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PubMed2000

Controlling dental hygiene work-related musculoskeletal disorders: the ergonomic process.

Work-related musculoskeletal disorders (WMSDs) have been reported frequently by dental hygienists. The practice of dental hygiene exposes practitioners to WMSD risk factors of repetitive motion, pinch-grasp, force, vibration, and prolonged awkward positions. The objective of an ergonomic program is to fit the job to the worker, rather than the worker to the work. Principles of the ergonomic process can be applied in private dental practice to design a program that meets the needs of each practitioner. The ergonomic process includes data collection, assessment, the ergonomic plan itself, and evaluation of strategies. The worker (dental hygienist), work processes, and the work environment are integral parts in the ergonomic process. The purpose of this article is to provide basic information on the ergonomic process so that individuals can develop a program that meets their need to reduce WMSDs.

Cumulative Trauma Disorders↗
PubMed2003

Modelling the control of interceptive actions.

In recent years, several phenomenological dynamical models have been formulated that describe how perceptual variables are incorporated in the control of motor variables. We call these short-route models as they do not address how perception-action patterns might be constrained by the dynamical properties of the sensory, neural and musculoskeletal subsystems of the human action system. As an alternative, we advocate a long-route modelling approach in which the dynamics of these subsystems are explicitly addressed and integrated to reproduce interceptive actions. The approach is exemplified through a discussion of a recently developed model for interceptive actions consisting of a neural network architecture for the online generation of motor outflow commands, based on time-to-contact information and information about the relative positions and velocities of hand and ball. This network is shown to be consistent with both behavioural and neurophysiological data. Finally, some problems are discussed with regard to the question of how the motor outflow commands (i.e. the intended movement) might be modulated in view of the musculoskeletal dynamics.

Hand↗
PubMed2006

Hypermobility disorders in children and adolescents.

It is well recognized that many if not most children and adolescents attending paediatric rheumatology clinics will have a non-inflammatory origin for their complaints or disorder. Mechanical causes are frequently identified, and hypermobility or ligamentous laxity of joints is increasingly recognized as an aetiological factor in the presentation. Such conditions include 'growing pains', recurrent lower-limb arthralgia, anterior knee pain syndromes, and back pain. Studies of significant cohorts of such patients have now been published supporting the link of ligamentous laxity to particular symptom complexes. However, much disagreement remains as to the validity of hypermobility as an aetiogical factor. What seems clear is that not all hypermobile individuals will be symptomatic or indeed possibly have any risk for specific musculoskeletal disorders in later life. Screening tools such as the Beighton score are likely to be inadequate in many paediatric populations. Along with increasing recognition of these disorders in childhood and adolescence has been the development of a multidisciplinary management approach, which usually involves predominantly allied health professionals such as podiatrists, physiotherapists and occupational therapists. The challenge remains to interpret symptoms correctly as being related to the hypermobility and to predict why such children become symptomatic. The answer is likely to involve physiological and psychosocial factors. In addition, early identification and modification of risk factors may have major implications for subsequent prevalence of many adult medical disorders such as low back pain, chronic pain syndromes and degenerative osteoarthritis.

Adolescent↗
PubMed2006

The effect of continuous wavy micropatterns on silicone substrates on the alignment of skeletal muscle myoblasts and myotubes.

Tissue-engineered muscle is a viable option for tissue repair, though presently technologies are not developed enough to produce tissue in vitro identical to that in vivo. One important step in generating accurate engineered muscle is to mimic natural muscle architecture. Skeletal muscle is composed of fibrils whose organization defines functionality. In musculoskeletal myogenesis, aligning myoblasts in preparation for myotube formation is a crucial step. The ability to efficiently organize myoblasts to form aligned myotubes in vitro would greatly benefit efforts in muscle tissue engineering. This paper reports alignment of prefused and differentiated skeletal muscle cells in vitro by use of continuous micropatterned wavy silicone surfaces, with features sized 3, 6 and 12 microm in periodicity. Wave features with 6 microm periodicity produced the most healthy, aligned myoblasts. Alignment was found to be a function of plating density. Further growth on these substrates with aligned myoblasts promoted fusion, yielding healthy aligned myotubes. This method will be useful for applications in which differentiated myogenic cells need to be aligned unidirectionally as in the development of engineered muscle.

Animals↗
PubMed2005

Acute pain following musculoskeletal injuries and orthopaedic surgery: mechanisms and management.

The undertreatment of acute pain associated with musculoskeletal conditions and surgical procedures is a focus of growing concern to orthopaedic surgeons. Fortunately, the armamentarium now includes recent advances in the understanding of how undertreated acute pain can lead to chronic pain, the development of new therapeutic agents, and new approaches to pain management. The concept of neuronal plasticity (the ability of neurons to profoundly alter their structure, function, or biochemical profile in response to repeated afferent sensory input) is now central to the understanding of the development of chronic pain from acute pain. Local inflammation in injured tissue increases the sensitization of specialized peripheral sensory neurons (nociceptors), leading to repeated afferent input into the central nervous system. Resolving inflammation before these events occur may prevent modifications in the central nervous system that lead to chronic pain. Therefore, it is important to reduce pain and inflammation at both the central and peripheral level. In addition to traditional agents (aspirin, nonspecific nonsteroidal anti-inflammatory drugs, opioids, local anesthetics, and regional blocks), more recently developed agents, such as cyclooxygenase-2 specific inhibitors, are now available. Combinations of these agents, as well as combinations of pharmacologic and nonpharmacologic approaches, are being used as multimodal therapy to treat the multiple sources of acute pain. Clinical practice guidelines for the management of acute pain now emphasize the incorporation of new knowledge into solid, evidence-based practice. This knowledge, combined with further understanding of the anatomic, physiologic, cellular, and molecular basis of pain, will provide the basis forfuture approaches to the management of acute pain in orthopaedic practice.

Acute Disease↗
PubMed2005

Characteristics of job rotation in the Midwest US manufacturing sector.

Job rotation has been advocated as a suitable intervention to control work-related musculoskeletal disorders. However, little is known regarding the prevalence of job rotation, methods used to identify jobs for rotation or the benefits or limitations of job rotation. A web-based questionnaire was developed to survey job rotation practices from Midwest US manufacturing companies. Results indicated that 42.7% of the companies contacted used job rotation, where the median time for which they had used job rotation was 5 years. Job rotation was used mainly to reduce exposure to risk factors for work-related injuries and to reduce work related injuries, whereas supervisor decisions and ergonomic analyses were used to select jobs for the rotation scheme. Major limitations to successful implementation of job rotation included rotation of individuals with medical restrictions, decreased product quality and lack of jobs to rotate to. These findings suggest that further study is needed to determine if exposure to risk factors is reduced through current efforts.

Data Collection↗
PubMed2001

Women at work despite ill health: diagnoses and pain before and after personnel support. A prospective study of hospital cleaners/home-help personnel with comparison groups.

The present study sought to elicit the diagnoses behind the pain conditions causing complaints by female hospital cleaners and home-help personnel who were working despite their symptoms. We also wished to describe the prevalence of musculoskeletal diagnoses and the intensity, frequency and location of pain, and changes in the clinical picture and pain after personnel supporting interventions. A prospective study was carried out with intervention groups and non-randomized comparison groups. The hospital cleaners intervention programme comprised occupational organizational measures, competence development, physical and psychosocial working environmental measures and individual and rehabilitation measures on both an individual and a group basis. The home-help programme comprised a 2-week stay at an orthopaedic rehabilitation unit, training of supervisors, comrade massage, purchase of training equipment and stress management. Myalgia/ tendinitis occurred in 61% of shoulder girdle elevators, 18% of rotator cuffs, 16% of dorsal neck muscles and 29% of hip muscles. There was musculoskeletal pain in the lower back in 28% of cases. Referred pain from a musculoskeletal focus occurred in about one-sixth to one-third of individuals with the diagnosis in question. Neurogenic pain occurred in 6% of cases. No fibromyalgia syndrome was found. One-third of individuals felt pain all the time or almost all the time. The mean rated perceived "worst pain" was 70 mm on a visual analogue scale of 1-100 mm. Comparisons between intervention and reference groups indicated that some improvement in the clinical picture can be attained using this kind of general support programme for employees.

Adult↗
PubMedDate not supplied

Toxic effects of quinolone antibacterial agents on the musculoskeletal system in juvenile rats.

Quinolone antibacterial agents have adverse effects on the musculoskeletal system in humans, consisting mainly of myalgia and arthralgia, and additionally of tendon disorders and rhabdomyolysis. The present study was conducted to examine the toxic effects of quinolones on the musculoskeletal system in juvenile rats using light microscopy, 5-bromo-2'-deoxyuridine (BrdU) immunohistochemistry and electron microscopy. Single oral administration of 900 mg/kg pefloxacin (PFLX) or levofloxacin (LVFX) was found to induce lesions in the muscle + fascia, tendon + sheath, and synovial membrane, in addition to articular cartilage in the fore- and hindlimbs. Articular cartilage lesions were not necessarily associated with changes in the muscle, tendon, and synovial membrane, or the reverse. Among all lesions, the ankle and elbow showed the highest incidence and severity. Changes were more severe in the PFLX than in the LVFX group. Lesions in the muscle + fascia, tendon + sheath, and synovial membrane were similar and characterized by edema and increased number of mononuclear cells, many of which were positively stained with BrdU, as well as vascular endothelial cells in the Achilles tendon sheath and synovial membrane in the ankle. Electron microscopic examination revealed an increased number of fibroblasts and macrophages and collagen deposition in the matrix of the synovial membrane and tendon sheath. Capillary endothelial cells were hypertrophied, increased in number, and stratified. These results suggest that quinolones have toxic potentials in the muscle, tendon, and synovial membrane in addition to articular cartilage, and that local vascular hyperpermeability may contribute to the development of these lesions.

4-Quinolones↗
PubMed2006

The practice of rheumatology in Kenya: challenges and opportunities. ILAR visiting professorship program report.

International League of Associations for Rheumatology (ILAR) is committed to promoting the care of those with musculoskeletal diseases. To further this aim, ILAR sponsors visiting professorships to countries with minimal or underdeveloped rheumatology services to promote the awareness and improve skills in the management of musculoskeletal conditions. Professor Luis Espinoza was sponsored and visited Kenya in March 2005.

Developing Countries↗
PubMed2004

Processes, barriers, and outcomes described by ergonomics consultants in preventing work-related musculoskeletal disorders.

Despite the importance of reducing work-related musculoskeletal disorders, there appears to have been little evaluation of routine ergonomics consultancy interventions aimed at reducing risks leading to these conditions. In many instances, the effectiveness of advice depends on organisations accepting and implementing measures recommended, involving changes of both individual and collective behaviour. Behaviour change theory, developed elsewhere, suggests that if change is to take place, recipients need to hold positive attitudes and beliefs relating to the desirable behaviour. To investigate the extent to which this is accommodated by current ergonomics consultancy practices, 14 ergonomics consultants were interviewed to explore the consultancy process from which recommendations are developed, exploring the factors that are assessed by consultants, perceived barriers to promoting change, and the extent to which evaluation of outcomes takes place. Consultants' recommendations generally focused on physical aspects of the work environment and did not take explicit account of employees' knowledge or attitudes. Little evaluation of outcomes was conducted by the consultants interviewed. Implications of these findings for improving the efficacy of interventions to reduce work-related musculoskeletal disorders within organisations are discussed.

Back Pain↗
PubMed2006

Ache, pain, and discomfort: the reward for working with many cows and sows?

The main purpose of the study was to investigate the prevalence of perceived symptoms of musculoskeletal disorders (MSD) among workers on large-scale dairy and pig farms in Sweden (herd size more than 300 cows and 450 sows) and to identify potential risk factors in the development of MSD. A study based on questionnaires was carried out among 42 workers on 10 large dairy farms and among 37 workers on 10 large pig farms in Southern Sweden during the autumn of 2002. Most importantly, the study showed that 86% of the dairy workers and 78% of the pig workers reported some kind of MSD during a period of 12 months prior to the study. The most frequently reported MSD among both the dairy and the pig workers were in the "upper extremities" (52% and 62%, respectively) especially in the shoulders and in "the back" (60% and 57%, respectively) especially in the lower back. Furthermore, being of short stature, doing repetitive work, working in awkward positions and being exposed to dust were significant risk factors in having MSD among the workers in this study. Thus, working with many cows and sows on large-scale farms in Sweden can be considered as a high risk job with regard to MSD.

Adult↗
PubMed2003

GP referral for physiotherapy to musculoskeletal conditions--a qualitative study.

BACKGROUND: Little is known about the dynamics of GP referral for physiotherapy. Better understanding of this process is important because of the growing number of physiotherapy referrals by GPs. OBJECTIVES: Our aim was to achieve insight into the experiences and views of patients, GPs and physiotherapists in relation to physiotherapy referral for musculoskeletal conditions. METHOD: The study involved qualitative methodology using 22 semi-structured in-depth interviews. The interviews were recorded and transcribed verbatim. The transcripts were coded and analysed using the methods developed in grounded theory. Interviews were undertaken with GPs in primary care, Health Authority and hospital locations. Interviews with physiotherapists and patients were undertaken within community and district hospital locations. RESULTS: Three classifications of referral type were developed by the authors from the data, 'appropriate referral', 'load-sharing referral' and 'dumping referral'. There are descriptions of influences on GP referral behaviour, physiotherapists' response to appropriateness and expectations from the perspective of GPs and physiotherapists. Communication was shown as important in determining appropriate referral, but the quality of communication was variable. GPs' past experience of physiotherapy significantly affected referral. Patients' expectations about physiotherapy were described as variable and sometimes unrealistic. CONCLUSIONS: The selection of appropriate referrals by GPs could be helped by improved communication and better definitions of appropriateness. Closer working between the two professions would result in the better management of problematic patients and prevent wasted resources through avoiding inappropriate referral. Written guidelines appeared to be of less use than direct contact. The concept of expectations appeared relevant to multiple aspects of physiotherapy referral.

Family Practice↗
PubMed2000

Sickness absence and early retirement on health grounds in the construction industry in Ireland.

OBJECTIVE: To establish a detailed pattern of the nature and extent of illnesses and injuries among construction workers in Ireland which cause temporary absence from work, and to identify diseases and disabilities which lead to premature retirement from the industry on health grounds. METHODS: The population base for the study consisted of construction workers who were members of the Construction Federation operatives pension and sick pay scheme. Records of sickness absence since 1981, stored on computer disks, and records of early retirement on health grounds since 1972, stored on microfiche film, were examined. Pertinent data were extracted and transferred to a database; after cleaning and the exclusion of unvalidated data, records of 28 792 absences and 3098 records of early retirement were available for analysis. Data were analysed with Access 97 and Epi Info. RESULTS: Over the period of the study the mean annual absences were 7.8/100 workers. Three quarters of absences were among younger workers; however, the rate of absence increased with age, as did the mean duration of absence. Injury was the most frequent reason for absence, followed by infectious disease, then musculoskeletal disorders. The mean annual rate of early retirement on health grounds was 5.3/1000 workers. The median age at retirement was 58 years. Cardiovascular disease and musculoskeletal disorders each accounted for nearly one third of the conditions leading to permanent disability on the grounds of which early retirement was granted. During the period of the study, over 677 000 working days were lost due to sickness absence, and over 24 000 potential years of working lives were lost due to early retirement on health grounds. CONCLUSIONS: The study has shown patterns of sickness absence and early retirement on health grounds in the Irish construction industry which will contribute to the further development of health promotion strategies for construction workers.

Adolescent↗
PubMed2005

Cardiac manifestations of graft-versus-host disease.

Graft-versus-host disease (GVHD) is a major cause of morbidity and mortality after bone marrow transplantation. Well-documented manifestations of GVHD include dermatologic, gastrointestinal, hepatic, pulmonary, musculoskeletal, and hematologic manifestations and sicca syndrome. To date, the heart has only rarely been reported to be a target of GVHD. We report a series of patients who developed bradycardia, coronary artery disease, or cardiomyolysis in association with acute or chronic GVHD. The severity of these manifestations ranged from asymptomatic to fatal. The bradycardias were responsive to increased immunosuppression. Although they are uncommon, it is important to recognize these cardiac manifestations, because they may reflect GVHD activity and may be reversible by increasing immunosuppression.

Adolescent↗
PubMed2007

Vascularized bone allotransplantation: current state and implications for future reconstructive surgery.

This article focuses on current advances in musculoskeletal tissue allotransplantation, including strategies for maintaining tissue viability in the face of histocompatibility mismatch and resulting acute and chronic rejection responses. In particular, it introduces a novel concept developed in the authors' laboratory and currently under evaluation that may obviate the problem of chronic rejection. The authors have used therapeutic angiogenesis to develop a host-derived neoangiogenic circulation that maintains blood flow regardless of rejection. The replacement of the allogeneic vessels together with bone remodeling from host-derived cells eventually may largely replace the allogeneic osteocytes and bone with native bone.

Animals↗
PubMed1998

Can we screen for problematic back pain? A screening questionnaire for predicting outcome in acute and subacute back pain.

OBJECTIVES: Because musculoskeletal pain is the second most frequent reason for seeking health care, the aims of this study were to determine the value of psychosocial variables in evaluating risk for developing chronic back pain problems and to develop a screening methodology to identify patients likely to have a poor prognosis. STUDY DESIGN: A prospective study was conducted on consecutive patients with acute or subacute back pain, in which patients completed a screening questionnaire and were then followed up for 6 months to determine outcome. The primary outcome variable was accumulated sick leave. METHODS: One hundred forty-two consecutive patients were asked to complete a questionnaire designed for this study. This questionnaire contained 24 items concerning psychosocial aspects of the problem. Six months later, patients were contacted to complete outcome questions about accumulated sick leave. RESULTS: A total of 97% of the patients completed both questionnaires. Although patients, on average, improved greatly, 18% had 1-30 days and 20% had fewer than 30 days of sick leave during the follow-up period. Five variables were found to be the strongest predictors of sick leave outcome (fear-avoidance work beliefs, perceived improvement, problems with work function, stress, and previous sick leave), correctly classifying 73% of the patients as opposed to a chance rate of 33%. A total score was evaluated as a means of judging risk and found to be strongly related to outcome. CONCLUSION: Potent psychosocial risk factors associated with future sick absenteeism were identified. Because the total score was related to outcome, the instrument may have use in screening patients with acute or subacute spinal pain in clinical situations.

Acute Disease↗
PubMed1999

Animal models of tendon and ligament injuries for tissue engineering applications.

Improved methods are needed for prevention and treatment of injuries to the musculoskeletal soft tissues. Tissue engineering techniques have led to more effective clinical protocols for treating these injuries. Improvement of tissue healing through the addition of biologic factors, and the development of biologically active tissue engineered replacements, are two promising areas of research. An essential component of progress in this field is the use of animal models of tendon and ligament injuries, which allows for rigorous testing of hypotheses related to disease pathogenesis and treatment. Because these animal models must be appropriate for the condition being studied, no single model exists that is appropriate for all investigations. It generally is necessary to differentiate between tendon and ligament tissues. Furthermore, ligaments should be divided into intraarticular and extraarticular models, whereas tendons should be divided into intrasynovial and extrasynovial models. Other important factors in the appropriate use of an animal model include size of the animal, anatomic features, and techniques available for tissue analysis. The tissues used should be large enough to allow for accurate and reproducible manipulations (injury creation, repair, reconstruction). In addition, it is preferable to use tissues that are amenable to quantitative analysis.

Animals↗