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PubMedDate not supplied

Musculoskeletal manifestations of infection with human immunodeficiency virus.

Musculoskeletal manifestations and autoimmune phenomena are recently recognized complications of infection with human immunodeficiency virus (HIV). Patients with HIV infection share several clinical and serologic features with patients with systemic lupus erythematosus and Sjögren's syndrome; these similarities may lead to diagnostic confusion. The significance of the presence of different types of autoantibodies in HIV-infected patients is still uncertain and may reflect polyclonal B cell activation. Musculoskeletal complications--particularly arthritis, arthralgia, and myalgia--are common in advanced stages of HIV infection. Clinical characteristics and serologic findings support the premise that most of the musculoskeletal complications (e.g., Reiter's syndrome, psoriatic arthritis, acquired immunodeficiency syndrome-associated arthritis and arthralgias) are reactive in nature--either a direct consequence of HIV infection or a result of various opportunistic infections. The possibility of HIV infection should be considered in all patients with conditions suggesting reactive arthritis. Further studies are needed to define the full spectrum and frequency of these musculoskeletal abnormalities.

Autoantibodies↗

PubMed1983

Stimulation of the peripheral nervous system for pain control.

Transcutaneous stimulation is a proven effective way to relieve pain. Its optimal use requires an accurate patient diagnosis. Treatment of pain as a symptom only is likely to fail. There must be a careful psychosocial evaluation, for the majority of patients who come to the doctor complaining of pain have major psychological, social, or behavioral factors that are most important in the genesis of the complaint. Drug abuse must be corrected. Related symptoms, such as anxiety and depression, must be treated. Then, a thorough trail of transcutaneous stimulation is mandatory. A desultory use will undoubtedly lead to failure. This trial must begin with patient education by experienced personnel. Then the electrodes must be properly applied, and there must be a regular follow-up of stimulation to be certain the patient is utilizing it correctly. The patient must be supported through an adequate trial which should extend over 2-4 weeks before purchase of the device is contemplated. Furthermore, all related nursing and physician personnel must be educated in the proper use of the technique. The uninformed professional who denigrates the therapy is a very effective deterrent to appropriate use. In this situation, transcutaneous electrical stimulation will be of great value in the treatment of acute musculoskeletal injury and acute postoperative pain. It will be effective in the treatment of peripheral nerve injury pain, chronic musculoskeletal abnormalities, chronic pain in the patient who has undergone multiple operations upon the low back and neck, visceral pain, some of the reflex sympathetic dystrophies, and postherpetic neuralgia. Stimulation will not help a complaint which is psychosomatic in origin. It will not influence drug addiction. It is not likely to be useful in any situation where secondary gain is important. The metabolic neuropathies, pain of spinal cord injury, and pain from cerebrovascular accident will not respond frequently enough to warrant more than hopeful trials. The technique is inexpensive, places the patient in control of his own pain, and has no known serious side effects. Its widespread application awaits the development of reasonable systems to provide this service to physicians and patients. Stimulation-induced analgesia deserves a place in the armamentarium of every physician dealing with the complaint of pain.

Back Pain↗

PubMed1991

Musculoskeletal development: a review.

The early development of the limbs, the skeletal and muscular systems, and the joints and early changes in joint mobility are reviewed. The musculoskeletal system is vulnerable to failures of specific morphogenetic processes in the embryonic period. Congenital anomalies and postural deformities also may arise in the fetal period. Awareness of prenatal and postnatal events and their timing will assist health care workers in management of pediatric clients.

Fetal Movement↗

PubMed1995

Agricultural work during pregnancy and selected structural malformations in Finland.

We studied the relation between birth defects and maternal agricultural work in a nationwide time- and area-matched case-referent series of 1,306 pairs of infants (581 orofacial clefts, 365 central nervous system defects, 360 skeletal defects) obtained through the Finnish Register of Congenital Malformations. We supplemented the Register data, including the mothers' latest and previous pregnancies, diseases, consumption of drugs and alcohol, smoking habits, and the like, with detailed interviews on the mothers' work conditions. When all of the birth defects were pooled and agricultural work was compared with nonagricultural work in the first trimester of pregnancy, the adjusted odds ratio was 1.4 [95% confidence interval (CI) = 0.9-2.0]. For orofacial clefts, the corresponding odds ratio was 1.9 (95% CI = 1.1-3.5). An industrial hygienist's blinded assessment indicated that seven mothers of infants with orofacial clefts and three reference mothers had been exposed to pesticides in agricultural work; the adjusted odds ratio for work with pesticide exposure, when compared with unexposed agricultural work, was 1.9 (95% CI = 0.4-8.3). Exposure to solvents did not explain the observed association.

Abnormalities, Drug-Induced↗

PubMedDate not supplied

Elbow complications after organ transplantation. Case reports.

Musculoskeletal abnormalities have rarely been reported after major organ transplantation. We recorded five cases of elbow complications after orthotopic liver and bilateral lung transplantation. Three patients (four elbows) developed heterotopic ossification at the elbow, leading to decreased range of motion, pain and difficulty performing self-feeding and perineal hygiene. Two patients (three elbows) had electrodiagnostic evidence of ulnar mononeuropathy at the elbow, whereas one patient had bilateral median mononeuropathies caused by compression at the level of the ligament of Struthers. Surgical resection of ectopic bone with postoperative radiation was required in two patients (two elbows), and nerve decompression was used in three patients (four elbows). Common factors noted in all patients with either heterotopic ossification or ulnar mononeuropathy at the elbow included prolonged encephalopathy and the use of wrist restraints with the presentation of symptoms occurring weeks after surgery. In the patient with bilateral median nerve entrapment, symptoms occurred immediately after surgery suggesting perioperative limb compression. Elbow complications after organ transplantation should be recognized to minimize long-term disability through preventive measures and appropriate treatment.

Adult↗

PubMed1999

Psoriatic arthritis and the spectrum of syndromes related to the SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome.

During the past year, the increasing use of nuclear magnetic resonance imaging techniques, with their ability to delineate cartilage and ligamentous structures and to identify edema, are providing a radical improvement in ascertainment of musculoskeletal abnormalities, although their significance remains incompletely delineated. A second theme has come from the study of spondyloarthropathies in different ethnic groups and societal environments, revealing that the Northern European and North American form of the disease, with its powerful association with HLA-B27, is little evident in the rest of the world's population and that different susceptibility genes and environmental factors operate in other regions and peoples. Related to this theme is the compelling evidence of the marked influence of HIV infection on the development of spondyloarthropathies in Africa. Two areas of immune recognition are discussed as examples of emerging fields that may provide useful paradigms for the experimental approach to mechanisms in psoriatic arthritis. One of these is the three-cell model of CD8 T-cell interaction, in which a dendritic cell presents a peptide from an immunogenic protein to both a CD4 and CD8 T-cell clone, providing a cognitive interaction that disrupts tolerance and results in the expansion of the cytotoxic T-cell clone. In this respect, the combination of an activated dendritic cell, together with enhanced availability of arthritogenic microbial antigens caused by microbial persistence, are interesting candidates to explore as the basis of the HIV-associated rheumatic diseases. The second area of immune recognition is the growing understanding of the outline of the solution to the problem of the association of a spondyloarthropathy with several

Acquired Hyperostosis Syndrome↗

PubMedDate not supplied

Posterior acetabular wall deficiency in Down syndrome.

Trisomy 21 or Down syndrome is the most common chromosomal anomaly and is associated with musculoskeletal abnormalities related to a generalized ligamentous laxity. Approximately 1% to 7% of Down syndrome patients have hip instability. Prior studies on the topic recommend Salter innominate osteotomy, capsular plication, and a varus derotational osteotomy of the proximal femur, which typically is in an anteverted and valgus position. The authors present a previously unreported bilateral finding in two patients noted on three-dimensional reconstruction computed tomography: deficiency of the posterior acetabular wall. Each was treated using a modification of the Pemberton osteotomy in which a wedge of iliac crest graft is placed posteriorly to hinge the posterior wall into a position of better posterior coverage of the femoral head. Both patients' hips have remained stable more than 10 years postoperatively. Follow-up imaging demonstrates well-remodeled osteotomy sites and excellent posterior coverage of the femoral heads.

Acetabulum↗

PubMed1999

Pediatric fibromyalgia and dizziness: evaluation of vestibular function.

Twelve children with fibromyalgia and complaints of chronic dizziness were evaluated with both clinical office maneuvers of vestibular function and laboratory tests composed of electronystagmography and sinusoidal harmonic acceleration rotary chair testing. All test results were normal for spontaneous nystagmus with or without visual fixation, oculocephalic reflex, dynamic visual acuity, head-shaking nystagmus, Quix test, and Dix-Hallpike maneuver. Electronystagmography test results were essentially normal for saccades, gaze, Dix-Hallpike, pendular tracking, and caloric evaluation. Rotary chair testing was normal in all 12 patients. These findings suggest that central (brainstem) and peripheral vestibular (inner ear) mechanisms do not account for the complaints of dizziness in the pediatric patient with fibromyalgia. The common musculoskeletal abnormalities of fibromyalgia may affect their proprioceptive orientation, therefore giving them a sense of imbalance.

Adolescent↗

PubMed1987

Unilateral athelia with a subcutaneous dermoid cyst.

A case of unilateral athelia with a subcutaneous dermoid cyst in the area in question is reported. The histologic features of the cyst wall suggest that it is derived from a base in the nipple-areola complex. Dozens of cases of congenital absence of the breast have been reported, some of them associated with congenital anhidrotic ectodermal dysplasia, others with additional musculoskeletal abnormalities, and still others normal in other respects. But to our knowledge, the combination of athelia and corresponding subcutaneous dermoid cyst has not been reported.

Adolescent↗

PubMed2005

Unusual spondylolisthesis.

STUDY DESIGN: Literature and personal experience review of the topic of unusual spondylolisthesis OBJECTIVE: To provide information to the readership on the association of spondylolisthesis with syndromic and other conditions and implications of, indications for, and details of treatment for the spondylolisthesis. SUMMARY OF BACKGROUND DATA: From personal experience and perusal of the literature, it is known that spondylolysis/spondylolisthesis is frequently associated with various conditions with musculoskeletal abnormalities as part of their overall presentation A formal literature search revealed a number of these conditions. The underlying conditions often have a significant effect or can even be the cause of the spondylolisthesis. In light of this, there needs to be a high index of suspicion when evaluating such patients to identify this spinal deformity, if it is present so that appropriate treatment can be rendered early, before severe deformity and disability occur as indicated. METHODS: A literature search was performed using search engines. RESULTS: The reader has been provided with discussions about a number of conditions with associated spondylolisthesis. CONCLUSION: A number of generalized conditions have as part of their presentation spondylolysis/spondylolisthesis, which should be identified as part of their initial and ongoing evaluations.

Humans↗

PubMedDate not supplied

Orthopedic manifestations of the Lowe (oculocerebrorenal) syndrome.

Lowe oculocerebrorenal syndrome (OCRS), as previously described in the literature, consists of a well-defined constellation of clinical findings involving the eyes, cerebrum, and kidneys. However, the only musculoskeletal abnormalities reported in patients with OCRS have been joint hypermobility, recurrent fractures, rickets, tenosynovitis, and joint effusions. No other specific orthopedic problems have been described. This study presents new clinical findings of scoliosis, kyphosis, platyspondyly, dislocated and/or subluxed hips, and cervical spine abnormalities in six patients with OCRS treated at Carrie Tingley Hospital (Albuquerque, NM, U.S.A.). This study further supports an X-linked recessive mode of inheritance and adds clinical support to the published work that suggests that Lowe syndrome may be due to biochemical abnormalities in glycosaminoglycan metabolism.

Adolescent↗

PubMed1995

Familial hypertryptophanemia in two siblings.

Mild and moderate mental retardation with exaggerated affective responses, periodic mood swings, and apparent hypersexual behavior were present in two siblings with hypertryptophanemia and tryptophanuria. In addition, the male had severe myopia, a speech impediment, musculoskeletal abnormalities and perceptual hypersensitivity. His sister was deaf, which was ascribed to antenatal rubella. The occurrence in siblings and the presence of abnormal urinary tryptophan metabolite in the mother and a half-sibling suggest that the condition results from an autosomal recessive gene with minor expression in some heterozygotes.

Adult↗

PubMed1993

Williams syndrome: a clinical study of children and adults.

Eighteen individuals in Western Australia with Williams syndrome were surveyed. Nine were adults. The majority (72%) presented initially because of developmental delay. The diagnosis was made at an average age of 35 months and in over half the cases was made by general paediatricians. Two-thirds of those surveyed had a significant cardiac murmur and eight had features of supravalvular aortic stenosis. Reduced peripheral circulation was found in 22%. One half had mild musculoskeletal abnormalities, joint contractures being the most common. Chronic or recurrent urinary symptoms were present in one-third of cases. Adults tended to be on a lower height centile and were more obese compared to children. The early diagnosis of Williams syndrome remains elusive. A wide range of complications may develop.

Abnormalities, Multiple↗

PubMed1988

Articular manifestations of acromegaly.

Forty-five patients with acromegaly or gigantism were reviewed for musculoskeletal abnormalities. Abnormalities of peripheral joints occurred in 74% of the patients and spinal involvement in 47%, leading to significant morbidity. Joint abnormalities most frequently affected the large joints (hips, knees and shoulders) but the wrist and hand were also involved. The radiological features of acromegalic arthropathy are described, including vertical widening of the hip joint, enthesopathy and osteophytosis. A favourable response to treatment is associated with a less severe arthropathy and a good functional outcome.

Adolescent↗

PubMed1997

Tendonitis of the branches of insertion of the superficial digital flexor tendon in horses.

OBJECTIVE: To describe clinical findings, ultrasonographic features and outcome of injury to the branches of insertion of the superficial digital flexor (SDF) tendon in horses. DESIGN: Retrospective study of 14 cases. PROCEDURE: Fourteen Thoroughbred horses with tendonitis affecting the branches of insertion of the SDF tendon were examined for lameness, location and amount of swelling, and the presence of other musculoskeletal abnormalities. The flexor tendons were assessed by ultrasonographic examination, and recommendations were made for management of the cases. Outcome was assessed by re-examination of some horses, direct communication with the owner or trainer, and examination of race records. RESULTS: The lateral SDF branch was affected in 10 horses; the medial branch in three, and both branches in one horse. Two horses had concurrent injuries to the SDF tendon in the metacarpal region of the contralateral limb. Ultrasonographic findings included swelling of the affected SDF branch, peritendinous fluid accumulation, disruption of normal fibre alignment on sagittal scan, and variable loss of echogenicity. As healing occurred, there was return of normal echogenicity, but normal fibre alignment did not return completely and apparent adhesions formed between the affected SDF branch and adjacent structures. Seven of 10 horses which returned to their previous use were able to compete without further tendon injury. Recurrence of injury occurred in one case, and another two horses developed tendonitis in the metacarpal region. One horse was retired from racing but was able to compete at dressage without recurrence of injury. Two horses were retired for breeding without returning to training, and one horse was sold and lost to follow up but did not race. CONCLUSION: The prognosis is fair for return to previous use following injury to the branches of insertion of the SDF tendon in athletic horses.

Animals↗

PubMed1999

Rasch analysis of the Western Ontario MacMaster questionnaire (WOMAC) in 2205 patients with osteoarthritis, rheumatoid arthritis, and fibromyalgia.

OBJECTIVE: Advances in health measurement have led to the application of Rasch Item Response Theory (IRT) analysis (Rasch analysis) to evaluate instruments measuring health status and quality of life of patients, including the Health Assessment Questionnaire and SF-36. This study investigated the extent to which the Western Ontario MacMaster osteoarthritis questionnaire (WOMAC) satisfies the Rasch model, particularly in respect to unidimensionality, item separation, and linearity. METHODS: The study included a total of 2205 patients, 1013 with rheumatoid arthritis (RA), 655 with osteoarthritis of the knee or hip (OA), and 537 with fibromyalgia. All patients completed the WOMAC as part of a longitudinal study of rheumatic disease outcomes. To examine whether the WOMAC pain and function scales each fits the Rasch model, the Winsteps program was used to assess item difficulty, scale unidimensionality, item separation, and linearity. RESULTS: Although the WOMAC worked best in OA, regardless of disorder, both the pain and function scales were unidimensional, had adequate item separation, and had a long range (25-150) of linearity in the function scale. Several functional items, however, had a high information weight fit (INFIT) statistic, indicating poor fit to the model. These items included "getting in and out of the bath" and "going down stairs." CONCLUSION: The WOMAC generally satisfies the requirements of Rasch item response theory across all disorders studied, and is an appropriate measure of lower body function in OA, RA and fibromyalgia. Although some individual items do not fit well, it is not likely that removing such items would result in more than overall minimal differences, and it will be difficult to remove traces of multidimensionality while keeping the central constructs of progressive lower body musculoskeletal abnormality intact. In addition, it is possible that a "purer", still more unidimensional instrument would be less useful in clinical trials and epidemiological studies by restricting the range of the scale.

Activities of Daily Living↗

PubMed1975

Central core disease. A correlated genetic, histochemical, ultramicroscopic, and biochemical study.

Two patients suffering from central core disease are presented. The condition is associated with musculoskeletal abnormalities which have been traced back over five generations. In addition to the typical histochemical findings, electronmicroscopic study has revealed the presence of both structured and non-structured cores in adjacent areas. The calcium uptake by the sarcoplasmic reticulum was reduced to one-third of normal. Phosphorylase activity was normal in the one case and reduced to 63% in the other. Actomyosin Mg2+-activated ATPase activity was decreased, as was the Ca2+-dependent ATPase of the sarcoplasmic reticulum.

Adenosine Triphosphatases↗

PubMed1989

Chemical shift imaging with paramagnetic contrast material enhancement for improved lesion depiction.

The depiction of contrast material-enhanced lesions with magnetic resonance imaging can be improved by using chemical shift imaging (CSI) for lipid suppression in combination with gadolinium diethylenetriaminepentaacetic acid (DTPA) enhancement. Gd-DTPA enhancement was combined with the hybrid technique for lipid suppression, which provides water-only images without increasing imaging time or postprocessing. Lesions with high signal intensity due to paramagnetic relaxation enhancement are easily distinguished from low-intensity lipid, which would otherwise dominate T1-weighted images. Preliminary studies were performed to compare Gd-DTPA-CSI images with conventional postcontrast T1-weighted images. In patients examined for orbital, pituitary, and musculoskeletal abnormalities, the Gd-DTPA-CSI technique enabled improved detection and finer anatomic staging of lesions. In theory, a similar result can be achieved by using any chemical shift-selective method that results in true lipid suppression together with paramagnetic contrast agents that generate high signal intensity. This general approach should be applicable to clinical studies in other tissues or organ systems dominated by lipid, including the pelvis, mediastinum, and breast.

Contrast Media↗