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PubMed2003

An overview of shock wave therapy in musculoskeletal disorders.

Shock waves are high-energy acoustic waves generated under water with high voltage explosion and vaporization. Shock wave in urology (lithotripsy) is primarily used to disintegrate urolithiasis, whereas shock wave in orthopedics (orthotripsy) is not used to disintegrate tissues, rather to induce neovascularization, improve blood supply and tissue regeneration. The application of shock wave therapy in certain musculoskeletal disorders has been around for approximately 15 years, and the success rate in non-union of long bone fracture, calcifying tendonitis of the shoulder, lateral epicondylitis of the elbow and proximal plantar fasciitis ranged from 65% to 91%. The complications are low and negligible. Recently, shock wave therapy was extended to treat other conditions including avascular necrosis of femoral head, patellar tendonitis (jumper's knee), osteochondritis dessicans and non-calcifying tendonitis of the shoulder. Shock wave therapy is a novel therapeutic modality without the need of surgery and surgical risks as well as surgical pain. It is convenient and cost-effective. The exact mechanism of shock wave therapy remains unknown. Based on the results of animal studies in our laboratory, it appears that the mechanism of shock waves first stimulates the early expression of angiogenesis-related growth factors including eNOS (endothelial nitric oxide synthase), VEGF (vessel endothelial growth factor) and PCNA (proliferating cell nuclear antigen), then induces the ingrowth of neovascularization that improves blood supply and increases cell proliferation and eventual tissue regeneration to repair tendon or bone tissues. The rise of angiogenic markers occurred in as early as one week and only lasted for approximately 8 weeks, whereas the neovascularization was first noted in 4 weeks and persisted for 12 weeks or longer along with cell proliferation. These findings support the clinical observation that the effect of shock wave therapy appears to be dose-dependent and symptom improvement with time. Additional information including the cellular and molecular changes after shock wave therapy are needed for further clarification on the mechanism of shock wave therapy in musculoskeletal system.

Animals↗

PubMed2006

[Musculoskeletal vascular malformations in children].

PURPOSE OF THE STUDY: This study on vascular malformations of the musculoskeletal system in children is concerned with the disease diagnosis and evaluation of treatment results in a group of pediatric patients. MATERIAL: Eighteen children with musculoskeletal vascular malformations, treated at the Department of Orthopedics in Hradec Králové, were assessed. The relevant data were obtained from their medical notes and the children were examined at the outpatient department. METHODS: The initial complaints leading to examination at our department, diagnostic methods used and outcomes of vascular malformation treatment were investigated. Special attention was paid to the results of treatment for unequal leg length. RESULTS: The most frequent initial complaint was a painful, growing, hard tissue mass on either an upper or a lower extremity. In addition to clinical and angiographic diagnostic methods, also Doppler sonography and magnetic resonance imaging were used. Therapy by intervention radiology (selective embolization or sclerotherapy) resulted in reduction of the lesion and subsidence of the signs in 76 % of the patients. In the rest (24 %), the clinical findings did not change. It was necessary to repeat these methods twice to four-times. The best results were achieved by combining intervention radiology and a subsequent excision of the malformation. Of the four patients, only one experienced recurrence after 11 years. Four children were successfully treated for unequal leg length by temporary epiphyseodesis of the proximal tibia which, in one, had to be completed with shortening osteotomy of the proximal femur performed after skeletal maturation. DISCUSSION: There is great inconsistency in the classification of vascular malformations as well as in views on their therapy. The increasing role of magnetic resonance imaging for the diagnosis of vascular malformations is apparent, and our results fully support this fact. Intervention radiology techniques still remain the prevailing methods of treatment. In our experience, the best results are achieved by their combination with an excision of the lesion. When unequal leg length is treated, temporary epiphyseodesis is recommended; if this is preceded by treatment of the malformation, the final discrepancy in leg length is smaller. CONCLUSIONS: The correct diagnosis and treatment of vascular malformations and their sequelae are based on inter-disciplinary cooperation. The use of magnetic resonance imaging for diagnosis is recommended. Good results are achieved by a combination of intervention radiology methods with lesion excision. Temporary epiphyseodesis is the method of choice for treatment of unequal leg length.

Arteriovenous Malformations↗

PubMed2006

Acupuncture for neck disorders.

BACKGROUND: Neck pain is one of the three most frequently reported complaints of the musculoskeletal system. Treatments for neck pain are varied, as are the perceptions of benefits. Acupuncture has been used as an alternative to more traditional treatments for musculoskeletal pain. This review summarizes the most current scientific evidence on the effectiveness of acupuncture for acute, subacute and chronic neck pain. OBJECTIVES: To determine the effects of acupuncture for individuals with neck pain. SEARCH STRATEGY: We searched CENTRAL (2006, issue 1) and MEDLINE, EMBASE, MANTIS, CINAHL from their beginning to February 2006. We searched reference lists and the acupuncture database TCMLARS in China. SELECTION CRITERIA: Any published trial using randomized (RCT) or quasi-randomized (quasi-RCT) assignment to the intervention groups, either in full text or abstract form, were included. DATA COLLECTION AND ANALYSIS: Two reviewers made independent decisions for each step of the review: article inclusion, data abstraction and assessment of trial methodological quality. Study quality was assessed using the Jadad criteria. Consensus was used to resolve disagreements. When clinical heterogeneity was absent, we combined studies using random-effects meta-analysis models. MAIN RESULTS: We did not find any trials that examined the effects of acupuncture for acute or subacute pain, but we found 10 trials that examined acupuncture treatments for chronic neck pain. Overall, methodological quality had a mean of 2.3/5 on the Jadad Scale. For chronic mechanical neck disorders, there was moderate evidence that acupuncture was more effective for pain relief than some types of sham controls, measured immediately post-treatment. There was moderate evidence that acupuncture was more effective than inactive, sham treatments measured immediately post-treatment and at short-term follow-up (pooled standardized mean difference (SMD) -0.37, 95% confidence interval (CI) -0.61 to -0.12). There was limited evidence that acupuncture was more effective than massage at short-term follow-up. For chronic neck disorders with radicular symptoms, there was moderate evidence that acupuncture was more effective than a wait-list control at short-term follow-up. AUTHORS' CONCLUSIONS: There is moderate evidence that acupuncture relieves pain better than some sham treatments, measured at the end of the treatment. There is moderate evidence that those who received acupuncture reported less pain at short term follow-up than those on a waiting list. There is also moderate evidence that acupuncture is more effective than inactive treatments for relieving pain post-treatment and this is maintained at short-term follow-up.

Acupuncture Therapy↗

PubMed1985

Renal agenesis in British Columbia.

We review the incidence of bilateral and unilateral renal agenesis occurring in more than 625,000 consecutive births in British Columbia from 1952 to 1982. In total, 92 cases of bilateral renal agenesis and 117 cases of unilateral renal agenesis were identified. Congenital anomalies occurring in association with these conditions were also analyzed. The findings of the study support a mechanism in at least a proportion of cases of a primary developmental defect involving multiple systems within the fetus, with oligohydramnios being the result of the syndrome not the cause. Oligohydramnios no doubt contributes to the anomalies of the face, musculoskeletal system, and genitalia. No trends in changing incidence over time were identified.

Abnormalities, Multiple↗

PubMed1986

MR imaging and CT of extrahepatic cavernous hemangiomas.

Ten extrahepatic cavernous hemangiomas in seven patients were evaluated by MR and CT. MR was done with a 1.0-T superconducting magnet and spin-echo imaging. The lesions occurred in the musculoskeletal system, parotid gland, and spleen. MR and CT features of hemangiomas were compared, and MR findings in hemangiomas were also compared with those in eight musculoskeletal tumors of nonvascular origin. MR detected 10 hemangiomas, while nine were shown by CT. Also, MR was more accurate than CT in three patients in determining the true extent of hemangiomas. At a pulse-repetition interval of 2000 msec and an echo delay time of 90 msec, all hemangiomas were markedly hyperintense compared with skeletal muscle. Quantitatively, at this pulse sequence, intensity ratios of hemangiomas to skeletal muscle were all seven or greater (mean = 9.89), while the ratios for other tumors were usually less than seven (mean = 5.14). These means differed significantly (p less than .001). Small cavernous hemangiomas were homogeneous, well-defined round or oval lesions, while large hemangiomas consisted of dilated, tortuous vascular channels. Other tumors, however, were usually heterogeneous owing to hemorrhage and necrosis and had irregular margins. MR may, therefore, be useful for distinguishing cavernous hemangiomas from other soft-tissue tumors, particularly sarcomas.

Adolescent↗

PubMed1992

Musculoskeletal tumors in childhood.

As treatment strategies improve, the ability to cure children with musculoskeletal tumors is growing. The stage of a given malignancy, representing the degree of spread of the tumor to its local surroundings or distant sites, is the best predictor of long-term survival. Unfortunately, the insidious nature of the presentation of these tumors leads to their late recognition in advanced stages. This review will present scenarios suggesting the need for consideration of malignancy in the differential diagnosis of clinical problems related to the musculoskeletal system. Pitfalls in diagnosis and therapeutic approaches will also be discussed.

Bone Neoplasms↗

PubMed1989

Limb reduction defects in over one million consecutive livebirths.

Limb reduction defects occurring among 1,213,913 consecutive livebirths in British Columbia during the period 1952-1984 inclusive were reviewed. A total of 659 cases of limb reduction defects were identified, 393 of them involving the long bones and 190 of them more than one limb. The time period 1966-1984, during which ascertainment was consistent, was evaluated, and an incidence of 5.97 per 10,000 livebirths (1 in 1,692 live births) was found. The data were evaluated for trends over time, sex ratio, and regional and ethnic distribution. Associated anomalies of other organ systems in these cases were analyzed, and overall about one-half of the cases have additional defects. The majority of these additional defects affect the musculoskeletal system and include such entities as clubfoot, hip dislocation, and congenital contractures. Defects are also frequent in other organ systems, such as the cardiovascular, gastrointestinal, and genitourinary systems. By far the most common limb defects are terminal longitudinal defects then terminal transverse defects. Of all cases of limb defects, 75% are upper limb and 25% lower limb. We found no evidence that one side is affected more frequently. About 6.5% of cases had another family member registered with a skeletal defect; 12.9% of cases died within the first year of life, the majority (85%) of those dying having additional defects. Etiological considerations are discussed for some subgroups.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormalities, Multiple↗

PubMed1991

Physiological prediction of muscle forces--II. Application to isokinetic exercise.

The successful application of a physiological model of the musculoskeletal system capable of accounting for nonequilibrium dynamic loading and predicting individual muscle forces in the knee is presented. The model incorporates rigid-body mechanics and musculoskeletal physiology. Unknown muscle and joint contact forces outnumber the equilibrium equations resulting in an indeterminant problem. Mathematical optimization is utilized to resolve the indeterminacy. The model is used to estimate individual muscle forces during isokinetic exercise. Five subjects were tested at speeds of 60 degrees/s and 180 degrees/s. A newly proposed optimal criterion, minimizing muscular activation, results in muscle force predictions which have significantly higher correlations with myoelectric activity than other linear and nonlinear optimal criteria. The results demonstrate that properly constrained linear programming methods do not limit the number of active muscles and allow for uniform recruitment of the active muscles.

Adult↗

PubMedDate not supplied

Computer simulation of the upper extremities.

The development of real-time, interactive, three-dimensional, computer graphic simulation of the musculoskeletal system with emphasis on the upper extremities is described. Developments in image analysis, scientific visualization, and interactive computer methods and the continuous improvement in knowledge of musculoskeletal function have combined to provide an exciting new tool for musculoskeletal research. Interactive simulation also has promising applications in medical education and clinical rehabilitation. Only those developments that fit the specific criteria of realism, real-time response, intuitive interaction, three-dimensional structures, and modeling flexibility are discussed. It is hoped that an improved understanding of this emerging tool and an appreciation for its potential applications will be gained.

Arm↗

PubMed1998

Musculoskeletal Ultrasound in Pediatrics.

Ultrasound is ideally suited to the evaluation of the pediatric musculoskeletal system because of the increased ratio of cartilage to bone in the immature skeleton. The purpose of this article is to review the current uses of musculoskeletal ultrasound in pediatric patients. Hip sonography is widely accepted; other applications are increasing in popularity.

Journal Article↗

PubMedDate not supplied

Microspherophakia in association with the rhizomelic form of chondrodysplasia punctata.

Chondrodysplasia punctata is a multisystem disorder, primarily involving the musculoskeletal system, skin, and eyes. Children with the rhizomelic form of this syndrome have characteristic facies with a saddle-nose deformity, hypertelorism, and frontal bossing. The musculoskeletal changes include proximal limb shortening, flexion contractures, congenital hip dislocations, and the characteristic radiographic finding of epiphyseal stippling of the axial skeleton and long bones. The most common ocular findings are cataracts and optic atrophy. We describe herein the first reported case of microspherophakia in association with the rhizomelic form of chondrodysplasia punctata.

Abnormalities, Multiple↗

PubMed1997

Associations between self-rated psychosocial work conditions and musculoskeletal symptoms and signs. Stockholm MUSIC I Study Group.

OBJECTIVES: The aim was to study the associations between self-rated psychosocial work conditions and the characteristics and location of musculoskeletal symptoms, signs, and syndromes. METHODS: Perceived psychosocial work conditions were recorded in a cross-sectional study with 358 men and women in various occupations. Symptoms were recorded from the musculoskeletal system with a questionnaire, and signs were detected in a medical examination of all body regions. The analyses of statistical associations between the psychosocial factors and musculoskeletal disorders were performed with control for age, gender, and physical load. RESULTS: The most consistent and pronounced associations were mainly seen between poor psychosocial work conditions and coexisting symptoms and signs of the neck and back regions. Poor psychosocial work conditions were more consistently and strongly associated with signs of muscular (soft tissue) tenderness than with signs of tenderness in the joints, tendons, or muscular insertions or signs in nerve compression tests. Mainly low social support at work, but also high psychological demands and high job strain, were associated with such symptoms and signs, whereas decision latitude at work showed few associations with musculoskeletal disorders. CONCLUSIONS: Perceived poor psychosocial work conditions are statistically associated mainly with symptoms and signs of muscular tenderness in the central body regions. Studies on associations between psychosocial work conditions and musculoskeletal disorders should separate effect measures of different clinical signs and different body regions in order to avoid attenuation of the risk estimates.

Adult↗

PubMed1986

Analysis of a corporation's health care experience: implications for cost containment and disease prevention.

This article presents the health care experience of 14,162 employees and their families, covered under a private third-party insurance plan of a large multinational corporation for the 1984 policy year. A total of $29.5 million was charged by health care providers to deliver medical care for the studied employees and their families. This amounted to $2,083 per employee and his/her family. Approximately 51% of the employees submitted claims, with females having greater utilization than males. The highest expenditures were for diseases of the circulatory system among adults (3.2 million or 23% for employees, $1.5 million or 14% for spouses). Among employees, neoplasms accounted for $1.4 million or 10% of costs, and musculoskeletal system $1.2 million or 9% of costs. Among spouses, pregnancy and diseases of the female reproductive system accounted for $1.2 million (12%) and $1.1 million (10%), respectively. Among dependents, the top three cost categories were mental disorders ($1.2 million or 24%), accident-related illnesses ($0.7 million or 14%), and diseases of the respiratory system ($0.6 million or 12%). Hospital care expenditures, including room and board, ancillary, and physician services, accounted for approximately 60% of total health care spending. The percentage of health care costs paid for by this insurance plan was 75% for active employees, 34% for retirees, 60% for female spouses, 38% for male spouses, and 64% for dependents. The analyses and parameters measured can be viewed as the first step toward the development of a health care cost containment and disease prevention strategy.

Adult↗

PubMed1988

An examination of the relationships between home health service use and primary diagnosis of patient.

This paper analyses the relationships between home health service use and primary diagnosis of patient. Relationships examined include: patient distribution by diagnosis, visit distribution by diagnosis, average number of visits per patient and standard deviation, by diagnosis. Reliability of diagnosis as a predictor or service use is examined by a scatter graph comparison of the mean number of visits per patient, by diagnosis, between two randomly assigned groups of agencies. Survey data indicate that circulatory system diseases are the largest diagnostic category in both patient and visit count, constituting approximately 25% of all visits. Neoplasms (11% of visits) and diseases of the musculoskeletal system and connective tissue (10% of visits) are also strongly represented. Although the range of means for average number of visits is large, the scatter graph analysis gave evidence of relationship between diagnosis and service use.

Catchment Area, Health↗

PubMed1995

In vitro degradation and release characteristics of biodegradable implants containing trypsin inhibitor.

The use of a biodegradable implant system that provides a steady, controlled release of drugs or bioactive factors can be an attractive delivery vehicle of substances that can enhance repair processes in the musculoskeletal system. The present in vitro study examined the degradative characteristics and release kinetics of a 50 to 50 polylactic acid/polyglycolic acid implant, used as a carrier of trypsin inhibitor, during a 10-week period. Morphological and scanning electron microscopic examinations demonstrated that the implant degraded in a gradual, extended fashion such that by 10 weeks the implant was completely dissolved. It also was shown that the protein was released from the implant in a sigmoidal fashion with increased release between 3 and 7 weeks. More than 95% of the trypsin inhibitor originally incorporated in the implants was released during the 10-week test period. To describe further the degradation process of the implant, temporal changes in its molecular weight and surface axial strain were determined also. It was shown that in the initial 4 weeks, there was a marked decrease in molecular weight of the implants. Axial strain decreased and then increased over time, suggesting an initial period of stiffening followed by a period of degradative softening.

Biodegradation, Environmental↗

PubMed1994

Ice freezes pain? A review of the clinical effectiveness of analgesic cold therapy.

Among the physical treatments to reduce pain, ice has had its place for many years. Experience tells us that ice has a strong short-term analgesic effect in many painful conditions, particularly those related to the musculoskeletal system. Serial applications may also be helpful. The scientific evidence from clinical trials is, however, fragmentary. This applies both for acute and serial cold-induced analgesia. The mechanisms by which cryotherapy might elevate pain threshold include an antinociceptive effect on the gate control system, a decrease in nerve conduction, reduction in muscle spasms, and prevention of edema after injury. It is concluded that ice may be useful for a variety of musculoskeletal pains, yet the evidence for its efficacy should be established more convincingly.

Analgesia↗

PubMed1996

Musculoskeletal adaptations to weightlessness and development of effective countermeasures.

A Research Roundtable, organized by the American College of Sports Medicine with sponsorship from the National Aeronautics and Space Administration, met in November 1995 to define research strategies for effective exercise countermeasures to weightlessness. Exercise was considered both independently of, and in conjunction with, other therapeutic modalities (e.g., pharmacological nutritional, hormonal, and growth-related factors) that could prevent or minimize the structural and functional deficits involving skeletal muscle and bone in response to chronic exposure to weightlessness, as well as return to Earth baseline function if a degree of loss is inevitable. Musculoskeletal deficits and countermeasures are described with respect to: 1) muscle and connective tissue atrophy and localized bone loss, 2) reductions in motor performance, 3) potential proneness to injury of hard and soft tissues, and 4) probable interaction between muscle atrophy and cardiovascular alterations that contribute to the postural hypotension observed immediately upon return from space flight. In spite of a variety of countermeasure protocols utilized previously involving largely endurance types of exercise, there is presently no activity-specific countermeasure(s) that adequately prevent or reduce musculoskeletal deficiencies. It seems apparent that countermeasure exercises that have a greater resistance element, as compared to endurance activities, may prove beneficial to the musculoskeletal system. Many questions remain for scientific investigation to identify efficacious countermeasure protocols, which will be imperative with the emerging era of long-term space flight.

Adaptation, Physiological↗

PubMed2003

Derivation and identification of questions that act as predictors of abdominal pain of musculoskeletal origin.

OBJECTIVE: Although most causes of abdominal pain have a visceral origin, the musculoskeletal system must be considered when the cause is not obvious. This prospective study aimed to identify questions that would aid the diagnosis of patients with abdominal pain of musculoskeletal origin. DESIGN: Assessment of consecutive patients with abdominal pain recruited from gastroenterological outpatient clinics to develop diagnostic pointers to identify abdominal pain arising from musculoskeletal disorders. PARTICIPANTS: Subjects with benign abdominal pain, with or without a change in bowel habit, were recruited from gastroenterological clinics. Patients with inflammatory or neoplastic disease were excluded. SETTING: The study was conducted in the Physiotherapy Department, Addenbrooke's NHS Trust Hospital, Cambridge. MAIN OUTCOME MEASURES: A set of questions developed to indicate a musculoskeletal cause of a patient's abdominal symptoms. RESULTS The questions 'Does taking a deep breath aggravate your symptoms?' and 'Does twisting your back aggravate your symptoms?' had a significant positive indication of abdominal symptoms of musculoskeletal origin. The questions 'Has there been any change in bowel habit since onset of your symptoms?', 'Does eating foods aggravate your symptoms?' and 'Has there been any weight change since onset of symptoms?' had a significant negative indication for abdominal symptoms not of musculoskeletal origin. A combination of these questions gave 96% specificity and 67% sensitivity. CONCLUSION: These questions may help with the early identification of patients with abdominal pain of musculoskeletal origin and will be tested in further studies.

Abdominal Pain↗