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PubMed2005

Development of a portable 3D ultrasound imaging system for musculoskeletal tissues.

3D ultrasound is a promising imaging modality for clinical diagnosis and treatment monitoring. Its cost is relatively low in comparison with CT and MRI, no intensive training and radiation protection is required for its operation, and its hardware is movable and can potentially be portable. In this study, we developed a portable freehand 3D ultrasound imaging system for the assessment of musculoskeletal body parts. A portable ultrasound scanner was used to obtain real-time B-mode ultrasound images of musculoskeletal tissues and an electromagnetic spatial sensor was fixed on the ultrasound probe to acquire the position and orientation of the images. The images were digitized with a video digitization device and displayed with its orientation and position synchronized in real-time with the data obtained by the spatial sensor. A program was developed for volume reconstruction, visualization, segmentation and measurement using Visual C++ and Visualization toolkits (VTK) software. A 2D Gaussian filter and a Median filter were implemented to improve the quality of the B-scan images collected by the portable ultrasound scanner. An improved distance-weighted grid-mapping algorithm was proposed for volume reconstruction. Temporal calibrations were conducted to correct the delay between the collections of images and spatial data. Spatial calibrations were performed using a cross-wire phantom. The system accuracy was validated by one cylinder and two cuboid phantoms made of silicone. The average errors for distance measurement in three orthogonal directions in comparison with micrometer measurement were 0.06+/-0.39, -0.27+/-0.27, and 0.33+/-0.39 mm, respectively. The average error for volume measurement was -0.18%+/-5.44% for the three phantoms. The system has been successfully used to obtain the volume images of a fetus phantom, the fingers and forearms of human subjects. For a typical volume with 126 x 103 x 109 voxels, the 3D image could be reconstructed from 258 B-scans (640 x 480 pixels) within one minute using a portable PC with Pentium IV 2.4 GHz CPU and 512 MB memories. It is believed that such a portable volume imaging system will have many applications in the assessment of musculoskeletal tissues because of its easy accessibility.

Equipment Design↗

PubMed2000

Magnetic resonance imaging of lipoma and liposarcoma: potential of short tau inversion recovery as a technique of fat suppression.

The present limited retrospective study was performed to assess MR imaging of lipomatous tumours of the musculoskeletal system and to evaluate the potential of the T2 short tau inversion-recovery (STIR) technique for differentiating lipomas from liposarcomas. Magnetic resonance imaging of 12 patients with lipomatous tumours of the musculoskeletal system (eight benign lipomas, three well-differentiated liposarcomas and one myxoid liposarcoma) were reviewed. Benign lipomas were usually superficial and showed homogeneity on T1- and T2-weighted spin echo sequences. Full suppression at T2 STIR was readily demonstrated. In contrast, the liposarcomas in the present series were all deep-seated. Two well-differentiated liposaromas showed homogeneity at long and short relaxation time (TR) but failed to show complete suppression at T2 STIR. One case of well-differentiated liposarcoma (dedifferentiated liposarcoma) and one of myxoid liposarcoma showed mild and moderate heterogeneity at T1 and T2, respectively, and posed no difficulty in being diagnosed correctly. In conclusion, short and long TR in combination with T2 STIR show promise in differentiating benign from malignant lipomatous tumours of the musculoskeletal system, when taken in combination with the position of the tumour.

Adolescent↗

PubMed2000

[Temporary work disability among firemen employed in rescue and fire brigades].

Workers of rescue and fire brigades participating in actions are exposed to harmful effect of toxic substances, chemicals or physical factors. They also experience enormous emotional shock evoked by direct threat or contact with victims of disasters and fires. The aim of the study was to define the pathology which increases the risk of temporary work disability among firemen. The study covered 150 firemen employed during the years 1994-97 in rescue and fire brigades selected at random. The data on the number of days and cases of work disability during the period of four years for each firemen covered by the study were analysed. In the group under study a mean annual number of work disability due to sickness accounted for 1443 days per 100 employed. The major causes of work disability were as follows: diseases of the respiratory system (22% of total sickness absenteeism); diseases of the nervous system and sense organs (19%); diseases of the musculoskeletal system (18%), diseases of the circulatory system (13%); mental disorders (8%); and diseases of digestive system (7%). Sickness absenteeism among workers of rescue and fire brigades was lower by 30% on average than that among men employed in the national economy. But in the 50-59 age group, it was higher by 68%. In this age group, the highest level of sickness absenteeism was associated with mental disorders (15 times higher than in other male occupational groups); diseases of the musculoskeletal system (higher by 53%); diseases of the respiratory system (2 times higher); neoplasms (7 times higher); diseases of the nervous system (higher by 46%). It should be stressed that the study revealed increased work disability due to lung (by 33%), bladder (6 times higher) and brain (over 3 times higher) cancers. The results of this study find their confirmation in many other epidemiological studies of this occupational group.

Adult↗

PubMed1994

Standing working posture compared in pregnant and non-pregnant conditions.

During pregnancy, an increase in body weight occurs together with changes in body weight distribution and in fit between body dimensions and workplace layout. These changes may cause alterations in working posture which may, in turn, have adverse consequences for the biomechanical load on the musculoskeletal system and so increase the risk of musculoskeletal disorders. Using photographic posture registration, the standing working posture was studied in 27 women during the last stage of pregnancy and after delivery (the experimental group). The women performed an assembly task while standing at various workplace layouts. The postural differences between the pregnant condition and the non-pregnant condition were studied and the effect of the various workplace layouts assessed. Ten non-pregnant controls were also studied twice to establish the effect of the time interval between the measuring occasions. We found that the women of the experimental group stood further from the work surface in the pregnant condition compared to the non-pregnant condition, the hips were positioned more backwards, and, in order to reach the tesk, they increased the flexion of the trunk, increased the anteflexion of the upper arms, and extended the arms more. At the workplace layout in which the work surface height was self-selected, the postural differences due to pregnancy were smallest or even absent, compared to the postural differences in the other workplace layouts studied. Ergonomists and workers in occupational health services should be alert to the consequences for the biomechanical load on the musculoskeletal system and the risk of development of health complaints caused by postural changes due to pregnancy. An adjustable workplace layout may prevent some problems.

Adult↗

PubMed2004

Musculoskeletal involvement in systemic lupus erythematosus.

Involvement of the musculoskeletal system is common if not universal in the clinical course of systemic lupus erythematosus (SLE). Joint involvement on the whole does not cause major erosive disease, however, recent developments in musculoskeletal imaging show clearly the presence of significant bony and soft tissue involvement. It might well explain the frequently observed discordance between the clinical signs and the articular symptoms assuming that fibromyalgia has been excluded. The clear demonstration of tendon involvement in SLE by MRI would merit considering tendonitis and tenosynovitis as candidates for inclusion in the diagnostic criteria.

Humans↗

PubMed2000

Computer-aided generation of stimulation data and model identification for functional electrical stimulation (FES) control of lower extremities.

Standard stimulation data for unassisted standing up of paraplegic patients was generated by dynamic optimization linked with model simulation, to overcome the difficulties in the present electromyogram (EMG)-based method. The generated stimulation data were roughly in agreement with the normal subjects' EMG. From these, it is suggested that the 'model-based' method is useful as an alternative of the 'EMG-based method'. The same technique can be applied to generation of patient-specific stimulation data once the musculoskeletal system of a patient is properly identified. The musculoskeletal system must be identified from data taken from simple and noninvasive experiments for the identification method to be practically acceptable. We developed a musculoskeletal model and systematic identification protocols for this purpose. They were validated for the vastus lateralis muscle at the knee joint. The identification was successful and the predicted joint angle trajectories closely matched the experimental data. This implies that the model-based generation of patient-specific stimulation data is possible.

Computer Simulation↗

PubMed1998

Pedal manifestations of musculoskeletal disease.

The major systemic musculoskeletal diseases that involve the foot include the inflammatory arthritides, gout, and diabetic osteoarthropathy. Podiatric problems are present in over one-third of patients with musculoskeletal disease and in over half of all patients with diabetes. The pedal manifestations of musculoskeletal disease are reviewed as the first indicators of systemic disorders and as they occur in established systemic diseases.

Arthritis, Rheumatoid↗

PubMed2005

Joint injury causes knee osteoarthritis in young adults.

PURPOSE OF REVIEW: This review presents recent data on joint injury as the cause of osteoarthritis development in young adults and proposes and discusses a model that highlights how joint injury and other risk factors may contribute to osteoarthritis development through two different pathways: joint-related mechanisms and deconditioning of the musculoskeletal system. RECENT FINDINGS: Knee osteoarthritis in young adults is common after knee injury. In women who sustained an anterior cruciate ligament injury in soccer, 51% (mean age 31) had radiographic changes after 12 years. Men, 41% (mean age 36) had osteoarthritis after 14 years. An injury to the menisci during middle age resulting in a horizontal tear is more probably the first signal of an already ongoing osteoarthritis process of the knee. Known risk factors seem to contribute to osteoarthritis through pathways related to (1) mechanical aspects of the joint and (2) the musculoskeletal system. SUMMARY: Osteoarthritis in young adults is most commonly a result of a previous injury to the knee. Deconditioning of the musculoskeletal system is seen with joint injury, obesity, and aging, all known risk factors for osteoarthritis. Muscular deconditioning contributes to increased joint loads and knee osteoarthritis development and progression. So far, it is unclear whether surgery reduces the development or progression of osteoarthritis. The risk for osteoarthritis development seems to increase as the amount of meniscal tissue removed increases. Knee injury prevention, rehabilitation after knee injuries, regular exercise, maintaining body weight, and a changed locomotion pattern may prevent osteoarthritis initiation and progression in young adults.

Adult↗

PubMed1990

Observations of working postures in garages using the Ovako Working posture Analysing System (OWAS) and consequent workload reduction recommendations.

The working postures of mechanics (n = 84) in 42 garages were observed using the Ovako Working posture Analysis System (OWAS). During observation, both working postures and work activities were recorded. A computer program was developed for the data analyses. Using this program it is possible to calculate the working posture load for each work activity and the contribution of a specific activity to the total working posture load. This is a substantial extension of the original OWAS method. Five out of 19 observed postures of the body members were classified as Action Category 2, which suggests they were slightly harmful to the musculoskeletal system and likely to cause discomfort. Of the so-called typical working postures, 31.9% was classified in Action Category 2, suggesting that during a substantial part of the working day typical working postures occur which are at least slightly harmful to the musculoskeletal system. Moreover, those work activities principally causing the workload to fall in OWAS' higher Action Categories were identified. For each of these three work activities an alternative work method was observed. The data show that in all three work activities the use of a vehicle lift reduces the number of poor working postures thereby reducing the load on the musculoskeletal system.

Accidents, Occupational↗

PubMed2004

A hierarchical analysis of the scaling of force and power production by dragonfly flight motors.

Maximum isometric force output by single muscles has long been known to be proportional to muscle mass(0.67), i.e to muscle cross-sectional area. However, locomotion often requires a different muscle contraction regime than that used under isometric conditions. Moreover, lever mechanisms generally affect the force outputs of muscle-limb linkages, which is one reason why the scaling of net force output by intact musculoskeletal systems can differ from mass(0.67). Indeed, several studies have demonstrated that force output by intact musculoskeletal systems and non-biological systems is proportional to motor mass(1.0). Here we trace the mechanisms that cause dragonflies to achieve a change from muscle mass(0.67) scaling of maximum force output by single flight muscles to mass(1.0) scaling of dynamic force output by the intact dragonfly flight motor. In eight species of dragonflies, tetanic force output by the basalar muscle during isometric contraction scaled as muscle mass(0.67). Mean force output by the basalar muscle under dynamic conditions (workloops) that simulated in vivo maximum musculoskeletal performance was proportional to muscle mass(0.83), a significant increase in the scaling exponent over that of maximum isometric force output. The dynamic performance of the basalar muscle and the anatomy of its lever, consisting of the second moment of area of the forewing (d(2)) and the distance between the muscle apodeme and the wing fulcrum (d(1)), were used to analyze net force output by the integrated muscle-lever system (F(ind)). The scaling of d(2) conformed closely to the expected value from geometic similarity (proportional to muscle mass(0.31)), whereas d(1) scaled as muscle mass(0.54), a significant increase over the expected value from geometric similarity. F(ind) scaled as muscle mass(1.036), and this scaling exponent was not significantly different from unity or from the scaling exponent relating maximum load-lifting by flying dragonflies to their thorax mass. Thus, the combined effect of a change in the scaling of force output by the muscle during dynamic contraction compared to that during isometric contraction and the departure from geometric similarity of one of the two lever arm lengths provides an explanation for how mass(1.0) scaling of force output by the intact musculoskeletal system is accomplished. We also show that maximum muscle mass-specific net work and power output available scale as mass(0.43) and mass(0.24), respectively.

Animals↗

PubMed2004

[Molecular basis for pain mediating properties of extracorporeal shock waves].

The biologic action of extracorporeal shock wave application on the musculoskeletal system is understood poorly. To prove the hypothesis that alterations of tissue concentrations of substance P and prostaglandin E(2) are involved in the biologic action of shock waves, extracorporeal shock waves with energy flux density of 0.9 mJ/mm(2 )(1500 pulses at 1/s) were applied in vivo to the distal femur of rabbits. The concentrations of substance P and prostaglandin E(2) eluated from the periosteum of the femur were measured. Compared with the untreated contralateral hindlimbs, substance P release from the periosteum from the femur was increased 6 and 24 h after extracorporeal shock wave application, but was decreased 6 weeks after extracorporeal shock wave application. By contrast, extracorporeal shock wave application did not result in altered prostaglandin E(2) release from the periosteum from the femur. Remarkably, there was a close relationship between the time course of substance P release found here, and the well-known clinical time course of initial pain occurrence and subsequent pain relief after extracorporeal shock wave application to tendon diseases. Accordingly, substance P might be involved in the biologic action of extracorporeal shock wave application on tissue of the musculoskeletal system. This is the first study providing insights into the molecular mechanisms of extracorporeal shock wave application to the musculoskeletal system.

Animals↗

PubMed2003

Substance P and prostaglandin E2 release after shock wave application to the rabbit femur.

The biologic action of extracorporeal shock wave application on the musculoskeletal system is poorly understood. To prove the hypothesis that alterations of tissue concentrations of substance P and prostaglandin E(2) are involved in the biologic action of shock waves, extracorporeal shock waves with energy flux density of 0.9 mJ/mm2 (1500 pulses at 1/second) were applied in vivo to the distal femur of rabbits. The concentrations of substance P and prostaglandin E(2) eluted from the periosteum of the femur were measured. Compared with the untreated contralateral hindlimbs, substance P release from the periosteum from the femur was increased 6 hours and 24 hours after extracorporeal shock wave application, but was decreased 6 weeks after extracorporeal shock wave application. By contrast, extracorporeal shock wave application did not result in altered prostaglandin E(2) release from the periosteum from the femur. Remarkably, there was a close relationship between the time course of substance P release found here, and the well-known clinical time course of initial pain occurrence and subsequent pain relief after extracorporeal shock wave application to tendon diseases. Accordingly, substance P might be involved in the biologic action of extracorporeal shock wave application on tissue of the musculoskeletal system. This is the first study providing insights into the molecular mechanisms of extracorporeal shock wave application to the musculoskeletal system.

Analysis of Variance↗

PubMed2005

Musculoskeletal examination: a complete review.

The musculoskeletal system provides the most obvious visual clues to a person's health. Problems in the musculoskeletal system can be intrinsic muscle problems or referred from organs. The history and physical examination, which are important in assessing the health of this system, are reviewed. Dynamic examination for assessing the functioning of the system are needed and are outlined. The aging of muscles and how it affects muscle function is discussed.

Aging↗

PubMed2004

Musculoskeletal disorders associated with HIV infection and AIDS. Part I: infectious musculoskeletal conditions.

The musculoskeletal system can be affected by a variety of abnormalities in association with human immunodeficiency virus (HIV) infection. Although not as common as complications involving other organ systems, such as the pulmonary and the central nervous systems, HIV-associated musculoskeletal disorders are sometimes the initial presentation of the viral illness. Knowledge of the existence and the characteristic appearance of the conditions affecting bone, joint, and muscle in HIV-infected patients is valuable to radiologists for diagnosis and to clinicians for detection and appropriate treatment. We reviewed recent literature to provide a comprehensive assessment of the HIV-associated musculoskeletal disorders, and present radiologic examples from our own collection. This article is divided into two parts. In the first part we review the infectious musculoskeletal disorders associated with HIV illness and AIDS, including cellulitis, abscesses, pyomyositis, septic bursitis, septic arthritis, osteomyelitis, and bacillary angiomatosis. We also present a comprehensive spectrum of mycobacterial infections, consisting of tuberculous spondylitis and spondylodiskitis, arthritis, osteomyelitis, and tenosynovitis, as well as infections caused by atypical mycobacteria. Part II of this review will concentrate on non-infectious musculoskeletal conditions, including rheumatic disorders and neoplasms.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Ultrasound in sports medicine.

The accuracy of sonography in evaluating various conditions of the musculoskeletal system has been demonstrated and its utility as a primary diagnostic imaging modality in the musculoskeletal system in the United States has been increasing in frequency. Sonography is universally tolerated across a broad patient population, including pediatric and pregnant patients and those in whom traditional magnetic resonance (MR) imaging is not an option, due either to absolute or relative contraindications. Sonographic examinations are relatively quick compared with an MR or computed tomographic study, and delays in scheduling are therefore minimal, an advantage for those patients who have traveled a long distance or who are in a considerable amount of discomfort at the time of their visit to the orthopedic surgeon. With portable ultrasound units, examinations can be performed on the playing field, immediately at the time of the acute injury, for rapid diagnosis. Lastly, ultrasound can be used to guide for therapeutic procedures at the same time the diagnostic exam is performed.

Athletic Injuries↗

PubMed1996

Role of endothelin in the cardiovascular effects of diaspirin crosslinked and stroma reduced hemoglobin.

OBJECTIVES: Diaspirin crosslinked hemoglobin is a resuscitative solution with excellent oxygen-carrying capacity. Diaspirin crosslinked hemoglobin produces an immediate increase in blood pressure and marked regional circulatory changes in rats and pigs. Our objective was to determine the role of endothelin in the cardiovascular actions of diaspirin crosslinked hemoglobin (modified) and (unmodified) stroma reduced hemoglobin solutions. DESIGN: Prospective, randomized comparison of cardiovascular effects of diaspirin crosslinked and stroma reduced hemoglobin in control rats and in rats pretreated with cyclo(D-Asp-Pro-D-Val-Leu-D-Trp) (BQ-123), an endothelin-A receptor antagonist. SETTING: Research laboratory. SUBJECTS: Male Sprague-Dawley rats. INTERVENTIONS: Modified, highly purified, and heat pasteurized (diaspirin crosslinked) and unmodified (stroma reduced) hemoglobin in control (untreated) and BQ-123 (5 mg/kg/hr iv)-treated rats. MEASUREMENTS AND MAIN RESULTS: Infusion of stroma reduced hemoglobin (400 mg/kg iv) in control rats produced an increase in blood pressure (43%) and total peripheral resistance (65%) without any change in heart rate, cardiac output, and stroke volume. Stroma reduced hemoglobin decreased blood flow to the kidneys and liver, increased blood flow to the heart, and had no effect on blood flow to the brain, gastrointestinal tract, spleen, musculoskeletal system, skin, and mesentery and pancreas. Infusion of stroma reduced hemoglobin in rats treated with BQ-123 (5 mg/kg/hr iv) increased the blood pressure to a similar degree when compared with control rats, but the increase in total peripheral resistance was significantly attenuated. The stroma reduced hemoglobin-induced decrease in blood flow to the kidneys and liver was significantly attenuated in BQ-123-treated rats as compared with control rats. However, the stroma reduced hemoglobin-induced increase in blood flow to the heart of BQ-123-treated rats was similar to the increase in control rats. Infusion of diaspirin crosslinked hemoglobin (400 mg/kg iv) produced increases in blood pressure (81%), cardiac output (36%), stroke volume (30%), and total peripheral vascular resistance (45%), along with increases in blood flow to the heart, spleen, gastrointestinal tract, and skin of control rats. The blood flows to the brain, kidneys, liver, musculoskeletal system, and mesentery and pancreas were not altered by diaspirin crosslinked hemoglobin in control rats. The increases in blood pressure, cardiac output, stroke volume, and total peripheral vascular resistance by diaspirin crosslinked hemoglobin were significantly blocked in BQ-123-treated rats as compared with control rats. The increases in blood flow to the heart, spleen, and skin by diaspirin crosslinked hemoglobin were significantly blocked in BQ-123-treated rats as compared with control rats. Diaspirin crosslinked hemoglobin produced an increase in the blood flow to the brain and a decrease in blood flow to the kidney and musculoskeletal system of BQ-123-treated rats as compared with control rats. Blood plasma endothelin-1-like immunoreactivity was found to be significantly increased after treatment with diaspirin crosslinked hemoglobin or stroma reduced hemoglobin. CONCLUSIONS: The endothelin-A receptor antagonist, BQ-123, could attenuate the systemic hemodynamic and regional circulatory effects of diaspirin crosslinked hemoglobin and stroma reduced hemoglobin. However, the increase in blood flow to the heart induced by stroma reduced hemoglobin could not be attenuated by BQ-123.

Animals↗

PubMed1988

Musculoskeletal status of men and women who entered a fitness programme.

The musculoskeletal status at entry into a fitness programme and the incidence of injuries during the first four months of the programme were evaluated in 991 men and women who were aged 20-63 years. At entry, about half of the subjects reported having received treatment for musculoskeletal ailments previously, or that currently they were experiencing musculoskeletal pain and/or discomfort, and about one-third of the subjects reported one or more movement limitations. New injuries during the first four months of the programme were reported by 38% of subjects, with an average duration of impairment of 3.8 weeks, and 43% of those who were injured sought medical treatment. The most frequent type, location, and cause of injury were "joint sprains/strains" (66%), the lower leg (70%), and jogging (33%), respectively. Musculoskeletal problems (previous treatment, current pain or discomfort or movement limitations) in the leg did not predict leg injuries during the programme, but back problems did predict back injuries. Age, sex, body mass index, a parental history of musculoskeletal disease, a sporting history, and the frequency of vigorous exercise during the first four months did not predict injury. The study emphasized: first, the vulnerability of previously-sedentary persons to musculoskeletal injury and the consequent need for care in the management of fitness programmes; secondly, the need for the evaluation of such programmes if they are to have a rational rather than an intuitive basis; and thirdly, the need for epidemiological research on the musculoskeletal system as a basis for systematic efforts, partly through education and ergonomics, to reduce wear and tear on the musculoskeletal system.

Adult↗

PubMed1996

Reasons for loss of fitness of dockers to perform physically heavy loading operations.

The present evaluation of reasons for loss of fitness to perform heavy and very heavy loading operations in dockers was based on a prospective study comprising a selected population of 508 men, carried out in 1989. A follow-up of their health and ability to perform loading operations continued until 1995. In this period change of the working post caused by health problems was observed in 185 (36.4%) men, 67 (13.2%) people either quitted work or got a disciplinary dismissal, 24 (4.7%) subjects got a promotion and 80 retired. 12 dockers deceased (2.45%); noteworthy, no death was associated with the work performed. They were 140 dockers (27.6%) that remained on their posts after 7 years of observation. In the group of 185 dockers the main reason for the medical disqualification for work were the diseases of the nervous peripheral and musculoskeletal system and of the connective tissue in 71 men (38.4%), chronic diseases of the upper respiratory tracts in 36 men (19.4%), circulatory system diseases in 24 cases (13.0%) and posttraumatic states of the musculoskeletal system in 16 cases (8.6%). A proper health qualification is crucial for a long-lasting fitness to work.

Adult↗