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Results for “Musculoskeletal Abnormalities”

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PubMedDate not supplied

Pain-related fear, lumbar flexion, and dynamic EMG among persons with chronic musculoskeletal low back pain.

OBJECTIVES: The purpose of this study was to examine the relationship between pain-related fear, lumbar flexion, and dynamic EMG activity among persons with chronic musculoskeletal low back pain. It was hypothesized that pain-related fear would be significantly related to decreased lumbar flexion and specific patterns of EMG activity during flexion and extension. STUDY DESIGN: Data was obtained from subjects who, on a single day, completed self-report measures of pain and pain-related fear, and were interviewed to determine demographic and pain information. Subjects then underwent a dynamic EMG evaluation for which they were asked to stand, then bend forward as far as possible, stay fully flexed, and return to standing. Lumbar EMG and angle of flexion were recorded during this time. A flexion-relaxation ratio (FRR) was computed by comparing maximal EMG while flexing to the average EMG in full flexion. SUBJECTS: Seventy-six persons with chronic musculoskeletal low back pain. RESULTS: Zero-order correlations indicated that pain-related fear was significantly related to reduced lumber flexion (r = -0.55), maximum EMG during flexion (r = -0.38) and extension (r = -0.51), and the FRR (r = -0.40). When controlling for pain and demographic factors, pain-related fear continued to be related to reduced lumbar flexion. Using a path-analytic model to examine whether angle of flexion mediated the relationship between fear and EMG activity, the models examining maximal EMG during flexion and extension supported the notion that pain-related fear influences these measures indirectly through its association with decreased range of motion. Conversely, pain-related fear was independently related to higher average EMG in full flexion, while angle of flexion was not significantly related. Pain-related fear was directly related to a smaller FRR, as well as indirectly through angle of flexion. CONCLUSIONS: Pain-related fear is significantly associated with reduced lumbar flexion, greater EMG in full flexion, and a smaller FRR. The relationship between pain-related fear and EMG during flexion and extension appears to be mediated by reduced lumbar flexion. These results suggest that pain-related fear is directly associated with musculoskeletal abnormalities observed among persons with chronic low back pain, as well as indirectly through limited lumbar flexion. These musculoskeletal abnormalities as well as limited movement may be involved in the development and maintenance of chronic low back pain. In addition, changes in musculoskeletal functioning and flexion associated with pain-related fear may warrant greater attention as part of treatment.

Adult↗

PubMed1995

Nontraumatic pediatric musculoskeletal MR imaging: comparison of conventional and fast-spin-echo short inversion time inversion-recovery technique.

PURPOSE: To compare conventional short inversion time inversion-recovery (STIR) with fast spin-echo (FSE) STIR techniques to evaluate suspected nontraumatic musculoskeletal abnormalities. MATERIALS AND METHODS: Thirty STIR and FSE-STIR examinations in 26 pediatric patients with suspected nontraumatic musculoskeletal abnormalities were prospectively evaluated. Qualitative (subjective) and quantitative (five-point rank score) analyses of the images were performed. RESULTS: FSE-STIR was faster than STIR (mean, 2 minutes 25 seconds and 6 minutes 35 seconds, respectively). Fat suppression was slightly better with STIR. Image degradation due to motion was judged similar. Lesion contrast to muscle was slightly better with STIR than FSE-STIR, and lesion contrast to fat was equivalent. Qualitatively, lesion conspicuity was similar: All lesions were seen with both techniques. CONCLUSION: FSE-STIR can replace STIR when an inversion-recovery fat-suppression sequence is desired. Considerable imaging time is saved.

Adolescent↗

PubMed1989

Computed tomographic features of renal osteodystrophy.

The spectrum of musculoskeletal abnormalities seen on routine computed tomographic (CT) examinations of five patients with renal osteodystrophy are described. CT findings included multiple brown tumors, osteitis fibrosa cystica, abnormal sacroiliac joints, periarticular tumoral calcifications, prominent Schmorl's nodes, and slipped capital femoral epiphyses. In this small group of patients, the musculoskeletal abnormalities ranged from the subtle to the dramatic. Although CT examination is rarely used as a screening test for renal osteodystrophy, it is important to be familiar with its many appearances on CT, in order not to confuse the CT changes of renal osteodystrophy with metastatic disease, osteomyelitis, or inflammatory arthritis.

Adolescent↗

PubMed2006

Musculoskeletal patterns in patients with voice disorders.

This study correlated the ear, nose, and throat (ENT) and physiotherapy input on 26 patients who presented with voice problems and were found by the ENT surgeon to have a degree of musculoskeletal issues. It also looked for patterns of musculoskeletal findings. Although all patients referred were found by the physiotherapist to have musculoskeletal abnormalities, the correlation proved to be excellent among the subgroup of performers, but only fair-to-good among the other voice professionals. Certain patterns of musculoskeletal abnormalities were frequently encountered, including a high held larynx, a shortening or contraction of the stylohyoid and sternocleidomastoid muscles, and a weak deep flexor mechanism. In this small group, most patients seemed to improve, although it must be noted that management was not limited to physiotherapy. In summary, physiotherapy input proved helpful in the evaluation and management of this group of patients presenting with voice problems.

Adult↗

PubMed1998

Genetic diseases with rheumatic manifestations in children.

Many nonrheumatic diseases of childhood present with musculoskeletal abnormalities. A significant proportion of these disorders have a genetic basis, many involving defects in structural proteins of the connective tissue. Chief among these are collagen mutations resulting in spondyloepiphyseal dysplasias and Ehlers-Danlos syndrome, as well as fibrillin defects associated with Marfan's syndrome. A variety of other chromosomal anomalies are associated with musculoskeletal abnormalities, and may result from as yet unidentified connective tissue defects. In addition, metabolic diseases may result in findings of hyper- or hypomobility, or carpal tunnel syndrome. Helpful clinical clues to identify nonrheumatologic musculoskeletal disease, as well as recent advances in our understanding of the genetic basis of several of these disorders, are reviewed here.

Child, Preschool↗

PubMed2005

Upper-extremity phocomelia reexamined: a longitudinal dysplasia.

BACKGROUND: In contrast to longitudinal deficiencies, phocomelia is considered a transverse, intercalated segmental dysplasia. Most patients demonstrate severe, but not otherwise classifiable, upper-extremity deformities, which usually cannot be placed into one of three previously described phocomelia groups. Additionally, these phocomelic extremities do not demonstrate true segmental deficits; the limb is also abnormal proximal and distal to the segmental defect. The purpose of this investigation was to present evidence that upper-extremity abnormalities in patients previously diagnosed as having phocomelia in fact represent a proximal continuum of radial or ulnar longitudinal dysplasia. METHODS: The charts and radiographs of forty-one patients (sixty extremities) diagnosed as having upper-extremity phocomelia were reviewed retrospectively. On the basis of the findings on the radiographs, the disorders were categorized into three groups: (1) proximal radial longitudinal dysplasia, which was characterized by an absent proximal part of the humerus, a nearly normal distal part of the humerus, a completely absent radius, and a radial-sided hand dysplasia; (2) proximal ulnar longitudinal dysplasia, characterized by a short one-bone upper extremity that bifurcated distally and by severe hand abnormalities compatible with ulnar dysplasia; and (3) severe combined dysplasia, with type A characterized by an absence of the forearm segment (i.e., the radius and ulna) and type B characterized by absence of the arm and forearm (i.e., the hand attached to the thorax). RESULTS: Twenty-nine limbs in sixteen patients could be classified as having proximal radial longitudinal dysplasia. Systemic medical conditions such as thrombocytopenia-absent radius syndrome were common in those patients, but additional musculoskeletal conditions were rare. Twenty limbs in seventeen patients could be classified as having proximal ulnar longitudinal dysplasia. Associated musculoskeletal abnormalities, such as proximal femoral focal deficiency, were common in those patients. Eleven limbs in ten patients were identified as having severe combined dysplasia, which was type A in seven of them and type B in four. Four patients with severe combined dysplasia had congenital cardiac anomalies, and four had associated musculoskeletal abnormalities. Three of the four patients with the type-B disorder had a contralateral ulnar longitudinal dysplasia. CONCLUSIONS: We propose that cases previously classified as upper-extremity phocomelia represent a spectrum of severe longitudinal dysplasia, as none of the sixty extremities that we studied demonstrated a true intercalary deficiency. These findings have both developmental and genetic implications.

Child↗

PubMed2006

Evaluation of noncardiac chest pain: diagnostic approach, coping strategies and quality of life.

BACKGROUND: Approximately 30% of coronary angiograms are negative for significant coronary artery disease and patients are classified as having noncardiac chest pain (NCCP). So far, no systematic diagnostic approach to patients with NCCP investigating for possible esophageal, psychiatric and musculoskeletal abnormalities exists. Furthermore, coping strategies and quality of life are poorly characterized in NCCP patients. METHODS AND RESULTS: A simple diagnostic approach was applied to 37 consecutive patients (21 female, age 61+/-12 years) with angina-like chest pain and normal coronary angiograms. Twenty-one patients were found to suffer from psychiatric disorders (combined anxiety (A) and depression (D): n = 10, D: n = 5, panic disorder (P): n = 3, somatization (S): n = 3) based on their Symptom Check List 90 scores and according to DSM IV-R criteria. Sixteen patients had an improvement of their chest pain after oral esomeprazole (40 mg for 7 days) and were therefore diagnosed with gastroesophageal reflux disease (GERD). Musculoskeletal abnormalities including chostochondritis (n = 4), thoracic spondylodynia (n = 1), and fibromyalgia (n = 1) were found in six patients. Multiple diagnoses were confirmed in six patients with GERD (additional D n = 3, additional musculoskeletal disorders n = 3). Patients with psychiatric disorders showed a diminished quality of life (MOS-SF 36), more frequent chest pain, less treatment satisfaction (Seattle Angina Questionnaire) and more rumination (Trier Coping Scales) compared to GERD patients. CONCLUSIONS: Immediate combined psychiatric and orthopedic evaluation as well as esomeprazole administration following exclusion of coronary artery disease may confirm the causes of noncardiac chest pain. Identification of psychiatric disorders seems especially warranted since these patients experience a reduced quality of life and exhibit pathologic coping strategies.

Adaptation, Psychological↗

PubMed2006

HRAS mutation analysis in Costello syndrome: genotype and phenotype correlation.

Costello syndrome is a rare condition comprising mental retardation, distinctive facial appearance, cardiovascular abnormalities (typically pulmonic stenosis, hypertrophic cardiomyopathy, and/or atrial tachycardia), tumor predisposition, and skin and musculoskeletal abnormalities. Recently mutations in HRAS were identified in 12 Japanese and Italian patients with clinical information available on 7 of the Japanese patients. To expand the molecular delineation of Costello syndrome, we performed mutation analysis in 34 North American and 6 European (total 40) patients with Costello syndrome, and detected missense mutations in HRAS in 33 (82.5%) patients. All mutations affected either codon 12 or 13 of the protein product, with G12S occurring in 30 (90.9%) patients of the mutation-positive cases. In two patients, we found a mutation resulting in an alanine substitution in position 12 (G12A), and in one patient, we detected a novel mutation (G13C). Five different HRAS mutations have now been reported in Costello syndrome, however genotype-phenotype correlation remains incomplete.

Abnormalities, Multiple↗

PubMedDate not supplied

Fast spin echo STIR imaging.

OBJECTIVE: Our goal was to evaluate the image quality, contrast characteristics, and possible clinical utility of STIR images obtained using a fast SE (FSE) technique. MATERIALS AND METHODS: The signal and contrast characteristics of FSE STIR images were evaluated using a lipid/water phantom and normal volunteers. Based upon these results, optimal FSE STIR imaging parameters were chosen. Conventional STIR and FSE STIR images were then obtained (while maintaining an equal number of section locations between the two sequences) in a series of 14 patients with known musculoskeletal abnormalities. These images were compared side by side by two experienced MR radiologists for image quality and lesion detection. RESULTS: There were no statistically significant differences between the FSE STIR images and conventional STIR images in lesion detection, image quality, motion artifact, or final diagnosis. CONCLUSION: STIR imaging provides optimal contrast for detection of many pathologic abnormalities. This is especially true for musculoskeletal tumors and infection. The long imaging time and reduced number of sections obtainable with conventional SE (CSE) STIR sequences limit their routine use. Our results show that FSE STIR images of the musculoskeletal system can be obtained up to seven times more rapidly than CSE STIR images without compromising lesion detection or image quality.

Adipose Tissue↗

PubMed1989

Moebius syndrome: animal model--human correlations and evidence for a brainstem vascular etiology.

The Moebius syndrome consists of congenital seventh nerve palsy associated with other cranial nerve palsies, most often of the sixth, and/or musculoskeletal abnormalities. A retrospective study of the events of pregnancy in 15 cases was undertaken, after a rat animal model showed that abdominal trauma, uterine vessel clamping and handling and hyperthermia caused bilateral brainstem lesions in fetal rats. Eight of the 15 cases surveyed included a possible associated event during pregnancy; hyperthermia, previous uterine surgery, electric shock, failed abortion, prolonged rupture of the membranes, or alcohol abuse. These events can be correlated with animal studies that involve acute uteroplacental vascular insufficiency produced by a variety of methods. The cause of most cases of Moebius syndrome is probably a transient ischemic/hypoxic insult to the fetus.

Abnormalities, Multiple↗

PubMed2006

HRAS mutations in Costello syndrome: detection of constitutional activating mutations in codon 12 and 13 and loss of wild-type allele in malignancy.

Costello syndrome (CS) is a complex developmental disorder involving characteristic craniofacial features, failure to thrive, developmental delay, cardiac and skeletal anomalies, and a predisposition to develop neoplasia. Based on similarities with other cancer syndromes, we previously hypothesized that CS is likely due to activation of signal transduction through the Ras/MAPK pathway [Tartaglia et al., 2003]. In this study, the HRAS coding region was sequenced for mutations in a large, well-characterized cohort of 36 CS patients. Heterogeneous missense point mutations predicting an amino acid substitution were identified in 33/36 (92%) patients. The majority (91%) had a 34G --> A transition in codon 12. Less frequent mutations included 35G --> C (codon 12) and 37G --> T (codon 13). Parental samples did not have an HRAS mutation supporting the hypothesis of de novo heterogeneous mutations. There is phenotypic variability among patients with a 34G --> A transition. The most consistent features included characteristic facies and skin, failure to thrive, developmental delay, musculoskeletal abnormalities, visual impairment, cardiac abnormalities, and generalized hyperpigmentation. The two patients with 35G --> C had cardiac arrhythmias whereas one patient with a 37G --> T transversion had an enlarged aortic root. Of the patients with a clinical diagnosis of CS, neoplasia was the most consistent phenotypic feature for predicating an HRAS mutation. To gain an understanding of the relationship between constitutional HRAS mutations and malignancy, HRAS was sequenced in an advanced biphasic rhabdomyosarcoma/fibrosarcoma from an individual with a 34G --> A mutation. Loss of the wild-type HRAS allele was observed, suggesting tumorigenesis in CS patients is accompanied by additional somatic changes affecting HRAS. Finally, due to phenotypic overlap between CS and cardio-facio-cutaneous (CFC) syndromes, the HRAS coding region was sequenced in a well-characterized CFC cohort. No mutations were found which support a distinct genetic etiology between CS and CFC syndromes.

Abnormalities, Multiple↗

PubMedDate not supplied

Comparison of muscle strength and flexibility between the preferred and non-preferred leg in English soccer players.

Most soccer players have a favoured foot for kicking the ball, and it is believed that this preference may lead to an asymmetry in the strength and flexibility of the lower extremities. This study was designed to determine whether asymmetry in strength and flexibility are present in the legs of soccer players.Forty-one elite and sub-elite soccer players (age 23.4 +/- 3.8 years; height 1.81 +/- 0.06 m; body mass 81.7 +/- 9.9 kg) were studied (data are presented as mean +/- SD). The dynamic strength of knee flexors (hamstrings) and knee extensors (quadriceps) was measured using an isokinetic dynamometer at angular velocities of 1.05, 2.09, 5.23 rad/s (in a concentric mode) and 2.09 rad/s (in an eccentric mode). The concentric strength ratio (hamstrings(conc)/quadriceps(conc)) and the dynamic control ratio (hamstrings(ecc)/quadriceps(conc)) were computed. Hip joint flexibility (in flexion) was measured using a goniometer.A significant difference between the preferred and non-preferred leg was found in the knee flexors at 2.09 rad/s (119 +/- 22 versus 126 +/- 24 Nm; P < 0.05) and for the dynamic control ratio (0.79 +/- 0.13 versus 0.84 +/- 0.16 Nm; P < 0.05). In both cases the knee flexors of the preferred leg were weaker than those of the non-preferred leg. A total of 28 of the 41 players (68%) had significant musculoskeletal abnormality (imbalance >10%) in one or more specific muscle groups. No significant differences were found in flexibility of the hip joint between the preferred and non-preferred leg (P > 0.05). It is concluded that the lower strength of the knee flexor muscles of the preferred leg may be associated with the differential use of these muscle during the kicking action and thus constitutes a unique training effect associated with soccer. This in turn can lead to muscular imbalance which is generally regarded as an injury risk factor.

Adult↗

PubMed2000

Marfan syndrome and fibrillin disorders.

Marfan syndrome is the second most common inherited connective tissue disorder after osteogenesis imperfecta. Musculoskeletal abnormalities are at the forefront of the clinical picture and count among the major diagnostic criteria for Marfan syndrome, together with cardiovascular and ocular system involvement. Early diagnosis is of the utmost importance since preventive measures significantly increase life expectancy and prevent the occurrence of impairments and disabilities. Marfan syndrome is due to mutations within the fibrillin-1 gene, which is the main protein of the microfibril network. Microfibrils play a crucial role in the trophicity and function of elastic tissue. Multidisciplinary management of the patients and their families is vital.

Extracellular Matrix Proteins↗

PubMed1996

Nonlinear dynamics stability measurements of locomotion in healthy greyhounds.

OBJECTIVE: To characterize normal locomotion of dogs, using nonlinear dynamic stability measurements to analyze two-dimensional kinematic data. ANIMALS: 5 healthy, orthopedically sound Greyhounds. PROCEDURE: Data were studied by sequentially constructing phase plane portraits from the angular velocity and displacement data; creating first-return (Poincaré) maps from periodically sampled data; and evaluating the dynamic stability of the gait, using Floquet multipliers calculated from the assembled data. Retroreflective markers were placed on the left craniodorsal aspect of the iliac spine, greater trochanter, lateral epicondyle of the femur, lateral malleolus, and fifth metatarsophalangeal joint. Each dog was repeatedly led at a trot along a 10-m runway. Data were collected, using a video-based, two-dimensional motion measurement and analysis system. Dogs were considered a nonlinear system and were represented by the joint angular displacements and velocities. Phase plane portraits and first-return maps were constructed to analyze the smoothed data. The Floquet theory was then used to investigate the local stability of critical points of the discrete map. RESULTS: The femorotibial joint had the highest angular velocity, ranging from -2.5 to 4.9 radians/s. Tarsal joint velocity ranged from -2.7 to 3.2 radians/s, and the coxofemoral angle had the lowest range of -2.2 to 2.2 radians/s. The points on the first-return maps converged to the 45 degrees diagonal line and were clustered together. The largest Floquet multiplier averaged 0.452, which characterized the stability of this population and will be used to draw a comparison between this and future work. CONCLUSIONS: Nonlinear dynamics can be effectively used to analyze two-dimensional kinematic data from animal models to quantify the dynamic stability of animal locomotion through precise mathematical measurements. The method is general and can be applied to normal or abnormal gaits. CLINICAL RELEVANCE: Point mapping and quantitative measurement of joint movement have several advantages associated with the application to animal and human locomotion. The clinician can visually distinguish the normal gait pattern from abnormal patterns to assist in the diagnosis of musculoskeletal abnormalities (diseases).

Animals↗

PubMed2005

Clinical and histopathological findings in Bannayan-Riley-Ruvalcaba syndrome.

Bannayan-Riley-Ruvalcaba syndrome is a rare autosomal dominant genodermatosis with the classical triad of macrocephaly, genital lentiginosis, and intestinal polyposis. Characteristic mucocutaneous manifestations include vascular malformations, lipomatosis, speckled lentiginosis of the penis or vulva, facial verrucae-like or acanthosis nigricans-like lesions, and multiple acrochordons of the neck, axilla, and groin. We present a case of Bannayan-Riley-Ruvalcaba syndrome with macrocephaly, abnormal facies, lipoma, tender and painful arteriovenous hemangiomas, lymphangiokeratomas, musculoskeletal abnormalities, and localized myopathy. We also describe previously unreported findings, including peripheral neuropathy, punctate cystic changes in acral tubular bones, and enostosis of talus. Bannayan-Riley-Ruvalcaba syndrome needs recognition by dermatologists because affected patients may present with mucocutaneous and subcutaneous lesions that may simulate other dermatological disorders.

Abnormalities, Multiple↗

PubMed2002

Monopharmacologic general anaesthesia with sevoflurane in paediatric patient with Prader-Willi syndrome.

Prader-Willi syndrome (PWS) is a genetic disease caused by a loss of paternal genes located in chromosome 15. Children affected by this syndrome often have preterm delivery; during childhood the hallmarks are: severe infantile hypotonia and feeding problems. Afterward, neurologic manifestations, endocrine signs and dysmetabolic abnormalities are usually seen together with craniofacial manifestations and musculoskeletal abnormalities. Obesity causes sleep abnormalities including sleep apnea. The case we present is of a 5 year old child (CA) scheduled for strabismus surgery. The child has a lot of typical (PWS) signs. A number of anaesthesiologic problems are associated with (PWS). Some of them relate to obesity, others to facial dysmorphism. Moreover, the syndrome may give a prolonged and exaggerated response to every sedative drug. P.W.S. is also characterized by thermoregulatory disorders. Sleep apnea occurs often. Considering all these problems, we planned a monopharmacologic anaesthesiologic procedure using sevoflurane.

Anesthesia, Inhalation↗

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↗

PubMed2003

Rehabilitation of the short pelvic floor. II: Treatment of the patient with the short pelvic floor.

Several urogynecologic syndromes are associated with the clinical finding of a short, painful, tender and weak pelvic floor and a variety of connective tissue abnormalities. Techniques for rehabilitation include the avoidance of perpetuating factors, rehabilitation of extrapelvic musculoskeletal abnormalities, the use of manual techniques and needling to promote resolution of connective tissue problems, closure of any diastasis recti, and transvaginal/transrectal manual release of muscular trigger points and contractures. Therapy can be facilitated by pudendal or epidural nerve block. Patients contribute to their success through home maintenance programs.

Acupuncture Therapy↗