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PubMed2002

Work-related musculoskeletal disorders of the upper limb.

Work-related musculoskeletal disorders of the upper limb (WRMSDs-UL) account for over two-thirds of all occupational disorders recognized in France. This broad term encompasses a vast array of disorders whose development is facilitated by environmental factors present at the workplace. Numerous epidemiological studies have established the key role of occupational activities in the genesis of WRMSDs-UL. This role is mediated by biomechanical factors (repetitive motion, strenuous effort, extreme joint postures) and/or psychosocial factors. Biological plausibility supports the epidemiological data. The high incidence of WRMSDs-UL indicates a need for greater emphasis on prevention.

Biomechanical Phenomena↗
PubMed2000

Acute abstinence syndrome following abrupt cessation of long-term use of tramadol (Ultram): a case study.

We report on a patient who had taken the centrally acting analgesic tramadol for over 1 year. The compound had proven to be sufficient to treat her painful episodes related to fibromyalgia. Due to lack of supply while being on a trip, intake of the drug was stopped abruptly, resulting in the development of classical abstinence-like symptoms within 1 week. Abstinence-like symptoms consisted of restlessness and insomnia for which the benzodiazepine lorazepam was given. Diarrhoea and abdominal cramps were treated with the peripherally active opioid loperamide, while bouts of cephalgia were treated with sumatriptan. Diffuse musculoskeletal-related pain and restless leg syndrome (RLS) were treated with dextromethorphan. All these different medications proved to be efficacious as they resulted in the cessation of symptoms. Within 1 week symptoms ceased and the patient regained her normal activities without any sequelae. Although tramadol is considered a non-habit- and non-dependence-forming analgesic, abstinence symptoms are likely to develop following abrupt cessation of intake, especially when the compound had been taken over 1 year. Therefore patients should be advised of such an effect whenever they decide to stop intake or their physician is planning to switch to another medication. To avoid abstinence-like symptoms doses should be slowly tapered down.

Acute Disease↗
PubMed2005

Bone mineralization and physical development of children.

A cross-sectional study of BMD and physical development values in children of various age-specific groups was carried out. In all, the study included 357 children (194 boys and 163 girls) aged from 5 to 16 years. The study did not include children with inherited or acquired diseases of the musculoskeletal system, chronic diseases of the liver or kidneys, diabetes, thyrotoxicosis or malabsorption syndrome or professional athletes. BMD values were estimated by dual X-ray absorbtiometry (DXA) of the lumbar part of the spine (L2-L4) using a "DPX-MD+" device equipped with a "child" software program. Out of all the examined children, 58.9% had harmonic physical development, and 13.1% had a decreased body height and body mass. It was revealed that BMC and BMD values in the lumbar part of the spine intensively increased with age. BMC closely correlates with body height (r = 0.8; p < 0.000) and body mass (r = 0.7; p < 0.000). BMD also correlates with anthropometric parameters. The lowest BMC and BMD values and Z-score as well can be found in children with a low body height and body mass (<10th percentile).

Absorptiometry, Photon↗
PubMed1992

Ergonomic analysis to characterize task constraint and repetitiveness as risk factors for musculoskeletal disorders in telecommunication office work.

A modified activity analysis procedure was devised to quantify the presence of two task attributes identified in previous research as contributing to an increase in work demands and ergonomic hazards. The purpose of this study was to develop an exposure index based on the presence of two task attributes. The utility of this job activity analysis will, of course, be determined by the extent to which workers with varying degrees of muscular pain and discomfort correspond to the risk exposure group we have described. The results of both the medical and psychological assessments of the workers--contained in the final HETA report--will be used to assess the utility of our method and determine whether the task attributes of constraint and repetitiveness contribute to the onset of cumulative trauma disorders among clerical workers.

Cumulative Trauma Disorders↗
PubMed2001

From exercise and education to movement and interaction. Treatment groups in primary care for women with chronic muscular pain.

OBJECTIVE: To develop a group-based treatment programme in primary health care for women with chronic muscle pain, and adjust programme development according to experiences obtained by the participating women and health personnel. The aim of the programme was to help the women develop a tool for handling their chronic state of pain. The article describes and discusses experiences essential for elaboration of the treatment programme. DESIGN: Action research design. SETTING: Existing therapy groups in Stovner for women with chronic muscle pain. SUBJECTS: We arranged eight treatment groups, each lasting 12 weeks, and three groups lasting 10 months, with a total of 133 participants. MAIN OUTCOME MEASURES: Experiences were systematised by means of pragmatic analysis of qualitative data from field notes, tape recordings of focus group interviews, and video recordings of training and discussion groups. RESULTS: While initially the training programme aimed at increasing physical fitness and muscle strength, it gradually developed into activity based on movement with an emphasis on noticing and experiencing. The instruction programme initially aimed at providing information, and developed towards discussion groups with emphasis on mutual understanding and recognition. CONCLUSIONS: The training programme is now concentrated on a few, simple exercises and is characterised by awareness of the relationship between breathing and muscle tension. Groups were found to be the main pillar of the programme, characterised by security and a feeling of belonging with room for reflection and development.

Adult↗
PubMed2005

[Clinical characteristics of nontraumatic rhabdomyolysis in patients with liver cirrhosis].

BACKGROUND/AIMS: Rhabdomyolysis is a serious and lethal condition that can be induced not only by traumatic causes but also by a variety of nontraumatic causes. However, there are few reports about rhabdomyolysis developed in patients with liver cirrhosis. We carried out this study to elucidate the clinical characteristics and courses of rhabdomyolysis in patients with liver cirrhosis. METHODS: We analyzed 19 cases of nontraumatic rhabdomyolysis in patients with liver cirrhosis who had admitted at Korea University Ansan Hospital between October 2001 and September 2004. RESULTS: Alcohol (50%) was the main etiology of rhabdomyolysis in alcoholic liver cirrhosis patients, and the precipitating factors were not apparent (69.2%) in majority of nonalcoholic liver cirrhosis patients with rhabdomyolysis. Nonalcoholic liver cirrhosis patients had complaints of pain referable to the musculoskeletal system, but alcoholic liver cirrhosis patients had no typical complaints. Mortality of rhabdomyolysis in liver cirrhosis patients was high (42.1%), especially in decompensated liver cirrhosis patients (p=0.04). In nonalcoholic liver cirrhosis patients, the development of oliguria (p=0.007) and acute renal failure (p=0.049) in the course of rhabdomyolysis increased the mortality significantly. CONCLUSIONS: In cirrhosis patients, rhabdomyolysis showed a poor prognosis, especially in nonalcoholic liver cirrhosis with oliguria, acute renal failure, or decompensated liver cirrhosis. It is believed that a high clinical suspicion for the occurrence of rhabdomyolysis in liver cirrhosis patients can lead to quicker recognition and better patient care.

Acute Kidney Injury↗
PubMedDate not supplied

[The prevention of risk due to the manual lifting of patients: the psychosocial component].

A high percentage of musculoskeletal disorders in nursing staff with the task of patient lifting is reported in the literature. These disorders are considered to be of multiple etiology and attempts have been made not only to assess the physical load but also to identify the direct or indirect influence of organisational and psychosocial factors so that preventive measures be more appropriate and effective (Law 626/94). In this context, in a recent publication NIOSH recalled that psychosocial factors can alter the relationship between exposure to physical loads and the development or the prognosis of these disorders, and stresses that understanding these relationships is the crucial factor in assessment of exposure that can be addressed with preventive and therapeutic measures. A study was carried out on the staff (113 subjects) of a large hospital in northern Italy with departments recognised by certified occupational physicians as at risk for the musculoskeletal apparatus. In order to quantify the working conditions and the disorders of the spine, a protocol proposed by the Ergonomics of Posture and Movement Research Unit of Milan University was further developed and validated. For assessment of psychosocial factors an Italian version of R. A. Karasek's "Job Content Questionnaire" was drawn up and validated by the Centre for Study and Research of Chronic Degenerative Diseases in Working Environments of Milan University. In addition, Borg's Scale was used for perception of physical load, Kurimori and Kakizaki's Scale for mental fatigue, Kjellberg and Iwanowski's Scale for states of stress, plus the Maslach burnout inventory. Nonparametric statistical analysis was applied to determine the influence of physical and organisational and psychosocial factors on disorders of the musculoskeletal apparatus. The results confirm a good agreement between the objective and subjective assessments of "manual patient handling" risk (Kendall p from 0.26 to 0.37, p > 0.001) and the significant relationships between psychosocial factors and disorders of the lumbar region of the spine: past history of episodes of acute low back pain is associated with limited possibility of making independent decisions (U-Mann Whitney z = 2.81, p 0.004) and job insecurity (U-Mann Whitney z = -2.36, p 0.01); episodes of acute low back pain above the threshold in the previous year were associated with low discretionary powers at work. The results will be discussed on the basis of the possible prevention measures.

Adult↗
PubMed2005

Myotendinous alterations and effects of resistive loading in old age.

The loss of muscle mass associated with ageing only partly explains the observed decline in muscle strength. This paper provides evidence of the contribution of muscular, tendinous and neural alterations to muscle weakness in old age and discusses the complex interplay between the changes of the contractile tissue with those of the tendinous tissue in relation to the mechanical behavior of the muscle as a whole. Despite the considerable structural and functional alterations, the elderly musculoskeletal system displays remarkable adaptability to training in old age and many of these adverse effects may be substantially mitigated, if not reversed, by resistive loading. The interplay between these muscular and tendinous adaptations has an impact both on the length-force and force-velocity relationships of the muscle and is likely to affect the range of motion, rate of force development, maximum force development and speed of movement of the older individual.

Adaptation, Physiological↗
PubMed2006

The fear-avoidance model of musculoskeletal pain: current state of scientific evidence.

Research studies focusing on the fear-avoidance model have expanded considerably since the review by Vlaeyen and Linton (Vlaeyen J. W. S. & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain, 85(3), 317--332). The fear-avoidance model is a cognitive-behavioral account that explains why a minority of acute low back pain sufferers develop a chronic pain problem. This paper reviews the current state of scientific evidence for the individual components of the model: pain severity, pain catastrophizing, attention to pain, escape/avoidance behavior, disability, disuse, and vulnerabilities. Furthermore, support for the contribution of pain-related fear in the inception of low back pain, the development of chronic low back pain from an acute episode, and the maintenance of enduring pain, will be highlighted. Finally, available evidence on recent clinical applications is provided, and unresolved issues that need further exploration are discussed.

Affect↗
PubMed2001

Work stress and musculoskeletal disorder etiology: The relative roles of psychosocial and physical risk factors.

The intense battles preceding the recent promulgation of OSHA's Ergonomics Program Standard serve as a case study demonstrating the growing understanding that MSD causation, development, and exacerbation are the result of the combined contribution of (and possibly interaction between) a wide range of biomechanical and psychosocial stressors. The best designed studies, those that adequately measure both biomechanical and psychosocial exposures, strongly support this hypothesis. Work stress is one of the results of this stressor combination and is part of the physiological pathway to MSDs and a wide range of other occupational diseases. Prevention efforts geared to a single or single class of exposure may be only partly effective, ineffective, or even counter productive. The most effective control strategies are rooted in on-going, participatory ergonomics programs, incorporating a joint labor/management ergonomic team; this blueprint for intervention necessarily addresses the roots of both physical and psychosocial work stress experienced by workers.

Journal Article↗
PubMed1985

Primary malignant tumors of the upper extremity: retrospective analysis of one hundred twenty-six cases.

We retrospectively evaluated 126 patients with primary sarcomas of bone (45) and soft tissue (61) in the upper extremity principally to evaluate the effectiveness of the Musculoskeletal Tumor Society staging system in predicting treatment outcome and to note differences between bone and soft tissue sarcomas. Patients were followed 2 to 11 years from diagnosis. The mean survival from treatment onset was 49 months (4 to 144 months). A strong statistical relationship (p less than 0.05) between anatomic location (above/below elbow) and surgical stage (stage I/II, A/B) was demonstrated. The type of primary operation and subsequent incidence in local tumor recurrence were found to be statistically different. Seventy percent of soft tissue tumors that metastasized first recurred locally, but such a strong association was not evident for bone. Development of metastases significantly shortened survival. Radical primary excision of soft tissue malignancies sharply reduced local recurrence and thereby diminished metastatic risk; similar findings were not present for bone malignancies. This study suggests that the Musculoskeletal Tumor Society staging system is valid and should be applied to these infrequent malignancies, permitting future statistical comparisons.

Adolescent↗
PubMed1988

Benefits of a back care and light duty health promotion program in a hospital setting.

Back injuries are a common and expensive problem in industry in terms of both direct and indirect costs. A dramatic increase in the costs of workers' compensation for work-related back injuries occurred from 1981-1985 in a hospital setting. During this five-year period, costs of back injuries rose from $36,384 to $272,751, a 750% increase, and the incidence per thousand employees rose from 21 in 1981 to 33 in 1985. A back care education program was instituted by the Physical Therapy Department and Employee Health Service for all departments within the hospital, with content tailored to individual job requirements. Because employees who have had one back injury are at risk for reinjury, an "at risk" program was also developed. For those injured employees without time off work and without need for medical care, a private session with a physical therapist is required to assess musculoskeletal problems and to review posture and body mechanics directly related to specific job tasks. Those employees unable to work in their usual positions are assigned to temporary modified jobs as part of the Light Duty Program. In 1986, following the institution of these two programs in the hospital, the cost of back injuries dramatically decreased to $72,296, a $200,000 drop, and the incidence per thousand employees fell to fifteen. The efficacy of this health promotion intervention program was confirmed both in the cost benefit to the hospital as well as in reduction in incidence of low back injury.

Back Pain↗
PubMed2003

High-dose-rate intraoperative brachytherapy (IOHDR) using flab technique in the treatment of soft tissue sarcomas.

BACKGROUND: Adjuvant radiotherapy has been shown to improve local control in patients with soft tissue sarcoma. Additional brachytherapy represents a means of enhancing the therapeutic ratio, as biological and dosimetric advantage over single external-beam irradiation (EBRT) can be expected. High-dose-rate intraoperative brachytherapy (IOHDR) as a boost therapy should therefore be able to further diminish the rate of local recurrence even when performing marginal resection. There are sparse data on IOHDR using flab applicators as adjuvant boost to EBRT in combination with marginal resection of soft tissue sarcomas. PATIENTS AND METHODS: Within a period of 8 years, we prospectively studied 39 adult patients treated by marginal resection, IOHDR using the flab technique and EBRT for soft tissue sarcomas. There were 32 high-grade and seven low-grade tumors, 35 were > 5 cm. Mean follow-up was 26 months (range 3-59 months). RESULTS: We could not detect any local recurrences. No treatment-related loss of limb or life occurred. There were no neurologic or vascular complications, all patients maintained functioning extremities as evidenced by a mean Musculoskeletal Tumor Society (MSTS) functional score of 88.5 (70-100). Treatment-related wound morbidity occurred in eleven patients necessitating revision surgery in eight. Metastatic disease developed in seven patients, six of them had died. The 2-year actuarial disease-free survival was 84%. CONCLUSIONS: IOHDR using the flab technique in combination with EBRT and marginal resection is an efficient treatment technique leading to optimal local control rates and limited functional impairment.

Adolescent↗
PubMed2002

[Multimodal interdisciplinary therapy to improve function and long-term survival in patients with high-grade osteosarcoma of the extremities].

INTRODUCTION: The probability for survival of patients with highly malignant osteosarcoma of the extremities was essentially improved by (neo-)adjuvant chemotherapy. The goal was to further improve survival rates by introducing operative treatment of metastases. In the last 20 years, the percentage of limb-preserving operations has increased. PATIENTS AND METHODS: A consecutive series of 23 patients with localized highly malignant osteosarcoma of the extremities received (neo-) adjuvant chemotherapy according to the Cooperative Osteosarcoma Study (COSS) protocol. Local treatment was performed by wide (22 patients) or radical (1 patient) resection (17 limb salvage procedures, 5 amputations, and 1 rotationplasty). In four of seven patients who developed pulmonary metastases, the metastases (up to four) were resected. The patients did not receive salvage chemotherapy. RESULTS: The cumulative survival was 87% at 174 months. The four patients who underwent metastasectomy survived between 42 and 116 months without evidence of disease. One local recurrence developed outside the operative field and could be resected without influencing the functional or oncological outcome. After limb salvage procedures, the mean score according to the Musculoskeletal Tumor Society (MSTS) was 83%, and after rotationplasty 67%. CONCLUSIONS: In patients with osteosarcoma of the extremities, limb salvage is possible in a high percentage of cases with a low risk of local recurrence by an effective interdisciplinary cooperation between diagnostic radiologists, oncologists, and orthopedic surgeons. The midterm survival could be improved by the multimodal therapy from about 20% up to about 80%. Metastasectomy gives patients with a limited number of pulmonary metastases a realistic chance to survive.

Adolescent↗
PubMedDate not supplied

Greater bone formation induction occurred in aged than young cancellous bone sites.

We have determined the differences in the effects of continual prostaglandin E2 (PGE2) treatment in aged (non-growing) and young (growing) cancellous bone sites in 7-month-old Sprague-Dawley rats. The sites involved are the aged distal tibial metaphysis (DTM) with a closed epiphysis and the young proximal tibial metaphysis (PTM) with a slow growing, open epiphysis. The study involved rats treated with 0, 1, 3 or 6 mg PGE2/kg/d for 60, 120 and 180 days. Static and dynamic histomorphometry of percent trabecular area, and tissue-referent bone formation rate (BFR/TV) were determined in both DTM and PTM. In pretreatment controls, the secondary spongiosa of the two metaphyses contain the same amount of cancellous bone (11% in DTM vs. 13% in PTM), but markedly less bone formation in DTM (0.6%/y in DTM vs. 41.5%/y in PTM). After 60 days of 6 mg PGE2/kg/d treatment, %Tb.Ar was increased 607% in DTM and 199% in PTM, BFR/TV was increased to nearly 14 fold in DTM and only 5 fold in PTM. These results indicated the aged metaphysis of the DTM was much more responsive to PGE2 treatment than young, growing metaphysis of the PTM. The results of 120 and 180 days treatment did not significantly differ from 60 days treatment in both sites, indicating that the effect of continuous daily PGE2 treatment were in equilibrium after 60 days. We concluded that aged metaphysis was much more responsive to PGE2 treatment than young growing metaphysis.

Aging↗
PubMed2006

Association of swaddling, rickets onset and bone properties in children in Ulaanbaatar, Mongolia.

OBJECTIVES: To examine the influence of duration of completely or partially wrapped swaddling on rickets onset and bone properties in children of school age. STUDY DESIGN: Case-control study. METHODS: Subjects were 73 children aged 7-10 years with a history of rickets (cases) and 70 children with no history of rickets (controls) in Ulaanbaatar, Mongolia. The periods of completely and partially wrapped swaddling, rickets onset and age-standardized mid-tibial cortical speed of sound (TCSOS) were examined. The associations between swaddling duration and rickets onset and that between swaddling duration and TCSOS were analysed. RESULTS: All except one control child were completely wrapped from the first month after birth. The durations of completely wrapped and partially wrapped swaddling were similar among cases (3.6 and 4.7 months) and controls (3.1 and 4.4 months) (P=0.42 and P=0.65, respectively). Standardized TCSOS values of cases and controls were -0.572 and -0.038, respectively (P=0.06). The duration of swaddling did not show associations with rickets onset and standardized TCSOS among both cases and controls. Standardized TCSOS of cases with skeletal deformities at examination (-1.467, n=18) was lower than that of cases without skeletal deformities (-0.280, n=55) (P<0.01) and controls (-0.038, n=69) (P<0.001). CONCLUSIONS: The practice of swaddling itself neither influences rickets onset nor bone properties in school-aged children in Ulaanbaatar. Bone properties of school-aged children who had suffered from rickets and with skeletal deformities were poorer than those in children without skeletal deformities and children without a history of rickets. Prevention of persistent skeletal deformities among the children who have suffered from rickets is critical to promote healthy bone development in Mongolia.

Case-Control Studies↗
PubMed1997

Clinical guidelines for management.

Guidelines provide explicit recommendations and seek to influence practice using a formal process to disseminate advice on most effective management in the light of scientific evidence. They provide a framework for the evaluation and treatment of common clinical problems, but are not intended to replace clinical judgement. There is considerable variation in rheumatology practice, fueled by uncertainty about the optimal measurement of disease outcome. Guidelines can help identify and eliminate ineffective or unnecessary care as they are systematically developed statements to assist practitioners and patients' decisions about appropriate health care. There are North American guidelines for the initial evaluation of adult patients with acute musculoskeletal symptoms, the management of rheumatoid arthritis and the management of osteoarthritis. These are discussed together with proposed guidelines for the management of early rheumatoid arthritis and areas of research into the value of guidelines. It is recommended that future work in this area should: (i) identify aspects of current guidelines which are directly related to outcome; (ii) educate clinicians in these aspects of care; (iii) ensure they are introduced into practice and the outcome of care subsequently improves; (iv) regularly update the guidelines to reflect current opinion. Present guidelines that give broadly similar recommendations from North American and UK perspectives. However, the available evidence all points to large variations between how clinicians practise and how they make their decisions and it may be unlikely that laying down exact recipes for practice will necessarily influence the clinician. Guidelines may appear relevant but they could prove to have very limited utility.

Arthritis, Rheumatoid↗
PubMed1999

The impact of workplace screening on the occurrence of cumulative trauma disorders and workers' compensation claims.

Work-related musculoskeletal pain, commonly referred to more specifically as musculoskeletal disorders or cumulative trauma disorders, has continued to occur despite efforts by employers, employees, health care providers, and the government to eradicate it. The National Institute for Occupational Safety and Health has encouraged employers to establish ergonomic prevention programs; however, many employers are concerned that screening, education, and focused attention on workplace pain will cause an increase in the number of OSHA 200 events and the incidence of workers' compensation claims. This prospective cohort study demonstrated that there was no increase in the number of OSHA 200 events and no increase in the incidence of workers' compensation claims after completion of an individual risk screening program that included education and employee awareness about work-related musculoskeletal pain. Incidence of cumulative trauma disorders has been most effectively reduced by use of individual risk-screening programs. Therefore, employers should be encouraged to develop and implement prevention programs that include individual risk screening.

Adult↗