Jäckel, Wilfried H; Farin, Erik
Multidisciplinary treatment focusing on impairments, activities and participation are an important component within the therapeutic regimen in musculoskeletal conditions. In Germany, for more than 95% of the patients multidisciplinary treatment is provided as inpatient rehabilitation. According to the results of a study from the Netherlands, inpatient rehabilitation is superior to usual care in terms of decreasing disease activity and improving emotional well-being in rheumatoid arthritis. Another randomized, controlled study gives evidence that rehabilitation is more effective as compared to usual care in ankylosing spondylitis. In patients suffering from fibromyalgia, after inpatient rehabilitation, symptoms improve significantly and this is true even one year after discharge. The results of a quality management project financed by the German health insurance and including several thousand patients with musculoskeletal diseases show an improvement in physical and emotional dimensions of health status at discharge and after a six month follow-up. Recent studies comparing inpatient with outpatient rehabilitation in patients with musculoskeletal diseases provide information that both forms are equally effective. Taking into account the high number of inpatient rehabilitation procedures in Germany, more outcomes research is required urgently.
... Institute of Arthritis and Musculoskeletal and Skin Diseases; Notice of Closed Meeting Pursuant to section... Institute of Arthritis and Musculoskeletal and Skin Diseases, Special Emphasis Panel, Clinical Trials... of Arthritis, Musculoskeletal and Skin Diseases, National Institutes of Health, 6701 Democracy...
Abdelhamid, Ramy E.
Chronic musculoskeletal pain is debilitating and affects ∼20% of adults. Tissue acidosis is present in painful musculoskeletal diseases like rheumatoid arthritis. ASICs are located on skeletal muscle and joint nociceptors as well as on nonneuronal cells in the muscles and joints, where they mediate nociception. This review discusses the properties of different types of ASICs, factors affecting their pH sensitivity, and their role in musculoskeletal hyperalgesia and inflammation. PMID:26525344
Dallaudière, B; Lecouvet, F; Vande Berg, B; Omoumi, P; Perlepe, V; Cerny, M; Malghem, J; Larbi, A
MR imaging is currently regarded as a pivotal technique for the assessment of a variety of musculoskeletal conditions. Diffusion-weighted MR imaging (DWI) is a relatively recent sequence that provides information on the degree of cellularity of lesions. Apparent diffusion coefficient (ADC) value provides information on the movement of water molecules outside the cells. The literature contains many studies that have evaluated the role of DWI in musculoskeletal diseases. However, to date they yielded conflicting results on the use and the diagnostic capabilities of DWI in the area of musculoskeletal diseases. However, many of them have showed that DWI is a useful technique for the evaluation of the extent of the disease in a subset of musculoskeletal cancers. In terms of tissue characterization, DWI may be an adjunct to the more conventional MR imaging techniques but should be interpreted along with the signal of the lesion as observed on conventional sequences, especially in musculoskeletal cancers. Regarding the monitoring of response to therapy in cancer or inflammatory disease, the use of ADC value may represent a more reliable additional tool but must be compared to the initial ADC value of the lesions along with the knowledge of the actual therapy.
... Skin Diseases; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory Committee Act... Musculoskeletal and Skin Diseases Special Emphasis Panel; NIAMS Small Grants in Musculoskeletal Diseases (R03... Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, 6701...
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... Skin Diseases; Notice of Closed Meetings Pursuant to section 10(d) of the Federal Advisory Committee... Musculoskeletal and Skin Diseases Special Emphasis Panel, Career Development, Research Training & Pathways to... Review Officer, Scientific Review Branch, National Institute of Arthritis, Musculoskeletal and...
Bremander, Ann; Bergman, Stefan
Musculoskeletal diseases as a group are one of the most common causes of contact in primary care and the most common causes of disability and long-term sick leave in several Western countries. Pain and dysfunction are often present without any specific findings in the musculoskeletal system, and a strictly biomedical approach is often inadequate. Body structure and function interact with personal and environmental factors, affecting the ability to perform activities and participate in society. It is important to meet these needs in primary care, and non-pharmacological principles such as physical activity and patient education with a cognitive approach are cornerstones in a multimodal management model.
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Jang, Tae-Won; Koo, Jung-Wan; Kwon, Soon-Chan; Song, Jaechul
The Industrial Accident Compensation Insurance Act (IACIA) regulates the workers' compensation insurance system and the standards for the recognition of occupational diseases (ODs). Since its establishment in 1994, the IACIA has been amended several times. Before 2008, the approval of compensation for work-related musculoskeletal diseases (WMSDs) was decided based on the recommendation of consultants of the Korea Workers' Compensation and Welfare Service (COMWEL). The IACIA was amended in 2008, and since then, the approval of compensation for occupational injuries has been decided based on the recommendation of COMWEL consultants, whereas the approval of compensation for ODs was decided based on the judgment of Committee on Occupational Diseases Judgment (CODJ) which was established in 2008. According to the 2013 amendment to the IACIA, degenerative musculoskeletal diseases among workers engaged in musculoskeletal-burdening work should be considered compensable ODs. Despite some commendable changes to the workers' compensation insurance system, other significant issues persist. To resolve these issues, related organizations including the associations of orthopedic surgery, neurosurgery, and occupational and environmental medicine; Ministry of Employment and Labor; and COMWEL need to work cooperatively.
The wide availability and recent improvement in technology coupled with portability, low cost and safety makes ultrasound the first choice imaging investigation for the evaluation of musculoskeletal diseases. Diagnostic use of ultrasound findings is greatly enhanced by knowledge of the clinical presentation. Conversely, ultrasound skills with its prerequisite anatomical knowledge make the clinical diagnosis more precise and reduce uncertainty in the choice of therapy. Therefore, it is essential for rheumatologists to acquire ultrasonography skills in order to improve patient care. Ultrasound examination provides an excellent opportunity for patient education and to explain the rationale for therapy. This review summarizes the indications for musculoskeletal ultrasound and describes its role in diagnosis, monitoring and prognosis. PMID:23024711
Cielen, Nele; Maes, Karen
Chronic obstructive pulmonary disease (COPD) is a lung disease characterized by airway obstruction and inflammation but also accompanied by several extrapulmonary consequences, such as skeletal muscle weakness and osteoporosis. Skeletal muscle weakness is of major concern, since it leads to poor functional capacity, impaired health status, increased healthcare utilization, and even mortality, independently of lung function. Osteoporosis leads to fractures and is associated with increased mortality, functional decline, loss of quality of life, and need for institutionalization. Therefore, the presence of the combination of these comorbidities will have a negative impact on daily life in patients with COPD. In this review, we will focus on these two comorbidities, their prevalence in COPD, combined risk factors, and pathogenesis. We will try to prove the clustering of these comorbidities and discuss possible preventive or therapeutic strategies. PMID:24783225
van Weeren, Paul René; Back, Willem
Musculoskeletal disorders are the most prevalent health problem in aging horses. They are not life threatening, but are painful and an important welfare issue. Chronic joint disease (osteoarthritis) and chronic laminitis are the most prevalent. Treating osteoarthritis in the elderly horse is similar to treating performance horses, but aims at providing a stable situation with optimal comfort. Immediate medical treatment of flare-ups, long-term pain management, and adaptation of exercise and living conditions are the mainstays of treatment. Laminitis in the geriatric horse is related often to pituitary pars intermedia dysfunction, which may be treated with additional pergolide.
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... Skin Diseases; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory Committee Act... Musculoskeletal and Skin Diseases, Special Emphasis Panel, Clinical Trial Pilot Grant Review. Date: May 12, 2011..., Musculoskeletal and Skin Diseases, National Institutes of Health, 6701 Democracy Boulevard, Suite 800,...
... Skin Diseases; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory Committee Act... Musculoskeletal and Skin Diseases Special Emphasis Panel, NIAMS Small Grant Program for New Investigators (R03..., National Institute of Arthritis, Musculoskeletal and Skin Diseases, NIH, 6701 Democracy Boulevard,...
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... Skin Diseases; Notice of Closed Meetings Pursuant to section 10(d) of the Federal Advisory Committee... Musculoskeletal and Skin Diseases Special Emphasis Panel; NIAMS BIRT grant review. Date: March 19-20, 2013. Time..., Musculoskeletal and Skin Diseases, National Institutes of Health, 6701 Democracy Plaza, Suite 800, Bethesda,...
... Skin Diseases; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory Committee Act... Musculoskeletal and Skin Diseases Special Emphasis Panel; Small Business Innovation Research on Rare Musculoskeletal, Rheumatic and Skin Diseases. Date: December 16, 2013. Time: 9:00 a.m. to 4:00 p.m. Agenda:...
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Susceptibility genes for various kinds of common diseases have been identified by the genome-wide association study (GWAS) and the outcome is changing the clinical medicine significantly. Musculoskeletal disease is no exception. In this paper, I review the current status and prospect of GWAS in musculoskeletal diseases in Japan by focusing on representative common musculoskeletal diseases : disc herniation, adolescent idiopathic scoliosis and ossification of the posterior longitudinal ligament of the spine.
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Sheth, Tejas; Pitchumoni, C. S.; Das, Kiron M.
Musculoskeletal manifestations are the most common extraintestinal manifestations in inflammatory bowel diseases. Some appendicular manifestations are independent of gut inflammation and are treated with standard anti-inflammatory strategies. On the other hand, axial involvement is linked to gut inflammatory activity; hence, there is a considerable amount of treatment overlap. Biological therapies have revolutionized management of inflammatory bowel diseases as well as of associated articular manifestations. Newer mechanisms driving gut associated arthropathy have surfaced in the past decade and have enhanced our interests in novel treatment targets. Introduction of biosimilar molecules is expected in the US market in the near future and will provide an opportunity for considerable cost savings on healthcare. A multidisciplinary approach involving a gastroenterologist, rheumatologist, and physical therapist is ideal for these patients. PMID:26170832
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... Skin Diseases; Amended Notice of Meeting Notice is hereby given of a change in the meeting of the National Institute of Arthritis and Musculoskeletal and Skin Diseases Special Emphasis Panel, October...
... Skin Diseases; Amended Notice of Meeting Notice is hereby given of a change in the meeting of the National Institute of Arthritis and Musculoskeletal and Skin Diseases Special Emphasis Panel, October...
... Skin Diseases; Amended Notice of Meeting Notice is hereby given of a change in the meeting of the National Institute of Arthritis and Musculoskeletal and Skin Diseases Special Emphasis Panel, November...
Background Musculoskeletal diseases are becoming increasingly important due to population aging. However, studies on the economic burden of musculoskeletal disease in Korea are scarce. Therefore, we conducted a population-based study to measure the economic burden of musculoskeletal disease in Korea using nationally representative data. Methods This study used a variety of data sources such as national health insurance statistics, the Korea Health Panel study and cause of death reports generated by the Korea National Statistical Office to estimate the economic burden of musculoskeletal disease. The total cost of musculoskeletal disease was estimated as the sum of direct medical care costs, direct non-medical care costs, and indirect costs. Direct medical care costs are composed of the costs paid by the insurer and patients, over the counter drugs costs, and other costs such as medical equipment costs. Direct non-medical costs are composed of transportation and caregiver costs. Indirect costs are the sum of the costs associated with premature death and the costs due to productivity loss. Age, sex, and disease specific costs were estimated. Results Among the musculoskeletal diseases, the highest costs are associated with other dorsopathies, followed by disc disorder and arthrosis. The direct medical and direct non-medical costs of all musculoskeletal diseases were $4.18 billion and $338 million in 2008, respectively. Among the indirect costs, those due to productivity loss were $2.28 billion and costs due to premature death were $79 million. The proportions of the total costs incurred by male and female patients were 33.8% and 66.2%, respectively, and the cost due to the female adult aged 20-64 years old was highest. The total economic cost of musculoskeletal disease was $6.89 billion, which represents 0.7% of the Korean gross domestic product. Conclusions The economic burden of musculoskeletal disease in Korea is substantial. As the Korean population continues to
... Skin Diseases; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory Committee Act... Musculoskeletal and Skin Diseases Special Emphasis Panel, P30 Rheumatic Diseases Core Center Review. Date: June 13... Skin Diseases, National Institutes of Health, 6701 Democracy Blvd., Suite 800, Bethesda, MD...
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... Skin Diseases; Notice of Meeting Pursuant to section 10(d) of the Federal Advisory Committee Act, as... and Skin Diseases Advisory Council. The meeting will be open to the public as indicated below, with... Committee: National Arthritis and Musculoskeletal and Skin Diseases Advisory Council. Date: June 15,...
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Girgis, Christian M.; Mokbel, Nancy; DiGirolamo, Douglas J.
Musculoskeletal diseases are highly prevalent with staggering annual health care costs across the globe. The combined wasting of muscle (sarcopenia) and bone (osteoporosis)— both in normal aging and pathologic states—can lead to vastly compounded risk for fracture in patients. Until now, our therapeutic approach to the prevention of such fractures has focused solely on bone, but our increasing understanding of the interconnected biology of muscle and bone has begun to shift our treatment paradigm for musculoskeletal disease. Targeting pathways that centrally regulate both bone and muscle (eg, GH/IGF-1, sex steroids, etc.) and newly emerging pathways that might facilitate communication between these 2 tissues (eg, activin/myostatin) might allow a greater therapeutic benefit and/or previously unanticipated means by which to treat these frail patients and prevent fracture. In this review, we will discuss a number of therapies currently under development that aim to treat musculoskeletal disease in precisely such a holistic fashion. PMID:24633910
Girgis, Christian M; Mokbel, Nancy; Digirolamo, Douglas J
Musculoskeletal diseases are highly prevalent with staggering annual health care costs across the globe. The combined wasting of muscle (sarcopenia) and bone (osteoporosis)-both in normal aging and pathologic states-can lead to vastly compounded risk for fracture in patients. Until now, our therapeutic approach to the prevention of such fractures has focused solely on bone, but our increasing understanding of the interconnected biology of muscle and bone has begun to shift our treatment paradigm for musculoskeletal disease. Targeting pathways that centrally regulate both bone and muscle (eg, GH/IGF-1, sex steroids, etc.) and newly emerging pathways that might facilitate communication between these 2 tissues (eg, activin/myostatin) might allow a greater therapeutic benefit and/or previously unanticipated means by which to treat these frail patients and prevent fracture. In this review, we will discuss a number of therapies currently under development that aim to treat musculoskeletal disease in precisely such a holistic fashion.
... Skin Diseases; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory Committee Act... Musculoskeletal and Skin Diseases, including consideration of personnel qualifications and performance, and the... Inflammation Branch and the Laboratory of Skin Biology. Place: National Institutes of Health, Building 31,...
... Skin Diseases; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory Committee Act... Musculoskeletal and Skin Diseases, including consideration of personnel qualifications and performance, and the... Branch and the Laboratory of Skin Biology. Place: National Institutes of Health, Building 31, 31...
Wittich, Christopher M.; Ficalora, Robert D.; Mason, Thomas G.; Beckman, Thomas J.
Patients commonly present to primary care physicians with musculoskeletal symptoms. Clinicians certified in internal medicine must be knowledgeable about the diagnosis and management of musculoskeletal diseases, yet they often receive inadequate postgraduate training on this topic. The musculoskeletal problems most frequently encountered in our busy injection practice involve, in decreasing order, the knees, trochanteric bursae, and glenohumeral joints. This article reviews the clinical presentations of these problems. It also discusses musculoskeletal injections for these problems in terms of medications, indications, injection technique, and supporting evidence from the literature. Experience with joint injection and the pharmacological principles described in this article should allow primary care physicians to become comfortable and proficient with musculoskeletal injections. PMID:19720781
Nair, Bindu; Taylor-Gjevre, Regina
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed medications for the treatment of musculoskeletal disorders. Osteoarthritis is the most common form of arthritis in humans and its prevalence rises with age. Oral NSAIDs have potential associated toxicities that must be monitored for and can limit the use of these drugs in certain populations including people of older age. Topical NSAIDs are now being recognized as an option for the treatment strategy of osteoarthritis. We review the efficacy and safety of one of the most common topical NSAIDS, topical diclofenac, for the treatment of osteoarthritis. PMID:27713334
Park, Minho; Ahn, Sung Eun; Ryu, Kyung Nam; Park, So Young; Jin, Wook
Diabetes mellitus (DM) can accompany many musculoskeletal (MSK) diseases. It is difficult to distinguish the DM-related MSK diseases based on clinical symptoms alone. Sonography is frequently used as a first imaging study for these MSK symptoms and is helpful to differentiate the various DM-related MSK diseases. This pictorial essay focuses on sonographic findings of various MSK diseases that can occur in diabetic patients. PMID:26957910
Macías-Hernández, Salvador Israel; Vázquez-Torres, Lucio; Morones-Alba, Juan Daniel; Coronado-Zarco, Roberto; de los Angeles Soria-Bastida, María; Cruz-Medina, Eva; Nava-Bringas, Tania Inés
Tai Chi is a low-impact and moderate intensity exercise that has shown positive effects in patients with musculoskeletal disorders. Recently have been developed clinical studies on the benefits of Tai Chi techniques combined with hydrotherapy. Both types of treatment include physical training of balance, mobility, strength, coordination and sensory input that could complement each other. This report aims to present the current evidence about the benefits of the combination of water based Tai Chi in musculoskeletal diseases in order to establish whether the combined intervention is better than Tai Chi or hydrotherapy alone. PMID:26171376
... rheumatoid arthritis and skin diseases. Date: November 16, 2012. Time: 9:00 a.m. to 12:00 p.m. Agenda: To... HUMAN SERVICES National Institutes of Health National Institute of Arthritis and Musculoskeletal and... unwarranted invasion of personal privacy. Name of Committee: National Institute of Arthritis...
Rashidifard, Christopher; Vercollone, Christopher; Martin, Scott; Liu, Bin; Brezinski, Mark E.
Many musculoskeletal disorders (MDs) are associated with irreversible bone and cartilage damage; this is particularly true for osteoarthritis (OA). Therefore, a clinical need exists for modalities which can detect OA and other MDs at early stages. Optical coherence tomography (OCT) is an infrared-based imaging, currently FDA approved in cardiology and ophthalmology, which has a resolution greater than 10 microns and acquisition rate of 120 frames/second. It has shown feasibility for imaging early OA, identifying changes prior to cartilage thinning both in vitro and in vivo in patients and in OA animal models. In addition, OCT has shown an ability to identify early rheumatoid arthritis (RA) and guide tendon repair, but has the potential for an even greater impact. Clinical trials in OA are currently underway, as well as in several other MDs. PMID:23424683
Fan, Audrey P.; Gold, Garry E.
Early detection of musculoskeletal disease leads to improved therapies and patient outcomes, and would benefit greatly from imaging at the cellular and molecular level. As it becomes clear that assessment of multiple tissues and functional processes are often necessary to study the complex pathogenesis of musculoskeletal disorders, the role of multi-modality molecular imaging becomes increasingly important. New positron emission tomography-magnetic resonance imaging (PET-MRI) systems offer to combine high-resolution MRI with simultaneous molecular information from PET to study the multifaceted processes involved in numerous musculoskeletal disorders. In this article, we aim to outline the potential clinical utility of hybrid PET-MRI to these non-oncologic musculoskeletal diseases. We summarize current applications of PET molecular imaging in osteoarthritis (OA), rheumatoid arthritis (RA), metabolic bone diseases and neuropathic peripheral pain. Advanced MRI approaches that reveal biochemical and functional information offer complementary assessment in soft tissues. Additionally, we discuss technical considerations for hybrid PET-MR imaging including MR attenuation correction, workflow, radiation dose, and quantification. PMID:28090451
Kertzman, Paulo; Lenza, Mario; Pedrinelli, André; Ejnisman, Benno
Shockwave treatment is an option within orthopedics. The exact mechanism through which shockwaves function for treating musculoskeletal diseases is unknown. The aim of this study was to make a qualitative analysis on the effectiveness of shockwave treatment among patients with musculoskeletal pathological conditions and pseudarthrosis. Searches were conducted in the Cochrane Library, Medline and Lilacs databases. Thirty-nine studies that reported using shockwave treatment for musculoskeletal diseases were found. Their results varied greatly, as did the types of protocol used. The studies that evaluated the effectiveness of shockwave treatment for lateral epicondylitis, shoulder tendinopathy, knee osteoarthrosis, femoral head osteonecrosis and trochanteric bursitis reported inconsistent results for most of their patients. Those that evaluated patients with calcifying tendinopathy, plantar fasciitis, Achilles tendinopathy, patellar tendinopathy and pseudarthrosis showed benefits. Shockwave treatment is a safe and non-invasive method for chronic cases in which conventional techniques have been unsatisfactory and should be used in association with other treatment methods for tendinopathy. Further quality studies are needed.
Kertzman, Paulo; Lenza, Mario; Pedrinelli, André; Ejnisman, Benno
Shockwave treatment is an option within orthopedics. The exact mechanism through which shockwaves function for treating musculoskeletal diseases is unknown. The aim of this study was to make a qualitative analysis on the effectiveness of shockwave treatment among patients with musculoskeletal pathological conditions and pseudarthrosis. Searches were conducted in the Cochrane Library, Medline and Lilacs databases. Thirty-nine studies that reported using shockwave treatment for musculoskeletal diseases were found. Their results varied greatly, as did the types of protocol used. The studies that evaluated the effectiveness of shockwave treatment for lateral epicondylitis, shoulder tendinopathy, knee osteoarthrosis, femoral head osteonecrosis and trochanteric bursitis reported inconsistent results for most of their patients. Those that evaluated patients with calcifying tendinopathy, plantar fasciitis, Achilles tendinopathy, patellar tendinopathy and pseudarthrosis showed benefits. Shockwave treatment is a safe and non-invasive method for chronic cases in which conventional techniques have been unsatisfactory and should be used in association with other treatment methods for tendinopathy. Further quality studies are needed. PMID:26229889
Chronic respiratory disease, such as chronic obstructive pulmonary disease(COPD)continues to cause a heavy health and economic burden in the world. Lower-limb muscle dysfunction is a prominent and major extrapulmonary features in individuals with moderate-to-very severe COPD and has important clinical implications, such as reduced exercise tolerance, activity of daily living(ADL), health related quality of life(HRQOL)and even survival. Osteoporosis is also an important systemic feature of COPD. Osteoprotic fracture cause many symptoms and complications, including the impairment of ventilation, and create a heavy economic burden. Comprehensive treatments(drug medication and non-drug treatment)for these impairments, such as pulmonary rehabilitation, are recommended. Pulmonary rehabilitation improves dyspnea, exercise capacity, ADL, and HRQOL, each of which is recognized predictors of mortality.
Vaishya, Raju; Agarwal, Amit Kumar; Edomwonyi, Edwin O; Vijay, Vipul
Sickle cell disease (SCD) is an inherited disorder of abnormal haemoglobin commonly encountered in the West African sub-region. It has varied osteoarticular and non-osseous complications that mimic some surgical conditions. The most common orthopaedic complications include avascular necrosis, osteomyelitis, septic arthritis, etc. A cautious and painstaking evaluation is required in handling these patients. Acute care and anaesthetic precautions are vital in ensuring an uneventful postoperative period.
Vaishya, Raju; Edomwonyi, Edwin O; Vijay, Vipul
Sickle cell disease (SCD) is an inherited disorder of abnormal haemoglobin commonly encountered in the West African sub-region. It has varied osteoarticular and non-osseous complications that mimic some surgical conditions. The most common orthopaedic complications include avascular necrosis, osteomyelitis, septic arthritis, etc. A cautious and painstaking evaluation is required in handling these patients. Acute care and anaesthetic precautions are vital in ensuring an uneventful postoperative period. PMID:26623213
Picavet, H; Hoeymans, N
Objective: To examine the health related quality of life of persons with one or more self reported musculoskeletal diseases, as measured by the short form 36 item health status survey (SF-36) and the Euroqol questionnaire (EQ-5D). Methods: A sample of Dutch inhabitants aged 25 years or more (n = 3664) participated in a questionnaire survey. Twelve lay descriptions of common musculoskeletal diseases were presented and the subjects were asked whether they had ever been told by a physician that they had any of these. Their responses were used to assess the prevalence of these conditions. Commonly used scores of SF-36 and descriptive scores from EQ-5D are presented, along with standardised differences between disease groups and the general population. Results: Subjects with musculoskeletal diseases had significantly lower scores on all SF-36 dimensions than those without musculoskeletal disease, especially for physical functioning (SF-36 score (SE), 75.2 (0.5) v 87.8 (0.5)); role limitations caused by physical problems (67.1 (0.9) v 85.8 (0.8)); and bodily pain (68.5 (0.5) v 84.1 (0.5)). The worst health related quality of life patterns were found for osteoarthritis of the hip, osteoporosis, rheumatoid arthritis, and fibromyalgia. Those with multiple musculoskeletal diseases had the poorest health related quality of life. Similar results were found for EQ-5D. Conclusions: All musculoskeletal diseases involve pain and reduced physical function. The coexistence of musculoskeletal diseases should be taken into account in research and clinical practice because of its high prevalence and its substantial impact on health related quality of life. PMID:15140781
Sudoł-Szopińska, Iwona; Jurik, Anne Grethe; Eshed, Iris; Lennart, Jans; Grainger, Andrew; Østergaard, Mikkel; Klauser, Andrea; Cotten, Anne; Wick, Marius C; Maas, Mario; Miese, Falk; Egund, Niels; Boutry, Nathalie; Rupreht, Mitja; Reijnierse, Monique; Oei, Edwin H G; Meier, Reinhard; O'Connor, Phil; Feydy, Antoine; Mascarenhas, Vasco; Plagou, Athena; Simoni, Paolo; Platzgummer, Hannes; Rennie, Winston J; Mester, Adam; Teh, James; Robinson, Philip; Guglielmi, Giuseppe; Åström, Gunnar; Schueller-Weiderkamm, Claudia
This article presents the recommendations of the European Society of Musculoskeletal Radiology Arthritis Subcommittee regarding the standards of the use of MRI in the diagnosis of musculoskeletal rheumatic diseases. The recommendations discuss (1) the role of MRI in current classification criteria of musculoskeletal rheumatic diseases (including early diagnosis of inflammation, disease follow-up, and identification of disease complications); (2) the impact of MRI on the diagnosis of axial and peripheral spondyloarthritis, rheumatoid arthritis, and juvenile spondyloarthritis; (3) MRI protocols for the axial and peripheral joints; (4) MRI interpretation and reporting for axial and peripheral joints; and finally, (5) methods for assessing MR images including quantitative, semiquantitative, and dynamic contrast-enhanced MRI studies.
Cunningham, Natoshia Raishevich; Kashikar-Zuck, Susmita
Pain is a complex phenomenon influenced by a number of biological, psychological, and social factors. The treatment of pain is most effective when using a multidisciplinary approach consisting of a careful selection of pharmacologic and non-pharmacologic interventions based upon disease factors, pain characteristics, psychological coping abilities and lifestyle factors. In this review we focus on research-based evidence for non-pharmacologic interventions including psychological interventions, physical exercise, patient education, and complementary approaches for pain management in patients with rheumatic diseases and common musculoskeletal pain conditions, such as low back pain. The vast proportion of research studies is on adults with chronically painful conditions but pediatric studies are also reviewed wherever possible to give the reader a more inclusive view of non-pharmacological approaches for pain management across the lifespan. PMID:23307578
Guevara-Pacheco, Sergio; Feicán-Alvarado, Astrid; Sanín, Luz Helena; Vintimilla-Ugalde, Jaime; Vintimilla-Moscoso, Fernando; Delgado-Pauta, Jorge; Lliguisaca-Segarra, Angelita; Dután-Erráez, Holger; Guevara-Mosquera, Daniel; Ochoa-Robles, Verónica; Cardiel, Mario H; Peláez-Ballestas, Ingris
The aim of this study was to determine the prevalence of musculoskeletal pain and rheumatic diseases in subjects over 18 years of age from the canton of Cuenca, Ecuador. Cross-sectional analytical community-based study was conducted in subjects over 18 years of age using the validated Community-Oriented Program for the Control of Rheumatic Diseases (COPCORD) questionnaire. Random sampling was used. The questionnaire was administered by standardized health workers. Subjects were visited house by house. Subjects positive for musculoskeletal (MSK) pain in the last 7 days and at some point in life were assessed by rheumatologists to confirm the diagnosis. A total of 4877 subjects participated, with an average age of 42.8 (SD 18.8) years of age; 59.7 % were women; 69.7 % lived in urban areas. 32.5 % reported MSK pain in the last 7 days and 45.7 % at some point in life. The prevalence of knee osteoarthritis was 7.4 %, hand osteoarthritis 5.3 %, low back pain 9.3 %, rheumatoid arthritis 0.8 %, fibromyalgia 2 %, gout 0.4 %, and lupus 0.06 %. Subjects from rural areas reported experiencing more MSK pain in the last 7 days and at some point in life, lower income, poorer health-care coverage, and increased physical activity involving repetitive tasks such as lifting weights or cooking with firewood. MSK pain prevalence was high. Osteoarthritis and low back pain were the most common diseases. Age, sex, physical activity, repetitive tasks, living in a rural area, and lack of health-care coverage were found to be associated with MSK pain.
Lien, Wei-Hung; Lien, Wei-Chih; Kuan, Ta-Shen; Wu, Shang-Te; Chen, Yi-Ting; Chiu, Ching-Ju
The aim of this study was to evaluate the incidence and clinical features of musculoskeletal pain (MSP) in patients with Parkinson disease (PD) compared with a control group without the disease. The retrospective cohort study used a subset of the Taiwan National Health Insurance Research Database (NHIRD) comprising information on 1 million beneficiaries randomly sampled from the entire population of Taiwan. A total of 490 patients aged 50 and above with newly diagnosed Parkinson disease were identified during a period from 2000 to 2005. Among them, 199 developed MSP after PD. The control group consisted of 1960 participants without PD over the study period randomly selected by matching PD cases according to the date of PD incidence, age, and sex. The study groups were then followed to the end of 2007. Musculoskeletal pain was the end point. The incidence rate ratios of MSP were higher in the PD group than in the control group, representing an adjusted hazard ratio of 1.31 (95% confidence interval 1.09 to 1.58). PD was associated with a significantly elevated risk of MSP in all sex and age stratifications, with the highest hazard ratio noted for middle-aged male patients with PD, followed by older male patients with PD. This study showed that the PD may significantly increase the risk of developing MSP. The risk of developing MSP seems to be greatest for middle-aged male patients with PD. Clinicians should be more alert for MSP in patients with PD, and early intervention should be considered.
.... Bloom, PhD, MBA, Scientific Review Officer, National Institute of Arthritis, Musculoskeletal and Skin..., 301-594-4953, Michael_Bloom@nih.gov . (Catalogue of Federal Domestic Assistance Program Nos....
Monaco, Edoardo; Vicaro, Vincenzo; Catarinozzi, Elena; Rossi, Marina; Prestigiacomo, Claudio
Musculo-skeletal injuries represent a significant medical problem in professional musicians for which was coined the following acronym PRMDs (that stands for Playing Related Musculoskeletal disorders). A little osteo-articular problem in the professional musicians can impact on a real decreasing performance activity. The purpose of this study is to quantify prevalence of PRMDs syntoms among the professional musicians and to verify their relative impact on quality lives. This study has investigated the orchestral staff of the principal lyric theatre of Rome to which it was distributed DASH OUTCOME and SF-36 questionnaires to identify the presence of musculoskeletal complaints for cervical brachial syndrome and the general quality of life respectively. The employment of the above methodology furnish statistically significant results, pointing out that the musicians quality life suffering from musculo-skeletal symptomatology (DASH SF > or = 15) was lower than ones without a clinical symptomatology. Subsequently these results were compared with the Italian population benchmarking values.
Kim, Chang-Gon; Mun, Su-Jeong; Kim, Ka-Na; Shin, Byung-Cheul; Kim, Nam-Kwen; Lee, Dong-Hyo; Lee, Jung-Han
Introduction Manual therapy is the non-surgical conservative management of musculoskeletal disorders using the practitioner's hands on the patient's body for diagnosing and treating disease. The aim of this study is to systematically review trial-based economic evaluations of manual therapy relative to other interventions used for the management of musculoskeletal diseases. Methods and analysis Randomised clinical trials (RCTs) on the economic evaluation of manual therapy for musculoskeletal diseases will be included in the review. The following databases will be searched from their inception: Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Econlit, Mantis, Index to Chiropractic Literature, Science Citation Index, Social Science Citation Index, Allied and Complementary Medicine Database (AMED), Cochrane Database of Systematic Reviews (CDSR), National Health Service Database of Abstracts of Reviews of Effects (NHS DARE), National Health Service Health Technology Assessment Database (NHS HTA), National Health Service Economic Evaluation Database (NHS EED), CENTRAL, five Korean medical databases (Oriental Medicine Advanced Searching Integrated System (OASIS), Research Information Service System (RISS), DBPIA, Korean Traditional Knowledge Portal (KTKP) and KoreaMed) and three Chinese databases (China National Knowledge Infrastructure (CNKI), VIP and Wanfang). The evidence for the cost-effectiveness, cost-utility and cost-benefit of manual therapy for musculoskeletal diseases will be assessed as the primary outcome. Health-related quality of life and adverse effects will be assessed as secondary outcomes. We will critically appraise the included studies using the Cochrane risk of bias tool and the Drummond checklist. Results will be summarised using Slavin's qualitative best-evidence synthesis approach. Ethics and dissemination The results of the study will be disseminated via
Billiet, Lieven; Swinnen, Thijs Willem; Westhovens, Rene; de Vlam, Kurt; Van Huffel, Sabine
One of the important aspects to be considered in rheumatic and musculoskeletal diseases is the patient’s activity capacity (or performance), defined as the ability to perform a task. Currently, it is assessed by physicians or health professionals mainly by means of a patient-reported questionnaire, sometimes combined with the therapist’s judgment on performance-based tasks. This work introduces an approach to assess the activity capacity at home in a more objective, yet interpretable way. It offers a pilot study on 28 patients suffering from axial spondyloarthritis (axSpA) to demonstrate its efficacy. Firstly, a protocol is introduced to recognize a limited set of six transition activities in the home environment using a single accelerometer. To this end, a hierarchical classifier with the rejection of non-informative activity segments has been developed drawing on both direct pattern recognition and statistical signal features. Secondly, the recognized activities should be assessed, similarly to the scoring performed by patients themselves. This is achieved through the interval coded scoring (ICS) system, a novel method to extract an interpretable scoring system from data. The activity recognition reaches an average accuracy of 93.5%; assessment is currently 64.3% accurate. These results indicate the potential of the approach; a next step should be its validation in a larger patient study. PMID:27999255
Background Chronic musculoskeletal (MS) pain is common in patients with chronic kidney disease (CKD) undergoing haemodialysis. However, epidemiological data for chronic MS pain and factors associated with chronic MS pain in patients with early- or late-stage CKD who are not undergoing dialysis are limited. Method A cross-sectional study to evaluate the prevalence of chronic MS pain and factors associated with chronic MS pain in patients with early- and late-stage CKD who were not undergoing dialysis, was conducted. In addition, the distribution of pain severity among patients with different stages of CKD was evaluated. Results Of the 456 CKD patients studied, 53.3% (n = 243/456) had chronic MS pain. Chronic MS pain was independently and significantly associated with hyperuricemia as co-morbidity, as well as with the calcium × phosphate product levels. In CKD patients with hyperuricemia, chronic MS pain showed a negative, independent significant association with diabetes mellitus as a co-morbidity (odds ratio: 0.413, p = 0.020). However, in the CKD patients without hyperuricemia as a co-morbidity, chronic MS pain showed an independent significant association with the calcium × phosphate product levels (odds ratio: 1.093, p = 0.027). Furthermore, stage-5 CKD patients seemed to experience more severe chronic MS pain than patients with other stages of CKD. Conclusion Chronic MS pain is common in CKD patients. Chronic MS pain was independently and significantly associated with hyperuricemia as co-morbidity, and with the calcium × phosphate product levels in early- and late-stage CKD patients who were not on dialysis. PMID:24400957
Granados, Ysabel; Cedeño, Ligia; Rosillo, Celenia; Berbin, Sol; Azocar, Miriam; Molina, María Elena; Lara, Onelia; Sanchez, Gloris; Peláez-Ballestas, Ingris
The aim of the study was to determine the prevalence of musculoskeletal disorders and rheumatic diseases in an urban community in Venezuela. We conducted a cross-sectional, community-based study using the COPCORD (Community Oriented Program for Control of Rheumatic Diseases) methodology in subjects older than 18 years. Positive cases were evaluated by rheumatologists. We surveyed 3,973 individuals (1,606 males and 2,367 females), with a mean age of 43.7 years (standard deviation (SD) 17.6). Mean duration of education was 8.9 years (SD 3.7), 79.2 % had a monthly income of < US$569, and 46.4 % were working. Excluding trauma, the prevalence of pain in the 7 days prior to interview was 19.9 % (95 % confidence interval (CI) 18.7-21.2 %). Mean pain intensity on a visual analog scale was 6.3 (SD 2.2), and 30.1 % (95 % CI 28.7-31.6 %) had a history of pain. Respondents reported pain in the knees, back, hands, shoulders, and ankles in the last 7 days; 4.7 % described current functional limitation, with 16.5 % reporting limitations in the past. Regarding treatment, 23.9 % received medication, 6.4 % received physical therapy, and 2.6 % received alternative treatment. The main diagnoses were osteoarthritis in 15.0 % (95 % CI 13.9-16.1 %), rheumatic regional pain syndromes in 6.3 % (95 % CI 5.5-7.1 %), back pain in 2.8 % (95 % CI 2.3-3.4 %), rheumatoid arthritis in 0.4 % (95 % CI 0.2-0.6 %), crystal arthropathy in 0.3 % (95 % CI 0.1-0.5 %), fibromyalgia in 0.2 % (95 % CI 0.1-0.4 %), and systemic lupus erythematosus in 0.07 % (95 % CI 0.01-0.2 %). The prevalence of musculoskeletal disorders was 22.4 %, and the most prevalent disease was osteoarthritis. Pain, in which a patient is receiving treatment for musculoskeletal disorders, and physical disability were associated with the presence of a rheumatic disease.
Sartorio, F; Vercelli, S; Ferriero, G; D'Angelo, F; Migliario, M; Franchignoni, M
The past two decades have witnessed a sharp rise in the incidence of work-related musculoskeletal disorders (WMSD). All occupations are involved; in dental professionals (dentists, dental hygienists and dental auxiliaries) this problem occurs in 54-93% of subjects, with higher risk in elderly subjects and women. Spine, shoulder, elbow and hand are mostly involved. Prevention of WMSD is becoming crucial and requires the identification and modification of risk factors. Individual characteristics of the worker--such as gender, age, stature, physical condition, strength, etc.--may contribute to the occurrence of these musculoskeletal disorders. Moreover, the specific occupation and work organisation may be the source of ergonomic hazards. Awkward postures, prolonged repetitive movements, intense work schedules or fast work pace represent important risk factors for WMSD. Sometimes the dentist's workstation is not suited to the specific professional characteristics and an ergonomic improvement is needed. Finally, factors connected with professional equipment (such as vibrations, or sharp and hard surfaces causing pressure points) may also contribute to generating WMSD in dental professionals.
Chiropractic care of a pediatric patient with symptoms associated with gastroesophageal reflux disease, fuss-cry-irritability with sleep disorder syndrome and irritable infant syndrome of musculoskeletal origin
Alcantara, Joel; Anderson, Renata
The mother of a 3-month old girl presented her daughter for chiropractic care with a medical diagnosis of gastroesophageal reflux disease. Her complaints included frequently interrupted sleep, excessive intestinal gas, frequent vomiting, excessive crying, difficulty breastfeeding, plagiocephaly and torticollis. Previous medical care consisted of Prilosec prescription medication. Notable improvement in the patient’s symptoms was observed within four visits and total resolution of symptoms within three months of care. This case study suggests that patients with complaints associated with both musculoskeletal and non-musculoskeletal origin may benefit from chiropractic care. PMID:19066699
Napoli, Alessandro; Sacconi, Beatrice; Battista, Giuseppe; Guglielmi, Giuseppe; Catalano, Carlo; Albisinni, Ugo
MRI-guided focused ultrasound surgery (MRgFUS) is a minimally invasive treatment guided by the most sophisticated imaging tool available in today's clinical practice. Both the imaging and therapeutic sides of the equipment are based on non-ionizing energy. This technique is a very promising option as potential treatment for several pathologies, including musculoskeletal (MSK) disorders. Apart from clinical applications, MRgFUS technology is the result of long, heavy and cumulative efforts exploring the effects of ultrasound on biological tissues and function, the generation of focused ultrasound and treatment monitoring by MRI. The aim of this article is to give an updated overview on a “new” interventional technique and on its applications for MSK and allied sciences. PMID:26607640
Casser, H-R; Schaible, H-G
Among the clinically relevant pain conditions, pain in the musculoskeletal system is most frequent. This article reports extensive epidemiological data on musculoskeletal system pain in Germany and worldwide. Since back pain is most frequent, the diagnostics and therapeutic algorithms of acute, recurring, and chronic lower back pain in Germany will be particularly addressed. The importance of the physiologic-organic, the cognitive-emotional, the behavioral, and the social level to diagnostics and treatment will be discussed. We will also focus on osteoarthritic pain and address its epidemiology, clinical importance, and significance for the health care system. This article will list some reasons why the musculoskeletal system in particular is frequently the site of chronic pain. The authors believe that these reasons are to be sought in the complex structures of the musculoskeletal system; in the particular sensitivity of the deep somatic nociceptive system for long-term sensitization processes, as well as the ensuing nervous system reactions; and in the interactions between the nervous and immune systems. The article will give some insights into the research carried out on this topic in Germany.
The role of calcium supplementation in healthy musculoskeletal ageing : An expert consensus meeting of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Foundation for Osteoporosis (IOF).
Harvey, N C; Biver, E; Kaufman, J-M; Bauer, J; Branco, J; Brandi, M L; Bruyère, O; Coxam, V; Cruz-Jentoft, A; Czerwinski, E; Dimai, H; Fardellone, P; Landi, F; Reginster, J-Y; Dawson-Hughes, B; Kanis, J A; Rizzoli, R; Cooper, C
The place of calcium supplementation, with or without concomitant vitamin D supplementation, has been much debated in terms of both efficacy and safety. There have been numerous trials and meta-analyses of supplementation for fracture reduction, and associations with risk of myocardial infarction have been suggested in recent years. In this report, the product of an expert consensus meeting of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Foundation for Osteoporosis (IOF), we review the evidence for the value of calcium supplementation, with or without vitamin D supplementation, for healthy musculoskeletal ageing. We conclude that (1) calcium and vitamin D supplementation leads to a modest reduction in fracture risk, although population-level intervention has not been shown to be an effective public health strategy; (2) supplementation with calcium alone for fracture reduction is not supported by the literature; (3) side effects of calcium supplementation include renal stones and gastrointestinal symptoms; (4) vitamin D supplementation, rather than calcium supplementation, may reduce falls risk; and (5) assertions of increased cardiovascular risk consequent to calcium supplementation are not convincingly supported by current evidence. In conclusion, we recommend, on the basis of the current evidence, that calcium supplementation, with concomitant vitamin D supplementation, is supported for patients at high risk of calcium and vitamin D insufficiency, and in those who are receiving treatment for osteoporosis.
Karimkhani, Chante; Boyers, Lindsay N.; Margolis, David J.; Naghavi, Mohsen; Hay, Roderick J.; Williams, Hywel C.; Naldi, Luigi; Coffeng, Luc E.; Weinstock, Martin A.; Dunnick, Cory A.; Pederson, Hannah; Vos, Theo; Murray, Christopher J. L.; Dellavalle, Robert P.
Importance Disease burden data helps guide research prioritization. Objective To determine the extent to which grants issued by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) reflect disease burden, measured by disability-adjusted life years (DALYs) from Global Burden of Disease (GBD) 2010 project. Design Two investigators independently assessed 15 skin conditions studied by GBD 2010 in the NIAMS database for grants issued in 2013. The 15 skin diseases were matched to their respective DALYs from GBD 2010. Setting The United States NIAMS database and GBD 2010 skin condition disability data. Main Outcome(s) and Measure(s) Relationship of NIAMS grant database topic funding with percent total GBD 2010 DALY and DALY rank for 15 skin conditions. Results During fiscal year 2013, 1,443 NIAMS grants were issued at a total value of $424 million. Of these grants, 17.7% covered skin topics. Of the total skin disease funding, 82% (91 grants) were categorized as “general cutaneous research.” Psoriasis, leprosy, and “other skin and subcutaneous diseases” (ie; immunobullous disorders, vitiligo, and hidradenitis suppurativa) were over-represented when funding was compared with disability. Conversely, cellulitis, decubitus ulcer, urticaria, acne vulgaris, viral skin diseases, fungal skin diseases, scabies, and melanoma were under-represented. Conditions for which disability and funding appeared well-matched were dermatitis, squamous and basal cell carcinoma, pruritus, bacterial skin diseases, and alopecia areata. Conclusions and Relevance Degree of representation in NIAMS is partly correlated with DALY metrics. Grant funding was well-matched with disability metrics for five of the 15 studied skin diseases, while two skin diseases were over-represented and seven were under-represented. Global burden estimates provide increasingly transparent and important information for investigating and prioritizing national research funding allocations
Yilmaz, Figen; Sahin, Fusun; Ergoz, Ernur; Deniz, Emel; Ercalik, Cem; Yucel, Serap Dalgic; Kuran, Banu
The aim of this study is to evaluate comparatively the life quality of patients with knee osteoarthritis (KO), shoulder impingement syndrome(SIS), fibromialgia(FM), or osteoporosis(OP) using SF 36 and establish the impact of these diseases on quality of life (QoL). A total of 193 patients with one of the above-mentioned different diagnoses completed SF 36 scale. The diseases were compared to each other with SF 36 subgroups scores. There were significant differences among patients with KO and SIS, SIS and FM with respect to all SF 36 subgroups scores. According to these assessments, QoL of KO and FM patients was worst than that of SIS. The QoL scores of KO patients were worse than those of FM patients considering the physical function, while QoL scores of FM patients were lower than those of KO patients with respect to their general well-being. Scores of physical function and pain in KO patients were lower than those of OP patients. In domains of social functioning, emotional role, energy, pain, and general health condition QoL of FM patients was worse than that of OP patients. Quality of life of SIS patients was less affected than the patients of the other disease groups. In spite of their young age, FM patients appear to be the group with the worst quality of life scores.
Carmona, L; Ballina, J; Gabriel, R; Laffon, A
OBJECTIVE—The objective of the EPISER study was to estimate the prevalence of rheumatoid arthritis (RA), low back pain, hand and knee osteoarthritis (OA), and fibromyalgia in the adult Spanish population, and to assess the impact of these diseases on function and quality of life, and use of health and social resources. METHODS—2998 subjects aged 20 years or above were randomly selected by stratified multistage cluster sampling from the censuses of 20 municipalities. Trained rheumatologists carried out structured visits at which subjects were asked about rheumatic symptoms and sociodemographic characteristics, completed validated instruments for measuring function (HAQ) and quality of life (SF-12), and underwent a standardised physical examination. Cases were defined by previously validated criteria. RESULTS—The estimated prevalences with 95% confidence intervals were as follows: RA lifetime cumulative: 0.5% (0.3 to 0.9); low back pain: 14.8% (12.2 to 17.4); symptomatic knee OA: 10.2% (8.5 to 11.9); hand OA: 6.2% (5.9 to 6.5); fibromyalgia: 2.4% (1.5 to 3.2). Most conditions significantly impaired function and quality of life. CONCLUSIONS—The EPISER study has internal and external validity for application of the results to the adult Spanish population. The diseases studied affect a significant proportion of the population, with various degrees of impact on disability and quality of life resulting in a significant number of physician visits, work disability, and medication use. PMID:11602475
Dogba, Maman Joyce; Rauch, Frank; Douglas, Erin; Bedos, Christophe
Achondroplasia, Duchenne muscular dystrophy, and osteogenesis imperfecta are among the most frequent rare genetic disorders affecting the musculoskeletal system in children. Rare genetic disorders are severely disabling and can have substantial impacts on families, children, and on healthcare systems. This literature review aims to classify, summarize and compare these non-medical impacts of achondroplasia, Duchenne muscular dystrophy and osteogenesis imperfecta.
Al Maini, Mustafa; Adelowo, Femi; Al Saleh, Jamal; Al Weshahi, Yousef; Burmester, Gerd-Rüdiger; Cutolo, Maurizio; Flood, Joseph; March, Lyn; McDonald-Blumer, Heather; Pile, Kevin; Pineda, Carlos; Thorne, Carter; Kvien, Tore K
Rheumatic and musculoskeletal diseases (RMDs) represent a multitude of degenerative, inflammatory and auto-immune conditions affecting millions of people worldwide. Persons with these diseases may potentially experience severe chronic pain, joint damage, increasing disability and even death. With an increasingly ageing population, the prevalence and burden of RMDs are predicted to increase, placing greater demands on the global practice of rheumatology and related healthcare budgets. Effective treatment of RMDs currently faces a number of challenges in both the developed and developing world, and individual countries may face more specific local challenges. However, limited understanding of the burden of RMDs amongst public health professionals and policy-makers means that these diseases are often not considered a public health priority. The objective of this review is to increase awareness of the RMDs and to identify opportunities to address RMD challenges on both a local and global scale. On 26 September 2014, rheumatology experts from five different continents met at the World Forum on Rheumatic and Musculoskeletal Diseases (WFRMD) to discuss and identify some key challenges for the RMDs community today. The outcomes are presented in this review, focusing on access to rheumatology services, diagnostics and therapies, rheumatology education and training and on clinical trials, as well as investigator-initiated and epidemiological research. The long-term vision of the WFRMD is to increase perception of the RMDs as a major burden to society and to explore potential opportunities to improve global and local RMD care.
Thiem, Ulrich; Trampisch, Ulrike; Trampisch, Hans-Joachim
Physical therapy modalities are regarded as an integral part of the treatment of musculoskeletal diseases like osteoarthritis of the knee or falls in the elderly. Guidelines and treatment recommendations promote such interventions. However, the evidence supporting physical therapy modalities is often weaker than that found for drug treatments. One reason is that a simple blinding of treatment assignments by means of a placebo is usually not possible. Another issue is patient preferences that have an impact on the conduct of the study and the interpretation of the results. This article highlights methodological challenges of studies investigating physical therapy modalities, and points out some possible solutions. (As supplied by publisher).
Jupille, Henri J; Oko, Lauren; Stoermer, Kristina A; Heise, Mark T; Mahalingam, Suresh; Gunn, Bronwyn M; Morrison, Thomas E
The viral determinants of alphavirus-induced rheumatic disease have not been elucidated. We identified an RRV strain (DC5692) which, in contrast to the T48 strain, does not induce musculoskeletal inflammation in a mouse model of RRV disease. Substitution of the RRV T48 strain nonstructural protein 1 (nsP1) coding sequence with that from strain DC5692 generated a virus that was attenuated in vivo despite similar viral loads in tissues. In contrast, substitution of the T48 PE2 coding region with the PE2 coding region from DC5692 resulted in attenuation in vivo and reduced viral loads in tissues. In gain of virulence experiments, substitution of the DC5692 strain nsP1 and PE2 coding regions with those from the T48 strain was sufficient to restore full virulence to the DC5692 strain. These findings indicate that determinants in both nsP1 and PE2 have critical and distinct roles in the pathogenesis of RRV-induced musculoskeletal inflammatory disease in mice.
Nessrine, Akasbi; Zahra, Abourazzak Fatima; Taoufik, Harzy
Sarcoidosis is a multisystem inflammatory disorder of unknown cause. It most commonly affects the pulmonary system but can also affect the musculoskeletal system, albeit less frequently. In patients with sarcoidosis, rheumatic involvement is polymorphic. It can be the presenting symptom of the disease or can appear during its progression. Articular involvement is dominated by nonspecific arthralgia, polyarthritis, and Löfgren's syndrome, which is defined as the presence of lung adenopathy, arthralgia (or arthritis), and erythema nodosum. Skeletal manifestations, especially dactylitis, appear mainly as complications of chronic, multiorgan sarcoidosis. Muscle involvement in sarcoidosis is rare and usually asymptomatic. The diagnosis of rheumatic sarcoidosis is based on X-ray findings and magnetic resonance imaging findings, although the definitive diagnosis is made by anatomopathological study of biopsy samples. Musculoskeletal involvement in sarcoidosis is generally relieved with nonsteroidal anti-inflammatory drugs or corticosteroids. In corticosteroid-resistant or -dependent forms of the disease, immunosuppressive therapy, such as treatment with methotrexate or anti-TNF-α, is employed. The aim of this review was to present an overview of the various types of osteoarticular and muscle involvement in sarcoidosis, focusing on their diagnosis and management. PMID:24831403
Starodubtseva, L A; Vasilieva, L V
The osteoarthritis and rheumatoid arthritis are considered as the most prevalent diseases in the structure of diseases of musculoskeletal system. The higher social significance of these nosologies dictates necessity of searching reliable cartilage biomarkers having diagnostic validity both in discerning degenerative alterations at early stage of disease of joints and in monitoring of treatment effectiveness. The content of oligomeric matrix protein of cartilage using ELISA was evaluated in blood serum ofpatients with secondary osteoarthritis under rheumatoid arthritis (n=248). The comparison of derived results was carried out using control groups. Within the framework of study relationship was evaluated between level of oligomeric matrix protein of cartilage in patients with secondary osteoarthritis under rheumatoid arthritis with values offunctional KOOS index. The analysis of derived results established trend to increasing of level of oligomeric matrix protein of cartilage in blood serum ofpatients with secondary osteoarthritis under rheumatoid arthritis as compared with control groups. The moderate correlation interdependence between cartilage biomarker and KOOS index.
Mirskaia, N B; Kolomenskaia, A N; Siniakina, A D
The urgency of the problem of the excess incidence of disorders and diseases of the musculoskeletal system (MSS) in contemporary children and adolescents is determined by its high medical and social significance. However, the poor quality of diagnosis of MSS disorders in children at the polyclinics level, especially at the initial stages, when timely commenced recreational and corrective-measures are most effective, do not allow to carry out remedial work timely, and this in turn is the cause of the high prevalence of violations of the MSS later With the aim of the improvement of the quality of diagnosis of early forms of musculoskeletal pathology in children and adolescents, as well as for the performance of the prevention during learning them in school there is developed an information system for health care workers "Identification, correction and prevention of disorders of the locomotor apparatus in students of educational institutions". The core of the system is formed by developed by authors a classification of functional disorders and initial forms of diseases of the MSS in students, as well as the organization of this work.
Peláez-Ballestas, I; Alvarez-Nemegyei, J; Loyola-Sánchez, A; Escudero, M L
This study aimed to estimate the prevalence of musculoskeletal disorders and rheumatic diseases in indigenous Maya-Yucateco communities using Community-Oriented Program for Control of Rheumatic Diseases (COPCORD) methodology. The study population comprised subjects aged ≥18 years from 11 communities in the municipality of Chankom, Yucatan. An analytical cross-sectional study was performed, and a census was used. Subjects positive for musculoskeletal (MSK) pain were examined by trained physicians. A total of 1523 community members were interviewed. The mean age was 45.2 years (standard deviation (SD) 17.9), and 917 (60.2 %) were women. Overall, 592 individuals (38.8 %; 95 % CI 36.3-41.3 %) had experienced MSK pain in the last 7 days. The pain intensity was reported as "strong" to "severe" in 43.4 %. The diagnoses were rheumatic regional pain syndromes in 165 (10.8 %; 95 % CI 9.4-12.5), low back pain in 153 (10.0 %; 95 % CI 8.5-11.6), osteoarthritis in 144 (9.4 %; 95 % CI 8.0-11.0), fibromyalgia in 35 (2.2 %; 95 % CI 1.6-3.1), rheumatoid arthritis in 17 (1.1 %; 95 % CI 0.6-1.7), undifferentiated arthritis in 8 (0.5 %; 95 % CI 0.2-0.8), and gout in 1 (0.06 %; 95 % CI 0.001-0.3). Older age, being female, disability, and physically demanding work were associated with a greater likelihood of having a rheumatic disease. In conclusion, MSK pain and rheumatic diseases were highly prevalent. The high impact of rheumatic diseases on daily activities in this indigenous population suggests the need to organize culturally-sensitive community interventions for the prevention of disabilities caused by MSK disorders and diseases.
Developing Community-Based Rehabilitation Programs for Musculoskeletal Diseases in Low-Income Areas of Mexico: The Community-Based Rehabilitation for Low-Income Communities Living With Rheumatic Diseases (CONCORD) Protocol
Background The negative impact of musculoskeletal diseases on the physical function and quality of life of people living in developing countries is considerable. This disabling effect is even more marked in low-socioeconomic communities within developing countries. In Mexico, there is a need to create community-based rehabilitation programs for people living with musculoskeletal diseases in low-socioeconomic areas. These programs should be directed to prevent and decrease disability, accommodating the specific local culture of communities. Objective The objective of this paper is to describe a research protocol designed to develop, implement, and evaluate culturally sensitive community-based rehabilitation programs aiming to decrease disability of people living with musculoskeletal diseases in two low-income Mexican communities. Methods A community-based participatory research approach is proposed, including multi and transdisciplinary efforts among the community, medical anthropology, and the health sciences. The project is structured in 4 main stages: (1) situation analysis, (2) program development, (3) program implementation, and (4) program evaluation. Each stage includes the use of quantitative and qualitative methods (mixed method program). Results So far, we obtained resources from a Mexican federal agency and completed stage one of the project at Chankom, Yucatán. We are currently receiving funding from an international agency to complete stage two at this same location. We expect that the project at Chankom will be concluded by December of 2017. On the other hand, we just started the execution of stage one at Nuevo León with funding from a Mexican federal agency. We expect to conclude the project at this site by September of 2018. Conclusions Using a community-based participatory research approach and a mixed method program could result in the creation of culturally sensitive community-based rehabilitation programs that promote community development and
Bernard, Christophe; Tourne, Mathias
Musculoskeletal disorders (MSD) are a major area of concern in the occupational world. The agricultural industry is particularly affected: 93 percent of occupational diseases in agriculture are MSD. Carpal tunnel syndrome occurs in one third of the cases. Shoulder is the second most common location. The most affected occupational areas are meat production, viticulture, market gardening, horticulture and small animal farming. This MSD phenomenon, of multifactorial origin, which has been amplifying for two decades, has led to some consensus in terms of definition and prevention strategy. The aim is to identify, limit or even suppress risk factors through worker training as well as through actions related to work organization. Regarding occupational health and safety in agriculture, two fronts of progress have been mentioned: the creation of a statistic observatory of MSD (disease, occupational area and cost) and the assessment of prevention activities. Finally, a new issue is being discussed: sustainable prevention of MSD.
The imaging approach to osteomyelitis has evolved in the past two decades. Advances in MRI allow for whole body imaging, decreasing the need for scintigraphy when symptoms are not localized or the disease may be multifocal. There is an increasing clinical need for depiction of abscesses in the soft tissues and subperiosteal space, particularly because methicillin-resistant Staphylococcus aureus infections constitute more than one-third of all the infections. The increasing emphasis on radiation dose reduction has also led away from scintigraphy and computed tomography. MR imaging has become the advanced imaging modality of choice in osteomyelitis. There is an increasing understanding of the appropriate role for gadolinium enhancement, which is not indicated when the pre-gadolinium images are normal. Other related infections, including pyomyositis, are best imaged with MRI.
Gulia, Ashish; Byregowda, Suman; Panda, Pankaj Kumar
Patients in advanced stages of illness trajectories with local and widespread musculoskeletal incurable malignancies, either treatment naive or having recurrence are referred to the palliative care clinic to relieve various disease-related symptoms and to improve the quality of life. Palliative care is a specialized medicine that offers treatment to the disease-specific symptoms, places emphasis on the psychosocial and spiritual aspects of life and help the patients and their family to cope with advance stage cancer in a stronger and reasonable way. The overall outcome of musculoskeletal malignancies has improved with the advent of multidisciplinary management. Even then these tumors do relapse and leads to organ failures and disease-specific deaths in children and young adults in productive age group thus requiring an integrated approach to improve the supportive/palliative care needs in end-stage disease. In this article, we would like to discuss the spectrum of presentation of advanced musculoskeletal malignancies, skeletal metastasis, and their management. PMID:27559251
Zanoni, Camila Tatiana; Galvão, Fábio; Cliquet Junior, Alberto; Saad, Sara Teresinha Olalla
Objective To compare the effect of aquatic and land-based physiotherapy in reducing musculoskeletal hip and lower back pain and increasing overall physical capabilities of sickle cell disease patients. Methods Informed written consent was obtained from all volunteers who were submitted to evaluations using different functional scales: Lequesne's Algofunctional Questionnaire and Oswestry Disability Index, trunk and hip range of motion, goniometry, trunk and hip muscle strength assessment using load cell, and surface electromyography of the iliocostalis, long dorsal (longissimus), gluteus maximus, gluteus medius and tensor fasciae latae muscles. Ten patients were randomized into two groups: aquatic physiotherapy with a mean age of 42 years (range: 25–67) and conventional physiotherapy with a mean age of 49 years (range: 43–59). Both groups were submitted to a twelve-week program of two sessions weekly. Results After the intervention, significant improvements were observed regarding the Lequesne index (p-value = 0.0217), Oswestry Disability Index (p-value = 0.0112), range of motion of trunk extension (p-value = 0.0320), trunk flexion muscle strength (p-value = 0.0459), hip extension and abduction muscle strength (p-value = 0.0062 and p-value = 0.0257, respectively). Range of motion of trunk and hip flexion, extension, adduction and abduction, trunk extensor muscle strength and all surface electromyography variables showed no significant statistical difference. Conclusion Physical therapy is efficient to treat musculoskeletal dysfunctions in sickle cell disease patients, irrespective of the technique; however, aquatic therapy showed a trend toward improvement in muscle strength. Further studies with a larger patient sample and longer periods of therapy are necessary to confirm these results. PMID:25818817
Jung, Kyoung-Sim; Jung, Jin-Hwa; In, Tae-Sung; Cho, Hwi-Young
[Purpose] The purpose of this study was to establish the reliability and validity of the Short Musculoskeletal Function Assessment questionnaire, which was translated into Korean, for patients with musculoskeletal disorder. [Subjects and Methods] Fifty-five subjects (26 males and 29 females) with musculoskeletal diseases participated in the study. The Short Musculoskeletal Function Assessment questionnaire focuses on a limited range of physical functions and includes a dysfunction index and a bother index. Reliability was determined using the intraclass correlation coefficient, and validity was examined by correlating short musculoskeletal function assessment scores with the 36-item Short-Form Health Survey (SF-36) score. [Results] The reliability was 0.97 for the dysfunction index and 0.94 for the bother index. Validity was established by comparison with Korean version of the SF-36. [Conclusion] This study demonstrated that the Korean version of the Short Musculoskeletal Function Assessment questionnaire is a reliable and valid instrument for the assessment of musculoskeletal disorders.
Jung, Kyoung-Sim; Jung, Jin-Hwa; In, Tae-Sung; Cho, Hwi-Young
[Purpose] The purpose of this study was to establish the reliability and validity of the Short Musculoskeletal Function Assessment questionnaire, which was translated into Korean, for patients with musculoskeletal disorder. [Subjects and Methods] Fifty-five subjects (26 males and 29 females) with musculoskeletal diseases participated in the study. The Short Musculoskeletal Function Assessment questionnaire focuses on a limited range of physical functions and includes a dysfunction index and a bother index. Reliability was determined using the intraclass correlation coefficient, and validity was examined by correlating short musculoskeletal function assessment scores with the 36-item Short-Form Health Survey (SF-36) score. [Results] The reliability was 0.97 for the dysfunction index and 0.94 for the bother index. Validity was established by comparison with Korean version of the SF-36. [Conclusion] This study demonstrated that the Korean version of the Short Musculoskeletal Function Assessment questionnaire is a reliable and valid instrument for the assessment of musculoskeletal disorders. PMID:27799696
MUSCULOSKELETAL disease accounts for a large proportion of a general practitioner's (GP's) workload. Proper management can not only improve quality of care, but also increase job satisfaction and reap rewards under the new contract. Osteoporosis creates a huge socioeconomic burden of disease and disability. Identifying high-risk groups in primary care and using preventative treatment can result in a substantial reduction in morbidity and mortality. GPs can help by presenting a unified lifestyle message, advising on fall prevention, and providing effective treatment; in particular, calcium and vitamin D for female nursing home residents. Osteoarthritis is eminently treatable in primary care with a number of management options for GPs, in addition to drug therapy. Glucosamine and chondroitin have few side effects and are worth recommending to patients with mild knee osteoarthritis. Rheumatoid arthritis can cause significant disability, which can be limited by early diagnosis, referral, and treatment. Severe refractory rheumatoid arthritis may warrant referral for consideration of biologic therapy. Assessment of the cardiovascular risk and possible use of statins in rheumatoid patients may reduce their cardiovascular mortality. GPs should aim to help patients to achieve optimum quality of life by using a holistic approach and by allowing maximum choice and control over their disease. PMID:15186570
Granados, Ysabel; Rosillo, Celenia; Cedeño, Ligia; Martínez, Yanira; Sánchez, Gloris; López, Geovalis; Pérez, Fernando; Martínez, Damarys; Maestre, Gabriela; Berbin, Sol; Chacón, Rosa; Stekman, Iván; Valls, Evart; Peláez-Ballestas, Ingris
This study aimed to estimate the prevalence of musculoskeletal disorders and rheumatic diseases in the Warao, Kari'ña, and Chaima indigenous populations of Monagas State, Venezuela. A cross-sectional, analytical, community-based study was conducted in 1537 indigenous subjects ≥18 years old (38.6 % male, mean age 41.4 ± 17.5 years). The cross-culturally validated Community Oriented Program for the Control of Rheumatic Diseases (COPCORD) diagnostic questionnaire was applied. Subjects with a positive COPCORD diagnosis (either historic or current pain) were evaluated by primary care physicians and rheumatologists. A descriptive analysis was performed and comparisons made using analysis of variance and the chi-square test. Pain in the last 7 days was reported by 32.9 %, with pain intensity, according to a Likert-type scale [no pain, 195 (38.5 %); minimal pain, 231 (45.6 %); strong pain, 68 (13.4 %); intense pain, 5 (0.9 %)], 38.0 % reported historical pain, and 641 (41.7 %) had either historic or current pain. Of the COPCORD-positive subjects, pain most frequently occurred in the knee, back, and hands. Musculoskeletal and rheumatic diseases included osteoarthritis (14.1 %), back pain (12.4 %), rheumatic regional pain syndromes (RRPS) (9.7 %), undifferentiated arthritis (1.5 %), rheumatoid arthritis (1.1 %), and fibromyalgia (0.5 %). Chaima (18.3 %) and Kari'ña (15.6 %) subjects had a high prevalence of osteoarthritis, and Warao subjects had a high prevalence of low back pain (13.8 %). The prevalence of RRPS was high in all three ethnic groups. The Chaima group had the highest prevalence of rheumatic diseases, with 2.0 % having rheumatoid arthritis. This study provides useful information for health care policy-making in indigenous communities.
Karasik, David; Cohen-Zinder, Miri
Musculoskeletal aging is detrimental to multiple bodily functions and starts early, probably in the fourth decade of an individual's life. Sarcopenia is a health problem that is expected to only increase as a greater portion of the population lives longer; prevalence of the related musculoskeletal diseases is similarly expected to increase. Unraveling the biological and biomechanical associations and molecular mechanisms underlying these diseases represents a formidable challenge. There are two major problems making disentangling the biological complexity of musculoskeletal aging difficult: (a) it is a systemic, rather than “compartmental,” problem, which should be approached accordingly, and (b) the aging per se is neither well defined nor reliably measurable. A unique challenge of studying any age-related condition is a need of distinguishing between the “norm” and “pathology,” which are interwoven throughout the aging organism. We argue that detecting genes with pleiotropic functions in musculoskeletal aging is needed to provide insights into the potential biological mechanisms underlying inter-individual differences insusceptibility to the musculoskeletal diseases. However, exploring pleiotropic relationships among the system's components is challenging both methodologically and conceptually. We aimed to focus on genetic aspects of the cross-talk between muscle and its “neighboring” tissues and organs (tendon, bone, and cartilage), and to explore the role of genetics to find the new molecular links between skeletal muscle and other parts of the “musculoskeleton.” Identification of significant genetic variants underlying the musculoskeletal system's aging is now possible more than ever due to the currently available advanced genomic technologies. In summary, a “holistic” genetic approach is needed to study the systems's normal functioning and the disease predisposition in order to improve musculoskeletal health. PMID:22934054
Hoy, Damian G; Smith, Emma; Cross, Marita; Sanchez-Riera, Lidia; Blyth, Fiona M; Buchbinder, Rachelle; Woolf, Anthony D; Driscoll, Tim; Brooks, Peter; March, Lyn M
The objective of this paper is to provide an overview of the strengths, limitations and lessons learned from estimating the burden from musculoskeletal (MSK) conditions in the Global Burden of Disease 2010 Study (GBD 2010 Study). It should be read in conjunction with the other GBD 2010 Study papers published in this journal. The strengths of the GBD 2010 Study include: the involvement of a MSK expert group; development of new and more valid case definitions, functional health states, and disability weights to better reflect the MSK conditions; the extensive series of systematic reviews undertaken to obtain data to derive the burden estimates; and the use of a new, more advanced version of the disease-modelling software (DisMod-MR). Limitations include: many regions of the world did not have data; the extent of heterogeneity between included studies; and burden does not include broader aspects of life, such as participation and well-being. A number of lessons were learned. Ongoing involvement of experts is critical to ensure the success of future efforts to quantify and monitor this burden. A paradigm shift is urgently needed among global agencies in order to alleviate the rapidly increasing global burden from MSK conditions. Prevention and control of MSK disability are required, along with health system changes. Further research is needed to improve understanding of the predictors and clinical course across different settings, and the ways in which MSK conditions can be better managed and prevented.
Tendon, ligament, and joint tissues are important in maintaining daily function. They can be affected by disease, age, and injury. Slow tissue turnover, hierarchical structure and function, and nonlinear mechanical properties present challenges to diagnosing and treating soft musculoskeletal tissues. Understanding these tissues in health, disease, and injury is important to improving pharmacologic and surgical repair outcomes. Raman spectroscopy is an important tool in the examination of soft musculoskeletal tissues. This article highlights exciting basic science and clinical/translational Raman studies of cartilage, tendon, and ligament. PMID:25286106
Life sciences research in the musculoskeletal discipline must identify possible consequences of weightlessness on this system, understand the mechanisms of these effects, and develop effective and operationally practical countermeasures to protect crewmembers. The musculoskeletal system is highly plastic in that is possesses the inherent capability to adapt its structural and functional properties in accordance with the type and degree of stimuli imposed on it. Prolonged space travel is essentially a period of significant unloading of the musculoskeletal system. This results in adaptive responses in the structure and function of this system, placing it on the low end of a continuum from one of complete disuse to one of maximal use. There is a high probability that the musculoskeletal system is functionally impaired with increasing duration of weightlessness. The purpose of this Discipline Science Plan is to provide a conceptual strategy for NASA's Life Sciences division research and development activities in the area of musculoskeletal function. This document summarizes the current status of the program, outlines available knowledge, establishes goals and objectives, identifies science priorities, and defines research opportunities, which encompass critical questions in the subdiscipline areas (e.g., muscle, bone, and other musculoskeletal connective tissues). These science activities include ground-based and flight; basic, applied, and operational; and animal and human research and development. This document contains a general plan that will be used by both NASA Headquarters Program Offices and the field centers to review and plan basic, applied, and operational intramural and extramural research and development activities in this area.
Peate, W F
Musculoskeletal disorders of the workplace include the acute, cumulative and chronic injuries or illnesses of the soft tissues which are caused by mechanical stress, strain, sprain, vibration, inflammation, or irritation. The successful management of occupational musculoskeletal disorders must account for workplace conditions (ergonomics and work practices), psychosocial factors, diagnostic uncertainties, and the need for active modalities (exercises and a progressive increase in activities of daily living), rather than passive (bed rest and traction). Although most occupational musculoskeletal disorders respond to conservative measures such as ice or heat, protective devices such as, neutral splints for carpal tunnel syndrome, nonsteroidal anti-inflammatory drugs, and progressive strengthening, resolution may take months. Prevention is often more important than treatment, and may entail workplace revisions and special worker training. Worker selection programs--strength testing, pre-placement radiographs, and inquiries about prior low back pain--have poor predictive value.
Kanazawa, Ippei; Sugimoto, Toshitsugu
Osteoporosis and sarcopenia directly affect healthy life expectancy in elderly people ; therefore, both diseases become social problem around the world. Sarcopenia increases the risk of osteoporotic fracture. Thus, not only agents affecting bone tissue directly but also treatments for sarcopenia are important for management of osteoporosis. Recently, it has been shown that there is an interaction between bone and muscle. Several hormones affect muscle and bone simultaneously. Moreover, myokines secreted from muscle are reported to regulate bone metabolism. On the other hand, several systemic and local factors derived from bone also affect muscle tissue. Therefore, further studies are necessary to develop the integrated treatments for osteoporosis toward harmony of bone and muscle.
Jakob, Franz; Ebert, Regina; Rudert, Maximilian; Nöth, Ulrich; Walles, Heike; Docheva, Denitsa; Schieker, Matthias; Meinel, Lorenz; Groll, Jürgen
In situ guided tissue regeneration, also addressed as in situ tissue engineering or endogenous regeneration, has a great potential for population-wide "minimal invasive" applications. During the last two decades, tissue engineering has been developed with remarkable in vitro and preclinical success but still the number of applications in clinical routine is extremely small. Moreover, the vision of population-wide applications of ex vivo tissue engineered constructs based on cells, growth and differentiation factors and scaffolds, must probably be deemed unrealistic for economic and regulation-related issues. Hence, the progress made in this respect will be mostly applicable to a fraction of post-traumatic or post-surgery situations such as big tissue defects due to tumor manifestation. Minimally invasive procedures would probably qualify for a broader application and ideally would only require off the shelf standardized products without cells. Such products should mimic the microenvironment of regenerating tissues and make use of the endogenous tissue regeneration capacities. Functionally, the chemotaxis of regenerative cells, their amplification as a transient amplifying pool and their concerted differentiation and remodeling should be addressed. This is especially important because the main target populations for such applications are the elderly and diseased. The quality of regenerative cells is impaired in such organisms and high levels of inhibitors also interfere with regeneration and healing. In metabolic bone diseases like osteoporosis, it is already known that antagonists for inhibitors such as activin and sclerostin enhance bone formation. Implementing such strategies into applications for in situ guided tissue regeneration should greatly enhance the efficacy of tailored procedures in the future.
Woolf, Anthony D.; Pfleger, Bruce
Musculoskeletal conditions are a major burden on individuals, health systems, and social care systems, with indirect costs being predominant. This burden has been recognized by the United Nations and WHO, by endorsing the Bone and Joint Decade 2000-2010. This paper describes the burden of four major musculoskeletal conditions: osteoarthritis, rheumatoid arthritis, osteoporosis, and low back pain. Osteoarthritis, which is characterized by loss of joint cartilage that leads to pain and loss of function primarily in the knees and hips, affects 9.6% of men and 18% of women aged > 60 years. Increases in life expectancy and ageing populations are expected to make osteoarthritis the fourth leading cause of disability by the year 2020. Joint replacement surgery, where available, provides effective relief. Rheumatoid arthritis is an inflammatory condition that usually affects multiple joints. It affects 0.3-1.0% of the general population and is more prevalent among women and in developed countries. Persistent inflammation leads to joint destruction, but the disease can be controlled with drugs. The incidence may be on the decline, but the increase in the number of older people in some regions makes it difficult to estimate future prevalence. Osteoporosis, which is characterized by low bone mass and microarchitectural deterioration, is a major risk factor for fractures of the hip, vertebrae, and distal forearm. Hip fracture is the most detrimental fracture, being associated with 20% mortality and 50% permanent loss in function. Low back pain is the most prevalent of musculoskeletal conditions; it affects nearly everyone at some point in time and about 4-33% of the population at any given point. Cultural factors greatly influence the prevalence and prognosis of low back pain. PMID:14710506
Brown, Cameron P
Nanoscience has arrived. Biological applications of nanoscience are particularly prominent and can be useful in a range of disciplines. Advances in nanoscience are underpinning breakthroughs in biomedical research and are beginning to be adopted by the rheumatology and musculoskeletal science communities. Within these fields, nanoscience can be applied to imaging, drug delivery, implant development, regenerative medicine, and the characterization of nanoscale features of cells, matrices and biomaterials. Nanoscience and nanotechnology also provide means by which the interaction of cells with their environment can be studied, thereby increasing the understanding of disease and regenerative processes. Although its potential is clear, nanoscience research tends to be highly technical, generally targeting an audience of physicists, chemists, materials scientists and engineers, and is difficult for a general audience to follow. This Review aims to step back from the most technical aspects of nanoscience and provide a widely accessible view of how it can be applied to advance the field of rheumatology, with an emphasis on technologies that can have an immediate impact on rheumatology and musculoskeletal research.
Fam, Adel G.; Smythe, Hugh A.
The musculoskeletal structures of the thoracic wall and the neck are a relatively common source of chest pain. Pain arising from these structures is often mistaken for angina pectoris, pleurisy or other serious disorders. In this article the clinical features, pathogenesis and management of the various musculoskeletal chest wall disorders are discussed. The more common causes are costochondritis, traumatic muscle pain, trauma to the chest wall, “fibrositis” syndrome, referred pain, psychogenic regional pain syndrome, and arthritis involving articulations of the sternum, ribs and thoracic spine. Careful analysis of the history, physical findings and results of investigation is essential for precise diagnosis and effective treatment. ImagesFig. 3Fig. 4Fig. 5 PMID:4027804
Carcao, Manuel; Hilliard, Pamela; Escobar, Miguel A; Solimeno, Luigi; Mahlangu, Johnny; Santagostino, Elena
Despite recent improvements in the quality of care and treatment outcomes for haemophilia, joint disease remains a major concern for patients with and without inhibitors. Most bleeding episodes occur in the musculoskeletal system, and recurrent bleeding may result in progressive joint damage, leading to haemophilic arthropathy. Consequently, early identification and management of musculoskeletal bleeding episodes are important to prevent crippling deformities and dysfunction. Management strategies should aim at optimising joint function by reducing the frequency of, and preventing, joint bleeds. Although prophylactic factor replacement is proven to be effective in reducing bleeding frequency into joints and preserving musculoskeletal function in patients without inhibitors, the role for prophylaxis (with bypassing agents) in patients with inhibitors remains unclear. The available bypassing agents, activated prothrombin complex concentrate and recombinant activated factor VII (rFVIIa), are currently the standard of care for acute bleeding episodes in patients with high-titre inhibitors. These agents also prevent bleeding during elective orthopaedic surgery (EOS) in this patient population. This review discusses published data and uses illustrative cases to describe effective strategies for assessing joint health and maintaining optimal musculoskeletal care, focusing on the use of rFVIIa for haemostatic control in haemarthroses and when EOS is required in patients with inhibitors.
Mody, Girish M; Brooks, Peter M
Musculoskeletal (MSK) disorders are among the leading reasons why patients consult a family or primary health practitioner, take time off work and become disabled. Many of the MSK disorders are more common in the elderly. Thus, as the proportion of the elderly increases all over the world, MSK disorders will make a greater contribution to the global burden of disease. Epidemiological studies have shown that the spectrum of MSK disorders in developing countries is similar to that seen in industrialised countries, but the burden of disease tends to be higher due to a delay in diagnosis or lack of access to adequate health-care facilities for effective treatment. Musculoskeletal pain is very common in the community while fibromyalgia is being recognised as part of a continuum of chronic widespread pain rather than a narrowly defined entity. This will allow research to improve our understanding of pain in a variety of diffuse pain syndromes. The availability of newer more effective therapies has resulted in efforts to initiate therapy at an earlier stage of diseases. The new criteria for rheumatoid arthritis, and the diagnosis of axial and peripheral involvement in spondyloarthritis, permit an earlier diagnosis without having to wait for radiological changes. One of the major health challenges is the global shortage of health workers, and based on current training of health workers and traditional models of care for service delivery, the global situation is unlikely to change in the near future. Thus, new models of care and strategies to train community health-care workers and primary health-care practitioners to detect and initiate the management of patients with MSK disorders at an earlier stage are required. There is also a need for prevention strategies with campaigns to educate and raise awareness among the entire population. Lifestyle interventions such as maintaining an ideal body weight to prevent obesity, regular exercises, avoidance of smoking and alcohol
Hunting, K L; Welch, L S; Cuccherini, B A; Seiger, L A
This study ascertained the presence of musculoskeletal symptoms among electricians, in order to evaluate the prevalence of cumulative trauma disorders (CTD) in this population. We adapted the CTD surveillance questionnaire used by National Institute for Occupational Safety and Health (NIOSH) to assess the prevalence of neck, shoulder, elbow, hand/wrist, back, and knee symptoms in the year prior to the survey. Questionnaires were completed by 308 apprentices and journeymen enrolled in training classes at the local union hall. The participants were relatively young individuals, and 86% of the participants were currently working as electricians. Participants reported a high prevalence of symptoms which occurred more than three times during the past year or which lasted more than 1 week. Back symptoms and hand/wrist symptoms were experienced most frequently, by about half the population, while elbow symptoms were reported by only 15% of participants. Symptom prevalence was lower, but still notable, when defined as symptoms which had occurred at least once a month or lasted more than a week in the past year. Eighty-two percent of participants reported at least one musculoskeletal symptom using the most inclusive definition, while 57% reported two or more symptoms. This survey highlights that: 1) low back discomfort is common in young construction workers, and resulted in medical care, missed work, or light duty for almost 35% of the participants; 2) neck discomfort is also very common and required doctor visits or work modification for almost one quarter of the participants; 3) these construction workers continued to work with symptoms that are classifiable as a CTD; and 4) history of injury is correlated with the subsequent prevalence of musculoskeletal symptoms.
Even in emergent situations, focused musculoskeletal sonography must not be overlooked. It has a place in traumatology no less valuable than its place in internal medicine. It can be used to identify traumatic joint effusions, occult fractures and fissures, joint inflammation, muscle and tendon rupture; it can differentiate soft tissue swelling, locate a foreign body, or identify the location of fractures. Focused ultrasound should be performed by the attending physician directly at the patient’s bedside, in order to answer these specific questions.
Jennings, Fabio; Sato, Emilia Inoue; da Rocha Castelar Pinheiro, Geraldo; Ferraz, Marcos Bosi
The disability caused by the musculoskeletal signs and symptoms affects the quality of life of a population, especially that related to health. The objective of this study is to evaluate the functional capacity of individuals of the Brazilian population who presented musculoskeletal signs and symptoms (MSK-S). The prevalence of MSK-S was evaluated in 5000 individuals (>15 years) in 16 capitals from the five regions of Brazil using the COPCORD Core Questionnaire. Those individuals (n = 2494) that experienced MSK-S and referred some level of disability at the time of the interview were invited to complete the Health Assessment Questionnaire-Disability Index (HAQ-DI). The HAQ-DI scores were compared among regions, and subgroups according to gender, age and type of activity. Three hundred ninety-four (7.9 %) participants reported disability at the time of the interview. The average score of HAQ-DI was 1.09 (SD = 0.71), and the Brazilian region with the highest level of disability was the North region. Among individuals without history of trauma, the disability was higher when the duration of MSK-S was longer. Disability was shown to worsen with increasing age, and the group with 25-34 years showed the lowest scores. Females showed worse functional capacity scores compared to males (p = 0.002). Individuals showed higher degrees of difficulty or were incapable of performing the activities walking, reaching, usual activities and dressing. MSK-S reduce the functional capacity of individuals of the Brazilian general population. The reduction in functional capacity was mainly observed in individuals with chronic musculoskeletal complaints not due to trauma, as well as in female gender and in advancing age.
Gheno, Ramon; Cepparo, Juan M.; Rosca, Cristina E.; Cotten, Anne
Musculoskeletal disorders are among the most common problems affecting the elderly. The resulting loss of mobility and physical independence can be particularly devastating in this population. The aim of this article is to present some of the most frequent musculoskeletal disorders of the elderly, such as fractures, osteoporosis, osteoarthritis, microcrystal disorders, infections, and tumors. PMID:22919553
Martinoli, Carlo; Bacigalupo, Lorenzo; Forni, Gian Luca; Balocco, Manuela; Garlaschi, Giacomo; Tagliafico, Alberto
This article provides an overview of the current use of diagnostic imaging modalities in the evaluation of a heterogeneous group of disorders causing chronic anemias by impaired blood cell production (inherited bone marrow failure syndromes of childhood, aplastic anemia and myelodysplastic syndromes, β-thalassemia) or increased blood cell destruction (sickle cell disease). During the course of these disorders, various musculoskeletal abnormalities can be encountered, including marrow hyperplasia, reversion of yellow marrow to red marrow, growth disturbances, and, occasionally, extramedullary hematopoiesis. Diagnostic imaging may help the clinician to identify specific complications related to either the disease (e.g., bone infarction and acute osteomyelitis in sickle cell disease) or transfusion (e.g., iron overload due to increased hemolysis) and iron chelation (e.g., desferrioxamine-related dysplastic bone changes and deferiprone-related degenerative arthritis) treatments. In this field, magnetic resonance imaging plays a pivotal role because of its high tissue contrast that enables early assessment of bone marrow changes before they become apparent on plain films or computed tomography or metabolic changes occur on bone scintigraphy or positron emission tomography scan. Overall, familiarity with the range of radiological appearances in chronic anemias is important to diagnose complications and establish appropriate therapy.
Garcés Iñigo, E F; Guasp Vizcaíno, M; Gómez Fernández-Montes, J
A high percentage of the pediatric imaging studies requested during calls are related to musculoskeletal disease. Since bones and joints in children are immature, constantly growing and remodeling, they have physiological and anatomical peculiarities that make it necessary to use an approach specific for pediatric patients. In this article, we use three clinical scenarios (limping, fractures, and musculoskeletal infections) to summarize and transmit the concepts that are essential in emergency musculoskeletal imaging in children.
Kelsey, Jennifer L.; Lamster, Ira B.
Both musculoskeletal disorders and diseases of the oral cavity are common and potentially serious problems among older persons, yet little attention has been given to the links between them. Several musculoskeletal diseases, including osteoporosis, Paget’s disease, and arthritic disorders, may directly involve the oral cavity and contiguous structures. Drugs used to treat musculoskeletal diseases, including corticosteroids and bisphosphonates, increase the risk of suppression of the immune system and osteonecrosis of the jaw, respectively. Many people with disabling osteoarthritis, rheumatoid arthritis, and other conditions have difficulty practicing good oral hygiene and traveling to dental offices for professional help. Various inexpensive measures can help such individuals, including education of their caregivers and provision of antimicrobial mouthwashes and special toothbrushes. PMID:18511715
Day, Charles S; Ahn, Christine S
Medical schools in the United States have continued to demonstrate deficiencies in musculoskeletal education. In response to the findings of numerous studies and to the objectives of the U.S. Bone and Joint Decade (an international collaborative movement sanctioned by the United Nations and the World Health Organization for the purpose of promoting awareness of musculoskeletal disease), several institutions, including Harvard Medical School, have reassessed the preclinical musculoskeletal curriculum at their respective medical schools. A cross-sectional survey at Harvard in 2004 found that students lacked clinical confidence in dealing with the musculoskeletal system. In addition, only one quarter of the graduating class of medical students passed a nationally validated exam in basic musculoskeletal competency. In 2005, 33 total hours of musculoskeletal medicine were added to the musculoskeletal blocks of the preclinical anatomy, pathophysiology, and physical examination courses. Alongside this movement toward more musculoskeletal education, there has been continued debate over the relevance and cost-effectiveness of cadaveric and surface anatomy labs. With the advent of advanced imaging technology, some argue that dissection anatomy is outdated and labor-intensive, whereas three-dimensional images are more accessible and time-effective for today's students. However, knowledge of anatomy is a critical foundation to learning musculoskeletal medicine. Thus, making room for more musculoskeletal curriculum time by cutting out cadaveric anatomy labs may ultimately be counterproductive.
Carter, Simon R.; Spooner, David; Sneath, Rodney S.
In 1993 we became aware of a worrying increase in apparent errors in the histopathological diagnosis of musculoskeletal tumours in our Unit. As a result all cases seen over the past 8 years were reviewed by an independent panel. Of the 1996 cases reviewed there was an error in 87. In 54 cases (2.7%) this had led to some significant change in the active management of the patient. The main areas where errors arose were in those very cases where clinical and radiological features were not helpful in confirming or refuting the diagnosis. The incidence of errors rose with the passage of time, possibly related to a deterioration in the pathologist’s health. The error rate in diagnosing bone tumours in previously published series ranges from 9 to 40%. To ensure as accurate a rate of diagnosis as possible multidisciplinary working and regular audit are essential. PMID:18521309
Scott, W.W. Magid, D. Fishman, E.K. )
This book contain 10 chapters. The chapter titles are: Soft Tissue Masses; Primary Bone Tumors; The Role of CT in the Therapeutic Management of Soft Tissue Sarcomas; Assessment of Musculoskeletal Inflammation; Assessment of Musculoskeletal Trauma; The Foot and Ankle; The Shoulder; Measurement of Bone Mineral for Early Detection of Osteoporosis; MRI of the Musculoskeletal System; and Advances in CT Imaging of Musculoskeletal Pathology.
Speerin, Robyn; Slater, Helen; Li, Linda; Moore, Karina; Chan, Madelynn; Dreinhöfer, Karsten; Ebeling, Peter R; Willcock, Simon; Briggs, Andrew M
With musculoskeletal conditions now identified as the second highest cause of the morbidity-related global burden of disease, models of care for the prevention and management of disability related to musculoskeletal conditions are an imperative. Musculoskeletal models of care aim to describe how to operationalise evidence-based guidelines for musculoskeletal conditions and thus support implementation by clinical teams and their health systems. This review of models of care for musculoskeletal pain conditions, osteoarthritis, rheumatoid arthritis, osteoporosis and musculoskeletal injuries and trauma outlines health system and local implementation strategies to improve consumer outcomes, including supporting access to multidisciplinary teams, improving access for vulnerable populations and levering digital technologies to support access and self-management. However, the challenge remains of how to inform health system decision-makers and policy about the human and fiscal benefits for broad implementation across health services. Recommendations are made for potential solutions, as well as highlighting where further evidence is required.
A musculoskeletal model of low grade connective tissue inflammation in patients with thyroid associated ophthalmopathy (TAO): the WOMED concept of lateral tension and its general implications in disease
Moncayo, Roy; Moncayo, Helga
Background Low level connective tissue inflammation has been proposed to play a role in thyroid associated ophthalmopathy (TAO). The aim of this study was to investigate this postulate by a musculoskeletal approach together with biochemical parameters. Methods 13 patients with TAO and 16 controls were examined. Erythrocyte levels of Zn, Cu, Ca2+, Mg, and Fe were determined. The musculoskeletal evaluation included observational data on body posture with emphasis on the orbit-head region. The angular foot position in the frontal plane was quantified following gait observation. The axial orientation of the legs and feet was evaluated in an unloaded supine position. Functional propioceptive tests based on stretch stimuli were done by using foot inversion and foot rotation. Results Alterations in the control group included neck tilt in 3 cases, asymmetrical foot angle during gait in 2, and a reaction to foot inversion in 5 cases. TAO patients presented facial asymmetry with displaced eye fissure inclination (mean 9.1°) as well as tilted head-on-neck position (mean 5.7°). A further asymmetry feature was external rotation of the legs and feet (mean 27°). Both foot inversion as well as foot rotation induced a condition of neuromuscular deficit. This condition could be regulated by gentle acupressure either on the lateral abdomen or the lateral ankle at the acupuncture points gall bladder 26 or bladder 62, respectively. In 5 patients, foot rotation produced a phenomenon of moving toes in the contra lateral foot. In addition foot rotation was accompanied by an audible tendon snapping. Lower erythrocyte Zn levels and altered correlations between Ca2+, Mg, and Fe were found in TAO. Conclusion This whole body observational study has revealed axial deviations and body asymmetry as well as the phenomenon of moving toes in TAO. The most common finding was an arch-like displacement of the body, i.e. eccentric position, with foot inversion and head tilt to the contra lateral side
Labusca, Luminita; Zugun-Eloae, Florin; Mashayekhi, Kaveh
Musculoskeletal-related pain is one of the most disabling health conditions affecting more than one third of the adult population worldwide. Pain from various mechanisms and origins is currently underdiagnosed and undertreated. The complexity of molecular mechanisms correlating pain and the progression of musculoskeletal diseases is not yet fully understood. Molecular biomarkers for objective evaluation and treatment follow-up are needed as a step towards targeted treatment of pain as a symptom or as a disease. Stem cell therapy is already under investigation for the treatment of different types of musculoskeletal-related pain. Mesenchymal stem cell-based therapies are already being tested in various clinical trials that use musculoskeletal system-related pain as the primary or secondary endpoint. Genetically engineered stem cells, as well as induced pluripotent stem cells, offer promising novel perspectives for pain treatment. It is possible that a more focused approach and reassessment of therapeutic goals will contribute to the overall efficacy, as well as to the clinical acceptance of regenerative medicine therapies. This article briefly describes the principal types of musculoskeletal-related pain and reviews the stem cell-based therapies that have been specifically designed for its treatment. PMID:25621109
Paolantonio, Guglielmo; Fruhwirth, Rodolfo; Alvaro, Giuseppe; Parapatt, George K; Toma', Paolo; Rollo, Massimo
Interventional radiology technique is now well established and widely used in the adult population. Through minimally invasive procedures, it increasingly replaces surgical interventions that involve higher percentages of invasiveness and, consequently, of morbidity and mortality. For these advantageous reasons, interventional radiology in recent years has spread to the paediatric age as well. The aim of this study was to review the literature on the development, use and perspectives of these procedures in the paediatric musculoskeletal field. Several topics are covered: osteomuscle neoplastic malignant and benign pathologies treated with invasive diagnostic and/or therapeutic procedures such as radiofrequency ablation in the osteoid osteoma; invasive and non-invasive procedures in vascular malformations; treatment of aneurysmal bone cysts; and role of interventional radiology in paediatric inflammatory and rheumatic inflammations. The positive results that have been generated with interventional radiology procedures in the paediatric field highly encourage both the development of new ad hoc materials, obviously adapted to young patients, as well as the improvement of such techniques, in consideration of the fact that childrens' pathologies do not always correspond to those of adults. In conclusion, as these interventional procedures have proven to be less invasive, with lower morbidity and mortality rates as well, they are becoming a viable and valid alternative to surgery in the paediatric population. PMID:26235144
Tugwell, Peter S; Wilson, Andrew J; Brooks, Peter M; Driedger, S Michelle; Gallois, Cindy; O'Connor, Annette M; Qualman, Ann; Santesso, Nancy; Wale, Janet; Wells, George A
The OMERACT 7 Effective Musculoskeletal Consumer Workshop brought together people with rheumatoid arthritis, healthcare professionals, and researchers to discuss what they thought made a musculoskeletal consumer effective at managing their disease. Preliminary work before OMERACT provided a draft list of potential characteristics of an effective consumer. Participants at the workshop provided feedback about the list including relevance, missing items, format, and language. The feedback provided was useful and will be incorporated into a revised list to aid in the development of an instrument to measure health consumer effectiveness.
Nedergaard, Anders; Henriksen, Kim; Karsdal, Morten A; Christiansen, Claus
Loss of musculoskeletal mass and function is a natural ageing trait, reinforced by an unhealthy life style. Loss of bone (osteoporosis) and muscle (sarcopaenia) are conditions whose prevalence are increasing because of the change in population distribution in the western world towards an older mean age. Improvements in lifestyle factors, such as diet, smoking and exercise, are the most powerful tools to combat this decline efficiently; however, public health interventions aimed at tackling these problems have shown abysmal success at the population level, mostly due to failure in compliance. With these issues in mind, we believe that the primary prevention modality in coming decades will be pharmacological. We review the basic biology of musculoskeletal ageing and what measures can be taken to prevent ageing-associated loss of musculoskeletal mass and function, with particular emphasis on pharmacological means.
Drakonaki, E E; Allen, G M; Wilson, D J
Ultrasound elastography (EUS) is a method to assess the mechanical properties of tissue, by applying stress and detecting tissue displacement using ultrasound. There are several EUS techniques used in clinical practice; strain (compression) EUS is the most common technique that allows real-time visualisation of the elastographic map on the screen. There is increasing evidence that EUS can be used to measure the mechanical properties of musculoskeletal tissue in clinical practice, with the future potential for early diagnosis to both guide and monitor therapy. This review describes the various EUS techniques available for clinical use, presents the published evidence on musculoskeletal applications of EUS and discusses the technical issues, limitations and future perspectives of this method in the assessment of the musculoskeletal system. PMID:23091287
Tok, F; Özçakar, L; De Muynck, M; Kara, M; Vanderstraeten, G
Each day, the role of musculoskeletal ultrasound (US) in the management of sports injuries is being consolidated. Yet, there is no doubt that the probe of US is (should be) the stethoscope of musculoskeletal physicians dealing with sports medicine. Not only for the diagnosis, but also for the close follow-up of the athletes and during likely onward interventions for their treatment, would US be of paramount importance. Accordingly, in this review paper on common sports injuries, we tried to shed light into the actual role of US in the clinical practice of sports medicine.
Prather, Heidi; Camacho-Soto, Alejandra
Several musculoskeletal diagnoses are frequently concomitant with pelvic floor pathology and pain. The definition of pelvic pain itself often depends on the medical specialist evaluating the patient. Because there is variability among disorders associated with pelvic pain, patients may seek treatment for extended periods as various treatment options are attempted. Further, health care providers should recognize that there may not be a single source of dysfunction. This article discusses the musculoskeletal disorders of the pelvic girdle (structures within the bony pelvis) and their association with lumbar spine and hip disorders.
Katzmarzyk, Peter T.; Craig, Cora L.
Quantified the relationship between musculoskeletal fitness and all-cause mortality in Canada, using measures of musculoskeletal fitness (situps, pushups, grip strength, and sit- and-reach trunk flexibility) from adult male and female participants in the Canadian Fitness Survey. Results indicated that some components of musculoskeletal fitness,…
Monseau, Aaron J; Nizran, Parminder Singh
Musculoskeletal injections are a common procedure in primary care and sports medicine but can be intimidating for some clinicians. This article addresses current evidence for corticosteroid injections, and common injection indications and techniques, namely knee, subacromial bursa, glenohumeral joint, lateral epicondyle, de Quervain tenosynovitis, and greater trochanteric bursa injections. Preparation for injections and some evidence for ultrasound guidance are also reviewed.
The sources of shockwave generation include electrohydraulic, electromagnetic and piezoelectric principles. Electrohydraulic shockwaves are high-energy acoustic waves generated under water explosion with high voltage electrode. Shockwave in urology (lithotripsy) is primarily used to disintegrate urolithiasis, whereas shockwave in orthopedics (orthotripsy) is not used to disintegrate tissues, rather to induce tissue repair and regeneration. The application of extracorporeal shockwave therapy (ESWT) in musculoskeletal disorders has been around for more than a decade and is primarily used in the treatment of sports related over-use tendinopathies such as proximal plantar fasciitis of the heel, lateral epicondylitis of the elbow, calcific or non-calcific tendonitis of the shoulder and patellar tendinopathy etc. The success rate ranged from 65% to 91%, and the complications were low and negligible. ESWT is also utilized in the treatment of non-union of long bone fracture, avascular necrosis of femoral head, chronic diabetic and non-diabetic ulcers and ischemic heart disease. The vast majority of the published papers showed positive and beneficial effects. FDA (USA) first approved ESWT for the treatment of proximal plantar fasciitis in 2000 and lateral epicondylitis in 2002. ESWT is a novel non-invasive therapeutic modality without surgery or surgical risks, and the clinical application of ESWT steadily increases over the years. This article reviews the current status of ESWT in musculoskeletal disorders. PMID:22433113
Crespo, Isabel; Bergmann, Lars; Portmann, Stefan; Lacker, Thomas; Lacker, Michael; Fleischmann, Jürgen; Kozó, Hans
Die Balanced Scorecard (BSC) ist ein Ansatz zum strategischen Management, der neben der Ausrichtung des Unternehmens auf finanzielle Zielwerte ebenso großes Gewicht auf so genannte weiche Faktoren legt, die den wirtschaftlichen Erfolg eines Unternehmens erst ermöglichen. Das entscheidende Merkmal der Balanced Scorecard ist dabei, dass sie ein ausgewogenes System strategischer Ziele herstellt, welches das Unternehmen hinsichtlich der vier Perspektiven Finanzen, Kunden, interne Prozesse und Mitarbeiter und Potenziale strategisch ausrichtet (Kaplan u. Norton 1997).
Palmer, Keith T; Goodson, Nicola
Changing demographics mean that many patients with soft tissue rheumatism, osteoarthritis, inflammatory arthritis, large joint prostheses and age-related co-morbidities are seeking to work beyond the traditional retirement age. In this chapter, we review the evidence on musculoskeletal health and work at older ages. We conclude that musculoskeletal problems are common in older workers and have a substantial impact on their work capacity. Factors that influence their job retention are described, together with approaches that may extend working life. Many gaps in evidence were found, notably on the health risks and benefits of continued work in affected patients and on which interventions work best. The roles of physicians and managers are also considered.
Although musculoskeletal ultrasound (MSUS) has emerged as an indispensible tool among physicians involved in musculoskeletal medicine in the last two decades, only recently has it become more attractive to pediatric rheumatologists. Thereafter, the use of MSUS in pediatric rheumatology has started to increase. Yet, an ever-growing body of literature shows parity and even superiority of MSUS when compared to physical examination and other imaging modalities. MSUS is suitable for examination of children of all ages and it has certain advantages over other imaging modalities; as it is cheaper, mobile, instantly accessible bedside, easy to combine with clinical assessment (interactivity) and non-invasive. It does not require sedation, which facilitates repetitive examinations. Assessment of multiple locations is possible during the same session. Agitation is rarely a problem and small children can be seated in their parents' lap or they can even play while being examined. PMID:21910870
Eponyms and colloquialisms are commonly used in orthopaedic literature and convey a great deal of information in a concise fashion. Several orthopaedic conditions have characteristic clinical or radiologic appearances, mimicking the appearance of certain arms or weapons. Most of these are easy to memorise and recognise, provided the orthopaedic surgeon is aware of the colloquialism and familiar with the appearance of the weapon on which it is based. Unfortunately, many such colloquialisms are based on traditional weapons no longer in current use, and their appearances are not familiar to most orthopaedists, creating confusion and difficulty in understanding them. In this paper, we have reviewed the musculoskeletal colloquialisms based on weapons, including a brief description of the weapon with illustrations, highlighting the importance of the colloquialism in diagnosis or treatment of musculoskeletal conditions.
Palmer, Keith; Goodson, Nicola
Changing demographics mean that many patients with soft tissue rheumatism, osteoarthritis, inflammatory arthritis, large joint prostheses, and age-related co-morbidities are seeking to work beyond the traditional retirement age. In this chapter we review the evidence on musculoskeletal health and work at older ages. We conclude that musculoskeletal problems are common in older workers and have a substantial impact on their work capacity. Factors that influence their job retention are described, together with approaches that may extend working life. Many gaps in evidence were found, notably on the health risks and benefits of continued work in affected patients and on which interventions work best. The roles of physicians and managers are also considered. PMID:26612237
Ohrndorf, Sarah; Backhaus, Marina
Musculoskeletal ultrasound has become a widely used imaging diagnostic tool both in the use of daily clinical practice and for clinical studies in monitoring treatment efficiency and predicting disease outcome. By US, detection of inflammatory soft tissue and erosive bone lesions is possible. Grey-scale and power Doppler ultrasound examination is more sensitive and more reliable than clinical examination. Furthermore, patients with unclear arthritic symptoms can be better diagnosed for arthritis by US than by clinical examination. This article gives an overview about the use of US in the diagnosis of early arthritis, especially early rheumatoid arthritis, its role as a prognostic assessor (structural damage), as a monitor for treatment response, as an detector of "real" remission, and a guide to injection procedure.
Carta, A; Parmigiani, F; Parrinello, G; Porru, S
Only few studies focused on musculoskeletal disorders (MSD) among physiotherapists (PT). The study population consisted of 50 PT and 50 clerical workers belonging to the same three rehabilitation hospitals in Northern Italy. The participants filled in a specifically designed questionnaire focused on risk factors, symptoms and diseases related to MSD. Data were self reported. Preliminary data show a significantly higher prevalence of low back symptoms (70%) and upper limb symptoms (36%) in PT than controls (16% and 4% respectively). PT had a higher prevalence of lumbar disk degeneration (20%), shoulder disorders (14%), wrist and hand tendinopathy (10%) than clerical workers (4% and 2% respectively). Both PT and clerical workers attributed their cervical symptoms to work (85% and 95% respectively). Only PT believed that low back and upper limb symptoms were work related (83% and 94% respectively). Our survey supported the findings that PT have e high prevalence of MSD. Specific preventive intervention should be applied to reduce risk of work related MSD.
Leino, P; Hasan, J; Karppi, S L
In 1973, 502 employees in three metal industry plants, stratified by age, sex, and occupational class, were examined for physical workload by interview and observation at the workplace and for musculoskeletal disorders by questionnaire, interview, and clinical examination. Five years later, 88% of the sample were re-examined for their musculoskeletal status. The work of the blue collar groups was heavier as measured by indices of physical work load based on the observation and interview (physical strain, physical load, static phases, and stereotypy). Rheumatic symptoms, clinical findings in the musculoskeletal system, and chronic musculoskeletal diseases were more frequent in both female and male blue collar workers than in the respective white collar groups on the first occasion and the increase in morbidity during follow up was higher in the blue collar groups. At an individual level within the blue collar class, however, associations between indices of physical workload and musculoskeletal morbidity were weak or non-existent. The associations were weakened by selective movement of people with musculoskeletal disorders from heavy jobs to premature retirement or to lighter jobs. Physical strain and physical load were negatively associated with the incidence of long term musculoskeletal disorders in the female blue collar group. PMID:3196661
Cook, Cristi R
Musculoskeletal ultrasound is a rapidly growing field within veterinary medicine. Ultrasound for musculoskeletal disorders has been commonly used in equine and human medicine and is becoming more commonly performed in small animal patients due to the increase in the recognition of soft tissue injuries. Ultrasound is widely available, cost-effective, but technically difficult to learn. Advantages of musculoskeletal ultrasound are the opposite limb is commonly used for comparison to evaluate symmetry of the tendinous structures and the ease of repeat examinations to assess healing. The article discusses the major areas of shoulder, stifle, iliopsoas, gastrocnemius, and musculoskeletal basics.
Prevalence of rheumatic and musculoskeletal diseases and their impact on health-related quality of life, physical function and mental health in Portugal: results from EpiReumaPt– a national health survey
Branco, Jaime C; Rodrigues, Ana M; Gouveia, Nélia; Eusébio, Mónica; Ramiro, Sofia; Machado, Pedro M; da Costa, Leonor Pereira; Mourão, Ana Filipa; Silva, Inês; Laires, Pedro; Sepriano, Alexandre; Araújo, Filipe; Gonçalves, Sónia; Coelho, Pedro S; Tavares, Viviana; Cerol, Jorge; Mendes, Jorge M; Carmona, Loreto
Objectives To estimate the national prevalence of rheumatic and musculoskeletal diseases (RMDs) in the adult Portuguese population and to determine their impact on health-related quality of life (HRQoL), physical function, anxiety and depression. Methods EpiReumaPt is a national health survey with a three-stage approach. First, 10 661 adult participants were randomly selected. Trained interviewers undertook structured face-to-face questionnaires that included screening for RMDs and assessments of health-related quality of life, physical function, anxiety and depression. Second, positive screenings for ≥1 RMD plus 20% negative screenings were invited to be evaluated by a rheumatologist. Finally, three rheumatologists revised all the information and confirmed the diagnoses according to validated criteria. Estimates were computed as weighted proportions, taking the sampling design into account. Results The disease-specific prevalence rates (and 95% CIs) of RMDs in the adult Portuguese population were: low back pain, 26.4% (23.3% to 29.5%); periarticular disease, 15.8% (13.5% to 18.0%); knee osteoarthritis (OA), 12.4% (11.0% to 13.8%); osteoporosis, 10.2% (9.0% to 11.3%); hand OA, 8.7% (7.5% to 9.9%); hip OA, 2.9% (2.3% to 3.6%); fibromyalgia, 1.7% (1.1% to 2.1%); spondyloarthritis, 1.6% (1.2% to 2.1%); gout, 1.3% (1.0% to 1.6%); rheumatoid arthritis, 0.7% (0.5% to 0.9%); systemic lupus erythaematosus, 0.1% (0.1% to 0.2%) and polymyalgia rheumatica, 0.1% (0.0% to 0.2%). After multivariable adjustment, participants with RMDs had significantly lower EQ5D scores (β=−0.09; p<0.001) and higher HAQ scores (β=0.13; p<0.001) than participants without RMDs. RMDs were also significantly associated with the presence of anxiety symptoms (OR=3.5; p=0.006). Conclusions RMDs are highly prevalent in Portugal and are associated not only with significant physical function and mental health impairment but also with poor HRQoL, leading to more health resource consumption. The Epi
Flodmark, B T; Aase, G
OBJECTIVE--Type A behaviour pattern, characterised by excessive competitiveness, impatience, hostility and time urgency, has been previously investigated as a risk factor for coronary heart disease. There are few studies concerning musculoskeletal symptoms and type A behaviour. Could there be a higher frequency of musculoskeletal symptoms with a more pronounced type A behaviour? DESIGN--A cross sectional retrospective study. Standardised nordic questionnaires were used for the analysis of musculoskeletal symptoms and the Bortner questionnaire and its subscales (1) speed and (2) hard driving and competitiveness were used to assess type A behaviour. SETTING--Factory based (a manufacturing industry where they make ventilating shafts). SUBJECTS--58 blue collar workers (51 men and seven women). Mean age was 36.9 years. Mean employment time was seven years. MAIN OUTCOME MEASURE--Blue collar workers with musculoskeletal symptoms had a more pronounced type A behaviour than those without symptoms. RESULTS--For shoulder symptoms during the past 12 months blue collar workers had a more pronounced type A behaviour (p < 0.001). For symptoms during the past seven days the results were significant for the neck (p < 0.01), the shoulder (p < 0.01), and also for lower back pain (p < 0.05). There were no differences in age, psychosocial factors, or psychosomatic symptoms. According to the Bortner subscales, the speed subscale seems to be more important than the hard driving and competitiveness subscales. CONCLUSIONS--Blue collar workers with a more pronounced type A behaviour seem to have a higher incidence of musculoskeletal symptoms. PMID:1419855
This book is a German translation, by V. Delavre, from the English original "The origin of the Universe and the origin of religion", published in 1993. Contents: E. Sens: Die unterbrochene Musikstunde. Einleitung zur deutschen Ausgabe. C. Ryskamp: Einführung. R. N. Anshen: Vorwort. F. Hoyle: Kosmische Katastrophen und der Ursprung der Religion - Die Folgen der Respektabilität; Eiszeiten und Kometen; Die allgemeine Situation in den Nacheiszeiten; Kometen und der Ursprung der Religionen; Der Übergang zu Mittelalter und Neuzeit. Diskussionsbeiträge: Ruth Nanda Anshen, Freeman Dyson, Paul Oscar Kristeller, John Archibald Wheeler, James Schwartz, Roger Shinn, Milton Gatch, Philip Solomon, Norman Newell. F. Hoyle: Schlußwort. A. Tollmann: Nachwort zur deutschen Ausgabe.
Wintermeyer, Elke; Ihle, Christoph; Ehnert, Sabrina; Stöckle, Ulrich; Ochs, Gunnar; de Zwart, Peter; Flesch, Ingo; Bahrs, Christian; Nussler, Andreas K.
Vitamin D is well known to exert multiple functions in bone biology, autoimmune diseases, cell growth, inflammation or neuromuscular and other immune functions. It is a fat-soluble vitamin present in many foods. It can be endogenously produced by ultraviolet rays from sunlight when the skin is exposed to initiate vitamin D synthesis. However, since vitamin D is biologically inert when obtained from sun exposure or diet, it must first be activated in human beings before functioning. The kidney and the liver play here a crucial role by hydroxylation of vitamin D to 25-hydroxyvitamin D in the liver and to 1,25-dihydroxyvitamin D in the kidney. In the past decades, it has been proven that vitamin D deficiency is involved in many diseases. Due to vitamin D’s central role in the musculoskeletal system and consequently the strong negative impact on bone health in cases of vitamin D deficiency, our aim was to underline its importance in bone physiology by summarizing recent findings on the correlation of vitamin D status and rickets, osteomalacia, osteopenia, primary and secondary osteoporosis as well as sarcopenia and musculoskeletal pain. While these diseases all positively correlate with a vitamin D deficiency, there is a great controversy regarding the appropriate vitamin D supplementation as both positive and negative effects on bone mineral density, musculoskeletal pain and incidence of falls are reported. PMID:27258303
Biasi, G; Di Sabatino, V; Ghizzani, A; Galeazzi, M
Chronic pelvic pain (CPP) is a common condition that has a major impact on the quality of life of both men and women. Male CPP is usually attributable to well-defined urogenital conditions (most frequently infectious/non infectious prostatic diseases) or musculoskeletal or bowel diseases, whereas the features of female CPP are much more complex and are of particular clinical and epidemiological importance. It is a multifactorial syndrome that can be due to diseases of the urogenital, gastrointestinal, or musculoskeletal systems, or to neurological or neuropsychiatric disorders. It is not always easy to identify its predominant pathogenesis, although it often occurs as a central sensitization syndrome triggered by an initial stimulus which is no longer detectable and only manifests itself clinically through pain. In this respect, there are some very interesting relationships between vulvodynia and fibromyalgic syndrome, as identified in a preliminary study of women with chronic musculoskeletal pain in which it was demonstrated that vulvar pain plays an important role, although it is often overlooked and undiagnosed.
Wintermeyer, Elke; Ihle, Christoph; Ehnert, Sabrina; Stöckle, Ulrich; Ochs, Gunnar; de Zwart, Peter; Flesch, Ingo; Bahrs, Christian; Nussler, Andreas K
Vitamin D is well known to exert multiple functions in bone biology, autoimmune diseases, cell growth, inflammation or neuromuscular and other immune functions. It is a fat-soluble vitamin present in many foods. It can be endogenously produced by ultraviolet rays from sunlight when the skin is exposed to initiate vitamin D synthesis. However, since vitamin D is biologically inert when obtained from sun exposure or diet, it must first be activated in human beings before functioning. The kidney and the liver play here a crucial role by hydroxylation of vitamin D to 25-hydroxyvitamin D in the liver and to 1,25-dihydroxyvitamin D in the kidney. In the past decades, it has been proven that vitamin D deficiency is involved in many diseases. Due to vitamin D's central role in the musculoskeletal system and consequently the strong negative impact on bone health in cases of vitamin D deficiency, our aim was to underline its importance in bone physiology by summarizing recent findings on the correlation of vitamin D status and rickets, osteomalacia, osteopenia, primary and secondary osteoporosis as well as sarcopenia and musculoskeletal pain. While these diseases all positively correlate with a vitamin D deficiency, there is a great controversy regarding the appropriate vitamin D supplementation as both positive and negative effects on bone mineral density, musculoskeletal pain and incidence of falls are reported.
Park, Byung-Chan; Kim, Eun-A; Kim, Soo Geun
Objectives This study was conducted to develop a model describing the interaction between lifestyle, job, and postural factors and parts of the upper extremities in shipyard workers. Methods A questionnaire survey was given to 2,140 workers at a shipyard in Ulsan City. The questionnaire consisted of questions regarding the subjects' general characteristics, lifestyle, tenure, physical burden, job control, posture and musculoskeletal symptoms. The overall relationship between variables was analyzed by a structural equation model (SEM). Results The positive rate of upper extremity musculoskeletal symptoms increased in employees who worked longer hours, had severe physical burden, and did not have any control over their job. Work with a more frequent unstable posture and for longer hours was also associated with an increased positive rate of musculoskeletal symptoms. Multiple logistic regression analysis showed that unstable posture and physical burden were closely related to the positive rate of musculoskeletal symptoms after controlling for age, smoking, drinking, exercise, tenure, and job control. In SEM analysis, work-related musculoskeletal disease was influenced directly and indirectly by physical and job stress factors, lifestyle, age, and tenure (p < 0.05). The strongest correlations were found between physical factors and work-related musculoskeletal disease. Conclusion The model in this study provides a better approximation of the complexity of the actual relationship between risk factors and work-related musculoskeletal disorders. Among the variables evaluated in this study, physical factors (work posture) had the strongest association with musculoskeletal disorders. PMID:22953172
Most tissues in the body are made up of more than one cell type. For successful tissue regeneration, it is essential to simulate the natural conditions of the cellular environment as much as possible. In a coculture system, two or more cell types are brought together, interact, and communicate in the same culture environment. The coculture system provides a powerful in vitro tool in research on cell-to-cell communications, repair, and regeneration. This review provides an overview on recent studies on general platforms and applications of coculture systems to enhance musculoskeletal regeneration, with a particular focus on osteogenesis, chondrogensis, and angiogenesis.
Baek, Ji Hye; Kim, Young Sun; Yi, Kwan Hyung
Background To investigate the relationship between musculoskeletal disorders and comorbid health problems, including depression/anxiety disorder, insomnia/sleep disorder, fatigue, and injury by accident, and to determine whether certain physical and psychological factors reduce comorbid health problems. Methods In total, 29,711 employees were selected from respondents of the Third Korean Working Conditions Survey and categorized into two groups: Musculoskeletal Complaints or Musculoskeletal Sickness Absence. Four self-reported health indicators (overall fatigue, depression/anxiety, insomnia/sleep disorder, and injury by accident) were selected as outcomes, based on their high prevalence in Korea. We used multiple logistic regression analysis to determine the relationship between comorbid health problems, musculoskeletal complaints, and sickness absence. Results The prevalence of musculoskeletal complaints and musculoskeletal sickness absence due to muscular pain was 32.26% and 0.59%, respectively. Compared to the reference group, depression/anxiety disorder and overall fatigue were 5.2–6.1 times more prevalent in the Musculoskeletal Complaints Group and insomnia/sleep disorder and injury by accident were 7.6–11.0 times more prevalent in the Sickness Absence Group. When adjusted for individual and work-related physical factors, prevalence of all four comorbid health problems were slightly decreased in both groups. Conclusion Increases in overall fatigue and depression/anxiety disorder were observed in the Musculoskeletal Complaints Group, while increases in insomnia/sleep disorder and injury by accident were observed in the Sickness Absence Group. For management of musculoskeletal complaints and sickness absence in the workplace, differences in health problems between employees with musculoskeletal complaints and those with sickness absence as well as the physical and psychological risk factors should be considered. PMID:26106512
Naddumba, E K
Approximately 2000 lives are lost in Uganda annually through road traffic accidents. In Kampala, they account for 39% of all injuries, primarily in males aged 16-44 years. They are a result of rapid motorization and urbanization in a country with a poor economy. Uganda's population is an estimated 28 million with a growth rate of 3.4% per year. Motorcycles and omnibuses, the main taxi vehicles, are the primary contributors to the accidents. Poor roads and drivers compound the situation. Twenty-three orthopaedic surgeons (one for every 1,300,000 people) provide specialist services that are available only at three regional hospitals and the National Referral Hospital in Kampala. The majority of musculoskeletal injuries are managed nonoperatively by 200 orthopaedic officers distributed at the district, regional and national referral hospitals. Because of the poor economy, 9% of the national budget is allocated to the health sector. Patients with musculoskeletal injuries in Uganda frequently fail to receive immediate care due to inadequate resources and most are treated by traditional bonesetters. Neglected injuries typically result in poor outcomes. Possible solutions include a public health approach for prevention of road traffic injuries, training of adequate human resources, and infrastructure development.
Die zielgerichtete Entwicklung der Fahrzeugakustik stellt eine hochkomplexe, integrative Aufgabenstellung im Rahmen der Fahrkomfortgestaltung des Automobils dar. Die Wahrnehmung der Komforteigenschaften eines Fahrzeugs erfolgt grundsätzlich als Wahrnehmung der Wirkung dieser Eigenschaften über einen oder mehrere Wahrnehmungskanäle des Menschen: visuell, auditiv, haptisch, olfaktorisch. Die individuelle Wahrnehmung ist hierbei subjektiv und daher mit rein physikalisch objektiven Messgrößen allein nur unvollständig zu beschreiben. Sie hängt einerseits von den Eigenschaften des betrachteten Fahrzeugs oder einer erlebten Situation ab und andererseits außerdem von der Sozialisation des Bewertenden und der Umgebung, in der die Bewertung stattfindet (Wikipedia). Der Fahrkomfort, den ein Fahrzeug Fahrer und Beifahrern bietet, wird also wegen unterschiedlicher Erwartungen des Kunden in den verschiedenen Weltmärkten sehr unterschiedlich erlebt.
James, Rebecca A; Singh-Grewal, Davinder; Lee, Senq-J; McGill, Jim; Adib, Navid
The lysosomal storage disorders are a collection of progressive, multisystem disorders that frequently present in childhood. Their timely diagnosis is paramount as they are becoming increasingly treatable. Musculoskeletal manifestations often occur early in the disease course, hence are useful as diagnostics clues. Non-inflammatory joint stiffness or pain, carpal tunnel syndrome, trigger fingers, unexplained pain crises and short stature should all prompt consideration of a lysosomal storage disorder. Recurrent ENT infections, hepatosplenomegaly, recurrent hernias and visual/hearing impairment - especially when clustered together - are important extra-skeletal features. As diagnostic and therapeutic options continue to evolve, children with lysosomal storage disorders and their families are facing more sophisticated options for screening and treatment. The aim of this article is to highlight the paediatric presentations of lysosomal storage disorders, with an emphasis on the musculoskeletal features.
Wir haben in (4.44) den II. Hauptsatz als empirische Tatsache folgendermaßen formuliert: (i) Wärmeenergie geht von selbst nur von einem wärmeren Körper auf einen kälteren über, niemals in der umgekehrten Richtung. Nun werden wir beweisen, dass sich aus diesem Prinzip folgende äquivalente Formulierungen für den II. Hauptsatz ableiten lassen: (ii) Es ist unmöglich, ein Perpetuum mobile zweiter Art zu bauen, d. h. eine Maschine, die fortlaufend Wärmeenergie vollständig in mechanische Arbeit umsetzen kann. Eine Wärmekraftmaschine, die einen Kreisprozess mit der höchsten Temperatur Tw und der niedrigsten Temperatur Tk durchläuft, hat höchstens den Carnotschen Wirkungsgrad c = (Tw - Tk)/Tw. Wenn in der Maschine nur reversible Prozesse ablaufen, die gesamte Wärmezufuhr bei der Temperatur Tw erfolgt und ausschließlich bei der Temperatur Tw gekühlt wird, ist ihr Wirkungsgrad = C. Es gibt keine Wärmekraftmaschine, die eine bessere Ausnutzung der Wärmeenergie ermöglicht. (iv) In jedem thermodynamischen System existiert die Zustandsgröße Entropie, definiert durch ihr Differential dS = (dQrev)/T . Entropie kann erzeugt, aber nicht vernichtet werden. Bei Zustandsänderungen, die in einem abgeschlossenen System ablaufen, nimmt die Entropie entweder zu (irreversible Prozesse), oder sie bleibt konstant (reversible Prozesse). Im Anschluss an (iii) werden wir zur Definition der thermodynamischen Temperatur und bei der Diskussion von (iv) zu einem tieferen Verständnis der Entropie gelangen. Es zeigt sich, dass die Entropie das eigentliche Bindeglied zwischen Mechanik und Wärmelehre darstellt. Am Ende des Kapitels werden wir einige Anwendungen des II. Hauptsatzes betrachten.
Bryant, D. D.; Greenfield, R.; Martin, E.
Between July 1987 and December 1990 in Washington, DC, 116 patients sustained 146 fractures and seven dislocations due to an assault with a baseball bat. The ulna was the most common site of trauma (61 fractures), followed by the hand (27 injuries) and the radius (14 injuries). Forty-two of the 146 fractures were significantly displaced and required open reduction and internal fixation to restore satisfactory alignment. Twenty-nine of the 146 fractures were open fractures. Treatment protocol for open fractures consisted of irrigation and debridement, antibiotic therapy, and bone stabilization with either internal or external fixation, or casting. Recognition of the severity of the soft tissue and bone damage is important in the management of musculoskeletal trauma secondary to the baseball bat. Images Figure 1 Figure 2 Figure 3 PMID:1460683
Generaal, Ellen; Vogelzangs, Nicole; Macfarlane, Gary J; Geenen, Rinie; Smit, Johannes H; Dekker, Joost; Penninx, Brenda W J H
Dysregulation of the immune system may play a role in chronic pain, although study findings are inconsistent. This cross-sectional study examined whether basal inflammatory markers and the innate immune response are associated with the presence and severity of chronic multisite musculoskeletal pain. Data were used on 1632 subjects of the Netherlands Study of Depression and Anxiety. The Chronic Pain Grade questionnaire was used to determine the presence and severity of chronic multisite musculoskeletal pain. Subjects were categorized in a chronic multisite musculoskeletal pain group (n=754) and a control group (n=878). Blood levels of the basal inflammatory markers C-reactive protein, interleukin-6, and tumor necrosis factor-alpha were determined. To obtain a measure of the innate immune response, 13 inflammatory markers were assessed after lipopolysaccharide (LPS) stimulation in a subsample (n=707). Subjects with chronic multisite musculoskeletal pain showed elevated levels of basal inflammatory markers compared with controls, but statistical significance was lost after adjustment for lifestyle and disease variables. For some LPS-stimulated inflammatory markers, we did find elevated levels in subjects with chronic multisite musculoskeletal pain both before and after adjustment for covariates. Pain severity was not associated with inflammation within chronic pain subjects. An enhanced innate immune response in chronic multisite musculoskeletal pain may be examined as a potential biomarker for the onset or perpetuation of chronic pain.
Der vorliegende Beitrag gibt anhand der Statistiken des Bundesministeriums für Gesundheit (BMG) einen Überblick über die Arbeitsunfähigkeitsdaten der Gesetzlichen Krankenkassen (GKV). Zunächst werden die Arbeitsunfähigkeitsstatistiken der Krankenkassen und die Erfassung der Arbeitsunfähigkeit erläutert. Hiernach wird auf die Entwicklung der Fehlzeiten auf GKV-Ebene eingegangen. Ebenfalls wird Bezug auf die Unterschiede der Fehlzeiten zwischen den verschiedenen Kassen genommen.
Daftary, Aditya Ravindra; Karnik, Alpana Sudhir
Ultrasonography (USG) is a safe, easily available, and cost-effective modality, which has the additional advantage of being real time for imaging and image-guided interventions of the musculoskeletal system. Musculoskeletal interventions are gaining popularity in sports and rehabilitation for rapid healing of muscle and tendon injuries in professional athletes, healing of chronic tendinopathies, aspiration of joint effusions, periarticular bursae and ganglia, and perineural injections in acute and chronic pain syndromes. This article aims to provide an overview of the spectrum of musculoskeletal interventions that can be done under USG guidance both for diagnostic and therapeutic purposes. PMID:26288519
Jacobs, Craig L; Hincapié, Cesar A; Cassidy, J David
The objective of this study was to assemble and synthesize the best available literature from 2004 to 2008 on musculoskeletal injury and pain in dancers. MEDLINE and CINAHL were the primary sources of data. Indexed terms such as dance, dancer, dancing, athletic injuries, occupational injuries, sprains and strains, musculoskeletal diseases, bone density, menstruation disturbances, and eating disorders were used to search the databases. Citations were screened for relevance using a priori criteria, and relevant studies were critically reviewed for scientific merit by the best-evidence synthesis method. After screening, 19 articles were found to be scientifically admissible. Data from accepted studies were abstracted into evidence tables relating to: prevalence and associated factors; incidence and risk factors; intervention; and injury characteristics and prognosis of musculoskeletal injury and pain in dancers. Principal findings included: a high prevalence and incidence of lower extremity, hip and back injuries; preliminary evidence that psychosocial and psychological issues such as stress and coping strategies affect injury frequency and duration; history of a previous lateral ankle sprain is associated with an increased risk of ankle sprain in the contralateral ankle in dance students; fatigue may play a role in ACL injury in dancers; acute hamstring strains in dancers affect tendon more than muscle tissue, often resulting in prolonged absence from dance. It is concluded that, while there are positive developments in the literature on the epidemiology, diagnosis, prognosis, treatment, and prevention of MSK injuries and pain in dancers, much room for improvement remains. Suggestions for future research are offered.
Chao, Edmund Y S
The ability to combine physiology and engineering analyses with computer sciences has opened the door to the possibility of creating the 'Virtual Human' reality. This paper presents a broad foundation for a full-featured biomechanical simulator for the human musculoskeletal system physiology. This simulation technology unites the expertise in biomechanical analysis and graphic modeling to investigate joint and connective tissue mechanics at the structural level and to visualize the results in both static and animated forms together with the model. Adaptable anatomical models including prosthetic implants and fracture fixation devices and a robust computational infrastructure for static, kinematic, kinetic, and stress analyses under varying boundary and loading conditions are incorporated on a common platform, the VIMS (Virtual Interactive Musculoskeletal System). Within this software system, a manageable database containing long bone dimensions, connective tissue material properties and a library of skeletal joint system functional activities and loading conditions are also available and they can easily be modified, updated and expanded. Application software is also available to allow end-users to perform biomechanical analyses interactively. This paper details the design, capabilities, and features of the VIMS development at Johns Hopkins University, an effort possible only through academic and commercial collaborations. Examples using these models and the computational algorithms in a virtual laboratory environment are used to demonstrate the utility of this unique database and simulation technology. This integrated system will impact on medical education, basic research, device development and application, and clinical patient care related to musculoskeletal diseases, trauma, and rehabilitation.
Karasik, David; Kiel, Douglas P.
There are both theoretical and empirical underpinnings that provide evidence that the musculoskeletal system develops, functions, and ages as a whole. Thus, the risk of osteoporotic fracture can be viewed as a function of loading conditions and the ability of the bone to withstand the load. Both bone loss (osteoporosis) and muscle wasting (sarcopenia) are the two sides of the same coin, an involution of the musculoskeletal system. Skeletal loads are dominated by muscle action; both bone and muscle share environmental, endocrine and paracrine influences. Muscle also has an endocrine function by producing bioactive molecules, which can contribute to homeostatic regulation of both bone and muscle. It also becomes clear that bone and muscle share genetic determinants; therefore the consideration of pleiotropy is an important aspect in the study of the genetics of osteoporosis and sarcopenia. The aim of this review is to provide an additional evidence for existence of the tight genetic co-regulation of muscles and bones, starting early in development and still evident in aging. Recently, important papers were published, including those dealing with the cellular mechanisms and anatomic substrate of bone mechanosensitivity. Further evidence has emerged suggesting that the relationship between skeletal muscle and bone parameters extends beyond the general paradigm of bone responses to mechanical loading. We provide insights into several pathways and single genes, which apparently have a biologically plausible pleiotropic effect on both bones and muscles; the list is continuing to grow. Understanding the crosstalk between muscles and bones will translate into a conceptual framework aimed at studying the pleiotropic genetic relationships in the etiology of complex musculoskeletal disease. We believe that further progress in understanding the common genetic etiology of osteoporosis and sarcopenia will provide valuable insight into important biological underpinnings for both
Ballegeer, Elizabeth A
Computed tomography (CT) has specific uses in veterinary species' appendicular musculoskeletal system. Parameters for acquisition of images, interpretation limitations, as well as published information regarding its use in small animals is reviewed.
Wang, David T.; Dubois, Melissa; Tutton, Sean M.
Musculoskeletal (MSK) intervention has proliferated in recent years among various subspecialties in medicine. Despite advancements in image guidance and percutaneous technique, the risk of complication has not been fully eliminated. Overall, complications in MSK interventions are rare, with bleeding and infection the most common encountered. Other complications are even rarer. This article reviews various complications unique to musculoskeletal interventions, assists the reader in understanding where pitfalls lie, and highlights ways to avoid them. PMID:26038623
Pineault, Kyriel M; Wellik, Deneen M
In the musculoskeletal system, muscle, tendon, and bone tissues develop in a spatially and temporally coordinated manner, and integrate into a cohesive functional unit by forming specific connections unique to each region of the musculoskeletal system. The mechanisms of these patterning and integration events are an area of great interest in musculoskeletal biology. Hox genes are a family of important developmental regulators and play critical roles in skeletal patterning throughout the axial and appendicular skeleton. Unexpectedly, Hox genes are not expressed in the differentiated cartilage or other skeletal cells, but rather are highly expressed in the tightly associated stromal connective tissues as well as regionally expressed in tendons and muscle connective tissue. Recent work has revealed a previously unappreciated role for Hox in patterning all the musculoskeletal tissues of the limb. These observations suggest that integration of the musculoskeletal system is regulated, at least in part, by Hox function in the stromal connective tissue. This review will outline our current understanding of Hox function in patterning and integrating the musculoskeletal tissues.
Im Rahmen seiner Kosmogonie entwickelte der junge Immanuel Kant eine Theorie der Sonne. Sie ist ein einzigartiges Zeugnis seiner intuitiven Vorstellungskraft und beweist auch die Leistungsfähigkeit der damaligen, vorwiegend von Newton geprägten Weltsicht. Entstehung, Aufbau und Dynamik der Sonne werden in Kants Theorie ebenso erklärt wie etwa das Phänomen der Sonnenflecken.
Marculescu, Camelia E.; Berbari, Elie F.; Cantey, J. Robert; Osmon, Douglas R.
Successful treatment of many musculoskeletal infections often requires an extended course of outpatient antimicrobial therapy, much of which is administered parenterally outside the hospital under the guidance of an infectious disease specialist. Delivery of outpatient parenteral antimicrobial therapy (OPAT) may occur in physicians' offices, ambulatory infusion centers, or hospital clinics but most frequently is done in patients' homes, often by the patients themselves. In this article, we outline the essential elements of outpatient antimicrobial therapy for musculoskeletal infections with particular emphasis on OPAT, including patient selection and evaluation; antimicrobial administration, including the route, duration, and complications of central venous access; and clinical and laboratory monitoring of antimicrobial therapy. We believe that primary care physicians, orthopedists, and infectious disease specialists caring for patients with musculoskeletal infections should become familiar with the use of, indications for, and complications of OPAT. PMID:22212975
-related musculoskeletal symptoms. Conclusion This study focused on structural risk factors in the working environment, such as the gender-based division of labor, shift work and labor intensity, that demonstrated a statistically significant correlation with the work-related musculoskeletal symptoms of hotel workers. Both men and women reported different prevalence rates of work-related musculoskeletal symptoms among different departments. This could indicate that a gender-based division of labor produces different ergonomic risk factors for each gender group. However, only females displayed a statistically significant correlation between shift work and labor intensity and musculoskeletal symptoms. Thus, minimizing ergonomic risk factors alone does not suffice to effectively prevent musculoskeletal diseases among hotel workers. Instead, work assignments should be based on gender, department, working hours and work intensity should be adjusted to address multi-dimensional musculoskeletal risk factors. In addition, an approach that seeks to minimize shift work is needed to reduce the incidence of musculoskeletal disorders. PMID:24472690
Because NASA's approach to space exploration calls for long-term extended missions, there is a pressing need to equip astronauts with effective exercise regimens that will maintain musculoskeletal and cardiovascular health. ZIN Technologies, Inc., has developed an innovative miniature treadmill for use in both zero-gravity and terrestrial environments. The treadmill offers excellent periodic impact exercise to stimulate cardiovascular activity and bone remodeling as well as resistive capability to encourage full-body muscle maintenance. A novel speed-control algorithm allows users to modulate treadmill speed by adjusting stride, and a new subject load device provides a more Earth-like gravity replacement load. This new and compact treadmill offers a unique approach to managing astronaut health while addressing the inherent and stringent challenges of space flight. The innovation also has the potential to offer numerous terrestrial applications, as a real-time daily load stimulus (DLS) measurement feature provides an effective mechanism to combat or manage osteoporosis, a major public health threat for 55 percent of Americans over the age of 50.
Snodgrass, Suzanne J; Heneghan, Nicola R; Tsao, Henry; Stanwell, Peter T; Rivett, Darren A; Van Vliet, Paulette M
Evidence is emerging for central nervous system (CNS) changes in the presence of musculoskeletal dysfunction and pain. Motor control exercises, and potentially manual therapy, can induce changes in the CNS, yet the focus in musculoskeletal physiotherapy practice is conventionally on movement impairments with less consideration of intervention-induced neuroplastic changes. Studies in healthy individuals and those with neurological dysfunction provide examples of strategies that may also be used to enhance neuroplasticity during the rehabilitation of individuals with musculoskeletal dysfunction, improving the effectiveness of interventions. In this paper, the evidence for neuroplastic changes in patients with musculoskeletal conditions is discussed. The authors compare and contrast neurological and musculoskeletal physiotherapy clinical paradigms in the context of the motor learning principles of experience-dependent plasticity: part and whole practice, repetition, task-specificity and feedback that induces an external focus of attention in the learner. It is proposed that increased collaboration between neurological and musculoskeletal physiotherapists and researchers will facilitate new discoveries on the neurophysiological mechanisms underpinning sensorimotor changes in patients with musculoskeletal dysfunction. This may lead to greater integration of strategies to enhance neuroplasticity in patients treated in musculoskeletal physiotherapy practice.
Viteri Jusué, A; Eguidazu Elosua, J M; Castillo de Juan, J; Grande Icaran, D
Eponyms reflect the history of medicine, of disease, and of physicians, but eponyms also reflect the history of the societies in which these physicians lived. Both loved and hated, eponyms are at the center of an interminable debate about whether they should continue to be used or whether they should disappear, and this debate has become more intense since some scientific societies have purged their terminologies of eponyms related to Nazism. Eponyms abound in conventional musculoskeletal radiology. In this article, rather than attempt an exhaustive review of all these eponyms, we take a few representative examples to illustrate the contributions of eponyms to medicine and the history of medicine.
Ostojic, Sergej M.
Molecular hydrogen (H 2) has recently been recognized as a potential novel therapeutic agent in biomedicine. Initially proposed to be a possible treatment for certain types of neuromuscular disorders, cardio-metabolic diseases and cancer, H 2 improved clinical end-points and surrogate markers in several clinical trials, mainly acting as an anti-inflammatory agent and powerful antioxidant. In this paper, the medicinal properties of H 2 in musculoskeletal medicine are discussed with the aim to provide an updated and practical overview for health professionals working in this field. PMID:28003879
Bárbara Pereira Costa, Aline; Andrade Carneiro Machado, Luciana; Marcos Domingues Dias, João; Keller Coelho de Oliveira, Adriana; Ude Viana, Joana; da Silva, Sílvia Lanziotti Azevedo; Gonçalves Pereira Couto, Flávia; Lustosa Torres, Juliana; Mendes, Liliane P; Correa Dias, Rosangela
Malnutrition is a risk factor for noncommunicable diseases related to ageing, and it can also contribute to musculoskeletal health. This study investigated whether nutritional risk is associated with chronic musculoskeletal pain in community-dwelling older persons. Nutritional risk was assessed by the DETERMINE Checklist. Chronic musculoskeletal pain was defined as the presence of pain in the past six months that did not disappear for at least 30 consecutive days. Multivariate logistic regression including confounding variables was used for the analysis. The sample was comprised of 383 participants (age 75.6 ± SD 6.1); the majority were at moderate-to-high nutritional risk (69%) and approximately one third presented chronic musculoskeletal pain (30%). The nutritional risk score was independently associated with chronic musculoskeletal pain: adding one unit in the risk score produces an 11% increment in the odds of presenting pain (OR 1.109, 95% CI 1.022-1.204). Individuals classified into moderate- or high-risk categories also had substantially higher odds (∼90%) of presenting chronic musculoskeletal pain when compared to those in the low-risk category, although our findings were only marginally significant. This is the first study to demonstrate the association between nutritional risk and chronic musculoskeletal pain above and beyond the contributed effects from relevant confounders.
Vanhoenacker, Filip M; Sanghvi, Darshana A; De Backer, Adelard I
Tuberculosis (TB) continues to be a public health problem in both developing and industrialized countries. TB can involve pulmonary as well as extrapulmonary sites. The musculoskeletal system is involved in 1–3% of patients with tuberculosis. Although musculoskeletal TB has become uncommon in the Western world, it remains a huge problem in Asia, Africa, and many developing countries. Tuberculous spondylitis is the most common form of musculoskeletal TB and accounts for approximately 50% of cases. Extraspinal musculoskeletal TB shows a predilection for large joints (hip and knee) and para-articular areas; isolated soft tissue TB is extremely rare. Early diagnosis and prompt treatment are mandatory to prevent serious destruction of joints and skeletal deformity. However, due to the nonspecific and often indolent clinical presentation, the diagnosis may be delayed. Radiological assessment is often the first step in the diagnostic workup of patients with musculoskeletal TB and further investigations are decided by the findings on radiography. Both the radiologist and the clinician should be aware of the possibility of this diagnosis. In this manuscript we review the imaging features of extraspinal bone, joint, and soft tissue TB. PMID:19881081
Contents: 1. Mythische Eier. 2. Thales-Welten. 3. "Alles ist voller Götter". 4. Griechische Astronomie. 5. "Rettung der Phänomene". 6. Aristotelische Kosmololgie. 7. Aristoteles-Welt und Platon-Welt. 8. Noch einmal: die Göttlichkeit der Welt. 9. Griechischer Idealismus.
Farooqui, Azhar; Eldin, Susan Gamal; Ali, Muna Dawood; AlTalhi, Ali; AlDigheari, Ahmad
Cystic fibrosis (CF) remains the most common hereditary disease in the western population. Its concomitant presence with other congenital abnormalities is a rare phenomenon with very little documentation. In this case report we describe a case of cystic fibrosis in a female infant with cardiac, ocular, and musculoskeletal abnormalities. A brief literature review is also provided. PMID:26693372
Curtis, Gannon L.; Chughtai, Morad; Khlopas, Anton; Newman, Jared M.; Khan, Rafay; Shaffiy, Shervin; Nadhim, Ali; Bhave, Anil; Mont, Michael A.
Physical activity is a well-known therapeutic tool for various types of medical conditions, including vasculopathic diseases such as coronary artery disease, stroke, type 2 diabetes, and obesity. Additionally, increased physical activity has been proposed as a therapy to improve musculoskeletal health; however, there are conflicting reports about physical activity potentially leading to degenerative musculoskeletal disease, especially osteoarthritis (OA). Additionally, although physical activity is known to have its benefits, it is unclear as to what amount of physical activity is the most advantageous. Too much, as well as not enough exercise can have negative consequences. This could impact how physicians advise their patients about exercise intensity. Multiple studies have evaluated the effect of physical activity on various aspects of health. However, there is a paucity of systematic studies which review cardiovascular and musculoskeletal health as outcomes. Therefore, the purpose of this review was to assess how physical activity impacts these aspects of health. Specifically, we evaluated the effect of various levels of physical activity on: 1) cardiovascular and 2) musculoskeletal health. The review revealed that physical activity may decrease cardiovascular disease and improve OA symptoms, and therefore, motion can be considered a “medicine”. However, because heavy activity can potentially lead to increased OA risk, physicians should advise their patients that excessive activity can also potentially impact their health negatively, and should be done in moderation, until further study. PMID:28392856
Buchbinder, Rachelle; Maher, Chris; Harris, Ian A
Despite a substantial contribution to the global burden of disease, musculoskeletal conditions are under-represented in clinical research, and that which is performed is often wasteful and lacking clinical relevance. Even clinically relevant musculoskeletal research might not lead to timely or adequate changes in clinical practice and associated improvements in patient outcomes. The formulation of clinical recommendations alone is usually insufficient to bring about changes in practice patterns. Research exploring how to improve the translation of evidence-based recommendations into practice, as well as the identification and removal of barriers to practice change, is necessary in order for the promise of musculoskeletal research to be realized in improved health outcomes. These goals can be achieved by improvements in the coordination of research activities, the resourcing and allocation of funding, and the involvement of clinicians and patients.
Verhagen, Arianne P; Cardoso, Jefferson R; Bierma-Zeinstra, Sita M A
This is a best-evidence synthesis providing an evidence-based summary on the effectiveness of aquatic exercises and balneotherapy in the treatment of musculoskeletal conditions. The most prevalent musculoskeletal conditions addressed in this review include: low back pain, osteoarthritis, fibromyalgia and rheumatoid arthritis. Over 30 years of research demonstrates that exercises in general, and specifically aquatic exercises, are beneficial for reducing pain and disability in many musculoskeletal conditions demonstrating small to moderate effect sizes ranging between 0.19 and 0.32. Balneotherapy might be beneficial, but the evidence is yet insufficient to make a definitive statement about its use. High-quality trials are needed on balneotherapy and aquatic exercises research especially in specific patient categories that might benefit most.
Grazio, Simeon; Balen, Diana
The use of complementary and alternative medicine (CAM) is high and increasing worldwide. Patients usually use CAM in addition to conventional medicine, mainly to treat pain. In a large number of cases, people use CAM for chronic musculoskeletal pain as in osteoarthritis, back pain, neck pain, or fibromyalgia. Herewith, a review is presented of CAM efficacy in treating musculoskeletal pain for which, however, no scientific research has so far provided evidence solid enough. In some rare cases where adequate pain control cannot be achieved, CAM might be considered in rational and individual approach based on the first general rule in medicine "not to harm" and on the utility theory of each intervention, i.e. according to the presumed mechanism of painful stimulus and with close monitoring of the patient's response. Further high quality studies are warranted to elucidate the efficacy and side effects of CAM methods. Therefore, conventional medicine remains the main mode of treatment for patients with musculoskeletal painful conditions.
Hakim, Z; Weerasinghe, C; Dunkow, P
Introduction Citrobacter koseri is a well known cause of central nervous system infections in the paediatric setting. Musculoskeletal infections caused by C koseri are rare, with only 14 previously reported cases. We present the first recorded case of C koseri induced septic arthritis of the knee along with a review of the literature. Methods A search of the PubMed, Embase® and Google Scholar™ databases was undertaken. Only complete or near complete cases were reviewed. Findings Fourteen musculoskeletal infections were identified. Of these, five were associated with an operative procedure and five involved a septic joint. Surgical treatment was required in the majority of cases and cure was achieved in all cases following prolonged antibiotic use. Conclusions C koseri associated musculoskeletal infections may complicate primary orthopaedic procedures. The organism can present aggressively and can be difficult to identify microbiologically. It is sensitive to newer generation beta-lactams, cephalosporin-based antibiotics and timely surgery. PMID:27412805
Kwaees, T A; Hakim, Z; Weerasinghe, C; Dunkow, P
Introduction Citrobacter koseri is a well known cause of central nervous system infections in the paediatric setting. Musculoskeletal infections caused by C koseri are rare, with only 14 previously reported cases. We present the first recorded case of C koseri induced septic arthritis of the knee along with a review of the literature. Methods A search of the PubMed, Embase(®) and Google Scholar™ databases was undertaken. Only complete or near complete cases were reviewed. Findings Fourteen musculoskeletal infections were identified. Of these, five were associated with an operative procedure and five involved a septic joint. Surgical treatment was required in the majority of cases and cure was achieved in all cases following prolonged antibiotic use. Conclusions C koseri associated musculoskeletal infections may complicate primary orthopaedic procedures. The organism can present aggressively and can be difficult to identify microbiologically. It is sensitive to newer generation beta-lactams, cephalosporin-based antibiotics and timely surgery.
The musculoskeletal system, which includes bone, cartilage, tendon/ligament, and skeletal muscle, is becoming the targets for tissue engineering because of the high need for their repair and regeneration. Numerous factors would affect the use of musculoskeletal tissue engineering for tissue regeneration ranging from cells used for scaffold seeding to the manufacture and structures of materials. The essential function of the scaffolds is to convey growth factors as well as cells to the target site to aid the regeneration of the injury. Among the variety of biomaterials used in scaffold engineering, silk fibroin is recognized as an ideal material for its impressive cytocompatibility, slow biodegradability, and excellent mechanical properties. The current review describes the advances made in the fabrication of silk fibroin scaffolds with different forms such as films, particles, electrospun fibers, hydrogels, three-dimensional porous scaffolds, and their applications in the regeneration of musculoskeletal tissues. PMID:26445979
Yao, Danyu; Liu, Haifeng; Fan, Yubo
The musculoskeletal system, which includes bone, cartilage, tendon/ligament, and skeletal muscle, is becoming the targets for tissue engineering because of the high need for their repair and regeneration. Numerous factors would affect the use of musculoskeletal tissue engineering for tissue regeneration ranging from cells used for scaffold seeding to the manufacture and structures of materials. The essential function of the scaffolds is to convey growth factors as well as cells to the target site to aid the regeneration of the injury. Among the variety of biomaterials used in scaffold engineering, silk fibroin is recognized as an ideal material for its impressive cytocompatibility, slow biodegradability, and excellent mechanical properties. The current review describes the advances made in the fabrication of silk fibroin scaffolds with different forms such as films, particles, electrospun fibers, hydrogels, three-dimensional porous scaffolds, and their applications in the regeneration of musculoskeletal tissues.
Kok, Laura M; Vliet Vlieland, Theodora P M; Fiocco, Marta; Kaptein, Ad A; Nelissen, Rob G H H
The purpose of this study is to know the views of people about their illness, i.e., illness perceptions, determine coping strategies, and outcome. Previous research suggests a higher prevalence and a different perception of musculoskeletal complaints between musicians and nonmusicians. The aim of this study is to compare illness perceptions related to musculoskeletal complaints between musicians and nonmusicians. In this cross-sectional study, students from three music academies (n = 345) and one university medical center (n = 2,870) in the Netherlands received an electronic questionnaire concerning questions on sociodemographic characteristics, use of musical instruments, occurrence and characteristics of musculoskeletal complaints in the past year, and the Brief Illness Perception Questionnaire (B-IPQ). Baseline and B-IPQ scores were compared between the samples by means of t tests, chi-square tests, and regression models to adjust for differences in sociodemographic characteristics. Eighty-three music academy students and 494 medical students completed the questionnaire (response rates, 25.5 and 17.6 %, respectively). Seventy-four (89 %) persons in the musician group and 382 (78 %) persons in the nonmusician group reported occurrence of musculoskeletal complaints during the last 12 months. Adjusted for sociodemographic characteristics, the B-IPQ scores of the domains consequences (my illness is a serious condition), concern (I am extremely concerned about my illness), and emotions (my illness makes me scared) were significantly higher among musicians, whereas personal control (there is little I can do to improve my illness), identity (number of symptoms patient sees as part of illness) were not significantly different. Music academy students had a significant more positive score on treatment control. Music academy students report more negative perceptions of their musculoskeletal complaints compared to medical students. Although some selection bias is
Stier-Jarmer, Marita; Kus, Sandra; Frisch, Dieter; Sabariego, Carla; Schuh, Angela
Health resort medicine (HRM; in German: Kurortmedizin) is a field of medicine with long-lasting tradition in several European countries. A number of systematic reviews have shown the effectiveness of HRM in musculoskeletal conditions. Reviews focusing on the effectiveness of HRM in non-musculoskeletal disorders are rare. This systematic review aims to provide an overview about all types of health resort treatments applied in non-musculoskeletal conditions, to summarize evidence for its effectiveness and to assess the quality of published studies. MEDLINE, Web of Knowledge and Embase were searched for articles published between January 2002 and December 2013. We used a broad search strategy in order to find studies investigating the effects of HRM in non-musculoskeletal disorders. Two authors independently extracted data and assessed quality using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies (EPHPP-QAT). Forty-one studies (19 of them with control group) from eight countries examining the efficacy of various forms of spa treatment for 12 disease groups were included. The studies are markedly heterogeneous regarding study design, population and treatment. HRM treatment is associated with clinical improvement in diseases of the skin, respiratory, circulatory, digestive and nervous system among others. However, small samples, the lack of control groups and an insufficient follow-up often limit the generated evidence. The scientific literature of the last decade has shown that a number of non-musculoskeletal disorders are treated with different kinds of HRM. The challenge for the future will be to carry out thoroughly designed studies in larger patient populations to corroborate the impact of HRM treatment on non-musculoskeletal disorders.
Suzuki, Hidetsugu; Asahara, Hiroshi
Genome editing is a genetic technology by which any DNA sequence is inserted, replaced or deleted. Genome editing has been making rapid progress recently, with the development of new techniques such as ZFN, TALEN and CRISPR/Cas9. Genome editing can be applied to various fields ranging from the production of knock out animals to gene therapy. This section summarizes these new genome editing technologies and its applications.
Longair, Malcolm S.; Simon, B.; Simon, H.
"Dies ist kein Lehrbuch der theoretischen Physik, auch kein Kompendium der Physikgeschichte ... , vielmehr eine recht anspruchsvolle Sammlung historischer Miniaturen zur Vergangenheit der theoretischen Physik - ihrer "Sternstunden", wenn man so will. Frei vom Zwang, etwas Erschöpfendes vorlegen zu müssen, gelingt dem Autor etwas Seltenes: einen "lebendigen" Zugang zum Ideengebäude der modernen Physik freizulegen, ... zu zeigen, wie Physik in praxi entsteht... Als Vehikel seiner Absichten dienen dem Autor geschichtliche Fallstudien, insgesamt sieben an der Zahl. Aus ihnen extrahiert er das seiner Meinung nach Lehrhafte, dabei bestrebt, mathematische Anachronismen womöglich zu vermeiden... Als Student hätte ich mir diese gescheiten Essays zum Werden unserer heutigen physikalischen Weltsicht gewünscht. Sie sind originell, didaktisch klug und genieren sich auch nicht, von der Faszination zu sprechen, die ... von der Physik ausgeht. Unnötig darauf hinzuweisen, das sie ein gründliches "konventionelles" Studium weder ersetzen wollen noch können, sie vermögen aber, dazu zu ermuntern." #Astronomische Nachrichten (zur englischen Ausgabe)#1
Schneider, Wilfried; Stöfen, Heinke
Kurzfassung Modelle zur Sickerwasserprognose stehen in unterschiedlicher Komplexität zur Verfügung. Komplexe Modelle werden aufgrund der schwierigen Handhabung und des enormen Eingabedatenumfangs in der Praxis kaum angewandt. Grobe Abschätzmethoden sind dagegen nicht ausreichend wissenschaftlich fundiert, um damit justiziable Ergebnisse erzielen zu können. Um die Kluft zwischen komplexer und einfacher, jedoch justiziabler sowie wissenschaftlich fundierter Methode zu schmälern, wurden Nomogramme für Sickerwasserprognosen zur Berücksichtigung der Endlichkeit der Quelle entwickelt. Mithilfe der Nomogramme können ohne Modellierungserfahrung schnell und einfach die zu erwartenden Schadstoffkonzentrationen am Ort der Beurteilung abgeschätzt werden, falls die Endlichkeit der Quelle der hauptsächlich zur Abminderung führende Prozess ist. Die Nomogramme basieren auf analytischen Lösungen der eindimensionalen Advektions-Dispersions-Gleichung. Sie berücksichtigen die Prozesse Advektion, Diffusion in Bodenwasser und -luft, Dispersion, lineare Sorption, Abbau 1. Ordnung innerhalb einer aus mehreren Bodenschichten bestehenden Sickerwasserzone, wobei die Endlichkeit der Schadstoffmasse in der Bodenkontamination einbezogen wird. Die Genauigkeit der Nomogramme wird dargestellt. Models of different complexity are available for groundwater risk assessment. In practice complex models are hardly used, due to their difficult handling and large data requirement. Rough estimation methods are not sufficiently scientifically founded to produce justiciable results. To reduce the gap between complex and easy to use but justiciable and scientifically founded methods we developed nomograms for groundwater risk assessment which take into account the finite mass of contaminant in the source. With the help of the nomograms the expected concentrations at the point of compliance (transition between the unsaturated and saturated zone) can be estimated easily, fast and without any
Zapata, Aura Ligia; Moraes, Ana Julia Pantoja; Leone, Claudio; Doria-Filho, Ulysses; Silva, Clovis Artur Almeida
The presence of musculoskeletal pain was evaluated in adolescents. Pain was reported by 40% of respondents, benign joint hypermobility syndrome by 10%, myofascial syndrome by 5%, tendonitis by 2%, and fibromialgia by 1%. Logistical regression analysis indicated that sex and age were predictive of pain.
Smith, S M; Sumar, B; Dixon, K A
This review seeks to provide a current overview of musculoskeletal pain in overweight and obese children. Databases searched were Academic Search Complete, CINAHL, Medline, Proquest Health and Medical Complete, Scopus, Google Scholar, SPORTDiscuss and Trove for studies published between 1 January 2000 and 30 December 2012. We used a broad definition of children within a 3- to 18-year age range. The search strategy included the following terms: obesity, morbid obesity, overweight, pain, musculoskeletal pain, child, adolescent, chronic pain, back pain, lower back pain, knee pain, hip pain, foot pain and pelvic pain. Two authors independently assessed each record, and any disagreement was resolved by the third author. Data were analysed using a narrative thematic approach owing to the heterogeneity of reported outcome measures. Ninety-seven records were initially identified using a variety of terms associated with children, obesity and musculoskeletal pain. Ten studies were included for thematic analysis when predetermined inclusion criteria were applied. Bone deformity and dysfunction, pain reporting and the impact of children being overweight or obese on physical activity, exercise and quality of life were the three themes identified from the literature. Chronic pain, obesity and a reduction in physical functioning and activity may contribute to a cycle of weight gain that affects a child's quality of life. Future studies are required to examine the sequela of overweight and obese children experiencing chronic musculoskeletal pain. PMID:24077005
Sereysky, Jedd B; Flatow, Evan L; Andarawis-Puri, Nelly
Tendinopathies are common muskoloskeletal injuries that lead to pain and disability. Development and pathogenesis of tendinopathy is attributed to progressive pathological changes to the structure, function, and biology of tendon. The nature of this disease state, whether acquired by acute or chronic injury, is being actively investigated. Scarring, disorganized tissue, and loss of function characterize adult tendon healing. Recent work from animal models has begun to reveal the potential for adult mammalian tendon regeneration, the replacement of diseased with innate tissue. This review discusses what is known about musculoskeletal regeneration from a molecular perspective and how these findings can be applied to tendinopathy. Non-mammalian and mammalian models are discussed with emphasis on the potential of Murphy Roths Large mice to serve as a model of adult tendon regeneration. Comparison of regeneration in non-mammals, foetal mammals and adult mammals emphasizes distinctly different contributing factors to effective regeneration.
Sereysky, Jedd B; Flatow, Evan L; Andarawis-Puri, Nelly
Tendinopathies are common muskoloskeletal injuries that lead to pain and disability. Development and pathogenesis of tendinopathy is attributed to progressive pathological changes to the structure, function, and biology of tendon. The nature of this disease state, whether acquired by acute or chronic injury, is being actively investigated. Scarring, disorganized tissue, and loss of function characterize adult tendon healing. Recent work from animal models has begun to reveal the potential for adult mammalian tendon regeneration, the replacement of diseased with innate tissue. This review discusses what is known about musculoskeletal regeneration from a molecular perspective and how these findings can be applied to tendinopathy. Non-mammalian and mammalian models are discussed with emphasis on the potential of Murphy Roths Large mice to serve as a model of adult tendon regeneration. Comparison of regeneration in non-mammals, foetal mammals and adult mammals emphasizes distinctly different contributing factors to effective regeneration. PMID:23772908
Lieberman, Gregory; Shpaner, Marina; Watts, Richard; Andrews, Trevor; Filippi, Christopher G.; Davis, Marcia; Naylor, Magdalena R.
There is emerging evidence that chronic musculoskeletal pain is associated with anatomical and functional abnormalities in gray matter. However, little research has investigated the relationship between chronic musculoskeletal pain and white matter (WM). In this study, we used whole-brain tract-based spatial statistics, and region-of-interest analyses of diffusion tensor imaging (DTI) data to demonstrate that patients with chronic musculoskeletal pain exhibit several abnormal WM integrity as compared to healthy controls. Chronic musculoskeletal pain was associated with lower fractional anisotropy (FA) in the splenium of corpus callosum, and left cingulum adjacent to the hippocampus. Patients also had higher radial diffusivity (RD) in the splenium, right anterior and posterior limbs of internal capsule, external capsule, superior longitudinal fasciculus, and cerebral peduncle. Patterns of axial diffusivity (AD) varied: patients exhibited lower AD in the left cingulum adjacent to the hippocampus and higher AD bilaterally in the anterior limbs of internal capsule, and in the right cerebral peduncle. Several correlations between diffusion metrics and clinical variables were also significant at a p<0.01 level: FA in the left uncinate fasciculus correlated positively with Total Pain Experience and typical levels of pain severity. AD in the left anterior limb of internal capsule and left uncinate fasciculus were correlated with Total Pain Experience and typical pain level. Positive correlations were also found between AD in the right uncinate and both Total Pain Experience and Pain Catastrophizing. These results demonstrate that WM abnormalities play a role in chronic musculoskeletal pain; either as a cause, predisposing factor, consequence, or compensatory adaptation. PMID:25135468
Children with CF are living longer than ever before, and thus issues pertaining to quality of life rather than just longevity of life need to be addressed by the entire healthcare team. This article addressed the issues pertaining to the external support of the dysfunctional internal organs: the secondary musculoskeletal (postural) and neuromuscular control deficits that occur to the maturing child with CF. The research pointed towards starting PT interventions for these deficits during the pre-pubescent phase when postural deficits were just emerging, but a suggestion was also made to explore whether these deficits can be even more effectively monitored and treated at an earlier age. The dual relationship between the muscles used to meet the increased respiratory demands of CF and the normal postural demands of physical activities was described through a model based on a soda-pop can and pressure support. A pre-pubescent child with a typical progression of CF was presented as a case report to illustrate how a PT programme that was focused on postural deficits could be implemented and what type of outcomes might be possible. The child made significant changes within a relatively short time frame of 4 months, proposing that the musculoskeletal and neuromuscular systems may play a significant role in the medical and physical long-term outcomes of CF. For that reason, the physical as well as medical needs of the patient should be incorporated into a comprehensive multi-system approach to the disease across the lifespan. PMID:16025768
Lima Júnior, Francisco Valtenor Araújo; Savarese, Leonor Garbin; Monsignore, Lucas Moretti; Martinez, Roberto; Nogueira-Barbosa, Marcello Henrique
Objective To evaluate musculoskeletal involvement in paracoccidioidomycosis at computed tomography. Materials and Methods Development of a retrospective study based on a review of radiologic and pathologic reports in the institution database. Patients with histopathologically confirmed musculoskeletal paracoccidioidomycosis and submitted to computed tomography were included in the present study. The imaging findings were consensually described by two radiologists. In order to avoid bias in the analysis, one patient with uncountable bone lesions was excluded from the study. Results A total of seven patients were included in the present study. A total of 18 bone lesions were counted. The study group consisted of 7 patients. A total number of 18 bone lesions were counted. Osteoarticular lesions were the first manifestation of the disease in four patients (57.14%). Bone lesions were multiple in 42.85% of patients. Appendicular and axial skeleton were affected in 85.71% and 42.85% of cases, respectively. Bone involvement was characterized by well-demarcated osteolytic lesions. Marginal osteosclerosis was identified in 72.22% of the lesions, while lamellar periosteal reaction and soft tissue component were present in 5.55% of them. One patient showed multiple small lesions with bone sequestra. Conclusion Paracoccidioidomycosis can be included in the differential diagnosis of either single or multiple osteolytic lesions in young patients even in the absence of a previous diagnosis of pulmonary or visceral paracoccidioidomycosis PMID:25798000
Wackerhage, Henning; Rennie, Michael J
In this article we review some of our recent work concerning the effects of nutrition and exercise on protein synthesis and signal transduction in human musculoskeletal tissues. A great deal of new information is being generated by the application of recently refined techniques for measuring protein turnover. The field remains one that is largely descriptive but increasingly we are beginning to discern mechanisms underlying lean tissue maintenance, growth and wasting especially as multidisciplinary tools are applied to its study. Several types of exercise and nutrition are potent stimuli for protein synthesis in skeletal muscle. By contrast, collagen in the extracellular matrix in muscle and tendon appears to be mechanically but not nutritionally sensitive. The rates of collagen turnover in a variety of tissues are sufficiently high to account for a sizeable proportion of whole body protein turnover. One of the most recent surprises is the high turnover rate of human bone collagen and its anabolic response to feeding. As our understanding of the normal physiology of these processes advances, we become better able to construct testable hypotheses concerning the effects of ageing and disease on the musculoskeletal mass. Current evidence suggests that one of the major problems with loss of muscle during ageing is an inability of the tissue to respond adequately to increased availability of nutrients. PMID:16637871
... Additional Information & Resources MedlinePlus (1 link) Health Topic: Bone Diseases Genetic and Rare Diseases Information Center (1 link) ... and Musculoskeletal and Skin Diseases: Osteoporosis and Related Bone Diseases Educational Resources (6 links) Cedars-Sinai Health System: ...
Ho, Michelle; Horn, B David; Lin, Ines C; Chang, Benjamin; Carrigan, Robert B; Shah, Apurva
Hoverboards were recently introduced to the US consumer market and experienced rapid popularity. Given the high frequency of musculoskeletal injury with other wheeled recreation devices, we sought to analyze hoverboard injuries in children. A retrospective review of patients with musculoskeletal injury related to hoverboard use was performed at a tertiary care children's hospital. From November 2015 to January 2016, 2.3% of all fractures were related to hoverboards. Common injury mechanisms were fall (79%) and finger entrapment between wheel and wheel-well (10%). The most frequently fractured sites included the distal radius (43%) and phalanx (17%). Common surgical procedures were nailbed repair and pinning for Seymour fracture and percutaneous pinning for distal radius fracture. There exists high risk for distal radius fractures from falls and phalanx fractures from finger entrapment between the wheel and wheel-well. Hoverboard safety can be improved with regular use of wrist guards and improved wheel-well design.
Chang, Eric Y.; Du, Jiang; Chung, Christine B.
Tissues, such as bone, tendon, and ligaments, contain a high fraction of components with “short” and “ultrashort” transverse relaxation times and therefore have short mean transverse relaxation times. With conventional MRI sequences that employ relatively long echo times (TEs), there is no opportunity to encode the decaying signal of short and ultrashort T2/T2* tissues before it has reached zero or near zero. The clinically compatible ultrashort TE (UTE) sequence has been increasingly used to study the musculoskeletal system. This article will review the UTE sequence as well as various modifications that have been implemented since its introduction. These modifications have been used to improve efficiency or contrast as well as provide quantitative analysis. This article also reviews several clinical musculoskeletal applications of UTE. PMID:25045018
Noureldine, M H A; Khamashta, M A; Merashli, M; Sabbouh, T; Hughes, G R V; Uthman, I
The scope of clinical and laboratory manifestations of the antiphospholipid syndrome (APS) has increased dramatically since its discovery in 1983, where any organ system can be involved. Musculoskeletal complications are consistently reported in APS patients, not only causing morbidity and mortality, but also affecting their quality of life. We reviewed all English papers on APS involvement in the musculoskeletal system using Google Scholar and Pubmed; all reports are summarized in a table in this review. The spectrum of manifestations includes arthralgia/arthritis, avascular necrosis of bone, bone marrow necrosis, complex regional pain syndrome type-1, muscle infarction, non-traumatic fractures, and osteoporosis. Some of these manifestations were reported in good quality studies, some of which showed an association between aPL-positivity and the occurrence of these manifestations, while others were merely described in case reports.
Struyf, Filip; Tate, Angela; Kuppens, Kevin; Feijen, Stef; Michener, Lori A
Shoulder pain is the most reported area of orthopaedic injury in swimmers. The so-called 'swimmers' shoulder' has been applied to a variety of complaints involving shoulder pain in swimmers without specific reference to contributing mechanisms or structures. Knowledge of dysfunctions associated with swimmers' shoulder can assist clinicians in developing rehabilitation strategies. This literature review aims at providing clinicians insight into the musculoskeletal mechanisms and impairments associated with swimmers' shoulder that could aid them in developing rehabilitation strategies. The following musculoskeletal dysfunctions will be discussed: muscle activity, strength, endurance, muscle control, range of motion, glenohumeral laxity, glenohumeral instability, shoulder posture and scapular dyskinesis. The findings in this review may have implications for swimmers, their coaches, and rehabilitation specialists working with swimmers.
McCullen, Seth D; Chow, Andre G Y; Stevens, Molly M
Tissue engineering of musculoskeletal tissues often involves the in vitro manipulation and culture of progenitor cells, growth factors and biomaterial scaffolds. Though in vitro tissue engineering has greatly increased our understanding of cellular behavior and cell-material interactions, this methodology is often unable to recreate tissue with the hierarchical organization and vascularization found within native tissues. Accordingly, investigators have focused on alternative in vivo tissue engineering strategies, whereby the traditional triad (cells, growth factors, scaffolds) or a combination thereof are directly implanted at the damaged tissue site or within ectopic sites capable of supporting neo-tissue formation. In vivo tissue engineering may offer a preferential route for regeneration of musculoskeletal and other tissues with distinct advantages over in vitro methods based on the specific location of endogenous cultivation, recruitment of autologous cells, and patient-specific regenerated tissues.
Practical procedures for treatment of fractures and dislocations have been used since the time of Hippocrates in fourth century BC. Orthopaedic surgery became a recognized part of surgical treatment since the mid-nineteenth century, but saw major developments with the invention of x-rays and antibiotics in the early part of the twentieth century. Though orthopaedic surgery had started with an interest in the correction of deformities in children, the major musculoskeletal problems facing orthopaedic surgery today relate to osteoarthritis, trauma (including sports injuries), and osteoporosis. The practice of orthopaedic surgery has evolved with technology: advances in engineering and material science and increasing expectations towards faster rehabilitation have moved orthopaedics into the era of joint replacements, arthroscopy, and less invasive surgical procedures. This chapter aims to provide an evidence-based condensed overview of the surgical management for a broad spectrum of musculoskeletal disorders encountered by primary-care clinicians and rheumatologists.
Bazzini, Giacomo; Capodaglio, Edda Maria; Mancin, Donatella
Shoes factory workers are engaged in ripetitive tasks, often performed in constrained postures and in concomitance of force applied, which result in increased risk of musculoskeletal disorders. Risk assessment and ergonomic interventions are part of the on-site prevention program, which should pertain also to gender and age differences. Health and safety issues can be adequately faced by an active epidemiological surveillance complemented by ergonomics.
Scheuring, Richard A.; Walton, Marlei; Davis-Street, Janis; Smaka, Todd J.; Griffin, DeVon
The Medical Informatics and Health Care Systems group in the Office of Space Medicine at NASA Johnson Space Center (JSC) has been tasked by NASA with improving overall medical care on the International Space Station (ISS) and providing insights for medical care for future exploration missions. To accomplish this task, a three day Operational and Research Musculoskeletal Summit was held on August 23-25th, 2005 at Space Center Houston. The purpose of the summit was to review NASA#s a) current strategy for preflight health maintenance and injury screening, b) current treatment methods in-flight, and c) risk mitigation strategy for musculoskeletal injuries or syndromes that could occur or impact the mission. Additionally, summit participants provided a list of research topics NASA should consider to mitigate risks to astronaut health. Prior to the summit, participants participated in a web-based pre-summit forum to review the NASA Space Medical Conditions List (SMCL) of musculoskeletal conditions that may occur on ISS as well as the resources currently available to treat them. Data from the participants were compiled and integrated with the summit proceedings. Summit participants included experts from the extramural physician and researcher communities, and representatives from NASA Headquarters, the astronaut corps, JSC Medical Operations and Human Adaptations and Countermeasures Offices, Glenn Research Center Human Research Office, and the Astronaut Strength, Conditioning, and Reconditioning (ASCR) group. The recommendations in this document are based on a summary of summit discussions and the best possible evidence-based recommendations for musculoskeletal care for astronauts while on the ISS, and include recommendati ons for exploration class missions.
Eranki, Avinash; Cortes, Nelson; Ferenček, Zrinka Gregurić; Sikdar, Siddhartha
Ultrasound is an attractive modality for imaging muscle and tendon motion during dynamic tasks and can provide a complementary methodological approach for biomechanical studies in a clinical or laboratory setting. Towards this goal, methods for quantification of muscle kinematics from ultrasound imagery are being developed based on image processing. The temporal resolution of these methods is typically not sufficient for highly dynamic tasks, such as drop-landing. We propose a new approach that utilizes a Doppler method for quantifying muscle kinematics. We have developed a novel vector tissue Doppler imaging (vTDI) technique that can be used to measure musculoskeletal contraction velocity, strain and strain rate with sub-millisecond temporal resolution during dynamic activities using ultrasound. The goal of this preliminary study was to investigate the repeatability and potential applicability of the vTDI technique in measuring musculoskeletal velocities during a drop-landing task, in healthy subjects. The vTDI measurements can be performed concurrently with other biomechanical techniques, such as 3D motion capture for joint kinematics and kinetics, electromyography for timing of muscle activation and force plates for ground reaction force. Integration of these complementary techniques could lead to a better understanding of dynamic muscle function and dysfunction underlying the pathogenesis and pathophysiology of musculoskeletal disorders.
Eranki, Avinash; Cortes, Nelson; Ferenček, Zrinka Gregurić; Sikdar, Siddhartha
Ultrasound is an attractive modality for imaging muscle and tendon motion during dynamic tasks and can provide a complementary methodological approach for biomechanical studies in a clinical or laboratory setting. Towards this goal, methods for quantification of muscle kinematics from ultrasound imagery are being developed based on image processing. The temporal resolution of these methods is typically not sufficient for highly dynamic tasks, such as drop-landing. We propose a new approach that utilizes a Doppler method for quantifying muscle kinematics. We have developed a novel vector tissue Doppler imaging (vTDI) technique that can be used to measure musculoskeletal contraction velocity, strain and strain rate with sub-millisecond temporal resolution during dynamic activities using ultrasound. The goal of this preliminary study was to investigate the repeatability and potential applicability of the vTDI technique in measuring musculoskeletal velocities during a drop-landing task, in healthy subjects. The vTDI measurements can be performed concurrently with other biomechanical techniques, such as 3D motion capture for joint kinematics and kinetics, electromyography for timing of muscle activation and force plates for ground reaction force. Integration of these complementary techniques could lead to a better understanding of dynamic muscle function and dysfunction underlying the pathogenesis and pathophysiology of musculoskeletal disorders. PMID:24084063
Ghogomu, Elizabeth A T; Maxwell, Lara J; Buchbinder, Rachelle; Rader, Tamara; Pardo Pardo, Jordi; Johnston, Renea V; Christensen, Robin D K; Rutjes, Anne W S; Winzenberg, Tania M; Singh, Jasvinder A; Zanoli, Gustavo; Wells, George A; Tugwell, Peter
The Cochrane Musculoskeletal Group (CMSG), one of 53 groups of the not-for-profit, international Cochrane Collaboration, prepares, maintains, and disseminates systematic reviews of treatments for musculoskeletal diseases. It is important that authors conducting CMSG reviews and the readers of our reviews be aware of and use updated, state-of-the-art systematic review methodology. One hundred sixty reviews have been published. Previous method guidelines for systematic reviews of interventions in the musculoskeletal field published in 2006 have been substantially updated to incorporate methodological advances that are mandatory or highly desirable in Cochrane reviews and knowledge translation advances. The methodological advances include new guidance on searching, new risk-of-bias assessment, grading the quality of the evidence, the new Summary of Findings table, and comparative effectiveness using network metaanalysis. Method guidelines specific to musculoskeletal disorders are provided by CMSG editors for various aspects of undertaking a systematic review. These method guidelines will help improve the quality of reporting and ensure high standards of conduct as well as consistency across CMSG reviews.
Farming is a physically arduous occupation that places farm workers' at potential risk of musculoskeletal disorders, which has been observed to impose a greater impact on their health. Each activity in agriculture brings about certain stress and strain on bones and muscles leading to work-related musculoskeletal disorders which can lead to several permanent diseases and disabilities. The purpose of analyzing musculoskeletal problems among male and female workers engaged in agriculture was to know about the risk factors dangerous to health so that interventions can be planned for mitigating them thereby increasing the efficiency of work. Educational intervention included audio-visual aids as well as printed literature. It was hoped that awareness of these factors through dissemination of information would contribute at preventing hazards amongst farmers and their families. The results revealed that the workers reported very severe to severe pain in low back while performing agricultural activities. Weeding was the most strenuous activity for females and threshing crop for males. Training and education on MSDs through educational intervention proved that the knowledge of the farm workers could be enhanced and can help reduce risk of many musculoskeletal problems. It can be help in empowering the community and mitigate MSDs in agriculture.
In diesem Kapitel geht es darum, Vorgänge zu analysieren, bei denen der thermische Zustand eines Systems verändert wird: Daher der Name "Thermodynamik". Wir werden zunächst untersuchen, unter welchen Umständen man eine Zustandsänderung im Detail beschreiben kann. Hierbei werden wir zwei grundsätzlich verschiedene Arten, Zustandsänderungen herbeizuführen, kennenlernen: reversible und irreversible Prozesse. Sodann werden wir die Eigenschaften von Zustandsgrößen allgemein definieren und dabei auf eine überaus wichtige neue Zustandsgröße, die Entropie, stoßen.
Dries, Billy; Jonkers, Ilse; Dingemanse, Walter; Vanwanseele, Benedicte; Vander Sloten, Jos; van Bree, Henri; Gielen, Ingrid
Musculoskeletal models have proven to be a valuable tool in human orthopaedics research. Recently, veterinary research started taking an interest in the computer modelling approach to understand the forces acting upon the canine musculoskeletal system. While many of the methods employed in human musculoskeletal models can applied to canine musculoskeletal models, not all techniques are applicable. This review summarizes the important parameters necessary for modelling, as well as the techniques employed in human musculoskeletal models and the limitations in transferring techniques to canine modelling research. The major challenges in future canine modelling research are likely to centre around devising alternative techniques for obtaining maximal voluntary contractions, as well as finding scaling factors to adapt a generalized canine musculoskeletal model to represent specific breeds and subjects.
Peckruhn, Melanie; Tittelbach, Jörg; Elsner, Peter
Die Necrobiosis lipoidica ist eine seltene granulomatöse Erkrankung von bisher unzureichend geklärter Ätiologie. Häufig stellt die bei Diabetikern gehäuft zu beobachtende und zur Ulzeration neigende Dermatose eine starke Belastung für die Patienten dar. Bezüglich der Therapie existieren aktuell keine deutschen oder europäischen Leitlinien. Gleichzeitig lässt sich unter der aktuellen Standardtherapie, der lokalen oder intraläsionalen Anwendung von Glukokortikoiden, nicht immer ein zufriedenstellendes Ansprechen beobachten. Daher wurde untersucht, ob seit dem Jahr 2000 publizierte Therapiemodalitäten das Therapiespektrum relevant und erfolgversprechend erweitern. Es erfolgte eine Betrachtung aller Arbeiten im oben genannten Zeitraum, bei denen mehr als ein Einzelfallbericht je Therapiemodalität publiziert wurde. Insgesamt wurden in einem systematischen Review die Daten von 16 verschiedenen, seit 2000 publizierten Therapieverfahren in 49 Publikationen analysiert. Im Ergebnis zeigte sich, dass die meisten Erfahrungen bezüglich der topischen PUVA-Therapie, der photodynamischen Therapie (PDT) und der systemischen Therapie mit Fumarsäureestern vorliegen. Allerdings ist auffällig, dass mit steigender Zahl der pro Behandlungsmodalität behandelten Patienten der Anteil der Patienten, bei denen eine Abheilung bzw. eine teilweise Abheilung berichtet wurde, sinkt. Wir interpretieren diese Beobachtung als Publikationsbias. Daher kann für keines der besprochenen Verfahren eine klare Empfehlung als Therapie der zweiten Wahl nach Versagen der lokalen bzw. intraläsionalen Steroidtherapie gegeben werden.
Alvarez-San Martín, R
Although Tissue Banks and their activities are not new in Mexico, the specific regulations for the activities of tissue banks and musculoskeletal tissues considered as health supplies are still under development. This review paper intends to provide information on the national situation of musculoskeletal tissue banks, major aspects concerning their regulation and organization, and the recognition of the national instances pertaining to the Coordination for Organ and Tissue Donation for Transplant Purposes for the obtention of (musculoskeletal) tissues from deceased donors.
Ono, Y; Lagerström, M; Hagberg, M; Lindén, A; Malker, B
OBJECTIVES--To describe the nationwide occurrence of work related musculoskeletal injuries among all home care service workers in Sweden, and to identify relative risks and risk factors of the injuries. METHODS--The study was based on work related injuries reported to the Swedish occupational injury information system in 1990-1. The work related musculoskeletal injuries were divided into overexertion accidents and musculoskeletal diseases. The incidence of the injuries in female home care service workers was compared with those in nursery school workers and all other employed women in Sweden. RESULTS--In home care service workers, the annual incidence of injury from overexertion accidents and musculoskeletal diseases were 19.2 and 15.1 per 1000 workers, respectively, which was higher than those in nursery school workers and all employed women in Sweden. For five injury locations including the back, all the age standardised relative risks (SRR) of overexertion accidents exceeded 4.0, and most of those for musculoskeletal diseases were 1.5 or more in home care service workers compared with all other employed women in Sweden. Total duration of sick leave due to overexertion accidents was 7.7 times, and musculoskeletal diseases 3.5 times, longer than in nursery school workers. National loss due to sick leave resulting from only musculoskeletal injuries in home care service workers was about 8.2% of the total work related sick leave in all employed women in Sweden, although the number of home care service workers represented only some 5% of this population. Lifting other people was most frequently reported as the main risk cause of overexertion accidents in both kinds of workers. CONCLUSIONS--The results support the hypothesis that home care service workers have higher annual injury incidence of musculoskeletal injuries than nursery school workers due to physically stressful tasks that are far less common in nursery school workers. PMID:7489060
Müller, Cornelia Sigrid Lissi; Burgard, Barbara; Zimmerman, Monika; Vogt, Thomas; Pföhler, Claudia
Die Methoden zur Behandlung akuter und chronischer Wunden unterliegen einer steten Weiterentwicklung, Reevaluierung und Anwendung innovativer Therapieformen. Die Vakuumtherapie zur Wundbehandlung gehört zu den etablierten Behandlungsmodalitäten. Ein innovatives Verfahren kombiniert die Vakuumtherapie mit der automatisierten, kontrollierten Zufuhr und Drainage wirkstoffhaltiger Lösungen zur topischen Wundbehandlung im Wundbett und auch wirkstofffrei durch Instillation physiologischer Kochsalzlösung (Unterdruck-Instillationstherapie). Hierdurch können die Effekte der konventionellen Vakuumtherapie mit denen der lokalen Antisepsis kombiniert werden. Hierdurch kommt es zu einer Reduktion der Wundfläche, einer Induktion von Granulationsgewebe sowie einer Reduktion der Keimbesiedelung der Wunden. Bisher publizierte Studien konzentrieren sich auf die Anwendung dieses Therapieverfahrens zur Behandlung orthopädisch-chirurgischer Krankheiten. Die Datenlage bezüglich der Vakuum-Instillationstherapie in der Dermatochirurgie beschränkt sich derzeit auf Fallberichte und Einzelfallerfahrungen. Randomisierte, prospektive Studien zum Vergleich der Vakuum-Instillationstherapie zur Behandlung dermatologischer Krankheitsbilder existieren bislang nicht. Ziele des vorliegenden Artikels sind die Vorstellung der Vakuumtherapie mit Instillation einschließlich ihres Wirkprinzips, deren mögliche Komplikationen, die Diskussion erdenklicher Kontraindikationen sowie eine Übersicht über die aktuell verfügbare Datenlage. Zusammenfassend scheint sich die Evidenz zu verdichten, dass mittels Unterdruck-Instillationstherapie sowohl einfache als auch komplizierte Wunden effizient behandelt werden können, was sich in einer deutlichen Beschleunigung der Wundgranulation mit konsekutiv früher möglichem Defektverschluss äußert.
Gaetke-Udager, Kara; Girish, Gandikota; Kaza, Ravi K; Jacobson, Jon; Fessell, David; Morag, Yoav; Jamadar, David
Occasionally patients who undergo magnetic resonance imaging for presumed pelvic disease demonstrate unexpected musculoskeletal imaging findings in the imaged field. Such incidental findings can be challenging to the abdominal radiologist, who may not be familiar with their appearance or know the appropriate diagnostic considerations. Findings can include both normal and abnormal bone marrow, osseous abnormalities such as Paget's disease, avascular necrosis, osteomyelitis, stress and insufficiency fractures, and athletic pubalgia, benign neoplasms such as enchondroma and bone island, malignant processes such as metastasis and chondrosarcoma, soft tissue processes such as abscess, nerve-related tumors, and chordoma, joint- and bursal-related processes such as sacroiliitis, iliopsoas bursitis, greater trochanteric pain syndrome, and labral tears, and iatrogenic processes such as bone graft or bone biopsy. Though not all-encompassing, this essay will help abdominal radiologists to identify and describe this variety of pelvic musculoskeletal conditions, understand key radiologic findings, and synthesize a differential diagnosis when appropriate.
Wu, Yulan; Jiang, Congli; Li, Meng; Yu, Haiqiong; Xiao, Xiaojun; Fan, Xiaoqin; Lin, Jianli; Liu, Xiaoyu; Zhang, Min; Yang, Pingchang; Liu, Zhigang
The Dermatophagoides farina (D. farina) allergens are an important factor contributing to allergic disease. To identify new allergens is important for diagnosis and treatment of allergic diseases. In this study, we sought to characterize the biological activity of Der f 21 of D. farina. The recombinant Der f 21 protein was characterized by western-blot, ELISA and Skin prick test using clinic patient's serum.An allergic asthma mouse model was established with the rDer f 21 as a specific antigen. The results showed that the sera from 28.9% in 38 dust mite allergic children displayed positive results in response to rDer f 21, and 42% in 98 dust mite allergic patients displayed positive response in skin prick test. In addition, Immune inhibition assays showed there was IgE cross-reactivity between rDer f 21 and rDer f 5. Moreover, an allergic asthma mouse model was established. Airway hyperresponsiveness, serum specific IgE, IgG1, eosinophil infiltration in the allergic mice, interleukin-4(IL-4) and interferon-γ (INF-γ) from spleen cells were markedly increased in the allergic mice. The results demonstrate that Der f 21 is a novel allergen.
Rosenbaum, Andrew J; Dunkman, Andrew; Goldberg, Daniel; Uhl, Richard L; Mulligan, Michael
Background: Approximately 33% of Americans have inadequate health literacy, which is associated with infrequent use of preventative services, increased hospitalization and use of emergency care, and worse control of chronic diseases. In this study, the Literacy in Musculoskeletal Problems (LiMP) questionnaire was used to evaluate the prevalence of limited musculoskeletal literacy in patients undergoing carpal tunnel release (CTR), as these individuals may be at increased risk of inferior outcomes. Methods: This cross-sectional study included individuals older than or equal to 18 years of age who were scheduled for elective CTR. Participants completed a demographic survey and the LiMP questionnaire during their preoperative office visit. The prevalence of limited health literacy was determined, with chi-square analysis used to determine the influence of demographic parameters. Results: The mean LiMP score was 6 ± 1.40. Limited musculoskeletal literacy was seen in 34% of participants (22/65). Analysis identified race (Caucasian), gender (female), higher education levels (≥college), current or prior employment in a health care field, and a prior physician visit for a non-carpal tunnel musculoskeletal complaint as being associated with higher literacy rates. Conclusions: Approximately one-third of patients scheduled for elective CTR have limited musculoskeletal literacy and may lack the necessary skills required for making informed decisions regarding their care. This is concerning, as CTR is performed in the United States on roughly 500 000 individuals annually, at an estimated cost of 2 billion dollars. The identification of those most at risk is thus crucial, and will facilitate the development of education campaigns and interventions geared toward those who are most vulnerable.
Zigheimat, Farzaneh; Ebadi, Abbas; Rahmati Najarkolaei, Fatemeh; Malakoti, Mohammad; Kheiri Tootkaleh, Farhad
Background The occupational health is an important issue. In some jobs, the working conditions contribute to musculoskeletal complaints and the overall health of the individual is compromised. Musculoskeletal complaints have gained credence in the public as one of the most important problems in the field of occupational diseases. Physical and mental health of crew members with critical jobs and stressful environments must be considered as well. Objectives This study performed an assessment on levels of mental health and the correlation with the frequency of accompanying musculoskeletal complaints (such as neck, back and knee pain) of crew members of speed boats. Material and Methods 149 onboard crew members of speed boats were recruited in a descriptive-correlation study by nonrandom sampling using conducted GHQ12, NMQ and demographic questionnaires. Results Although 63.8% (95 people) had what is conventionally defined as normal mental health, 36.2% (54 cases) had an inherent mental health condition. Overall, 61.1% (91 cases) suffered from back pain, 60.4% (90 cases) complained of knee pain, and 40.3% (60 patients) complained of neck pain. The combination of knee and back pain (48.3%) were the most common complaints whereas the combination of neck and knee pain (31.5%) were the least frequent; 28.2% complained of pain in all three areas. Interestingly, there was correlation between the presence of musculoskeletal complaints and less than optimum mental health. Conclusions Due to the high number of musculoskeletal complaints and the compromised mental health conditions among one-third of the onboard crew members of speed boats, attention for maintaining and improving the health of these members must be considered. PMID:24350130
Singh, Jasvinder A
Chronic musculoskeletal pain is a common cause of chronic pain, which is associated with a total cost of $635 billion per year in the U.S. Emerging evidence suggests an anti-nociceptive action of botulinum toxin, independent of its muscle paralyzing action. This review provides a summary of data from both non-randomized and randomized clinical studies of botulinum toxin in back pain and various osteoarticular conditions, including osteoarthritis, tennis elbow, low back pain and hand pain. Three randomized controlled trials (RCTs) of small sizes provide evidence of short-term efficacy of a single intra-articular injection of 100 units of botulinum toxin A (BoNT/A) for the relief of pain and the improvement of both function and quality of life in patients with chronic joint pain due to arthritis. Three RCTs studied intramuscular BoNT/A for tennis elbow with one showing a significant improvement in pain relief compared with placebo, another one showing no difference from placebo, and the third finding that pain and function improvement with BoNT/A injection were similar to those obtained with surgical release. One RCT of intramuscular BoNT/A for low back pain found improvement in pain and function compared to placebo. Single RCTs using local injections of BoNT in patients with either temporomandibular joint (TMJ) pain or plantar fasciitis found superior efficacy compared to placebo. One RCT of intramuscular BoNT/B in patients with hand pain and carpal tunnel syndrome found improvement in pain in both BoNT/B and placebo groups, but no significant difference between groups. Most evidence is based on small studies, but the use of BoNT is supported by a single, and sometimes up to three, RCTs for several chronic musculoskeletal pain conditions. This indicates that botulinum toxin may be a promising potential new treatment for chronic refractory musculoskeletal pain. Well-designed large clinical trials are needed. PMID:24715952
Forde, Martin S; Punnett, Laura; Wegman, David H
The prevalence of musculoskeletal disorder (MSD) symptoms and doctor-diagnosed musculoskeletal disorders (DDMDs) were estimated among union construction ironworkers by a telephone-administered questionnaire. Of 1996 ironworkers eligible, 1566 were contacted and 981 were interviewed. The prevalence of self-reported MSD symptoms was high for the lower back (56%), wrist/hands/fingers (40%), knees (39%), and shoulders (36%). The most common DDMDs were tendonitis (19%), ruptured disk in the back (18%), bursitis in the shoulder (15%), and carpal tunnel syndrome (12%). Generally, the prevalence of DDMDs and MSD symptoms increased with duration of employment. In age-adjusted logistic regression analyses, those who worked 25 to 35 years were more likely to have tendonitis (odds ratio [OR] 7.1, 95% confidence interval [CI] 3.116.6), shoulder bursitis (OR 13.7, 95% CI 3.160.4), knee bursitis (OR 5.1, 95% CI 1.025.1), and ruptured intervertebral back disk (OR 6.7, 95% CI 2.617.5). The effect of prior injury was also consistently high (upper extremities, OR 4.6; lower extremities OR 5.1; lower back, OR 6.0). Among workers without prior injuries, MSD symptoms were more frequent for the lower back in structural ironwork (OR 1.7, 95% CI 1.12.6), and for the upper extremity in concrete reinforcement ironwork (OR 1.9, 95% CI 1.22.9). These findings suggest that some musculoskeletal morbidity in construction ironworkers may be work related and thus preventable.
Duftner, Christina; Schüller-Weidekamm, Claudia; Mandl, Peter; Nothnagl, Thomas; Schirmer, Michael; Kainberger, Franz; Machold, Klaus; Dejaco, Christian
The aim of the study is to assess the clinical implementation of musculoskeletal ultrasound (MSUS) in rheumatology in Austria. A survey was conducted among Austrian rheumatologists and physicians of other specialties with a focus on rheumatology. The questionnaire was designed by the members of the Austrian Radiology-Rheumatology Initiative for Musculoskeletal UltraSound including the following items: demographics, access to MSUS and MSUS training, application of MSUS to support diagnosis, monitoring and treatment decisions, and obstacles for the routine performance of MSUS. Eighty-eight (21.9 %) out of the 402 surveyed physicians responded. No access to MSUS and/or inadequate training in the technique was more commonly reported by senior (>50 years; 64.3 and 67.7 %, respectively) than by younger physicians (16.7 %, p = 0.01 and 18.5 %, p < 0.001, respectively). The lowest availability of sonography was found among senior rheumatologists (25.0 %, p = 0.001 compared to the total group). MSUS is routinely used for diagnosis and/or monitoring purposes by 12.5 % of physicians and 20.5 % perform sonography in clinically unclear cases. A limited number of physicians apply the method to support treatment decisions and/or to evaluate treatment success. The most important obstacles for routine application of MSUS in rheumatology are limited access to ultrasound machines, lack of training/education in the technique, and time constraints in daily routine. Low access to high-end ultrasound devices, lack of training, and time constraints may explain the low appreciation of MSUS among Austrian physicians evaluating patients with rheumatic diseases.
Downs, Meghan E.
Ground based and ISS (International Space Station) exercise research have shown that axial loading via two-point loading at the shoulders and load quality (i.e. consistent load and at least 1:1 concentric to eccentric ratio) are extremely important to optimize musculoskeletal adaptations to resistance exercise. The Advanced Resistance Exercise Device (ARED) is on ISS now and is the "state of the art" for resistance exercise capabilities in microgravity; however, the ARED is far too large and power consuming for exploration vehicles. The single cable exercise device design selected for MPCV (Multi-Purpose Crew Vehicle), does not readily allow for the two-point loading at the shoulders.
Ayloo, Amba; Cvengros, Teresa; Marella, Srimannarayana
This article summarizes the evaluation and treatment of musculoskeletal causes of chest pain. Conditions such as costochondritis, rib pain caused by stress fractures, slipping rib syndrome, chest wall muscle injuries, fibromyalgia, and herpes zoster are discussed, with emphasis on evaluation and treatment of these and other disorders. Many of these conditions can be diagnosed by the primary care clinician in the office by history and physical examination. Treatment is also discussed, including description of manual therapy and exercises as needed for some of the conditions.
YAO, DAN; DENG, XINGQIANG; WANG, MINGGUANG
Excessive crying (or infant colic) is a common pain syndrome of infancy without any specific known aetiology or effective management. Many cases result in long-term poor sleep, behavioral problems and parental stress. The biomechanical aspects of this condition lack adequate investigation despite its strong link with assisted and/or difficult births. The present review focused on the current trends in the management of this mal-musculoskeletal health of infants associated with the condition of excessive crying. In addition, the risk factors associated with therapeutic procedures used to manage the above conditions were also discussed. PMID:27284288
Oztug, Ozhan; Cowie, Helen
The aim of the present research was to understand how office workers cope with back, neck and upper limb musculoskeletal disorders at work (and their implications for work). A small (N = 120) questionnaire survey collected information about potential participants' background and history of musculoskeletal disorders. These data were used to inform…
Hootman, Jennifer M.; Macera, Carol A.; Ainsworth, Barbara E.; Addy, Cheryl L.; Martin, Malissa; Blair, Steven N.
Examined types and frequencies of musculoskeletal injuries among adults with above average activity levels enrolled in the Dallas Aerobics Center Longitudinal Study. Participant surveys and examinations indicated that one-quarter of all respondents reported musculoskeletal injuries (most of which were activity- related). Sport participants had the…
Merlino, Linda A; Rosecrance, John C; Anton, Dan; Cook, Thomas M
Musculoskeletal disorders (MSDs) are a major cause of work-related disability and lost-time illnesses for many occupational groups. This study determined the prevalence of musculoskeletal symptoms among young construction workers. A symptom and job factors survey was self-administered to 996 construction apprentices. Prevalence was determined by the percent of positive responses to musculoskeletal symptom questions. Odds ratios and 95 percent confidence intervals were the measures of association between prevalent musculoskeletal symptoms and demographic, leisure, and job factors and were determined by logistic regression. The low back was the site most commonly reported for job-related musculoskeletal symptoms (54.4%), which was also the most common reason for seeking care from a physician (16.8%) and missing work (7.3%). Number of years worked in the construction trade was significantly associated with knee (p-trend = 0.0009) and wrist/hand (p-trend < 0.04) MSD symptoms and was suggestive of an association with low back pain (p-trend = 0.05). "Working in the same position for long periods" was the job factor identified as most problematic, with 49.7 percent of all construction apprentices rating it as a moderate/major problem contributing to musculoskeletal symptoms. Musculoskeletal symptoms are a significant problem among young construction workers at the beginning of their careers. Prevention strategies are needed early in the apprentice training program to reduce the potential disability associated with work-related musculoskeletal symptom disorders.
Sikdar, Siddhartha; Wei, Qi; Cortes, Nelson
Advances in imaging methods have led to new capability to study muscle and tendon motion in vivo. Direct measurements of muscle and tendon kinematics using imaging may lead to improved understanding of musculoskeletal function. This review presents quantitative ultrasound methods for muscle dynamics that can be used to assess in vivo musculoskeletal function when integrated with other conventional biomechanical measurements. PMID:24949846
Sikdar, Siddhartha; Wei, Qi; Cortes, Nelson
Advances in imaging methods have led to new capability to study muscle and tendon motion in vivo. Direct measurements of muscle and tendon kinematics using imaging may lead to improved understanding of musculoskeletal function. This review presents quantitative ultrasound methods for muscle dynamics that can be used to assess in vivo musculoskeletal function when integrated with other conventional biomechanical measurements.
Avila-Chaurand, R; Prado-León, L R; González-Muñoz, E L
This study of 114 workers in the hydrocarbon industry was conducted to identify the relationship between stress and musculoskeletal discomfort, and to view the roles played by such factors as age, schooling, obesity, workplace and job seniority. All factors except seniority were found to affect the presence of musculoskeletal discomfort in some area of the body.
Spath, Dieter; Koch, Steffen
In diesem Kapitel werden Grundlagen der Organisationsgestaltung dargestellt. Es scheint nahe liegend, diese Inhalte wie in einem Lehrbuch aufzubereiten. Schließlich handelt es sich um grundlegende Inhalte. Die Neufassung dieses Abschnitts ist aber stärker für Verantwortliche in Unternehmen geschrieben und weniger wissenschaftlich geprägt. Das "Lehrbuchwissen“ wird daher bewusst knapp gehalten. Das betrifft z.B. die Klärung des Organisationsbegriffes und die Fragen nach den Zielsetzungen und den Gestaltungsbereichen von Organisation. Stattdessen widmet sich das Kapitel ausführlicher den Fragen, ob es Trends in der Organisationsgestaltung gibt, welche wichtigen Einflussgrößen existieren und welche übergeordneten und beständigen Leitlinien es gibt.
... Effects Stress Tick-Borne Diseases Tobacco in the Workplace Traumatic Occupational Injuries Traumatic Incident Stress Upper Limb Musculoskeletal Disorder Consortium Tuberculosis Violence (Occupational) ( ...
Ahn, Joong Mo; El-Khoury, Georges Y
The unique ability of magnetic resonance (MR) imaging to visualize injuries of bone, cartilage, bone marrow, and supporting soft tissue structure makes it ideally suited for the evaluation of musculoskeletal trauma. Magnetic resonance imaging also offers exquisitely detailed anatomical information on the musculoskeletal system. The widespread availability of MR imaging and the constantly improving technology make it the imaging modality of choice for the patients with a musculoskeletal trauma. This review discusses the role and applications of MR imaging for musculoskeletal trauma. It covers traumatic conditions of the musculoskeletal system, including hemarthrosis, lipohemarthrosis, stress fracture, occult fractures, cartilage injuries, the muscle and tendon trauma, avulsion injuries, extensor mechanism injuries, and traumatic conditions of joints.
Sahoo, Sambit; Teh, Thomas Kh; He, Pengfei; Toh, Siew Lok; Goh, James Ch
Increasing incidence of musculoskeletal injuries coupled with limitations in the current treatment options have necessitated tissue engineering and regenerative medicine- based approaches. Moving forward from engineering isolated musculoskeletal tissues, research strategies are now being increasingly focused on repairing and regenerating the interfaces between dissimilar musculoskeletal tissues with the aim to achieve seamless integration of engineered musculoskeletal tissues. This article reviews the state-of-the-art in the tissue engineering of musculoskeletal tissue interfaces with a focus on Singapore's contribution in this emerging field. Various biomimetic scaffold and cellbased strategies, the use of growth factors, gene therapy and mechanical loading, as well as animal models for functional validation of the tissue engineering strategies are discussed.
Rao, Rohit T; Browe, Daniel P; Lowe, Christopher J; Freeman, Joseph W
Interface tissue engineering involves the development of engineered grafts that promote integration between multiple tissue types. Musculoskeletal tissue interfaces are critical to the safe and efficient transmission of mechanical forces between multiple musculoskeletal tissues, e.g., between ligament and bone tissue. However, these interfaces often do not physiologically regenerate upon injury, resulting in impaired tissue function. Therefore, interface tissue engineering approaches are considered to be particularly relevant for the structural restoration of musculoskeletal tissues interfaces. In this article, we provide an overview of the various strategies used for engineering musculoskeletal tissue interfaces with a specific focus on the recent important patents that have been issued for inventions that were specifically designed for engineering musculoskeletal interfaces as well as those that show promise to be adapted for this purpose.
Stephens, Mark B; Beutler, Anthony I; O'Connor, Francis G
Injections are valuable procedures for managing musculoskeletal conditions commonly encountered by family physicians. Corticosteroid injections into articular, periarticular, or soft tissue structures relieve pain, reduce inflammation, and improve mobility. Injections can provide diagnostic information and are commonly used for postoperative pain control. Local anesthetics may be injected with corticosteroids to provide additional, rapid pain relief. Steroid injection is the preferred and definitive treatment for de Quervain tenosynovitis and trochanteric bursitis. Steroid injections can also be helpful in controlling pain during physical rehabilitation from rotator cuff syndrome and lateral epicondylitis. Intra-articular steroid injection provides pain relief in rheumatoid arthritis and osteoarthritis. There is little systematic evidence to guide medication selection for therapeutic injections. The medication used and the frequency of injection should be guided by the goal of the injection (i.e., diagnostic or therapeutic), the underlying musculoskeletal diagnosis, and clinical experience. Complications from steroid injections are rare, but physicians should understand the potential risks and counsel patients appropriately. Patients with diabetes who receive periarticular or soft tissue steroid injections should closely monitor their blood glucose for two weeks following injection.
Metz, John P
Injections are valuable procedures for managing musculoskeletal conditions commonly encountered by family physicians. Corticosteroid injections into articular, periarticular, or soft tissue structures relieve pain, reduce inflammation, and improve mobility. Injections can provide diagnostic information and are commonly used for postoperative pain control. Local anesthetics may be injected with corticosteroids to provide additional, rapid pain relief. Steroid injection is the preferred and definitive treatment for de Quervain tenosynovitis and trochanteric bursitis. Steroid injections can also be helpful in controlling pain during physical rehabilitation from rotator cuff syndrome and lateral epicondylitis. Intra-articular steroid injection provides pain relief in rheumatoid arthritis and osteoarthritis. There is little systematic evidence to guide medication selection for therapeutic injections. The medication used and the frequency of injection should be guided by the goal of the injection (i.e., diagnostic or therapeutic), the underlying musculoskeletal diagnosis, and clinical experience. Complications from steroid injections are rare, but physicians should understand the potential risks and counsel patients appropriately. Patients with diabetes who receive periarticular or soft tissue steroid injections should closely monitor their blood glucose for two weeks following injection.
Palestro, Christopher J
There are numerous imaging tests for diagnosing musculoskeletal infection. Radiographs are routinely performed, because even when not diagnostic, they provide an anatomic overview of the region of interest that could influence subsequent procedure selection and interpretation. MRI is sensitive and provides superb anatomic detail. Bone scintigraphy accurately diagnoses osteomyelitis in bones not affected by underlying conditions. (67)Ga is used primarily for spondylodiskitis. Although in vitro labeled leukocyte imaging is the radionuclide test of choice for complicating osteomyelitis such as diabetic pedal osteomyelitis and prosthetic joint infection, it is not useful for spondylodiskitis. Antigranulocyte antibodies and antibody fragments have limitations and are not widely available. (111)In-biotin is useful for spondylodiskitis. Radiolabeled synthetic fragments of the antimicrobial peptide ubiquicidin are promising infection-specific agents. (18)F-FDG is the radiopharmaceutical of choice for spondylodiskitis. Its role in diabetic pedal osteomyelitis and prosthetic joint infection is not established. Preliminary data suggest (68)Ga may be useful in musculoskeletal infection. (124)I-fialuridine initially showed promise as an infection-specific radiopharmaceutical, but subsequent investigations were disappointing. The development of PET/CT and SPECT/CT imaging systems, which combine anatomic and functional imaging, has revolutionized diagnostic imaging. These hybrid systems are redefining the diagnostic workup of patients with suspected or known infection and inflammation by improving diagnostic accuracy and influencing patient management.
Hansen, Pamela A; Reed, Kristi
In this chapter we touched on a wide variety of unique musculoskeletal conditions in the musician and dancer. We outlined generalized methods of evaluation that stress the importance of the interdisciplinary approach in this highly specialized patient population and stressed the importance of specific involvement of the music or dance instructor in evaluation and management. We sought to emphasize the need to refer to specialized care early when in doubt of diagnosis or when usual first-line treatments fail. We gave examples of specific injury patterns common in these subgroups and suggestions for early management. Finally, we described some general principals for prevention of musculoskeletal injury in this group. A physician treating the performing artist must always keep in mind that in this unique patient population, their occupation is not only a means of earning a living, it is their passion. Artists make great sacrifice both physically and mentally to bring the world such immeasurable beauty. It is our responsibility to care for them in the most comprehensive and compassionate manner possible while informing them as honestly as possible about their treatment options.
Martel Villagrán, J; Bueno Horcajadas, Á; Agrela Rojas, E
We aim to describe imaging-guided (ultrasound and CT) interventional techniques in the musculoskeletal system that can be performed by general radiologists, whether in hospitals, primary care clinics, private offices, or other settings. The first requirement for doing these procedures is adequate knowledge of the anatomy of the musculoskeletal system. The second requirement is to inform the patient thoroughly about the technique, the risks involved, and the alternatives available in order to obtain written informed consent. The third requirement is to ensure that the procedure is performed in accordance with the principles of asepsis in relation to the puncture zone and to all the material employed throughout the procedure. The main procedures that can be done under ultrasound guidance are the following: fine needle aspiration cytology (FNAC), core needle biopsy (CNB), diagnostic and/or therapeutic arthrocentesis, drainage of juxta-articular fluid collections, drainage of abscesses, drainage of hematomas, treatment of Baker's cyst, treatment of ganglia, treatment of bursitis, infiltrations and treatment of plantar fasciitis, plantar fibrosis, epicondylitis, Achilles tendinopathy, and Morton's neuroma, puncture and lavage of calcifications in calcifying tendinopathy. We also review the following CT-guided procedures: diagnosis of spondylodiscitis, FNAC of metastases, arthrography, drainages. Finally, we also mention more complex procedures that can only be done in appropriate settings: bone biopsies, treatment of facet joint pain, radiofrequency treatment.
Bhatnagar, M K; Curtis, M J; Smith, G S
Among the 1274 patients admitted to a Pakistan border hospital from 1985 to 1987, the distribution and outcome of musculoskeletal war injuries differed from those seen in other conflicts. Serious complications from injuries were found in approximately 50 per cent of patients, of which most were wound infections, chronic osteomyelitis, and restriction of joint motion. Guerrillas in the Afghan war had no access to acute medical treatment in the field. Many patients died before reaching the hospital, as reflected in the low proportion of paraxial injuries; very high complication rates were noted for all injuries. Although some complications, such as soft tissue infection and foreign body retention are not site specific, other complications such as contracture, non-union, loss of range of motion, and chronic osteomyelitis are highly related to the region injured. Early surgical management and evacuation of those with musculoskeletal war injuries can greatly improve the outcome from war trauma and reduce the subsequent disability. However, the increasing use of hand-held anti-aircraft missiles may prevent the rapid evacuation of the wounded in future conflicts, and may make the situation seen in Afghanistan more common.
Lund, Marie; Stâhl, Fredrik; Gulliksson, Mârten
Inverse simulations of musculoskeletal models computes the internal forces such as muscle and joint reaction forces, which are hard to measure, using the more easily measured motion and external forces as input data. Because of the difficulties of measuring muscle forces and joint reactions, simulations are hard to validate. One way of reducing errors for the simulations is to ensure that the mathematical problem is well-posed. This paper presents a study of regularity aspects for an inverse simulation method, often called forward dynamics or dynamical optimization, that takes into account both measurement errors and muscle dynamics. Regularity is examined for a test problem around the optimum using the approximated quadratic problem. The results shows improved rank by including a regularization term in the objective that handles the mechanical over-determinancy. Using the 3-element Hill muscle model the chosen regularization term is the norm of the activation. To make the problem full-rank only the excitation bounds should be included in the constraints. However, this results in small negative values of the activation which indicates that muscles are pushing and not pulling, which is unrealistic but the error maybe small enough to be accepted for specific applications. These results are a start to ensure better results of inverse musculoskeletal simulations from a numerical point of view.
Müller, Ute; Lücker, Volker
Die Unversehrtheit von Leib und Leben ist das größte Rechtsgut unserer Gesellschaft. Dies macht schon das Grundgesetz in Art. 2 Abs. Satz 1 GG deutlich. Die Öffentlichkeit zeigt daher größtes Interesse an Produkten, welche der Gesundheit dienen und Leben retten oder erhalten. Dieses Interesse gilt einerseits der Entwicklung und Bereitstellung leistungsfähiger Medizinprodukte, andererseits zielt es auf deren Sicherheit. Um vor allem letztere zu gewährleisten, nimmt der Gesetzgeber alle Beteiligten in die Pflicht, die auftretenden Risiken auf das geringstmögliche Maß zu begrenzen. Dies spiegelt sich in den rechtlichen Vorgaben ebenso wie in den Haftungsfolgen, die bei Verletzung dieser Vorgaben greifen, wieder. Diese Folgen können dementsprechend gravierend ausfallen, von Geldstrafen bis zu Freiheitsstrafen, von Bußgeldzahlungen bis zum Schadenersatzansprüchen, die schnell ein wirtschaftliches Aus bedeuten können. Den Beteiligten, allen voran den Herstellern, muss deshalb daran gelegen sein, nicht nur die Produkte, sondern auch deren Sicherheit stetig weiter zu entwickeln.
Schulze, Elvira; Baume, Matthias; Graf, Stephan; Gergintchev, Ivan
Die Notwendigkeit der Qualitätssicherung und -kontrolle für innovative universitäre Lehr-/Lernszenarien ist in der Praxis unbestritten. Die Wirksamkeit der Einführung der zentralen Lernplattform CLIX Campus der imc AG an der TUM wurde mittels quantitativer und qualitativer Evaluation überprüft. Als statistische Bewertungsgrundlage wurde der Erreichungsgrad bestimmter Projektziele herangezogen. Aufbauend auf den theoretischen Grundlagen der Evaluation von Bildungsangeboten gibt diese Studie Aufschluss über die Ergebnisse der Datenerhebungen sowie die Einschätzung der Plattform aus Nutzersicht und belegt die wesentliche Bedeutung der durchgängigen IT-Infrastruktur und speziell der einheitlichen Verfügbarkeit der eLearning Angebote.
Querol, F; Rodriguez-Merchan, E C
Recurrent haemarthrosis is the final cause of haemophilic arthrosic disease in haemophilia patients. Therefore, it is essential to diagnose it early, both clinically and by imaging. In addition, haemophilia patients experience chronic synovitis, joint degeneration, muscle haematoma and pseudotumours. The objective of this article is to highlight the value of ultrasounds in the diagnosis and control of the evolution of musculo-skeletal problems in haemophilia patients. To this end, we have performed a literature search in the PubMed, Web of Science(®) (WOS) and SciVerse bases, using the following keywords: hemophilia or haemophilia and ultrasonography (US), ultrasound, echography and sonography. The search was limited to studies published in English between the years 1991 and 2011, finding a total of 221 references. After reviewing the title or abstract for evidence of the use of US for the diagnosis of musculo-skeletal lesions in haemophilia, we selected 24 of these references. We added data collected from our experience to the most important data found in the references. Our main conclusion is that US is highly valuable for the diagnosis of musculo-skeletal diseases in haemophilia. It is a fast, effective, safe, available, comparative, real-time technique that can help us confirm the clinical examination. It is particularly important in acute haemarthrosis, as it can be used to objectively identify the presence of blood in the joints, measure its size, pinpoint its location, assess its evolution and confirm its complete disappearance.
Historically, most diagnostic and treatment modalities have been based on a male model. Osteoporosis is one of the few diseases in which there has been sex-based research and treatment bias in favor of women. As such, it is not known whether treatments developed for women will be efficacious for men. Similarly, scientists are just beginning to research whether sex-based differences in musculoskeletal health exist with extended space travel. Both women and men lose muscle and bone with extended space travel, but the low numbers of female astronauts combined with a lack of discrete data make it challenging to accurately pinpoint sex-based differences. More data collection is needed to ensure that the musculoskeletal health of astronauts is better managed both on earth and in space.
Hu, Xiao; Blemker, Silvia S
Duchenne muscular dystrophy (DMD) is a genetic disease that occurs due to the deficiency of the dystrophin protein. Although dystrophin is deficient in all muscles, it is unclear why degeneration progresses differently across muscles in DMD. We hypothesized that each muscle undergoes a different degree of eccentric contraction during gait, which could contribute to the selective degeneration in lower limb muscle, as indicated by various amounts of fatty infiltration. By comparing eccentric contractions quantified from a previous multibody dynamic musculoskeletal gait simulation and fat fractions quantified in a recent imaging study, our preliminary analyses show a strong correlation between eccentric contractions during gait and lower limb muscle fat fractions, supporting our hypothesis. This knowledge is critical for developing safe exercise regimens for the DMD population. This study also provides supportive evidence for using multiscale modeling and simulation of the musculoskeletal system in future DMD research.
Cho, KiHun; Cho, Hwi-Young; Han, Gyeong-Soon
[Purpose] The purpose of this study was to investigate the association between psychosocial stress, occupational stress, and musculoskeletal symptoms in Korean dental practitioners. [Subjects and Methods] Self-reported questionnaires were distributed to 401 dental practitioners in Korea. To assess the risk factors related to musculoskeletal disorders, the Nordic Musculoskeletal Questionnaire, the Korean Occupational Stress Scale, and Psychosocial Well-Being Index Short Form were used. General and work-related characteristics of the subjects consisted of seven items, including age, career, height, weight, working days/week, working hours/day, and physical strain levels. [Results] In this study, 86.8% of the practitioners experienced musculoskeletal symptoms (shoulders, 72.8%; neck, 69.3%; waist, 68.3%; wrist, 58.4%; back, 44.1%; ankle, 38.7%; knee, 36.9%; hip, 20.4%; and elbows, 9.2%). Moreover, psychosocial and occupational stress can affect the occurrence of musculoskeletal disorders. In particular, we found that psychosocial stress has significant influence on the occurrence of musculoskeletal disorders. [Conclusion] To increase the quality of life and provide high-quality medical service for dental practitioners, risk factors for musculoskeletal disorders must be managed. Accordingly, dental practitioners must maintain good posture, get an appropriate amount of rest, and perform regular stretching exercise to reduce psychological stress and improve the work environment.
Maiya, Arun G.; Kumar, Pratap; Kamath, Asha
Background and Objectives. Pregnancy triggers a wide range of changes in a woman's body leading to various musculoskeletal dysfunctions. Most commonly reported musculoskeletal discomforts by pregnant women are low back pain and symphysis pubis pain. The culture and the environmental factors may influence the discomforts experienced by a pregnant woman. There is a dearth of literature in India, regarding the common musculoskeletal dysfunctions experienced by a pregnant woman, and hence this study. Method. A questionnaire to identify the musculoskeletal dysfunction was developed; content was validated and was translated to local languages through parallel back translation. 261 primiparous pregnant women participated in the study and filled the questionnaire in their native language. Results. Among the musculoskeletal dysfunctions reported by the pregnant women, 64.6% reported calf muscle cramps, 37.1% reported foot pain, and 33.7% experienced low back pain in their third trimester. In the second trimester, common musculoskeletal dysfunctions experienced by the women were that of calf pain (47.8%), low back pain (42%), and pelvic girdle pain (37%). Conclusion. Musculoskeletal dysfunctions and general discomforts very commonly affect the activities of daily living of pregnant women. Understanding the common discomforts during various trimesters of pregnancy will help to develop a comprehensive program for prevention and cure. PMID:25642349
Foster, Zoë J; Voss, Tyler T; Hatch, Jacquelynn; Frimodig, Adam
Family physicians considering corticosteroid injections as part of a comprehensive treatment plan for musculoskeletal diagnoses will find few high-quality studies to assist with evidence-based decision making. Most studies of corticosteroid injections for the treatment of osteoarthritis, tendinopathy, bursitis, or neuropathy include only small numbers of patients and have inconsistent long-term follow-up. Corticosteroid injections for the treatment of adhesive capsulitis result in short-term improvements in pain and range of motion. For subacromial impingement syndrome, corticosteroid injections provide short-term pain relief and improvement in function. In medial and lateral epicondylitis, corticosteroid injections offer only short-term improvement of symptoms and have a high rate of symptom recurrence. Corticosteroid injections for carpal tunnel syndrome may help patients avoid or delay surgery. Trigger finger and de Quervain tenosynovitis may be treated effectively with corticosteroid injections. Patients with hip or knee osteoarthritis may have short-term symptom relief with corticosteroid injections.
Sun, Yulong; Berger, Evelyn J; Zhao, Chunfeng; An, Kai-Nan; Amadio, Peter C; Jay, Gregory
Lubricin, also known as superficial zone protein or PRG4, has many distinct biological functions, including lubrication, antiadhesion, and as a regulator of cell growth. This study investigated lubricin in canine musculoskeletal tissues using RT-PCR and immunohistochemistry. One or more variants were noted in canine flexor digitorum profundus (FDP) tendon, Achilles tendon, patellar tendon, A2 pulley, anterior cruciate ligament (ACL), knee lateral collateral ligament (LCL), articular cartilage, meniscus, muscle, and skin. We found 6 N-terminal lubricin splicing variants. The variants with larger sizes were identified in FDP tendon, ACL, LCL, A2 pulley, and cartilage. Lubricin was distributed both on the tissue surfaces and at the interface of fiber bundles within tissues, but this distribution varied by tissue type. We conclude that lubricin is present in many tissues; variations in splicing and physical distribution suggest that the variants of lubricin may play different roles in different locations.
Nuclear scintigraphic examination of equine athletes has a potentially important role in the diagnosis of lameness or poor performance, but increased radiopharmaceutical uptake (IRU) is not necessarily synonymous with pain causing lameness. Nuclear scintigraphy is highly sensitive to changes in bone turnover that may be induced by loading and knowledge of normal patterns of RU is crucial for accurate diagnosis. Blood pool images can be useful for identification of some soft tissue injuries, although acute bone injuries may also have intense IRU in blood pool images. Some muscle injuries may be associated with IRU in bone phase images. The use of scintigraphy together with other diagnostic imaging modalities has helped us to better understand the mechanisms of some musculoskeletal injuries. In immature racehorses, stress-related bone injury is a common finding and may be multifocal, whereas in mature sport horses, a very different spectrum of injuries may be identified. False-negative results are common with some injuries.
Draghi, F; Robotti, G; Jacob, D; Bianchi, S
In recent years ultrasonography (US) has emerged as the imaging technique of choice for guiding diagnostic and therapeutic procedures including those related to the musculoskeletal system. However, the absence of ionizing radiation and the elevated safety of the method must not lead us to forget that there are precautions and contraindications to keep in mind, which are crucial to the protection of both the patient and the physician.Among these precautions it is first of all essential to obtain the patient's accurate clinical history including current medication, particularly if it involves drugs influencing the blood clotting, and information related to possible allergies. The patient should furthermore receive detailed information concerning the procedure (sterile precautions as well as possible side-effects of the drugs which will be injected). In addition to this, there must be a close contact between the radiologist and the patient's general physician (GP) in order to obtain the best possible result of the procedure.
The treatment of musculoskeletal sarcomas has made vast strides in the last few decades. From an era where amputation was the only option to the current day function preserving resections and complex reconstructions has been a major advance. The objectives of extremity reconstruction after oncologic resection include providing skeletal stability where necessary, adequate wound coverage to allow early subsequent adjuvant therapy, optimising the aesthetic outcome and preservation of functional capability with early return to function. This article highlights the concepts of surgical margins in oncology, discusses the principles governing safe surgical resection in these tumors and summarises the current modalities and recent developments relevant to reconstruction after limb salvage. The rationale of choice of a particular resection modality, the unique challenges of reconstruction in skeletally immature individuals and the impact of adjuvant modalities like chemotherapy and radiotherapy on surgical outcomes are also discussed. PMID:25190911
Pabinger-Fasching, Ingrid; Eichinger-Hasenauer, Sabine; Grohs, Josef; Hochreiter, Josef; Kastner, Norbert; Korninger, Hans Christian; Kozek-Langenecker, Sibylle; Marlovits, Stefan; Niessner, Herwig; Rachbauer, Franz; Ritschl, Peter; Wurnig, Christian; Windhager, Reinhard
Musculoskeletal surgery is associated with a high risk of venous thrombosis and pulmonary embolism. The introduction of direct oral anticoagulants (DOAK) has broadened the possibilities for prevention of venous thromboembolism in the course of orthopedic and trauma surgery. Addressing this recent development, the Austrian Societies of Orthopedics and Orthopedic Surgery (ÖGO), Trauma Surgery (ÖGU), Hematology and Oncology (OeGHO) and of Anaesthesiology, Reanimation und Intensive Care Medicine (ÖGARI) have taken the initiative to create Austrian guidelines for the prevention of thromboembolism after total hip and knee replacement, hip fracture surgery, interventions at the spine and cases of minor orthopedic and traumatic surgery. Furthermore, the pharmacology of the DOAK and the pivotal trial data for each of the three currently available substances - apixaban, dabigatran, and rivaroxaban - are briefly presented. Separate chapters are dedicated to "anticoagulation and neuroaxial anesthesia" and "bridging".
Esquivel-Sirvent, Raul; Schatz, George
The theory of generalized van der Waals forces by Lifshtz when applied to optically anisotropic media predicts the existence of a torque. In this work we present a theoretical calculation of the van der Waals torque for two systems. First we consider two isotropic parallel plates where the anisotropy is induced using an external magnetic field. The anisotropy will in turn induce a torque. As a case study we consider III-IV semiconductors such as InSb that can support magneto plasmons. The calculations of the torque are done in the Voigt configuration, that occurs when the magnetic field is parallel to the surface of the slabs. The change in the dielectric function as the magnetic field increases has the effect of decreasing the van der Waals force and increasing the torque. Thus, the external magnetic field is used to tune both the force and torque. The second example we present is the use of the torque in the non retarded regime to align arrays of nano particle slabs. The torque is calculated within Barash and Ginzburg formalism in the nonretarded limit, and is quantified by the introduction of a Hamaker torque constant. Calculations are conducted between anisotropic slabs of materials including BaTiO3 and arrays of Ag nano particles. Depending on the shape and arrangement of the Ag nano particles the effective dielectric function of the array can be tuned as to make it more or less anisotropic. We show how this torque can be used in self assembly of arrays of nano particles. ref. R. Esquivel-Sirvent, G. C. Schatz, Phys. Chem C, 117, 5492 (2013). partial support from DGAPA-UNAM.
Thompson, L.; Ouzounian, T.J.; Webber, M.M.; Amstutz, H.C.
This study evaluated the accuracy and utility of the In-111 labeled WBC imaging in a series of patients who were suspected of having musculoskeletal sepsis. The labeling of the WBCs was patterned after a method previously described, in which the WBCs are labeled with In-111 oxine in plasma. The WBCs from 100 ml of blood are separated and incubated with In-111 oxine complex, and then 500 ..mu..Ci. of the labeled cells were reinjected into the patient. Images of the areas in question were obtained at 24 hrs. In some instances, 48 hour images were also obtained. Images were interpreted using consistent criteria. Forty imaging procedures were done on 39 patients. These included 39 total joint protheses, and 17 other images to evaluate possible osteomyelitis, septic arthritis or deep abscesses. Of these studies, 15 were positive, and 42 negative. The findings were then correlated with operative culture and pathology in 21, aspiration cultures and gram stains in 14, and with clinical findings in the remaining 21. This correlation showed 41 true negatives, 12 true positives, 1 false negative, and 2 false positives. The sensitivity was 92.9% and the specificity was 95.2%l. The false negative occurred in a patient on chronic suppressive antibiotic therapy for an infected total hip replacement. The false positive images occurred in a patient with active rheumatoid arthritis and in a patient imaged one month post operative placement of the prosthesis. These images were very useful in several septic patients who had many possible sites of infection. The authors conclude that In-III imaging is an accurate and useful non-invasive method of evaluating musculoskeletal sepsis.
Briggs, Andrew M; Cross, Marita J; Hoy, Damian G; Sànchez-Riera, Lídia; Blyth, Fiona M; Woolf, Anthony D; March, Lyn
Persistent pain, impaired mobility and function, and reduced quality of life and mental well-being are the most common experiences associated with musculoskeletal conditions, of which there are more than 150 types. The prevalence and impact of musculoskeletal conditions increase with aging. A profound burden of musculoskeletal disease exists in developed and developing nations. Notably, this burden far exceeds service capacity. Population growth, aging, and sedentary lifestyles, particularly in developing countries, will create a crisis for population health that requires a multisystem response with musculoskeletal health services as a critical component. Globally, there is an emphasis on maintaining an active lifestyle to reduce the impacts of obesity, cardiovascular conditions, cancer, osteoporosis, and diabetes in older people. Painful musculoskeletal conditions, however, profoundly limit the ability of people to make these lifestyle changes. A strong relationship exists between painful musculoskeletal conditions and a reduced capacity to engage in physical activity resulting in functional decline, frailty, reduced well-being, and loss of independence. Multilevel strategies and approaches to care that adopt a whole person approach are needed to address the impact of impaired musculoskeletal health and its sequelae. Effective strategies are available to address the impact of musculoskeletal conditions; some are of low cost (e.g., primary care-based interventions) but others are expensive and, as such, are usually only feasible for developed nations. In developing nations, it is crucial that any reform or development initiatives, including research, must adhere to the principles of development effectiveness to avoid doing harm to the health systems in these settings.
Betrachtet man die Quantenphysik als Zusammenspiel von elementaren Erzeugungs- und Vernichtungsprozessen, so sind Eichfeldtheorien nicht nur möglich, sondern auch notwendig. Die komplex konjugierten Phasenfaktoren jedes Paares von Erzeugungs- und Vernichtungsoperatoren sind nämlich. willkürlich wählbar. Darum müssen Quantenfeldtheorien vollständig phaseninvariant sein. Das ist ohne Eichfelder nicht möglich.Dem steht im Wege, daß die Diracgleichung nicht einmal global vollständig phaseninvariant ist. Multipliziert man nämlich die Komponenten der Erzeugungs- und Vernichtungsoperatoren mit verschiedenen konstanten Phasenfaktoren, so ändern sich die Diracmatrizen. Nur die Diracschen Vertauschungsrelationen bleiben invariant. Doch sind die Diracgleichungen vor und nach der Transformation physikalisch äquivalent. Man kann also sagen: Systeme freier Fermionen werden erst durch die Klasse aller äquivalenten Diracgleichungen vollständig dargestellt.Da die Diracschen Vertauschungsrelationen gegen beliebige unitäre Transformationen invariant sind, ist die Klasse äquivalenter Diracgleichungen U 4-invariant. Unitäre Diagonalmatrizen liefern willkürliche Phasentransformationen der Spinorkomponenten, so daß die zur Gruppe U 4 gehörigen Eichfelder zu eine allgemein phaseninvarianten Theorie führen. Sie ist so eng mit der QED verwandt, daß wir von einer erweiterten Quantenelektrodynamik, EQE, sprechen können.Hier soll nur gezeigt werden, daß die EQE existiert. Dabei liefert die invariante Untergruppe U 1 von U 4 die QED. Die komplementäre Untergruppe SU 4 umschließt vier Untergruppen SU 3, drei Untergruppen O 4 und sechs Untergruppen SU 2. Letztere könnten den drei Paaren von Quarks und den drei Paaren von Leptonen entsprechen, wobei sich die Quarkpaare zu einer Gruppe SU 3 zusammenschließen. Mehr als zweimal drei Paare von elementaren Fermionen gibt es in der EQE nicht. Sie wird zwar kaum mit der vereinigten QED und QCD identisch sein. Doch sollte sie
Mito, Takayuki; Ishizaki, Hikari; Suzuki, Michiko; Morishima, Hitomi; Ota, Azusa; Ishikawa, Kaori; Nakada, Kazuto; Maeno, Akiteru; Shiroishi, Toshihiko; Hayashi, Jun-Ichi
The spectra of phenotypes associated with aging and mitochondrial diseases sometimes appear to overlap with each other. We used aged mice and a mouse model of mitochondrial diseases (transmitochondrial mito-miceΔ with deleted mtDNA) to study whether premature aging phenotypes observed in mtDNA mutator mice are associated with aging or mitochondrial diseases. Here, we provide convincing evidence that all the mice examined had musculoskeletal disorders of osteoporosis and muscle atrophy, which correspond to phenotypes prevalently observed in the elderly. However, precise investigation of musculoskeletal disorders revealed that the spectra of osteoporosis and muscle atrophy phenotypes in mtDNA mutator mice were very close to those in mito-miceΔ, but different from those of aged mice. Therefore, mtDNA mutator mice and mito-miceΔ, but not aged mice, share the spectra of musculoskeletal disorders.
Winn, Naomi; Lalam, Radhesh; Cassar-Pullicino, Victor
Ultrasound is an essential modality within musculoskeletal imaging, with the recent addition of elastography. The elastic properties of tissues are different from the acoustic impedance used to create B mode imaging and the flow properties used within Doppler imaging, hence elastography provides a different form of tissue assessment. The current role of ultrasound elastography in the musculoskeletal system will be reviewed, in particular with reference to muscles, tendons, ligaments, joints and soft tissue tumours. The different ultrasound elastography methods currently available will be described, in particular strain elastography and shear wave elastography. Future directions of ultrasound elastography in the musculoskeletal system will also be discussed. PMID:27928468
Effects of Dairy Products Consumption on Health: Benefits and Beliefs--A Commentary from the Belgian Bone Club and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases.
Rozenberg, Serge; Body, Jean-Jacques; Bruyère, Olivier; Bergmann, Pierre; Brandi, Maria Luisa; Cooper, Cyrus; Devogelaer, Jean-Pierre; Gielen, Evelien; Goemaere, Stefan; Kaufman, Jean-Marc; Rizzoli, René; Reginster, Jean-Yves
Dairy products provide a package of essential nutrients that is difficult to obtain in low-dairy or dairy-free diets, and for many people it is not possible to achieve recommended daily calcium intakes with a dairy-free diet. Despite the established benefits for bone health, some people avoid dairy in their diet due to beliefs that dairy may be detrimental to health, especially in those with weight management issues, lactose intolerance, osteoarthritis, rheumatoid arthritis, or trying to avoid cardiovascular disease. This review provides information for health professionals to enable them to help their patients make informed decisions about consuming dairy products as part of a balanced diet. There may be a weak association between dairy consumption and a possible small weight reduction, with decreases in fat mass and waist circumference and increases in lean body mass. Lactose intolerant individuals may not need to completely eliminate dairy products from their diet, as both yogurt and hard cheese are well tolerated. Among people with arthritis, there is no evidence for a benefit to avoid dairy consumption. Dairy products do not increase the risk of cardiovascular disease, particularly if low fat. Intake of up to three servings of dairy products per day appears to be safe and may confer a favourable benefit with regard to bone health.
The open access model, where researchers can publish their work and make it freely available to the whole medical community, is gaining ground over the traditional type of publication. However, fees are to be paid by either the authors or their institutions. The purpose of this paper is to assess the proportion and type of open access evidence-based articles in the form of systematic reviews and meta-analyses in the field of musculoskeletal disorders and orthopedic surgery. PubMed database was searched and the results showed a maximal number of hits for low back pain and total hip arthroplasty. We demonstrated that despite a 10-fold increase in the number of evidence-based publications in the past 10 years, the rate of free systematic reviews in the general biomedical literature did not change for the last two decades. In addition, the average percentage of free open access systematic reviews and meta-analyses for the commonest painful musculoskeletal conditions and orthopedic procedures was 20% and 18%, respectively. Those results were significantly lower than those of the systematic reviews and meta-analyses in the remaining biomedical research. Such findings could indicate a divergence between the efforts engaged at promoting evidence-based principles and those at disseminating evidence-based findings in the field of musculoskeletal disease and trauma. The high processing fee is thought to be a major limitation when considering open access model for publication.
Cardozo, Alejandro; Silva, Carlos; Dominguez, Luis; Botero, Beatriz; Zambrano, Paulo; Bareno, Jose
BACKGROUND: Mild to moderate musculoskeletal trauma is a common cause for an emergency room visit, and frequent pain is one of the cardinal symptoms of consultation. The objective of this study is to assess the perception of a single subcutaneous dose of 50 mg tramadol for pain management in patients with mild to moderate musculoskeletal trauma, likewise to appraise the perception of pain by subcutaneous injection. METHODS: A total of 77 patients, who met inclusion criteria, received a single subcutaneous dose of tramadol. Pain control was evaluated based on the verbal numerical pain scale (0–10) at baseline, 20 and 60 minutes; similarly, pain perception was evaluated secondary to subcutaneous injection of the analgesic. RESULTS: On admission, the average pain perceived by patients was 8; twenty minutes later, 89% of the patients reported five or less, and after sixty minutes, 94% had three or less on the verbal numerical pain scale. Of the patients, 88% reported pain perception by verbal numeric scale of 3 or less by injection of the drug, and 6.5% required a second analgesic for pain control. Two events with drug administration (soft tissue infection and mild abdominal rectus injection) were reported. CONCLUSION: We conclude that a single subcutaneous dose of tramadol is a safe and effective option for the management of patients with mild to moderate pain and musculoskeletal disease in the emergency department. PMID:25548601
Aichelburg, P. C.
Contents: Einleitung(P. C. Aichelburg). 1. Über Zeit, Bewegung und Veränderung (Aristoteles). 2. Ewigkeit und Zeit (Plotin). 3. Was ist die Zeit? (Augustinus). 4. Von der Zeit (Immanuel Kant). 5. Newtons Ansichten über Zeit, Raum und Bewegung (Ernst Mach). 6. Über die mechanische Erklärung irreversibler Vorgänge (Ludwig Boltzmann). 7. Das Maß der Zeit (Henri Poincaré). 8. Dauer und Intuition (Henri Bergson). 9. Die Geschichte des Unendlichkeitsproblems (Bertrand Russell). 10. Raum und Zeit (Hermann Minkowski). 11. Der Unterschied von Zeit und Raum (Hans Reichenbach). 12. Newtonscher und Bergsonscher Zeitbegriff (Norbert Wiener). 13. Die Bildung des Zeitbegriffs beim Kinde (JeanPiaget).14. Eine Bemerkung über die Beziehungen zwischen Relativitätstheorie und der idealistischen Philosophie (Kurt Gödel). 15. Der zweite Hauptsatz und der Unterschied von Vergangenheit und Zukunft (Carl Friedrich v. Weizsäcker). 16. Zeit als physikalischer Begriff (Friedrich Hund). 17. Zeitmessung und Zeitbegriff in der Astronomie (Otto Heckmann). 18. Kann die Zeit rückwärts gehen? (Martin Gardner). 19. Zeit und Zeiten (Ilya Prigogine, Isabelle Stengers). 20. Zeit als dynamische Größe in der Relativitätstheorie (P. C. Aichelburg).
Paluch, Łukasz; Nawrocka-Laskus, Ewa; Wieczorek, Janusz; Mruk, Bartosz; Frel, Małgorzata; Walecki, Jerzy
Summary This article presents possible applications of ultrasound elastography in musculoskeletal imaging based on the available literature, as well as the possibility of extending indications for the use of elastography in the future. Ultrasound elastography (EUS) is a new method that shows structural changes in tissues following application of physical stress. Elastography techniques have been widely used to assess muscles and tendons in vitro since the early parts of the twentieth century. Only recently with the advent of new technology and creation of highly specialized ultrasound devices, has elastography gained widespread use in numerous applications. The authors performed a search of the Medline/PubMed databases for original research and reviewed publications on the application of ultrasound elastography for musculoskeletal imaging. All publications demonstrate possible uses of ultrasound elastography in examinations of the musculoskeletal system. The most widely studied areas include the muscles, tendons and rheumatic diseases. There are also reports on the employment in vessel imaging. The main limitation of elastography as a technique is above all the variability of applied pressure during imaging, which is operator-dependent. It would therefore be reasonable to provide clear guidelines on the technique applied, as well as clear indications for performing the test. It is important to develop methods for creating artifact-free, closed-loop, compression-decompression cycles. The main advantages include cost-effectiveness, short duration of the study, non-invasive nature of the procedure, as well as a potentially broader clinical availability. There are no clear guidelines with regard to indications as well as examination techniques. Ultrasound elastography is a new and still poorly researched method. We conclude, however, that it can be widely used in the examinations of musculoskeletal system. Therefore, it is necessary to conduct large, multi
Naredo, E; Möller, I; Moragues, C; de Agustín, J J; Scheel, A K; Grassi, W; de Miguel, E; Backhaus, M; Balint, P; Bruyn, G A W; D'Agostino, M A; Filippucci, E; Iagnocco, A; Kane, D; Koski, J M; Mayordomo, L; Schmidt, W A; Swen, W A A; Szkudlarek, M; Terslev, L; Torp‐Pedersen, S; Uson, J; Wakefield, R J; Werner, C
Objective To assess the interobserver reliability of the main periarticular and intra‐articular ultrasonographic pathologies and to establish the principal disagreements on scanning technique and diagnostic criteria between a group of experts in musculoskeletal ultrasonography. Methods The shoulder, wrist/hand, ankle/foot, or knee of 24 patients with rheumatic diseases were evaluated by 23 musculoskeletal ultrasound experts from different European countries randomly assigned to six groups. The participants did not reach consensus on scanning method or diagnostic criteria before the investigation. They were unaware of the patients' clinical and imaging data. The experts from each group undertook a blinded ultrasound examination of the four anatomical regions. The ultrasound investigation included the presence/absence of joint effusion/synovitis, bony cortex abnormalities, tenosynovitis, tendon lesions, bursitis, and power Doppler signal. Afterwards they compared the ultrasound findings and re‐examined the patients together while discussing their results. Results Overall agreements were 91% for joint effusion/synovitis and tendon lesions, 87% for cortical abnormalities, 84% for tenosynovitis, 83.5% for bursitis, and 83% for power Doppler signal; κ values were good for the wrist/hand and knee (0.61 and 0.60) and fair for the shoulder and ankle/foot (0.50 and 0.54). The principal differences in scanning method and diagnostic criteria between experts were related to dynamic examination, definition of tendon lesions, and pathological v physiological fluid within joints, tendon sheaths, and bursae. Conclusions Musculoskeletal ultrasound has a moderate to good interobserver reliability. Further consensus on standardisation of scanning technique and diagnostic criteria is necessary to improve musculoskeletal ultrasonography reproducibility. PMID:15941835
Seo, Jeong-Woo; Kang, Dong-Won; Kim, Ju-Young; Yang, Seung-Tae; Kim, Dae-Hyeok; Choi, Jin-Seung; Tack, Gye-Rae
In this study, the accuracy of the inputs required for finite element analysis, which is mainly used for the biomechanical analysis of bones, was improved. To ensure a muscle force and joint contact force similar to the actual values, a musculoskeletal model that was based on the actual gait experiment was used. Gait data were obtained from a healthy male adult aged 29 who had no history of musculoskeletal disease and walked normally (171 cm height and 72 kg weight), and were used as inputs for the musculoskeletal model simulation to determine the muscle force and joint contact force. Among the phases of gait, which is the most common activity in daily life, the stance phase is the most affected by the load. The results data were extracted from five events in the stance phase: heel contact (ST1), loading response (ST2), early mid-stance (ST2), late mid-stance (ST4), and terminal stance (ST5). The results were used as the inputs for the finite element model that was formed using 1.5mm intervals computed tomography (CT) images and the maximum Von-Mises stress and the maximum Von-Mises strain of the right femur were examined. The maximum stress and strain were lowest at the ST4. The maximum values for the femur occurred in the medial part and then in the lateral part after the mid-stance. In this study, the results of the musculoskeletal model simulation using the inverse-dynamic analysis were utilized to improve the accuracy of the inputs, which affected the finite element analysis results, and the possibility of the bone-specific analysis according to the lapse of time was examined.
Crespo, Isabel; Bergmann, Lars; Lacker, Thomas
Ursprünglich stammt der Begriff "Strategie“ aus dem Altgriechischen: "strategos“ bedeutete "Heer“, "Heeresmacht“ und damit auch "konzentrierte Kraft“; das Wort "agein“ bedeutete "tun, machen, treiben“. Ein Stratege war also eine Person, die ein Heer führte und damit Kraft, Macht und Stärke konzentrierte und einsetzen konnte. Strategie bezeichnete dementsprechend die Maßnahmen, die in dieser Funktion entwickelt wurden. Daher ist es leicht verständlich, dass der Begriff Strategie bis in die Mitte des letzten Jahrhunderts in erster Linie militärisch verstanden wurde. Anschließend wurde der Begriff in weiteren Bereichen, wie beispielsweise der Unternehmensführung, verwendet. Im betriebswirtschaftlichen Sinne bedeutet der Begriff Strategie die langfristig geplante Verhaltensweise eines Unternehmens zur Erreichung seiner Ziele.
Vargas-Prada, Sergio; Coggon, David
Although much attention has been given to the physical determinants of common musculoskeletal complaints such as back and arm pain, research points to a stronger influence of psychological factors. Multiple studies have implicated poor mental health and somatisation (a tendency to worry about common somatic symptoms) in the incidence and chronicity of musculoskeletal pain and associated disability. Also important are adverse beliefs about the prognosis of such disorders, and about the role of physical activity in their development and persistence. Differences in societal beliefs may have contributed to major variation in the prevalence of disabling musculoskeletal pain that has been observed between countries and in the same countries over time. Psychosocial aspects of work have also been linked with musculoskeletal pain, although relative risks have generally been smaller. There is a need to take account of psychological factors in the clinical management of patients with back, neck and arm pain. PMID:26612236
Die Schwedische Akademie der Wissenschaften vergab in diesem Jahr den Physik-Nobelpreis zu gleichen Teilen an die amerikanischen Physiker David Gross, David Politzer und Frank Wilczek. Sie würdigte damit ihre theoretischen Arbeiten zur asymptotischen Freiheit in der starken Wechselwirkung.
Zhang, Joanne Y.; Fabricant, Peter D.; Ishmael, Chad R.; Wang, Jeffrey C.; Petrigliano, Frank A.; Jones, Kristofer J.
Background: Platelet-rich plasma (PRP) has emerged as a popular biologic treatment for musculoskeletal injuries and conditions. Despite numerous investigations on the efficacy of PRP therapy, current utilization of this treatment within the United States is not widely known. Purpose: To investigate the national utilization of PRP, including the incidence and conditions for which it is used in the clinical setting, and to determine the current charges associated with this treatment. Study Design: Descriptive epidemiology study. Methods: Using a national database (PearlDiver) of private insurance billing records, we conducted a comprehensive search using Current Procedural Terminology (CPT) codes to identify patients who received PRP injections over a 2-year period (2010-2011). Associated International Classification of Diseases, 9th Revision (ICD-9) codes were identified to determine the specific conditions the injection was used to treat. The aggregate patient data were analyzed by yearly quarter, practice setting, geographic region, and demographics. PRP therapy charges were calculated and reported as per-patient average charges (PPACs). Results: A total of 2571 patients who received PRP injections were identified; 51% were male and 75% were older than 35 years. The overall incidence ranged from 5.9 to 7.9 per 1000 patients over the study period. PRP was most commonly administered in hospitals (39%) and ambulatory surgical centers (37%) compared with in private offices (26%). The most common conditions treated were knee meniscus/plica disorders, followed by unspecified shoulder conditions, rotator cuff injuries, epicondylitis, and plantar fasciitis. Further evaluation revealed that 25% of all patients received injections for cartilage-related conditions, 25% meniscus, 25% unspecified, 12% tendon, 8% glenoid labrum, and 5% ligament. The PPAC for PRP treatment was US$1755 per injection. Conclusion: Despite a lack of consensus regarding PRP indications and efficacy
military medical records containing ICD-9 codes to investigate the incidence of musculoskeletal injuries within flight nurses and medical technicians...the incidence of musculoskeletal injuries within flight nurses and medical technicians compared to their non-flying counterparts from 2006 through...healthcare facilities. Back and joint pain are frequently reported, with 52% of nurses reporting back pain.21–26 An investigation of occupational
Padalkar, Mugdha; McGoverin, Cushla; Onigbanjo, Quam; Spencer, Richard; Barbash, Scott; Kropf, Eric; Pleshko, Nancy
Musculoskeletal pathology of the knee commonly occurs with aging and as a result of injury. The incidence of anterior cruciate ligament (ACL) injuries continues to increase annually, and may precede the eventual onset of osteoarthritis (OA), a debilitating and prevalent disease characterized by cartilage degeneration. Early detection of OA remains elusive, with current imaging methods lacking adequate sensitivity to detect early pathologic cartilage changes. We used mid- and near- infrared (IR) spectroscopy through arthroscopic-based fiber-optic devices to assess cartilage damage and differentiate tendon from ligament. Mid-IR spectroscopy is characterized by distinct bands and low penetration depth (< 10 μm) and near-IR spectroscopy is characterized by complex overlapping bands and greater penetration depths (< 1 cm). We have found that combined mid- and near-IR analysis greatly extends the information available through either in the analysis of soft tissues, including cartilage, ligaments and tendons. We discuss here basic science studies and the potential for translation to clinical research with novel arthroscopic probes.
The present study was undertaken to investigate the effect on ergonomic conditions by Labour Inspectorate intervention at the work place and to follow health and employment among occupationally injured. 195 reports on occupational musculo-skeletal injury (accidents and diseases) from men and women with different occupations were collected consecutively at three Labour Inspectorate offices. Fifteen Labour Inspectors volunteered to investigate half of the reports by work place visits within three months. The other half was kept for control. The inspectors were trained in ergonomics and also got complementary training in ergonomic work place assessment. A check-list was designed for the purpose and tested for validity and reliability. Eighteen months after the time of the injury reports, all work places were visited by ergonomists to evaluate possible improvements in ergonomic conditions. Due to turnover and prolonged sick-leaves, evaluations were performed for only 92 of the injured. At 160 work places other employees had performed similar tasks as the injured at the time of the injury report. Evaluations of possible improvements in ergonomic conditions were performed also for these employees. As regards changes at the work place there were no differences between the injured in the study and control groups. The inspectors had delivered 11 inspection notices to the employers demanding improvements for the injured and 14 notices regarding the conditions of work-mates. For this latter group there was a significant association between delivered notices and improved ergonomic conditions eighteen months after the reports. Three years after the time of the reports a postal questionnaire on health, psychological well-being and employment was distributed to the injured. The response rate was 93%. Questionnaire answers were compared to results from other studies, where identical questions were used. There was a significantly higher prevalence of musculo-skeletal and
Hübner, Philipp; Spinner, Christoph
In der Schweiz wird die Mehrheit der hoheitlichen Aufgaben von den 26 Kantonen, die zusammen die schweizerische Eidgenossenschaft bilden, autonom vollzogen. So liegt zum Beispiel die Kompetenz in den Bereichen Steuern, Gesundheit, Schulen oder Polizei grundsätzlich bei den Kantonen. Im Gegensatz dazu ist die Lebensmittelgesetzgebung national durch eidgenössische Erlasse harmonisiert. Die Vollzugsaufgaben liegen aber auch in diesem Bereich, abgesehen vom Vollzug an der Grenze und von einer nationalen Vollzugsaufsicht und Weisungsberechtigung, in kantonaler Kompetenz. Die Kantone können anhand kantonaler Erlasse das Bundesrecht präzisieren - insbesondere die organisatorischen Aspekte - und Regelungen im nicht harmonisierten Bereich treffen.
Bailey, C J; Reid, S W; Hodgson, D R; Bourke, J M; Rose, R J
A retrospective case-control study was conducted to identify and quantify risk factors for serious musculoskeletal injury sustained at 4 Australian metropolitan racetracks. During the period of study (August 1988-July 1995) there were 196 cases from flat racing, 52 cases from hurdle racing and 53 cases from steeplechases. The incidences of fatal musculoskeletal injuries per start for flat, hurdle and steeple races were 0.06, 0.63 and 1.43% respectively. Logistic regression identified harder track surfaces, horses being older than age 3 years, one racecourse (Flemington) and jumping races as significant risk factors which increased the risk of musculoskeletal breakdown. The incidence of fatal musculoskeletal injuries for flat races at the 4 study tracks was similar to that reported in the UK but less than the USA. Death rates for hurdle and steeple races in the study population were higher than in the UK. Strategies to reduce the incidence of serious musculoskeletal injuries may include avoidance of excessively hard track surfaces through closer regulation of track moisture content; implementation of more rigorous prerace lameness examinations of horses, particularly older horses; and altering the design and number of jumps in hurdle and steeple races. The quantification of risk, as we have reported here, is the first step towards addressing the causes of musculoskeletal breakdown and should help in applying a reasoned approach to intervention measures that may be effective in reducing racing injuries.
Shakerian, Mahnaz; Rismanchian, Masoud; Khalili, Pejman; Torki, Akram
Introduction: Handicrafts seems to be one of the high-risk jobs regarding work-related musculoskeletal disorders (WMSDs) which necessitate the implementation of different corrective intervention like regular physical activities. This study aimed to investigate the impact of physical activity on WMSDs among craftsmen. Methods: This cross-sectional study was an analytical – descriptive study carried out on 100 craftsmen working in Isfahan, Iran, in 2013. The sampling method was census, and all workshops involved with this job were included. Information on demographic parameters and physical activity was collected by demographic forms. The data related to worker's musculoskeletal discomforts were conducted using Cornell Musculoskeletal Discomfort Questionnaire. The data were analyzed using statistical tests including independent t-test, Chi-square, and ANOVA. The statistical analysis was performed using SPSS 18. Results: The highest percentages of complaints related to severe musculoskeletal discomfort were reported in right shoulder (%36), right wrist (%26), neck (%25), and upper right arm (%24), respectively. A significant relationship was observed between physical activity and musculoskeletal discomforts of left wrist (P = 0.012), lower back (P = 0.016), and neck (P = 0.006). Discussion and Conclusion: Based on the study results, it can be inferred that regular but not too heavy physical activity can have a positive impact on decreasing the musculoskeletal discomforts. PMID:27512700
The aim of this article is to present the most relevant musculoskeletal complications known to be associated with being overweight or obese in childhood and adolescence in order to help the clinicians and physiotherapists in the diagnostic and management of these patients. Various musculoskeletal problems like slipped capital femoral epiphysis and Blount disease are well-known complications. More recent studies describe the effects of overweight on musculoskeletal pain and controversial influences on fracture rates. Reduced physical activity is a contributing factor in obesity, but also effects bone mineral accrual. Reduced postural stability and increased falls may be the reason for increased fracture rates. Furthermore these data show relevant changes of locomotion studied by gait analysis. Longitudinal kinematic studies may be needed to understand the entire aspect of gait development in overweight children. Obesity is still a serious health problem and has a relevant impact on the development of a child's musculoskeletal system. Obesity affects the locomotor sytem both functionally and structurally. Future studies are necessary to help us better understand the pathophysiology and development of optimal therapeutic strategies.
Chavalitsakulchai, P; Shahnavaz, H
In industrial work, working postures play an important role, separately and combined with other strain factors. The combined effects may be worse than those of single factors. The purpose of this investigation was to compare the body size, work postures and musculoskeletal discomforts between a group of female workers in a pharmaceutical plant and another group in a textile plant. Two hundred workers have participated in the following studies; (i) measuring anthropometric data in the standing and sitting positions, (ii) using the Ovako Working Posture Analysis System (OWAS), and (iii) using the detail Standardized Nordic Questionnaire for analyzing the musculoskeletal troubles in different parts of the body. The investigation has identified five main factors associated with the musculoskeletal discomforts: (i) lack of worker selection and lack of appropriate training to prevent occupational hazards or work-related diseases, (ii) poor ergonomic design of the work place and task including work organization, (iii) poor working postures, (iv) lack of task variation, and (v) insufficient rest breaks. These could be improved by introducing ergonomic interventions for both adjusting the individual work places and the task performed. It is necessary to consider preventive measures for musculoskeletal disorders, especially for female workers in industrially developing countries. Ergonomic aspects of the preventive measures should include: (a) consideration of appropriate worker selection for various works with sufficient training and instruction, (b) ergonomic redesign of work places, and (c) ergonomic considerations in work organization.
The assembly of the Japanese Experiment Module "Kibo" to international space station was completed in 2009 and Koichi Wakata became the first Japanese station astronaut who spent more than 4 months in the station. Bone and muscle losses are significant medical concerns for long duration human space flight. Effective countermeasure program for bone loss and muscle atrophy is necessary to avoid post flight bone fracture and joint sprain after landing. The musculoskeletal response to human space flight and current physical countermeasure program for station astronauts are described.
Ens, Konstantin; Wenzel, Fabian; Fischer, Bernd
Die lokale Symmetrie von Hirnscans entlang der Sagittalebene zu ermitteln und zu modizifieren, ist für eine Reihe neurologischer Anwendungen interessant. Beispielsweise kann der voxelweise Vergleich von rechter und linker Hirnhälfte nur dann Aufschluss über die Lokalisierung von Läsionen geben, wenn durch Transformation ein Hirnscan eine möglichst hohe Symmetrie aufweist. Ein weiteres Anwendungsgebiet ist die Visualisierung von medialen Hirnschnitten, für die die Trennfläche beider Hirnhälfte möglichst eben sein sollte. Diese Arbeit stellt die Entwicklung eines Verfahrens vor, mit dessen Hilfe die Symmetrie von Hirnaufnahmen entlang der Sagittalebene verbessert werden kann. Dies geschieht unter Verwendung von aktiven Konturen, die mit Hilfe einer neuartigen Kostenfunktion gesteuert werden. Experimente am Ende der Arbeit mit strukturellen Kernspinaufnahmen demonstrieren die Leistungsfähigkeit des Verfahrens.
Der absolute Determinismus der klassischen Mechanik bietet keine Ansatzpunkte für eine befriedigende Naturphilosophie. Mit der Quantenmechanik werden nicht lediglich die Unzulänglichkeiten einzelner klassischer Begriffe, sondern die des gesamten klassischen Begriffssystems beseitigt.Translated AbstractDialectical Materialism in Quantum TheoryThe absolute determinism of classical mechanics does not provide any base for a satisfactory philosophy of nature. In quantum mechanics the shortcomings of not only some single classical concepts but of the classical description as a whole are removed.
Han, Zhumin; Wei, Xinyuan; Xu, Chen; Chiang, Chi-Lun; Zhang, Yanxing; Wu, Ruqian; Ho, W
The van der Waals interactions are responsible for a large diversity of structures and functions in chemistry, biology, and materials. Discussion of van der Waals interactions has focused on the attractive potential energy that varies as the inverse power of the distance between the two interacting partners. The origin of the attractive force is widely discussed as being due to the correlated fluctuations of electron charges that lead to instantaneous dipole-induced dipole attractions. Here, we use the inelastic tunneling probe to image the potential energy surface associated with the van der Waals interactions of xenon atoms.
Many inferences on the biology, behaviour and ecology of extinct vertebrates are based on the reconstruction of the musculature and rely considerably on its accuracy. Although the advent of digital reconstruction techniques has facilitated the creation and testing of musculoskeletal hypotheses in recent years, muscle strain capabilities have rarely been considered. Here, a digital modelling approach using the freely available visualization and animation software Blender is applied to estimate cranial muscle length changes and optimal and maximal possible gape in different theropod dinosaurs. Models of living archosaur taxa (Alligator mississippiensis, Buteo buteo) were used in an extant phylogenetically bracketed framework to validate the method. Results of this study demonstrate that Tyrannosaurus rex, Allosaurus fragilis and Erlikosaurus andrewsi show distinct differences in the recruitment of the jaw adductor musculature and resulting gape, confirming previous dietary and ecological assumptions. While the carnivorous taxa T. rex and Allo. fragilis were capable of a wide gape and sustained muscle force, the herbivorous therizinosaurian E. andrewsi was constrained to small gape angles. PMID:26716007
Many inferences on the biology, behaviour and ecology of extinct vertebrates are based on the reconstruction of the musculature and rely considerably on its accuracy. Although the advent of digital reconstruction techniques has facilitated the creation and testing of musculoskeletal hypotheses in recent years, muscle strain capabilities have rarely been considered. Here, a digital modelling approach using the freely available visualization and animation software Blender is applied to estimate cranial muscle length changes and optimal and maximal possible gape in different theropod dinosaurs. Models of living archosaur taxa (Alligator mississippiensis, Buteo buteo) were used in an extant phylogenetically bracketed framework to validate the method. Results of this study demonstrate that Tyrannosaurus rex, Allosaurus fragilis and Erlikosaurus andrewsi show distinct differences in the recruitment of the jaw adductor musculature and resulting gape, confirming previous dietary and ecological assumptions. While the carnivorous taxa T. rex and Allo. fragilis were capable of a wide gape and sustained muscle force, the herbivorous therizinosaurian E. andrewsi was constrained to small gape angles.
Kerstman, Eric; Scheuring, Richard
The Astronaut Strength, Conditioning, and Rehabilitation (ASCR) group is comprised of certified strength and conditioning coaches and licensed and certified athletic trainers. The ASCR group works within NASA s Space Medicine Division providing direction and supervision to the astronaut corp with regards to physical readiness throughout all phases of space flight. The ASCR group is overseen by flight surgeons with specialized training in sports medicine or physical medicine and rehabilitation. The goals of the ASCR group include 1) designing and administering strength and conditioning programs that maximize the potential for physical performance while minimizing the rate of injury, 2) providing appropriate injury management and rehabilitation services, 3) collaborating with medical, research, engineering, and mission operations groups to develop and implement safe and effective in-flight exercise countermeasures, and 4) providing a structured, individualized post-flight reconditioning program for long duration crew members. This Panel will present the current approach to the management of musculoskeletal injuries commonly seen within the astronaut corp and will present an overview of the pre-flight physical training, in-flight exercise countermeasures, and post-flight reconditioning program for ISS astronauts.
Occhipinti, E; Colombini, D
By means of a critical review of the international literature and of their own published experiences, the Authors discuss the influence of the "age" factor on work related musculoskeletal disorders of the spine and upper limbs. Regarding the spine, the lumbosacral spine in particular, there is evidence (both in relation to pathways and from epidemiological data) of the influence of age in determining a progressive increase in the occurrence of spondyloarthropathy with clear radiological signs. For upper limb disorders the influence of the "age" factor is still under debate and in any case does not seem of great importance. As far prevention is concerned for elderly workers subject to fixed postures and repetitive movements of the upper limbs it seems sufficient, to adopt the general measures used for the whole working population. However, specific measures should be adopted for elderly workers exposed to manual material handling (MMH). These consist in using reference values for the recommended weight that are lower than those adopted for younger workers (aged 18-45 years) and in implementing specific programs of active health surveillance.
Rischewski, Dorothea; Kuper, Hannah; Atijosan, Oluwarantimi; Simms, Victoria; Jofret-Bonet, Mireia; Foster, Allen; Lavy, Christopher
The recently adopted UN Convention on the Rights of Persons with Disabilities acknowledges the need to address social exclusion and poverty of persons with disabilities. However, policy makers, especially in low-income countries, often lack information about the socioeconomic situation of this vulnerable group of society. This study aimed to assess the association between poverty and musculoskeletal impairment (MSI) in Rwanda. A nationwide population-based matched case-control study was undertaken in Rwanda. Data were collected on education, literacy, employment, household expenditure and assets for 345 cases and 532 matched controls. Conditional logistic regression was performed, and the results indicated that adults with MSI in Rwanda are more likely to have no employment (odds ratio (OR)=3.3, 95% CI 2.1-5.2) while children with MSI are less likely to attend school (OR=0.4, 95% CI 0.2-0.9). Cases with MSI are disadvantaged vis-à-vis housing conditions and household size, potentially indicating crowding. However, cases with MSI were not poorer than controls in terms of assets or expenditure. These data suggest that increased efforts should be undertaken in Rwanda in order to ensure that children with disabilities are included in schools and that adults with disabilities can find appropriate employment opportunities.
Sherry, David D; Malleson, Peter N
Idiopathic musculoskeletal pain syndromes in children have a variety of manifestations; they can be diffuse or well localized, constant or intermittent, with or without autonomic symptoms and signs, completely incapacitating or not limiting activities, and they can tax the physician's diagnostic skill. A careful history and examination is usually all that is needed to make a diagnosis, although the differential diagnosis is large and might require laboratory and radiographic investigation. Pain and functional assessment help track the progress with therapy. Intense exercise therapy is associated with the best outcome. Psychologic issues should be evaluated to determine if further psychologic intervention is indicated. The medium-term outcome is probably good for most of these children, but the long-term prognosis is unknown. One must be aware that other manifestations of psychologic problems might emerge. By the time these children and their families see the rheumatologist they are desperate and can be frustrating to work with due to their difficulty in accepting any kind of psychologic element to the pain and its associated disability. Nevertheless, it is rewarding to help the children understand and work through their pain so they can resume normal lives.
Verrall, Geoffrey; Dolman, Bronwyn
Summary Background The mechanism of musculoskeletal (MSK) injuries is not well understood. This research applies principles of elastic motion to the anatomy and movement patterns of MSK structures. From this an insight into the application and timing of forces on MSK structures can be established and the mechanism/s of injury derived. Methods (Current Knowledge) All MSK structures demonstrate varying degrees of elasticity. Movement occurs primarily as a consequence of Muscle Tendon Unit (MTU) shortening. The application of an applied external force results in MSK structure lengthening. Results The MTU acts as a non-idealised Hookean Spring. The resting length of MSK structures is the minimum distance between attachment points. The anatomical constraints results in MSK structures having adequate compressive strength during shortening. Thus MSK injuries only occur during lengthening of the MSK structure. From this with knowledge of MSK movement cycles, we can derive the mechanism of injury. Conclusions MSK injuries result from an inability to counter applied forces whilst lengthening. Muscles, tendons and ligaments can only injure during their lengthening contraction phase. Insertional tendons and bone near attachment points injure during the MTU shortening phase. Injuries to other MSK structures can occur independent of the lengthening and shortening phases such as direct contact injuries. PMID:27900289
Markwick, William J.
Background and Purpose Youth participation in basketball is on the rise, with basketball one of the top five participation sports in Australia. With increased participation there is a need for greater awareness of the importance of the pre-participation examination, including musculoskeletal screening and functional performance testing as part of a multidisciplinary approach to reducing the risk for future injuries. As majority of all basketball injuries affect the lower extremities, pre-participation musculoskeletal screening and functional performance testing should assess fundamental movement qualities throughout the kinetic chain with an emphasis on lower extremity force characteristics, specifically eccentric loading tasks. Thus, the purpose of this clinical commentary is to review the existing literature elucidating pre-participation musculoskeletal screening and functional performance tests that can be used as a framework for rehabilitation professionals in assessing basketball athletes’ readiness to safely perform the movement demands of their sport. Methods Relevant articles published between 2000 and 2016 using the search terms ‘musculoskeletal screening’, ‘functional testing’, ‘youth athletes’, and ‘basketball’ were identified using MEDLINE. From a basketball-specific perspective, several relevant musculoskeletal assessments were identified, including: the Functional Hop Test Combination, the Landing Error Scoring System, the Tuck Jump Assessment, the Weight-Bearing Lunge Test, and the Star Excursion Balance Test. Each of these assessments creates movement demands that allow for easy identification of inefficient and/or compensatory movement tendencies. A basic understanding of musculoskeletal deficits including bilateral strength and flexibility imbalances, lower crossed syndrome, and dominance-related factors are key components in determination of injury risk. Discussion Assessment of sport-specific movement demands through
Die Anforderungen des heutigen Energiemarkts und damit einhergehende veränderte Einsatzbedingungen für ältere Kraftwerksblöcke haben unvorhergesehene Produktionsausfälle in den letzten Jahren erheblich verteuert. Nach der Optimierung der Kraftwerksprozesse und der Steigerung der Wirkungsgrade richten die Energieversorger ihren Blick daher nun verstärkt auch auf die Verfügbarkeit ihrer Anlagen. Zur Verbesserung der Anlagenverfügbarkeit und der Minimierung der Instandhaltungskosten bietet sich der Einsatz von Condition Monitoring Systemen an. Nach der Erprobung eines Systems zur Vibrationsanalyse setzt die Evonik Steag GmbH jetzt in einem Pilotprojekt die Stresswellenanalyse ein, ein Online Condition Monitoring System auf der Basis von Ultraschallsensoren. Dieser Beitrag erläutert an einem Beispiel die Methode und grenzt sie gegen den De-facto-Standard Vibrationsanalyse ab.
Kaiser, Marie I.
Charles Darwin hat eindrucksvoll gezeigt, dass der Mensch ebenso wie alle anderen Lebewesen ein Produkt der biologischen Evolution ist. Die sich an Darwin anschließende Forschung hat außerdem plausibel gemacht, dass sich nicht nur viele der körperlichen Merkmale des Menschen, sondern auch (zumindest einige) seiner Verhaltensdispositionen in adaptiven Selektionsprozessen herausgebildet haben. Die Vorstellung, dass auch die menschliche Moralität evolutionär bedingt ist, scheint daher auf den ersten Blick ganz überzeugend. Schließlich hat die Evolutionstheorie in den vergangenen Jahrzehnten in vielen Bereichen (auch außerhalb der Biologie) ihre weitreichende Bedeutung unter Beweis gestellt. Warum sollte, so könnte man beispielsweise fragen, gerade die Fähigkeit des Menschen, moralische Normen aufzustellen und gemäß ihnen zu handeln, nicht evolutionär erklärt werden können? Und warum sollte eine solche evolutionäre Erklärung der menschlichen Moralität irrelevant für die Rechtfertigung moralischer Normen sein? Warum sollte die Ethik eine Bastion der Philosophen bleiben, für die evolutionsbiologische Forschungsergebnisse über den Menschen und seine nächsten Verwandten keinerlei Relevanz besitzen?
Gondim Teixeira, Pedro Augusto; Gervaise, Alban; Louis, Matthias; Lecocq, Sophie; Raymond, Ariane; Aptel, Sabine; Blum, Alain
A progressive increase in the detector width in CT scanners has meant that advanced techniques such as dynamic, perfusion and dual-energy CT are now at the radiologist's disposal. Although these techniques may be important for the diagnosis of various musculoskeletal diseases, data acquisition and interpretation can be challenging. This article offers a practical guide for the use of these tools including acquisition protocol, post-processing options and data interpretation based on 7 years of clinical experience in a tertiary university hospital.
Martín Alvarez-San, R
Tissue banks currently warrant an interdisciplinary management leading to detect and address pressure conflicts taking into account ethical aspects, the safety and quality of the tissues provided, behavior under the principles of altruism, solidarity and equity, and the procurement of deceased donor tissues. This review article intends to inform about the main work-related and coordination aspects of the departments in tissue banks, and recognize their instances of sanitary responsibility and the bodies issuing recommendations to maintain clinical safety from the perspective of infection prevention and transmission of diseases related with musculoskeletal grafts.
Fraser, G.; Lillestøl, E.; Sellevåg, I.
This book is a German translation by C. Ascheron and J. Urbahn, of "The search for infinity: solving the mysteries of the universe", published in 1994. Diese Buch beschreibt anschaulich die Meilensteine, die der Mensch seit der Antike auf der Suche nach dem Unendlichen erreicht und hinter sich gelassen hat. Es enthält Kurzbiographien der wichtigsten Forscher, verständlich geschriebene Texte sowie Erläuterungen der entscheidenen Fachtermini.
Akesson, Kristina; Dreinhöfer, Karsten E.; Woolf, A. D.
It is likely that everyone will, at some time, suffer from a problem related to the musculoskeletal system, ranging from a very common problem such as osteoarthritis or back pain to severely disabling limb trauma or rheumatoid arthritis. Many musculoskeletal problems are chronic conditions. The most common symptoms are pain and disability, with an impact not only on individuals' quality of life but also, importantly, on people's ability to earn a living and be independent. It has been estimated that one in four consultations in primary care is caused by problems of the musculoskeletal system and that these conditions may account for up to 60% of all disability pensions. In contrast, teaching at undergraduate and graduate levels--and the resulting competence and confidence of many doctors--do not reflect the impact of these conditions on individuals and society. Many medical students do not have any clinical training in assessing patients with bone and joint problems. Under the umbrella of the Bone and Joint Decade 2000-2010, experts from all parts of the world with an interest in teaching have developed recommendations for an undergraduate curriculum to improve the teaching of musculoskeletal conditions in medical schools. The goal for each medical school should be a course in musculoskeletal medicine concentrating on clinical assessment, common outpatient musculoskeletal problems and recognition of emergencies. Improving competency in the management of musculoskeletal problems within primary care settings through improved education is the next aim, but there are needs for improvement for all professionals and at all levels within the health care system. PMID:14710510
Lobo, Francisco S. N.
The van der Waals quintessence equation of state is an interesting scenario for describing the late universe, and seems to provide a solution to the puzzle of dark energy, without the presence of exotic fluids or modifications of the Friedmann equations. In this work, the construction of inhomogeneous compact spheres supported by a van der Waals equation of state is explored. These relativistic stellar configurations shall be denoted as van der Waals quintessence stars. Despite of the fact that, in a cosmological context, the van der Waals fluid is considered homogeneous, inhomogeneities may arise through gravitational instabilities. Thus, these solutions may possibly originate from density fluctuations in the cosmological background. Two specific classes of solutions, namely, gravastars and traversable wormholes are analyzed. Exact solutions are found, and their respective characteristics and physical properties are further explored.
Eric Meffre; Lionel Ivashkiv
Inflammation on musculoskeletal disorders such as rheumatoid arthritis (RA) is the result of dysregulation of the immune system. When the immune system, which maintains the integrity of the organism in an environment rich in infectious microbes, becomes misdirected toward components of one’s own tissue, autoimmune disease can result with autoantibodies contributing to the inflammation and tissue damage. RA is a chronic autoimmune disease marked by severe inflammation that causes pain, swelling, stiffness and loss of function in the joints, which is estimated to affect 1 percent of the US adult population. Furthermore, autoimmune diseases, which affect women at a higher rate, are the fourth largest cause of disability among women in the US and among the top ten causes of death. The long range goal of this study is to elucidate the mechanisms that regulate the generation of autoantibodies by B cells in normal individuals and in patients with autoimmune diseases and provide insights into potential therapeutic interventions.
Asada, Fuminari; Takano, Kenichiro
Musculoskeletal disorders in workers decrease the productivity of companies and result in socioeconomic losses. Low back pain accounted for approximately 60% of occupational diseases in the past and this is still true at present, making it a major occupational health problem in Japan. Herein, the findings about low back pain are explained as follows: the correlation between imaging examination findings and low back pain is low; psychosocial factors are involved in the onset of low back pain and how it becomes chronic; and improvement of activity is more useful than rest. Furthermore, the advantages of employing physical therapists for improving occupational health are as follows: they can 1) evaluate and intervene ergonomically; 2) provide instructions using a behavioral modification technique based on psychosocial factors; and 3) provide instructions regarding exercise programs considering obstacles to the development of a good exercise habit (painful diseases including osteoarthritis and other diseases such as hypertension and diabetes). In addition, falling, whose incidence has recently been increasing and is an important issue in occupational health, is examined from the aspect of musculoskeletal disorders. The following activities of physical therapists are introduced: the items to be checked during a tour of inspection of a workplace and detailed descriptions of work management and working environment management measures. Physical therapists are rarely involved in studies of low back pain and falling, but their knowledge and skills have been demonstrated to contribute to improving occupational health.
... the MoTrPAC awards. Tofacitinib Shows Potential for Treating Lupus A drug that effectively treats rheumatoid arthritis and ... may also control the symptoms associated with systemic lupus erythematosus (SLE or lupus) and potentially slow the ...
... influences on Child Health Outcomes (ECHO). The ECHO program will investigate how exposure to a range of environmental factors in early development influences the health of children and adolescents. Read the press release about the ECHO awards. ...
Cao, Tuo; Zhang, Zhang; Liu, Zhi-Gao; Dou, Xia; Zhang, Jie; Zhang, Wei; Wu, Bo; Yu, Zhen-Dong; Wei, Zhun; Yu, Bo
Der p 2, a major allergen derived from the house dust mite Dermatophagoides pteronyssinus, is one of the most clinically relevant allergens worldwide. Recombinant Der p 2 (rDer p 2) is useful in clinical diagnosis and disease-specific immunotherapy. However, previous studies showed that Der p 2 can only be expressed in Escherichia coli (E. coli) cells as inclusion bodies, thus protein refolding is required to obtain functional products. Here we report a new method to produce biologically active Der p 2 protein in E. coli. N-terminal hexahistidine- and trigger factor (TF)-tagged Der p 2 was expressed in soluble form in E. coli and purified using a combination of chromatography processes. This procedure produced milligram-level high purity Der p 2 per liter of bacterial culture. Moreover, far-UV region circular dichroism (CD) analysis and serum specific IgE reactivity test demonstrated that the secondary structure and IgE reactivity properties of rDer p 2 produced in our study were almost identical to those of natural Der p 2 (nDer p 2). In conclusion, the method developed in this work provides a useful tool for the production of immunologically active recombinant Der p 2 for clinical applications.
Duftner, Christina; Dejaco, Christian; Kainberger, Franz; Machold, Klaus; Mandl, Peter; Nothnagl, Thomas; DeZordo, Tobias; Husic, Rusmir; Schüller-Weidekamm, Claudia; Schirmer, Michael
It is the current goal in rheumatology to diagnose and treat inflammatory rheumatic diseases early in order to avoid structural damage. Functional imaging methods such as musculoskeletal sonography are increasingly used to support the clinical diagnosis. To ascertain the quality of ultrasound assessments performed by rheumatologists in Austria, the Austrian Radiology-Rheumatology Initiative for Musculoskeletal Ultrasound (ARRIMUS) proposed recommendations for a training curriculum, technical standards for ultrasound equipment, minimum requirements for documentation, indications for sonography and the use of ultrasound for interventions. These recommendations have been endorsed by the Austrian Society of Rheumatology and should aid rheumatologists to perform high quality ultrasound assessment in clinical practice.
Downs, Meghan; Newby, Nate; Trinh, Tinh; Hanson, Andrea
Long duration spaceflight places astronauts at increased risk for muscle strain and bone fracture upon return to a 1-g or partial gravity environment. Functionally limiting decrements in musculoskeletal health are likely during Mars proving-ground and Earth-independent missions given extended transit times and the vehicle limitations for exercise devices (low-mass, small volume, little to no power). This is particularly alarming for exploration missions because astronauts will be required to perform novel and physically demanding tasks (i.e. vehicle egress, exploration, and habitat building activities) on unfamiliar terrain. Accordingly, NASA's exploration roadmap identifies the need for development of small exercise equipment that can prevent musculoskeletal atrophy and has the ability to assess musculoskeletal health at multiple time points during long-duration missions.
Bangerter, Neal K; Taylor, Meredith D; Tarbox, Grayson J; Palmer, Antony J; Park, Daniel J
Whole-body 7 Tesla MRI scanners have been approved solely for research since they appeared on the market over 10 years ago, but may soon be approved for selected clinical neurological and musculoskeletal applications in both the EU and the United States. There has been considerable research work on musculoskeletal applications at 7 Tesla over the past decade, including techniques for ultra-high resolution morphological imaging, 3D T2 and T2* mapping, ultra-short TE applications, diffusion tensor imaging of cartilage, and several techniques for assessing proteoglycan content in cartilage. Most of this work has been done in the knee or other extremities, due to technical difficulties associated with scanning areas such as the hip and torso at 7 Tesla. In this manuscript, we first provide some technical context for 7 Tesla imaging, including challenges and potential advantages. We then review the major quantitative MRI techniques being applied to musculoskeletal applications on 7 Tesla whole-body systems.
Houston, Thomas K; Connors, Robert L; Cutler, Naomi; Nidiry, Mary Anne
Musculoskeletal complaints are common, but are often underemphasized in residency training. We evaluated the experience of residents (12) in 4 sessions of an innovative concentrated ambulatory, community-based musculoskeletal (MS) clinic precepted by general internists with additional training in teaching MS medicine. Compared with the year long longitudinal house staff (HS) clinic experience, the mean number of musculoskeletal diagnoses per resident seen in MS clinic was higher (13.9 [standard deviation 4.0] vs 5.4 [standard deviation 4.0]; P <.01). Common diagnoses in MS clinic included shoulder, hip, and knee tendonitis/bursitis, and the majority of diagnoses in HS clinic were nonspecific arthralgia (66%). Fifty-two injections were performed in MS clinic over the year, compared with one in HS clinic.
Jones, J. A.; Johnson-Throop, K. A.; Scheuring, R. A.; Walton, M. E.; Davis-Street, J. E.; Smaka, T.; McCulley, P. A.; Jones, J. A.; Stokes, C. R.; Parker, K. K.; Wear, M.; Johnson-Throop, K. A.
Introduction: Continuously evolving medical standards of care, limited crew training time, and the inherent constraints of space flight necessitate regular revisions of the mission medical support infrastructure and methodology. A three-day Operational and Research Musculoskeletal Summit was held to review NASA s current strategy for preflight health maintenance and injury screening, risk mitigation for musculoskeletal injuries or syndromes, treatment methods during flight, and research topics to mitigate risks to astronaut health. The Summit also undertook consideration of the best evidence-based terrestrial musculoskeletal practices to recommend their adaptation for use in space. Methods: The types and frequencies of musculoskeletal injuries sustained by short- and long-duration astronauts were obtained from the Longitudinal Study of Astronaut Health. The Summit panel was comprised of experts from the clinical and research communities, as well as representatives from NASA Headquarters, the Astronaut corps, and the offices of JSC Medical Operations, JSC Human Adaptation and Countermeasures, Glenn Research Center Human Research, and Astronaut Strength Conditioning and Rehabilitation. Before the summit, panelists participated in a Web-based review of NASA s Space Medical Conditions List (SMCL). Results: The Summit generated seventy-five operational and research recommendations to the NASA Office of Space Medicine, including changes to the SMCL and to the musculoskeletal section of the ISS debrief questionnaire. From these recommendations, seven were assigned highest value and priority, and could be immediately adopted for the exploration architecture. Discussion: Optimized exercise and conditioning to improve performance and forestall musculoskeletal damage on orbit were the primary area of focus. Special attention was paid to exercise timing and muscle group specificity. The panel s recommendations are currently in various stages of consideration or integration
Colberg, Ricardo E.; Aune, Kyle T.; Propst, Matthew S.
Background: Tennis-teaching professionals represent a significant proportion of all avid tennis players worldwide, with 15,000 belonging to the largest professional organization, the United States Professional Tennis Association (USPTA). However, there is no epidemiologic study to date reporting the prevalence of musculoskeletal conditions in these tennis-teaching professionals. Purpose: To investigate the prevalence of musculoskeletal conditions in tennis-teaching professionals following the International Tennis Federation’s (ITF) guidelines for epidemiologic studies. Study Design: Descriptive epidemiology study. Methods: Electronic surveys were distributed to 13,500 American members of the USPTA. The prevalence of musculoskeletal conditions was calculated. Results: A total of 1176 USPTA members completed the survey. Most participants reported teaching more than 5 days per week and more than 2 hours per day. The prevalence of musculoskeletal injury secondary to teaching tennis was 42%. The most affected area was the lower extremities (43% of all injuries) followed by the upper extremities (37%). The most commonly injured structures were muscles or tendons (36% of all injuries) and joints or ligaments (28%). The majority of injuries did not cause participants to miss more than 24 hours of teaching (57%). Conclusion: This is the first epidemiologic study on the occupational risk of musculoskeletal injuries and conditions in tennis-teaching professionals. Tennis-teaching professionals have a significant risk of musculoskeletal injuries or conditions related to their occupation. The prevalence of injury is consistent with previously published studies of injury prevalence among other tennis-playing populations. The proportions of upper and lower extremity injuries were fairly equitable. PMID:27790624
Sachdeva, Rohit; Donkers, Sarah J; Kim, Soo Y
Angelman's syndrome (AS) is a genetic neurodevelopment disorder. The cause is a known abnormality involving the maternal inherited ubiquitin-protein ligase (UBE3A) gene. Clinical characteristics universal to the disorder are well documented in the literature and include developmental delay, seizures, ataxia, altered tone, severely impaired speech and intellect, as well as an overall happy demeanor, frequent bouts of laughter, and hypermotoric behavior. Associated with this disorder are several musculoskeletal aberrations. To date, a review of case studies reporting on these musculoskeletal changes has not been carried out. Thus, the purpose of this paper was to provide an overview of the musculoskeletal changes present in individuals with AS. In our review of 21 case reports from 1965-2013, the most consistently reported anatomical changes were of the craniofacial region. These include microcephaly, brachycephaly, a palpable occipital groove, prognathism, and wide spaced teeth. Other musculoskeletal abnormalities less frequently reported in the literature include scoliosis, excessive lumbar lordosis, and pes planus. Given that the majority of the case reports reviewed was of young children, the possibility of underreporting musculoskeletal changes which may manifest in the later years of life may be present. Early diagnosis and interventions to minimize secondary complications are crucial to maintain quality of life. An overall multidisciplinary approach is emphasized to maximize developmental potential for these individuals. Future prospective studies that follow patients into adulthood are needed to better understand the prevalence and development of secondary musculoskeletal changes, which in turn can inform intervention techniques and preventative measures. Clin. Anat. 29:561-567, 2016. © 2015 Wiley Periodicals, Inc.
Schneider, S P
The first step in addressing any problem is recognition of the problem and a measure of its size and scope. There have been few reviews to date of the evidence of a musculoskeletal disorders problem in construction, particularly in the United States. Construction contractors in the United States have questioned the existence of a musculoskeletal disorders problem in construction, so a review of the evidence is warranted. The types of evidence reviewed include: 1) historical evidence, 2) injury data, 3) workers' compensation data, 4) medical exam data, 5) survey data, and 6) exposure data. Injury data generally represent injuries that the employers have identified as work-related and recorded or reported. Workers' compensation data are from cases that have been filed by workers for compensation and quite often represent only "closed" cases where compensation has been awarded. Medical exam data are from physical examinations of workers. Symptom survey data are the most inclusive and show the number of workers who self-report musculoskeletal problems. Exposure data include measurements made of exposure to musculoskeletal risk factors. The existing data show construction workers to be at significant risk of musculoskeletal injury, specifically related to the work they do. Their risk of musculoskeletal injury is much higher than that of other workers who have less heavy work, about 50 percent higher than all other workers. Several trades have been extensively studied, while others have been studied to a lesser extent. While the exact relationship between exposures and injuries is complex and often multifaceted, it would be difficult to deny the existence of the problem and the fact that these injuries are, to a great extent, related to the work that construction workers perform.
Hassan, O M; Bayomy, H
Hairdressing is associated with exposure to a variety of harmful agents which have been linked to respiratory and musculoskeletal disorders in hairdressers. This study aimed to identify respiratory and musculoskeletal disorders in hairdressers compared to office workers. A cross-sectional study was conducted on 80 female hairdressers and 50 matched controls. A structured questionnaire was used to collect information on personal and occupational data, hairdressing activities, the presence of respiratory symptoms and the prevalence of musculoskeletal pain in the past 12 months. Reported symptoms were compared between hairdressers and controls. The associations between self-reported symptoms and hairdressing activities were investigated. Hairdressers were more likely to report symptoms than controls particularly for those who were older, with higher body mass index and longer duration of work as hairdresser. There were significant associations between frequent hair treatments (bleaching, dye and wave) and hand dermatitis (P < 0.001), running nose (P < 0.05), eye irritation (P < 0.01) and phlegm (P < 0.05). Elbow pain and shoulder and back pain were the most prevalent musculoskeletal pains in the past 12 months (13.8 and 12.5% respectively), back and knee pains were the most frequent chronic pain (7.5%), hand and wrist pain led 12.5% of hairdressers to visit a doctor and shoulder pain and back pain indicated a period of sickness absence in 13.8% of hairdressers. Musculoskeletal disorders were associated with manual handling, prolonged standing, strenuous shoulder movements and awkward body posture. Hairdressing is associated with increased risk to respiratory and musculoskeletal disorders due to adverse work conditions.
In the last 15 years, ultrasonography of the bovine musculoskeletal system has become an established diagnostic method used routinely in many veterinary teaching hospitals worldwide. Ultrasonography is ideal for the evaluation of musculoskeletal disorders because they are often associated with extensive soft tissue swelling and inflammatory exudation. The goal of this article is to encourage veterinarians to use ultrasonography for the evaluation of bovine orthopedic disorders. Not only does ultrasonography improve the likelihood of a definitive diagnosis, added use of the machine helps recoup expenses.
Dean Deyle, Gail
This clinical perspective presents an overview of current and potential uses for magnetic resonance imaging (MRI) in musculoskeletal practice. Clinical practice guidelines and current evidence for improved outcomes will help providers determine the situations when an MRI is indicated. The advanced competency standard of examination used by physical therapists will be helpful to prevent overuse of musculoskeletal imaging, reduce diagnostic errors, and provide the appropriate clinical context to pathology revealed on MRI. Physical therapists are diagnostically accurate and appropriately conservative in their use of MRI consistent with evidence-based principles of diagnosis and screening. PMID:22851878
Lemasters, G. K.; Atterbury, M. R.; Booth-Jones, A. D.; Bhattacharya, A.; Ollila-Glenn, N.; Forrester, C.; Forst, L.
OBJECTIVES: To determine the prevalence and risk factors for work related musculoskeletal disorders among union carpenters. METHODS: A detailed questionnaire on musculoskeletal symptoms and work history was administered to 522 carpenters. The symptom questions assessed if carpenters experienced pain, numbness, or tingling in a particular body region. A subset of this group then received a physical examination of the upper extremities and knees. RESULTS: The study group was primarily white (94.9%) and male (97.8%) with a mean age of 42.3 years. The highest prevalence of work related musculoskeletal disorders cases by carpentry specialty ranged from 20%-24% for those doing drywall or ceiling, finishing or framing, and the building of concrete forms. Generally, as duration of employment increased, the prevalence of symptoms increased. An adjusted logistic regression analysis showed that the group with the longest (> or = 20 years) duration of employment in carpentry was significantly associated with work related musculoskeletal disorders of the shoulders (odds ratio (OR) 3.2, 95% confidence interval (95% CI) 1.1 to 8.9), hands or wrists (OR 3.1, 95% CI 1.1 to 8.4), and knees (OR 3.5, 95% CI 1.3 to 9.2). Also, analyses showed that carpenters who reported that they had little or no influence over their work schedule had significant increases of work related musculoskeletal disorders of the shoulders, hips, and knees with ORs of 1.9 (95% CI 1.1 to 3.2), 2.9 (95% CI 1.1 to 7.2), and 2.3 (95% CI 1.2 to 4.1), respectively. Feeling exhausted at the end of day was also a significant risk factor for work related musculoskeletal disorders of the knee (OR 1.8, 95% CI 1.1 to 3.1). Upper extremity disorders were the most prevalent work related musculoskeletal disorders reported among all carpenters. Drywall or ceiling activities involve a considerable amount of repetitive motion and awkward postures often with arms raised holding heavy dry walls in place, whereas form work is
Gonzalez, Roger V.; Barr, Ronald E.; Abraham, Lawrence D.
This paper describes a musculoskeletal model that represents human elbow flexion-extension and forearm pronation-supination. Musculotendon parameters and the skeletal geometry were determined for the musculoskeletal model in the analysis of ballistic elbow joint complex movements. The key objective was to develop a computational model, guided by optimal control, to investigate the relationship among patterns of muscle excitation, individual muscle forces, and movement kinematics. The model was verified using experimental kinematic, torque, and electromyographic data from volunteer subjects performing both isometric and ballistic elbow joint complex movements. In general, the model predicted kinematic and muscle excitation patterns similar to what was experimentally measured.
Dehghan, F; Haerian, B S; Muniandy, S; Yusof, A; Dragoo, J L; Salleh, N
Relaxin is a hormone structurally related to insulin and insulin-like growth factor, which exerts its regulatory effect on the musculoskeletal and other systems through binding to its receptor in various tissues, mediated by different signaling pathways. Relaxin alters the properties of cartilage and tendon by activating collagenase. This hormone is also involved in bone remodeling and healing of injured ligaments and skeletal muscle. In this review, we have summarized the literature on the effect of relaxin in musculoskeletal system to provide a broad perspective for future studies in this field. PMID:24283470
Jordan, Kelvin P.; Roddy, Edward; Croft, Peter R.
Objective. To estimate the incidence of, and factors associated with, consultation for musculoskeletal foot problems in primary care. Methods. Survey data from 13 986 people aged ≥50 years who took part in the North Staffordshire Osteoarthritis Project were linked to a database of primary care consultations. Foot problems were defined as responding affirmatively to the questions: ‘Have you had any problems with your feet over the last year?’ or ‘Have you had pain in the last year in and around the foot?’. The main outcome measure was a record of a musculoskeletal foot-related consultation within 18 months following the survey. Results. Of the 3858 participants with foot problems who had not consulted before the survey, 350 (9.1%) consulted in the 18 months following the survey. Age, sex, education, general health and pain in other regions were not associated with future consultation. However, those who consulted were more likely to have reported foot pain [adjusted odds ratio (OR) 2.04; 95% CI 1.22, 3.42) and to consider treatments to be effective in controlling disease (OR 1.54; 95% CI 1.07, 2.21) in the baseline survey, and to have been a frequent consulter in the 18 months before the survey (OR 1.65; 95% CI 1.30, 2.09). Conclusions. Only a minority of older people with musculoskeletal foot problems consult their general practitioner about them. Foot pain, frequent consultation for other problems and positive perceptions of treatment efficacy appear to be the strongest factors influencing future consultation. PMID:20660499
Gomes de Lima, Jeane F; Colaço, Geraldo; da Silva, Ricardo; Masculo, Francisco
This study present areas of the body more prone to develop diseases by musculoskeletal efforts, ie, RTD, in two companies of Paraiba, Brazil. To this end, was made a comparative analysis with respect to the type of work performed (standing, sitting) and the parts that suffer most discomfort after a day's work in a footwear industry and a bus transportation company. The quanti-qualitative research was conducted through semi-structured interviews with 227 employees in the period 2008 to 2009, having as methodological the tool diagram of painful areas of Corlett and Manenica. It was concluded that the areas most affected by musculoskeletal disorders are located in the neck (9,2%), backs (23,6%), shoulders (14,5%) and legs (11,3%), being usually caused by inappropriate postures, repetitive movements and work station no adequate the anthropometry of the users. Thus, we recommend the adoption of ergonomic measures that enable a healthy and safe environment for workers.
Gani, Satrio; Rossi, Enrico
Van der Waals systems formed by two-dimensional (2D) crystals and nanostructures possess electronic properties that make them extremely interesting for basic science and for possible technological applications. By tuning the relative angle (the twist angle) between the layers, or nanostructures, forming the Van der Waals systems experimentalists have been able to control the stacking configuration of such systems. We study the dependence on the twist angle of the electronic properties of two classes of Van der Waals systems: double layers formed by two, one-atom thick, layers of a metal dichalcogenide such as molybdenum disulfide (MoS2), and graphene nanoribbons on a hexagonal boron nitride substrate. We present results that show how, for both classes of systems, the electronic properties can be strongly tuned via the twist angle. Work supported by ACS-PRF-53581-DNI5 and NSF-DMR-1455233.
Glaßner, Gottfried; Pärr, Nora
Die Melker Stiftsbibliothek besitzt ein Globenpaar des berühmten venezianischen Globenbauers Vincenzo Coronelli (1650-1718), einen Erdglobus von 1688 und einen Himmelsglobus von 1693. Wie und wann die beiden Globen nach Melk gekommen sind, ist nicht bekannt. Dass sie zur ursprünglichen Ausstattung der 1735 fertig gestellten Barockbibliothek gehörten, wird aber aus der zentralen Stellung deutlich, die dem Globus (Erdglobus und Armillarphäre) in dem von Paul Troger 1732 gemalten Deckenfresko zukommt. Mehrfach begegnet das Motiv des Globus als Attribut der Weisheit bzw. Philosophie, der Geographie bzw. Geometrie und der Astronomie in den beiden Hauptsälen wie auch in der Deckenmalerei von Johann Bergl in der Oberen Bibliothek (1768) und in der Kuppel des Gartenpavillons (1764).
Park, J W; Kim, Y S; Yoon, J O; Kim, J S; Chang, J S; Kim, J M; Chun, J M; Jeon, I H
Non-tuberculous mycobacterial (NTM) infection of the musculoskeletal tissue is a rare disease. An early and accurate diagnosis is often difficult because of the indolent clinical course and difficulty of isolating pathogens. Our goal was to determine the clinical features of musculoskeletal NTM infection and to present the treatment outcomes. A total of 29 patients (nine females, 20 males between 34 and 85 years old, mean age 61.7 years; 34 to 85) with NTM infection of the musculoskeletal system between 1998 to 2011 were identified and their treatment retrospectively analysed. Microbiological studies demonstrated NTM in 29 patients: the isolates were Mycobacterium intracellulare in six patients, M. fortuitum in three, M. abscessus in two and M. marinum in one. In the remaining patients we failed to identify the species. The involved sites were the hand/wrist in nine patients the knee in five patients, spine in four patients, foot in two patients, elbow in two patients, shoulder in one, ankle in two patients, leg in three patients and multiple in one patient. The mean interval between the appearance of symptoms and diagnosis was 20.8 months (1.5 to 180). All patients underwent surgical treatment and antimicrobial medication according to our protocol for chronic musculoskeletal infection: 20 patients had NTM-specific medication and nine had conventional antimicrobial therapy. At the final follow-up 22 patients were cured, three failed to respond to treatment and four were lost to follow-up. Identifying these diseases due the initial non-specific presentation can be difficult. Treatment consists of surgical intervention and adequate antimicrobial therapy, which can result in satisfactory outcomes.
In Australia, there are six Therapeutic Goods Administration-licensed clinical bacteriology laboratories providing bacterial and fungal bioburden testing of allograft musculoskeletal samples sent from 10 tissue banks. Musculoskeletal swab and/or tissue biopsy samples are collected at the time of allograft retrieval and sent to bacteriology laboratories for bioburden testing, in some cases requiring interstate transport. Bacteria and fungi may be present within the allograft at the time of retrieval or contaminated from an external source. The type of organism recovered will determine if the allograft is rejected for transplant, which may include all allografts from the same donor. Bacteriology staff also provides unpaid support of tissue banks through meeting involvement, consultations, licence-related activities, validations and research funded by their organisation and not part of any contractual agreement. Bacteriology laboratories and tissue banks must be compliant to the Code of Good Manufacturing Practice - Human Blood and Tissues and regulated by the Therapeutic Goods Administration. Clinical bacteriology laboratories also require mandatory accreditation to Standards Australia International Organisation for Standardisation (ISO) 15189:2009 medical laboratories - particular requirements for quality and competence, and may also attain Standards Australia/New Zealand Standard ISO 9001:2000 quality management systems certification. Bacteriology laboratories and musculoskeletal tissue banks are integral partners in providing safe allograft musculoskeletal tissue for transplant.
Background Back pain is one of the most common complaints that patients report to physicians and two-thirds of the population has an elevated body mass index (BMI), indicating they are either overweight or obese. It was once assumed that extra body weight would stress the low back and lead to pain, however, researchers have reported inconsistencies association between body weight and back pain. In contrast, more recent studies do indicate that an elevated BMI is associated with back pain and other musculoskeletal pain syndromes due to the presence of a chronic systemic inflammatory state, suggesting that the relationship between BMI and musculoskeletal pains be considered in more detail. Objective To describe how an elevated BMI can be associated with chronic systemic inflammation and pain expression. To outline measurable risk factors for chronic inflammation that can be used in clinical practice and discuss basic treatment considerations. Discussion Adiposopathy, or “sick fat” syndrome, is a term that refers to an elevated BMI that is associated with a chronic systemic inflammatory state most commonly referred to as the metabolic syndrome. The best available evidence suggests that the presence of adiposopathy determines if an elevated BMI will contribute to musculoskeletal pain expression. It is not uncommon for physicians to fail to identify the presence of adiposopathy/metabolic syndrome. Conclusion Patients with an elevated BMI should be further examined to identify inflammatory factors associated with adiposopathy, such as the metabolic syndrome, which may be promoting back pain and other musculoskeletal pain syndromes. PMID:23687943
Diatchenko, Luda; Fillingim, Roger B.; Smith, Shad B.; Maixner, William
Musculoskeletal pain conditions, such as fibromyalgia and low back pain, tend to coexist in affected individuals and are characterized by a report of pain greater than expected based on the results of a standard physical evaluation. The pathophysiology of these conditions is largely unknown, we lack biological markers for accurate diagnosis, and conventional therapeutics have limited effectiveness. Growing evidence suggests that chronic pain conditions are associated with both physical and psychological triggers, which initiate pain amplification and psychological distress; thus, susceptibility is dictated by complex interactions between genetic and environmental factors. Herein, we review phenotypic and genetic markers of common musculoskeletal pain conditions, selected based on their association with musculoskeletal pain in previous research. The phenotypic markers of greatest interest include measures of pain amplification and ‘psychological’ measures (such as emotional distress, somatic awareness, psychosocial stress and catastrophizing). Genetic polymorphisms reproducibly linked with musculoskeletal pain are found in genes contributing to serotonergic and adrenergic pathways. Elucidation of the biological mechanisms by which these markers contribute to the perception of pain in these patients will enable the development of novel effective drugs and methodologies that permit better diagnoses and approaches to personalized medicine. PMID:23545734
McKiernan, Fergus E
The musculoskeletal manifestations of mild forms of osteogenesis imperfecta are not well defined in the adult. The aim of this study was to characterize the musculoskeletal manifestations and resulting impairments reported by adults with mild osteogenesis imperfecta. For this task a survey of musculoskeletal symptoms and impairments was hosted on the Osteogenesis Imperfecta Foundation web site for 6 weeks. Survey responses are reported herein. There were 111 unduplicated, adult respondents (78 female). Mean age was 40.8 years. More than one-quarter of 3,410 lifetime fractures occurred in adulthood. Nearly half of respondents reported an established diagnosis of "arthritis" (usually osteoarthritis), and the majority of these reported some degree of impairment attributable to arthritis. Articular pain, stiffness and instability were dominant in the large, weight-bearing joints of the lower extremities. Back pain and scoliosis were common. Of the respondents, 15% required assistance with light physical tasks and personal care. Two-thirds reported joint hyper-mobility, and one-third reported a previous tendon rupture. Complex regional pain syndrome was rare. Respondents reported frequent use of medications known to have potential adverse skeletal effects. In spite of these concerns the majority rated their overall physical health as good or excellent. Adults with mild osteogenesis imperfecta continue to sustain fractures into adulthood, and the majority reports some functional impairment due to musculoskeletal issues. Significant impairment is not rare.
Hanklang, Suda; Kaewboonchoo, Orawan; Silpasuwan, Pimpan; Mungarndee, Suriyaphun S
A cross-sectional study was conducted to determine the prevalence of musculoskeletal disorder symptoms and its risk factors among women rebar workers. A simple random sampling method was used and data were collected by face-to-face interview and ergonomic assessment from February to March 2011. A total of 272 women rebar workers with at least 6 months' job experience participated in this study. The findings revealed that 57.7% of workers reported musculoskeletal disorder symptoms with low back and shoulders as the most common body parts affected (46.0%). Multiple logistic regression analysis indicated 2 variables that are significantly associated with musculoskeletal disorders: prolonged working hours (adjusted odds ratio = 7.63; 95% confidence interval = 2.06-28.31) and awkward posture (adjusted odds ratio = 43.79; 95% confidence interval = 17.09-112.20). The high prevalence of musculoskeletal disorders among women rebar workers suggests that an appropriate ergonomic workstation design and ergonomic training for women rebar workers are necessary.
Aksnes, Liv Hege; Bruland, Øyvind Sverre
This paper deals with some of the musculo-skeletal complication that can occur after cancer treatment. In particular, we focus on Cancer Treatment Induced Bone Loss (CTIBL) and the musculo-skeletal complications that can occur in patients treated for extremity sarcoma. In addition we discuss peripheral neuropathy, musculo-skeletal pain and briefly mention some of the complications related to radiotherapy. CTIBL is mostly studied in breast cancer and prostate cancer survivors. The cause in these groups is mainly due to treatment induced hypogonadism. Other causes of CTIBL are indirect or direct cause of chemotherapy, physical inactivity and inadequate intake of vitamin D and calcium. Treatment of CTIBL consists of diet and lifestyle changes and pharmacological intervention. Extremity bone sarcomas constitute a special group since they often experience mutilating surgery and heavy combination chemotherapy. The treatment results in worse function than the normal population and the amputated usually have lower physical functioning than patients treated with limb sparing surgery (LSS). However, most studies fail to show differences in quality of life between the amputated and LSS. Most of the studies performed on musculo-skeletal sequelae have been done on survivors of childhood cancer, breast cancer or prostate cancer. More studies among the other cancer groups are needed to reveal the extent and prevalence of these complications.
Stovitz, Steven D.; Johnson, Robert J.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for musculoskeletal injuries because the conditions are considered inflammatory in nature. However, because inflammation is a necessary component in healing, decreasing inflammation may be counterproductive. Also, many tendon injuries are, in fact, degenerative and not…
of multiple cell types as well as patterning to direct the fate of undifferentiated cells. The determination of the fundamental molecular causes of...Genes that are differentially expressed only in MRL include multiple transcription factors suggesting increased cellular replication in regenerating...and development of musculoskeletal tissues and that deficiencies in these two growth factors contribute to impaired growth and maintenance. Furthermore
Bialosky, Joel E; Bishop, Mark D; Cleland, Joshua A
Physical therapists consider many factors in the treatment of patients with musculoskeletal pain. The current literature suggests expectation is an influential component of clinical outcomes related to musculoskeletal pain for which physical therapists frequently do not account. The purpose of this clinical perspective is to highlight the potential role of expectation in the clinical outcomes associated with the rehabilitation of individuals experiencing musculoskeletal pain. The discussion focuses on the definition and measurement of expectation, the relationship between expectation and outcomes related to musculoskeletal pain conditions, the mechanisms through which expectation may alter musculoskeletal pain conditions, and suggested ways in which clinicians may integrate the current literature regarding expectation into clinical practice.
Rao, Smita; Riskowski, Jody; Hannan, Marian T.
Musculoskeletal conditions of the foot and ankle are an important public health challenge due to their increasing incidence combined with their substantial negative impact on patients’ quality of life. Non-pharmacological treatments serve as the first line of treatment and are frequently used for patients with musculoskeletal conditions of the foot and ankle. This review provides a summary of the assessments and non-invasive treatment options based upon available evidence. Recent studies show that individuals with foot and ankle pain have multiple co-existing impairments in alignment, motion, load distribution and muscle performance that may be evident in static and/or dynamic tasks. Additionally, both clinical and epidemiological studies support the inter-dependence between the foot and proximal joints. For instance, aberrant foot structure has been linked to foot osteoarthritis (OA), as well as OA and pain at the knee and hip. Most recently, advances in motion capture technology and plantar load distribution measurement offer opportunities for precise dynamic assessments of the foot and ankle. In individuals with musculoskeletal conditions of the foot and ankle, the chief objectives of treatment are to afford pain relief, restore mechanics (alignment, motion and/or load distribution) and return the patient to their desired level of activity participation. Given that most patients present with multiple impairments, combinational therapies that target foot-specific as well as global impairments have shown promising results. In particular, in individuals with rheumatoid arthritis and other rheumatic diseases, comprehensive rehabilitation strategies including early detection, foot-based interventions (such as orthoses) and wellness-based approaches for physical activity and self-management have been successful. While significant improvements have been made in the last decade to the assessment and treatment of foot and ankle conditions, few randomized clinical
Kömürcü, Erkam; Tok, Fatih; Simşek, Ayşe; Ozçakar, Levent
Homer's Iliad--the most famous and influential epic poem--has been previously reviewed with respect to head, craniomaxillofacial, neck, thoracic, and hand injuries in the literature. However, to the best of the authors' knowledge, there are no data regarding musculoskeletal injuries. This article describes the musculoskeletal injuries that had ensued during the war of Troy. The Turkish translation of the original epic poem Iliad was reviewed for musculoskeletal injuries, that is, their descriptions, outcome, the weapons used, and the engaged warriors. Extremity injuries were evaluated as regards the affected bones. The pertinent treatment methods were also recorded. In total, 103 musculoskeletal injuries were detected during 81 combats. The most commonly involved areas were the shoulder (15.5%), the head (14.5%), the cervical vertebrae (14.5%), and the thoracic vertebrae (8.7%). The weapons used were spear (n = 52); sword (n = 9); arrow (n = 9); stone (n = 8); and cane, animal, the hand, Chariot race, and broken yoke (n = 1 for each). Fifty-four combats (66.6%) resulted in death. Therapeutic herbs, compound of milk, and essence of fig were used as treatment alternatives. While providing a historic snapshot on the war of Troy, in this article, the authors have reviewed the musculoskeletal injuries and their management in those ancient times. Despite the long period in between, unfortunately, physicians/surgeons are still faced with war injuries in current medical practice. The authors strongly hope that, at least in the near future, physicians will be left with only natural health problems and without those artificially generated by human beings.
Ozelo, M C; Villaça, P R; Pérez-Bianco, R; Candela, M; Garcia-Chavez, J; Moreno-Rodriguez, B; Rodrigues, M B; Rodriguez-Grecco, I; Solano, M H; Chumpitaz, G; Morales-Gana, M M; Ruiz-Sáez, A
There is a paucity of literature on haemophilia treatment in Latin American countries, a region characterized by rapidly improving systems of care, but with substantial disparities in treatment between countries. The aim of this study was to evaluate the musculoskeletal status of haemophilia patients from Latin America and to examine the relationship between musculoskeletal status and treatment practices across countries. The Committee of Latin America on the Therapeutics of Inhibitor Groups conducted a survey of its member country representatives on key aspects of haemophilia treatment in 10 countries. Musculoskeletal status of patients was obtained during routine comprehensive evaluations between March 2009 and March 2011. Eligible patients had severe haemophilia A (factor VIII <1%) without inhibitors (<0.6 BU mL(-1) ) and were ≥5 years of age. Musculoskeletal status was compared between three groups of countries, based primarily on differences in the availability of long-term prophylaxis. Overall, 143 patients (5-66 years of age) were enrolled from nine countries. In countries where long-term prophylaxis had been available for at least 10 years (Group A), patients aged 5-10 years had significantly better mean World Federation of Hemophilia clinical scores, fewer target joints and fewer affected joints than patients from countries where long-term prophylaxis has been available for about 5 years (Group B) or was not available (Group C). In Latin America, the musculoskeletal status of patients with severe haemophilia without inhibitors has improved significantly in association with the provision of long-term prophylaxis. As more countries in Latin America institute this practice, further improvements are anticipated.
Ozelo, M C; Villaça, P R; Pérez-Bianco, R; Candela, M; Garcia-Chavez, J; Moreno-Rodriguez, B; Rodrigues, M B; Rodriguez-Grecco, I; Solano, M H; Chumpitaz, G; Morales-Gana, M M; Ruiz-Sáez, A
Summary There is a paucity of literature on haemophilia treatment in Latin American countries, a region characterized by rapidly improving systems of care, but with substantial disparities in treatment between countries. The aim of this study was to evaluate the musculoskeletal status of haemophilia patients from Latin America and to examine the relationship between musculoskeletal status and treatment practices across countries. The Committee of Latin America on the Therapeutics of Inhibitor Groups conducted a survey of its member country representatives on key aspects of haemophilia treatment in 10 countries. Musculoskeletal status of patients was obtained during routine comprehensive evaluations between March 2009 and March 2011. Eligible patients had severe haemophilia A (factor VIII <1%) without inhibitors (<0.6 BU mL−1) and were ≥5 years of age. Musculoskeletal status was compared between three groups of countries, based primarily on differences in the availability of long-term prophylaxis. Overall, 143 patients (5–66 years of age) were enrolled from nine countries. In countries where long-term prophylaxis had been available for at least 10 years (Group A), patients aged 5–10 years had significantly better mean World Federation of Hemophilia clinical scores, fewer target joints and fewer affected joints than patients from countries where long-term prophylaxis has been available for about 5 years (Group B) or was not available (Group C). In Latin America, the musculoskeletal status of patients with severe haemophilia without inhibitors has improved significantly in association with the provision of long-term prophylaxis. As more countries in Latin America institute this practice, further improvements are anticipated. PMID:24354487
Ekinci, Şafak; Kocak, Necmettin; Aydin, Ibrahim; Koca, Kenan; Akyildiz, Ramazan; Ersen, Omer; Kilic, Selim
Objectives: The aim of this cross-sectional epidemiologic study was to investigate the prevalence and distribution of musculoskeletal disorders causing unfitness to Turkish Military Service. Methods: This study has been carried out by examining the medical reports of 1.777.500 people who applied to the Turkish Armed Forces for military service between 2009-2011. Age and geographic region of individuals were compiled and organized in groups. Musculoskeletal disorders were classified mainly as fracture sequel, spine disorders, absence of phalanges, extremity amputation, aggressive or multiple benign tumors of bones and pes planus. Results: Unfitness to military service caused by musculoskeletal disorders was found to be 6.53‰ in 2009, 7.10‰ in 2010 and 7.28‰ in 2011. The prevalence of musculoskeletal diseases has increased by years. The prevalence of fracture squeal by years was found to be 2.83‰ in 2009, 3.10‰ in 2010 and 3.03‰ in 2011. In this study, the most common musculoskeletal disorders were: limitation of joint mobility (0.89‰), degeneration of joint surface (0.69‰), lower and upper limb discrepancies (0.60‰), posterior fusion surgery (0.59‰) and the absence of the phalanges in hand (0.51‰). We found an increase in both the prevalence of posterior fusion surgery and the absence of the phalanges in study group. Conclusion: These results has given information about severe musculoskeletal disorders among young adult male in Turkey. New studies including young adult female will add important information to our knowledge about musculuskelatal problems in our community. PMID:25878612
Koneru, Suneetha; Tanikonda, Rambabu
Background: Work-related musculoskeletal pain is one of the occupational hazards in dentists. Aims: To find the prevalence and severity of musculoskeletal pain in dentists, to compare musculoskeletal pain among dentists practicing yoga, those practicing physical activities, and those without any physical activity, and also to know the effects of sex, age, and workload on musculoskeletal pain. Materials and Methods: A self-reporting work-related questionnaire and the Nordic questionnaire for analysis of musculoskeletal disorders were given to graduated dentists attending Indian dental conference in Mumbai, to know the musculoskeletal pain experienced in the last 12 months and feedback was obtained from 220 dentists. Results: The prevalence of musculoskeletal pain in dentists was 34.5%. Prevalence of musculoskeletal pain was 10.5%, 21.7%, and 45.6% in dentists with regular yoga practice, other physical activity, and no physical activity, respectively. There was statistically significant difference in the prevalence of musculoskeletal pain among dentists who were practicing yoga when compared with those in no regular activity group. Conclusion: Within the limitations of the study, there was significant role of physical activity on the quality and quantity of work-related musculoskeletal disorders experienced by dentists. Yoga was found to be more effective than other modes of physical activities. More research is needed on musculoskeletal problems in dentists, with an emphasis on larger sample sizes and correlating other factors like age and sex of the dentists, duration of practice, years of practicing yoga, and working hours per week. PMID:26236679
Distributed energy resources (DER) are quickly making their way to industry primarily as backup generation. They are effective at starting and then producing full-load power within a few seconds. The distribution system is aging and transmission system development has not kept up with the growth in load and generation. The nation's transmission system is stressed with heavy power flows over long distances, and many areas are experiencing problems in providing the power quality needed to satisfy customers. Thus, a new market for DER is beginning to emerge. DER can alleviate the burden on the distribution system by providing ancillary services while providing a cost adjustment for the DER owner. This report describes 10 types of ancillary services that distributed generation (DG) can provide to the distribution system. Of these 10 services the feasibility, control strategy, effectiveness, and cost benefits are all analyzed as in the context of a future utility-power market. In this market, services will be provided at a local level that will benefit the customer, the distribution utility, and the transmission company.
Nagano, Satoshi; Yokouchi, Masahiro; Setoguchi, Takao; Sasaki, Hiromi; Shimada, Hirofumi; Kawamura, Ichiro; Ishidou, Yasuhiro; Kamizono, Junichi; Yamamoto, Takuya; Kawamura, Hideki; Komiya, Setsuro
Surgical site infection (SSI) has not been extensively studied in musculoskeletal tumors (MST) owing to the rarity of the disease. We analyzed incidence and risk factors of SSI in MST. SSI incidence was evaluated in consecutive 457 MST cases (benign, 310 cases and malignant, 147 cases) treated at our institution. A detailed analysis of the clinical background of the patients, pre- and postoperative hematological data, and other factors that might be associated with SSI incidence was performed for malignant MST cases. SSI occurred in 0.32% and 12.2% of benign and malignant MST cases, respectively. The duration of the surgery (P = 0.0002) and intraoperative blood loss (P = 0.0005) was significantly more in the SSI group than in the non-SSI group. We established the musculoskeletal oncological surgery invasiveness (MOSI) index by combining 4 risk factors (blood loss, operation duration, preoperative chemotherapy, and the use of artificial materials). The MOSI index (0–4 points) score significantly correlated with the risk of SSI, as demonstrated by an SSI incidence of 38.5% in the group with a high score (3-4 points). The MOSI index score and laboratory data at 1 week after surgery could facilitate risk evaluation and prompt diagnosis of SSI. PMID:24672281
Thompson, William R; Scott, Alexander; Loghmani, M Terry; Ward, Samuel R; Warden, Stuart J
Achieving functional restoration of diseased or injured tissues is the ultimate goal of both regenerative medicine approaches and physical therapy interventions. Proper integration and healing of the surrogate cells, tissues, or organs introduced using regenerative medicine techniques are often dependent on the co-introduction of therapeutic physical stimuli. Thus, regenerative rehabilitation represents a collaborative approach whereby rehabilitation specialists, basic scientists, physicians, and surgeons work closely to enhance tissue restoration by creating tailored rehabilitation treatments. One of the primary treatment regimens that physical therapists use to promote tissue healing is the introduction of mechanical forces, or mechanotherapies. These mechanotherapies in regenerative rehabilitation activate specific biological responses in musculoskeletal tissues to enhance the integration, healing, and restorative capacity of implanted cells, tissues, or synthetic scaffolds. To become future leaders in the field of regenerative rehabilitation, physical therapists must understand the principles of mechanobiology and how mechanotherapies augment tissue responses. This perspective article provides an overview of mechanotherapy and discusses how mechanical signals are transmitted at the tissue, cellular, and molecular levels. The synergistic effects of physical interventions and pharmacological agents also are discussed. The goals are to highlight the critical importance of mechanical signals on biological tissue healing and to emphasize the need for collaboration within the field of regenerative rehabilitation. As this field continues to emerge, physical therapists are poised to provide a critical contribution by integrating mechanotherapies with regenerative medicine to restore musculoskeletal function.
Thompson, William R.; Scott, Alexander; Loghmani, M. Terry; Ward, Samuel R.
Achieving functional restoration of diseased or injured tissues is the ultimate goal of both regenerative medicine approaches and physical therapy interventions. Proper integration and healing of the surrogate cells, tissues, or organs introduced using regenerative medicine techniques are often dependent on the co-introduction of therapeutic physical stimuli. Thus, regenerative rehabilitation represents a collaborative approach whereby rehabilitation specialists, basic scientists, physicians, and surgeons work closely to enhance tissue restoration by creating tailored rehabilitation treatments. One of the primary treatment regimens that physical therapists use to promote tissue healing is the introduction of mechanical forces, or mechanotherapies. These mechanotherapies in regenerative rehabilitation activate specific biological responses in musculoskeletal tissues to enhance the integration, healing, and restorative capacity of implanted cells, tissues, or synthetic scaffolds. To become future leaders in the field of regenerative rehabilitation, physical therapists must understand the principles of mechanobiology and how mechanotherapies augment tissue responses. This perspective article provides an overview of mechanotherapy and discusses how mechanical signals are transmitted at the tissue, cellular, and molecular levels. The synergistic effects of physical interventions and pharmacological agents also are discussed. The goals are to highlight the critical importance of mechanical signals on biological tissue healing and to emphasize the need for collaboration within the field of regenerative rehabilitation. As this field continues to emerge, physical therapists are poised to provide a critical contribution by integrating mechanotherapies with regenerative medicine to restore musculoskeletal function. PMID:26637643
Schmidt, Torsten; Doering, Axel
In der vorliegenden Arbeit präsentieren wir einen praxistauglichen Algorithmus zur automatischen Segmentierung der Disc-Grenze der Papille in Fundusaufnahmen. Ausgehend von einem lokalisierten Papillenpunkt werden Grauwertverläufe in horizontaler und vertikaler Richtung mittels einer Energiefunktion ausgewertet. In einem iterativen Prozess wird die Ellipse der tatsächlichen Disc-Grenze angenähert. Der Papillenrand konnte im Testdatensatz in 88% der Aufnahmen erfolgreich segmentiert werden. Der Algorithmus ist robust gegenüber der Lage des Startpunktes innerhalb der Papille und soll als Unterstützung bei der Glaukombefundung eingesetzt werden.
Haddad, Natalie; de Oliveira, Jayme; Nasser, Kassila da Rosa; Corbett, Ana Maria França; Tebet, Ana Carolina Franco; Reis, Mariana Lacerda Junqueira
Sarcoidosis is a multisystem granulomatous disease of unknown cause. The osteoarticular involvement in sarcoidosis is rare and is often associated with cutaneous and long-standing chronic multisystem disease. More common in black women, osseous sarcoidosis is difficult to diagnose, with an incidence of 3 to 13%. The most characteristic radiological clinical picture evidences rounded, well-defined cysts, with no periosteal reaction and without peripheral sclerosis. The small bones of hands and feet are the most frequently involved sites. This report aims to demonstrate a rare case of osteoarticular sarcoidosis with characteristic clinical presentation, and highlight the importance of detecting osteoarticular involvement in this pathology. PMID:25054759
Bahebeck, Jean; Atangana, Réné; Techa, André; Monny-Lobe, Marcel; Sosso, Maurice; Hoffmeyer, Pierre
The purpose of this study was to prospectively look for the relative rates and features of musculoskeletal complications in a sample of adult homozygous SS sicklers in Yaoundé. During a 3-year period, known homozygous SS sicklers aged sixteen years or more, with suspicion or evidence of locomotor system disease, including leg ulcer, were consecutively investigated through complete medical history, clinical examination, full blood count, C-reactive protein, standard radiographs of the area of complaint, and, when necessary, CT scan and pus analysis. Those patients with no definite diagnosis were excluded. The study group comprised 84 patients aged 16 to 51 years (mean age: 22 years), with a male/female ratio of 0.75. Four of them (4.5%) were older than 40 years. Thirty five (41.6%) presented a total of 50 lesions of aseptic osteonecrosis, which were located in the hips in 25 cases (50%), in the lumbar spine in 20 cases (40%), in the humeral head in four cases (10%) and in the talar body in one case. The hip necrosis was grade I in 6 cases, grade II in four, grade III in 11 and terminal in four. Multiple sites of necrosis were observed in six patients. Nineteen (22.6%) of the sicklers came on with 36 malleolar ulcers, more frequently in males (sex ratio: 5/1) and 28 (78%) located on the medial side. Fifteen sites of osteomyelitis were noted in 14 patients (17.8%) and septic arthritis in six (7%). Less frequent complications were impingement syndrome, gout osteoarthropathy, stress fracture, subtalar fusion, knee osteoarthritis, tendonitis of the anterior tibialis, and recurrent dislocation of the patella. All patients were managed conventionally, except for advanced aseptic necrosis in which the indication for arthroplasty was delayed till the terminal stage. As suggested by another recent report from Senegal, efforts should be made to improve the life expectancy of sicklers in Sub-Saharan African countries, by acting on education, social and medical care
Hauser, Ross A.; Lackner, Johanna B.; Steilen-Matias, Danielle; Harris, David K.
OBJECTIVE The aim of this study was to systematically review dextrose (d-glucose) prolotherapy efficacy in the treatment of chronic musculoskeletal pain. DATA SOURCES Electronic databases PubMed, Healthline, OmniMedicalSearch, Medscape, and EMBASE were searched from 1990 to January 2016. STUDY SELECTION Prospectively designed studies that used dextrose as the sole active prolotherapy constituent were selected. DATA EXTRACTION Two independent reviewers rated studies for quality of evidence using the Physiotherapy Evidence Database assessment scale for randomized controlled trials (RCTs) and the Downs and Black evaluation tool for non-RCTs, for level of evidence using a modified Sackett scale, and for clinically relevant pain score difference using minimal clinically important change criteria. Study population, methods, and results data were extracted and tabulated. DATA SYNTHESIS Fourteen RCTs, 1 case–control study, and 18 case series studies met the inclusion criteria and were evaluated. Pain conditions were clustered into tendinopathies, osteoarthritis (OA), spinal/pelvic, and myofascial pain. The RCTs were high-quality Level 1 evidence (Physiotherapy Evidence Database ≥8) and found dextrose injection superior to controls in Osgood–Schlatter disease, lateral epicondylitis of the elbow, traumatic rotator cuff injury, knee OA, finger OA, and myofascial pain; in biomechanical but not subjective measures in temporal mandibular joint; and comparable in a short-term RCT but superior in a long-term RCT in low back pain. Many observational studies were of high quality and reported consistent positive evidence in multiple studies of tendinopathies, knee OA, sacroiliac pain, and iliac crest pain that received RCT confirmation in separate studies. Eighteen studies combined patient self-rating (subjective) with psychometric, imaging, and/or biomechanical (objective) outcome measurement and found both positive subjective and objective outcomes in 16 studies and positive
Kumar, Dodda Kiran; Mohan, Sreevalli; Begum, Mohammadi; Prasad, Bhanu; Prasad, Eswar Ravi Vara
Since the number of dental patients is increasing day by day dentists are forced to spend longer times in dental chairs. This is increasing the prevalence of musculoskeletal disorders in dentists. This article reviews the mechanisms causing musculoskeletal disorders among dentists and also covers the exercises that can be done to prevent them. Exercises that increase the fitness of a dentist are divided into aerobic exercises – concentrating on total body fitness, stretching exercises – that concentrate on the muscles that tend to tighten in prolonged dental postures and strengthening exercises – that concentrate on the muscles that are opposite to the tight muscles. These exercises are made simple and of minimal intensity so that a dentist can practice them independently. PMID:25177661
Ultrasound elastography is a widely used technique for assessing the mechanical characteristics of tissues. Although there are several ultrasound elastography techniques, strain elastography (SE) is currently the most widely used technique for visualizing an elastographic map in real time. Among its various indications, SE is especially useful in evaluating the musculoskeletal system. In this article, we review the SE techniques for clinical practice and describe the images produced by these techniques in the context of the musculoskeletal system. SE provides information about tissue stiffness and allows real-time visualization of the image; however, SE cannot completely replace gray-scale, color, or power Doppler ultrasonography. SE can increase diagnostic accuracy and may be useful for the follow-up of benign lesions. PMID:26810195
The functional morphology of arthropod appendages shows remarkable diversity. Plausible functional integrations, particularly between muscles and the exoskeleton, must be achieved in these diverse morphologies. This study provides an insight into the evolutionary pathway of diversified appendages from a functional point of view. The musculoskeletal structure and development of antennae in five species of Cypridocopina were compared. The muscle and skeletal systems are integrated in several ways: The integration in Propontocypris attenuata occurs during various stages of the molting growth, whereas that in Fabaeformiscandona breuili occurs during the myogenesis. These two types of developmental processes have notable similarities, despite their occurrence during different developmental phases. From the overview of the molecular phylogeny presented by earlier studies, it is suggested that the integrated musculoskeletal system has reappeared repeatedly in cypridoid lineages as an atavism. This study demonstrates how arthropod appendages evolve without losing the integrity of the functional whole.
Nejad, Naser Hashemi; Choobineh, Alireza; Rahimifard, Hoda; Haidari, Hamid Reza; Tabatabaei, Sayed Hamid Reza
In Iran, furniture is mainly manufactured in small workshops, where most activities are performed manually. This study was conducted among workers of furniture workshops to determine prevalence of musculoskeletal symptoms and to assess ergonomic working conditions to identify major risk factors associated with musculoskeletal symptoms. In this study, 410 randomly selected furniture workers participated. The Nordic questionnaire and an ergonomics checklist consisting of 6 sections were used as data collection tools. An index was calculated for each section of the checklist. Action categories indicating the priority of corrective measures were also defined. The highest prevalence of symptoms was reported in the knees (39%), lower back (35.6%) and wrists/hands (29.5%). It was found that manual material handling, poor workstation design and awkward working postures were associated with the reported symptoms in these regions (OR 1.77-4.52). Poor general working conditions and work organization showed association as well. Any interventional measures should focus on these areas.
Rhee, Hak Young; Cho, Jae Hwan; Seok, Jong Min; Cho, Taek Sang; Jeon, Woo Jin; Lee, Jin Gu; Kim, Sung Kyu
This study was conducted to investigate efficient, systematic management of the Korean police and to examine the status and prevention of musculoskeletal disorders in Korean police officers. For police officers in special working environments, the importance of basic data is emphasized for human resources (HR) management and the prevention of industrial hazards from an industrial health care perspective. This study was conducted on police officers who visited the national police hospital and who underwent x-ray, computed tomography (CT), and magnetic resonance imaging (MRI) for the diagnosis of musculoskeletal disorders. The results revealed that examinations for the lower extremities and spine were most frequently conducted using x-ray, CT, and MRI. In particular, knee and lumbar examinations were most frequently conducted among all lower extremity and spine examinations, respectively.
Greiner, Birgit A; Krause, Niklas
Associations and pathways between observed (rather than self-reported) job stressors and musculoskeletal disorders in 66 transit operators were investigated to determine specific stressors and vulnerable body regions affected, while adjusting for physical workload. Job stressors, defined as barriers to progress with work, comprised 7 categories and the sum of stressors. Outcomes included back and neck pain, low back pain, neck pain, pain of the upper extremities and the lower extremities, and any combination of these. Stressors were significantly associated with the combined musculoskeletal disorders category (odds ratio [OR] = 1.55), back and neck pain (OR = 1.41), low back pain (OR = 1.46), and pain in the lower extremities (OR = 1.44) after controlling for confounders. Five barrier categories had at least 1 significant association with outcomes. Results provide specific intervention targets by avoiding common method variance bias.
Shultz, Sarah P; Byrne, Nuala M; Hills, Andrew P
However quantified, obesity is a global health problem of significant magnitude. The condition is no longer limited to the developed world, with an increasing proportion of low-to-middle income countries burdened by obesity and its comorbidities. Specifically, obesity is a risk factor for a raft of psychosocial, physiological, cardiovascular, and metabolic problems. The carriage of excess body weight, including an unhealthy proportion of body fat, also has important implications for musculoskeletal health. To date, this important relationship has not received as much attention by the research community. Coincidentally, there has been a heightened interest in the role of physical activity and exercise across the lifespan in the prevention, treatment and management of obesity. This paper considers some of the more common musculoskeletal problems in children, adolescents and adults with implications for the overweight and obese and their meaningful engagement in physical activity.
Reichardt, Benjamin; Sarwar, Ammar; Bartling, Soenke H; Cheung, Arnold; Grasruck, Michael; Leidecker, Christianne; Bredella, Miriam A; Brady, Thomas J; Gupta, Rajiv
Flat-panel volume computed tomography (fpVCT) is a recent development in imaging. We discuss some of the musculoskeletal applications of a high-resolution flat-panel CT scanner. FpVCT has four main advantages over conventional multidetector computed tomography (MDCT): high-resolution imaging; volumetric coverage; dynamic imaging; omni-scanning. The overall effective dose of fpVCT is comparable to that of MDCT scanning. Although current fpVCT technology has higher spatial resolution, its contrast resolution is slightly lower than that of MDCT (5-10HU vs. 1-3HU respectively). We discuss the efficacy and potential utility of fpVCT in various applications related to musculoskeletal radiology and review some novel applications for pediatric bones, soft tissues, tumor perfusion, and imaging of tissue-engineered bone growth. We further discuss high-resolution CT and omni-scanning (combines fluoroscopic and tomographic imaging).
Welch, Brian T; Welch, Timothy J
Percutaneous image-guided biopsy plays an important role in the management of multiple pathologic conditions involving the musculoskeletal system. The vast majority of these conditions require histologic diagnosis to guide decision making concerning treatment. Percutaneous image-guided biopsy has supplanted open surgical biopsy as the primary modality for tissue diagnosis in this patient cohort. The safety, efficacy, and clinical outcome of percutaneous image-guided biopsy for a multitude of musculoskeletal conditions are well documented. Improvements in needle design and image guidance have continued to further the efficacy and safety of this diagnostic technique. Complications associated with percutaneous biopsy are minimal compared with those seen in open surgical biopsy, whereas diagnostic accuracy is comparable to that of surgical biopsy.
AWARD NUMBER: W81XWH-13-2-0043 TITLE: Lumbar Spine Musculoskeletal Physiology and Biomechanics During Simulated Military Operations PRINCIPAL...muscle physiology and lumbar spine kinematics data we have collected to date. We currently have three manuscripts in preparation for this study...Evaluation of SEAL Delivery Vehicles Unit Level Training The primary aim of this project is to describe the physiological , physical, cognitive and sleep
There are many challenges to conducting valid epidemiological research of work-related musculoskeletal disorders and interpreting reports describing the results. In particular, these concern the basic study design, selection of subjects, measurement of exposure and outcome, control of confounding and the limitations of workers' compensation data systems. Researchers and people interested in the research results need to be aware of the major potential problems and pay careful attention to them when designing, conducting and using the results of such research.
Lewandowski, B. E.; Pennline, J. A.; Stalker, A. R.; Mulugeta, L.; Myers, J. G.
The NASA Digital Astronaut Project s (DAP) objective is to provide computational tools that support research of the physiological response to low gravity environments and analyses of how changes cause health and safety risks to the astronauts and to the success of the mission. The spaceflight risk associated with muscle atrophy is impaired performance due to reduced muscle mass, strength and endurance. Risks of early onset of osteoporosis and bone fracture are among the spaceflight risks associated with loss of bone mineral density. METHODS: Tools under development include a neuromuscular model, a biomechanical model and a bone remodeling model. The neuromuscular model will include models of neuromuscular drive, muscle atrophy, fiber morphology and metabolic processes as a function of time in space. Human movement will be modeled with the biomechanical model, using muscle and bone model parameters at various states. The bone remodeling model will allow analysis of bone turnover, loss and adaptation. A comprehensive trade study was completed to identify the current state of the art in musculoskeletal modeling. The DAP musculoskeletal models will be developed using a combination of existing commercial software and academic research codes identified in the study, which will be modified for use in human spaceflight research. These individual models are highly dependent upon each other and will be integrated together once they reach sufficient levels of maturity. ANALYSES: The analyses performed with these models will include comparison of different countermeasure exercises for optimizing effectiveness and comparison of task requirements and the state of strength and endurance of a crew member at a particular time in a mission. DISCUSSION: The DAP musculoskeletal model has the potential to complement research conducted on spaceflight induced changes to the musculoskeletal system. It can help with hypothesis formation, identification of causative mechanisms and
We describe the case of a three-week-old female, who presented with fever and swelling of the left thigh. Initial examination revealed signs of infection in both hips, which was confirmed at surgery. However, as the child did not recover despite relevant antibiotics, a full body MRI was performed, revealing multiple abscesses, some of which had to be managed surgically. We emphasize the benefit of MRI as part of the preoperative assessment of multifocal musculoskeletal infections in children.
van den Bogert, Antonie J.; Blana, Dimitra; Heinrich, Dieter
The ordinary differential equations for musculoskeletal dynamics are often numerically stiff and highly nonlinear. Consequently, simulations require small time steps, and optimal control problems are slow to solve and have poor convergence. In this paper, we present an implicit formulation of musculoskeletal dynamics, which leads to new numerical methods for simulation and optimal control, with the expectation that we can mitigate some of these problems. A first order Rosenbrock method was developed for solving forward dynamic problems using the implicit formulation. It was used to perform real-time dynamic simulation of a complex shoulder arm system with extreme dynamic stiffness. Simulations had an RMS error of only 0.11 degrees in joint angles when running at real-time speed. For optimal control of musculoskeletal systems, a direct collocation method was developed for implicitly formulated models. The method was applied to predict gait with a prosthetic foot and ankle. Solutions were obtained in well under one hour of computation time and demonstrated how patients may adapt their gait to compensate for limitations of a specific prosthetic limb design. The optimal control method was also applied to a state estimation problem in sports biomechanics, where forces during skiing were estimated from noisy and incomplete kinematic data. Using a full musculoskeletal dynamics model for state estimation had the additional advantage that forward dynamic simulations, could be done with the same implicitly formulated model to simulate injuries and perturbation responses. While these methods are powerful and allow solution of previously intractable problems, there are still considerable numerical challenges, especially related to the convergence of gradient-based solvers. PMID:22102983
van den Bogert, Antonie J; Blana, Dimitra; Heinrich, Dieter
The ordinary differential equations for musculoskeletal dynamics are often numerically stiff and highly nonlinear. Consequently, simulations require small time steps, and optimal control problems are slow to solve and have poor convergence. In this paper, we present an implicit formulation of musculoskeletal dynamics, which leads to new numerical methods for simulation and optimal control, with the expectation that we can mitigate some of these problems. A first order Rosenbrock method was developed for solving forward dynamic problems using the implicit formulation. It was used to perform real-time dynamic simulation of a complex shoulder arm system with extreme dynamic stiffness. Simulations had an RMS error of only 0.11 degrees in joint angles when running at real-time speed. For optimal control of musculoskeletal systems, a direct collocation method was developed for implicitly formulated models. The method was applied to predict gait with a prosthetic foot and ankle. Solutions were obtained in well under one hour of computation time and demonstrated how patients may adapt their gait to compensate for limitations of a specific prosthetic limb design. The optimal control method was also applied to a state estimation problem in sports biomechanics, where forces during skiing were estimated from noisy and incomplete kinematic data. Using a full musculoskeletal dynamics model for state estimation had the additional advantage that forward dynamic simulations, could be done with the same implicitly formulated model to simulate injuries and perturbation responses. While these methods are powerful and allow solution of previously intractable problems, there are still considerable numerical challenges, especially related to the convergence of gradient-based solvers.
Hermanson, James E; Choi, Sang D
Due to the cost and time benefits associated with patients and physicians, outpatient surgeries continue to become more and more popular over time. With the increase in the number of office-based surgical procedures, the prevalence of work-related musculoskeletal disorders (WMSDs) associated with office-based surgeries has been reported. The purpose of this pilot study is to ergonomically evaluate the risk of work-related musculoskeletal disorders of physicians/surgeons performing office-based surgery (OBS). Ergonomic assessment tools included Questionnaire, the BodyMap and the Rapid Upper Limb Assessment for measuring potential ergonomic concerns. The findings have shown that the ergonomic issues of greatest concerns were the discomforts in the neck, shoulders, arms/wrists, and back. Some additional comments were provided by the participants regarding the duration of discomfort or clarification on the frequency of their body discomfort. This study suggests that there is a considerable risk of musculoskeletal injuries of physicians/surgeons performing the OBS tasks. By properly using the ergonomic assessment techniques, valuable information on ergonomic OBS workplace design and selection could assist in the early interventions of WMSD prevention.
Al Kaissi, Ali; Zwettler, Elisabeth; Ganger, Rudolf; Schreiner, Simone; Klaushofer, Klaus; Grill, Franz
Background A leptosomic body type is tall and thin with long hands. Marfanoid features may be familial in nature or pathological, as occurs in congenital contractual arachnodactyly (Beal’s syndrome) and Shprintzen-Goldberg syndrome mimicking some of the changes of Marfan syndrome, although not accompanied by luxation of lens and dissecting aneurysm of aorta. Methods In this article we collected eight patients who were consistent with the diagnosis of Marfan syndrome via phenotypic and genotypic characterization. Results Our patients manifested a constellation of variable presentations of musculo-skeletal abnormalities ranging from developmental dysplasia of the hip, protrusio acetabuli, leg length inequality, patellar instability, scoliosis, to early onset osteoarthritis. Each abnormality has been treated accordingly. Conclusion This is the first paper which includes the diagnosis and the management of the associated musculo-skeletal abnormalities in patients with Marfan syndrome, stressing that patients with Marfan syndrome are exhibiting great variability in the natural history and the severity of musculo-skeletal abnormalities. PMID:23399831
Darwish, Magdy A.; Al-Zuhair, Shatha Z.
Objective. This study was conducted to estimate prevalence and pattern of musculoskeletal pain disorders among secondary school Saudi female teachers in Al-Khobar area and the psychodemographic and psychosocial factors that may affect them. Material and Method. A cross-sectional study was conducted using sample of secondary schools teachers (governmental and private school) in Al-Khobar area, Saudi Arabia (KSA). Data were collected using a structured self-administered questionnaire. Result. Prevalence of musculoskeletal pain disorders was 79.17%. Main sites of pain were lower back (63.8%) followed by shoulder (45.4%), neck (42.1%), leg (40.0%), wrist (16.2%), and elbow joint (10.0%). Factors that showed significant relationship were type of school (p value 0.038), age (p value 0.002), weight (p value 0.007), number of children (p value 0.006), shoe type (p value 0.000), teaching years (p value 0.003), and working daily hours (p value 0.027). Conclusion. Secondary school female teachers showed high prevalence of musculoskeletal pain disorders in most anatomic sites, namely, the back, shoulder, neck, legs, wrist, and elbow joint. Risk factors associated with significant pain were type of school, age, weight, number of children, and number of teaching years. PMID:23970968
Baldwin, K. M.; White, T. P.; Arnaud, S. B.; Edgerton, V. R.; Kraemer, W. J.; Kram, R.; Raab-Cullen, D.; Snow, C. M.
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.
Meltzer, Lisa J; Logan, Deirdre E; Mindell, Jodi A
This study examined sleep patterns in female adolescents with chronic musculoskeletal pain. Twenty-six participants with chronic musculoskeletal pain completed questionnaires during their clinic visit, and three 24-Hour Sleep Patterns Interviews during the following 2 weeks. Compared to normative data (Acebo & Carskadon, 2002), adolescents with chronic pain reported similar total sleep time (TST) and bedtimes. However, study participants reported significantly longer sleep onset latency, more night wakings, a later morning wake time, and more symptoms of daytime sleepiness. Pain improved after sleep for 27% of the study sample, and was associated with longer TST. Finally, depression and anxiety were related to daytime sleepiness, but not total sleep time or sleep onset latency. Female adolescents with chronic pain either may be more sensitive to the chronic sleep debt that is common in this age group, or they may experience underlying physiological sleep disrupters (e.g., periodic limb movement disorder) or sleep abnormalities (e.g., alpha-delta intrusions) not measured in this study. Additional research is needed to examine the complex relation between sleep and chronic musculoskeletal pain.
Lipscomb, H J; Dement, J M; Loomis, D P; Silverstein, B; Kalat, J
Combined data sources, including union administrative records and workers' compensation claims, were used to construct event histories for a dynamic cohort of union carpenters from Washington State during the period 1989-1992. Person-time at risk and the events of interest were stratified by age, sex, time in the union, and predominant type of carpentry work. Poisson regression techniques were used to identify subgroups at greatest risk of filing claims for a variety of musculoskeletal disorders defined by ANSI codes for body part injured and injury nature. Distinguishing different kinds of musculoskeletal disorders, even crudely with ANSI codes, led to different conclusions about the effects of the explanatory variables. Among older workers, the rates of fractures of the foot were higher, while rates of contusions of the hand and foot were lower. Women had higher rates of sprain/strains and nerve conditions of the wrist/forearm. Higher rates of injuries to the axial skeleton were seen among carpenters who did predominantly light commercial and drywall work, while piledrivers had lower rates of these injuries. Drywall workers had higher rates of sprains to the ankle/lower leg. Workers who were members of the union as long as four years had lower risks for the vast majority of musculoskeletal disorders studied. Similar patterns were seen for more serious claims that resulted in paid lost time from work.
Choobineh, Alireza; Tabatabaei, Sayed Hamidreza; Tozihian, Marzieh; Ghadami, Fatemeh
Introduction: Work-related musculoskeletal disorders (WMSDs) are a common health problem throughout the world and a major cause of disability in the workplace. Awkward working posture is a main risk factor for developing WMSDs. Assessment of exposure level to WMSDs risks can be an appropriate base for planning and implementing interventional ergonomics program in the workplace. This study was conducted among workers of an Iranian communication company with the objectives of a) determination of WMSDs prevalence and b) assessment of exposure level to WMSDs risks. Materials and Methods: In this cross-sectional study, 85 randomly selected workers from assembly line and closed circuit TV (CCTV) participated. Nordic musculoskeletal questionnaire (NMQ) was used to study prevalence of WMSDs and rapid upper limb assessment (RULA) technique was applied to assess physical exposure to the risks. Results: The results of NMQ revealed that WMSDs occurred at an high rate. The highest rates of WMSDs prevalence were reported in shoulders (73%), knees (67.1%) and back (66.7%). RULA showed that the Grand Score of 88.1% of cases were high and very high (action levels 3 and 4). Significant association was found between risk level and musculoskeletal symptoms in lower back (P < 0.05). Conclusion: Given the association between RULA score and the prevalence of the problems, reducing RULA score by designing ergonomic workstation may reduce the prevalence of WMSDs among the workers. PMID:21957370
Dabholkar, Tejashree Ajit; Nakhawa, Priyanka; Yardi, Sujata
Introduction: Work-related musculoskeletal disorders (WMSDs) are a common health problem throughout the world and a major cause of disability in the workplace. Awkward working posture is a main risk factor for developing WMSDs. Assessment of exposure level to WMSDs risks can be an appropriate base for planning and implementing interventional ergonomics program in the workplace. Fihing in India is a major industry in the coastal states employing over 14 million people. The job demand of fishermen make them vulnerable for various musculoskeletal problems This study was conducted among workers of fishing industry in Mumbai, India with the objective to determine WMSDs prevalence in fishing industry. Materials and Methods: In this cross-sectional study, 110 randomly selected workers from fishing industry, India, Mumbai, Anonymous questionnaire was used to study prevalence of WMSDs.visual analogue scale used to assess intensity of pain. Results: The results of NMQ revealed that WMSDs occurrence was high. The highest rates of WMSDs prevalence were reported in Low back(92.4%), Shoulder (64.8%) and Knee(31%) and Hand (25%). Conclusion: This study showed that maximum of the fishermen have musculoskeletal problem with the most common joint involved is low back and then followed by shoulder, knee, and hand. Ergonomic risk factor involved were found to be repeated pulling and throwing of the net as well as repeated bending forward action to lift heavy load and transfer that heavy load. PMID:25568597
This review considers the definition of a healthy bone phenotype through the life course and the modulating effects of muscle function and nutrition. In particular, it will emphasise that optimal bone strength (and how that is regulated) is more important than simple measures of bone mass. The forces imposed on bone by muscle loading are the primary determinants of musculoskeletal health. Any factor that changes muscle loading on the bone, or the response of bone to loading results in alterations of bone strength. Advances in technology have enhanced the understanding of a healthy bone phenotype in different skeletal compartments. Multiple components of muscle strength can also be quantified. The critical evaluation of emerging technologies for assessment of bone and muscle phenotype is vital. Populations with low and moderate/high daily Ca intakes and/or different vitamin D status illustrate the importance of nutrition in determining musculoskeletal phenotype. Changes in mass and architecture maintain strength despite low Ca intake or vitamin D status. There is a complex interaction between body fat and bone which, in addition to protein intake, is emerging as a key area of research. Muscle and bone should be considered as an integrative unit; the role of body fat requires definition. There remains a lack of longitudinal evidence to understand how nutrition and lifestyle define musculoskeletal health. In conclusion, a life-course approach is required to understand the definition of healthy skeletal phenotype in different populations and at different stages of life.
Taylor, Meredith D.; Tarbox, Grayson J.; Palmer, Antony J.; Park, Daniel J.
Whole-body 7 Tesla MRI scanners have been approved solely for research since they appeared on the market over 10 years ago, but may soon be approved for selected clinical neurological and musculoskeletal applications in both the EU and the United States. There has been considerable research work on musculoskeletal applications at 7 Tesla over the past decade, including techniques for ultra-high resolution morphological imaging, 3D T2 and T2* mapping, ultra-short TE applications, diffusion tensor imaging of cartilage, and several techniques for assessing proteoglycan content in cartilage. Most of this work has been done in the knee or other extremities, due to technical difficulties associated with scanning areas such as the hip and torso at 7 Tesla. In this manuscript, we first provide some technical context for 7 Tesla imaging, including challenges and potential advantages. We then review the major quantitative MRI techniques being applied to musculoskeletal applications on 7 Tesla whole-body systems. PMID:28090448
Attarchi, Mirsaeed; Raeisi, Saeed; Namvar, Mohamad; Golabadi, Majid
Background: Some health problems are more prevalent in shift workers than day workers. Musculoskeletal disorders are considered as one of the most common health-related problems that can cause disability among health care workers. The aim of this study was to assess the associations between shift working and the prevalence of musculoskeletal symptoms (MSs) among nursing personnel. Materials and Methods: This study was conducted among 454 health care workers including nurses and nurses’ aides in a general hospital in Iran. A Nordic musculoskeletal questionnaire was used to evaluate the prevalence of MSs. Logistic regression analysis with adjusting for confounding factors was performed to evaluate the associations between shift working and the prevalence of MSs. Results: Lower back, knees, and upper back symptoms with the prevalence of 57.4%, 48.4%, and 47%, respectively, were the most common MSs. The prevalence of MSs in eight regions of the body (lower back, neck, knees, upper back, shoulder, wrist, buttock, and ankle) was higher among shift workers than day workers. The differences were statistically significant only in the lower back and ankle regions (P < 0.05). Odds Ratio for lower back symptoms in shift workers was 1.94 compared to day workers (P = 0.003). Conclusion: Findings of this study suggested that shift working could be associated with increased prevalence of lower back disorders among nursing personnel. This study emphasizes on the importance of proper work planning and regulating working hours for nursing personnel. PMID:24949072
Kim, Su Young; Cheon, Ji Hyun; Seo, Won Jun; Yang, Geun Young; Choi, Yun Mi
The musculoskeletal system is mainly composed of the bones, muscles, tendons, and ligaments, in addition to nerves and blood vessels. The greatest difficulty in an ultrasonographic freeze-frame created by the examiner is recognition of the targeted structures without indicators, since an elephant's trunk may not be easily distinguished from its leg. It is not difficult to find descriptive ultrasonographic terms used for educational purposes, which help in distinguishing features of these structures either in a normal or abnormal anatomic condition. However, the terms sometimes create confusion when describing common objects, for example, in Western countries, pears have a triangular shape, but in Asia they are round. Skilled experts in musculoskeletal ultrasound have tried to express certain distinguishing features of anatomic landmarks using terms taken from everyday objects which may be reminiscent of that particular feature. This pictorial review introduces known signature patterns of distinguishing features in musculoskeletal ultrasound in a normal or abnormal condition, and may stir the beginners' interest to play a treasure-hunt game among unfamiliar images within a boundless ocean. PMID:27738500
Die meisten Schädeltiere sind in der Lage, die Wasser- und Ionenkonzentration ihres Innenmilieus zu regulieren, sind also im Hinblick auf ihren Ionenhaushalt weitgehend unabhängig von der Umgebung. Sie halten die Konzentration von Wasser und anorganischen Ionen in ihren Körperflüssigkeiten (interstitielle Flüssigkeit und Blut) innerhalb enger Grenzen konstant (Osmoregulierer). Schleim aale (Myxinoida) können zwar die Konzentration einzelner anorganischer Ionen regulieren, sind aber insgesamt der hohen Osmolarität des Meerwassers angepasst, also isoosmostisch zu diesem. Isoosmotisch oder leic ht hyperosmostisch zur Umgebung sind auch marine Neoselachier und Latimeria chalumnae (Actinistia), die dazu organische Osmolyte (Harnstoff und Trimethylaminoxid) im Blut akkumulieren (Osmokonformer). Bei anderen aquatischen Schädeltieren sind die Körperflüssigkeiten zur Umgebung hypoosmotisch (im Meerwasser) — sie halten Wasser zurück und scheiden anorganiche Ionen aus — oder hyperosmotisch (im Süßwasser), indem sie Wasser abgeben und anorganische Ionen aufnehmen.
Raub, James A
Yoga has become increasingly popular in Western cultures as a means of exercise and fitness training; however, it is still depicted as trendy as evidenced by an April 2001 Time magazine cover story on "The Power of Yoga." There is a need to have yoga better recognized by the health care community as a complement to conventional medical care. Over the last 10 years, a growing number of research studies have shown that the practice of Hatha Yoga can improve strength and flexibility, and may help control such physiological variables as blood pressure, respiration and heart rate, and metabolic rate to improve overall exercise capacity. This review presents a summary of medically substantiated information about the health benefits of yoga for healthy people and for people compromised by musculoskeletal and cardiopulmonary disease.
Siriwanarangsun, Palanan; Statum, Sheronda; Biswas, Reni; Bae, Won C.
Magnetic resonance (MR) imaging has been widely implemented as a non-invasive modality to investigate musculoskeletal (MSK) tissue disease, injury, and pathology. Advancements in MR sequences provide not only enhanced morphologic contrast for soft tissues, but also quantitative biochemical evaluation. Ultrashort time to echo (UTE) sequence, in particular, enables novel morphologic and quantitative evaluation of previously unseen MSK tissues. By using short minimum echo times (TE) below 1 msec, the UTE sequence can unveil short T2 properties of tissues including the deepest layers of the articular cartilage, cartilaginous endplate at the discovertebral junction, the meniscus, and the cortical bone. This article will discuss the application of UTE to evaluate these MSK tissues, starting with tissue structure, MR imaging appearance on standard versus short and ultrashort TE sequences, and provide the range of quantitative MR values found in literature. PMID:28090449
Sauer, Anne; Schwarz, Tobias; Engel, Nicole; Seitel, Mathias; Kenngott, Hannes; Mohrhardt, Carsten; Loßnitzer, Dirk; Giannitsis, Evangelos; Katus, Hugo A.; Meinzer, Hans-Peter
Die computergestützte bildbasierte Analyse der Herzfunktionen ist mittlerweile Standard in der Kardiologie. Die verfügbaren Produkte erfordern meist ein hohes Maß an Benutzerinteraktion und somit einen erhöhten Zeitaufwand. In dieser Arbeit wird ein Ansatz vorgestellt, der dem Kardiologen eine größtenteils automatische Analyse der Herzfunktionen mittels MRT-Bilddaten ermöglicht und damit Zeitersparnis schafft. Hierbei werden alle relevanten herzphysiologsichen Parameter berechnet und mithilfe von Diagrammen und Graphen visualisiert. Diese Berechnungen werden evaluiert, indem die ermittelten Werte mit manuell vermessenen verglichen werden. Der hierbei berechnete mittlere Fehler liegt mit 2,85 mm für die Wanddicke und 1,61 mm für die Wanddickenzunahme immer noch im Bereich einer Pixelgrösse der verwendeten Bilder.
Wolf, Michael D. C.
Das Ziel dieser Arbeit ist es, die Strukturen im äueren Erdkern zu untersuchen und Rückschlüsse auf die sich daraus ergebenden Konsequenzen für geodynamische Modellvorstellungen zu ziehen. Die Untersuchung der Kernphasenkaustik B mit Hilfe einer kumulierten Amplituden-Entfernungskurve ist Gegenstand des ersten Teils. Dazu werden die absoluten Amplituden der PKP-Phasen im Entfernungsbereich von 142 ° bis 147 ° bestimmt und mit den Amplituden synthetischer Seismogramme verglichen. Als Datenmaterial dienen die Breitbandregistrierungen des Deutschen Seismologischen Re-gionalnetzes (GRSN 1 ) und des Arrays Gräfenberg (GRF). Die verwendeten Wellen-formen werden im WWSSN-SP-Frequenzbereich gefiltert. Als Datenbasis dienen vier Tiefherdbeben der Subduktionszone der Neuen Hebriden (Vanuatu Island) und vier Nuklearexplosionen, die auf dem Mururoa und Fangataufa Atoll im Südpazifik stattgefunden haben. Beide Regionen befinden sich vom Regionalnetz aus gesehen in einer Epizentraldistanz von ungefähr 145 °. Die Verwendung eines homogen instrumentierten Netzes von Detektoren und die Anwendung von Stations- und Magnitudenkorrekturen verringern den Hauptteil der Streuung bei den Amplitudenwerten. Dies gilt auch im Vergleich zu Untersuchungen von langperiodischen Amplituden im Bereich der Kernphasenkaustik (Häge, 1981). Ein weiterer Grund für die geringe Streuung ist die ausschlieliche Verwendung von Ereignissen mit kurzer impulsiver Herdzeitfunktion. Erst die geringe Streuung der Amplitudenwerte ermöglicht eine Interpretation der Daten. Die theoretischen Amplitudenkurven der untersuchten Erdmodelle zeigen im Bereich der Kaustik B einen gleichartigen Kurvenverlauf. Bei allen Berechnungen wird ein einheitliches Modell für die Güte der P- und S-Wellen verwendet, das sich aus den Q-Werten der Modelle CIT112 und PREM 2 zusammensetzt. Die mit diesem Q-Modell berechneten Amplituden liegen in geringem Mae oberhalb der gemessenen Amplituden. Dies braucht nicht ber
Mavrogenis, Andreas F; Papagelopoulos, Panayiotis J; Romantini, Matteo; Angelini, Andrea; Ruggieri, Pietro
With recent advances in medical and orthopedic oncology, radiation therapy and single- or multiple-agent perioperative chemotherapy are currently applied as an essential part of the multidisciplinary treatment to improve disease-free and overall survival of patients with primary and metastatic bone and soft tissue tumors. However, these treatments have led to unwanted complications. A better understanding of the effects of various antineoplastic agents on bone, soft tissue, and organs may provide the basis for the more efficacious use of antiproliferative drugs when fracture healing or allograft incorporation is required. This knowledge may also provide a rationale for concurrent treatment with drugs that protect against or compensate for adverse effects in osseous repair resulting from chemotherapy.
Friedrich Möglich, ein Schüler von Max von Laue und Erwin Schrödinger, übernahm 1947 die Chefredaktion der Annalen der Physik.Translated AbstractFriedrich Möglich - His Contributions to the Formation of Physics in GDRFriedrich Möglich a student of Max von Laue and Erwin Schrödinger took over as editor in chief of Annalen der Physik in 1947.
Vor der Erfindung des Fernrohrs war der dänische Astronom Tycho Brahe (1546 - 1601) der bedeutendste beobachtende Astronom. Von seinem Observatorium Uraniborg auf der - damals dänischen - Insel Hven ist heute noch der Grundriß erkennbar, von Stjerneborg sind die Fundamente erhalten, die Kuppeln in den 1950er Jahren ergänzt. In der Astronomie-Ausstellung im Deutschen Museum gibt es ein Modell der Sternwarte Uraniborg und der zugehörigen Instrumente (Maßstab 1:10); das größere Modell wurde dem Technischen Museum in Malmö geschenkt. Die Instrumente, die er in den Observatorien Uraniborg und Stjerneborg benutzte, sind nicht erhalten. Aber es gibt gute Beschreibungen der Instrumente (Halbkreis, Quadranten, Sextanten, Armillarsphären, Triquetrum, Himmelsglobus) in seinem Buch Astronomiae instauratae mechanica (Wandsbek 1598). Eine Nachbildung des großen hölzernen Quadranten kann man im Runden Turm in Kopenhagen sehen. Zwei Sextanten, hergestellt für Tycho um 1600 von Jost Bürgi und Erasmus Habermel, gibt es noch im Nationalmuseum für Technik in Prag. Ähnlichkeiten von Tychos Instrumenten mit Groß-Instrumenten aus dem islamischen Kulturkreis sind auffällig. Tycho Brahes Meßgeräte markieren einen großen Fortschritt in der Entwicklung astronomischer Instrumente und Meßtechniken und bilden die Grundlage für den weiteren Fortschritt der Positionsastronomie und der damit verbundenen Tabellenwerke. Die Nachwirkungen sind bis ins 17. und 18. Jahrhundert nachweisbar.
AD Award Number: DAMD17-03-1-0055 TITLE: A Randomized Trial of Musculoskeletal Pain Treatment in a Military Population PRINCIPAL INVESTIGATOR: Robert...NUMBERS A Randomized Trial of Musculoskeletal Pain Treatment in a DAMD17-03-1-0055 Military Population 6. AUTHOR(S) Robert J. Gatchel, Ph.D. 7...restoration approach to the treatment of Active Duty military from all 4 branches suffering from chronic musculoskeletal pain (CMP). The primary aims of this
Award Number: W81XWH-10-2-0163 TITLE: Auricular Therapy for Treatment of Musculoskeletal Pain in the Setting of Military Personnel: A Randomized...TITLE AND SUBTITLE 5a. CONTRACT NUMBER W81XWH-10-2-0163 Auricular Therapy for Treatment of Musculoskeletal Pain in the Setting of Military Personnel: A...SUBJET TERMS Auricular Therapy; Musculoskeletal Pain 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18. NUMBER OF PAGES 19a. NAME OF
Guddal, Maren Hjelle; Stensland, Synne Øien; Småstuen, Milada Cvancarova; Johnsen, Marianne Bakke; Zwart, John-Anker; Storheim, Kjersti
Background: Prevalence of musculoskeletal pain among adolescents is high, and pain in adolescence increases the risk of chronic pain in adulthood. Studies have shown conflicting evidence regarding associations between physical activity and musculoskeletal pain, and few have evaluated the potential impact of sport participation on musculoskeletal pain in adolescent population samples. Purpose: To examine the associations between physical activity level, sport participation, and musculoskeletal pain in the neck and shoulders, low back, and lower extremities in a population-based sample of adolescents. Study Design: Cross-sectional study; Level of evidence 4. Methods: Data from the Nord-Trøndelag Health Study (Young-HUNT3) were used. All 10,464 adolescents in the Nord-Trøndelag county of Norway were invited, of whom 74% participated. Participants were asked how often they had experienced pain, unrelated to any known disease or acute injury, in the neck and shoulders, low back, and lower extremities in the past 3 months. The associations between (1) physical activity level (low [reference], medium or high) or (2) sport participation (weekly compared with no/infrequent participation) and pain were evaluated using logistic regression analyses, stratified by sex, and adjusted for age, socioeconomic status, and psychological distress. Results: The analyses included 7596 adolescents (mean age, 15.8 years; SD, 1.7). Neck and shoulder pain was most prevalent (17%). A moderate level of physical activity was associated with reduced odds of neck and shoulder pain (OR = 0.79 [95% CI, 0.66-0.94]) and low back pain (OR = 0.75 [95% CI, 0.62-0.91]), whereas a high level of activity increased the odds of lower extremity pain (OR = 1.60 [95% CI, 1.29-1.99]). Participation in endurance sports was associated with lower odds of neck and shoulder pain (OR = 0.79 [95% CI, 0.68-0.92]) and low back pain (OR = 0.77 [95% CI, 0.65-0.92]), especially among girls. Participation in technical
Magdowski, M.; Vick, R.
Elektrische Leitungen und Kabel stellen häufig die Haupteinfallstore für elektromagnetische Felder in die daran angeschlossenen Geräte und Systeme dar. Für die Einkopplung einer ebenen Welle kann der in eine Leitung eingekoppelte Strom unter bestimmten Voraussetzungen mit Hilfe der Leitungstheorie sehr effizient bestimmt werden. Er hängt dabei von den Abmessungen der Leitung, den Leitungsabschlüssen sowie der Amplitude, der Wellenlänge und der Einfallsrichtung der ebenen Welle ab. In dieser Arbeit wird die Abhängigkeit der Einkopplung von der Einfallsrichtung näher untersucht. Dazu werden Richtdiagramme der Einkopplung berechnet, dargestellt und hinsichtlich der mittleren und maximalen Einkopplung über alle Einfallsrichtungen und Polarisationen ausgewertet. Die Ergebnisse werden genutzt, um die maximale Direktivität der Einkopplung in eine Leitung zu bestimmen. Fasst man die Einkopplung externer Felder in eine Leitung als einen Störfestigkeitstest auf, so kann die maximale Direktivität benutzt werden, um einen Vergleich zwischen unterschiedlichen Messumgebungen wie Absorberhallen und Modenverwirbelungskammern herzustellen.
... Veterans Benefits Administration (VBA)/Veterans Health Administration (VHA) Musculoskeletal Forum... discussed. Contingent upon available capacity and time, individuals wishing to make oral statements will...
Lee, CC; Ho, H; Lee, KT; Jeng, ST; Chiang, BL
In clinical therapy, the amount of antigen administered to achieve oral tolerance for allergic diseases is large, and the cost is a major consideration. In this study, we used tobacco plants to develop a large-scale protein production system for allergen-specific immunotherapy, and we investigated the mechanisms of oral tolerance induced by a transgenic plant-derived antigen. We used plants (tobacco leaves) transgenic for the Dermatophagoides pteronyssinus 2 (Der p2) antigen to produce Der p2. Mice received total protein extract from Der p2 orally once per day over 6 days (days 0–2 and days 6–8). Mice were also sensitized and challenged with yeast-derived recombinant Der p2 (rDer p2), after which the mice were examined for airway hyper-responsiveness and airway inflammation. After sensitization and challenge with rDer p2, mice that were fed with total protein extracted from transgenic plants showed decreases in serum Der p2-specific IgE and IgG1 titers, decreased IL-5 and eotaxin levels in bronchial alveolar lavage fluid, and eosinophil infiltration in the airway. In addition, hyper-responsiveness was also decreased in mice that were fed with total protein extracted from transgenic plants, and CD4+CD25+Foxp3+ regulatory T cells were significantly increased in mediastinal and mesenteric lymph nodes. Furthermore, splenocytes isolated from transgenic plant protein-fed mice exhibited decreased proliferation and increased IL-10 secretion after stimulation with rDer p2. The data here suggest that allergen-expressing transgenic plants could be used for therapeutic purposes for allergic diseases. PMID:21602845
Longo, Umile Giuseppe; Loppini, Mattia; Cavagnino, Roberta; Maffulli, Nicola; Denaro, Vincenzo
Soccer is the most popular sport worldwide, with about 200 million players, both professionals and amateurs. Because of its popularity, it has been often proposed to be able to prevent or cure health problems around the world. Although participation in football leads to significant physical benefits such as improving well-being, extending life expectancy and reducing the likelihood of several major non-communicable diseases, the possibility to incur in soccer injuries must be considered. On average, an elite football player suffers from 1.5-7.6 injuries each 1,000 hours of training and 12-35 injuries each 1000 hours of match. Several risk factors for soccer injuries have been described. The most important of them are the level of play (the risk appears to be higher in professional than amateur players); the exercise load; and the standard of training. The injury prevention program "The 11", developed with the support of the Federation Internationale de Football Association (FIFA), aims to reduce the impact of intrinsic injury risk factors in soccer, and it has been validated in that sport. A successive modified version of "The 11" ("The 11+") has been also shown to be effective in preventing injuries in young female soccer players. The FIFA 11+ provided more than 40% of reduction of the risk of injury. Several factors can be related to the risk of injury during sport. Therefore different exercises or factors might have been responsible for efficacy of the FIFA 11+ to prevent injuries. Several improvements have been surely achieved in the last ten years, but further investigation is needed to improve the benefits of playing soccer on human health.
Jeong, Kyoung Yong; Lee, In-Yong; Yong, Tai-Soon; Lee, Jae-Hyun; Kim, Eun-Jin; Lee, Joo-Shil; Hong, Chein-Soo; Park, Jung-Won
Amino acid sequence variations have possible influences on the allergenicity of allergens and may be important factors in allergen standardization. This study was undertaken to investigate the sequence polymorphisms of group 1 and 2 allergens from Korean isolates of the house dust mites Dermatophagoides farinae and D. pteronyssinus. cDNA sequences encoding group 1 and 2 allergens were amplified by RT-PCR and compared the deduced amino acid sequences. Der f 1.0101, which appeared in 64.0 % of the 50 sequences analyzed, was found to be predominant. Among the Der p 1 sequences, Der p 1.0102 and 1.0105 were predominant (58 %). Among the Der f 2 sequences, Der f 2.0102 (40.7 %) and a new variant with Gly at position 42 (27.8 %) were predominant. The deduced amino acid sequences of 60 Der p 2 clones were examined, and 28 variants with 1-5 amino acid substitutions were found. Interestingly, all of the Der p 2 sequences had Thr instead of Lys at position 49. Two variants (Leu40, Thr49, and Asn114 (26.6 %); Val40, Thr49, and Asn114 (20.0 %)) were found to be the most predominant forms of Der p 2. Der p 1 has a high rate of sporadic substitutions and the group 2 allergens show a more regular pattern with orderly associations of amino acid substitutions. Der f 1 and Der p 2 from Korean mite isolates have unique amino acid sequence polymorphisms. These findings provide important data for house dust mite allergen standardization.
Contents: 1. Die Anfänge. 2. Die Ära Dirichlet-Jacobi. 3. Der Ausbau der experimentellen Naturwissenschaften. 4. Alexander von Humboldt. 5. Berlin wird "Weltzentrum" der Mathematik. 6. Die Ära Helmholtz. 7. Neue Arbeitsweisen der Astronomie. 8. Chemie: Forschung und Industrie. 9. Max Planck. 10. Ins technische Zeitalter. 11. Zur Mathematik der zwanziger Jahre. 12. Albert Einstein. 13. Fortschritte der Grundlagenforschung. 14. Erwin Schrödinger: Physiker, Philosoph und Poet. 15. Zum Schluß.
Vlahakis, George N.
Die vorliegende Arbeit analysiert Ansichten griechischer Physiker zur Atomenergie und deren mögliche Anwendung nach dem Zweiten Weltkrieg, insbesondere während des Kalten Kriegs. Einerseits werden Ansichten von Physik- Professoren griechischer Universitäten präsentiert - beispielsweise von Dimitrios Hondros, der Student von Arnold Sommerfeld und Mitarbeiter von Peter Debye in München war, und andererseits wird die Politik der griechischen Regierung für die Etablierung eines Forschungsinstitutes diskutiert, das der Entwicklung der Atomenergie dienen sollte; ebenfalls wird eine öffentliche Meinungsumfrage zu diesen Thema, die in den Tageszeitungen der damaligen Zeit präsentiert wurde, diskutiert.
Gaspar, Michael P; Gaspar, Jonathan P; Kane, Patrick M
Inflammatory bowel diseases (IBD) are chronic immunemediated inflammatory conditions involving the gastrointestinal system with potential to adversely affect the musculoskeletal system as well. The numerous overlapping immunogenic and pathophysiologic disease mechanisms of the gastrointestinal and musculoskeletal systems have led to the concept of the "Joint-Gut Axis," illustrating an intimate link between the two organ systems. A solid understanding of the Joint-Gut Axis is necessary for the rheumatologist as well as the orthopaedic surgeon, as concomitant musculoskeletal disease may impart a profoundly negative impact on the quality of life of patients with IBD. Furthermore, a significant subset of patients initially present with secondary musculoskeletal symptoms resulting from an underlying, undiagnosed IBD. Additional non-inflammatory musculoskeletal sequelae of IBD that are not typically attributed to the Joint-Gut Axis should also be recognized by rheumatologists and orthopaedic surgeons in order that the proper preventative and supportive interdisciplinary management may be employed, maximizing patient outcomes and quality of life.
Choobineh, Alireza; Tabatabaei, Sayed Hamidreza; Mokhtarzadeh, Abbas; Salehi, Maryam
Musculoskeletal disorders (MSDs) are a common health problem throughout the world and a major cause of disability among the work force. Assessment of exposure level to MSD risk factors can be an appropriate base for planning and implementing interventional ergonomic programs in the workplace. This study was conducted among workers of an Iranian rubber factory with the objectives of (a) determination of the prevalence of MSDs among production line workers, and (b) assessment of the level of exposure to MSD risks. In this study, all 16 production units of the factory were studied. In each unit, 50% of the workers were randomly selected and included in the study. A total of 454 workers participated. The Nordic Musculoskeletal Questionnaire was used to study the prevalence of MSDs and the Quick Exposure Check (QEC) technique was applied to assess physical exposure to the risks. The videotaping technique was used to collect the required data for each worker. The vast majority of the workers (73.6%) had suffered from some kind of musculoskeletal symptoms during the last 12 months. The highest prevalence was reported in the lower back (50.2%), knees (48.5%) and upper back (38.1%). In 85.5% of the workers studied, the QEC score was high or very high. Statistical analysis showed a significant association between the QEC level of risk and MSDs symptoms (p<0.001). The most common ergonomics problems were found to be awkward postures and manual material handling. MSDs had occurred with a high rate among workers of this rubber factory. Corrective measures for reducing risk level seemed essential. Elimination of awkward postures and manual material handling in the workplace were recommended.
Sievert, Lynnette Leidy; Goode-Null, Susan K
Worldwide, complaints of musculoskeletal pain are more frequent than complaints of hot flashes amongst women of menopausal age. The purpose of this study was to examine musculoskeletal pain among women of menopausal age in the city of Puebla, Mexico. An opportunity sample was recruited from public parks and markets, with representation from all social classes (n=755). Mean age was 50.1 years, and the majority were employed as saleswomen in small businesses. Symptom frequencies were collected by open-ended interviews and with a structured symptom list that queried symptom experience during the two weeks prior to interview. In response to open-ended questions, "dolores de huesos" (bone pain) was volunteered by 47% of respondents as a symptom associated with menopause, second only to hot flashes (53%). From the structured symptom list, 55.8% and 55.6% reported back pain and joint stiffness during the two weeks prior to interview. Women with back pain and joint stiffness were less likely to report being active during their leisure time (p<.01). The results of backwards stepwise logistic regressions indicate that women with back pain were more likely to be older, with less education, a higher BMI, and ate less meat. Women with joint pain were more likely to be post-menopausal, with less education, more children, a higher BMI, and were likely to drink milk and coffee more than once/week but less than once/day. While menopause is not necessarily a risk factor for musculoskeletal pain, it is important to recognize the pervasiveness of this complaint among women of menopausal age.
REHN, B.; BERGDAHL, I. A.; AHLGREN, C.; FROM, C.; JÄRVHOLM, B.; LUNDSTRÖM, R.; NILSSON, T.; SUNDELIN, G.
The aim of this cross-sectional study was to characterize the risk of experiencing musculoskeletal symptoms in the region of the neck, shoulders and upper and lower back for professional drivers of various categories of all-terrain vehicles and to assess the association between symptoms and duration of exposure to whole-body vibration (WBV) and shock from driving all-terrain vehicles. The study group consisted of 215 drivers of forest machines, 137 drivers of snowmobiles and 79 drivers of snowgroomers and a control group of 167 men randomly selected from the general population. The subjects were all from one of the four most northern counties in Sweden and they were all men. Musculoskeletal symptoms were assessed by use of a standardized questionnaire. In addition, the questionnaire held items about the driving time with all-terrain vehicles and a subjective estimation of exposure to unpleasant movements (shock, jolt, irregular sway). The job strain was measured according to Karasek's demands/control model. The prevalence ratios were adjusted for age, smoking and job strain. Among drivers, significantly increased prevalence ratios within the range of 1∂5-2·9 were revealed for symptoms from the neck-shoulder and thoracic regions during the previous year. None of the driver categories had a statistically significantly increased risk of low back pain. Forest vehicles were those most reported to cause unpleasant movements. In conclusion, drivers of all-terrain vehicles exhibit an increased risk of symptoms of musculoskeletal disorders in the neck-shoulder and thoracic regions. The increased risk is suggested to be related to physical factors such as exposure to whole-body vibration (WBV) and shock, static overload or extreme body postures. However, since symptoms of low back pain were not significantly increased, it appears that factors other than WBV would explain the occurrence of symptoms in the group of all-terrain drivers.
Kondo, Hisataka; Yumoto, Kenji; Alwood, Joshua S.; Mojarrab, Rose; Wang, Angela; Almeida, Eduardo A. C.; Searby, Nancy D.; Limoli, Charles L.
Exposure of astronauts in space to radiation during weightlessness may contribute to subsequent bone loss. Gamma irradiation of postpubertal mice rapidly increases the number of bone-resorbing osteoclasts and causes bone loss in cancellous tissue; similar changes occur in skeletal diseases associated with oxidative stress. Therefore, we hypothesized that increased oxidative stress mediates radiation-induced bone loss and that musculoskeletal disuse changes the sensitivity of cancellous tissue to radiation exposure. Musculoskeletal disuse by hindlimb unloading (1 or 2 wk) or total body gamma irradiation (1 or 2 Gy of 137Cs) of 4-mo-old, male C57BL/6 mice each decreased cancellous bone volume fraction in the proximal tibiae and lumbar vertebrae. The extent of radiation-induced acute cancellous bone loss in tibiae and lumbar vertebrae was similar in normally loaded and hindlimb-unloaded mice. Similarly, osteoclast surface in the tibiae increased 46% as a result of irradiation, 47% as a result of hindlimb unloading, and 64% as a result of irradiation + hindlimb unloading compared with normally loaded mice. Irradiation, but not hindlimb unloading, reduced viability and increased apoptosis of marrow cells and caused oxidative damage to lipids within mineralized tissue. Irradiation also stimulated generation of reactive oxygen species in marrow cells. Furthermore, injection of α-lipoic acid, an antioxidant, mitigated the acute bone loss caused by irradiation. Together, these results showed that disuse and gamma irradiation, alone or in combination, caused a similar degree of acute cancellous bone loss and shared a common cellular mechanism of increased bone resorption. Furthermore, irradiation, but not disuse, may increase the number of osteoclasts and the extent of acute bone loss via increased reactive oxygen species production and ensuing oxidative damage, implying different molecular mechanisms. The finding that α-lipoic acid protected cancellous tissue from the
Grundkenntnisse zur Zusammensetzung und den regulatorischen Hintergründen von Topika gehören zu den alltäglich benötigten Herausforderungen dermatologisch-ärztlichen Handelns. Ein professioneller und indikationsgerechter Umgang bei der Auswahl, Verordnung und Anwendung topischer Präparate ist somit Voraussetzung für eine verantwortungsvolle fachärztliche Tätigkeit. Dabei bereiten die regulatorische Zuordnung (Arzneimittel, Medizinprodukt, Kosmetikum), die Feststellung der Erstattungsfähigkeit durch die GKV und die unzureichende Kennzeichnung des Vehikelsystems einzelner Präparate nicht selten Probleme. Bestreben sollte es sein, neben der Wahl des geeigneten Wirkstoffs und der geeigneten Konzentration ein an die Indikation der Therapie angepasstes galenisches System auszuwählen, um dessen Eigenwirkung für den therapeutischen Effekt nutzen zu können. Bei der Verschreibung von Rezepturarzneimitteln sollte nach Möglichkeit immer auf eine standardisierte Rezeptur (Magistralrezeptur) zurückgegriffen werden. Durch die Vielzahl der möglichen Inhaltsstoffe und der sich daraus ergebenden Komplexität eines galenischen Systems ist eine willkürliche Manipulation durch qualitative oder quantitative Veränderungen einzelner Komponenten mit hohen Risiken für eine Instabilität und damit für Sicherheit und Sinnhaftigkeit verbunden. Eine optimierte Anwendung von Topika setzt zudem Grundlagenkenntnisse zur Pharmakokinetik und zur evidenzbasierten Therapieplanung voraus.
Scheuring, Richard A.
The in-flight musculoskeletal database provides the foundation for directing operationally-relevant research in space medicine. This effort will enable medical operations to develop medical kits, training programs, and preventive medicine strategies for future CxP missions: a) Quantify medications and medical supplies for next-generation spacecraft. b) Objective data for engineers to determine weight requirements. Flight surgeons can make specific recommendations to astronauts based on injury data, such as emphasizing hand protection while in-flight. EVA and spacecraft engineers can examine evidence-based data on injuries and design countermeasures to help prevent them.
A major concern of the US and Russian space programs is the health and safety of astronauts and cosmonauts. One of the areas receiving the most attention has been the effects of long duration space flight on the musculoskeletel system. After three decades of space flight and research, questions continue. Can exercise in space maintain musculoskeletal tissue mass and function in an adult? The objective of this paper is to address this question in a way that hopefully provides a rational basis for quantifying and evaluating the influnence of daily activities on muscle and bone on Earth and in space.
Myszka, Anna; Piontek, Janusz
The objective of this paper is to assess the relationship between the degree of development of muscle attachment sites (musculoskeletal stress markers - MSM1) and the length and circumference measurements of long bones and the body build expressed with the reconstructed values of body height (BH) and body mass (BM). The bone material (102 male and 99 female skeletons) used in the study was collected in the medieval burial ground in Cedynia, Poland. The authors analyzed 10 musculoskeletal stress markers located on the scapula (2), humerus (2), radius (2), femur (2) and tibia (2). The frequency and the degree of expression of muscle attachment size was carried out using the scale prepared by Myszka (2007). The scale encompassed three degrees of expression of muscle attachment size. Only changes of robusticity type (nonpathological changes) were taken into account. The assessment of body build of individuals was carried out according to the method proposed by Vancata & Charvátová (2001). Body height was reconstructed from the length of the humerus and femur using eight equations. Body mass was reconstructed from the measurements of the breadth of the proximal and distal sections of the femur and tibia (mechanical method) using twenty one equations. The equations were developed for different reference populations. The same equations were used for men and women. The correlation between the MSM and the length and circumference measurements of the bones was analyzed using the principal components analysis and the Gamma correlation coefficient. The strength of the correlation between the reconstructed body build traits (BH, BM) and the moderate degree of musculoskeletal stress markers expression was studied based on the principal components method and the Pearson correlation coefficient. A linear correlation was found between musculoskeletal stress markers and the circumference measurements and the reconstructed body mass, but no relationship with body height and the
Iagnocco, A; Ceccarelli, F; Cuomo, G; Delle Sedie, A; Filippou, G; Filippucci, E; Grassi, W; Porta, F; Sakellariou, Garifallia
The Musculoskeletal Ultrasound Study Group of the Italian Society of Rheumatology (SIR) was founded during the 68th SIR Congress, on November 2011. The request of activation of this group was based on the increasing interest and the widespread diffusion of ultrasound in the scientific rheumatology community and on the solid experience of some Italian rheumatologists in the field. The aims of the Study Group are to stimulate the applications and use of ultrasound in the clinical practice at the level of the Italian rheumatology units and, in addition, to develop research projects at a national level...
Correas, J M; Drakonakis, E; Isidori, A M; Hélénon, O; Pozza, C; Cantisani, V; Di Leo, N; Maghella, F; Rubini, A; Drudi, F M; D'ambrosio, F
Nowadays ultrasound elastosonography is an established technique, although with limited clinical application, used to assess tissue stiffness, which is a parameter that in most cases is associated with malignancy. However, although a consistent number of articles have been published about several applications of elastosonography, its use in certain human body districts is still not well defined. In this paper we write on the use of elastosonography in prostate, testicle and musculo-skeletal apparatus. We report and compare the work of several authors, different type of elastosonography (shear wave, strain elastography, etc.) and instrumental data obtained in the study of both benign and malignant lesions.
Tarkin, Ivan S; Dunman, Paul M; Garvin, Kevin L
Molecular diagnostic strategies have been implemented to enhance the treatment of musculoskeletal infections. Once primarily a research tool, molecular-based assays, have become accepted clinical tests for the genomic detection of certain pathogens involved in bone and joint infections. Currently, culture remains the gold standard for identifying most organisms causing infection. However, molecular assays are beneficial in clinical cases in which standard culture-based tests are unreliable or untimely. We will review current clinical utility of this emerging technology and roles for assays in the future.
Carlson, Hans; Carlson, Nels
Musculoskeletal pain is a common reason for patients to seek care from healthcare providers. These conditions are predominantly nontraumatic injuries with a broad differential diagnosis and often without a specific diagnosis despite thorough history and examination. The management of these conditions is often discouraging for patients with continued chronic symptoms despite numerous diagnostic workups and treatment options. Effective communication with respect to the patient's goals is the key to a good outcome. The combination of an accurate diagnosis, an informed, motivated patient and a comprehensive review of the potential treatment options is beneficial for long-term success. PMID:22870469
Tardive dyskinesia (TD) is an umbrella term typically used to describe a movement disorder associated with the use of neuroleptic (anti-psychotic) medication. It is characterized by abnormal, repetitive and involuntary movements. The movements may be around the mouth and face (orofacial dyskinesia) and less frequently, in the trunk and limbs (trunk and limb dyskinesia). TD occurs in over 20% of those using neuroleptic medication continually for longer than three months. A case report is presented of a patient affected by TD who suffered mechanical musculoskeletal pain secondary to its effects, and was managed by chiropractic care. PMID:17549198
Figure 1) and also to the human supraspinatus tendon (Itoi et al., 1995). 0 10 20 30 40 50 0 0.2 0.4 0.6 0.8 1 Grip-to-Grip Strain St re ss (M Pa...species are being explored for the repair of musculoskeletal tendon injuries. In this paper we demonstrate that amongst these ECM scaffolds, only...tensor fascia lata has structural and tensile material properties comparable to tendon , but fascia has poor suture retention properties. We have
Choi, Eunsil; Kang, Nalae; Jeon, Young; Pai, Hyun-Sook
ABSTRACT The unique Escherichia coli GTPase Der (double Era-like GTPase), which contains tandemly repeated GTP-binding domains, has been shown to play an essential role in 50S ribosomal subunit biogenesis. The depletion of Der results in the accumulation of precursors of 50S ribosomal subunits that are structurally unstable at low Mg2+ concentrations. Der homologs are ubiquitously found in eubacteria. Conversely, very few are conserved in eukaryotes, and none is conserved in archaea. In the present study, to verify their conserved role in bacterial 50S ribosomal subunit biogenesis, we cloned Der homologs from two gammaproteobacteria, Klebsiella pneumoniae and Salmonella enterica serovar Typhimurium; two pathogenic bacteria, Staphylococcus aureus and Neisseria gonorrhoeae; and the extremophile Deinococcus radiodurans and then evaluated whether they could functionally complement the E. coli der-null phenotype. Only K. pneumoniae and S. Typhimurium Der proteins enabled the E. coli der-null strain to grow under nonpermissive conditions. Sucrose density gradient experiments revealed that the expression of K. pneumoniae and S. Typhimurium Der proteins rescued the structural instability of 50S ribosomal subunits, which was caused by E. coli Der depletion. To determine what allows their complementation, we constructed Der chimeras. We found that only Der chimeras harboring both the linker and long C-terminal regions could reverse the growth defects of the der-null strain. Our findings suggest that ubiquitously conserved essential GTPase Der is involved in 50S ribosomal subunit biosynthesis in various bacteria and that the linker and C-terminal regions may participate in species-specific recognition or interaction with the 50S ribosomal subunit. IMPORTANCE In Escherichia coli, Der (double Era-like GTPase) is an essential GTPase that is important for the production of mature 50S ribosomal subunits. However, to date, its precise role in ribosome biogenesis has not been
Morosky, Frank N.
This brief paper summarizes requirements of the Americans with Disabilities Act (ADA) of 1990 related to workplace accommodations for persons with musculo-skeletal disorders. The following topics are addressed: (1) the relevance of the ADA to people with musculo-skeletal disorders; (2) employment provisions of the ADA to protect individuals with…
Leider, Priscilla C; Boschman, Julitta S; Frings-Dresen, Monique H W; van der Molen, Henk F
The aim of this systematic review was to summarise evidence on the effects of job rotation on musculoskeletal complaints, exposures related to musculoskeletal complaints and sustainable working life parameters. A total of 16 studies were included. No studies on sustainable working life parameters were found. The quality of the studies was assessed using a checklist; eight field studies and three laboratory studies of sufficient quality were used to summarise the following evidence: one field study showed positive results and one field study showed negative results for musculoskeletal complaints, two field studies showed positive results and two field studies showed inconsistent results for exposures, and two field studies showed inconsistent results for musculoskeletal complaints and exposures. Two laboratory studies showed inconsistent results and one laboratory study showed no changes for exposures. In conclusion, there is currently inconsistent evidence for positive or negative effects of job rotation on musculoskeletal complaints and exposures related to musculoskeletal complaints. Practitioner's Summary: Currently, there is inconsistent evidence for recommending job rotation as a strategy for preventing musculoskeletal complaints. Exposures from all involved work activities and body regions should be identified and assessed first, to determine if job rotation provides increased exposure variation and/or beneficial changes in mean exposures related to musculoskeletal complaints.
National Highway Traffic Safety Administration (DOT), Washington, DC.
This instructor's lesson plan guide on the musculoskeletal system is one of fifteen modules designed for use in the training of emergency medical technicians (paramedics). Five units of study are presented: (1) the major bones, joints, and muscles of the body; (2) patient assessment of a musculoskeletal injury; (3) pathophysiology and management…
Azma, Kamran; Hosseini, Alireza; Safarian, Mohammad Hasan; Abedi, Masoumeh
Background: Stress in nurses may increase the prevalence of musculoskeletal discomforts. Aim: The aim of this study was to determine the prevalence of musculoskeletal discomforts and job stress among nurses and to investigate the association between musculoskeletal discomforts and occupational stressors. Materials and Methods: In this cross-sectional study, 144 nurses in one of the main referral hospitals of Tehran-Iran were randomly selected and studied. Data were collected by HSE job stress questionnaire and The Cornell Musculoskeletal Discomfort Questionnaire through interviews with nurses in their workplace. Results: Most reported musculoskeletal discomforts localized in the neck, back, knee and shoulder and the minimal discomforts were in wrist and elbow. On the other hand, stressors such as demand, changes in workplace, control and responsibilities had significant effect on increasing musculoskeletal discomforts of organs such as neck, shoulders and back (P < 0.001). Conclusion: There was a significant association between stressors such as demand, control, responsibilities and changes in workplace and reported musculoskeletal disorders, especially in neck, shoulders and back. It is suggested to use defined programs for management and control of stressors to control occupational stress in nurses. Moreover, prevention of musculoskeletal discomforts due to their high prevalence in the study population is important. PMID:26258080
National Evaluation Systems, Inc., Amherst, MA.
This instructional modular unit with instructor's guide provides materials on aspects of one of the major systems of the human body--the musculoskeletal system. Its purpose is to introduce the student to the structures and functions of the human musculoskeletal system--and the interrelationships of the two--and to familiarize the student with some…
Cui, Yubao; Zhou, Ying; Ma, Guifang; Yang, Li; Wang, Yungang; Shi, Weihong
Crude extracts of house dust mites are used clinically for diagnosis and immunotherapy of allergic diseases, including bronchial asthma, perennial rhinitis, and atopic dermatitis. However, crude extracts are complexes with non-allergenic antigens and lack effective concentrations of important allergens, resulting in several side effects. Dermatophagoides farinae (Hughes; Acari: Pyroglyphidae) is one of the predominant sources of dust mite allergens, which has more than 30 groups of allergen. The cDNA coding for the group 5 allergen of D. farinae from China was cloned, sequenced and expressed. According to alignment using the VECTOR NTI 9.0 software, there were eight mismatched nucleotides in five cDNA clones resulting in seven incompatible amino acid residues, suggesting that the Der f 5 allergen might have sequence polymorphism. Bioinformatics analysis revealed that the matured Der f 5 allergen has a molecular mass of 13604.03 Da, a theoretical pI of 5.43 and is probably hydrophobic and cytoplasmic. Similarities in amino acid sequences between Der f 5 and allergens of other domestic mite species, viz. Der p 5, Blo t 5, Sui m 5, and Lep d 5, were 79, 48, 53, and 37%, respectively. Phylogenetic analysis indicated that Der f 5 and Der p 5 clustered together. Blo t 5 and Ale o 5 also clustered together, although Blomia tropicalis and Aleuroglyphus ovatus belong to different mite families, viz. Echimyopodidae and Acaridae, respectively.
Edwards, Jennifer Helen; Reilly, Gwendolen Clair
Due to the increasing burden on healthcare budgets of musculoskeletal system disease and injury, there is a growing need for safe, effective and simple therapies. Conditions such as osteoporosis severely impact on quality of life and result in hundreds of hours of hospital time and resources. There is growing interest in the use of low magnitude, high frequency vibration (LMHFV) to improve bone structure and muscle performance in a variety of different patient groups. The technique has shown promise in a number of different diseases, but is poorly understood in terms of the mechanism of action. Scientific papers concerning both the in vivo and in vitro use of LMHFV are growing fast, but they cover a wide range of study types, outcomes measured and regimens tested. This paper aims to provide an overview of some effects of LMHFV found during in vivo studies. Furthermore we will review research concerning the effects of vibration on the cellular responses, in particular for cells within the musculoskeletal system. This includes both osteogenesis and adipogenesis, as well as the interaction between MSCs and other cell types within bone tissue. PMID:25914764
Turło, Agnieszka; Cywińska, Anna; Czopowicz, Michał; Witkowski, Lucjan; Niedźwiedź, Artur; Słowikowska, Malwina; Borowicz, Hieronim; Jaśkiewicz, Anna; Winnicka, Anna
Background Training-induced muscle, skeletal and joint trauma may result in acute phase response reflected by the changes in the blood concentration of serum amyloid A (SAA) in racehorses. It remains yet unclear if such systemic reaction could be triggered by sport injuries and what is the impact of different types of musculoskeletal trauma on SAA concentrations in racehorses. This study aimed to determine changes in the SAA blood concentration in racehorses with different types of injuries of musculoskeletal system. Materials and Methods The study involved 28 racehorses diagnosed after the race with bone fractures (n = 7), dorsal metacarpal disease (n = 11), joint trauma (n = 4) or tendon and muscle trauma (n = 6) and 28 healthy control racehorses. Serum samples were collected twice, between 1 and 4 days of the injury or succesful completion of the race. SAA concentration was measured using the commercial ELISA kit. Differences between mean SAA concentration in respective groups were analyzed using ANOVA and Tukey post-hoc test. Results Mean SAA concentration within the first 4 days of the injury of muscle and tendon was significantly higher than in bone fractures, dorsal metacarpal disease, joint trauma or in the healthy horses (p<0,001). There were no significant differences between the other groups. Conclusions Strain injuries of muscle and tendons can cause a moderate increase in SAA blood concentration in racehorses, reflecting the occurrence of the acute phase response. Similar reaction is not observed in the stress-related bone injuries. PMID:26466121
Allen, A L; Doige, C E; Fretz, P B; Townsend, H G
A syndrome of neonatal foals characterized by hyperplasia of the thyroid gland and concurrent musculoskeletal deformities (TH-MSD) has been described in western Canada and may be increasing in incidence. In an attempt to improve recognition and understanding of this syndrome, 2946 records of equine abortuses, stillborns, and dead neonatal foals were examined to determine the laboratory involved, the year and month of submission, the breed and sex of the fetus or foal, the type of perinatal loss, the length of gestation, and whether or not the submission had evidence of a lesion of the thyroid gland, the musculoskeletal system, or other abnormal clinical or postmortem findings. One hundred and fifty-four (5.2%) records indicated the presence of an abnormal thyroid gland. Of these, 79 (2.7%) had additional lesions consistent with the TH-MSD syndrome described in the 1980s, while 75 (2.5%) were without these additional lesions. Comparisons among these two groups and a third group of fetuses and foals without lesions of the thyroids glands are described. The results confirm that the TH-MSD syndrome is a specific and unique disease with no breed or sex predilection. It is argued that there may be an "exposure-related" cause, and based on a review of similar disease syndromes of the horse, it is suggested that an examination of the feed is indicated in outbreaks of the TH-MSD syndrome. PMID:8044756
Day, Charles S; Boden, Scott D; Knott, Patrick T; O'Rourke, Nancy C; Yang, Brian W
Growth estimates and demographic shifts of the population of the United States foreshadow a future heightened demand for musculoskeletal care. Although many articles have discussed this growing demand on the musculoskeletal workforce, few address the inevitable need for more musculoskeletal care providers. As we are unable to increase the number of orthopaedic surgeons because of restrictions on graduate medical education slots, physician assistants (PAs) and nurse practitioners (NPs) represent one potential solution to the impending musculoskeletal care supply shortage. This American Orthopaedic Association (AOA) symposium report investigates models for advanced practice provider integration, considers key issues affecting PAs and NPs, and proposes guidelines to help to assess the logistical and educational possibilities of further incorporating NPs and PAs into the orthopaedic workforce in order to address future musculoskeletal care needs.
Allograft musculoskeletal tissue is commonly used in orthopaedic surgical procedures. Cadaveric donors of musculoskeletal tissue supply multiple allografts such as tendons, ligaments and bone. The microbiology laboratory of the South Eastern Area Laboratory Services (SEALS, Australia) has cultured cadaveric allograft musculoskeletal tissue samples for bacterial and fungal isolates since 2006. This study will retrospectively review the micro-organisms isolated over a 6-year period, 2006-2011. Swab and tissue samples were received for bioburden testing and were inoculated onto agar and/or broth culture media. Growth was obtained from 25.1 % of cadaveric allograft musculoskeletal tissue samples received. The predominant organisms isolated were coagulase-negative staphylococci and coliforms, with the heaviest bioburden recovered from the hemipelvis. The rate of bacterial and fungal isolates from cadaveric allograft musculoskeletal tissue samples is higher than that from living donors. The type of organism isolated may influence the suitability of the allograft for transplant.
Ikemoto, Shuhei; Kimoto, Yuya; Hosoda, Koh
The shoulder complex in the human body consists of the scapula, clavicle, humerus, and thorax and bears the load imposed by arm movements while at the same time realizing a wide range of motions. To mimic and exploit its role, several musculoskeletal robot arms with shoulder complex mechanisms have been developed. However, although many research groups have tried to design the structures using links and joints that faithfully correspond to the bones and joints in the human shoulder complex, its function has not been successfully reproduced because biologically plausible designs seriously compromise engineering plausibility. In this paper, we propose a linkage mechanism that can reproduce complex three-dimensional scapulo movements and considers the trade-off between biological and engineering plausibilities. Subsequently, the design was validated by driving the mechanism using pneumatic artificial muscles (PAMs) placed similarly to muscles in humans. Further, we present experiments in which the robot was controlled by surface electromyographic signals from a human. We show that the proposed design, due to its kinematic similarity with human musculoskeletal systems, eases the conversion between the surface electromyogram signals and the PAMs control inputs.
Phethuayluk, Piriyalux; Maneelok, Supandee
Objectives. The objective of this study was to describe the socioeconomic situation of dental health work and work characteristics and to evaluate the prevalence of musculoskeletal symptoms among dental health workers. Material and Methods. A cross-sectional study was conducted with 124 dental health workers and 124 persons in the reference group, matched to dental health workers by gender, were recruited from the workers who worked at the same 17 community hospitals in Nakhon Si Thammarat province, Thailand. Information was collected by using questionnaire. Data analysis comprised descriptive and analytical components. Results and Discussion. 75.8% were female and 24.2% were male dental health workers. 91.9% of subjects had worked >5 years. Most subjects worked for >8 hours per day and worked >6 days per week, at 63.7% and 53.2%, respectively. 100% of subjects worked in public institutions, and 68% also worked in both public and private institutions. Most subjects (52.4%) did not exercise. Daily activity, gender, duration of work, hours worked per day, days worked per week, and physical activity were significantly associated with musculoskeletal symptoms at <0.001. Conclusion. The prevention and reduction of MSDs among dentists should include improving their education in dental ergonomics. PMID:27597901
Roos, Lilian; Taube, Wolfgang; Zuest, Peter; Clénin, German; Wyss, Thomas
Findings about the relation between musculoskeletal injuries and training patterns in orienteering athletes are sparse. Therefore, the musculoskeletal injuries and training patterns of 31 Swiss elite orienteering athletes aged 18-19 years were analyzed in a retrospective study. Individual training diaries and medical records were used to assess training data and injury history, respectively. Group comparisons and a multiple linear regression (MLR) were performed for statistical analysis. The junior elite orienteering athletes performed 7.38 ± 2.00 training sessions weekly, with a total duration of 455.75 ± 98.22 minutes. An injury incidence rate (IIR) of 2.18 ± 2.13 injuries per 1000 hours of training was observed. The lower extremity was affected in 93% of all injuries, and the knee (33%) was the most commonly injured location. The MLR revealed that gender and six training variables explained 60% of the variance in the injury severity index in this study. Supported by the low IIR in the observed age group, the training protocol of the junior elite orienteering athletes was generally adequate. In comparison to elite track, marathon, and orienteering athletes, the junior elite athletes performed less high-intensity interval training (HIIT). However, more frequent HIIT seems to be a protective factor against injuries.
Roos, Lilian; Taube, Wolfgang; Zuest, Peter; Clénin, German; Wyss, Thomas
Findings about the relation between musculoskeletal injuries and training patterns in orienteering athletes are sparse. Therefore, the musculoskeletal injuries and training patterns of 31 Swiss elite orienteering athletes aged 18-19 years were analyzed in a retrospective study. Individual training diaries and medical records were used to assess training data and injury history, respectively. Group comparisons and a multiple linear regression (MLR) were performed for statistical analysis. The junior elite orienteering athletes performed 7.38 ± 2.00 training sessions weekly, with a total duration of 455.75 ± 98.22 minutes. An injury incidence rate (IIR) of 2.18 ± 2.13 injuries per 1000 hours of training was observed. The lower extremity was affected in 93% of all injuries, and the knee (33%) was the most commonly injured location. The MLR revealed that gender and six training variables explained 60% of the variance in the injury severity index in this study. Supported by the low IIR in the observed age group, the training protocol of the junior elite orienteering athletes was generally adequate. In comparison to elite track, marathon, and orienteering athletes, the junior elite athletes performed less high-intensity interval training (HIIT). However, more frequent HIIT seems to be a protective factor against injuries. PMID:26258134
Decharat, Somsiri; Phethuayluk, Piriyalux; Maneelok, Supandee
Objectives. The objective of this study was to describe the socioeconomic situation of dental health work and work characteristics and to evaluate the prevalence of musculoskeletal symptoms among dental health workers. Material and Methods. A cross-sectional study was conducted with 124 dental health workers and 124 persons in the reference group, matched to dental health workers by gender, were recruited from the workers who worked at the same 17 community hospitals in Nakhon Si Thammarat province, Thailand. Information was collected by using questionnaire. Data analysis comprised descriptive and analytical components. Results and Discussion. 75.8% were female and 24.2% were male dental health workers. 91.9% of subjects had worked >5 years. Most subjects worked for >8 hours per day and worked >6 days per week, at 63.7% and 53.2%, respectively. 100% of subjects worked in public institutions, and 68% also worked in both public and private institutions. Most subjects (52.4%) did not exercise. Daily activity, gender, duration of work, hours worked per day, days worked per week, and physical activity were significantly associated with musculoskeletal symptoms at <0.001. Conclusion. The prevention and reduction of MSDs among dentists should include improving their education in dental ergonomics.
Snyder-Mackler, L.; Bork, C.; Bourbon, B.; Trumbore, D.
Cold lasers have been proposed recently as a therapeutic tool for treating a wide variety of pathological conditions, including wounds, arthritis, orthopedic problems, and pain. These proposed therapeutic effects largely have been unsubstantiated by research. A randomized, double blind study was undertaken to ascertain the effect of a helium-neon (He-Ne) laser on the resistance of areas of skin overlying musculoskeletal trigger points. These areas usually demonstrate decreased skin resistance when compared with the surrounding tissue. Thirty patients with musculoskeletal trigger points were assigned randomly to either an experimental or a placebo group. In addition to standard physical therapy, each patient received three 15-second applications of a He-Ne laser or placebo stimulation from an identical unit that did not emit a laser. The results of a two-way analysis of covariance with one repeated measure showed a statistically significant increase (p less than .007) in skin resistance. This increase in an abnormal skin resistance pattern may accompany the resolution of pathological conditions.
Hakkanen, M; Viikari-Juntura, E; Martikainen, R
OBJECTIVES—To investigate the effects of physical work load and job experience on morbidity from musculoskeletal disorders among trailer assembly workers. METHODS—A longitudinal study was carried out in a trailer assembly factory with many new workers employed during the follow up. The sickness absence of 532 workers (160 experienced and 372 new (separately for the first year of employment and from the second year on)) was followed up. Exposure was assessed by job titles, visits, task descriptions, and some direct measurements. The associations between the explanatory variables and sick leave were assessed by log linear models. RESULTS—A higher rate of sick leave due to disorders of the upper limbs was found for new workers compared with experienced ones, especially in the high work load group. Women had a higher rate than men. New male workers in physically strenuous tasks had a high rate of sick leave due to neck and shoulder disorders. CONCLUSIONS—As being unaccustomed to work seems to increase the risk of musculoskeletal disorders, special attention should be paid to newly employed workers. Keywords: new workers; physical work load; assembly work PMID:11160992
Vie, Tina Løkke; Glasø, Lars; Einarsen, Ståle
The present study examines experienced emotions among self-labelled victims of ongoing workplace bullying and tests whether emotions mediate the relationship between exposure to bullying and health in the form of musculoskeletal complaints. A total of 1,024 employees from a Norwegian public transport company participated in the study, in which 116 self-labelled victims were identified. Ten positive and 10 negative emotions were measured (PANAS). The results showed significant differences in emotional experiences between victims and non-victims regarding all 10 negative emotions and one out of 10 positive emotions. Victims felt less "interested" and more "afraid," "upset," "angry," "guilty," "nervous," "hostile," "frustrated," "ashamed," "scared" and "stressed" than did non-victims. Further, the results pointed to both positive and negative emotions as mediators of the relationship between exposure to bullying and musculoskeletal complaints. In particular the negative emotion "stress" acted as a significant mediator regarding this relationship. Hence, emotions seem to be central to understanding the detrimental effects of bullying on the victims' health.
Carter, Cordelia W; Sharkey, Melinda S; Fishman, Felicity
Firearm injuries are a major cause of morbidity and mortality among children and adolescents in the United States and take financial and emotional tolls on the affected children, their families, and society as a whole. Musculoskeletal injuries resulting from firearms are common and may involve bones, joints, and neurovascular structures and other soft tissues. Child-specific factors that must be considered in the setting of gunshot injuries include physeal arrest and lead toxicity. Understanding the ballistics associated with various types of weaponry is useful for guiding orthopaedic surgical treatment. Various strategies for preventing these injuries range from educational programs to the enactment of legislation focused on regulating guns and gun ownership. Several prominent medical societies whose members routinely care for children and adolescents with firearm-related injuries, including the American Academy of Pediatrics and the American Pediatric Surgical Association, have issued policy statements aimed at mitigating gun-related injuries and deaths in children. Healthcare providers for young patients with firearm-related musculoskeletal injuries must appreciate the full scope of this important public health issue.
Background and Purpose The long-term management following an hemicorporectomy (HCP) is not well documented in the scientific literature. The purpose of this case report is to describe the 25-year history of a man with a spinal cord injury who experienced severe musculoskeletal deterioration and hemicorporectomy. Case Description The client sustained T10 complete paraplegia at age 18 years, developed severe decubitus ulcers, and required an HCP as a lifesaving measure 13 years later. The authors describe the chronology of several rehabilitation and prosthetic strategies and speculate on factors that may have contributed to their successes and failures. Outcomes The client survived 12 years after the HCP and returned to independent mobility, self-care, and schooling despite complications with continued skin breakdown. Over the 12 years following discharge from the hospital after the spinal cord injury, he spent 749 days in the hospital. During the 12 years he lived after discharge from the hospital following the HCP, he was hospitalized 190 days. Discussion The authors discuss factors contributing to the client’s musculoskeletal deterioration including chronic wounds, postural deviations, and incomplete adherence to pressure-relief recommendations and raise considerations for physical therapists who treat patients after HCP. PMID:12620090
Piposar, Jonathan R; Easley, Mark; Nunley, James A; DeOrio, James K; Talusan, Paul G; Gubler, Kyle E; Reach, John S
Musculoskeletal ultrasound (MSK-US) is a quick and effective imaging tool that can be utilized by orthopaedic surgeons to identify common musculoskeletal pathology such as ankle tendinopathy. This study evaluated the ability of 15 orthopaedic surgery residents to identify and measure ankle tendons after attending a multimedia tutorial on MSK-US. Afterwards, proficiency of usage was assessed by identification and quantification of three ankle tendons (Achilles, tibialis posterior, and flexor hallucis longus) in a cadaver limb. Resident comfort level and plan for future use were also assessed. After completing the tutorial, accuracy measuring the Achilles, tibialis posterior, and flexor hallucis longus tendons was 94.8%, 90.2%, and 90.1%, respectively. Resident comfort level improved from a level of 2.3 before the tutorial to 6.8 afterwards. Seventy-one percent of residents plan to use ultrasound in clinical practice. These results show that orthopaedic surgery residents can identify and assess tendon size via MSK-US with sufficient accuracy after a multimedia tutorial.
Pollock, N. W.; Natoli, M. J.; Conkin, J.; Wessel, J. H., III; Gernhardt, M. L.
Musculoskeletal activity has the potential to both improve and compromise decompression safety. Exercise enhances inert gas elimination during oxygen breathing prior to decompression (prebreathe), but it may also promote bubble nuclei formation (nucleation), which can lead to gas phase separation and bubble growth and increase the risk of decompression sickness (DCS). The timing, pattern and intensity of musculoskeletal activity and the level of tissue supersaturation may be critical to the net effect. There are limited data available to evaluate cost-benefit relationships. Understanding the relationship is important to improve our understanding of the underlying mechanisms of nucleation in exercise prebreathe protocols and to quantify risk in gravity and microgravity environments. Data gathered during NASA's Prebreathe Reduction Program (PRP) studies combined oxygen prebreathe and exercise followed by low pressure (4.3 psi; altitude equivalent of 30,300 ft [9,235 m]) microgravity simulation to produce two protocols used by astronauts preparing for extravehicular activity. Both the Phase II/CEVIS (cycle ergometer vibration isolation system) and ISLE (in-suit light exercise) trials eliminated ambulation to more closely simulate the microgravity environment. The CEVIS results (35 male, 10 female) serve as control data for this NASA/Duke study to investigate the influence of ambulation exercise on bubble formation and the subsequent risk of DCS.
Salaffi, F; Ciapetti, A; Carotti, M
Valid and reliable assessment of pain is fundamental for both clinical trials and effective pain management. The nature of pain makes objective measurement impossible. Chronic musculoskeletal pain assessment and its impact on physical, emotional and social functions require multidimensional qualitative tools and healthrelated quality of life instruments. The recommendations concerning outcome measurements for pain trials are useful for making routine assessments that should include an evaluation of pain, fatigue, disturbed sleep, physical functioning, emotional functioning, patient global ratings of satisfaction, and quality of life. Despite the growing availability of instruments and theoretical publications related to measuring the various aspects of chronic pain, there is still little agreement and no unified approach has been devised. There is, therefore, still a considerable need for the development of a core set of measurement tools and response criteria, as well as for the development and refinement of the related instruments, standardized assessor training, the cross-cultural adaptation of health status questionnaires, electronic data capture, and the introduction of valid, reliable and responsive standardized quantitative measurement procedures into routine clinical care. This article reviews a selection of the instruments used to assess chronic musculoskeletal pain, including validated newly developed and well-established screening instruments, and discusses their advantages and limitations.
Cullen, S; Donohoe, A; McGoldrick, A; McCaffrey, N; Davenport, C; Byrne, B; Donaghy, C; Tormey, W; Smith, D; Warrington, G
The long-term implications of making-weight daily on musculoskeletal health and functioning of the kidney and liver remain unknown. This study aimed to investigate musculoskeletal health and kidney and liver function in a group of retired jockeys. 28 retired male jockeys (age 50-70 years) provided fasting blood samples for markers of bone metabolism and kidney and liver function. A dual-energy x-ray absorptiometry (DXA) scan was performed for the assessment of bone mineral density (BMD). Established reference ranges were used for interpretation of results. Comparisons were made between retired jockeys based on the professional racing licence held: Flat, National Hunt or Dual. Mean whole-body osteopenia was reported, with no differences between groups. Bone markers, micronutrients, electrolytes and associated hormones, and markers for kidney and liver function were within clinical normative ranges. No differences existed between groups. Results indicate the retired jockeys in this study do not demonstrate compromised bone health or kidney and liver function. However, the retired jockeys may not have undergone chronic weight cycling in the extreme manner evident in present-day jockeys, indicating the next generation of jockeys may face more of a problem. Jockeys should be tracked longitudinally throughout their racing career and beyond.
Nagai, Takashi; Abt, John P; Sell, Timothy C; Keenan, Karen A; McGrail, Mark A; Smalley, Brian W; Lephart, Scott M
Despite many nonbattle injuries reported during deployment, few studies have been conducted to evaluate the effects of deployment on musculoskeletal and physiological characteristics and balance. A total of 35 active duty U.S. Army Soldiers participated in laboratory testing before and after deployment to Afghanistan. The following measures were obtained for each Soldier: shoulder, trunk, hip, knee, and ankle strength and range of motion (ROM), balance, body composition, aerobic capacity, and anaerobic power/capacity. Additionally, Soldiers were asked about their physical activity and load carriage. Paired t tests or Wilcoxon tests with an α = 0.05 set a priori were used for statistical analyses. Shoulder external rotation ROM, torso rotation ROM, ankle dorsiflexion ROM, torso rotation strength, and anaerobic power significantly increased following deployment (p < 0.05). Shoulder extension ROM, shoulder external rotation strength, and eyes-closed balance (p < 0.05) were significantly worse following deployment. The majority of Soldiers (85%) engaged in physical activity. In addition, 58% of Soldiers reported regularly carrying a load (22 kg average). The deployment-related changes in musculoskeletal and physiological characteristics and balance as well as physical activity and load carriage during deployment may assist with proper preparation with the intent to optimize tactical readiness and mitigate injury risk.
Brown, Justin C.; Mao, Jun J.; Stricker, Carrie; Hwang, Wei-Ting; Tan, Kay-See; Schmitz, Kathryn H.
Background Physical activity has numerous health benefits for breast cancer survivors. Recent data suggest that some breast cancer survivors treated with aromatase inhibitors may experience aromatase inhibitor associated musculoskeletal symptoms. It is unknown whether aromatase inhibitor associated musculoskeletal symptoms are associated with reduced physical activity and what other risk factors are associated with such physical activity reductions. Methods We conducted a cross-sectional study at a large university-based breast cancer clinic among breast cancer survivors prescribed an aromatase inhibitor. At routine follow-up, we surveyed participants about aromatase inhibitor associated musculoskeletal symptoms, as well as pre-aromatase inhibitor, and current, physical activity levels. Results Among 300 participants, 90 (30%) reported a reduction of physical activity since the initiation of aromatase inhibitor therapy. Those with aromatase inhibitor associated musculoskeletal symptoms were more likely to report decreased physical activity (62% versus 38%, p=0.001) compared to those without aromatase inhibitor associated musculoskeletal symptoms. In multivariate analyses, aromatase inhibitor associated musculoskeletal symptoms [odds ratio (OR) =2.29 (95% confidence interval (CI): 1.36–3.86)], and body mass index [OR=1.06 (95% CI: 1.02–1.12)] were associated with reductions in physical activity. In subgroup analysis among breast cancer survivors with aromatase inhibitor associated musculoskeletal symptoms, self-reported lower extremity joint pain [OR=1.23 (95% CI: 1.00–1.50)] and impaired lower extremity physical function [OR=1.07 (95% CI: 1.01–1.14)] were associated with reductions in physical activity. Conclusion Breast cancer survivors with aromatase inhibitor associated musculoskeletal symptoms were more likely to report reductions in physical activity since initiating aromatase inhibitor therapy compared to those without aromatase inhibitor associated
Background Occupational use of computers has increased rapidly over recent decades, and has been linked with various musculoskeletal disorders, which are now the most commonly diagnosed occupational diseases in Estonia. The aim of this study was to assess the prevalence of musculoskeletal pain (MSP) by anatomical region during the past 12 months and to investigate its association with personal characteristics and work-related risk factors among Estonian office workers using computers. Methods In a cross-sectional survey, the questionnaires were sent to the 415 computer users. Data were collected by self-administered questionnaire from 202 computer users at two universities in Estonia. The questionnaire asked about MSP at different anatomical sites, and potential individual and work related risk factors. Associations with risk factors were assessed by logistic regression. Results Most respondents (77%) reported MSP in at least one anatomical region during the past 12 months. Most prevalent was pain in the neck (51%), followed by low back pain (42%), wrist/hand pain (35%) and shoulder pain (30%). Older age, right-handedness, not currently smoking, emotional exhaustion, belief that musculoskeletal problems are commonly caused by work, and low job security were the statistically significant risk factors for MSP in different anatomical sites. Conclusions A high prevalence of MSP in the neck, low back, wrist/arm and shoulder was observed among Estonian computer users. Psychosocial risk factors were broadly consistent with those reported from elsewhere. While computer users should be aware of ergonomic techniques that can make their work easier and more comfortable, presenting computer use as a serious health hazard may modify health beliefs in a way that is unhelpful. PMID:24884911
Background The proportion of older people will be tripled by the year 2050. In addition, the incidence of chronic musculoskeletal (MSK) conditions will also increase among the elderly people. Thus, in order to prepare for future health care demands, the magnitude and impact of MSK conditions from this growing population is needed. The objective of this literature review is to determine the current prevalence of MSK disorders in the elderly population. Methods A systematic literature search was conducted in Pubmed on articles in English, published between January 2000 and July 2011. Studies from developed countries with prevalence estimates on elderly people (60+) on the following MSK conditions were included: Non-specific extremity pain, rheumatoid arthritis, osteoarthritis, osteoporosis, and back pain. The included articles were extracted for information and assessed for risk of bias. Results A total of 85 articles were included with 173 different prevalence estimates. Musculoskeletal disorders are common in the elderly population, but due to heterogeneity of the studies, no general estimate on the prevalence of MSK can be determined. Women report more often MSK pain than men. Overall, prevalence estimates either remain fairly constant or increase slightly with increasing age, but with a tendency to decrease in the oldest (80+) people. Conclusions Musculoskeletal disorders remain prevalent in the elderly population. Given the increasing proportion of elderly population in the world population and the burden of MSK diseases among the elderly people, efforts must be made to maintain their functional capacity for as long as possible through optimal primary and secondary health care. PMID:23006836
Die wesentlichen Kunden der Lebensmittelindustrie sind der Einzel- und Großhandel und die Verbraucher. Jedes Unternehmen kann mittel- und langfristig nur existieren, wenn seine Kunden zufrieden sind. Kunden sind zufrieden, wenn ihre Erwartungen, die sie an Produkt, Service und Preis stellen, erfüllt werden. Also die bestimmte erwartete Qualität (Leistung) sichergestellt wird. Trotz aller Bemühungen und Anstrengungen der Anbieter, Qualitätsprodukte auf den Markt zu bringen, kames in den letzten Jahren immer wieder zu Lebensmittelskandalen.
Werner Heisenberg war eine der prägendsten Gestalten der Physik des 20. Jahrhunderts. Zu seinen wichtigsten Verdiensten gehören die Grundlegung der Quantenmechanik, die Formulierung der Unschärferelationen sowie die Beteiligung an der Ausarbeitung der Kopenhagener Deutung der Quantenmechanik. Darüber hinaus lieferte er Arbeiten von fundamentalem Charakter zur Theorie des Atomkerns, zur kosmischen Strahlung und zur Quantenfeldtheorie. Während des Krieges war er an den Arbeiten des Uranvereins beteiligt, der die Möglichkeit einer Entwicklung von Kernwaffen untersuchte, jedoch über Vorarbeiten zur Reaktorphysik nicht hinauskam. Wegen dieser Tätigkeit wurde er bei Kriegsende für einige Monate in England interniert. Nach seiner Rückkehr widmete er sich vor allem dem Aufbau der Physik in Deutschland, die während der NS-Zeit nahezu ihrer gesamten Substanz beraubt worden war.
Smith, Preston J.; Gerrie, Brayden J.; Varner, Kevin E.; McCulloch, Patrick C.; Lintner, David M.; Harris, Joshua D.
Background Most published studies on injuries in the ballet dancer focus on the lower extremity. The rigors of this activity require special training and care. By understanding prevalence and injury pattern to the musculoskeletal system, targeted prevention and treatment for this population can be developed. Purpose To determine the incidence and prevalence of musculoskeletal injuries in ballet. Study Design Systematic review; Level of evidence, 4. Methods A systematic review registered with PROSPERO was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Level 1 through 4 evidence studies reporting incidence of musculoskeletal injuries in male and female ballet dancers were included, with the numbers and types of injuries extracted from each. Injury rates were recorded and calculated based on professional status, sex, and nature of injury. Incidence was defined as number of injuries sustained over a specific time. Prevalence was defined as proportion of subjects with an injury at a given point in time. Results The studies analyzed reported injury incidence or prevalence in more than 1365 amateur and 900 professional dancers. The mean age was 16.2 years among amateur and 27.0 years among professional dancers. The incidence of injury among amateur dancers was 0.99 and 1.09 injuries per 1000 dance hours in males and females, respectively; 75% of injuries were overuse, with similar rates among males and females. In professional dancers, the incidence of injury was 1.06 and 1.46 injuries per 1000 dance hours in males and females, respectively, and 64% of female injuries were overuse, compared with 50% in males (P < .001). Only 3 studies provided prevalence data, including 62% prevalence of lumbosacral pain, 58% painful snapping hip, and 29% patellofemoral pain. Lower extremity injuries comprised 66% to 91% of all injuries, with the foot and ankle accounting for 14% to 57%. Conclusion The overall incidence of injury
Peters, D; Davies, P; Pietroni, P
BACKGROUND. A musculoskeletal clinic, staffed by a general practitioner trained in osteopathy, medical acupuncture and intralesional injections, was set up in an inner London general practice in 1987. AIM. A retrospective study was undertaken of one year's referrals to the clinic in 1989-90 to determine how general practitioners were using the clinic in terms of problems referred; consultation patterns of patients attending the clinic and 12 months after initially being seen; and how access to the clinic influenced referrals to relevant hospital departments. METHOD. Day sheets were studied which recorded information on demographic characteristics of patients referred to the clinic and their problems, diagnoses made, duration of symptoms, number and range of treatments given, and recurrence of problems. Use of secondary referral sources was also examined. RESULTS. During the study year 154 of 3264 practice patients were referred to the musculoskeletal clinic, and attended a mean of 3.5 times each. Of all the attenders 64% were women and 52% were 30-54 years old. Eighty one patients (53%) presented with neck, back or sciatic pain. A specific traumatic, inflammatory or other pathological process could be ascribed to only 19% of patients. Regarding treatment, 88% of patients received osteopathic manual treatment or acupuncture, or a combination of these treatments and 4% received intralesional injections. Nine patients from the clinic (6%) were referred to an orthopaedic specialist during the year, two with acute back pain. Referrals to orthopaedic specialists by the practice as a whole were not significantly lower than the national average, although the practice made fewer referrals to physiotherapy and rheumatology departments than national figures would have predicted. Seventeen patients (11%) returned to the clinic with a recurrence of their main complaint within a year of their initial appointment; second courses of treatment were usually brief. CONCLUSION. The
Bout-Tabaku, Sharon; Michalsky, Marc P.; Jenkins, Todd M.; Baughcum, Amy; Zeller, Meg H.; Brandt, Mary L.; Courcoulas, Anita; Buncher, Ralph; Helmrath, Michael; Harmon, Carroll M.; Chen, Mike K.; Inge, Thomas H.
IMPORTANCE Obesity is associated with chronic musculoskeletal pain and is a risk factor for disability and osteoarthritis. OBJECTIVES To describe the prevalence, sites, and intensity of musculoskeletal pain in adolescents with severe obesity; to evaluate associations between musculoskeletal pain and self-reported physical function as well as weight-related quality of life; and to evaluate the association between musculoskeletal pain and high-sensitivity C-reactive protein level. DESIGN, SETTING, AND PARTICIPANTS Teen–Longitudinal Assessment of Bariatric Surgery (Teen-LABS) is a prospective, observational study that collects standardized data on adolescents undergoing weight loss surgery at 5 US centers. We examined baseline data from this cohort between February 28, 2007, and December 30, 2011. We excluded adolescents with Blount disease and slipped capital femoral epiphyses. A total of 233 participants were included in these analyses. MAIN OUTCOMES AND MEASURES We assessed musculoskeletal pain and pain intensity of the lower back, hips, knees, and ankles/feet using the visual analog scale, categorizing musculoskeletal pain into lower back pain, lower extremity (hips, knees, and feet/ankles combined) pain, and no pain. We assessed self-reported physical function status with the Health Assessment Questionnaire Disability Index and assessed weight-related quality of life with the Impact of Weight on Quality of Life–Kids measure. We adjusted for sex, race, age at surgery, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), and clinical depressive symptoms in regression analyses. RESULTS Among the 233 participants, the mean (SD) age at surgery was 17.1 (1.56) years and the median BMI was 50.4. Participants were predominantly female (77%), white (73%), and non-Hispanic (93%). Among the participants, 49% had poor functional status and 76% had musculoskeletal pain. Lower back pain was prevalent (63%), followed by ankle
Although widely misunderstood, Lyme disease is the most prevalent vector borne disease in the United States. Children are the most at-risk group for Lyme disease, which can impact every system in the body. It can produce the musculo-skeletal, neurologic, psychiatric, opthalmologic, and cardiac symptoms. The symptoms of Lyme disease can have a…
Ardahan, Melek; Simsek, Hatice
Objective: This study analyzed the prevalence of work-related computer-user musculoskeletal discomforts, personal and computer-related risk factors. Methods: A cross-sectional survey on 395 office workers was made between July-September 2015. Musculoskeletal symptoms and risk factors were evaluated for participants’ demographics and job attributes on the 21-item questionnaire and the Turkish-Cornell Musculoskeletal Discomfort Questionnaire. Results: Participants reported musculoskeletal symptoms in the neck (67.85%), back (66.33%), lower back (59.49%), right shoulder (45.32%) and left shoulder (43.54%) during the past week and work interference was 33.6%, 28.5%, 30.6%, 31.3% and 31.9%, respectively. Musculoskeletal discomfort risks were being male, increasing daily computer usage, feeling computer-usage discomfort, hours working at desk and having knowledge about ergonomic exercises. Conclusion: Musculoskeletal symptoms are common in Turkish office workers and indicated the need for more attention to musculoskeletal disorders and designing effective preventive interventions. PMID:28083038
Geffen, Saul J
Evaluation of patients for rehabilitation after musculoskeletal injury involves identifying, grading and assessing the injury and its impact on the patient's normal activities. Management is guided by a multidisciplinary team, comprising the patient, doctor and physical therapist, with other health professionals recruited as required. Parallel interventions involving the various team members are specified in a customised management plan. The key component of the plan is active mobilisation utilising strengthening, flexibility and endurance exercise programs. Passive physical treatments (heat, ice, and manual therapy), as well as drug therapy and psychological interventions, are used as adjunctive therapy. Biomechanical devices or techniques (eg, orthotic devices) may also be helpful. Coexisting conditions such as depression and drug dependence are treated at the same time as the injury. Effective team communication, simulated environmental testing and, for those employed, contact with the employer facilitate a staged return to normal living, sports and occupational activities.
Ferguson, Sue A.; Marras, William S.; Allread, W. Gary; Knapik, Gregory G.; Splittstoesser, Riley E.
Musculoskeletal disorder risk was assessed during automotive assembly processes. The risk associated with current assembly processes was compared to using a cantilever chair intervention. Spine loads and normalized shoulder muscle activity were evaluated during assembly in eight regions of the vehicle. Eight interior cabin regions of the vehicle were classified by reach distance, height from vehicle floor and front to back. The cantilever chair intervention tool was most effective in the far reach regions regardless of the height. In the front far reach regions both spine loads and normalized shoulder muscle activity levels were reduced. In the middle and close reach regions spine loads were reduced, however, shoulder muscle activity was not, thus an additional intervention would be necessary to reduce shoulder risk. In the back far reach region, spine loads were not significantly different between the current and cantilever chair conditions. Thus, the effectiveness of the cantilever chair was dependent on the region of the vehicle. PMID:22036450
Teixeira, Pedro A Gondim; Beaumont, Marine; Gabriela, Hossu; Bailiang, Chen; Verhaeghe, Jean-luc; Sirveaux, François; Blum, Alain
The imaging characterization of musculoskeletal tumors can be challenging, and a significant number of lesions remain indeterminate when conventional imaging protocols are used. In recent years, clinical availability of functional imaging methods has increased. Functional imaging has the potential to improve tumor detection, characterization, and follow-up. The most frequently used functional methods are perfusion imaging, diffusion-weighted imaging (DWI), and MR proton spectroscopy (MRS). Each of these techniques has specific protocol requirements and diagnostic pitfalls that need to be acknowledged to avoid misdiagnoses. Additionally, the application of functional methods in the MSK system has various technical issues that need to be addressed to ensure data quality and comparability. In this article, the application of contrast-enhanced perfusion imaging, DWI, and MRS for the evaluation of bone and soft tissue tumors is discussed, with emphasis on acquisition protocols, technical difficulties, and current clinical indications.
Bailey, C J; Reid, S W; Hodgson, D R; Suann, C J; Rose, R J
Risk factors for musculoskeletal injury in racing Thoroughbreds were investigated in a case-control study conducted at racetracks administered by the Australian Jockey Club. Univariable analysis of 137 cases from the official Veterinary Surgeon's reports and an equal number of randomly selected controls from the Australian Race Results identified field size, barrier position and class of race as being significantly associated with breakdown (P < 0.05). Multiple logistic regression was then used to investigate the effect of each putative risk factor whilst controlling for all others. Horses at greater risk were older, started from a wider barrier position, ran at the same distance as their previous race and raced in the highest class of race. There was no significant difference between tracks or significant association with track condition. The incidence of fatalities in the study population was less than that reported in the UK and USA.
Dickerson, Clark R; Chaffin, Don B; Hughes, Richard E
Occupational shoulder musculoskeletal injuries and disorders are common. Generally available shoulder work analysis tools do not offer insight into specific muscle load magnitudes that may indicate increased risk, nor do they address many concerns germane to job analysis. To address these issues, a biomechanical model of the shoulder was developed to include several critical components: the systematic inclusion of kinematic and kinetic effects, population scalability, geometric realism, an empirical glenohumeral constraint, and integration with digital ergonomics analysis software tools. This unique combination of features in a single model was explored through examination of both experimental and simulated data with the developed analysis tool. The utility of the model is discussed together with a review of its specific strengths and weaknesses, and the potential for its future use in proactive ergonomic analyses and workplace simulations.
Long, Jennifer; Burgess-Limerick, Robin; Stapleton, Fiona
Work-related musculoskeletal discomfort and injuries are reported by optometrists. The purpose of this paper is to describe the process used to investigate work-related discomfort in Australian optometrists. A multistage project was conducted which included questionnaires, interviews and onsite observations. Participants, with and without self-reported discomfort, included clinical optometrists, optometry students and clinical teachers. The various stages of the study developed over the course of the project, primarily in response to results collected at various stages. A multistage approach proved valuable for confirming results and testing hypotheses, and for investigating different groups of workers (clinicians, teachers and students). General guidelines to reduce the risk of work-related discomfort in optometrists can be developed from this project. Specific recommendations and teaching curricula have been identified in this project as areas of future research and development.
Gartley, Rosanna M; Prosser, J Lynn
A pre-shift stretching protocol to reduce employee injuries was initiated at a beverage company and a tin mill in the northeastern United States. The primary goal of this study was to determine the effects of a pre-shift stretching program on work-related musculoskeletal injuries. A secondary goal was to evaluate daily participation compliance during the 90-day program. Data on employee injuries during the stretching program were collected and compared to injury events during the same time period 1 year earlier. Comparison to injury events of the total eligible population during the study time frame was also included. Results of this pilot program in terms of injury rate reduction and participant compliance are promising. Study results may be useful for employers considering implementing similar programs and also suggest the need for further study in this area.
Entzel, Pamela; Albers, Jim; Welch, Laura
Brick masons and mason tenders report a high prevalence of work-related musculoskeletal disorders (WMSDs), many of which can be prevented with changes in materials, work equipment or work practices. To explore the use of "best practices" in the masonry industry, NIOSH organized a 2-day meeting of masonry stakeholders. Attendees included 30 industry representatives, 5 health and safety researchers, 4 health/safety specialists, 2 ergonomic consultants, and 2 representatives of state workers' compensation programs. Small groups discussed ergonomic interventions currently utilized in the masonry industry, including factors affecting intervention implementation and ways to promote diffusion of interventions. Meeting participants also identified various barriers to intervention implementation, including business considerations, quality concerns, design issues, supply problems, jobsite conditions and management practices that can slow or limit intervention diffusion. To be successful, future diffusion efforts must not only raise awareness of available solutions but also address these practical concerns.
Baker, Susan C; Gallois, Cindy; Driedger, S Michelle; Santesso, Nancy
This study examined the ways in which health care providers (general practitioners and specialists) and patients communicate with each other about managing musculoskeletal (MSK) disorders, a major cause of long-term pain and physical disability. In managing their illness, patients must interact closely with health care providers, who play a large role in transferring knowledge to them. In-depth interviews with patients, general practitioners, and specialist rheumatologists in Australia and Canada were analyzed using Leximancer (a text-mining tool). Results indicated that, in their communication, doctors subtly emphasized accepting and adjusting to the illness ("new normal"), whereas patients emphasized pain relief and getting "back to normal." These results suggest that doctors and patients should accommodate in their communication across subtle and often unexpressed differences in the priorities of provider and patient, or they are likely to be at cross purposes and thus less effective.
Xiao, Guo-Bing; Dempsey, Patrick G; Lei, Ling; Ma, Zao-Hua; Liang, You-Xin
Musculoskeletal disorders and related risk factors in machinery manufacturing were investigated using interviews, postural analysis, and the revised National Institute for Occupational Safety & Health lifting equation. Sixty-nine workers involved in manual materials handling (Job A) and 51 machinery workers less involved with manual material-handling tasks (Job B) were studied. Low back pain (LBP) (at least one episode lasting for 24 hours or more in past 12 months) prevalence rates were 63.8% and 37.3% for Jobs A and B, respectively. Prevalence rates of LBP every day for a week or more attributed to lifting were 26.09% and 5.88% for Jobs A and B, respectively. Multiple regression analysis revealed that lifting repetitiveness and work age contributed to the occurrence of LBP. The "composite load" (object weight x activity repetitiveness) had a significant adverse effect on LBP.
Sutton, Blair C.; Opp, Mark R.
Study Objectives: Musculoskeletal pain in humans is often associated with poor sleep quality. We used a model in which mechanical hypersensitivity was induced by injection of acidified saline into muscle to study the impact of musculoskeletal sensitization on sleep of mice. Design: A one month pre-clinical study was designed to determine the impact of musculoskeletal sensitization on sleep of C57BL/6J mice. Methods: We instrumented mice with telemeters to record the electroencephalogram (EEG) and body temperature. We used an established model of musculoskeletal sensitization in which mechanical hypersensitivity was induced using two unilateral injections of acidified saline (pH 4.0). The injections were given into the gastrocnemius muscle and spaced five days apart. EEG and body temperature recordings started prior to injections (baseline) and continued for three weeks after musculoskeletal sensitization was induced by the second injection. Mechanical hypersensitivity was assessed using von Frey filaments at baseline (before any injections) and on days 1, 3, 7, 14, and 21 after the second injection. Results: Mice injected with acidified saline developed bilateral mechanical hypersensitivity at the hind paws as measured by von Frey testing and as compared to control mice and baseline data. Sleep during the light period was fragmented in experimental mice injected with acidified saline, and EEG spectra altered. Musculoskeletal sensitization did not alter the duration of time spent in wakefulness, non-rapid eye movement sleep, or rapid eye movement sleep. Conclusions: Musculoskeletal sensitization in this model results in a distinct sleep phenotype in which sleep is fragmented during the light period, but the overall duration of sleep is not changed. This study suggests the consequences of musculoskeletal pain include sleep disruption, an observation that has been made in the clinical literature but has yet to be studied using preclinical models. Citation: Sutton BC