Diagnosis Of Musculoskeletal Injuries Research Articles

Infrared thermography in the diagnosis of musculoskeletal injuries: A protocol for a systematic review and meta-analysis.

Background:Musculoskeletal injuries (MSDs) have become a major public health problem worldwide. Current diagnosis techniques for MSDs are often associated with radiation exposure, expensive cost, or contraindication. Infrared thermography (IRT) is becoming a proposed tool to assist in diagnosing MSDs, but current evidence is inconclusive. Thus, herein we aimed to evaluate the diagnostic accuracy of IRT for MSDs.Methods:We will search EMBASE, MEDLINE, EBSCO, Cochrane Library, SCOPUS, Web of Science, CNKI, SinoMed, and Wangfang. Two researchers will independently screen eligible studies. Study quality will be evaluated based on the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Data synthesis will be completed using STATA 14.0 software. A bivariate random-effects analysis will be utilized to estimate the pooled estimation of the diagnostic odds ratio (DOR) and the summary receiver operating characteristics (SROC) curve. Subgroup analyses will be performed to determine heterogeneity sources.Results:This systematic review and meta-analysis will provide reliable evidence about the diagnostic accuracy of IRT for MSDs.Conclusion:The conclusion of this study will be published in a peer-reviewed journal.Ethics and Communication:Given that this is a systematic review of published research, patient consent and ethical approval are not relevant. The findings of this study will be disseminated through conference presentations and publication in peer-reviewed journals.Prospero registration number:CRD42020184867.

Систематический обзор применения томосинтеза для диагностики травм и заболеваний опорно-двигательной системы

Digital tomosynthesis is a radiological method having an intermediate position between x-ray and computed tomography (CT). Benefits with the imaging technology include improved image quality, post-processing (reconstructed to 1 mm thick slices), minimal tissue overlap in the projection image and a lower X-ray dose as compared to CT. Tomosynthesis is most commonly used in breast, chest (pulmonary tuberculosis), musculoskeletal and intraoral screening examinations. There is disagreement among professionals on feasibility and clinical effectiveness of tomosynthesis in the diagnosis of musculoskeletal injuries and diseases. Our goal was to summarize evidence relating to efficacy and feasibility of tomosynthesis in the diagnosis of musculoskeletal injuries and diseases. Russian and foreign literature was reviewed based on methodological principles of the PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions. The review included 34 articles in English and in Russian (referenced 16 to 49) describing an original study with focus on phantom, diagnostic, clinical studies. We considered articles which investigated use of tomosynthesis in the diagnosis of musculoskeletal injuries and diseases including rheumatoid arthritis affecting the hands and feet, specific and nonspecific spine lesions and injuries, nonspecific lesions and injuries to the joints; subtle fractures and dislocations. With the advantages of tomosynthesis in clinical practice, the imaging modality can be recommended for the diagnosis of the above conditions.

Avaliação dos parâmetros fisiológicos e de alterações musculoesqueléticas em equinos de vaquejada, utilizando a termografia

<p>Objetivou-se determinar os parâmetros fisiológicos de equinos atletas de vaquejada e avaliar o emprego da termografia infravermelha como ferramenta de auxílio ao diagnóstico precoce de lesões musculoesqueléticas decorrentes do treinamento físico desses animais. Foram utilizados 10 animais atletas da raça Quarto de Milha, machos e fêmeas, com idades entre 5 e 15 anos. Os animais foram divididos em dois grupos: animais da categoria puxada (G1) e animais da categoria esteira (G2). Foram determinados: frequência cardíaca (FC), frequência respiratória (FR), temperatura retal (TR), tempo de preenchimento capilar (TPC), movimentos intestinais e coloração das mucosas. Temperatura superficial (TS) foi obtida por meio da realização de projeções de cada animal com câmera termográfica FLIR<sup>®</sup> T10611. As variáveis foram mensuradas em três momentos: antes do treino (AT), imediatamente após o treino (PT) e duas horas após o treino (2h PT). As variáveis climáticas foram mensuradas com Data Loggers Hobo<sup>®</sup>. O índice de conforto térmico (IC) indicou que os animais se encontravam em conforto térmico durante os momentos avaliados. O esforço físico foi suficiente para causar alterações em alguns dos parâmetros avaliados: FC, FR, TR e TS. Na avaliação das termografias, observou-se um aumento da temperatura local na região de músculo semitendinoso em um dos animais avaliados. A utilização da câmera termográfica pode contribuir para a prevenção e para o diagnóstico precoce de lesões musculoesqueléticas de equinos de vaquejada.</p>

Revisiting predictive biomarkers of musculoskeletal injury in thoroughbred racehorses: longitudinal study in polish population

BackgroundHigh prevalence of musculoskeletal disorders in racehorses and its impact on horse welfare and racing economics call for improved measures of injury diagnosis and prevention. Serum biomarkers of bone and cartilage metabolism have previously shown promise in prediction of musculoskeletal injuries in horses. This study aimed to re-evaluate usability of the predictive serum biomarkers identified in North American Thoroughbred racehorses in a geographically distinct group of Polish Thoroughbreds.ResultsSerum concentrations of bone and cartilage biomarkers: osteocalcin, c-terminal telopeptide of type I collagen, total glycosaminoglycans (GAG), chondroitin sulfate epitope and c-propeptide of type II procollagen (CPII) were evaluated in the beginning and the next 3 months of one racing season in a cohort of twenty-six 2-year-old Polish racehorses. Exit criteria were diagnosis of musculoskeletal injury, leading to > 5 days off training (n = 8), or completion of 3 study months with no training interruptions (n = 18). Normalized results and matching archival data from 35 2-year-old North American racehorses was used for logistic regression analysis to identify universal predictors of injury. Mean GAG and CPII levels were lower in injured group comparing to control, which is consistent with previous findings in racehorses. These biomarkers were also identified as predictors of injury in the mixed population model. Population origin had no significant effect on predictive value of evaluated biomarkers (Wald test p = 0.137). Decreased osteocalcin and increased c-terminal telopeptide of type I collagen levels in injured horses comparing to controls were specific for Polish population and signalized disruption in bone turnover homeostasis.ConclusionsChanges in serum GAG and CPII in racehorses at risk of injury appear to be similar across distinct populations while dynamics of serum bone marker is more population-specific.

Infrared thermal imaging in the diagnosis of musculoskeletal injuries: a systematic review and meta-analysis.

Musculoskeletal injuries occur frequently. Diagnostic tests using ionizing radiation can lead to problems for patients, and infrared thermal imaging could be useful when diagnosing these injuries. A systematic review was performed to determine the diagnostic accuracy of infrared thermal imaging in patients with musculoskeletal injuries. A meta-analysis of three studies evaluating stress fractures was performed and found a lack of support for the usefulness of infrared thermal imaging in musculoskeletal injuries diagnosis.

Extended scope physiotherapists in the emergency department: a literature review

Background: Emergency departments (EDs) are one of the main providers of minor injury care in the UK. The use of extended scope physiotherapists (ESPs), independently managing patients from arrival to discharge, has not been widely considered in the UK or internationally. It is possible that ESPs will contribute to the staffing of the twenty-first-century EDs, and their role is gaining momentum in Australia, Canada, and several European counties.Objectives: The aim of the review was to establish the UK and international evidence for clinical effectiveness and cost efficiencies for ESPs independently managing a case load of 'minor injuries' in the ED setting.Methods: A comprehensive review of the published and non-published international literature was undertaken.Results: ESPs are independent professionals with pre-existing skills in the assessment and diagnosis of musculoskeletal injuries. Evidence was only found from UK hospitals regarding the clinical effectiveness and cost efficiencies. ESPs obtain equivalent clinical outcomes compared to the care provided by doctors of all grades, and they are likely to be equivalent in cost, but patients may take longer to return to normal activities when treated by an ESP. ESPs can work to existing ED protocols and achieve significantly higher patient satisfaction than other professional groups, but spend longer with patients.Conclusions: ESPs can provide a high standard of care at an affordable cost, whilst positively influencing patient satisfaction. The use of ESPs working in the ED, carrying out duties traditionally undertaken by doctors, could provide one of the solutions to staffing shortages in emergency care.

MISSED LARYNGOTRACHEAL RUPTURE LEADING TO DELAYED PRESENTATION

A 16-year-old male presented to a regional emergency department with sharp neck pain with associated dyspnoea and hoarseness of voice after a high tackle to the chest during a rugby league match. He was assessed, a chest X-ray carried out and discharged home with a diagnosis of musculoskeletal injury. He was later recalled when his chest X-ray and lateral airway X-ray were reviewed by a radiologist, and free air in the deep neck spaces was detected (Fig. 1). He was referred to a tertiary hospital for further management. On arrival, he was mildly distressed by persisting neck pain; however, there was no evidence of impending respiratory compromise. On examination, he was exquisitely tender over the thyroid cartilage, with extensive subcutaneous emphysema of the neck. Antero-posterior and lateral X-ray of the neck showing free air extending between the prevertebral and retropharyngeal spaces. A 65-year-old woman presented to the emergency department with worsening neck pain, neck swelling and dyspnoea after a laparoscopic cholecystectomy at a regional hospital 3 days before. Postoperatively, she had complained of neck pain to her surgeon; however, after being clinically assessed, she was discharged home on the first postoperative day. The condition of the patient deteriorated further at home, and on presentation to the emergency department, she was distressed, was tachypnoeic and had extensive subcutaneous emphysema of the neck and anterior chest wall. In both cases, patency and safety of the airway were assessed by flexible nasendoscopy. Computed tomography (CT) scans of the neck and chest were carried out, which revealed extensive subcutaneous emphysema with extension of free air into the deep neck spaces as well as the presence of pneumomediastinum (Fig. 2). Barium swallows were also carried out to exclude oesophageal injury. Both patients were managed conservatively in the high dependency unit with continuous airway monitoring, prophylactic intravenous antibiotics, steroids and antireflux medication. They were kept fasting for the first 24 hours, and after clinical improvement in symptoms, they were commenced on a soft diet. Both patients remained stable and in hospital for at least 4 days, and after discharge from hospital were followed-up in an outpatient clinic until there was resolution of all free air on subsequent CT scans. Computed tomography scan of the neck showing extensive subcutaneous emphysema with free air in the deep neck spaces. Historically, laryngotracheal injury has predominantly been associated with blunt trauma as a result of motor vehicle accidents; although with the advent of safer car design and airbags, this has become less common. Injuries to the tracheobronchial tree are rare and are thought to account for only 1:30 000 emergency department presentations in an American series,1 with blunt laryngotracheal trauma reportedly carrying a mortality rate of approximately 40%.2 Trauma to the chest sustained during sporting matches is a less common cause of tracheal rupture, but iatrogenic tracheal rupture after intubation trauma is increasingly being recognized.2 Patients may present with non-specific symptoms, including hoarseness, pain, dyspnoea or stridor, cough and odynophagia. Clinical examination may reveal tenderness over the larynx and trachea, external signs of trauma, including ecchymosis, or haematoma of the neck; however, the most telling finding is the presence of subcutaneous emphysema of the neck with extension onto the chest. Recognizing the presence of laryngotracheal trauma can be difficult because approximately one-third of patients are thought to be asymptomatic at initial presentation, with symptoms and signs developing over a 24- to 48-hour period.2 Using appropriate patient selection, mild laryngotracheal injuries can be managed conservatively and successfully as illustrated by the cases above. Despite the sometimes mild and non-specific symptoms laryngotracheal injury may present with, knowledge of the mechanism of injury can help determine the underlying pathology. It remains a potentially lethal injury with potential for serious morbidity; therefore, we suggest a low threshold for investigating patients with possible laryngotracheal injury to prevent further missed and misdiagnoses.

Bone bruises: definition, classification and significance

The increasing use of magnetic resonance imaging in the diagnosis of musculoskeletal injuries has alerted clinicians to the phenomenon of bone bruising. This article will outline the current knowledge and treatment implications of these interesting radiological findings.

Delayed identification of skeletal injury in multisystem trauma: the 'missed' fracture.

Delay in diagnosis of musculoskeletal injury in multiply injured patients may potentially lead to functional or cosmetic disability in survivors. In an 18-month prospective study to determine the incidence and spectrum of delayed recognition of skeletal injury at our Level I trauma center, delayed diagnosis of 39 fractures was made in 26 of 1,006 consecutive blunt trauma patients. The delay in recognition ranged from 1-91 days. Twenty-one (55%) of the fractures were not X-rayed at the time of admission, but nine (23%) fractures were clearly visible on admission films. Four (10%) fractures were missed because of technically inadequate X-rays, and five (13%) had adequate X-rays but could not be identified on admission films. In only two instances was a second anesthetic exposure required for operative therapy. For the patients in this series, the delay of fracture identification was not felt to contribute to additional long-term cosmetic, functional, or neurologic problems. Continued clinical and radiologic surveillance is required in multiply injured patients to prevent musculoskeletal diagnostic failure.