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PubMed1981

Selected aspects of deconditioning secondary to immobilization.

Although activity is a normal state of the human body, a variety of orthopedic conditions may necessitate some degree of immobilization. Major deconditioning changes in the cardiovascular system and musculoskeletal system have been identified. The deconditioning changes affecting the cardiovascular system are decreased venous flow, decreased orthostatic tolerance, and decreased work capacity. The deconditioning changes associated with the musculoskeletal system are bone demineralization, altered joint function, and loss of muscle mass, strength, and tone. Possible nursing interventions and their rationales for use with the identified deconditioning changes have been explored. The general goal of any intervention is to minimize the deconditioning that occurs with immobilization.

Bed Rest↗

PubMed1996

An integrated care system for musculoskeletal disorders in a managed care setting.

Practice guidelines, education, consensus building, and extensive communication were the tools used in developing a musculoskeletal care system. Primary care physicians directed patient care using practice guidelines for common musculoskeletal conditions. Patient education and empowerment were emphasized. Specialist consultations were made available by telephone/voicemail to advise primary care physicians regarding treatment plans and the need for specialty referrals. Significant reductions in medical service utilization for this patient population were achieved while high levels of patient satisfaction were maintained. Such integrated systems are likely to work well within other MCOs.

Case Management↗

PubMed1989

Applied physiology of a triathlon.

The triathlon is an endurance contest in which contestants must compete in 3 consecutive events, usually swimming, cycling and running. Success in a triathlon depends upon the ability of the triathlete to perform each of the sequential events at optimal pace without creating fatigue that will hinder performance in the next event. The successful triathlete must, therefore, have highly developed oxygen transport and utilisation systems as well as the ability to efficiently produce a high energy output for prolonged periods without creating metabolic acidosis. Accordingly, mean VO2max values for groups of triathletes during treadmill running have been reported to range from 52.4 to 72 ml/kg/min in men; 58.7 to 65.9 ml/kg/min in women. VO2max values during cycle ergometry were 3 to 6% less than treadmill running values; tethered swimming maximums 13 to 18% less. Predictable and well-known adaptations occur in the cardiovascular systems of triathletes. Structural adaptations of the heart that have been documented in triathletes include increased left ventricular cavity size or wall thickness, or both. Morphological characteristics of the triathlete's heart appear to be unrelated to success in triathlon races. Following the acute stress of triathlon competition, alterations in both systolic and diastolic function have been observed. Heart muscle fatigue is the most likely reason for these changes, since there is a rapid return to normal with rest. Like the cardiovascular system, the musculoskeletal system responds to triathlon training. Peripheral adaptations occur that lead to increased muscle respiratory capacity and to modifications in substrate utilisation. The musculoskeletal system is the site of most injuries to triathletes, and non-traumatic overuse injuries account for 80 to 85% of the musculoskeletal injuries. Maintenance of fluid and electrolyte balance is of primary importance for the triathlete both in day-to-day training and during races. Water may be an adequate replacement fluid for short distance triathlons, but some combination of carbohydrate, electrolyte and fluid replacement is necessary for longer races. Although the physiological bases for success in a triathlon are not well understood at present, the ability to maintain minimal alterations in the homeostasis of cardiovascular, haemodynamic, thermal, metabolic, and musculoskeletal functions are of obvious importance.

Adolescent↗

PubMed1999

Hormonal pertubations in fibromyalgia syndrome.

The symptomatology characterizing fibromyalgia (FM) comprises three systems: the musculoskeletal system with widespread muscular pain, neuroendocrine disorders, and psychological distress including depression. Though the most prominent symptom of FM is pain in defined points of the musculoskeletal system, the numerous other somatoform and psychological disorders suppose a common primary disturbance which we consider to originate within higher levels of the central nervous system. Recent studies of the entire endocrine profile of FM patients following a simultaneous challenge of the hypophysis with corticotropin-releasing hormone (CRH), thyrotropin-releasing hormone, growth hormone-releasing hormone, and luteinizing hormone-releasing hormone support the hypothesis that an elevated activity of CRH neurons determines not only many symptoms of FM but may also cause the deviations observed in the other hormonal axes. Hypothalamic CRH neurons thus may play a key role not only in "resetting" the various endocrine loops but possibly also nociceptive and psychological mechanisms as well.

Animals↗

PubMed1998

In vitro release of colchicine using poly(phosphazenes): the development of delivery systems for musculoskeletal use.

A colchicine release system utilizing biodegradable poly(phosphazenes) was investigated in vitro for intra-articular administration. Polymer degradation and drug release studies were performed on colchicine-loaded poly(phosphazenes) containing either imidazolyl (I-PPHOS) or ethyl glycinato (EG-PPHOS) side chain substituents over a 21-day period. To study the effects of an implantable colchicine-PPHOS delivery system on local musculoskeletal tissue in vitro, osteoblast-like cells were grown on the matrices. Colchicine release was 20% for I-PPHOS and 60% for EG-PPHOS over the 21-day period. Release appeared to proceed through a combination of diffusional and degradative mechanisms. Environmental scanning electron microscopy (ESEM) studies revealed large pores in the drug-depleted devices in contrast to the control matrices without drug, which may have contributed to the release seen, especially with ethyl glycinato-containing matrices. Cell growth on matrices containing colchicine was significantly (p < 0.05) inhibited in contrast to growth on tissue culture polystyrene (TCPS) and EG-PPHOS matrices without drug. The in vitro cell kinetic data suggest that designs for in vivo studies must take into account possible toxicity of colchicine and the polymer matrix on local tissue. Biodegradable PPHOS systems are promising candidates for use as intra-articular delivery vehicles for drugs with potential for systemic toxicity.

3T3 Cells↗

PubMed1997

Drug-related mortality in Canada (1984-1994).

OBJECTIVE: To examine drug-related deaths due to adverse drug reactions between 1984 and 1994. DATA SOURCE: Voluntary reports of deaths due to adverse events as reported to the Adverse Drug Reaction Monitoring Program, Drugs Directorate, Health Protection Branch, Health Canada. METHODS: Drugs were classified according to the Anatomical, Therapeutic, Chemical (ATC) coding system. Descriptive statistics were utilized. RESULTS: One thousand four hundred and seventeen drug-related deaths were reported (700 male, 685 female, 32 unknown). The mean+/-SD age of patients was 54.6+/-21.7 years (range 1 month-97 years). In total, 2131 medications were implicated as suspect drugs (1.5+/-1.0, range 1-7). The most commonly reported categories of suspect drugs were the nervous system agents (50.6%), followed by cardiovascular system agents (9.0%), general antiinfectives for systemic use (8.8%) and musculoskeletal system agents (8.3%). One thousand and eighty-six deaths were classified as non-suicides. For non-suicide deaths, the most commonly reported suspect drugs were classified as nervous system agents (37.9%), followed by general antiinfectives for systemic use (12.3%), musculoskeletal system (11.5%) and cardiovascular system agents (10.2%). Three hundred and thirty-one (23.3%) reports were identified as suicides. For suicides, the most commonly reported suspect drugs were the nervous system agents (81.1%), followed by the respiratory system agents (8.5%) and the cardiovascular system agents (6.0%). CONCLUSION: Nervous system agents, musculoskeletal medications and general antiinfectives for systemic use figured prominently in deaths reported to HPB between 1984 and 1994.

Journal Article↗

PubMed1994

Prazosin blocks the pressor but not the regional circulatory effects of diaspirin crosslinked hemoglobin.

Diaspirin crosslinked hemoglobin (DCLHb) (400 mg/kg, i.v.) produces an increase in blood pressure and blood flow to the heart, spleen, stomach, small intestine, skin, mesentery and pancreas when administered to rats. The present study was conducted to determine (1) whether prazosin, an alpha 1-adrenergic antagonist, can block the pressor effect of DCLHb and (2) the effect of prazosin pretreatment on regional circulatory changes induced by DCLHb in rats. DCLHb (400 mg/kg, i.v.) produced an increase in blood pressure (64%), cardiac output (20%) and total peripheral resistance (65%) when administered to control rats. Infusion of DCLHb in prazosin (1 mg/kg, i.v.) treated rats did not show any significant pressor effect, but reversed the hypotensive effect of prazosin. Cardiac output and stroke volume were significantly increased and total peripheral resistance decreased in prazosin treated rats as compared to control (untreated) rats. DCLHb significantly increased blood flow to the heart, gastrointestinal tract, portal system (spleen), and skin of control rats. Blood flow to the brain, kidneys, and musculo-skeletal system was not altered following the infusion of DCLHb in controls rats. Infusion of DCLHb in prazosin treated rats produced a significant increase in blood flow to the brain, heart, kidneys, gastrointestinal tract, portal system, skin and musculoskeletal system. In summary, prazosin pretreatment blocked the pressor effect of DCLHb, however, blood flow to the heart, brain, gastrointestinal tract, portal system, kidneys, skin and musculoskeletal system was increased by DCLHb. It is concluded that blood flow to most of the organs is increased by DCLHb but the pressor effect of DCLHb is blocked by prazosin pretreatment.

Animals↗

PubMed1988

Adverse reactions to isotretinoin. A report from the Adverse Drug Reaction Reporting System.

Between October 1982 and June 1985 the Adverse Drug Reaction Reporting System received reports of 104 suspected adverse reactions occurring in 93 patients who took isotretinoin. Adverse reactions involving the skin and mucous membranes (29 reports), central nervous system (23), musculoskeletal system (12), pregnancy (11), and eyes (8) were most commonly reported. Severe headache was the most frequently reported adverse reaction (15 reports). In four cases headaches were attributed to pseudotumor cerebri. Some of the reported reactions, for example, a disulfiram (Antabuse)-like reaction and oculogyric crisis, have not been described previously in the literature. Other reports, such as congenital malformations, serve to emphasize some of the serious reactions that are known to occur. These spontaneous reports of adverse reactions associated with isotretinoin use, together with the literature we review, may help alert physicians to the diverse spectrum of adverse reactions that may develop in patients taking isotretinoin.

Abnormalities, Drug-Induced↗

PubMed1997

[Sports in patients with systemic inflammatory musculoskeletal diseases].

Local and systemic inflammatory mechanisms and immobilisation, perhaps secondarily intensified by corticosteroid treatment, very often produce reduced load capacity of the tissues. Pain, swelling of the joints, muscular atrophy and instability favour such development. Increased activity of the disease rapidly leads to general discomfort and unfitness. Drugs generally help to reduce the inflammatory activity. To increase and restore the musculo-skeletal load capacity, however, the patient must undergo physiotherapy and exercises adapted to the disease activity and, if he/she so desires adequate sporting activity.

Female↗

PubMed1985

Adverse metabolic consequences of total parenteral nutrition.

Recently described metabolic complications of total parenteral nutrition (TPN) are discussed. Included are descriptions of disorders affecting the hepatobiliary system and the musculoskeletal system. The effects of TPN on the hepatobiliary system include cholestatic hepatitis and cholelithiasis; the complications affecting the musculoskeletal system include acute polymyopathy and low-turnover, osteomalacic bone disease. With the exception of the acute polymyopathy, which is probably due to essential fatty acid deficiency, the other systemic disorders may have multiple etiologies. Also summarized are the relatively recent findings of iatrogenic micronutrient deficiencies, including chromium, selenium, and molybdenum. These trace element deficiencies appear to have multisystem manifestations. Recommendations for management are discussed.

Aluminum↗

PubMed2001

Use of ultrasonographic guidance in interventional musculoskeletal procedures: a review from a single institution.

We have evaluated the utility of ultrasonographic guidance for intervention in the musculoskeletal system. All interventional musculoskeletal procedures using ultrasonographic guidance performed at our institution from July 1998 through November 1999 were reviewed. Examinations were performed using either a linear or curved phased array transducer, based on depth and local geometry. The choice of needle was likewise optimized for specific anatomic conditions. One hundred ninety-five procedures were performed on 167 patients from July 1998 through November 1999. Thirty-one procedures had magnetic resonance correlation within 6 months beforehand. Excluding large-joint aspirations and injections, we found that 180 of the procedures were more readily performed using ultrasonography than any other imaging modality. These included therapeutic injections into tendon sheaths (biceps, flexor digitorum longus, posterior tibial, and iliopsoas), Morton's neuromas, plantar fascia, wrist ganglia, and tarsal tunnel cysts; peritendinous hamstring injections; and synovial cyst and muscle biopsies. In all cases, the target of interest was identified easily with ultrasonography, and needle position was documented readily. Also in all cases, aspiration or medication delivery to the site of interest was observed during real time and was documented on postprocedure images of the area. No significant complications (e.g., bleeding, infection, and neurovascular compromise) were encountered during or immediately after any procedure. Ultrasonography is a readily available imaging modality useful for guiding interventional procedures in the musculoskeletal system. The ability to document exact needle placement in real time confirms accurate placement of therapeutic injections, fluid aspiration, and soft tissue biopsies.

Adolescent↗

PubMed1993

Simulation and animation of musculoskeletal joint system.

This paper describes the development of computer-based software for three-dimensional geometric data base of the human musculoskeletal system. Using a computer graphics workstation, a user of the software will interactively display detailed information about the muscles, tendons, ligaments, bone, and joint anatomy. This software will enable a wide range of health care workers to visualize complex physiological data. In addition to geometric and visual realism, this software will include kinematic relationships which allow the calculation and display of the motion and forces of the joints, muscles, and tendons. This will permit a user to interactively move joints or tendons and display the resulting motion of the surrounding tissues, as well as internal reactive forces and joint pressure distribution. A two-dimensional version of this software is currently being used for knee and hip osteotomy preoperative planning, total joint replacement prosthesis design and dimensional selection, and osteochondral allograft sizing and reconstruction using radiographic data.

Computer Simulation↗

PubMed2005

Common malignant musculoskeletal neoplasms of dogs and cats.

Malignancies of the musculoskeletal system in dogs and cats can be categorized as either primary or metastatic within the bony or soft structures that comprise the musculoskeletal system. By far, the most common tumor that affects the musculoskeletal system in dogs is osteosarcoma. The most common tumors that affect the musculoskeletal system in cats are injection site sarcomas. These tumors are locally infiltrative; whereas up to 25% metastasize, most animals die from our inability to control local disease. The aim of this article is to provide a brief review of the biologic behavior of and treatment recommendations for common tumors of the musculoskeletal system, excluding the oral and nasal cavities.

Animals↗

PubMed2004

Evaluation of the influence of muscle deactivation on other muscles and joints during gait motion.

When any muscle in the human musculoskeletal system is damaged, other muscles and ligaments tend to compensate for the role of the damaged muscle by exerting extra effort. It is beneficial to clarify how the roles of the damaged muscles are compensated by other parts of the musculoskeletal system from the following points of view: From a clinical point of view, it will be possible to know how the abnormal muscle and joint forces caused by the acute compensations lead to further physical damage to the musculoskeletal system. From the viewpoint of rehabilitation, it will be possible to know how the role of the damaged muscle can be compensated by extra training of the other muscles. A method to evaluate the influence of muscle deactivation on other muscles and joints is proposed in this report. Methodology based on inverse dynamics and static optimization, which is applicable to arbitrary motion was used in this study. The evaluation method was applied to gait motion to obtain matrices representing (1) the dependence of muscle force compensation and (2) the change to bone-on-bone contact forces. These matrices make it possible to evaluate the effects of deactivation of one of the muscles of the musculoskeletal system on the forces exerted by other muscles as well as the change to the bone-on-bone forces when the musculoskeletal system is performing the same motion. Through observation of this matrix, it was found that deactivation of a muscle often results in increment/decrement of force developed by muscles with completely different primary functions and bone-on-bone contact force in different parts of the body. For example, deactivation of the iliopsoas leads to a large reduction in force by the soleus. The results suggest that acute deactivation of a muscle can result in damage to another part of the body. The results also suggest that the whole musculoskeletal system must go through extra retraining in the case of damage to certain muscles.

Adaptation, Physiological↗

PubMedDate not supplied

Physiologic aspects of aging: impact on cancer management and decision making, part II.

In this second article of our two-part review, we focus on age-associated physiologic changes involving the nervous, endocrine, hematologic, immune, and musculoskeletal systems, with close attention to the interconnected nature of these systems. There is a well-known connection between the neuroendocrine and immune systems via the hypothalamic-pituitary-adrenal axis and via interaction by means of cytokines, hormones, and neurotransmitters. These changes may lead to a loss of integration and resiliency with age, thus decreasing the ability of the elderly patient with cancer to adapt to stressful circumstances. Prominent changes include decline in memory and cognition, and increased susceptibility to peripheral neuropathy. Hematologic and immune changes like reduced bone marrow reserve and increased susceptibility to infections have far reaching implications for cancer care in the elderly. Gradual decline in hormone levels, and changes in muscle and body composition, can lead to functional decline and frailty. Use of the clinical interventions suggested in this article, along with an appreciation of the interplay of these age-related physiologic changes and their consequences, allows oncology professionals to customize therapy and minimize side effects in the geriatric oncology patient.

Aged↗

PubMedDate not supplied

Electrical shock injury.

OBJECTIVE: To discuss the case of a patient who received an electrical shock injury to the back of his head and was co-managed by a neurologist and a chiropractor. The common manifestations of electrical shock injuries are presented. CLINICAL FEATURES: The patient was a 31-yr-old man. His initial symptoms consisted of headaches, dizziness, pain in the suboccipital area, tingling down both arms to the hands, nausea, blurred vision, increased sweating, chest pain, loss of appetite and memory lapses. The patient received a neurological examination, MRI of the brain, EEG, brain stem auditory evoked response and EKG. The neurologist's diagnosis was post-traumatic head syndrome following electrocution. INTERVENTION AND OUTCOME: He was treated by a neurologist and a chiropractor, with fair results. Chiropractic treatments were directed toward correcting the fixations, fibrotic tissue and joint proprioception in his neck using manipulation, physical therapy and active care exercises. CONCLUSION: Electrical shocks commonly cause immediate damage to the heart, nervous system and musculoskeletal system. They can also cause delayed complications days to years later, including cholelithiasis, cataracts and nervous system conditions such as ALS. Chiropractors can play an important role in managing the musculoskeletal manifestations of electrical shock injuries.

Adult↗

PubMedDate not supplied

Routine obstetrical ultrasound at 18-22 weeks: our experience on 7,236 fetuses.

OBJECTIVE: This study aimed at examining the detection rate of congenital abnormalities by using routine ultrasonography at 18-22 weeks of gestation. METHODS: The sample included 7,236 fetuses. A detailed sonographic examination was performed in each fetus and a neonatal evaluation or pathology examination was made to confirm the prenatal findings. RESULTS: The total prevalence of fetal abnormalities in our sample was 2.24% (162/7,236). There were 29/162 (17.9%) fetuses with CNS abnormalities, 27/162 (16.7%) fetuses with gastrointestinal abnormalities, and 28/162 (17.3%) fetuses with urinary tract abnormalities. There were also 31/162 (19.1%) fetuses with cardiovascular abnormalities, 26/162 (16.0%) with malformation of the limbs and musculoskeletal system, and 21/162 (13%) fetuses with other various abnormalities. The overall sensitivity in detecting fetuses with congenital abnormalities was 80.25% (130/162). The sensitivity per system was 93.1% (27/29) for CNS, 45.2% (14/31) for cardiovascular system, 85.2% (23/27) for gastrointestinal system, 85.7% (24/28) for urinary system, 84.6% (22/26) for musculoskeletal system, and 95.2% (20/21) for the rest of the abnormalities detected. We performed 40 pregnancy terminations in the group of malformed fetuses. Among the fetuses considered as normal, 1.7% had chromosomal abnormalities. CONCLUSIONS: The results indicate that routine sonographic examination at 18-22 weeks of gestation can detect the majority of congenital abnormalities. More experience is needed for the examination of the cardiovascular system, where the sensitivity was particularly low (14/31 or 45.2%).

Central Nervous System↗

PubMed1998

The origin and relief of common pain.

Where pain of the musculoskeletal system is present, commonly, this pain is without objective evidence of disease, trauma, or disorder. Absence of an apparent cause for common pain prompts the consideration of mechanical stress as a contributing factor. The principal stress of the musculoskeletal system is postural. By posture it is usually meant the distribution of body mass with respect to gravity. Past efforts to predict chronic pain by postural analysis or to reduce such pain by strengthening, conscious control or splinting of posture has had marginal success. Past failure to relate posture to pain is attributable to (1) ubiquity of sub-optimal posture that precludes clinical comparison to those with optimal posture; (2) presupposition that the causal relation between posture and pain is of the observational class of causality rather than the manipulable kind; (3) a definition of posture that is too narrow to complete the picture; and (4) inadequate methods for reduction of postural asymmetry to an extent that is sufficient to elicit a significant and enduring effect on sub-optimal posture and related pain. Posture can be defined more broadly as the stance of the body performing within the boundaries of posture and which is mediated by the Postural Control System towards greatest stability (Fx. 1). The stance of the body is the arrangement of the body with respect to gravity and other accelerative forces. The postural boundaries are the set of forces that resist acceleration and thereby provide the limits within which one functions stably, and this resistance is currently approximated by six principal sources of resistance to acceleration: viscous, elastic, neuromuscular, rigid, viscoelastic, and inertial. The Postural Control System is located in the brainstem and modulates body stance to more economically and stably effect and resist acceleration. The rigid boundaries can be so with respect to compressive, tractive, or tensile qualities that permits three kinds of motion: translation, rotation and oscillation. An example of postural boundaries that are rigid with respect to compression and tensile character are the bones that bear weight. In contrast, ligaments provide a tractive rigidity and musculotendons a relatively elastic boundary. Joint surfaces are considered boundaries that are rigid but not perfectly so. Of fundamental importance are those joints that arc lowermost in a column of the musculoskeletal system namely: (1) the feet and ankles that support the entirety of the musculoskeletal system and; (2) the base of the sacrum that supports the vertebral spine. This broadened definition of posture leads to a greatly enhanced manipulability of posture in the upright stance and alleviation of more than two-thirds of common pain by the coherent combination of (1) manual manipulation to reduce somatic dysfunction; (2) foot orthotics to optimize the amplitude of the arches of the feet and vertically align the ankle; (3) a heel lift to level the sacral base; (4) and a group of therapeutic postures configured to minimize restriction of peripheral soft tissue reflective of the earlier posture, all aimed to optimize posture. Mediated by the postural control system, manipulation of postural boundaries accordingly modifies the structure and function of the entire musculoskeletal system. Typically, this relief is maintained by foot orthotic and heel lift alone without maintenance by manual manipulation, medication, or exercise.

Back Pain↗