Medicine › Rehabilitation

Musculoskeletal Disorders and Rehabilitation

Works Count: 51873

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Description

This cluster of papers focuses on the inadequacies and challenges in musculoskeletal education within medical training programs. It addresses the need for improved curriculum, training, and clinical skills development in areas such as orthopaedics, rheumatology, and rehabilitation medicine, particularly in primary care settings.

Keywords

Musculoskeletal Medicine; Medical Education; Curriculum; Training; Orthopaedics; Rheumatology; Primary Care; Clinical Skills; Rehabilitation Medicine; Competency

Estimates of the prevalence of selected arthritic and musculoskeletal diseases in the United States.

1989-04-01

Reva C. Lawrence , Marc C. Hochberg , Jennifer L. Kelsey +4 more

The National Arthritis Data Workgroup focused its studies primarily on joint disease with the addition of osteoporosis which is a frequently occurring musculoskeletal condition and public health problem. We used … The National Arthritis Data Workgroup focused its studies primarily on joint disease with the addition of osteoporosis which is a frequently occurring musculoskeletal condition and public health problem. We used national data sets as well as published studies to estimate prevalence in the United States. We report on prevalence rather than incidence because of the difficulty in defining the point of onset and because primary national data sources currently available are concerned with disease prevalence.

Campbell's Operative Orthopaedics

1956-11-01

S. Terry Canale

The tibial plateau fracture. The Toronto experience 1968--1975.

1979-01-01

J. Schatzker , Robert McBroom , David Bruce

Ankle arthrodesis. Long-term follow-up with gait analysis.

1979-10-01

J M Mazur , EMILY N. SCHWARTZ , S.R. Simon

A functional assessment of twelve patients after ankle arthrodesis for post-traumatic arthritis was carried out by means of an extensive clinical evaluation and gait analysis after an average follow-up of … A functional assessment of twelve patients after ankle arthrodesis for post-traumatic arthritis was carried out by means of an extensive clinical evaluation and gait analysis after an average follow-up of eight years. A weighted point system was developed to grade ankle function clinically. The data on gait analysis were examined to determine the effect of arthrodesis of the ankle on the over-all pattern of walking. Under conditions of normal daily living while wearing shoes, all patients functioned well after arthrodesis. The gait-analysis data obtained with the patients wearing shoes showed excellent gait characteristics, and the ankle motion that had been lost was compensated for by: (1) motion of the small joints of the ipsilateral foot; (2) altered motion of the ankle in the contralateral limb; and (3) appropriate footwear. While the patients were walking barefooted, some adverse effects of fusion of the ankle were evident. Velocity of gait was slowed and the length of stride was shortened in all twelve patients. One patient whose ankle had been fused in an equinus position had a back-knee deformity during stance phase, and another walked only on his toes when he was without shoes. The gait patterns of all patients were markedly improved when they were wearing shoes with appropriate heel heights.

Functional Reconstruction of the Foot and Ankle.

2001-02-01

Robert B. Anderson

Sigvard T. Hansen, Jr. Philadelphia: Lippincott Williams and Wilkins; 2000. $159.00, 544 pp. The popularity of foot and ankle surgery has increased over the past decade, and this has led … Sigvard T. Hansen, Jr. Philadelphia: Lippincott Williams and Wilkins; 2000. $159.00, 544 pp. The popularity of foot and ankle surgery has increased over the past decade, and this has led to a number of texts offering instruction in the management of many entities. The question of which text is the most appropriate for any given individual is often a difficult one to answer. This text represents the commendable effort by a single author to place his experiences and philosophies regarding foot and ankle surgery into print. Dr. Hansen has long been considered an innovative educator in the field of orthopaedic trauma; he has pioneered numerous surgical techniques and popularized AO principles in this country. More recently, he …

The World Report on Disability

2012-05-03

Walter R. Frontera

American Journal of Physical Medicine & Rehabilitation 91(7):p 549, July 2012. | DOI: 10.1097/PHM.0b013e318255982e American Journal of Physical Medicine & Rehabilitation 91(7):p 549, July 2012. | DOI: 10.1097/PHM.0b013e318255982e

Medicine and Science in Sports and Exercise-1980

1980-01-01

Charles M. Tipton

The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties

2001-10-01

Sara McConnell , Pamela Kolopack , Aileen M. Davis

Arthritis and Allied Conditions: A Textbook of Rheumatology

1985-11-08

Charley J. Smyth

During the remarkable period of the evolution of rheumatology over the past 45 years, this comprehensive textbook has won a preeminent position as the classic and standard American treatise on … During the remarkable period of the evolution of rheumatology over the past 45 years, this comprehensive textbook has won a preeminent position as the classic and standard American treatise on arthritis and allied connective-tissue diseases. This well-earned reputation for excellence has not only been maintained but improved in this latest revised tenth edition. The editor, Daniel J. McCarty, MD, an esteemed rheumatologist highly respected for his research on crystal-induced synovitis and an experienced writer, has been assisted by 116 universally respected authors. This prestigious one-volume source book has been largely rewritten, brought up-to-date, and enlarged by the additions of 30 new contributors and 16 new chapters. The long list of distinguished contributors reads like Who's Who in the rapidly expanding specialty of American rheumatology. The organization of this volume into clear sections has followed that used in previous editions but has been vastly expanded to incorporate the complete spectrum of

Care and management of osteoarthritis in adults: summary of NICE guidance

2008-02-28

Philip G. Conaghan , John Dickson , Robert Grant

Osteoarthritis refers to a syndrome of joint pain accompanied by functional limitation and reduced quality of life. It is the most common form of arthritis and one of the leading … Osteoarthritis refers to a syndrome of joint pain accompanied by functional limitation and reduced quality of life. It is the most common form of arthritis and one of the leading causes of pain and disability in the United Kingdom. The published evidence for osteoarthritis treatment has many limitations—typically, short duration studies using single drug treatments. However, people with osteoarthritis need to be aware of the treatments that represent core management and of the range of additional treatments available. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the care and management of osteoarthritis in adults.1 NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, recommendations are based on the guideline development group's opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets. ### Holistic assessment and management of symptomatic osteoarthritis ### Core treatments Provide advice on the following to all people with symptomatic osteoarthritis:

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Kelley’s Textbook of Rheumatology

2009-08-25

George E. Ehrlich

Projections of US prevalence of arthritis and associated activity limitations

2005-12-29

Jennifer M. Hootman , Charles G. Helmick

Abstract Objective To update the projected prevalence of self‐reported, doctor‐diagnosed arthritis and arthritis‐attributable activity limitations among US adults ages 18 years and older from 2005 through 2030. Methods Baseline age‐ … Abstract Objective To update the projected prevalence of self‐reported, doctor‐diagnosed arthritis and arthritis‐attributable activity limitations among US adults ages 18 years and older from 2005 through 2030. Methods Baseline age‐ and sex‐specific prevalence rates of arthritis and activity limitation, using the latest surveillance case definitions, were estimated from the 2003 National Health Interview Survey, which is an annual, cross‐sectional, population‐based health interview survey of ∼31,000 adults. These estimates were used to calculate projected arthritis prevalence and activity limitations for 2005–2030 using future population projections obtained from the US Census Bureau. Results The prevalence of self‐reported, doctor‐diagnosed arthritis is projected to increase from 47.8 million in 2005 to nearly 67 million by 2030 (25% of the adult population). By 2030, 25 million (9.3% of the adult population) are projected to report arthritis‐attributable activity limitations. In 2030, >50% of arthritis cases will be among adults older than age 65 years. However, working‐age adults (45–64 years) will account for almost one‐third of cases. Conclusion By 2030, the number of US adults with arthritis and its associated activity limitation is expected to increase substantially, resulting in a large impact on individuals, the health care system, and society in general. The growing epidemic of obesity may also significantly contribute to the future burden of arthritis. Improving access and availability of current clinical and public health interventions aimed at improving quality of life among persons with arthritis through lifestyle changes and disease self‐management may help lessen the long‐term impact.

Observations of the Function of the Shoulder Joint

1996-09-01

Verne T. Inman , John B. Saunders , Leroy C. Abbott

Attendance in the concert hall or opera house brings the expectation of hearing equally talented individuals playing or singing together to produce the effect desired by the composer. Such ensemble … Attendance in the concert hall or opera house brings the expectation of hearing equally talented individuals playing or singing together to produce the effect desired by the composer. Such ensemble performances are not often encountered in medical literature. The classic article for this symposium is an example of such an exception. John B de CM Saunders came to the University of California Medical School in San Francisco from Edinburgh's Royal Hospital for Sick Children. Born in Grahamstown, South Africa, he received a comprehensive classical education before going to the University of Edinburgh to study medicine. After graduation, he had postgraduate training in orthopaedic surgery. His initial appointment in San Francisco was in the Department of Anatomy. His interest in the history of medicine was shown by his important studies of Vesalius and Leonardo da Vinci. A man of great ability and energy, de CM Saunders was at 1 time the head of 2 departments, Anatomy and the History of Medicine, and dean of the medical school. Later he held the position of provost of the San Francisco campus. Leroy C. Abbott was born in Madelia, MN. After graduating from the University of California School of Medicine in 1914, he spent a year as a house officer in orthopaedic surgery at the Massachusetts General Hospital in Boston before returning to his alma mater. Immediately after the United States entered into World War I, he went overseas as a member of the Goldthwaite Unit, the group of young American orthopaedic surgeons recruited by Joel E. Goldthwaite. During his period in the service, Abbott worked with Harold Stiles and Robert Jones. After the war, Abbott spent time on the faculty of the University of Michigan in Ann Arbor and Washington University in St. Louis before returning to San Francisco to become Chairman of the Division of Orthopaedic Surgery. Under his aegis, the division grew to become a great department. Abbott was a pioneer in the development of leg lengthening procedures. His work in the production of teaching films on surgical approaches made a valuable contribution to the teaching of residents everywhere. Upon Abbott's retirement, he was succeeded by his pupil and colleague, Verne T. Inman who was born in San Jose, CA, and educated at the University of California, San Francisco. Inman's area of interest was functional anatomy. He was 1 of the first to use electromyography to analyze muscle function. After World War II, he became interested in lower limb prosthetics. This led to the founding of the Biomechanics Laboratory at the University of California in San Francisco and Berkeley which he directed for 16 years. The following article, of necessity, has been greatly abbreviated. Anyone with a serious interest in the subject should seek out and read the original in its entirety. It reflects the collective wisdom of 3 gifted observers and serious students of kinesiology. Leonard F. Peltier, MD, PhD The manifest complexity of the mechanism of the shoulder joint is evident to anyone who has watched the progression of what Codman has so aptly described as "scapulohumeral rhythm". This rhythm is participated in by the whole complex of joints constituting the shoulder girdle. Therefore, the term shoulder joint is somewhat misleading, unless we clearly bear in mind that this expression includes no less than four different joints: the sternoclavicular, the acromioclavicular, the scapulothoracic, and the glenohumeral; and that motion at the shoulder is the sum of movement contributed by synchronous participation of all these joint units. In the development of rational procedures for the correction and reconstruction of disabilities affecting the shoulder mechanism, it is necessary to break down this complex into its various components in order that we may uncover some of the fundamental principles underlying their action. Many such analyses have been carried out in the past, but none, so far as we are aware, have attempted to solve or derive a comprehensive picture of the whole. Much of the early work is very contradictory, and nearly all is incomplete, due to lack of an adequate experimental method. For this reason many misconceptions exist, owing to the too ready facility with which investigators have evolved conceptions based on a priori reasoning from the inert cadaver. In studying functional mechanisms, there is only one touch-stone to which we can appeal, and that is the living body. It is this appeal which enlivens the observations derived from the cadaver to which nonetheless we are compelled to turn on occasion for certain basic information. It is with such dynamic considerations uppermost, acting as the unifying theme, that we have attacked the problem anew, so as to obtain an unbiased and more vital point of view. Logically and chronologically, we have, therefore, examined the shoulder mechanism from several aspects,-namely the comparative anatomical, the roentgenographic analysis of motion, the theoretical force requirements, and the action current potential derived from the living muscle in motion, and from the data so obtained have attempted a resynthesis of the whole. Our studies have been rendered possible, thanks to the generosity of The National Foundation for Infantile Paralysis to whose support we acknowledge our deep indebtendness. MOTION AT THE SHOULDER JOINT An essential preliminary to the analysis of the mechanism of the shoulder is an understanding of the sequence of motion which occurs at its component joints. The shoulder joint complex is composed of four independent articulations,-the sternoclavicular, acromioclavicular, scapulothoracic, and glenohumeral joints. While each of these is an independent entity, capable of independent motion, all contribute their share to the total in the normal functional mechanism of the extremity. Furthermore, the participation of each of these joints in the entire movement is simultaneous, and not successive. We have employed for the elucidation of these movements both roentgenography and the direct insertion of pins into the bones of the living subject. Elevation of the extremity, both in flexion and in abduction, at the glenohumeral articulation is simultaneously accompanied by scapulothoracic movement, an arrangement which critically enhances the power of the attendant muscles. In the first 30 to 60 degrees of elevation, the scapula seeks, in relationship to the humerus, a precise position of stability which it may obtain in one of several ways. Either the scapula remains fixed, motion occurring at the glenohumeral joint until the stable position is reached, or the scapula moves laterally or medially on the chest wall, or in rare instances oscillates until stabilization is attained. Hence the early phase of motion is highly irregular, and is characteristic for each individual. It would seem to depend upon the habitual position which the scapula occupies in the subject when at rest. This phase of motion is related to the setting action of the muscles, and we have, therefore, termed it "the setting phase". Once 30 degrees of abduction, or 60 degrees of forward flexion has been reached, the relationship of scapular to humeral motion remains remarkably constant. Thereafter a ratio of two of humeral to one of scapular motion obtains; and thus between 30 and 170 degrees of elevation, for every 15 degrees of motion, 10 degrees occurs at the glenohumeral joint, and 5 degrees by rotation of the scapula on the thorax. It should be clearly recognized that the orthodox teaching on these motions is entirely incorrect. The standard textbooks state that glenohumeral motion occurs up to the right angle and that thereafter further elevation is brought about by rotation of the scapula. Roentgenography and examination of the living prove beyond a doubt that scapular and humeral motion are simultaneously continuous. As this ratio pertains, it is evident that the total range of scapular motion is not more than 60 degrees, nor that of the glenohumeral joint greater than 120 degrees. Under special and abnormal conditions, the motions of either one of these two joints can occur independently. For example, when the scapula is fixed, it is possible to raise the arm actively to the right angle, and passively to 120 degrees. However, observation and measurement demonstrate that the loss of the effective bone leverage, owing to lack of scapular participation, consequently diminishes power by a third. It should be pointed out in passing that, for free and full elevation of the extremity, lateral rotation of the humerus is essential. Clavicular motion is more complicated than has been hitherto suspected. The continuous rotation of the scapula on the thoracic wall during elevation of the extremity is only possible because of the motion permitted at the two clavicular joints, and the phase and amount of movement is unequally distributed between them. Elevation of the arm is accompanied by elevation of the clavicle at the sternoclavicular joint. This movement begins early and is almost complete during the first 90 degrees, when for every 10 degrees of elevation of the arm, there are 4 degrees of elevation of the clavicle. Above 90 degrees, clavicular motion at this joint is almost negligible. Motion at the acromioclavicular joint contrasts markedly with that found at the sternoclavicular joint. The total range is approximately 20 degrees and occurs both early, in the first 30 degrees of abduction, and late, after 135 degrees of elevation of the arm. Between these two points there is almost no motion of this joint. The sum of the movements at the sternoclavicular and acromioclavicular joints is naturally equal to the range of movement permitted the scapula, the two bones being welded together by means of their ligamentous attachments. For this reason, it was difficult to understand how motion of such extent could occur at the acromioclavicular joint, in view of the fact that the clavicle is rigidly attached at its lateral extremity to the scapula through the medium of the coracoclavicular ligament. For motion to occur at the acromioclavicular joint in the plane of elevation of the arm, elongation of this ligament would appear to be necessary, and on first sight this would seem to be impossible. Because of the marked curvature of the outer third of the clavicle, we could envisage a relative elongation of the coracoclavicular ligament, only by the clavicle rotating on its long axis, so as to allow this curvature to act as a crankshaft. We were able to measure the excursion of this rotation experimentally by insertion of a pin into the bone of the living subject. We found that clavicular rotation was a fundamental feature of shoulder motion, for by manually preventing rotation of the pin, the range of motion at the shoulder was restricted to 110 degrees. These findings bore out our experience of three years before, when we attempted to treat a case of acromioclavicular dislocation by nailing the joint. We found that, thereafter, this patient was unable to elevate the extremity beyond 60 degrees. We were, therefore, particularly interested in an article by Caldwell in which he discusses a series of cases treated by arthrodesis of the acromioclavicular joint. We would prognosticate that, if fusion of this joint was carried out with the arm elevated to less than 30 degrees, there would be limitation of shoulder-joint motion to slightly below 90 degrees. Whereas, if fusion was carried out with the arm abducted above 30 degrees, the extremity could be carried at least to 135 degrees without difficulty. Even under these circumstances, however, we would expect some limitation of motion between 135 and 180 degrees of elevation. In addition, knowledge of the significance of this joint suggests the possibility of increasing the functional range of abduction, after arthrodesis of the glenohumeral joint, by excision of the outer end of the clavicle. MECHANICAL REQUIREMENTS FOR SHOULDER-JOINT MOTION After measuring by means of roentgenographic studies and direct methods the precise relationships of the bony parts to one another, and the relative positions which they occupy during motion, we were able to set up equations and to calculate the force requirements for the maintenance of the extremity during flexion or abduction. By the technique employed, these calculations were arrived at by theoretical analysis, and the results were then checked on a force model which yielded empirical data. To establish equilibrium at the glenohumeral joint in any position of the arm, a minimum of three forces is required. One of these is represented by the weight of the extremity, acting at the center of gravity of the limb; the second, the abducting musculature represented predominantly by the deltoid; and the third, the resultant of the former forces acting through the center of rotation in a direction opposite to that of the deltoid. This last force is, in turn, obviously the resultant of other components, for there is no muscle capable of exercising pull in the direction which it occupies. These components are undoubtedly: first, the pressure and friction of the head of the humerus at the glenoid; and, second, the downward pull of muscles-such as the subscapularis, infraspinatus, and teres minor-whose action is below the center of rotation of the humeral head. In order to represent them, we therefore selected two forces, one acting at right angles to the plane of the glenoid, and the other, parallel to the axillary border of the scapula. The theoretical and empirical values for these forces were determined in the range from 30 degrees to 180 degrees of elevation, as below 30 degrees individual variation is so great as to make the findings highly questionable. The curve representing the force requirements for elevation, almost a pure sine wave, reaches its summit at 90 degrees of elevation, where the magnitude of the force required represents 8.2 times the weight of the extremity. It then falls progressively to zero at 180 degrees, because, when the extremity is in the exact vertical position above the head, no force is theoretically required to maintain that position. In the living mechanism, muscle power is expended throughout the full range of motion. The second force is the resultant which we have broken up into two components representing, on the one hand, active force in the form of the downward pull of infraspinous muscles and, on the other, the passive resistance of pressure and friction. The active component, shown in myographic recordings of the muscles during motion, is one of the greatest significance and importance. It establishes, with the pull of the deltoid, the essential force couple necessary for elevation of the extremity. This force reaches its maximum at 60 degrees, where its magnitude is 9.6 times the weight of the extremity*, a pull greater than that of the elevating force. Beyond 90 degrees the force falls rapidly, reaching zero at 135 degrees. The pressure and friction against the glenoid is a force of considerable size, which reaches its summit at 90 degrees of elevation, where it represents no less than 10.2 times the weight of the extremity. We should like to emphasize the importance of the muscle force couple as an essential principle in the mechanics of elevation, as this same principle will be seen to operate in scapular rotation. Here, as at the glenohumeral joint, three essential forces participate the mechanism. The first of these is the force necessary to counteract the weight of the entire shoulder girdle which, therefore, acts in a vertical and upward direction. The other two forces establish the rotary couple, one acting from the region of the acromion process in a medial direction, and the other from the inferior angle in an outward or forward direction. The force acting on the inferior angle is represented predominantly by the serratus anterior. That acting on the acromion is in part passive, and in part active. The passive component is resisted by the antagonistic pressure of the clavicle. The active or kinetic component is supplied by the upper portion of the trapezius, which must, however, also, act in supporting the weight of the pectoral girdle. The force acting from the acromion is a resultant, fulfilling the requirements of both the supportive and the rotary roles. The weight of the extremity is a constant during the entire range of motion, and is consequently represented by a straight line. The forces necessary to establish the upper and lower components of the rotary force couple are equal but opposite in direction, and reach their summit at 90 degrees of elevation, theoretically falling to zero at 180 degrees. Owing to the changes in position of the scapula during elevation, the resultant of the supportive and rotary components supplied by the upper portion of the trapezius was found to fluctuate in its angle of action. This fluctuation reveals an interesting mechanism in the action of the trapezius. In the resting position, the muscle is entirely supportive. With the first 35 degrees of elevation, the angle of action of the muscle changes, so that its force is equally divided between the supportive and the rotary rôles. From 35 to 140 degrees, the muscle is increasingly more effective as a rotator, with its maximum power at 90 degrees, and beyond 140 degrees its rotary efficiency decreases and its supportive rises. This complicated mechanism of action of the upper trapezius is achieved by simple elevation of the shoulder girdle as a whole. In consequence, where the supportive rôle is the more important, the muscle acts predominantly for this purpose. As rotation of the scapula develops, progressive changes in the angle of action of the muscle enable it to serve the requirements of the rotary couple more effectively. The magnitude of the forces rotating the scapula, in contrast to those acting on the glenohumeral joint, is very much smaller. The forces reach their maximum at about 90 degrees, when they are approximately only twice the weight of the extremity. MYOGRAPHIC STUDIES In order to correlate the findings and test the validity of the conclusions reached in the comparative anatomical studies and by analysis of the mechanical-force requirements of the shoulder mechanism, we have employed an entirely new method of approach. The method consists in sampling the muscle activity developed during motion in the living subject. The electrical action potentials of the muscle are drawn off through electrodes, implanted in their substance. The differences in potential so obtained are amplified and mechanically recorded. The procedure is valuable, not only for analyzing the activity of an individual muscle during motion, but also for the study of the phase of action of muscle groups participating in any free coordinated movement. The use of six separate amplifiers has enabled us to examine the action of a like number of muscles simultaneously. Experiments have determined that a direct relationship between the tension developed in a muscle and the action current potential, as recorded by the magnitude of the amplitude, exists. This relationship is not however a linear one, for in normal muscle the action potential rises more rapidly than the increase in tension, the precise relationship being the function of the square, and is expressed as a quadratic equation. It is interesting to observe that muscles affected by poliomyelitis behave somewhat differently. In postpoliomyelitic paralysis with increasing tension, the action potential rises far more rapidly than in the normal. The shape of the curve is changed and the relationship now becomes logarithmic. We have not been able as yet to establish the significance of these changes in the abnormal muscle. As the sampling of muscle depends upon the distance between the inserted electrodes, we are thus able to record the activity either of the entire muscle or of any of its parts. This is an important asset, because it reveals that different portions of the same muscle differ in their degree of activity, depending upon the precise motion carried out. From the records of their action potential and phase of activity, we have been able to construct, based upon averages from four to twenty individual observations, a series of curves for each muscle participating in the shoulder motion. Analysis of these reveals that we must group the muscles into functional rather than into topographical groups. The Abductors and Flexors of the Humerus The Deltoid The deltoid muscle exhibits its greatest activity between 90 and 180 degrees of elevation, the curve plateauing between these points. In flexion, the total potential is of less amplitude than in the corresponding curve for abduction. It reaches an initial peak at 110 degrees, plateaus to 130 degrees, and finally rises abruptly to attain the same level as that for abduction when the arm is fully elevated above the head. Pectoralis Major The pectoralis major exhibits differences in activity in the various portions of the muscle, and these in turn vary with the type of motion carried out. In abduction no portion of the pectoralis major is active. In forward flexion, the clavicular head is most active, reaching a primary peak at 75 degrees, and a secondary peak at 115 degrees. The manubrial segment of the sternocostal head is the only other part of the muscle to show any activity in flexion. Its activity is, however, slight; it is maximum at 110 degrees, and, thereafter, falls abruptly to zero at 145 degrees. The lower sternal and abdominal portions are inactive in both flexion and abduction. These studies clearly reveal that the clavicular head of the pectoralis major works synchronously with the anterior deltoid in forward flexion, and accounts for the relatively low level of the action potential of the deltoid found in this movement. Supraspinatus The curve for the supraspinatus describes almost a pure sine wave, which is strongly reminiscent of the force curve elaborated by mechanical analysis. In forward flexion it reaches its peak slightly before that of the abduction curve, the maximum being at 80 degrees, while that of abduction is greatest at 100 degrees. The heights of the curves in both flexion and abduction are the same. It is commonly considered that the supraspinatus is the initiator of abduction. The action-potential curves, however, definitely show that this is not the case. The muscle acts together with the deltoid progressively throughout the entire range of motion. When we summate the action potentials of all the abducting musculature, we find that individual irregularities disappear, and a smooth curve results which compares very closely with that established from analysis of the force requirements for elevation of the arm. In abduction, the summit is reached at 90 degrees and flexion slightly later at 110 degrees. It will be noted that the flexion curve is of somewhat greater amplitude than that of abduction, and further is displaced slightly to the right. We would account for the difference in amplitude in flexion as being due to the activity of the clavicular head of the pectoralis major, whose force is utilized in this movement, not only for elevation, but partly to maintain the forward position of the arm. The additional functional requirement would account for the slight increase of amplitude of the curve and its displacement to the right when compared to the force-requirement curve. Muscle activity does not fall to zero at 180 degrees of elevation, indicating that, unlike the theoretical calculations, muscle activity is still required, as is to be expected, to maintain the extremity above the head. However, in this position their amplitude is reduced. The Depressors of the Humerus The subscapularis, infraspinatus, and teres minor constitute a functional group which, as already revealed from the force studies, act as the second or inferior component of the force couple. These muscles were, therefore, found to act continuously throughout both abduction and flexion. In abduction, activity of the infraspinatus rises in almost linear fashion to attain its summit at 180 degrees. In flexion, the curve is somewhat higher, is irregular, and exhibits two major peaks of activity, the first at 60 degrees, and a second of greater amplitude at 120 degrees. Thereafter the curve falls to coincide with the abduction curve. The teres minor behaves in a similar fashion to that of the infraspinatus. The abduction curve is almost linear, but slightly peaked at 120 degrees of abduction. In flexion, the total amplitude is higher, rising to its maximum between 90 and 120 degrees, thence falling slightly to coincide with the curve of abduction. The curve of activity of the subscapularis contrasts with those of the infraspinatus and teres minor in that the picture is reversed. In this muscle the abduction curve is of higher potential than the flexion, and reaches its summit at 90 degrees, is maintained from there to 130, and thence falls abruptly to 180. The amplitude of the flexion curve is lower, and its summit is arrived at later-between 110 and 130 degrees-and thereafter coincides with that for abduction. If we summate the amplitudes of these three depressor muscles, we find that on the whole they describe a curve remarkably similar to that of abduction, excepting that the summit of the curve occurs a little later,-namely, at 110 to 120 degrees, the flexion curve being slightly higher in amplitude than that of abduction. There is, however, an important and remarkable secondary peak prominent in the curve for abduction which is maximal between 60 and 80 degrees. This secondary peak occurs at the level which force analysis indicates is the period when the depressor action of the lower force couple should be most active. We believe that this curve is formed by the superimposition of two essential forces which are necessary for abduction. The first peak is unquestionably due to the depressor action and the second to the activity of those muscles in their function as rotators. That this interpretation is correct is shown by the behavior of these muscles when the rotary action is minimized by the addition of a lever and weight so as to resist this movement in one or the other direction. We find for example that we are totally unable to suppress the activity of these muscles by passively supplying the rotary power through the medium of weights applied to varying lengths of lever arm. The more we increase rotary resistance with such apparatus, the more we weaken the power of abduction. Although in these experiments, we have in no way altered the power of the abducting musculature, nonetheless, by absorbing an increasing amount of the depressor power of the muscle for the purposes of rotation, we have weakened the lower element of the couple, and in consequence minimized its effectiveness for abduction. Teres Major The teres major occupies a special position in the scapulohumeral musculature. The muscle never exhibits any activity during motion, but plays a peculiar rôle in that it only comes into action when it is necessary to maintain a static position. In static positions, it reaches its maximum activity at about 90 degrees. The teres major, in elevation of the extremity, therefore, is not a kinetic muscle, but is important in maintaining a static posture, its activity directly increasing with the increase of weight. The Scapular Rotators The scapular rotators are a distinct functional group. We have already pointed out from comparative anatomical studies that both the trapezius and serratus anterior show evidence of division into separate upper, intermediate, and lower components. This anatomical separation is reflected in the functional activity of these portions of the muscles. The upper trapezius, levator scapulae, and upper digitations of the serratus anterior constitute a unit whose activities are essentially the same. The unit performs three functions: passive support of the shoulder, active elevation of the shoulder, and, in addition is the upper component of the force couple necessary for scapular rotation. The postural function of the group is evidenced by the fact that these muscles exhibit an action current potential while the arm is at rest. With elevation of the extremity, both in flexion and abduction, the amplitude of their action current potential rises in linear form reaching its maximum when the arm is above the head. The curve undulates slightly above 90 degrees, for mechanical analysis has shown that the supportive function of the muscle at this point becomes one predominantly assocaited with rotation of the scapula. The inferior portion of the trapezius and the lower four digitations of the serratus anterior constitute the lower component of the scapular rotary force couple, and are found to act throughout elevation of the extremity in a complementary manner. The general shape of their action curves is similar, starting at zero and reaching their maximum at 180 degrees of elevation. The inferior portion of the trapezius and the seventh and eighth digitations of the serratus anterior describe curves which are mirror images of one another. The inferior trapezius acts with slight undulations continuously and predominantly in abduction, the seventh and eighth digitations of the serratus predominantly in flexion. The curves demonstrate, therefore, that the lower trapezius is the more active component of the lower force couple in abduction, for in flexion it relaxes somewhat to allow the scapula to migrate forward as a whole, and the major component of the lower force couple is then supplied by the lower digitations of the serratus anterior. The intermediate portion of the trapezius muscle is most active in abduction, when its potential rises to a maximum at 90 degrees, flattens off, and finally falls slightly at 180 degrees. In forward flexion, its action potential decreases in amplitude during the early ranges of movement, and then builds up slightly to 180 degrees. The findings indicate that the middle trapezius functionally serves to fix the scapula in its plane of motion during abduction, and relaxes somewhat in forward flexion to allow the scapula to rotate around the thorax. The rhomboid muscles function in much the same manner as the middle trapezius, and, like it, are most active in abduction. In flexion, their amplitude is found to flatten off between 60 and 150 degrees, after which it rises sharply to its maximum at 180 degrees. The curves indicate that the rhomboid and the middle trapezius are but little active in flexion. Once, however, 140 degrees is reached, a position little different whether the arm has been carried to that level by flexion or by abduction, the muscles strongly contract and the flexion and abduction curves superimpose. SUMMARY AND CONCLUSION The eclectic approach to an understanding of the functional mechanism of the shoulder enables us to lay down, with considerable certainty, fundamental principles which are of supreme significance to the surgeon in planning reconstructive procedures for both postpoliomyelitic paralysis and other disorders affecting this region. The evidence obtained from comparative anatomical trends, the changes in the relative size of the musculature, the elaboration of the bony parts, the theoretical force requirements, and the basic behavior of the muscles in the living, as revealed by myographic analysis, is consistent, and points in the same general direction. Briefly, the morphological changes have consisted of elaboration and massive development of the deltoid, with a corresponding suppression of the supraspinatus and biceps muscles as active abductors. Associated with these changes, the muscles lying below the spine of the scapula and acting on the humerus assume increasing importance; by establishing the necessary components of a force couple, they, together with the deltoid, bring about the rotary motion necessary for elevation. The upper trapezius, the upper serratus, and levator angulae scapulae, by functional and morphological separation from the lower trapezius and lower serratus, have produced the components of a similar force couple acting upon the scapula. These changes have been attained structurally in surprisingly simple fashion. Elongation of the inferior angle of the scapula, together with minor migrations of muscle masses, such as the teres minor, has accomplished a twofold object informing the depressor group of the glenohumeral joint, and at the same time in increasing the lever arm for the action of the lower trapezius and serratus muscles as a rotary unit for the scapula. Alterations, such as the distal migration of the insertion of the deltoid and the increasing mass of the acromion, are relatively minor in comparison to the effects achieved by this extension of the scapula, and should be looked upon as adjustments perfecting the essential mechanism. The studies of joint motion prove conclusively that complete elevation of the arm, in either the coronal or frontal plane, is dependent on free motion in all the joints of the shoulder complex. The old teaching, still commonly accepted, that abduction to the right angle takes place entirely at the glenohumeral joint, and that, thereafter, full elevation is completed by motion of the scapula on the chest wall, is incorrect. On the contrary, it should be stressed that motion occurs in all the joints of the region simultaneously, each contributing its share to the completion of the movement. The maintenance of the rhythm of smooth and coordinated motion requires intact joints and the preservation of power in the muscles that move them. We may say in summary, that during early phases of elevation of the arm, the sternoclavicular joint passes through its greatest ranges of movement, and in the terminal phase, the acromioclavicular. At the glenohumeral and scapulothoracic articulations, the ratio, from almost the beginning to the termination of the arc, is respectively two to one, so that for every 15 degrees of elevation, the glenohumeral contributes 10 degrees, and the scapulothoracic 5 degrees. It is helpful in diagnosis to recognize that disturbance of rhythm or actual loss of motion in any one phase of motion may indicate that this disturbance is due to loss of function at the joint or joints which contribute the major share of movement during that phase. Furthermore, ankylosis of any one of the joints associated in the complex will cause a permanent loss in degree of movement in direct proportion to the amount of movement contributed by that joint. In fusion of the acromioclavicular joint, as practiced by some surgeons for its dislocation, a permanent loss of abduction in greater or less degree in the terminal phases of this movement, should be anticipated. Restriction at the sternoclavicular joint will not only limit abduction, but will greatly diminish its power. When the surgeon performs an arthrodesis of the glenohumeral joint, he should be aware that the maximum range is but 60 degrees of actual motion. Evidence, that awaits further experimental confirmation, suggests that this range might be increased by resection of the outer end of the clavicle with preservation of the coracoclavicular ligaments. The myographic studies of the basic activity in the living clearly reveal the nature of the pattern of muscular activity. There is, for example, no such thing as a prime mover, as ordinarily understood. There are only patterns of action. This conception extends and amplifies the axiom laid down by Beevor when he said with regard to the brain that it knows nothing of the action of the individual muscles, but only of movement. We can, then, see a central pattern of motion carried to the periphery. Furthermore, we are forced to recognize that the principles as adumbrated by MacKenzie are entirely incorrect. MacKenzie contends that an individual muscle has but one function. Sampling of various portions of an individual muscle shows that they can act independently, but synchronously in association with the total pattern of a specific movement. This great principle is absolutely fundamental for establishing rational procedures of muscle re-education. These patterns of muscular activity cannot be reduplicated by voluntary contraction of the muscle alone. They can only be brought into play by carrying out the precise motion itself, which probably brings into play proprioceptive mechanisms. It is our opinion that here lies the rational explanation for the empirical methods employed in the Kenny treatment of poliomyelitis. Motion, and motion alone, is the only known stimulus able to engender, in phase and degree, the muscle activity requisite for the establishment of the pattern as a whole. A further principle is demonstrated in the existence of certain muscles which play a static rôle in the maintenance of a posture of the extremity. These must be borne in mind when attempts are made to utilize such muscles as kinetic elements in reconstruction procedures. This static action has been confirmed clinically, for example, when the teres major, transplanted to replace the infraspinatus group, failed to act during motion of the extremity and came into play forcibly only when a static position was maintained.

The Roland–Morris Disability Questionnaire and the Oswestry Disability Questionnaire

2000-12-01

Martín Roland , Jeremy Fairbank

From the *National Primary Care Research and Development Centre, University of Manchester, Manchester, United Kingdom; †Nuffield Orthopaedic Centre, Oxford, United Kingdom. Address reprint requests to Martin Roland National Primary Care … From the *National Primary Care Research and Development Centre, University of Manchester, Manchester, United Kingdom; †Nuffield Orthopaedic Centre, Oxford, United Kingdom. Address reprint requests to Martin Roland National Primary Care Research and Development Centre University of Manchester Williamson Building, Oxford Road Manchester M13 9PL, UK E-mail: [email protected] Some of the text of this article has been derived, with permission, from Fairbank and Pynsent. 31

Basic Biomechanics of the Musculoskeletal System

1989-12-01

Harcharan Singh Ranu

American Journal of Physical Medicine & Rehabilitation: December 1989 - Volume 68 - Issue 6 - p 302 American Journal of Physical Medicine & Rehabilitation: December 1989 - Volume 68 - Issue 6 - p 302

10 Economics of osteoarthritis: a global perspective

1997-11-01

Lyn March , C.J.M. Bachmeier

The Revival of Sympiiysiotomv in Italy, with comparative Tables of the early and later cases, showing that the operation has been more frequently perfomed in that country in the last seventeen years than in all europe in the previous eighty, and with far better results. The whole subject examined historically and Clinically

1883-01-01

Robert P. Harris

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Clinical Orthopaedics and Related Research

1966-07-01

The Adequacy of Medical School Education in Musculoskeletal Medicine*†

1998-10-01

Kevin B. Freedman , Joseph Bernstein

A basic familiarity with musculoskeletal disorders is essential for all medical school graduates. The purpose of the current study was to test a group of recent medical school graduates on … A basic familiarity with musculoskeletal disorders is essential for all medical school graduates. The purpose of the current study was to test a group of recent medical school graduates on basic topics in musculoskeletal medicine in order to assess the adequacy of their preparation in this area.A basic-competency examination in musculoskeletal medicine was developed and validated. The examination was sent to all 157 chairpersons of orthopaedic residency programs in the United States, who were asked to rate each question for importance and to suggest a passing score. To assess the criterion validity, the examination was administered to eight chief residents in orthopaedic surgery. The study population comprised all eighty-five residents who were in their first postgraduate year at our institution; the examination was administered on their first day of residency.One hundred and twenty-four (81 per cent) of the 154 orthopaedic residency-program chairpersons who received the survey responded to it. The chairpersons rated twenty-four of the twenty-five questions as at least important. The mean passing score (and standard deviation) that they recommended for the assessment of basic competency was 73.1 ± 6.8 per cent. The mean score for the eight orthopaedic chief residents was 98.5 ± 1.07 per cent, and that for the eighty-five residents in their first postgraduate year was 59.6 ± 12 per cent. Seventy (82 per cent) of the eighty-five residents failed to demonstrate basic competency on the examination according to the chairpersons' criterion. The residents who had taken an elective course in orthopaedic surgery in medical school scored higher on the examination (mean score, 68.4 per cent) than did those who had taken only a required course in orthopaedic surgery (mean score, 57.9 per cent) and those who had taken no rotation in orthopaedic surgery (mean score, 55.9 per cent) (p = 0.005 and p = 0.001, respectively).In summary, seventy (82 per cent) of eighty-five medical school graduates failed a valid musculoskeletal competency examination. We therefore believe that medical school preparation in musculoskeletal medicine is inadequate.

Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation

1998-11-01

M. Urwin , Deborah Symmons , T. Allison +5 more

<h3>BACKGROUND</h3> Epidemiologically-based rheumatology healthcare needs assessment requires an understanding of the incidence and prevalence of musculoskeletal disorders in the community, of the reasons why people consult in primary care, and … <h3>BACKGROUND</h3> Epidemiologically-based rheumatology healthcare needs assessment requires an understanding of the incidence and prevalence of musculoskeletal disorders in the community, of the reasons why people consult in primary care, and of the proportion of people who would benefit from referral to secondary care and paramedical services. This paper reports the first phase of such a needs assessment exercise. <h3>SPECIFIC OBJECTIVE</h3> To estimate the relative frequency of musculoskeletal pain in different, and multiple, anatomical sites in the adult population. <h3>SETTING</h3> Three general practices in the former Tameside and Glossop Health Authority, Greater Manchester, UK, a predominantly urban area. <h3>DESIGN</h3> Population survey. <h3>METHODS</h3> An age and sex stratified sample of 6000 adults from the three practices was mailed a questionnaire that sought data on demographic factors, musculoskeletal symptoms (pain in the past month lasting for more than a week), and physical disability (using the modified Health Assessment Questionnaire- mHAQ). The areas of pain covered were neck, back, shoulder, elbow, hand, hip, knee, and multiple joints. The Carstairs index was used as a measure of social deprivation of the postcode sector in which the person lived. <h3>RESULTS</h3> The response rate after two reminders was 78.5%. Non-responders were more likely to live in areas of high social deprivation. People who lived in more deprived areas were also more likely to report musculoskeletal pain, especially backpain. After adjusting for social deprivation the rates of musculoskeletal pain did not differ between the practices and so their results were combined. After adjustment for social deprivation, the most common site of pain was back (23%; 95% CI 21, 25) followed by knee (19%; 95% CI 18, 21), and shoulder (16%; 95% CI 14, 17). The majority of subjects who reported pain had pain in more than one site. The prevalence of physical disability in the community rose with age. It was highest in those with multiple joint problems but was also high in those with isolated back or knee pain. <h3>CONCLUSION</h3> Musculoskeletal pain is common in the community. People who live in socially deprived areas have more musculoskeletal symptoms. Estimates of the overall burden of musculoskeletal pain that combine the results of site specific surveys will be too high, those that do not adjust for socioeconomic factors will be too low.

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Arthritis and allied conditions

1979-12-01

Gene V. Ball

Corrective shoes and inserts as treatment for flexible flatfoot in infants and children.

1989-07-01

Dennis R. Wenger , Donald M. Mauldin , G Speck +2 more

We performed a prospective study to determine whether flexible flatfoot in children can be influenced by treatment. One hundred and twenty-nine children who had been referred by pediatricians, and for … We performed a prospective study to determine whether flexible flatfoot in children can be influenced by treatment. One hundred and twenty-nine children who had been referred by pediatricians, and for whom the radiographic findings met the criteria for flatfoot, were randomly assigned to one of four groups: Group I, controls; Group II, treatment with corrective orthopaedic shoes; Group III, treatment with a Helfet heel-cup; or Group IV, treatment with a custom-molded plastic insert. All of the patients in Groups II, III, and IV had a minimum of three years of treatment, and ninety-eight patients whose compliance with the protocol was documented completed the study. Analysis of radiographs before treatment and at the most recent follow-up demonstrated a significant improvement in all groups (p less than 0.01), including the controls, and no significant difference between the controls and the treated patients (p greater than 0.4). We concluded that wearing corrective shoes or inserts for three years does not influence the course of flexible flatfoot in children.

The Textbook of Rheumatology.

1997-11-01

Chris Deighton , Phil Perkins

The Textbook of Rheumatology. Edited by William N Kelley, et al . (Pp 1792; £179) Philadelphia, PA: WB Saunders, 1997. 5th ed. ISBN0-7216-5692-7. CMD was given the honour of reviewing … The Textbook of Rheumatology. Edited by William N Kelley, et al . (Pp 1792; £179) Philadelphia, PA: WB Saunders, 1997. 5th ed. ISBN0-7216-5692-7. CMD was given the honour of reviewing the fourth edition of this encyclopaedic textbook (Ann Rheum Dis 1994;53:89). He had the following criticisms to make on that occasion: (1) Huge tomes go quickly out of date, particularly when CD roms and computer literature searches are readily available. (2) Some chapters were unpalatable to a wide rheumatology audience and there was unnecessary overlap between chapters. (3) Summaries, conclusions, tables instead of text, and diagrams and pictures were …

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Prevalence and incidence of adults consulting for shoulder conditions in UK primary care; patterns of diagnosis and referral

2005-11-01

Louise Linsell , Jill Dawson , Krina T. Zondervan +4 more

To estimate the national prevalence and incidence of adults consulting for a shoulder condition and to investigate patterns of diagnosis, treatment, consultation and referral 3 yr after initial presentation.Prevalence and … To estimate the national prevalence and incidence of adults consulting for a shoulder condition and to investigate patterns of diagnosis, treatment, consultation and referral 3 yr after initial presentation.Prevalence and incidence rates were estimated for 658469 patients aged 18 and over in the year 2000 using a primary care database, the IMS Disease Analyzer-Mediplus UK. A cohort of 9215 incident cases was followed-up prospectively for 3 yr beyond the initial consultation.The annual prevalence and incidence of people consulting for a shoulder condition was 2.36% [95% confidence interval (CI) 2.32-2.40%] and 1.47% (95% CI 1.44-1.50%), respectively. Prevalence increased linearly with age whilst incidence peaked at around 50 yr then remained static at around 2%. Around half of the incident cases consulted once only, while 13.6% were still consulting with a shoulder problem during the third year of follow-up. During the 3 yr following initial presentation, 22.4% of patients were referred to secondary care, 30.8% were prescribed non-steroidal anti-inflammatory drugs and 10.6% were given an injection by their general practitioner (GP). GPs tended to use a limited number of generalized codes when recording a diagnosis; just five of 426 possible Read codes relating to shoulder conditions accounted for 74.6% of the diagnoses of new cases recorded by GPs.The prevalence of people consulting for shoulder problems in primary care is substantially lower than community-based estimates of shoulder pain. Most referrals occur within 3 months of initial presentation, but only a minority of patients are referred to orthopaedic specialists or rheumatologists. GPs may lack confidence in applying precise diagnoses to shoulder conditions.

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A newly developed visual method of sexing the os pubis

1969-03-01

T. W. Phenice

Abstract Preliminary investigation has indicated that the use of the ventral arc, subpubic concavity, and medial aspect of the ischio‐pubic ramus as sexing criteria allows one to sex the os … Abstract Preliminary investigation has indicated that the use of the ventral arc, subpubic concavity, and medial aspect of the ischio‐pubic ramus as sexing criteria allows one to sex the os pubis with an accuracy in excess of 95%. The method described here is simple and objective enough to allow the beginning researcher to sex hip bones accurately while requiring the presence of only a small fragment of the bone.

The burden of musculoskeletal conditions at the start of the new millennium

2003-12-01

Julie Agel , Kristina Åkesson , Peter C. Amadio +7 more

Musculoskeletal conditions are extremely common and include more than 150 different diseases and syndromes, which are usually associated with pain and loss of function. In the developed world, where these … Musculoskeletal conditions are extremely common and include more than 150 different diseases and syndromes, which are usually associated with pain and loss of function. In the developed world, where these conditions are already the most frequent cause of physical disability, ageing of the most populous demographic groups will further increase the burden these conditions impose. In the developing world, successful care of childhood and communicable diseases and an increase in road traffic accidents is shifting the burden to musculoskeletal and other noncommunicable conditions. To help better prepare nations for the increase in disability brought about by musculoskeletal conditions, a Scientific Group meeting was held to map out the burden of the most prominent musculoskeletal conditions at the start of the Bone and Joint Decade. In particular, the Group gathered data on the incidence and prevalence of rheumatoid arthritis, osteoarthritis, osteoporosis, major limb trauma and spinal disorders. Data were collected and organized by world region, gender and age groups to assist with the ongoing WHO Global Burden of Disease 2000 study. The Group also considered what is known about the severity and course of these conditions, along with their economic impact. The most relevant domains to assess and monitor the consequences of these conditions were identified and used to describe health states for the different stages of the conditions. Instruments that measure these most important domains for the different conditions were recommended. It is clear from data collated that the impact from musculoskeletal conditions and trauma varies among different parts of the world and is influenced by social structure, expectation and economics, and that it is most difficult to measure impact in less developed nations, where the predicted increase is greatest.

Campbell’s operative orthopaedics.

2003-04-01

M. Laurence

The journal of science and medicine in sport

2011-01-01

Gregory S. Kolt

Orthopedic Physical Assessment

1998-07-01

Randall L. Braddom

American Journal of Physical Medicine & Rehabilitation: July 1998 - Volume 77 - Issue 4 - p 316 American Journal of Physical Medicine & Rehabilitation: July 1998 - Volume 77 - Issue 4 - p 316

Health services research

1999-03-01

María E. Suarez‐Almazor , Padma Kaul

In the past year, several publications have reported on aspects of health services research in regard to musculoskeletal disorders. Utilization studies in the elderly have shown that an effective procedure … In the past year, several publications have reported on aspects of health services research in regard to musculoskeletal disorders. Utilization studies in the elderly have shown that an effective procedure such as hip arthroplasty may be underused in this population. As well, surgical complications in these patients appear to vary according to the number of procedures performed in a hospital, with high-volume hospitals showing better outcomes. Studies of practice patterns show variations among rheumatologists in the treatment of various rheumatic diseases. Practice variations between physician groups, in particular, rheumatologists versus primary care providers, have also been reported. Several studies show that primary care physicians may have some difficulties in diagnosing common rheumatic disorders. There is some evidence as well that rheumatologists may provide better care for some conditions, such as rheumatoid arthritis. These findings have major implications for restrictions to patient access to specialist care by health organizations. A variety of clinical practice guidelines have been developed and tested, most aimed at general practitioners. Physician compliance with guidelines continues to be low for most implementation strategies. Multidisciplinary programs for the treatment of rheumatoid arthritis appear to have a somewhat beneficial effect. Programs based only on patient education appear to have short-term gains, and longer-term effects are diluted because of noncompliant behaviors.

Gray’s Anatomy: the anatomical basis of clinical practice

2009-06-30

Frank Horan

Leydig, Sertoli, and Reinke: three anatomists who were on the ball.

1981-01-01

Ober Wb , C Sciagura

Medicine and Science in Sports and Exercise???1983

1983-01-01

Charles M. Tipton

The Physician and Sportsmedicine

1992-02-01

Richard Strauss , Terry Monahan

Archives of Physical Medicine and Rehabilitation

1976-06-01

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Textbook of Orthopædic Medicine

1963-11-01

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Clinical Orthopaedics and Related Research

1967-11-01

DIAGNOSTIC criteria for rheumatoid arthritis: 1958 revision by a committee of the American Rheumatism Association.

1959-03-01

On a Form of Chronic Joint Disease in Children

1897-01-01

George Still , Archibald E. Garrod

[Evaluation of a German version of WOMAC (Western Ontario and McMaster Universities) Arthrosis Index].

1996-01-01

Gerold Stucki , Debora Meier , S Stucki +4 more

Avulsion fracture of the tibial eminence

1977-12-01

Basilius Zaricznyj

Soft Tissue Paradigm Based Treatment Planning in Skeletal Class III

2025-06-24

Shiji Song , Eun‐jin Kim , Won-seob Jo | International Journal of Oral and Maxillofacial Surgery

Arthrocentesis vs. Arthroscopy: Comparing Patient-Reported Outcomes Pre- and Post-Operatively

2025-06-24

S. Shivji , Sukhpreet Singh Dubb , A. Parbhoo | International Journal of Oral and Maxillofacial Surgery

Reflections on eponyms in musculoskeletal radiology: enhancing communication and pellucidity in patient care

2025-06-24

Nidhi Agrawal , Karthikeyan P. Iyengar , Rajesh Botchu | Postgraduate Medical Journal

Epidémiologie des pathologies rhumatismales au centre médico-chirurgical des armées de Bamako

2025-06-23

LM Diaby , K Sidibé , Arouna" Sangare +7 more | Journal of African clinical cases and reviews.

Introduction : Les pathologies rhumatismales ont longtemps été négligées par méconnaissances ou par défaut de spécialistes dans nos contrées. C’est vers les années 2000 au Mali que les premiers Rhumatologues … Introduction : Les pathologies rhumatismales ont longtemps été négligées par méconnaissances ou par défaut de spécialistes dans nos contrées. C’est vers les années 2000 au Mali que les premiers Rhumatologues sont arrivés, comme au Sénégal. Le cout de prise en charge a un impact sur le diagnostic mais aussi sur la thérapeutique. Le traitement des pathologies rhumatismales est fonction des familles pathologiques et des classes thérapeutiques : les antis inflammatoires non stéroïdiens, les corticoïdes, les immunosuppresseurs, la biothérapie, les antalgiques et les adjuvants. L’objectif cette étude est d’analyser l’épidémiologie des pathologies rhumatismales au centre Médico-Chirurgical des Armées de Bamako Patients et méthodes : Notre étude était rétrospective s’est déroulée à l’unité de rhumatologie du centre Medico chirurgical des armées de Bamako durant trois ans allant de janvier 2020 au 31 décembre 2023. Le registre de consultations et le dossier numérique des patients ont servi de support de collecte de données. Les patients non consentants et les dossiers sans diagnostic étaient exclus de notre étude. Résultats : L’unité de rhumatologie reçoit environ 728 consultants par ans. Au cours de notre étude nous avons colligé 2004 patients. Le sexe féminin était le plus dominant soit une fréquence de 1297 femmes soit 64,72% contre 701 hommes soit 35,28 %. L’âge des patients variait entre 4 à 89 ans avec une moyenne d’âge de 44,7 +/- 3 ans. Les patients généralement provenaient du Mali mais aussi des pays voisins (Guinée, Sénégal, Mauritanie) et étaient majoritairement de races noires (phototype 6). Le motif de consultation était la douleur dans 94,7% reparti selon l’échelle visuel analogique (EVA), douleur faible chez 35,2 ; moyenne chez 20,3% et sévère chez 39,2%. Mots-clés : épidémiologie, rhumatisme, Bamako.

The rheumatology workforce in Australia: current and projected shortfalls

2025-06-21

Alice Terrett , Arvin Damodaran , Simon Burnet +7 more | Internal Medicine Journal

Abstract Aim To determine the status of the current rheumatology workforce and model projections for the future rheumatology workforce in Australia. Background The rheumatology workforce in Australia is currently facing … Abstract Aim To determine the status of the current rheumatology workforce and model projections for the future rheumatology workforce in Australia. Background The rheumatology workforce in Australia is currently facing a significant shortage. Identification of the optimal number of rheumatologists for the Australian population is challenging, and requires assessment of the current workforce. Methods A survey of Australian Rheumatology Association (ARA) full members was undertaken in 2021, collecting demographic data, information about type and location of rheumatology practice and other clinical and non‐clinical work, work intentions and job satisfaction. Descriptive statistics and multivariable regression analyses were performed. The clinical full‐time equivalent (cFTE) was estimated based on the reported number of half‐days worked in clinical rheumatology practice. Using the age and gender distribution of rheumatology specialists from the Department of Health Workforce Data Tool, workforce projections were produced for the period from 2018 to 2038. Results A total of 81% (323/404) of full members of the ARA completed the survey. The median (interquartile range (IQR)) rheumatology clinical half‐days worked/week was 6 (4–8). Adjusted to survey response, the reported clinical workload equates to the cFTE of 231 adult and 13 paediatric rheumatologists. A current shortfall of 302 adult rheumatologists and 41 paediatric rheumatologists exists relative to optimal care estimates. Furthermore, 38% of rheumatologists are considering reducing clinical hours temporarily or permanently, predominantly within the next 2 years. Based on current supply models, the shortfall will improve but will not reach optimal levels by 2038. Conclusion Australia has an undersupply of both adult and paediatric rheumatologists compared to optimal care ideals. An ageing workforce, many part‐time, and the significant number planning to reduce hours within 2 years will exacerbate this undersupply unless the supply of rheumatologists is substantially increased.

Steven F. DeFroda, M.D., M.E., Associate Editor, Arthroscopy Techniques

2025-06-20

Michael J. Rossi | Arthroscopy The Journal of Arthroscopic and Related Surgery

Use of Ultrasound to Enhance Musculoskeletal Palpation Skills of the Upper and Lower Limbs Anatomy: A Scoping Review

2025-06-20

Youyi Huang , Tze Chao Wee , Kee Jin Loh +1 more | Journal of Medical Ultrasound

Abstract Background: Ultrasound is an important tool to enhance clinical understanding of various musculoskeletal (MSK) structures. Various ultrasound-aided education materials have been incorporated by ultrasound educators to enhance the learning … Abstract Background: Ultrasound is an important tool to enhance clinical understanding of various musculoskeletal (MSK) structures. Various ultrasound-aided education materials have been incorporated by ultrasound educators to enhance the learning of clinical palpation examination skills. This study aimed to scope ultrasound programs, training, or curricula, purview the demographics of these educators and their learners, and determine if ultrasound-aided education could improve MSK palpation skills of the upper and lower limbs for learners. Methods: A scoping review was conducted according to the five-step framework (Arksey and O’Malley). The review included a broad literature search of three databases (PubMed, CINHAL, and EMBASE) regarding various ultrasound education strategies that enhance the MSK palpation skills of the upper and lower limbs. Results: Fifteen studies were identified. Most studies involved Physical Medicine and Rehabilitation (PM and R) residents ( n = 8, 53%) and physiotherapy students ( n = 3, 20%). The knee was the most common anatomical area of interest ( n = 8, 53%). The ultrasound content, mode of delivery of the education materials, and duration of training were heterogeneous across all studies. Ten out of 15 (67%) studies were comparative studies while the remaining 5 (33%) were observational studies. All 15 studies showed the benefits of ultrasound-aided training by providing learners with real-time and precise feedback. Palpation accuracy improved by 1.0 cm–17.0 cm or 20%–52%. Conclusion: Despite the heterogeneity of existing ultrasound training programs in the mode of instruction, training duration, and trainer experience, learners from diverse healthcare backgrounds benefited from the incorporation of ultrasound in their respective training programs to enhance their MSK palpation skills.

What transformations will arthroscopic surgery systems undergo? perspectives from sports medicine surgeons

2025-06-20

Zi Zhang , Binyang Meng , Wenhe Li +2 more | International Journal of Surgery

Optimizing Return to Performance Following Injury

2025-06-18

Luca Maestroni , Paul Read | Routledge eBooks

Pyometrium

2025-06-18

Hidayatullah Hamidi | Radiopaedia.org

Global burden of osteoarthritis attributable to high body mass index, 1990‐2021: insights from the Global Burden of Disease study 2021: Comment on the Article by Lu et al.

2025-06-18

Bi Da Gao , Chun‐Chieh Chen , Shiuan‐Chih Chen | Arthritis & Rheumatology

Editorial: Ground improvement in practice – insights from laboratory to field

2025-06-17

Xueyu Geng | Proceedings of the Institution of Civil Engineers - Ground Improvement

[Poliomyelitis in Spain: from the past to the present, a continuous challenge].

2025-06-16

Pedro Gullón Tosio , Cristina De Castro | PubMed

Pilot Study

2025-06-16

Ibtissam Gad , Christopher Podgorski , Kylie Springer +3 more | JCR Journal of Clinical Rheumatology

Objective To create an affordable, easily reproducible, low-fidelity hand model and present a validity argument for its use to support residents' learning to identify inflammatory arthritis. Methods We designed a … Objective To create an affordable, easily reproducible, low-fidelity hand model and present a validity argument for its use to support residents' learning to identify inflammatory arthritis. Methods We designed a hand model to simulate small joint swelling and evaluated evidence to support its use using Messick's Framework between April 2023 and April 2024. Rheumatologists nationwide rated our model (content validity). At 2 tertiary institutions, rheumatologists (experts) and internal medicine residents (learners) evaluated 3 sets of models for small joint swelling, and their scores were compared with Mann-Whitney U test (construct validity). Learners applied their skills to 3 patient encounters, and patient versus model scores were compared with Wilcoxon signed rank test (predictive validity). Results One set of 2 hand models cost less than US $5 to create. Thirteen rheumatologists rated our model at 7.23 ± 2.52 out of 10 points; 11 of the 13 (84.6%) rheumatologists thought the model was helpful for training learners to examine swollen joints. Median model evaluation scores for 12 experts (98.9%; range, 92.2%–100%) and 32 learners (100%; range, 84.4%–100%) were not significantly different ( p = 0.143). The 18 learners who also evaluated patients had a significantly lower median score when evaluating patients versus the hand models (difference 10.0%; range, 5.6–15.6; p < 0.001). Conclusion Content validity evidence supported our model's use in internal medicine training; however, the model needs improvement for greater construct and predictive validity. Our easily constructed, low-cost hand model may be a promising introductory training tool for rheumatology medical education.

Foundation for Physical Therapy research grants

2025-06-16

| Corporate Philanthropy Report

The Orthopaedic World Maps (OWMs): defining the shape of geographic equivalence of each orthopaedic challenge

2025-06-14

Philippe Hernigou , Marius M. Scarlat | International Orthopaedics

565-P: From Knowledge to Practice—Evaluating Diabetes Training for U.S. Physical Therapy Residents

2025-06-13

Kathleen Cummer , Mike Ferguson , D Quach +1 more | Diabetes

Introduction and Objective: Exercise is key in diabetes management, yet patients’ knowledge and absence of exercise specialists may be limiting factors. Physical therapists (PTs), as exercise specialists, should be part … Introduction and Objective: Exercise is key in diabetes management, yet patients’ knowledge and absence of exercise specialists may be limiting factors. Physical therapists (PTs), as exercise specialists, should be part of diabetes care. Yet PTs knowledge of diabetes in the US and abroad is limited. The aim of this study was to 1) compare baseline knowledge of US PTs in a residency program to PTs in Canada (CA) and Saudi Arabia (SA), and 2) assess the effect of an education module for US PTs. Methods: Eight participants enrolled in PT residency programs, at two universities, completed pre- and post-training surveys. The surveys have been used to describe PTs knowledge of diabetes in CA and SA. The module was a 2-hour lecture about foundational diabetes and pathophysiology knowledge, the role of PTs, and clinical decision making. Correct responses to knowledge questions were compared across studies, and over time for US PTs. Results: US trained PTs baseline diabetes knowledge varied but was comparable to CA and SA. (Table) Current clinical practice standards were poorer for US PTs compared to CA and SA. (Table) However, after the module, all US diabetes scores improved and were higher than CA and SA scores Conclusion: US PTs diabetes knowledge is comparable to those in CA and SA. However, PTs current clinical practice approach was worse. US PTs knowledge improved after an education module about diabetes. Follow-up is needed to determine if the education module impacted clinical practice. Disclosure K. Cummer: None. M.D. Ferguson: None. D. Quach: None. M. Hastings: None.

Data Resource Profile: The Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR)

2025-06-11

Yushy Zhou , Christopher J. Wall , Jarrad Stevens +7 more | PubMed

Hunt, Roger (1938–2021), footballer

2025-06-09

John Williams | Oxford Dictionary of National Biography

Long [née Chegwin], Janice (1955–2021), broadcaster and disc jockey

2025-06-09

Chloe Govan | Oxford Dictionary of National Biography

Harper, Brian Sidney [known as Brian London] (1934–2021), boxer

2025-06-09

Matthew Taylor | Oxford Dictionary of National Biography

Bell, Colin (1946–2021), footballer and restaurateur

2025-06-09

Gary James | Oxford Dictionary of National Biography

Orthopedic Clinics of North America

2025-06-08

Frederick M. Azar | Orthopedic Clinics of North America

Essential Areas of Knowledge in Rheumatology for Pediatric Residents: A Modified Delphi Study

2025-06-06

Julia Shalen , Emma Austenfeld , McKenzie Vater +4 more | PEDIATRICS

BACKGROUND Graduating pediatric residents need practical knowledge to recognize, provide initial management, and appropriately triage patients with childhood rheumatologic diseases (cRDs). The pediatric rheumatology workforce shortage and lack of focused … BACKGROUND Graduating pediatric residents need practical knowledge to recognize, provide initial management, and appropriately triage patients with childhood rheumatologic diseases (cRDs). The pediatric rheumatology workforce shortage and lack of focused American Board of Pediatrics rheumatology content specifications lead to challenges in the adequate education of trainees. The purpose of this study was to define essential knowledge areas in rheumatology for pediatric residents. METHODS A literature search was performed to identify resources pertinent to resident education in pediatric rheumatology. Results were used to inform items on a survey asking, “How important is it for graduating pediatric residents to demonstrate competency in each of these rheumatology-related activities?” Stakeholders in rheumatology-related pediatric resident education were invited to participate in a modified Delphi process. Subsequent surveys were created iteratively based on their responses. RESULTS Twenty-one panelists from diverse geographic regions and specialties completed 2 rounds of surveys with a 100% completion rate. Analysis yielded 107 items: those rated by &gt;70% of respondents as “Very Important” were categorized as Essential (n = 54, 47.7%), and those rated by &gt;70% of respondents as either “Very Important” or “Somewhat Important” were categorized as Recommended (n = 55, 52.3%). CONCLUSIONS Broad content specifications are insufficient to prepare graduating pediatric residents to address cRDs in practice. Given the pediatric rheumatology workforce shortage, access to an expanded, standardized list of critical rheumatology-related competencies is essential to better prepare graduating pediatric residents to evaluate patients with cRDs. These competencies should drive curriculum design to enhance pediatric resident education.

POS1495-HPR TRENDS IN WORK PARTICIPATION AMONG PATIENTS WITH INFLAMMATORY RHEUMATIC MUSCULOSKELETAL DISEASES (iRMD): DATA FROM THE GERMAN NATIONAL DATABASE (2010-2023)

2025-06-01

Carlo Veltri , Katinka Albrecht , U. Kiltz +5 more | Annals of the Rheumatic Diseases

POS0163 ANXIETY AT 3 MONTHS IS ASSOCIATED WITH WORSE DISEASE ACTIVITY, PROs, AND PREDICTS PROGRESSION TO ADVANCED THERAPIES BY 12 MONTHS IN EARLY RA: RESULTS FROM THE CANADIAN EARLY ARTHRITIS COHORT (CATCH)

2025-06-01

Susan J. Bartlett , C.O. Bingham , M. F. Valois +7 more | Annals of the Rheumatic Diseases

POS0909 WORLDWIDE DISTRIBUTION AND FACTORS INFLUENCING DIAGNOSTIC DELAY IN VARIOUS SPONDYLOARTHRITIS TYPES: DATA FROM THE INTERNATIONAL ASAS-PerSpA STUDY

2025-06-01

M. Aoun , Sherif M. Gamal , Ihsane Hmamouchi +4 more | Annals of the Rheumatic Diseases