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PubMed2005

Management of chest pain: exploring the views and experiences of chiropractors and medical practitioners in a focus group interview.

BACKGROUND: We report on a multidisciplinary focus group project related to the appropriate care of chiropractic patients who present with chest pain. The prevalence and clinical management, both diagnosis and treatment, of musculoskeletal chest pain in ambulatory medical settings, was explored as the second dimension of the focus group project reported here. METHODS: This project collected observational data from a multidisciplinary focus group composed of both chiropractic and medical professionals. The goals of the focus group were to explore the attitudes and experiences of medical and chiropractic clinicians regarding their patients with chest pain who receive care from both medical and chiropractic providers, to identify important clinical or research questions that may inform the development of 'best practices' for coordinating or managing care of chest pain patients between medical and chiropractic providers, to identify important clinical or research questions regarding the diagnosis and treatment of chest pain of musculoskeletal origin, to explore various methods that might be used to answer those questions, and to discuss the feasibility of conducting or coordinating a multidisciplinary research effort along this line of inquiry. The convenience-sample of five focus group participants included two chiropractors, two medical cardiologists, and one dual-degreed chiropractor/medical physician. The focus group was audiotaped and transcripts were prepared of the focus group interaction. Content analysis of the focus group transcripts were performed to identify key themes and concepts, using categories of narratives. RESULTS: Six key themes emerged from the analysis of the focus group interaction, including issues surrounding (1) Diagnosis; (2) Treatment and prognosis; (3) Chest pain as a chronic, multifactorial, or comorbid condition; (4) Inter-professional coordination of care; (5) Best practices and standardization of care; and (6) Training and education. CONCLUSION: This study carries implications for chiropractic clinical training relative to enhancing diagnostic competencies in chest pain, as well as the need to ascertain and improve those skills, competencies, and standards for referrals and sharing of clinical information that may improve cross-disciplinary coordination of care for chest pain patients.

Journal Article↗

PubMed2004

Hypovitaminosis D-induced pain.

Vitamin D deficiency is a problem of considerable magnitude that has reemerged as a major public health issue in the United States and several other developed countries. Vitamin D plays a crucial role in calcium homeostasis in the body. Hypovitaminosis D leads to osteomalacia and increased risk of fractures, especially in the elderly. Preliminary research suggests that vitamin D can prevent certain types of cancer and autoimmune diseases. A recent large study has shown the association between severe hypovitaminosis D and persistent, non-specific musculoskeletal pain, further suggesting that patients with no apparent cause of pain should be assessed and possibly treated for vitamin D deficiency.

Calcium↗

PubMed2005

Is the effect of a countermovement on jump height due to active state development?

PURPOSE: To investigate whether the difference in jump height between countermovement jumps (CMJ) and squat jumps (SJ) could be explained by a difference in active state during propulsion. METHODS: Simulations were performed with a model of the human musculoskeletal system comprising four body segments and six muscles. The model's only input was STIM, the stimulation of muscles, which could be switched "off" or "on." After switching "on," STIM increased to its maximum at a fixed rate of change (dSTIM/dt). For various values of dSTIM/dt, stimulation switch times were optimized to produce a maximum height CMJ. From this CMJ, the configuration at the lowest height of the center of gravity (CG) was selected and used as static starting configuration for simulation of SJ. Next, STIM-switch times were optimized to find the maximum height SJ. RESULTS: Simulated CMJ and SJ closely resembled jumps of human subjects. Maximum jump height of the model was greater in CMJ than in SJ, with the difference ranging from 0.4 cm at infinitely high dSTIM/dt to about 2.5 cm at the lowest dSTIM/dt investigated. The greater jump height in CMJ was due to a greater work output of the hip extensor muscles. These muscles could produce more force and work over the first 30% of their shortening range in CMJ, due to the fact that they had a higher active state in CMJ than in SJ. CONCLUSION: The greater jump height in CMJ than in SJ could be explained by the fact that in CMJ active state developed during the preparatory countermovement, whereas in SJ it inevitably developed during the propulsion phase, so that the muscles could produce more force and work during shortening in CMJ.

Algorithms↗

PubMed1997

Classification of pain following spinal cord injury.

Pain continues to be a significant management problem in people with spinal cord injuries. Despite this there is little consensus regarding the nature, terminology and definitions of the various types of pain that occur following spinal cord injury. This has led to large variations in the reported incidence and prevalence of pain following spinal cord injury. Treatment studies have been hampered by inconsistent and inaccurate identification of pain types. We believe that both research and management would benefit from an agreed upon classification system which accurately and reliably identifies the types of pain that occur following spinal cord injury. We have reviewed the literature on the classification of pain following spinal cord injury and have developed a classification system which adopts the strengths of previous systems and attempts to avoid the weakness inherent in others. Our proposed classification system of pain following spinal cord injury includes four major divisions: musculoskeletal, visceral, neuropathic and other types of pain. We have divided neuropathic pain on the basis of region into two subdivisions: neuropathic at level and neuropathic below level pain. We have further divided neuropathic at level pain into two categories: radicular and central, to indicate the presumed site of the lesion responsible for pain generation. We believe that our proposed classification system is comprehensive, simple and readily applicable in the clinical and research situation. It is our hope that this proposed classification will contribute to the eventual development of a universal system for the classification of pain following spinal cord injury.

Humans↗

PubMed2000

Musculoskeletal problems of neurogenic origin.

A number of neurological disorders can manifest as isolated pain or as joint, muscle or bone alterations. These manifestations can raise significant diagnostic challenges when they occur early, before the development of neurological and/or radiological abnormalities. This chapter discusses neuropathic osteoarthropathies, neurofibromatosis, Parkinson's disease, multiple sclerosis and the complications of central nervous system lesions.

Arthropathy, Neurogenic↗

PubMed2005

[Erdheim-Chester disease].

HISTORY AND CLINICAL FINDINGS: A 55-year-old female was admitted complaining of musculoskeletal pain and weakness of both lower extremities for a number of years. Due to a hypothalamic mass of unknown aetiology a diabetes insipidus, a gonadotrophic, somatotrophic and a partially corticotrophic insufficiency had developed. INVESTIGATIONS: Laboratory investigations yielded elevated levels of several inflammatory parameters (C-reactive protein, blood sedimentation rate, fibrinogen and thrombocytes). Serological parameters indicating a systemic rheumatic disorder were absent. X-ray examination revealed combined osteolytic and osteoblastic lesions within the distal parts of both femora and within the proximal portions of both tibiae. MRI showed signal alterations and (99m)Technetium bone scan exhibited a considerably increased uptake. Histopathologically, a biopsy of the left tibia showed multifocal small infiltrates of foamy histiocytes indicating Erdheim-Chester disease (ECD). TREATMENT AND COURSE: Under treatment with glucocorticosteroids musculoskeletal complaints improved, but re-appeared following dose reduction. A therapeutic trial using methotrexat did not affect the complaints. CONCLUSION: The Erdheim-Chester syndrome is considered to belong to diseases with a proliferation of the monocytic-histiocytic and dendritic cellular system. In the presence of symmetric musculoskeletal symptoms associated with osteosclerotic and osteolytic lesions particularly occurring in the long bones of the lower extremities and concomitant with elevated serum markers of inflammation, the Erdheim-Chester disease should be taken into account. To date, no validated therapy exists.

Biopsy↗

PubMed2005

Musculoskeletal differentiation of cells derived from human embryonic germ cells.

Stem cells have the potential to significantly improve cell and tissue regeneration therapies, but little is understood about how to control their behavior. We investigated the potential differentiation capability of cells derived from human embryonic germ (EG) cells into musculoskeletal lineages by providing a three-dimensional environment with increased cell-cell contact and growth factors. Cells were clustered into pellets to mimic the mesenchyme condensation process during limb development. LVEC cells, an embryoid body-derived (EBD) cell culture generated from EG cells, were cultured in micromass pellets for 21 days in the presence of bone morphogenetic protein 2 (BMP2) and/or transforming growth factor beta-3 (TGFbeta3). Gene expression for cartilage-, bone-, and muscle-specific matrix proteins--including collagen types I, II, III, IX, X; aggrecan; cartilage proteoglycan link protein; cartilage oligomeric protein; chondroitin sulfate-4-S; and myf5--was upregulated in the pellets treated with TGFbeta3, while mRNAs for neurofilament heavy (NFH), a neuron marker, and flk-1, a hematopoietic marker, decreased. Total collagen and proteoglycan production exhibited a time-dependent increase in the pellets treated with TGFbeta3, further confirming the expression of characteristic musculoskeletal markers. Furthermore, our results indicate the ability to select or differentiate stem cells toward a musculoskeletal lineage from a heterogenous EBD cell line.

Cartilage↗

PubMedDate not supplied

Adverse effects of anabolic steroids.

Anabolic steroids are used therapeutically for various disorders and as ergogenic aids by athletes to augment strength, muscular development, and to enhance performance. There is a wide range of concomitant temporary and permanent adverse effects with steroid administration. Several well-documented adverse actions of these hormones may develop rapidly within several weeks or less (i.e. altered reproductive function) or require up to several years of steroid intake (i.e. liver carcinoma). More recent studies indicate that glucose intolerance, insulin resistance, increased cardiovascular disease risk profiles, cerebral dangers, musculoskeletal injuries, prostate cancer, psychosis and schizophrenic episodes, among others, accompany anabolic steroid intake. There is, at present, no evidence to support the claim that athletes are less susceptible to adverse effects than those individuals receiving hormone treatment in a clinical setting. Based on the available information which has accumulated primarily from cross-sectional, short term longitudinal, and case studies, there is a need: (a) to develop a comprehensive battery of specific and sensitive markers of adverse effects, particularly those that would be able to detect the onset of adverse actions; and (b) to conduct controlled long term longitudinal studies in order to fully understand the extensiveness and mechanisms involved in the occurrence of adverse effects.

Anabolic Agents↗

PubMed2001

Tolerance to musculoskeletal allografts with transient lymphocyte chimerism in miniature swine.

BACKGROUND: Although transplantation of musculoskeletal allografts in humans is technically feasible, the adverse effects of long-term immunosuppression subject the patient to high risks for correcting a non-life-threatening condition. Achieving immunologic tolerance to musculoskeletal allografts, without the need for chronic immunosuppression, could expand the clinical application of limb tissue allografting. Tolerance to musculoskeletal allografts has been accomplished previously in miniature swine in our laboratory. Although stable, mixed chimerism has been suggested as the mechanism underlying long-term tolerance in a rat limb model, the mechanism of this tolerance induction has not been established. This report explores the possible relationship between hematopoietic chimerism and tolerance to musculoskeletal allografts in swine. METHODS: Twelve miniature swine underwent vascularized musculoskeletal allograft transplantation from histocompatibility complex (MHC) matched, minor antigen-mismatched donors. Eight animals received a 12-day coprse of cyclosporine, one of which was excluded due to subtherapeutic levels. Four recipients were not immunosuppressed. Serial biopsies to assess graft viability and flow cytometry to assess chimerism were performed. Donor and third-party skin grafts were placed on recipients with surviving allografts greater than 100 days to validate tolerance. RESULTS: Both groups developed early peripheral chimerism, but this chimerism became undetectable by postoperative day 19 in the cyclosporine group and by day 13 in the control group. Animals receiving cyclosporine developed permanent tolerance to their allografts, whereas those not receiving cyclosporine rejected their allografts in 6-9 weeks. Animals demonstrating tolerance to their bone allografts also demonstrated prolonged donor skin graft survival. CONCLUSIONS: Induction of tolerance to musculoskeletal allografts can be achieved in the MHC matched swine. Although hematopoietic chimerism is present in the immediate postoperative period, persistent, long-term chimerism does not seem to be necessary for maintenance of such tolerance.

Animals↗

PubMed2003

Continued neurocognitive development and prevention of cardiopulmonary complications after successful BMT for I-cell disease: a long-term follow-up report.

I-cell disease or mucolipidosis type II, a rare inherited storage disorder of lysosomal enzyme localization, is characterized by dysostosis multiplex, progressive severe psychomotor retardation and death by 5-8 years from congestive heart failure and recurrent pulmonary infections. A 19-month old girl with I-cell disease received a bone marrow transplant (BMT) from an HLA-identical carrier brother. At the age of 7 years, 5 years after BMT, she has no history of respiratory infections. Her cardiac function remains normal with a shortening fraction of 47%, and she continues to gain neurodevelopmental milestones, albeit at a very slow rate. Musculoskeletal deformities have worsened despite BMT. This is the first report describing neurodevelopmental gains and prevention of cardiopulmonary complications in I-cell disease after BMT.

Bone Marrow Transplantation↗

PubMed2000

Accuracy of muscle moment arms estimated from MRI-based musculoskeletal models of the lower extremity.

OBJECTIVE: Biomechanical models that compute the lengths and moment arms of soft tissues are broadly applicable to the treatment of movement abnormalities and the planning of orthopaedic surgical procedures. The goals of this study were to: (i) develop methods to construct subject-specific biomechanical models from magnetic resonance (MR) images, (ii) create models of three lower-extremity cadaveric specimens, and (iii) quantify the accuracy of muscle-tendon lengths and moment arms estimated using these models. MATERIALS AND METHODS: Models describing the paths of the medial hamstrings and psoas muscles for a wide range of body positions were developed from MR images in one joint configuration by defining kinematic models of the hip and knee, and by specifying "wrapping surfaces" that simulate interactions between the muscles and underlying structures. Our methods for constructing these models were evaluated by comparing hip and knee flexion moment arms estimated from models of three specimens to the moment arms determined experimentally on the same specimens. Because a muscle's moment arm determines its change in length with joint rotation, these comparisons also tested the accuracy with which the models could estimate muscle-tendon lengths over a range of hip and knee motions. RESULTS: Errors in the moment arms calculated with the models, averaged over functional ranges of hip and knee flexion, were less than 4 mm (within 10% of experimental values). CONCLUSION: The combination of MR imaging and graphics-based musculoskeletal modeling provides an accurate and efficient means of estimating muscle-tendon lengths and moment arms in vivo.

Biomechanical Phenomena↗

PubMed2002

Epidemiology of musculoskeletal injuries among sedentary and physically active adults.

PURPOSE: This study describes the types and frequencies of musculoskeletal injuries among a cohort of adults with above average activity levels who were enrolled in the Aerobics Center Longitudinal Study (Dallas, TX). METHODS: Participants were adults aged 20-85 yr who completed a baseline clinical examination (1970-1982) and returned a mailed follow-up survey in 1986. Participants (5,028 men, 1,285 women) were measured for aerobic fitness, height, and body weight during the baseline examination. They reported detailed information about their physical activity levels and injury experiences on the follow-up survey (1986). An injury was defined as any self-reported soft tissue or bone injury that occurred within the previous 12 months. Activity-related injuries were those injuries participants attributed to participation in a formal exercise program. RESULTS: A quarter of all participants reported a musculoskeletal injury. Of these, 83% were activity-related. More than 66% of activity-related injuries occurred in the lower extremity; the knee was listed as the joint most often affected. There were no significant sex differences in the prevalence of injury, regardless of cause. Sport participants had the highest proportion of all-cause and activity-related musculoskeletal injuries among both men and women. Self-perceived severe injuries had a significant negative impact on physical activity levels since almost 1/3 of subjects reported permanently stopping their exercise program after injury. CONCLUSION: These results suggest the need for developing and implementing injury prevention programs targeted toward moderately active adults.

Adult↗

PubMed1996

Development of an anthropometric database for Hong Kong Chinese CAD operators.

With the increasing popularity of using computer-aided design (CAD) in Hong Kong, it is time to look into the design of a suitable workplace for the CAD operators working in the industries. This can be achieved by applying anthropometric data into the design for enhancing performance and reducing musculoskeletal problems. In order to avoid any mismatches in anthropometric dimensions, which is believed to be one of the main causes of fatigue and occupational illness among workers, in the workplace design for them, eleven relevant body dimensions from a group of 150 Hong Kong male adults with ages ranging from 18 to 28 years were collected and analyzed to develop a computerized anthropometric database for Hong Kong CAD operators. The eleven anthropometric dimensions measured were: shoulder rest height, elbow-fingertip length, shoulder breadth, hip breadth, sitting eye height, elbow rest height, third lumbar disc-pan length, thigh clearance height, popliteal height, buttock-popliteal length, and stature. The computerized database can provide some useful statistics such as mean, standard deviation and relevant percentiles of all the measured dimensions. With the aid of these statistics, a new workplace for CAD operators was designed which improved performance substantially.

Adolescent↗

PubMed2003

The physiology of erectile dysfunction.

Male erectile dysfunction is a common urologic disorder which can have a profound detrimental impact on a patient's quality of life. Normal erectile function represents a complex physiologic process requiring integrated synchronized function of vascular, neurologic, and musculoskeletal body systems, with significant psychologic factors playing a role as well. A breakdown in any one of these body systems can contribute to the development of erectile dysfunction. As men age, many of the same risk factors for the development of cardiovascular disease also can have a detrimental effect on the organ systems needed for good erectile function. A solid grasp of the anatomy and physiology involved in normal erectile function is important in understanding the interactions between cardiovascular disease and erectile dysfunction, and in developing new ways to effectively treat and prevent both disease processes in the future.

Cardiovascular Diseases↗

PubMed1983

Computed tomography in orthopedics.

The enormous interest in CT scanning appears fully justified as this remarkable technique continues its development. In orthopedics, it has a variety of roles to play: in trauma, tumor management, and developmental disorders. As experience with the CT scan in musculoskeletal disease is accumulated, new applications will undoubtedly become apparent, adding to the already impressive list.

Bone Diseases↗

PubMed2006

Initial clinical impressions of the U.C. Davis large animal lift and its use in recumbent equine patients.

The U.C. Davis Large Animal Lift (LAL) is a lightweight sling developed to help lift horses in clinical and rescue situations. Here we report on its first use in 16 recumbent horses with neurologic, muscular and musculoskeletal disorders. For each horse, history, sedation, ease and time of LAL application and hoisting, standing ability, LAL tolerance and outcome were recorded. The LAL was easily and safely applied in all horses in less than five minutes and the procedure was well tolerated with minimal to no sedation. While 10 horses were able to stand in the LAL after being hoisted, 6 horses were unable to stand and were eventually euthanized due to the inability to regain weight bearing function. The LAL has shown to be a useful devise to evaluate the standing ability of recumbent horses and can be used alone or in combination with the Anderson Sling Support Devise to allow standing support of horses with a variety of debilitating problems.

Animals↗

PubMed1998

Criteria for the health surveillance of workers exposed to repetitive movements.

In the light of the experience and guidelines developed by other countries and of Italian legislative and operational conditions, the authors outline a strategy for a health surveillance programme for work-related musculoskeletal disorders of the upper limbs. In particular, the paper defines the various aims of the health surveillance programme and identifies significant relevant criteria for its implementation (i.e. existence of risks or effects). A screening schedule is presented based on subsequent investigations (first and second level surveillance); the authors discuss the principal methods used for processing the results of the health surveillance programme, in collective (i.e. statistical comparisons, planning of periodical investigations) and individual terms (job fitness judgements, reporting of suspected occupational diseases).

Humans↗

PubMedDate not supplied

Greater trochanter enthesopathy: an example of "short course retinoid enthesopathy": a case report.

Irreversible skeletal changes have been described in patients with dermatologic disorders treated with isotretinoin (Accutane), a synthetic vitamin A derivative. Although retinoids were developed to avoid toxicity associated with vitamin A, skeletal lesions and rheumatologic consequences are possible hazards of isotretinoin treatment. Enthesopathy is one of the potential musculoskeletal sequelae and is characterized by pathologic, sometimes painful changes at the insertion sites (entheses) of tendons, ligaments, and articular capsules into bone. We report a patient who was referred secondary to an extended history of bilateral hip region pain. She was subsequently found to have a greater trochanteric enthesopathy. A detailed patient history revealed past use of Accutane for cystic acne. The subsequent treatment course, including medications, corticosteroid injections, physical therapy, and activity modifications, is described and the pertinent literature is reviewed. We believe that patients who are prescribed isotretinoin should be warned about this potential pathologic condition at the initiation of treatment and that physicians who are treating patients with a history of Accutane use should be suspicious of underlying enthesopathies as the etiology behind pain of musculoskeletal origin.

Acne Vulgaris↗