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PubMed2005

Management of musculoskeletal complications in endstage renal disease: an update.

People treated with prolonged hemodialysis now survive longer and increasingly develop musculoskeletal complications. Significant advances have been made in the management of musculoskeletal manifestations in patients undergoing hemodialysis for endstage renal disease. Noncalcium-based phosphate binders are preferred for the management of hyperphosphatemia. Vitamin D therapy is based on intact parathyroid hormone levels. Newer Vitamin D sterols and calcimimetic agents seem to control secondary hyperparathyroidism without increasing the calcium-phosphorous product. Use of biocompatible dialyzers for hemodialysis may delay articular manifestations of beta-2 microglobulin amyloidosis. Beta-2 microglobulin adsorption columns when used along with hemodialysis may lead to lower beta-2 microglobulin levels and improvement in articular manifestations of beta-2 microglobulin amyloidosis. In this review, we focus on the latest advancements in the management of secondary hyperparathyroidism and beta-2 microglobulin amyloidosis.

Amyloidosis↗

PubMed2002

A review of functional status measures for workers with upper extremity disorders.

In order to identify functional status measures for epidemiological studies among workers with mild to moderate disorders of the neck and upper extremity, a literature search was conducted for the years 1966 to 2001. Inclusion criteria were: (1) relevance to neck and upper extremity; (2) assessment among workers; and (3) relevance to mild to moderate disorders. Of 13 instruments reviewed, six measures were tested among workers. The three best measures, depending on the purpose of research, included the standardised Nordic Musculoskeletal Questionnaire, the Upper Extremity Questionnaire, and the Neck and Upper Limb Instrument. Development of a functional protocol is regarded as a realistic enhancement for research of neck and upper extremity disorders in the workplace. For research and clinical practice, measures of functional status, sensitive enough to measure the subtle conditions in mild to moderate disorders, may provide prognostic information about the risk of developing musculoskeletal disorders in apparently healthy patients. Appropriate use of functional status questionnaires is imperative for a meaningful portrayal of health.

Disability Evaluation↗

PubMed1977

A radiographic study of the human fetal spine. 1. The development of the secondary cervical curvature.

The present study has shown that the secondary curvature in the cervical spine of the human fetus develops at a much earlier age than has been thought. It may, in fact, develop soon after the embryo first acquires a neck and begins to uncurl. The early appearance of this curvature may be related to the early development of function in the muscles responsible for head extension, this movement being a basic component of the primitive "gasp" reflex. It is further suggested that, although the embryo develops in flexion, the traditional assumption that such flexion is a consequence of fetal musculoskeletal development must be questioned, and the expression "normal fetal flexed position" is probably misleading, since it does not take into account the wide range of movements of which the fetus is capable.

Embryo, Mammalian↗

PubMed2004

Musculoskeletal symptoms as related to ergonomic factors in Iranian hand-woven carpet industry and general guidelines for workstation design.

Carpet weaving is a high risk occupation for developing musculoskeletal disorders (MSDs). The objectives of the present study, which was carried out in the Iranian hand-woven carpet industry, were determination of the prevalence of MSD symptoms, identification of major factors associated with MSD symptoms and development of guidelines for workstation design. 1,439 randomly selected weavers participated in this study. A questionnaire was used to collect data on MSD symptoms. The results revealed that the prevalence rates for symptoms in different body regions were high as compared to the general Iranian population (for neck, back and large joints, p <.0001). The results of multivariate analyses showed that major ergonomic factors associated with musculoskeletal symptoms were loom type, working posture, daily working time and seat type. Based on the results, some general guidelines for designing weaving workstations were developed. A prototype test showed that the new workstation was acceptable for subject tests and that it improved working posture.

Adolescent↗

PubMed1993

Musculoskeletal disorders among male sewing machine operators in shoemaking.

Research on the relationship between the operation of sewing machines and the appearance of musculoskeletal disorders has been conducted mainly among women working in garment or textile production, in developed countries; little is known about male sewing machine operators in other industries, in less developed countries. This study involved 143 Mexican men operating sewing machines in eight shoe factories; 132 of them operated flat-type machines, 11 column-type machines. When studied, the operators had been in this task for at least one year. The study aimed to identify the body regions more liable to develop musculoskeletal disorders and the rates both of appearance of such troubles and of sick leave resulting from them. A questionnaire was given to each worker, asking for their work history, the presence of musculoskeletal disorders at the time of the inquiry, and the frequency of sick leave during the previous 12 months; additionally, a number of workers were filmed on video and this material was then used to identify the body regions undergoing the major work demands. 47.5% of the subjects declared current musculoskeletal disorders; a statistical difference was found when the two groups were considered separately. Low back pain was the most frequent at a rate of 18.2% for both groups; the shoulder was a site of complaint for 14% of the subjects, being three times more frequent among column-machine operators; the back as a whole was mentioned also by 14% of the subjects, all of them flat-machine operators; 4.9% of the subjects complained of neck pain and again none of the column-machine operators was affected.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2001

The weight and use of schoolbags in New Zealand secondary schools.

The weight and use of schoolbags amongst 140 students (70 third form students comprising 35 females and 35 males, and 70 sixth form students comprising 35 females and 35 males) from five New Zealand secondary schools was investigated. Third form students, who were smaller in stature and weight than sixth form students, were found to carry 13.2% of their body weight in schoolbags, while sixth form students carried 10.3% of their body weight. Third form students reported carrying their schoolbags for a longer period of time than sixth form students. Third form students also had less access to lockers to store their schoolbooks and supplies as only one of the five schools investigated provided lockers for third form students, whereas four of the five schools provided lockers for sixth form students. Most students used backpacks to transport their supplies, and these were predominantly carried on two shoulders. Heavy schoolbags, long carriage durations and lack of access to lockers amongst third formers, could contribute to the production or maintenance of musculoskeletal symptoms. This study suggests that third form students may be at a higher risk of developing musculoskeletal symptoms than sixth form students.

Adolescent↗

PubMed2003

Tendon morphogenesis in the developing avian limb: plasticity of fetal tendon fibroblasts.

The differentiation and patterning of tendon fibroblasts is at present a poorly understood aspect of musculoskeletal development in the vertebrate limb. Precursors of tendon fibroblasts originate in the somatic mesoderm adjacent to the early limb bud and gradually become incorporated into the limb mesenchyme as development proceeds. It is unclear whether these progenitor cells are committed to the tendon lineage at this early stage, or whether cells become committed only as they are incorporated into a developing tendon. Following a review of our current knowledge of early tendon development, we present recent results from our preliminary studies looking at tendon cell commitment. Using a lacZ encoding replication-deficient retrovirus, we have mapped regions of the early limb bud that contain presumptive tendon progenitor cells, and later used these sites for implanting labelled fetal tendon fibroblasts into developing limbs. Following implantation, we found that these cells successfully re-incorporated into developing proximal and distal tendons, but also surprisingly contributed to other tissue lineages within the limb. Our results suggest that fetal tendon fibroblasts may not be irreversibly committed to a tendon cell fate in the limb and may be somewhat plastic in their ability to integrate into other tissue lineages during development.

Animals↗

PubMed1994

Bone-marrow transplantation in Hurler's syndrome. Effect on skeletal development.

Between 1980 and 1988, displacement bone-marrow transplantation was performed on 25 children with Hurler's syndrome (type-1 mucopolysaccharidosis). We describe the musculoskeletal development of 11 of the 12 surviving children and the orthopaedic procedures undertaken to treat progressive thoracolumbar kyphosis, hip subluxation and carpal tunnel syndrome. We found abnormal bone modelling, focal failures of ossification and an avascular disorder of the femoral head in every patient and offer an explanation for these phenomena. Increasing valgus deformity of the knees and progressive generalised myopathy caused loss of mobility as the children entered adolescence. The benefit of bone-marrow transplantation as a treatment for the skeletal disorders of Hurler's syndrome is limited by the poor penetration of the musculoskeletal tissues by the enzyme derived from the leucocytes.

Bone Marrow Transplantation↗

PubMed1989

MR imaging of muscles of mastication.

High-field MR imaging was used to study structural and physiologic alterations involving the muscles of mastication in 46 patients. Muscular abnormalities were often detected incidentally in conjunction with lesions of the CNS, cranial nerves, facial bones, and/or temporomandibular joint (TMJ). Specific pathologic alterations observed included anomalies of musculoskeletal development, muscle hypertrophy, atrophy (disuse and denervation), inflammatory disorders, injuries (including contusions, tears, and muscle rupture), posttraumatic musculoskeletal deformities, and reflex sympathetic dystrophy. Atrophy, fatty replacement, fibrosis, and contracture of selected muscles of mastication may accompany internal derangement of the TMJ in the absence of traumatic deformity. We conclude that MR is a highly accurate imaging method for detecting masticatory muscle disease. Nontraumatic anatomic and physiologic abnormalities of the muscles of mastication are uncommon disorders. Demonstrable muscle alterations frequently accompany fracture dislocations of the mandibular condyle neck and related facial bones onto which masticatory muscles attach.

Adolescent↗

PubMed2004

Working conditions and health among female and male employees at a call center in Sweden.

BACKGROUND: The call center industry is one of the most expansive labor market sectors in Sweden today. The purpose of this study was to investigate the working conditions and symptoms among employees at a call center in Sweden. METHODS: This study represents the cross-sectional baseline survey, which was part of a prospective cohort study. Fifty-seven call center workers were compared with a reference group of 1,459 professional computer users from other occupations. A questionnaire covered physical and psychosocial working conditions and symptoms during the last month. Structured observations in accordance with an ergonomic checklist were used to assess workstation design during the subject's ordinary work. RESULTS: The call center group had worked for a shorter time in their present tasks and spent longer continuous time in front of the computer than the reference group. There were deficiencies in workspace, keyboard- and input device placement. The subjects reported poor support from their immediate supervisor, low control and limited opportunities to influence their work. A higher proportion of the call center group reported musculoskeletal symptoms. CONCLUSION: The call center operators were exposed to working conditions that in other studies have indicated an increased risk of developing musculoskeletal disorders. The study also shows that young computer operators in the call center group with a short working career had a higher prevalence of neck- and upper extremity symptoms than older computer workers in other labor market sectors.

Adult↗

PubMed1993

Effects of prenatal alcohol exposure on neuromotor and cognitive development during early childhood: a series of case reports.

The purpose of this article is to present a series of case reports of infants and young children who were exposed to alcohol prenatally. The five infants and two 5-year-old twins in this series all presented facial features characteristic of prenatal alcohol exposure, and all had medical histories of maternal alcohol abuse. The neuromotor and cognitive development of these seven children is described by presenting results of standardized tests administered longitudinally. In addition, clinical observations of growth, behavior, feeding, and musculoskeletal development are provided. Following a discussion of these assessment results, implications for physical therapy intervention and the need for clinical research are provided. Because children with fetal alcohol syndrome or alcohol-related birth defects present a spectrum of developmental differences that often include areas of concern to physical therapists, we need to increase our involvement in the assessment and treatment of these children as well as in research efforts to examine the efficacy of these interventions.

Child, Preschool↗

PubMed2002

Locoregional control in infants with neuroblastoma: role of radiation therapy and late toxicity.

PURPOSE: To review patterns of failure in infants with neuroblastoma and determine late toxicity and efficacy of radiotherapy (RT) on locoregional control. MATERIALS AND METHODS: From 1955 to 1998, 53 children (35 males and 18 females) <1 year old with neuroblastoma were seen at our institution. Twenty-one (40%) were </=1 month of age (neonates). Seven congenital anomalies were seen in 4 children (atrial septal defect, pulmonary valve stenosis, and absent corpus callosum were seen in 1 patient each; the other child had atrial and ventricular septal defect, aortic arch hypoplasia, and mitral valve stenosis). Primary tumor was located in the adrenal gland in 26 (49%), abdomen/nonadrenal in 14 (26%), thorax in 9 (17%), neck in 2 (4%), and pelvis in 2 (4%). All infants were retrospectively staged according to the International Neuroblastoma Staging System (INSS); 8 had Stage 1, 7 Stage 2A, 6 Stage 2B, 15 Stage 3, 6 Stage 4, and 11 Stage 4S. All patients, except 11 with Stage 4S and 4 with Stage 4, had resection of the primary tumor. Sixteen infants had pathologic involvement of regional lymph nodes (LN+). Twenty patients received RT. Kilovoltage beams were used in 10, megavoltage photons in 9, and electrons in 1 child. Fifteen received RT to the primary site and regional nodes (postoperative 8, preoperative 7). Postoperative doses ranged from 15 to 25 Gy whereas preoperative doses ranged from 12 to 31 Gy using a median fraction size of 1.5 Gy. Chemotherapy was employed in 22 of 53 patients (42%) with the most common agents being cyclophosphamide in 22 and doxorubicin in 11. Median follow-up was 13.1 years (range, 2-41 years). RESULTS: Tumor control: The 5-year overall and freedom from progression rates were 79 +/- 9% and 81 +/- 11%; the locoregional control rate was 88 +/- 9%. INSS Stage was a prognostic factor for overall survival (p = 0.03) and freedom from progression (p = 0.035). Gender, age (</=1 month vs. >1 month), and primary site were not found to impact on survival or progression. None of the Stage 1, 2A, or 2B patients recurred. One of 15 Stage 3 and 5 of 6 Stage 4 children recurred (6 distant metastases, 4 local failure). Four of 6 (67%) LN+ patients treated with locoregional RT and 8 of 10 (80%) LN+ patients treated without RT were locally controlled. There was no isolated locoregional relapse. Two Stage 4S patients died of respiratory compromise secondary to hepatomegaly. RT toxicity: For the 20 infants who received RT, 13 are alive with long-term follow-up ranging from 9.3 to 41 years, median 23 years. The 10 and 15-year musculoskeletal toxicity rates were 38.5% and 47.3% for those receiving RT and 3.3% for no RT (p = 0.02, log-rank test). Five of 6 infants <6 months of age and 1 of 7 >/=6 months developed musculoskeletal toxicity. Musculoskeletal effects were seen in 6 RT patients and included bony hypoplasia in 6, scoliosis in 5, soft tissue hypoplasia in 3, slipped capital femoral epiphysis in 2, kyphosis in 1, and osteochondroma in 1. Three required orthopedic intervention, all receiving >/=20 Gy. One child developed bowel obstruction at 21 months and another developed a leiomyosarcoma in the treatment field 34 years after RT. CONCLUSION: Our study shows that most LN+ infants achieve locoregional control without RT. Infants <6 months receiving RT were the most susceptible to musculoskeletal abnormalities. Further studies are needed to determine if cardiovascular anomalies are more frequently seen in children with neuroblastoma.

Abdominal Neoplasms↗

PubMed1993

Overuse injury and growing bones: the young athlete at risk.

Increasing numbers of children are becoming involved in competitive sport. International trends in pre-adolescent sports participation are mirrored in New Zealand, where promising young athletes are being exposed to high-intensity training from an earlier age. As a consequence, overuse injuries which were traditionally described in more mature athletes are now becoming recognized in pre-adolescents. The immature musculoskeletal system is less able to cope with repetitive biomechanical stress. Sites of overuse injury reflect the sites of rapid musculoskeletal development. It therefore behoves all medical practitioners, but particularly those in primary care, to be aware of the young athlete at risk. Inherent in the presentation of such musculoskeletal insult there often lurks an over-enthusiastic parent. We are all well reminded of the covert pressures adults may bring to bear upon children. Psychological, as well as physical injury often results.

Bone Development↗

PubMed2006

Regulation of procollagen amino-propeptide processing during mouse embryogenesis by specialization of homologous ADAMTS proteases: insights on collagen biosynthesis and dermatosparaxis.

Mutations in ADAMTS2, a procollagen amino-propeptidase, cause severe skin fragility, designated as dermatosparaxis in animals, and a subtype of the Ehlers-Danlos syndrome (dermatosparactic type or VIIC) in humans. Not all collagen-rich tissues are affected to the same degree, which suggests compensation by the ADAMTS2 homologs ADAMTS3 and ADAMTS14. In situ hybridization of Adamts2, Adamts3 and Adamts14, and of the genes encoding the major fibrillar collagens, Col1a1, Col2a1 and Col3a1, during mouse embryogenesis, demonstrated distinct tissue-specific, overlapping expression patterns of the protease and substrate genes. Adamts3, but not Adamts2 or Adamts14, was co-expressed with Col2a1 in cartilage throughout development, and with Col1a1 in bone and musculotendinous tissues. ADAMTS3 induced procollagen I processing in dermatosparactic fibroblasts, suggesting a role in procollagen I processing during musculoskeletal development. Adamts2, but not Adamts3 or Adamts14, was co-expressed with Col3a1 in many tissues including the lungs and aorta, and Adamts2(-/-) mice showed widespread defects in procollagen III processing. Adamts2(-/-) mice had abnormal lungs, characterized by a decreased parenchymal density. However, the aorta and collagen fibrils in the aortic wall appeared normal. Although Adamts14 lacked developmental tissue-specific expression, it was co-expressed with Adamts2 in mature dermis, which possibly explains the presence of some processed skin procollagen in dermatosparaxis. The data show how evolutionarily related proteases with similar substrate preferences may have distinct biological roles owing to tissue-specific gene expression, and provide insights into collagen biosynthesis and the pathobiology of dermatosparaxis.

ADAM Proteins↗

PubMed1999

Work related risk factors for musculoskeletal complaints in the spinning industry in Lithuania.

OBJECTIVES: To describe the prevalence of self reported musculoskeletal complaints in the back, arms or neck, and legs among workers in the spinning industry, and to investigate the relations between these complaints and work related variables. METHODS: An interview based questionnaire survey was carried out in two spinning industry factories in Lithuania. RESULTS: The study group consisted of all workers in production (n = 363). Symptoms of the legs were the musculoskeletal symptom reported most often (61%). Many subjects had arms or neck (55%) or back problems (28%). 20% had experienced pain from all three sites. Almost 25% had had musculoskeletal pain every day and 16% had experienced constant pain during previous year. Packers had the highest risk of arms or neck problems whereas spinners had the highest risk of back or leg problems. Working in a strained posture (bending, work with arms raised up above shoulder level, and repetitive movements of the fingers) was associated with all three complaints. Only arms or neck complaints were associated with age. CONCLUSIONS: Musculoskeletal disorders are a common problem among workers producing gobelin or synthetic thread in Lithuania and working in a strained posture is a risk factor for developing musculoskeletal disorders in three body sites: legs, arms or neck, and back. To better understand the different aspects of physical load as risk factors, a more detailed study of the frequency of postural changes as well as an observation of individually adopted postures would be necessary. This applies to intervention studies in factories of the spinning industry to prevent complaints of the legs and shoulders.

Adolescent↗

PubMed2006

Post-hatching growth and development of the pectoral and pelvic limbs in the black noddy, Anous minutus.

The black tern (Anous minutus) uses a semi-precocial growth strategy. Terrestrial locomotor capacity occurs soon after hatching, but pectoral limb development is delayed and flight is not possible until about post-hatching day 50. A growth series (hatchlings to fledglings) was used to explore how limb musculoskeletal development varied with body mass. In the pelvic limb, bone lengths scaled isometrically or with negative allometry. Gastrocnemius muscle mass and the failure load and stiffness of the tibiotarsus scaled isometrically. In the pectoral limb, pectoralis and supracoracoideus muscle masses increased with strong positive allometry that was mirrored by increases in wing bone strength and stiffness. Bending strength (sigma(ult)) and modulus (E) remained fairly constant throughout development to fledging for all limb bones. The moment of inertia (I) scaled with negative allometry for the tibiotarsus and with strong positive allometry in the wing bones. Differences in sigma(ult) and E of the tibiotarsus between pre-fledged chicks and adults was due, primarily, to increases in bone density rather than increases in the moment of inertia of the skeletal elements, whereas sigma(ult) of wing bones was a function of increases in both bone density and I. Early development of functional pelvic limbs in tree-nesting birds is relatively unusual, and presumably reflects a familial trait that does not appear to compromise breeding success in this species.

Animals↗

PubMed2003

Invited Review: Role of mechanophysiology in aging of ECM: effects of changes in mechanochemical transduction.

Mechanical forces play a role in the development and evolution of extracellular matrices (ECMs) found in connective tissue. Gravitational forces acting on mammalian tissues increase the net muscle forces required for movement of vertebrates. As body mass increases during development, musculoskeletal tissues and other ECMs are able to adapt their size to meet the increased mechanical requirements. However, the control mechanisms that allow for rapid growth in tissue size during development are altered during maturation and aging. The purpose of this mini-review is to examine the relationship between mechanical loading and cellular events that are associated with downregulation of mechanochemical transduction, which appears to contribute to aging of connective tissue. These changes result from decreases in growth factor and hormone levels, as well as decreased activation of the phosphorelay system that controls cell division, gene expression, and protein synthesis. Studies pertaining to the interactions among mechanical forces, growth factors, hormones, and their receptors will better define the relationship between mechanochemical transduction processes and cellular behavior in aging tissues.

Aging↗

PubMed1998

Techniques, coils, pulse sequences, and contrast enhancement in pediatric musculoskeletal MR imaging.

The first half of this article emphasizes the basic techniques involved in performing MR imaging of the pediatric musculoskeletal system. These include patient preparation, sedation issues, immobilization, coil selection, and pulse sequences. The second half of this article provides a detailed discussion of the use of Gadolinium and its enhancement characteristics in the normal developing musculoskeletal system, and its pathologic states are given.

Adolescent↗