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PubMed1996

Lower limb kinematics during treadmill walking after space flight: implications for gaze stabilization.

We examined the lower limb joint kinematics observed during pre- and postflight treadmill walking performed by seven subjects from three Space Shuttle flights flown between March 1992 and February 1994. Basic temporal characteristics of the gait patterns, such as stride time and duty cycle, showed no significant changes after flight. Evaluation of phaseplane variability across the gait cycle suggests that postflight treadmill walking is more variable than preflight, but the response throughout the course of a cycle is joint dependent and, furthermore, the changes are subject dependent. However, analysis of the phaseplane variability at the specific locomotor events of heel strike and toe off indicated statistically significant postflight increases in knee variability at the moment of heel strike and significantly higher postflight hip joint variability at the moment of toe off. Nevertheless, the observation of component-specific variability was not sufficient to cause a change in the overall lower limb joint system stability, since there was no significant change in an index used to evaluate this at both toe off and heel strike. The implications of the observed lower limb kinematics for head and gaze control during locomotion are discussed in light of a hypothesized change in the energy attenuation capacity of the musculoskeletal system in adapting to weightlessness.

Adult↗

PubMed2002

Muscle response while holding an unstable load.

OBJECTIVE: Basic biomechanical measurement was applied to explore the physical risk associated with holding an unstable load. DESIGN: We investigated muscle response, before and after the initiation of the balance-recovery responses from perturbation when handling unstable loads. BACKGROUND: Most studies of muscle response and postural control during load handling focused on stable (fixed) loads. Investigation of muscle response while handling an unstable load deserves similar attention. METHODS: Twelve male subjects experienced time-variant loads (18 kg), with additional sudden 12 kgm/s impact momentum, under three different load-shift conditions (stable, posterior-to-anterior rolling, or anterior-to-posterior rolling load), and in three foot placements (straddle, wide, and narrow stance). Normalized electromyography (expressed as percentage of maximum voluntary contraction) for the brachioradialis, biceps, erector spinae, and hamstrings were measured. RESULTS: The maximal exertions for brachioradialis (91.0%) and biceps (42.5%) were observed approximately 0.1 s after posterior-to-anterior impact, with maximal measured contractions for erector spinae (57.2%) and hamstrings (59.9%) noted approximately 0.2 s after impact. CONCLUSIONS; The central nervous system detects and responds to the need to stabilize the joints close to the location of load-shift perturbation, with these responses determined according to the anatomical and functional limitation of each biomechanical link. RELEVANCE: Handling shifting loads, impact loading and sudden-unexpected loading may be more damaging to the musculoskeletal system than handling stable loads.

Adult↗

PubMed1988

The concept of primary fibromyalgia (fibrositis): clinical value, relation and significance to other chronic musculoskeletal pain syndromes.

PFS, MPS and TMPDS can be identified using positive diagnostic criteria among patients presenting with chronic pain. A directed rather than exhaustive search for organic diseases known to coexist with these syndromes is usually all that is necessary. Criteria are presently empirical but do identify homogeneous populations of patients for study and treatment. Some patients, however, provide examples of overlap and it may be useful to think of CMPS in terms of the Venn diagram depicted in Fig. 2. In this report we have attempted an initial classification for a group of common and perplexing chronic pain disorders of the musculoskeletal system which at present have no identifiable cause. Previous investigations have been hampered by erroneous pathological concepts, heterogeneous patient populations and poor study design particularly with respect to treatment modalities. We hope that this classification, while empirical, will lead to needed epidemiological studies outlining the similarities and differences between these clinically observable and different musculoskeletal syndromes. We hope, further, that it will foster cooperation between different medical disciplines so that clinical biases might be tested in light of current concepts of the scientific method.

Bone Diseases↗

PubMed1998

Understanding women in pain. New pathways suggested by Umeå researchers: qualitative research and feminist perspectives.

A substantial proportion of GPs' patients are women who suffer from "unexplained" pain conditions, often from the musculoskeletal system. Few medical findings are revealed, although the symptoms lead to extensive suffering and disability. Two experienced Swedish GPs, Katarina Hamberg and Eva E Johansson, took their own frustration as their point of departure to explore the expectations, experiences, family lives and working lives of women who were sick-listed due to chronic musculoskeletal pain. Their doctoral dissertations, defended at the University of Umeå in September this year, are based on a qualitative interview study with 20 women aged 21-61 years. Johansson and Hamberg found that when seeing a doctor, the women expect to be seen, heard and taken seriously, to get information and time for discussion with the doctor, and to receive help and support over time. However, they experienced being ignored, disregarded and rejected. Symptom perception was characterized by loss of control and feelings of threat and unpredictability. The women believed that the pain had a bodily origin triggered by various mechanisms such as heavy and monotonous work, environmental influences, tensions and worries, rightful punishment or heritage. The Swedish study showed that family considerations had a strong impact on organizations and priorities in paid work. In this sample of working class women, family orientation strengthened and works aspiration declined in a situation of pain and sick leave. Problems related to rehabilitation could be explained by looking more closely on home conditions, especially the unwritten deal among the woman and her partner regarding the division of duties and power structure--the marital contract. Experiences of abuse and violence were reported to Hamberg and Johansson by several women, most of them considering this to be one root of their pain and ill health. The women emphasized that an understanding doctor would ask about violence, apprehend the hints, confirm that it was acceptable to talk about it, and avoid the questioning and blame that easily might increase the woman's feelings of guilt.

Absenteeism↗

PubMed2005

[Occupational hazads in metal mining industry].

Miners of basic professions employed in contemporary metal mining industry are exposed to a range of industrial factors, such as vibration, noise, dustiness, and unfavorable microclimate. Long-term exposure to these factors is hazardous to their health, which is manifested by elevated general and occupational morbidity and a higher rate of biological aging. This is most typical of Far North miners, who are exposed to the combination of the industrial factors and extremal climate and geographic conditions. Research into the health status of miners engaged to underground works and open excavations in regions with contrasting climate and geographic conditions, allowed determination of main industrial risk factors (vibration and noise), leading occupational diseases and groups of high risk of their development (according to the occupation and the length of service). The study found high risk of cardivascular diseases as well as pathology of the musculoskeletal system, which was highest in miners in Norilsk region.

Adult↗

PubMed1994

Arthritis and the process of disablement.

Rheumatoid arthritis and osteoarthritis are two medical conditions that broadly alter the musculoskeletal system and influence a person's ability to perform the functional activities and tasks expected of an independent adult. A burgeoning literature depicts the process of disablement in arthritis and details the relationships among disease, impairments, and functional limitations. There is, however, a substantial gap in the physical therapy literature regarding the relationship among arthritis, musculoskeletal impairment, and physical function. Furthermore, the search for the most effective ways to remediate musculoskeletal impairment and improve function remains a challenge for clinicians and researchers alike.

Activities of Daily Living↗

PubMed1993

[Pain syndromes of the locomotor system. Strategy and research of etiology in general practice].

PROBLEM: The basis of classical medicine with its specific taxonomy for diagnoses and their etiopathogenesis was originally established by clinicians and pathologists, and has a traditional historical background. It thus also contains information as to the frequency distribution of diseases in the hospital, which often show an inverse relationship to health disorders seen in general practice. However, the fact that we have different disease statistics in general medicine gives rise to a basically different viewpoint. OBJECTIVES: Using painful conditions of the musculoskeletal system as a model, this point of view will be characterized and confirmed on the basis of the results of our own investigations into their etiology and treatment. Three questions in particular are discussed: etiological-diagnostic classification, expanded diagnostic evaluation, and applied therapy. RESULTS: In general practice, specific approaches are available for diagnosis and treatment; traditional terms employed in the hospital context cannot simply be applied or taken over unmodified.

Combined Modality Therapy↗

PubMed1998

An overview of home health and hospice care patients: 1996 National Home and Hospice Care Survey.

OBJECTIVE: This report presents numbers and percents of home health and hospice care agencies, their current patients, and their discharges. Agency characteristics include type of ownership, region, certification, location, and affiliation. Patient and discharge characteristics include age, sex, race, marital status admission diagnoses, and procedures. METHODS: The data used for this report are from the National Center for Health Statistics' 1996 National Home and Hospice Care Survey. This is a sample survey through which data are collected on the use of home health and hospice care agencies in the United States. RESULTS: During 1996, there were an estimated 2.5 million current patients and 8.2 million discharges from 13,500 home health and hospice care agencies in the United States. The agencies tended to be proprietary, certified by Medicare and Medicaid as a home health agency, and located in a metropolitan statistical area. Almost half were part of a chain or group of agencies. The home health and hospice care patients and discharges tended to be 65 years of age and over, female, white, and married or widowed. The most common diagnoses for home health care patients were diseases of the circulatory system, and the most common diagnoses for hospice care patients were malignant neoplasms. About a third of the home health care patients and about a fifth of the hospice care patients had a surgical or diagnostic procedure related to their admission for care. The most common procedures for home health care patients were operations on the musculoskeletal system, and for hospice care patients they were miscellaneous diagnostic and therapeutic procedures.

Adult↗

PubMed1997

[Examination and treatment of musculoskeletal diseases in general practice investigated by medical audit].

The general practitioner has a central role in the investigation and treatment musculoskeletal diseases, because he often is the first to see the patient. Correct initial care can save days lost through sickness and prevent chronic courses. In May 1995, 173 general practitioners registered every patient contact with complaints from the musculoskeletal system. The registration continued for three weeks following an audit model used in Denmark among general practitioners (in total 6869 contacts). After the registration four follow-up meetings took place. The two main results were 1) frequent conventional X-rays of osteoarthritis, and 2) prescription of non-steroidal antiinflammatory drugs to every fourth contact with musculoskeletal complaints. The follow-up meetings revealed some non-professional motives for sending the patient to X-ray examination and for prescribing non-steroidal anti-inflammatory drugs. The results will form the basis for clinical guidelines for handling some of the musculoskeletal diseases.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2001

Metal toxicosis in horses.

The ubiquity and stability of metals in the environment make them unique as a pollutant or an essential dietary component. Metals are neither created nor destroyed by chemical processes but are redistributed in the environment. In combination with other elements, metal compounds and alloys are essential materials of the contemporary world. Inappropriate use or distribution in the environment leads to adverse health effects on all biologic systems, including horses. Gastrointestinal upset is a common feature of acute toxicosis with metals in general. Among the metals discussed, arsenic and inorganic mercury have a propensity to do severe damage to the gut. Deposition of cadmium on forage is the source most likely to intoxicate horses. This subchronic to chronic problem in horses is manifest as disease of the musculoskeletal system and kidneys. Iron-containing hematinics are widely used in racetrack horses and occasionally result in hepatopathy when excessive doses are administered. Lead continues to be recognized as the most significant environmental metal pollutant. Poisoning is encountered routinely in humans and animals. Of the animal species of veterinary concern, lead-poisoned horses are not a frequent encounter. Lead-intoxicated horses show signs of peripheral neuropathy (laryngeal hemiplegia), intermittent colic, and mild anemia. Acute mercury poisoning sometimes occurs from the common use of mercury-containing blistering agents, with most clinical findings related to acute renal failure. Chronic excessive intake of zinc by horses is uncommon but devastating in rapidly growing foals. The mechanism of chronic zinc toxicosis is coupled to the induced copper deficiency. The condition is a disease of cartilage in the articular and growth physes.

Animals↗

PubMed2005

Musculoskeletal complaints among a group of Turkish nurses.

The aim of the present study was to describe the prevalence and distribution of symptoms of musculoskeletal complaints among Turkish nurses who are practicing general nursing. The study population consisted of 120 nursing staff from four large general hospitals in Erzurum, Turkey. In every hospital six departments (surgery, medical, obstetric and gynecology, psychiatry, pediatric, and neurology) were selected. A Nordic standardized questionnaire described by Kuorinka et al. (1987) about complaints of the musculoskeletal system and a self-administered questionnaire involved information on the respondent's job and employment history, individual characteristics, physical and psychosocial risk factors at work, and general health status, were used by the researchers. Test data were analyzed for the difference between two population proportion and percentage. In the total population, 90% of all nurses reported at least one musculoskeletal complaint, 60% reported at least two, and 36% reported spells of three complaints in the past 6 months. Low back complaints were the most prevalent of musculoskeletal complaints, reported by 69% of the nurses. Neck complaints were less prevalent than shoulder (46% and 54%, respectively). Nurses with back complaint more often reported neck (28%) and shoulder (34%) complaints. Chronic low back, neck, and shoulder complaints were experienced by 41%, 25%, and 33% nurses, respectively. On the other hand, chronic complaints showed a correlation with working departments. The nurses working in surgery and obstetric and gynecology departments have more chronic complaints than the nurses working in other department (p<.05). The article's findings do not differ from those of other countries. Despite its limitations, this study points to the importance of perceived worked-related physical demands in relation to reported neck, shoulder, and back musculoskeletal complaints in Turkish nurses. But, further inquiries are needed to identify other physical exposures that may be related to musculoskeletal complaints.

Adolescent↗

PubMedDate not supplied

[Radiologic diagnosis of Erdheim-Chester disease. A case report].

Erdheim-Chester disease is a rare disorder, belonging to the group of histiocytoses, in which diffuse infiltration of histiocytes affects various organs and systems. Bone involvement in Erdheim-Chester disease manifests as generalized sclerosis of the bone marrow and cortex of the long bones, and this peculiar radiologic characteristic differentiates it from other histiocytoses. Diagnostic suspicion of the disease derives from the pulmonary and bone radiologic findings as well as from the clinical findings. Histological study reveals histiocyte infiltration affecting the soft tissues, musculoskeletal system, and central nervous system. The definitive diagnosis is reached by immunohistochemistry. Like other histiocytoses, such as Langerhans cell histiocytosis, immunohistochemical techniques reveal lipid-laden histiocytes; however, unlike the other types, Erdheim-Chester histiocytes stain negatively for S 100 protein and do not contain Birbeck granules.

Erdheim-Chester Disease↗

PubMed2001

Easily removed drill guide for pin insertion during external fixation.

A new guide for tissue protection while drilling and inserting screws in external fixation without taking down the system is presented. It can be used for pin insertion in both unilateral and ring-type external fixators. The external fixator is used as a template guide, and pin insertion can be easily performed with the fixator in place. With its use, operative time is decreased, and tissue protection is achieved for all pin insertions in any part of the musculoskeletal system.

Bone Nails↗

PubMed1991

Sick absence in dockers.

The reasons for sick absence in dockers performing heavy loading jobs (stevedores) in the port of Gdynia, in 1986-1991, were identified and subjected to statistical analysis. The study group consisted of 603 people--73% of the whole population of dockers in the port. The prevailing reason were the diseases of the musculoskeletal system--on the average 5.6 days of sick leave per 1 docker per year--28.7% of the total sick absence in the occupational group studied. On the second place were traumas, mainly of the extremities and of the spine--4.7 days (24.9%). The proportion of the circulatory system diseases was a mere 1.9-0.4 days. The high sick absence caused by the first group of diseases calls for preventive interventions during pre-entry and periodic medical examinations of dockers.

Absenteeism↗

PubMed2003

Bone and joint diseases around the world. Sweden: a brief update on burden and priority.

Musculoskeletal conditions are increasingly common with advancing age. The life expectancy increased early and rapidly in Sweden, and today 17% of the population is over age 65. Musculoskeletal problems are therefore common but in general are receiving low attention, despite enormous costs for society. The indirect costs for musculoskeletal conditions vastly exceed direct costs (80% vs 20%). This is obviated by the fact that in 2001, of all persons receiving disability pension or taking longterm sick leave, 60% had a diagnosis related to the musculoskeletal system. Further, in a population of 9 million, 70,000 fragility fractures occur each year, 18,000 of the hip and 25,000 of the forearm, corresponding to a hip fracture incidence of 20.14/10,000, among the highest in the world. Government policy is implemented through several agencies, national and local. State of the art reports are currently available in 12 areas of musculoskeletal condition, including osteoarthritis, rheumatoid arthritis, osteoporosis, and hip fracture, while no national evidence-based guidelines have been developed for these conditions. The Swedish Council on Technology Assessment in Health Care provides the scientific foundation of present methods for treatment through evidence-based evaluations. National registers are continuously evaluating orthopedic implant procedures, of which the Swedish Hip Register has provided valuable information on total hip replacements since 1979. For the future, there is a need for setting of priorities with regard to musculoskeletal conditions, including development of guidelines of mechanism of implementation.

Cost of Illness↗

PubMed2004

Analysis of the force-sharing problem using an optimization model.

In biomechanics, one frequently used approach for finding a unique set of muscle forces in the 'force-sharing problem' is to formulate and solve a non-linear optimization problem of the form: min phi(f)= summation operator (f(i)/omega(i))(alpha) subject to Af = b and f > or = 0. Solutions to this problem have typically been obtained numerically for complex models, or analytically for specific musculoskeletal geometries. Here, we present simple geometrical methods for analyzing the solution to this family of optimization problems for a general n-degrees-of-freedom musculoskeletal system. For example, it is shown that the moment-arm vectors of active (f(i) > 0) and passive (f(i) = 0) muscles are separated by a hyperplane through the origin of the moment-arm vector space. For the special case of a system with two degrees-of-freedom, solutions can be readily represented in graphical form. This allows for powerful interpretations of force-sharing calculated using optimization.

Animals↗

PubMed1988

Vibrations in orthopedics.

Measurements of various mechanical properties of skeletal material using vibration techniques have been reported. The purposes of such investigations include the monitoring of pathogenic disorders such as osteoporosis, the rate and extent of fracture healing, and the status of internal fixations. Early investigations pioneered the application of conventional vibration measurement equipment to biological systems. The more recent advent of the microcomputer has made available to research groups more sophisticated techniques for data acquisition and analysis. The economical advantages of such equipment has led to the development of portable research instrumentation which lends itself to use in a clinical environment. This review article reports on the developments and progression of the various vibrational techniques and theories as applied to musculoskeletal systems.

Biomechanical Phenomena↗

PubMed1997

Modelling muscle activity in standing with considerations for bone safety.

The functional use of electrical stimulation (FES) for the restoration of movement to paraplegics has been improved in the last decade but questions about the mechanical effect of stimulation on the skeleton have arisen. In intact people, neuromuscular activity not only controls movement, but also minimizes bone and joint tissue loading. Current FES systems do not use feedback and do not even use average natural patterns of muscle activation. FES systems would be safer if muscle activation patterns were synthesized so as to minimize bending in the long bones. By modelling, we have verified that appropriate muscular activity reduces bone bending stresses, an approach we named active unloading of the skeleton. Using this criterion for control is novel. The muscle activation was calculated using measurements from intact people in different postures, and later modelling of the musculoskeletal system. The two-dimensional model of the lower limb includes 23 muscles relevant primarily for movement in the sagittal plane. The muscle model for constraint calculation is divided into first-order activation dynamics and first-order contraction dynamics. Optimization, which includes minimization of net bending moment calculated along the long bones, is static because changes in the observed postures are slow. In the calculated muscle activity patterns, muscle coactivation and cocontraction yield very uniform and low bone loading. Net bending moment values were fairly stable as the posture varies. The moment distribution in the femur was found to be U-shaped, while in the tibia it is sometimes V-shaped. The bones are naturally thicker at the points of peak moment.

Adult↗