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PubMed2003

An increased frequency of carpal tunnel syndrome in sarcoidosis. Results of a study based on nerve conduction study.

Sarcoidosis is a systemic disease which affects the musculoskeletal system; however, its association with carpal tunnel syndrome (CTS) has been reported only rarely. In our study, we tried to determine the prevalence of CTS in our consecutive sarcoidosis patients based on their symptoms and nerve conduction study (NCS). Fifty-six patients (mean age: 45.2) who were followed up with the diagnosis of sarcoidosis at our center and who gave informed consent for NCS were included into the study. The patients were questionned for the presence of hand symptoms: paresthesia, pain, nocturnal paresthesia and/or pain, and, they underwent NCS. Ten (17.9%) patients had recurrent paresthesia, 12 (21.4%) had pain, and 8 (14.3%) had nocturnal paresthesia and/or pain. The results of NCS showed that 41% of the patients had findings compatible with CTS. Extrapulmonary involvement was significantly more frequent in these patients when compared to patients without CTS (p=0.04). Also, patients with CTS were older than the others and CTS-associated symptoms were more frequent in them although this was not significant (p>0.05). In this study, by performing NCS we detected quite a high prevalence of CTS in our sarcoidosis patients. The fact that most of the patients were asymptomatic was interesting.

Adult↗

PubMed1980

Three-year-incidence of disability pensions among male members of the Danish semi-skilled workers' union.

The aim of this study is to evaluate the age- and diagnosis-specific incidence of disability pensions awarded within a large group of working men. The study population is the 228,612 male members, aged 20-64, of Denmark's largest trade union, the Semi-skilled Workers' Union (SID), of which two thirds of the so-called unskilled male workers are members. In all 4838 awarded disability pensions were registered in the period April 1, 1973--March 31, 1976 against 3787 expected, i.e. an excess of 31.7%. The incidence rates increases more rapidly with age for the SID-men than for all men in Denmark. The Standard Disability Ratio(SDR) is found to be over 100 for all major diagnoses. The highest SDRs are found for major diagnoses of the respiratory system (183.9) and of the musculoskeletal system (169.2). For these diagnoses a "wear syndrom" is suggested, where small handicaps combined with demands for strenuous work cause a considerable reduction in capacity to work. Regional differens in the 3-year incidence of disability pensions are found. In all 15 counties, except one, significantly more disability pensions are found to have been awarded to SID-men than expected. The highest SDRs can be found within the large branches in the Copenhagen area.

Adult↗

PubMed1993

Physical examination of the aged patient.

The aged patient presents challenges to the examining physician. Some of these relate to inefficient historical information transfer, reduced mobility, increased disease burden, cognitive and sensory alterations, and confusing background changes in the prevalence and interpretation of physical signs that would be unequivocally abnormal in the younger adult. This review suggests techniques to overcome these difficulties. Descriptions of methods of improving evaluation and interpretation are grouped into the following categories: general appearance and vital signs; skin; head and neck; respiratory and cardiovascular systems; abdomen, rectum and genitalia; musculoskeletal system; hands and fett; and neurologic and mental status evaluations. Several newly recognized signs are also described. The extra time, effort and ingenuity required for examination of the aged patient are richly repaid by enhanced diagnosis.

Aged↗

PubMedDate not supplied

National Survey of Ambulatory Surgery: 1994.

In 1994, 27.7 million surgical and nonsurgical procedures were performed during 18.4 million visits to ambulatory surgery settings. Eighty-five percent of the ambulatory procedures (23.4 million) were performed in hospital-based settings and 15 percent (4.3 million) were in freestanding settings. More than half of the ambulatory procedures were in three major categories: operations on the digestive system, the eye and the musculoskeletal system. The leading ambulatory procedures were extraction of lens (performed almost 2 million times), endoscopy of large intestine with or without biopsy (1.8 million) and insertion of prosthetic lens (1.6 million). Women had significantly more ambulatory surgery procedures than men. The ambulatory procedure performed most frequently on children under 15 was myringotomy. Also common for children were tonsillectomies and adenoidectomies. For those aged 15-44, frequently performed ambulatory procedures included endoscopies of large and small intestine; dilation and curettage of uterus; bilateral destruction or occlusion of fallopian tubes; and arthroscopy of knee. In the 45-64 year old group, endoscopies of large and small intestine were the most commonly performed ambulatory procedures. Extraction of lens and insertion of prosthetic lens were the leading ambulatory procedures for those 65 years and older, though endoscopies of large and small intestine were also performed frequently for this age group.

Adolescent↗

PubMed2001

Incomplete lupus erythematosus: results of a multicentre study under the supervision of the EULAR Standing Committee on International Clinical Studies Including Therapeutic Trials (ESCISIT).

OBJECTIVE: Patients characterized with antinuclear antibodies (ANA) and disease symptoms related to one organ system can be described as having incomplete systemic lupus erythematosus (SLE). The aim of this multicentre study was to describe the outcome of these so-called incomplete SLE patients. Two aspects of the outcome were studied: (i) the disease course, defined by the presence or absence of clinical symptoms; and (ii) the number of patients that eventually developed full SLE. METHODS: Outcome parameters were the ACR criteria, the SLE disease Activity Index (SLEDAI), the European Consensus Lupus Activity Measure (ECLAM) and the requirement for treatment. In 10 European rheumatology centres, patients who had been evaluated in the last 3 months of 1994 and had been diagnosed as having incomplete SLE on clinical grounds for at least 1 yr were included in the study. All 122 patients who were included in the study were evaluated annually during 3 yr of follow-up. RESULTS: Our results are confined to a patient cohort defined by disease duration of at least 1 yr, being under clinical care at the different centres in Europe. These patients showed disease activity that was related mostly to symptoms of the skin and the musculoskeletal system, and leucocytopenia. During the follow-up, low doses of prednisolone were still being prescribed in 43% of the patients. On recruitment to the study, 22 of the 122 incomplete SLE patients already fulfilled the ACR criteria for the diagnosis of SLE. In the 3 yr of follow-up only three patients developed SLE. CONCLUSIONS: A high proportion of patients in our cohort defined on clinical grounds as having incomplete SLE eventually showed disease activity defined by the SLEDAI as well as ECLAM. However, only three cases developed to SLE during the follow-up. This suggests that incomplete SLE forms a subgroup of SLE that has a good prognosis.

Adolescent↗

PubMed1999

The role of gene therapy. Fact or fiction?

Current research in molecular biology and genetics has dramatically advanced the understanding of the cellular events involved in homeostasis, disease, injury, and healing processes of the tissues of the musculoskeletal system. Recently, genetic predispositions to diseases have been described which offer novel means to address musculoskeletal disorders. Growth factors and cytokines have been identified as key elements in both the injured and healing states. Gene therapy offers an elegant solution to the delivery of therapeutic proteins to the site of disease or injury.

Cytokines↗

PubMed2002

Review article: diagnostic ultrasonography: applications in orthopaedic surgery.

Diagnostic ultrasonography of musculoskeletal diseases in the United States has been used most often for detection of rotator cuff tears or developmental dysplasia of the hip. Diagnostic ultrasonography also is useful in imaging the periarticular soft tissues about the knee, hip, ankle, occult pediatric fractures, muscle injury, bone healing, and foreign bodies. Recent technologic improvements have made this imaging modality increasingly more accurate while providing significant benefits over traditional modalities such as magnetic resonance imaging, particularly regarding cost, patient satisfaction, and ease of usage. Increasing use in the future of diagnostic ultrasonography for musculoskeletal conditions is likely as acceptance grows. This review focuses on recent, practical applications of diagnostic ultrasonography of the musculoskeletal system.

Humans↗

PubMed1995

Aspects of musculoskeletal magnetic resonance imaging.

MRI can clearly identify many pathological processes in the musculoskeletal system. Because it is a non invasive investigation, it plays an important role in assessing joint pathology and musculoskeletal masses prior to any interventional procedure. If used properly, it can be cost effective and redundant diagnostic tests can be reduced, appropriate therapy can be instituted and unnecessary surgical intervention and hospitalisation can be avoided.

Humans↗

PubMedDate not supplied

Primary care for women. Comprehensive assessment of common musculoskeletal disorders.

This article reviews the common musculoskeletal disorders that are likely to be encountered in the women's primary care setting. Basic anatomy and physiology of the musculoskeletal system are reviewed, and the assessment and treatment of complaints of strains, sprains, low back pain, chest pain, carpal tunnel syndrome, musculoskeletal pain syndrome, fibromyalgia, osteoporosis, and osteoarthritis are discussed. Examples of low-technology treatment strategies are included.

Female↗

PubMed1994

Effect of space flight on cytokine production.

Space flight has been shown to alter many immunological responses. Among those affected are the production of cytokines. Cytokines are the messengers of the immune system that facilitate communication among cells that allow the interaction among cells leading to the development of immune responses. Included among the cytokines are the interferons, interleukins, and colony stimulating factors. Cytokines also facilitate communication between the immune system and other body systems, such as the neuroendocrine and musculoskeletal systems. Some cytokines also have direct protective effects on the host, such as interferon, which can inhibit the replication of viruses. Studies in both humans and animals indicate that models of space flight as well as actual space flight alter the production and action of cytokines. Included among these changes are altered interferon production, altered responsiveness of bone marrow cells to granulocyte/monocyte-colony stimulating factor, but no alteration in the production of interleukin-3. This suggests that there are selective effects of space flight on immune responses, i.e. not all cytokines are affected in the same fashion by space flight. Tissue culture studies also suggest that there may be direct effects of space flight on the cells responsible for cytokine production and action. The results of the above study indicate that the effects of space flight on cytokines may be a fundamental mechanism by which space flight not only affects immune responses, but also other biological systems of the human.

Animals↗

PubMedDate not supplied

Interactive multiplanar reformation of conventional two-dimensional MR images.

In this report, we describe a new application for three-dimensional computer image processing that can provide for improved depiction of anatomical structures on routine nonvolumetric magnetic resonance (MR) examinations. The technique can be applied to standard two-dimensional MR images of the brain, spine, musculoskeletal system, and body including those obtained with relatively thick slices and with an intersection gap. This report demonstrates use of the reformation technique to establish retrospectively the symmetry in bilateral structures that were displayed out of alignment due to suboptimal patient positioning or patient motion during image acquisition and to improve the depiction of anatomical structures that were oriented out of the plane of original image acquisition. This method can be performed interactively in near real time, requires no increase in patient examination time, and has potential application throughout the body.

Artifacts↗

PubMed1996

Interstitial granulomatous dermatitis with arthritis.

BACKGROUND: Interstitial granulomatous dermatitis with arthritis is an uncommon systemic disorder involving the cutaneous and musculoskeletal systems. The eruption may mimic other dermatoses including granuloma annulare, erythema chronicum migrans, and the inflammatory stage of morphea. Key histopathologic characteristics, along with clinical correlation, allow accurate diagnosis. OBJECTIVE: We describe the clinical, serologic, and histologic features in three patients with interstitial granulomatous dermatitis with arthritis. METHODS: Skin biopsy specimens were examined and correlated with the clinical and laboratory findings. RESULTS: Erythematous, annular, indurated plaques on the extremities were present in two women. An erythematous, papular eruption on the head and neck was present in a third patient. All patients had myalgia and migratory polyarthralgias of the extremities along with various serologic abnormalities. Histologic examination revealed a dense lymphohistiocytic interstitial infiltrate involving primarily the reticular dermis. Foci of necrobiotic collagen were present. Vasculitis was absent. CONCLUSION: Interstitial granulomatous dermatitis with arthritis is unique multisystem disease with variable cutaneous expression. Abnormal serologic findings indicate a possible connection to collagen vascular disease.

Adult↗

PubMed1989

Noninfectious diseases, metabolic diseases, toxicities, and neoplastic diseases of South American camelids.

Although the SAC generally are healthy and tolerant of a wide variety of management schemes, a number of noninfectious diseases have been documented to occur, affecting all body systems. Gastrointestinal diseases appear to be the most common afflictions, particularly dental diseases, indigestion, ulceration of the third compartment, and the various causes of colic, such as enteritis, peritonitis, and intestinal accidents. Diseases of the urinary system (urolithiasis, amyloidosis, and glomerulonephritis in particular), the nervous system (especially various compressive lesions of the spinal cord), and the respiratory system (such as obstructive pulmonary diseases) are not uncommon. Diseases of the cardiovascular system (other than congenital defects), hemolymphatic system, and nonsurgical diseases of the musculoskeletal system only rarely are encountered. Heat stress appears to be a very common problem in certain areas, but other metabolic diseases (ketosis, hypocalcemia, and hypothyroidism) are of minor importance. It is assumed that SAC are susceptible to most of the same toxicities that affect domestic livestock species. The best documented examples appear to be the Ericaceae family of plants (laurels, rhododendrons, and so on) and the organophosphate chlorpyrifos. Neoplasia occasionally is seen; examples include lymphosarcoma, gastric squamous cell carcinoma, and adenocarcinoma. As the longevity of these species increases because of their pet status, neoplasia can be expected to become more common. The treatment of most of these conditions is based upon extrapolation from domestic ruminants.

Animals↗

PubMed2002

[Adrenal hematoma associated with rheumatoid purpura].

UNLABELLED: Schönlein-Henoch purpura is a systemic vasculitis involving primarily the skin, musculoskeletal system, gastro-intestinal tract, and kidneys. The purpose of this paper was to report the first described pediatric case, to our knowledge, of adrenal hemorrhage occurring in Schönlein-Henoch purpura. CASE REPORT: Our patient was a 12 year-old girl who presented a right adrenal hematoma diagnosed following an episode of acute right flank pain, ten days prior to the appearance of the clinical symptoms of Schönlein-Henoch purpura. CONCLUSION: We think that Schönlein-Henoch purpura should be included in the diagnosis of adrenal hematomas.

Adrenal Gland Diseases↗

PubMed1995

Symptoms of temporomandibular joint osteoarthrosis and internal derangement 30 years after non-surgical treatment.

To evaluate the long-term condition of temporomandibular joints (TMJs) affected by osteoarthrosis and internal derangement, 99 patients treated non-surgically between 1958 and 1962 were recalled for follow-up. The patients, 16 men and 83 women (mean age 58.2 years) with either reducing or permanent disk displacement, were submitted to a structured interview concerning previous treatment, masticatory function, and the presence of symptoms of osteoarthrosis and internal derangement of the masticatory system, and of complaints of the musculoskeletal system in general. A control group, consisting of eight men and 27 women (mean age 58.9 years) without complaints of the masticatory system, matching the patient group for sex, age and state of dentition, was included in the study to avoid simply documenting age-related joint conditions. Satisfaction with the treatment outcome was high. Chewing ability of the the patients did not differ from that of the controls, although patients more often expected pain and difficulty with opening the mouth wide. The main TMJ symptoms of the patients had decreased significantly; patients reported joint noises more often than controls. It is concluded that, despite some persisting symptoms, the non-surgical treatment approach of TMJ osteoarthrosis and internal derangement provides long-lasting satisfactory subjective results and is well-accepted by the patients.

Cartilage, Articular↗

PubMed1991

Hip fractures among the elderly: factors associated with in-hospital mortality.

Factors associated with mortality were examined for 27,370 hip fracture patients aged 65 years or older in Maryland hospitals, using discharge data for 1979-1988. Variables of interest included sociodemography, principal medical and injury diagnoses, E-code, year, disposition, and hospital. For both white males and white females, the hip fracture rate doubled with each 5-year increment in age. The overall proportion who died during hospitalization was 4.9% (n = 1,339). After multivariate adjustment, there remained a substantially increased risk of death for males. The relative odds (RO) of dying for males versus females were 1.6. Other factors associated with high relative odds of dying during hospitalization included the diagnosis of septicemia (RO = 12.3), pneumonia/influenza (RO = 4.9), and digestive system disorder (RO = 3.6). The RO of dying doubled in the presence of cardiac, neoplastic, or cerebrovascular disease. Patients with diagnoses of nervous system or mental disorder, hypertension, anemia, musculoskeletal system disease, or urinary tract infection were at decreased risk of dying. Results of the study suggest that the prevention or early diagnosis and treatment of serious infections in the elderly patient with a hip fracture remain an important challenge to clinicians.

Black or African American↗

PubMed1999

The young athlete.

BACKGROUND: It is very much part of the Australian lifestyle to encourage children and adolescents to participate in sport and exercise. As a result the general practitioner is often presented with injuries in younger patients. OBJECTIVE: This article presents an overview of the growth and development of the musculoskeletal system, and discusses relevant aspects of conditioning and training and the nature of injuries seen in the younger athlete. DISCUSSION: The range of common musculoskeletal problems seen in young children and adolescents is outlined with some recommendations made for an approach to management of the commoner conditions.

Adolescent↗

PubMed2001

Carpal tunnel syndrome in sarcoidosis.

Sarcoidosis is a systemic disease that may affect the musculoskeletal system. An association between carpal tunnel syndrome (CTS) and sarcoidosis has not been demonstrated. Consecutive patients from the sarcoidosis clinic at our institution were questioned about history and symptoms of carpal tunnel syndrome: hand numbness and nocturnal paresthesias with relief of symptoms by shaking of the hands (flick sign). A physical exam was performed to evaluate for Tinel's and Phalen's signs. A comparison of the presence of arthritis, prednisone treatment, spirometry, and number of organs involved with sarcoidosis was made in patients with a history or clinical findings of CTS versus those without. Eighty-nine patients were evaluated. Thirty-five patients (39%) had nocturnal paresthesias with a positive flick sign. Fourteen patients (16%) had physical findings of CTS. A history of CTS was present in 14 (16%) of the patients, four of which were documented by EMG. There was no significant difference between the frequency of prednisone treatment in patients with or without CTS history, nocturnal paresthesias, or Phalen's sign. There were significantly fewer patients with a positive Tinel's sign who were receiving prednisone. There was a trend toward an increased frequency of wrist arthritis in patients with a history or clinical findings of CTS. There was no significant difference in disease severity, assessed by spirometry or organ involvement, when comparing sarcoidosis patients with or without a history or clinical findings of CTS. Thirty-nine (44%) had symptoms and/or signs of CTS. Even when we adjusted our sarcoidosis population for other factors associated with CTS, the prevalence of symptoms and signs of CTS was much higher in our patient population than in studies of the general population. Our findings suggest that CTS is common in sarcoidosis.

Adult↗