Journal of Back and Musculoskeletal Rehabilitation - Volume 7, issue 1
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Journal of Back and Musculoskeletal Rehabilitation is a journal whose main focus is to present relevant information about the interdisciplinary approach to musculoskeletal rehabilitation for clinicians who treat patients with back and musculoskeletal pain complaints. It will provide readers with both 1) a general fund of knowledge on the assessment and management of specific problems and 2) new information considered to be state-of-the-art in the field. The intended audience is multidisciplinary as well as multi-specialty.
In each issue clinicians can find information which they can use in their patient setting the very next day. Manuscripts are provided from a range of health care providers including those in physical medicine, orthopedic surgery, rheumatology, neurosurgery, physical therapy, radiology, osteopathy, chiropractic and nursing on topics ranging from chronic pain to sports medicine. Diagnostic decision trees and treatment algorithms are encouraged in each manuscript. Controversial topics are discussed in commentaries and rebuttals. Associated areas such as medical-legal, worker's compensation and practice guidelines are included.
The journal publishes original research papers, review articles, programme descriptions and cast studies. Letters to the editors, commentaries, and editorials are also welcomed. Manuscripts are peer reviewed. Constructive critiques are given to each author. Suggestions for thematic issues and proposed manuscripts are welcomed.
Abstract: Analysis of shoulder dysfunction in throwing and overhead athletes can no longer be restricted to evaluation of the glenohumeral joint alone. The isolated shoulder is incapable of generating the force necessary to hurl a baseball at velocities of 90–100 miles per hour or serve a tennis ball in excess of 120 miles per hour. The purpose of this paper is to provide a literature based theoretical framework for the role of the spine during these activities. The spine is a pivotal component of the kinematic chain which functions as a transfer link between the lower and upper limbs, a force…generator capable of accelerating the arm, and a force attenuator which dampens shear forces at the glenohumeral joint during the deceleration phase of the pitching motion. Side bending and rotation of the cervical spine facilitates visual acquisition of the intended target. Inflexibility of the hip musculature and weakness of the muscles which attach to the thoracolumbar fascia have profound effects upon spine function which secondarily places greater stress upon the glenohumeral joint and rotator cuff. Shoulder rehabilitation and injury prevention programs should include evaluation of and exercise regimens for the lumbar, thoracic and cervical spine.
Abstract: The current article offers guidelines to systematically evaluate programs which treat chronic non-malignant pain syndrome patients. The guidelines represent a basic program evaluation strategy and include specific recommendations and choices on measurement-assessment tools based upon available research literature and common clinical practice. They are based on evaluation by objectives, which include the program's ability to reduce the misuse of medications, increase physical function, increase productive activity at home, work and socially, improve overall mood, reduce subjective pain intensity, reduce the use of healthcare, when applicable, achieve equitable case settlement, and minimize pain treatment program cost without compromising quality of care.…The method and timing of assessing each of these objectives are delineated with an emphasis on using reliable, valid measures which can be applied effectively within a clinical setting. The guidelines also advocate patient and staff satisfaction assessment, thus offering a fully integrated program evaluation system which can measure effectiveness and allow ongoing improvement in care.
Keywords: Chronic pain, Program evaluation, Guidelines, Pain rehabilitation
Abstract: Some individuals with repetitive strain injury (RSI) develop focal dystonia of the hand (FDh ), a disorder of motor control manifested in a specific context during skilled, hand movements. This descriptive study was designed to determine if musicians with FDh had reduced tactile discrimination. Ten healthy adults and ten patients with FDh participated in the study. From the standardized Sensory Integration and Praxis Test, five subtests were selected to measure tactile discrimination. The Paired Wilcoxon Test was used to analyze, meaningful, planned pairwise differences by side and by group. The two groups performed similarly on the three tests…measuring tactile motor perception (Finger Identification, Localization and Kinesthesia). However, those with FDh performed significantly worse than the healthy comparison group on two tactile perceptual tasks: (1) Graphesthesia, right affected (P < 0.003) and left unaffected (P < 0.005); and (2) Manual Form Perception (stereognosis) on the right affected (P < 0.002) and left unaffected (P < 0.002). It is possible that the somatosensory differences as measured by tactile discrimination tasks represent some degradation of the hand representation following prolonged, repetitive, near simultaneous sensory stimulation of adjacent digits. Tactile discrimination should be tested in patients with RSI to detect potential risks for developing FDh . Effective treatment of patients with RSI including FDh may need to target the somatosensory deficits in order to restore stress-free motor movements.
Keywords: Writer's cramp, Task specific dystonia, Musician, Repetitive injury syndrome, Repetitive strain injury Cumulative trauma disorder, Focal dystonia of the hand
Abstract: Patients with occupational musculoskeletal injuries who participate in multidisciplinary rehabilitation programs will likely undergo psychological assessment as a part of the evaluation process. Although the importance of examining non-physical influences on the patient’s recovery is widely recognized among clinicians, it is often unclear how findings from psychological assessment are being utilized to facilitate rate of recovery from injury. The purpose of this study was to encourage a re-examination of current psychological assessment practices among multidisciplinary rehabilitation programs and to describe how the Minnesota Multiphasic Personality Inventory (MMPI-2) was utilized with a work-hardening patient sample (n = 86 ).…For the overall patient sample, the MMPI-2 depicted relatively high levels of somatic focus and low levels of psychological distress. To enhance clinical utility, a clustering method identified profile groupings that were distinguishable on the basis of known personality and behavioral correlates. Two profile groupings (Scale 1; Scales 1–/3–1) were discussed with recommendations for how clinicians may facilitate rate of recovery from injury. The MMPI-2 appears to be particularly useful in identifying treatment conditions that may favorably influence rate of recovery from occupational musculoskeletal injuries.
Keywords: Psychological assessment, Work-hardening, MMPI-2, Rate of recovery
Abstract: A maladaptive pattern of abnormally increased anterior pelvic tilt during gait was documented using quantitative gait analysis in two patients presenting with lumbar spinal stenosis. Both patients also had, by physical examination, mild bilateral hip flexion contracture impairments which mayor may not have been directly related to the spinal stenosis. There is no literature to date supporting the presence of either hip flexion contractures or excessive anterior pelvic tilt during gait in patients with lumbar spinal stenosis. The excessive anterior pelvic tilt present in these patients was presumably a compensation for the hip flexion contractures to achieve reasonable step lengths.…Increased anterior pelvic tilt induces increased hyperextension of the lumbosacral spine, which in a patient with spinal stenosis, could cause pain and lead to further spinal nerve impingement. Since hip flexion contracture impairments are amenable to stretching, their presence should be especially pursued in patients with spinal stenosis.
Abstract: Intra-articular ganglion cysts have been reported in the medical literature but are extremely rare. A MEDLINE search from 1966 to July 1995 revealed no reported cases in the Physical Medicine literature. This case report details the presentation, evaluation and treatment course of a patient with knee complaints who was subsequently diagnosed to have a ganglion cyst arising from the anterior cruciate ligament. The patient was a 38-year-old woman with a 6-month history of knee swelling and pain. She had difficulty walking. Non-steroidal anti-inflammatory agents had not alleviated her symptoms significantly. Physiatric evaluation revealed a supra-patellar effusion and a mass lateral…to the patellar tendon. MRI evaluation revealed an intra-articular cyst. The patient underwent surgical removal of what was subsequently determined to be an intra-articular ganglion cyst arising from the anterior cruciate ligament. The patient has had progressive resolution of her knee symptoms post-operatively. Physiatrists need to be aware of this cause of mechanical knee symptoms.
Keywords: Knee injuries, Cruciate ligaments, Ganglion cyst, Magnetic resonance imaging
Abstract: This is the first installment of a new section on Alternative Medicine. Alternative medicine practices are fast becoming the treatment of choice for many Americans, as will be discussed below. As clinicians devoted to rehabilitating patients to their fullest potential, it is an avenue that deserves further exploration into the benefits and controversies surrounding it. Future columns will delve further into the disadvantages, advantages, varying methods available, and current research in Alternative Medicine.
Abstract: This article reviews widely available medical computer applications and discusses their use for individual physicians and physician groups. The medical applications reviewed include electronic mail, electronic medical references, medical literature databases, and medical areas of interest on the Internet. The reader is directed to other key sources for review of office management software solutions.