Lower Extremity Disorders Research Articles

Musculoskeletal disorders in relation to age and occupation in Swedish construction workers.

Physical exposure load varies between trades in the construction industry. Our hypothesis is that the prevalence of MSD in a trade, reflects the level of physical exposure; the aim of the study was to describe MSD in relation to age and occupation within the industry. The study is based on data from self-administered questionnaires filled out by 85,191 males in the Swedish construction industry. Construction workers had higher age-adjusted prevalence of MSD than foremen and office workers. In general prevalence rates increased steadily with age. Scaffolders showed the highest prevalence of MSD in all body locations. Elevated prevalence of neck disorders was found in crane operators, insulators, and painters, and of lower back and lower extremity disorders in roofers and floorers. MSD increase with age. The variation between trades of MSD prevalence seems to correspond to the variation with respect to physical exposure.

Prevalence of work related musculoskeletal disorders in active union carpenters.

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...

Diabetic wound and lower extremity disorder management

Diabetic wound and lower extremity disorder management

Clinical experience with paraspinal mapping. I: Neurophysiology of the paraspinal muscles in various spinal disorders

Objective: To assess the extent of denervation of the paraspinal muscles in spinal disorders. Design: Nonrandomized prospective trial. Setting: Electrodiagnostic laboratory of a university spine center and of a private practice in a small community. Subjects: One hundred fourteen consecutive persons referred for electrodiagnosis of spinal or lower extremity disorders. Intervention: The paraspinal mapping (PM) electromyography (EMG) protocol along with codified history, physical examination, extremity EMG, and in 44 cases, radiologic imaging results. Main Outcome Measures: PM scores compared with recently established norms (95% of normal subjects scoring less than <6), lower extremity (LE) EMG findings, and imaging results. Results: Fifty-eight subjects had normal PM scores; 62 were abnormal. Compared to imaging studies, false positive rate was 8% (1/13). False negative rate (normal PM with definite nerve involvement on imaging) was 33% (6/18), but this decreased to 5% when PM was combined with LE EMG. Four of 4 high lumbar lesions were detected by PM. Of 14 apparent false negatives (13%) compared to LE EMG, 6 had S1 root lesions and 5 had nonspinal lesions. All 7 subjects with isolated S1 radiculopathy had PM scores within normal limits. Occasional polyneuropathies presented with normal PM and abnormal distal findings or with abnormal PM but normal distal findings. No patient with isolated paraspinal findings had evidence of malignancy on follow-up. This report also describes the distribution of denervation in the multifidus, longissimus, and iliocostalis in various disorders. Conclusions: PM relates well to imaging studies and LE EMG. It detects uncommon high lumbar root lesions. S 1 may not innervate the paraspinal muscles. There are isolated paraspinal findings in persons without malignancy. The effects of specific muscle denervation on biomechanics, rehabilitation exercise, and prognosis are not known.

Clinical experience with paraspinal mapping. II: A simplified technique that eliminates three-fourths of needle insertions

Objective: To simplify and minimize the quantified needle examination of the paraspinal muscles (paraspinal mapping [PM]) without compromising sensitivity or specificity. Design: Nonrandomized prospective trial. Setting: Electrodiagnostic laboratory of a university spine center and of a private practice in a small community. Subjects: One hundred fourteen consecutive persons referred for electrodiagnosis of spinal or lower extremity disorders who had PM data and 35 previously reported asymptomatic volunteers. Intervention: Abbreviated PM protocols were simulated by progressively eliminating data from the 45 needle insertions of the original PM. Simulations involving 35, 15, 13, and 5 insertions resulted in different normal values (95% of asymptomatic volunteers) and different scores in patients. The resulting reclassification of patients as normal or abnormal was compared with the original protocol and with clinical data. Main Outcome Measures: False positive and false negative rates of the simulations compared with the original protocol. Results: Abbreviated protocols involving 30, 15, 13, and 5 needle insertions had normal cutoff scores of less than 5, less than 4, less than 3, and less than 2, respectively, with 2%, 2%, 4%, and 8% false positive rates and 3%, 8%, 13%, and 21% false negative rates compared with the original. In many cases clinical information correlated better with the abbreviated test results than the original PM. Conclusions: The third protocol compared well with the original PM, and in a limited number of patients with imaging studies demonstrated 92% sensitivity and 92% specificity. By eliminating the iliocostalis, longissimus, and lowest multifidus needle explorations, 73% fewer needle insertions were used. We recommend that this new technique, now called “miniPM,” be used in most clinical settings.

Shock-Absorbing Effect of Shoe Insert Materials Commonly Used in Management of Lower Extremity Disorders

The efficacy of 3 shock-absorbing materials was compared by determining impact characteristics with a drop test method and also by testing the effect of each material when used as a shoe insert in 16 asymptomatic subjects. Peak vertical ground reaction force (F1, F2, F3) and temporal force factors (T1, T2, T3) were obtained with a force plate at a high-frequency sampling rate. Impact force, impact time, impact slope, and impact energy were determined. A standard weight was dropped from 3 heights on each material covering the force plate while reduction of peak force was compared. Impact force was attenuated most effectively by Insert 3 (polymeric foam rubber) and averaged 11% less than that in shoes without inserts. Impact time was increased for all 3 inserts. Impact slope and impact energy were reduced significantly in Insert 3. There was a significant difference in peak vertical force F1 for all 3 inserts, in vertical force F2 for Insert 2 (viscoelastic polymeric material), and in vertical force F3 for Insert 2. Drop-test studies showed that at all ball heights, the highest mean peak force was observed consistently in Insert 2.

Reviews and Notes: Dermatology: Color Atlas of Cutaneous Disorders of the Lower Extremities

Reviews and Notes: Dermatology: Color Atlas of Cutaneous Disorders of the Lower Extremities

The parascapular flap for treatment of lower extremity disorders.

The parascapular flap was used as a free microvascular transfer for soft-tissue resurfacing of 11 lower extremities. The diagnoses included four cases of osteomyelitis, three cases of vascular ulceration, one case of combined osteomyelitis and vascular ulceration, two cases of posttraumatic heel defects, and one case of extensive soft-tissue contracture overlying a posttraumatic defect of the femur. All cases were successful clinically. Anatomically, the parascapular flap is supplied by the cutaneous parascapular artery, a branch of the circumflex scapular artery, which itself derives from the subscapular artery. Flap territory may reach 15 x 30 cm, and the vascular pedicle can extend 14 cm if the subscapular artery is taken. Advantages of this flap include the constancy, length, and caliber of the vascular pedicle; the length and width attributes, which allow both coverage of large wounds and primary closure of the donor defect; and an absence of disruption of musculoskeletal function.

Pes cavus and pes planus. Analyses and treatment.

The arch of the foot serves as an adaptable, supportive base for the entire body. This article discusses how the arch of the foot affects the normal biomechanics of the lower limb. An anatomical overview of the three components of the arch of the foot is presented, identifying the medial longitudinal arch as the arch mainly responsible for related structural problems throughout the lower limb. Deviations in the normal structure of the medial longitudinal arch produce unbalanced, functionally unstable conditions of the foot such as pes cavus or pes planus. Specific evaluation criteria for both pes cavus and pes planus are discussed, in addition to the adverse effects these two disorders have on weight bearing, force dissipation, and normal gait. Compensatory pronation associated with pes planus is one of the most common lower extremity disorders seen currently by physical therapists working in sports medicine, and its causes and related lower limb disorders are discussed. Most of these structural deformities can be corrected through the use of various orthotic devices. Specific guidelines are presented for using both soft and permanent orthoses, which offer the foot increased shock absorption and proper structural alignment.

Clinical use and fabrication of molded thermoplastic foot orthotic devices. Suggestion from the field.

The semirigid or rigid molded thermoplastic foot orthosis can be used as treatment for a variety of foot and lower extremity disorders. The foot orthosis functions to decrease biomechanical dysfunction or to change plantar contact points on the foot. Clinicians providing foot orthotic device therapy can best meet the therapeutic needs of their patients by fabricating orthotic devices from a variety of materials according to the nature of each case.