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At least 955 records · Page 53Linked to original sources
PubMed1998

A Three-Dimensional Musculoskeletal Model of the Human Knee Joint. Part 1: Theoretical Construct.

A three-dimensional model of the knee is developed to study the interactions between the muscles, ligaments, and bones during activity. The geometry of the distal femur, proximal tibia, and patella is based on cadaver data reported for an average-size knee. The shapes of the femoral condyles are represented by high-order polynomials; the tibial plateaux and patellar facets are approximated as flat surfaces. The contacting surfaces of the femur and tibia are modeled as deformable, while those of the femur and patella are assumed to be rigid. Interpenetration of the femur and tibia is taken into account by modeling cartilage as a thin, linear, elastic layer, mounted on rigid bone. Twelve elastic elements describe the geometry and mechanical properties of the cruciate ligaments, the collateral ligaments, and the posterior capsule. The model is actuated by thirteen musculotendinous units, each unit modeled as a three-element muscle in series with tendon. The path of each muscle is approximated as a straight line, except where it contacts and wraps around bone and other muscles; changes in muscle paths are taken into account using data obtained from MRI. In the first part of this paper, the model is used to simulate passive knee flexion. Quantitative comparisons of the model results with experimental data reported in the literature indicate that the relative movements of the bones and the geometry of the ligaments and muscles in the model are similar to those evident in the real knee. In Part II, the model is used to describe knee-ligament function during anterior-posterior draw, axial rotation, and isometric knee-extension and knee-flexion exercises.

Journal Article↗
PubMed2004

Role of vascularised tissue transfer after oncological resection in the upper extremity.

We reviewed 12 patients who had had vascularised tissue transfer after oncological resection in the upper extremity. All patients had immediate reconstruction, and one had a double tissue transfer. Tissues used were skin flaps, free muscles, and vascularised fibulas, for resurfacing the wound, motor recovery, and reconstruction of large bony defects, respectively. All the patients returned early to their daily activities. Although local recurrences were encountered in two patients, they were again rendered disease-free by salvage operations. Two patients had secondary reconstructions using pedicle latissimus dorsi flaps for late problems, including one of the two patients who developed a local recurrence. The mean functional score using the system devised by the Musculoskeletal Tumor Society was 84%. All the upper extremities were successfully rescued with satisfactory function. Vascularised tissue transfer was invaluable for achieving both curative resection of the tumour and a useful upper extremity.

Adolescent↗
PubMed1989

Management of individuals with Parkinson's disease: rationale and case studies.

In this article, we present a systematic approach to physical therapy management of individuals with Parkinson's disease. This approach is based on a model that relates knowledge of the underlying pathology of the disease to impairments and disability. We discuss use of the model to evaluate, interpret, and treat impairments and disabilities of the patient with Parkinson's disease. We emphasize the relative influence of impairments that arise directly from the neuroanatomical pathology and those that arise indirectly through subsequent musculoskeletal alterations. We illustrate the use of the model in setting goals and in developing a treatment program. Two case studies are presented to illustrate the application of this approach to specific patient care. These case studies suggest the efficacy of physical therapy initiated early in the disease process. The first case study illustrates improvements of balance, gait, and functional movement made by an individual who was not yet receiving medication for Parkinson's disease. The second case study illustrates improvements of balance, gait, and functional movement made by an individual who was already receiving medication for the disease. These case studies illustrate the dramatic improvements that can be achieved in the patient with Parkinson's disease.

Aged↗
PubMed1998

Transforming growth factor beta in fracture repair.

Transforming growth factor betas are a group of polypeptide growth factors that have a wide range of activities in the musculoskeletal and immunological systems. They are thought to play an important role in the development, induction, and repair of bone. This family of closely related genes includes the five known transforming growth factor betas and also the bone morphogenetic proteins. With the development of new techniques to analyze gene expression, the broad range of cellular activities regulated by transforming growth factor beta is beginning to be understood. The critical role that transforming growth factor beta plays in the regulation and stimulation of mesenchymal precursor cells for chondrocytes, osteoblasts, and osteoclasts is now emerging based on a series of in vitro studies. Although transforming growth factor betas appear to stimulate proliferation of precursor cells, it appears that transforming growth factor betas have an inhibitory effect on mature cell lines. In vivo studies indicate the presence of transforming growth factor beta protein and transforming growth factor beta gene expression in normal fracture healing, whereas exogenous transforming growth factor beta administration stimulates the recruitment and proliferation of osteoblasts in fracture healing. Although the cascade of events that leads to bone formation and repair is not completely understood, transforming growth factor beta's central role in the regulation of fracture healing is not disputed.

Bone Morphogenetic Proteins↗
PubMedDate not supplied

[Fibromyalgia: a challenge for neuroscience].

AIMS: In this survey we present the most recent findings regarding the physiopathology and therapeutic guidelines of a disease we still know very little about: fibromyalgia. This disorder is characterized by a chronic process of generalized musculoskeletal pain accompanied by chronic fatigue, sleep disorders and, on many occasions, neuroendocrine disorders. DEVELOPMENT: Most research on the physiopathology of fibromyalgia points towards some kind of pain transmission disorder in the dorsal horn of the spinal cord. In chronic pain processes, a resonance effect is produced in the synapse of the dorsal horn and this gives rise to allodynia and hyperalgesia. From a biochemical point of view, glutamate and substance P receptors, as well as the main systems involved in the transmission of pain, serotonin and noradrenaline, seem to play a fundamental role. Patients with fibromyalgia have generally been seen to have lowered 5HT activity and an increase in substance P. In addition to these alterations in the perception of pain, serotonin could also be responsible for the frequently occurring sleep, hormone and neuropsychiatric disorders observed in these patients. CONCLUSIONS: Nowadays fibromyalgia is still a challenge for modern medicine. Indeed, the neuroscientific community must design a basic scientific approach carried out at the patient s bedside in order to find pharmacological tools with which to relieve these symptoms. Of the extensive therapeutic arsenal that has been tested in these patients to date, classical antidepressants and serotonin and noradrenaline reuptake inhibitors, used in sub antidepressant doses, seem to be the most effective.

Antidepressive Agents↗
PubMed2003

Novel osteoinductive biomimetic scaffolds stimulate human osteoprogenitor activity--implications for skeletal repair.

The development of new bone formation strategies offers tremendous therapeutic implications in a variety of musculoskeletal diseases. One approach involves harnessing the regenerative capacity of osteoprogenitor bone cells in combination with biomimetic scaffolds generated from appropriate scaffold matrices and osteoinductive factors. The aims of our study were to test the efficacy of two innovative osteoinductive agents: the osteoblast stimulating factor-1 (osf-1), an extracellular matrix-associated protein, and osteoinductive extracts of Saos-2 cells on human osteoprogenitor cells. Saos-2 extracted osteoinductive factors significantly stimulated alkaline phosphatase specific activity in basal and osteogenic conditions. Osf-1 significantly stimulated chemotaxis, total colony formation, alkaline phosphatase-positive colony formation, and alkaline phosphatase specific activity at concentrations as low as 10 pg/ml compared with control cultures. Osteoinductive factors present in Saos-2 cell extracts and osf-1 promoted adhesion, migration, expansion, and differentiation of human osteoprogenitor cells on 3-D scaffolds. The successful generation of 3-D biomimetic structures incorporating osf-1 or osteoinductive factors from Saos-2 cells indicates their potential for de novo bone formation that exploits cell-matrix interactions.

Aged↗
PubMed2003

Treatment of nonunions following anterior cervical discectomy and fusion with interspinous wiring and bone grafting.

Between 1979 and 2000, 25 posterior arthrodeses were performed for repair of symptomatic nonunions following anterior discectomy and fusion. The surgical technique in all cases was an interspinous wiring with an autogenous bone graft in 20 and morselized allograft bone in five. The average follow-up was 5 years (range, 1-14 years). In all patients, the anterior pseudarthrosis progressed to a solid union as judged by an independent musculoskeletal radiologist. In 17 patients, their preoperative pain was relieved; however, of these, six developed recurrent pain caused by degeneration at an adjacent level on an average of 5 years (range, 1-14 years) after their posterior surgery. The authors propose that posterior interspinous wiring with a bone graft is a safe and efficacious method of repair of an anterior pseudarthrosis. However, patients must be cautioned that even though the pseudarthrosis can be predictably repaired by a posterior procedure, preoperative pain may not be relieved.

Bone Transplantation↗
PubMed2005

Reduction of low back muscular discomfort through an applied ergonomics intervention program.

An applied ergonomics intervention program (AEIP) was conducted with male employees who work in the pressing and storage sections of a metal auto parts factory in eastern Thailand. The objective of this study was to reduce worker muscular discomfort at the low back. The study design was a participatory research approach, with quasi-experimental pretest-posttest, and with a non-equivalent control group. Thirty-five persons participated in the AEIP (AEIP group) and 17 persons did not (non-AEIP group). The AEIP was composed of three major categories: (1) top management support; (2) equipment designed for workstations and manual material handling; and (3) administrative intervention, training, and health education. Muscle activity was measured by surface electromyography of the left and right erector spinae, and multifidus muscles; and evaluated by multivariate test for dependent samples (paired observation) and for independent samples. After the AEIP, the low back muscular loads of the AEIP group was significantly reduced, while those of the non-AEIP group were not. Comparison of the means of percentage maximum voluntary contractions (% MVC) of low back muscular activity between the AEIP group and non-AEIP group indicated that the AEIP group had significantly reduced low back muscular load, with a 95% confidence level (p-value < 0.05).

Adult↗
PubMedDate not supplied

[Non-steroidal anti-inflammatory drugs and lower intestinal tract toxicity].

In addition to adverse effects on gastroduodenal mucosa, it is recognized that non-steroidal antiinflammatory drugs (NSAIDs) can also induce toxicity to the lower intestinal tract. The diagnostic tools available and the lack of information about its pathogenesis and clinical importance are still limitations for its diagnosis. For their anti-inflammatory and analgesic effects, NSAIDs are largely used to treat musculoskeletal disorders. Increased intestinal permeability and inflammation are the main pathogenic steps in the development of NSAIDs enteropathy which may result in bleeding and protein loss. Selective COX-2 inhibitors, although seem safer, may also induce intestinal lesions. In this article, about NSAIDs damage to the lower intestine, we review aspects about its prevalence, pathogenesis, lesions, clinical spectrum and practical clues to diagnosis and treatment.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1987

Osteomyelitis of the sacrum as the initial manifestation of Crohn's disease.

A 17-year-old boy had low back pain for four months prior to the development of sacral osteomyelitis, which led to the initial diagnosis of Crohn's disease. Musculoskeletal problems occur in about one-third of the patients with Crohn's disease. Only a few patients with osteomyelitis complicating Crohn's disease have been reported. This case is rare because he had had no gastrointestinal symptoms. This patient illustrates the point that musculoskeletal signs and symptoms, including osteomyelitis, may prove to be a manifestation of gastrointestinal tract disease.

Adolescent↗
PubMed1996

[Linkage between ambulatory and inpatient rehabilitation in the Euregio Model].

The SASPC-oriented rehabilitation approach, combining patient's somatic situation, activities of daily living, social circumstances as well as psychological status and communication skills, has been developed in the Netherlands with special regard to impairments, disabilities and handicaps of the musculoskeletal system. In the framework of an Interreg Project, a study was carried out comparing the rehabilitation systems in place in Germany and the Netherlands. Proposals are submitted for implementation of a graded rehabilitation scheme.

Ambulatory Care↗
PubMed1995

Cutaneous pathology in Wegener's granulomatosis. A clinicopathologic study of 75 biopsies in 46 patients.

While no cutaneous lesion is specific for Wegener's granulomatosis (WG), several histopathologic entities, including leukocytoclastic vasculitis and necrotizing granulomatous inflammation, are characteristic. This report details the histopathologic features of 75 cutaneous biopsies from 46 patients with WG. Biopsies were subdivided into histologic groups that included leukocytoclastic vasculitis (31%), granulomatous inflammation (GI) (19%), nonspecific ulceration (4%), superficial dermal and epidermal necrosis without inflammation (2.7%), erythema nodosum (2.7%), granuloma annulare (1%), chronic inflammation (31%), and acute inflammatory lesions without vasculitis (9%). No convincing example of granulomatous vasculitis was observed. The histopathologic subgroups were correlated with clinical features, and the results were compared with those from a control group of 82 WG patients with no skin involvement. We found that the histopathologic subgroups of leukocytoclastic vasculitis and granulomatous inflammation correlated with different clinical courses. Patients with leukocytoclastic vasculitis developed WG at an earlier age (median age, 30 years) than did the control group (median age, 45 years). Leukocytoclastic vasculitis developed shortly after onset of WG (median, 15 months vs. 35 months for patients with nonspecific chronic inflammation). All lesions occurred during active disease. Active disease with leukocytoclastic vasculitis was associated with a mean erythrocyte sedimentation rate twice that of active disease in the same patient when leukocytoclastic vasculitis was absent. The patients with leukocytoclastic vasculitis had more rapidly progressive and widespread WG than patients with granulomatous skin lesions or patients without skin lesions. A marked excess of joint and musculoskeletal symptoms and renal disease was seen in patients with leukocytoclastic vasculitis. Patients with granulomatous inflammation also developed WG at an early age (median age, 30 years) when compared with the control group. Cutaneous granulomatous lesions also developed shortly after presentation (median, 12 months). Only 64% of granulomatous biopsies were from patients with active disease. These patients frequently had neither renal nor pulmonary manifestations of WG, and their disease progressed at a slower rate than that of the patients with leukocytoclastic vasculitis. These findings suggest that the cutaneous lesions characteristic of WG may correlate with the activity, distribution, and course of the disease.

Adolescent↗
PubMed2003

Musculoskeletal deterioration and hemicorporectomy after spinal cord injury.

BACKGROUND AND PURPOSE: The long-term management following an hemicorporectomy (HCP) is not well documented in the scientific literature. The purpose of this case report is to describe the 25-year history of a man with a spinal cord injury who experienced severe musculoskeletal deterioration and hemicorporectomy. CASE DESCRIPTION: The client sustained T10 complete paraplegia at age 18 years, developed severe decubitus ulcers, and required an HCP as a life-saving measure 13 years later. The authors describe the chronology of several rehabilitation and prosthetic strategies and speculate on factors that may have contributed to their successes and failures. OUTCOMES: The client survived 12 years after the HCP and returned to independent mobility, self-care, and schooling despite complications with continued skin breakdown. Over the 12 years following discharge from the hospital after the spinal cord injury, he spent 749 days in the hospital. During the 12 years he lived after discharge from the hospital following the HCP, he was hospitalized 190 days. DISCUSSION: The authors discuss factors contributing to the client's musculoskeletal deterioration including chronic wounds, postural deviations, and incomplete adherence to pressure-relief recommendations and raise considerations for physical therapists who treat patients after HCP.

Adult↗