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Peripheral nerve entrapments, repetitive strain disorder, occupation-related syndromes, bursitis, and tendonitis.

Physiologically, peripheral nerve entrapments show focal slowing, and histologically, segmental demyelination and remyelination occur. Entrapment neuropathies result from direct mechanical injury (eg, chronic low pressure or friction in the carpal tunnel syndrome). Compartment syndromes occur when locally increased pressure within a closed muscle compartment compromises local circulation and neuromuscular function. Perioperative nerve lesions result from acute trauma to susceptible individual nerves during surgical procedures. Overuse syndromes belong to the broad clinical group of repetitive strain disorders, and are injuries caused by cumulative effects on tissues of repetitive physical stress that exceeds physiologic limits (eg, occupation-related focal nerve compressions in certain musicians). Current utilization of neurophysiologic electrodiagnostic studies and neuroimaging technology, such as magnetic resonance imaging, facilitates diagnosis and appropriate therapy in many of the disorders mentioned in this paper.

Bursitis↗

Cumulative industrial trauma as an etiology of seven common disorders in the foot and ankle: what is the evidence?

The concept of cumulative industrial trauma as an etiology of orthopaedic disease has recently generated considerable attention in both the medical and legal communities. To clarify the current state of knowledge about the issue as applied to the foot and ankle, we critically reviewed the literature on the etiology of seven foot and ankle disorders commonly involved in compensation litigation in the practice of the senior author: hallux valgus, interdigital neuroma, tarsal tunnel syndrome, lesser toe deformity, heel pain, adult acquired flatfoot, and foot and ankle osteoarthritis. Koch's postulates were appropriately modified and used as a logistic framework to analyze the potential for cumulative industrial trauma to cause foot pathology. In none of the disorders analyzed could cumulative industrial trauma reasonably satisfy even one of Koch's three postulates. We conclude there is currently no unequivocal literature support upon which to invoke cumulative industrial trauma as a clear etiology of these disorders of the adult foot and ankle. The superb evolutionary adaptation of the human foot to prolonged ambulation and the absence of industrial demands that significantly differ from this task likely account for this dramatically reduced vulnerability of the foot to industrial repetitive motion disorders compared to the upper extremity.

Ankle Injuries↗

Nonspecific work-related upper extremity disorders.

The incidence of work-related repetitive motion disorders has increased rapidly during the past 20 years. While it appears that psychosocial factors have contributed largely to the increasing incidence of these disorders, ergonomic factors and other medical conditions also play a role. The most common single diagnostic category of work-related upper extremity disorders is likely to be nonspecific. The presentation and physical findings in patients with these regional myofascial pain syndromes are often characteristic. In most cases, no measurable tissue damage or inflammatory response is found. A traditional medical approach that reduces risk factors, provides symptomatic treatment and utilizes rehabilitative techniques is usually effective in maintaining productivity in patients with nonspecific repetitive motion disorders and, thus, minimizes the personal and economic impact of these disorders.

Arm Injuries↗

A placebo controlled crossover trial of liquid fluoxetine on repetitive behaviors in childhood and adolescent autism.

Repetitive behaviors are a core symptom domain in autism that has been linked to alterations in the serotonin system. While the selective serotonin-receptive inhibitor fluvoxamine has been shown to be effective in adults with autism, as yet no published placebo controlled trials with these agents document safety and efficacy in children with autism. This study examines the selective serotonin reuptake inhibitor liquid fluoxetine in the treatment of repetitive behaviors in childhood and adolescent autism spectrum disorders (ASDs). In total, 45 child or adolescent patients with ASD were randomized into two acute 8-week phases in a double-blind placebo-controlled crossover study of liquid fluoxetine. Study design included two randomized 8-week fluoxetine and placebo phases separated by a 4-week washout phase. Outcome measures included measures of repetitive behaviors and global improvement. Low-dose liquid fluoxetine (mean final dose: 9.9+/-4.35 mg/day) was superior to placebo in the treatment of repetitive behaviors by CY-BOCS compulsion scale. The effect size was in the moderate to large range, and the doses used were low. Liquid fluoxetine was only slightly, and not significantly, superior to placebo on CGI autism score partially due to a phase order effect. However, fluoxetine was marginally superior to placebo on a composite measure of global effectiveness. Liquid fluoxetine did not significantly differ from placebo on treatment emergent side effects. Liquid fluoxetine in low doses is more effective than placebo in the treatment of repetitive behaviors in childhood autism. Limitations include small sample size and the crossover design of the study. Further replication and long-term maintenance trials are needed.

Administration, Oral↗

A literature search strategy using the broad topic of carpal tunnel syndrome/cumulative trauma disorders.

Searching the periodical literature for information relevant to a specific topic or diagnosis is an activity that must be undertaken by most therapists at one time or another. A literature search can be incomplete and performing it excessively time consuming unless a carefully planned search strategy is employed. This article presents the process and the results of a literature search of the broad topic of carpal tunnel syndrome/cumulative trauma disorders. The search involved both computerized and printed indexes.

Carpal Tunnel Syndrome↗

Too much of a good thing: overuse injuries of the knee.

Overuse injuries constitute a distinct group of abnormalities arising from excessive stress, repeated microtrauma, inadequate injury repair, or pathologic motion of the knee. Chronic pain resulting from overuse injuries may progress to the point that the patient can no longer perform the inciting activity. MR image appearances of the more common overuse syndromes involving the soft tissues surrounding the knee are presented, pertinent anatomic features are reviewed, and the role of MR imaging in patient management in these disorders is discussed.

Cumulative Trauma Disorders↗

Upper extremity disorders in women.

Carpal tunnel syndrome, Colles' fracture, and osteoarthritis of the basilar joint of the thumb are only three of the many upper extremity conditions that preferentially affect women. With more and more women entering the workplace, these conditions become more disruptive of patients' lifestyles and even may be increasing in incidence. Orthopaedic surgeons traditionally have focused on the surgical treatment of patients with these conditions, but it is becoming increasingly clear that surgeons also must focus on delineating pathophysiology to better identify those individuals at risk and help prevent these potentially disabling disorders.

Carpal Tunnel Syndrome↗

Menstrual irregularity and stress fractures in collegiate female distance runners.

From 240 questionnaires, we investigated the prevalence of stress fractures in competitive collegiate female long distance runners and its relationship to menstrual history. The runners were divided into three groups according to their menstrual history: very irregular 69/240 (0 to 5 menses/year), irregular 51/240 (6 to 9 menses/year), and regular 120/240 (10 to 13 menses/year). Stress fractures occurred in 49% of the very irregular runners, 39% of the irregular runners, and 29% of the regular runners. The majority of the stress fractures occurred in the tibia. Runners who had never used oral contraceptives were over twice as likely to have had a stress fracture when compared with runners who had used oral contraceptives for more than 1 year. These data suggest that female distance runners who have a history of irregular or absent menses and who have never used oral contraceptives may be at an increased risk for developing a stress fracture. When amenorrheal runners were separated from the very irregular group, an alarming trend was noted in eating behavior disorders. Forty-seven percent of the amenorrheal group, 20% of the one to five menses/year group, 10% of the irregular group, and 7% of the regular group admitted to an eating behavior disorder.

Adult↗

The traction apophysitises.

The traction apophysitises are one of the frequently encountered overuse injuries to children. Although known for many years and classed as osteochondroses, the traumatic origin of these disorders--from repetitive microtrauma--is now receiving wider acceptance. Discussion of the assessment, treatment, and prevention of these disorders is included.

Adolescent↗