Musculoskeletal Structures Research Articles

The Effect of Cartilage Thickness on Reconstructions of Range of Motion and Muscle Leverage in Extinct Tetrapods

Investigating structure‐function relationships in the locomotor system requires an understanding of the complex interactions between bones, cartilage and muscles. This is especially true when examining how these musculoskeletal structures evolved over time and across different environments in both extant and extinct species. We aimed to quantify the effect of different assumptions about cartilage thickness on reconstructions of femur length, hip range of motion (ROM), and muscle leverage in Acanthostega gunnari, one of the earliest known tetrapods and an important species in the vertebrate water‐land transition. We began by examining the hindlimbs of two extant salamanders, Dicamptodon ensatus and Ambystoma mexicanum, using contrast‐enhanced micro‐CT in order to extrapolate the degree to which cartilage thickness might affect femur length in a fossil taxon with salamander‐like morphology. Data visualization software was used to measure the distal and proximal cartilage caps of the femora in each of the extant species. Three‐dimensional modeling software was then used to estimate the center of rotation of the hip joint of Acanthostega. Then, cartilage correction factors were applied based on the measurements from the extant taxa. The limit of ROM was defined as the point at which either the femur contacted the pelvis, or less than 50% of the femoral head remained within the acetabulum. Finally, we used biomechanical modeling software to map muscles onto the bones of Acanthostega and plotted their leverage to examine how assumptions about cartilage affect reconstructions of muscle leverage. Cartilage caps on the proximal end of the femur in Dicamptodon and Ambystoma measured 36% and 14% of femur length, respectively. Taking the most conservative estimate, we modeled Acanthostega with cartilage caps of 0, 7.5 and 13% femur length. The greatest variation in muscle leverage occurred in muscles whose axes of movement were nearly perpendicular to the femur (70–120% of the mean moment arm), as opposed to those muscles whose axes were nearly parallel (less than 10%). We also found that assuming the highest percentage of cartilage increased ROM in protraction and retraction by 15–20° and in elevation and depression by 15–30° but had little to no effect on long‐axis rotation. These results will help to predict the effects of unpreserved soft tissues in future studies that reconstruct ROM and muscle leverage in extinct animals.Effect of different cartilage correction factors on reconstructed hip muscle leverage in the early tetrapod Acanthostega gunnari.The y‐axis shows coefficient of variation of muscle leverage (standard deviation/mean moment arms) across cartilage correction factors of 0, 7.5 and 13% femur length. Moment arms were measured in 3 axes of movement for muscles that cross the hip joint. The greatest effects occurred in muscles with lines of action nearly perpendicular to the femur.Figure 1

Cross-Sectional Survey of Musculoskeletal Disorders in Workers Practicing Traditional Methods of Underground Coal Mining.

Background: In subcontinental underground mines, coal mining is carried out manually and requires many laborers to practice traditional means of coal excavation. Each task of this occupation disturbs workers’ musculoskeletal order. In order to propose and practice possible ergonomic interventions, it is necessary to know what tasks (drilling and blasting, coal cutting, dumping, transporting, timbering and supporting, loading and unloading) cause disorder in either upper limbs, lower limbs, or both. Methods: To this end, R-programming, version R 3.1.2 and SPSS, software 20, were used to calculate data obtained by studying 260 workers (working at different tasks of coal mining) from 20 mines of four districts of Punjab, Pakistan. In addition, a Standard Nordic Musculoskeletal Questionnaire (SNMQ) and Rapid Upper Limb Assessment (RULA) sheet were used to collect data and to analyze postures respectively. Results: In multi regression models, significance of the five tasks for upper and lower limb disorder is 0.00, which means that task based prevalence of upper and lower limb disorders are common in underground coal mines. The results of the multiple bar chart showed that 96 coal cutters got upper limb disorders and 82 got lower limb disorders. The task of timbering and supporting was shown to be dangerous for the lower limbs and relatively less dangerous for the upper limbs, with 25 workers reporting pain in their lower limbs, and 19 workers reporting pain in their upper limbs. Documented on the RULA sheet, all tasks got the maximum possible score (7), meaning that each of these tasks pose a threat to the posture of 100% of workers. The majority of participants (182) fell in the age group of 26 to 35 years. Of those workers, 131 reported pain in the lower limbs and slight discomfort (128) in the upper limbs. The significance value of age was 0.00 for upper limb disorder and was 0.012 for lower limb disorder. Frequency graphs show age in direct proportion to severity of pain while in inverse proportion with number of repetitions performed per min. Conclusions: All findings infer that each task of underground coal mining inflicts different levels of disorder in a workers’ musculoskeletal structure of the upper and lower limbs. It highlighted the need for urgent intervention in postural aspects of each task.

Geometric conditions of a two-link-and-six muscle structure based on internal force stability

In a musculoskeletal system, internal tensile forces are generated among the muscles because it is a redundant system. The balancing of the internal tensile forces for a given posture generates a potential field in the system. Therefore, the potential field is utilized for the sensorless feedforward position control and improvement of stability based on the feedback method. However, the stability of the internal tensile forces is strongly influenced by the muscular arrangement. Previous studies showed that a stable condition can be identified through the minimization of the potential at a desired posture, and the sufficient condition has been theoretically established; however, the geometric condition of the muscular arrangement has not been determined. To effectively exploit the characteristics of the internal tensile forces, the geometric condition must be elucidated in the design of a musculoskeletal system. This paper aims to clarify the geometric condition to generate stable internal tensile forces. Based on the conditions generating the potential that is minimum at the desired posture, the paper analyzes that the geometric condition on a musculoskeletal structure with two-link and six-muscle. Additionally, the identified condition is assessed based on simulations. As a result, we revealed the geometric condition of the muscular arrangement to generate stable internal tensile forces. By designing the muscular arrangement to satisfy the condition, the stability of the internal tensile forces is ensured, and consequently, a control method utilizing the characteristics of the internal tensile force is stably implemented.

Intra-rater reliability and smallest detectable change of compression sonoelastography in quantifying the material properties of the musculoskeletal system.

Musculoskeletal conditions can change tissue elasticity. Knowledge of musculoskeletal elasticity could therefore aid clinical diagnosis and management. Sonoelastography is an ultrasound-based system that examines the material properties of tissues, and it may be useful in musculoskeletal practice. Therefore, it is important to establish its clinimetric properties. This study aimed to explore the intra-rater reliability and the smallest detectable changes of sonoelastography in examining musculoskeletal structures. A quantitative reliability design was used to examine 22 healthy participants using a compression sonoelastography system that produces color-coded images. The deltoid, biceps brachii, brachioradialis, rectus femoris, gastrocnemius medius muscles, and Achilles tendon were examined twice at 1-hr intervals to assess the intra-rater reliability. The sonoelastography images were analyzed using the strain index, strain ratio, and color pixels. The intra-rater reliability and the smallest detectable changes of each outcome variable were determined. The intra-class correlation coefficient was used to quantify the repeatability of the measurements, and the smallest detectable changes were calculated to determine clinically important differences above the error of measurement. The intra-rater reliability for the strain index, strain ratio, and color pixel analysis ranged from moderate to excellent (intra-class correlation coefficients: .734-.950, .776-.921, and .754-.990, respectively), with color pixel analysis demonstrating the highest reliability. The smallest detectable changes were determined for all structures, including the Achilles tendon (0.11 for the higher boundary of the strain index, 1.80 for the strain ratio, and 2.90% for red pixels, representing soft tissues). Color pixel analysis may be more reliable for sonoelastography interpretation compared with the strain index and strain ratio. The calculated smallest detectable changes could be used to identify clinically important differences.

Identifying and Monitoring Deficiencies in Physical Examination of the Foot and Ankle With Diagnostic Ultrasound: Experience From a Physical Medicine and Rehabilitation Residency Training Program.

Despite the high incidence of foot and ankle injuries and their biomechanical importance to more proximal joints, the foot and ankle are some of the most daunting and underemphasized musculoskeletal structures in medical training. This study used musculoskeletal ultrasound to identify a knowledge gap in physical medicine and rehabilitation residents in foot and ankle surface anatomy palpation and to determine whether senior residents had higher examination performance compared with more junior residents. Physical medicine and rehabilitation residents at different levels of training were tested cross-sectionally, and palpation accuracy was compared by class year. There was a trend of improvement across class years, with significant class differences in accuracy for the talonavicular joint, calcaneocuboidal joint, and posterior tibialis and peroneal tendons (P < 0.05). Despite this trend, the accuracy was not consistently higher among the senior residents considering the training they received. For all 30 residents assessed, accuracy within 1 cm was highest for the tibiotalar joint (93.3%), peroneal tendons (83.3%), posterior tibialis tendon (63.3%), and talonavicular joint (50%). It was lower for the calcaneocuboidal joint (26.7%) and the second (13.3%) and fourth for the tarsometatarsal joints (20%). Anatomical knowledge and palpation skills of the foot and ankle, particularly at the midfoot and forefoot, may be an area of improvement for physical medicine and rehabilitation resident training.

Influência do sobrepeso sobre a Estrutura de Sustentação Osteomuscular

In this century, among the numerous chronic diseases, we highlight obesity and osteoporosis as a result of the growing and high prevalence which are now considered epidemic and two major public health problems. There is little multidisciplinary research related to musculoskeletal clinical symptoms in patients with overweight and simultaneously evaluating the state of the musculoskeletal support structure and bone composition. The New Biology Bone, from an early age enables to trace the two bone matrix (protein and inorganic) that make up the support structure of the entire musculoskeletal system. Nowadays you can trace comprehensively bone protein matrix and detect early changes resulting from the habits, drugs, idleness, hormone deficiencies, obesity, chronic diseases among others. The old understanding that obesity exerts protective action to fractures was commuted by research in molecular level, which found that adipocytes and osteoblasts share the same progenitor cell. Objective: To trace the two bone matrix and compare the pattern of bone support structure in healthy young adults and on overweight. Result: The comparison showed that both qualitative tools accused significant difference at p <0.001. Stratification of UBPI tool revealed bone quality was poor in 7.7% of the patients with overweight and none in the control group. Stratification Profile Biophysical Bone (PBO) detected in 43.1% of overweight with Inverse Profile and none in the control group. Regarding quantitative tool (T-score) we didn´t detect differences in its three stratifications. Conclusion: In patients with overweight an early analysis of two bone-qualitative tools (PBO and UBPI) provide important information about the musculoskeletal support structure and enables the clinical nutrition specialist to develop preventive actions in the short term.

Investigation into thoracic asymmetry in ridden horses

Progressive training of horses focusses on the muscular development and flexibility to both the right and the left. However anecdotal evidence suggests that horses are not symmetrically structured through the thoracic region and this may have effects on saddle fitting and performance. The aim of this research was to determine if asymmetry exists in the thoracic musculoskeletal structure of ridden horses by analysing retrospective data of saddle fits (n=490) obtained from a saddle fitting company. A flexible wither tracer tool was used to obtain tracings of wither shape. Each tracing yielded four repeatable points (two on the left; two on the right) measured from the midline at the highest and lowest points of the withers. Descriptive assessments of shoulder, wither, and back shape, and demographic information on both horse and rider were recorded. A Wilcoxon signed-rank test compared the means of the wither shape measurements. A GLIMMIX procedure identified relationships between the wither measurements, descriptive assessments, and horse and rider demographics. The means of measurements from the wither tracer tool showed almost 60% of horses having larger measurements on the left side (P&lt;0.0001). There was no effect of horse breed, age, sex, height or level of training on wither measurements (P&gt;0.05). Rider age, gender, height, weight and level of training did not affect wither measurements (P&gt;0.05). These results show that horses are asymmetric in their thoracic structure with a majority of horses larger on their left side than the right. This asymmetry may be due to genetics, environment or training and should be considered when fitting a saddle to the horse.

An evaluation of the effectiveness of teaching anatomy to rheumatologists through combined musculoskeletal sonoanatomy and human cadaveric dissection.

ObjectiveOur aim was to evaluate the effectiveness of teaching anatomy through combined musculoskeletal sonoanatomy and human cadaveric dissection for rheumatologists practising musculoskeletal US.MethodsThe principal focus was on scanning and then dissecting relevant musculoskeletal structures. Outcomes measured included confidence levels and objective knowledge. A mixed-methods approach of evaluation and descriptive statistical data analysis was performed.ResultsThe change in confidence ratings by delegates after the teaching event as represented by the mean difference (s.d.) (s.e.m.) for identification of surface anatomy was 1.846 (1.281) (0.355), with Student’s paired t = 5.196 and P=0.000223. The mean difference (s.d.) (s.e.m) for performing IA injections was 1.538 (1.266) (0.351), with Student’s paired t = 4.382, P=0.001, and for recognizing sonoanatomical structures it was 1.769 (1.235) (0.343), with Student’s paired t = 5.165 and P= 0.000235. There was a significant increase in correct identification of anatomical and sonoanatomical knowledge in the pre- and post-course assessments. Rotator cuff interval region improved from 13 to 73%, P = 0.004; knee tendons insertion sites from 47 to 93%, P = 0.016; and muscles not adjacent to joints from 27 to 93%, P = 0.002.ConclusionDissection of joints enabled a three-dimensional relational mind map of the relevant regions of the human body, producing clarity in understanding regional relational topographic anatomy and sonoanatomy. The combination of US and cadaveric dissection improved learners’ satisfaction, confidence and knowledge in areas where soft tissue complaints are common, which is likely to lead to accurate early diagnosis and cost-conscious, better overall care.

圧力信号をトリガとした筋骨格ロボットのペダリング

Bicycle is a tool in everyday life that allows you to travel farther and faster.It is important to consider a design that allows the human musculoskeletal structure to efficiently transmit the forces that can be generated to the bicycle.The purpose of this research is to constructively elucidate how humans generate force when pedaling by using a robot that imitates the human musculoskeletal structure. For the analysis, in this report, we developed a robot driven by pneumatic artificial muscle and realized a pedaling by using a pressure signal inside the artificial muscle as a trigger.As a result, pedaling was realized by using the pressure drop as a trigger.

Prevalência da lombalgia e sua repercussão anatomofuncional em adultos e idosos: Revisão sistemática

Common or non-specific mechanical low back pain is characterized by severe or moderate pain in the region between the last ribs and buttocks. We sought to identify in the literature the conditioning factors that favor the triggering of low back pain and its relationship with anatomical structures and functionality in adults and the elderly. It is a systematic review of the literature that allows the analysis of studies for application in clinical practice aiming to understand the theme from independent studies. In this perspective, he identified that in females there is a predominance in the age group over 40 years, while in males, the age range of incidence is from 31 years old. The recurrent characteristics of pain were repetitive labor movements, long periods of sitting, absence of exercises to activate and relax musculoskeletal structures, physical inactivity. The study showed that adults differ from the elderly in the etiological context of the causes of low back pain. In adults, the muscles are the main affected, followed by articular and bone structures, whereas in the elderly there is a predominance of bone and joint wear processes, with women being the most affected. A critical analysis finds that socioeconomic status determines the quality of treatment and prophylaxis, with drugs and physiotherapy being the most frequent approaches.

Audiología y Mareo de Origen Cervical

En esta revisión sistemática se discute el rol del especialista en audiología en el abordaje del mareo de origen cervical mediante la identificación de las diferentes hipótesis causales de esta condición reportadas en la literatura. Para la búsqueda de artículos en bases de datos se usaron palabras claves como mareo de origen cervical, vértigo cervicogénico, cervicogenic dizziness, dolor cervical, latigazo cervical, espondilosis cervical y audiología. Los resultados de la revisión sugieren que la afectación de las estructuras musculoesqueléticas del cuello puede derivar en sensaciones de mareo. No se encuentran estudios que reporten el rol específico que el especialista en audiología puede desempeñar en el abordaje del mareo cervical, pero algunos estudios sugieren que es pertinente realizar exploración del sistema vestibular para determinar si existe afectación vestibular y así contribuir en el proceso de diagnóstico por exclusión. Adicionalmente, otras investigaciones reportan que el uso de estrategias de rehabilitación vestibular mejora la propiocepción cervical del paciente con mareo cervicogénico. A partir de la revisión se infiere que es pertinente que el especialista en audiología aborde este tipo de mareo desde su fase diagnóstica y de intervención.

Male Genitalia Muscles in the Afrotropical Subfamily Lipteninae (Lepidoptera, Lycaenidae)

The muscles of the male genitalia were studied for the first time in representatives of 3 tribes of the Afrotropical endemic subfamily Lipteninae (Lycaenidae): Larinopoda tera (Hewitson, 1873) (Liptenini), Cephetola viridana (Joicey and Talbot, 1921) (Epitolini), Pentila tachyroides (Dewitz, 1879), P. tropicalis (Boisduval, 1847), P. umangiana Aurivillus, 1898, and Ornipholidotos amieti angulata Libert, 2005 (Pentilini). The essential differences in the genital muscles between the tribe Pentilini on the one hand and the tribes Lipteninini and Epitolini on the other are found. The tribes Liptenini and Epitolini are characterized by preservation of the characters initial for the large taxa of Papilionomorpha; the only apomorphic similarity between them, which arisen independently, is established. This apomorphy is the attachment of the only pair of aedeagus retractors m7(6) not to the zonal area of the aedeagus, as at the initial state for lepidopterans, but to its coecum penis. In the tribe Pentilini, along with the known modifications in the structure of the genital skeleton, the following apomorphic changes in muscles are established: reduction of 2 pairs of valvar muscles m5(7) and m8(3), a shift of the attachment of hypertrophied valvar adductors m4 onto a considerable part of the surface of the tegumen, and the splitting of aedeagus protractors m6(5) into 2 independent muscles. Autapomorphies of the musculoskeletal structures of Pentila Westwood, [1851] and Ornipholidotos Bethune-Baker, 1914 (Pentilini) are described. Synapomorphies in the structure of the genital muscles in the Lipteninae examined have not been found.

Pengaruh Penggunaan Medial Arch Support Terhadap Keseimbangan Dinamis Pada Kaki Pes Cavus Pada Orang Tua Lanjut Usia (LANSIA)

Background: According to The World Health Organization (WHO), in the Southeast Asia the Elderly population is 8% or around 142 million people. Feet function for shock absorber, Generally there are three types of foot structure, namely neutral or normal, flat foot, and cavus foot. The cavus foot will improve performance on the musculoskeletal structure to maintain postural stability and balance due to midfoothypomobile. As a result, cavus foot cannot distribute body weight evenly along the metatarsal heads and the lateral side of the foot, lowering the sensory plantar input and significantly the pressure on the foot is greater than the other foot postures. Method: The research design used was quasy experiment with cross sectional design. dynamic balance measurement with TUG test The study was conducted in April - July 2018 at the Posyandu at the elderly Klodran, Colomadu, Karanganyar. with a sample of 20 elderly. data collection using the wetfootprint pre test and post test with medial arch support. Results: the results of p value 0,000 &lt;0,05 so that there is a difference in the dynamic balance in the elderly before and after being given Medial arch support. can also see from the mean acquisition value of the elderly before using the medial arch support of 13.7 while after using the medial arch support the mean gain of 13.2.Conclusion: the results of a study of 20 elderly people showed that dynamic balance in the legs of pes cavus in the elderly (elderly). before using the medial arch support higher than the dynamic balance at the foot of pes cavus in the elderly (elderly)

Autonomous dysfunction and musculoskeletal therapeutic approach

자율 신경계는 다양한 외적 환경의 변화에 대하여 내적 환경을 일정하게 유지하는 항상성을 위하여 내장 기관의 기능을 통합 조절한다. 자율 신경계 조절의 원심 성분인 교감 신경과 부교감 신경은 내장 기관과 신체의 감각 기관으로부터 일반적인 구심성 감각 신경에 의하여 되먹이 기전으로 조절된다. 교감 신경은 일정한 체온을 조절 하기 위한 방법으로 혈액의 재분배 역할을 담당한다. 척추 주변에서 부과되는 많은 힘에 맞서는 척추안정성은 근골격계 통증뿐만 아니라, 척추 신경이 감각, 운동, 자율 신경으로 구성된 점을 고려한다면, 나아가서 신체화 증상에 해당하는 다양한 증상과 서로 연결된다. 오랫동안 근 골격계 스트레스, 급격한 육체적 일을 한 후의 피로, 두통, 소화 불량, 식은 땀, 몸살과 같은 신체 증상들은 이에 해당하는 척추 주변에서 나오는 자율 신경의 분절과 연결된 다. 척추 주변 근골격계의 척수 신경 압박과 견인이 자율 신경 부전의 원인이 될 수 있으며, 자율 신경 부전으로 발생하는 증상을 척추 주변 근골격계 접근으로 치료할수 있다.The autonomic nervous system integrates the functions of the internal organs for the homeostasis to keep the internal environment against various external environmental changes. The sympathetic and parasympathetic nerves are regulated by brain-feedback system of the general afferent sensory nerves from the internal organs and body sensory organs. The sympathetic nervous system plays a role in blood redistribution as a way to regulate constant body temperature. The spinal stability that confronts the many forces imposed on musculoskeletal system is linked to the various symptoms of psycho-somatization, taking into account not only musculoskeletal pain but also the sensory, motor and autonomic nerves of the spinal nerves. Physical symptoms such as long-term musculoskeletal stress, fatigue, headache, dyspepsia, cold sweats, and body aches after acute physical work are associated with the autonomic nervous segments coming from the corresponding spinal segments. Sympathetic nerve compression and traction around the vertebral foramen by the musculoskeletal structure can be the cause of autonomic nerve dysfunction, and the symptoms caused by autonomic dysfunction can be improved by a musculoskeletal approach.

An aberrant bald eagle (Haliaeetus leucocephalus) with multiple anatomical abnormalities

Genetic abnormalities, especially polydactyly, are quite common among birds. Although there are numerous accounts of anatomically abnormal birds with polydactyly, few written anatomical descriptions have elucidated whether or not these physical aberrations extend to the musculoskeletal structure of the feet. Here, we present the findings of a dissection of a 14-week old female bald eagle that exhibited polydactyly and numerous other aberrations and discuss the functional impact these aberrations would cause. The specimen displayed a myriad of feather anomalies including missing feathers (i.e., had never grown in), ingrown feathers, stress bars, and most strikingly, bifurcated feathers wherein two feathers were seen to grow out of one rachis. Further, an extra, anomalous tendon was observed stemming from the tendinous origin of the m. extensor carpi radialis. The carpometacarpi were unable to reach full extension, stopping at less than 140º, and had phalanges bent downward at 45º. This mobility is limited in comparison to that of a normal bird. Most notably, the specimen exhibited polydactyly with one extra hallux on each foot. Several tendons of the left foot were seen to have aberrant connections as well.

Automated postoperative muscle assessment of hip arthroplasty patients using multimodal imaging joint segmentation

Background and objectiveIn patients treated with hip arthroplasty, the muscular condition and presence of inflammatory reactions are assessed using magnetic resonance imaging (MRI). As MRI lacks contrast for bony structures, computed tomography (CT) is preferred for clinical evaluation of bone tissue and orthopaedic surgical planning. Combining the complementary information of MRI and CT could improve current clinical practice for diagnosis, monitoring and treatment planning. In particular, the different contrast of these modalities could help better quantify the presence of fatty infiltration to characterise muscular condition and assess implant failure. In this work, we combine CT and MRI for joint bone and muscle segmentation and we propose a novel Intramuscular Fat Fraction estimation method for the quantification of muscle atrophy. MethodsOur multimodal framework is able to segment healthy and pathological musculoskeletal structures as well as implants, and develops into three steps. First, input images are pre-processed to improve the low quality of clinically acquired images and to reduce the noise associated with metal artefact. Subsequently, CT and MRI are non-linearly aligned using a novel approach which imposes rigidity constraints on bony structures to ensure realistic deformation. Finally, taking advantage of a multimodal atlas we created for this task, a multi-atlas based segmentation delineates pelvic bones, abductor muscles and implants on both modalities jointly. From the obtained segmentation, a multimodal estimation of the Intramuscular Fat Fraction can be automatically derived. ResultsEvaluation of the segmentation in a leave-one-out cross-validation study on 22 hip sides resulted in an average Dice score of 0.90 for skeletal and 0.84 for muscular structures. Our multimodal Intramuscular Fat Fraction was benchmarked on 27 different cases against a standard radiological score, showing stronger association than a single modality approach in a one-way ANOVA F-test analysis. ConclusionsThe proposed framework represents a promising tool to support image analysis in hip arthroplasty, being robust to the presence of implants and associated image artefacts. By allowing for the automated extraction of a muscle atrophy imaging biomarker, it could quantitatively inform the decision-making process about patient’s management.

The Adipokine Network in Rheumatic Joint Diseases.

Rheumatic diseases encompass a diverse group of chronic disorders that commonly affect musculoskeletal structures. Osteoarthritis (OA) and rheumatoid arthritis (RA) are the two most common, leading to considerable functional limitations and irreversible disability when patients are unsuccessfully treated. Although the specific causes of many rheumatic conditions remain unknown, it is generally accepted that immune mechanisms and/or uncontrolled inflammatory responses are involved in their etiology and symptomatology. In this regard, the bidirectional communication between neuroendocrine and immune system has been demonstrated to provide a homeostatic network that is involved in several pathological conditions. Adipokines represent a wide variety of bioactive, immune and inflammatory mediators mainly released by adipocytes that act as signal molecules in the neuroendocrine-immune interactions. Adipokines can also be synthesized by synoviocytes, osteoclasts, osteoblasts, chondrocytes and inflammatory cells in the joint microenvironment, showing potent modulatory properties on different effector cells in OA and RA pathogenesis. Effects of adiponectin, leptin, resistin and visfatin on local and systemic inflammation are broadly described. However, more recently, other adipokines, such as progranulin, chemerin, lipocalin-2, vaspin, omentin-1 and nesfatin, have been recognized to display immunomodulatory actions in rheumatic diseases. This review highlights the latest relevant findings on the role of the adipokine network in the pathophysiology of OA and RA.

Disregard for traffic rules lead to hemi-facial degloving injury with rupture of eye ball

Degloving injuries are a result of rotational forces that stretch the skin and subcutaneous tissue causing their avulsion from the deeper, less mobile musculoskeletal structures. In this case report, we present the case of a 53 year old male pedestrian who sustained a grievous hemi-facial injury with expulsion of eyeball just because of improper implementation and non- following of traffic rules. Most Hemi-facial degloving injuries are reported with intact vision and eyeball. An extensive hemi-facial degloving avulsion injury with rupture of the eyeball encountered by us is extremely rare. To the best of our knowledge, this is the first such reported case in literature. This nature of grievous injury could have been avoided with proper lighting and following of traffic rules. Keywords: Hemi-facial, Degloving, Rupture, Eyeball, Traffic rules.

Widespread Pressure Pain Sensitivity over Nerve Trunk Areas in Women with Frequent Episodic Tension-Type Headache as a Sign of Central Sensitization.

Previous studies reported the presence of widespread pressure pain sensitivity in patients with tension-type headache. However, most of the studies assessed pressure pain sensitivity over muscle tissue. Our aim was to investigate the difference in pressure pain sensitivity over musculoskeletal and nerve symptomatic and distant areas between women with frequent episodic tension-type headache (FETTH) and healthy subjects. Thirty-two women with FETTH and 32 matched healthy women participated. Pressure pain threshold (PPT) was bilaterally assessed over several nerve trunks (greater occipital, median, radial, ulnar, common peroneal, tibialis posterior) and musculoskeletal structures (temporalis muscle, C5/C6 joint, tibialis anterior) by an assessor blinded to the subject's condition. A four-week headache diary was used to collect the intensity, frequency, and duration of headache. The Hospital Anxiety and Depression Scale was used to determine anxiety and depressive levels. Analysis of covariance found lower widespread and bilateral PPTs over all nerve trunks and musculoskeletal structures in women with FETTH pain (P < 0.001). No significant effect of anxiety and depressive levels on PPTs was found (all P > 0.222). PPT over the temporalis muscle was significantly negatively correlated with headache intensity. This study found widespread pressure pain hypersensitivity over both nerve trunks and musculoskeletal structures in women with FETTH, suggesting that the presence of central altered nociceptive processing is not just restricted to musculoskeletal areas, for example, muscles, but also pain evoked from directly provoking the nerve trunks by pressure. It is also possible that nerve tissue treatment could lead to a decrease in central sensitization and headache features.

Epidemiology of musculoskeletal injuries in tennis players: risk factors.

Tennis practice involves repetitive stresses through several strokes and movements during several hours. These factors can lead to injuries on musculoskeletal structures. This study aims to determine injury epidemiology in tennis players, as well as their type, location, mechanism of injury and risk factors. The sample was constituted by 218 tennis athletes, aged 9 to 72, being 156 (71.6%) male. The measurement instrument was a questionnaire concerning characterization of the population, and aspects related to the modality and injuries. 86 athletes (39.4%) referred having an injury in a 12-month period, totalizing 107 injuries, and 76 athletes (34.9%) in a 6-month period, totalizing 95 injuries. There were 3.49 injuries per 1000 hours of tennis training. The most common injuries were joint injuries (29.5%), following by tendinopathy (22.1%), located in the ankle (20%) and wrist (15.8%), both occurred by service (23.2%). Tennis athletes who trained three times or more per week had 2.29 higher probability of injury (95% CI: 1.28-4.13; P=0.006), those who trained more than 4.5 hours per week had 2.04 more chances (95% CI: 1.16-3.60; P=0.013), those who were elite tennis players had 2.81 more chances (95% CI: 1.41-5.59; P=0.003), and those who trained on a clay court more frequently, had 4.11-fold higher probability of injury (95% CI: 1.46-11.55; P=0.007). In the analyzed sample, data revealed a high prevalence of injuries in tennis athletes, being joint injuries the most common type of injuries, and the most affected body area were the ankle and the wrist.