Journal of Musculoskeletal Research

Musculoskeletal disorders can significantly disrupt the quality of life of an individual. Early diagnosis and management are critical for minimizing the long-term impact of these disorders. The musculoskeletal upper extremities radiographs (MURA) and lower extremity radiographs (LERA) datasets have emerged as a significant resource in the field of musculoskeletal imaging, facilitating the development and evaluation of various AI models for diagnostic and predictive tasks. The systematic review is carried out in this work to scrutinize existing deep learning models, unraveling their capabilities in decoding complex abnormalities within the musculoskeletal system. By intricately analyzing these models, this study contributes valuable insights into their strengths, weaknesses and performance that are pivotal for advancing the field of musculoskeletal health, ultimately facilitating more informed and precise diagnostic practices. The various limitations and gaps identified during this review will undoubtedly prove valuable for researchers in this field, offering insights to increase the efficiency and effectiveness of their models for the classification and detection of abnormalities in the musculoskeletal system. This undertaking is not merely an aggregation of disparate studies but a deliberate effort to contribute to the ongoing discourse within healthcare, fostering a foundation for evidence-based practice and policy development.

Purpose: Ankle instability is a major factor responsible for injuries such as ankle sprain. Changes in foot progression angle can also be one of the contributing factors for such injuries. This study aimed to find the correlation between chronic ankle instability (CAI) and foot progression angle (FPA) in young adults.

Methods: The present cross-sectional study included 120 subjects with chronic ankle instability, aged 18-26 years. They were selected using the Cumberland Ankle Instability Tool (CAIT) and Identification of Functional Ankle Instability (IdFAI) self-reporting outcome measuring tool and International Ankle Consortium (IAC) criteria. Their foot progression angle was measured by using the dynamic footprint method in which subjects covered their feet with colored powder and then walked across the paper walkway. The data was analyzed to find the correlation between CAI and FPA.

Results: The FPA showed a statistically non-significant but weak positive correlation with CAI.

Conclusion: There was a statistically non-significant correlation of CAI with foot progression angle and CAI was more prevalent in females. Approximately, 50% of the sample population sought healthcare provider services for their ankle injury.

Introduction: Femoral neck fractures in young adults pose a great challenge to the orthopedic surgeon because of the high rate of non-union and high risk of avascular necrosis (AVN) of the femoral head. Anatomical reduction is the most important factor for union success. Fixed Angle devices can resist shear and torsion forces across the fracture helping the union. The aim of the study is to assess the functional and radiological outcome following fixed angle fixation of a femoral neck fracture.

Patients and methods: A prospective study including 40 patients for fixation of femoral neck fracture utilizing fixed angle device in the form of dynamic hip screw and anti-rotational screw.

Results: The study included 40 cases, 34 males (85%) and 6 females (15%). The mean age of the patients was 32.2 years (range 18–50 years). The mean follow-up period was 12.5 months (range 12–14 months). The mean tip-apex distance was 18.85 mm (range 10–30 mm). Time to union was 13.8 weeks (range 12–36 weeks) with three fractures of delayed union and 1 case on non-union.

Discussion: In the current thesis, all cases had anatomical reduction with a failure rate of 2.5%. No cases of AVN were encountered in comparison to Gautam et al. who had three cases of AVN (12%). Also, Protzman and Burkhalter showed a very high incidence of AVN with an incidence of (87%). In a meta-analysis done by Lang et al. comparing DHS against multiple cannulated screws, the incidence of non-union was 8.6% with DHS and 8% with multiple cannulated screws. By performing a sensitive analysis, they found that the incidence of AVN in patients fixed with multiple cannulated screws was significantly lower than in cases fixed with DHS.

Conclusion: Dynamic hip screw with anti-rotational screw is a successful method of fixation of femoral neck fractures in the young adult population. Anatomical reduction of the femoral neck fracture can decrease the incidence of non-union and AVN in the presence of posterior comminution of the femoral neck. Closed methods of reduction can achieve proper reduction if used properly.

Background: Musculoskeletal disorders (MSDs) are major health problems that cause disability and, as a result, have a significant impact on the quality of life of individuals and also impose very high economic costs on countries School teachers are a professional group with a high prevalence of musculoskeletal disorders, especially in the lumbar, neck, and shoulder regions. Therefore, this study was conducted with the aim of determining the prevalence and risk factors associated with neck/shoulder pain and low back pain among school teachers.

Methods: A cross-sectional study was conducted in Eslamabad-e Gharb City, located in western Iran, between May and June 2023. The study included 361 teachers selected from primary, secondary, and high schools in the city. Data collection was performed using two questionnaires designed to assess demographic characteristics, lifestyle factors, occupational characteristics, and social-psychological exposures related to neck/shoulder and low back pain. The face validity of the questionnaires was evaluated by eight teachers. Data analysis was conducted using SPSS24 software, utilizing a binary logistic regression model.

Results: A significant 63.4% of participants reported experiencing pain in the neck, shoulder, and lower back. Factors significantly associated with neck pain include: bachelor’s degree (OR = 4.23, 95% CI = 1.28–13.98), larger household size (OR = 1.96, 95% CI = 1.11–3.46), teaching in co-ed schools (OR = 0.11, 95% CI = 0.01–0.81), not maintaining a forward-bent neck posture for long periods (OR = 0.30, 95% CI = 0.20–0.80), and job satisfaction (OR = 0.15, 95% CI = 0.10-0.88). Factors significantly associated with shoulder pain include: bachelor’s degree (OR = 4.22, 95% CI = 1.31–13.60), sleep duration of $\ge$9 h (OR = 2.73, 95% CI = 1.06–6.99), employment in a private school (OR = 2.12, 95% CI = 1.05–4.28), and lack of support from colleagues (OR = 2.47, 95% CI = 1.04–5.85). Factors significantly associated with low back pain include: number of working $\ge$10 h per week (OR = 1.08, 95% CI = 1.01–1.60), avoiding prolonged forward bending of the neck (OR = 0.84, 95% CI = 0.52–0.99), inappropriate desk and chair (OR = 1.92, 95% CI = 1.09–3.74), and job satisfaction (OR = 0.49, 95% CI = 0.16–0.92).

Conclusion: The findings stress the essential role of ergonomic practices, supportive work environments, and job satisfaction in reducing musculoskeletal disorders among teachers. Prioritizing ergonomic practices and fostering supportive work environments can significantly reduce musculoskeletal pain among teachers.

Spondylodiscitis is a infective processes of the spinal column, that can affect the vertebrae in isolation (spondylitis), the discs (discitis) or both (spondylodiscitis). Three infection pathways are described from a pathogenetic perspective: endogenous, exogenous, and per continuitatem. The hematogenic form is the most common (about 60%), but cases of direct inoculation following surgical procedures on the spine (15%) or contamination by contiguity (12%) are not rare. Diagnosis is based on clinical, laboratory, radiological, microbiological and histopathological data, where the magnetic resonance imaging is the technique of choice for the diagnosis. Treatment may be medical using antibiotics to eliminate the infection or surgery using spinal fixation to prevent spinal instability and ample debridement of infected tissue. We report on a patient who had spondylodiscitis due to a sigmo-rettal fistula caused by a intrarectal penetration of a toothpick which was accidentally swallowed by the patient; which was successfully treated with targeted antibiotic therapy and immobilization.

Background: Chronic Low Back Pain (CLBP) has been the leading cause of disability globally for at least three decades. Totally, 10% to 20% of people who experience acute lower back pain episodes often develop CLBP. In CLBP, there is an altered sensorimotor pathway which impairs body the balance. There are lacunae in studies prescribing balance exercise to CLBP individuals. This study aims to determine the effects of balance exercises on pain intensity, back physical performance, trunk extensor muscle endurance, and disability in CLBP individuals.

Methods: A qualified therapist unaware of the study assessed all outcome measures (Visual Analogue scale– VAS, Oswestry Disability Index — ODI, Back Performance Scale — BPS, Biering Sorenson test — BST) at baseline, end of 4th week, and 8th week. All participants underwent balance exercise intervention for 30 min/day, 3 days a week, for 8 weeks. Repeated measures ANOVA was performed at $p$ < 0.05.

Results: Out of 65 screened participants, 40 (24 females, 16 males) fulfilled the study criteria and performed the balance exercise. The BPS score for back physical performance, VAS score for patient-reported pain intensity, BST value for trunk extensor muscle endurance, and ODI score for low back disability domains significantly improved after the balance exercise intervention at the end of 4th week and 8th week ($p$ < 0.05).

Conclusions: Balance exercise effectively improves back physical performance, reducing pain and back-related impairments. Further, the controlled trial is warranted to add the level of evidence.

The objective of this case report is to emphasize the importance of the identification of all the causative factors responsible for the creation of the congenital clasped thumb, as their detection will perform a critical part in the choice of the proper surgical treatment. This study presents the case of a four-year-old boy with a congenital clasped thumb of the right hand. A short Flexor Pollicis Longus (FPL), an absent Abductor Pollicis Longus (APL), a hypoplastic Extensor Pollicis Brevis (EPB), and palmar displacement of the Extensor Pollicis Longus (EPL) were detected. The surgical treatment included Z-lengthening of the short FPL and augmentation of the insufficient EPL and EPB by tendons transfer. Postoperatively, the thumb was halted in a place of full radial abduction and $20^{\circ }$ of palmar flexion with scotchcast plaster for four weeks. In his last follow-up three years after surgery, he was able to do full abduction and extension of the thumb. He was able to open a door or grasp and hold various objects. He was fully satisfied with the result of the operation. Treatment should be adjusted to address all causative issues of clasped thumb effectively, reduce deforming forces, and increase the activity of insufficient muscles.

Introduction: Ehlers–Danlos Syndrome (EDS) is a hereditary and heterogeneous syndrome that affects conjunctive tissue, due to collagen production compromise. Hypermobile EDS (hEDS) is the most common subtype of this syndrome and can cause shoulder joint instability, which can lead to chronic pain and significant functional impairment.

Methods: A case report of a patient with hEDS followed in our local health unit was made. The authors describe their clinical insight regarding the case, as well as the rehabilitation program the patient was submitted to.

Results: Female patient, 32 years old. Functionally autonomous in every daily living activity. Clinically diagnosed with hEDS in 2013, after reporting bilateral shoulder instability. The patient presented herself in a Physical and Rehabilitation Medicine consultation, 6 months after being submitted to the third surgical intervention of the right shoulder. She presented an overall limited range of motion, decreased muscle strength and positive apprehension and drawer tests. An extensive rehabilitation program was prescribed, focusing on joint mobilization, dynamic stabilizers strengthening and proprioceptive training. After 12 weeks, the patient presented reduced shoulder pain and a better functional status.

Conclusion: hEDS compromises the integrity of the static and dynamic stabilizers of the shoulder. Clinical management of these cases involves a multidisciplinary approach with early and adequate rehabilitation care treatments.

Background: The rheumatic condition fibromyalgia syndrome (FMS) is marked by extensive pain, and tender points, with accompanying complaints such as stiffened muscles, depression, anxiety, sleep disturbance, along with dyspnea, exhaustion, and other cardio-respiratory related dysfunction. This study’s goal was to determine the effect of dry cupping intervention on pain, cardiorespiratory parameters as well as lung function in patients with FMS.

Methods: Thirty females with FMS (40–60 years old) were enlisted and subsequently divided into two distinct groups: conventional treatment with ($n$ = 15) and without ($n$ = 15) cupping therapy i.e. experimental and control groups respectively. All participants received therapies 3 days a week during this study. Visual Analogue Scale (VAS), digital pressure pain threshold (PPT), cardiac parameters including blood pressure using a sphygmomanometer, O₂ saturation and pulse rate using a pulse oximeter, respiratory parameters including chest expansion using a measuring tape, lung functions including FVC and FEV1/FVC using a spirometer were used to assess participants on baseline, last day of 2nd and 4th week of treatment.

Results: Improvements in pain, PPT, oxygen saturation, pulse rate, and chest expansion, FVC and FEV1/FVC were higher in the group who got cupping therapy including conventional treatment against the group who just received conventional treatment ($p<$ 0.05). At the end of the 4th week, there was no appreciable change in blood pressure levels between the groups ($p>$ 0.05).

Conclusion: The FMS treatment plan should include cupping therapy in addition to conventional treatment to help patients improve their cardio-respiratory fitness and overall quality of life.

Objective: To compare the effectiveness of the slider, tensioner neurodynamic mobilization techniques and stretching exercises on pain, range of motion (ROM), and functional disability in patients with chronic discogenic sciatica.

Design: A pre-test post-test multi arm parallel RCT.

Setting: Outpatient clinics, faculty of physical therapy, Kafrelsheikh University.

Participants: Thirty-six patients with unilateral chronic discogenic sciatica were randomly allocated into three equal groups: Group (A) slider neurodynamic mobilization, Group (B) tensioner neurodynamic mobilization, and Group (C) stretching exercises of back extensors, hamstrings, and gastrocnemius muscles. Treatment was given three sessions per week for two weeks.

Outcome measures: All patients were examined by visual analogue scale (VAS) for pain intensity, Modified-Modified Schober test (MMST) for lumbar flexion ROM, goniometer for hip flexion and knee extension ROM, and Oswestry Disability Index (ODI) for functional assessment.

Results: There were no statistically significant differences between groups at baseline ($p<$ 0.05). There were statistically significant differences in the slider and tensioner groups compared to the stretching group for all variables. Furthermore, statistically significant differences were found in the slider technique as compared to the tensioner technique regarding ROM of lumbar flexion ($p$ = 0.03), hip flexion ($p$ = 0.004), and knee extension ($p$ = 0.005).

Conclusion: Slider and tensioner neurodynamic mobilization techniques are more effective than stretching exercises in terms of reducing pain, increasing ROM, and improving function. Slider technique is more effective in ROM improvement.

Musculoskeletal complications following COVID-19 infection or because of its medications had been reported in the literature. Here, we report on seven hips in four patients who presented with osteonecrosis of the femoral head (ONFH) after having COVID-19 infection, and their treatment regimen included glucocorticoid. Four patients presented to us complaining of hip pain (bilateral in three patients and unilateral in one), all reported being diagnosed as having COVID-19 infection, and their line of management included corticosteroid intake for various durations. The diagnosis was confirmed by plain hip radiographs and magnetic resonance imaging. The disease was in the early stages in all patients without femoral head collapse. Thus, all hips were treated by core decompression. ONFH is a real concern in patients who have COVID-19 infection, especially when corticosteroids are administered as part of their management. A follow-up and screening strategy should be established for patients who had COVID-19 infection to detect the early development of hip osteonecrosis.

Reconstruction of extra-articular shoulder resections is challenging. We present a novel method using the patient’s own pedicled proximal humerus and scapula, sterilized with liquid nitrogen cryoablation and recycled as an autograft. The technique was used for three patients with malignant tumors. We present the surgical technique and clinical outcomes. All patients had high-grade sarcomas of the proximal humerus requiring extra-articular resection. At surgery, the tumor-bearing shoulder girdle was exteriorized with wide margins and pedicled on the humerus via a medial scapula and clavicular osteotomy. The pedicled shoulder was then frozen in liquid nitrogen, the extraosseous tumor mass and non-viable muscle were removed and the residual shoulder girdle was re-implanted. Average follow up was 4.5 years. At the time of writing, all patients are alive without disease and have retained their original reconstructions. Scapulothoracic and elbow movements were preserved with stiff glenohumeral joints. One patient experienced an implant complication requiring surgery to remove a migrated Kirschner wire and to mesh reinforce the glenohumeral capsule. The flag technique is a reliable, low cost reconstructive option for extensive sarcomas of the shoulder girdle. A stiff glenohumeral joint with preserved scapulothoracic motion may be expected post-surgery.

Introduction: Distal tibia involvement is very rare and it merely accounts for around 4% of all the excised lesions. (Mirra, 1989) Distal tibia osteochondromas mainly present pain, deformity like varus/valgus around ankle joint, pathologic fractures of surrounding structures and for the above-mentioned problems, surgical excision has to be considered as a possible option. (Ismail et al., 2008).

Methods: We conducted a prospective study from 1st June 2018 to 1st June 2021 including five patients (4 males and 1 female) with distal tibia osteochondroma. In our study, surgical excision was performed in all the cases. Pre-operative and at final follow-up ‘AOFAS-AHFS score’ and ‘VAS score’ were evaluated.

Results: All five patients had good functional outcome at final follow-up, mean AOFAS-AHFS score improved from 61.2±5.4 to 85±3.39, and mean VAS score improved from 7.2±0.83 to 0.8±0.44 at final follow-up and found no difficulty in daily routine activities. All patients had complete ROM at final follow-up.

Conclusion: Distal tibia osteochondroma has good functional outcome and less complications, if managed properly.

Several fractures that occur in the human body depend on trauma or as a result of hormonal and bone fatigue. Fracture types that take place out of the neck area of the femoral bone are named femoral shaft fractures. Femoral shaft fractures are frequent conditions in orthopedics. Conventional plating method is a method that necessitates the fixation of the contact surface by contacting the epiphyses used in the treatment of such fractures. This method is known to be efficent in speeding up the healing process by reducing the movement between the epiphyses. In this study, femur models which are plated in various forms with fractures were analyzed with computer-aided finite element software and stresses on bone surfaces and fracture surfaces were determined. It is aimed to determine the best result by examining the relationship between the inputs such as the number of screws used during plating, the fixation area and material selection and the outputs obtained by finding the stresses on the bone surface and stresses on the broken surfaces.

Hip’s open reduction combined with Salter innominate osteotomy and femoral osteotomy is the treatment of choice when treating Developmental Dislocation of the Hip (DDH) at walking age. We report a case of a five-year-old girl who underwent a failed surgical procedure of hip’s open reduction, Salter innominate osteotomy, and the femoral osteotomy. One year later, one-stage surgical procedure of hip’s open reduction, Dega pelvic osteotomy, and femoral de-rotation varus shortening osteotomy was performed. During the five-year follow-up, the clinical outcome was evaluated as excellent.

The Dega pelvic osteotomy is an effective pelvic osteotomy for DDH, in a case of a failed Salter osteotomy.

Background: Musculoskeletal disorders are prevalent in communities across the world and their impact is affecting people in almost all occupational settings. Aim: The aim of this study was to determine the prevalence of self-reported musculoskeletal disorders among urban dwellers, Kano metropolis. Method: A total of 206 participants were recruited using a stratified sampling technique in a cross-sectional survey. The data was collected using a standard Nordic Musculoskeletal Questionnaire (NMQ) and International Physical Activity Questionnaire (IPAQ) to measure work-related musculoskeletal disorders and physical activity levels of the participants. Results: The results showed that the majority of the participants (63.9%) were males and 36.9% were females between the ages of 18 and 65 years, with the majority of them between 18 and 34 years, singles and self-employed. Also, the majority of the participants had moderate physical activity levels, normal body mass index and low risk of cardiovascular diseases using the waist to hip ratio classifications. About 78.2% of the participants reported 12-month musculoskeletal disorders while 37.4% reported 7-day musculoskeletal disorders. Low back was the most common site affected by 45.6% of the respondents. Also, the result showed no significant relationship between 12-month musculoskeletal disorder and BMI, physical activity level and waist/hip ratio but a relationship between 7 Days musculoskeletal disorder and BMI, physical activity level and waist/hip ratio. Conclusion: It was concluded that there was a high prevalence of musculoskeletal disorders among urban community dwellers in Kano metropolis, with low back pain the most reported while upper back has the least prevalence. Clinical Rehabilitation Impact: There was a high prevalence of WMSD among the general populace irrespective of the sociodemographic affiliations. Lower back was the most reported anatomical site among our participants. Men had a higher number of WMSD than women. There was an association between WMSD and WHR and BMI. Excess weight management might be helpful especially in individuals with high BMI and WHR.

Objective: Neck pain is a common cause of disability and costly problem, especially in the working population. However, there is a paucity of studies examining the efficacy of pressure-biofeedback guided craniocervical flexion exercise (CCFE) in neck pain. Therefore, this study aims to find out the efficacy of Pressure-Biofeedback guided CCFE on the treatment of neck pain. Methods: This randomized controlled trial included 60 participants with neck pain who were randomly assigned to the experimental group ($n=30$) and control group ($n=30$). The experimental group received pressure-biofeedback guided CCFE for four times per week for four weeks, whereas the control group received physical therapy agents (PTA) (radiant heat and transcutaneous electrical nerve stimulation). Outcome measures included the Visual Analogue Scale (VAS) and Neck Disability Index (NDI). Results: The baseline demographics and outcome measurements were not significantly different between the two groups. More significant reduction in VAS of the experimental group was found in comparison with control group at week 2 and week 4, respectively ($p<0.05$). Regarding the NDI, there was a more significant reduction in the experimental group than the control group at week 4 ($p<0.05$). Conclusion: Pressure-biofeedback guided CCFE was useful for improving pain and functional disability of neck for the management of neck pain.