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PubMed2006

Preventing upper limb work-related musculoskeletal disorders (UL-WMSDS): new approaches in job (re)design and current trends in standardization.

In industrialized countries, upper limb work-related musculoskeletal disorders (UL-WMSDs) are the most common form of occupational diseases. They are generating a growing population of workers with reduced working capacity. The link between these pathologies and different aspects of work organization has been convincingly proven. Recent experiences in Europe supporting the combination of traditional work design methods used in manufacturing companies with ergonomics methods are reported briefly, with special focus on the use of the occupational repetitive action (OCRA) method for risk assessment and management of manual repetitive tasks. The combined approach strives to achieve the goal of maintaining a satisfactory level of productivity while respecting ergonomics criteria and, definitely, workers' health. New ergonomics standards provide for interaction between job and machinery designers and ergonomists in the design of work processes and workplaces. These standards generally refer only to the healthy adult working population and do not always provide criteria for protecting particular working populations, such as that represented by workers affected by UL-WMSDs. The results of preliminary studies concerning productive re-employment of workers with UL-WMSDs allow the introduction of some criteria for implementing current ergonomics standards in this connection. One aim of this paper is to summarize experiences of close cooperation between ergonomists, machinery designers and job designers to guarantee productivity and the prevention of musculoskeletal disorders. A second aim is to examine current ergonomics standards in the field of manual physical work (designed for healthy workers) and to suggest preliminary criteria for their implementation taking into account the capabilities and needs of specific sub-groups of the working population.

Cumulative Trauma Disorders↗
PubMed1992

Antimicrobial susceptibility of bacterial isolates from 233 horses with musculoskeletal infection during 1979-1989.

Bacterial culture and susceptibility results were analysed from 233 horses with septic arthritis/tenosynovitis or osteomyelitis that developed after fracture repair. Antibiotics were deemed highly effective, effective or ineffective if > or = 85%, 70-84.9% or < 70% of the isolates were susceptible respectively. In total, 424 bacterial types were isolated; 386 were aerobic or facultative and 38 were anaerobic. Enterobacteriaceae (28.8%) were the most common bacterial group isolated, followed by non-beta-haemolytic streptococci (13.0%), coagulase-positive staphylococci (11.8%), beta-haemolytic streptococci (9.4%), and coagulase-negative staphylococci (7.3%). The remainder of the organisms were other Gram-negative (15.8%), other Gram-positive (2.3%) and miscellaneous (2.6%) bacteria. Penicillin and ampicillin were highly effective against beta-haemolytic streptococci, but were ineffective against other bacteria. Ampicillin was no more effective than penicillin against most bacteria. Amikacin was the most effective antibiotic against the wide range of bacteria isolated in this study. Amikacin was highly effective against coagulase-positive staphylococci, Enterobacteriaceae and Pseudomonas and was effective against coagulase-negative staphylococci and Actinobacillus. Gentamycin was not highly effective against any bacterial group; but was effective against coagulase-positive and negative staphylococci, Pseudomonas, Salmonella and Actinobacillus. Kanamycin was ineffective against all bacteria with the exception of Actinobacillus. Cephalothin was highly effective against beta-haemolytic streptococci, coagulase-positive staphylococci and Actinobacillus and was effective against coagulase-negative staphylococci.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1997

A longitudinal study of pain: reported pain from middle age to old age.

OBJECTIVE: Describe patterns of pain reporting over a span of 24 years. DESIGN: Individuals were interviewed on four occasions (1968, 1974, 1981, 1992). PARTICIPANTS: Representative sample (n = 321) of the Swedish population aged 53-63 at baseline. MEASURES: Self-reported pain in the chest, abdomen, and musculoskeletal system (back or hips, shoulders, hands, elbows, legs, or knees). RESULTS: Less than 1% reported chest or abdominal pain on all four occasions. Whereas 21.8% of the sample reported musculoskeletal pain on all four occasions. More than half of the sample reported some kind of pain on three or four occasions. Women reported more severe and more persistent pain compared with men. There were more people who developed pain during the 24-year period than there were who became pain free. An increase in pain was equally common for chest and musculoskeletal pain, but a decrease in pain was much more common for musculoskeletal pain than chest pain. CONCLUSIONS: Cross-sectional studies have shown differing age patterns in pain. This longitudinal study demonstrates different patterns for men and women and for different pain localities.

Aged↗
PubMed2002

The prevalence of musculoskeletal troubles among car drivers.

In order to explore the relationship between car driving and musculoskeletal troubles, a cross-sectional structured-interview survey of low- to high-mileage drivers (including individuals who drove as part of their job) was conducted based on the Nordic Musculoskeletal Questionnaire. The results clearly showed that exposure to car driving was associated with reported sickness absence due to low back trouble and that those who drive as part of their job appear to be more at risk from low back trouble than those whose jobs primarily involve sitting (not driving) and standing activities. The frequency of reported discomfort also increased with higher annual mileage. In addition, drivers of cars with more adjustable driving packages had fewer reported musculoskeletal troubles. This identifies an urgent need for the training of managers of fleet vehicles in the importance of developing measures to reduce this problem, for example, the selection of an individual's car with respect to comfort and postural criteria.

Adolescent↗
PubMedDate not supplied

Mineral and nitrogen balance study: results of metabolic observations on Skylab II 28-day orbital mission.

Prediction that the various stresses of flight, particularly weightlessness, would bring about significant derangements in the metabolism of the musculoskeletal system has been based on various observations of long-term immobilized or inactive bed rest. The only attempt at controlled measurement of metabolic changes in space prior to Skylab, a study during the 14-day Gemini VII flight, revealed rather modest losses of important elements. The three astronauts of Skylab II consumed a planned day-by-day, quite constant, dietary intake of major metabolic elements in mixed foods and beverages and provided virtually complete collections of excreta for 31 days preflight, during the 28 days inflight, and for 17 days postflight. Analyses showed that, in varying degree among the crewmen, urinary calcium increased gradually during flight in a pattern similar to that observed in bed-rest studies: the mean plateau peak of urinary calcium excretion in the latter part of flight was double preflight levels. Fecal calcium excretion did not change significantly, but calcium balance, owing to the urinary calcium rise, became either negative or less positive than in preflight measurement. Increased excretion and negative balance of nitrogen and phosphorus indicated appreciable loss of muscle tissue in all three crewmen. Significant losses also occurred inflight in potassium, sodium, and magnesium. Based on the similarity in pattern and degree between these observations and those in bed rest of the losses in calcium, phosphorus, and nitrogen, musculoskeletal integrity would not be threatened in space flights of up to at least 3 months. However, if similar changes occur, indicative of continuing losses of these elements, in the planned Skylab flights for considerably more than 28 days, concern for capable musculoskeletal function should be serious for flights of very many months' duration, and greater research attention will need to be given to development of protective counter-measures.

Aerospace Medicine↗
PubMedDate not supplied

Joint manifestations of Lyme borreliosis in Czechoslovakian patients.

Involvement of the musculoskeletal system in 50 Lyme borreliosis patients seen in Czechoslovakia is described. Thirty-three patients reported tick bites or that they had removed a tick, four patients had been bitten by some other insect. Skin reaction following tick bite were found in 29 patients. Neurologic involvements have been described in 40 subjects. In one patient complete heart block developed after ECM, so that a permanent pacemaker was necessary for two weeks. Mainly three types of involvement of the musculoskeletal system were observed, mostly as intermittent episodes of arthralgia or migratory musculoskeletal pain. In 37 patients brief attacks of monoarthritis or asymmetrical oligoarthritis were seen, chiefly of intermittent subacute course. Chronic arthritis was diagnosed in seven cases, sacroiliitis in four patients. The authors discuss differential diagnosis, especially in patients with chronic joint involvement.

Adolescent↗
PubMed1998

Prevalence of upper extremity symptoms and possible risk factors in workers handling paper currency.

The prevalence of upper extremity symptoms in the workforce is high, particularly in industries characterized by forceful, repetitive or awkward movements. A study was undertaken to assess the prevalence of upper extremity symptoms in bank workers in a paper currency processing operation and to examine the role of possible risk factors for these complaints. Thirty-nine workers of a total workforce of 47 were assessed with a questionnaire and physical examination. The questionnaire collected information about demographics, health status, symptom reporting, psychosocial work stressors and other work exposure characteristics. Overall, 59% of the workers reported having significant work-related upper extremity musculoskeletal symptoms in the preceding year, including 49% with neck and shoulder symptoms and 49% with arm and wrist symptoms. In this study the key predictive factor for upper extremity musculoskeletal symptoms was psychological job demands. The workers had similar ergonomic stressors (with little gradient of exposure) and therefore our results do not contradict the importance of ergonomic factors in the development of upper extremity symptoms. However, the results do suggest that within a group exposed to similar ergonomic stressors, psychological job demands may be an important factor associated with musculoskeletal symptoms.

Adult↗
PubMed1998

Maintenance of musculoskeletal function in people with haemophilia.

Bleeding affecting muscles and joints is the most common manifestation of haemophilia. In the long term, prevention of musculoskeletal abnormality in haemophilic patients is cost effective. Early diagnosis and proper treatment is fundamental to prevent disability. Prevention can be divided into secondary and tertiary levels. Secondary prevention concentrates on how to handle a haemophilic child, and on the education of the family so that they develop a safe and healthy lifestyle and awareness of the importance of early diagnosis and treatment. Tertiary prevention deals with minimizing the musculoskeletal consequences of muscle and joint bleeding. Coagulation factor replacement, appropriate care of the bleeding site and early physical therapy helps to prevent complications and yields the best results. Recurrent episodes of joint bleeding can lead to chronic synovitis. Initially synovitis demands conservative treatment. However, conservative methods are often not successful. Chronic synovitis is the most important cause of joint degeneration and the aim of rehabilitation is to achieve functional status using special casting techniques, orthoses or preventative surgery. Surgical, radioisotope or chemical synovectomy may be used. Technical requirements and availability of haemostatic cover limit the use of surgical and radioisotope synovectomy. The author has found chemical synovectomy with rifampicin to be an easier and more effective procedure than surgery. Problems related to joint deformities, muscle atrophy and chronicle pain demand comprehensive care. They are the main factors affecting the maintenance of musculoskeletal function and the social integration of people with haemophilia.

Adaptation, Physiological↗
PubMedDate not supplied

Ankylosing spondylitis: a difficult diagnosis in patients on long-term renal replacement therapy.

We report the case of a 48-year-old male, whose musculoskeletal manifestations, previously related to long-term renal replacement therapy (RRT), were diagnosed as ankylosing spondylitis when symptoms changed their pattern on daily hemodialysis (DHD). The patient started RRT in 1981; in 1985 he received a cadaver graft, which failed in 1987. Secondary hyperparathyroidism, amyloid geoids, bilateral carpal tunnel syndrome and high aluminium levels were present. Musculoskeletal pain, reported since 1986, involved feet, heels, hips, shoulders, hands, spine. Symptoms impairing daily life did not improve after parathyroidectomy. He developed chronic hypotension and recurrent atrial fibrillation. In 1994 and 1998, because of thoracic pain, coronarography was performed (normal on both occasions). In June 2000, DHD was started. Equivalent renal clearance increased from 9-12 to 15-17 mL/min. Well-being remarkably improved. In September 2000, musculoskeletal pain worsened and bilateral Achilles tendinitis occurred. The worsening of musculoskeletal symptoms despite the improvements in well-being and other dialysis related symptoms prompted a re-evaluation of the case. The diagnosis of ankylosing spondylitis was based on: history of plantar fasciitis, bilateral Achilles tendinitis, inflammatory spinal pain with limitation of lumbar spine mobility (positive Schober test), radiological evidence of grade 2 bilateral sacroiliitis, presence of HLA-B27. This diagnosis cast light on the episodes of chest pain, explained by enthesopathy at the costosternal and manubriosternal joints and atrial fibrillation, due to HLA-B27 associated impairment in heart conduction. This case exemplifies the difficulty of differential diagnosis of multisystem illness in patients with long RRT follow-up.

Atrial Fibrillation↗
PubMed1979

A syndrome resembling progressive systemic sclerosis after bone marrow transplantation. A model for scleroderma?

Six long term survivors of bone marrow transplants developed a syndrome similar to progressive systemic sclerosis (PSS). Cutaneous involvement (6/6), pulmonary disease (6/6), musculoskeletal involvement (4/6), keratoconjunctivitis/positive Schirmer's test (4/6), Raynaud's phenomenon (2/6), and renal and cardiac disease (1/6) were similar to findings in PSS patients. T and B lymphocyte counts and functions were also similar. This PSS-like syndrome, including visceral involvement, after bone marrow transplantation lends support to an immunologic hypothesis of the pathogenesis of progressive systemic sclerosis.

Antigen-Antibody Complex↗
PubMed2006

Local delivery of bisphosphonate from coated orthopedic implants increases implants mechanical stability in osteoporotic rats.

Patients with osteoporosis and joint disabilities represent a constant growing and challenging population to be treated in the musculoskeletal clinical field. Especially in the case of total hip arthroplasty, new solutions should be developed to compensate for the double negative factors, peri-implant osteolysis, and osteoporotic bone loss, affecting the quality of implant outcome. The goal of this study was then to establish a proof of concept for orthopedic implant used as Zoledronate delivery in osteoporotic rats, and in particular, to verify if this approach could increase the initial implant stability. Twenty-five female 6-month-old Wistar rats were ovariectomized 6 weeks before the implantation to induce osteoporosis. The animals were randomly separated in five groups representing the different Zoledronate concentrations in the HA coating: 0, 0.2, 2.1, 8.5, and 16 microg/implant. Histomorphometric measures and peri-implant bone volume fraction were assessed and mechanical stability tests were performed. Bone volume fraction and biomechanical results clearly illustrate the positive effect of Zoledronate coated implants in the osteoporotic rats. A remarkable result was to show the existence of a window of Zoledronate content (0.2 to 8.5 microg/implant) in which the mechanical fixation of the implant increased. We were able to establish the proof of concept for orthopedic implants used as a drug delivery system in osteoporotic rats. The local bisphosphonate delivery from a calcium phosphate coating allowed increase of the mechanical fixation of an orthopedic implant. This study shows that orthopedic implants containing bisphosphonates could be beneficial for osteoporotic patients in need of a total joint replacement.

Animals↗
PubMed2005

Paracetamol use in musculoskeletal pain: an audit of use and patient perceptions of paracetamol as an effective analgesic.

Musculoskeletal pain is a complex problem with often very detrimental consequences which affects a high proportion of the general population. Health care professionals, when prescribing for musculoskeletal pain, often overlook simple analgesia. Patient perceptions of analgesia may vary to those of health care professionals, and in part affect the use of simple analgesia for musculoskeletal pain. This paper describes an audit of paracetamol use and patient perceptions of paracetamol as an effective analgesic agent, in 113 patients attending a musculoskeletal pain outpatient clinic in a university teaching hospital. The audit has helped prompt the development of a multi-disciplinary strategy to achieve optimum management.

Journal Article↗
PubMed2001

[Outcome analysis after open reconstruction of rotator cuff ruptures. A comparative assessment of recent evaluation procedures].

Outcome evaluation is becoming increasingly important for reconstructive surgery in musculoskeletal diseases. In addition to established shoulder-scores, new outcome-scores are being developed to cover all effects caused by a disease or intervention. Three validated, self-administered shoulder questionnaires were applied prospectively in 23 otherwise healthy patients suffering from rotator cuff deficiency. These were correlated to the Constant-Murley Shoulder Score and to a visual analogue scale for satisfaction. 7 women and 16 men with combined tears of supraspinatus and infraspinatus (mean age 55.3 +/- 10.5, r/l: 14/9, FU 57.8 +/- 15.7 weeks) were gathered prospectively and evaluated pre- and postoperatively with the American Shoulder and Elbow Surgeons Shoulder Index (ASES), the Simple Shoulder Test (SST) and the Disabilities of the Arm, Shoulder and Hand Module (DASH questionnaire). In addition, a visual analogue scale for satisfaction was employed. All four scores as well as the visual analogue scale revealed improvement at a statistically significant level (paired, two-tailed t-test, P < 0.01) after surgery. All questionnaires had a significant correlation with the Constant-Murley Shoulder Score (Pearson's correlation coefficient: ASES: r = 0.871, P < 0.01; DASH: r = -0.758, P = < 0.01; SST: r = 0.494, P < 0.05). All were easy to apply and provided a reliable, postoperative evaluation of shoulder function. The SST was easy to apply, however compound outcome analysis was only possible with the ASES Shoulder Index and the DASH questionnaire. The DASH scale was the most complex evaluation instrument. The Constant-Murley Shoulder Score comprises a physical examination which is advantageous but must be carried out in the clinic. For postoperative assessment, without the patient having to return to the clinic, the ASES Shoulder Index is preferred as it correlates well with the Constant-Murley Shoulder Score (r = 0.871) and the visual analogue scale for satisfaction (r = 0.762).

Adult↗
PubMed1994

Failure of arthroscopic decompression by subacromial heterotopic ossification causing recurrent impingement.

Heterotopic ossification is a well-recognized complication of musculoskeletal trauma and elective orthopaedic surgery. A series of 10 cases of arthroscopic subacromial decompressions developed postoperative heterotopic bone. In eight, the ectopic bone caused recurrent shoulder impingement. These are the first reported cases in which heterotopic ossification compromised the results of an arthroscopic procedure. It is recommended that the patient at risk (e.g., with active spondolytic arthropathy or a profile of hypertrophic pulmonary osteoarthropathy--obesity, diabetes with a history of chronic pulmonary disease) be considered for heterotopic ossification prophylaxis.

Adult↗
PubMed2004

[Injuries and muscle tightness in soccer].

Soccer is one of the most popular sports worldwide. Due to its characteristic many injuries are expected. Muscular tightness is postulated as an intrinsic risk factor for the developement of a muscle injury. Muscle flexibility testing can identify soccer players at risk for musculoskeletal lesions. One-hundred-and-seventeen male amateur soccer players aged 4 to 29 were examined for former injuries and muscular flexibility by using Janda's "functional muscular diagnostic". Muscle injuries and ankle lesions predominated among the injuries. The "functional muscular diagnostic" is suitable for screening muscular flexibility in soccer players. You found comprehensive muscular tightness among the soccer players. The value of stretching for preventing exercise-related muscle injury is still unclear.

Adolescent↗
PubMed1978

The use of instructor-patients to teach physical examination techniques.

The increasing difficulty in obtaining appropriate hospitalized patients to give enlarging classes of medical students their first exposure to abnormal physical findings has led to the development of an instructor-patient program. Sixteen community residents with relatively stable respiratory, cardiovascular, musculoskeletal, or neurological findings were recruited and trained as instructor-patients to teach the technical elements of the examination of the affected organ system. Evaluation of the technical skills of 46 second-year students trained by instructor-patients and those of 41 randomly selected students trained in these skills by physician instructors demonstrated that the two have comparable technical skills five to eight weeks after the training sessions. Faculty recruitment, instructor-patient recruitment and training, and evaluation are discussed.

Education, Medical, Undergraduate↗
PubMed1999

Effectiveness of rehabilitation for spinal pain.

The evidence for effectiveness of different approaches is often diluted by the inclusion of heterogeneous groups and, in this case, lack of agreement over what constitutes 'acute' and 'chronic' back pain is a clear confounding factor. Although there are undoubtedly common issues in the approach to these problems, there are also clear differences. Closer definition of the problem and the development of specific and targeted outcome measures is required. In common with other areas of musculoskeletal rehabilitation, the evidence strongly supports exercise (except possibly in the rare case of true radicular back pain) and a cognitive behavioural approach to pain management. The variability of evidence in support of manipulation suggests that patient selection is important, but as yet those selection criteria are not clear. As is often the case, medical interventions are rarely submitted to evaluation in terms of functional outcome so, for procedures such as epidurals and facet joint injections, the jury is still out at the current time.

Analgesics↗