Musculoskeletal Causes Research Articles

Superior gluteal vein syndrome: an intrapelvic cause of sciatica.

The role of malformed or dilated branches of iliac vessels in causing pelvic pain is not well understood. Such vessels may entrap nerves of the lumbosacral (LS) plexus against the pelvic sidewalls, producing symptoms not typically encountered in gynecological practice, including sciatica and refractory urinary and/or anorectal dysfunction. We describe cases of sciatica in which laparoscopy revealed compression of the LS plexus by variant superior gluteal veins (SGVs). In demonstrating an improvement in patient symptoms after decompression, we identify this neurovascular conflict as a potential intrapelvic cause of sciatica. This study is a retrospective case series (Canadian Task Force Classification II-3). Nerve decompression laparoscopies were performed in São Paulo, Brazil. Thirteen female patients undergoing laparoscopy for sciatica with no clear spinal or musculoskeletal causes were included in this study. In all cases, we identified LS entrapment by aberrant SGVs, and performed decompression by vessel ligation. The average preoperative visual analog scale score of 9.62 ± 0.77 decreased significantly to 2.54 ± 2.88 post-operatively (P < 0.001). The success rate (defined as ≥ 50% improvement in visual analog scale score) was 92.3%, over a follow-up of 13.2 ± 10.6 months. Our case series demonstrates a high success rate and significant decrease in pain scores after laparoscopic intrapelvic decompression, thereby identifying pelvic nerve entrapment by aberrant SGVs as a potential yet previously unrecognized cause of sciatica. This intrapelvic neurovascular conflict—the SGV syndrome—should be considered in cases of sciatica with no identifiable spinal or musculoskeletal etiology.

Sonographic assessment of musculoskeletal causes of calf pain and swelling.

Calf pain or swelling is a common presentation to the emergency department. The differential diagnoses are wide. Deep vein thrombosis (DVT) is often the first diagnosis to be excluded given its potentially fatal complications. Musculoskeletal causes of calf pain or swelling such as Baker's cyst, muscle or tendon tear, soft tissue infection, and inflammation are not uncommon and can often be confidently diagnosed with ultrasonography (US). Familiarity with these conditions and the sonographic findings would be useful in making timely and correct diagnosis.

Cervical Nerve Plexus Block for Treatment of Acquired Spasmodic Cervical Torticollis (Scoliosis) in an Arabian Horse

In the horse, acquired cervical torticollis (scoliosis), in which the cervical vertebrae are twisted or crooked, appears to be rare with few reported cases [1,2]. A variety of reasons are reported for acquired cervical scoliosis. Musculo-skeletal causes have included fracture/subluxation of cervical vertebrae, unilateral cicatrical muscle contracture, unilateral muscle rupture, unilateral paralysis subsequent to cervical spinal nerve damage and nutritional dystrophic myo-degeneration [1].

Non-venous causes of leg and arm swelling

Extremity swelling, pain, edema and erythema are non-specific signs and symptoms for an upper or lower extremity deep venous thrombosis (DVT). There is a poor clinical accuracy to diagnose DVT. The clinical signs and symptoms of DCVT are often mimicked by other pathologies (musculoskeletal, other vascular and infectious disorders). In this presentation we will discuss the differential diagnoses and conditions, which may mimic the clinical signs and symptoms of a DVT such as musculoskeletal causes (lymphadenopathy, hematoma and abscesses, muscle tears, soft tissue masses, popliteal cysts and joint effusions), fluid collections/edema (groin, popliteal fossa and calf) and arterial causes (pseudoaneurysm, arteriovenous fistula and arterial thrombosis).

New insights and long-term safety of tocilizumab in rheumatoid arthritis.

Rheumatoid arthritis is a leading musculoskeletal cause of disability in Western society. Therapeutic options have expanded rapidly with the advent of biological agents as treatment options. One of these, tocilizumab, targets the interleukin-6 receptor and has been approved since the late 2000s in many jurisdictions. This approval was based on 6-12 month trials. It is now appropriate to look at longer-term studies and what new insights they have provided into this agent. Data are based largely on observational studies with their well-known limitations as well as some further randomized trials and provide a number of important observations regarding both efficacy and safety. In conclusion, the longer-term data suggest tocilizumab efficacy increases over time for both signs and symptoms and radiographic change. It is also corticosteroid sparing. The safety data are consistent with the shorter-term trials and are largely reassuring but some questions still remain over cardiovascular safety and cancer risk.

Risk of Hospitalization for Cancer, Musculoskeletal Disorders, Injuries, or Poisonings Surrounding Widowhood.

Psychological distress has been indicated to affect the risk of death from cardiovascular disease, cancer, and external causes. Mortality from these major causes of death is also known to be elevated after widowhood when distress is at a heightened level. Surprisingly little is known about changes in health other than mental and cardiac health shortly before widowhood. We used longitudinal data on widowed (n = 19,185) and continuously married (n = 105,939) individuals in Finland (1996-2002) to assess the risk of hospitalization for cancer and for external and musculoskeletal causes surrounding widowhood or random dates. We fitted population-averaged logit models using longitudinal data of older adults aged 65 years or over. The results show that hospitalization for injuries had already increased prior to widowhood and clearly peaked after it. The increases were largely related to falls. A similar increasing pattern of findings was not found around a random date for a group of continuously married individuals. Hospitalizations for cancer and musculoskeletal disorders appeared to be unrelated to the process of widowhood. Hospitalizations for poisonings increased after widowhood. The results imply that the process of widowhood is multifaceted and that various types of health changes should be studied separately and before the actual loss.

Personal Safety of the Plastic Surgeon: Keeping Yourself Healthy While You Work.

After reading this study, the participant should be able to: 1. Recognize the primary physical and mental risks faced by the practicing plastic surgeon. 2. State the primary risk factors for cervical spine disease and back pain. 3. State the critical steps for protection from ionizing and nonionizing radiation. 4. List the characteristics of a surgeon exhibiting signs of burnout. 5. Develop a plan for mitigating personal risk of musculoskeletal, exposure, and other injuries. Health care workers are exposed to significant occupational hazards, and have a risk of injury similar to that of construction, mining, and manufacturing employees. Plastic surgeons must have a clear understanding of the types of risks they face and the techniques for mitigating them. Exposure to some risks is attributable to unavoidable occupational conditions, but others can be avoided completely. The sources of injury risk from musculoskeletal, exposure, and other causes are discussed in this article, and evidence-based recommendations to ameliorate these risks are presented.

Impact of early systemic lupus erythematosus on work disability-results from the Finnish nationwide register 2000-2007.

Objectives of this study were to examine work disability (WD) and its leading causes in incident SLE patients. Data were derived from the Finnish nationwide registries to identify all non-retired, 18 to 64-year-old incident SLE patients between 2000 and 2007. Sick benefits and WD pensions and the causes for them were monitored until the end of 2008. A total of 446 working-aged, incident SLE patients available for work force (mean age 42 ± 13years, 89% females) were found. During the follow-up (median 5.3years), WD pension was granted to 27 patients. The most common cause was SLE itself (14 patients, 52%), with cumulative incidence of 3.4% (95% CI 1.9 to 5.8) in 5years and 5.0% (95% CI 3.0 to 8.5) in 8years, followed by musculoskeletal and psychiatric causes. The age- and sex- adjusted incidence ratio for WD pension in SLE patients due to any cause was 5.4 (95% CI 3.7 to 7.9) compared to the Finnish population. The mean number of WD days was 32 (95% CI 28 to 35) per patient-year among all SLE patients during the follow-up. The study concludes that SLE patients have an increased risk for WD already in early course of the disease.

Effectiveness and Safety of Oral Dexketoprofen for Mild to Moderate Pain among Filipino Adults: A Post-marketing Surveillance Study

Background: Studies abroad demonstrate the effectiveness and safety of dexketoprofen in various therapeutic indications. However, there has been no related study on our local population. Objectives: To evaluate the effectiveness and safety of oral dexketoprofen among Filipino adults in the treatment of mild to moderate acute pain due to musculoskeletal causes (such as osteoarthritis and low back pain), postoperative pain, headache, or dysmenorrhea in primary health care setting in the Philippines. Methods: This was a prospective observational study. Drug prescription by attending physicians was based on the drug’s Summary of Product Characteristics, which included its indications, contraindications, and precautions. Dosage prescriptions varied, depending on the nature and severity of pain on initial consultation, and physicians’ clinical judgment. Effectiveness was evaluated using Wong-Baker faces pain rating scale, clinical global impressions scale, and efficacy index; while safety was evaluated according to incidence and severity of adverse events. Results: Osteoarthritis and low back pain were the most common conditions seen by the physicians during the study period. Majority received the recommended dosage and duration of the medicine, which was 51-75 milligrams of dexketoprofen a day (56.2%) for at least 1 week (57.5%). On follow-up, there was statistically significant improvement (p<0.0001) in pain scores among patients, regardless of medical condition and dexketoprofen dosage and duration. There was low (2.8%) incidence of adverse events in the study population. Majority of side effects did not significantly interfere with daily functioning of patients. Conclusion: This study demonstrated the effectiveness and safety of oral dexketoprofen in various therapeutic indications. Majority experienced moderate or marked therapeutic effect with no to minimal side effect. No serious adverse event from intake of non-steroidal anti-inflammatory drug, particularly related to gastrointestinal and nervous system disorders was noted.

Variations in elderly peoples’ visits to the emergency departments in Iceland: A five-year population study

IntroductionElderly people visiting emergency departments (ED) are a non-homogenous group. Gender and other socio-demographic variations in emergency care might be present. However, gender-specific ED-data is scarce. MethodsWe retrieved retrospective data on all ED-visits, by 67years and older from 2008 to 2012, and calculated incidence of visits applying population registries. The relationship of age-categories, marital status, health and residence with outcomes were analyzed descriptively by Chi-square tests. Regression models were built to analyze gender-specific variations. ResultsOf the total ED-visits, 20% were from the elderly population (n=66,141), at a mean 3.1 visits per individual. Men (n=30.269) had higher incidence of visits in all age-categories. They were mostly married (69%) and women widowed (43%), although the incidence of partnered visitors underrepresented population-data while widowed and single living overrepresented. Women had more often co-morbidities, their most common causes of visits were musculoskeletal (20%) and men circulatory causes (14%). Men were more likely to be admitted (OR: 1.23; 95% CI 1.16–1.30) and had more unplanned ED-revisits (HR: 1.20; 95% CI 1.06–1.35) within 30 days. DiscussionElderly men visiting the ED were more often married than women. Gender differences were found in causes of visits and outcomes. In clinical practice, gender may be considered when identifying risk and planning adequate care related elderly ED-visits.

Occupational and leisure-time physical activity and risk of disability pension: prospective data from the HUNT Study, Norway

ObjectivesTo prospectively investigate the association between occupational physical activity (OPA) and disability pension due to musculoskeletal cause, mental cause or any cause. We also examined the combined association of OPA...

Occupational And Leisure-time Physical Activity And Risk Of Disability Pension

Objectives To prospectively investigate the association between occupational physical activity (OPA) and disability pension due to musculoskeletal cause, mental cause or any cause. We also examined the combined association of OPA and leisure-time physical activity (LTPA) with disability pension. Methods A population-based cohort study in Norway on 32 362 persons aged 20–65 years with questionnaire data on OPA and LTPA that were followed up for incident disability pension through the National Insurance Database. We used Cox regression to estimate adjusted HRs with 95% CIs. Results During a follow-up of 9.3 years, 3837 (12%) received disability pension. Compared with people with mostly sedentary work, those who performed much walking, much walking and lifting, and heavy physical work had HRs of 1.26 (95% CI 1.16 to 1.38), 1.44 (95% CI 1.32 to 1.58) and 1.48 (95% CI 1.33 to 1.70), respectively. These associations were stronger for disability pension due to musculoskeletal disorders, whereas there was no clear association between OPA and risk of disability pension due to mental disorders. People with high OPA and low LTPA had a HR of 1.77 (95% CI 1.58 to 1.98) for overall disability pension and HR of 2.56 (95% CI 2.10 to 3.11) for disability pension due to musculoskeletal disorders, versus low OPA and high LTPA. Conclusions We observed a positive association between OPA and risk of disability pension due to all causes and musculoskeletal disorders, but not for mental disorders. Physical activity during leisure time reduced some, but not all of the unfavourable effect of physically demanding work on risk of disability pension.

Significance of sequential cardiac rehabilitation program through inter-hospital cooperation between acute care and rehabilitation hospitals in elderly patients after cardiac surgery in Japan.

This study is to evaluate the impact of cooperation between acute care hospital and rehabilitation hospital on physical function, exercise tolerance, activities of daily living (ADL), health-related quality of life (HR-QOL), and psychological function in heart disease patients undergoing cardiac rehabilitation. Among patients undergoing concurrent medical treatment and cardiac rehabilitation starting early in acute care hospitalization, we selected 30 patients who required continued cardiac rehabilitation in rehabilitation hospitals as subjects. At the time of admission and discharge from the rehabilitation hospital, we measured and compared physical function [grip strength, knee extension strength, and the short physical performance battery (SPPB)], ADL ability using the Functional Independence Measure (FIM), exercise tolerance [six-minute walking distance (6MD)], and psychological functions such as the MOS 36-Item Short-Form Health Survey (SF-36). The average age of the subjects was 76.8years and 60% were women. In 70% of cases, musculoskeletal causes were the reasons for continued cardiac rehabilitation in a rehabilitation hospital. In evaluations before and after hospitalization, significant improvements were observed in knee extension strength and the results of the SPPB (p<0.01), FIM, and 6MD (p<0.01). In SF-36, significant improvements were observed in physical function, role functioning, vitality, and emotional functioning (p<0.05, p<0.01). With intensive cardiac rehabilitation in rehabilitation hospitals, physical function, ADL, exercise tolerance, and HR-QOL improved significantly. As the severity and prevalence of heart disease are expected to increase in association with multiple disabilities and aging, the importance of cooperation between acute care hospitals and rehabilitation hospitals will increase; therefore, cardiac rehabilitation should be the basis for such cooperation.

Ultrasound Diagnosis of Calf Injuries.

Context:The medial head of the gastrocnemius is the third most commonly strained muscle in elite athletes after the biceps femoris and rectus femoris. The differential diagnosis of posterior calf injury includes musculoskeletal and nonmusculoskeletal causes. Classically, delineation of these injuries from one another relied primarily on historical features and physical examination findings. The utilization of musculoskeletal ultrasound (sonography) has augmented the diagnosis of these injuries by providing dynamic, real-time confirmation.Evidence Acquisition:A review of PubMed, OVID, and MD Consult prior to January 2016 was performed using search terms, including soleus ultrasound, gastrocnemius ultrasound, and tennis leg. The references of the pertinent articles were further reviewed for other relevant sources.Study Design:Clinical review.Level of Evidence:Level 4.Results:There have been few reviews to date of calf injuries and the use of sonography in their diagnosis. Prompt diagnosis utilizing ultrasound allows the clinician to focus management on gastrocnemius injury if present. Two-thirds of calf injuries occur at the junction of the fascia between the medial head of the gastrocnemius and the soleus. Injuries to the lateral head of the gastrocnemius occur in up to 14% of patients in some case series, but injury may occur anywhere from the proximal origin to the mid-belly to the fascial junction with the soleus. Numerous injuries to the posterior compartment can mimic gastrocnemius strain, and musculoskeletal ultrasound can aide in their diagnosis by incorporating real-time imaging into the grading of the injury and visual confirmation of physical examination findings.Conclusion:Acute injury to the posterior compartment of the lower extremity can represent a diagnostic challenge. Medial gastrocnemius strain represents the most common injury of the posterior compartment of the lower extremity. Ultrasound is a useful tool to assist the clinician in determining the specific cause of calf injury, estimate the severity of the injury, and monitor progress of healing. The vast majority of calf injuries can be diagnosed and managed without any additional imaging. Serial diagnostic ultrasound of an injured area allows for direct monitoring of tissue healing and may allow the clinician to more confidently assess response to treatment and help guide return-to-play decisions.

Vitamin D Deficiency as a Cause of Flank Pain

Introduction: Loin pain is a relatively common complaint seen in a variety of clinical settings. Many of these cases seek medical advice of urologists and nephrologists based on the impression that this pain originates from the urinary tract. In spite of the importance of diseases of the urinary tract as causes of loin pain, many of the patients presenting with this complaint are devoid of any urinary abnormalities. Methods: Differential diagnosis includes musculoskeletal, respiratory, gastrointestinal, neurologic and cutaneous causes. In this work, we present a series of 187 cases presenting to our center with loin pain that did not prove a renal cause. Results: During physical examination of these cases, tenderness over the lowermost ribs above the flank at the posterior and mid axillary lines was eminent. Within the laboratory and radiologic work-up performed to these cases, very low serum level of 25 (OH) vitamin D was a constant feature. Vitamin D replacement was associated with complete relief of the pain in most of these cases. Conclusion: The presence of tenderness over the costal margin rather than the renal angle proper should alert examining physician to the possibility of disease in the ribs. After exclusion of trauma as a cause of this pain and tenderness, estimation of vitamin D level is a mandate.

Musculoskeletal-related chest pain

Approximately 10-50% of chest pains are caused by musculoskeletal disorders. The association is twice as frequent in primary care as in emergency admissions. This article provides an overview of the most important musculoskeletal causes of chest pain and on the diagnostics and therapy. A selective search and analysis of the literature related to the topic of musculoskeletal causes of chest pain were carried out. Non-inflammatory diseases, such as costochondritis and fibromyalgia are frequent causes of chest pain. Inflammatory diseases, such as rheumatoid arthritis, spondyloarthritis and systemic lupus erythematosus are much less common but are more severe conditions and therefore have to be diagnosed and treated. The diagnostics and treatment often necessitate interdisciplinary approaches. Chest pain caused by musculoskeletal diseases always represents a diagnosis by exclusion of other severe diseases of the heart, lungs and stomach. Physiotherapeutic and physical treatment measures are particularly important, including manual therapy, transcutaneous electrical stimulation and stabilization exercises, especially for functional myofascial disorders.

The Impact of Chronic Pelvic Pain and Its Associated Symptoms on Women'S Quality of Life in a TERTiary Care Hospital in Brazil

Introduction Chronic pelvic pain (CPP) is a common manifestation of multiple diseases, and might be related to gynecological, musculoskeletal and gastrointestinal causes. CPP is often associated with reduced quality of life (QOL). Objective To investigate whether pain intensity correlates negatively with the QOL in Brazilian women with CPP. Methods We recruited women with CPP referred to our outpatient service from December 2014 to December 2015. QOL was assessed using the Short Form Health Survey (SF-36) while clinical and demographic data were obtained using a standardized form. Statistics included Spearman's rank coefficient test and chi-square test. Results The total SF-36 score correlated negatively with pain intensity as measured by visual analog scale (rho = -0.46). Significant correlations were seen in the role-physical (rho = -0.596), physical functioning (rho = -0.463), role-emotional (rho = -0.402) and bodily pain (rho = -0.471) domains, but not in the other SF-36 domains. There was a positive association between presence of acyclic chronic pain and history of being at emergency rooms for pain control (p = 0.026, chi-square test). Conclusions Pain intensity correlates negatively with QOL in Brazilian women with CPP, but different QOL domains are affected in a heterogeneous fashion. Further research is needed in order to determine the specific reasons behind such differences.

Role of Skeletal Scintigraphy in Evaluation of Low Backache in Treated Cases of Carcinoma Cervix

The presence of bone metastases indicates advanced disease in cervical cancer. Lumbar spine is the most common site affected followed by pelvis with rare involvement of distal extremities. Low back ache in these patients has wide spectrum of etiologies including benign conditions like musculoskeletal causes, inflammatory, Infectious and metastatic spread of disease. In this study, we evaluated the causes of low back ache in treated cases of carcinoma cervix based on different patterns of radio tracer uptake on 99m Tc Methylene diphosphonate (99m Tc MDP) bone scan.To evaluate the role of 99m Tc MDP bone scan in differential diagnosis of low back ache in treated cases of carcinoma cervix. 99m Tc MDP bone scans of treated carcinoma cervix patients presenting with low back ache were reviewed retrospectively from May 2012 to May 2016. A total of 120 patients were reviewed, 99m Tc MDP bone scan detected metastases in 69 (57.5%) patients, degenerative changes in 26 (21.6%) patients, insufficiency fractures in 13 (10.8%) patients, erosion from adjacent nodal mass in 4 (3.3%) patients. No abnormality was detected on bone scan in 8 patients (6.6%). Skeletal scintigraphy plays a vital role in the evaluation of low back ache in carcinoma cervix and changes management in significant proportion of patients. Pattern recognition especially in identifying insufficiency fractures and erosion of bone from adjacent nodal mass is an important aspect in the interpretation of skeletal scintigraphy.

Changes in Leisure-Time Physical Activity and Subsequent Sickness Absence Due to Any Cause, Musculoskeletal, and Mental Causes.

The association between changes in physical activity and sickness absence is poorly understood. The aim of this study was to examine the association between changes in leisure-time physical activity and long-term sickness absence due to any cause and musculoskeletal and mental causes. We measured physical activity at baseline in 2000-2002 (response rate 67%) and at follow-up in 2007 (response rate 83%) among middle-aged employees of the City of Helsinki, Finland. The survey data were linked to the Finnish Social Insurance Institute's register data on sickness benefit periods > 9 days, including diagnoses (ICD-10; International Statistical Classification of Diseases and Related Health Problems, 10th revision) (mean follow-up 2.3 years). We used a negative binomial model to calculate rate ratios. The analyses included 4010 respondents (81% women). Those who were persistently vigorously active and those whose physical activity level changed from low to moderate or vigorous, from moderate to vigorous, or from vigorous to moderate were at lower risk for sickness absence than were the persistently low-activity group. For sickness absence due to musculoskeletal causes, vigorous activity showed stronger associations, whereas mental causes showed no such associations. To reduce sickness absence due to both musculoskeletal and mental causes, middle-aged and aging employees should be encouraged to engage in physical activity.

What's new in osteoarthritis pathogenesis?

Osteoarthritis is the leading musculoskeletal cause of disability in the Western society. Despite this, it is still difficult to gain a precise definition of what osteoarthritis actually is. The methods used for the study are narrative review and viewpoint focussing on the knee. It is well known that there is a modest correlation between X-ray changes and pain. Improvements in imaging have shown that osteoarthritis should be regarded as an umbrella term for a number of pathophysiological processes leading to pain and/or cartilage loss. If these are inside the joint (such as bone marrow lesions, cartilage defects or meniscal tear) then they can be considered osteoarthritis, while those outside the joint (such as obesity, weak muscles and vitamin D deficiency) could be considered the osteoarthritis syndrome. These improvements in basic science are leading to lesion-specific therapies indicating the importance of trying to pinpoint causes of pain in the individual.