New Advances in Musculoskeletal Disorders

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10 January 2025

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Topic Information

Dear Colleagues,

Musculoskeletal disorders (MSDs) are the leading contributor to disability worldwide, with lower back pain being the single leading cause of disability across 160 countries. Disability associated with MSDs has been increasing, and it is projected to rapidly increase in the coming decades due to population increase and aging. MSDs are considered work-related musculoskeletal disorders (WMSDs) if an event or exposure in the work environment either caused or contributed to the resulting disorders or significantly aggravated a pre-existing disorder. In the USA, 272,780 WMSD cases were reported in 2018, with the incidence rate of 27.2 per 10,000 full-time workers, accounting for approximately 30% of all occupational injuries and illnesses involving days away from work. Therefore, it is crucial to survey the prevalence and risk factors of WMSDs and to develop preventive measures to reduce WMSDs.

This Topic focuses on updating our knowledge concerning WMSDs. New research papers, reviews, case studies and any WMSDs relevant studies are also welcome to this Topic. The major themes of which are as follows:

• Prevalence of WMSDs by industry and country;
• Symptoms by body parts;
• Smart assessment tools and their applications in industry;
• Interventions and their effects;
• Relationships between risk factors and specific WMSDs;
• Diagnosis methods;
• Effects of individual differences and psychosocial, environmental, and organizational factors on WMSDs.

Prof. Dr. Dohyung Kee
Prof. Dr. Inseok Lee
Topic Editors

Keywords

Participating Journals

Journal Name	Impact Factor	CiteScore	Launched Year	First Decision (median)	APC
Diagnostics diagnostics	3.0	4.7	2011	20.5 Days	CHF 2600	Submit
Healthcare healthcare	2.4	3.5	2013	20.5 Days	CHF 2700	Submit
Journal of Clinical Medicine jcm	3.0	5.7	2012	17.3 Days	CHF 2600	Submit
Journal of Functional Morphology and Kinesiology jfmk	2.6	4.2	2016	18.9 Days	CHF 1600	Submit
Medicina medicina	2.4	3.3	1920	17.8 Days	CHF 2200	Submit
Therapeutics therapeutics	-	-	2024	15.0 days *	CHF 1000	Submit

* Median value for all MDPI journals in the first half of 2024.

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Published Papers (11 papers)

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10 pages, 3109 KiB  

Open AccessArticle

Range of Flexion Improvement in Degenerative Stages of the First Metatarsophalangeal Joint (Hallux rigidus) with Cross-Linked Hyaluronic Acid: A Cadaveric Study

by Annabel Capell Morera, Elena de Planell Mas, Laura Perez Palma and Maria Cristina Manzanares-Céspedes

J. Funct. Morphol. Kinesiol. 2024, 9(4), 259; https://doi.org/10.3390/jfmk9040259 - 6 Dec 2024

Viewed by 373

Abstract

Background: Viscosupplementation consists of intraarticular hyaluronic acid injections applied to treat pain and improve joint mobility. The objective of the study was to analyze the improvement of the range of mobility of the first metatarsophalangeal joint with a single dose of cross-linked hyaluronic [...] Read more.

Background: Viscosupplementation consists of intraarticular hyaluronic acid injections applied to treat pain and improve joint mobility. The objective of the study was to analyze the improvement of the range of mobility of the first metatarsophalangeal joint with a single dose of cross-linked hyaluronic acid. Methods: Ten fresh frozen specimens of feet sectioned below the knee were selected. Before and after the infiltration procedure, the range of flexion was calculated for all specimen’s metatarsophalangeal joints. To detect complications due to the procedure, five feet were dissected and five were sectioned with a diamond saw. Results: The range of the first metatarsophalangeal joint flexion differences between the preoperative and the postoperative period was as follows: (1) 47° (range, 37–51.5) to 58° (range, 49–69.5) degrees of loaded dorsiflexion (p > 0.006); (2) 41° (range, 40–51.5) to 58° (range, 52.5–66.5) degrees of unloaded dorsiflexion (p > 0.009); and (3) 14° (range, 10.5–24.25) to 16° (range, 14.25–28.5) degrees of unloaded plantarflexion (p > 0.083). No injuries of anatomical structures were observed either by anatomical dissection or in the anatomical sections. Conclusions: The results obtained in this viscosupplementation study demonstrate the improvement of the range of mobility of the first metatarsophalangeal joint without evidence of extravasation and lesions of the periarticular anatomical structures. Full article

(This article belongs to the Topic New Advances in Musculoskeletal Disorders)

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<p>Reference points and position of the goniometer for the joint flexion assessment. (1) Interphalangeal joint of the hallux; (2) first MTP joint; (3) internal tuberosity of the navicular.</p> Full article ">Figure 2
<p>Technique and limits for intra-articular infiltration of cross-linked HA.</p> Full article ">Figure 3
<p>Plane-by-plane anatomical dissection results. (<b>a</b>). Dorsal view of a left foot, showing the unharmed EHL (1) and articular capsule (2) of the first metatarsophalangeal joint. (<b>b</b>). Lateral view of a left foot showing the EHL (1) and articular capsule (2) of the first metatarsophalangeal joint.</p> Full article ">Figure 4
<p>Sectional anatomy results. (<b>a</b>). Lateral view: section of the middle sagittal plane of the first toe, right foot. (1) proximal phalanx of the hallux; (2) first MTP joint space; (3) first metatarsal; (4) flexor hallucis longus; (<b>b</b>). Lateral view: section of the parasagittal plane of the first toe, right foot. (1) proximal phalanx of the hallux; (2) first MTP joint space; (3) first metatarsal; (5) lateral sesamoid bone. (<b>c</b>). Coronal view: left foot, axial cross section of the first metatarsal head (3), showing the inferior aspect of the first metatarsal joint space (2) at the level of the sesamoid bones (5).</p> Full article ">

16 pages, 2343 KiB  

Open AccessArticle

Automated Diagnosis of Knee Osteoarthritis Using ResNet101 on a DEEP:PHI: Leveraging a No-Code AI Platform for Efficient and Accurate Medical Image Analysis

by Kyu-Hong Lee, Ro-Woon Lee, Jae-Sung Yun, Myung-Sub Kim and Hyun-Seok Choi

Diagnostics 2024, 14(21), 2451; https://doi.org/10.3390/diagnostics14212451 - 1 Nov 2024

Viewed by 884

Abstract

Background: Knee osteoarthritis (OA) is a prevalent degenerative joint disease significantly impacting global health. Early and accurate diagnosis is crucial for effective management, but traditional methods often rely on subjective assessments. This study evaluates the efficacy of a deep learning model implemented through [...] Read more.

Background: Knee osteoarthritis (OA) is a prevalent degenerative joint disease significantly impacting global health. Early and accurate diagnosis is crucial for effective management, but traditional methods often rely on subjective assessments. This study evaluates the efficacy of a deep learning model implemented through a no-code AI platform for diagnosing and grading knee OA from plain radiographs. Methods: We utilized the Osteoarthritis Initiative (OAI) dataset, comprising knee X-ray data from 1526 patients. The data were split into training (47.0%), validation (26.5%), and test (26.5%) sets. We employed a ResNet101 model on the DEEP:PHI no-code AI platform for image analysis. The model was trained to classify knee OA into five grades (0–4) based on the Kellgren–Lawrence scale. Results: Our AI model demonstrated high accuracy in distinguishing between different OA grades, with particular strength in early-stage detection. The model achieved optimal performance at 20 epochs, suggesting efficient learning dynamics. Grad-CAM visualizations were used to enhance the interpretability of the model’s decision-making process. Conclusions: This study demonstrates the potential of AI, implemented through a no-code platform, to accurately diagnose and grade knee OA from radiographs. The use of a no-code AI platform such as DEEP:PHI represents a step towards democratizing AI in healthcare, enabling the rapid development and deployment of sophisticated medical AI applications without extensive coding expertise. This approach could significantly enhance the early detection and management of knee OA, potentially improving patient outcomes and streamlining clinical workflows. Full article

(This article belongs to the Topic New Advances in Musculoskeletal Disorders)

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<p>The architecture of ResNet101.</p> Full article ">Figure 2
<p>A schematic image of using the DEEP:PHI platform.</p> Full article ">Figure 3
<p>Diagnostic performance of AI algorithm during the training epoch.</p> Full article ">Figure 4
<p>True-positive cases on AI algorithms with Grad-CAM images. The abnormal regions learned through the training can be identified by the observer through color mapping.</p> Full article ">

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15 pages, 2328 KiB  

Open AccessReview

Chiropractic and Spinal Manipulation: A Review of Research Trends, Evidence Gaps, and Guideline Recommendations

by Robert J. Trager, Geronimo Bejarano, Romeo-Paolo T. Perfecto, Elizabeth R. Blackwood and Christine M. Goertz

J. Clin. Med. 2024, 13(19), 5668; https://doi.org/10.3390/jcm13195668 - 24 Sep 2024

Viewed by 7011

Abstract

Chiropractors diagnose and manage musculoskeletal disorders, commonly using spinal manipulative therapy (SMT). Over the past half-century, the chiropractic profession has seen increased utilization in the United States following Medicare authorization for payment of chiropractic SMT in 1972. We reviewed chiropractic research trends since [...] Read more.

Chiropractors diagnose and manage musculoskeletal disorders, commonly using spinal manipulative therapy (SMT). Over the past half-century, the chiropractic profession has seen increased utilization in the United States following Medicare authorization for payment of chiropractic SMT in 1972. We reviewed chiropractic research trends since that year and recent clinical practice guideline (CPG) recommendations regarding SMT. We searched Scopus for articles associated with chiropractic (spanning 1972–2024), analyzing publication trends and keywords, and searched PubMed, Scopus, and Web of Science for CPGs addressing SMT use (spanning 2013–2024). We identified 6286 articles on chiropractic. The rate of publication trended upward. Keywords initially related to historical evolution, scope of practice, medicolegal, and regulatory aspects evolved to include randomized controlled trials and systematic reviews. We identified 33 CPGs, providing a total of 59 SMT-related recommendations. The recommendations primarily targeted low back pain (n = 21) and neck pain (n = 14); of these, 90% favored SMT for low back pain while 100% favored SMT for neck pain. Recent CPG recommendations favored SMT for tension-type and cervicogenic headaches. There has been substantial growth in the number and quality of chiropractic research articles over the past 50 years, resulting in multiple CPG recommendations favoring SMT. These findings reinforce the utility of SMT for spine-related disorders. Full article

(This article belongs to the Topic New Advances in Musculoskeletal Disorders)

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<p>Publication trends of chiropractic research from 1970 to 2023. Image (<b>A</b>) (publications per year; blue) and Image (<b>B</b>) (cumulative publications; orange). The most recent year (2024) is not shown to provide a more accurate representation of publication trends and account for lags in indexing.</p> Full article ">Figure 2
<p>Trends in topic keywords per year from 1972 to 2024. The plot displays keywords having a frequency of ≥150 and words per year of 1, thereby tending to omit keywords from 1972 to 1981 given the relative lack of research during that time. The bars represent the first and third quartiles of keyword representation, while the circle position represents the median year of occurrence. The size of the circle corresponds to the total frequency of the keyword occurrence. We used a thesaurus to merge synonymous terms, and we removed meaningless terms (e.g., “article” and “research”) given the threshold for occurrence. The figure was created by Robert Trager using Bibliometrix and Biblioshiny.</p> Full article ">Figure 3
<p>Keyword co-occurrence map (1972–2024). The figure was created using author keywords using Scopus, with the parameters of occurrences (~35), ignoring the term “chiropractic”, scale of 2.0, strength ≥ 8, using a thesaurus to merge similar terms. The size of the circles increases with greater occurrence of keyword use, while bars connecting circles indicate co-occurring keywords, with the width of bars indicating the strength of co-occurrence. The figure was created by Robert Trager using VOSviewer, version 1.6.20.</p> Full article ">Figure 4
<p>Article selection diagram. Abbreviations: Cumulative Index to Nursing and Allied Health Literature (CINAHL), spinal manipulative therapy (SMT). Please note that a large number of studies were excluded at the title/abstract phase due to our broad search strategy. Many articles mentioned clinical practice guidelines but did not constitute guidelines themselves (e.g., protocols, randomized trials, guideline adherence studies). Full-text exclusions with specific reasons are detailed in <a href="#app1-jcm-13-05668" class="html-app">Supplemental File S2</a>.</p> Full article ">Figure 5
<p>Timeline plot of clinical practice guideline recommendations for spinal manipulation by condition and year from 2014 to 2024. Recommendations for episodic and chronic tension-type headaches were grouped under “Any” to simplify the plot, considering these terms typically denote headache frequency rather than duration. Abbreviations: lower back pain (LBP), lumbar radiculopathy (LR), pelvic girdle pain (PGP), vasomotor symptoms (VMS). Recommendations in favor (“Yes” or “Multimodal”) are shown in light and dark green, respectively, while recommendations not in favor (“No” or “Insufficient evidence”) are shown in red and orange, respectively.</p> Full article ">

13 pages, 1508 KiB  

Open AccessArticle

Identifying the Problem Side with Single-Leg Squat and Hamstrings Flexibility for Non-Specific Chronic Low Back Pain

by Boon Chong Kwok, Helen Elizabeth Smith and Pui Wah Kong

Medicina 2024, 60(9), 1428; https://doi.org/10.3390/medicina60091428 - 1 Sep 2024

Viewed by 1133

Abstract

Background and Objectives: In patients with non-specific chronic low back pain (LBP), their pain and problem sides can differ. Clinical Pilates assessment provides an approach to identify the problem side, but this approach requires experience and can be subjective. This study aimed [...] Read more.

Background and Objectives: In patients with non-specific chronic low back pain (LBP), their pain and problem sides can differ. Clinical Pilates assessment provides an approach to identify the problem side, but this approach requires experience and can be subjective. This study aimed to investigate if objective measures of single-leg squat postural control and hamstrings flexibility could identify the problem side in adults with non-specific chronic LBP. Materials and Methods: Forty adults with non-specific chronic LBP were tested on single-leg squat postural control and hamstrings flexibility. The problem side of participants was assessed with the Clinical Pilates method. Paired t-tests were used to compare the postural sway parameters of the single-leg squat and hamstrings flexibility between the problem and non-problem sides. Cohen’s kappa was then used to assess the agreement of postural sway and flexibility measures with the Clinical Pilates method. Results: The problem side showed smaller vertical force variance, larger sway path distances, lower peak vertical force, smaller terminal knee flexion angle, longer time to complete the five single-leg squats, and tighter hamstrings as compared to the non-problem side. However, only the overall and anteroposterior sway path distances, terminal knee flexion angle, total squat duration, and hamstrings flexibility yielded moderate to strong agreement with the Clinical Pilates method. Conclusions: Single-leg squat postural sway parameters and hamstrings flexibility can objectively identify the problem side in adults with non-specific chronic LBP. Full article

(This article belongs to the Topic New Advances in Musculoskeletal Disorders)

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<p>Assessment of (<b>a</b>) single-leg squat using a force plate and an electrogoniometer, (<b>b</b>) hamstrings flexibility using a goniometer.</p> Full article ">Figure 2
<p>Examples of right flexion directional preference (in green) assessed with the DMA Clinical Pilates method that could find unidirectional (<b>i</b>,<b>v</b>), duo-directional (<b>ii</b>,<b>vi</b>), and multi-directional (<b>iii</b>,<b>iv</b>,<b>vii</b>,<b>viii</b>) preferences.</p> Full article ">Figure 3
<p>Examples of raw data acquired during the SLS test: (<b>a</b>) force plate data collected via the Bioware software, in Newtons (N), and (<b>b</b>) knee angle (green line) data collected using the electrogoniometer via the Biometrics software, in degrees.</p> Full article ">

16 pages, 317 KiB  

Open AccessArticle

The Influence of Hip-Strengthening Program on Patients with Chronic Ankle Instability

by Woo-Jin Yeum, Mi-Young Lee and Byoung-Hee Lee

Medicina 2024, 60(8), 1199; https://doi.org/10.3390/medicina60081199 - 24 Jul 2024

Cited by 1 | Viewed by 1624

Abstract

Background and Objectives: Repetitive ankle sprains lead to mechanical instability of the ankle. Patients with chronic ankle instability may experience decreased muscle strength and limited postural control. This study investigated the effects of a hip-strengthening exercise program on muscle strength, balance, and [...] Read more.

Background and Objectives: Repetitive ankle sprains lead to mechanical instability of the ankle. Patients with chronic ankle instability may experience decreased muscle strength and limited postural control. This study investigated the effects of a hip-strengthening exercise program on muscle strength, balance, and function in patients with chronic ankle instability. Materials and Methods: A total of 30 patients participated in the study and were randomly assigned to the two groups. Among the 30 participants, 14 were assigned to the hip joint-strengthening exercise group and 16 to the control group. The experimental group underwent a hip-strengthening exercise program and received training for 40 min per session twice a week for four weeks. The control group received the same frequency, duration, and number of sessions. Measurements were performed before and after the training period to assess changes in hip strength, balance, and function. Results: In the within-group and between-group comparisons, both groups showed significant differences in hip joint strength, static balance, dynamic balance, and function (FAAM; foot and ankle ability measures) (p < 0.05). Statistically significant differences were observed in the time × group interaction effects among the hip abductors and external rotation in hip joint strength, path length in static balance, posterolateral and posteromedial in dynamic balance, and FAAM-ADL and FAAM-SPORT functions (p < 0.05). Conclusions: Accordingly, this study confirmed that hip joint-strengthening exercises have a positive effect on the strength, balance, and function of patients with chronic ankle instability, and we believe that hip joint-strengthening exercises will be recommended as an effective intervention method for patients suffering from chronic ankle instability. Full article

(This article belongs to the Topic New Advances in Musculoskeletal Disorders)

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14 pages, 1057 KiB  

Open AccessArticle

Short-Term Effects of Cold Therapy and Kinesio Taping on Pain Relief and Upper Extremity Functionality in Individuals with Rotator Cuff Tendonitis: A Randomized Study

by Elif Durgut, Hulya Nilgun Gurses, Kerem Bilsel, Kubra Alpay, Zeynep Hosbay, Gokcer Uzer, Fatih Yıldız and Nurzat Elmalı

Medicina 2024, 60(8), 1188; https://doi.org/10.3390/medicina60081188 - 23 Jul 2024

Viewed by 1705

Abstract

Background and Objectives: Rotator cuff tendonitis (RCT) is one of the most common shoulder pathologies. It causes pain, limits shoulder joint movements, and impairs function. Despite various treatment methods, there are currently no specific guidelines regarding the most effective intervention for RCT. [...] Read more.

Background and Objectives: Rotator cuff tendonitis (RCT) is one of the most common shoulder pathologies. It causes pain, limits shoulder joint movements, and impairs function. Despite various treatment methods, there are currently no specific guidelines regarding the most effective intervention for RCT. To the best of our knowledge, no studies have compared the effects of Kinesio taping (KT) and cold therapy (CT) on individuals with RCT. To this end, this study aimed to investigate and compare the short-term effects of KT and CT on pain relief and upper extremity functionality in individuals with RCT. Materials and Methods: One hundred and fourteen individuals were assessed for eligibility. Fifty-two individuals with RCT who met the inclusion criteria and agreed to participate were randomly allocated into either the KT or the CT group. A standardized home exercise program was given to all the participants. Their pain intensity, upper extremity function, shoulder range of motion (ROM), and grip strength were evaluated initially and after the three days of KT or CT applications. Results: All the assessment values significantly improved in the KT group. In the CT group, only the pain scores (except for the numerical rating scale (NRS) pain score during activity) were significantly improved in the CT group at the end of the third day of application compared to the initial values (p < 0.05). For all the measurement outcomes, the effects of time × group interactions were statistically significant (p < 0.05) in favor of the KT group, except for the resting pain (p = 0.688). Conclusions: The findings suggest that KT and CT could be used as adjunctive modalities to exercise for resting and night pain relief in patients with RCT. KT also had positive effects on the activity pain, function, ROM, and grip strength. The use of KT along with an exercise program could be a more effective therapeutic choice than the use of CT for improving night pain, activity pain, and upper extremity function during the short-term rehabilitation of RCT patients. Full article

(This article belongs to the Topic New Advances in Musculoskeletal Disorders)

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<p>Kinesio-taping method.</p> Full article ">Figure 2
<p>Study flow chart.</p> Full article ">

7 pages, 4290 KiB  

Open AccessArticle

Medial Rectus Disinsertion for the Management of Large-Angle Sensory Esotropia

by So Young Han, Bo Young Chun, Hye Jin Lee, Hyun Kyung Kim, Mi Sun Kwon, Ho Seok Lee and Soolienah Rhiu

Medicina 2024, 60(7), 1104; https://doi.org/10.3390/medicina60071104 - 6 Jul 2024

Viewed by 910

Abstract

Background and Objectives: The aim of the report is to report the outcomes of the medial rectus (MR) disinsertion procedure for the management of large-angle esotropia (ET) patients. Materials and Methods: This is a retrospective case series of patients with large-angle [...] Read more.

Background and Objectives: The aim of the report is to report the outcomes of the medial rectus (MR) disinsertion procedure for the management of large-angle esotropia (ET) patients. Materials and Methods: This is a retrospective case series of patients with large-angle ET who underwent an MR disinsertion procedure between March 2012 to April 2022. The procedure happened accidentally during muscle surgery. The demographic and clinical data, including sex, age, visual acuity, pre- and postoperative angle of strabismus, duction limitations, results of intraoperative forced duction tests, and follow-up duration were collected from medical records. Results: Five patients were enrolled in this study. The mean age was 62.2 ± 9.8 years, and the mean follow-up was 24.8 ± 8.7 months. The ET at the primary position of gaze was 92.0 ± 17.9 prism diopters (PD) before MR disinsertion and 38.0 ± 29.5 PD after MR disinsertion only. Abduction deficiency was −4 before after MR disinsertion, which improved to −1 at the last follow-up. Conclusions: The results of MR disinsertion were not as frustrating as anticipated. MR disinsertion may be considered in patients with large-angle sensory ET who refuse surgery on the opposite eye. Full article

(This article belongs to the Topic New Advances in Musculoskeletal Disorders)

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<p>Photos of Case 1 preoperative (<b>upper column</b>) and 1 month postoperative (<b>lower</b>). A 63-year-old patient presented with 100 PD esotropia in the right eye. One month after medial rectus disinsertion and lateral rectus with a 7.0 mm resection of the right eye, he had esodeviation of 10 PD in the primary position of gaze with nearly normal adduction and abduction. * Abduction in left eye was complete preoperatively.</p> Full article ">Figure 2
<p>Photos of Case 3 preoperative (<b>upper column</b>) and 1 month postoperative (<b>lower</b>). A 72-year-old patient presented with 90 PD esotropia in the right eye. One month after Jenson operation and medial rectus disinsertion of the right eye, he was orthophoric in the primary position of gaze with nearly normal adduction and abduction.</p> Full article ">Figure 3
<p>Photos of Case 4 preoperative esotropia in 9 cardinal directions. A 63-year-old patient presented with 100 PD esotropia in the left eye. Two weeks after medial rectus muscle disinsertion and lateral rectus muscle resection of the left eye, she was orthophoric and slightly hypotropic in the primary position of gaze with normal adduction and abduction.</p> Full article ">Figure 4
<p>Postoperative CT image of Case 4. No definite abnormality is noted after left medial rectus muscle disinsertion.</p> Full article ">Figure 5
<p>Photos of Case 5 preoperative esotropia in 9 cardinal directions. A 67-year-old patient presented with 100 PD esotropia in the left eye. One day after medial rectus muscle disinsertion she still had 100 PD esotropia in the left eye with severe abduction restriction.</p> Full article ">Figure 6
<p>Preoperative CT image of Case 5. Thickening of the left medial rectus muscle with severe left esotropia is noted.</p> Full article ">

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30 pages, 1931 KiB  

Open AccessArticle

At Early Rheumatoid Arthritis Stage, the Infectious Spectrum Is Driven by Non-Familial Factors and Anti-CCP Immunization

by Marina I. Arleevskaya, Andrej A. Novikov, Anna R. Valeeva, Marina O. Korovina, Igor L. Serdiuk, Vladimir A. Popov, Caroline Carlé and Yves Renaudineau

J. Clin. Med. 2024, 13(10), 2796; https://doi.org/10.3390/jcm13102796 - 9 May 2024

Viewed by 1832

Abstract

Background/Objectives: Patients with rheumatoid arthritis (RA) are prone to develop infections. Methods: Accordingly, 195 untreated early (e)RA patients and 398 healthy controls were selected from women in Tatarstan’s cohort to study infectious history in the anamnesis (four criteria) and in the previous year [...] Read more.

Background/Objectives: Patients with rheumatoid arthritis (RA) are prone to develop infections. Methods: Accordingly, 195 untreated early (e)RA patients and 398 healthy controls were selected from women in Tatarstan’s cohort to study infectious history in the anamnesis (four criteria) and in the previous year (16 criteria). Information about annual infections was collected face-to-face from year to year by a qualified rheumatologist/general practitioner and included the active use of information from medical records. Results: In the anamnesis, tuberculosis, and pneumonia, and in the previous year, respiratory tract infections, skin infections, and herpes simplex virus reactivation incidence were reported to be increased in eRA patients, as well as the event number and duration of acute and chronic tonsillitis. Moreover, more bacterial-suspected upper respiratory infections and urinary tract infections were retrieved in sporadic eRA patients as compared to familial eRA patients. An elevated immunization against CCP prevented respiratory tract infection in those with HSV exacerbation. Finally, associations were retrieved between infection (event number/delay) and RA indices: (i) chronic tonsillitis exacerbations with disease activity and health assessment (HAQ) in familial eRA; (ii) bacterial-suspected upper respiratory infections with the number of swollen and tender joints in sporadic eRA; and (iii) HSV exacerbation with inflammation in eRA patients with negative/low response against CCP. Here, we demonstrate the complex nature of the interplay of RA with specific infections. Conclusions: For the first time, differences in the patterns of annual trivial infections and their links with RA indices were found in cohorts of familial and sporadic cases of the disease. Additionally, for the first time, we identified a remarkable relationship between early RA and exacerbations of chronic tonsillitis, as well as tuberculosis in the patient’s history. Altogether, this study supports the existence of a complex interplay between infections and RA at onset driven by familial status and the presence of anti-CCP Ab at elevated levels. Full article

(This article belongs to the Topic New Advances in Musculoskeletal Disorders)

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<p>Flow chart analysis.</p> Full article ">Figure 2
<p>Infectious incidence in the anamnesis and in the previous year at RA onset when comparing eRA patients with healthy controls (<b>left</b>), familial from sporadic eRA patients (<b>middle</b>), and eRA with an elevated immunization status against CCP (<b>left</b>). (<b>A</b>) Infections in the anamnesis of eRA patients. (<b>B</b>) Infections reported in the previous year of eRA. (<b>C</b>) The interplay between herpes reactivation and oral tract infections. Data are presented as log10 (<span class="html-italic">p</span>-value) with a significant threshold fixed at <span class="html-italic">p</span> <math display="inline"><semantics> <mrow> <mo>≤</mo> </mrow> </semantics></math> 0.01 corresponding to the false discovery rate post hoc. Abbreviations: eRA: early rheumatoid arthritis; Cont: healthy controls; aCCP: anti-citrullinated peptide antibodies; Fam: eRA with familial cases of RA; Spo: sporadic eRA without familial cases reported; CMU: women <span class="html-italic">Chlamydia</span>, <span class="html-italic">Mycoplasma</span>, and <span class="html-italic">Ureoplasma</span> species carriage; V-URI: viral-suspected upper respiratory infections; B-URI: bacterial-suspected upper respiratory infections treated with antibiotics; HSV: herpes simplex; UTI: urinary tract infections.</p> Full article ">Figure 3
<p><b>Number of infectious events and duration per event in the previous year at RA onset.</b> (<b>A</b>) Comparison between eRA patients with healthy controls. (<b>B</b>) Comparison between familial and sporadic eRA patients. (<b>C</b>) Comparison between eRA patients having or not having an elevated immunization status against CCP at onset. Data are presented as log10 (<span class="html-italic">p</span>-value) with a significant threshold fixed at <span class="html-italic">p</span> <math display="inline"><semantics> <mrow> <mo>≤</mo> </mrow> </semantics></math> 0.01 corresponding to the false discovery rate post hoc. Abbreviations: eRA: early rheumatoid arthritis; aCCP: anti-citrullinated peptide antibodies; Fam: eRA with familial cases of RA; Spo: sporadic eRA without familial cases reported; V-URI: viral-suspected upper respiratory infections; B-URI: bacterial-suspected upper respiratory infections treated with antibiotics; HSV: herpes simplex; UTI: urinary tract infections.</p> Full article ">Figure 4
<p>Heat map of Spearman correlation between infectious events and clinical features of RA in four subgroups at early (e)RA. (<b>A</b>) Familial eRA; (<b>B</b>) sporadic eRA; (<b>C</b>) eRA patients having an elevated immunization status against CCP; D: eRA patients with a negative or low immunization against CCP. <span class="html-italic">p</span>-values are indicated and considered significant when <span class="html-italic">p</span> &lt; 0.01.</p> Full article ">Figure 5
<p>The link of RA indices and infections in eRAfam and eRAaCCP subgroups (Kruscal–Wallis median test). (<b>a</b>) eRAfam subgroup: the number of swollen joints (68 joint count) was lower in patients with TB in their history when compared with those without this infection (Chi-square = 3.93, df = 1, <span class="html-italic">p</span> = 0.05). (<b>b</b>) eRAfam subgroup: the serum RF level was lower in patients with TB in their history when compared with those without this infection (Chi-square = 4.73, df = 1, <span class="html-italic">p</span> = 0.03). (<b>c</b>) eRAfam subgroup: the ESR was lower in patients with pneumonia in their history when compared with those without this infection (Chi-square = 3.81, df = 1, <span class="html-italic">p</span> = 0.05). (<b>d</b>) eRAaCCP subgroup: the number of swollen joints (68 joint count) was lower in patients with TB in their history when compared with those without this infection (Chi-square = 5.34, df = 1, <span class="html-italic">p</span> = 0.02). (<b>e</b>) eRAaCCP subgroup: the HAQ value was lower in patients with TB in their history when compared with those without this infection (Chi-square = 9.33, df = 1, <span class="html-italic">p</span> = 0.002). (<b>f</b>) eRAaCCP subgroup: the ESR was lower in patients with TB in their history when compared with those without this infection (Chi-square = 4.21, df = 1, <span class="html-italic">p</span> = 0.04).</p> Full article ">

12 pages, 770 KiB  

Open AccessArticle

The Flexion Relaxation Phenomenon in Patients with Radiculopathy and Low Back Pain: A Cross-Sectional Study

by Marijan Peharec, Stanislav Peharec, Vedran Srhoj-Egekher, Romana Jerković, Dean Girotto and Gordana Starčević-Klasan

J. Funct. Morphol. Kinesiol. 2024, 9(2), 77; https://doi.org/10.3390/jfmk9020077 - 19 Apr 2024

Viewed by 1605

Abstract

Although the measurements of the lumbar spine and pelvic flexion have shown that subjects with radiculopathy exhibited greater decreases of motion when compared with subjects with low back pain, there is still a lack of evidence regarding the changes in flexion relaxation ratio [...] Read more.

Although the measurements of the lumbar spine and pelvic flexion have shown that subjects with radiculopathy exhibited greater decreases of motion when compared with subjects with low back pain, there is still a lack of evidence regarding the changes in flexion relaxation ratio in patients with radiculopathy. The aims of this study were to investigate the flexion relaxation ratio and flexion of the lumbar spine and pelvis in subjects with low back pain (LBP) and LBP with radiculopathy (LBPR) in comparison with healthy subjects (CG—control group). A total of 146 participants were divided in three groups: LBP patients (54 males; 21 females); LBPR patients (26 males; 11 females); and CG subjects (16 males; 18 females). The lumbar spine and pelvis flexion was recorded using optoelectronic motion capture system. The electrical activity of the erector spinae muscles was assessed by surface electromyography during flexion-extension movements. Comparisons between groups were made using one-way ANOVA tests and Mann–Whithney U test with the level of statistical significance at 0.05. The lumbar and pelvic flexion and electromyography of the erector spinae muscle showed significant differences between LBP and LBPR patients compared to CG. Patients LBPR showed significantly smaller angles of lumbar and pelvic flexion compared to LBP patients and CG. An increase in the erector spinae muscle activity during flexion was also observed in patients with radiculopathy. The increased muscular activity of the erector spinae is related to the reduced flexion of the lumbar spine in order to protect the lumbar spine structure. Measurements of trunk, lumbar spine and pelvic flexion, and the flexion relaxation ratio may allow us to predict better outcomes or responsiveness to treatment of LBPR patients in the future. Full article

(This article belongs to the Topic New Advances in Musculoskeletal Disorders)

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Figure 1
<p>(<b>a</b>) Locations of the markers and electrodes for kinematic and sEMG recordings. Two pairs of electrodes applied bilaterally over the lumbar erector spinae muscles at the L1–L2 level and at the L4–L5 level. Six infrared-sensitive markers were placed on spinous processes Th1, Th3, Th6, Th9, Th12, L3, and three were placed on elastic belt and fastened over pelvis landmarks: the anterior superior iliac spine and the posterior superior iliac spine on the left and right sides. (<b>b</b>) Position of the participants for trunk flexion analysis. Model showing three variables as an example of the flexed position that was used: total trunk flexion (TF), pelvic flexion (PF) and lumbar spine flexion (LF). Four vectors were used for calculation: vector perpendicular to the horizontal reference plane, vector perpendicular to the pelvis plane, vector starting at S1 and pointing toward T1 for total flexion definition and the lumbar vector between L3–T9.</p> Full article ">Figure 2
<p>Study CONSORT flow diagram. LBP: low back pain group; LBPR: low back pain with radiculopathy group.</p> Full article ">

9 pages, 2586 KiB  

Open AccessTechnical Note

Arthroscopic Medialization Partial Repair with Biologic Interposition Tuberoplasty for Large to Massive Irreparable Rotator Cuff Tear

by Jae-Wook Jung, Joong-Bae Seo, Jun-Yeul Lee and Jae-Sung Yoo

Medicina 2024, 60(3), 484; https://doi.org/10.3390/medicina60030484 - 14 Mar 2024

Cited by 1 | Viewed by 1347

Abstract

An irreparable rotator cuff tear is a challenging condition to treat, and various treatment modalities are being introduced. Medialization in the partial repair method has the limitation of exposing the tuberosity, while tension-free biologic interposition tuberoplasty using acellular dermal matrix has the limitation [...] Read more.

An irreparable rotator cuff tear is a challenging condition to treat, and various treatment modalities are being introduced. Medialization in the partial repair method has the limitation of exposing the tuberosity, while tension-free biologic interposition tuberoplasty using acellular dermal matrix has the limitation of exposing the humeral head. The authors believe that by combining these two techniques, it is possible to complement each other’s limitations. Therefore, they propose a surgical method that combines medialization and biologic interposition tuberoplasty for addressing these constraints. Full article

(This article belongs to the Topic New Advances in Musculoskeletal Disorders)

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Figure 1
<p>(<b>A</b>) The arthroscopic examination of a 72-year-old female reveals findings consistent with a massive rotator cuff tear. (<b>B</b>) Footprint medialization and single-row repair were performed using two suture anchors, and three pairs of FiberWire sutures were left for the biologic tuberoplasty procedure. RC; rotator cuff, H; Humerus.</p> Full article ">Figure 2
<p>The remaining FiberWire sutures from the medial row and acellular dermal matrix were interposed, and biologic tuberoplasty was performed using the suture bridge repair method.</p> Full article ">Figure 3
<p>(<b>A</b>) On preoperative magnetic resonance imaging of a 72-year-old female with a massive rotator cuff tear, findings reveal a large-sized acromial spur and retracted cuff tear (arrow). (<b>B</b>) Postoperative magnetic resonance imaging shows the medialization and repair of the cuff tendon (arrow), as well as the presence of biologic interposition tuberoplasty (arrowhead).</p> Full article ">Figure 4
<p>A satisfactory outcome was observed at 6 months post-surgery, with the patient demonstrating active full range of motion.</p> Full article ">

11 pages, 1176 KiB  

Open AccessArticle

Musculoskeletal Pain, Physical Activity, Muscle Mass, and Mortality in Older Adults: Results from the Korean Longitudinal Study on Health and Aging (KLoSHA)

by Sun-Woo Hwang, Chang-Woo Kim, Yun-Jeong Jang, Chang-Han Lee, Min-Kyun Oh, Ki-Woong Kim, Hak-Chul Jang, Jae-Young Lim, Se-Woong Chun and Seung-Kyu Lim

Medicina 2024, 60(3), 462; https://doi.org/10.3390/medicina60030462 - 11 Mar 2024

Viewed by 2301

Abstract

Background and objectives: Musculoskeletal (MSK) pain significantly impacts physical activity and quality of life in older adults, potentially influencing mortality. This study explored the relationship between MSK pain, physical activity, muscle mass, and mortality among older adults. Material and Methods: We studied 1000 [...] Read more.

Background and objectives: Musculoskeletal (MSK) pain significantly impacts physical activity and quality of life in older adults, potentially influencing mortality. This study explored the relationship between MSK pain, physical activity, muscle mass, and mortality among older adults. Material and Methods: We studied 1000 participants in the Korean Longitudinal Study on Health and Aging (KLoSHA), a prospective, population-based cohort study of people aged 65 years or older. Survival status was tracked over a 5-year period. Correlations between low back pain (LBP), knee pain, regular exercise, appendicular skeletal muscle mass (ASM), and other variables were analyzed. Logistic regression analyses were used to identify independent risk factors for mortality. Results: Of the total participants, 829 (82.9%) survived over a 5-year period. Survivors tended to be younger, had a higher BMI, and were more active in regular exercise. In contrast, non-survivors exhibited a higher prevalence of both LBP and knee pain, along with increased instances of multiple MSK pains. Lower ASM correlated moderately with LBP and knee pain, whereas higher ASM was associated with regular exercise. There was a moderate correlation between LBP and knee pain, both of which were associated with a lack of regular exercise. Age, sex, ASM, and regular exercise were significant predictors, even though MSK pain itself did not directly predict all-cause mortality. Conclusions: This study demonstrated the independent association between ASM, regular exercise, and mortality. Although MSK pain did not directly correlate with all-cause mortality, the non-survivor group had higher levels of both single and multiple MSK pains. Recognizing the interplay of MSK pain, physical activity, and muscle mass for older adults, the research underscores the need for holistic strategies to enhance health outcomes in older individuals with MSK pain. Full article

(This article belongs to the Topic New Advances in Musculoskeletal Disorders)

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<p>The proportion of MSK pain: (<b>A</b>) individual pain and (<b>B</b>) number of pains between survivor and non-survivor groups (n (%)). The non-survivor group showed significantly higher rates of MSK pain and multiple MSK pains.</p> Full article ">

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