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PubMed1994

Ulnar collateral ligament in the growing elbow: MR imaging of normal development and throwing injuries.

PURPOSE: To study the magnetic resonance (MR) imaging appearance of the ulnar collateral ligament (UCL) and its insertion into the medial epicondyle. MATERIALS AND METHODS: Sixteen normal and 20 symptomatic elbows were examined with a 1.5-T unit. Normal elbows were imaged with axial T2*-weighted three-dimensional Fourier transform sequences. Symptomatic elbows were imaged with coronal T1-, T2-, and T2*-weighted and/or short-inversion-time inversion-recovery sequences. RESULTS: In normal immature elbows, the ulnar periosteum was seen as an extension of the UCL, and its enthesis had signal intensity characteristics that differed from those of the mature ligament. In symptomatic elbows imaged before epiphyseal fusion, segmentation and subchondral bone resorption of the ossification center were seen with or without a capsular tear. After epiphyseal fusion, a full-thickness or a partial UCL tear at the site of its insertion, with or without subcortical bone resorption, was seen. CONCLUSION: The MR imaging characteristics of the developing elbow differ from those of the mature elbow. MR imaging is useful in assessing UCL damage.

Adolescent↗
PubMed1995

Chronically stressed wrists in adolescent gymnasts: MR imaging appearance.

PURPOSE: To investigate the magnetic resonance (MR) imaging appearance of a chronically stressed wrist and to assess the utility of MR imaging for evaluation of injuries to the growth plate. MATERIALS AND METHODS: Coronal T1-weighted spin-echo and gradient-echo MR images were obtained of 93 wrists in 47 high-risk gymnasts of a Chinese opera school. MR imaging and radiographic findings were correlated in 93 wrists. RESULTS: The major MR imaging abnormalities of 47 radii with abnormal radiographic findings were horizontal fractures (n = 23), physeal cartilage extension to metaphysis (n = 17), and physeal widening (n = 17). The major MR abnormalities of 46 radii with normal radiographs included physeal cartilage extension (n = 12), metaphyseal bone bruise (n = 8), and vertical fractures (n = 4). CONCLUSION: Physeal cartilage extension into the metaphysis represents a healing sign in chronically stressed adolescent wrists. MR imaging findings including horizontal fracture and physeal cartilage extension to the metaphysis suggest that physeal widening occurred secondary to metaphyseal injury.

Adolescent↗
PubMed1995

Wrist injuries in adolescent gymnasts of a Chinese opera school: radiographic survey.

PURPOSE: To determine the prevalence of chronic wrist injuries among adolescent gymnasts and the consequences of repetitive stress. MATERIALS AND METHODS: Students of a Chinese opera school underwent radiography of both wrists and answered a questionnaire. They were separated into study (n = 261) and control (n = 63) groups according to participation in or abstinence from exercise training, respectively. They were further separated into fused and unfused physis subgroups. The ulnar variance was measured on posteroanterior radiographs. Abnormalities of distal radii were investigated. RESULTS: An increase in both mean ulnar variance and frequency of ulnar-plus variance was noted in the study subgroups. Fourteen (8.2%) of 170 wrists of the fused physis study subgroup had an exceedingly large ulnar-plus variance. Sixty-one (17.3%) of 352 wrists had abnormal morphology of the distal radii in the unfused physis study subgroup. Widening of the physis was the most common finding. CONCLUSION: Chronic, repetitive stress in the wrists of adolescent gymnasts results in a localized growth disturbance of the distal radius with resultant ulnar-plus variance. Stress injuries of the physis may lead to permanent sequelae, even in asymptomatic individuals.

Adolescent↗
PubMed1997

Can running cause the appearance of marrow edema on MR images of the foot and ankle?

PURPOSE: To determine if runners have an increased prevalence of marrow edema in the foot and ankle compared with nonrunners at magnetic resonance (MR) imaging. MATERIALS AND METHODS: Ankles and feet were imaged in 20 runners and 12 nonrunners with a fast short inversion time inversion-recovery sequence at 1.5 T. Edema within each bone was graded from 0 (no edema) to 3 (severe edema). Total scores for each subject equaled the sum of the grades. RESULTS: Reader 1 found edema in 16 of 20 runners and four of 12 nonrunners (P < .04); runners had a mean score of 4.7 and nonrunners had a mean score of 0.9 (P < .006). The average number of bones with edema was 3.4 for runners and 0.7 for nonrunners (P < .005). Reader 2 found edema in 16 of 20 runners and two of 12 nonrunners (P < .002); runners had a mean score of 4.5 and nonrunners had a mean score of 0.3 (P < .001). The average number of bones with edema was 3.6 for runners and 0.3 for nonrunners (P < .001). CONCLUSION: When the fast short inversion time inversion-recovery sequence is performed, edema seen within the marrow of runners on MR images may be due to exercise alone.

Adult↗
PubMed1999

Iliotibial band friction syndrome: MR imaging findings in 16 patients and MR arthrographic study of six cadaveric knees.

PURPOSE: To define magnetic resonance (MR) imaging findings in patients with the iliotibial band friction syndrome (ITBFS) and to correlate these findings with anatomic features defined at magnetic resonance (MR) arthrography in cadavers. MATERIALS AND METHODS: The anatomic relationship of the iliotibial tract (ITT) to the lateral recesses of the knee joint and the lateral femoral epicondyle was investigated with MR arthrography at full extension and at 30 degrees and 60 degrees of knee flexion in six cadaveric knees. Seventeen MR imaging studies in 16 patients with ITBFS were evaluated. RESULTS: In the cadaveric study, no interference of the lateral synovial recess with the lateral femoral epicondyle at full extension and at 30 degrees and 60 degrees of knee flexion was observed. In all specimens, correlation of MR images with macroscopic and microscopic sections revealed no primary bursa between the lateral femoral epicondyle and the ITT. In clinical studies, MR imaging findings of poorly defined signal intensity abnormalities or circumscribed fluid collections were located in a compartmentlike space confined laterally by the ITT and medially by the meniscocapsular junction, the lateral collateral ligament, and the lateral femoral epicondyle. CONCLUSION: MR imaging accurately depicts the compartmentlike distribution of signal intensity abnormalities in patients with ITBFS.

Adolescent↗
PubMedDate not supplied

Importance and effects of altered workplace ergonomics in modern radiology suites.

The transition from a film-based to a filmless soft-copy picture archiving and communication system (PACS)-based environment has resulted in improved work flow as well as increased productivity, diagnostic accuracy, and job satisfaction. Adapting to this filmless environment in an efficient manner requires seamless integration of various components such as PACS workstations, the Internet and hospital intranet, speech recognition software, paperless electronic hospital medical records, e-mail, office software, and telecommunications. However, the importance of optimizing workplace ergonomics has received little attention. Factors such as the position of the work chair, workstation table, keyboard, mouse, and monitors, along with monitor refresh rates and ambient room lighting, have become secondary considerations. Paying close attention to the basics of workplace ergonomics can go a long way in increasing productivity and reducing fatigue, thus allowing full realization of the potential benefits of a PACS. Optimization of workplace ergonomics should be considered in the basic design of any modern radiology suite.

Asthenopia↗
PubMedDate not supplied

Musculoskeletal colloquialisms: how did we come up with these names?

Eponyms and colloquial terms are labels that provide two kinds of information: the pattern of a complex injury or pathologic problem and, in the case of an eponym, the name of an individual who has been closely identified with the pathologic problem. Such terms remind us that the medicine of today is not entirely the work of our contemporaries. The article illustrates many of the common colloquial terms applied to fractures and musculoskeletal injuries seen in everyday practice. Wherever possible, the illustrations and definitions are based on the original descriptions of the injuries.

Accidents, Occupational↗
PubMed2005

Angiotensin-converting enzyme inhibition attenuates myonuclear addition in overloaded slow-twitch skeletal muscle.

Because optimal overload-induced skeletal muscle hypertrophy requires ANG II, we aimed to determine the effects of blocking ANG II production [via angiotensin-converting enzyme (ACE) inhibition] on potential mediators of hypertrophy in overloaded skeletal muscle, namely, myonuclear addition and fibroblast content. In a 2 x 2 design, adult (200-225 g) female Sprague-Dawley rats were placed into one of four groups (n = 8/group): 7-day skeletal muscle overload, sham operation, 7-day skeletal muscle overload with ACE inhibition, or sham operation with ACE inhibition. Functional overloads of the plantaris and soleus muscles were produced via bilateral surgical ablation of the synergistic gastrocnemius muscle, and ACE inhibition was accomplished by the addition of the ACE inhibitor enalapril maleate to the animals' daily drinking water (0.3 mg/ml). Myonuclear addition and extrasarcolemmal nuclear proliferation, as measured by in vivo 5-bromo-2'-deoxyuridine labeling, were significantly (P < or = 0.05) increased by overload in both the slow-twitch soleus and fast-twitch plantaris muscles. Furthermore, ACE inhibition attenuated these overload-induced increases in the soleus muscle but not in the plantaris muscle. However, the effect of ACE inhibition on soleus extrasarcolemmal nuclei was not likely due to differences in fibroblast content because overload elicited significant increases in vimentin-positive areas in soleus and plantaris muscles, and these areas were unaffected by ACE inhibition in either muscle. There was no effect of ACE inhibition on any measure in sham-operated muscles. Collectively, these data indicate that ANG II may mediate the satellite cell response to overload in slow-twitch soleus but not in fast-twitch plantaris muscles and that this effect may occur independently of changes in fibroblast content.

Angiotensin II↗
PubMed2004

Exercise training increases oxidative capacity and attenuates exercise-induced ultrastructural damage in skeletal muscle of aged horses.

Exercise training improves functional capacity in aged individuals. Whether such training reduces the severity of exercise-induced muscle damage is unknown. The purpose of the present study was to determine the effect of 10 wk of treadmill exercise training on skeletal muscle oxidative capacity and exercise-induced ultrastructural damage in six aged female Quarter horses (>23 yr of age). The magnitude of ultrastructural muscle damage induced by an incremental exercise test before and after training was determined by electron microscopic examination of samples of triceps, semimembranosus, and masseter (control) muscles. Maximal aerobic capacity increased 22% after 10 wk of exercise training. The percentage of type IIa myosin heavy chain increased in semimembranosus muscle, whereas the percentage of type IIx myosin heavy chain decreased in triceps muscle. After training, triceps muscle showed significant increases in activities of both citrate synthase and 3-hydroxyacyl-CoA-dehydrogenase. Attenuation of exercise-induced ultrastructural muscle damage occurred in the semimembranosus muscle at both the same absolute and the same relative workloads after the 10-wk conditioning period. We conclude that aged horses adapt readily to intense aerobic exercise training with improvements in endurance, whole body aerobic capacity, and muscle oxidative capacity, and heightened resistance to exercise-induced ultrastructural muscle cell damage. However, adaptations may be muscle-group specific.

Adaptation, Physiological↗
PubMed2004

Lactate dehydrogenase expression at the onset of altered loading in rat soleus muscle.

Both functional overload and hindlimb disuse induce significant energy-dependent remodeling of skeletal muscle. Lactate dehydrogenase (LDH), an important enzyme involved in anaerobic glycolysis, catalyzes the interconversion of lactate and pyruvate critical for meeting rapid high-energy demands. The purpose of this study was to determine rat soleus LDH-A and -B isoform expression, mRNA abundance, and enzymatic activity at the onset of increased or decreased loading in the rat soleus muscle. The soleus muscles from male Sprague-Dawley rats were functionally overloaded for up to 3 days by a modified synergist ablation or subjected to disuse by hindlimb suspension for 3 days. LDH mRNA concentration was determined by Northern blotting, LDH protein isoenzyme composition was determined by zymogram analysis, and LDH enzymatic activity was determined spectrophotometrically. LDH-A mRNA abundance increased by 372%, and LDH-B mRNA abundance decreased by 43 and 31% after 24 h and 3 days of functional overload, respectively, compared with that in control rats. LDH protein expression demonstrated a shift by decreasing LDH-B isoforms and increasing LDH-A isoforms. LDH-B activity decreased 80% after 3 days of functional overload. Additionally, LDH-A activity increased by 234% following 3 days of hindlimb suspension. However, neither LDH-A or LDH-B mRNA abundance was affected following 3 days of hindlimb suspension. In summary, the onset of altered loading induced a differential expression of LDH-A and -B in the rat soleus muscle, favoring rapid energy production. Long-term altered loading is associated with myofiber conversion; however, the rapid changes in LDH at the onset of altered loading may be involved in other physiological processes.

Adaptation, Physiological↗
PubMed2005

Intensive exercise training suppresses testosterone during bed rest.

Spaceflight and prolonged bed rest (BR) alter plasma hormone levels inconsistently. This may be due, in part, to prescription of heavy exercise as a countermeasure for ameliorating the adverse effects of disuse. The initial project was to assess exercise programs to maintain aerobic performance and leg strength during BR. The present study evaluates the effect of BR and the performance of the prescribed exercise countermeasures on plasma steroid levels. In a 30-day BR study of male subjects, the efficacy of isotonic (ITE, n = 7) or isokinetic exercise (IKE, n = 7) training was evaluated in contrast to no exercise (n = 5). These exercise countermeasures protected aerobic performance and leg strength successfully. BR alone (no-exercise group) did not change steroidogenesis, as assessed by the plasma concentrations of cortisol, progesterone, aldosterone, and free (FT) and total testosterone (TT). In the exercise groups, both FT and TT were decreased (P < 0.05): FT during IKE from 24 +/- 1.7 to 18 +/- 2.0 pg/ml and during ITE from 21 +/- 1.5 to 18 +/- 1 pg/ml, and TT during IKE from 748 +/- 68 to 534 +/- 46 ng/dl and during ITE from 565 +/- 36 to 496 +/- 38 ng/dl. The effect of intensive exercise countermeasures on plasma testosterone was not associated with indexes of overtraining. The reduction in plasma testosterone associated with both the IKE and ITE countermeasures during BR supports our hypothesis that intensive exercise countermeasures may, in part, contribute to changes in plasma steroid concentrations during spaceflight.

Adaptation, Physiological↗
PubMed2006

Effect of aging on the recovery following contraction-induced injury in muscles of female mice.

By the age of 80 yr, the skeletal muscles of men and women decrease in mass and maximum force by approximately 30%. Severe contraction-induced injury may contribute to these age-related declines. One to two months after a 225 lengthening contraction protocol (LCP), muscles of young/adult male mice recovered completely, whereas those of old male mice sustained deficits of approximately 15% in mass and approximately 25% in maximum force. Although gender-related differences in the early events of contraction-induced injury have been reported, the recovery phase of muscles in old female animals has not been investigated. The hypothesis tested was that 2 mo after a severe LCP to the plantar flexor muscle group, the magnitude of recovery of mass and force for old female mice is less than that for adult female mice. The LCP was administered to muscles of adult and old, female C57BL/6 mice. At 3 days, 1 mo, and 2 mo following the LCP, maximum isometric force was measured, and muscles were removed and weighed. Two months following the LCP, the muscles of adult female mice recovered mass and force. In contrast, for old female mice, even after 2 mo, muscle masses were decreased by 11% and maximum forces by 38%. We conclude that, as reported previously for old male mice, a severe contraction-induced injury to muscles of old female mice results in prolonged deficits in mass and force.

Aging↗
PubMed2004

Diminished overload-induced hypertrophy in aged fast-twitch skeletal muscle is associated with AMPK hyperphosphorylation.

Skeletal muscle mass declines with age, as does the potential for overload-induced fast-twitch skeletal muscle hypertrophy. Because 5'-AMP-activated protein kinase (AMPK) activity is thought to inhibit skeletal muscle protein synthesis and may therefore modulate muscle mass and hypertrophy, the purpose of this investigation was to examine AMPK phosphorylation status (a marker of AMPK activity) and its potential association with the attenuated overload-induced hypertrophy observed in aged skeletal muscle. One-week overload of fast-twitch plantaris and slow-twitch soleus muscles was achieved in young adult (8 mo; n = 7) and old (30 mo; n = 7) Fischer344 x Brown Norway male rats via unilateral gastrocnemius ablation. Significant (P < or = 0.05) age-related atrophy (as measured by total protein content) was noted in plantaris and soleus control (sham-operated) muscles. In fast-twitch plantaris muscles, percent hypertrophy with overload was significantly attenuated with age, whereas AMPK phosphorylation status as determined by Western blotting [phospho-AMPK (Thr172)/total AMPK] was significantly elevated with age (regardless of loading status). There was also a main effect of loading on AMPK phosphorylation status in plantaris muscles (overload > control). Moreover, a strong and significant negative correlation (r = -0.82) was observed between AMPK phosphorylation status and percent hypertrophy in the overloaded plantaris muscles of all animals. In contrast to the plantaris, overload-induced hypertrophy of the slow-twitch soleus muscle was similar between ages, and AMPK phosphorylation in this muscle was also unaffected by age or overload. These data support the possibility that an age-related elevation in AMPK phosphorylation may partly contribute to the attenuated hypertrophic response observed with age in overloaded fast-twitch plantaris muscle.

AMP-Activated Protein Kinases↗
PubMed2005

In vivo inhibition of nitric oxide synthase impairs upregulation of contractile protein mRNA in overloaded plantaris muscle.

Inhibition of nitric oxide synthase (NOS) activity in vivo impedes hypertrophy in the overloaded rat plantaris. We investigated the mechanism for this effect by examining early events leading to muscle growth following 5 or 12 days of functional overload. Male Sprague-Dawley rats (approximately 350 g) were randomly divided into three treatment groups: control, N(G)-nitro-L-arginine methyl ester (L-NAME; 90 mg.kg(-1).day(-1)), and 1-(2-trifluoromethyl-phenyl)-imidazole (TRIM; 10 mg.kg(-1).day(-1)). Unilateral removal of synergists induced chronic overload (OL) of the right plantaris. Sham surgery performed on the left hindlimb served as a normally loaded control. L-NAME and TRIM treatments prevented OL-induced skeletal alpha-actin and type I (slow) myosin heavy chain mRNA expression at 5 days. Conversely, neither L-NAME nor TRIM affected hepatocyte growth factor or VEGF mRNA responses to OL at 5 days. However, OL induction of IGF-I and mechanogrowth factor mRNA was greater (P < 0.05) in the TRIM group compared with the controls. Furthermore, the phosphorylated-to-total p70 S6 kinase ratio was higher in OL muscle from NOS-inhibited groups, compared with control OL. At 12 days of OL, the cumulative proliferation of plantaris satellite cells was assessed by subcutaneous implantation of time release 5'-bromo-2'-deoxyuridine pellets during the OL-inducing surgeries. Although OL caused a fivefold increase in the number of mitotically active (5'-bromo-2'-deoxyuridine positive) sublaminar nuclei, this was unaffected by concurrent NOS inhibition. Therefore, NOS activity may provide negative feedback control of IGF-I/p70 S6 kinase signaling during muscle growth. Moreover, NOS activity may be involved in transcriptional regulation of skeletal alpha-actin and type I (slow) myosin heavy chain during functional overload.

Animals↗
PubMed2004

Adaptation to lengthening contraction-induced injury in mouse muscle.

Adaptations to repeated bouts of injury-inducing lengthening contractions were studied in mouse anterior crural muscles. Five bouts of 150 lengthening contractions were performed in vivo, with each bout separated by 2 wk of rest. Three primary observations were made. First, there was little, if any, attenuation in the immediate isometric torque losses after lengthening contractions at "physiological" stimulation frequencies (i.e., <125 Hz), although there was a pronounced decrease in torque loss at higher frequencies between the first and second bouts. Second, the immediate losses in strength that occurred after all five lengthening contraction bouts could be explained in part by excitation-contraction uncoupling. Third, the most important adaptation was a significant enhancement in the rate of recovery of strength after the lengthening contractions. It is probable that the accelerated rate of strength recovery resulted from the more rapid loss and subsequent recovery of myofibrillar protein observed after the fifth bout.

Adaptation, Physiological↗
PubMed2005

Quantification of muscle fiber strain during in vivo repetitive stretch-shortening cycles.

Muscles subjected to lengthening contractions exhibit evidence of subcellular disruption, arguably a result of fiber strain magnitude. Due to the difficulty associated with measuring fiber strains during lengthening contractions, fiber length estimates have been used to formulate relationships between the magnitude of injury and mechanical measures such as fiber strain. In such protocols, the series compliance is typically minimized by removing the distal tendon and/or preactivating the muscle. These in vitro and in situ experiments do not represent physiological contractions well where fiber strain and muscle strain may be disassociated; thus the mechanisms of in vivo muscle injury remain elusive. The purpose of this paper was to quantify fiber strains during lengthening contractions in vivo and assess the potential role of fiber strain in muscle injury following repetitive stretch-shortening cycles. Using intact New Zealand White rabbit dorsiflexors, fiber strain and joint torque were measured during 50 stretch-shortening cycles. We were able to show that fiber length changes are disassociated from muscle tendon unit length changes and that complex fiber dynamics during these cycles prevent easy estimates of fiber strains. In addition, fiber strains vary, depending on how they are defined, and vary from repetition to repetition, thereby further complicating the potential relationship between muscle injury and fiber strain. We conclude from this study that, during in vivo stretch-shortening cycles, the relationship between fiber strain and muscle injury is complex. This is due, in part, to temporal effects of repeated loading on fiber strain magnitude that may be explained by an increasing compliance of the contractile element as exercise progresses.

Adaptation, Physiological↗
PubMed2005

Comparison of the symptoms of exercise-induced muscle damage after an initial and repeated bout of plyometric exercise in men and boys.

The purpose of this study was to compare symptoms of exercise-induced muscle damage after an initial and repeated bout of plyometric exercise in men and boys. Ten boys (9-10 yr) and 10 men (20-29 yr) completed two bouts of eight sets of 10 plyometric jumps, 2 wk apart. Perceived soreness (0-10, visual analog scale), isometric strength of the quadriceps at six knee flexion angles, and countermovement jump and squat jump height were assessed before and at 30 min, 24 h, 48 h, and 72 h after each bout. All variables followed the expected patterns of change in men, with soreness peaking at 24-48 h (5.8 +/- 1.7) and decrements in muscle function peaking at 30 min after the first bout (73-85% of baseline scores). Symptoms remained for 72 h after the first bout in men. In boys, symptoms were much less severe and peaked at 30 min (visual analog scale = 2.1 +/- 1.8, functional decrements 87-92% of baseline) and, with the exception of soreness, returned to baseline after 24 h. After the second bout of plyometric exercise, the level of soreness and decrements in countermovement jump, squat jump, and isometric strength were lower, although the effect was stronger in men, in all cases. The results of this study suggest that although children may experience symptoms of muscle damage after intensive plyometric exercise, they are much less severe. A prior bout of plyometric exercise also appears to provide children with some protection from soreness after a subsequent bout of plyometric exercise. Explanations for milder symptoms of exercise-induced muscle damage in children include greater flexibility leading to less overextension of sarcomeres during eccentric exercise, fewer fast-twitch muscle fibers, and greater and perhaps more varied habitual physical activity patterns.

Adult↗
PubMed1998

Muscular strain and fatigue among urologists during transurethral resections using direct and monitor endoscopy.

OBJECTIVES: The aims of the study were to analyze muscular strain and fatigue of urologists during the performance of transurethral resections using direct and video endoscopy and to reduce the muscular effort by an ergonomic arrangement of the operation equipment. METHODS: The study was performed before, during and after the introduction of a video-guided resection method. Muscular strain and fatigue were studied by means of surface electromyograms derived from various shoulder and back muscles of surgeons. RESULTS: During direct endoscopy, muscular strain was found to be significantly higher for the shoulder muscles than during monitor endoscopy. The occurrence of muscular fatigue was established for at least one of the muscles under test in all operations during the application of direct endoscopy. A routine use of the video method was facilitated by arranging the operation equipment according to ergonomic principles. This results in a reduction in muscular fatigue, in particular for the trapezius muscle. For this muscle the number of operations accompanied with fatigue was lowered from about 80% before redesign to about 42% after redesign. CONCLUSION: Muscular strain and fatigue of urologists occurring during transurethral resections is reduced by applying video endoscopy instead of using direct endoscopy. The routine use of the video method requires an ergonomic arrangement of the operation equipment.

Adult↗