Factors associated with asymptomatic vertebral fractures in patients with rheumatoid arthritis in a rheumatology service in Bogotá (Colombia)

Introduction: In patients with rheumatoid arthritis (RA), osteoporotic vertebral fractures (OVF) are of multifactorial etiology. The main mechanism is spontaneous and therefore most are asymptomatic. The presence of VF has an impact on the quality of life of patients, and consequently on morbidity and mortality, therefore it should be systematically evaluated in this population, especially when associated factors have been reported. The main objective of this study was to identify clinical characteristics for osteoporosis and poor prognosis in rheumatoid arthritis that could be associated with the development of osteoporotic vertebral fractures identified in the lateral chest X-ray of asymptomatic patients with RA. The secondary objectives were to present the frequency, location, and severity of the fractures, as well as the inter and intra-observer correlation, when analyzing the radiographs. Methodology: Patients with a diagnosis of RA were included, with a lateral chest X-ray and indication dissimilar to spinal symptoms. The mean age was 58 years (IQR 21-88). Three researchers evaluated 151 images in a sequenced and standardized manner using the Algorithm-Base Qualitative approach (ABQ) and Genant methods. Variables associated with the presence of osteoporosis and poor prognosis in RA were identified. Subsequently, a multivariate analysis was carried out to find an association with the presence of VF in this population. Results: We found 39 fractures in 32/151 patients. Identifying multiple fractures in 5 of them. The prevalence of osteoporotic vertebral fractures was 21.2%. The distribution of fractures was mainly at the level of T5, T8 and T9, with a predominance of Genant grade 1 in 46%. In the multivariate analysis, age, duration of RA (mainly greater than 10 years), rheumatoid factor, anti-citrullinated peptide antibodies, DAS28, HAQ, presence of antinuclear antibodies (ANA), smoking and being under treatment for osteoporosis showed a statistically significant association. The interobserver correlation for the ABQ and Genant methods presented a kappa index of .9 and .92, respectively. Conclusion: In patients with RA there is a significant association with the development of VF, independent of the presence of osteoporosis. Furthermore, this research suggests that the presence of some clinical and paraclinical characteristics could be associated with the prevalence of osteoporotic vertebral fractures. Age, duration of arthritis, poor prognostic markers for RA in terms of serology and functionality, as well as being in treatment for osteoporosis had statistical significance of association. This should guide the timely detection of fractures, independent of symptoms, with the respective targeted treatment in this population and thus avoid functional complications and a decrease in quality of life.

Introducción: En los pacientes con artritis reumatoide (AR) las fracturas vertebrales osteoporóticas (FVO) son de etiología multifactorial. El principal mecanismo es espontáneo y por ende la mayoría son asintomáticas. La presencia de FVO impacta en la calidad de vida de los pacientes y, en consecuencia, en la morbilidad y la mortalidad, por lo tanto, se debería evaluar de forma sistemática en esta población, más aún cuando se han reportado factores asociados. Objetivos: Los objetivos principales fueron identificar las características clínicas de osteoporosis y de mal pronóstico en AR, que podrían estar asociadas con el desarrollo de fracturas vertebrales osteoporóticas identificadas en la radiografía lateral de tórax en pacientes asintomáticos con AR, y los objetivos secundarios fueron presentar la frecuencia, la localización y la severidad de las fracturas, como también la correlación inter e intraobservador al analizar las radiografías. Metodología: Se incluyeron pacientes con diagnóstico de AR, con radiografía lateral de tórax e indicación disímil a síntomas en columna. La media de edad fue de 58 arios (RIC 21-88). Tres investigadores evaluaron 151 imágenes, de manera secuencial y estandarizada, utilizando los métodos Algorithm-Base Qualitative approach (ABQ) y de Genant. Se identificaron variables asociadas con la presencia de osteoporosis y de pobre pronóstico en AR. Posteriormente, se hizo un análisis multivariado orientado a encontrar asociación con la presencia de FVO en esta población. Resultados: Se encontraron 39 fracturas en 32/151 pacientes, en cinco de ellos se encontraron múltiples fracturas. La prevalencia de fracturas vertebrales osteoporóticas fue de 21,2%. La distribución de fracturas fue principalmente a nivel de T5, T8 y T9, con predominio de aquellas grado 1 de Genant (46%). En el análisis multivariado, la edad, la duración de la AR (principalmente mayor a 10 anos), el factor reumatoideo, los anticuerpos antipéptidos citrulinados, el Disease Activity Score-28 (DAS28), el Health Assessment Questionnaire (HAQ), la presencia de anticuerpos antinucleares (ANA), el tabaquismo y estar en tratamiento para osteoporosis presentaron una asociación estadísticamente significativa. La correlación interobservador para los métodos ABQ y Genant presentó un índice kappa de 0,9 y 0,92, respectivamente. Conclusión: En pacientes con AR existe una asociación significativa con el desarrollo de FVO, con independencia de la presencia de osteoporosis. Además, esta investigación sugiere que la presencia de algunas características clínicas y paraclínicas podría estar asociada con la prevalencia de fracturas vertebrales osteoporóticas. La edad, la duración de la artritis, los marcadores de mal pronóstico de la AR en cuanto a serología como funcionalidad, así como estar en tratamiento para osteoporosis tuvieron significancia estadística de asociación. Esto debería guiar una detección oportuna de las fracturas, más allá de los síntomas, con el respectivo tratamiento dirigido a esta población y así evitar complicaciones funcionales y una disminución en la calidad de vida.

Measuring Back Injury Risk in Mexican Workers of an Automotive Company / Medición del riesgo de lesión de espalda en trabajadores mexicanos de una empresa automotriz / Medição do risco de lesão de costas em trabalhadores mexicanos de uma empresa automotiva

Abstract Introduction : The Mexican manufacturing sector in the automotive industry employs an average of 8 million 850 thousand workers per year spread across the 32 states, of which Puebla contributes with 465106, developing, in a high percentage, the verification of new parts as part of the manufacture process. This activity is supported by the use of devices known as fixtures, whose equipment and tool forces operators to lift loads between 10 and 50 kilograms by performing manual operations to hold parts, presenting pain at the lumbar level, therefore, it is essential to measure the risks of back injuries in the study population. The objective was to identify and measure the risks of back injuries in the study population. Materials and Methods : The inspection process is analyzed by identifying the potential risk factors. Ergonomic methodologies and instruments are used, such as Quick Exposure Check (QEC), the National Institute for Occupational Safety and Health (NIOSH) equation, the REBA (Rapid Entire Body Assessment) method, Ovako's Work Posture Analysis System (OWAS), among others. Results : The QEC method shows that trunk/back and wrist/hand are the most sensitive parts to risk exposure, indicating that 18 % of the postures are rated 4 in the level of risk, with the back rotated and bent in over 32 % of time. The weight of the operation exceeds 20 kilograms in 71.4 %. Conclusion: Four ergonomic techniques are used to assess the risk of injury, the inspection process of manufactured parts is analyzed.

Resumen Introducción: la industria manufacturera mexicana del ramo automotor emplea en promedio 8 millones 850 mil trabajadores al año repartidos en los 32 estados, de los cuales Puebla contribuye con 465106, desarrollando, en un alto porcentaje, la verificación de piezas nuevas como parte de los procesos de manufactura. Esta actividad se apoya en el uso de dispositivos conocidos como fixtures, cuyo equipo y herramienta obliga a los operarios a levantar cargas entre los 10 y los 50 kilogramos, realizando operaciones manuales para la sujeción de piezas, presentándose dolores a nivel lumbar, por lo que es primordial medir los riesgos de lesiones en la espalda de la población en estudio. El objetivo fue identificar y medir los riesgos de lesiones en la espalda de la población en estudio. Materiales y métodos : se analiza el proceso de inspección identificando los factores de riesgo potencial. Se utilizan metodologías y herramientas ergonómicas, tales como Quick Exposure Check (QEC), la ecuación del National Institute for Occupational Safety and Health (NIOSH), el método REBA (Rapid Entire Body Assessment), el sistema de análisis de posturas de trabajo de Ovako (OWAS), entre otras. Resultados : el método QEC muestra que tronco/ espalda y muñeca/mano son las partes más sensibles a la exposición de riesgo, señalando el 18 % de las posturas en un nivel de riesgo 4, con la espalda rotada y flexionada en más del 32 % del tiempo. El peso que conlleva la operación supera los 20 kilogramos en el 71,4%. Conclusión : se utilizan cuatro técnicas ergonómicas para evaluar el riesgo de lesión y se analiza el proceso de inspección de piezas fabricadas.

Resumo Introdução : a indústria manufatureira mexicana do ramo automotivo emprega em média 8 milhões 850 mil trabalhadores ao ano repartidos nos 32 estados, dos quais Puebla contribui com 465106 deles, desenvolvendo, em uma alta porcentagem a verificação de peças novas como parte dos processos de manufatura. Esta atividade apoia-se no uso de dispositivos conhecidos como fixtures, cuja equipe e ferramentas abriga aos operários a levantar cargas entre os 10 e 50 quilogramas realizando operações manuais para a fixação de peças, se apresentando dores no nível lombar, pelo que é primordial medir os riscos de lesões nas costas da população em estudo. Materiais e métodos : se analisa o processo de inspeção identificando os fatores de risco potencial. Se utilizam metodologias e ferramentas ergonómicas, tais como Quick Exposure Check (QEC), a equação do National Institute for Occupational Safety and Health (NIOSH), o método REBA (Rapid Entire Body Assessment), o sistema de análise de posturas de trabalho de Ovako (OWAS), entre outras. Resultados : o método QEC mostra que o torso/costas e o pulso/mão são as partes mais sensíveis à exposição de risco, assinalando o 18 % das posturas em um nível de risco 4, com as costas rotadas e curvadas em mais do 32 % do tempo. O peso que leva a operação supera os 20 quilogramas no 71.4 %. Conclusão : utilizam-se quatro técnicas ergonómicas para avaliar o risco de lesão e se analisa o processo de inspeção de peças fabricadas.

Occupational lumbar back accidents in the private sector: prevalence and factors associated with their severity and sequelae in central Tunisia

In Tunisia, few studies have been focused on occupational lumbar back accidents. We conducted a descriptive retrospective study of private sector employees in central Tunisia who were victims of lumbar back accidents, reported during a 5-year period from 2010 to 2014, to determine the prevalence and factors associated with their severity and sequelae. Data were collected from the regional centre of the National Health Insurance Fund of Sousse. We identified 293 cases, a prevalence of 14.2% in relation to all occupational accidents reported during this period. More than two thirds of the injured [69.2%] were victims of serious occupational lumbar back accidents and 33.8% of victims reported serious sequelae. After adjustment by binary logistic regression, the occupational category persisted as an associated factor with the severity of occupational lumbar back accidents [P = 0.001, OR = 2.86 [1.50–5.47]]. Surgical treatment appeared as an associated factor of severity [P < 0.001, OR = 9.06 [3.09–26.56]] and prominent after effects resulting from these accidents [P < 0.001 OR = 54.72 [18.84–158.93]]. Occupational lumbar back accidents are a real health problem. Thus, a preventive strategy should be implemented to reduce their socio-economic consequences

Tratamiento de síndrome de espalda fallida con nucleolisis percutánea más bloqueo peridural y foraminal con ozonoterapia / Treatment of failed back syndrome with percutaneous nucleolisis and Epidural, foraminal Block with oxygen-ozone

Se realiza estudio prospectivo para demostrar que la nucleolisis percutánea, más el bloqueo peridural y foraminal con ozonoterapia es efectiva y muy segura para disminuir el dolor producido por síndrome de espalda fallida. Material y método: previo consentimiento informado, a 45 pacientes con síndrome de espalda fallida, se les realizó un total de 45 nucleolisis percutáneas, más bloqueo peridural y foraminal con ozonoterapia, durante un periodo comprendido entre mayo 2012 a mayo del 2013. Todas las nucleolisis se realizaron bajo control fluoroscopio con medidas de asepsia y antisepsia estrictas, y sedación consciente. A todos los pacientes, se les administró ozono en disco, peridural y foraminal (5-10 ml) a 10ug/ml, más procaina al 2% y 1cc de 40mg de cristales esteroideos; en todos los casos se administró 1gr. de cefacidal como profilaxis. Discusión: La eficacia del tratamiento, se basa en el control del dolor según la escala visual analógica basal (EVA 0), a los 30 días (EVA 1), a los seis meses (EVA 3) y a los 12 meses (EVA 6). Se aplicó el test de oswestry, antes del tratamiento y al final del estudio; a todos los pacientes se les realizo encuesta en la primera consulta, y luego al final del tratamiento con una respuesta satisfactoria(AU)

This prospective study is to demonstrate that percutaneous nucleolisys and epidural, foraminal block with oxygen-ozone is effective and very safe to decrease the pain from failed back syndrome. Materials and Methods: previous reported 45 patients with failed back syndrome consent to a total of 45 percutaneous nucleolisys more and foraminal Epidural blockade with ozone therapy was conducted over a period from May 2012 to May 2013 all nucleolisys were performed under fluoroscopic control measures strict asepsis and antisepsis, conscious sedation. All patients were administered ozone in disk, epidural and foraminal (5-10 ml) at 10 ug / ml over 2% procaine more steroidal 1cc 40mg of crystals, in all cases of cefaolin sodium 1grs administered prophylactically. Discution: The effectiveness of treatment is based on pain control by baseline visual analog scale (EVA 0), 30 days (EVA 1), six (EVA 3) and 12 months (EVA 6). By oswestry test evaluated before treatment and at study end; all patients were conducted survey in the first query and then at the end of treatment with satisfactory response

Influence of Hamstring Tightness in Pelvic, Lumbar and Trunk Range of Motion in Low Back Pain and Asymptomatic Volunteers during Forward Bending

STUDY DESIGN: Cross-sectional study. PURPOSE: To verify the association of hamstring tightness and range of motion in anterior pelvic tilt (PT), lumbar motion (LM), and trunk flexion (TF) during forward bending. OVERVIEW OF LITERATURE: Increased hamstring stiffness could be a possible contributing factor to low back injuries. Clinical observations have suggested that hamstring tightness influences lumbar pelvic rhythm. Movement restrictions or postural asymmetry likely lead to compensatory movement patterns of the lumbar spine, and subsequently to increased stress on the spinal soft tissues and an increased risk of low back pain (LBP). METHODS: Hamstring muscle tightness was measured using the self-monitored active knee extension (AKE) test. A bubble inclinometer was used to determine the range of motion of PT, LM, and TF during forward bending. Statistical analysis included descriptive statistics, comparisons between groups and a correlation between hamstring tightness (AKE) and anterior PT, TF, and regional LM with p< or =0.05. RESULTS: The LBP group was composed of 36 participants, and the asymptomatic group consisted of 32 participants. The mean for PT in the control group was 66.7degrees, 64.5degrees for LM and 104.6degrees for TF. Respective values in the symptomatic group were 57.0degrees, 79.8degrees, and 82.2degrees. CONCLUSIONS: Participants with LBP showed restriction in the pelvis and TF range of motion, but had higher amplitudes in the lumbar spine during forward bending.

A Review of Back Injury Cases Notified to the Ministry of Manpower from 2011 to 2012

<p><b>INTRODUCTION</b>In Singapore, the notification of workplace accidents and occupational diseases is a legal requirement under the Workplace Safety and Health (Incident Reporting) Regulations. This review is to identify back injury cases with physical work stresses and propose recommendations for preventive measures.</p><p><b>MATERIALS AND METHODS</b>Cases involving back injuries notified to the Ministry of Manpower (MOM) from 1 January 2011 to 31 December 2012 were reviewed. Using predefined criteria, cases with physical work stresses were identified and the associated variables analysed.</p><p><b>RESULTS</b>A total of 1124 notifications involving back injuries were received from 2011 to 2012; 579 cases (52%) were identified to have physical work stresses, of which 447 cases (77%) were males and 375 (64%) of them were between the ages of 21 to 40 years. The commonest physical work stresses were carrying (35%), awkward postures (22%) and lifting (20%). Majority of the cases came from the following sectors: construction (14%), accommodation and food services (12%), transport and storage (12%), manufacturing (10%) and wholesale and retail trade (10%).</p><p><b>CONCLUSION</b>We identified the main physical work stresses in the back injury cases as carrying, awkward postures and lifting. The common industries involved were construction, accommodation and food services, and transport and storage sectors. This is useful for programmes aimed at reducing physical work stresses which can lead to improved work and health outcomes for our workers.</p>

Automation of Workplace Lifting Hazard Assessment for Musculoskeletal Injury Prevention

OBJECTIVES: Existing methods for practically evaluating musculoskeletal exposures such as posture and repetition in workplace settings have limitations. We aimed to automate the estimation of parameters in the revised United States National Institute for Occupational Safety and Health (NIOSH) lifting equation, a standard manual observational tool used to evaluate back injury risk related to lifting in workplace settings, using depth camera (Microsoft Kinect) and skeleton algorithm technology. METHODS: A large dataset (approximately 22,000 frames, derived from six subjects) of simultaneous lifting and other motions recorded in a laboratory setting using the Kinect (Microsoft Corporation, Redmond, Washington, United States) and a standard optical motion capture system (Qualysis, Qualysis Motion Capture Systems, Qualysis AB, Sweden) was assembled. Error-correction regression models were developed to improve the accuracy of NIOSH lifting equation parameters estimated from the Kinect skeleton. Kinect-Qualysis errors were modelled using gradient boosted regression trees with a Huber loss function. Models were trained on data from all but one subject and tested on the excluded subject. Finally, models were tested on three lifting trials performed by subjects not involved in the generation of the model-building dataset. RESULTS: Error-correction appears to produce estimates for NIOSH lifting equation parameters that are more accurate than those derived from the Microsoft Kinect algorithm alone. Our error-correction models substantially decreased the variance of parameter errors. In general, the Kinect underestimated parameters, and modelling reduced this bias, particularly for more biased estimates. Use of the raw Kinect skeleton model tended to result in falsely high safe recommended weight limits of loads, whereas error-corrected models gave more conservative, protective estimates. CONCLUSIONS: Our results suggest that it may be possible to produce reasonable estimates of posture and temporal elements of tasks such as task frequency in an automated fashion, although these findings should be confirmed in a larger study. Further work is needed to incorporate force assessments and address workplace feasibility challenges. We anticipate that this approach could ultimately be used to perform large-scale musculoskeletal exposure assessment not only for research but also to provide real-time feedback to workers and employers during work method improvement activities and employee training.

[Occupational low back trauma in Tunisia]

In Tunisia, eight researches works, dealing with low back trauma [LBT], have been achieved in some occupational sector activities and only 2 of them have been published. To synthesize data provided by these 8 works realized between 1998 and 2007, in order to estimate the disorder magnitude and to describe LBT victims profile in Tunisia. The global population of study is made of 1357 LBT victims [977 belonging to the private sector and 380 to the public sector]. The data collection was carried out according to an uniformed model for the 8 studies. In the public sector, Commission M‚dicale Centrale data show that LBT account for 4 to 5% of occupational accidents [OA] and that their annual incidence is from 32 to 36/100000. In the private sector, Caisse Nationale d'Assurance Maladie data reveal that LBT account for 7.7% to 9.5% of OA. LBT victim is a male [83%], with an age ranging between 36 and 43.5 years, married [84%], educated up to the secondary educational [91%] with a vertebral disorders history [34%]. He belongs to the general-purpose workmen category in 1/2 of cases with an average seniority ranging between 7.8 and 16.2 years. LBT almost subjects, get at least of a sick leave. Work days lost is around 210 days for the private sector and 18 days for the public. The per annum amount versed for each LBT case, within the framework of the Total Temporary incapacity, is of 1449.319 DT and 45% of the subjects profit from a professional reclassification. Our results join those of international studies having dealt with LBD in professional environment. In spite of some limiting methodological issues, they allowed us to provide to professionals in occupational health useful data for this occupational risk management

Effects of backrest density on lumbar load and comfort during seated work / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Seated workplaces have greatly increased in China. Many researchers have found that seated work is a risk factor in the development of low-back pain. Backrest can reduce the load on the lower back by transmitting more of the weight from the upper body to the floor via the backrest so as to prevent low-back pain. To design a suitable chair backrest for seated office work, some backrest parameters must be optimized. In this study, the role of backrest density on lumbar load and comfort were investigated. The goal of the study was to help establish criteria with which backrests that alleviate and prevent low back pain during seated office work can be designed and selected.</p><p><b>METHODS</b>Twenty volunteers (10 men and 10 women) were seated in three backrest conditions (10 kg/m(3), 25 kg/m(3), and 40 kg/m(3)). Pressure data, including contact pressure (CP), peak contact pressure (PCP) and contact area were collected during 15-minute trial. Subjective data were collected after each pressure test.</p><p><b>RESULTS</b>Backrest density had a significant effect on backrest pressure variables. CP and PCP increased with increasing backrest density. Contact area decreased with increased density. In terms of user preference, the backrest with low density was most highly rated.</p><p><b>CONCLUSIONS</b>Backrest density plays an important role in lumbar load and comfort during seated work. During designing and selecting backrests, backrest density should be focused on so as to alleviate and prevent low-back pain during seated office work. Backrest density at 10 kg/m(3) got the lowest CP and PCP and largest contact area. Backrest with low density can reduce lumbar pressure and increase support contact area, which could raise comfort feeling. Backrest density at 10 kg/m(3) is better to maintain a balance between providing effective support and alleviating excess lordosis.</p>

Tumor de partes blandas de bajo potencial maligno: caso clínico y revisión de la literatura / Soft tissue tumor of low potential malignancy: clinic case and review of literature

El tumor de células gigantes de partes blandas de bajo potencial de maligno, es una neoplasia poco frecuente, clasifica dentro de las lesiones fibrohistiocíticas. Histológicamente es un tumor con hallazgos idénticos al tumor de células gigantes del hueso. Presentamos un caso correspondiente a esta neoplasia. Se trató de paciente de 26 años con una lesión tumoral 20 cm x15 cm x15 cm, en ambas regiones lumbares y región sacra. El estudio histológico reveló una neoplasia con abundantes células gigantes, células fusiformes, hemosiderina y hueso metaplásico. Los estudios inmunohistoquímicos demostraron fuerte positividad de CD68 para las células osteoclásticas. La evolución del paciente fue favorable, sin evidencia de recidivas. Es imprescindible realizar el diagnóstico diferencial de este tumor con otras neoplasias con abundantes células gigantes, como el tumor de células gigantes de la vaina tendinosa y el fibrohistiocitoma maligno rico en células gigantes, el cual es un sarcoma de alto grado

The giant cell tumor of soft tissues of low potential malignancy is a very rare tumor. It’s classified in fibrohistiocytic neoplasm and has features identical to giant cell tumor of bone. We present a clinical case for this less frequent malignancy. Patient 26 years old man with a tumor of 20 cm x 15 cm x 15 cm, in both lumbar and the sacral regions. Histological examination revealed a neoplasm with abundant giant cells, spindle cells, hemosiderin and metaplastic bone. The immunohistochemistry studies practice showed strong positivity of CD68 for the osteoclastic cells. The patient outcome was favorable, without evidence of recurrence. It is essential to make the differential diagnosis of this kind of tumor with other neoplasm with abundant giant cells, such as the giant cell tumor of the tendon sheath and malignant giant cell, also malignant fibrous hystiocitoma, which is rich in giant cells and high grade sarcoma

Occupational Infections of Health Care Personnel in Korea / 한양의대학술지

Healthcare personnel (HCP) face a wide range of occupational hazards, including needle-stick injuries, back injuries, latex allergy, violence, and stress. In particular, occupational exposures to infectious agents, such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV),or tuberculosis, are devastating to the victims. The World Health Organization (WHO) estimates the global burden of disease from occupational exposure to be 40% of hepatitis B and C virus infections and 2.5% of the HIV infections among HCP. Infectious disease cases for which compensation is given by the Korean Occupational Safety and Health Agency are increasing, and tuberculosis is the most common infectious disease compensated by KOSHA for HCP in Korea. While viral respiratory infections are common in health care settings, systematic surveillance has not been established yet in Korea. Infection control programs for HCP, such as engineering control in medical facilities, immunization, post exposure prophylaxis, and use of personal protective equipment need to be improved in Korea. This article describes the epidemiologic characteristics of occupational infectious diseases among HCP in Korea, especially focusing on needle-stick injuries and airborne infections. Also brief commentary is offered concerning effective measures for the control and prevention of occupational infectious disease transmission among HCP.

Rehabilitation Treatments for the Sports Injuries on the Lumbar Spine, Hip & Pelvis / 한양의대학술지

Low back pain is a common problem seen in both atheletes and general population. The elite athlete losing significant playing time because of a back injury. Although an actual pain generator is not always found , the majority of athletes with low back injuries are likely to have pain from a benign source. These athletes will be expected to respond well to non operative treatment. However some athletes may experience pain from more severe stuructural sources such as fracture or tumor. In these cases, different management may be indicated. The clinician evaluating athletes with LBP must have overall understanding about back problems for making proper decision and therapeutic regimen. In this article, the authors discuss common back pain related injuries in the atheletic population, typical mechanisms of injury and the treatment methods include rehabilitation exercise for these problems.

Rehabilitation Treatments for the Sports Injuries on the Lumbar Spine, Hip & Pelvis / 한양의대학술지

Low back pain is a common problem seen in both atheletes and general population. The elite athlete losing significant playing time because of a back injury. Although an actual pain generator is not always found , the majority of athletes with low back injuries are likely to have pain from a benign source. These athletes will be expected to respond well to non operative treatment. However some athletes may experience pain from more severe stuructural sources such as fracture or tumor. In these cases, different management may be indicated. The clinician evaluating athletes with LBP must have overall understanding about back problems for making proper decision and therapeutic regimen. In this article, the authors discuss common back pain related injuries in the atheletic population, typical mechanisms of injury and the treatment methods include rehabilitation exercise for these problems.

Accurate determination of wound depth with ultrasound and its forensic significance / 法医学杂志

Accurate determination of the wound depth has long been a difficult task in forensic medicine due to lack of technology. Nowadays, the depth of the wound can be accurately determined by using high frequency 2-D ultrasound and Color Doppler Flow Imaging (CDFI). Two typical cases with ultrasonic images were reported to show the importance of ultrasound technology in forensic medicine. The new technology provides scientific evidence of the injury assessment.

Persistent vegetative state caused by non-brain damage and its forensic assessment / 法医学杂志

Persistent vegetative state (PVS) is described as one of the complications of brain damage in the current forensic science literatures. PVS unrelated to brain damage, however, is not uncommon in daily forensic practice. Currently, only "Assessment for Body Impairment of the Injured in Road Traffic Accident" designates PVS as one of its items under the section of "Brain, Spinal Cord, and Nerves Injury." Therefore, it is difficult to assess the damage and disability in PVS, especially PVS due to non-brain damage. Based on a case of PVS caused by chest injury in combination with relevant literature review, this paper provides a summary on the general information, etiology, pathogenesis, clinical manifestation, diagnosis and differential diagnosis of PVS, as well as a guideline for its forensic assessment.

Primary identification of an abused child in dental office: a case report.

Although the injuries of child abuse are many and varied, several types of injuries are common to abuse. Many of these injuries are within the scope of dentistry or easily observed by the dental professional in the course of routine dental treatment. The authors present a case of child abuse with multiple bruises. The child had been spanked in the previous night and the morning of the attendance by his mother. This case emphasized that all practitioners should be vigilant when patients present with abnormal injuries which may be the result of abuse and further investigation should be instigated.

An Epidemiologic Study of Low Back Pain of Women Working at a General Hospital / 영남의대학술지

BACKGROUND: The aim of this study was to confirm the risk factors for low back pain and injury to improve the prevention and treatment of lower back pain. MATERIALS AND METHODS: An epidemiologic study of low back pain and injury was performed with questionnaires distributed to 471 women working at Yeungnam university hospital. The differences in low back pain and injuries among various hospital departments were analyzed by a one-way analysis of variance (ANOVA), and the relevant factors included in the questionnaire were determined by a factor analysis. RESULTS: The frequency of low back pain in women in the department of diet and in the maintenance department was higher than among the other departments. The frequency of low back pain was mainly related to the frequency of psychosomatic symptoms. In addition, the low back pain was partially related to the frequency of psychosomatic symptoms and partially related to the frequency of pushing during the workday. The degree of disability from low back pain was increased by lifting and hard physical work and was related to the frequency of psychosomatic symptoms and the degree of work dissatisfaction. The frequency of low back injury was increased by increased standing time during work and hard physical work. The frequency of low back injury was related to advancing age and in part to psychosomatic symptoms. CONCLUSION: Lower back pain and its associated complications are related to psychosomatic factors and type of work. Lower back injury is related to physiological factors such as age. For the prevention and treatment of lower back pain, a multidisciplinary approach is required.

Treatment of Tremor and Spasticity in Failed Back Surgery Syndrome with Spinal Cord Stimulation: A case report / 대한통증학회지

Tremor is a rhythmic, involuntary and oscillatory movement of body parts, and it is the most common movement disorder. Spasticity is also one of the movement disorders that is commonly accompanied with Complex Regional Pain Syndrome; however, the basic nature of spasticity has not yet been proved. A 25-year-old male patient had two operations and he was being treated because of a back injury that occurred 4 years ago. He suffered from pain, tremor and spasticity on both his lower legs, and his symptoms were diagnosed as failed back surgery syndrome. The tremor and spasticity were aggravated despite of continuous treatments. We then treated him with spinal cord stimulation. His pain, tremor and spasticity disappeared after spinal cord stimulation.

An ergonomics intervention program to prevent worker injuries in a metal autoparts factory.

An ergonomics intervention program (EIP) was conducted with male employees working in the pressing and storage sections of a metal autoparts factory in Samut Prakan Province, Thailand. The objectives of this study were to assess the causes of injuries in the pressing and storage sections of that factory, and to improve working conditions by reducing worker injuries from accidents and low back muscular discomfort, using an EIR The study design used a participatory research approach which was quasi-experimental with pretest-posttest evaluations, with a non-equivalent control group. A total of 172 male participants working in Building A were the target group for assessing causes of injury. A retrospective study of official accident information, and questionnaires for general information, health and muscular discomfort, injury frequency rate (IFR), injury severity rate (ISR), medical expenses, and EIP design. Two groups of employees volunteered for the study on muscular back discomfort. The first group of 35 persons volunteered to participate in the EIP (EIP group), and the second 17 persons from Building B did not (non-EIP group). The EIP was composed of 4 major categories: (1) engineering improvement, (2) change in personal protective equipment, (3) environmental improvement, (4) administrative intervention, training, and health education. Low back muscular discomfort was measured through questionnaires on subjective feelings of muscular discomfort, and by surface electromyography (sEMG). Muscle activities were measured by sEMG of the left and right erector spinae and multifidus muscles, and evaluated by multivariate test for dependent samples (paired observation), and multivariate test for two independent samples. After EIP, IFR decreased 65.46%, ISR decreased 41.02%, and medical expenses decreased 42.79%. The low back muscular loads of the EIP group were significantly reduced, with a 95% confidence level (p < 0.05) while those of the non-EIP group were not. Subjective feelings of muscular discomfort, determined by Wilcoxon Signed Ranks test, showed that after applying the EIP to the EIP group, the mean scores for general bodily discomfort and low back muscular discomfort in the EIP group had significantly reduced, while those of the non-EIP group increased, (p < 0.05).

Effects of Back-belt on Electromyographic Activities and Angle of Lower Back and Extremity during Lifting / 대한산업의학회지

OBJECTIVES: The purpose of this study was to examine the electromyographic activities of the erector spinae muscle of the back and the rectus femoris muscle of the thigh, and to measure the angles of the spinal and knee flexions in order to determine the effect of wearing a back belt. METHODS: Fifteen healthy males participated in the study. Surface electromyography was used to measure the level of muscle activities at the two muscle groups. The Simi system, utilizing two-dimensional analysis of movement, was used to examine the range of motion of the back and low extremity. RESULTS: Firstly, the angle of the spinal flexion was significantly less in the back-belt-wearing group than in the control, and that of the knee flexion was significantly increased in the back-belt-wearing group. Secondly, there was no significant change in the electromyographic signals of the erector spinae muscle of the back and the rectus femoris muscle of the thigh. CONCLUSIONS: The use of back belts helps workers to correct their posture when lifting boxes. It can therefore protect workers from acute back injuries.