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PubMed2000

An overview of amplified musculoskeletal pain syndromes.

Children may have a wide variety of amplified musculoskeletal pain syndromes that may or may not be associated with overt autonomic signs and may be diffuse or localized to one body part. It is most common in pre- to adolescent girls. Hallmarks of the diagnosis include increasing pain over time, allodynia, an incongruent affect, disproportional dysfunction, and the absence of other causes. Psychological distress within the child or family is apparent in most, but not all, since it also is associated with injury or illness. Once the diagnosis is established, all medicines and testing are stopped. A sympathetically driven pain model is used to explain the pain to make it understandable. Treatment is an intense exercise program; ours is 5 hours daily. We focus on functional aerobic training specifically using the involved body part such as sports related drills, running, play activities, and swimming. Allodynia is treated with desensitization such as towel rubbing. A psychological evaluation is done and specific psychotherapy is recommended if indicated. The average duration of the daily program is 2 weeks with a 1 hour home program being done for another 2 to 8 weeks. After one month roughly 80% of the children have no pain and are fully functional, another 15% are fully functional with mild or recurrent pain; 5% are not better. Significant relapses are infrequent; 15% require retreatment. Five to 10% of the children will develop a different symptom of psychological distress. At 5 years, 90% are doing well.

Adolescent↗
PubMed2002

The diagnosis of disorders caused by hand-transmitted vibration: Southampton Workshop 2000.

OBJECTIVES: To identify the current state of knowledge, current uncertainties and future needs related to the diagnosis of disorders associated with the use of vibratory hand-held tools. METHOD: An international workshop was convened with invited experts, medical doctors, scientists and engineers familiar with hand-transmitted vibration and the diagnosis of vascular, neurological and musculoskeletal disorders. This paper records the general conclusions from four panel discussions. RESULTS: For the most common vascular disorder (vibration-induced white finger), the principal symptom and sign involves attacks of well-demarcated finger blanching (Raynaud's phenomenon); low finger systolic blood pressure following cooling is indicative of vibration-induced white finger and zero finger systolic blood pressure can confirm an attack of Raynaud's phenomenon. For neurological disorders, some symptoms can exist without detectable signs and some signs can exist without symptoms; numbness and tingling are commonly reported but neurological changes may be present without these symptoms. The pathogenesis of musculoskeletal disorders in users of vibratory tools is not clear; symptoms may include pain that may not be associated with abnormal results in objective tests. For both neurological and musculoskeletal disorders, a thorough neuromuscular and skeletal examination is required; diagnosis must consider the work history and medical history, the results of physical examination and any objective tests in addition to other factors (e.g. age, smoking, alcohol, systemic disorders, medication and neurotoxic agents) that might have contributed to symptoms, signs and test results. CONCLUSIONS: While vibration-induced white finger is caused by vibration, some neurological and musculoskeletal disorders are the result of work with vibratory tools where the separate roles of vibration, repetitive movements, grip and push forces, non-neutral postures and any other ergonomic stressors are often unclear. Such disorders may be more easily identified as being caused by the work rather than by exposure to hand-transmitted vibration per se. A person found to have developed disorders induced by either vibration or the work situation should not be returned to the same vibration exposure or work without any changes expected to lessen the risks.

Education↗
PubMed1988

Psoriatic arthritis and acquired immunodeficiency syndrome.

We describe 2 patients who developed psoriatic arthritis during the course of acquired immunodeficiency syndrome. Both patients developed skin and articular involvement characteristic of psoriatic arthritis; these manifestations were refractory to conventional therapy. Our findings suggest that psoriatic arthritis should be added to the expanding spectrum of musculoskeletal manifestations of the acquired immunodeficiency syndrome.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Is chronic musculoskeletal pain in adulthood related to factors at birth? A population-based case-control study of young adults.

Chronic musculoskeletal pain affects one-third of the general population, yet apart from occupational and psychosocial risk factors, relatively little is known about its aetiology. Exposures in very early life may influence the development of chronic pain as a young adult. However, unlike the study of early life influences on some other common chronic diseases, little research has been conducted in this area. Using a nested case-control analysis of a population-based cross-sectional survey, this pilot study investigated associations of selected birth-related factors with chronic pain in young adults living in North Staffordshire. 858 participants responded to the survey (adjusted response 37%). 580 were included in the case-control analysis. No association was found between prematurity (OR: 0.14 95% CI: 0.0, 1.1), foetal distress (OR: 0.80 95% CI: 0.4, 1.8), artificial commencement of labour (OR: 1.04 95% CI: 0.6, 1.8), or non-vaginal delivery (OR: 1.03 95% CI: 0.5, 2.0) and chronic pain at age 18-25 years. Associations were observed between pain status and low birth weight (OR: 2.17 95% CI: 0.6, 7.0) and neonatal ITU admission (OR: 1.63 95% CI: 0.4, 7.4). Although these estimates were not statistically significant in this exploratory study they may be worthy of further investigation.

Adolescent↗
PubMed1985

Avulsion of muscles from the femoral trochanter in the fowl.

Post-mortem examination revealed lateral femoral trochanteric defects in 14 out of 104 broiler type chickens. All birds were severely lame, and in the absence of concomitant musculoskeletal disease trochanteric lesions were implicated in their clinical signs. Trochanteric muscle insertions had avulsed and the lateral metaphyseal defect was usually lined with granulation tissue. Examination of normal trochanteric development identified endochondral ossification at sites of muscle attachment. In some skeletally immature, proximal femurs evidence of osteochondrosis was detected at sites of trochanteric muscle attachment. It is deduced that broiler femoral trochanters are susceptible to muscle avulsion by virtue of their known predisposition to osteochondrosis and the pattern of muscle insertion.

Animals↗
PubMed1996

The measurement of beliefs about physical symptoms in English general practice patients.

A way of measuring patients' beliefs about the origin of their symptoms would allow the investigation of important questions concerning the consultation process and its outcome. The purpose of this study was to develop an instrument that could measure the beliefs about symptoms of patients attending their general practitioner and to demonstrate its utility by comparing beliefs about three types of symptom (respiratory, musculoskeletal and gastrointestinal). Interviews of 150 patients generated items for the belief questionnaire which was then completed by a second sample of 406 general practice patients. Principal components analysis of the responses identified eight readily interpretable belief dimensions: stress; lifestyle; wearing out; environment; internal-structural; internal-functional; weak constitution; concern. Scales were constructed to measure each dimension and the symptom groups were compared. Gastrointestinal symptoms were the most likely to be attributed to internal malfunction and to lifestyle or weak constitution. Musculoskeletal symptoms were more likely to be attributed to structural problems caused by the body wearing out and respiratory symptoms, in contrast, to the influence of the environment. Contrary to prediction, attribution to stress was made equally for the different types of symptom. We have devised a questionnaire, valid specifically for general practice patients, which permits the quantification of beliefs in this setting. The questionnaire could be used in future to track how beliefs respond to medical intervention and how, in turn, beliefs influence illness behaviour.

Adolescent↗
PubMed1991

Can the adult skeleton recover lost bone?

The loss of bone mineral with aging and subsequent development of osteoporosis is a common problem in elderly women, and as life expectancy increases, in elderly men as well. Space flight also causes bone loss and could be a limiting factor for long duration missions, such as, a Mars expedition or extended occupation of a space station. Before effective countermeasures can be devised, a thorough knowledge of the extent, location, and rate of bone loss during weightlessness is needed from actual space flight data or ground-based disuse models. In addition, the rate and extent that these losses are reversed after return from space flight are of primary importance. Although the mechanisms are not likely to be the same in aging and space flight, there are common elements. For example, strategies developed to prevent disuse bone loss or to enhance the rate of recovery following space flight might have direct applicability to clinical medicine. For various reasons, little attention has been given to recovery of bone mass following space flight. As a prelude to the design of strategies to enhance recovery of bone, this paper reviews published literature related to bone recovery in the adult. We conclude that recovery can be expected, but the rate and extent will be individual and bone site dependent. The development of strategies to encourage or enhance bone formation following space flight may be as important as implementing countermeasures during flight.

Adult↗
PubMed2004

Effectiveness of tendon transfers for massive rotator cuff tears: a simulation study.

UNLABELLED: OBJECTIVE To determine what the most effective tendon transfer is in the case of a dysfunctional rotator cuff. DESIGN: A tendon transfer procedure of latissimus dorsi, teres major or a combination of these two to the insertions of either teres minor, infraspinatus, supraspinatus, or subscapularis is simulated using a biomechanical musculoskeletal model of the upper extremity. BACKGROUND: Massive rotator cuff tears are not easily repaired. To compensate for this loss of rotator cuff function other techniques like muscle transfers are developed. METHODS: Three range of motion tasks and six activities of daily living of 24 subjects were measured. Kinematics from these tasks were used as input to the Delft Shoulder and Elbow Model. The muscle parameters of the Delft Shoulder and Elbow Model were modified to simulate a rotator cuff tear and the ability to perform the measured tasks with and without simulated transfer procedures was checked. RESULTS: The highest improvements (28-30%, P = 0.00 ) in the ability to perform tasks were observed after a simulated tendon transfer of either both muscles or teres major alone attached to the supraspinatus or infraspinatus insertion. Although all transfer procedures produce significant improvements (P = 0.00 ), there is a significant difference between the procedures (Chi square=58.8, P = 0.00 ) dependent on attachment site. CONCLUSIONS: According to the simulation procedure used in the current study, a tendon transfer of teres major and latissimus dorsi or teres major alone to the supraspinatus insertion appears to be the most effective procedure in the case of a dysfunctional rotator cuff. Practical factors, like subacromial space, volume of the muscles and tendons, tensile properties and the ability to split the muscles, will finally determine which is the preferred transfer option.

Analysis of Variance↗
PubMed2004

Biomechanical analysis of tendon transfers for massive rotator cuff tears.

OBJECTIVE: To determine why certain tendon transfers are mechanically more effective than other tendon transfers for the treatment of a massive rotator cuff tear. DESIGN: A tendon transfer procedure of latissimus dorsi, teres major or a combination of these two to the insertions of either teres minor, infraspinatus, supraspinatus, or subscapularis is simulated using a biomechanical musculoskeletal model of the upper extremity. BACKGROUND: Massive rotator cuff tears are not easily repaired. To compensate for the loss of rotator cuff function, techniques such as muscle transfers are developed. METHODS: Three range of motion tasks were used as input to the Delft shoulder and elbow model. The muscle parameters of the Delft shoulder and elbow model were modified to simulate a rotator cuff tear. A biomechanical analysis of the transferred muscles was performed, taking outcome variables such as moment arms, muscle length and muscle force into account. RESULTS: Due to the massive rotator cuff tear, an elevation and external rotation moment is lost. When the tendon was transferred to the insertions of infraspinatus or supraspinatus, the humerus was capable of elevating and externally rotating. CONCLUSIONS: On the basis of mechanical parameters such as moment arms, muscle length and force it can be concluded that a tendon transfer of the teres major to the supraspinatus insertion will produce the best functional outcome in the treatment of massive rotator cuff tears. RELEVANCE: To find biomechanical evidence for an optimal tendon transfer that will lead to improved treatment of patients with a massive rotator cuff tear.

Biomechanical Phenomena↗
PubMed2005

Delayed onset muscle soreness in neck/shoulder muscles.

The aim of the present study is to: (1) induce delayed onset muscle soreness (DOMS) in the neck and shoulder muscles; (2) compare the pressure pain sensitivity of muscle belly with that of musculotendinous tissue after DOMS; (3) examine the gender differences in the development of DOMS. An eccentric shoulder exercise was developed to induce DOMS on neck/shoulder muscles using a specially designed dynamometer. Eccentric shoulder contraction consisted of 5 bouts, each bout lasted 3min, with 3min rest period between each bout. The right shoulder was elevating against a downward pressure force of 110% maximal voluntary contraction force exerted by the dynamometer. Pressure pain thresholds (PPT) of 11 sites (seven sites measured were muscle belly and four sites were myotendinous area) on neck/shoulder region were measured before, immediately after, 24 and 48h after exercise. Pain intensity, pain area and index of McGill pain questionnaire were assessed and all were increased after exercise. DOMS was induced in the shoulder muscles. PPT was significantly decreased and reached lowest values at 24h. The muscle belly sites are more sensitive to pain than the musculotendinous sites. No gender differences were found in any of the parameters used to assess the development of DOMS. DOMS did not distribute evenly in the neck/shoulder region. Soreness after exercise in the neck and shoulder seems not to be among the conditions that produce predominant musculoskeletal pain in females.

Adult↗
PubMed1998

Clinical safety of becaplermin (rhPDGF-BB) gel. Becaplermin Studies Group.

This overview of the safety of becaplermin gel is based on six well-controlled clinical studies that included patients with lower extremity diabetic neuropathic ulcers. Patients receiving becaplermin gel (n = 538), placebo gel (n = 278), or good ulcer care alone (n = 190) had a similar incidence of ulcer-related adverse events, such as infection, cellulitis, or osteomyelitis. Erythematous rash occurred in 2% of patients with suspected wound infections treated with becaplermin gel and 1% of patients treated with placebo gel. No rashes were observed in patients treated with good ulcer care alone. The incidence of cardiovascular, respiratory, musculoskeletal, and central and peripheral nervous system disorders were similar across all treatment groups. Mortality rates were also similar across all treatment groups. Patients treated with becaplermin gel did not develop neutralizing antibodies against becaplermin. Therefore, becaplermin gel appears to be a safe therapy for the treatment of lower extremity diabetic ulcers.

Absorption↗
PubMed1993

Anabolic responses of an adult cancellous bone site to prostaglandin E2 in the rat.

The objects of this study were to determine: (1) the response of a non-growing cancellous bone site to daily prostaglandin E2 (PGE2) administration; and (2) the differences in the effects of daily PGE2 administration in growing (proximal tibial metaphysis, PTM) and non-growing cancellous bone sites (distal tibial metaphysis, DTM). Seven-month-old male Sprague-Dawley rats were given daily subcutaneous injections of 0, 1, 3 and 6 mg PGE2/kg per day for 60, 120 and 180 days. The static and dynamic histomorphometric analyses were performed on double-fluorescent labeled undecalcified distal tibial metaphyses (DTM). No age-related changes were found in static and dynamic histomorphometry of DTM cancellous bone between 7 and 13 months of age. The DTM of 7-month-old (basal controls) rats consisted of a 24.5 +/- 7.6%-metaphyseal cancellous bone mass, and a thick trabeculae (92 +/- 12 micron). It also had a very low tissue-base bone formation rate (3.0 +/- 7.3%/year). Exogenous PGE2 administration produced the following transient changes in a dose-response manner between zero and 60 days: (1) increased trabecular bone mass and improved architecture (increased trabecular bone area, width and number, and decreased trabecular separation); (2) increased trabecular interconnections; (3) increased bone formation parameters; and (4) decreased eroded perimeter. A new steady state with more cancellous bone mass and higher bone turnover was observed from day 60 onward. The elevated bone mass induced by the first 60 days of PGE2 treatment was maintained by another 60 and 120 days with continuous daily PGE2 treatment. When these findings were compared to those previously reported for the PTM, we found that the DTM was much more responsive to PGE2 treatment than the PTM. Percent trabecular bone area and tissue-based bone formation rate increased significantly more in DTM as compared to PTM after the 60 days of 6 mg PGE2 treatment. These observations indicate that a non-growing cancellous bone site is more responsive than growing bone site to long-term daily administration of PGE2.

Aging↗
PubMed2001

Musculoskeletal system of the neck of the polar bear (Ursus maritimus) and the Malayan bear (Helarctos malayanus).

The gross anatomical study was undertaken in the musculoskeletal system of the neck of the polar bear, and the findings were compared with those of the Malayan bear. The Musculus splenius and the M. trapezius were well-developed in the polar bear. The long neck of the polar bear consisted mainly of the M. splenius with the M. biventer cervicis and the M. complexus lying tightly underneath. The cervical vertebrae possessed huge ventral tubercle in the ventral part of the transverse process in the polar bear. These morphological characteristics suggest that the polar bear may rotate and bend the skull and the long cervical vertebrae. We postulate that the polar bear has evolved the high-mobility long neck to adapt for swimming. Unlike the polar bear, the Malayan bear has not specialized in the neck structure.

Animals↗
PubMed2006

Estimation of the muscle force distribution in ballistic motion based on a multibody methodology.

This work presents a general three-dimensional multibody procedure for studying the human body motion with emphasis on the locomotion apparatus. The methodology includes a three-dimensional biomechanical model, data acquisition techniques and an inverse dynamics approach. The biomechanical model is based on a multibody formulation using natural coordinates and consists of 16 anatomical segments modeled by 33 rigid bodies for a total of 44 degrees-of-freedom. The action of the muscles is introduced in the equations of motion of the multibody model by means of driver actuators defined as kinematic constraints. By associating a Lagrange multiplier to each muscle actuator the muscle forces became coupled with the biomechanical model through the Jacobian matrix of the underlying multibody system. A Hill type muscle model is used to calculate individual muscle forces. The model for the muscle apparatus comprises 43 muscle groups for each leg, which use the full three-dimensional lines of action for these muscles in their geometric description. The problem of the redundancy of the forces on the musculoskeletal structure is solved by using inverse dynamics and static optimization methods. In the process of describing the methodology the benefits of modeling in natural coordinates are highlighted. The methodology developed is demonstrated through its application to a case of ballistic motion, represented by the take-off to an aerial trajectory in order to estimate the joint torques and the muscle force distribution in the supporting leg. The time characteristics of the resultant net torques at the basic joints of the supporting leg and the time-varying muscle force patterns are presented and discussed. The results obtained are explained in terms of their relevance to the activity under study.

Computer Simulation↗
PubMed2005

Infection in massive bone allografts.

We studied a series of 945 patients who received cadaveric allografts implanted for nonpelvic bone or soft tissue tumor lesions since 1971. We specifically were interested in the role of infection in the graft process, and, more specifically its history, frequency, and affect on outcome. Primary infections (not related to reoperations for nonunions or fractures of the graft) occurred in 75 patients (7.9%), and an additional 46 patients had infections related to reoperations, increasing the total number of patients with infections to 121 (12.8%). The highest frequency of infection occurred in patients with soft tissue tumors, radiated sites, Musculoskeletal Tumor Society Stage IIB tumors, or surgeries consisting of an allograft arthrodesis. Most of the infected grafts failed; however, none of the patients died. One patient had hepatitis C develop, and one patient became HIV positive after receiving the virus from a blood transfusion. A comparison with other series of surgically treated patients, including those receiving metallic devices, suggests that the infection rate may be related to the surgery or the graft's immunologic resistance, rather than the graft. The problem of infection is a major issue for tumor surgeons. Suggestions regarding how to decrease the frequency of this complication are presented.

Adult↗
PubMed1993

Pharmacokinetics of 18F-labeled fluconazole in healthy human subjects by positron emission tomography.

The distribution of fluconazole in tissue of human volunteers was determined by positron emission tomographic scanning over a 2-h period following the infusion of a tracer dose of 18F-fluconazole (5 to 7 mCi) plus 400 mg of unlabeled drug (the standard daily dose of fluconazole). Previous studies have validated this approach for animals. From serial positron emission tomographic imaging and blood sampling, pharmacokinetics of fluconazole in tissue were determined. There was significant distribution of the radiolabeled drug in all organs studied, with nearly constant levels achieved by 1 h. Plateau concentrations of fluconazole in key organs (micrograms per gram) included the following: whole brain, 4.92 +/- 0.17; heart, 6.98 +/- 0.20; lung, 7.81 +/- 0.46; liver, 12.94 +/- 0.24; spleen, 22.96 +/- 2.5; kidney, 11.23 +/- 0.61; prostate, 8.24 +/- 0.58; and blood, 3.76 +/- 0.30. Since levels of fluconazole of > 6 micrograms/g are needed to treat infection with most strains of Candida and levels of > 10 micrograms/g are needed for Cryptococcus neoformans, Coccidioides immitis, and Histoplasma capsulatum, the following predictions can be made. The current standard dose of 400 mg/day should be more than adequate in the treatment of urinary tract and hepatosplenic candidiasis but problematic in the treatment of candidal osteomyelitis, even with the higher levels that develop after multiple doses. Similarly, higher doses should be considered, particularly in immunocompromised patients, with infection with C. neoformans, H. capsulatum, and C. immitis that involves the central nervous and musculoskeletal systems.

Adult↗
PubMed1990

Bone growth and calcium balance during simulated weightlessness in the rat.

Rats, age 28 days, experiencing tail suspension in modified metabolic cages for 1, 2, and 3 wk were compared with littermate controls. Food and water consumption, urinary and fecal Ca excretion, and serum Ca were measured; hearts, fore- and hindlimb bones, skulls, and mandibles were removed for determination of wet, dry, and ash weights and Ca concentration and for histological examination. Weight gain and Ca intake and excretion were the same for both groups; both displayed net Ca gain. Suspended rats had significantly lower wet, dry, and ash weights of femora and tibiae. Dry weights of the humeri and radii/ulnae were moderately higher, and the skull and mandible dry and ash weights were significantly higher in suspended than in control rats. Cortical thickness of the femur, but not humerus, was less in suspended rats. The data are consistent with the hypothesis that bone growth is influenced by the cardiovascular changes associated with tail suspension.

Animals↗