Specific Musculoskeletal Disorders Research Articles

Psychische Komorbidität bei muskuloskelettalen Erkrankungen

The present review summarizes the evidence on epidemiology, etiology, and treatment of comorbid mental disorders in patients with musculoskeletal diseases. Epidemiological studies highlight a significantly increased risk of comorbid mental disorders in patients with musculoskeletal diseases compared to patients without musculoskeletal diseases and physically healthy persons. With regard to the question of the causal link between these comorbidities, specific musculoskeletal disease-mental disorder combinations show specific pathogenetic pathways. Using the example of arthritis-depression comorbidity, a causality model is presented. This model describes depression as following arthritis and, in turn, aggravating the course of arthritis. Treatment studies emphasize the effectiveness of both psychotherapeutic and psychopharmacological interventions for the treatment of patients with musculoskeletal diseases and comorbid mental disorders. In particular, collaborative care interventions are promising approaches to improve the routine care of comorbid patients.

근골격계 질환 예방을 위한 하지의 불균형 작업자세에서 근전도를 이용한 하지 근육의 작업부하 평가

Work related musculoskeletal disorders(WMSDs) was a leading cause of sick leave and injuries in the industries of our country. Posture was an important consideration in the design of work method and workplaces, because it affected the ability of workers to use various equipments and influenced how long they could perform their job without feeling discomfort, fatigue, and musculoskeletal disorders. Imbalanced lower limb postures such as a squatting posture were awkward working postures common to the shipbuilding shops, farms, automobiles assembly lines in our country. Different awkward working postures were known to be associated with specific musculoskeletal disorders. Eight postures in lower limb postures divided into balanced and imbalanced postures were evaluated by electromyographic(EMG) activity for lower limb muscles. Twelve male subjects participated in this study. This paper was to analyze the effects of lower limb muscles workload according to lower limb postures(knee angle) and working time. The ANOVA results showed that most EMG root mean square(RMS) values were statistically significant effect according to lower limb postures(knee angle) and working time. Therefore, the results of this study will provide the basis to evaluate workload of lower limb postures correctly adopted by workers in various jobs and the ergonomic reference to prevent WMSDs.

Comparative Safety Profile of Levofloxacin in 2523 Children With a Focus on Four Specific Musculoskeletal Disorders

Fluoroquinolones, including levofloxacin, have not been recommended for use in children largely because studies in juvenile laboratory animals suggest there may be an increased risk of fluoroquinolone-associated cartilage lesions. A large prospective trial is needed to assess the risks associated with using levofloxacin in children. Assess the safety and tolerability of levofloxacin therapy in children based on observations for 1 year after therapy. Safety data were collected in children who participated in 1 of 3 efficacy trials (N = 2523) and a subset of these children who also subsequently participated in a long-term 1-year surveillance trial (N = 2233). Incidence of adverse events in children randomized to receive levofloxacin versus nonfluoroquinolone antibiotics was compared. Based on assessments by treating physicians and an independent data safety monitoring committee, events related to the musculoskeletal system were further categorized as 1 of 4 predefined musculoskeletal disorders (arthralgia, arthritis, tendinopathy, gait abnormality) considered most likely clinical correlates of fluoroquinolone-associated cartilage lesions observed in laboratory animals. Levofloxacin was well tolerated during and for 1 month after therapy as evidenced by similar incidence and character of adverse events compared with nonfluoroquinolone antibiotics. However, incidence of at least 1 of the 4 predefined musculoskeletal disorders (largely due to reports of arthralgia) was greater in levofloxacin-treated compared with nonfluoroquinolone-treated children at 2 months (2.1% vs. 0.9%; P = 0.04) and 12 months (3.4% vs. 1.8%; P = 0.03) after starting therapy. The incidence of 1 or more of the 4 predefined musculoskeletal disorders identified in nonblinded, prospective evaluations, was statistically greater in levofloxacin-treated compared with comparator-treated children.

Diagnosis and classification of pelvic girdle pain disorders—Part 1: A mechanism based approach within a biopsychosocial framework

The diagnosis and classification of pelvic girdle pain (PGP) disorders remains controversial despite a proliferation of research into this field. The majority of PGP disorders have no identified pathoanatomical basis leaving a management vacuum. Diagnostic and treatment paradigms for PGP disorders exist although many of these approaches have limited validity and are uni-dimensional (i.e. biomechanical) in nature. Furthermore single approaches for the management of PGP fail to benefit all. This highlights the possibility that ‘non-specific’ PGP disorders are represented by a number of sub-groups with different underlying pain mechanisms rather than a single entity. This paper examines the current knowledge and challenges some of the common beliefs regarding the sacroiliac joints and pelvic function. A hypothetical ‘mechanism based’ classification system for PGP, based within a biopsychosocial framework is proposed. This has developed from a synthesis of the current evidence combined with the clinical observations of the authors. It recognises the presence of both specific and non-specific musculoskeletal PGP disorders. It acknowledges the complex and multifactorial nature of chronic PGP disorders and the potential of both the peripheral and central nervous system to promote and modulate pain. It is proposed that there is a large group of predominantly peripherally mediated PGP disorders which are associated with either ‘reduced’ or ‘excessive’ force closure of the pelvis, resulting in abnormal stresses on pain sensitive pelvic structures. It acknowledges that the interaction of psychosocial factors (such as passive coping strategies, faulty beliefs, anxiety and depression) in these pain disorders has the potential to promote pain and disability. It also acknowledges the complex interaction that hormonal factors may play in these pain disorders. This classification model is flexible and helps guide appropriate management of these disorders within a biopsychosocial framework. While the validity of this approach is emerging, further research is required.

Hypermobility disorders in children and adolescents

It is well recognized that many if not most children and adolescents attending paediatric rheumatology clinics will have a non-inflammatory origin for their complaints or disorder. Mechanical causes are frequently identified, and hypermobility or ligamentous laxity of joints is increasingly recognized as an aetiological factor in the presentation. Such conditions include 'growing pains', recurrent lower-limb arthralgia, anterior knee pain syndromes, and back pain. Studies of significant cohorts of such patients have now been published supporting the link of ligamentous laxity to particular symptom complexes. However, much disagreement remains as to the validity of hypermobility as an aetiogical factor. What seems clear is that not all hypermobile individuals will be symptomatic or indeed possibly have any risk for specific musculoskeletal disorders in later life. Screening tools such as the Beighton score are likely to be inadequate in many paediatric populations. Along with increasing recognition of these disorders in childhood and adolescence has been the development of a multidisciplinary management approach, which usually involves predominantly allied health professionals such as podiatrists, physiotherapists and occupational therapists. The challenge remains to interpret symptoms correctly as being related to the hypermobility and to predict why such children become symptomatic. The answer is likely to involve physiological and psychosocial factors. In addition, early identification and modification of risk factors may have major implications for subsequent prevalence of many adult medical disorders such as low back pain, chronic pain syndromes and degenerative osteoarthritis.

A Population Study on Differences in the Determinants of a Specific Shoulder Disorder versus Nonspecific Shoulder Pain without Clinical Findings

Musculoskeletal pain frequently occurs without particular clinical findings. Pain per se may be determined by factors other than those indicating a clinical disorder. The authors examined the prevalence and determinants of clinically diagnosed chronic rotator cuff tendinitis and self-reported nonspecific shoulder pain. The Health 2000 survey, carried out in 2000-2001 in Finland, included a nationally representative sample of 8,028 persons aged 30 years or more. In the present study, analyses were restricted to subjects aged 30-64 years who had held a job during the preceding 12 months. The prevalences of chronic rotator cuff tendinitis and nonspecific shoulder pain were 2.0% (78 of 3,909 subjects) and 12% (410 of 3,525 subjects), respectively. Nonspecific pain was related to burnout (adjusted odds ratio (OR) = 1.7, 95% confidence interval (CI): 1.4, 2.2), depression (among women, the adjusted OR was 1.8 (95% CI: 1.1, 2.9) for mild depression and 3.0 (95% CI: 1.6, 5.6) for severe depression), and inability to express one's feelings (alexithymia) (adjusted OR = 1.6, 95% CI: 1.1, 2.5). However, these factors were not associated with chronic rotator cuff tendinitis, determinants of which were work-related cumulative loading on the shoulder, age, and insulin-dependent diabetes mellitus (adjusted OR = 8.8, 95% CI: 1.9, 40.3). The determinants of specific musculoskeletal disorders differ from those of subjective complaints without clinical findings. Such complaints may be indicators of adverse psychological and psychosocial factors rather than the presence of an underlying pathologic condition.

Pathomechanisms of work-related musculoskeletal disorders: conceptual issues

Work-related musculoskeletal disorders (WRMSDs) by definition are a subset of musculoskeletal disorders (MSDs) that arise out of occupational exposures. While traditional exposure assessment techniques have proved to be successful in identifying ergonomic exposures that are epidemiologically linked to these disorders, some are troubled by the lack of one-to-one correspondence between specific occupational exposure profiles and specific MSDs. In the absence of more sophisticated hypotheses that might explain the occurrence of WRMSDs in a variety of exposure patterns, the aetiologic relationships may (again) be called into question. Another unanswered question is whether specific types of WRMSDs have qualitatively different exposure-response relationships. A clearer understanding of the underlying pathomechanisms associated with specific WRMSDs could help future researchers better determine how and when various occupational exposure profiles become pathogenic. Such knowledge could also be used to design exposure assessment tools to capture exposure information more relevant to the risk of WRMSDs. The main goals of this paper are to summarize several recently described pathomechanisms, most of which have been discussed primarily in clinical and experimental literature that might not be widely read by occupational health scientists. Suggestions are made as to how future research could evaluate whether these phenomena are relevant to the effects of physical exposures and the underlying disease processes of common WRMSDs.

Musculoskeletal disorders and orthopedic conditions.

Ongoing advances in orthopedics include discoveries of functions of matrix proteins, development of new implant materials that are more durable and more compatible with magnetic resonance imaging, and identification of genes causing musculoskeletal disorders and disease. The Human Genome Project will further clarify the genetic basis of specific musculoskeletal disorders, enhancing risk factor identification, diagnosis, and therapy. Engineered, cell-based materials will replace metals and plastics in implants, and new composite materials will promote bone in-growth.

Washington State Summary of Work-Related Musculoskeletal Disorders by Industry

An analysis of work-related musculoskeletal disorders (MSDs) in Washington State using workers' compensation claims and Bureau of Labor Statistics (BLS) data was conducted in order to identify high risk industries. All claims and BLS cases from 1992–1994 were searched using a specific MSD selection criteria and grouped by risk classification and standard industrial classification (SIC). Twenty-seven percent of all State Fund claims were classified as MSDs. The mean annual cost of MSDs was $166.8 million. Incidence rate claims data showed clerical offices ranked 286 out of 303 risk classes with a rate of 0.64 per 100 workers per year, over five times below the state mean incidence rate of 3.7. The only industry to appear in the top 10 by highest MSD count, incidence rate (including BLS data), and cost was nursing homes. Detailed MSD data by industry can be used by researchers to hypothesis test dose-response relationships and by practitioners to focus intervention efforts where they're most needed.

Rehabilitation dimensions of AIDS: a review.

With the spread of human immunodeficiency virus (HIV) infection and of the acquired immune deficiency syndrome (AIDS), many rehabilitation professionals are faced with new challenges. This report covers two basic problems that are becoming common in rehabilitation practice: the management of the patient who suffers from disability resulting from HIV infection or AIDS, and the management of the traditional rehabilitation patient who may coincidentally be infected with HIV. Common manifestations of HIV infection and associated secondary infections and neoplasms are discussed, as well as are the complications of current medical treatments. This report also explores specific neurologic and musculoskeletal disorders and the fatigue associated with AIDS. In addition, potential approaches to rehabilitation management are evaluated, and consideration is given to the management of the asymptomatic HIV carrier. The differences between HIV infection in adults and children are explored, and the social implications of HIV rehabilitation are discussed. After consideration of the basic pathophysiology of infection and the modes of transmission, the significance and ethics of serologic testing are examined, and the concept of universal precautions is described. The paper concludes with a discussion of the use of safe sex practices by the disabled population.