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PubMed1995

Musculoskeletal syndromes associated with malignancies.

Literature on the association of malignancies with various rheumatic disorders published over the past year is summarized in this review. The possible roles of methotrexate treatment in predisposing to the development of lung cancer and Felty's syndrome in predisposing to non-Hodgkin's lymphoma in rheumatoid arthritis patients are discussed. The increased occurrence of monoclonal gammopathies and non-Hodgkin's lymphoma in patients with Sjögren's syndrome is reported. The possible increased frequency of malignancies among patients with systemic lupus erythematosus (SLE), scleroderma, and polymositis-dermatomyositis is revisited; of interest, the overlapping clinical features of non-Hodgkin's lymphoma and SLE are presented, as well as the increased occurrence of ovarian cancer in patients (especially older women) with dermatomyositis. The proceedings of the first International Workshop on Hypertrophic Osteoarthropathy, as well as the association of this syndrome with nasopharyngeal carcinoma in the childhood years, are presented. Finally, postchemotherapy and post-bacille Calmette-Guérin rheumatism are described.

Antineoplastic Agents↗
PubMed2005

Pain catastrophizing and consequences of musculoskeletal pain: a prospective study in the Dutch community.

UNLABELLED: By elaborating on previous prospective and cross-sectional research, the primary aim of this study was to examine in the general community whether pain catastrophizing predicts the development of chronic pain complaints and other consequences of pain. The following health index values were examined as consequences of pain: specialist consultation, use of pain medication, and absenteeism. It was also examined whether these relationships were moderated by the number of pain problems and by pain intensity. The results demonstrated a generally low level of catastrophizing and a small but significant effect of catastrophizing on the development of chronic pain complaints. With respect to the health index values, no significant effects of catastrophizing were found, nor were the relationships between catastrophizing and chronicity and the health index values moderated by the number of pain problems or by pain intensity. PERSPECTIVE: Because in the general community the level of catastrophizing is low, its role in the development of future pain problems is probably limited in this type of setting. More practically, the Pain Catastrophizing Scale, used to measure pain catastrophizing, is probably of limited use as a screening instrument in the general community. The disappointing results may indicate that, depending on the specific setting (eg, clinical, outpatient, or community) the role of pain catastrophizing is either more or less prominent.

Adult↗
PubMed1996

Long-term sickness absence due to musculoskeletal disorders: the necessary intervention of work conditions.

To make rehabilitation of musculoskeletal disorders effective it is crucial to identify circumstances that tend to support the persistence of sickness absence. A total of 93 patients with recently developed disorders in the neck and shoulders were followed for one year after rehabilitation, in order to identify factors associated with recovery and chronicity, respectively. Health status was evaluated before rehabilitation and after 12 months in terms of sickness absence, pain ratings and self-rated quality of life, the Sickness Impact Profile. The study group was divided into tertiles based on their number of days of sickness absence during the follow-up period (short: < 25 days, medium: 25-101 days, long: > 101 days). Those with long-term sickness absence perceived higher physical and mental load in their jobs. There was also a higher proportion of persons who were not born in Sweden in this group and on average they had more sick-leave days the preceding year. Other background characteristics and personality ratings were similar between the groups. Long-term sickness absence was associated with worse ratings in quality of life after one year, and pain did not diminish during the follow-up year. Multiple regression analysis indicated that long-term sickness absence was largely associated with work conditions rather than with individual characteristics. Therefore, the results underscore the importance not only of treating the individual with musculoskeletal disorders, but in particular of improving his or her work conditions.

Adult↗
PubMed2003

Gene therapy and tissue engineering in repair of the musculoskeletal system.

Historically, surgeons have sought and used different procedures in order to augment the repair of various skeletal tissues. Now, with the completion of the Human Genome Project, many researchers have turned to gene therapy as a means to aid various ailments. In the orthopedic field, many strides have been made toward using gene therapy and tissue engineering in a clinical setting. In this review, several studies are outlined in different areas that gene therapy has or will influence orthopedic surgery. Gene therapy and tissue engineering can aid in fracture healing and spinal fusions by inducing bone formation, ligamentous repairs by increasing the production of connective tissue fibers, intervertebral disc disease by creating potential replacements, and articular cartilage repairs by providing means to improve cartilage. As we continue to see great contributions, such as the few mentioned here, this field will continue to mature and develop.

Animals↗
PubMedDate not supplied

Hemophilic arthropathy: evaluation of clinical and radiological characteristics and disability.

Hemophilia is an inherited bleeding disorder which produces its greatest morbidity in the musculoskeletal system. Musculoskeletal complications of hemophilia include acute hemarthrosis, chronic arthritis and hemophilic arthropathy. We studied the clinical and radiological characteristics of joint involvement in hemophiliacs. Functional loss was also demonstrated. There were 25 patients with a mean age of 17; the mean coagulant factor level was 4.2 percent. All the patients had hemarthrotic attacks. Knees were the most commonly affected joints followed by elbows, ankles and hips. The mean number of involved joints was 3.3. Even the patients with moderate disease had arthropathy. Sixty-four percent of the patients had pain and motion restrictions of the involved joints. Four patients developed intramuscular hematoma. We had patients at several radiological stages of severity. Radiological scores best correlated with age and the total number of involved joints. Various degrees of functional loss, namely disability, were observed. The disability score significantly correlated with the radiological score and age. The results of this study suggest that hemophilic arthropathy is an important problem and that multidisciplinary management is needed. Musculoskeletal care as well as appropriate and timely rehabilitation programs could prevent the development of sequelae.

Activities of Daily Living↗
PubMed1999

Wrist and forearm postures and motions during typing.

Awkward upper extremity postures and repetitive wrist motions have been identified by some studies as risk factors for upper extremity musculoskeletal disorders during keyboard work. However, accurate body postures and joint motions of typists typing on standardized workstations are not known. A laboratory study was conducted to continuously measure wrist and forearm postures and motions of 25 subjects while they typed for 10-15 min at a standard computer workstation adjusted to the subjects' anthropometry. Electrogoniometers continuously recorded wrist and forearm angles. Joint angular velocities and accelerations were calculated from the postural data. The results indicate that wrist and forearm postures during typing were sustained at non-neutral angles; mean wrist extension angle was 23.4 +/- 10.9 degrees on the left and 19.9 +/- 8.6 degrees on the right. Mean ulnar deviation was 14.7 +/- 10.1 degrees on the left and 18.6 +/- 5.8 degrees on the right. More than 73% of subjects typed with the left or right wrist in greater than 15 degrees extension and more than 20% typed with the left or right wrist in greater than 20 degrees ulnar deviation. Joint angles and motions while typing on an adjusted computer workstation were not predictable based on anthropometry or typing speed and varied widely between subjects. Wrist motions are rapid and are similar in magnitude to wrist motions of industrial workers performing jobs having a high risk for developing cumulative trauma disorders. The magnitude of the dynamic components suggests that wrist joint motions may need to be evaluated as a risk factor for musculoskeletal disorders during typing.

Adult↗
PubMed1996

Work-related musculoskeletal disorders among physical therapists.

BACKGROUND AND PURPOSE: Increasing evidence suggests that musculoskeletal disorders are common in workers in the United States health care industry. Physical therapists, who commonly treat patients with these disorders, are also at risk for work-related musculoskeletal disorders (WMD) in the upper limbs and low back. The purpose of this study was to determine the prevalence of WMD during a 12-month period and the job factors that may be associated with these disorders in physical therapists. SUBJECTS: A four-page questionnaire was mailed to physical therapists (N = 1,160) who attended The University of Iowa between 1943 and 1993. Nine hundred twenty-eight questionnaires were returned (80% response rate) from physical therapists in 46 states. METHODS: Based on a literature review and pilot study of physical therapists, a survey instrument was constructed consisting of a symptom survey, a job-factor survey, and various demographic information. RESULTS: The highest prevalences of WMD among physical therapists were in the following anatomical areas: low back (45%), wrist/hand (29.6%), upper back (28.7%), and neck (24.7%). The job factor rated most likely to contribute to job-related musculoskeletal disorders was "lifting or transferring dependent patients." The prevalence of WMD in physical therapists also was affected by work setting, practice specialty, age of patient, and gender of therapist. CONCLUSION AND DISCUSSION: Specific strategies should be developed to reduce WMD in the practice of physical therapy.

Adult↗
PubMed2002

Risk markers for thrombocytopenia in critically ill patients: a prospective analysis.

STUDY OBJECTIVE: To identify independent risk markers for thrombocytopenia in critically ill patients. DESIGN: Prospective, observational study. SETTING: Eleven-bed intensive care unit-coronary care unit (ICU-CCU) in a community hospital. PATIENTS: Three hundred sixty-two consecutive patients meeting inclusion criteria during 1 year. INTERVENTION: Potential risk marker data were collected on admission to the ICU-CCU and for the period before development of thrombocytopenia (defined as two or more consecutive platelet counts < 150 x 10(3)/mm3 obtained at least 12 hours apart), or for the duration of ICU-CCU stay if thrombocytopenia did not develop. MEASUREMENTS AND MAIN RESULTS: Thrombocytopenia developed in 68 patients (18.8%). Multivariate logistic regression analyses identified patients at risk on admission, but the predictive, potential of the regression model improved when all risk marker exposures during the ICU-CCU stay were considered. Independent risk markers included fresh frozen plasma administration, sepsis, musculoskeletal diagnosis, pulmonary artery catheter insertion, gastrointestinal diagnosis, packed red blood cell administration, and nonsurgical respiratory diagnosis. Higher admission platelet count and aspirin administration were associated with a lower risk of thrombocytopenia. Heparin administration was not identified as a risk marker, and no patient developed heparin-induced thrombocytopenia with thrombosis. Patients with thrombocytopenia had longer ICU-CCU and hospital stays, and higher ICU-CCU and hospital mortality than those without thrombocytopenia. CONCLUSIONS: Development of thrombocytopenia in critically ill patients is associated with specific diagnoses, packed red cell and fresh frozen plasma transfusions, pulmonary artery catheter insertion, and admission platelet count.

Aged↗
PubMed2006

Musculoskeletal imaging at 3T: current techniques and future applications.

MSK MR imaging applications are making the transition rapidly from 1.5T to 3T. Initial experience in the knee suggests that the higher SNR provides technical improvement in routine clinical imaging with the potential for greater accuracy in the diagnosis of articular cartilage injury. Similarly, initial experience with 3T MR imaging in the evaluation of the hip and small joints of the hand and wrist has been positive. In other joints, clinical development has been limited by the lack of availability of dedicated surface coils, and sensitivity of 3TMR imaging to artifact. The clinical impact of this technology remains uncertain because no published controlled clinical trial has evaluated the impact of 3T MR imaging on diagnostic outcomes. In addition to clinical application, 3T MR imaging has an important role for furthering translational research in MSK diseases through the development of new molecular and functional MR imaging techniques.

Artifacts↗
PubMed2006

How to treat acute musculoskeletal infections in children.

Timely diagnosis of musculoskeletal infections is essential to prevent severe complications of this disease. Important symptoms that lead to the diagnosis include high fever, malaise, local pain and loss of function of the involved extremity. In the case of arthritis, swelling of the affected joint may develop quickly in the course of disease. Imaging techniques include ultrasound and MRI. Both are useful in determining the exact site of infection. Infectious parameters, C-reactive protein and/or sedimentation rate of erythrocytes (ESR) are used in following disease activity during treatment. The gold standard for diagnosing musculoskeletal infection is microbiological isolation of the organism. Bone-biopsy of an involved metaphysis or aspiration of joint-fluid gives the highest chance of a positive culture. Usually S. aureus is the causative micro-organism, although specific underlying diseases may predispose to other bacterial infections. Antibiotic treatment is aimed at the most likely causative micro-organism. In some instances surgical treatment is necessary, especially in cases of focal and chronic osteomyelitis and when the adjacent joint is involved in the inflammatory process. Collaboration between paediatrician and orthopaedic surgeon is essential to achieve the best treatment for the patient.

Child↗
PubMed2006

The association between information and communication technology exposure and physical activity, musculoskeletal and visual symptoms and socio-economic status in 5-year-olds.

BACKGROUND: Increasing use of computers by children has raised concerns over the potential impact on their cognitive, social, educational, visual and physical development. Despite this concern, there are no large-scale studies relating the use of computers to specific health indicators in children as they reach school age. METHODS: A cross-sectional analysis of 1600 5-year-old Western Australian children participating in a longitudinal cohort study was conducted to ascertain their computer use, other activities (watching television and videos, playing electronic games, reading and looking at books, drawing on paper and moderate to vigorous physical activity), and specific health indicators. RESULTS: More than half (56%) of the children used computers each week. Computer use was significantly related to TV viewing (OR 1.97 weekday) and electronic game use (console games OR 2.48 weekday, 1.81 weekend; hand-held games OR 1.88 weekend) and negatively associated with vigorous physical activity on weekends (OR 0.72). Computer use was also significantly related to socio-economic indicators such as the mother being older (40+ years, OR 1.70 weekend, 1.73 weekday), tertiary educated (OR 1.63 weekend) and studying (OR 1.52 weekend, 1.41 weekday). Almost 1% children were reported to have complained of tired or sore muscles, and 2.2% had complained of tired or sore eyes, after watching television or using a computer. CONCLUSION: A substantial proportion of 5-year-old Western Australian children are using computers. Computer use was related to other sedentary activities and less vigorous activity. While musculoskeletal and vision problems are not widespread, their presence and the sedentary nature of computer use is of public health concern.

Child Behavior↗
PubMed2002

[DRGs of musculoskeletal diseases: consequences for orthopaedics and accident surgery].

The introduction of the new prospective payment system for inpatient care entails considerable changes for hospitals in Germany. The Australian Refined Diagnosis Related Groups (AR-DRGs), which form the basis for the German system, give the chance to estimate the consequences and implications for the specialty of orthopaedic surgery in Germany. Our study aims at highlighting the most important musculoskeletal diagnoses and to provide an initial economic forecast for them. The comparison with Australian data gives hints for operative and conservative-rehabilitative orthopaedic departments in respect to potentials and focal points for the development of novel patient management tools. The success of orthopaedic departments will depend in the future much more than now on organisational and management issues.

Australia↗
PubMed1995

New method of evaluating the surgical margin and safety margin for musculoskeletal sarcoma, analysed on the basis of 457 surgical cases.

The evaluation of surgical margin is useful in determining the curative success of surgical treatment of musculoskeletal sarcoma and the degree to which later surgery will be reduced by the preoperative therapy. However, until recently no reliable evaluation method has been developed for these purposes. In this paper we propose a new method for evaluating the surgical margin as drafted in 1989 by the Bone and Soft Tissue Tumor Committee of the Japanese Orthopaedic Association (JOA). In this method, surgical margin was classified into four types based on the distance between the surgical margin and the reactive zone of the tumour. These classifications of surgical margin (in order to surgical extent) are curative wide margin (curative margin), wide margin, marginal margin, and intralesional margin. The surgical margin is said to be curative if the margin is more than 5 cm outside the reactive zone. It is referred to as wide if the margin is less than 5 cm. Similarly, a margin that is in the reactive zone is considered as marginal, and a margin passing through a tumour as intralesional. Moreover, wide margin is classified as adequate (at least 2 cm outside the reactive zone) or inadequate (1 cm). In our evaluation, a "thin" barrier is considered to be a 2-cm thickness of normal tissue, a "thick" barrier as a 3-cm thickness, and joint cartilage is said to be equivalent to a 5-cm thickness. In addition, a surgical margin that is outside a barrier, with normal tissue between the barrier and the reactive zone of the tumour, is considered to be curative. This method was applied in 457 cases (involving 499 surgeries) at the Cancer Institute Hospital to determine clinical significance in the treatment of musculoskeletal sarcoma (1979-1994). From the results of this study we were able to conclude that this evaluation method can be highly useful in clinical practice for establishing optimum surgery. Moreover, we found that the safety margin for high-grade musculoskeletal sarcoma is a curative margin providing an adequate wide margin of 3 cm or more when preoperative therapy is not performed or is not effective, while the safety margin for high-grade sarcoma that responds to preoperative chemo- or radiotherapy seems to be an adequate wide margin of 2 cm. Here, radiotherapy is more effective compared to chemotherapy for reducing surgical margin. An inadequate wide margin, however, combined with radiotherapy, is not enough to ensure local curative success following surgery for musculoskeletal sarcoma.(ABSTRACT TRUNCATED AT 400 WORDS)

Bone Neoplasms↗
PubMed1996

Work-related musculoskeletal problems: Some ergonomic considerations.

Musculoskeletal disorders (MSD) in industrialized and industrializing countries are situated and discussed. Considerations are made on the registration of MSD cases, on the consequences for humans, industry and society, on scientific methodology and prevention strategies. These considerations are used to develop proposals for future actions. These concern the development of structures, some ideas about training and education as well as a common method for applied field research enabling the use of data in all industries.

Ergonomics↗
PubMed1986

A review of the medical standards for civilian airmen. Synopsis of a two-year study.

This article summarizes the report of a comprehensive review by the American Medical Association (AMA) of the medical standards for civilian airmen. The present standards were promulgated by the Federal Aviation Administration in 1959; the alcoholism and cardiovascular standards were revised in 1982. The AMA report recommends new or revised standards for cardiovascular, mental and behavioral, visual, endocrine, respiratory, hematological, hearing and equilibrium, musculoskeletal, and nervous system disorders. It also provides guidance for the medical certification of airmen with conditions not covered specifically by the standards and recommends a new medical history and examination form for use by aviation medical examiners. Risk factors for the development of sudden incapacitating disease, such as coronary heart disease and stroke, receive special attention. Final standards will be developed by the Federal Aviation Administration.

Adult↗
PubMed2004

Ergonomic intervention in carpet mending operation.

Carpet mending operations are performed in traditional workshops in a squatting position. Seventy-two menders were questioned regarding musculoskeletal disorders (MSDs). Among the menders, knees, back and shoulders problems were more prevalent compared to other body regions. Based on the problems found, a new workstation was developed and eight menders were asked to work in the new workstation. They were observed and evaluated with the RULA technique and their opinion on the improvement was asked working on four frequently seen tasks. The new workstation improved working posture noticeably. In 57% of the cases, the new workstation was evaluated good or very good and the comfort was increased.

Adult↗
PubMed2006

The extruded talus: results of reimplantation.

BACKGROUND: There is considerable debate regarding the appropriate treatment of the extruded talus regardless of the presence of a fracture. The purpose of this study was to report the clinical results, complications, and functional outcome following reimplantation of the traumatically extruded talus. METHODS: A database of 119 patients with an open injury of the talus occurring between 1995 and 2003 at a level-I trauma center was reviewed to identify patients with a complete talar extrusion. Demographic, imaging, and treatment data were obtained from a review of the medical records. Follow-up was undertaken during clinic visits or by telephone. Preoperative and follow-up radiographs were reviewed to identify posttraumatic arthritis, osteonecrosis, or talar collapse, and the Musculoskeletal Functional Assessment was used to assess functional outcome. RESULTS: Twenty-seven patients were identified. A minimum follow-up of one year (average, forty-two months) was obtained for nineteen patients. Infection and the need for a secondary surgical procedure were the primary determinants of clinical outcome. Two of the nineteen patients had documented infections: one had developed at two weeks and one, after a calcaneal osteotomy at nineteen months. Twelve patients had no subsequent surgery, and seven had subsequent procedures (range, one to four procedures). No patient underwent a delayed amputation. The average Musculoskeletal Functional Assessment score at the time of follow-up was 29.8 (range, 5 to 59). With the numbers studied, no association was found between functional outcome and the following variables: ipsilateral lower-extremity injury, associated talar fracture, secondary procedures, osteonecrosis, or age. CONCLUSIONS: While functional outcome is difficult to assess, salvage of the extruded talus appears to be a relatively safe operation, with a minimal risk of infection, which allows maximal flexibility in aftercare by preserving the most normal ankle anatomy possible.

Adolescent↗