Musculoskeletal Structures Research Articles

Effectiveness of motor control exercises versus other musculoskeletal therapies in patients with pelvic girdle pain of sacroiliac joint origin: A systematic review with meta-analysis of randomized controlled trials.

Pelvic girdle pain represents a group of musculoskeletal pain disorders associated with the sacroiliac joint and/or the surrounding musculoskeletal and ligamentous structures. Its physical management is still a serious challenge as it has been considered the primary cause of low back pain. This review sought to determine the effectiveness of motor control exercises for two clinically relevant measures; i.e., pain and disability, on patients with pelvic girdle pain of sacroiliac joint origin. This review covered only randomized controlled studies. Online databases, such as PubMed, Embase, Scopus, and Cochrane Library, were searched from January 1, 1990, to December 31, 2019. PEDro scale was used to assess the methodological quality of included studies, while Review Manager was employed to synthesize data in view of meta-analysis. The PRISMA guidelines were applied for this review. Twelve randomized controlled trials of moderate-to-high quality were included in this review. The studies involved 1407 patients with a mean age ranging from 25.5 to 42.1 years as well as intervention and follow-up durations from 1week to 2years. Motor control exercises alone for pelvic girdle pain of sacroiliac joint origin were not effective in terms of pain reduction (SMD = 0.29 [-0.64,1.22]) compared to control interventions whereas they were slightly effective in terms of disability reduction (SMD =-0.07 [-0.67, 0.53]) at short-term. The combination of motor control exercises with other musculoskeletal therapies, however, revealed to be more effective than control interventions in terms of pain reduction (SMD =-1.78 [-2.49, -1.07]; 95%CI) and lessened disability (SMD =-1.80 [-3.03, -0.56]; 95%CI) at short-term. Motor control exercises alone were not found to be effective in reducing pain at short-term. However, their combination with other musculoskeletal therapies revealed a significant and clinically-relevant decrease in pain and disability at short-term, especially in peripartum period.

Homoeopathic medicine Gettysburg water in osteoarthritis: A case series

Introduction: Rheumatism alludes to various painful medical conditions which influence joints, bones, ligaments, tendons and muscles. It is also called musculoskeletal disease which is portrayed by pain and a gradual diminishing in the range of motion and function, in one or more areas of the musculoskeletal structure. In a few specific diseases, there are indications of inflammation, swelling, redness and warmth in the influenced zones like in osteoarthritis (OA), rheumatoid arthritis, etc. Cases Summary: Four cases of Osteoarthritis were treated with Gettysburg water (Get.) as a potentised homoeopathic medicine. Each case was followed up with clinical observation and reported according to the criteria of the HOM-CASE guidelines. Assessment of homoeopathic treatment and its effect was carried out using the visual analogue scale (VAS) during every visit. Improvement in all cases was evident from the reduction of pain in the affected joints and relief in other associated symptoms within 2–6 months of treatment. VAS scores for the cases ranged from 8 to 4 in all cases. Complaints associated with chronic OA were relieved by potentised Get. This case series has shown promising outcomes and a further high-quality clinical trial is needed for the establishment of effectiveness data for the said medicine.

Repeated botulinum treatment of rabbit masseter causes cumulative tissue damage

ObjectiveBotulinum neurotoxins (BoNT) are used in masticatory muscles for pain relief, unloading of the mandible, and cosmetic facial contouring. Treatment is often repeated every few months as function returns. This study assessed masticatory function and musculoskeletal structure after multiple BoNT treatment of the rabbit masseter. DesignFemale rabbits received 3 injections of BoNT (n = 13) or saline (n = 5) into one masseter muscle at intervals of 12 weeks. The contralateral side served as control. Periodic measurements of masticatory electromyography (EMG) and stimulated anterior bite force were made. After the final 12-week recovery interval, neuromuscular connection was investigated by stimulating the masseteric nerve to elicit an evoked EMG response. Mandibular specimens were collected for microCT analysis, and masseters were collected for histomorphometry and counts of replicating cells. ResultsControl and saline-injected muscles maintained consistent masticatory EMG and anterior bite force throughout the study. BoNT-injected masseters showed strong declines after each injection; during the 12-week recovery period, masticatory EMG and anterior bite force improved, although only electrical activity reached normal levels. Multiple injection resulted in persistently atrophied muscle fibers with fibrosis, and notable loss of bone from the mandibular body and condyle. The uninjected masseters of the BoNT group also showed evidence of mild toxin-related changes. ConclusionsAlthough muscle function is mostly regained after each injection, masseters receiving multiple doses of BoNT show extensive damage. In addition, mandibular bone density is decreased on the injected side.

Effectiveness of Ultrasound Imaging in Assessing the Palpation Skills of Rotating Physicians.

As an important means of physical examination, palpation is usually limited to the physical examination before surgery and used as an auxiliary method for disease diagnosis in the field of surgery. In practice, palpation is also used in every aspect of the surgical procedure, and its application is of great significance to surgery. The purpose of this study was to investigate the ability of ultrasound imaging to assess the ability of rotating physicians to locate musculoskeletal structures by palpation. Rotating physicians were asked to palpate and locate the long head tendon of the biceps (LHB), posterior tibialis (TPT), acromioclavicular joint (ACJ), and medial tibiofemoral joint (TFJ) spaces on two volunteer models. After positioning, a truncated steel needle was attached to the skin and parallel to the palpable structure, and the position of the steel needle relative to the designated structure was assessed by ultrasound imaging, using the Cohen kappa test to study the inter-rater agreement. The results showed that the assessor’s Kappa coefficient for judging the location of all structures was 0.816, LHB was 1.00, TPT was 0.912, ACJ gap was 0.796, and TFJ medial space was 0.844, and the success rate of palpation for TPT was 62.2%, TFJ medial space was 37.8%, ACJ clearance was 24.3%, and LHB was 8.1%. In conclusion, the teaching methods of anatomy and palpation skills need further improvement, and ultrasound imaging is an effective tool for assessing palpation skills.

Functional foot correction is the basis of any therapy

The main element that supports lymph and blood circulation in the body - the processes of cell metabolism, are musculoskeletal structures. This is indicated by human physiology, but this is not taken into account in the treatment - rehabilitation of the body. The skeleton must be considered not only as a system of levers and muscles that form our posture, but also as a set of movements that are laid down by nature to support the functioning of lymphatic and venous-muscle pumps. The paired muscles hold the bones of the skeleton in the so-called neutral stable position. This achieves the relative stability of the body, in which the General Center of Gravity (GCG) of the body constantly makes oscillations in the X-Y planes within 2-4 cm from its neutral position. So in a state of rest, cell nutrition is continuously maintained, and their decay products are excreted. Without muscle contraction, the respiratory, digestive, and thermoregulation systems would not work.

Shoulder-sideWINDER (Shoulder-side Wearable INDustrial Ergonomic Robot): Design and Evaluation of Shoulder Wearable Robot With Mechanisms to Compensate for Joint Misalignment

Shoulder-sideWINDER is an exoskeleton to assist the shoulder movement of workers performing manual tasks. It aims to minimize discomfort caused by a joint misalignment between the shoulder and an exoskeleton, which is a common problem with many closely coupled systems. Based on the shoulder’s musculoskeletal structure, we propose two novel misalignment correction mechanisms: center-of-rotation tracking mechanism and force-guiding mechanism. The center-of-rotation tracking mechanism compensates for the vertical misalignment that arises from the scapulohumeral rhythm. The force-guiding mechanism compensates for the horizontal misalignment due to changes in the plane of the arm elevation. The kinematic performance of reducing joint misalignment was evaluated using the angle ratio as the indicator under two conditions: with and without the center-of-rotation tracking mechanism. The muscle load caused by the kinematic disturbance was evaluated under three conditions: wearing the exoskeleton with and without the center-of-rotation tracking mechanism and not wearing the exoskeleton. The analysis used muscle load data measured by surface electromyography on five shoulder muscles. Five subjects executed 12 arm motions each, in 4 planes of elevation. Since the system was optimized for a pilot user, subjects with similar morphology presented positive results showing that the proposed mechanism reduced the misalignment in the dominant range of working motion. Apart from the anterior deltoid, the loads on muscles responsible for the dominant range of working motion also showed a significant reduction compared to the case without the mechanism. In conclusion, we verified that the Shoulder-sideWINDER provides comfortable support by reducing joint misalignment, and identified directions for design improvements that will further enhance usability.

Adaptations for bipedal walking: Musculoskeletal structure and three-dimensional joint mechanics of humans and bipedal chimpanzees (Pan troglodytes)

Humans are unique among apes and other primates in the musculoskeletal design of their lower back, pelvis, and lower limbs. Here, we describe the three-dimensional ground reaction forces and lower/hindlimb joint mechanics of human and bipedal chimpanzees walking over a full stride and test whether: 1) the estimated limb joint work and power during the stance phase, especially the single-support period, is lower in humans than bipedal chimpanzees, 2) the limb joint work and power required for limb swing is lower in humans than in bipedal chimpanzees, and 3) the estimated total mechanical power during walking, accounting for the storage of passive elastic strain energy in humans, is lower in humans than in bipedal chimpanzees. Humans and bipedal chimpanzees were compared at matched dimensionless and dimensional velocities. Our results indicate that humans walk with significantly less work and power output in the first double-support period and the single-support period of stance, but markedly exceed chimpanzees in the second double-support period (i.e., push-off). Humans generate less work and power in limb swing, although the species difference in limb swing power was not statistically significant. We estimated that total mechanical positive ‘muscle fiber’ work and power were 46.9% and 35.8% lower, respectively, in humans than in bipedal chimpanzees at matched dimensionless speeds. This is due in part to mechanisms for the storage and release of elastic energy at the ankle and hip in humans. Furthermore, these results indicate distinct ‘heel strike’ and ‘lateral balance’ mechanics in humans and bipedal chimpanzees and suggest a greater dissipation of mechanical energy through soft tissue deformations in humans. Together, our results document important differences between human and bipedal chimpanzee walking mechanics over a full stride, permitting a more comprehensive understanding of the mechanics and energetics of chimpanzee bipedalism and the evolution of hominin walking.

Follow Your Nose: Ontogeny of the Olfactory Duct in Primates

Most primates are characterized by orbital convergence, the displacement of the orbits toward the rostral midline. In platyrrhine primates and tarsiers, this convergence is so extreme that orbits meet in the midline at the apical interorbital septum. This produces a spatial separation of the anterior cranial fossa and the nasal cavity. The olfactory bulbs of the brain pass dorsal and then rostral to the orbits to reach the nasal cavity via a bony tube, the olfactory duct. Nerves are expected to constrain growth of musculoskeletal structures. We hypothesized that the network of olfactory nerves effectively tethers the olfactory bulbs to the mucosa of the nasal cavity, and the growth of facial structures in these primates results in rostral displacement of the olfactory bulbs through ontogeny. In addition, growth of the midface may be constrained by this functional relationship.This comparative analysis was based on 3D reconstructions of cranial structures in newborns and adults from representative platyrrhine species (e.g., Aotus nancymaae and Cebuella pygmaea) and tarsiers (Tarsius syrichta). Spatial relationships of the olfactory duct were estimated using endocasts based on conventional microCT scans. In addition, diffusion iodine contrast‐enhanced CT (diceCT) images were used to study Aotus nancymaae at multiple stages of ontogeny. DiceCT allowed us to reconstruct the actual position of olfactory bulbs relative to the olfactory duct and the distribution of olfactory nerves in the nasal cavity. 3DSlicer and Blender software were used to render 3D models. These data confirm our hypothesis that the rostral projection of the olfactory bulbs relative to the frontal lobes of the brain increases through ontogeny. In addition, the paths of olfactory nerves are diverted around the convergent eyes. The ontogenetic relationships occurring in platyrrhine and tarsier olfactory ducts have evolutionary implications for biological variation in the primate skull.

The Relationship Between Acute Exercise-Induced Changes in Extramuscular Connective Tissue Thickness and Delayed Onset Muscle Soreness in Healthy Participants: A Randomized Controlled Crossover Trial

BackgroundThe extramuscular connective tissue (ECT) has been shown to play a significant role in mechanical force transmission between musculoskeletal structures. Due to this and owing to its tight connection with the underlying muscle, the ECT may be vulnerable to excessive loading. The present study aimed to investigate the effect of eccentric elbow flexor exercise on the morphology of the biceps brachii ECT. In view of the high nociceptive capacity of the ECT, an additional objective was to elucidate the potential relationship between ECT damage and the occurrence of delayed onset muscle soreness (DOMS).MethodsEleven healthy participants (♂ = 7; 24 ± 2 years) performed fatiguing dumbbell elbow flexor eccentric exercise (EE) for one arm and concentric exercise (CE) for the other arm in random order and with random arm allocation. Before, immediately after and 24–96 h post-exercise, maximal voluntary isometric contraction torque of the elbow flexors (dynamometer), pressure pain (algometer), palpation pain (100 mm visual analog scale), biceps brachii ECT thickness and ECT/muscle mobility during passive movement (both high-resolution ultrasound) were examined.ResultsPalpation pain, suggestive of DOMS, was greater after EE than CE, and maximal voluntary isometric contraction torque decreased greater after EE than CE (p < .05). Relative to CE, EE increased ECT thickness at 48 (+ 17%), 72 (+ 14%) and 96 (+ 15%) hours post-exercise (p < .05). At 96 h post-EE, the increase in ECT thickness correlated with palpation pain (r = .68; p < .05). ECT mobility was not different between conditions, but compared to CE, muscle displacement increased at 24 (+ 31%), 72 (+ 31%) and 96 (+ 41%) hours post-EE (p < .05).ConclusionCollectively, these results suggest an involvement of the ECT changes in delayed onset muscle soreness.

A lab-based comparison of differential ratings of perceived exertion between a run and jump protocol involving low or high impacts on the lower extremities

ABSTRACT The rating of perceived exertion method (RPE) allows to describe training intensity in a single value. To better understand the underlying components, the separate rating of perceived breathlessness (RPE-B) and leg-muscle exertion (RPE-L) has been proposed. Here we hypothesised that the separation between the two components may (partly) be determined by the impacts on the lower extremities. In this study, we aimed to experimentally evaluate the differential effect of high versus low impact running and jumping on RPE-B and RPE-L in team sport activities by manipulating the movement strategy (heel strike and passive landing pattern versus forefoot strike and active landing pattern). Eighteen recreational team sport players participated in two submaximal tests consisting of a sequence of running and jumping bouts, whilst ground reaction forces (GRF) were collected. RPE-B and RPE-L data were collected after each bout using the CR100 scale. Paired-samples t-tests were used to analyse between-session differences in these variables. GRF analysis showed that absorption mechanics differed considerably between the two sessions. RPE-L was on average 6.50 AU higher in the low impact session (p = 0.006). However, RPE-B was also increased by 4.96 AU with low impact (p = 0.009). We conclude that the extent to which the lower extremities are being exposed to high or low impacts does not explain a possible separation between the two RPE types. Highlights The separate rating of the different underlying components of RPE (e.g. variables related to the cardiorespiratory and the muscular system) may provide more insight in the relationship between training load and training outcomes, which likely differs between these components. The findings of this study do not support the idea that the separation in rating between perceived breathlessness (RPE-B, cardiorespiratory) and leg-muscle exertion (RPE-L, muscular) is also rooted in the extent to which musculoskeletal structures in the lower extremities are being exposed to high or low impacts.

APPLICATION OF SHOCK WAVE THERAPY IN NEUROREHABILITATION (LITERATURE REVIEW)

The review presents current literature data on the use of shock wave therapy (SWT) in neurorehabilitation. In recent years, the development of this method is progressing. The uniqueness of the method lies in the wide and safe range of its capabilities used in various fields of medicine, including the rehabilitation of neurological diseases. It is indicated that SWT works by emitting acoustic waves (shock waves) that carry energy and can propagate through tissues, focus on a given area of the body, exerting a precisely directed therapeutic effect, without damaging other tissues of the body. It has been noted that shock waves can generate interstitial and extracellular responses, causing many beneficial effects such as pain relief, vascularization, protein biosynthesis, cell proliferation, neuro- and chondroprotection, and destruction of calcium deposits in musculoskeletal structures. The combination of these effects can lead to tissue regeneration and significant pain relief, improving functional outcomes in damaged structures. Given these facts, SWT demonstrates great potential as a useful method of regenerative medicine for the treatment of various pathologies. It is emphasized that the modern concept of tissue regeneration is closely related to neoangiogenesis. This is a new interpretation of the therapeutic effect and opens new horizons for the use of SWT, in addition to traditional orthopedic applications. In recent years, SWT has been shown to be a safe and effective method of reducing muscle spasticity. Possible mechanisms include nitric oxide formation, decreased excitability of motor neurons, induction of neuromuscular dysfunction, and direct effects on rheological properties. It has also been investigated that SWT can affect neuromuscular junctions, causing degeneration and a decrease in acetylcholine receptors, which in turn causes a significant reduction in maximal muscle action potential. A large number of clinical studies evaluating the effect of SWT on muscle spasticity in patients after stroke have shown that the use of SWT helps reduce pain, improve muscle strength, stimulate revascularization and neurogenesis. Also, the use of SWT improves motor function, reduces pain and restores functional independence in patients with post-stroke spasticity. Decreased muscle tone was also observed in children with cerebral palsy. Radial SWT reduces pain and muscle tone in patients with multiple sclerosis without side effects. SWT has been used also to treat carpal tunnel syndrome as a new and non-invasive method. It is noted that during the experimental study it was found that under the influence of SWT is the regeneration of neurons by accelerating the elimination of the damaged axon, increasing the proliferation of Schwann cells and increasing the regeneration of axons. It is emphasized that the mechanism of SWT in pinching neuropathy has not been fully studied, but two main effects, such as anti-inflammatory and neuronal regeneration effect, are potential recovery mechanisms in this pathology. SWT can be successfully used in neurological diseases to relieve pain, spastic and tunnel syndromes, inflammatory processes and to improve overall functional status. Potential new uses for SWT include spasticity, neuropathic changes, and other neurological disorders. Due to its non-invasive approach, lack of major side effects, recurrence, good tolerability and compliance with patients, SWT offers new rehabilitation perspectives in neurology.

The impact of Drew Noden's work on our understanding of craniofacial musculoskeletal integration.

The classical anatomist Drew Noden spearheaded craniofacial research, laying the foundation for our modern molecular understanding of development, evolution, and disorders of the craniofacial skeleton. His work revealed the origin of cephalic musculature and the role of cranial neural crest (CNC) in early formation and patterning of the head musculoskeletal structures. Much of modern cranial tendon research advances a foundation of knowledge that Noden built using classical quail-chick transplantation experiments. This elegant avian chimeric system involves grafting of donor quail cells into host chick embryos to identify the cell types they can form and their interactions with the surrounding tissues. In this review, we will give a brief background of vertebrate head formation and the impact of CNC on the patterning, development, and evolution of the head musculoskeletal attachments. Using the zebrafish as a model system, we will discuss examples of modifications of craniofacial structures in evolution with a special focus on the role of tendon and ligaments. Lastly, we will discuss pathologies in craniofacial tendons and the importance of understanding the molecular and cellular dynamics during craniofacial tendon development in human disease.

Ultrasonographic Evaluation of Peripheral Nerves: Technical Considerations.

Advances in ultrasonographic (US) technology featuring high-resolution transducers have revolutionized US over recent years as a modality increasingly used in the evaluation of musculoskeletal structures and peripheral nerves. A wide variety of nerve pathologies can be detected, such as neoplastic and tumorlike lesions, entrapment syndromes, posttraumatic injuries, and inflammatory conditions. US can serve as an imaging tool for guiding percutaneous treatments, such as injection therapies or hydrodissection, and assist with perioperative nerve marking and visualization of peripheral nerves in the operating room. This article describes the normal US appearance of peripheral nerves, US imaging techniques, common peripheral nerve pathologies, and interventional applications.

Biomechanical Analysis of the Influence of SACH Foot and Dynamic-Response Foot in Individual With Unilateral Transtibial Amputee During Running

Objective: Amputation of the lower limb due to loss of part of the musculoskeletal structure reduces performance and increases injury during locomotion. The effect of various types of prosthetic feet has been analyzed in several studies during running. The purpose of this study was a biomechanical analysis of the influence of SACH and Dynamic-Response foot on several kinetic variables in the stance phase of running in individuals with unilateral transtibial amputation. Materials &amp; Methods: In this semi-experimental study, 8 left foot transtibial amputees were included in this study using an available or easy sampling method. The target population was unilateral transtibial amputees who were able to run and the available population included left transtibial amputees who were referred to Kosar Rehabilitation Center in Tehran from 2008 to 2012. To adapt to the foot, each foot was used by the subjects for at least one week before the experiment. All subjects participated in 3 running evaluation sessions; 1 session involving the use of their own foot (familiarization session), 1 session involving the use of SACH foot, and 1 session involving the use of Dynamic foot. Only data from the 2 last sessions were used to compare both feet. Each subject runs in 12-meter walkway 3 times at a speed of 2.5 meters per second. The same running speed was chosen for the comparability of kinetic variables. Sport shoes were used to bring the test conditions closer to the actual running conditions. In each session, 3 successful trials were performed so that the foot was in full and perfect contact with the force plate. Kistler force plate and three-dimensional motion analysis Vicon system were used to collect kinetic and kinematic data, respectively. The motion and the force plate data were sampled simultaneously at 200 and 1000 Hz, respectively. The trajectories of the markers and analog data were filtered using the predicted mean square error adaptive filter in version 1.7 of the Vicon software package. The Kinetic variables were generated using the dynamic model of the Vicon Plug-in-Gait. The vertical ground reaction force was normalized for body weight. In the present study, 5 variables were selected for biomechanical analysis of feet. The maximum vertical ground reaction force, power, spring efficiency, ankle moments at the amputated leg, and the symmetry ratio (percentage) of the maximum vertical ground reaction force between the amputated leg and the intact leg were calculated. All values ​​in each trial were averaged for each subject with each foot. A paired t-test and a Wilcoxon test were used to analyze the data based on normality (P ≤0.05). Results: In examining the normality of the data distribution, the results showed that the data of maximum power absorption of the ankle with the SACH foot and the maximum power absorption of the hip with the Dynamic-Response foot did not have a normal distribution and other variables had a normal distribution. The results of paired t-test and Wilcoxon showed that Spring Efficiency and Maximum Plantar Flexion were significantly different between the SACH and Dynamic-Response feet (P ≤0.05). The Spring Efficiency was greater with Dynamic-Response foot than the SACH foot (P =0.05), although the Maximum Plantar Flexion with the SACH foot was greater than Dynamic-Response foot (P =0.05). While there is no statistical difference between the maximum vertical ground reaction force, maximum power absorption and generation in the ankle, maximum power absorption and generation in the knee, maximum power absorption and generation in the hip, maximum dorsiflexion moment, and the symmetry ratio (percentage) of the maximum vertical ground reaction force between the amputated leg and the intact leg. Conclusion: The results of the study showed that the spring efficiency with Dynamic-Response foot was greater than SACH foot and closing to the spring efficiency of a normal foot. With this perspective, the Dynamic-Response foot has more natural performance than the SACH foot.

Asymptomatic foot and ankle structural injuries: a 3D imaging and finite element analysis of elite fencers

BackgroundFencing is a highly asymmetrical combat sport, that imposes high mechanical demands over repeated exposures on the musculoskeletal structures, a primary cause of injuries in fencers. However, there are limited epidemiological studies on the structural injuries of the foot and ankle in fencers. This study aimed to investigate foot and ankle structural injuries, and explore how metatarsophalangeal joint structural changes may affect the mechanisms of foot and ankle injuries in asymptomatic fencers.Methods3D images of foot and ankle morphology using computed tomography were obtained from ten elite fencers. We then constructed finite element models of the first metatarsophalangeal joint in the foot of their trail legs. The validated models were used to simulate stress distribution changes from different ankle joint angles during lunging.ResultsThe findings showed that stress distribution changes at the medial and lateral sesamoid may have caused sesamoid fractures, and that habitual and concentrated stress on the metatarsal bones might have flattened the sesamoid groove. This process may damage the integrity of the first metatarsophalangeal joint, and consequently affect the efficiency of the windlass mechanism in fencers. During lunging, different ankle joint angles of the trail foot increased the total stress difference of the medial and lateral foot, and thus influenced the lunging quality and its stability.ConclusionsOur findings revealed that the asymmetric nature of fencing might have caused asymptomatic foot and ankle structural injuries, and finite element analysis results indicated that this might increase the incidence of the serious injuries if unattended. Regular computed tomography examination should be introduced to monitor elite fencers’ lower limb alterations, permitting unique angle adjustments in the trail foot without sacrificing technical or physiologic properties based on the exam results and reduce the lower limb injury risk.

Mixed Neuropathologies, Neural Motor Resilience and Target Discovery for Therapies of Late-Life Motor Impairment.

By age 85, most adults manifest some degree of motor impairment. However, in most individuals a specific etiology for motor decline and treatment to modify its inexorable progression cannot be identified. Recent clinical-pathologic studies provide evidence that mixed-brain pathologies are commonly associated with late-life motor impairment. Yet, while nearly all older adults show some degree of accumulation of Alzheimer’s disease and related dementias (ADRD) pathologies, the extent to which these pathologies contribute to motor decline varies widely from person to person. Slower or faster than expected motor decline in the presence of brain injury and/or pathology has been conceptualized as more or less “resilience” relative to the average person This suggests that other factors, such as lifestyles or other neurobiologic indices may offset or exacerbate the negative effects of pathologies via other molecular pathways. The mechanisms underlying neural motor resilience are just beginning to be illuminated. Unlike its cousin, cognitive resilience which is restricted to neural mechanisms above the neck, the motor system extends the total length of the CNS and beyond the CNS to reach muscle and musculoskeletal structures, all of which are crucial for motor function. Building on prior work, we propose that by isolating motor decline unrelated to neuropathologies and degeneration, investigators can identify genes and proteins that may provide neural motor resilience. Elucidating these molecular mechanisms will advance our understanding of the heterogeneity of late-life motor impairment. This approach will also provide high value therapeutic targets for drug discovery of therapies that may offset the negative motor consequences of CNS pathologies that are currently untreatable.

Toward a Sonographic Composite Index for Diagnosis in Psoriatic Arthritis: Highlights From the GRAPPA Ultrasound Workshop.

The ability to visualize musculoskeletal structures with high-resolution ultrasound is an asset to understanding the complexity of psoriatic arthritis (PsA). During the 2021 Annual Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) meeting, 3 topics were presented and discussed in the ultrasound workshop: (1) the progress on the Diagnostic Ultrasound Enthesitis Tool (DUET) project; (2) the sonographic evaluation of joints in PsA-GRAPPA joint project; and (3) extrasynovial lesions in PsA. The ultrasound group aims to develop sonographic tools that are feasible and can be used in standard care to diagnose PsA early. The discussions around these topics will shape the group's work toward developing a composite index to diagnose PsA early.

What you need to know about: arterial cerebrovascular syndromes caused by static or dynamic musculoskeletal compression.

Compressive syndromes of the cervical arteries caused by musculoskeletal structures include bow hunter's syndrome, beauty parlour stroke syndrome, carotid compression by the hyoid bone, carotid compression by the digastric muscle and Eagle syndrome. They are a rare but increasingly recognised group of syndromes, so a high level of suspicion is needed so the diagnosis is not missed. The diagnosis is typically based on a combination of clinical history and advanced imaging investigations. Compression of the arteries may be static (only provoked by compression) or dynamic (exaggerated by movement), and this should be considered when selecting imaging studies. Symptoms resulting from vertebrobasilar insufficiency or ischaemia of areas supplied by the internal carotid artery are caused by compression of the vertebral artery and the internal carotid artery respectively. Surgical procedures are the preferred treatment for most of these syndromes.

Intra-operative wearable visualization in spine surgery: past, present, and future.

The history of modern surgery has run parallel to the invention and development of intra-operative visualization techniques. The first operating room, built in 1804 at Pennsylvania Hospital, demonstrates this principle: illumination of the surgical field by the Sun through an overhead skylight allowed surgeries to proceed even prior to the invention of anesthesia or sterile technique. Surgeries were restricted to begin around when the Sun was at its zenith; without adequate light from the Sun and skylight, surgeons were unable to achieve adequate visualization. In the years since, new visualization instruments have expanded the scope and success of surgical intervention. Spine surgery in particular has benefited greatly from improved visualization technologies, due to the complex and intricate nervous, vascular and musculoskeletal structures that are closely intertwined which surgeons must manipulate. Over time, new technologies have also advanced to take up smaller footprints, leading to the rise of wearable tools that surgeons don intra-operatively to better visualize the surgical field. As surgical techniques shift to more minimally invasive methods, reliable, fidelitous, and ergonomic wearables are of growing importance. Here, we discuss the past and present of wearable visualization tools, from the first surgical loupes to cutting-edge augmented reality (AR) goggles, and comment on how emerging innovations will continue to revolutionize spine surgery.

Prognostic factors affecting overall survival in patients with spinal metastasis due to lung cancer: a systematic review and meta-analysis.

Metastatic lung cancer often spreads to the musculoskeletal structures and spinal column. Patients suffering from spinal metastasis due to lung cancer present poorer prognostic outcomes in terms of overall survival compared to spinal metastases from other origins. To date, no meta-analysis has attempted to evaluate the prognostic impact of various predictive factors that may influence the overall survival of patients with spinal metastasis due to metastatic lung cancer. The aim of the study was to evaluate the prognostic impact of different predictive factors that might influence the overall survival of patients with spinal metastasis due to metastatic lung cancer. Five electronic databases (Web of Science, EMBASE, CENTRAL, Scopus, and MEDLINE) were screened for eligible studies according to PRISMA guidelines. We conducted a random-effects meta-analysis to evaluate the prognostic impact of aging, pre-ambulatory status, radiotherapy, adenocarcinoma, performance status, visceral metastasis, and number of affected vertebrae on the overall survival of patients with spinal metastasis due to lung cancer. From 963 studies, we found 13 eligible studies with data on 1144 patients. Our meta-analysis revealed that pre-treatment ambulatory status (2.08), Eastern cooperative oncology group score (1.78), and aging (1.68) had significant impacts on overall survival. We provide preliminary evidence highlighting three factors potentially predictive of overall survival for patients suffering from spinal metastasis due to metastatic lung cancer. These findings may help clinicians stratify and manage patients more effectively.