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Emergency Medicine Clinics of North... Nov 1984This article, written for emergency room physicians, provides simple, practical guidelines for the assessment and immediate treatment of musculoskeletal injuries of the...
This article, written for emergency room physicians, provides simple, practical guidelines for the assessment and immediate treatment of musculoskeletal injuries of the multiply injured patient. The importance of the team approach and multidisciplinary management is stressed. An algorithm is provided to aid the emergency physician in performing the initial assessment and treatment in an organized fashion, with proper priorities given to musculoskeletal injuries. A systematic, anatomically oriented head-to-toe examination is suggested, performed in a cyclic fashion, correcting serious life- or limb-threatening pathology first. During the examination, special attention is required to support the cervical spine until there is radiologic evidence that the spine is stable. The emergency physician should remember that injuries that are not obvious during initial assessment may easily be missed unless the patient is re-examined in detail when the vital signs are stabilized. This is especially true in an unconscious patient with head or pelvic injuries or compartment syndromes. Guidelines are given for emergency treatment of dislocations, open fractures, and wounds because these may be the responsibility of the emergency room physician, depending upon local policies, availability of specialty staff, or constraints of time.
Topics: Emergencies; Emergency Medicine; Humans; Musculoskeletal System; Wounds and Injuries
PubMed: 6532785
DOI: No ID Found -
BMC Veterinary Research Feb 2019High prevalence of musculoskeletal disorders in racehorses and its impact on horse welfare and racing economics call for improved measures of injury diagnosis and...
BACKGROUND
High prevalence of musculoskeletal disorders in racehorses and its impact on horse welfare and racing economics call for improved measures of injury diagnosis and prevention. Serum biomarkers of bone and cartilage metabolism have previously shown promise in prediction of musculoskeletal injuries in horses. This study aimed to re-evaluate usability of the predictive serum biomarkers identified in North American Thoroughbred racehorses in a geographically distinct group of Polish Thoroughbreds.
RESULTS
Serum concentrations of bone and cartilage biomarkers: osteocalcin, c-terminal telopeptide of type I collagen, total glycosaminoglycans (GAG), chondroitin sulfate epitope and c-propeptide of type II procollagen (CPII) were evaluated in the beginning and the next 3 months of one racing season in a cohort of twenty-six 2-year-old Polish racehorses. Exit criteria were diagnosis of musculoskeletal injury, leading to > 5 days off training (n = 8), or completion of 3 study months with no training interruptions (n = 18). Normalized results and matching archival data from 35 2-year-old North American racehorses was used for logistic regression analysis to identify universal predictors of injury. Mean GAG and CPII levels were lower in injured group comparing to control, which is consistent with previous findings in racehorses. These biomarkers were also identified as predictors of injury in the mixed population model. Population origin had no significant effect on predictive value of evaluated biomarkers (Wald test p = 0.137). Decreased osteocalcin and increased c-terminal telopeptide of type I collagen levels in injured horses comparing to controls were specific for Polish population and signalized disruption in bone turnover homeostasis.
CONCLUSIONS
Changes in serum GAG and CPII in racehorses at risk of injury appear to be similar across distinct populations while dynamics of serum bone marker is more population-specific.
Topics: Animals; Biomarkers; Horses; Longitudinal Studies; Musculoskeletal System; North America; Physical Conditioning, Animal; Risk; Wounds and Injuries
PubMed: 30808359
DOI: 10.1186/s12917-019-1799-7 -
The Surgical Clinics of North America Oct 2017Musculoskeletal injuries cause a significant burden to society and can have a considerable impact on patient morbidity and mortality. It was initially thought that these... (Review)
Review
Musculoskeletal injuries cause a significant burden to society and can have a considerable impact on patient morbidity and mortality. It was initially thought that these patients were too sick to undergo surgery and later believed that they were too sick not to undergo surgery. The pendulum has subsequently swung back and forth between damage control orthopedics and early total care for polytrauma patients with extremity injuries and has settled on providing early appropriate care (EAC). The decision-making process in providing EAC is reviewed in an effort to optimize patient outcomes following severe extremity trauma.
Topics: Advanced Trauma Life Support Care; Fractures, Bone; Health Care Costs; Humans; Joint Dislocations; Musculoskeletal System; Orthopedic Procedures; Vascular System Injuries; Wounds and Injuries
PubMed: 28958361
DOI: 10.1016/j.suc.2017.06.005 -
Emergency Medicine Clinics of North... May 2021Geriatric trauma patients will continue to increase in prevalence as the population ages, and many specific considerations need to be made to provide appropriate care to... (Review)
Review
Geriatric trauma patients will continue to increase in prevalence as the population ages, and many specific considerations need to be made to provide appropriate care to these patients. This article outlines common presentations of trauma in geriatric patients, with consideration to baseline physiologic function and patterns of injury that may be more prevalent in geriatric populations. Additionally, the article explores specific evidence-based management practices, the significance of trauma team and geriatrician involvement, and disposition decisions.
Topics: Accidental Falls; Aged; Aging; Cardiovascular Diseases; Comorbidity; Frailty; Geriatricians; Health Services Accessibility; Humans; Lung Diseases; Musculoskeletal Diseases; Neurocognitive Disorders; Pain Management; Patient Discharge; Trauma Centers; Vital Signs; Wounds and Injuries
PubMed: 33863458
DOI: 10.1016/j.emc.2021.01.002 -
Current Rheumatology Reviews 2019Musculoskeletal Injury (MSKI), a common problem in both military and physically active civilian populations, has been suggested to result from both extrinsic and...
BACKGROUND
Musculoskeletal Injury (MSKI), a common problem in both military and physically active civilian populations, has been suggested to result from both extrinsic and intrinsic factors.
OBJECTIVE
To investigate prospectively whether gait biomechanics, aerobic fitness levels and smoking status as well as entry military selection test variables can be used to predict MSKI development during recruit training.
METHODS
British infantry male recruits (n = 562) were selected for the study. Plantar pressure variables, smoking habit, aerobic fitness as measured by a 1.5 mile run time and initial military selection test (combination of fitness, Trainability score) were collected prior to commencement of infantry recruit training. Injury data were collected during the 26 week training period.
RESULTS
Incidence rate of MSKI over a 26 week training period was 41.28% (95 % CI: 37.28 - 45.40%). The injured group had a higher medial plantar pressure (p < 0.03), shorter time to peak heel rotation (p < 0.02), current smoking status (p < 0.001) and a slower 1.5 mile run time (p < 0.03). In contrast, there were no significant differences (p > 0.23) in lateral heel pressure, age, weight, height, BMI and military selection test. A logistic regression model predicted MSKI significantly (p= 0.03) with an accuracy of 34.50% of all MSK injury and 76.70% of the non-injured group with an overall accuracy of 69.50%.
CONCLUSION
The logistic regression model combining the three risk factors was capable of predicting 34.5% of all MSKI. A specific biomechanical profile, slow 1.5 mile run time and current smoking status were identified as predictors of subsequent MSKI development. The proposed model could include evaluation of other potential risk factors and if validated then further enhance the specificity, sensitivity and applicability.
Topics: Adolescent; Age Factors; Biomechanical Phenomena; Gait; Humans; Incidence; Male; Military Personnel; Physical Fitness; Risk Factors; Wounds and Injuries; Young Adult
PubMed: 29708075
DOI: 10.2174/1573397114666180430103855 -
Seminars in Arthritis and Rheumatism Feb 1997This study describes in modern medical terms a traumatic hip injury suffered by the Biblical patriarch Jacob approximately 3,500 years ago. The case history is based on...
This study describes in modern medical terms a traumatic hip injury suffered by the Biblical patriarch Jacob approximately 3,500 years ago. The case history is based on the original Hebrew text found in the Bible book of Genesis (Chapter 32:25-33) as interpreted by traditional Jewish commentaries on the Bible. Jacob sustained a hip injury in hand-to-hand combat with an adversary or through an intense physiological reaction to a prophetic vision of such a battle. He appears to have sustained neurological injury to his sciatic nerve as well as musculoskeletal damage to his hip. These injuries caused a temporary limping gait. Jacob probably sustained a neurapraxia of the sciatic nerve. The differential diagnosis of his musculoskeletal hip injury includes hip dislocation, fracture, soft tissue trauma, and articular pathology.
Topics: Bible; Hip Injuries; History, Ancient; Judaism; Religion and Medicine; Sciatic Nerve; Wounds and Injuries
PubMed: 9062949
DOI: 10.1016/s0049-0172(97)80004-2 -
Osteoarthritis and Cartilage Nov 2015Inflammation is a variable feature of osteoarthritis (OA), associated with joint symptoms and progression of disease. Signs of inflammation can be observed in joint... (Review)
Review
Inflammation is a variable feature of osteoarthritis (OA), associated with joint symptoms and progression of disease. Signs of inflammation can be observed in joint fluids and tissues from patients with joint injuries at risk for development of post-traumatic osteoarthritis (PTOA). Furthermore, inflammatory mechanisms are hypothesized to contribute to the risk of OA development and progression after injury. Animal models of PTOA have been instrumental in understanding factors and mechanisms involved in chronic progressive cartilage degradation observed after a predisposing injury. Specific aspects of inflammation observed in humans, including cytokine and chemokine production, synovial reaction, cellular infiltration and inflammatory pathway activation, are also observed in models of PTOA. Many of these models are now being utilized to understand the impact of post-injury inflammatory response on PTOA development and progression, including risk of progressive cartilage degeneration and development of chronic symptoms post-injury. As evidenced from these models, a vigorous inflammatory response occurs very early after joint injury but is then sustained at a lower level at the later phases. This early inflammatory response contributes to the development of PTOA features including cartilage erosion and is potentially modifiable, but specific mediators may also play a role in tissue repair. Although the optimal approach and timing of anti-inflammatory interventions after joint injury are yet to be determined, this body of work should provide hope for the future of disease modification tin PTOA.
Topics: Animals; Cartilage, Articular; Disease Progression; Humans; Inflammation; Inflammation Mediators; Joints; Osteoarthritis; Wounds and Injuries
PubMed: 26521728
DOI: 10.1016/j.joca.2015.08.015 -
Journal of Dance Medicine & Science :... 2012The objective of this study was to assemble and synthesize the best available literature from 2004 to 2008 on musculoskeletal injury and pain in dancers. MEDLINE and... (Review)
Review
The objective of this study was to assemble and synthesize the best available literature from 2004 to 2008 on musculoskeletal injury and pain in dancers. MEDLINE and CINAHL were the primary sources of data. Indexed terms such as dance, dancer, dancing, athletic injuries, occupational injuries, sprains and strains, musculoskeletal diseases, bone density, menstruation disturbances, and eating disorders were used to search the databases. Citations were screened for relevance using a priori criteria, and relevant studies were critically reviewed for scientific merit by the best-evidence synthesis method. After screening, 19 articles were found to be scientifically admissible. Data from accepted studies were abstracted into evidence tables relating to: prevalence and associated factors; incidence and risk factors; intervention; and injury characteristics and prognosis of musculoskeletal injury and pain in dancers. Principal findings included: a high prevalence and incidence of lower extremity, hip and back injuries; preliminary evidence that psychosocial and psychological issues such as stress and coping strategies affect injury frequency and duration; history of a previous lateral ankle sprain is associated with an increased risk of ankle sprain in the contralateral ankle in dance students; fatigue may play a role in ACL injury in dancers; acute hamstring strains in dancers affect tendon more than muscle tissue, often resulting in prolonged absence from dance. It is concluded that, while there are positive developments in the literature on the epidemiology, diagnosis, prognosis, treatment, and prevention of MSK injuries and pain in dancers, much room for improvement remains. Suggestions for future research are offered.
Topics: Dancing; Humans; Incidence; Muscle, Skeletal; Pain; Prevalence; Prognosis; Wounds and Injuries
PubMed: 22687721
DOI: No ID Found -
World Journal of Surgery Apr 2020Though declining in the recent decades, high-energy musculoskeletal trauma remains a major contributor to the burden of disease in high-income countries (HICs). However,... (Review)
Review
INTRODUCTION TO THE PROBLEM
Though declining in the recent decades, high-energy musculoskeletal trauma remains a major contributor to the burden of disease in high-income countries (HICs). However, due to limitations in the available body of the literature, evaluation of this burden is challenging. The purpose of this review is to assess: (1) the current epidemiologic data on the surgical burden of high-energy musculoskeletal trauma in HICs; (2) the current data on the economic impact of high-energy musculoskeletal trauma; and (3) potential strategies for addressing gaps in musculoskeletal trauma care for the future.
REVIEW OF LITERATURE
In 2016, mortality from road traffic injuries (RTIs) between the ages of 15-49 was reported to be 9.5% (9.0-9.9) in high-income countries, accounting for approximately 255 million DALYs. While RTIs do not fully capture the extent of high-energy musculoskeletal trauma, as the most common mechanism, they serve as a useful indicator of the impact on the surgical and economic burden. In 2009, the global losses related to RTIs were estimated to be 518 billion USD, costing governments between 1 and 3% of their gross domestic product (GDP). In the last decade, both the total direct per-person healthcare cost and the incremental direct per-person costs for those with a musculoskeletal injury in the USA rose 75 and 58%, respectively.
FUTURE DIRECTIONS
ADDRESSING THE GAPS: While its impact is large, research on musculoskeletal conditions, including high-energy trauma, is underfunded compared to other fields of medicine. An increased awareness among policy makers and healthcare professionals of the importance of care for the high-energy musculoskeletal trauma patient is critical. Full implementation of trauma systems is imperative, and metrics such as the ICD-DALY have the potential to allow for real-time evaluation of prevention and treatment programs aimed to reduce injury-related morbidity and mortality. The dearth in knowledge in optimal and cost-effective post-acute care for high-energy musculoskeletal trauma is a reason for concern, especially since almost half of the costs are attributed to this phase of care. Multidisciplinary rehabilitation teams as part of a musculoskeletal trauma system may be of interest to decrease further the long-term negative effects and the economic burden of high-energy musculoskeletal trauma.
Topics: Accidental Falls; Accidents, Traffic; Adolescent; Adult; Aged; Developed Countries; Female; Gross Domestic Product; Health Care Costs; Humans; Income; Male; Middle Aged; Musculoskeletal System; Quality-Adjusted Life Years; Wounds and Injuries; Young Adult
PubMed: 30043200
DOI: 10.1007/s00268-018-4742-3 -
Journal of Science and Medicine in Sport Oct 2021To provide an overall perspective on musculoskeletal injury (MSI) epidemiology, risk factors, and preventive strategies in military personnel. (Review)
Review
OBJECTIVES
To provide an overall perspective on musculoskeletal injury (MSI) epidemiology, risk factors, and preventive strategies in military personnel.
DESIGN
Narrative review.
METHODS
The thematic session on MSIs in military personnel at the 5th International Congress on Soldiers' Physical Performance (ICSPP) included eight presentations on the descriptive epidemiology, risk factor identification, and prevention of MSIs in military personnel. Additional topics presented were bone anabolism, machine learning analysis, and the effects of non-steroidal anti-inflammatory drugs (NSAIDs) on MSIs. This narrative review focuses on the thematic session topics and includes identification of gaps in existing literature, as well as areas for future study.
RESULTS
MSIs cause significant morbidity among military personnel. Physical training and occupational tasks are leading causes of MSI limited duty days (LDDs) for the U.S. Army. Recent studies have shown that MSIs are associated with the use of NSAIDs. Bone MSIs are very common in training; new imaging technology such as high resolution peripheral quantitative computed tomography allows visualization of bone microarchitecture and has been used to assess new bone formation during military training. Physical activity monitoring and machine learning have important applications in monitoring and informing evidence-based solutions to prevent MSIs.
CONCLUSIONS
Despite many years of research, MSIs continue to have a high incidence among military personnel. Areas for future research include quantifying exposure when determining MSI risk; understanding associations between health-related components of physical fitness and MSI occurrence; and application of innovative imaging, physical activity monitoring and data analysis techniques for MSI prevention and return to duty.
Topics: Clinical Decision-Making; Humans; Incidence; Machine Learning; Military Personnel; Musculoskeletal Diseases; Physical Fitness; Risk Factors; United States; Wounds and Injuries
PubMed: 33824080
DOI: 10.1016/j.jsams.2021.03.016