trunk muscles to sudden arm raises. METHODS: Surface myoelectric activity was collected from the transversus abdominis/internal oblique, the lower erector spinae and the deltoid muscle during sudden ballistic arm raising before and after 10 minutes of prolonged forward bend in 11 healthy participants free of low back injury. The timing of trunk muscle activity relative to the deltoid muscle was calculated for 5 trials before and 5 trials after the creep procedure. RESULTS: Viscoelastic creep had no influence on the feedforward response of the trunk muscles during sudden arm raises. A feedforward response of the trunk muscles was not seen in every study participant and during every trial. CONCLUSION: Passive trunk muscle fatigue does not appear to influence the timing of the stabilizing role of the investigated trunk muscles to sudden arm flexion.
Journal Article↗
Pars interarticularis stress lesions in the lumbar spine of cricket fast bowlers.
PURPOSE: This prospective magnetic resonance (MR) imaging study investigated the development of symptomatic pars lesions in the lumbar spine of adolescent cricket fast bowlers. METHODS: Annual MR examinations of the lumbar spine in male fast bowlers (N = 51) and swimmers (N = 20) without a prestudy history of symptomatic back injury were conducted to identify stress-induced pars injuries over 4 and 2 yr periods, respectively. RESULTS: Symptomatic L4 and L5 pars lesions developed in 11 of 51 and 1 of 51 of the bowlers, respectively. Preexisting L5 lesions were observed in both bowlers (10 of 51) and swimmers (4 of 20). No significant difference existed between the proportion of bowlers and swimmers with preexisting L5 lesions (P = 1.00, Fisher's exact test). In contrast, bowlers had a significantly greater proportion of L4 pars lesions compared with swimmers, with 22% of the bowlers developing L4 injuries during the study, whereas there were no L4 lesions in the swimmers (P = 0.027, Fisher's exact test). The symptomatic L4 lesions in the bowlers developed between 15 and 17 yr of age, and all were unilateral lesions lateralized to the nonbowling-arm side. The MR characteristics of the L4 pars lesions were consistent with a stress fracture through the cortical bone. Of the acquired L4 lesions in the bowlers, 4 of 11 and 7 of 11 developed in individuals with and without preexisting L5 defects, respectively. No significant association existed between the acquired L4 pars lesions and preexisting L5 defects in the bowlers (P = 0.216, Fisher's exact test). CONCLUSION: Fast bowling was directly associated with the development of symptomatic pars lesions of the lumbar spine, particularly unilateral L4 stress lesions, in a significant proportion of the adolescent bowlers examined in this prospective MR study.
Adolescent↗
Developing a new uniform policy for student nurses.
It has been recognized that for many years traditional nurse uniforms are far from ideal. Inappropriate uniforms can be a contributory causative factor in back injury among nurses. Many nurses hold firmly to a traditional view of what constitutes a 'proper' nurse's uniform. Uniforms can act as a barrier and hindrance in the development of the therapeutic relationship between nurse and patient. Many colleges of nursing face amalgamation. This presents them with an opportunity to re-examine their uniform policies and rationalize the many into the one.
Clothing↗
The safety and dignity of patients and nurses during patient handling.
Since the implementation of the Moving and Handling Operations Regulations (Health and Safety Executive, 1992) there has been considerable effort to reduce back injury among nurses by developing patient handling policy that eliminates actual manual handling. Recently, however, there have been challenges to 'no manual handling' policies by patients as an issue of dignity and human rights. This article offers a literature-based discussion of patient handling in relation to safety and dignity for both patients and nurses. The literature does not offer a solid evidence base for handling practice, and research, involving patents, is limited. However, nurses' handling practice is governed by legislation and NHS Trust policies. Patient handling that is safe and dignified for both patient and handler is a vital skill that requires knowledge and competence. This article suggests ways of developing practice that is safe and dignified for both patient and handler.
Humans↗
Measuring quality of life in back patients: comparison of Health Status Questionnaire 2.0 and Quality of Life Inventory.
This paper is a reliability and validity test of the Health Status Questionnaire (HSQ) 2.0. In addition, the Quality of Life Inventory (QOLI) is compared with the HSQ 2.0 to assess concurrent validity. The study is unique because these instruments are assessed for the first time using a sample of chronic back patients. Practitioners will therefore now be able to evaluate important quality of life issues and treatment changes in this population. The HSQ 2.0 was generally found to be valid for these patients. However, two scale domains were not differentiated due to unique characteristics of spinal disease patients. The QOLI, due to the limitation of measuring only psychological well-being, did not measure problems specific to back patients.
Activities of Daily Living↗
[Analyses of work-relatedness of health problems among truck drivers by questionnaire survey].
In order to estimate occupational risk factors for health problems among truck drivers, a questionnaire survey of working conditions, job content in truck transportation, subjective symptoms and present illnesses was carried out among 541 truck transportation workers in 1997. The valid response rate was 85.7%, and 134 local truck drivers, 199 long-distance truck drivers and 71 clerical workers were analyzed. First, to examine occupational risk factors and health problems among the three groups, the authors analyzed working conditions, job content in truck transportation, subjective symptoms and present illnesses. Second, to estimate the work-relatedness of health problems among local truck drivers and long-distance truck drivers, logistic regression analyses were conducted, and odds ratios and 95% confidence intervals were computed. The prevalence rates of working factors affecting health problems of truck drivers were significantly higher than those of clerical workers in the items on irregular shift work, working environment, working posture, handling heavy materials, job stress due to overloading and long working time and limited time off. The prevalence rates for subjective symptoms (ringing in the ears, neck pain and low back pain) and present illnesses (hypertension, ulcers in the digestive tract, back injuries, whiplash injuries and hemorrhoids) among truck drivers were significantly higher than those of clerical workers. In logistic regression analyses, many work-related items except age, BMI and smoking habit showed significantly higher odds ratios for subjective symptoms and present illnesses of truck drivers. Odds ratios for hypertension, heart diseases and related subjective symptoms among local truck drivers were significantly increased by job career, twisting posture, vibration and driving stress. Odds ratios for gastro-duodenal diseases and related subjective symptoms were significantly increased by narrow working space, sleeping in the truck, driving distance, squatting posture and driving stress. Odds ratios for ringing in the ears among local truck drivers were significantly increased by job career, long working time, narrow working space, sleeping in the truck and driving stress. Odds ratios for musculo-skeletal diseases and related subjective symptoms were significantly increased by overwork, vibration, narrow working space, sitting posture and shortage of recess. Odds ratios for fatigue symptoms were significantly increased by the shortage of recess, vibration and driving stress. In order to cope with the health problems of truck drivers, it is recommended that working conditions and work loads for among truck drivers as described above be improved.
Automobile Driving↗
[Assessment of a hospital bath chair: an ergonomic approach].
A high rate of musculoskeletal disorders in members of the nursing team is observed in the literature. The use of special devices such as the bath chair has reduced the risk of back injuries in these workers and has also provided the patient with greater safety as well as comfort. The aim of the present study was to assess the ergonomic characteristics of a bath chair utilized in a hospital Separate questionnaires were applied for the nurses and the patients. The bath chair accessories presented several ergonomic problems. The perceived physical exertion according to the Borg-CR10 Scale indicated that a high level of exertion was required to manipulate the equipment (8.33).
Baths↗
Revolutionary advances in adaptive seating systems for the elderly and persons with disabilities that assist sit-to-stand transfers.
The independence of elderly and arthritic patients as well as persons with disabilities is influenced considerably by their ability to stand from a chair. The presence of pain, reduced joint range of motion, stiffness, and muscle weakness often limit the ability to achieve a sit-to-stand position (STS). Realizing the enormous implications of STS performance, physicians, scientists, and industry have joined together to design and manufacture a wide variety of adaptive seating systems that facilitate therising process. These systems can be divided into three groups: those without mechanical devices, those with mechanical lifts, and those that can lift, tilt in space, recline, or rock. The design of mechanical seating systems without mechanical assists have been influenced by several factors, including chair height, armrest height, and foot position of the occupant. The evaluation of STS performance involves a variety of measurements to include joint angles and moments, speed of time to rise, functional reach and sway, and perception of patient stability (or perceived safety) in rising from a chair. These studies reported that chair seat height, use of armrest, and foot position had a major influence on the ability to do a STS movement. The use of higher chair seats resulted in lower moments at the knee and hip level. Investigators reported that lowering the chair height increased the need for momentum generation or repositioning of the feet to lower the needed moments. They found that the use of an armrest reduced the moments needed at the hip without altering the range of motion of the joints. These investigators found that repositioning of the feet influenced the strategy of STS movement, allowing lower mean extension moments at the hipwhen the foot position changed from anterior to posterior. Adaptive seating systems with lifts include the spring-booster chair spring-loaded flap seat, and ejector chair. Innovative investigators reported that increased seat height complemented by the mechanical lift enhanced STS transfers by persons with disabilities. The investigators noted that it was easier to perform STS transfer when using a mechanical lift than when rising unassisted or from a raised seat height. The latest adaptive seating system, the elevator chair, has the unique ability to assist the occupant to the STS position. The rear section of this chair remains in a fixed position to support the buttocks of the user during the mechanical lift. The front portion of the seat folds down incrementally as the chair rises to allow the feet of the user to be positioned firmly on the floor. Using an elevator chair, the height that the chair rises will vary with the length of the occupant's legs. When the user reaches a point when his/her legs are comfortably straight and the body is in an erect position, the occupant will walk unassisted from the chair. This elevator chair will soon be available with a tilt-in-space capability as well as a gently rocking motion. The elevator chairs are ideally suited for offices, waiting rooms, hospitals, long-term care facilities, and homes. While persons with disabilities appreciate the benefits of these adaptive seating systems, which allow them to achieve a STS position without assistance, healthcare personnel also value the benefits of these adaptive seating systems because they eliminate their need to lift the occupant to a standing position--an invitation for a potentially serious back injury.
Activities of Daily Living↗
The Sit & Stand chair. A revolutionary advance in adaptive seating systems.
A major factor governing independence for the elderly and persons with disabilities is the ability to stand from a chair. Factors such as pain, reduced joint range of motion, stiffness, and muscle weakness frequently limit the ability to stand. Sit-to-stand position is even further reduced in patients whose hands and shoulders are afflicted with rheumatoid arthritis. When achieving a sit-to-stand position in the elderly and persons with disabilities, there is considerable risk of the individual falling and sustaining bone fracture. The purposes of this scientific report are to achieve the following goals: (1) to provide a narrative discussion of the senior author's contributions to furniture manufacturing as well as his successful patent application for the SIT & STAND chair, (2) to describe the steps involved in the development of the SIT & STAND prototype, and (3) to examine the performance of the SIT & STAND chair in assisting the elderly or persons with disabilities in achieving a sit-to-stand position. The invention of the SIT & STAND chair by the senior author, Michael Galumbeck, was a culmination of his lifelong interest in adaptive seating systems. His electrically operated chair has the unique ability to assist the occupant to achieve safely a sit-to-stand position. The rear portion of his chair remains in a fixed position to support the buttocks of the user during mechanical lift. The front portion of the seat folds down incrementally as the chair rises to allow the feet of the user to be positioned in a more posterior position firmly on the floor. Using its actuator, the height that the chair rises will vary with the length of the legs of the occupant. Using the drawing program Solid Works (Solid Works, Concord, Massachusetts), drawings of the chair were made. To visualize the operation and performance of the chair, separate drawings were made in the lateral position. The prototype of the SIT & STAND chair was manufactured with an electric actuator that allows elevation of the back portion of the seat. The design of this chair ensured that there were no pinch points that could endanger the user or assistant. Its framework ensured that it was stable and did not tip over. After the prototype chair is manufactured, it is being sent to Underwriters Laboratory Inc. (Los Angeles, California) for review and certification. The performance of the SIT & STAND chair was determined in a clinical study involving seven elderly or disabled individuals who complained of difficulty in rising from a chair from a seated position. During each performance evaluation, a mechanical chest and shoulder harness attached to an overhead sling encircled the individual to ensure that he/she would not fall. In the first part of the evaluation, these individuals were asked to achieve a standing position after being seated in the SIT & STAND chair without the use of the actuator. Three individuals were unable to achieve a standing position, while four achieved this standing position with considerable difficulty and potential instability. When these participants used the SIT & STAND chair with the use of the electrical actuator, all individuals achieved a standing position without difficulty or instability. All individuals expressed disappointment that the SIT & STAND chair was not commercially available for them to purchase and use in their homes. Because the SIT & STAND chair allows the individual to achieve a standing position without assistance, the SIT & STAND chair has other potential benefits not evaluated in this study. The beneficial effects of standing have been documented by comprehensive scientific studies. These benefits include reduction of seating pressure, decreased bone demineralization, increased bladder pressure, enhanced circulatory regulation, reduction in muscular tone, decrease in upper extremity muscle stress, and participation in activities of daily living. Another irrefutable benefit of the SIT & STAND chair is that the chair eliminates the need for physical assistance from family members or health care personnel, preventing the development of disabling back injuries in personal care assistants. In addition, the SIT & STAND chair entirely removes the risk of pain or harm to the individual, which sometimes occurs with manual assist to stand, such as dislocation or fracture of frail shoulders with the under-axilla lift. Realizing the medical benefits of the SIT & STAND chair, Aetna completed a clinical policy bulletin that states that the seat lift mechanism is a medically necessary durable medical product. On the basis of this extensive product and performance evaluation, we recommend the SIT & STAND chair for the elderly as well as persons with disability to safely achieve a sit-to-stand position.
Activities of Daily Living↗
Revolutionary advances in medical waste management. The Sanitec system.
It is the purpose of this collective review to provide a detailed outline of a revolutionary medical waste disposal system that should be used in all medical centers in the world to prevent pollution of our planet from medical waste. The Sanitec medical waste disposal system consists of the following seven components: (1) an all-weather steel enclosure of the waste management system, allowing it to be used inside or outside of the hospital center; (2) an automatic mechanical lift-and-load system that protects the workers from devastating back injuries; (3) a sophisticated shredding system designed for medical waste; (4) a series of air filters including the High Efficiency Particulate Air (HEPA) filter; (5) microwave disinfection of the medical waste material; (6) a waste compactor or dumpster; and (7) an onboard microprocessor. It must be emphasized that this waste management system can be used either inside or outside the hospital. From start to finish, the Sanitec Microwave Disinfection system is designed to provide process and engineering controls that assure complete disinfection and destruction, while minimizing the operator's exposure to risk. There are numerous technologic benefits to the Sanitec systems, including environmental, operational, physical, and disinfection efficiency as well as waste residue disinfection. Wastes treated through the Sanitec system are thoroughly disinfected, unrecognizable, and reduced in volume by approximately 80% (saving valuable landfill space and reducing hauling requirements and costs). They are acceptable in any municipal solid waste program. Sanitec's Zero Pollution Advantage is augmented by a complete range of services, including installation, startup, testing, training, maintenance, and repair, over the life of this system. The Sanitec waste management system has essentially been designed to provide the best overall solution to the customer, when that customer actually looks at the total cost of dealing with the medical waste issue. The Sanitec system is the right choice for healthcare and medical waste professionals around the world.
Equipment Design↗
Total knee arthroplasty in patients receiving Workers' Compensation.
The poor outcomes in patients who have a low-back injury that was sustained while they were on the job have been well described in many studies. The purpose of the current study was to determine the influence of Workers' Compensation on the outcome of total knee arthroplasty in forty-two patients who had been managed between January 1980 and December 1993. There were thirty-two men and ten women, and the mean age at the time of the operation was forty-eight years (range, twenty-nine to sixty-eight years). These patients were directly matched with a group of forty-two patients who were not receiving compensation. The two groups were matched with regard to nine parameters: age, gender, obesity index, preoperative deformity in the coronal plane, preoperative level of symptoms, preoperative radiographic severity according to the criteria of Ahlbäck, method of fixation, number of previous procedures, and duration of follow-up. After a mean duration of follow-up of eighty months (range, forty-eight to 178 months), the patients who were receiving compensation had a mean Knee Society score of 64 points (range, 25 to 100 points). Twelve (29 per cent) of the patients in this group had an excellent or good clinical result, and thirty (71 per cent) had a fair or poor result or had had a revision. The patients who were not receiving compensation had a mean Knee Society score of 93 points (range, 57 to 100 points) after a similar duration of follow-up. Thirty-seven patients (88 per cent) in this group had an excellent or good clinical result, and five (12 per cent) had a fair or poor result or had had a revision; the difference between the two groups with regard to fair or poor results and revisions was significant (p < 0.01). With the numbers available, no significant differences could be detected between the two groups with regard to objective measurements of range of motion and stability or with regard to radiographic alignment, the presence of radiolucent lines, or the shedding of beads. On the basis of our findings, we believe that surgeons should be aware that Workers' Compensation is one of several variables that may have an untoward influence on the perceived outcome of total knee arthroplasty.
Adult↗
Applied physiology of rowing.
Elite oarsmen and oarswomen possess large body dimensions and show outstanding aerobic and anaerobic qualities. Oarsmen have VO2max values of 6.1 +/- 0.6 L/min and have incurred O2 debts of between 10 and 20 litres. The caloric expenditure of rowing estimated from the O2 cost of a 6-minute rowing ergometer exercise was calculated at 36 kcal/min, one of the highest energy costs so far reported for any predominantly aerobic-type sport. Aerobic and anaerobic calculations show that 70 to 75% of the energy necessary to row the standard 2000m distance for men is derived from aerobiosis while the remaining 25 to 30% is anaerobic. Women achieve VO2max values of 4.1 +/- 0.4 L/min and slightly lower anaerobic values than men. The relative 60 to 65% energy contribution of aerobic metabolism and 35 to 40% for anaerobiosis is not surprising since women compete at 1000m. Rowers also exhibit excellent isokinetic leg strength and power when compared with other elite athletes and oarswomen produced higher relative leg strength values than men when lean body mass is considered. Muscle fibre type distributions in oarsmen resemble those of distance runners while women tend to have a slightly higher proportion of fast-twitch fibres. An average power output of 390 +/- 13.6W was produced by oarsmen for 6 minutes of simulated rowing while women were able to develop 300 +/- 18.4 for 3 minutes of the same activity. Mechanical efficiency for rowing was calculated at 20 +/- 0.9%. Oarsmen also achieve very high ventilation volumes being able to average above 200 L/min BTPS for 6 minutes of simulated rowing; women ventilate 170 L/min BTPS for 3 minutes of this exercise. Excellent VO2/VE and O2 pulse values demonstrate outstanding cardiorespiratory efficiency. Both oarsmen and oarswomen utilise a unique physiological pattern of race pacing; they begin exertion with a vigorous sprint which places excessive demands on anaerobic metabolism followed by a severely high aerobic steady-state and then an exhaustive sprint at the finish. Tolerance to excessive anaerobiosis is evident by very high lactates and O2 deficits measured during the first 2 minutes of exercise. Physiological profiles of successful international calibre rowing athletes have been established as a result of studies described in this review and the data have been used in a variety of ways to improve rowing performance.
Adult↗
Psychometric study of forms A and B of the Multidimensional Health Locus of Control scale.
Forms A and B of the Multidimensional Health Locus of Control scales were included in a battery of preworkshop measures at a program on back care for staff at a psychiatric hospital (N = 82). Lack of extensive reports regarding alternate-form reliability of the health forms led to this study. Factor analytic results, item-by-item correlations, alpha coefficients, and Pearson correlations between forms are reported. Through these procedures the authors found discrepancies between Forms A and B, particularly for Scale P.
Adolescent↗
Therapists' ability to identify safe maximum lifting in low back pain patients during functional capacity evaluation.
Functional capacity evaluation (FCE) of an injured worker's ability to lift weight guides the determination of whether he or she is capable of handling the physical demands of a job. The purpose of this study was to examine the interrater and intrarater reliability in determining the safe maximum floor-to-waist lift for patients with low back pain during FCE testing. Twenty-one patients with low back pain were evaluated. Patients were videotaped lifting weight in progressive increments using a kinesiophysical approach. Five experienced physical therapists viewed the videotape and judged the lifts for body mechanics safety. Safety reliability was high, indicating that therapists can accurately judge safe lifting methods during FCE. As lifting loads increased, body mechanics deteriorated, indicating the patient was approaching or had reached a biomechanical end point. Clinical information is needed, in addition to visual observations, to accurately determine when maximum lift capacity is reached.
Adult↗