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PubMedDate not supplied

[Backache from exertion in health personnel of the Istituti Ortopedici Rizzoli in Bologna. A case-control study of the injury phenomenon in the 10-year period of 1987-1996].

Low-back (lumbosacral) injuries are known as one of more important occupational health problems in health care workers, because of high prevalence and impact of socioeconomic costs. To investigate the risk of low-back pain in hospital workers into the Istituti Ortopedici Rizzoli in Bologna (Italy), a retrospective study was carried out. The adapted study design was the matched (1:1 for age) case-control, enlisting the first injuries occurred in the hospital staff like cases, and personnel in force, matched for age and year of happened case, like controls. Information about diagnoses and occupational data was obtained from the current informative systems. Comparison with a control group suggests the validity of the work-relatedness of low-back pain in nursing and health aides (OR: 21.67; LC: 4.69-196.56), in nurses (OR: 20.21; LC: 4.81-177.95), in therapists (OR: 16.36; LC: 2.80-163.54) and in X-ray technicians (OR: 13.64; LC: 2.25-138.99). The risk of occupational injury is not homogeneously allocated into the hospital, and significatively prevails in the orthopaedic wards, in the plaster-rooms, in the operating blocks and in the sterilization plants. Specific manual handling were associated with an increased risk of back pain, while some non occupational factors like cigarette smoking, previous trauma leading to hospital admission, and number of children in female, were resulted weakly associated.

Adult↗
PubMedDate not supplied

Spine injuries in gymnasts and swimmers. An epidemiologic investigation.

Three groups of top level female gymnasts of preelite, elite, national and Olympic caliber were studied without regard to back pain or injury. These athletes were compared to a similar group of national caliber female swimmers. Magnetic resonance imaging scans of each participant were used to document disk or bony abnormalities. The relationship between magnetic resonance imaging findings and age, height, weight, previous injuries, back symptoms, and hours of training per week each year was examined. Nine percent of preelite (1/11), 43% of elite (6/14), and 63% of Olympic level (5/8) gymnasts had spine abnormalities; 15.8% of all swimmers had spine abnormalities. Average hours of training per week and age were found to be associated with abnormalities seen on magnetic resonance imaging. Increased intensity and length of training correlated with previous data that suggests the female gymnast is prone to spine injuries.

Adolescent↗
PubMed1990

Evaluation of the injury profile of personnel in a busy urban EMS system.

The occupational injury profile of emergency medical technicians (EMTs) and paramedics is not well described. We retrospectively studied 254 injuries over a 3.5-year period in a busy urban EMS system. Low back strain was the most common injury (93/254, 36%), with EMTs suffering a significantly higher injury rate than paramedics (0.33 v 0.17 injuries/person-years at risk, P = .03). Lifting caused 58/93 (62.4%) of back injuries, and most occurred at the scene to which personnel were dispatched (58/93, 62.4%). The back injuries were recurrent in 31% of personnel. The data showed trends toward higher overall injury rates among EMTs compared with paramedics (0.83 v 0.55, P = 0.057) and women compared with men (0.86 v 0.50, P = 0.11). There was a significantly higher injury rate among personnel less than 30 years of age compared with those 30 years or older (0.65 v 0.39, P = 0.01). Over 25% of the personnel injured had more than one injury per year. There was no correlation between injury rates and job experience. Approximately 96 injuries accounted for 481 compensation days with low back strain the cause of 375 days (78%). Our findings suggest a high incidence of occupational injury in EMS personnel with EMTs and persons under 30 years of age at higher risk. Guidelines for prevention programs are suggested.

Accidents, Occupational↗
PubMed1990

Management of penetrating back trauma.

The best management plan for patients with stab wounds of the posterior abdomen who have no obvious indication for operation is a selective one. Repeated physical examination is the mainstay of treatment, as indicated by many authors. Other special studies, such as DPL, angiography, intravenous pyelography, and contrast CT scanning, are indicated on a case-by-case basis, but as yet lack convincing justification for routine use.

Abdominal Injuries↗
PubMed2005

Back strength and flexibility of EMS providers in practicing prehospital providers.

In the execution of prehospital care duties, an EMS provider may be required to carry equipment and patients over long distances or over multiple flights of stairs at any time of the day. At a minimum, a prehospital provider must have sufficient lower back strength and hamstring flexibility to prevent musculoskeletal injury while lifting. This study administered fitness assessments related to the occupational activities of the prehospital provider with the purpose of describing the incidence of occupational back injury and percentage of providers with known risk factors for back injury. Ninety subjects were tested during a regional EMS conference. Men were significantly taller and heavier than women and had significantly less hamstring flexibility. Body Mass Index was 30.7 +/- 7.2 in men and 28 +/- 5.7 in women. However, no significant differences were noted in an extension test of back strength. When surveyed, 47.8% of subjects reported a back injury in the previous 6 months but only 39.1% of these injuries were sustained while performing EMS duties. While only 13% of these injuries resulted in missed work, 52.2% reported their injury interfered with their daily activities. In spite of the physical nature of the profession, EMS providers in our sample were significantly overweight according to their Body Mass Index and may lack sufficient back strength and flexibilityfor safe execution of their duties. This group of professionals may be at risk for occupational injury and should be targeted for interventions to improve strength and flexibility.

Adult↗
PubMed1994

Prostaglandin E2 enhances gastric defense mechanisms against acid injury in uremic rats.

BACKGROUND/AIMS: Uremia increases gastric mucosal H+ permeability and acid back-diffusion-related injury in rats. The aim of this study was to examine the effect of the synthetic gastroprotective compound 16,16-dimethyl prostaglandin E2 (16,16-dm PGE2) on the gastric barrier to acid injury in uremic rats. METHODS: Chronic renal failure was induced by subtotal nephrectomy. Acid back-diffusion injury was induced by superfusion with 15% ethanol in 0.15N HCl and was assessed by image analysis. Intracellular pH, initial surface cell acidification rate, and thickness of mucous gel layer were measured with in vivo microscopy. Gastric mucosal blood flow was measured in separate experiments by laser-Doppler flowmetry. RESULTS: Pretreatment with 16,16-dm PGE2 attenuated H+ back-diffusion and prevented the production of gross lesions. 16,16-dm PGE2 increased gastric mucous gel thickness, decreased initial acidification rate, and maintained intracellular pH homeostasis during exposure to luminal acid. Gastric mucosal blood flow was not changed during superfusion with a neutral buffer but increased during acid exposure in rats treated with 16,16-dm PGE2. CONCLUSIONS: 16,16-dm PGE2 attenuated H+ back-diffusion injury in uremic rats. This effect was associated with blunting of the initial decrease of intracellular pH and enhanced surface cell intracellular pH homeostasis during acid exposure. These effects were associated with an increased mucous gel layer thickness and an acid-related increase in blood flow.

16,16-Dimethylprostaglandin E2↗
PubMed2000

Survey of neuromuscular injuries to the patient and surgeon during urologic laparoscopic surgery.

OBJECTIVES: Laparoscopy may be complicated by neuromuscular injuries, both to the patient and to the surgeon. We used a survey to estimate the incidence of these injuries during urologic laparoscopic surgery, to assess risk factors for these injuries, and to determine preventive measures. METHODS: A survey of neuromuscular injuries associated with laparoscopy submitted to 18 institutions in the United States was completed by 18 attending urologists from 15 institutions. RESULTS: From among a total of 1651 procedures, there were 46 neuromuscular injuries in 45 patients (2.7%), including abdominal wall neuralgia (14), extremity sensory deficit (12), extremity motor deficit (8), clinical rhabdomyolysis (6), shoulder contusion (4), and back spasm (2). Neuromuscular injuries were twice as common with upper retroperitoneal as with pelvic laparoscopy (3. 1% versus 1.5%). Among patients with neuromuscular injuries, those with rhabdomyolysis were heavier (means 91 versus 80 kg) and underwent longer procedures (means 379 versus 300 minutes), and those with motor deficits were older (means 51 versus 42 years of age). Of the surgeons, 28% and 17% reported frequent neck and shoulder pain, respectively. CONCLUSIONS: Although not common, neuromuscular injuries during laparoscopy do contribute to morbidity. Abdominal wall neuralgias, injuries to peripheral nerves, and joint or back injuries likely occur no more frequently than during open surgery, but risk of rhabdomyolysis may be increased. Positioning in a partial rather than full flank position may reduce the incidence of some injuries. Measures to reduce neuromuscular strain on the surgeon during laparoscopy should be considered.

Abdominal Muscles↗
PubMed2002

Comparing injuries of spin bowling with fast bowling in young cricketers.

OBJECTIVE: To compare the incidence and anatomic distribution of injuries sustained in spin and fast bowling in young cricketers. DESIGN: A prospective cohort study. Physical characteristics and retrospective data (sporting involvement and previous injuries) from young cricketers were recorded. The cohort of young cricketers was divided according to style of bowling into a group of spin bowlers and a group of fast bowlers. Data from the spin bowler group was compared with the data from the fast bowler group to assess whether these groups were matched. A prospective study of injuries sustained by the bowlers was then undertaken. Data regarding cricket played and injuries sustained were collected by telephone questionnaire every 6 weeks for 6 months from each bowler. SETTING: Bowlers were recruited from young cricketers training at Centers of Excellence of 3 "First Class" Counties in England in January 1998. PARTICIPANTS: There were 42 spin bowlers and 70 fast bowlers. The mean age was 14.9 years (range 9 to 21 years). MAIN OUTCOME MEASURES: Injuries caused by bowling and interfering with bowling are included in incidence data. The number of deliveries bowled in matches and practice is used as the denominator for the reported incidence. RESULTS: Telephone follow-up was achieved when planned on 98.2% of occasions. There were 29 injuries meeting the criteria above. The incidence of injury in spin bowlers was 0.066 per 1,000 balls and 0.165 per 1,000 balls in fast bowlers (p = 0.097 Wilcoxon rank sum test). The incidence of injury (per 1,000 balls) at various anatomic sites in fast bowling was knee 0.057, ankle 0.043, low back 0.029, and shoulder 0.007. In spin bowlers, the site incidence was shoulder 0.055 and low back 0.011. The percentage with injuries at ankle, knee, and shoulder was significantly different (95% confidence intervals) for fast and spin bowlers. A significant difference was not found for lower back injuries. CONCLUSIONS: Incidence of injuries in fast bowling is greater than in spin bowling (but this was not a significant difference within the limits of this study). Low back injuries in fast bowlers have been the subject of published research. However, injuries in spin bowling have not previously been described, and this study indicates that shoulder injuries in wrist spinners merit further study.

Adolescent↗
PubMed1998

Pushing and pulling in relation to musculoskeletal disorders: a review of risk factors.

The objective was to review the literature on risk factors for musculoskeletal disorders related to pushing and pulling. The risk factors have been described and evaluated from four perspectives: epidemiology, psychophysics, physiology, and biomechanics. Epidemiological studies have shown, based on cross-sectional data, that pushing and pulling is associated with low back pain. Evidence with respect to complaints of other parts of the musculoskeletal system is lacking. Risk factors have been found to influence the maximum (acceptable) push or pull forces as well as the physiological and mechanical strain on the human body. The risk factors have been divided into: (a) work situation, such as distance, frequency, handle height, and cart weight, (b) actual working method and posture/movement/exerted forces, such as foot distance and velocity, and (c) worker's characteristics, such as body weight. Longitudinal epidemiological studies are needed to relate pushing and pulling to musculoskeletal disorders.

Arm Injuries↗
PubMed2004

Return to play after lumbar spine conditions and surgeries.

Low back pain in athletes can result from a wide variety of conditions. A detailed history and physical examination supplemented by appropriate imaging studies can lead to an accurate diagnosis. The majority of cases will be self-limiting and resolve within 6 weeks regardless of treatment, but it is important to be able to identify conditions that require specific treatment. The decision of when an athlete can return to active competition is determined by the specific condition, associated symptoms, and treatment provided. Most athletes can return to full unrestricted play after sufficient resolution of pain and restoration of range of motion. Athletes undergoing spinal fusion are typically restricted from full-contact sports.

Athletic Injuries↗
PubMed1989

Disabling backache in France, Switzerland, and The Netherlands: contrasting sociopolitical constraints on clinical judgment.

A century has passed since clinicians assumed a linchpin role in the administration of programs to provide recourse and redress for persons suffering the illness of work incapacity. Medicine was asked to certify whether the illness was an injury in the absence of trauma, to ascertain whether further healing was possible, and to quantify the residual functional capacity. The response has been to force the vagaries of clinical judgment into the programmatic algorithm. No country has abandoned or redirected all three of these charges. Physicians have generally remained passive or intransigent as the society in which they function attempts to compensate for the indeterminate nature of these clinical questions. The current study compares the fashion in which the programs in Holland, Switzerland, and France have evolved in response to the clinical uncertainties. The Dutch have discarded the accident question. The Swiss emphasize the accident issue but consider the work-relatedness of the event to be irrelevant. The French have honed the traditional paradigm and have added a tier of clinical judgment within the program to monitor that without. These and other distinctions should cause all physicians to question their own convictions with regard to the three issues and, further, to question whether the basic paradigm is clinically flawed and therapeutically counterproductive.

Accidents, Occupational↗
PubMedDate not supplied

Psychologically based occupational rehabilitation: the Pain-Disability Prevention Program.

OBJECTIVES: To describe the development, implementation, and preliminary outcome of the Pain-Disability Prevention (PDP) Program. The PDP Program is a 10-week cognitive-behavioral intervention program that aims to increase daily involvement in goal-directed activity and minimize psychological barriers to activity involvement after occupational injury. Workers' Compensation Board claimants with soft tissue injuries to the back, who were still off work 6 weeks after injury and showed evidence of at least one "yellow flag," were offered participation in the PDP Program. DESIGN: A single-group, prospective treatment outcome analysis. PARTICIPANTS: Data from the first 104 claimants who participated in the PDP Program are summarized. RESULTS: Participation in the PDP Program was associated with a 60% success rate, where success was defined as return to work (45%) or readiness to return to work (15%). Initial scores on measures of catastrophizing, fear of movement/reinjury, and depression afforded 92% correct classification of treatment outcome. Early treatment changes in catastrophizing and fear of movement/reinjury were also predictive of treatment outcome. CONCLUSIONS: The findings suggest that a psychologically based activity mobilization program can be an effective means of yielding reductions in psychological risk factors for occupational disability. Challenges to program implementation, fidelity to protocol, and issues related to cost efficacy are discussed.

Adolescent↗
PubMed2000

Tethered cord syndrome in adults.

BACKGROUND: The tethered cord syndrome (TCS) consists of an abnormally low conus medullaris tethered by a thickened filum terminale or various forms of spinal dysraphism. The adult variant of the syndrome seems not to be as rare as once thought. METHOD: This study includes 11 patients with a TCS. Clinical, radiological findings and outcome were reviewed in these adult patients with TCS. FINDINGS: The patients ranged in age from 18 to 34 years (mean 24.09 years). There were 7 men and 4 women. The presenting symptoms in order of frequency were as follows: low back pain radiating to legs, urinary complaints, weakness in legs and impotence. All patients had magnetic resonance imaging scans. Physical exercise in 8, birth delivery in 1 and carrying heavy objects in 1 patient were determined as the precipitating factors. No precipitating factor could be defined in one of the patients. All patients were operated on, except for one. None of the patients worsened after surgery. INTERPRETATION: The patients presenting with low back pain and sciatica responded to surgery better than those with sphincter problems.

Adolescent↗
PubMed2003

Selective management of penetrating truncal injuries: is emergency department discharge a reasonable goal?

We undertook this retrospective review to examine the appropriateness of a protocol for the selective emergency department (ED) workup of asymptomatic penetrating truncal injuries. Records of consecutive patients presenting to our urban Level I trauma center with penetrating truncal injuries between January 1, 1997 and September 2000 were reviewed. Data obtained included: patient demographics, ED workup, ED disposition, complications, and follow-up. Selective ED workup included hospital triple-contrast CT, admission for observation, and local wound exploration for selected anterior abdominal stab wounds. Four hundred fifty-five patients presented with penetrating truncal wounds during the study period. One hundred ninety-four patients were taken directly to the operating room, 136 were discharged based solely on physical examination and plain radiographs, 18 were admitted for observation without ED workup, and 107 had selective ED workup. Sixty-two patients (58% of those selectively worked up) were discharged home after negative ED workup, 18 were managed operatively, and 27 were managed nonoperatively. There were two missed injuries that were later identified and managed with no complications. Follow-up was available on 66 per cent of ED workup patients (range 1-42 months). We conclude that selective management of certain penetrating truncal injuries appears appropriate. Patients having a negative selective ED workup can be safely discharged thereby avoiding the cost and resource utilization associated with hospital admission.

Abdominal Injuries↗