JOURNAL OF BACK AND MUSCULOSKELETAL
REHABILITATION
Volume 7, Issue 1, August 1996
ABSTRACTS
The Influence of the Spine on the Shoulder in the Throwing Athlete
Young JL, Herring SA, Press JM, Casazza BA.
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.
Keywords: Sports medicine, baseball injuries, biomechanics, shoulder, spine
Guidelines for Program Evaluation in Chronic Non-Malignant Pain Management
Sanders SH, Rucker KS , Anderson KO, Harden RN, Jackson KW, Vicente PJ, Gallagher RM.
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
The Sensory Consequences of Repetitive Strain Injury in Musicians: Focal Dystonia of the Hand
Byl N, Hamati D, Melnick M, Wilson F, McKenzie A.
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 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
Utilizing Psychological Assessment in Rehabilitating Patients with
Occupational Musculoskeletal Injuries
Alexy WD, Webb PM, Crismore LA, Mark DJ.
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 1-3/3-1) 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
A Maladaptive Gait Abnormality in Patients with Lumbar Spinal Stenosis
Kerrigan DC, Ehrenthal SR.
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 may or 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.
Keywords: Spinal stenosis, gait
Intra-articular Ganglion Cyst Arising from the Anterior Cruciate Ligament: A Case Report
Peterson JR, Frieman BG, Kaplan RH.
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