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Subcutaneous hematoma detected on Tc-99m pyrophosphate muscle imaging.
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Stress fractures of the thoracic spine transverse processes in a water skier.
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Customer satisfaction and workplace safety.
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Improved surgical care of posterior burns and donor sites using air-fluidized support.
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The HoverMatt system for patient transfer: enhancing productivity, efficiency, and safety.
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Right axillary artery bullet embolus following gunshot wound of the back.
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Back safety for MCH nurses.
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Guillain-Barre: a case of muscular weakness and ambulatory difficulty.
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Use of the mud bed in the treatment of burns.
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Low-back impairment-rating practices of orthopaedic surgeons and neurosurgeons in West Virginia.
The inquiry on low-back impairment rating practices among physicians who treat or evaluate workers' compensation claimants replicates an earlier inquiry appearing in Spine by Brand and Lehmann (1983). Findings are essentially similar. Physicians consider factors other than those of physical impairment in assigning ratings, and ratings in two states are similar rather than different. The conclusion of the earlier inquiry and premise of this inquiry is that lacking widely accepted criteria for rating low-back impairment, physicians rate the disability of an individual as they perceive it. Based on findings from both inquiries, variance among ratings increases as ratings become higher. A second conclusion is that duration of time-loss disability from work before a permanent rating is made can be detrimental regarding return to work.
Back sprain in industry. The role of socioeconomic factors in chronicity.
A minority of industrial-back-sprain claimants account for most of the cost of industrial back sprain: those whose disability persists into "chronicity", which is defined as 90 days or more off work. The data in this study demonstrate the effects of socioeconomic factors on chronicity. This analysis is based on State of Washington industrial insurance claims for back sprain. For both men and women, three socioeconomic factors significantly affect the risk of chronicity: age, wage, and the family status of being either widowed or divorced with no children. In addition, the Nam-Powers Socioeconomic Index is significant for men. Wage compensation ratio cannot be shown to be a factor in chronicity.
Muscle flap closure for salvage of complex back wounds.
STUDY DESIGN: The use of muscle flaps for closing complex thoracolumbar and lumbar spine wounds was studied retrospectively. Five patients in whom traditional, conservative treatment modalities did not work underwent a variety of muscle flap closures with successful healing. OBJECTIVES: Patients with complicated back wounds ranging from exposed hardware to post-traumatic defects were treated initially with conservative treatments. The authors evaluated the efficacy of applying techniques and knowledge gained from complex lower extremity wound coverage of back wounds. SUMMARY OF BACKGROUND DATA: Six muscle transfer procedures were performed on five patients. All patients were closed with local muscle flaps using the trapezius and latissimus dorsi muscles. METHODS: Success was defined as a closed stable wound that needed no future surgery nor allowed the primary defect to heal before hardware removal. There was no evidence of chronic infection. Surgical hardware was salvaged in one of three patients. RESULTS: All were successfully closed and have been followed up to 30 months without evidence of recurrence. CONCLUSIONS: The cases presented illustrate the usefulness of rotation flaps when there is an extensive soft tissue defect that has exposed neural, osseous, and foreign structures. The use of local transposition muscle flaps as an adjunct in closing complex back wounds has been very successful in our experience. Although recurrent infection may occur, this technique has facilitated the establishment of a soft tissue envelope to achieve short- and long-term wound healing.
A test to measure lift capacity of physically impaired adults. Part 1--Development and reliability testing.
STUDY DESIGN: Two laboratory studies and one field study evaluated the safety and test-retest reliability of a new test of lift capacity. The first two studies were conducted in a carefully controlled laboratory setting. The first study investigated the safety and intra-rater reliability of the EPIC Lift Capacity test protocol with healthy adult subjects. The second study assessed the safety and inter-rater reliability of the test with disabled subjects. The third study was conducted in the field with 65 evaluators and investigated the safety and intra-rater reliability of the test with healthy adult subjects. OBJECTIVE: To assess the safety and reliability of a new test of lift capacity. SUMMARY OF BACKGROUND DATA: A new test of lift capacity has been developed. Test development occurred within the context of ergonomic standards and guide-lines of the major professional associations and public agencies that govern test development in the United States. METHODS: In study no. 1, 26 healthy subjects participated. In study no. 2, 14 disabled subjects participated. In study no. 3, 318 healthy subjects participated. After subjects underwent basic screening and warm-up, the EPIC Lift Capacity test was administered. One to 2 weeks later, the test was administered again. Correlations between the times of testing were calculated. RESULTS: No subjects were injured. Hamstring soreness the next day that resolved without complication was reported by some healthy subjects. None of the disabled subjects reported new symptoms. CONCLUSION: The safety and reliability of the EPIC Lift Capacity test was adequately demonstrated in a laboratory setting and across multiple field sites with evaluators who have varying types and degrees of professional preparation.
The effects of external compression by three different retractors on pressure in the erector spine muscles during and after posterior lumbar spine surgery in humans.
STUDY DESIGN: An experimental study on patients undergoing posterior lumbar spine surgery. OBJECTIVES: To study the relation between external compression and muscle strain induced by spinal retractors and intramuscular pressure in the dorsolumbar compartment during posterior spinal surgery. SUMMARY OF BACKGROUND DATA: Pressures were studied as a function of the distance between the retractor blades during surgery. METHODS: Intramuscular pressure was measured bilaterally in the erector spinae muscle with intermittent microcapillary infusion technique in 12 patients undergoing posterior lumbar spine surgery during 271 (range 90-420) minutes. Three self-retaining retractors were tested; the McCulloch, the Viking, and the Richard retractors. RESULTS: Intramuscular pressure was 7.7 mm Hg before surgery. It varied between 35 mm Hg and 69 mm Hg during surgical exposure of the laminas and facet joints. Intramuscular pressure varied between 61 mm Hg and 158 mm Hg depending on which retractor was used and on the distance between the retractor blades. Intramuscular pressure never exceeded 30 mm Hg at rest after the operation. CONCLUSIONS: External compression and muscle strain from retractor blades during surgery increased intramuscular pressure in the paravertebral muscles to levels that, according to other studies, induce ischemia in the muscles.