Management Of Musculoskeletal Injuries Research Articles

Process quality indicators for musculoskeletal injuries in the emergency department

ObjectivesMeasuring quality of care for musculoskeletal injuries presenting to the ED is important given their prevalence, variations in care, the associated morbidity and financial impacts and pressure to achieve time-based...

Current Evidence for Acute Pain Management of Musculoskeletal Injuries and Postoperative Pain in Pediatric and Adolescent Athletes.

Sports-related injuries in young athletes are increasingly prevalent with an estimated 2.6 million children and adolescents sustaining a sports-related injury annually. Acute sports-related injuries and surgical correction of sports-related injuries cause physical pain and psychological burdens on pediatric athletes and their families. This article aims to evaluate current acute pain management options in pediatric athletes and acute pain management strategies for postoperative pain after sports-related injuries. This article will also elucidate which areas of pain management for pediatric athletes are lacking evidence and help direct future clinical trials. We conducted a literature search through PubMed and the Cochrane Central Register of Controlled Trials to provide an extensive review of initial and postoperative pain management strategies for pediatric sports-related musculoskeletal injuries. The current knowledge of acute pain management for initial sports-related injuries, postoperative pain management for orthopedic surgeries, as well as complementary and alternative medical therapies in pediatric sports-related injuries is presented. Studies evaluating conservative management, enteral and nonenteral medications, regional anesthesia, and complementary medical therapies are included. Adequate pain management is important for sports injuries in children and adolescents for emotional as well as physical healing, but a balance must be achieved to provide acceptable pain relief while minimizing opioid use and side effects from analgesic medications. More studies are needed to evaluate the efficacy of nonopioid analgesic medications and complementary therapies in pediatric patients with acute sports-related injuries.

Acoustic Emissions as a Non-invasive Biomarker of the Structural Health of the Knee.

The longitudinal assessment of joint health is a long-standing issue in the management of musculoskeletal injuries. The acoustic emissions (AEs) produced by joint articulation could serve as a biomarker for joint health assessment, but their use has been limited by a lack of mechanistic understanding of their creation. In this paper, we investigate that mechanism using an injury model in human lower-limb cadavers, and relate AEs to joint kinematics. Using our custom joint sound recording system, we recorded the AEs from nine cadaver legs in four stages: at baseline, after a sham surgery, after a meniscus tear, and post-meniscectomy. We compare the resulting AEs using their b-values. We then compare joint anatomy/kinematics to the AEs using the X-ray reconstruction of moving morphology (XROMM) technique. After the meniscus tear the number and amplitude of the AE peaks greatly increased from baseline and sham (b-value = 1.33 ± 0.15; p < 0.05). The XROMM analysis showed a close correlation between the minimal inter-joint distances (0.251 ± 0.082cm during extension, 0.265 ± .003 during flexion, at 145°) and a large increase in the AEs. This work provides key insight into the nature of joint AEs, and details a novel technique and analysis for recording and interpreting these biosignals.

Strain counter-strain technique versus kinesio tape in treating patients with myofascial neck pain syndrome

Myofascial pain syndrome is one of the most common complaints in clinical practice. Strain counter-strain technique is non-invasive therapeutic modality for treatment of soft tissue disorders. Kinesio tape is now widely used in management of musculoskeletal injuries. Forty-five patients with myofascial neck pain syndrome assigned randomly into: strain counter-strain technique group ( n = 15), kinesio tape group ( n = 15) and control group ( n = 15). The strain counter-strain technique was applied for two weeks (3 sessions/week-20 minutes per session). Kinesio tape was applied for upper Trapezius muscle for two weeks (3 days on and one day off). Pressure algometry, Visual Analogue Scale (VAS) and Neck Disability Index (NDI) were used to evaluate participants before and after the corresponding interventions. Analysis of variance test (Anova) was used to determine differences between groups for all measured parameters. Paired t -test was used to compare between the pre- and post-treatment values within groups. For the 45 study participants (33 women and 12 men; mean age = 44.1 ± 7 years) statistical analysis revealed that subjects in strain counter-strain technique and kinesio tape groups experienced significant increase in pressure pain threshold, decrease in neck disability scale and pain level than those in the control group in favour of strain counter-strain technique group ( P > 0.05). The results suggest that treatment with strain counter-strain technique and kinesio tape were effective however strain counter-strain technique was more effective for management of myofascial neck pain syndrome.

Cell Therapies in Tendon, Ligament, and Musculoskeletal System Repair.

In the last few decades, several techniques have been used to optimize tendon, ligament, and musculoskeletal healing. The evidence in favor of these techniques is still not proven, and level I studies are lacking. We performed an analysis of the therapeutic strategies and tissue engineering projects recently published in this field. Here, we try to give an insight into the current status of cell therapies and the latest techniques of bioengineering applied to the field of orthopedic surgery. The future areas for research in the management of musculoskeletal injuries are outlined. There are emerging technologies developing into substantial clinical treatment options that need to be critically evaluated. Mechanical stimulation of the constructs reproduces a more propitious environment for effective healing.

Review article: Methodology for the 'rapid review' series on musculoskeletal injuries in the emergency department.

Musculoskeletal injuries are a common presentation to the ED, with significant costs involved in the management of these injuries, variances in care within the ED and associated morbidity. A series of rapid review papers were completed to guide best practice for the assessment and management of common musculoskeletal injuries presenting to the ED. This paper presents the methodology used across the rapid reviews. PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites, were searched in 2015. The search was repeated consistently for each topic area (injuries of the foot and ankle, knee, hand and wrist, elbow, shoulder, lumbar spine and cervical spine). English-language primary studies, systematic reviews and guidelines that were published in the last 10 years and addressed acute musculoskeletal injury management were considered for inclusion. Data extraction of each included article was conducted, followed by a quality appraisal. The extracted data from each article was synthesised to group similar evidence together. For each rapid review, the evidence has been organised in a way that a clinician can direct their attention to a specific component of the clinical cycle of care in the ED, such as the assessment, diagnostic tests, management and follow-up considerations from ED. The series of rapid reviews are designed to foster evidence-based practice within the ED, targeting the injuries most commonly presenting. The reviews provide clinicians in EDs with rapid access to the best current evidence, which has been synthesised and organised to assist decision-making.

The Preparticipation Physical Evaluation.

With rising rates of sports participation among children and adolescents, pediatricians are increasingly being called upon to perform preparticipation physical evaluations (PPEs) for young athletes. The purpose of this review article is to discuss the general structure of a comprehensive PPE and how the PPE differs from a typical health maintenance visit. The PPE focuses attention on screening for cardiac conditions that predispose athletes to sudden cardiac death with exercise. This review also addresses the debate over whether electrocardiogram screening should be a routine required part of the PPE. In addition to cardiac screening, evaluation and management of musculoskeletal injury, concussion, and the female athlete triad will be discussed in greater detail. [Pediatr Ann. 2017;46(3):e85-e92.].

Cost of initial management of musculoskeletal injuries due to road traffic crashes: A register-based study from North-West India

Background: There is a paucity of information on the actual costs incurred by the family as a result of musculoskeletal injuries due to road traffic crash from our part of India. This study was conducted with the objective to ascertain the costs of initial management of musculoskeletal injuries due to road traffic crashes. Materials and Methods: This prospective study was conducted as a register-based descriptive study in a tertiary care teaching hospital in a rural area (with a predominantly mountainous terrain) of North-West India. All patients with nonfatal musculoskeletal injuries due to road traffic crashes, presenting between 2014 and 2015 and agreeing to participate in the study were included in the study. Results: Of 313 cases, 116 were managed conservatively, whereas in 189 cases, operative intervention was required. In 8 cases, both the modalities of management were required. The average cost of management was Rs. 20,386 in operative group. The average cost in the conservative group was Rs. 3726. Average cost calculated for patients in whom both modality of treatment was required was Rs. 24,000. It was observed that the indirect cost of management was proportionately higher in conservative group. Conclusions: The initial cost of management for patients managed conservatively is less than those managed by operative intervention. Importantly, however, the indirect cost of management is a major contributor to the total cost of management.

Profile and Management of Musculoskeletal Injuries Associated With the Lushan Earthquake in 2013.

On April 20, 2013, a 7.0-magnitude earthquake hit Lushan County, Ya'an City, Sichuan Province in southwest China. West China Hospital of Sichuan University, the largest and best hospital in Sichuan Province, is located in the city of Chengdu-about 100 km from the epicenter-and provided medical treatment to a total of 400 seismic patients. In this article, we retrospectively investigated 199 patients with musculoskeletal injuries who were treated in the Department of Orthopedics. Based on the seismic intensity distribution map, injury-occurring locations were divided into 5 grade-related areas: IX, VIII, VII, VI, and ≤V grade-area. The characteristics of seismic injuries were analyzed according to the geographic distribution of victims. We found that the constituent ratio of injury causes significantly differed in different earthquake areas according to the seismic intensity. (Disaster Med Public Health Preparedness. 2018; 12: 408-410).

Perspectives in musculoskeletal injury management by traditional bone setters in Ashanti, Ghana

BackgroundThe popularity of the services of traditional bone setters (TBS) in Ghana as an alternative health care requires exploration and documentation of the perspectives of providers and users.ObjectiveTo explore and document the perspectives of providers and users of the services of TBS in the management of musculoskeletal injuries in the Ashanti region, Ghana.MethodsFrom the social constructivist and qualitative approach, in-depth interviews were used to explore the perspectives of eight TBS and 16 users of their services, selected purposively through snowballing. Thematic content analysis (TCA) was employed.ResultsHigh recovery rate, warm reception, prompt attention, and the relatively lower charges, are reported to motivate the patronage of the services of TBS for the management of fractures in the legs, arms, ribs, joint bones dislocations, waist and spinal cord problems. The TBS combined traditional and orthodox procedures, using plant and animal-based materials, beliefs, spirituality (God-given) and physical therapy in the management of musculoskeletal injuries. No adverse experience was reported by either the providers or users of the traditional management methods.ConclusionWith plant and animal-based materials, TBS are observed to combine traditional and orthodox procedures to confidently manage musculoskeletal injuries to the satisfaction of their highly motivated patrons. Although over 60% of the TBS attribute the healing power behind their practice to God, the rest do not discount the role of spiritual therapy. Further studies expanded to include the perspectives of non-users of the services of the TBS will authenticate the findings of this study.

Quality indicators for musculoskeletal injury management in the emergency department: a systematic review.

There is increasing importance placed on quality of health care for musculoskeletal injuries in emergency departments (EDs). This systematic review aimed to identify existing musculoskeletal quality indicators (QIs) developed for ED use and to critically evaluate their methodological quality. MEDLINE, EMBASE, CINAHL, and the gray literature, including relevant organizational websites, were searched in 2013. English-language articles were included that described the development of at least one QI related to the ED care of musculoskeletal injuries. Data extraction of each included article was conducted. A quality assessment was then performed by rating each relevant QI against the Appraisal of Indicators through Research and Evaluation (AIRE) Instrument. QIs with similar definitions were grouped together and categorized according to the health care quality frameworks of Donabedian and the Institute of Medicine. The search revealed 1,805 potentially relevant articles, of which 15 were finally included in the review. The number of relevant QIs per article ranged from one to 11, resulting in a total of 71 QIs overall. Pain (n=17) and fracture management (n=13) QIs were predominant. Ten QIs scored at least 50% across all AIRE Instrument domains, and these related to pain management and appropriate imaging of the spine. Methodological quality of the development of most QIs is poor. Recommendations for a core set of QIs that address the complete spectrum of musculoskeletal injury management in emergency medicine is not possible, and more work is needed. Currently, QIs with highest methodological quality are in the areas of pain management and medical imaging.

Automatic Detection, Extraction, and Analysis of Landing During a Training Session, Using a Wearable Sensor System

We demonstrate an end-to-end wearable inertial sensor-based system for use in a natural sports training environment, which can automatically extract different movement actions and their individual movement cycles to generate and statistically analyse representative joint angle and impact acceleration data. The Discrete Wavelet Transform in conjunction with a Random Forest classifier was able to successfully distinguish between the six training activities (98% accurate). Accurate sensor orientation in 3D space were estimated using a computationally efficient gradient decent algorithm and were utilized to calculate joint angles, which were temporally aligned using curve registration to facilitate inter-participant comparisons. An Analysis of Characterizing Phases was applied to the whole joint angle curve and showed a statistically significant difference in knee joint flexion-extension landing strategy between a participant with low back pain and nine uninjured participants. The presented end-to-end system has the potential to be used in the automatic extraction and analysis of movement technique and loading in various unconstrained environments for musculoskeletal injury management.

Relative Therapeutic Efficacy of Phonophoresis and Cryotherapy as Combined Therapy in the Management of Musculoskeletal Injuries

Relative Therapeutic Efficacy of Phonophoresis and Cryotherapy as Combined Therapy in the Management of Musculoskeletal Injuries

Relative Therapeutic Efficacy of Phonophoresis and Cryotherapy as Combined Therapy in the Management of Musculoskeletal Injuries

This study was designed to investigate the efficacy of phonophoresis and cryotherapy as combined therapy (double-modality therapy – DMT) in the management of pain among subjects with musculoskeletal injuries (MSIs).Subjects were assigned randomly to one of three groups: DMT group (n=17) received cryotherapy and 15% methyl salicylate phonophoresis, PHONO group (n=14) received 15% methyl salicylate phonophoresis, andCRYO group (n=19) received cryotherapy and ‘sham’ phonophoresis. Ultrasound at an intensity of 1.5 W/cm² and frequency of 1MHz was used to apply methyl salicylate while intermittent cryotherapy was the mode ofapplication. The pre- and post-treatment pain perception scores (PPS) of the patients were assessed using the visual analogue scale (VAS), and the sessions of treatment in all groups were recorded. Treatment was administered on alternate days and subjects in all groups were discharged when they were pain free. In total, 233 treatment sessions were recorded – 61(26.2%) in DMT, 77(33.0%) in PHONO and 95(40.8%) in CRYO group respectively, which indicated no significant difference (P &gt; 0.05). In the DMT, CRYO and PHONO groups, 16, 12 and 7 subjects respectively were pain free after 1 to 5 treatments. The difference in the severity of pain was significant (P &lt; 0.05) in each group post-treatment, which suggests that DMT, phonophoresis and cryotherapy were equally effective. The study has demonstrated the therapeutic efficacy of DMT, but it was not superior to the single treatment protocol of phonophoresis or cryotherapy. It might however, take less treatment sessions to reduce pain among the subjects with the use of DMT compared with other two modalities.KEYWORDS: cryotherapy, double-modality therapy, musculoskeletal injury, phonophoresis, ultrasound

Minor Traumatic Brain Injury: A Primer for the Orthopaedic Surgeon

Minor traumatic brain injury (mTBI) is a major public health problem. The Centers for Disease Control and Prevention and the National Center for Injury Prevention and Control label it a "silent epidemic." Subtle signs and symptoms of mTBI, including headache, fatigue, and memory loss, are often seen in conjunction with musculoskeletal trauma. Although sometimes evident immediately, mTBI may not manifest until patients return to work and their personal lives. In the patient with acute concurrent mTBI, skeletal management must be based on either a period of observation to rule out evolving neurologic symptoms or, when warranted, the recommendations of a neurosurgeon. Such input is particularly important when mTBI is associated with a prolonged loss of consciousness or posttraumatic amnesia. In the outpatient setting, when concern for mTBI exists weeks after an injury, familiarity with and referral to locally available mTBI specialists and programs can facilitate proper care. Armed with this knowledge, the orthopaedic surgeon has an opportunity to positively influence outcomes and help provide crucial care that extends beyond the management of musculoskeletal injuries.

Injection Therapy in the Management of Musculoskeletal Injuries: Foot and Ankle

Despite their widespread and frequent use, there is little guidance of injectable treatments to the ankle and foot. Common pathologies in the foot and ankle that injectable therapy is useful for include: plantar fasciitis, tarsal tunnel syndrome, degenerative joint disease of the ankle, Morton's neuroma, hallux rigidus, and Achilles tendinopathy. While corticosteroid therapy is useful in many of the aforementioned diagnoses, its use should be limited in Achilles tendinopathy. More recently, platelet rich plasma is being investigated as a possible efficacious treatment modality in plantar fasciitis, ankle arthritis, and Achilles tendinopathy. This article serves to summarize the current literature and provide guidance of injectable therapy in common foot and ankle pathologies.

Injection Therapies in the Management of Shoulder Injuries

Injections are frequently used in the management of musculoskeletal injuries and complaints. This article reviews the most commonly treated shoulder diagnoses, including the symptoms, physical examination findings, diagnostic studies, and treatment options. Injection techniques within each anatomical location will also be reviewed.

Injection Therapy in the Management of Musculoskeletal Injuries: The Elbow

Elbow injuries are common both in the general population and in the athlete. Given the repetition and forces that the elbow is exposed to during daily activities and sport, it is a site of several different pathologies. Tendinopathy or epicondylitis, both lateral and medial, are a common cause of elbow pain secondary to these repetitive loads. Complicating matters, ligamentous injuries can be mistaken for tendinopathies, making the clinical and radiological diagnoses important before treatment. Other pathologies such as bursitis, arthritis, osteochondritis dissecans, radial tunnel syndrome, and tendonitis can be causes of pain in the elbow. Furthermore, other sites of pathology can cause referred pain to the elbow, such as cervical radiculopathy. Treatment of elbow pathologies with injection therapies has been studied extensively in the literature. Some diagnoses, such as elbow tendinopathy/epicondylitis, ligamentous injuries, bursitis, and arthritis, are more commonly treated with injection therapies. This article reviews some of these common diagnoses in the elbow, including both the clinical symptoms and physical examination findings. We will discuss the indications for injection treatment and the literature supporting or refuting their use, as well as demonstrate some of the techniques used while administrating these treatments.

Injection Therapy in the Management of Musculoskeletal Injuries: Hand and Wrist

Injections are valuable diagnostic and therapeutic nonoperative treatments for a myriad of painful conditions affecting the hand and wrist. Corticosteroid and analgesic preparations are frequently injected for the treatment of carpal tunnel syndrome, stenosing tenosynovitis, tendinopathy, and ganglion cysts, as well as for radiocarpal and basilar joint arthrosis. Although upper extremity surgeons frequently perform injections as part of their daily practice, other clinicians may not be as familiar with the appropriate indications and proper techniques required for injection therapy in the hand and wrist. The purpose of this review is to briefly describe the clinical presentation and evaluation of common hand and wrist conditions most frequently amenable to injection therapy. Appropriate indications for injections will be presented along with a detailed description of proper injection technique.

Injection Therapy in the Management of Musculoskeletal Injuries of the Knee

Injections of the knee joint and the surrounding structures are one of the most common interventions performed by providers of musculoskeletal care. With appropriate patient selection, injections may provide substantial short-term relief with infrequent complications. Longer-term outcomes, including modification of the underlying disease processes, are debated within the literature. In this review, we provide an overview of injection therapy in and around the knee, with a focus on the indications, complications, pertinent techniques (including preparation, approaches, and aftercare), types of injectables (corticosteroids, viscosupplementation, and platelet-rich plasma), and evidence-based recommendations for roles of injection therapy in both intra- and extra-articular disease processes.