Search Results (1,167)

Introduction: Musculoskeletal conditions impose a substantial economic burden on the United States (U.S.) healthcare system, but contemporary national estimates of condition-specific spending for common orthopaedic conditions remain limited. This study utilized the 2023 Medical Expenditure Panel Survey (MEPS) to estimate the national prevalence, condition-specific expenditures, and payer distribution for treated knee injuries and shoulder disorders. Methods: Adults with treated knee injuries or shoulder disorders were identified using ICD-10-CM codes from the MEPS Medical Conditions File. Condition-specific expenditures were estimated by linking diagnoses to medical events and payments using the MEPS Condition–Event Link File. Expenditures were aggregated across inpatient, outpatient, office-based, emergency, home health, and prescribed medicine categories. Survey-weighted analyses were used to estimate national prevalence, mean expenditures, service-level spending patterns, and payer distributions. Survey-weighted Gamma generalized linear models with log link were used to examine patient characteristics associated with expenditures among the U.S. civilian noninstitutionalized population with positive condition-specific spending. Results: The analysis identified 2.55 million adults with treated knee injuries and 2.58 million adults with treated shoulder disorders. Mean annual condition-specific expenditures per person were higher for knee injuries ($10,552; 95% CI: $6128–$14,975) than for shoulder disorders ($4310; 95% CI: $3337–$5283). Knee injury expenditures were concentrated in inpatient and home health care, whereas shoulder disorder expenditures were concentrated in outpatient and office-based care. Private insurance, Medicare, out-of-pocket payments, and Worker’s Compensation each contributed to the financial burden, with payer distributions varying by condition. In adjusted models, fair/poor self-rated health and female sex were associated with higher knee injury expenditures, while no covariates were statistically significant for shoulder disorder expenditures. Conclusions: Treated knee injuries and shoulder disorders showed distinct condition-specific expenditure profiles across care settings and payer sources. These findings provide contemporary national benchmarks for orthopaedic spending and may support future research, utilization monitoring, and value-based reimbursement planning. Full article

Background: Developmental dysplasia of the hip (DDH) is the most common congenital musculoskeletal disorder in newborns. Flexion–abduction orthoses are widely used in early treatment; however, in vivo data on their biomechanical load characteristics remain limited. This study aimed to evaluate axial force transmission in a hip flexion–abduction orthosis and to compare load patterns between healthy newborns and infants with DDH. Methods: In this exploratory observational study, 36 newborns (19 healthy, 17 with unilateral DDH) were examined within the first week of life. Axial forces transmitted through a Mittelmeier–Graf hip flexion–abduction orthosis (MGO) were measured using integrated force sensors under symmetrical and asymmetrical adjustment configurations. Intergroup comparisons were performed using non-parametric statistical tests. Results: Mean axial forces were significantly higher in healthy infants than in those with DDH under both symmetrical (4.02 N vs. 2.51 N; p = 0.019) and asymmetrical (3.67 N vs. 1.83 N; p = 0.001) conditions. Relative load corresponded to approximately 11–12% of body weight in healthy infants and 5–7% in the DDH group. No significant intra-individual differences were observed between dysplastic and contralateral hips. Orthosis configuration (symmetrical vs. asymmetrical) did not significantly affect load distribution. Conclusions: This exploratory in vivo study demonstrates that axial load transmission in a hip flexion–abduction orthosis is low and influenced by underlying hip pathology. Infants with DDH generate lower forces than healthy newborns, potentially reflecting altered biomechanics. As no significant differences were observed between orthosis configurations, symmetrical adjustment may be favored in clinical practice due to better usability and compliance. Further studies with larger cohorts are needed to confirm these findings. Full article

Background: Walking a dog on-leash is a common activity for a large portion of our society. Many dogs consistently pull on the leash, which transmits potentially dangerous forces to the human body. The purpose of this in silico study was to determine the effects of dog-leash tension and human posture on lumbar compression, and how comparable the effects of dog walking on lumbar compression are to lifting, an activity known to contribute to low back pain. Methods: Dog-leash simulations were performed with 50–300 N directed along the arm segment of a static three-dimensional musculoskeletal model across a range of trunk segment and shoulder joint angles. Lifting simulations were performed across a range of test postures with the model holding a 50–300 N weight close to the ground. Lumbar compression was computed for each simulation using McGill’s polynomial equation and compared with the 3400 N cutoff used to develop occupational safety guidelines. Results: Lumbar compression increased as trunk segment flexion increased for all simulation conditions. With 200 N of leash tension, lumbar compression exceeded 3400 N for all postures with 25° or more of trunk segment flexion. When lifting 150 N, lumbar compression exceeded 3400 N for all postures with shank segment angle of 80° or greater and knee flexion angle of 100° or less. Conclusions: Our in silico results suggest that dog owners should seek intervention if their dog routinely pulls on the leash with a force of 200 N or greater and should attempt to lean backward when resisting leash pulling to reduce lumbar compression and injury risk. Full article

Forest firefighters face concurrent thermal stress, biomechanical loading, high metabolic demand, smoke, and time-constrained manual work, conditions that increase musculoskeletal disorder (MSD) risk. In Chile, occupational health regulation requires biomechanical risk management, but no task-specific activation protocol has been evaluated within wildfire suppression operations. This pilot study assessed the feasibility, acceptability, and safety of ActivAcción, a 5 min dynamic activation protocol integrated into Corporación Nacional Forestal (CONAF) wildfire brigade routines. A single-group mixed-methods feasibility study was conducted over 8 weeks at the Placilla CONAF base, Valparaíso Region, Chile. Ten firefighters and supervisors participated. The intervention included two educational sessions and an eight-exercise routine adapted from the WFX-FIT manual and delivered within existing safety briefings. Outcomes were adverse events, musculoskeletal complaints, perceived feasibility and acceptability, implementation fidelity, and qualitative themes. No adverse events or new musculoskeletal complaints were recorded. Feasibility and acceptability ratings were high among brigadistas (mean, 6.71/7.0, SD = 0.69) and maximal among supervisors (7.0/7.0). Protocol fidelity reached 75% (12/16 sessions). Qualitative findings identified task-specificity, ease of integration, and leadership endorsement as implementation facilitators. ActivAcción is feasible, acceptable, and safe under the studied low-exposure conditions; controlled high-season evaluation is required before inference on MSD prevention effectiveness. Full article

Healthcare organizations face emerging challenges that threaten the safety of professionals and patients, as well as the performance and long-term sustainability of healthcare systems. Health problems such as work-related musculoskeletal disorders are highly prevalent among nurses, not only due to the physical demands but also because of significant psychosocial stressors and mental health challenges inherent in healthcare environments. This study investigates the influence of psychosocial risks at work (PSRs) on the occurrence of work-related musculoskeletal disorders (WRMSDs) in nurses. A cross-sectional study was conducted, using a snowball recruitment method, from October 2025 to March 2026, among 266 nurses. Data were collected using the Psychosocial Risk Factors scale (INSAT_ERPS) and The Depression, Anxiety and Stress Scale-21 Items (DASS-21), to examine relationships among PSRs, mental health and WRMSDs using descriptive and inferential statistics. Key psychosocial determinants of WRMSDs include high psychological strain—manifesting as anxiety—compounded by psychosocial stressors such as work intensity, employment relations, and emotional demands. The results highlight the importance of addressing PSR and mental health, to reduce the incidence of WRMSDs among nurses. Interventions focused on improving working conditions and promoting mental health may be effective in preventing WRMSDs. Full article

(1) Background: The global expansion of teleworking has increased concern regarding musculoskeletal pain associated with home-based working conditions. This study quantified the prevalence of musculoskeletal pain among Brazilian teleworkers and explored ergonomic and environmental factors associated with the distribution of physical symptoms and the multisite pain burden. (2) Methods: A cross-sectional survey was conducted between June and August 2024, analyzing 184 valid responses from teleworkers across various professional sectors. Data were collected via an online questionnaire assessing sociodemographic characteristics, workstation ergonomics, and musculoskeletal symptoms using the Nordic Musculoskeletal Questionnaire (NMQ). Statistical analyses included Pearson’s chi-square tests, logistic regression, and exploratory Random Forest modeling to prioritize predictors. (3) Results: Musculoskeletal pain was reported by 74% of participants, with the lower back (40.8%), neck (36.4%), and upper back (30.4%) being the most frequently affected anatomical regions. The primary ergonomic and environmental factors associated with pain reports included discomfort with the desk and mouse, suboptimal thermal comfort, and prolonged sitting. Odds ratios demonstrated strong statistical co-occurrence between recent and 12-month pain reports, particularly for the shoulders, reflecting overlapping recall indicators rather than temporal symptom progression. (4) Conclusions: Musculoskeletal pain is highly prevalent among Brazilian teleworkers, showing clear links to localized workstation inadequacies and overlapping short- and long-term symptom reporting. These findings highlight the need for targeted institutional occupational health policies, such as ergonomics training and adjustable furniture provision, while future longitudinal research remains essential to confirm causal pathways. Full article

Background: Chronic neck pain is a prevalent musculoskeletal condition associated with functional limitations and reduced quality of life, representing a significant public health concern. The Neck Disability Index (NDI) is one of the most widely used patient-reported outcome measures for assessing neck-related disability. Although validated in multiple languages, a comprehensive psychometric evaluation of an Albanian version in a large clinical sample has been lacking. Methods: A methodological cross-sectional study was conducted to translate, culturally adapt, and evaluate the psychometric properties of the Albanian version of the NDI. The translation process followed standardized forward–backward cross-cultural adaptation procedures with authorization from the MAPI Research Trust. A total of 377 individuals with chronic cervical pain completed the questionnaire. Structural validity was assessed using Principal Component Analysis (PCA). Internal consistency was evaluated using Cronbach’s alpha, and test–retest reliability was assessed using intraclass correlation coefficients (ICC). Measurement error was estimated using the Standard Error of Measurement (SEM) and Minimal Detectable Change at the 95% confidence level (MDC95) at both item and total score levels. Results: Sampling adequacy was excellent (KMO = 0.948; Bartlett’s test p < 0.001). Structural validity supported a predominantly unidimensional structure, with a dominant component explaining 64.17% of the total variance. Internal consistency was excellent (Cronbach’s α = 0.99). Test–retest reliability was outstanding, with item-level ICC values ranging from 0.980 to 0.992 and a total score ICC of 0.989. Measurement error for the total score was low (SEM = 0.94; MDC95 = 2.60), indicating that changes greater than 2.60 points reflect real change beyond measurement error. Item-level MDC95 ranged from 0.36 to 0.67. Conclusions: The Albanian version of the NDI demonstrates strong structural validity, excellent internal consistency, high test–retest reliability, and low measurement error in individuals with chronic cervical pain. These findings are most applicable to relatively young, convenience-based Albanian-speaking populations, reflecting the characteristics of the study sample. Full article

Background/Objectives: L-carnitine and Coenzyme Q₁₀ (CoQ₁₀) are widely used in health and sports supplementation settings to improve energy metabolism, reduce fatigue, and support recovery. Although generally perceived as safe, their safety profiles are mainly based on pre-marketing studies and selected clinical populations, while real-world pharmacovigilance evidence remains limited. This study aimed to evaluate and compare the adverse drug reaction (ADR) reporting patterns associated with L-carnitine and CoQ10 using the EudraVigilance database. Methods: A retrospective pharmacovigilance analysis was conducted using spontaneous individual case safety reports (ICSRs) retrieved from the EudraVigilance database. ADRs associated with L-carnitine and CoQ₁₀ were analyzed and compared at the System Organ Class (SOC) level. Disproportionality analyses were performed using the reporting odds ratio (ROR) and proportional reporting ratio (PRR). Results: A total of 257 ICSRs for L-carnitine and 271 for CoQ10 were identified. Serious cases accounted for 34.2% of L-carnitine reports and 74.5% of CoQ₁₀ reports. For L-carnitine, the most frequently reported SOC categories were gastrointestinal disorders, skin and subcutaneous tissue disorders, general disorders and administration site conditions, and nervous system disorders. For CoQ₁₀, the most commonly reported SOC categories were general disorders and administration site conditions, nervous system disorders, investigations, and gastrointestinal disorders. Comparative disproportionality analysis showed higher reporting frequencies for CoQ₁₀ in blood and lymphatic system disorders (ROR 3.04; PRR 2.99), musculoskeletal and connective tissue disorders (ROR 2.63; PRR 2.52). Conclusions: Real-world pharmacovigilance data suggest partially different ADR reporting patterns for L-carnitine and CoQ₁₀ compared with those described in pre-marketing studies. CoQ₁₀ was associated with a higher proportion of serious reports and greater disproportionality signals for selected SOC categories; however, these findings should be interpreted cautiously, as reporting patterns may be influenced by reporting bias, comorbidities, concomitant therapies, and differences in the populations using these compounds. Continuous pharmacovigilance monitoring and periodic reassessment of their benefit–risk profile remain essential given their widespread use in health and sports supplementation settings. Full article

Temporomandibular disorders (TMDs) are a group of musculoskeletal conditions characterized by pain, restricted mandibular movement, and joint sounds, which may significantly impair quality of life. Among conservative treatment modalities, low-level laser therapy (LLLT) has gained increasing attention due to its noninvasive nature and its documented analgesic and anti-inflammatory effects. Despite growing evidence supporting the clinical effectiveness of LLLT in the management of TMD-related pain and dysfunction, there is still no consensus regarding the optimal energy density parameters to achieve the most favorable therapeutic outcomes. Therefore, the primary objective of this randomized clinical trial was to determine the optimal energy density of low-level laser therapy. This clinical study evaluated the effects of LLLT applied at different energy densities in patients diagnosed with disk displacement with reduction (DDwR) and myofascial pain. A total of 100 patients were divided into two diagnostic groups, each divided into three subgroups: 940 nm, 1.5 W, 90 J; 940 nm, 3 W, 180 J; and a soft diet group. Laser treatment was performed three times per week for three weeks, for a total of nine sessions. Pain intensity, mandibular movements, and joint sounds were assessed at baseline and at one and six months. Comparable and favorable clinical improvements were achieved in both the laser therapy groups and the soft diet group. The 1.5 W-treated group showed the most significant VAS (visual analog scale) parameter reduction at 6 months. Laser treatment outcomes can be summarized as follows: low-level laser therapy was associated with clinical improvement; however, similar positive outcomes were also observed in the soft diet group. These findings indicate that further controlled studies are needed to better clarify the specific role of laser therapy in the management of temporomandibular disorders. Full article

Preliminary estimation of lower-limb motor function is important in rehabilitation research, especially for biomechanical assessment of post-stroke hemiplegic gait. However, subject-specific musculoskeletal modeling in this population is challenging because standard maximum voluntary contraction (MVC) testing is often unsafe or unreliable for normalizing surface electromyography (sEMG) signals. To address this limitation, a normalized correction coefficient was introduced for pathological sEMG preprocessing, and an improved Hill-type muscle model (iHMM) was established to account for submaximal activation conditions. By combining inverse dynamics, static optimization, and a subject-specific lower-limb dynamic model, the proposed framework was used to estimate musculotendon force, knee joint torque, knee joint kinematics, and shank center-of-mass trajectory. In a preliminary validation involving six hemiplegic subjects, the predicted knee joint torques showed moderate to good agreement with the reference results, with correlation coefficients ranging from 0.724 to 0.807 and RMSE values ranging from 3.872 to 7.814 Nm. These preliminary results support the feasibility of the proposed framework for subject-specific biomechanical analysis of the hemiplegic lower extremity and suggest its potential utility in individualized rehabilitation assessment. Full article

As the population ages, the incidence and prevalence of musculoskeletal degeneration, such as osteoarthritis, increase. While the currently accepted treatment options provide symptomatic and functional improvement, they do not halt the progression of osteoarthritis. This results in the eventual need for surgery for many patients with advanced osteoarthritis. Due to the seemingly inevitable progression of OA, many clinicians and researchers have shifted their focus to regenerative therapies. Orthobiologics, a specific type of regenerative therapy designed to treat orthopedic conditions, has been gaining traction in recent years due to the utilization of autologous biological substances and synthetic peptides in healing musculoskeletal injuries and degenerative conditions. Orthobiologics can be distinguished into one of four classes: cell-based, biologic fluids-based, matrix-based, molecular-based, and based on their composition. In this review, key examples of each class, mechanism of action, and current clinical data for each agent are examined. Limitations of current orthobiologics involve a lack of standardization in the preparation and administration of each agent, as well as uniformity in assessment endpoints across different clinical studies. Lastly, we will discuss future directions of orthobiologics as a therapy for the treatment of osteoarthritis. Full article

In Uganda, in 2019, 6.8 million people experienced health conditions that are amenable to rehabilitation. This is largely due to musculoskeletal disorders such as low back pain (LBP). Measuring effective coverage of rehabilitation means assessing whether a population that needs rehabilitation services receives the interventions with sufficient quality to produce the desired health gain. This study reports on the first measurement of effective coverage of rehabilitation in Uganda and globally using chronic primary LBP as the tracer health condition. A population survey was conducted to administer the WHO global tracer indicator questions. The survey questions were used to identify respondents with chronic primary LBP experiencing limitations in functioning and to determine utilization of rehabilitation services. The WHO Disability Assessment Schedule (WHODAS) 2.0 12-item was used for the measurement of an improvement in functioning that is meaningful to service users. The questions were nested in the Iganga–Mayuge Health and Demographic Surveillance Site (IMHDSS) update round 22 in seven sub-counties in rural Eastern Uganda between June and September 2023. Data collection followed a training session on survey administration and data capture for enumerators, field supervisors, research managers and lead scientists from the Makerere University Centre for Health and Population Research and a pilot testing of the data collection tool. Survey administration resulted in data collection for 8645 respondents aged 18 years and above. Specifically, 15.2% of the respondents had experienced chronic LBP in the last 12 months, of which 88.5% had experienced pain that was severe enough to affect their usual household, recreational or work activities. A total of 46% of this population in need of rehabilitation had been utilizing rehabilitation services (crude coverage), with no difference between women and men. Only 7.05% of the respondents with chronic primary low back pain experiencing limitations in functioning had been managed with sufficient quality to produce the desired health gain, defined by a minimal but meaningful improvement in functioning (effective coverage). Full article

Playing-related musculoskeletal disorders (PRMDs) are highly prevalent among bass-guitar players due to sustained asymmetrical postures, repetitive finger movements, and prolonged support of instrument weight. This study proposes a Human Digital Biomechanical Twin-driven, simulation-based approach to optimize bass-guitar support systems, integrating biomechanical modelling, motion capture, and musculoskeletal simulation. A preliminary survey among 63 Italian bass-guitar players was performed to define the experimental conditions regarding posture, instrument type, and session duration. Fifteen experienced bassists participated in laboratory trials using motion capture and postural assessment tools, including MediaPipe Pose, RULA, and AnyBody Modelling System. Baseline results highlighted significant activation of the trapezius and spinal extensor muscles (19–26% MVC), confirming high ergonomic risk. Three alternative support configurations were digitally simulated, revealing that a three-point harness system (bilateral shoulder straps plus thoracic anchoring) reduced spinal stabilizer activation by 15–25% across four anthropometric percentiles. Experimental validation confirmed enhanced comfort, reduced fatigue, and improved instrument stability, with the majority of participants preferring the ergonomic configuration. These findings demonstrate the feasibility of a simulation-based, prospective, and human-centred ergonomic design framework, offering a scalable methodology to compare and optimize adaptive instrument-support systems before physical prototyping. Full article

Sensors are an established driver of diagnostics and prevention in the medical field, including orthopaedics. Today, the subclass of ion-selective sensors (ISSs) is on the leading edge due to its advantages, enabled by technological advancements in manufacturing, such as miniaturization, precision, accuracy, specificity, a wide measuring scale, ease of use, flexible operating conditions, and measuring speed. While ISSs’ impact on environmental and health fields is already the subject of investigation, it still needs to be analysed specifically in orthopaedics, which is the aim of this Review. A PubMed and Scopus search was performed using the keywords “ion”, “sensor”, “electrodes”, “selective”, “musculoskeletal”, “implant”, “joint replacement”, and “orthopaedic”; after systematic screening, 44 studies were included in the synthesis. First, studies were classified based on the target ion. Only a few papers treated applications specifically in orthopaedics, confirming that ISSs are still largely an unexplored frontier here. However, all of the studies targeted ions with a role also in musculoskeletal pathophysiology, thus relative ISSs could have a potential impact on orthopaedic diagnosis and treatment. Then, when described by the papers, ISSs’ technological solutions were systematically evaluated. Finally, the main ISSs development targets for reaching orthopaedic clinical application were highlighted, including biocompatibility (e.g., implantability), long-term stability, calibration, and validation. Overcoming these challenges will enable ISSs to progress from laboratory prototypes to clinically viable tools, supporting the advancement of next-generation sensorised prostheses, fixation devices, and surgical instruments, and paving the way for predictive and personalised orthopaedic medicine. Full article