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PubMed1999

Spatial and temporal summation of sensory and affective dimensions of deep somatic pain.

There is considerable evidence in support of differential information processing of the sensory-discriminative and motivational-affective meanings of pain. The purpose of this work was to examine whether temporal (acute, tonic, persistent) and spatial (local, regional, widespread) aspects of deep somatic pain influence the sensory and affective dimensions of pain. Acute pain consisted of a short bout of pain, lasting about 100 s. Tonic pain was the experience of experimentally maintained pain for 18 min. Both acute and tonic pain were induced by infusion of an algesic or control substance into muscle with the subject blinded with respect to the type of infusion and randomization of the application sequence. Comparing the response of experimental subjects to a group of matched cases with persistent masticatory myalgia alone or in combination with widespread musculoskeletal pain, we examine whether the experimental state is different from the matched clinical condition, and whether there is a difference between the condition being restricted to the face or not. The McGill pain questionnaire was used to assess the sensory and affective correlates of pain. The normalized sensory score for acute/unilateral face pain was different from that established for tonic/unilateral face pain (P = 0.055, borderline s.), and so was the normalized affective score (P = 0.009, s.). When comparing tonic/unilateral versus tonic/bilateral face pain, the affective scores increased with increased pain involvement (P = 0.009, s.) while the sensory sores were unaffected by the additional pain induced in the contralateral masseter muscle (P = 0.357, n.s). Notably, sensory and affective scores for tonic/bilateral and persistent/bilateral face pain were not statistically different (sensory: P = 0.169, n.s.; affective: P = 0.643, n.s). On the other hand, when contrasting persistent/bilateral face pain with persistent/ widespread musculoskeletal pain, both scores were significantly different (sensory: P < 0.001, s.; affective: P = 0.041, s.). Time in and spread of pain influenced the perceptual correlates of pain to a significant degree. The major increase in the sensory dimension occurred from 'no pain' to 'acute pain'. Affective scores showed the most significant increases from acute to tonic pain, particularly with greater spatial involvement. The significant increases in sensory scores observed when contrasting persistent facial pain alone and in combination with widespread musculoskeletal pain was attributed to the broader body experience. Because the perceptual correlates of tonic and matched persistent (chronic) pain states were similar, we concluded that it does not require months for the development of the sensory and affective meaning of persistent pain as assumed.

Acute Disease↗
PubMed1994

Exposure assessment of biomechanical stress in repetitive manual work using frequency-weighted filters.

A quantitative exposure assessment strategy for physical stress associated with repetitive manual tasks is proposed using continuous biomechanical data measured directly from electrogoniometers or force sensors. This paper describes an efficient method for reducing large quantities of biomechanical data into a quantifiable metric that accounts for recognized musculoskeletal exposure factors, including repetitiveness, postural or forceful exertion stress, and duration. A frequency domain approach is used for averaging elemental data recorded for repetitive cycles. Parameters for frequency-weighted filters are developed using psychophysical data for equivalent discomfort levels resulting from repetitive movements of different amplitudes and frequencies. These filters enable continuous biomechanical data to be filtered and integrated, resulting in a single quantity corresponding to psychophysical response characteristics for repetitive motion stress. It is anticipated that a similar approach may be used for epidemiological response characteristics. Applications of this theory may make it possible for assessing exposure to physical stress in a manner analogous to the way in which sound level meters are used for measuring exposure to acoustic noise. Repetitive wrist flexion and localized discomfort was used for demonstrating the feasibility of this approach. Suitable data reduction techniques are necessary for evaluating work methods, job designs, and for conducting large scale detailed epidemiological investigations of cumulative trauma disorder risk factors. Frequency-weighted filters based on human response to physical stress at different frequencies can greatly simplify exposure analysis and ultimately may make it possible for quantitative exposure limits to be established.

Adult↗
PubMed1984

Staggers in sheep associated with the ingestion of Tribulus terrestris.

The history of an unusual locomotory disturbance of sheep is traced from its first recognition in 1937 through to the most recent outbreak in 1981-83. The condition occurred only at certain times and in restricted areas of the central and northern slopes districts of New South Wales. Outbreaks were repeatedly associated with drought periods during which sheep grazed large areas of Tribulus terrestris for many months at a time. Many thousands of sheep were affected, but the prevalence varied greatly between flocks. The course of the disease was characterised by a slowly developing, irreversible, asymmetrical, weakness of the hindlimbs. The clinical signs suggested that a lesion of the thoraco-lumbar spinal cord region was present. The macroscopic and microscopic examination of the nervous and musculoskeletal systems failed to demonstrate abnormalities which would account for the clinical signs. Haematological, biochemical and toxicological test results supported the concept of a neuromuscular disease process being present, but failed to indicate its aetiology.

Age Factors↗
PubMed2001

Non-work factors associated with musculoskeletal upper extremity disorders in women: Beyond the work environment.

It is women who are predominantly affected by musculoskeletal disorders of the upper extremities (MSD/UE), especially those disorders attributed to repetitive strain or cumulative trauma. This study focuses on a female sample of supermarket employees and the effects of stress acquired from their non-work environments on the reporting of musculoskeletal symptoms. Stress and life events were shown to be positively associated with the presence of UE disorders and measures of intensity, duration, and frequency of pain. A multifactorial model for explaining the development of MSD/UE in female workers is proferred, while the significance of understanding the inter-relational nature of women's lives is underscored. Additionally, the study lends credence to the physiological underpinning of stress.

Journal Article↗
PubMed2003

Chronic fatigue syndrome. The patient centred clinical method--a guide for the perplexed.

BACKGROUND: Chronic fatigue states are common in general practice and over the past 20 years there has been considerable worldwide consensus developed on the criteria for chronic fatigue syndrome (CFS) also commonly known as myalgic encephalomyelitis (ME). Chronic fatigue syndrome is an illness characterised by the new onset of disabling fatigue, accompanied by cognitive, musculoskeletal and sleep symptoms. There are no specific diagnostic tests or biological markers and the diagnosis is made by ruling out other causes of fatigue. The pathophysiology of CFS is still unclear. OBJECTIVE: This article discusses the application of the patient centred clinical method to the diagnosis and treatment of CFS. DISCUSSION: There is no new breakthrough in the diagnosis or management of CFS in spite of much research and controversy. There is considerable evidence that the best place to manage CFS is in primary care under the care of the patient's own general practitioner, but it has been suggested that doctors feel unable to deal with the problem. The patient centred clinical method offers a constructive guide to management. The author considers that the best hope for sufferers is self management guided by a supportive and helpful health professional, preferably the patient's own GP.

Australia↗
PubMed2006

[Obesity related complications in children and adolescents].

The epidemic of obesity concerns also children and adolescents. Excess weight increases the risk of metabolic complications, diabetes type 2, hypertension, cardiovascular disease, pulmonary and musculoskeletal disorders, psychosocial problems. Simple obesity leads to secondary endocrine disturbances. Long lasting insulin resistance and proinflammatory state induced by cytokines, which are produced in adipose tissue, play the main role in the development of obesity associated complications. Many disturbances can be reversed at the early stage, if even small weight loss is achieved.

Adipose Tissue↗
PubMed1988

Neoplastic associations of rheumatic diseases and rheumatic manifestations of cancer.

Associations between rheumatic diseases and malignant neoplasms are still inferential and based largely on epidemiologic data. Rheumatoid arthritis predisposes weakly to the occurrence of lymphoreticular neoplasms. This is more clearly true of Sjögren's disease, whether or not it is associated with RA. A subset of DM/PM which becomes manifest in close temporal proximity to a neoplasm may be a paraneoplastic reaction, but DM/PM, in general, does not predispose to neoplasia. Scleroderma in its early phase is associated with the development of breast cancer in women, and after a decade or longer, if pulmonary fibrosis has developed, with lung cancer. Of the drugs that have been used to treat these diseases, cyclophosphamide is most strongly implicated as a carcinogenic agent, particularly inducing lymphoreticular neoplasms and carcinoma of the bladder. Musculoskeletal symptoms that may be clues to the existence of cancer may either be caused by invasion of the neoplasm or be mediated by unidentified neurohumoral mechanisms. Except for multiple myeloma, primary neoplasms of skeletal tissues tend to occur under the age of 50 years. Metastatic disease occurs congruently with the age incidence of the primary neoplasm. Metastases may mimic mono- or oligoarticular arthritis if they happen to be periarticular or synovial. These metastases result most often from carcinoma of the lung or, in women, carcinoma of the breast. Hypertrophic pulmonary osteoarthropathy usually is due to carcinomas of the lung other than the small cell variety, and infrequently from other intrathoracic primary or secondary neoplasms. RA may be mimicked. Both skeletal metastases and HPOA are detected with greater sensitivity, but not specificity, by isotopic scanning techniques than by radiography. Of the other paraneoplastic musculoskeletal syndromes, neuromyopathy is the most frequent. It must be distinguished from cachexia, polymyositis, polymyalgia rheumatica, and the myasthenic syndrome. Both neuromyopathy and Eaton-Lambert (myasthenic) syndrome are predominantly associated with small cell carcinoma of the lung and both are best diagnosed by electromyography. Carcinomatous polyarthritis and the palmar fasciitis-arthritis syndrome occur with various neoplasms, although the latter appears to be particularly associated with ovarian carcinomas. The paraneoplastic arthritides test negatively for the rheumatoid factor, but no reliable positive immunochemical clues have as yet been identified.

Adolescent↗
PubMed1993

[Orthopedic surgery in children with cerebral palsy].

The authors present their experience with orthopaedic surgical treatment of children with cerebral palsy. The paper is based on a group of 630 patients where they performed 1882 operations of the lower extremities in 1970-1992. The authors evaluate the long-term results in regularly checked 361 patients (205 boys and 156 girls), mostly with the spastic form of cerebral palsy, with regard to different types of affections which markedly influence the prognosis of surgery (monoparesis, hemiparesis, diparesis, triparesis, quadruparesis). The authors emphasize the primary importance of rehabilitation and team work where the orthopaedist's work is guided by efforts to make further rehabilitation training possible and to facilitate it. They consider surgery an integral part of comprehensive treatment of cerebral palsy which must be followed immediately by further rehabilitation. The authors emphasize the part played be the orthopaedic surgeon to prevent the genesis and development of deformities of the locomotor apparatus.

Adolescent↗
PubMed1994

Head posture measurements among work vehicle drivers and implications for work and workplace design.

An increased risk of musculoskeletal disorders, e.g. from the neck region, has been found among professional drivers of work vehicles. The purpose of this study was to identify causes of postural load and implications for vehicle design and work tasks. A second purpose was to develop the methods for measurement and analysis of head postures. Field measurements of head postures for drivers of fork lift trucks, forestry machines, and cranes were carried out. The equipment used was an electric goniometer measurement system, containing a mechanical transmission between the head and the upper trunk. Methods for data presentation and quantification were developed. The results showed that rotatable and movable driver cabins improved head postures and viewing angles substantially. Narrow window frame structures and large, optimally-placed windows were also advantageous. The steering wheel, controls, and a high backrest restricted shoulder rotation, which increased head rotation in unfavourable viewing angles. Improved workspace layouts and work organization factors such as job enlargement decreased the influence of strenuous postures. The results also showed that head postures should be analysed in two or three dimensions simultaneously, otherwise the postures taken will be underestimated in relation to the maximal voluntary movement.

Adult↗
PubMed1998

A five year study comparing early retirements on medical grounds in ambulance personnel with those in other groups of health service staff. Part II: Causes of retirements.

The objective of this study was to compare morbidity between ambulance staff and other groups of health service workers, to facilitate planning of occupational health (OH) services. A retrospective study of employees of the Eastern Health and Social Services Board, Northern Ireland was conducted. Subject were 181 men and 353 women assessed at OH between 1988-92 and found eligible (on the basis of permanent incapacity) to apply for early retirement on medical grounds (EROMG). When causes of retirement were looked at it was found that musculoskeletal, circulatory and mental disorders were most common in all groups (overall making up three-quarters of retirements). Differences in causes of retirements between different groups of workers were not found to be statistically significant, but when male staff were compared ambulance staff showed the highest proportion of retirements due to circulatory disorders. Retirements due to musculoskeletal disorders occurred after shorter service than those due to mental disorders and those due to mental disorders occurred after shorter service than those due to circulatory disorders; these findings achieved statistical significance. In comparison with previous studies this study showed the highest proportion of ambulance retirements due to mental disorders, with an unexpectedly high proportion being related to alcohol problems. Occupational health services for ambulance staff would be best targeted towards facilitating the development of physical fitness and rehabilitation programmes, and health promotional activities such as training in stress management.

Alcohol-Related Disorders↗
PubMed2003

Molecular imaging of musculoskeletal diseases.

Chronic musculoskeletal diseases such as arthritis, malignancy, chronic injury/ inflammation, and chronic musculoskeletal pain often pose challenges for current clinical imaging modalities. There is hope that a growing field, referred to as "molecular imaging," will shed new light on these chronic phenomenon as it aims to noninvasively detect special molecular and physiologic effects such as metabolism rate, specific proteins, cell death, and particular gene-related events. Molecular imaging represents recent advances in imaging technology, engineering, chemistry, molecular biology, and genetics that have coalesced into a multidisciplinary and multimodality effort. Molecular probes are currently being developed not only in radionuclide-based techniques but also in magnetic resonance imaging, magnetic resonance spectroscopy, ultrasound, and the emerging field of optical imaging. Furthermore, molecular imagers are fueling the development of novel molecular therapies and gene therapy, as tracking these efforts in living subjects is now possible with molecular imaging protocols.

Animals↗
PubMed1999

Identification of optimal strategies for increasing whole arm strength using Karush-Kuhn-Tucker multipliers.

OBJECTIVE: The purpose of this study was to develop a computer model for identifying muscles critical to improving functional upper extremity strength. DESIGN: A three-dimensional biomechanical model of the upper extremity was developed, and the predictions were compared to maximal arm strength data collected from healthy volunteers. BACKGROUND: Although several optimization-based mathematical models of the shoulder have been developed, none have utilized the mathematical properties of the Karush-Kuhn-Tucker multipliers to efficiently estimate the effect of strengthening individual muscles on functional strength of the whole arm. METHODS: A static three-dimensional biomechanical model of the glenohumeral, radio-humeral, ulno-humeral and wrist joints was developed for predicting maximal hand exertion forces. The model was formulated as a linear program. Constraints consisted of moment equilibrium conditions and limits on maximum and minimum allowable muscle forces. Predicted arm strengths were compared to maximal pull strength measurements made on 10 subjects (5 male; 5 female). The task involved pulling toward the mid-sagittal plane of the body with the arm flexed 45 degrees. The Karush-Kuhn-Tucker variables associated with the maximal limits on muscle force were computed to estimate the effect of altering the strength of individual muscles on functional arm strength. RESULTS: Maximum pull strengths were predicted well by the model. Karush-Kuhn-Tucker values ranged from 0 (for muscles not at their upper force limits) to 0.11 for the flexor carpi radialis and pectoralis major muscles. Karush-Kuhn-Tucker multipliers were found to be insensitive to the assumed specific tension of muscle. CONCLUSIONS: Upper extremity strength can be predicted from musculoskeletal geometry and physiology using linear programming. RELEVANCE: Karush-Kuhn-Tucker multipliers associated with the muscle force upper limits give insight into the effect of strengthening individual muscles on whole arm exertion strength. Such an analysis may provide insight into the development of optimal rehabilitation protocols.

Adult↗
PubMed1998

Measurement of damage in 210 Mexican patients with systemic lupus erythematosus: relationship with disease duration.

The Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index is a validated instrument specifically designed to ascertain damage in SLE; this instrument has been applied mainly to Caucasians and African-American SLE patients. The objective of this study was to assess damage using the SLICC/ACR Damage Index in Mexican SLE patients. The SLICC/ACR Damage Index was applied to 210 consecutive SLE patients with disease of variable duration. The SLICC/ACR Damage Index was assessed by review of hospital clinical records, interview and physical examination. One hundred and seventeen (55.5%) patients had some damage. The proportion of patients with damage increased significantly with disease duration (33% at 1-60 months, 66% at 61-120 months and 70% at > or = 121 months, P < 0.001). The main organ systems involved were musculoskeletal (osteonecrosis), neuropsychiatric (neuropathy, seizures), gonadal (amenorrhea prior to age 40 years), ocular (cataracts), renal (glomerular filtration < 50%) and peripheral vascular (permanent damage by venous thrombosis). Damage was frequent, increased over time, particularly for ocular, renal, musculoskeletal and gonadal. Patients who experienced damage were older, had a longer disease duration, a greater number of ACR criteria at diagnosis, and were more likely to have renal involvement and antibodies to dsDNA. The damage occurred in many different domains and started to develop early after disease onset. Mexican patients had more peripheral vascular and gonadal involvement compared with published data from non-Hispanic SLE populations.

Activities of Daily Living↗
PubMed2001

Application of spherical and cylindrical wrapping algorithms in a musculoskeletal model of the upper limb.

In the modelling of the upper limb, many muscles cannot be represented as a straight line from origin to insertion due to the complex morphology causing them to wrap around passive structures. The majority of bony contours that form these obstructions can be described adequately as simple geometric shapes such as spheres and cylinders.A novel technique for the parameterisation of muscle paths as they wrap around such shapes has been developed for use in an upper limb model. The new method involves the definition of moving co-ordinate systems in which the path of a wrapped muscle does not move, allowing simplified specification. In addition, an analytical calculation of the wrapping path around a cylinder is presented over previous approximate methods. Muscle moment arms were pre-calculated from vector considerations and within SIMM by tendon excursion. Close agreement between the two suggests that the proposed implementations accurately follow the theoretical relationship and can be used with confidence in musculoskeletal models.

Algorithms↗
PubMed2003

Risk factors and prevalence of injuries in horses during various types of steeplechase races.

OBJECTIVE: To identify the types of injuries sustained by horses that competed in steeplechase races and determine the prevalence of and risk factors for those injuries. DESIGN: Prospective study. ANIMALS: 2,680 horses that competed in various types of steeplechase races from 1996 through 2000. PROCEDURE: Data regarding races; environment; equipment problems; the number of horses that entered, started, and finished races; the number of riders that fell; and the number of horses that were slowed or stopped by the rider, ran off the course, fell, and sustained injuries or physical abnormalities during races were collected on a standard form by the official veterinarian who attended each meet. Data from all meets were not recorded; however, in recorded meets, data from every race were reported. RESULTS: Data for 197 hurdle, 65 timber, 76 flat, and 8 mixed races were recorded. Nine (3.4/1,000 horses that started in races) horses died or were euthanatized, and 7 of those were associated with catastrophic musculoskeletal injury. Seven fractures were recorded. Four fractures involved forelimbs, 1 involved a hind limb, and 2 involved the cervical portion of the vertebral column. All horses with fractures were euthanatized. Deep or hard course conditions were associated with an increased risk of breakdown injuries. CONCLUSIONS AND CLINICAL RELEVANCE: Successful development and implementation of strategies to prevent injuries and death in horses in steeplechase races depend on a clear understanding of the types and prevalence of injuries involved and risk factors associated with those injuries.

Animals↗
PubMed1993

From structure to process, from organ to cell: recent developments of FE-analysis in orthopaedic biomechanics.

The introduction of finite element analysis (FEA) into orthopaedic biomechanics allowed continuum structural analysis of bone and bone-implant composites of complicated shapes (Huiskes and Chao, J. Biomechanics, Vol. 16, 1983, pp. 385-409). However, besides having complicated shapes, musculoskeletal tissues are hierarchical composites with multiple structural levels that adapt to their mechanical environment. Mechanical adaptation influences the success of many orthopaedic treatments, especially total joint replacements. Recent advances in FEA applications have begun to address questions concerning the optimality of bone structure, the processes of bone remodeling, the mechanics of soft hydrated tissues, and the mechanics of tissues down to the microstructural and cell levels. Advances in each of these areas, which have brought FEA from a continuum stress analysis tool to a tool which plays an ever-increasing role in the scientific understanding of tissue structure, adaptation, and the optimal design of orthopaedic implants, are reviewed.

Adaptation, Physiological↗
PubMed2005

Gender difference in prevalence of upper extremity musculoskeletal symptoms among Swedish pig farmers.

There have been very few epidemiological studies dealing with pig farmers' musculoskeletal health. The aim of this study was to carry out a cross-section postal questionnaire survey dealing with musculoskeletal symptoms among female and male pig farmers in large-scale production. The participation rate overall was 70% (288/410). Over 10% of the questionnaires had missing gender data. Three different questionnaires were used: the general standardized Nordic questionnaire for the analysis of musculoskeletal symptoms; a questionnaire dealing with occurrence of numbness, reduced muscle strength, etc., in the wrists and hands; and occupational factors were screened by a special questionnaire. The results showed that musculoskeletal morbidity is high among pig farmers. The women had significantly more problems than the men with respect to the upper extremities. Symptoms in the wrists and hands such as numbness, reduced muscle strength, aching fingers and wrists, and tendency to drop things were significantly more common among the women than the men. Occupational factors dealing with, for example, the size of the pig farm, were not related to the occurrence of symptoms. Occupational factors of importance for the development of disorders, particularly among women pig farmers, should be given priority in ergonomic interventions.

Adult↗