Musculoskeletal pain among school teachers are we underestimating its impact?

Background: Musculoskeletal disorders (MSDs) are a common occupational health condition which may significantly impact both work attendance and performance. School teachers represent an occupational group among which there appears to be a high prevalence of neck and/or shoulder pain (NSP) and low back pain (LBP). Epidemiological data on NSP and LBP in South African teachers are limited.Objectives: To determine the prevalence of NSP and LBP among primary school teachers in the Central Durban area of KwaZulu-Natal, South Africa; to identify predominant occupational factors associated with NSP and LBP pain; and to highlight key actions associated with such factors so as to direct future preventive measures/interventions.Methods: A cross-sectional, questionnaire-based study was conducted on teachers from 12 randomly selected primary schools.Results: Among the 97 completed questionnaires, the prevalence of NSP and LBP was 80.4% and 68.0%, respectively. There was no association between age and NSP (p < 0.250) or LBP (p < 0.595). However, there were higher prevalence rates of NSP and LBP among the 45-54 years age group (39.2% and 33.0%, respectively). Factors associated with NSP included marking of assessments (56.7%; n = 55), and writing on a blackboard (39.2%; n = 38); prolonged standing was associated with LBP (83.5%; n = 81). These findings highlighted specific actions, such as forward-bending of the head for prolonged periods (61.9%; n = 60), backward-bending of the head for prolonged periods (20.6%; n = 20), and reaching/stretching with arms above chest height (41.2%; n = 40). Conclusion: Key occupational factors associated with MSP, and associated actions identified in this study can be used as a basis to direct strategies that can be applied to reduce the prevalence of MSP and the onset of MSD in teachers

A Biomechanical Analysis of Strength and Motion Following Total Shoulder Arthroplasty

Background: The primary goal of total shoulder arthroplasty (TSA) has traditionally been pain relief and motion improvement. The literature contains multiple studies that have documented the restoration of motion and consistent pain relief following the procedure. However; there has been little attention placed on strength following TSA. Therefore; the purpose of this study was to determine in an objective manner whether strength and motion improve with shoulder arthroplasty and over what time course this may occur. aterials and Methods: Between April 2002 and January 2004; 15 patients who underwent TSA for osteoarthritis had biomechanical strength testing preoperatively; at 6 and 12 months postoperatively. The mean age at the time of TSA was 66 years (range; 52-82). None of the patients had full thickness rotator cuff tears at the time of surgery. Peak forces for shoulder flexion; extension; abduction; internal rotation and external rotation strength were recorded. In addition; patients had shoulder range of motion measurements performed.Findings: Range of motion improved significantly with TSA from preoperative to 6 months postoperative: flexion 104o to 147o ( P = 0.0034); abduction 86o to 145o ( P = 0.0001); internal rotation 43o to 54o ( P = 0.0475) and external rotation 25o to 50o ( P = 0.0008). There was minimal improvement in range of motion from 6 to 12 months. In contrast; there continued to be improvements in strength from the 6 month to the 12 month postoperative time frame: extension 18.3 kg to 22.4 kg ( P = 0.006); abduction 11.3 kg to 12.8 kg (0.0474) and external rotation 8.8 kg to 10.1 kg ( P = 0.016). Despite these improvements; compared to normative values; there continued to be relative weakness of the shoulder following TSA.Interpretation: The data from this study suggest that recovery of strength and motion follow different time frames after TSA. The results of this study may allow the surgeon to more accurately discuss with the patient over what time course strength and motion may return. In addition; this study raises important questions in regard to the current rehabilitation program used after shoulder arthroplasty and whether development of new protocols may improve the functional outcome from surgery

Early Arthroscopic Release in Stiff Shoulder

Purpose: To evaluate the results of early arthroscopic release in the patients of stiff shoulder Methods: Twenty patients of stiff shoulder; who had symptoms for at least three months and failed to improve with steroid injections and physical therapy of 6 weeks duration; underwent arthroscopic release. The average time between onset of symptoms and the time of surgery was 4 months and 2 weeks. The functional outcome was evaluated using ASES and Constant and Murley scoring systems. Results: All the patients showed significant improvement in the range of motion and relief of pain by end of three months following the procedure. At 12 months; mean improvement in ASES score is 38 points and Constant and Murley score is 4O.5 points. All patients returned to work by 3-5 months (average -4.5 months). Conclusion: Early arthroscopic release showed promising results with reliable increase in range of motion; early relief of symptoms and consequent early return to work. So it is highly recommended in properly selected patients. Level of evidence: Level IV

Rupture of the Intra-Articular Portion of the Long Head of the Biceps associated with a Symptomatic os Acromiale

We report the case of a 45-year-old male who presented with a 5-year history of shoulder pain following an injury. Clinical and radiological investigations revealed a ruptured long head of the biceps and a meso-os acromiale. We performed an arthroscopic resection of the intra-articular stump of the long head of the biceps; followed by internal fixation of the mobile os acromiale using a tension band technique. Rupture of the long head of the biceps associated with a symptomatic os acromiale has not been previously described. This case reinforces the importance of routine shoulder arthroscopy in the treatment of symptomatic os acromiale

Complications de l' epaule de l'hemiplegique vasculaire : prevalence et facteurs associes au sein d 'une population de cerebroleses vasculaires au Chu d'Abidjan (Cote D'ivoire)

Objectif Evaluer la fréquence des complications de l'épaule de l'hémiplégique vasculaire et identifier les facteurs associés à ces complications Méthodes C'est une étude prospective réalisée entre Juin et Octobre 2005 au Centre hospitalo-universitaire de Cocody (Abidjan, Cote d'Ivoire). Elle concerne des patients admis en consultation de rééducation fonctionnelle (RF) ou en hospitalisation de neurologie.Résultats Cinquante patients âgés en moyenne de 56,6 ± 13,4 ans (extrêmes de 29 et 85 ans) avec un sexe ratio de 1,17 en faveur des femmes, recrutés le plus souvent en RF (60%) ont été inclus dans cette étude. Ils avaient un accident vasculaire cérébral (AVC) principalement ischémique (72%), qui évoluait en moyenne depuis 11,3 ± 12,9 semaines. Parmi eux 28 (56%) avaient une complication de l'épaule qui était : une douleur (DL, n=25), un syndrome épaule-main (SEM, n=10) ou une subluxation (SUB, n=18). Ces complications étaient associées dans 46,4% des cas. Ces patients étaient plus âgés, avaient un AVC plus ancien, un index moteur du membre supérieur plus faible mais un niveau d'autonomie globale semblable à celui des patients sans complications. Ni l'âge, ni la durée d'évolution de l'AVC n'était différent selon le type de complication diagnostiqué. La fonctionnalité était associé à la SUB (dans 72,2% des SUB le Frenchay arm test était égal à 0 vs 37,5% chez les patients sans SUB p=0,02) tandis que le tonus des adducteurs du bras était associé à la DL (dans 40% des DL le tonus des adducteurs était égal à 1 vs 84% chez les patients ne présentant pas de DL p=0,006).Conclusion L'épaule douloureuse de l'hémiplégique est donc une complication fréquemment retrouvée dans notre étude. Des études ultérieures seront utiles pour conforter la fréquence de ces complications, l'impact des différents facteurs qui semblent s'y associer et analyser les possibilités de prise en charge tant curative que préventive dans notre milieu