Treatment Of Musculoskeletal Disorders Research Articles

The role of self-management in the treatment of musculoskeletal disorders

The role of self-management in the treatment of musculoskeletal disorders

Safety of Acupuncture and Pharmacopuncture in 80,523 Musculoskeletal Disorder Patients: A Retrospective Review of Internal Safety Inspection and Electronic Medical Records.

We investigated the range and frequency of significant adverse events (AEs) in use of pharmacopuncture and acupuncture using large-scale, single-center safety data as evidence supporting safety of acupuncture with pharmacopuncture, used extensively in Asia, is scarce. Status reports (nurse records in ambulatory and inpatient care units, and administrative event records) as a part of an internal audit at a Korean Medicine hospital specializing in the treatment of musculoskeletal disorders, patient complaints filed through the hospital website, and medical records of patients visiting from December, 2010 (inception of internal audit) to October, 2014 were retrospectively reviewed. A total 80,523 patients (5966 inpatients and 74,557 outpatients) visited during this period. Inpatients received an average 31.9 ± 20.7 acupuncture, 23.0 ± 15.6 pharmacopuncture, and 15.4 ± 11.3 bee venom pharmacopuncture sessions, and outpatients were administered 8.2 ± 12.2 acupuncture, 7.8 ± 11.5 pharmacopuncture, and 10.0 ± 12.3 bee venom sessions, respectively. AEs associated with acupuncture/pharmacopuncture were forgotten needle (n = 47), hypersensitivity to bee venom (n = 37), presyncopic episode (n = 4), pneumothorax (n = 4), and infection (n = 2). Most cases were mild requiring little or no additional intervention and leaving no sequelae. Although serious AEs including infection (n = 2) and anaphylaxis associated with bee venom treatment (n = 3) were also reported, incidence was rare at 0.002% in infection and 0.019% in anaphylaxis. Incidence of AEs associated with acupuncture/pharmacopuncture treatment was low, and most cases were not serious. Still, however rare, avoidable AEs can and should be prevented through education and corrective action. Further prospective studies on the effect of error reduction strategies on incidence of adverse effects are warranted.

Immunomodulatory activity of mefenamic acid in mice models of cell-mediated and humoral immunity.

Objectives:Previously, different nonsteroidal anti-inflammatory drugs (NSAIDs) have been evaluated for their potential immunomodulatory activities. Mefenamic acid is a well-known NSAID and is used in the treatment of musculoskeletal disorders, inflammation, fever, and pain. To the best of our knowledge, promising data regarding the immunomodulatory activity of mefenamic acid is scarce. Current study investigates the immunomodulatory activity of mefenamic acid in different models of cell-mediated and humoral immunity.Materials and Methods:Immunomodulatory effects on cell-mediated immunity were evaluated using dinitrochlorobenzene-induced delayed type hypersensitivity (DTH) and cyclophosphamide-induce myelosuppression assays. While effects on humoral immunity were evaluated using hemagglutination assay and mice lethality test.Results:Hematological analysis showed that mefenamic acid significantly reduced white blood cell count, red blood cell (RBC) count, hemoglobin content, lymphocytes levels, and neutrophils levels in healthy mice as compared with control, suggesting the immunosuppressive activity of mefenamic acid. Treatment with mefenamic acid also significantly reduced all the hematological parameters in cyclophosphamide-induced neutropenic mice, as compared with positive control group. We found that treatment with mefenamic acid significantly suppressed DTH after 24 h, 48 h, and 72 h, as compared with positive control group. Mefenamic acid treated groups showed a significant reduction in antibody titer against sheep RBCs as compared to control group, similar to the effect of cyclophosphamide. We also found increased mice lethality rate in mefenamic acid treated groups, as compared with positive control group.Conclusions:The results provided basic information of immunosuppression of mefenamic acid on both cell-mediated and humoral immunity.

Economic Analysis of Accuracy and Cost of Ultrasound-guided Intraarticular Hip Injections

ABSTRACT Background Ultrasonography is an increasingly valuable tool for the diagnosis and treatment of musculoskeletal disorders. In the past, ultrasound has been used for diagnostic purposes, with increasing use of image guidance for joint injections. Hypothesis Ultrasound-guided intraarticular native nontraumatic hip injections are equally as accurate with less cost as other diagnostic imaging modalities including fluoroscopicguided injections. Design This analysis was based on a meta-analysis of the accuracy of the different imaging modalities. Initially a search was performed for intraarticular hip injections in PubMed, EMbasE, and ClinicalTrials.gov. Injection accuracy rates between groups were analyzed via proportional meta-analysis. For the economic analysis, compensation data were determined from estimated charges from Duke University Medical Center. Results Compared with gold standards of accurate injections (such as fluoroscopic and computed tomography-guided injections), ultrasound is 97% as accurate (confidence interval 93%, 99%). based on 2014 reimbursement data, reimbursement for large-joint intraarticular injection averages $61.99 (37.38£, 47.18€) ($49.20–$76.31). Fluoroscopic global reimbursement averages $105.32 (63.51£, 80.13€) ($76.75–$134.72). Ultrasound guidance global reimbursement averages $75.99 (45.86£, 57.83€) ($57.95–$93.15). Conclusion Ultrasound-guided hip injections are an accurate technique for alleviating hip pain at less cost. In an era of increasing concern for health care expenditures, finding an accurate, effective, and cost-friendly alternative has the potential for widespread adaptation and practice. Porras L, boggess b. Economic analysis of accuracy and Cost of Ultrasound-guided Intraarticular Hip Injections. The Duke Orthop J 2016;6(1):35-40.

A pragmatic observational feasibility study on integrative treatment for musculoskeletal disorders: Quantitative results

A pragmatic observational feasibility study on integrative treatment for musculoskeletal disorders: Quantitative results

MRI of the Musculoskeletal System: Advanced Applications using High and Ultrahigh Field MRI.

In vivo MRI has revolutionized the diagnosis and treatment of musculoskeletal disorders over the past 3 decades. Traditionally performed at 1.5 T, MRI at higher field strengths offers several advantages over lower field strengths including increased signal-to-noise ratio, higher spatial resolution, improved spectral resolution for spectroscopy, improved sensitivity for X-nucleus imaging, and decreased image acquisition times. However, the physics of imaging at higher field strengths also presents technical challenges. These include B0 and B1+ field inhomogeneity, design and construction of dedicated radiofrequency (RF) coils for use at high field, increased chemical shift and susceptibility artifacts, increased RF energy deposition (specific absorption rate), increased metal artifacts, and changes in relaxation times compared with the lower field scanners. These challenges were overcome in optimizing high-field (HF) (3 T) MRI over a decade ago. HF MRI systems have since gained universal acceptance for clinical musculoskeletal imaging and have also been widely utilized for the study of musculoskeletal anatomy and physiology. Recently there has been an increasing interest in exploring musculoskeletal applications of ultrahigh field (UHF) (7 T) systems. However, technical challenges similar to those encountered when moving from 1.5 T to 3 T have to be overcome to optimize 7 T musculoskeletal imaging. In this narrative review, we discuss the many potential opportunities and technical challenges presented by the HF and UHF MRI systems. We highlight recent developments in in vivo imaging of musculoskeletal tissues that benefit most from HF imaging including cartilage, skeletal muscle, and bone.

A Hertzian Integrated Contact Model of the Total Knee Replacement Implant for the Estimation of Joint Contact Forces

The prediction of lower limb muscle and contact forces may provide useful knowledge to assist the clinicians in the diagnosis as well as in the development of appropriate treatment for musculoskeletal disorders. Research studies have commonly estimated joint contact forces using model-based muscle force estimation due to the lack of a reliable contact model and material properties. The objective of this present study was to develop a Hertzian integrated contact model. Then, in vivo elastic properties of the Total Knee Replacement (TKR) implant were identified using in vivo contact forces leading to providing reliable material properties for modeling purposes. First, a patient specific rigid musculoskeletal model was built. Second, a STL-based implant model was designed to compute the contact area evolutions during gait motions. Finally, a Hertzian integrated contact model was defined for the in vivo identification of elastic properties (Young’s modulus and Poisson coefficient) of the instrumented TKR implant. Our study showed a potential use of a new approach to predict the contact forces without knowledge of muscle forces. Thus, the outcomes may lead to accurate and reliable prediction of human joint contact forces for new case study.

Integrative treatment for musculoskeletal disorders: A mixed methods study

Integrative treatment for musculoskeletal disorders: A mixed methods study

Prevalence of Work-related Musculoskeletal Disorders in Auto-mission Assembly Plant Workers

Objective: This study was performed to investigate the prevalence of musculoskeletal disorders in auto of a mission assembly plants. Background: Most studies of musculoskeletal disorders have used car assembly line as their participants. However, little research has been done on musculoskeletal disorders afflictions of mission assembly line workers. Method: Through a focus group interview with an ergonomist and a manager at a mission assembly plant site, a questionnaire was developed for musculoskeletal disorders. The questionnaire consisted of five parts, demographic factors, musculoskeletal disorder symptoms, and musculoskeletal disorder experiences; 137 participated in this survey. The surveys were analyzed by correlation and Chi-squared analysis. Results: Musculoskeletal disorder symptoms and serious pain were reported in the neck, shoulder, back, and fingers. These problems were statistically related to various demographic factors, such as age, stature, stretching, and work satisfaction. Conclusion: Treatment of musculoskeletal disorders should consider the workers traits. If there is no specific cause of the pain, developing stretches and exercises before and after work should be applied to prevent musculoskeletal disorders. Application: The results of this study can be used to develop guidelines to prevent injury in auto at mission assembly plants.

Measuring distress in musculoskeletal physiotherapy: An example of integrated care in action

Introduction: musculoskeletal disorders (MSDs) are a major cause of pain and disability, constituting a significant societal burden. Psychological constructs are important predictors and mediators for developing and maintaining long term pain-related disability and a biopsychosocial approach to assessment and treatment of MSDs is recommended. Physiotherapists are a key professional group assessing and treating people with MSDs but screening by them for psychosocial risk factors is inconsistent. Embedding routine collection of patient-reported psychological factors such as depression, pain self-efficacy and avoidance behaviours, may improve quality of patient care and outcomes. Method: the primary aim of this project was to implement screening for psychological risk factors in people attending a NHS physiotherapy musculoskeletal service and characterise the prevalence of distress. To achieve this, self-report questionnaires were embedded within informatics associated with the Integrating Mental and Physical Health Research and Training (IMPARTS) programme to assess: depression, anxiety, risk of persistent disability secondary to back pain, fear avoidance beliefs, pain catastrophizing and pain self-efficacy. A secondary aim was to develop associated care pathways to guide physiotherapist decision making. These include group physical exercise, psychologically informed physiotherapy, Improving Access to Psychological Therapies (IAPT), Accident & Emergency (AE of 406 screened, 14% were identified as having probable major depression and 18% as having probable anxiety disorder. Of the 121 patients using the developed care pathway, 68% (N = 82) were allocated to group exercise or IAPT for symptoms of depression or anxiety, and 32% (N = 39) had severe levels of depression and or suicidal ideation and required a letter to the GP or A&E. Just over one third of those screened reported back pain as the primary reason for attendance. Of those, 40% scored at high risk of persistent pain-related disability. Conclusion: physiotherapy musculoskeletal service redesign to incorporate a systematic approach to identifying psychosocial risk factors in people with MSDs has highlighted the prevalence of comorbid distress. The need for physiotherapists to expand their approach and integrate psychologically-informed practices into consultations is paramount

Orthopedic uses of stem cell therapy.

The treatment of musculoskeletal disorders is gaining importance as the population ages. In addition to the complications brought on by prolonged life expectancy, the growing epidemic of obesity is contributing to joint degradation. Cell-based tissue engineering has the potential to advance the current treatment for musculoskeletal disorders. This article reviews the various forms of arthritis and describes stem cell therapy as a promising treatment option.

Muscle electrical activity during exercises with and without load executed on dry land and in an aquatic environment

Introduction Muscle activity in the aquatic environment was investigated using electromyographic analyses. The physical properties of water and the resistance used may influence the response of the muscle during exercise. The objective of this study was to evaluate the electrical activity in water and on the floor during flexion and knee extension exercises with and without load and aimed at understanding the muscular response while performing resistance exercises in water. Methods The sample consisted of 14 volunteers between 18 and 35 years old who were subjected to active exercises involving knee flexion and extension with and without load on the floor and in water. Electromyography was performed during the movement. Results A significant increase was found in the electrical activity of the rectus femoris muscle during exercises on the floor. The biceps femoris muscle showed increased electromyographic activity when resistance was used. A significant increase was found in the electrical activity of the rectus femoris muscle compared with exercises with and without load and the moment of rest in immersion. The electrical activity of the rectus and biceps femoris muscles was reduced in exercises with load and without load in a therapy pool compared with on the floor. Conclusion There was a reduction of the electromyographic activity in the aquatic environment compared with that on the ground, which could be attributed to the effects from hot water. Therefore, it is believed that resistance exercises can be performed early in a therapy pool, which will facilitate the prevention and treatment of musculoskeletal disorders.

Kinematic gait analyses in healthy Golden Retrievers

Kinematic analysis relates to the relative movement between rigid bodies and finds application in gait analysis and other body movements, interpretation of their data when there is change, determines the choice of treatment to be instituted. The objective of this study was to standardize the march of Dog Golden Retriever Healthy to assist in the diagnosis and treatment of musculoskeletal disorders. We used a kinematic analysis system to analyse the gait of seven dogs Golden Retriever, female, aged between 2 and 4 years, weighing 21.5 to 28 kg, clinically normal. Flexion and extension were described for shoulder, elbow, carpal, hip, femorotibialis and tarsal joints. The gait was characterized lateral and had accepted hypothesis of normality for all variables, except for the stance of hip and elbow, considering a confidence level of 95%, significance level α = 0.05. Variations have been attributed to displacement of the stripes during movement and the duplicated number of reviews. The kinematic analysis proved to be a consistent method of evaluation of the movement during canine gait and the data can be used in the diagnosis and evaluation of canine gait in comparison to other studies and treatment of dogs with musculoskeletal disorders.

Radon balneotherapy and physical activity for osteoporosis prevention: a randomized, placebo-controlled intervention study.

Low-dose radon hyperthermia balneo treatment (LDRnHBT) is applied as a traditional measure in the non-pharmacological treatment of rheumatic diseases in Europe. During the last decades, the main approach of LDRnHBT was focused on the treatment of musculoskeletal disorders, but scientific evidence for the biological background of LDRnHBT is weak. Recently, evidence emerged that LDRnHBT influences bone metabolism. We investigated, whether combined LDRnHBT and exercise treatment has an impact on bone metabolism and quality of life in a study population in an age group at risk for developing osteoporosis. This randomized, double-blind, placebo-controlled trial comprised guided hiking tours and hyperthermia treatment in either radon thermal water (LDRnHBT) or radon-free thermal water (PlaceboHBT). Markers of bone metabolism, quality of life and somatic complaints were evaluated. Statistics was performed by linear regression and a linear mixed model analysis. Significant changes over time were observed for most analytes investigated as well as an improvement in self-assessed health in both groups. No significant impact from the LDRnHBT could be observed. After 6months, the LDRnHBT group showed a slightly stronger reduction of the osteoclast stimulating protein receptor activator of nuclear kB-ligand compared to the PlaceboHBT group, indicating a possible trend. A combined hyperthermia balneo and exercise treatment has significant immediate and long-term effects on regulators of bone metabolism as well as somatic complaints. LDRnHBT and placeboHBT yielded statistically equal outcomes.

Stratified medicine approaches for the treatment of musculoskeletal disorders.

Stratified medicine approaches for the treatment of musculoskeletal disorders offer opportunities to effectively target interventions to those individuals who will gain most benefit from them and minimise adverse side effects. Such approaches have been the 'holy grail' of a variety of research fields spanning epidemiological, (epi)genetic, transcriptomic, proteomic and imaging biomarkers that predict disease diagnosis, prognosis or response to treatment. In this review, we highlight the successes and opportunities for stratified medicine approaches across a range of musculoskeletal disorders, with a focus on genetic risk factors, since these are the most stable across the lifetime of each individual.

Adjunctive use of combination of super-pulsed laser and light-emitting diodes phototherapy on nonspecific knee pain: double-blinded randomized placebo-controlled trial.

Phototherapy with low-level laser therapy (LLLT) and light-emitting diode therapy (LEDT) has arisen as an interesting alternative to drugs in treatments of musculoskeletal disorders. However, there is a lack of studies investigating the effects of combined use of different wavelengths from different light sources like lasers and light-emitting diodes (LEDs) in skeletal muscle disorders. With this perspective in mind, this study aimed to investigate the effects of phototherapy with combination of different light sources on nonspecific knee pain. It was performed a randomized, placebo-controlled, double-blinded clinical trial. Eighty-six patients rated 30 or greater on the pain visual analogue scale (VAS) were recruited and included in study. Patients of LLLT group received 12 treatments with active phototherapy (with 905 nm super-pulsed laser and 875 and 640 nm LEDs, Manufactured by Multi Radiance Medical, Solon, OH, USA) and conventional treatment (physical therapy or chiropractic care), and patients of placebo group were treated at same way but with placebo phototherapy device. Pain assessments (VAS) were performed at baseline, 4th, 7th, and 10th treatments, after the completion of treatments and at 1-month follow-up visit. Quality of life assessments (SF-36®) were performed at baseline, after the completion of treatments and at 1-month follow-up visit. Our results demonstrate that phototherapy significantly decreased pain (p < 0.05) from 10th treatment to follow-up assessments and significantly improved (p < 0.05) SF-36® physical component summary at posttreatments and follow-up assessments compared to placebo. We conclude that combination of super-pulsed laser, red and infrared LEDs is effective to decrease pain and improve quality of life in patients with knee pain.

Costs and Utilities of Manual Therapy and Orthopedic Standard Care for Low-prioritized Orthopedic Outpatients of Working Age

Treatment for musculoskeletal disorders in primary care in Sweden is generally initiated with advice and medication. Second-line therapy is physiotherapy and/or injection and radiography; third-line therapy is referral to an orthopedist. Manual therapy is not routine. It is a challenge to identify patients who benefit from treatment by different specialists. The current referral strategy probably contributes to long waiting lists in orthopedic departments, which is costly and implies prolonged suffering for the patients. The aim of this health economic evaluation was to compare costs and outcomes from naprapathic manual therapy (NMT) with orthopedic standard care for common, low-prioritized, nonsurgical musculoskeletal disorders, after second-line treatment. Diagnose Related Groups were used to define the costs, and the SF-36 was encoded to evaluate the outcomes in cost per quality adjusted life years gained. Results from a 12 months' follow-up showed significantly larger improvement for the NMT than for orthopedic standard care, significantly lower mean cost per patient; 5427 SEK (*Price level 2009; 1 Euro=106,213 SEK; 1 US Dollar=76,457 SEK) (95% confidence interval, 3693-7161) compared to14298 SEK (95% confidence interval, 8322-20,274), and more gains in outcomes in cost per quality adjusted life years per patient (0.066 compared with 0.026). Thus the result is "dominant." It is plausible that improved outcomes and reasonable cost savings for low-prioritized nonsurgical outpatients would be attainable if NMT were available as an additional standard care option in orthopedic outpatient clinics.

Benefical effects of Low Level Laser Therapy in Musculoskeletal Disorders of Foot-Plantar Fasciitis, a Review

Plantar fasciitis (PF) is a common pathological condition affecting the hind foot and was first described by Wood in 1812, he attributed it to tuberculosis. By definition PF is an inflammation of the plantar fascia. There are lot of perpetuating factors for PF which can be divided under intrinsic and extrinsic factors. The major goal of therapy is to relieve pain and increase functional ability. Currently used treatments include complementary methods out of which LLLT is one of the most common. To conclude LLLT could produce pain relief by one or a combination of these mechanisms - collagen proliferation, anti-inflammatory effect, circulation enhancement, and peripheral nerve stimulation. Thus, there have been adequate physiological effects and evidences for the significant role of LLLT in musculoskeletal disorders. Therefore frequent use of LLLT should be undertaken in any clinical setup for the treatment of musculoskeletal disorders of the foot- Plantar fasciitis.

A pragmatic observational feasibility study on integrated treatment for musculoskeletal disorders: Design and protocol

Musculoskeletal disorders (MSD) comprise a wide range of conditions, associated with an enormous pain and impaired mobility, and are affecting people's lives and work. Management of musculoskeletal disorders typically involves a multidisciplinary team approach. Positive findings have been found in previous studies evaluating the effectiveness of complementary therapies, though little attention has been paid to evaluating of the effectiveness of integrated packages of care combining conventional and complementary approaches for musculoskeletal conditions in a National Health Service (NHS) setting. To determine the feasibility of all aspects of a pragmatic observational study designed: (1) to evaluate the effectiveness and cost effectiveness of integrated treatments for MSDs in an integrated NHS hospital in the UK; (2) to determine the acceptability of the study design and research process to patients; (3) to explore patients' expectation and experience of receiving integrated treatments. This is an observational feasibility study, with 1-year recruitment and 1-year follow-up, conducted in Royal London Hospital for Integrated Medicine, University College London Hospital Trust, UK. All eligible patients with MSDs newly referred to the hospital were included in the study. Interventions are integrated packages of care (conventional and complementary) as currently provided in the hospital. SF-36™ Health Survey, short form Brief Pain Inventory, Visual Analogue Scale, and modified Client Service Receipt Inventory will be assessed at 4/5 time points. Semi-structured interview/focus group will be carried out before treatment, and 1 year after commence of treatment. We intend to conduct a pragmatic observational study of integrated medical treatment of MSDs at a public sector hospital. It will inform the design of a future trial including recruitment, retention, suitability of the outcome measures and patients experiences.

Chimerism of allogeneic mesenchymal cells in bone marrow, liver, and spleen after mesenchymal stem cells infusion

Although an infusion of culture-expanded MSCs is applied in clinic to improve results of HSCs transplantation and for a treatment of musculoskeletal disorders, homing, and engraftment potential of culture-expanded MSC in humans is still obscure. We report two female patients who received allogeneic BM transplantation as a treatment of hematological diseases and a transplantation of MSCs from third-party male donors. Both patients died within one yr of infectious complications. Specimens of paraffin-embedded blocks of tissues from transplanted patients were taken. The aim of the study was to estimate possible homing and engraftment of allogeneic BM-derived MSCs in some tissues/organs of recipient. Sensitive real-time quantitative PCR analysis was applied with SRY gene as a target. MSC chimerism was found in BM, liver, and spleen of both patients. We conclude that sensitive RQ-PCR analysis is acceptable for low-level chimerism evaluation even in paraffin-embedded tissue specimens.