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PubMed2002

Simulation of mechanical responses of fingertip to dynamic loading.

Extended exposure to mechanical vibration has been related to many vascular, sensorineural and musculoskeletal disorders of the hand-arm system, frequently termed 'hand-arm vibration syndrome' (HAVS). A two-dimensional, nonlinear finite element model of a fingertip is developed to study the stress and strain fields of the soft tissue under dynamic loading, that may be encountered while grasping and operating a hand-held power tool. The model incorporates the most essential anatomical elements of a fingertip, such as soft tissue, bone, and nail. The finger is assumed to be in contact with a steel plate, simulating the interaction between the fingertip and a vibrating machine tool or handle. The soft tissue is assumed to be nonlinearly visco-elastic, while the nail, bone, and steel plate are considered to be linearly elastic. In order to study the time-dependent deformation behavior of the fingertip, the numerical simulations were performed under ramp-like loading with different ramping periods and sinusoidal vibrations of the contacting plate at three different frequencies (1, 10, and 31.5 Hz). Owing to relatively large deformations of the soft tissue under specified static and dynamic loading, Lagrangian large deformation theory was applied in the present analysis. The effects of the loading rate and the frequency of the sinusoidal vibration on the time-dependent strain/stress distributions in the different depth within the soft tissue of the fingertip are investigated numerically. Our simulations suggest that the soft tissue of the fingertip experiences high local stress and strain under dynamic loading and the fingertip may separate from the vibrating contact surface due to the viscous deformation behaviour of the soft tissue. For a given deformation, the high frequency loading produces a higher stress in the tissues compared to that obtained at a low frequency loading. The present model may serve as a useful tool to study the mechanism of tissue degeneration under vibratory loading encountered during operation of hand-held power tools.

Computer Simulation↗
PubMed2003

Fibromyalgia patients' own experiences of video self-interpretation: a phenomenological-hermeneutic study.

Fibromyalgia syndrome (FMS) is a disorder with musculoskeletal pain as well as many other psychological and physical symptoms. Up-to-date treatment strategies for this disorder often have only limited effects. In order to develop more effective and adequate treatment tools, a phenomenological-hermeneutic study inspired by Paul Ricoeur was used. FMS patients viewed themselves on videotapes. After the video sessions the FMS patients were interviewed about thoughts that were triggered when they saw themselves on videotape. Video interpretation in combination with interviews facilitated a communication and understanding between the patient and therapist about the patients' body and self-image. The results showed that with the help of video interpretation, the patients' body and self-awareness could be improved, which in turn may help therapists to find better treatment tools for a more directed and individually adapted treatment. This is of importance as this method can be useful to FMS patients for early identification of maladaptive movement patterns and for a better integration their body and self-image. By allowing the FMS patients to interpret themselves from videotape, the FMS patients become more aware of both body and self-signals, which make it easier for the clinician/therapist to know where to start to work with each patients' specific rehabilitation programme.

Activities of Daily Living↗
PubMedDate not supplied

ICF Core Sets development for the acute hospital and early post-acute rehabilitation facilities.

The goal of this paper is to report on the background and the methods used in the ICF Core Set development for patients in the acute hospital and early post-acute rehabilitation facilities. ICF Core Sets are sets of categories out of the International Classification of Functioning, Disability and Health (ICF) which can serve as minimal standards for the assessment, communication and reporting of functioning and health for clinical studies, clinical encounters and multi-professional comprehensive assessment and management. The ICF Core Sets were developed in a formal decision-making and consensus process, integrating evidence gathered from preliminary studies and expert opinion. The Acute ICF Core Sets for patients with neurological, musculoskeletal and cardiopulmonary conditions are intended for use by physicians, nurses, therapists and other health professionals working in the acute hospital on medical, surgical or other units not specialised in rehabilitation. The Post-acute ICF Core Sets for geriatric patients and patients with neurological, musculoskeletal or cardiopulmonary conditions are intended for use by physicians, nurses, therapists and other health professionals involved in early post-acute rehabilitation. The Acute and Post-acute ICF Core Sets are first versions and need to be tested and validated in the patient and professional perspective and in different countries, regions, health care and provider settings.

Activities of Daily Living↗
PubMedDate not supplied

Elbow complications after organ transplantation. Case reports.

Musculoskeletal abnormalities have rarely been reported after major organ transplantation. We recorded five cases of elbow complications after orthotopic liver and bilateral lung transplantation. Three patients (four elbows) developed heterotopic ossification at the elbow, leading to decreased range of motion, pain and difficulty performing self-feeding and perineal hygiene. Two patients (three elbows) had electrodiagnostic evidence of ulnar mononeuropathy at the elbow, whereas one patient had bilateral median mononeuropathies caused by compression at the level of the ligament of Struthers. Surgical resection of ectopic bone with postoperative radiation was required in two patients (two elbows), and nerve decompression was used in three patients (four elbows). Common factors noted in all patients with either heterotopic ossification or ulnar mononeuropathy at the elbow included prolonged encephalopathy and the use of wrist restraints with the presentation of symptoms occurring weeks after surgery. In the patient with bilateral median nerve entrapment, symptoms occurred immediately after surgery suggesting perioperative limb compression. Elbow complications after organ transplantation should be recognized to minimize long-term disability through preventive measures and appropriate treatment.

Adult↗
PubMed1993

Spaceflight on STS-48 and earth-based unweighting produce similar effects on skeletal muscle of young rats.

Our knowledge of the effects of unweighting on skeletal muscle of juvenile rapidly growing rats has been obtained entirely by using hindlimb-suspension models. No spaceflight data on juvenile animals are available to validate these models of simulated weightlessness. Therefore, eight 26-day-old female Sprague-Dawley albino rats were exposed to 5.4 days of weightlessness aboard the space shuttle Discovery (mission STS-48, September 1991). An asynchronous ground control experiment mimicked the flight cage condition, ambient shuttle temperatures, and mission duration for a second group of rats. A third group of animals underwent hindlimb suspension for 5.4 days at ambient temperatures. Although all groups consumed food at a similar rate, flight animals gained a greater percentage of body mass per day (P < 0.05). Mass and protein data showed weight-bearing hindlimb muscles were most affected, with atrophy of the soleus and reduced growth of the plantaris and gastrocnemius in both the flight and suspended animals. In contrast, the non-weight-bearing extensor digitorum longus and tibialis anterior muscles grew normally. Earlier suspension studies showed that the soleus develops an increased sensitivity to insulin during unweighting atrophy, particularly for the uptake of 2-[1,2-3H]deoxyglucose. Therefore, this characteristic was studied in isolated muscles within 2 h after cessation of spaceflight or suspension. Insulin increased uptake 2.5- and 2.7-fold in soleus of flight and suspended animals, respectively, whereas it increased only 1.6-fold in control animals. In contrast, the effect of insulin was similar among the three groups for the extensor digitorum longus, which provides a control for potential systemic differences in the animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

Sculpturing new muscle phenotypes.

Changes in the pattern of muscle activity are followed by new patterns of protein synthesis, both in the contractile elements and in the enzymes of energy metabolism. Although the signal transducers have not been identified, techniques of molecular biology have clearly shown that the adaptive responses are the regulated consequence of differential gene expression.

Adaptation, Physiological↗
PubMedDate not supplied

Current concepts in the rehabilitation of the overhead throwing athlete.

The overhead throwing motion is an extremely skillful and intricate movement that is very stressful on the shoulder joint complex. The overhead throwing athlete places extraordinary demands on this complex. Excessively high stresses are applied to the shoulder joint because of the tremendous forces generated by the thrower. The thrower's shoulder must be lax enough to allow excessive external rotation, but stable enough to prevent symptomatic humeral head subluxations, thus requiring a delicate balance between mobility and functional stability. We refer to this as the "thrower's paradox." This balance is frequently compromised, which leads to injury. Numerous types of injuries may occur to the surrounding tissues during overhead throwing. Frequently, injuries can be successfully treated with a well-structured and carefully implemented nonoperative rehabilitation program. The key to successful nonoperative treatment is a thorough clinical examination and accurate diagnosis. Athletes often exhibit numerous adaptive changes that develop from the repetitive microtraumatic stresses observed during overhead throwing. Treatment should focus on the restoration of these adaptations during the rehabilitation program. In this article, the typical musculoskeletal profile of the overhead thrower and various rehabilitation programs for specific injuries are discussed. Rehabilitation follows a structured, multiphase approach with emphasis on controlling inflammation, restoring muscle balance, improving soft tissue flexibility, enhancing proprioception and neuromuscular control, and efficiently returning the athlete to competitive throwing.

Athletic Injuries↗
PubMed2004

Tethered cord syndrome in childhood: diagnostic features and relationship to congenital anomalies.

Tethered Cord Syndrome (TCS) is a stretch-induced functional disorder of the spinal cord that often develops and presents in childhood in association with spinal dysraphism. While the subtlety with which TCS can present makes it challenging to diagnose, awareness of the common neurological, musculoskeletal and urologic symptoms are of great value to the clinician, and can aid timely referral for neurosurgical evaluation. This article reviews these symptoms, as well as the clinical and radiological findings of the most common dysraphic conditions associated with TCS.

Cauda Equina↗
PubMed2000

Mammalian skeletogenesis and extracellular matrix: what can we learn from knockout mice?

Formation of the vertebrate skeleton and the proper functions of bony and cartilaginous elements are determined by extracellular, cell surface and intracellular molecules. Genetic and biochemical analyses of human heritable skeletal disorders as well as the generation of knockout mice provide useful tools to identify the key players of mammalian skeletogenesis. This review summarises our recent work with transgenic animals carrying ablated genes for cartilage extracellular matrix proteins. Some of these mice exhibit a lethal phenotype associated with severe skeletal defects (type II collagen-null, perlecan-null), whereas others show mild (type IX collagen-null) or no skeletal abnormalities (matrilin-1-null, fibromodulin-null, tenascin-C-null). The appropriate human genetic disorders are discussed and contrasted with the knockout mice phenotypes.

Animals↗
PubMed2000

The pleiotropic effects of fibroblast growth factor receptors in mammalian development.

In recent years the study of fibroblast growth factor receptors (FGFRs) in normal development and human genetic disorders has increased our understanding of some complex cellular processes. At least fifteen genetic disorders result from mutations within FGFR genes including skeletal dysplasias such as Apert syndrome and achondroplasia. In vitro experiments and the generation of animal models indicate that these mutations result in activation of the receptors and that FGFRs act as negative regulators of bone growth. FGFRs also play a role in wound healing and cancer. In this article, we review the expression of FGFRs in human development, the phenotypes resulting from FGFR mutations, and recent data identifying pathways downstream of the activated receptors.

Animals↗
PubMed1997

[Designing the construction of an FE model exemplified by the knee joint].

For the scientific investigation of the problems encountered in joint arthroplasty, routine use is made of clinical follow-up of patients, studies on cadaver specimens, and simulation with the aid of technical or mathematical models. An appropriate method for the stress analysis of the musculoskeletal system is the finite element method (FE method), since it is free from any restrictions in terms of the geometry of the structure to be studied. The development of a finite element model of the knee joint on the basis of computer tomography data is described. Using this method, intra-osseous stress distribution within the bones, contact stresses and the articulating surfaces between bones and implants for various boundary conditions can be calculated. For the development of such an FE model, the exterior and interior structure/geometry of the bones and implants, and the muscular forces involved, must be known. With this in mind, a method enabling the determination of surface coordinates of the knee joint from CT scans is presented. Using the special CAD-FE program I-DEASTM, plane slices and then the 3D CAD model are generated from these coordinates. After appropriate processing, the CAD model can be meshed with tetrahedral or brick elements.

Biomechanical Phenomena↗
PubMed2004

Reducing the incidence of pressure ulcers: implementation of a turn-team nursing program.

This study examined the effects a structured program designed to reduce pressure ulcers among patients in a midsized geriatric hospital. A select group of caregivers were organized into a "turn team that was responsible for preventive pressure ulcer care. Patient and staff data were collected during 6-month trial period. Subsequent analysis showed patient referrals to the staff enterostomal nurse and average length of stay, as well compensable musculoskeletal injuries among all staff declined. In addition, concerns the program might lead to an increased incidence of nosocomial infections were not substantiated.

Aged↗
PubMed1998

Cortical bone responses to 2G hypergravity in growing rats.

BACKGROUND: Rat cortical bone adaptation to chronic hypergravity (2G) was studied using young growing male Wistar rats (60 d). METHODS: Animals (10 rats) were subjected to chronic hypergravity (14 d) in order to understand the plastic nature of bone under a constant hypergravity stress using a special rodent habitat that was attached to a 12-ft. radius centrifuge. Also, an equal number of stationary controls were housed in a rodent vivarium containing identical cages that were used for centrifugation. After 14 d of centrifugation, femur bones were excised and prepared for morphological and biochemical measurements. RESULTS: Results showed that 2G had significantly shortened the femurs (3%) and reduced the cortical bone area (13%). In particular, hypergravity induced significant reductions in the thicknesses of cortical bone at the anterior (13%) and medial regions (15%) of the mid-diaphysis. However, femoral bone density, collagen and calcium concentrations were unaltered. The content of mature, stable bone collagen cross-links hydroxylysylpyridinoline (HP), lysylpyridinoline (LP), were significantly greater in bones from centrifuged animals. CONCLUSION: Our findings suggest that short term exposure to 2G does not enhance bone formation or induce changes in cortical bone composition, or alter specific gravity. These data also suggest that bone maturation as reflected by collagen cross-linking is upregulated. However, it is undetermined at this time whether the enhanced content of mature bone collagen in the centrifuged rats is a result of either an increased rate of cross-linking or reduction in the degradation of "older collagen."

Adaptation, Physiological↗
PubMed2006

Data entry workers perceptions and satisfaction response to the "stop and stretch" software program.

Cumulative Trauma Disorder (CTD) is a collection of chronic musculoskeletal disorders caused by frequent, sustained, and repetitive movements, most notably by computer usage at the workplace. A computer based break reminder program (Stop and Stretch) has been developed and installed to prevent CTDs caused by prolonged computer usage at the workplace. We investigated users' opinions to the Stop and Stretch program at their work place. 19 computer users were recruited as the subjects of the study. We conducted a survey after all the subjects used the Stop and Stretch program for one month. Among the nineteen subjects, 52.5% or 10 noticed a difference of symptoms after using the program; 63.3% or 12 thought the program had positive effect on their productivity; 100% or all 19 thought the program was easy to follow; 100% or all 19 thought it was helpful; 94.7% or18 were satisfied with the program; and the same value would recommend the program to others. When grouped into those who had prior experience with using stretch and exercise as part of their work routine15 subjects had no prior experience; and 14 participants within that group were satisfied or very satisfied with the program; 93.3% or 14 would recommend it to co-workers; and over half of those 15 thought the program is easy to use. The study provided insight to the response to using "stretch break software" and provided indicators of satisfaction with the Stop and Stretch program and that the program had sufficient usability and acceptance within a workplace setting which might be applied in other work settings similar to these.

Consumer Behavior↗
PubMed1992

Occupational repetitive strain injury.

Repetitive strain injuries include a group of disorders that most commonly develop in workers using excessive and repetitious motions of the neck and upper extremity. A careful occupational history, physical examination and specific diagnostic maneuvers can help distinguish these musculoskeletal injuries from rheumatologic diseases, psychologic disorders, acute joint or tendon inflammation from other causes and single-event traumatic sprains and strains. Repetitive strain injury may be manifested by cervical syndrome, tension neck syndrome, thoracic outlet syndrome and frozen shoulder syndrome. Common injuries involving the elbow, wrist and hand include epicondylitis, carpal tunnel syndrome and ulnar nerve entrapment. Conservative treatment consisting of rest, application of ice or heat and anti-inflammatory drugs is usually effective, but the injury may take weeks or months to resolve. Modifications in the workplace can prevent many of these injuries and may be required to prevent reinjury after the patient returns to work.

Arm↗
PubMed1979

Ultrastructural studies of the equine uterus and placenta following parturition.

Post-partum placentae and uterine biopsy samples from mares after normal and abnormal foalings are described. After normal delivery there is little damage to fetal or maternal tissues. The villous epitheliochorial palcenta separates cleanly at the maternal-fetal interface and the afterbirth consists almost exclusively of fetal tissue. Uterine involution is well advanced by the 3rd and 4th days post partum and the changes are usually complete by the oestrus 7--10 days after parturition. Placental separation and involution of the uterus appear to proceed normally in malpresented foals and in otherwise viable foals with musculoskeletal defects. In aborted, stillborn or dysmature foals there are obvious signs of damage to both fetal and maternal tissues. It is generally accepted that the growth and development of the fetus is dependent upon a placenta of adequate functional capabilities. The observations suggest that the placenta is similarly dependent upon its association with a normal healthy fetus.

Abortion, Veterinary↗
PubMed1978

[Malignant hyperthermia in a black child. A case report].

A case of malignant hyperthermia in a Black boy is presented. He developed this condition during repair of a cleft palate, with halothane as the triggering agent. The importance of the high incidence of malignant hyperthermia in patients with certain musculoskeletal abnormalities is stressed. Despite a cool and well air-conditioned theatre, the patient's temperature was 41 degree C when the condition was suspected. At that stage general muscle rigidity was present. The patient was successfully treated with procainamide, sodium bicarbonate and hydrocortisone; surface cooling (with ice packs) was instituted and the stomach was washed out with ice-cold Ringer's solution. Over a period of 14 days serum creatine phosphokinase values decreased from 630 IU (on the day of the incident) to 12 IU. A muscle biopsy showed variation in muscle fibre size. Electron microscopical studies showed myofibrillar disruption and folding of the basement membrane. A modified version of Denborough's technique was used for the in vitro exposure of muscle strips to halothane and suxamethonium. Isometric contraction was measured and recorded. A severe contraction followed the exposure of muscle strips to halothane, which confirmed the diagnosis.

Child↗