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PubMed1981

Musculoskeletal syndromes associated with malignancy.

Evidence has been presented supporting a causal relationship between malignancies and musculoskeletal syndromes. This discussion has dealt primarily with lesser known relationships, more common associations such as hypertrophic osteoarthropathy and dermatomyositis being reviewed elsewhere. The ones discussed herein closely mimic primary connective tissue diseases and offer an insight into the study of the pathogenesis of these primary diseases. In view of the natural history of malignant disease, the hope for such patients arises from the physicians early diagnosis and treatment of the underlying malignancy. Early diagnosis and treatment may in turn be entirely dependent on the physician's awareness of a musculoskeletal syndrome being the presenting feature of an otherwise occult neoplasm. Several connective tissue syndromes appear to predispose to the development of malignancy, and increasing evidence suggests that this development of malignancy may be further enhanced by immunosuppressive therapy.

Aged↗

PubMed2000

A survey of practice patterns and the health promotion and prevention attitudes of US chiropractors. Maintenance care: part I.

OBJECTIVE: To investigate the primary care, health promotion activities associated with what has historically been called "maintenance care" (MC) as used in the practice of chiropractic in the United States. This includes issues such as investigating the purpose of MC, what conditions and patient populations it best serves, how frequently it is required, what therapeutic interventions constitute MC, how often it is recommended, and what percent of patient visits are for prevention and health promotion services. It also investigates the economic impact of these services. DESIGN: Postal survey of a randomized sample of practicing US chiropractors. The questionnaire was structured with a 5-point ordinal Likert scale (28 questions) and brief fill-in questionnaire (12 questions). The 40-question survey was mailed to 1500 chiropractors selected at random from a pool of chiropractors with active practices in the United States. The National Directory of Chiropractic database was the source of actively practicing chiropractors from which doctor selection was made. The sample was derived by using the last numbers composing the zip codes assigned by the US Postal Service. This sampling method assured potential inclusion of chiropractors from all 50 states, from rural areas and large cities, and assured a sample weighting based on population density that might not have been afforded by a simple random sample. RESULTS: Six hundred and fifty-eight (44%) of the questionnaires were completed and returned. US chiropractors agreed or strongly agreed that the purpose of MC was to optimize health (90%), prevent conditions from developing (88%), provide palliative care (86%), and minimize recurrence or exacerbations (95%). MC was viewed as helpful in preventing both musculoskeletal and visceral health problems. There was strong agreement that the therapeutic composition of MC placed virtually equal weight on exercise (96%) and adjustments/manipulation (97%) and that other interventions, including dietary recommendations (93%) and patient education about lifestyle changes (84%), shared a high level of importance. Seventy-nine percent of chiropractic patients have MC recommended to them and nearly half of those (34%) comply. The average number of recommended MC visits was 14.4 visits per year, and the total revenue represents an estimated 23% of practice income. CONCLUSIONS: Despite educational, philosophic, and political differences, US chiropractors come to a consensus about the purpose and composition of MC. Not withstanding the absence of scientific support, they believe that it is of value to all age groups and a variety of conditions from stress to musculoskeletal and visceral conditions. This strong belief in the preventive and health promotion value of MC motivates them to recommend this care to most patients. This, in turn, results in a high level of preventive services and income averaging an estimated $50,000 per chiropractic practice in 1994. The data suggest that the amount of services and income generated by preventive and health-promoting services may be second only to those from the treatment of low-back pain. The response from this survey also suggests that the level of primary care, health promotion and prevention activities of chiropractors surpasses that of other physicians.

Adult↗

PubMedDate not supplied

New OTC drugs and devices 2000: a selective review.

OBJECTIVES: To create a heightened awareness of the issues confronting pharmacists in the self-care arena. To educate pharmacists about newly introduced nonprescription products, devices, and diagnostic products. DATA SOURCES: Recently published governmental, clinical, and pharmaceutical industry literature. DATA SYNTHESIS: Several developments during the previous year have important implications for patient self-care. The Food and Drug Administration recommended the withdrawal of phenylpropanolamine from the market and denied proposals to switch lovastatin, pravastatin, and omeprazole to nonprescription status. Widespread use of dietary supplements in the face of insufficient data on their safety and efficacy continued to be a problem in 2000, although there were several encouraging developments. In 2000, new over-the-counter products were introduced for, among other purposes, treating acid-peptic disorders, musculoskeletal injuries, dermatologic disorders, and minor wounds. Numerous nonprescription products, including sophisticated home diagnostic products and accessories, continue to become available on the U.S. market. It is important that the pharmacist become as knowledgeable as possible about these products so he or she can educate patients about their appropriate use. CONCLUSION: Patients will continue to place an increasing emphasis on self-care. To assist them, pharmacists must remain up to date on trends and have a balanced understanding of new products. The new nonprescription medications and diagnostic products discussed in this review article represent valuable additions to the growing array of self-care products.

Equipment and Supplies↗

PubMed2004

Identification of ergonomic issues that affect workers in oilrigs in desert environments.

The main objective of this research was to conduct an assessment of ergonomic-related problems in oilrigs in a desert environment. A checklist, physical audit and medical records were used in the investigation. The results showed significant health, environment and work-related problems that could be attributed to ergonomic deficiencies in the work system of the oilrig. Some major ergonomic issues identified were hard physical work, back pain, discomfort, hot environment, long shift, and diverse schedule. Ninety-four percent of the employees perceived the workday as very long, 79% were dissatisfied with the work schedule, while 61% of the employees perceived the summer work environment as extremely hot. Ergonomics should be considered in the work system design so as to reduce or eliminate problems in oilrigs in hot desert environments.

Adult↗

PubMedDate not supplied

Restraint reduction in orthopaedics.

Restraint reduction is a challenge, especially when working with an elderly population. This article describes one orthopaedic unit's successful restraint reduction program. The role of the nurses on the unit is discussed, along with forms that were helpful and the fact that the reduction program fit into the Performance Improvement Plan for the institution. The most frequently used and successful alternatives are discussed. A restraint/seclusion data collection form has been highlighted. Finally, areas for additional research are suggested.

Hospitals, Urban↗

PubMed2006

The appropriate use of radiography in clinical practice: a report of two cases of biomechanical versus malignant spine pain.

BACKGROUND: To describe the evaluation, treatment, management and referral of two patients with back pain with an eventual malignant etiology, who were first thought to have a non-organic biomechanical disorder. CLINICAL FEATURES: The study was a retrospective review of the clinical course of two patients seen by a chiropractor in a multi-disciplinary outpatient facility, who presented with what was thought to be non-organic biomechanical spine pain. Clinical examination by both medical and chiropractic physicians did not indicate the need for radiography in the early course of management of either patient. Upon subsequent re-evaluation, it was decided that certain clinical factors required investigation with advanced imaging. In one instance, the patient responded to conservative care of low back pain for nine weeks, after which she developed severe pain in the pelvis. In the second case, the patient presented with signs and symptoms consistent with uncomplicated musculoskeletal pain that failed to respond to a course of conservative care. He was referred for medical therapy which also failed to relieve his pain. In both patients, malignancy was eventually discovered with magnetic resonance imaging and both patients are now deceased, resulting in an inability to obtain informed consent for the publication of this manuscript. CONCLUSION: In these two cases, the prudent use of diagnostic plain film radiography did not significantly alter the appropriate long-term management of patients with neuromusculoskeletal signs and symptoms. The judicious use of magnetic resonance imaging was an effective procedure when investigating recalcitrant neuromusculoskeletal pain in these two patients.

Journal Article↗

PubMed1995

Late effects among long-term survivors of childhood acute leukemia in The Netherlands: a Dutch Childhood Leukemia Study Group Report.

Late events and side effects are reported in 392 children cured of leukemia. They originated from 1193 consecutively newly diagnosed children between 1972 and 1982, in first continuous complete remission for at least 6 y after diagnosis, and were treated according to Dutch Childhood Leukemia Study Group protocols (70%) or institutional protocols (30%), all including cranial irradiation for CNS prophylaxis. Data on late events (relapses, death in complete remission, and second malignancies) were collected prospectively after treatment; late side effects were retrospectively collected by a questionnaire, completed by the responsible pediatrician. The event-free survival of the 6-y survivors at 15 y after diagnosis was 92% (+/- 2%). Eight late relapses and nine second malignancies were diagnosed, two children died in first complete remission of late toxicity of treatment, and one child died in a car accident. The most important long-term side effects reported were learning disabilities (50%), short stature, obesity, and delayed pubertal development. No increase in the incidence of cardiovascular, pulmonary, urogenital, or gastrointestinal tract diseases or an increased vulnerability of the musculoskeletal system was found. However, prolonged follow-up is necessary to study the full-scale late effects of cytostatic treatment and radiotherapy administered during childhood.

Adolescent↗

PubMed2003

Aging of microstructural compartments in human compact bone.

Composition of microstructural compartments in compact bone of aging male subjects was assessed using Raman microscopy. Secondary mineralization of unremodeled fragments persisted for two decades. Replacement of these tissue fragments with secondary osteons kept mean composition constant over age, but at a fully mineralized limit. Slowing of remodeling may increase fracture susceptibility through an increase in proportion of highly mineralized tissue. In this study, the aging process in the microstructural compartments of human femoral cortical bone was investigated and related to changes in the overall tissue composition within the age range of 17-73 years. Raman microprobe analysis was used to assess the mineral content, mineral crystallinity, and carbonate substitution in fragments of primary lamellar bone that survived remodeling for decades. Tissue composition of the secondary osteonal population was investigated to determine the composition of turned over tissue volume. Finally, Raman spectral analysis of homogenized tissue was performed to evaluate the effects of unremodeled and newly formed tissue on the overall tissue composition. The chemical composition of the primary lamellar bone exhibited two chronological stages. Organic matrix became more mineralized and the crystallinity of the mineral improved during the first stage, which lasted for two decades. The mineral content and the mineral crystallinity did not vary during the second stage. The results for the primary lamellar bone demonstrated that physiological mineralization, as evidenced by crystal growth and maturation, is a continuous process that may persist as long as two decades, and the growth and maturation process stops after the organic matrix becomes "fully mineralized." The average mineral content and the average mineral crystallinity of the homogenized tissue did not change with age. It was also observed that the mineral content of the homogenized tissue was consistently greater than the osteons and similar to the "fully mineralized" stage of primary bone. The results of this study demonstrated that unremodeled compartments of bone grow older through maturation and growth of mineral crystals in a protracted fashion. However, the secondary osteonal remodeling impedes this aging process and maintains the mean tissue age fairly constant over decades. Therefore, slowing of remodeling may lead to brittle bone tissue through accumulation of fully mineralized tissue fragments.

Adolescent↗

PubMed1999

Hutchinson-Gilford progeria syndrome.

Hutchinson-Gilford progeria syndrome is an extremely rare condition of premature aging. It is characterized by growth retardation and accelerated degenerative changes of cutaneous, musculoskeletal and cardiovascular systems. The pathogenesis of the disease is unknown. The patients usually appear normal at birth. Typical manifestations develop gradually and are evident by the first or second year of life. They have a remarkably similar physical appearance consisting of short stature, alopecia, craniofacial disproportion, micrognathia, hypoplastic mandible, beak-like nose, decreased subcutaneous fat, atrophic skin, sclerodermoid lesion, mottling hyperpigmentation, prominent scalp veins, prominent eyes, protruding ears with absence of earlobes, faint midfacial cyanosis, delayed closure of fontanelles and sutures, delayed dentition, horse-riding stance, thin limbs with prominent stiff joints, coxa valga, skeletal hypoplasia and dysplasia, dystrophic nails and high-pitched voice. Laboratory investigations are unremarkable. Metabolic, endocrine, serum lipid and immunologic studies show no uniform abnormalities. Typical radiographs demonstrate evidence of resorption of the distal ends of clavicles, attenuation of the terminal phalanges, diffuse osteopenia, and fishmouth vertebral bodies. In this report, a 3-year-old Thai girl with typical characteristics of Hutchinson-Gilford progeria syndrome is described.

Child, Preschool↗

PubMed1999

The role of joint innervation in the pathogenesis of arthritis.

Recently, an expanding body of knowledge has documented the nature and functions of receptors in joint tissues and their potential importance in preserving the smooth normal functioning of the motor-skeletal system and in amplifying the inflammatory response to joint injuries and diseases. This review summarizes the current knowledge of the anatomical and physiological substrates of these mechanisms. The distribution, morphologic and functional characteristics of joint receptors have been well described. In the past decade there has been a new appreciation of the major role played by sensory neurons in promoting regional inflammatory responses, and many of the specific neuronal mechanisms and molecules that mediate these reflexes have been identified. This knowledge promises to significantly improve the selectivity and effectiveness of pharmacologic approaches to pain, trauma and regional inflammatory disorders. Other investigations have revealed important contributions of joint receptors to motor function. These refer not to proprioception or the sense of limb position in space, but rather to a more sophisticated tailoring of muscle activity to increase joint stability and to protect joint structures from damaging loads. Whether a loss of these reflexes may play a role in the pathogenesis of osteoarthritis remains controversial. However, there is a growing consensus that a loss of these reflexes may contribute to the morbidity associated with disruption of the anterior cruciate ligament. Synovial joints are sites of major interactions between the musculoskeletal and the nervous systems. Understanding the mechanisms that activate and control these interactions will certainly offer the opportunity to develop new, more effective treatments for patients with joint disorders.

Animals↗

PubMed2002

Secondary injury after musculoskeletal trauma: a review and update.

OBJECTIVES: To revisit the secondary injury model, to incorporate several current pathophysiologic theories into the model, and to show the need for more direct research examining the model. DATA SOURCES: I searched MEDLINE and CINAHL from 1976 to 2001 for literature related to acute injury pathology and pathophysiology and selected classic articles and pathology, pathophysiology, and immunology texts. DATA SYNTHESIS: Acute musculoskeletal injury management is based on a pathophysiologic model, often referred to as the secondary injury model, which was originally developed more than 25 years ago. In this model, acute trauma is referred to as primary injury, whereas secondary injury refers to damage to otherwise uninjured cells that was a direct consequence of the physiologic response to primary injury. In the original model, mechanisms for secondary injury were hypothesized based on then-contemporary understandings of immunology and cellular pathology. These mechanisms were broadly categorized as either enzymatic or hypoxic. Since this time, the pathologic paradigms for cell death from trauma have evolved, and the secondary injury model requires some updating. Some controversy now exists regarding the categorization of injury as primary or secondary, specifically whether posttraumatic damage is actually secondary injury in previously uninjured tissue or delayed death of primary injured cells. Similarly, the postulated mechanisms that lead to secondary injury now appear to be considerably more complex than originally anticipated. CONCLUSIONS/RECOMMENDATIONS: The secondary injury model has been reconciled with our contemporary understanding of pathophysiology. Specifically, secondary hypoxic injury has been clarified to be secondary ischemic injury, and several specific mechanisms for ischemic injury have been identified. Similarly, secondary injury from mitochondrial failure and other potential mechanisms has been identified, and the role and interaction of these mechanisms in relation to total secondary injury have been expanded.

Journal Article↗

PubMed1990

[Magnetic resonance in oncology].

The physical and biological background to magnetic resonance imaging (MRI) in patients with neoplasms is reviewed. The clinical indications for this method of diagnosis, staging, and follow-up of malignant neoplasms are discussed on the basis of the guidelines given by the MRI Consensus Conference on April 25-26, 1989, in Berne. MRI is the modality of choice in patients with neoplasms of the central nervous system and the musculoskeletal system. Further emerging indications for MRI are neoplasma of the ENT region, liver, and pelvic organs. Finally, the foreseeable developments in MRI and in magnetic resonance spectroscopy (MRS) are mentioned.

Abdominal Neoplasms↗

PubMed1988

Physical demands in worklife.

Industrial occupations which are physically strenuous in the traditional sense of the word have decreased in number. They have partly been replaced by "light," repetitive, monotonous work tasks performed in a sitting position. The number of heavy work tasks within the service sector has increased. Specialization has been intensified. The individual's capacity for strenuous work is still of importance to successful work performance. Many studies show that an optional choice of work pace in physically demanding occupational work results in an adaptation of pace or intensity until the worker is utilizing 40-50% of her or his capacity. When the work rate is constrained, the relative strain of the individual varies inversely with the physical work capacity. The frequency of musculoskeletal disorders has concurrently increased with the implementation of industrial mechanization. New, wise, ergonomic moves are needed to stop this development.

Bone Diseases↗

PubMed1995

Musculoskeletal disability, employment, and rehabilitation.

OBJECTIVE: To determine which, if any, baseline social and disease characteristics can be used to identify persons with musculoskeletal disabilities accepted for state-federal vocational rehabilitation services who are most likely to return to work. METHODS: A database of case closures from the Alabama Vocational Rehabilitation Service was analyzed using segmentation modelling. This included all persons (n = 4093) with musculoskeletal disability who were accepted by the Alabama Vocational Rehabilitation Agency in 1987-91. Demographics, income, type of disability, severity of disability, medical insurance, similar benefits, benefit status, and referral source were independent variables. Outcome (dependent) variable was work status at end of agency services. RESULTS: Overall, 71% of persons with arthritis and musculoskeletal disorders who were accepted for vocational rehabilitation services in 1987-91 returned to work at the end of agency services. Segmentation modelling created a tree in which certain baseline characteristics formed subgroups with differing rates of successful rehabilitation. Social Security Disability Insurance (SSDI) status was the single best predictor of rehabilitation. Seventy-three percent of nonbeneficiaries were rehabilitated compared to 55% of beneficiaries (p < 0.00001). For non-SSDI beneficiaries, education level > or = grade 12 was associated with better rehabilitation outcome (p < 0.00001). SSDI beneficiaries with nonback disorders fared better than those with back disorders (p < 0.05). Disease severity, assessed by Federal Special Programs criteria, was not associated with rehabilitation outcome at any level of the tree. CONCLUSION: Simple baseline social and disease characteristics can be used to identify groups of persons accepted for vocational rehabilitation services with musculoskeletal disability with differing rates of vocational rehabilitation. Disability benefit status and education level are important predictors of return to work after agency services. These findings can lead to the development of strategies to improve the efficacy of vocational rehabilitation services.

Adult↗

PubMed1994

Ventricular dysphonia following long-term endotracheal intubation: a case study.

Although dysphonia following long-term endotracheal intubation (EI) is a common complication, no cases of ventricular dysphonia have been reported. This investigation reports a case of persistent ventricular dysphonia following a 12-day intubation period. The patient received eight sessions of voice therapy employing the manual, laryngeal musculoskeletal tension reduction procedure. Improvements in perceptual, acoustic, and videolaryngoendoscopic measures of voice production are reported. Mechanisms contributing to the development, maintenance, and resolution of ventricular dysphonia are discussed.

Humans↗

PubMed1993

[Supracondylar femoral fractures in children before the age of walking].

Supracondylar femoral fractures were found, in this report, to be the most common traumatic lesion in the healthy, pre-walking age infant. Diagnosis of such cases which display no longer a rare occurrence, requires accurate x-ray films on two levels, because incomplete fractures may be easily overlooked. Awareness of the normal development of motor function within the first year of life is of great importance to prevent injuries to the immature musculoskeletal system before the beginning of voluntary walking. The acquisition of motor skills was not interrupted and limb length discrepancy was not noted in any of our patients.

Casts, Surgical↗

PubMed1994

A quality-based protocol for management of musculoskeletal injuries. A ten-year prospective outcome study.

Musculoskeletal injuries in the workplace are recognized as a major health and economic problem; however, little has been done to develop strategies that emphasize both quality and cost control. The purpose of this ten-year perspective investigation was to evaluate the use of quality-based standardized diagnostic and treatment protocols as part of an unbiased injury surveillance system. The program was evaluated in a public utility company with more than 5300 employees, and resulted in a measurable and long-term improvement in all outcome parameters measured: (1) The number of days lost from work and the number of new injuries reported fell by 55 and 51%, respectively. (2) The average time lost per injury dropped by 40%. (3) The number of surgeries performed decreased by 67%, and the operative success rate increased dramatically. (4) Finally, as an added benefit, there was a 60% reduction in expenditures for lost time and replacement wages, resulting in a cumulative ten-year savings of more than 4.1 million dollars. The program accomplished the goal of ensuring quality care in a prospective concurrent fashion. As an additional benefit, the program also reduced unjustified lost time and compensation costs through early functional return, efficient use of diagnostic studies, and avoidance of surgery whenever possible. Future emphasis on health-care delivery in the workers' compensation setting should concentrate on high-quality medical care, which will, in turn, lead to secondary cost savings.

Algorithms↗

PubMed1996

Ergonomics in parallelized car assembly: a case study, with reference also to productivity aspects.

In 1985 Volvo started the development of a new plant for the assembling of cars. This plant was situated in the town of Uddevalla in Sweden. One deliberate aim with this plant was to combine an enhanced productivity and product quality with good ergonomics conditions and improved work organization. The plant was designed with a production system where parallel work-teams of about five persons could assemble from 1/4 up to complete cars. A newly developed tilting device, a piece of equipment that could rotate, rise and lower the car body in order to facilitate assembly work, was introduced. Ergonomic analyses of postural and musculoskeletal strain showed that parallelized flow production, according to the production principles of the Uddevalla plant, was superior to traditional car assembly according to the serial flow production concept, i.e. the traditional assembly line. It was noted that this ergonomic standard was implemented without compromising productivity. In conclusion, increased knowledge and experience of parallelized production systems has been gained which should be considered in the development of future assembly plants, even though the Uddevalla factory itself was closed down in 1993.

Journal Article↗