-
Journal of Orthopaedic Trauma May 2019We aimed to produce comprehensive guidelines and recommendations that can be utilized by orthopaedic practices as well as other specialties to improve the management of... (Review)
Review
PURPOSE
We aimed to produce comprehensive guidelines and recommendations that can be utilized by orthopaedic practices as well as other specialties to improve the management of acute pain following musculoskeletal injury.
METHODS
A panel of 15 members with expertise in orthopaedic trauma, pain management, or both was convened to review the literature and develop recommendations on acute musculoskeletal pain management. The methods described by the Grading of Recommendations Assessment, Development, and Evaluation Working Group were applied to each recommendation. The guideline was submitted to the Orthopaedic Trauma Association (OTA) for review and was approved on October 16, 2018.
RESULTS
We present evidence-based best practice recommendations and pain medication recommendations with the hope that they can be utilized by orthopaedic practices as well as other specialties to improve the management of acute pain following musculoskeletal injury. Recommendations are presented regarding pain management, cognitive strategies, physical strategies, strategies for patients on long term opioids at presentation, and system implementation strategies. We recommend the use of multimodal analgesia, prescribing the lowest effective immediate-release opioid for the shortest period possible, and considering regional anesthesia. We also recommend connecting patients to psychosocial interventions as indicated and considering anxiety reduction strategies such as aromatherapy. Finally, we also recommend physical strategies including ice, elevation, and transcutaneous electrical stimulation. Prescribing for patients on long term opioids at presentation should be limited to one prescriber. Both pain and sedation should be assessed regularly for inpatients with short, validated tools. Finally, the group supports querying the relevant regional and state prescription drug monitoring program, development of clinical decision support, opioid education efforts for prescribers and patients, and implementing a department or organization pain medication prescribing strategy or policy.
CONCLUSIONS
Balancing comfort and patient safety following acute musculoskeletal injury is possible when utilizing a true multimodal approach including cognitive, physical, and pharmaceutical strategies. In this guideline, we attempt to provide practical, evidence-based guidance for clinicians in both the operative and non-operative settings to address acute pain from musculoskeletal injury. We also organized and graded the evidence to both support recommendations and identify gap areas for future research.
Topics: Humans; Musculoskeletal Pain; Musculoskeletal System; Pain Management; Practice Guidelines as Topic; Wounds and Injuries
PubMed: 30681429
DOI: 10.1097/BOT.0000000000001430 -
Current Rheumatology Reports Apr 2000The issue of musculoskeletal injury as a trigger for fibromyalgia (FM) is controversial. The present review critically evaluates the evidence that trauma can initiate... (Review)
Review
The issue of musculoskeletal injury as a trigger for fibromyalgia (FM) is controversial. The present review critically evaluates the evidence that trauma can initiate FM, specifically addressing the scope of the problem, the issue of causality, possible pathophysiologic mechanisms, and medicolegal aspects. One major problem is the fact that most of the data come from anecdotal reports and small case series and not from controlled prospective studies. Overall data from the current literature are insufficient to indicate whether causal relationships exist between trauma and FM. However, recent reports suggest that soft tissue trauma to the neck can result in an increased incidence of FM compared with other injuries. Future studies should prospectively document the chronology of symptoms from the onset of trauma and repeatedly evaluate the patients for disability, quality of life, change in occupation, and litigation status.
Topics: Female; Fibromyalgia; Fractures, Bone; Humans; Injury Severity Score; Male; Musculoskeletal System; Prognosis; Prospective Studies; Risk Assessment; Severity of Illness Index; Whiplash Injuries; Wounds and Injuries
PubMed: 11123046
DOI: 10.1007/s11926-000-0049-z -
Ergonomics Jan 2001Based on the scientific evidence in published literature about precipitation of musculoskeletal injuries in the workplace, four theories have been proposed to explain... (Review)
Review
Based on the scientific evidence in published literature about precipitation of musculoskeletal injuries in the workplace, four theories have been proposed to explain these afflictions. Central to all theories is the presupposition that all occupational musculoskeletal injuries are biomechanical in nature. Disruption of mechanical order of a biological system is dependent on the individual components and their mechanical properties. These common denominators will be causally affected by the individual's genetic endowment, morphological characteristics and psychosocial makeup, and by the occupational biomechanical hazards. This phenomenon is explained by the Multivariate Interaction Theory. Differential Fatigue Theory accounts for unbalanced and asymmetric occupational activities creating differential fatigue and thereby a kinetic and kinematic imbalance resulting in injury precipitation. Cumulative Load Theory suggests a threshold range of load and repetition product beyond which injury precipitates, as all material substances have a finite life. Finally, Overexertion Theory claims that exertion exceeding the tolerance limit precipitates occupational musculoskeletal injury. It is also suggested that while these theories may explain the immediate mechanism of precipitation of injuries, they all operate simultaneously and interact to modulate injuries to varying degrees in different cases.
Topics: Biomechanical Phenomena; Cartilage; Elasticity; Humans; Models, Theoretical; Muscle, Skeletal; Musculoskeletal System; Risk Factors; Spine; Wounds and Injuries
PubMed: 11214897
DOI: 10.1080/00140130120716 -
Systematic Reviews May 2018Exertional lower body musculoskeletal injuries (ELBI) cost billions of dollars and compromise the readiness and job performance of military service and public safety... (Meta-Analysis)
Meta-Analysis Review
Prevention of exertional lower body musculoskeletal injury in tactical populations: protocol for a systematic review and planned meta-analysis of prospective studies from 1955 to 2018.
BACKGROUND
Exertional lower body musculoskeletal injuries (ELBI) cost billions of dollars and compromise the readiness and job performance of military service and public safety workers (i.e., tactical populations). The prevalence and burden of such injuries underscores the importance of prevention efforts during activities necessary to sustain core occupational competencies. Attempts to synthesize prevention techniques specific to tactical populations have provided limited insight on the comparative efficacy of interventions that do not modify physical training practices. There is also a need to assess the influence of sex, exposure, injury classification scheme, and study design. Thus, the primary purpose of the systematic review and planned meta-analysis detailed in this protocol is to evaluate the comparative efficacy of ELBI prevention strategies in tactical populations.
METHODS
A systematic search strategy will be implemented in MEDLINE, EMBASE, Cochrane, and CINAHL. A multi-tiered process will be used to capture randomized controlled trials and prospective cohort studies that directly assess the prevention of ELBI in tactical population(s). Extracted data will be used to compare prevention strategies and assess the influence of heterogeneity related to occupation, sex, exposure, injury characteristics, and study quality. In addition, individual risk of bias, meta-bias, and the quality of the body of evidence will be rigorously tested.
DISCUSSION
This systematic review and planned meta-analysis will comprehensively evaluate ELBI mitigation strategies in tactical populations, elucidate factors that influence responses to treatment, and assess the overall quality of the body of research. Results of this work will guide the prioritization of ELBI prevention strategies and direct future research efforts, with direct relevance to tactical, health and rehabilitation science, and human performance optimization stakeholders.
SYSTEMATIC REVIEW REGISTRATION
The systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 3 Jan 2018 (registration number CRD42018081799 ).
Topics: Emergency Responders; Exercise; Humans; Lower Extremity; Military Personnel; Musculoskeletal System; Occupational Injuries; Prevalence; Wounds and Injuries
PubMed: 29729666
DOI: 10.1186/s13643-018-0730-9 -
Bulletin of the Hospital For Joint... Sep 2018While yoga has been widely studied for its benefits to many health conditions, little research has been performed on the nature of musculoskeletal injuries occurring... (Review)
Review
While yoga has been widely studied for its benefits to many health conditions, little research has been performed on the nature of musculoskeletal injuries occurring during yoga practice. Yoga is considered to be generally safe, however, injury can occur in nearly any part of the body-especially the neck, shoulders, lumbar spine, hamstrings, and knees. As broad interest in yoga grows, so will the number of patients presenting with yoga-related injuries. In this literature review, the prevalence, types of injuries, forms of yoga related with injury, specific poses (asanas) associated with injury, and preventive measures are discussed in order to familiarize practitioners with yoga-related injuries.
Topics: Humans; Musculoskeletal System; Risk Factors; Wounds and Injuries; Yoga
PubMed: 31513523
DOI: No ID Found -
Injury Dec 2019
Topics: Cost of Illness; Global Health; Humans; Infections; Musculoskeletal Diseases; Outcome and Process Assessment, Health Care; Patient Care Management; Quality Improvement; Wounds and Injuries
PubMed: 31727403
DOI: 10.1016/j.injury.2019.11.001 -
Journal of Sport Rehabilitation Nov 2014Injuries are somewhat commonplace in highly active populations. One strategy for reducing injuries is to identify individuals with an elevated injury risk before... (Review)
Review
CLINICAL SCENARIO
Injuries are somewhat commonplace in highly active populations. One strategy for reducing injuries is to identify individuals with an elevated injury risk before participation so that remediative interventions can be provided. Preparticipation screenings have traditionally entailed strength and flexibility measures thought to be indicative of inflated injury risk. Some researchers, however, have suggested that functional movements/tasks should be assessed to help identify individuals with a high risk of future injury. One assessment tool used for this purpose is the Functional Movement Screen (FMS). The FMS generates a numeric score based on performance attributes during 7 dynamic tasks; this score is purported to reflect future injury risk. Expanding interest in the FMS has led researchers to investigate how accurately it can identify individuals with an increased risk of injury.
FOCUSED CLINICAL QUESTION
Can the Functional Movement Screen accurately identify highly active individuals with an elevated risk of injury?
Topics: Adolescent; Adult; Athletic Performance; Female; Humans; Male; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal System; Predictive Value of Tests; Reproducibility of Results; Risk Assessment; Wounds and Injuries; Young Adult
PubMed: 24458441
DOI: 10.1123/jsr.2013-0027 -
Clinical Orthopaedics and Related... Apr 2003Musculoskeletal fitness is an important and inadequately appreciated component of overall health and well-being. Wellness as it applies to strength and conditioning has... (Review)
Review
Musculoskeletal fitness is an important and inadequately appreciated component of overall health and well-being. Wellness as it applies to strength and conditioning has numerous benefits. It allows maintenance of functional independence for longer periods in older adults. It impacts the metabolic capabilities of children and adults affecting the ability to maintain an ideal body weight. It has been shown to influence the prevalence and possibly the prevention of many musculoskeletal disorders such as muscle sprains, low back pain, osteoarthritis, osteoporosis, shoulder instability, and knee stability and pain. The current author summarizes the most recent recommendations for achievement and maintenance of musculoskeletal fitness for children and adults.
Topics: Accident Prevention; Adult; Age Factors; Child; Female; Health Promotion; Health Status; Humans; Male; Musculoskeletal System; Physical Fitness; Wounds and Injuries
PubMed: 12671491
DOI: 10.1097/01.blo.0000057787.10364.4e -
Musculoskeletal injuries description of an under-recognized injury problem among military personnel.American Journal of Preventive Medicine Jan 2010Although injuries are recognized as a leading health problem in the military, the size of the problem is underestimated when only acute traumatic injuries are...
INTRODUCTION
Although injuries are recognized as a leading health problem in the military, the size of the problem is underestimated when only acute traumatic injuries are considered. Injury-related musculoskeletal conditions are common in this young, active population. Many of these involve physical damage caused by micro-trauma (overuse) in recreation, sports, training, and job performance. The purpose of this analysis was to determine the incidence of injury-related musculoskeletal conditions in the military services (2006) and describe a standardized format in which to categorize and report them.
METHODS
The subset of musculoskeletal diagnoses found to be injury-related in previous military investigations was identified. Musculoskeletal injuries among nondeployed, active duty service members in 2006 were identified from military medical surveillance data. A matrix was used to report and categorize these conditions by injury type and body region.
RESULTS
There were 743,547 injury-related musculoskeletal conditions in 2006 (outpatient and inpatient, combined), including primary and nonprimary diagnoses. In the matrix, 82% of injury-related musculoskeletal conditions were classified as inflammation/pain (overuse), followed by joint derangements (15%) and stress fractures (2%). The knee/lower leg (22%), lumbar spine (20%), and ankle/foot (13%) were leading body region categories.
CONCLUSIONS
When assessing the magnitude of the injury problem in the military services, injury-related musculoskeletal conditions should be included. When these injuries are combined with acute traumatic injuries, there are almost 1.6 million injury-related medical encounters each year. The matrix provides a standardized format to categorize these injuries, make comparisons over time, and focus prevention efforts on leading injury types and/or body regions.
Topics: Cumulative Trauma Disorders; Fractures, Bone; Humans; Incidence; Military Medicine; Military Personnel; Musculoskeletal System; Population Surveillance; Sprains and Strains; United States; Wounds and Injuries
PubMed: 20117601
DOI: 10.1016/j.amepre.2009.10.021 -
Muscle & Nerve Dec 2020The sonographic appearance of soft tissue can be altered by trauma and positional change with torsional stress. This creates challenges for ultrasonographic... (Review)
Review
The sonographic appearance of soft tissue can be altered by trauma and positional change with torsional stress. This creates challenges for ultrasonographic interpretation, because most descriptive literature and standard instructional references are displayed in anatomically neutral or other conventional positions. Knowledge of anatomic alteration and changes in sonographic appearance with torsional stress is essential for accurately assessing soft tissue abnormalities in conditions of spasticity, traumatic and post-surgical changes, and other conditions that distort musculoskeletal relationships. A systematic scanning approach to these alterations is needed for accurate diagnostic interpretation, optimizing electrode placement for electrodiagnostic techniques, effective needle placement for therapeutic ultrasound-guided procedures, and even planning for restorative surgery. This review describes expected positional changes of normal structures with torsional alteration, as well as sonographic recognition of scars, burns, hematomas, fat layer fracture, Morel-Lavallee lesions, abscesses, foreign bodies, myotendinous lesions, muscle injury and denervation, and traumatic peripheral nerve injury.
Topics: Biomechanical Phenomena; Electromyography; Foreign Bodies; Hematoma; Humans; Muscle Spasticity; Muscles; Musculoskeletal System; Peripheral Nerve Injuries; Peripheral Nerves; Soft Tissue Injuries; Tendon Injuries; Torsion Abnormality; Ultrasonography; Wounds and Injuries
PubMed: 32696511
DOI: 10.1002/mus.27025