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At least 145 records · Page 8Linked to original sources
PubMed2004

Practice, training, and assessment among experts performing musculoskeletal ultrasonography: toward the development of an international consensus of educational standards for ultrasonography for rheumatologists.

OBJECTIVE: To evaluate the training and practice of specialist practitioners in musculoskeletal ultrasonography (MUS) with the aim of developing an expert-derived consensus of educational standards for rheumatologists performing MUS. METHODS: A panel of worldwide experts in MUS was identified by literature review, consultation with members of training committees, and peer recommendation. Using a postal questionnaire, information was obtained about personal experience, current practice, training regimen, and participation in competency assessment. RESULTS: International experts in MUS were identified (57 in total: 37 radiologists, 20 rheumatologists). Response rate was 70%. Radiologists had been performing MUS for longer than rheumatologists. Both rheumatologists and radiologists conducted the same number of MUS sessions per week, although radiologists examined more patients. More radiologists performed MUS for muscle and ligament injury, nerve lesions, soft tissue masses, and of the groin (P <0.01). The number of training hours was similar. Approaches to training varied, although attending a training course and scanning with an expert was more common among rheumatologists (P <0.001). More than two-thirds of the group had not undergone any form of competency assessment. CONCLUSION: This study highlights differences in training and practice between individual expert ultrasonographers and between specialty backgrounds. In particular, there appears to be no formal training regimen and competency assessment is uncommon. The establishment of a core set of internationally applicable educational standards for MUS training for rheumatologists is required.

Internationality↗
PubMed2006

Normal variants in the paediatric orthopaedic population.

Normal variations of lower limb development are a common source of parental concern and are commonly referred to paediatric orthopaedic clinics. To determine the proportion of children referred to a paediatric orthopaedic outpatients with potentially normal developmental variations, referral letters and case notes of children attending the paediatric orthopaedic clinic at our institution over three months were analysed and categorized according to the main reason for referral. The number with true orthopaedic pathology was documented. Variations of normal anatomy and physiology accounted for 53.1% of all new referrals seen at the clinic with intoeing and flexible flat feet being the commonest referrals in this category. The rate of true primary pathology was only 16.3%. Normal developmental variations form a significant proportion of all new referrals to paediatric orthopaedic clinics. These take time and resources to process. Strategies to minimise these referrals are needed.

Child↗
PubMed1991

Inertia and muscle contraction parameters for musculoskeletal modelling of the shoulder mechanism.

To develop a musculoskeletal model of the shoulder mechanism, both shoulders of seven cadavers were measured to obtain a complete set of parameters. Using antropometric measurements, the mass and rotational inertia of segments were estimated, followed by three-dimensional measurements of all morphological structures relevant for modelling, i.e. muscle origins and insertions, muscle bundle directions, ligament attachments and articular surfaces; all in relation to selected bony landmarks. Subsequently, muscle contraction parameters as muscle mass and physiological cross-sectional area were measured. The method of data collection and the results for inertia and muscle contraction parameters as prerequisities for modelling are described.

Aged↗
PubMed2003

Musculoskeletal disorders in diabetes mellitus: an update.

Diabetes mellitus (DM) is associated with several musculoskeletal disorders. The incidence of DM and the life expectancy of the diabetic patient have both increased, resulting in the increased prevalence and clinical importance of musculoskeletal alterations in diabetic subjects. The exact pathophysiology of most of these musculoskeletal disorders remains obscure. Connective tissue disorders, neuropathy, vasculopathy or combinations of these problems, may underlie the increased incidence of musculoskeletal disorders in DM. The development of musculoskeletal disorders is dependent on age and on the duration of DM; however, it has been difficult to show a direct correlation with the metabolic control of DM. Most of these disorders can be diagnosed clinically, but some radiological examination may help, especially in differential diagnosis. No specific treatment is available, and treatments used in the general population are also recommended for diabetic subjects. Infectious complications affecting the musculoskeletal system are common in DM subjects, and these, possibly life-threatening, complications should be systematically discussed.

Diabetes Complications↗
PubMed1996

Development and evaluation of a musculoskeletal model of the elbow joint complex.

This paper describes the development and evaluation of a musculoskeletal model that represents human elbow flexion-extension and forearm pronation-supination. The length, velocity, and moment arm for each of the eight musculotendon actuators were based on skeletal anatomy and joint position. Musculotendon parameters were determined for each actuator and verified by comparing analytical moment-angle curves with experimental joint torque data. The parameters and skeletal geometry were also utilized in the musculoskeletal model for the analysis of ballistic (rapid-directed) elbow joint complex movements. The key objective was to develop a computational model, guided by parameterized optimal control, to investigate the relationship among patterns of muscle excitation, individual muscle forces, and to determine the effects of forearm and elbow position on the recruitment of individual muscles during a variety of ballistic movements. The model was partially verified using experimental kinematic, torque, and electromyographic data from volunteer subjects performing both isometric and ballistic elbow joint complex movements. This verification lends credibility to the time-varying muscle force predictions and the recruitment of muscles that contribute to both elbow flexion-extension and forearm pronation-supination.

Adult↗
PubMed1995

A graphics-based software system to develop and analyze models of musculoskeletal structures.

We have created a graphics-based software system that enables users to develop and analyze musculoskeletal models without programming. To define a model using this system one specifies the surfaces of the bones, the kinematics of the joints and the lines of action and force-generating parameters of the muscles. Once a model is defined, the function of each muscle can be analyzed by computing its length, moment arms, force and joint moments. The software has been implemented on a computer graphics workstation so that users can view the model from any perspective and graphically manipulate the joint kinematics and musculoskeletal geometry. Models can also be animated to visualize the results of motion analysis experiments. Since the software can be used to study models of many different musculoskeletal structures, it can enhance the productivity of investigators working on diverse problems in biomechanics.

Algorithms↗
PubMed2002

Complexities in ETS-domain transcription factor function and regulation: lessons from the TCF (ternary complex factor) subfamily. The Colworth Medal Lecture.

The ETS-domain transcription factor family can be divided into a series of subfamilies. Elk-1 represents the founding member of the ternary complex factor (TCF) subfamily. By focusing on the TCF subfamily, we can demonstrate the complexities that exist in the function and regulation of ETS-domain transcription factors. This article focuses on Elk-1 in detail and summarizes the functions of other TCFs. The key themes covered include the domain structure of the TCFs, the mechanisms of complex formation with serum response factor, regulation of TCFs by mitogen-activated protein kinase cascades, and transcriptional regulatory properties of the TCFs. Finally, the emerging role of the TCFs in vivo is discussed. A picture is developing indicating that, while these proteins exhibit significant sequence and functional conservation, key differences in their structure and regulation are being identified which may relate to unique functions of these proteins in vivo.

Amino Acid Sequence↗
PubMed1999

Out-patient parenteral antimicrobial therapy--a viable option for the management of cutaneous leishmaniasis.

Cutaneous infection with Leishmania braziliensis complex requires treatment with parenteral pentavalent antimonials to prevent development of mucocutaneous leishmaniasis. Patients with imported disease are usually managed in hospital because of concerns over drug toxicity. This study describes the clinical features and outcome of infection treated in the UK in an out-patient setting. Thirteen marines (aged 19-35 years) who acquired leishmaniasis in Belize were studied prospectively. Three had at least two lesions (0. 6-3 cm diameter), eight had regional lymphadenopathy and one had localized painless lymphatic thickening. Histology for amastigotes and PCR for Leishmania braziliensis complex was positive in all. Culture was positive in six. Patients received 1.5-2 g (mean 1.7 g) (20 mg/kg) sodium stibogluconate intravenously daily for 20 days. All developed transient musculoskeletal symptoms and asymptomatic hepatitis. Eleven developed biochemical pancreatitis, and one thrombocytopenia. Three developed transient ECG changes and one herpes zoster. There were four device-related infections, two requiring hospitalization (one required surgical drainage of an abscess). All lesions re-epithelialized. A total of 250 bed-days were saved over a 67-day period. These results indicate that in selected patients, out-patient therapy for cutaneous leishmaniasis with parenteral high-dose sodium stibogluconate may be appropriate, provided there is adequate monitoring of therapy.

Adult↗
PubMed1996

Neural and musculoskeletal contributions to the development of stance balance control in typical children and in children with cerebral palsy.

Studies on the development of automatic postural responses in both typically developing children and children with cerebral palsy were performed. With the appearance of "pull-to-stand" behavior, typically developing children first began to show muscle responses to platform movements in mainly the ankle muscles. With increased development, additional agonist muscles were added to the response pattern and a consistent distal to proximal sequence began to emerge. Well-organized responses were seen with the onset of independent stance and walking, along with the reduction of antagonist muscle co-activation. The older children with cerebral palsy who were pre-walkers had immature muscle activation patterns like those seen in the typically developing children at the pull-to-stand stage of development. These included disorganized muscle responses and increased frequency of coactivation of both proximal-distal and agonist-antagonist muscles. In order to determine if musculoskeletal constraints contributed to these response patterns, normal children were asked to stand in a crouched posture similar to that of children with CP. This caused postural muscle response patterns to more closely approximate those of children with spastic diplegia.

Cerebral Palsy↗
PubMed2002

A hyperventilation theory of job stress and musculoskeletal disorders.

BACKGROUND: There is evidence of a link between job stress and upper extremity work-related musculoskeletal disorders. However, the biobehavioral mechanisms by which psychosocial stress factors contribute to the development of musculoskeletal disorders are uncertain. METHODS: Based on established principles of breathing and job stress and the relevant empirical literatures, a hyperventilation theory of job stress and work-related musculoskeletal disorders was developed. RESULTS: Hyperventilation (overbreathing) refers to a drop in arterial CO2 caused by ventilation that exceeds metabolic demands for O2. Excessive loss of CO2 (increase in rate of flow of CO2 from cells to longs) that results from hyperventilation produces a rise in blood pH (i.e., respiratory alkalosis). This disruption in the acid-base equilibrium triggers a chain of systemic physiological reactions that have adverse implications for musculoskeletal health, including increased muscle tension, muscle spasm, amplified response to catecholamines, and muscle ischemia and hypoxia. Hyperventilation is often characterized by a shift from a diaphragmatic to a thoracic breathing pattern, which imposes biomechanical stress on the neck/shoulder region due to the ancillary recruitment of sternocelidomastoid, scalene, and trapezius muscles in support of thoraci breathing. CONCLUSIONS: A hyperventilation theory provides an innovative framework for understanding how job stress contributes to pathophysiological processes that increase the risk of work-related musculoskeletal disorders. With respect to the control of these disorders, a hyperventilation theory has important implications for establishing effective work organization interventions and individual stress-management methods. In this regard, breathing is a biobehavioral metric for assessing whether psychosocial aspects of work organization are in balance with a worker's needs and resources. A hyperventilation theory also provides a unique rationale for coping with job stress and musculoskeletal discomfort through breathing training, light physical exercise, and rest breaks.

Arm Injuries↗
PubMed2003

The effect of chemotherapy on the morphology of the growth plate and metaphysis of the growing skeleton.

AIM: To establish the effect of three single chemotherapeutic agents on the growing skeleton, male Wistar rats were studied. METHODS: From the age of 4 weeks the rats were given iv doxorubicin (DOX) 15 mg/m(2) body surface area (BSA), methotrexate (MTX) 60 mg/m(2) BSA or cisplatin (CDDP) 7.5 mg/m(2) BSA. One non-treated control group was fed ad libitum (ad lib) and for every drug-treated group there was a diet-control group. After dissection at 13 weeks of age, morphology of the proximal tibial growth plate and metaphysis were studied. RESULTS: Compared to the ad lib group, DOX significantly decreased and MTX increased growth plate height (P<0.05). CDDP decreased height of the proliferating layer (P<0.05). Trabecular volume was decreased in the DOX and CDDP treated rats compared to the ad lib group (P=0.054). Compared to the diet control group trabecular bone volume was unaffected in the DOX group and decreased in the MTX and CDDP group (P<0.05). CONCLUSIONS: Doxorubicin causes growth plate thinning, methotrexate increases growth plate height and cisplatin does not affect growth plate height. All three chemotherapeutic agents decrease the trabecular volume of the proximal tibial metaphysis. Part of the effect of DOX, MTX and CDDP is related to the treatment induced malnutrition.

Animals↗
PubMed1994

Assessment of risk factors for development of work-related musculoskeletal disorders (RSI).

This paper describes an approach to assessing the exposure to risk factors for the development of work-related chronic musculoskeletal disorders (repetitive strain injuries) of the upper limbs and low back. Instrumentation has been developed that combines a video image of the worker performing the task with superimposed quantitative information on risk factors. A description of the methodology, the rationale for the quantities displayed and workplace examples are presented. Continuous monitoring with both muscle activation and video has been found to be useful for identifying risk factors for both acute and chronic injuries in many workplaces. The approach gives information on chronic low-level loading not easily identified with observational methods. The methods presented give quantified information necessary for exposure measures in epidemiological studies. They also give semi-quantified information useful for identifying risks and justifying changes as well as for presentation to non-technical audiences.

Journal Article↗
PubMed2004

Static load repetition is a risk factor in the development of lumbar cumulative musculoskeletal disorder.

STUDY DESIGN: In vivo feline model subjected to variable number of repetitions of a short static lumbar flexion followed by an equally long rest period. OBJECTIVES: The purpose of this study was to determine the influence of the number of repetitions as a risk factor in promoting a cumulative low back disorder in the feline model. SUMMARY OF BACKGROUND DATA: Epidemiologic data point out that the increased number of repetitions of static lumbar loading is a major risk factor in the development of cumulative low back disorder. Biomechanical and physiologic confirmation of the epidemiology is lacking. Recent work demonstrated that repetitive static loading results in accumulation of creep in the lumbar viscoelastic tissues, resulting in a neuromuscular disorder consisting of spasms during loading and hyperexcitability of lumbar muscles during following rest. It was also shown that the load magnitude is a major risk factor. It is hypothesized that increased number of repetitions of static load periods result in increased severity of the resulting neuromuscular disorder. METHODS: Static lumbar flexion of 10 minutes duration followed by 10 minutes rest was repeated three times in one experimental group, six times in the second, and nine times in the third group. In all groups, the creep developing in the lumbar viscoelastic tissues as well as the reflexive EMG from the multifidus were monitored during the flexion/rest periods and throughout a 7-hour recovery period after the repetitions. RESULTS: Creep developed and accumulated during each of the flexion/rest periods in the three experimental protocols, with larger residual creep at the end of the nine repetitions. A residual creep was still present at the end of the 7 hours of recovery allowed in each of the three groups. During the flexion/rest sessions, EMG spasms were present, and the presence of an initial hyperexcitability was detected during the 7 hours of recovery in all the preparations. The presence of a delayed hyperexcitability was revealed only in the group subjected to nine flexion/rest periods, while it was not observed in the groups subjected to three and six flexion/rest repetitions. The statistical analysis (post hoc Fisher test) performed on the normalized integrated EMG and displacement data during the recovery phase showed a significant difference between the nine repetitions group and the other two groups (P < 0.0001). The two-way ANOVA analysis revealed a significant effect of time (P < 0.005) and number of repetitions (P < 0.0001) on all considered parameters. CONCLUSIONS: It was concluded that a cumulative neuromuscular disorder develops because of repetition of static lumbar flexion, and the severity of the disorder provoked is magnified by the number of repetitions. Despite the highly favorable 1:1 work-to-rest ratio and the 7-hour post loading rest period, a full recovery of creep was not obtained in this study.

Animals↗
PubMed2002

Reactive arthritis following an outbreak of Salmonella typhimurium phage type 193 infection.

OBJECTIVES: To determine the occurrence and the clinical picture of reactive arthritis (ReA) following an outbreak of Salmonella typhimurium. METHODS: An outbreak of S typhimurium phage type DT 193 occurred in several municipalities in Finland in 1999. A questionnaire which had a specific emphasis on musculoskeletal symptoms was mailed to all 78 subjects with a positive stool culture. Based on the answers, all subjects with recent joint complaints were clinically examined or interviewed by telephone. RESULTS: Sixty three of 78 subjects (81%) returned the questionnaire. Of these 63 subjects, five (8%) fulfilled the criteria for ReA. All the five subjects with ReA were adults with oligo- or polyarthritis. The antigen HLA-B27 was positive in two of the four subjects tested. In two of five subjects with ReA, the duration of acute arthritis was over six months. Subjects who had received antimicrobial drugs developed acute musculoskeletal symptoms significantly (p=0.013) less often than those without such treatment. None of the subjects with ReA had received antimicrobial drugs before the onset of joint symptoms. CONCLUSIONS: The occurrence of ReA following an outbreak of S typhimurium was at the same level as in outbreaks due to other salmonella serotypes reported previously by us, indicating that the frequency of ReA after various outbreaks is approximately 10%. Early use of antimicrobial drugs may prevent the development of musculoskeletal symptoms.

Adolescent↗
PubMed2004

Development and evaluation of an integrated musculoskeletal disease course for medical students.

BACKGROUND: A recent survey of medical and surgical residents in the United States suggested that our current training of physicians may be inadequate to meet the increasing demand for diagnosis and treatment of musculoskeletal disorders. In response, we developed an integrated, multidisciplinary course to teach knowledge and skills related to musculoskeletal disease to second-year medical students. A three-year prospective outcomes study was conducted to evaluate the new course. METHODS: The primary outcomes that were studied during the first year of the new course were the gains in knowledge, changes in levels of confidence, and long-term retention of skills. Secondary outcomes consisted of student and faculty satisfaction. Ten-item pre-tests and post-tests covering core course concepts were administered to students. A matched-pairs t test was used to evaluate the difference between pre-test and post-test scores. Students were also asked to rate, on a 10-point scale, how much confidence they had in their ability to perform the musculoskeletal physical examination before and after the institution of the new curriculum. A general linear model analysis with post hoc pairwise comparisons (F test) was used to evaluate the changes in the confidence levels of the students. Also, a knee examination station was organized to compare students' scores before and after revision of the course. At the conclusion of the course, students rated each aspect of it on a scale of 1 to 5. Instructors were asked to rate the effectiveness of all elements of the course on the same scale. RESULTS: On the basis of student satisfaction and confidence and faculty satisfaction, the most effective changes in the curriculum were the introduction of a physical examination workshop and simulated clinical situations. Students' knowledge increased significantly (p < 0.001), and their level of confidence increased significantly in thirteen specifically targeted areas (p < 0.0001). On the end-of-the-year examination assessing retention of physical examination skills, the scores for the skills emphasized in the revised course increased significantly whereas the scores for a skill not emphasized in the course remained the same. Revisions made in the second and third years after implementation of the course expanded the more successful elements and further improved student ratings. CONCLUSIONS: Integration of the three clinical disciplines related to musculoskeletal disease--orthopaedics, rheumatology, and physical medicine and rehabilitation--resulted in a highly effective introductory course for second-year medical students. The heuristic strategy of introducing core content through lectures and workshops followed by small-group teaching sessions for practice with the new knowledge effectively increased students' knowledge, confidence, and satisfaction.

Curriculum↗
PubMed2002

Why mechanobiology? A survey article.

The central paradigm of skeletal mechanobiology is that mechanical forces modulate morphological and structural fitness of the skeletal tissues-bone, cartilage, ligament and tendon. Traditionally, skeletal biomechanics has focussed on how these tissues perform the structural and locomotory functions of the vertebrate skeleton. In mechanobiology the central question is how these same load-bearing tissues are produced, maintained and adapted by cells as an active response to biophysical stimuli in their environment. The idea that 'form follows function' is not new, but we now believe that the scientific community has the knowledge and tools to prove, understand and use functional adaptation to benefit medicine and human health. In this Survey Article the philosophy and progress of skeletal mechanobiology are discussed. The revival of this science, with roots dating back to the 19th Century, is now driven by new developments in cellular, molecular and computational technologies. These developments are still in an early stage of application, but if modern mechanobiology fulfills the promises of its ambitions, the results will bring great benefits to tissue engineering and to the treatment and prevention of skeletal conditions such as congenital deformities, osteoporosis, osteoarthritis and bone fractures.

Animals↗
PubMed2002

Mechanical induction in limb morphogenesis: the role of growth-generated strains and pressures.

Morphogenesis is regulated by intrinsic factors within cells and by inductive signals transmitted through direct contact, diffusible molecules, and gap junctions. In addition, connected tissues growing at different rates necessarily generate complicated distributions of physical deformations (strains) and pressures. In this Perspective we present the hypothesis that growth-generated strains and pressures in developing tissues regulate morphogenesis throughout development. We propose that these local mechanical cues influence morphogenesis by: (1) modulating growth rates; (2) modulating tissue differentiation; (3) influencing the direction of growth; and (4) deforming tissues. It is in this context that we review concepts and experiments of cell signaling and gene expression in various mechanical environments. Tissue and organ culture experiments are interpreted in light of the developmental events associated with the growth of the limb buds and provide initial support for the presence and morphological importance of growth-generated strains and pressures. The concepts presented are used to suggest future lines of research that may give rise to a more integrated mechanobiological view of early embryonic musculoskeletal morphogenesis.

Animals↗
PubMed2000

Intensive training and sports specialization in young athletes. American Academy of Pediatrics. Committee on Sports Medicine and Fitness.

Children involved in sports should be encouraged to participate in a variety of different activities and develop a wide range of skills. Young athletes who specialize in just one sport may be denied the benefits of varied activity while facing additional physical, physiologic, and psychologic demands from intense training and competition. This statement reviews the potential risks of high-intensity training and sports specialization in young athletes. Pediatricians who recognize these risks can have a key role in monitoring the health of these young athletes and helping reduce risks associated with high-level sports participation.

Adolescent↗