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PubMed2006

Musculoskeletal exam and joint injection training for internal medicine residents.

We developed a musculoskeletal education intervention for internal medicine residents consisting of lectures, anatomic models, and a joint injection clinic. Written tests, observed musculoskeletal exams, and self-confidence scales were administered to 27 internal medicine residents before and after the intervention. Improvement was found in observed physical exam and self-reported confidence levels in performing knee injections. Confidence in shoulder injection skills improved, but remained low. Improved scores on written examination, though statistically significant, were not educationally significant. This single-institution pilot study demonstrates that a simple educational program results in improved knee and shoulder examination skills and confidence in performing knee injections.

Ambulatory Care↗
PubMed1992

Working postures and activities of lorry drivers: a reliability study of on-site observation and recording on a pocket computer.

Poor working postures are associated with the development of musculoskeletal disorders. Many different observation methods have been developed to analyse working posture and activity. TRAC (Task Recording and Analysis on Computer) enables the observer to choose and define the variables and the categories within variables to be recorded at the workplace and analysed afterwards. In this study, inter-observer reliabilities were determined for the variables that were essential to ensure accurate recording of both working posture and activity of lorry drivers. The pre-set standard for observer reliability was not reached before the number of variables was decreased: the variables concerning activities and load handled were omitted in favour of those concerning body posture. As a result of this reliability study an improved application of TRAC is proposed. For the purpose of recording all selected variables a second observer is introduced, so that two observers work simultaneously at the working site. The first observer pays attention only to working postures and the second observer records, among other things, activities. An additional program has been written to combine the variables of both observers for subsequent analysis. This enables us to investigate the relation between activity, appliances or goods being handled, and the corresponding working postures. The second observer records on a real-time basis and provides accurate information on the duration and sequence of activities. It is considered that this twofold application of TRAC is an important contribution to the accurate analysis of workplaces.

Journal Article↗
PubMedDate not supplied

Arthritis and bursitis in multiple sclerosis patients treated with interferon-beta.

Interferon-beta (IFN-beta) is a type I interferon used in the management of multiple sclerosis. Therapy with IFN-beta has rarely been associated with the development of autoimmune disorders. We present the cases of two female patients diagnosed with relapsing-remitting multiple sclerosis (RRMS) who developed inflammatory musculoskeletal manifestations, following IFN-beta therapy. The first patient developed a monoarthritis 2 weeks after initiation of IFN-beta, which persisted during the 14 months of therapy and resolved with discontinuation of the medication. The second patient developed both autoimmune thyroid disease and a refractory pre-patellar bursitis after 50 months of IFN-beta therapy. Our literature review revealed an additional six cases of onset of inflammatory arthritis in MS patients receiving IFN-beta. We review these reports with comparison to our two cases. The role of IFN-beta in inflammatory musculoskeletal disease is unclear. The potential autoimmune complications of this therapeutic agent should be comprehended when monitoring patients receiving such treatment.

Adjuvants, Immunologic↗
PubMed2007

Maturity assessment and curve progression in girls with idiopathic scoliosis.

BACKGROUND: Scoliosis progression during adolescence is closely related to patient maturity. Maturity has various indicators, including chronological age, height and weight changes, and skeletal and sexual maturation. It is not certain which of these indicators correlates most strongly with scoliosis progression. The purpose of the present study was to evaluate various maturity measurements and how they relate to scoliosis progression. METHODS: Physically immature girls with idiopathic scoliosis were evaluated every six months through their growth spurt with serial spinal radiographs; hand skeletal ages; Oxford pelvic scores; Risser sign determinations; height; weight; sexual staging; and serologic studies of the levels of selected growth factors, estradiol, bone-specific alkaline phosphatase, and osteocalcin. These measurements were then correlated with the curve-acceleration phase. RESULTS: The period and pattern of curve acceleration began during Risser stage 0 for all patients. Skeletal maturation scores derived with the use of the Tanner-Whitehouse-III RUS method, particularly those for the metacarpals and phalanges, were superior to all other indicators of maturity. Regression of the scores provided good estimates of maturity relative to the period of curve progression (Pearson r = 0.93). The initiation of this period occurred simultaneously with digital changes from Tanner-Whitehouse-III stage F to G. At this stage, curves also separated into rapid, moderate, and low-acceleration patterns, with specific curve types in the rapid and moderate-acceleration groups. The low-acceleration group was not confined to a specific curve type. CONCLUSIONS: The curve-acceleration phase separates curves into various types of curve progression. The Tanner-Whitehouse-III RUS scores are highly correlated with timing relative to the curve-acceleration phase and provide better maturity determination and prognosis determination during adolescence than the other parameters tested. Accurate skeletal maturity determination should be used as the primary maturity measurement in girls with idiopathic scoliosis.

Adolescent↗
PubMed2003

Preventing musculoskeletal disorders in clinical dentistry: strategies to address the mechanisms leading to musculoskeletal disorders.

BACKGROUND: The authors reviewed studies to identify methods for dental operators to use to prevent the development of musculoskeletal disorders, or MSDs. TYPES OF STUDIES REVIEWED: The authors reviewed studies that related to the prevention of MSDs among dental operators. Some studies investigated the relationship between the biomechanics of seated working postures and physiological damage or pain. Other studies suggested that repeated unidirectional twisting of the trunk can lead to low back pain, while yet other studies examined the detrimental effects of working in one position for prolonged periods. Additional studies confirmed the roles that operators' flexibility and core strength can play in balanced musculoskeletal health and the need for operators to know how to properly adjust ergonomic equipment. RESULTS: This review indicates that strategies to prevent the multifactorial problem of dental operators' developing MSDs exist. These strategies address deficiencies in operator position, posture, flexibility, strength and ergonomics. Education and additional research are needed to promote an understanding of the complexity of the problem and to address the problem's multifactorial nature. CLINICAL IMPLICATIONS: A comprehensive approach to address the problem of MSDs in dentistry represents a paradigm shift in how operators work. New educational models that incorporate a multifactorial approach can be developed to help dental operators manage and prevent MSDs effectively.

Back Pain↗
PubMed1995

Musculoskeletal symptoms among sewing machine operators.

OBJECTIVES: A longitudinal study was conducted to describe the prevalences and development of musculoskeletal symptoms among sewing machine operators in relation to age and exposure and among former sewing machine operators who changed exposure by changing occupation. METHODS: Musculoskeletal symptoms were assessed among 327 sewing machine operators in 1985 with the use of the standardized Nordic questionnaire. A follow-up study in 1991 showed that approximately one-third was still working as a sewing machine operator, one-third had changed occupation, and the rest were out of employment. The exposure was assessed by a questionnaire regarding the type of machine being operated, work organization, workplace design, units produced per day, and payment system. RESULTS: High prevalences of musculoskeletal symptoms of the neck and shoulders were found, with some associations to exposure variables such as efficiency. Initially symptom-free sewing machine operators were not at a higher risk of developing symptoms when they continued sewing during the six-year follow-up when compared with those who changed to other employment. However, symptomatic sewing machine operators who quit sewing were much more likely to be relieved of their symptoms than were symptomatic operators who continued sewing, odds ratio 3.26 [95% confidence interval (95% CI) 1.38-7.72] for 12-month symptoms and odds ratio 3.90 (95% CI 1.28-11.90) for 7-day symptoms. This trend also applied to long-lasting symptoms. CONCLUSIONS: The results demonstrate that, for many sewing machine operators, neck and shoulder symptoms are reversible and may be influenced by reallocation to other worktasks.

Adolescent↗
PubMed1998

A method for developing biomechanical profiles of hand-intensive tasks.

OBJECTIVE: To develop a methodology for generic, comprehensive biomechanical profiling of hand-intensive tasks. DESIGN: Based on a multifactorial model of work-related musculoskeletal disorder development, a method was developed for continuous, simultaneous measurement of relevant variables (wrist and finger joint position, force, muscle activity, and carpal tunnel pressure). Joint dynamics and tendon travel were derived. BACKGROUND: Few generic dose-response relationships have been identified for work-related musculoskeletal disorders. This may improve if methodologies are developed that quantify multiple factors along several dimensions (means, cumulative exposure, etc.). This requires continuous, simultaneous measurements, and facilitates examination of interactions. METHODS: Five touch-typists were instrumented to quantify their biomechanical profiles using the methodology, and to evaluate the sensitivity of the method to various work organization/design conditions. RESULTS: The method captured individual and group responses to design conditions and revealed interactions and trade-offs between response variables. Carpal tunnel pressure was found to be sensitive to radial-ulnar wrist posture. CONCLUSIONS: Multi-variable biomechanical profiling can provide insight into effects of work design on workers; however, to achieve statistical significance large numbers of subjects are needed.

Journal Article↗
PubMed2004

Back pain prevalence in nursing personnel: measurement issues.

1. The problem of work related musculoskeletal disorders of the low back in nursing personnel has been well documented in the literature by cross sectional studies showing high prevalence rates in licensed nurses and nursing aides. However, it is difficult to compare findings among these studies because of the use of nonstandardized symptom surveys, variations in case definitions, and other methodological inconsistencies. 2. Measuring the change in current back pain prevalence yields more timely information about the effectiveness of an ergonomic intervention than assessing injury incidence rates, because of the high percent of nursing staff members who work in pain but delay filing workers' compensation claims. 3. As employers attempt to reduce manual handling injuries, occupational health nurses may be called upon to survey workers for musculoskeletal symptom prevalence and document the effectiveness of ergonomic interventions. Before using or developing any musculoskeletal disorder symptom survey for workplace surveillance or research, occupational health nurses should determine whether the survey has adequate reliability, validity, responsiveness, and practicality.

Back Pain↗
PubMed1996

An integrated care system for musculoskeletal disorders in a managed care setting.

Practice guidelines, education, consensus building, and extensive communication were the tools used in developing a musculoskeletal care system. Primary care physicians directed patient care using practice guidelines for common musculoskeletal conditions. Patient education and empowerment were emphasized. Specialist consultations were made available by telephone/voicemail to advise primary care physicians regarding treatment plans and the need for specialty referrals. Significant reductions in medical service utilization for this patient population were achieved while high levels of patient satisfaction were maintained. Such integrated systems are likely to work well within other MCOs.

Case Management↗
PubMedDate not supplied

The effect of foot structure and range of motion on musculoskeletal overuse injuries.

The purpose of this prospective study was to determine whether an association exists between foot structure and the development of musculoskeletal overuse injuries. The study group was a well-defined cohort of 449 trainees at the Naval Special Warfare Training Center in Coronado, California. Before beginning training, measurements were made of ankle motion, subtalar motion, and the static (standing) and dynamic (walking) characteristics of the foot arch. The subjects were tracked prospectively for injuries throughout training. We identified risk factors that predispose people to lower extremity overuse injuries. These risk factors include dynamic pes planus, pes cavus, restricted ankle dorsiflexion, and increased hindfoot inversion, all of which are subject to intervention and possible correction.

Achilles Tendon↗
PubMed1994

A finite element musculoskeletal model of the shoulder mechanism.

The finite element method described in this study provides an easy method to simulate the kinetics of multibody mechanisms. It is used in order to develop a musculoskeletal model of the shoulder mechanism. Each relevant morphological structure has been represented by an appropriate element. For the shoulder mechanism two special-purpose elements have been developed: a SURFACE element representing the scapulothoracic gliding plane and a CURVED-TRUSS element to represent muscles which are wrapped around bony contours. The model contains four bones, three joints, three extracapsular ligaments, the scapulothoracic gliding plane and 20 muscles and muscle parts. In the model, input variables are the positions of the shoulder girdle and humerus and the external load on the humerus. Output variables are muscles forces subject to an optimization procedure in which the mechanical stability of the glenohumeral joint is one of the constraints. Four different optimization criteria are compared. For 12 muscles, surface EMG is used to verify the model. Since the optimum muscle length and force-length relationship are unknown, and since maximal EMG amplitude is length dependent, verification is only possible in a qualitative sense. Nevertheless, it is concluded that a detailed model of the shoulder mechanism has been developed which provides good insight into the function of morphological structures.

Acceleration↗
PubMed2005

terra is a left-right asymmetry gene required for left-right synchronization of the segmentation clock.

To establish the vertebrate body plan, it is fundamental to create left-right asymmetry in the lateral-plate mesoderm to correctly position the organs. However, it is also crucial to maintain symmetry between the left and the right sides of the presomitic mesoderm, ensuring the allocation of symmetrical body structures, such as the axial skeleton and skeletal muscles. Here, we show that terra is an early left-sided expressed gene that links left-right patterning with bilateral synchronization of the segmentation clock.

Animals↗
PubMed1990

A musculoskeletal model of the human lower extremity: the effect of muscle, tendon, and moment arm on the moment-angle relationship of musculotendon actuators at the hip, knee, and ankle.

We have developed a musculoskeletal model of the human lower extremity for computer simulation studies of musculotendon function and muscle coordination during movement. This model incorporates the salient features of muscle and tendon, specifies the musculoskeletal geometry and musculotendon parameters of 18 musculotendon actuators, and defines the active isometric moment of these actuators about the hip, knee, and ankle joints in the sagittal plane. We found that tendon slack length, optimal muscle-fiber length, and moment arm are different for each actuator, thus each actuator develops peak isometric moment at a different joint angle. The joint angle where an actuator produces peak moment does not necessarily coincide with the joint angle where: (1) muscle force peaks, (2) moment arm peaks, or (3) the in vivo moment developed by maximum voluntary contractions peaks. We conclude that when tendon is neglected in analyses of musculotendon force or moment about joints, erroneous predictions of human musculotendon function may be stated, not only in static situations as studied here, but during movement as well.

Ankle Joint↗
PubMed2000

Physical work load between 1970 and 1993--did it change?

OBJECTIVES: This study investigates changes in self-reported and expert-evaluated physical work loads between 1970 and 1993 in relation to calendar year, birth cohort, and gender in an urban and suburban population sample (232 men and 252 women) born between 1935 and 1952. METHODS: A self-administered questionnaire was answered in 1993 concerning different aspects of physical work loads between 1970 and 1993. With the use of a classification matrix, the objective physical work load on different body regions was also assessed. RESULTS: Between 1970 and 1993 the fraction of subjects in blue-collar occupations and the physical work loads decreased among the men, but they both increased among the women. Physical work loads were, in general, higher among the men than among the women at younger ages (below 30 years), but less so at higher ages. Expert evaluations of the musculoskeletal load showed a pattern similar to that of self-reported work loads. CONCLUSIONS: The gender difference in work load development with age may have implications for the development of musculoskeletal disorders.

Adolescent↗
PubMedDate not supplied

Mechanisms of development of morphological changes in mammals aboard biological satellites.

After orbital space flights lasting 19.5--22.5 days, disturbances are observed in mineral metabolism in rats, which are morphologically manifested as osteoporosis of the spongy sections of long hollow skeletal bones, periosteocytic osteolysis of them, atrophy and dystrophy of skeletal muscles, and inhibition of erythroid growth of bone marrow, which occurred and developed in weightlessness as a result of deprivation of motor activity due to removal (or reduction) of static load from the musculoskeletal system. Development of stress reaction, which is apparently intensified at certain stages of flight (lift off and touchdown) and during transition from weightlessness to conditions of gravitational force on earth, leads to corresponding changes in the structure and cellular composition of lymphoid organs, and to changes in the hypothalamic-hypophyseal neurosecretory system, adrenal glands, and other organs. Changes in the receptor apparatus of the vestibular system are associated with local circulatory changes occurring during weightlessness and G forces, while retinal injuries are associated with the effect of heavy charged particles of cosmic radiation. All changes are reversible and disappear completely or to a substantial degree a month after completion of the flight.

Animals↗