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PubMed2004

Musculoskeletal ultrasound--a state of the art review in rheumatology. Part 1: Current controversies and issues in the development of musculoskeletal ultrasound in rheumatology.

As we begin the 21st century, musculoskeletal ultrasound (MSUS) is routinely used by an increasing number of rheumatologists throughout Europe and there is a growing interest in the application of MSUS in rheumatological practice in the UK. MSUS allows high-resolution, real-time imaging of articular and periarticular structures and has the advantages of being non-radioactive, inexpensive, portable, highly acceptable to patients and repeatable. There are a number of critical issues that need to be addressed in order to develop the role of MSUS within rheumatology. These include issues of equipment costs, training and certification and the relationship of rheumatologists and radiologists in advancing the field of MSUS. Rheumatologists must demonstrate the relevance of MSUS in their clinical practice through high-quality research. Emerging technologies such as power Doppler and 3D imaging will further improve imaging capabilities and the range of clinical applications of MSUS systems. This paper reviews how MSUS in rheumatology has evolved and the controversies and issues that rheumatologists must now address in developing MSUS as an indispensable, everyday clinical tool.

Clinical Competence↗
PubMed1991

Workplace ergonomic factors and the development of musculoskeletal disorders of the neck and upper limbs: a meta-analysis.

In the past 10 years there has been growing awareness among occupational health professionals worldwide of the large burden of illness associated with musculoskeletal disorders of the neck and upper limbs. It has been suggested that these disorders are associated with highly repetitive work and are due, at least in part, to ergonomic factors. This review examines the epidemiologic evidence of the relationship between workplace ergonomic factors such as repetition, force, static muscle loading, and extreme joint position and the development of muscle, tendon, and nerve entrapment disorders of the neck and upper limbs of exposed workers. An extensive search for relevant studies was undertaken. Of 54 potentially relevant studies identified, three met the a priori inclusion criteria. The validity of these studies was assessed, and one study was found to have major flaws. Criteria to demonstrate causality were also applied and were met in the most rigorously conducted study. When the results of these studies are compared and aggregated where appropriate, they provide strong evidence of a causal relationship between repetitive, forceful work and the development of musculoskeletal disorders of the tendons and tendon sheaths in the hands and wrists and nerve entrapment of the median nerve at the carpal tunnel. The comparison of exposed to controls for hand/wrist tendinitis gives an unadjusted common odds ratio of 9.1 (95% CI 4.9-16.2). The adjusted odds ratio for carpal tunnel syndrome is 15.5 (95% CI 1.7-141.5) based on the most rigorous study.

Activities of Daily Living↗
PubMed1997

In vivo validation of whole body composition estimates from dual-energy X-ray absorptiometry.

We validated whole body composition estimates from dual-energy X-ray absorptiometry (DEXA) against estimates from a four-component model to determine whether accuracy is affected by gender, race, athletic status, or musculoskeletal development in young adults. Measurements of body density by hydrostatic weighing, body water by deuterium dilution, and bone mineral by whole body DEXA were obtained in 172 young men (n = 91) and women (n = 81). Estimates of body fat (%Fat) from DEXA (%FatDEXA) were highly correlated with estimates of body fat from the four-component model [body density, total body water, and total body mineral (%Fatd,w,m); r = 0.94, standard error of the estimante (SEE) = 2.8% body mass (BM)] with no significant difference between methods [mean of the difference +/- SD of the difference = -0.4 +/- 2.9 (SD) % BM, P = 0.10] in women and men. On the basis of the comparison with %Fatd,w,m, estimates of %FatDEXA were slightly more accurate than those from body density (r = 0.91, SEE = 3.4%; mean of the difference +/- SD of the difference = -1.2 +/- 3.4% BM). Differences between %FatDEXA and %Fatd,w,m were weakly related to body thickness, as reflected by BMI (r = -0.34), and to the percentage of water in the fat-free mass (r = -0.51), but were not affected by race, athletic status, or musculoskeletal development. We conclude that body composition estimates from DEXA are accurate compared with those from a four-component model in young adults who vary in gender, race, athletic status, body size, musculoskeletal development, and body fatness.

Absorptiometry, Photon↗
PubMed1976

Effect of chronic centrifugation on the structural development of the musculoskeletal system of the rat.

25 female Sprague-Dawley rats were placed on a 3.66 m radius centrifuge and subsequently exposed almost continuously for 810 days to 2.76 G. Compared to normal gravity controls, the most noticeable effect of hypergravity was the inhibition of growth of the centrifuged animals. The rats exposed to hypergravity showed on average a smaller femur length (-6.5%), a smaller cross-sectional area (-7.7%, when expressed linearly, i. e. (area/pi)1/2), and smaller outer and inner cross-sectional radii (linearly -9.3% and -12.3%) at the mid-shaft of the femoral bones. The growth inhibition of 3 hind-leg muscles was on average significantly less ranging from (-3.5% to -4.1%), compared to the growth inhibition of the linear dimension of the femur. Statistically there was no difference in the slope and elevation of the regression of the square-root of the cross-sectional area divided by pi on the length of the femur between centrifuged animals and their 16 age matched controls. In the weight control group of 24 animals, comprised of 34,74, and 102 day old rats, the corresponding regression line was parallel and lower in elevation by -12.8%, compared to the line for the centrifuged and age control groups. But, compared to the regression derived from all control animals ranging from 34 to 840 days of age, the cross-sectional area at the mid-shaft of the femur was 8.4% greater in the rats exposed to 2.76 G for 810 days. The slopes of the regression of the outer radius at mid-shaft on the length of the femur were the same in the centrifuged group and in the weight and age control groups of animals. But, the regression lines differed in elevation by -4.4% on average between the centrifuged and age control animals. The line for the regression of the inner radius at the mid-shaft on the length of the femur was parallel and lower in elevation by -7.6% in the centrifuged animals compared to the line for the age controls. But, compared to all control animals living at normal gravity, the outer radius was increased by 3.0% and the inner radius was decreased by 5.7% in the animals exposed to 2.76 G for 810 days. Since the centrifuged animals were all 840 days old, while the controls were from 34 to 840 days old, only further experiments comparing centrifuged and control animals of the same age at various growth stages will be able to furnish evidence for an unambiguous bone hypertrophy. The regressions of the cube-root of body weight on length of the femur deviate significantly in the 3 groups of animals. The heavier rats of the age control group have relatively shorter femurs than the lighter animals. The opposite applies to the centrifuged and the weight control groups of rats. Although the rats on the centrifuge are markedly smaller in overall body size than the controls, they exhibit on average the same absolute muscle weights as the animals at earth gravity, if rats of the same overall body size are compared...

Animals↗
PubMed1994

Replacement laminoplasty in selective dorsal rhizotomy: possible protection against the development of musculoskeletal pain.

The authors present a retrospective review of 35 patients who underwent selective dorsal rhizotomy between 1990 and 1992. The first 15 patients underwent laminectomy from L1 to the sacrum without replacement of the posterior elements. The subsequent 20 patients had the laminae replaced during wound closure. No patient in either group developed spinal instability or symptomatic deformity. However, 4 patients in the first group (mean follow-up period 35 months) developed significant low-back pain of musculoskeletal origin following minor accidents (mean time to injury 12 months). No patients in the group in whom the laminae were replaced (mean follow-up period 24 months) developed back pain. This review suggests that although the lumbar laminae are not essential for the structural integrity of the spine, their removal may predispose to musculoskeletal injury and associated pain. The authors propose a mechanism for these findings and recommend replacement of the posterior elements when possible.

Activities of Daily Living↗
PubMed1986

Body type and speech breathing.

Diameter changes of the rib cage and abdomen were recorded during tidal breathing and speech production in 12 adult male subjects grouped on the basis of prominence on three body type components: relative fatness, relative musculoskeletal development, and relative linearity. Data were charted to solve for lung volume, volume displacements of the rib cage and abdomen, and muscular mechanism. Tidal breathing differed across subject groups with regard to depth, rate, and chest wall configuration. Subjects rated high in relative fatness breathed deeper, slower, and with a greater chest wall deformation from relaxation than did other subjects. Speech breathing differed across subject groups with regard to relative volume contributions of the rib cage and abdomen, abdomen excursions, rib cage paradoxing, and chest wall configuration. Subjects rated high in relative fatness demonstrated substantial abdomen contributions to lung volume change, large abdomen excursions, frequent rib cage paradoxing, and marked chest wall deformations from relaxation. By contrast, subjects rated high in relative linearity demonstrated large rib cage contributions to lung volume change, small abdomen excursions, and slight chest wall deformations from relaxation. Subjects rated high in relative musculoskeletal development generally represented a mixture of characteristics of the other two subject groups in their speech breathing performance. Functional differences are discussed in relation to possible underlying mechanism and inferences are drawn concerning evaluation and management of individuals with speech breathing disorders.

Adolescent↗
PubMed2001

Work activities of practical nurses and risk factors for the development of musculoskeletal disorders.

Musculoskeletal and emotional disorders are important causes of reported diseases, causing medical absences, and eventually earlier decrease of work ability. This paper reports the results of a study carried out among practical nurses working at the Orthopedics and Trauma Institute. The objectives of the study were: (a) to describe the routine activities performed during day and night shifts, and (b) to compare the work activities performed in different wards during these shifts. A Brazilian version of the Work Ability Index--WAI (TUOMI et al., 1994) was answered by 83 practical nurses. Forty-three of them (52%) reported pains or musculoskeletal diseases, either based on their own opinion or diagnosed by a physician. These nurses were invited to join the second phase of the study and twenty-nine accepted it. All work activities performed in 29 shifts were observed and recorded. The results showed that day shifts were far more demanding in terms of the number of activities related to patients' care than afternoon and night shifts. Also, body postures associated with day work activities demanded important physical efforts. The number of nurses in charge during night shifts was substantially lower than during day shifts. This could lead to an overload and affect the health of the nurses.

Adult↗
PubMed2006

Early effects of embryonic movement: 'a shot out of the dark'.

It has long been appreciated that studying the embryonic chick in ovo provides a variety of advantages, including the potential to control the embryo's environment and its movement independently of maternal influences. This allowed early workers to identify movement as a pivotal factor in the development of the locomotor apparatus. With an increasing focus on the earliest detectable movements, we have exploited this system by developing novel models and schemes to examine the influence of defined periods of movement during musculoskeletal development. Utilizing drugs with known neuromuscular actions to provoke hyperactivity (4-aminopyridine, AP) and either rigid (decamethonium bromide, DMB) or flaccid (pancuronium bromide, PB) paralysis, we have examined the role of movement in joint, osteochondral and muscle development. Our initial studies focusing on the joint showed that AP-induced hyperactivity had little, if any, effect on the timing or scope of joint cavity elaboration, suggesting that endogenous activity levels provide sufficient stimulus, and additional mobilization is without effect. By contrast, imposition of either rigid or flaccid paralysis prior to cavity formation completely blocked this process and, with time, produced fusion of cartilaginous elements and formation of continuous single cartilaginous rods across locations where joints would ordinarily form. The effect of these distinct forms of paralysis differed, however, when treatment was initiated after formation of an overt cavity; rigid, but not flaccid, paralysis partly conserved precavitated joints. This observation suggests that 'static' loading derived from 'spastic' rigidity can act to preserve joint cavities. Another facet of these studies was the observation that DMB-induced rigid paralysis produces a uniform and specific pattern of limb deformity whereas PB generated a diverse range of fixed positional deformities. Both also reduced limb growth, with different developmental periods preferentially modifying specific osteochondral components. Changes in cartilage and bone growth induced by 3-day periods of flaccid immobilization, imposed at distinct developmental phases, provides support for a diminution in cartilage elaboration at an early phase and for a relatively delayed influence of movement on osteogenesis, invoking critical periods during which the developing skeleton becomes receptive to the impact of movement. Immobilization also exerts differential impact along the proximo-distal axis of the limb. Finally, our preliminary results support the possibility that embryonic hyperactivity influences the potential for postnatal muscle growth.

4-Aminopyridine↗
PubMed2002

Influence of dietary calcium and phosphorus content in a fixed ratio on growth and development in Great Danes.

OBJECTIVE: To study the musculoskeletal development of Great Dane puppies fed various dietary concentrations of calcium (Ca) and phosphorus (P) in fixed ratio by use of dual energy x-ray absorptiometry (DEXA), determination of serum insulin-like growth factor 1 and parathyroid hormone concentrations, radiography, and blood chemistry analysis results. ANIMALS: 32 purebred Great Dane puppies from 4 litters. PROCEDURE: At weaning, puppies were assigned randomly to 1 of 3 diets. Blood was collected for biochemical analyses and hormone assays, and radiography and DEXA were performed through 18 months of age. Changes in body weight, bone mineral content, fat tissue weight, lean mass, result of serum biochemical analyses, hormonal concentrations, and radius lengths were analyzed through 18 months of age. RESULTS: Bone mineral content of puppies correlated positively with Ca and P content of the diets fed. Significant differences between groups in bone mineral content, lean mass, and body fat were apparent early. The disparity among groups increased until 6 months of age and then declined until body composition was no longer different at 12 months of age. Accretion rates for skeletal mineral content, fat, and lean tissue differed from each other and by diet group. CONCLUSIONS AND CLINICAL RELEVANCE: Ca and P concentrations in the diet of young Great Dane puppies are rapidly reflected in the bone mineral content of the puppies until 5 to 6 months of age, after which hormonal regulation adjusts absorption and excretion of these minerals. Appropriate Ca and P concentrations in diets are important in young puppies < 6 months of age.

Absorptiometry, Photon↗
PubMedDate not supplied

Selenium-induced teratogenicity in Sacramento splittail (Pogonichthys macrolepidotus).

Selenium is a potent reproductive and teratogenic environmental contaminant and there are concerns over possible reproductive effects of selenium on the Sacramento splittail (Pogonichthys macrolepidotus) population, a threatened species, in California, USA. In this study, the teratogenic effects of selenium were examined in splittail embryos exposed to 0.0, 5.0, and 15.0 mg l(-1) sodium selenite for 48-h at 18.0 degrees C under static conditions, with renewal every 12 h. Embryo development was evaluated daily for abnormalities from initiation of exposure (stage 27) to initiation of exogenous feeding. At the end of evaluation, prelarvae were preserved for histological analysis. There were no significant differences in mortality or hatching success between control and exposed embryos. Exposed fish had pericardial edema and deformities of skeletal tissues (loss of tail, lordosis, scoliosis, and kyphosis). Other histological alterations were limited to dysplasia, hyperplasia and metaplasia of skeletal tissues in the deformed fish. This study showed that a short exposure of embryos during somite development has significant effects on the musculoskeletal development.

Animals↗
PubMed1980

Ontogeny of oral function in hamsters (Mesocricetus auratus).

The oral apparatus of neonatal and juvenile golden hamsters was investigated by clearing and staining of whole crania, videotaping of behavior, and electromyography of several jaw muscles. Chewing developed during the first postnatal week and matured in the second; however, suckling was still the primary mode of feeding. Micromovements of the jaws occurred early when the osseous skeleton and joints developed. Macromovements correlated well with EMG records and were limited to jaw opening at birth. Muscles of the oral floor generated large bursts of activity during jaw opening and tongue protrusion from 0 days postnatal (dpn), when simple and stereotyped gaping was induced, until 14 dpn, when movements were spontaneous and not stereotyped nor inducible. However, adductor muscle activity was brief, low in amplitude, and primarily involved with jaw stabilization until 4 dpn, when these muscles became active during closing the jaws; closing activity increased in frequency and amplitude until the end of the second week. Development of frequent, coordinated macromovements of chewing was associated with the refinement of joint structure and dental occlusion and with the growth of the craniofacial skeleton. Jaw movements and associated EMG's correlated better with available data on development of neural circuitry than with that for musculoskeletal development.

Animals↗
PubMed1991

An observational study of isotretinoin recipients treated for acne in a health maintenance organization.

From September 1982 to June 1987, all members (N = 513) of the Group Health Cooperative of Puget Sound, Seattle, Wash, who were prescribed isotretinoin for acne were observed throughout the first 4- to 5-month course of therapy for effectiveness and adverse effects. The highest rates of use were among male subjects aged 15 to 24 years. Excluding 47 subjects whose prescriptions were stopped because of noncompliance or who left the care of Group Health Cooperative physicians, 39 (8.4%) of the remaining 466 discontinued taking the drug because of the following adverse effects: mucous/skin/musculoskeletal effects (17); elevated triglyceride levels (eight); headaches (five); increased liver enzyme levels (three); amenorrhea (two); and other (four). One subject, excluded from the 466 because of noncompliance, became pregnant while using medication from a previous prescription and had a therapeutic abortion; she was not under the care of a physician at the time of pregnancy. Most subjects (97%) developed a mucocutaneous symptom, and 42% developed musculoskeletal symptoms. Moderate elevations in liver enzyme levels developed in six (1.8%) of 341 subjects with normal baseline values. Of 389 subjects with normal baseline triglyceride values (less than 2.25 mmol/L), nine (2.3%) developed moderate elevations (4.5 to 9.0 mmol/L), and one (0.3%) developed a severe elevation (greater than or equal to 9.0 mmol/L). Of 24 subjects with elevated baseline triglyceride levels, three (12.5%) developed moderate elevations. Of an additional 53 subjects whose baseline serum triglyceride levels were not determined, two developed elevations during therapy, one up to 13.4 mmol/L. Subjects who were overweight or had elevated baseline serum triglyceride values had an increased risk of developing elevations in triglyceride levels during therapy (odds ratio, 6.0; 95% confidence interval, 1.6 to 22.0; and odds ratio, 4.35; 95% confidence interval, 0.9 to 20.2, respectively). Acne was improved for at least 94.0% of subjects.

Acne Vulgaris↗
PubMed2002

Expression of the boc gene during murine embryogenesis.

BOC is a receptor-like protein that, with the related factor CDO, belongs to a newly recognized subfamily within the immunoglobulin superfamily of cell-surface molecules. BOC and CDO form complexes that positively regulate myogenesis in vitro. To gain a better understanding of the role of boc during vertebrate embryogenesis and whether it could cooperate with cdo in vivo, we carried out an extensive in situ hybridization analysis of boc expression in mouse embryos from E7.0 to E17.5. Our results show that boc is widely expressed during murine embryogenesis, in a spatially and temporally restricted pattern. Overall, the highest levels of boc expression are detected between E10.5 and E15.5, with the strongest signals observed in the developing musculoskeletal and central nervous systems. At late stages of development, boc expression becomes more restricted and is limited primarily to regions harboring proliferating cells, undifferentiated cells, or both. This expression pattern is strikingly similar to that described for cdo (Mulieri et al., 2000). The overlapping expression patterns of cdo and boc in vivo, combined with the promotion of myogenesis by CDO/BOC complexes in cultured cells, strongly suggests that these proteins play a role together in the determination, differentiation, or both, of numerous cell types during vertebrate embryogenesis.

Animals↗
PubMed1996

Guidelines for occupational musculoskeletal load as a basis for intervention: a critical review.

Rationalization efforts in industry, both in the Scientific Management tradition and also based on recent rationalization theories, have as one of their main aims to increase the utilization of workers. Clearly, there is a limit to the amount of physical work each employee can perform without developing musculoskeletal disorders. Such limits are generally set by guidelines for acceptable work load. This paper reviews the physical work load concept, the historical development of guidelines, and current guidelines as found in ergonomics textbooks. The focus is on the change in the aim of the guidelines over time: increased productivity, reduced fatigue and finally improved musculoskeletal health. Current guidelines for physical work load mostly emphazise a reduction in the level of work load, while there are few guidelines that consider the repetitiveness and duration of work load. As the guidelines in general only consider one exposure variable, this is a particular problem in rationalization where all three exposure dimensions may be changed simultaneously. Present guidelines are mainly based on laboratory studies aiming to eliminate short-term physiological or psychological responses. These guidelines are clearly inadequate and may be misleading in view of recent research regarding the relationship between physical work load exposure and the development of musculoskeletal complaints at the work place.

Journal Article↗
PubMed1995

Calcitonin gene-related peptide (CGRP) in the developing mouse limb.

The mitogenic effects of neuropeptides and their localization to developing tissues suggest an important role for these peptides during gestation. We examined the expression and action of the neuropeptide calcitonin gene-related peptide (CGRP) in the developing mouse limb bud, an excellent model system for studying musculoskeletal development. CGRP immunoreactivity (CGRP-ir) was detected in the developing limb at day 16.5 of gestation (E 16.5) and was limited to nerve fibers surrounding blood vessels, within the developing muscle or in close proximity to the developing cartilaginous skeleton. Although CGRP-ir was not observed until E 16.5, limb buds were responsive to CGRP as early as E 11.5. Within 5 min of exposure to CGRP (10(-8) to 10(-7) M) a 2--3-fold increase in cyclic AMP (cAMP) levels was observed. This CGRP-induced increase in cAMP was abolished by the addition of human CGRP8-37, a CGRP receptor antagonist. This result suggests that the effect on cAMP was mediated by the interaction of CGRP with CGRP receptors. Our findings indicate that mouse limbs are responsive to CGRP when they are composed of primarily undifferentiated mesenchyme and that CGRP-ir appears at a later stage of development in association with cartilage and muscle differentiation.

Animals↗