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PubMed1990

Nociceptive reflexes and the somatic dysfunction: a model.

A model of somatic dysfunction is developed in which restriction in mobility and autonomic, visceral, and immunologic changes are produced by pain-related sensory neurons and their reflexes. Nociceptors are known to produce muscular guarding reactions, as well as autonomic activation, when musculoskeletal or visceral tissue is stressed or damaged. This guarding causes abnormal musculoskeletal position and range of motion. Local inflammatory responses and autonomic reflexes further reinforce nociceptor activity, maintaining restriction. Nociceptive autonomic reflexes also evoke changes in visceral and immunologic function. Finally, maintenance of muscles, joints, and related tissues in an abnormal guarding position causes changes in the connective tissues, solidifying the abnormal position. Stretching these tissues into a normal range of motion will restimulate the nociceptor, reflexly reinforcing the somatic dysfunction. This model has evolved from Korr's neurologic model but emphasizes the nociceptor and its reflexes as a source of the connective tissue, circulatory, visceral, and immunologic changes seen in the somatic dysfunction.

Bone and Bones↗
PubMedDate not supplied

The risks of exercise: a public health view of injuries and hazards.

Relatively little is known about the incidence of the risks facing those who exercise regularly. Clinical reports suggest a variety of musculoskeletal ailments, and several pathophysiologic conditions may result from the various aerobic activities most likely to be pursued by large parts of the U.S. population. But adequate epidemiologic data are scarce. Careful epidemiologic studies are needed to develop incidence information.

Athletic Injuries↗
PubMed1994

Reliability and validity of a newly developed test of physical work performance.

This study examined the interrater reliability and validity of a newly developed test of physical work abilities, the Physical Work Performance Evaluation. Eleven physical therapists were trained to administer and score this evaluation. From this group, two therapists at a time simultaneously and independently evaluated 50 patients with musculoskeletal disorders as they performed the tasks of the Physical Work Performance Evaluation. At the conclusion of the evaluation, each therapist determined the safe level of physical work for each patient. A comparison of the two independent evaluations was used to determine reliability. To determine validity, the predicted level of work was compared with the actual level of work. Kappa coefficient between the two therapists on the level of work was .83. Spearman rho correlations between the predicted and actual levels of work ranged from .41 to .55. Only 14 to 18% were working above the level predicted by the Physical Work Performance Evaluation. These results indicate high interrater reliability. Given the lack of a perfect standard for validity comparisons, these results also provide evidence in support of convergent validity. The test can be used in making decisions regarding return to work after injury, preemployment placement, and vocational exploration.

Adolescent↗
PubMed2005

Local antibiotic delivery vehicles in the treatment of musculoskeletal infection.

The primary benefit achieved with local antibiotic delivery vehicles is the ability to obtain extremely high levels of local antibiotics without increasing systemic toxicity. Antibiotic-loaded bone cement represents the current standard as an antibiotic delivery vehicle in orthopaedic surgery. Biodegradable alternatives to antibiotic-loaded bone cement also are being used clinically and there are many new products in the active stages of development. These alternatives can be categorized as bone graft, bone graft substitutes or extenders, natural polymers (protein-based products), and synthetic polymers. Composite biomaterials that simultaneously provide the functions of variable antibiotic delivery patterns and also contribute to the process of bone regeneration represent the most ideal class of local antibiotic delivery vehicles. High concentrations of certain antibiotics have been shown to affect the process of normal bone regeneration adversely in a dose dependent response. Considerable investigation still is required to determine the proper use of locally administered antibiotics to negotiate the balance between eradicating infection without excessively inhibiting the processes of bone regeneration.

Anti-Bacterial Agents↗
PubMed2006

3T MR imaging of the musculoskeletal system (Part I): considerations, coils, and challenges.

As 3T MR imaging systems become more wide-spread in the clinical realm, a full understanding of the opportunities for image improvement and the limitations in the applications of the signal gain is needed. It is clear that even with current coil technology, much of the gain in signal can be harnessed effectively; however, continued coil development is necessary to realize the full potential of 3T, especially with the wonderful synergy that can be achieved with the use of parallel imaging and multiple-channel phased-array extremity coils. Furthermore, despite the theoretic imaging challenges at higher field strengths (eg, susceptibility, chemical shift, SAR, pulsation, T1 time prolongation, and T2 time shortening), the techniques and methods that were discussed above can eliminate any obstacles to clinical imaging. This creates excellent opportunities to improve image quality, spatial resolution, and diagnostic accuracy in the musculo-skeletal system. From the author's experience, the superb image quality has impressed referring orthopedic surgeons, and the reduction in scan time has resulted in greater patient satisfaction and reduced anxiety.

Artifacts↗
PubMed2004

Pediatric generalized joint hypomobility and musculoskeletal complaints: a new entity? Clinical, biochemical, and osseal characteristics.

OBJECTIVE: To describe the clinical features, osseal characteristics, and collagen biochemistry in children who attended our clinic with predominantly generalized hypomobility of the joints, in combination with musculoskeletal complaints or abnormal walking, and no known syndrome or known rheumatic, neurologic, skeletal, metabolic, or connective tissue disorder was present. METHODS: Nineteen children who attended the Children's Hospital of the University Medical Center Utrecht for generalized hypomobility of the joints (mean age: 11.6; standard deviation: 2.7), in combination with musculoskeletal complaints or abnormal walking as primary complaints (symptomatic generalized hypomobility [SGH]), were compared with an age-matched reference group of 284 healthy children with normal mobility of the joints. Anthropometrics, range of joint motion, muscle strength, exercise tolerance, motor development, quantitative ultrasound measurements of bone, and degradation products of collagen in urine were studied. Collagen modifications were determined in skin biopsies of 3 children and in hypertrophic scar tissue of another child, all with SGH. RESULTS: The range of joint motion was significantly decreased in almost all joints of all 19 children and after adjustment for age, gender, body weight, and height, significantly lower than that of the reference group (-108.3 degrees; 95% confidence interval [CI]: -136.9 to -79.8). Quantitative ultrasound measurements as well as urinary pyridinoline cross-link levels were, after adjustment for possible confounders, significantly lower in SGH children (broad-band ultrasound attenuation: -9.6 dB/MHz [95% CI: -17.4 to -1.9]; speed of sound: -25.0 m/s [95% CI: -39.7 to -10.3]; hydroxylysylpyridinoline: -50.1 micromol/mmol [95% CI: -87.6 to -12.6], lysylpyridinoline: -21.3 micromol/mmol [95% CI: -34.0 to -8.6]). An increased amount of pyridinoline cross-links per collagen molecule was observed in skin and hypertrophic scar tissue, in combination with increased amounts of collagen. CONCLUSION: SGH in children is considered a new clinical entity with specific clinical characteristics and might be related to an increased stiffness of connective tissue as a result of higher amounts of collagen with increased cross-linking.

Adolescent↗
PubMed2000

Physiology of a microgravity environment invited review: microgravity and skeletal muscle.

Spaceflight (SF) has been shown to cause skeletal muscle atrophy; a loss in force and power; and, in the first few weeks, a preferential atrophy of extensors over flexors. The atrophy primarily results from a reduced protein synthesis that is likely triggered by the removal of the antigravity load. Contractile proteins are lost out of proportion to other cellular proteins, and the actin thin filament is lost disproportionately to the myosin thick filament. The decline in contractile protein explains the decrease in force per cross-sectional area, whereas the thin-filament loss may explain the observed postflight increase in the maximal velocity of shortening in the type I and IIa fiber types. Importantly, the microgravity-induced decline in peak power is partially offset by the increased fiber velocity. Muscle velocity is further increased by the microgravity-induced expression of fast-type myosin isozymes in slow fibers (hybrid I/II fibers) and by the increased expression of fast type II fiber types. SF increases the susceptibility of skeletal muscle to damage, with the actual damage elicited during postflight reloading. Evidence in rats indicates that SF increases fatigability and reduces the capacity for fat oxidation in skeletal muscles. Future studies will be required to establish the cellular and molecular mechanisms of the SF-induced muscle atrophy and functional loss and to develop effective exercise countermeasures.

Animals↗
PubMed1998

[Sports as a health risk for the locomotor system].

The analysis of sport injuries commonly takes into account well known external and internal risk factors. This brief review is dealing with some general risks related to emotional and cognitive aspects. It is emphasized that such risks play a major role in developing prevention strategies.

Adolescent↗
PubMed1997

Musicians' playing-related musculoskeletal disorders: an examination of risk factors.

Several studies have shown that playing-related musculoskeletal disorders (PRMDs) present a significant health problem for musicians. To examine physiological, psychological, and behavioral risk factors of musicians' PRMDs, data for a case-control analysis were collected from classically-trained professional and university student musicians in the Canadian province of Ontario in 1994. Two-hundred and eighty-one subjects completed a self-report questionnaire and hypermobility and hand-span measurements. Cases were identified according to an operational PRMD definition developed by musicians and health care professionals in a qualitative study. Logistic regression was used to compare data from 44 prevalent PRMD cases who had no previous history of a PRMD, and 90 controls who had never experienced a PRMD. Data from all subjects were analyzed to examine the role of a prior PRMD on the risk of a current PRMD. This study suggests that females and string players were at a higher PRMD risk. A number of other individual characteristics were also important determinants of the development of a PRMD. Warming up before and taking breaks during practice sessions protected the subject from a PRMD. Given the high proportion of musicians who experience PRMDs, prevention programs are warranted.

Adult↗
PubMed2006

Development of a tool for early referral of children and adolescents with signs and symptoms suggestive of chronic arthropathy to pediatric rheumatology centers.

OBJECTIVE: To develop an easy, time-efficient tool to identify children and adolescents with signs and symptoms suggestive of chronic arthropathies, and to evaluate its interobserver reproducibility and reliability. METHODS: The instrument used standardized techniques as required for the development of health-related instruments, targeting parents of apparently healthy children and adolescents ages 1-16 years. A multidisciplinary team was involved in the design of the instrument. RESULTS: Each health professional generated 10-15 questions addressing musculoskeletal complaints that they considered to be the most relevant. A total of 60 questions were listed. During the reduction step, each health professional scored questions from 1 to 4 according to the question's relevance. The tool comprised 12 questions and was administered to the parents of 3 groups: patients with juvenile idiopathic arthritis (JIA; n = 48), children with diffuse musculoskeletal pain (n = 39), and a healthy control group (n = 42). The JIA group achieved the highest scores, followed by the diffuse musculoskeletal pain group and the control group. Nine (18.7%) of 48 patients with JIA and 2 (5.1%) of 39 children with musculoskeletal pain had a score of 5. The interobserver reproducibility was confirmed. All 12 questions were included in the final version of the instrument. We determined that children and adolescents with a score > or =5 should be referred for a rheumatologic evaluation (cluster analysis and logistic regression). CONCLUSION: Our questionnaire seems to be a useful tool for the early detection of musculoskeletal problems in children that may need a referral for a rheumatologic evaluation.

Adolescent↗
PubMed1989

Evaluation of a new work seat for industrial sewing operations: results of three field studies.

A newly developed work seat for industrial sewing operations was compared with a traditional sewing work seat to evaluate the effectiveness of design features. The new seat was designed with special seat-pan and backrest features to accommodate the musculoskeletal geometry of a low sit-stand posture. The seat-pan consisted of a pelvic support which supported the ischial tuberosities and areas behind them, and a thigh support which maintained the thighs at a 15 degrees downward angle, resulting in a 105 degrees trunk-thigh angle. The backrest consisted of a lumbar support which preserved lumbar lordosis and a thoracic support which supported the upper back during backward leaning. The traditional work seat was similar to an office chair (i e, a large horizontal seat-pan and a wide backrest) with the exception of having a higher than normal seat-height. This investigation consisted of three studies to compare the seats: (1) A user comfort and acceptance experiment which compared the initial psychophysical responses of 50 industrial sewers when introduced to the new seat; (2) a backrest usage experiment which compared the duration of backrest use among 10 industrial sewers; and (3) a follow-up experiment to evaluate chair preference after extended use of the new seat. The results of the user comfort and acceptance experiment found that the new work seat had greater comfort and user preference; the results of the backrest usage experiment found that the new seat had greater backrest use than the traditional seat; the results of the follow-up experiment found that the preference for the new seat was maintained over time and not due to a Hawthorne Effect.

Journal Article↗
PubMed1996

Skeletal response to corticosteroid deficiency and excess in growing male rats.

The study was designed to investigate bone histomorphometric changes induced by corticosteroid deficiency and supplementation at different dose levels in the rat skeleton. Male rats were adrenalectomized (ADX) or sham-operated and divided into six groups. At 2 days after surgery, sham-operated control rats (CON + PLA) and one group of ADX rats (ADX + PLA) were implanted subcutaneously (s.c.) with placebo pellets. ADX rats in the remaining four groups (ADX + C25, ADX + C50, ADX + C100, and ADX + C300) were implanted sc with corticosterone pellets designed to release 25, 50, 100, or 300 mg of the hormone over a 60 day period. Each ADX rat was also implanted sc with an aldosterone pellet (2.5 mg) similarly designed to release its contents over the same time period. All rats were killed at 3 weeks after implantation of pellets. Terminal blood samples were collected for serum biochemistry and the proximal tibial metaphyses (PTM), tibial diaphyses, and first lumbar vertebrae (LV) were processed undecalcified for quantitative bone histomorphometry. A dose-dependent increase in serum corticosterone concentration was observed in ADX rats implanted with hormone pellets. In comparison to CON + PLA rats, ADX + PLA rats had lower cancellous bone volume associated with a stimulation in longitudinal bone growth, an increase in mineral apposition rate, and a trend for increased osteoclast and osteoblast surfaces in PTM. In contrast, cancellous bone of ADX + C25 rats was preserved at nearly the CON + PLA level. However, the higher doses of corticosterone increased cancellous bone mass, but decreased longitudinal bone growth and all indices of bone resorption and formation in a dose-dependent manner in PTM. Similar cancellous bone changes were observed in the LV of corticosterone-treated rats, with the exception of a lack of an hormonal effect on cancellous bone mass. In the tibial diaphysis, corticosterone inhibited periosteal bone formation in a dose-dependent manner, but did not affect cortical bone mass. The results indicate that corticosteroid deficiency induces cancellous osteopenia, whereas supplementation with a near physiologic dose of the hormone prevents this bone loss in ADX rats. Furthermore, corticosteroid excess inhibits bone growth and bone turnover in a dose-dependent manner, but does not induce cancellous osteopenia in growing male rats.

Adrenal Cortex Hormones↗
PubMed2006

Are natural coordinates a useful tool in modeling planar biomechanical linkages?

The paper analyzes the use of natural coordinates in modeling and simulation of musculoskeletal models of the human body. A biomechanical model of the lower extremity of the human body was constructed for the analysis. It consists of three anatomical segments described by eight natural coordinates located at the joints. The developed model was applied to solve three classic dynamics problems of human motion: inverse dynamics, direct dynamics, and static optimization. The analysis covers the raising of a leg together with; the time characteristics of the resultant net torques at the basic joints of the leg (inverse dynamics), the time histories of natural coordinates and their velocities (direct dynamics) as well as the time-varying muscle force patterns (static optimization). In order to check the numerical efficiency of modeling in the natural coordinates' environment the results were compared with the ones received through generalized coordinates. Some conclusions drawn from this comparison and final remarks referring to the biomechanical identification of the analyzed motor task were included in the paper.

Computer Simulation↗
PubMed2006

Trapezius muscle rest time during standardised computer work--a comparison of female computer users with and without self-reported neck/shoulder complaints.

Work related musculoskeletal disorders (WMSDs) in the shoulder/neck area are a common and increasing problem among European computer workers, especially women. Long-term low-level workloads with low degree of muscle rest are a potential risk factor for developing WMSDs. The purpose of the present study of female computer users (age 45-65 years) in Denmark and Sweden was to investigate if subjects with self-reported neck/shoulder complaints (cases, N=35) show less trapezius muscle relative rest time (RRT) than controls (N=44) when performing standardised short-term computer work tasks in controlled laboratory conditions. Surface electromyography (EMG) signals were recorded bilaterally from the upper trapezius muscles during a type, edit, precision and colour word stress task. Besides RRT, 10th percentile RMS values were calculated. On the average, 15 of the cases and 18 of the controls showed analysable EMG files per task. For the colour word stress task, the results showed lower RRT values and higher 10th percentile RMS amplitude levels among cases compared to controls. No such signs could be found for the other tasks performed. The present results indicate an increased motor response to a psychological stressor among subjects with self-reported neck/shoulder complaints.

Aged↗
PubMed2005

Initial presentation of childhood-onset systemic lupus erythematosus: a French multicenter study.

OBJECTIVE: To describe the clinical and laboratory manifestations of childhood-onset systemic lupus erythematosus (SLE) at presentation. STUDY DESIGN: This retrospective French multicenter study involved 155 patients in whom SLE developed before the age of 16 years. Mean patient age at onset was 11.5 +/- 2.5 years (range, 1.5-16 years). The female to male ratio was 4.5. RESULTS: The most common initial manifestations were hematologic (72%), cutaneous (70%), musculoskeletal (64%), renal (50%), and fever (58%). Thirty-two percent of children had atypical symptoms, mainly including abdominal involvement in 26 patients, which lead to negative laparotomy results for presumed appendicitis. Severe renal, neurologic, hematologic, abdominal, cardiac, pulmonary, thrombotic, and/or cutaneous manifestations occurred within the first month after the diagnosis in 40% of patients. The mean erythrocyte sedimentation rate was 72 +/- 29 mm/h, and the mean C-reactive protein value 22 +/- 21 mg/L. Antinuclear antibodies an, anti-double stranded DNA antibodies, and low C3 or C4 level were retrieved in 97%, 93%, and 78 % of patients, respectively. CONCLUSION: Initial manifestations of childhood-onset SLE are diverse and often severe. The diagnosis of SLE should be promptly considered in any febrile adolescent with unexplained organ involvement, especially when associated with an increased erythrocyte sedimentation rate.

Child↗
PubMed1992

Cross-linking connectivity in bone collagen fibrils: the COOH-terminal locus of free aldehyde.

Quantitative analyses of the chemical state of the 16c residue of the alpha 1 chain of bone collagen were performed on samples from fetal (4-6-month embryo) and mature (2-3 year old) bovine animals. All of this residue could be accounted for in terms of three chemical states, in relative amounts which depended upon the age of the animal. Most of the residue was incorporated into either bifunctional or trifunctional cross-links. Some of it, however, was present as free aldehyde, and the content increased with maturation. This was established by isolating and characterizing the aldehyde-containing peptides generated by tryptic digestion of NaB3H4-reduced mature bone collagen. We have concluded that the connectivity of COOH-terminal cross-linking in bone collagen fibrils changes with maturation in the following way: at first, each 16c residue in each of the two alpha 1 chains of the collagen molecule is incorporated into a sheet-like pattern of intermolecular iminium cross-links, which stabilizes the young, nonmineralized fibril as a whole. In time, some of these labile cross-links maturate into pyridinoline while others dissociate back to their precursor form. The latter is likely due to changes in the molecular packing brought about by the mineralization of the collagen fibrils. The resultant reduction in cross-linking connectivity may provide a mechanism for enhancing certain mechanical characteristics of the skeleton of a mature animal.

Aldehydes↗
PubMedDate not supplied

Reporting traditional Chinese medicine morbidity--A University of Technology, Sydney, project with an emphasis on developing standards for testing and reporting data.

OBJECTIVES: Morbidity in Traditional Chinese Medicine (TCM) research is an emerging field. Few studies have been published, and there is a lack of international standards for data collection and reporting. Based on the experience of developing a computerized system for patient data collection at the University of Technology, Sydney, (UTS) Acupuncture Clinic (Sydney, Australia), and reporting results from that database, a start can be made toward developing guidelines for reporting similar results from TCM clinical audits. METHODS: This study reports on data relating to 5735 patients who had undergone 29,697 treatments. Patient information is collected by a computerized database recording International Classification of Primary Care (ICPC) reason for encounter (RFE) and symptom for encounter (SFE) data and TCM tongue, pulse, diagnostic, and treatment data. Data coding is automated, and systems for reliability testing and error reporting were developed. RESULTS: UTS data has a 2.7% error rate and is within international standards of 5% error. Sixty-one-point three percent (61.3%) of patients were female and of these, 59.45 were 25-44 years of age. Musculoskeletal disorders are the most common presentation (41.4%) of all RFE, followed by general disorders (13.1%) and digestive disorders (8.1%). CONCLUSIONS: International standards must be set for TCM morbidity data collection methods and reporting. It is hoped that the methods described and reported in this paper are an initial step in the setting of such standards and that they will be adopted by other researchers. In particular, methods for testing and reporting data reliability must be adopted if TCM morbidity studies are to maintain any credibility.

Adolescent↗
PubMed2001

The anabolic activity of bone tissue, suppressed by disuse, is normalized by brief exposure to extremely low-magnitude mechanical stimuli.

It is generally believed that mechanical signals must be large in order to be anabolic to bone tissue. Recent evidence indicates, however, that extremely low-magnitude (<10 microstrain) mechanical signals readily stimulate bone formation if induced at a high frequency. We examined the ability of extremely low-magnitude, high-frequency mechanical signals to restore anabolic bone cell activity inhibited by disuse. Adult female rats were randomly assigned to six groups: baseline control, age-matched control, mechanically stimulated for 10 min/day, disuse (hind limb suspension), disuse interrupted by 10 min/day of weight bearing, and disuse interrupted by 10 min/day of mechanical stimulation. After a 28 day protocol, bone formation rates (BFR) in the proximal tibia of mechanically stimulated rats increased compared with age-matched control (+97%). Disuse alone reduced BFR (-92%), a suppression only slightly curbed when disuse was interrupted by 10 min of weight bearing (-61%). In contrast, disuse interrupted by 10 min per day of low-level mechanical intervention normalized BFR to values seen in age-matched controls. This work indicates that this noninvasive, extremely low-level stimulus may provide an effective biomechanical intervention for the bone loss that plagues long-term space flight, bed rest, or immobilization caused by paralysis.

Animals↗