Neuromusculoskeletal Disorders Research Articles

GENDER DIFFERENCE IN CARPAL TUNNEL COMPLIANCE

The purposes of this study were to investigate the mechanical properties of the carpal tunnel and to examine carpal tunnel compliance as it related to gender difference. Twelve male and twelve female subjects without any neuromusculoskeletal disorders in the upper extremities participated in the study. Indentation testing was manually performed on the wrist volar to the transverse carpal ligament. Effective compliance was defined as the slope of the regression analyses of indentation force and displacement data. In the tested indentation force range (2.45–19.60 N), the displacement of females was 1.38 ± 0.25 mm, significantly smaller than that of the males, 1.82 ± 0.30 mm (p < 0.001). Regression analyses in the force range showed that the effective compliance for females, 0.075 ± 0.012 mm/N, was 26.3% lower than that for males, 0.101 ± 0.018 mm/N (p < 0.005). It was concluded that females have less compliant carpal tunnel than males. The gender difference in carpal tunnel mechanics may predispose females to detrimental compression of the median nerve and carpal tunnel syndrome.

Neuromusculoskeletal disorders in the neck and upper extremities among drivers of all-terrain vehicles--a case series.

BackgroundThe purpose of this study was to investigate whether professional drivers of all-terrain vehicles (ATVs) with neck pain have a different array of neuromusculoskeletal disorders in the neck and upper extremities than a referent group with neck pain from the general population. It is hypothesized that exposure to shock-type vibration and unfavorable working postures in ATVs have the capacity to cause peripheral nervous lesions.MethodsThis study was based on a case series analyzed according to a case-case comparison design. The study population consisted of 60 male subjects, including professional drivers of forest machines (n = 15), snowmobiles (n = 15), snowgroomers (n = 15) and referents from the general population (n = 15) all of whom had reported neck pain in a questionnaire and underwent an extensive physical examination of the neck and upper extremities. Based on symptom history, symptoms and signs, and in some cases chemical, electroneurographical and radiological findings, subjects were classified as having a nociceptive or neuropathic disorder or a mix of these types.ResultsThe occurrence of asymmetrical and focal neuropathies (peripheral nervous lesion), pure or in a mix with a nociceptive disorder was common among cases in the ATV driver groups (47%–79%). This contrasted with the referents that were less often classified as having asymmetrical and focal neuropathy (27%), but instead had more nociceptive disorders. The difference was most pronounced among drivers of snowgroomers, while drivers of forest machines were more frequently classified as having a nociceptive disorder originating in the muscles.ConclusionThis study found a high prevalence of assymetrical and focal neuropathies among drivers with pain in the neck, operating various ATVs. It seems as if exposure to shock-type whole-body vibration (WBV) and appurtenant unfavorable postures in ATVs may be associated to peripheral nervous lesions.

Ligaments: a source of work-related musculoskeletal disorders

The mechanical and neurological properties of ligaments are reviewed and updated with recent development from the perspective which evaluates their role as a source of neuromusculoskeletal disorders resulting from exposure to occupational activities. Creep, tension-relaxation, hysteresis, sensitivity to strain rate and strain/load frequency were shown to result not only in mechanical functional degradation but also in the development of sensory-motor disorders with short- and long-term implication on function and disability. The recently exposed relationships between collagen fibers, applied mechanical stimuli, tissue microdamage, acute and chronic inflammation and neuromuscular disorders is delineated with special reference to occupational stressors.

“Waiter’s tip” (Erb’s) palsy: a case report and literature review

As primary health care clinicians, chiropractors are increasingly providing the initial assessment of many diverse musculoskeletal conditions. As a consequence, occasionally chiropractors are consulted to assess rare neuromusculoskeletal disorders. A 12-year-old girl was brought in by her mother for a second opinion on the present status of her daughter’s Erb-Duchenne palsy (Erb’s palsy), a diagnosis given at birth. Erb’s palsy is a birth-induced upper brachial plexus injury that, if unresolved, is known to lead to permanent developmental shoulder and elbow articular deformities. These deformities can result in severe restrictions in the proper function of the involved upper limb. The exact pathogenesis is unclear and therefore certain theories are presented. It would appear that early detection of these functional restrictions and the restoration of normal joint function, through active and passive mobilisation during childhood, are an important factor in limiting the extent of these disabilities.

Multilevel nerve compression and muscle imbalance in work-related neuromuscular disorders.

Work-related upper limb disorders have come under increasing scrutiny and become a frustrating problem. A unifying hypothesis to explain the multiplicity of symptoms with work related neuromuscular disorders is outlined. This multifactorial problem includes physical, individual, and psychosocial factors. Abnormal postures and positions may compress nerves or may alter muscle length resulting in secondary compressive forces on nerves or in muscle imbalances. Evaluation should identify all nerve compression levels and muscle imbalance in the arm and cervicoscapular region. Management must include patient education, postural correction, and an exercise program to address the multiple nerve compression levels and muscle imbalance. The etiology of work related neuromusculoskeletal disorders is multifactorial and successful management must address all contributing factors. Appropriate conservative management will relieve symptoms in most patients. Surgery should be reserved for those few patients with evidence of a specific diagnosis who have failed conservative management.

Biomechanical models for the pathogenesis of specific distal upper extremity disorders.

Knowledge of the pathogenesis of most disorders that occur in the distal upper extremity is generally lacking. The individual roles of postulated etiologic factors, such as biomechanical or psychosocial exposures, are poorly understood and their potential interactions even less so. This article proposes biomechanical or physiological models of pathogenesis for specific distal upper extremity disorders. Tendon entrapment of the dorsal wrist compartments (tenosynovitis), peritendinitis, lateral epicondylitis, and carpal tunnel syndrome are common specific neuromusculoskeletal disorders of the upper extremities observed among workers. The normal anatomy and function of the targeted structures is considered the initial state; their pathology is considered the final state. Using biomechanical or physiological principles combined with clinical observations and experimental studies, pathways leading from the initial state to the final state are proposed. Each model defined a critical biomechanical or physiological attribute that was considered to best characterize 'dose.' Two temporal patterns of exposure (duration vs. repetition) were used to characterize 'dosage.' The roles of long-term exposure vs. unaccustomed work were mentioned, but not incorporated into the models. Compressive force transmitted to the extensor retinaculum was considered the critical factor in the model for tendon entrapment at the dorsal wrist compartments. Two models were proposed for lateral epicondylitis. One emphasized the role of eccentric exertions; the other emphasized contact pressure from the radial head. The model for peritendinitis relied on localized muscle fatigue. Seven plausible models were presented for carpal tunnel syndrome. It is possible to propose biologically plausible models of pathogenesis that are both coherent with current knowledge of tissue responses and consistent with clinical observations; however, more than one model was plausible for some conditions. Additional research is needed to determine which, if any, of the proposed models might be correct. Such models may be useful to health care providers and ergonomists in the context of primary, secondary, or tertiary prevention.

Chiropractic Evaluation and Management

A thorough knowledge of equine spinal anatomy, biomechanics, and potential pathology is required to understand the principles and theories behind chiropractic and to apply its techniques properly. Chiropractic provides additional diagnostic and therapeutic means that may help equine practitioners to identify and treat the primary cause of lameness or poor performance. Specialized training in the evaluation and treatment of vertebral joint dysfunction and neuromusculoskeletal disorders places chiropractic in the forefront of conservative treatment of spinal-related disorders. Nevertheless, limited research is currently available on equine chiropractic and other nontraditional modalities in veterinary medicine. In 1996, the American Veterinary Medicine Association's Committee on Alternative and Complementary Therapies suggested that the research community should be encouraged to prioritize avenues of research and to allocate research funds to projects that are designed to provide further scientific evaluation of these modalities. The future of equine chiropractic in veterinary medicine is dependent on future research into the clinical effects of chiropractic techniques and the basic pathophysiology of spinal-related disorders in horses.

Design and test of neural networks and statistical classifiers in computer-aided movement analysis: a case study on gait analysis

Objective. To describe the methods for designing and testing diagnostic systems in movement analysis and to verify the clinical usefulness of neural networks and statistical classifiers in a case study. Design. Connectionist and statistical models trained and tested with measured data. Background. A basic need in rehabilitation and related fields is to efficiently manage the vast information obtained from a movement analysis laboratory. Many studies have dealt with the interpretation of measured variables in order to correlate objective descriptors to the presence and/or severity of specific neuromusculoskeletal disorders or their consequences. This traditional analytical approach has been complemented in the last decade by new non-linear classification tools called neural networks. Methods. A gait analysis study on 148 lower limb arthrosis patients and 88 age-matched control subjects. Pathological and healthy gait patterns obtained from force plates were discriminated by means of multilayer perceptrons and statistical classifiers. Results. Ten input features were enough to train a multilayer perceptron with six hidden neurons. The discrimination rate of the neural net was 80% after cross-validation, significantly higher ( P < 0.05) than the performance of a Bayes quadratic classifier (about 75%). A great variance due to a small cross-validation set could be demonstrated. Conclusions. Strict statistical requirements must be observed for designing a neural network. Although these models attain a better performance than conventional statistical approaches, the benefits they bring are sometimes not sufficient to justify their use. Further-more, clinicians routinely involved in critical decisions may not consider such diagnostic systems reliable enough.

Movement arousals and sleep-related disordered breathing in adults.

Sleep fragmentation (an increase in the number of short EEG arousals) is considered a major determinant of excessive daytime sleepiness but is seldom quantified in sleep studies, and reference values are scarce at best. We present data on the movement arousal index (MAI) in five groups of subjects: normals, simple snorers, patients with the sleep apnea-hypopnea syndrome (SAHS), and patients with sleep-related oxygen desaturations due to chronic obstructive pulmonary disease or neuromusculoskeletal disorders. In normal subjects, the MAI was 13 +/- 7 (mean +/- SD). MAI was distinctly increased in most patients with SAHS and was strongly correlated with the apnea-hypopnea index and loss of both slow wave and REM sleep. It was corrected to normal by nasal continuous positive airway pressure (CPAP). There was some overlap of MAI between SAHS patients and snorers, suggesting that a minority of nonapneic snorers may suffer from daytime sleepiness due to upper airway dysfunction. Sleep fragmentation is not a feature of sleep-related hypoventilation due to COPD or neuromusculoskeletal disorders, and an increase of the number of movement arousals (MA) is very suggestive of upper airway dysfunction and of potential success of CPAP. Quantification of sleep fragmentation is feasible and clinically useful; it should be included in the assessment of sleep-related breathing disorders.

Assistive Technology and the Prevention of Secondary Disabling Conditions Among Persons with Spinal Cord Injury

Individuals with spinal cord injury have a high probability of developing secondary disabling conditions. A number of prevention strategies have been implemented. The article explores the application of assistive technology as a method to prevent secondary health conditions from bladder and urinary tract infections, pressure sores, respiratory tract diseases, cardiovascular disorders, neuromusculoskeletal disorders, psychosocial disorders and to improve quality of life. Recommendations for developing secondary prevention plans in the context of the rehabilitation process are recommended.

The United States Army Physical Therapy Experience: Evaluation and Treatment of Patients With Neuromusculoskeletal Disorders

Army physical therapists have had unique experiences relevant to orthopaedic physical therapy. The educational process, expanded clinical privileges, and physician supervisor role as developed to prepare and support physical therapists working as primary neuromusculoskeletal screeners are summarized. After-action reports demonstrate that Army physical therapists can evaluate and treat one-third of all sick-call patients generated in field training missions and significantly improve return-to-duty rates without requiring physician intervention. The historic events that led to the physician-extender role in the evaluation and treatment of patients with neuromusculoskeletal conditions are presented. These events support the current battlefield assignment of physical therapists as far forward as the inflatable Combat Support Hospitals. The scope of Army physical therapy practice continues to evolve and expand to meet the new challenge of nation assistance, peace-keeping, and humanitarian missions.

Generalization capabilities of subtle image pattern classifiers

The generalization capabilities, for learned subtle image pattern categories, of neural network and algorithmic classification techniques are described. Several neural network and algorithmic techniques have been applied to a set of feature vectors extracted from thermal infrared images which characterize the extent of whiplash injury. Thermography recently has been reported to have clinical utility in a multitude of neuromusculoskeletal disorders, particularly with soft tissue injuries such as whiplash in which there are few widely agreed upon diagnostic standards. The results of this research indicate that the backpropagation neural network produces the best classification results and provides significantly better generalization from a set of training patterns. Results of unsupervised classification of the data using clustering algorithms and the Adaptive Resonance Theory (ART2) neural network demonstrate the difficulties of learning and of generalization of patterns from such data. >

Myofascial Aspects of Low Back Pain

Myofascial TrPs are an often overlooked but treatable source of pain and discomfort in the low back. They often complicate or coexist with other causes of low back pain, and they can mimic other neuromuscular or back musculoskeletal problems. Successful treatment of myofascial pain requires the identification of TrPs by manual examination, identification of mechanical or systemic perpetuating factors, treatment of the specific TrPs, and corrective action to prevent their recurrence.

An Overview of Therapeutic Positioning for Multiply-Handicapped Persons, Including Augmentative Communication Users

The body of literature related to adaptive equipment for positioning clients with neuro-musculoskeletal disorders has expanded slowly since the early 1970s. Much of this literature describes custom solutions to positioning problems for individual clients with cerebral palsy. Papers addressing the positioning needs for augmentative communication users remain sparse and superficial in scope. Furthermore, the literature on adaptive equipment solutions is substantially limited to clinicians' perceptions and theoretical premises of the effectiveness of positioning devices. Few formal studies of the effects of positioning have been reported, and none of the studies have addressed the relationship of body positioning to the use of augmentative communication devices. The purpose of this paper is to provide a review of the literature devoted to formal studies and guidelines for the use of therapeutic positioning for clients with multiple physical needs. Considerations for employing seating and positioning systems ...

INTRAVENOUS PROCAINE AS AN ANALGESIC AND THERAPEUTIC PROCEDURE IN PAINFUL, CHRONIC NEUROMUSCULOSKELETAL DISORDERS

INTRAVENOUS PROCAINE AS AN ANALGESIC AND THERAPEUTIC PROCEDURE IN PAINFUL, CHRONIC NEUROMUSCULOSKELETAL DISORDERS