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PubMed1994

Effects of muscle strengthening on vertical jump height: a simulation study.

In this study the effects of systematic manipulations of control and muscle strength on vertical jump height were investigated. Forward dynamic simulations of vertical squat jumps were performed with a model of the human musculoskeletal system. Model input was STIM(t), stimulation of six lower extremity muscles as function of time; model output was body motion. The model incorporated all features of the musculoskeletal system of human test subjects considered salient for vertical jumping, and the initial body configuration was set equal to that of the test subjects. First, optimal STIM(t) was found for a standard version of the model (experiment A). A satisfactory correspondence was found between simulation results and kinematics, kinetics and electromyograms of the test subjects. Subsequently, optimal STIM(t) for the standard model was used to drive a model with strengthened muscles (experiment B). Jump height was now lower than that found in experiment A. Finally, optimal STIM(t) was found for the model with strengthened muscles (experiment C). Jump height was now higher than that found in experiment A. These results suggest that in order to take full benefit of an increase in muscle strength, control needs to be adapted. It is speculated that in training programs aimed at improving jumping achievement, muscle training exercises should be accompanied by exercises that allow athletes to practice with their changed muscles.

Adult↗

PubMedDate not supplied

Joint manifestations of Lyme borreliosis in Czechoslovakian patients.

Involvement of the musculoskeletal system in 50 Lyme borreliosis patients seen in Czechoslovakia is described. Thirty-three patients reported tick bites or that they had removed a tick, four patients had been bitten by some other insect. Skin reaction following tick bite were found in 29 patients. Neurologic involvements have been described in 40 subjects. In one patient complete heart block developed after ECM, so that a permanent pacemaker was necessary for two weeks. Mainly three types of involvement of the musculoskeletal system were observed, mostly as intermittent episodes of arthralgia or migratory musculoskeletal pain. In 37 patients brief attacks of monoarthritis or asymmetrical oligoarthritis were seen, chiefly of intermittent subacute course. Chronic arthritis was diagnosed in seven cases, sacroiliitis in four patients. The authors discuss differential diagnosis, especially in patients with chronic joint involvement.

Adolescent↗

PubMed2005

Variance in manual treatment of nonspecific low back pain between orthomanual physicians, manual therapists, and chiropractors.

OBJECTIVE: The aim of the study was to identify differences in the diagnosis and treatment of nonspecific low back pain among 3 professional groups in the Netherlands: orthomanual physicians, manual therapists, and chiropractors. METHODS: Information was obtained from training materials from professional groups, literature searches, and observation of selected practitioners at work. RESULTS: In The Netherlands, there are differences in education between the 3 professional groups. The focus of orthomanual medicine is on abnormal positions of components of the skeleton and symmetry in the spine. Manual therapy focuses on functional disorders of the musculoskeletal system. Chiropractic focuses on the musculoskeletal and nervous systems in relation to patients' health in general. Orthomanual medicine considers inspection and palpation the most important diagnostic tools. Manual therapists and chiropractors additionally perform tests to determine functional disorders and manual therapists evaluate psychosocial influences. Chiropractors take radiographs if necessary. Orthomanual physicians apply mobilization techniques using fixed protocols. Manual therapists and chiropractors use various manipulation and mobilization techniques and their manipulation techniques differ in amplitude and velocity. CONCLUSIONS: Diagnostic techniques and treatment methods of the 3 professional groups differ considerably. For more accurate reporting of the efficacy of manipulative and mobilizing therapies, the characteristics of treatments should be described in more detail when reported in studies such as randomized clinical trials.

Humans↗

PubMed1995

Neural network control of functional neuromuscular stimulation systems: computer simulation studies.

A neural network control system has been designed for the control of cyclic movements in Functional Neuromuscular Stimulation (FNS) systems. The design directly addresses three major problems in FNS control systems: customization of control system parameters for a particular individual, adaptation during operation to account for changes in the musculoskeletal system, and attaining resistance to mechanical disturbances. The control system was implemented by a two-stage neural network that utilizes a combination of adaptive feedforward and feedback control techniques. A new learning algorithm was developed to provide rapid customization and adaptation. The control system was evaluated in a series of studies on a computer simulated musculoskeletal model. The model of electrically stimulated muscle used in the study included nonlinear recruitment, linear dynamics, and multiplicative nonlinear torque-angle and torque-velocity scaling factors. The skeletal model consisted of a one-segment planar system with passive constraints on joint movement. Results of the evaluation have demonstrated that the control system can provide automated customization of the feedforward controller parameters for a given musculoskeletal system. It can account for changes in the musculoskeletal system by adapting the feedforward controller parameters on-line and it can resist the effects of mechanical disturbances. These results suggest that this design may be suitable for the control of FNS systems and other dynamic systems.

Adaptation, Physiological↗

PubMed1995

Musculoskeletal disorders in children: a study in Dutch general practice.

OBJECTIVE: This study focuses on the occurrence of musculoskeletal disorders in children presented in general practice. Known epidemiological studies addressing musculoskeletal diseases in childhood are scarce and based on a low number of episodes. DESIGN AND SETTING: Prospective study of all patient contacts in general practice. A total number of 161 general practitioners participated, divided into four groups, registering during four consecutive three-month periods. PATIENTS: All children younger than 15 years of age who visited their GP during the registration period. All diagnoses and working hypotheses concerning musculoskeletal disorders were selected. RESULTS: The total number of children in the study was 64,198. Disorders of the musculoskeletal system accounted for 3,699 (7.5%) of all 49,309 contacts and for 3,046 (7.5%) of all 40,340 episodes. Of the 3,046 episodes registered for ICPC-chapter L (musculoskeletal), 2,562 (84%) were new episodes, i.e. not presented to the GP before. Fifty-four percent of all new episodes were acute injuries. In 22% of the new episodes the general practitioner made a symptom diagnosis. Differences by age and sex were found for a limited number of diagnosis categories. CONCLUSION: Children present disorders of the musculoskeletal system less often than adults; they also present different disorders to their general practitioners. The majority of disorders presented by children are acute injuries, mostly sprains and strains.

Adolescent↗

PubMed1991

[Study of the changes in the morbidity and disease incidence patterns based on the absenteeism data analyzed during the 20-year period].

The aim of the study was to determine which of the absenteeism parameters was responsible for the changes in absenteeism rate in the period between 1967 and 1987 and to detect the major reasons of sick absenteeism over the period. The study was carried on in an electronic plant. Changes in the sick absenteeism rate in this plant reflect general variations in morbidity and disease incidence during these years. The changes result mainly from an extremely fast growth of absenteeism rate caused by circulatory and musculoskeletal system diseases and from a constant level of absenteeism rate observed as a result of digestive system diseases. Overall, the analysis showed that the duration of individual cases of absenteeism grew with time, the process which resulted in higher absenteeism among workers suffering from circulatory and musculoskeletal system diseases, chronic gastric and duodenal ulcer diseases, hepatopathies, gallbladder diseases, +pancreatic diseases and from pregnancy, delivery and puerperium complications. This growing duration of absenteeism cases may be related to the intensity of the observed pathologies, to complications and to effectiveness of medical treatment.

Absenteeism↗

PubMed1991

Musculoskeletal disease in Denmark. The Danish Health and Morbidity Survey 1986-87.

The Danish Health and Morbidity Survey of 1986-87 demonstrates a high prevalence of musculoskeletal disorders in the population over 15 years of age. The point-prevalence for long-standing illnesses of the musculoskeletal system was 13 percent. Half of the respondents had had pain during the last 2 weeks. Back disorder was the specific disease that was most frequent. Diseases and symptoms of the musculoskeletal system were frequent in the age groups over 44 years old, and occurred more often in women than in men. Back disorders were reported more often by blue-collar workers and self-employed persons than by white-collar workers. The study has contributed to an action program in the Danish government program on health.

Adolescent↗

PubMed2006

Economic problem of referred trauma cases in Siriraj Hospital.

To improve the service for referred trauma patients, the authors have to know the types of injury, the cost, and the reimbursement for each individual category. Therefore, the authors studied the characteristics of accident of patients transferred for treatment at Siriraj Hospital, including types of trauma (wounds), cost of treatment (excluding doctor's fees) and charges for treatments for each group. There were 678 trauma cases referred to the Division of Trauma Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital from 1st September 2002 to 31st August 2003 and of these, 571 cases were admitted From the admitted cases, the most common injury was the musculoskeletal system (38.6%), followed by nervous system injury (15.1%), eye injury (8.1%), toxic substance injury (6.3%), burns (5.8%), and others. The total cost of treatment was 36,249,150 baht. The reimbursement was 30,135,709 baht. There were four categories where the reimbursed amount was below the actual cost. They were burns, followed by nervous system injury, eye injury and skin or subcutaneous tissue injury. To deal with the referred cases in trauma center level I, the center should prepare to manage the common trauma groups such as musculoskeletal system injury, nervous system injury and eye injury. Burns, nervous system injury, eye injury and skin or subcutaneous tissue injuries are the major groups that cost more than the reimbursement amount. The reimbursement of these groups should be reconsidered in the future to solve the problem.

Adolescent↗

PubMed1995

The effects of exercise on growth.

The way in which exercise influences statural, hypertrophic and reparative growth is examined from the perspective of the human lifespan. Statural growth depends on a neuroendocrine programme which channels nutrient energy towards increments in lean body mass. Exercise can facilitate statural growth and is a necessary stimulus for reparative growth through its stimulatory effects on secretion of growth hormone (GH) and other anabolic hormones. An exercise-associated increase in GH secretion is a response to acute or prolonged exercise-induced fuel shortage that directs metabolism towards utilisation of lipids and promotes growth. Exercise can transiently block the expression of statural growth by competitively removing the necessary nutritional support for growth. Statural growth retardation can be corrected by catch-up growth, but stunting may also be permanent (depending on the timing and magnitude of the energy drain). Hypertrophic growth is less dependent on hormonal and nutritional support than statural growth, and exercise provides the necessary mechanical stress for growth and remodelling of the musculoskeletal system. Excessive mechanical strain may suppress hypertrophic growth. The intermittent nature of exercise provides temporal organisation that is necessary for the normal operation of cellular growth process. Exercise by pregnant women does not appear to influence fetal growth. Evaluation of the effect of exercise on growth of children and adolescents is complicated by nonrandom selection of individuals for participation in organised sports, and by lack of information on the magnitude of exercise-induced energy drain. Exercise is essential for regulation of body composition in adulthood. It provides mechanical and metabolic stimuli that are necessary for hypertrophy of the musculoskeletal system and increased GH secretion for reparative growth.

Adolescent↗

PubMed1987

Connective tissue and immobilization. Key factors in musculoskeletal degeneration?

Periarticular connective tissue is one important part of the musculoskeletal system. Its unique ability to adapt to the shortest distance between its origin and insertion, however, produces harmful effects during immobilization. All situations that lead to immobilization can cause some degree of degenerative change in the musculoskeletal system. When immobilization, whatever its cause, cannot be avoided, every attempt should be made to minimize it and to try to treat its harmful effects. There is some evidence that early mobilization, traction, and continuous passive motion overcome the harmful effects of immobilization, but more knowledge on this subject is needed. Animal experiments play an important role in the attainment of knowledge of immobilization and mobilization processes in health and disease.

Animals↗

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↗

PubMed2003

Graphic-based musculoskeletal model for biomechanical analyses and animation.

The ability to combine physiology and engineering analyses with computer sciences has opened the door to the possibility of creating the 'Virtual Human' reality. This paper presents a broad foundation for a full-featured biomechanical simulator for the human musculoskeletal system physiology. This simulation technology unites the expertise in biomechanical analysis and graphic modeling to investigate joint and connective tissue mechanics at the structural level and to visualize the results in both static and animated forms together with the model. Adaptable anatomical models including prosthetic implants and fracture fixation devices and a robust computational infrastructure for static, kinematic, kinetic, and stress analyses under varying boundary and loading conditions are incorporated on a common platform, the VIMS (Virtual Interactive Musculoskeletal System). Within this software system, a manageable database containing long bone dimensions, connective tissue material properties and a library of skeletal joint system functional activities and loading conditions are also available and they can easily be modified, updated and expanded. Application software is also available to allow end-users to perform biomechanical analyses interactively. This paper details the design, capabilities, and features of the VIMS development at Johns Hopkins University, an effort possible only through academic and commercial collaborations. Examples using these models and the computational algorithms in a virtual laboratory environment are used to demonstrate the utility of this unique database and simulation technology. This integrated system will impact on medical education, basic research, device development and application, and clinical patient care related to musculoskeletal diseases, trauma, and rehabilitation.

Algorithms↗

PubMedDate not supplied

Dynamic contrast-enhanced MR imaging of musculoskeletal tumors: basic principles and clinical applications.

The purpose of this article is to review the basic principles and clinical applications of dynamic contrast-enhanced MRI in the musculoskeletal system. This method of physiologic imaging provides clinically useful information by depicting tissue vascularization and perfusion, capillary permeability, and composition of the interstitial space. Different imaging, evaluation, and postprocessing techniques are described. The most important applications in the musculoskeletal system are identification of areas of viable tumor for biopsy, tissue characterization, and monitoring of preoperative chemotherapy. Practical guidelines for performing a dynamic contrast-enhanced MR examination are proposed.

Adolescent↗

PubMed2004

Unclaimed prescriptions after automated prescription transmittals to pharmacies.

OBJECTIVE: To assess the extent of and the reasons for unclaimed prescriptions, primary non-compliance, after automated transmittals to pharmacies. METHODS: Cross-sectional study in 3 health care districts (population 240,000) in the southernmost of Sweden on unclaimed electronic prescriptions (e-prescriptions), transmitted to 21 pharmacies during the period of 3 months (2000) and semi-structured interview study with patients not claiming their e-prescriptions transmitted to 4 pharmacies during a period of 3 weeks (2001). MAIN OUTCOME MEASURE: Proportion of unclaimed e-prescriptions of total number of (dispensed and unclaimed) e-prescriptions and reasons for primary non-compliance. RESULTS: In total, 2171 (2.4%) e-prescriptions remained unclaimed at the pharmacies. The peak non-redemption rate was observed for those 15-24 years old (5.5%). The lowest rate was observed for those 65-74 years old. Men had a higher non-redemption rate than women. The highest rate for men was observed 25-34 years old (6.6%). Drugs for the musculoskeletal system (ATC group M) had higher non-redemption rates than expected (3.9%), and antibiotics (ATC-group J) lower (1.7%). Adolescents and young adults, 15-24 years old, had high non-compliance rates for drugs for the musculoskeletal system (14%) and anti-asthmatic drugs (11%). Of 78 interviewed patients, not claiming their e-prescriptions, 61% reported no need to have the prescription dispensed. However, unintentional non-compliance was reported by 28%, most of them were not aware that a prescription had been transmitted to the pharmacy. Thirteen percent reported that non-redemption had given further medical problems or made obtaining a new prescription necessary. CONCLUSION: Primary non-compliance was generally low, but there were differences related to age, gender and type of drugs. The most common reason reported for non-redemption was that the prescription was not needed, but some patients were unaware that prescriptions were issued and transmitted to the pharmacy.

Adolescent↗

PubMed1998

[The effect of systemic changes on sick-day absenteeism in the workplace. II. Causes of work disability among persons under termination of employment].

During the period of transformations and restructuring of workplaces in Poland, the reduction of employment becomes quite common, what seems to make a considerable impact on sick absenteeism. The analysis presented aimed at defining how far the risk of sick absenteeism increases among workers under termination of employment because of different reasons, and indicating morbidity causes in case of which sick absenteeism is most extensive. The study was carried out in one of the largest plants of the motor car industry (before the process of restructuring), and it covered a cohort of 5,373 men and 3,215 women employed during the years 1989-94. The workers who terminated their employment during those years made 77% of the whole cohort under study. The case index, calculated as the ratio of the number of cases to the number of man-days under observation, was taken as an analysis parameter. Poisson regression model involving a number of variables (age, departments, current workers, workers discharged according to particular reasons, and the period preceding the termination of employment) was used in the statistical analysis. The study indicated an increased risk of sick absenteeism in the group of workers approaching the termination of employment in comparison with that among current workers. The highest risk of work disability, both among men and women, was observed in persons leaving their jobs because of long-lasting illness or disability pension. The highest risk indices were noted in men whose sick absenteeism was caused by neoplasms (RR = 14.42); endocrine secretion disorders (RR = 4.83); cardiovascular disorders (RR = 3.60); mental disorders (RR = 3.04); and diseases of the musculoskeletal system (RR = 2.95); and in women with neoplasms (R = 6.42); diseases of the musculoskeletal system (RR = 4.01); and cardiovascular diseases (RR = 3.99). Risk of sick absenteeism was over 50% higher among retiring workers than among current workers (RR = 1.50 for men; and RR = 1.53 for women). Among workers discharged because of economic reasons, statistically significant risk of sick absenteeism was also observed (RR = 1.51 for men; and RR = 1.37 for women). In the group of workers leaving their jobs, following the agreement of the parties, an increased risk of sick absenteeism was noted in men (RR = 1.45). The economy transformation processes make a considerable impact on the occurrence of sick absenteeism in workplaces. Workers leaving their jobs because of health problems or of their own accord, as well as those discharged because of economic reasons belong to the highest risk groups.

Absenteeism↗

PubMed2002

Concordance of histopathologic and cytologic grading in musculoskeletal sarcomas: can grades obtained from analysis of the fine-needle aspirates serve as the basis for therapeutic decisions?

BACKGROUND: Utilization of fine-needle aspiration (FNA) for the diagnosis of musculoskeletal lesions has been de-emphasized by many clinicians because of concerns regarding the technique's ability to supply all information necessary for prognostication and appropriate selection of therapy. Paramount among the concerns is the belief that FNA is incapable of supplying precise subtyping and grading in many cases. Secondary concerns regarding the use of FNA involve its perceived inability to supply adequate tissue for ancillary studies including immunohistochemistry and molecular diagnostic analysis. The authors investigated the ability of FNA to accurately subtype and grade a series of 107 primary sarcomas of the musculoskeletal system. METHODS: The files of the Departments of Pathology at Duke University Medical Center and the University of California at Los Angeles and the private consultation files of one of the authors were searched for all fine-needle aspirates of sarcomas arising within the musculoskeletal system. A total of 107 cases were obtained and reviewed by three board-certified cytopathologists. Each cytopathologist independently assigned subtype when possible and generated a grade for each of the sarcomas. Corresponding surgical material was available for 77 cases. The surgical material was re-reviewed for accuracy of diagnosis and assignment of grade independently of the cytologic examination. Correlation of cytologic grade with histopathologic grade was made and analyzed by the kappa test. In addition, agreement on grade between cytopathologists was analyzed, and accuracy of histologic subtype prediction by cytologic analysis was studied. RESULTS: Most of the sarcomas were cytologically graded as Grade 1 or 2 but were assigned a histologic grade of 2 or 3. Cytopathologist A graded 93% of the sarcomas as either Grade 1 or 2, cytopathologist B graded 89% of cases as Grade 1 or 2, and cytopathologist C graded 94% of cases as Grade 1 or 2. Histologic evaluation demonstrated 82% of cases to be Grade 2 or 3. Correlation of cytologic and surgical grade varied among the observers. Cytopathologist A showed the highest degree of correlation between cytologic and surgical grade with an r value of 0.5. The corresponding r values for cytopathologists B and C were 0.46 and 0.41, respectively. Correlation between cytologic and surgical grade was significant for all three observers (P < 0.001). Only nuclear grade showed a consistent correlation in predicting final surgical pathology grade. Cellularity, mitotic rate, and the presence of necrosis were not statistically significant for predicting histopathologic grade. Accurate exact subtyping by cytologic examination was achieved in approximately 55% of cases. Prediction of histopathologic subtype by cytologic analysis was most successful when a distinctive stroma was present or high-grade features indicative of malignant fibrous histiocytoma were observed. There was little agreement as to histopathologic type as predicated by cytology for low-grade spindle cell sarcomas. CONCLUSIONS: Although there was a statistically significant correlation between cytologically assigned grade and final histopathologic grade, statistical analysis revealed only a moderate correlation between the two with an overall r value of approximately 0.57. Cytologic analysis tended to undergrade in comparison to final histopathologic grading. Only analysis of nuclear atypia showed good correlation with final surgical grade. Fine-needle aspiration was only moderately successful at predicting histopathologic subtype for musculoskeletal sarcomas in this series.

Adult↗

PubMedDate not supplied

Unifying principles in terrestrial locomotion: do hopping Australian marsupials fit in?

Mammalian terrestrial locomotion has many unifying principles. However, the Macropodoidea are a particularly interesting group that exhibit a number of significant deviations from the principles that seem to apply to other mammals. While the properties of materials that comprise the musculoskeletal system of mammals are similar, evidence suggests that tendon properties in macropodoid marsupials may be size or function dependent, in contrast to the situation in placental mammals. Postural differences related to hopping versus running have a dramatic effect on the scaling of the pelvic limb musculoskeletal system. Ratios of muscle fibre to tendon cross-sectional areas for ankle extensors and digital flexors scale with positive allometry in all mammals, but exponents are significantly higher in macropods. Tendon safety factors decline with increasing body mass in mammals, with eutherians at risk of ankle extensor tendon rupture at a body mass of about 150 kg, whereas kangaroos encounter similar problems at a body mass of approximately 35 kg. Tendon strength appears to limit locomotor performance in these animals. Elastic strain energy storage in tendons is mass dependent in all mammals, but exponents are significantly larger in macropodid. Tibial stresses may scale with positive allometry in kangaroos, which result in lower bone safety factors in macropods compared to eutherian mammals.

Animals↗

PubMed1982

The effect of vibration on the skeleton, joints and muscles. A review of the literature.

Owing to the elasticity and plasticity of the skeleton, joints and muscles, the musculoskeletal system is capable of absorbing and damping mechanical vibration without damage as long as the vibration level is within tolerable limits. However, technical developments have led to the exposure of many people to intolerable variation levels with destructive changes as a result. These injuries to the musculoskeletal system continue to be the subject of research interest. Initially, the joints and joint complaints attracted the greatest attention. Vibration damping takes place mainly in the joints. The incidence of destructive joint changes has been examined in comprehensive clinical, epidemiological and radiographic studies, mainly concentrating on the joints of the hand and arm. The response of muscles to vibration is often expressed in the form of a tonic vibration reflex (TVR) which arises as a result of stimulation of the muscle spindles and therefore resembles the classic tonic stretch reflex. There is increased muscular activation for stabilisation of the joint positions, especially during whole-body vibration. Studies have also disclosed how vibration affects body equilibrium and equilibrium control and how vibration can elicit muscle pain, cramps and reduced muscular strength.

Journal Article↗