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PubMedDate not supplied

Disabling spondyloarthrosis risk factors in valley of Mexico workers.

BACKGROUND: The objective of this study was to describe the most prevalent physically disabling conditions for insured workers belonging to the Mexican Social Security Institute (IMSS) in the Valley of Mexico and to identify risk factors for disabling spondyloarthrosis. METHODS: Retrospective cases and prevalent controls from IMSS clinics in the Mexico City metropolitan area were studied. Eighty cases were IMSS workers reporting disability due to spondyloarthrosis; 80 controls were active workers at the same workplace and shared the economic activity of the cases. The 1995 IMSS Disability Report was reviewed. From this report congenital conditions of the musculoskeletal system, obesity, history of trauma, and sociodemographic patient characteristics were assessed. RESULTS: The most important risk factors were a history of spina bifida (odds ratio [OR] = 29.3, 95% confidence interval [95% CI] = 5.3-161; p = 0.0009), supernumerary vertebrae (OR = 21.3, 95% CI = 5.3-95; p = 0.0001), history of low back (lumbar) trauma (OR = 3.9, 95% CI = 1.9-8.3; p = 0.0004), flatfoot (OR = 11.7, 95% CI = 1.9-69, p = 0.02), and obesity (OR = 2.0, 95% CI = 1.06-4.03; p = 0.04). CONCLUSIONS: A history of congenital deformity of the musculoskeletal system, spinal column trauma, and obesity were risk factors most associated with work disability due to spondyloarthrosis.

Adult↗

PubMed2003

Musculoskeletal assessment of general medical in-patients--joints still crying out for attention.

OBJECTIVES: The aim of this study was to assess the extent of musculoskeletal assessment (history and examination) amongst medical in-patients and to determine the effects that GALS (gait, arms, legs, spine) teaching has had on this. METHODS: General medical in-patients were interviewed and examined. Case notes were reviewed to determine diagnoses and assess documentation of clinical signs and/or symptoms. Doctors were interviewed to determine whether they had been taught the GALS locomotor screen, assess their confidence in examining the musculoskeletal system and explore their attitudes to musculoskeletal problems. RESULTS: The presence or absence of locomotor symptoms was recorded in 50% of the 100 patients, whilst signs were recorded in 20%; 63% of all the patients had locomotor symptoms and/or signs. Relevant musculoskeletal history was missed in 49% of the patients, whilst signs were missed in 78%; 42% of those with musculoskeletal conditions would have benefited from additional treatment. Teaching of the GALS screen significantly increased doctors' confidence in examination of the locomotor system. CONCLUSIONS: Active musculoskeletal problems are seen frequently amongst medical in-patients. There is a significant discrepancy between the number of patients with clinical symptoms and signs and the frequency with which they are detected and treated.

Education, Medical, Graduate↗

PubMed2000

Skin disease in military personnel.

Skin disease, disease of the musculoskeletal system, and respiratory infections are the most frequent reasons for military personnel to seek medical care. The Oslo Military Clinic serves all of the military personnel in Oslo and the surrounding region, including officers and civilian employees. From September 1996 to May 1997, 1,360 patients were diagnosed and treated by the author, and the data are included in the following study. Upper respiratory disease was the primary reason for seeking medical attention in 26% of the patients, 21% visited the clinic because of disease or pain in the musculoskeletal system, and 16% suffered from a skin disease. Apart from the low number of female patients, the patient population and the disease spectrum observed in the military clinic are very similar to those in a general medical practice. Among the 222 patients suffering from a cutaneous disease, eczema (42 patients), allergy (excluding dermatitis) (34 patients), acne vulgaris (23 patients), and sexually transmitted diseases (28 patients) were the most prevalent processes. Other less prevalent skin diseases were fungal infections, herpes simplex infection, nevi, common warts, and superficial bacterial skin infections. Skin diseases seen in one patient only included erysipelas, herpes zoster, dermatitis herpetiformis, and Ehlers-Danlos syndrome. Good clinical skills in dermatology are of paramount importance in military medicine, and if possible, the military should appoint a dermatologist to its medical team to rapidly diagnose and treat the large number of patients with skin disorders.

Adult↗

PubMed1994

An OWAS-based analysis of nurses' working postures.

The working postures of Dutch nurses (n = 18) in an orthopaedic ward and a urology ward were observed using the Ovako Working posture Analysis System (OWAS). During observation, both working postures and activities were recorded. A specially developed computer program was used for data analysis. By means of this program, it was possible to calculate the working posture load for each activity and the contribution of a specific activity to the total working posture load. This study shows that some activities of the nurses in both wards were performed with poor working postures. In the orthopaedic (resp. urology) ward two (resp. one) out of 19 observed postures of parts of the body were classified as Action Category 2. Moreover, 20% (resp. 16%) of the so-called typical working postures was classified in Action Category 2. This suggests, that in both wards working postures that are slightly harmful to the musculoskeletal system, occur during a substantial part of the working day. Differences between both wards with respect to working posture load and time expenditure were determined. Activities causing the workload to fall into OWAS higher Action Categories were identified. The data show that poor working postures in the nursing profession not only occur during patient handling activities but also during tasks like 'administration'. Focusing on patient-handling (i.e., lifting patients) in order to determine the load on the musculoskeletal system would therefore lead to an underestimation of the total working posture load of nurses.

Adult↗

PubMed2001

Modelling soft tissue for kinematic analysis of multi-segment human body models.

Traditionally biomechanical models represent the musculoskeletal system by a series of rigid links connected by rigidly defined rotational joints. More recently though the mechanics of joints and the action of soft tissues has come under closer scrutiny: biomechanical models might now include a full range of physiological structures. However, soft tissue representation, within multi-segment human body models, presents significant problems; not least in computational speed. We present a method for representing soft tissue physiology which provides for soft tissue wrapping around multiple bony objects; while showing forces at the insertion points, as well as normal reactions due to contact between the soft and bony tissues. These soft tissue representations may therefore be used to constrain the joint, as ligaments would, or to generate motion, like a muscle, so that joints may be modelled which more accurately simulate musculoskeletal motion in all degrees of freedom--rotational and translational. This method produces soft tissues that do not need to be tied to a certain path or route between the bony structures, but may move with the motion of the model; demonstrating a more realistic analysis of soft tissue activity in the musculoskeletal system. The combination of solid geometry models of the skeletal structure, and these novel soft tissue representations, may also provide a useful approach to synthesised human motion.

Biomechanical Phenomena↗

PubMed1989

[Double-blind randomized multicenter study with tenoxicam, piroxicam and diclofenac sodium retard in the treatment of ambulatory patients with arthroses and soft tissue rheumatism].

In a randomized, double-blind comparative study involving a total of 1630 outpatients, tenoxicam, a new nonsteroidal anti-inflammatory drug belonging to the oxicam group, piroxicam and diclofenac retard were tested for their efficacy und tolerability in the treatment of osteoarthritis and extra-articular rheumatism. Single doses of 20 mg tenoxicam, 20 mg piroxicam or 100 mg diclofenac sodium retard were administered daily. Tenoxicam was found to be as effective as piroxicam and diclofenac-sodium retard in treating degenerative and extra-articular rheumatic disorders of the musculoskeletal system. When baseline values were compared with values obtained at all subsequent examinations, all evaluation parameters for all three substances showed improvement. In analyses of frequency, degree of severity and type of undesired effects tenoxicam proved to be superior to the reference drugs. This was particularly evident from an improved GI and CNS tolerance and a lower rate of withdrawal from treatment. Tenoxicam has a favourable risk-benefit ratio and can be recommended for the treatment of chronic pain due to inflammation resulting from degenerative and extra-articular rheumatic disorders of the musculoskeletal system.

Adult↗

PubMedDate not supplied

[I. Cultural adaptation, practicability and reliability evaluation of the Musculoskeletal Functional Assessment Questionnaire].

INTRODUCTION: The patient-based evaluation of outcome is gaining increased importance. The aim of the study was to translate and culturally adapt the short musculoskeletal function assessment questionnaire (SMFA) into German and to evaluate the practicability, metric properties, and distribution characteristics of the German version (SMFA-D). METHODS: The SMFA is a questionnaire on the functional status of the musculoskeletal system of patients consisting of a function index (34 items) and bother index (12 items) with a 5-point response format. The SMFA was independently translated by orthopaedic-trained, qualified German- and English-speaking translators. A consensus committee review and selection of an optimally comprehensible German version was performed. Patients checked this version for comprehensibility and time to complete the questionnaire. 40 fluently German-speaking patients with primary osteoarthritis of the knee completed the SMFA-D twice at a one week interval. The test-retest reliability and internal consistency were evaluated. The values are standardized on an scale from 0-100. High values indicate a poor function. RESULTS: The SMFA-D is comprehensible and can be completed within 20 minutes in the mean. There were no skewness and no floor or ceiling effects. The mean function index was 47 (SD 17, range 16-80). The mean bother index was 44 (SD 19, range 5-75). Test-retest reliability were 0.88 (function index) and 0.71 (bother index), respectively. Internal consistency (Cronbach's alpha) was 0.92 (function index) and 0.88 (bother index), respectively. CONCLUSIONS: The SMFA-D is a practical and reliable questionnaire for patient-based evaluation of functional problems of the musculoskeletal system.

Aged↗

PubMed1996

[The importance of sonography in orthopedics for dogs].

For the ultrasonographic examination of the musculoskeletal system in dogs a 7,5 MHz linear scanner is used best, in some cases with a standoff pad. Radiography is the technique of choice to detect bone abnormalities. For certain circumstances the sonography can be used to give additional information (e.g. surrounding tissue with osteomyelitis or bone tumors). For the diagnostic of joint diseases ultrasonography is an excellent completion for the radiographic examination. Joint effusion and thickened capsule can be detected. Defects of articular cartilage like osteochondrosis dissecans in the knee or shoulder joint can be well seen. Instabilities of the joint can be identified with a dynamic examination. For evaluating the soft tissue areas ultrasonography is the optimal imaging procedure. Tears of muscles or tendons (e.g. achilles or biceps tendon), partial or complete ones, are seen in the sonographic examination. The process of healing with consolidation of the tendon can be controlled and documented. The tendon of the biceps brachii muscle is often affected in the soft tissue area of the shoulder. Luxation of the tendon, old injuries with scar formation, free dissections in the biceps tendon sheath and a tendovaginitis can be seen. Abscesses, foreign bodies, hematomas and soft tissue tumors in the musculoskeletal system can be well presented in the echotomogram. A tumor in the region of the brachial plexus can be detected directly with ultrasound.

Animals↗

PubMed2004

Terrorism and blast phenomena: lessons learned from the attack on the USS Cole (DDG67).

Blast phenomena and injuries to the musculoskeletal system have been well documented for the past 50 years. The USS Cole was attacked in Aden Harbor in Yemen on October 12, 2000. Seventeen sailors were killed and 39 were wounded. The bombing of the USS Cole and an analysis of the pattern of injury are unique compared with previous terrorist bombing attacks in which the predominant injury pattern is from Type II and Type III blast phenomena. Because the ship superstructure did not collapse, there were no confounding variables in examining the pattern of injury as there would have been with shrapnel-generating devices or detonations with subsequent building collapse. The morbidity and mortality sustained by the victims was almost exclusively from Type I and Type III blast effects. The musculoskeletal system was a clear marker for mortality and morbidity. Fractures of the cranium, spine, pelvis, and long bones denoted increasing severity of injury to critical organ systems. Shipboard firefighting was successful in containing fires and there was very little morbidity from inhalational injuries or burns. Blast phenomena that affect ships or buildings that have been specifically built to absorb a blast attack likely will manifest a different mode and pattern of injury than those seen in traditional terrorist blast events.

Blast Injuries↗

PubMed2000

MR imaging of clear cell sarcoma (malignant melanoma of the soft parts): a multicenter correlative MRI-pathology study of 21 cases and literature review.

OBJECTIVE: To evaluate MR imaging and pathology findings in order to define the characteristic features of clear cell sarcoma of the soft tissues (malignant melanoma of the soft parts). DESIGN AND PATIENTS: MR examinations of 21 patients with histologically proven clear cell sarcoma of the musculoskeletal system were retrospectively reviewed and assessed for shape, homogeneity, delineation, signal intensities on T1- and T2-weighted images, contrast enhancement, relationship with adjacent fascia or tendon, secondary bone involvement, and intratumoral necrosis. In 19 cases the pathology findings were available for review and for a comparative MR-pathology study. RESULTS: On T1-weighted images, lesions were isointense (n=3), hypointense (n=7) or slightly hyperintense to muscle (n=11). Immunohistochemical examination was performed in 17 patients. All 17 specimens showed positivity for HMB-45 antibody. In nine of 11 lesions with slightly increased signal intensity on T1-weighted images, a correlative MR imaging-pathology study was possible. All nine were positive to HMB-45 antibody. CONCLUSIONS: Clear cell sarcoma of the musculoskeletal system often has a benign-looking appearance on MR images. In up to 52% of patients, this lesion with melanocytic differentiation has slightly increased signal intensity on T1-weighted images compared with muscle. As the presence of this relative higher signal intensity on T1-weighted images is rather specific for tumors displaying melanocytic differentiation, radiologists should familiarize themselves with this rare entity and include it in their differential diagnosis when confronted with a well-defined, homogeneous, strongly enhancing mass with slightly higher signal intensity compared with muscle on native T1-weighted images.

Adolescent↗

PubMed2003

Evidence that sensitivity to growth hormone (GH) is growth period and tissue type dependent: studies in GH-deficient lit/lit mice.

We previously found that the magnitude of skeletal deficits caused by GH deficiency varied during different growth periods. To test the hypothesis that the sensitivity to GH is growth period dependent, we treated GH-deficient lit/lit mice with GH (4 mg/kg body weight.d) or vehicle during the prepubertal and pubertal (d 7-34), pubertal (d 23-34), postpubertal (d 42-55), and adult (d 204-217) periods and evaluated GH effects on the musculoskeletal system by dual energy x-ray absorptiometry (DEXA) and peripheral quantitative computed tomography. GH treatment during different periods significantly increased total body bone mineral content, bone mineral density (BMD), bone area, and lean body mass and decreased percentage of fat compared with vehicle; however, the magnitude of change varied markedly depending on the treatment period. For example, the increase in total body BMD was significantly (P < 0.01) greater when GH was administered between d 42-55 (15%) compared with pubertal (8%) or adult (7.7%) periods, whereas the net loss in percentage of body fat was greatest (-56%) when GH was administered between d 204 and 216 and least (-27%) when GH was administered between d 7 and 35. To determine whether GH-induced anabolic effects on the musculoskeletal system are maintained after GH withdrawal, we performed DEXA measurements 3-7 wk after stopping GH treatment. The increases in total body bone mineral content, BMD, and lean body mass, but not the decrease in body fat, were sustained after GH withdrawal. Our findings demonstrate that the sensitivity to GH in target tissues is growth period and tissue type dependent and that continuous GH treatment is necessary to maintain body fat loss but not BMD gain during a 3-7 wk follow-up.

Absorptiometry, Photon↗

PubMed2003

Mechanical energy and power flow of the upper extremity in manual wheelchair propulsion.

OBJECTIVE: To investigate the characteristics of mechanical energy and power flow of the upper limb during wheelchair propulsion. DESIGN: Mechanical energy and power flow of segments were calculated. BACKGROUND: Very few studies have taken into account the mechanical energy and power flow of the musculoskeletal system during wheelchair propulsion. Mechanical energy and power flow have proven to be useful tools for investigating locomotion disorders during human gait. METHODS: Twelve healthy male adults (mean age, 23.5 years) were recruited for this study. Three-dimensional kinematic and kinetic data of the upper extremity were collected during wheelchair propulsion using a Hi-Res Expert Vision system and an instrumented wheel, respectively. RESULTS: During the initiation of the propulsion phase, joint power is generated in the upper arm or is transferred from the trunk downward to the forearm and hand to propel the wheel forward. During terminal propulsion, joint power is transferred upward to the trunk from the forearm and upper arm. The rate of change of mechanical energy and power flow for the forearm and hand have similar patterns, but the upper arm values differ. CONCLUSIONS: Joint power plays an important role in energy transfer as well as the energy generated and absorbed by muscles spanning the joints during wheelchair propulsion. RELEVANCE: Energy and power flow information during wheelchair propulsion allows us to gain a better understanding of the coordination of the movement by the musculoskeletal system.

Adult↗

PubMed2003

A new view of patterning domains in the vertebrate mesoderm.

The musculoskeletal system of vertebrates is derived from the embryonic mesoderm. Its structures are categorized as epaxial or hypaxial based on their adult position and innervation. The epaxial/hypaxial terminology is also used to describe regions of the embryonic somites based on fate mapping of somitic derivatives. However, the adult, functional distinctions are not fully consistent with the changing embryonic environments of mesodermal populations during morphogenesis, and the traditional terminology loses accuracy when used to describe certain mutant phenotypes. Here we describe a new terminology naming two mesodermal environments defined by the lineage of the included cells. We discuss how mutant phenotypes may be better explained by consideration of the embryonic context in which genes take their effect and argue that the recognition of these embryonic territories clarifies description and discussion of the morphogenesis and patterning of the musculoskeletal system.

Animals↗

PubMed1996

Colour doppler ultrasound examination of hand tendon pathologies. A preliminary report.

Apart from real-time sonography, in most of the imaging techniques used to examine the musculoskeletal system, such as X-ray, computerized tomography scan and magnetic resonance imaging produce mainly static images. Although colour Doppler imaging (CDI) is generally used in the examination of blood flow, it may offer the opportunity to study the dynamic characteristics of tendons and muscles. The purpose of this study was to examine the unilateral flexor and extensor tendon pathologies of the hand and compare these images with the healthy side. A Phillips Quantum Doppler was used to study patients with tendon adhesions and trigger finger. The normal and pathological tendons were scanned at three anatomical levels: wrist, metacarpal and proximal phalanx. The results obtained from the comparison of pathological images with normal ones indicate that CDI offers a promising approach to image dynamically and, in the future, to quantify the function of the tendons and muscles in the musculoskeletal system and to define their pathologies.

Adolescent↗

PubMed2006

[Evaluation of factors influencing effectiveness of kinesitherapy in patients after traumatic brain injury].

OBJECTIVE OF THE STUDY: To establish the factors, which have an influence on recovery of motor and cognitive functions in patients after moderate or severe traumatic brain injury, when kinesitherapy is applied during the acute stage of injury and early stage of rehabilitation. MATERIAL AND METHODS: Subjects were 131 patients (99 men and 32 women) with a mean age of 39.5+/-15.9 years. Patients were divided into two subgroups according to degree of injury: severe injury (103 subjects) and moderate injury (28 subjects). During acute stage of injury, patients were treated at the Unit of Brain Injuries, Kaunas University of Medicine Hospital; thereafter, 80 patients continued rehabilitation at the Unit of Neurorehabilitation, while 51--in another rehabilitation centers. Recovery of motor and cognitive functions was evaluated using Functional Independence Measure: during acute stage of injury (beginning and end) and during early stage of rehabilitation (beginning, day 25, and end). RESULTS: In order to determine the effect of kinesitherapy, the influence of following factors was evaluated: meningitis, cranial nerves damage, musculoskeletal system dysfunctions, plegia of extremities, speech and cognitive dysfunctions, behavioral changes, sleep disorders, depression, pneumonia, edema, hydrocephalus, epilepsy. The motor score in patients after moderate traumatic brain injury at the beginning of acute stage was 32.4+/-12.7, while in patients after severe injury it was 21.3+/-7.7 (p<0.01). At the end of this stage, the difference between subgroups was insignificant: 61.8+/-24.0 and 60.9+/-22.5, respectively (p>0.05). At the beginning of acute stage of injury, cognitive function score differed significantly: in moderate injury subgroup, the score was 14.2+/-5.5, while in severe injury subgroup - 10.0+/-4.9 (p<0.01). At the end of early stage of rehabilitation, no significant difference in cognitive function scores was found between subgroups: 22.3+/-8.4 and 22.5+/-8.6 scores, respectively (p>0.05). CONCLUSIONS: Insufficient recovery of motor functions during period of kinesitherapy was influenced by depression, pneumonia, plegia of extremities, speech and cognitive dysfunctions, sleep disorders, dysfunctions of musculoskeletal system, behavioral changes, while the recovery of cognitive functions was influenced mainly by pneumonia, speech and cognitive dysfunctions, and sleep disorders (p<0.05).

Activities of Daily Living↗

PubMed1999

Visualization technology in medical education.

Visualization technology offers the possibility of profoundly changing the way in which osteopathic medical students assimilate basic osteopathic principles by giving them the ability to interactively explore biomechanical components of the musculoskeletal system, and to investigate the effects that changes in physical properties can have on functionality. The authors are developing a multiple-volume series of computer-assisted learning modules that use three-dimensional, visualization technology to enhance the acquisition of knowledge and skills necessary for clinical evaluation and treatment of the lumbar and cervical spines. These materials, designed to serve as an adjunct to teaching strategies that faculty are currently using, are available to students on campus through the Kobiljak Resource Center at Michigan State University College of Osteopathic Medicine (MSUCOM) and via the Internet (http://hal.bim.msu.edu/EdTech) to individuals and groups who are physically removed from the Michigan State University campus. In addition to addressing needs in undergraduate and graduate medical education, these osteopathic materials, delivered to users via CD-ROM, have been approved for obtaining Category 1-B CME credits (http://hal.bim.msu.edu/cme). It is anticipated that the use of these materials will facilitate understanding of static and dynamic relationships among physical components of the musculoskeletal system, thus contributing to ongoing efforts to develop and maintain physician, faculty, and student expertise in areas that are uniquely osteopathic. Although initial efforts were restricted to the cervical and lumbar spines, future modules will include other regions of the body. The ultimate goal is to enable students to visualize the effects of pathologic processes as they interactively control an articulation in three-dimensional space.

Cervical Vertebrae↗

PubMed1994

A biomechanical perspective on spinal mechanisms of coordinated muscular action: an architecture principle.

A principle of organization of spinal circuitry which emerges from the studies reviewed here is that the structure of the distributed network of pathways in the spinal cord contains a detailed representation of the corresponding three dimensional architecture of the musculoskeletal system. The pertinent architectural features for a given muscle include (1) the number and identity of spanned joints, and (2) the line of action at a joint with respect to the torque directions of other muscles and to the gravity vector. In accordance with established ideas, muscles with common primary actions (synergists) at the ankle are linked by excitatory, length-dependent pathways. Those muscles which have opposite actions are linked by reciprocal inhibition, although muscles which are not principally involved in postural control are not connected in this way. Among antigravity and stabilizing muscles, force-dependent, inhibitory pathways link (1) muscles crossing different joints, and (2) members of different synergistic groups which exert torques in different directions. Therefore, each muscle has a unique set of actions in terms of joints spanned and line of action, and each muscle receives a unique combination of reflex inputs. The cross-joint coordination resulting from actions of force-dependent pathways becomes stronger at higher forces with a consequent reduction in degrees of freedom of the musculoskeletal system. Length-dependent pathways link muscles which share some, but not all, mechanical actions at a joint and may have different patterns of activation during locomotion. Length-dependent pathways appear to coordinate muscle responses to postural disturbances and enhance joint stiffness.

Animals↗

PubMed1988

Pediatric musculoskeletal magnetic resonance imaging.

MRI has demonstrated clinical applicability and improved diagnostic capability in the musculoskeletal system to a degree rivaling its success in the neurologic system. For certain regions such as the joints, the superficial nature of these structures is ideal for the application of localized radiofrequency coils, enabling considerably improved signal, spatial resolution, and detectable contrast. The multiplanar capability is often invaluable in assessing such regions as the weight-bearing surfaces of the hips. It has been shown to be the most sensitive single test for diagnosing avascular necrosis, and has yielded very high resolution images of the internal architecture of the joints and soft tissues in an entirely noninvasive manner and without the need for the administration of exogenous contrast agents. Short TE images are quite useful in evaluating fatty background regions of interest, such as the bone marrow and subcutaneous tissue, whereas long TR and TE studies are frequently more suitable for soft tissue pathology. The lack of ionizing radiation and the continued failure of intensive research to disclose any deleterious effects at the levels used for clinical diagnostic imaging make this tool especially appealing for application to the pediatric population. With the continual development of new pulsing sequences, contrast agents, and further advances in imaging/spectroscopic correlation, magnetic resonance imaging of the musculoskeletal system is ensured of a solid role in the clinical diagnostic evaluation of the pediatric population.

Bone Diseases↗