Development of a musculoskeletal organ system curriculum.
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Stability analysis of paraplegic standing while wearing an orthosis.
Paraplegics can maintain a standing posture, called the "C-posture", while wearing an orthosis. The significant feature of the C-posture is that the body's center of mass is located behind the hip joint. In this study, we investigate the C-posture mechanism and assess the relationship between posture and stability, the aim being to restore standing function. We first measured the standing postures of paraplegic subjects wearing an orthosis. The subjects maintained the standing posture for 30 s. Next, assuming the C-posture to be an equilibrium attractor in the musculoskeletal system, we used a dynamic model of the musculoskeletal system to analyze the relationship between posture and stability, and also to assess the influence of ankle stiffness. We calculated the standing posture on the basis of a return map. The calculated standing postures show some features of the C-posture. The stability analysis revealed that, despite a limitation in the range of stable postures, the C-posture is more stable than the postures of normal people. The results suggest that although the C-posture is an appropriate posture for paraplegic standing, sufficient ankle stiffness and an appropriate alignment of ankle angle are necessary and preventing hip flexion movements is desirable.
Adult↗
Considerations in prescribing preflight aerobic exercise for astronauts.
Many human responses to the weightless environment have been documented from actual spaceflights. These include physiological effects on the nervous system, cardiovascular system and fluid balance, and the musculoskeletal system, as well as psychological effects. Simulations on Earth have added to our knowledge about the physiology of weightlessness. Early data on orthostatic intolerance after real and simulated spaceflight led some scientists to discourage a high level of aerobic fitness for astronauts. They believed it was detrimental to orthostatic tolerance on return to Earth. However, most of the data available today do not support this contention. Furthermore, aerobic fitness is beneficial to cardiovascular function and mental performance. Therefore, it may be important in performing extra-vehicular activities during flight. Some astronauts claim exercise enhances their feeling of well-being and self image. And, although the cardiovascular system and exercise performance may recover more slowly after flight to preflight levels when fitness level prior to flight is high, the musculoskeletal system may recover more rapidly. Research is needed to determine optimal levels of aerobic training for performing tasks in flight, maintaining health and well-being during flight, and assuring satisfactory recovery on return to Earth.
Cardiovascular Physiological Phenomena↗
Reconstructive considerations for limb salvage surgery.
Tumors in the musculoskeletal system are generally treated surgically, although radiation therapy and chemotherapy have greatly improved survival statistics of patients with high-grade sarcomas of the musculoskeletal system. The mainstay in treatment of nearly every primary tumor of the musculoskeletal system is surgical resection for cure. Radiation therapy and chemotherapy continue to be important adjuvants in the overall management of musculoskeletal tumors. Functional limb salvage following radical resection is now possible in most resectable cases by placement of an alloplastic prosthesis, homograft, or autogenous bone for skeletal reconstitution, followed by well-vascularized soft-tissue coverage.
Adult↗
Physiological methods used in Japan for the diagnosis of suspected hand-arm vibration syndrome.
In the pathogenesis of hand-arm vibration syndrome, vibration affects the peripheral system, especially the circulatory, nervous, and musculoskeletal systems. Medical questionnaires, physical examinations, and laboratory tests are used to diagnose the hand-arm vibration syndrome. The laboratory tests are satisfactory diagnostic aids for detecting slight disorders of the peripheral circulatory, nervous, and musculoskeletal systems. Peripheral circulatory function tests include skin temperature measured by a thermistor under specific temperature conditions, the nail compression test, and the cold provocation test (10-min immersion in cold water at 5 or 10 degrees C). To assess peripheral nervous function, tests for the pain and vibration senses are included. Peripheral musculoskeletal function tests consist of grip strength, pinch strength and tapping counts. These physiological tests are applied in worker screening twice a year. These tests have been authorized by the Ministry of Labour since 1973. Several criteria for the tests, although not authorized, are widely used. The diagnostic implication of each separate test may be low. Consequently, some laboratory tests should be evaluated, along with medical questionnaires and physical examinations, in the diagnosis of suspected hand-arm vibration syndrome.
Arm↗
Work load and musculoskeletal complaints during pregnancy.
OBJECTIVES: Many pregnant women have musculoskeletal complaints, the onset and aggravation of which are thought to be associated with their activity or work postures. The purpose of this paper was to obtain more insight into the influence of pregnancy on the load of the musculoskeletal system at work to provide a better basis for preventing complaints. METHODS: To this end, literature pertinent to a model called "work load of the musculoskeletal system" was reviewed. The model was developed to describe how work contributes to musculoskeletal complaints. RESULTS: It was found that pregnancy causes changes in a worker's characteristics. These changes can lead to changes in the work situation, activity pattern, and postural characteristics and possibly result in a change in work load. In addition, physical changes such as weight gain increase the work load in a given posture. The load-bearing capacity of the musculoskeletal system decreases due to pregnancy. CONCLUSIONS: The changes in load and the decrease in load-bearing capacity singly or simultaneously increase the risk of musculoskeletal complaints. The multifactorial cause of musculoskeletal complaints during pregnancy reveals various possibilities for prevention.
Biomechanical Phenomena↗
Microbial isolates in early swabs of open musculoskeletal injuries.
BACKGROUND: Infections of open musculoskeletal injuries, especially open fractures, continue to pose a challenge to the Orthopaedic and Trauma surgeons. There is a dearth of information on the early bacterial contaminants of these open wounds and their antibiotic sensitivity patterns in our environment. OBJECTIVE: To determine the bacteriology of open wounds of the musculoskeletal system at initial presentation in hospital and their antibiotic susceptibility profile in Ile-Ife, Nigeria. MATERIALS AND METHODS: A prospective study of 86 consecutive patients over an eight-month period (March to October 2002). Eighty-six patients with 96 open wounds of the musculoskeletal system admitted to the Accident and Emergency unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife. Bacteria were isolated from swabs taken from the depth of the wounds and their antibiotic susceptibility determined. RESULTS: A total of 126 bacterial isolates were recovered from 96 wounds in 86 patients (61 males and 25 females) with mean age of 31.4 years +/- SD. About 73.3% of the wounds were from road traffic accidents and 72.3% of the wounds were severe open fractures (Grades IIIA to C). Staphylococcus aureus constituted 22.2% while coagulase negative Staphylococci (CONS) accounted for 21.4% with Staphylococcus. epidermidis leading the group with 13.5%. Gram negative rods constituted 40.5% of the isolates with Pseudomonas aeruginosa accounting for 11.1%. Antibiotic sensitivity profile revealed that many of the isolates were multiply resistant to the antimicrobials employed but were sensitive to Ofloxacin. CONCLUSION: This study has shown that open wounds of the musculoskeletal system are usually contaminated at presentation with pathogenic organisms. The antibiotic sensitivity pattern of the isolates shows that the quinolones, represented by Ofloxacin, is the most effective antibiotic.
Adolescent↗
Biomechanical factors affecting performance in netball. Implications for improving performance and injury reduction.
Despite netball having one of the largest number of participants of any team game within the Commonwealth there has been limited research conducted which biomechanically analysed skills of the game. However, information presented from biomechanical analyses of skills can provide coaches with the necessary theoretical basis to teach netball fundamentals to junior players. Biomechanical information can also be used to refine the existing techniques of experienced netball players so they may achieve optimal technical performance of game skills while minimising the potential for injury. Changes to footwork rules and to the material properties of court surfaces and footwear could reduce stress placed on the musculoskeletal system. However, the factor which influences musculoskeletal stress to the greatest extent is a player's landing technique. Thus, the first concern for all netball coaches must be to teach all players to land correctly. The magnitude and rate of loading of the high vertical and horizontal ground reaction forces generated when players execute abrupt landings in netball are reduced more effectively by encouraging players to throw higher passes, requiring the receiver to jump upward to catch the ball. However, to maximise the reduction in stress placed on the musculoskeletal system on landing, players should be encouraged to land with the foot neutrally aligned (not abducted or adducted), ensure adequate hip and knee flexion, and reduce the foot-hip displacement by eliminating an exaggerated 'striding out' position often adopted by netball players. Apart from landing techniques, the only netball skill that has been objectively analysed is goal shooting. To improve shooting accuracy players should demonstrate greater flexion of the knees and shooting elbow when preparing to shoot, sufficient but not excessive hyperextension of the hand to stabilise the ball, minimisation of trunk, arm and forearm movements during the shooting action in favour of increased hand motion, greater release height and greater release velocity. If the potential for injury from poorly executed skills in netball is to be minimised, further research is required to identify the most efficient methods of performing all skills involved in the game, including pivoting, rebounding, defensive movement patterns, and attacking movement strategies.
Athletic Injuries↗
[Temporary work disability in Poland--analysis of morbidity causes in the years 1985-1994].
Observation and analysis of sickness absenteeism, its morbidity causes, range and trends in certain periods of time, help to identify major health problems in the working population and the dynamic of changes. They also permit to anticipate the consequences reflected in permanent work disability. Certificates recording temporary work disability serve as a reference source for the analysis. The material under study comes from the national sickness absenteeism data base developed and managed by the Nofer Institute of Occupational Medicine in Lodz. It covers a 15-percent random sample of those cards. During the last decade, temporary work disability showed a rapidly growing tendency. During the years 1985-1994 mean annual rate of sickness absenteeism growth accounted for 6.4%, and since 1990 this rate has evidently increased reaching 10% per year. The rate of sickness absenteeism growth was considerably higher among males (9.8%) than among females (4.1%). The highest mean annual rates of growth were noted in absenteeism caused by diseases of the musculoskeletal system (33%--males; 15%--females), the nervous system (18%--males; 4% females) and the circulatory system (12% in general) including arterial hypertension (52%--males; 17% females). A differentiated trend in work disability due to individual disease categories observed during the analysed decade was responsible for changes in the structure of sick absenteeism noted in the same period. Thus, sickness absenteeism because of diseases of the respiratory system has decreased while diseases of the musculoskeletal system have contributed to its increase (at present they account for 18.2% in males and 15.4% in females), the same applies to diseases of the nervous system (17.2% in males) and to gynecological diseases (17.1% of female absenteeism). During the past five years a high dynamics of sickness absenteeism growth can be mostly attributed to a modified system of sickness allowances as well as to social and economic transformations, restructuring of industry and an increased unemployment in our country.
Absenteeism↗
Role of endothelin-converting enzyme in the systemic hemodynamics and regional circulatory effects of proendothelin-1 (1-38) and diaspirin cross-linked hemoglobin in rats.
Diaspirin cross-linked hemoglobin (DCLHb) is a promising hemoglobin-based, oxygen-carrying resuscitative solution. DCLHb (400 mg/kg, iv) produces significant cardiovascular effects, along with an increase in plasma endothelin-1 (ET-1) level, when administered to conscious or anesthetized rats. Present studies were performed to determine whether the cardiovascular effects of DCLHb are due to an increase in the conversion of proendothelin-1 (1-38) (proET-1) to ET-1 by endothelin-converting enzyme (ECE). The regional circulatory and systemic hemodynamic effects of proET-1 (20 micrograms/kg, iv) and DCLHb (400 mg/kg, iv) were determined by using a radioactive microsphere technique in control rats and rats pretreated with phosphoramidon (ECE inhibitor). Administration of proET-1 produced an immediate increase in mean arterial pressure (MAP)(52%) and total peripheral resistance (TPR) (55%); stroke volume (SV) and cardiac output were not affected in the initial phase but were decreased subsequently. Heart rate (HR) was not affected after administration of proET-1. A significant increase in blood flow to the heart (39%), brain (46%), kidneys (74%), portal system (40%), and gastrointestinal tract (GIT) (42%) was also observed after administration of proET-1. Vascular resistance was found to be significantly increased in the mesentery and pancreas (168%) and in the musculoskeletal system (147%) and decreased in the kidneys (-11%) after administration of proET-1. Phosphoramidon (4 mg/kg, iv) pretreatment attenuated the increase in MAP and TPR induced by proET-1. Phosphoramidon pretreatment significantly attenuated the proET-1-induced increase in blood flow to the heart, brain, kidneys, portal system, and GIT. The increase in vascular resistance induced by proET-1 in the mesentery and pancreas and in the musculoskeletal system was also attenuated by phosphoramidon. DCLHb increased MAP (63%) and TPR (54%) without affecting HR. DCLHb increased blood flow to the heart (95%), GIT (45%), portal system (43%), and skin (79%) and increased vascular resistance in the musculoskeletal system (58%). In phosphoramidon-treated rats, DCLHb increased MAP (99%), HR (25%), cardiac output (37%), and TPR (60%). DCLHb increased blood flow to the heart (104%), brain (66%), kidneys (49%), GIT (59%), portal system (63%), and skin (100%) when administered to phosphoramidon-treated rats. Phosphoramidon did not attenuate any of the DCLHb-induced cardiovascular effects. It is concluded that proET-1 increases blood flow to various organs and that phosphoramidon, an ECE inhibitor, could block the proET-1-induced increases in regional blood flow.(ABSTRACT TRUNCATED AT 400 WORDS)
Animals↗
Power Doppler ultrasound in musculoskeletal disease: a systematic review.
OBJECTIVE: To evaluate the performance characteristics of power Doppler ultrasound as a diagnostic and monitoring tool in the assessment of musculoskeletal disease through a systematic review of the literature. METHODS SEARCH STRATEGY: We performed a literature search of PUBMED (1966 to June 2005). SELECTION CRITERIA: Only original research reports written in English involving musculoskeletal disease and power Doppler ultrasound were included. Reviews were noted but not included. Data Extraction/Reporting: The design, subjects, methods, imaging protocols, and performance characteristics studied in the research papers were reported. RESULTS: Of 3568 identified reports, 139 involved power Doppler ultrasound of the musculoskeletal system. Fifty-three of these reports met the inclusion criteria. Ultrasound machine settings were specified in 63% of reports. Rheumatoid arthritis was the most commonly studied musculoskeletal disease (64% of papers). Validity was the most studied performance characteristic (94% of reports), while reliability and responsiveness were studied in 17 and 34%, respectively. CONCLUSIONS: Although the majority of research reports of power Doppler ultrasound assessment of the musculoskeletal system evaluated validity, less than half reported reliability and responsiveness. Further work is needed to evaluate power Doppler ultrasound assessment of the musculoskeletal system before it can be used to guide clinical decisions or be used as an endpoint in clinical trials.
Arthritis, Rheumatoid↗
Biomechanics of stair walking and jumping.
Physical activities such as stair walking and jumping result in increased dynamic loading on the human musculoskeletal system. Use of light weight, externally attached accelerometers allows for in-vivo monitoring of the shock waves invading the human musculoskeletal system during those activities. Shock waves were measured in four subjects performing stair walking up and down, jumping in place and jumping off a fixed elevation. The results obtained show that walking down a staircase induced shock waves with amplitude of 130% of that observed in walking up stairs and 250% of the shock waves experienced in level gait. The jumping test revealed levels of the shock waves nearly eight times higher than that in level walking. It was also shown that the shock waves invading the human musculoskeletal system may be generated not only by the heel strike, but also by the metatarsal strike. To moderate the risk of degenerative joint disorders four types of viscoelastic insoles were utilized to reduce the impact generated shock waves. The insoles investigated were able to reduce the amplitude of the shock wave by between 9% and 41% depending on the insole type and particular physical activity. The insoles were more effective in the reduction of the heel strike impacts than in the reduction of the metatarsal strike impacts. In all instances, the shock attenuation capacities of the insoles tested were greater in the jumping trials than in the stair walking studies. The insoles were ranked in three groups on the basis of their shock absorbing capacity.
Adult↗
A system of staging musculoskeletal neoplasms.
A system for staging benign and malignant musculoskeletal lesions is presented. This system, first devised at the University of Florida in 1977, was based on data assembled from 1968 through 1976. It was field tested by the Musculoskeletal Tumor Society and published in Clinical Orthopaedics and Related Research in 1980. In the ensuing five years, the system has undergone refinement. It has recently been adapted by the American Joint Committee Task Force on Bone Tumors and proposed by them to the International Union Against Cancer (IUCC) for international usage. Based upon histologic grade (G), anatomic site (T), and presence or absence of metastases (M), it describes the progressive stages, irrespective of histogenesis, that assess the progressive degrees of risk to which the patient is subject. This system articulates well with current radiologic techniques of staging and serves as a useful guide in the selection of an appropriate definitive surgical procedure. Its usage permits comparative end result studies on the effect of surgical and nonsurgical methods of management.
Bone Neoplasms↗
A review of adaptive change in musculoskeletal impedance during space flight and associated implications for postflight head movement control.
We present a review of converging sources of evidence which suggest that the differences between loading histories experienced in 1-g and weightlessness are sufficient to stimulate adaptation in mechanical impedance of the musculoskeletal system. As a consequence of this adaptive change we argue that we should observe changes in the ability to attenuate force transmission through the musculoskeletal system both during and after space flight. By focusing attention on the relation between human sensorimotor activity and support surfaces, the importance of controlling mechanical energy flow through the musculoskeletal system is demonstrated. The implications of such control are discussed in light of visual-vestibular function in the specific context of head and gaze control during postflight locomotion. Evidence from locomotory biomechanics, visual-vestibular function, ergonomic evaluations of human vibration, and specific investigations of locomotion and head and gaze control after space flight, is considered.
Adaptation, Physiological↗
[Sickness absence among workers with occupational locomotor system diseases].
A long-term analysis of the data on temporary incapacity for work may be useful in identifying the most essential changes in the pattern of the causes of the disease-related incapacity for work and give the alert for taking necessary measures to protect the human health. The aim of the analysis is to define the causes of temporary incapacity for work prior to the diagnosis of chronic diseases of the locomotor system induced by the way the job is performed and the work overload in workers' groups of the highest disease incidence. The sickness absence study was carried out in the group of 395 workers with the locomotor system diseases due to the above-mentioned causes, diagnosed during the years 1996-1997. The analysis was based on numbers of days of work disability, numbers of cases and the average duration of disease. The rates of work disability days in the study group were compared with relevant rates in the occupationally active population of Poland. The analysis of sickness absence during a five-year period before the certification of the occupational diseases of the locomotor system revealed the sickness absence higher by 52% in male workers and by 60% in female workers than the average sickness absence in the general population. In this group, the diseases of the musculoskeletal system were the major cause of work disability, being responsible for 48% of sickness absence. The highest work disability was found in male workers with shoulder pain syndrome (about 49 days/person/year) and female workers with tenosynovitis and bursitis (45 days/person/year). As to the selected occupational groups, the first place was occupied by the group of workers engaged in metal processing (53 days/person/year), in which diseases of the musculoskeletal system made over 50%. In miners, besides locomotor diseases, a high level of sickness absence was due to the diseases of the nervous system and sense organs (17% of absence). In the group of dentists, the circulatory system diseases were the major cause of work disability in men (38% of absence), and the musculoskeletal system diseases in women (36% of absence). The study indicates that sickness absence can prove to be a substantial parameter that renders it possible to identify persons with enhanced risk of occupational disease by physicians involved in prophylactics and to take necessary preventive measures.
Aged↗
Musculoskeletal sonography and MR imaging. A role for both imaging methods.
Sonography is currently being applied to many areas of the musculoskeletal system. Although some areas are in the experimental stage, there exist several indications in which sonography can produce results at least equal to what is possible with MR imaging. Examples include evaluation for shoulder and ankle tendon abnormalities; soft tissue infection and joint effusion; soft tissue foreign bodies; soft tissue masses, such as Baker's cyst and wrist ganglion cyst; carpal tunnel syndrome; developmental dysplasia of the hip; and other indications where MR imaging is contraindicated. The role of sonography in evaluation of the musculoskeletal system is evolving. With continued experience and research, newer applications for musculoskeletal sonography will likely become established further defining the roles of sonography and MR imaging in evaluation of the musculoskeletal system.
Achilles Tendon↗
Workload and musculoskeletal problems: a comparison between welders and office clerks (with reference also to fishermen).
Previous studies have shown that subjective as well as clinical shoulder signs and symptoms are more common among welders than among office clerks. In the present study we wished to further evaluate the influence of different jobs on musculoskeletal problems, as well as the relationship between objective signs and subjective symptoms. This study confirmed that symptoms and signs from the shoulder were more common among the welders, who also had more subjective symptoms and clinical signs from other parts of the musculoskeletal system. Range of motion in different joint systems was, however, similar in the two groups except in external rotation of the shoulder, where welders had a more limited range. The degree of co-existence of subjective symptoms and clinical signs differed between different parts of the musculoskeletal system and was low particularly in the low back, hips, and ankles. This indicates low validity of many common clinical methods for determining musculoskeletal dysfunction. General health was good in both vocational groups and isometric strength for the welders was intermediate between that of office clerks (who had lower strength) and that of fishermen (who had higher strength, as disclosed in a previous investigation). To a similar degree welders and fishermen also had objective signs from most parts of the musculoskeletal system, whereas subjective symptoms from some parts of the body and medical consultations due to these problems were more common among welders. Atrophied shoulder muscles were more common among welders than among fishermen, whereas crepitations in the shoulder tended to be more common among the fishermen. This indicates that heavy dynamic work and prolonged static work may both induce shoulder injuries, but of different types.
Adult↗
Safety of the new quinolones in pregnancy.
OBJECTIVE: To investigate the effect on the fetus of intrauterine exposure to quinolones in terms of teratogenicity, with special focus on the musculoskeletal system. METHODS: We studied 38 pregnant women who received quinolones and consulted the Motherisk Program in Toronto from 1989-1992. Perinatal complications, birth weight, birth defects, and developmental milestones, with particular emphasis on the musculoskeletal system, were compared with those of controls matched for both maternal age and indication for antibacterial therapy. RESULTS: Thirty-five women (92%) treated with norfloxacin or ciprofloxacin received therapy during the first trimester. The most common indication for therapy (92%) was urinary tract infection. More pregnancies in the quinolone group resulted in cesarean delivery due to reported fetal distress as compared to the controls (P = .005), without clear reason. Children born to mothers treated with quinolones were significantly heavier (P = .05) than the control infants, possibly because of better control of the urinary tract infection. No malformations were found in the quinolone group, whereas one child in the control group had a ventricular septal defect. No differences were detected between the groups in achievement of developmental milestones or in the musculoskeletal system. CONCLUSION: The use of the new quinolones during the first trimester of pregnancy does not appear to be associated with an increased risk of malformations or musculoskeletal problems; however, longer follow-up and magnetic resonance imaging of the joints may be warranted to exclude subtle cartilage and bone damage.
Abnormalities, Drug-Induced↗