Musculoskeletal Unit Research Articles

Degloving injuries of the hand

Avulsion of skin from the hand or fingers is an injury that has a dramatic presentation. The entire musculo-skeletal unit of the finger is intact, and the patient can often move the parts of his naked hand quite normally. The challenge for the reconstructive surgeon lies in resurfacing the hand or finger with a good quality pliable sensate skin cover while preserving the movements and function of the hand. Traditionally, skin grafting has been the standard method of reconstruction in such injuries. However, skin grafting does have many disadvantages, too. This article deals with the features of such injuries, management protocols and other reconstructive options available in the armamentarium of the hand surgeon.

Book Review: J. R. Gage, M. H. Schwartz, S. E. Koop, T. F. Novacheck (eds): The identification and treatment of gait problems in cerebral palsy

Book Review: J. R. Gage, M. H. Schwartz, S. E. Koop, T. F. Novacheck (eds): The identification and treatment of gait problems in cerebral palsy

A Comparison of Two Stretching Modalities on Lower-Limb Range of Motion Measurements in Recreational Dancers

Most stretching techniques are designed to place a "stress" on the musculoskeletal unit that will increase its resting length and range of motion (ROM). Twenty-four adolescent dancers participated in a 6-week intervention program that compared low-intensity stretching (Microstretching) with moderate-intensity static stretching on active and passive ranges of motion. Microstretching is a new modality that reduces the possibility of the parasympathetic system being activated. Repeated measures analysis indicated changes in ROM over the intervention period (p < 0.05), with the Microstretching group demonstrating greater increases in passive and active ROM than the static stretch group (p < 0.01); there was no noted bilateral differences in ROM. The results from this study agree with past studies that have found that stretching increases the compliance of any given muscle and therefore increases the range of motion. One main finding of the present study was that throughout a 6-week training program very-low-intensity stretching had a greater positive effect on lower-limb ROM than moderate-intensity static stretching. The most interesting aspect of the study was the greater increase in active ROM compared to passive ROM by the Microstretching group. This suggests that adaptation has occurred within the muscle itself to a greater extent than in structures of the hip joint. Practical application for this technique suggests it is beneficial as a postexercise modality that potentially has a restorative component.

Calcium and vitamin D in the prevention of osteoporotic fractures

Osteoporosis has been defined as a skeletal disorder characterized by compromised bone strength, predisposing a person to increased risk of fracture.1 The three major osteoporotic fractures are those of the forearm, vertebra and hip, but fractures of the humerus, pelvis and ribs are also common. The incidence of these fracture rises steeply with age, such that most occur in people aged >65 years, where they are associated with excess mortality, substantial morbidity, and significant health and social services expenditure.2 This paper outlines the physiological roles of calcium and vitamin D, and assesses the current criteria for adequate calcium intake and optimal vitamin D status in adults. It highlights the prevalence of vitamin D insufficiency and low calcium intake in the UK, and reviews studies of vitamin D supplementation, with and without calcium, in the prevention of falls and fractures. Relevant clinical trials were identified using the search strategies described in recent meta-analyses.3,,4 Calcium is required for a number of functions in the body, including neuromuscular activity, membrane function, hormone secretion, enzyme activity, coagulation of the blood and skeletal mineralization.5 Over 99% of the body's calcium is stored in bone, where it provides mechanical strength to the skeleton, and serves as a mineral reservoir that can be drawn upon to maintain a normal plasma calcium. An adequate dietary calcium is therefore required to offset the obligatory losses of calcium in the urine and digestive juices, and prevent unnecessary loss of calcium from the skeletal reservoir.5 The recommended dietary calcium intake varies widely from country to country.6 In the US an intake of between 1000 and 1500 mg/day is recommended for adults, depending on age, gender and menstrual status.7 In contrast, the UK Committee on the Medical Aspects of Food and Nutrition Policy (COMA) … Address correspondence to Professor R.M. Francis, Musculoskeletal Unit, Freeman Hospital, Newcastle upon Tyne NE7 7DN. email: rmfrancis{at}compuserve.com

Pressure pain sensitivity and hardness along human normal and sensitized muscle

The spatial distribution of pressure sensitivity and muscle hardness was examined on normal muscle tissue and muscle tissue after induction of delayed onset muscle soreness (DOMS). The pressure sensitivity and muscle hardness were assessed at nine sites on the tibialis muscle from the proximal to distal tendon on two separate days. In total 37 healthy volunteers participated in three experiments. In the first experiment pressure pain threshold (PPT) and pressure pain tolerance (PPTO) were assessed. Decreased PPT and PPTO were found on day 2, 7 days after day 1. Proximal and distal stimulation sites were harder compared to muscle belly sites. In a second experiment two different probe sizes were used. Variation in PPT between the nine sites was found for the large probe with muscle belly being less sensitive to pressure stimulation compared to proximal and distal sites. The most proximal stimulation site was harder compared to muscle belly sites. In a third experiment PPT and muscle hardness were assessed before and 48 h after eccentric exercise. PPT at two muscle belly sites was significantly decreased during DOMS. No specific sites were harder during DOMS, the average muscle hardness across sites was however significantly increased. Decreased PPT and increased muscle hardness did not correlate. In conclusion, within subjects the pressure sensitivity varies along the musculoskeletal unit. In DOMS, specific muscle belly sites were more sensitive to pressure stimulation. Muscle–tendon sites were harder compared to muscle belly sites.

Doctor-patient communication in a musculoskeletal unit: relationship between an observer-rated structured scoring system and patient opinion.

To investigate the ability of consultant rheumatologists and orthopaedic surgeons to communicate well with patients and to determine the validity of a structured proforma used to assess medical students' communication skills. Seventy new patient appointments with consultant rheumatologists and orthopaedic surgeons were assessed for communication skills exhibited by the consultants and patient satisfaction. Communication skills were assessed using a proforma previously used to examine medical students, and patient ratings were obtained using visual analogue scales. Median scores attained using the structured proforma for rheumatology, elective orthopaedic and fracture clinic consultations were 17, 15 and 14 out of 20 (P < 0.05). Patient satisfaction scores were high in all three domains measured. Scores were statistically significantly higher for rheumatology appointments than in fracture clinic (median scores 29.5, 29.5 and 28 out of 30). Consultation durations varied, with a median of 23 min for rheumatology and 10.5 and 4 min for orthopaedic surgeons in clinic and fracture clinic, respectively. Consultant rheumatologists and orthopaedic surgeons demonstrate good communication skills, according to a tool used to assess medical students. These scores correlate with patient views, suggesting that teaching and assessment of communication skills at medical schools may address concerns of patients. Scores and satisfaction correlate with the duration of the consultation.