Musculoskeletal extremity pain in Danish school children - how often and for how long? The CHAMPS study-DK.
ABSTRACT: Musculoskeletal pain is common in childhood and adolescence, and may be long-lasting and recurrent. Musculoskeletal problems tend to follow adolescents into adulthood, and therefore it is important to design better prevention strategies and early effective treatment. To this end, we need in-depth knowledge about the epidemiology of musculoskeletal extremity problems in this age group, and therefore, the aim of this study was to determine the prevalence, frequency and course of musculoskeletal pain in the upper and lower extremities in a cohort of Danish school children aged 8-14 years at baseline.This was a prospective 3-year school-based cohort study, with information about musculoskeletal pain collected in two ways. Parents answered weekly mobile phone text messages about the presence or absence of musculoskeletal pain in their children, and a clinical consultation was performed in a subset of the children.We found that approximately half the children had lower extremity pain every study year. This pain lasted on average for 8 weeks out of a study year, and the children had on average two and a half episodes per study year. Approximately one quarter of the children had upper extremity pain every study year that lasted on average 3 weeks during a study year, with one and a half episodes being the average. In general, there were more non-traumatic pain episodes compared with traumatic episodes in the lower extremities, whereas the opposite was true in the upper extremities. The most common anatomical pain sites were 'knee' and 'ankle/ft'.Lower extremity pain among children and adolescents is common, recurrent and most often of non-traumatic origin. Upper extremity pain is less common, with fewer and shorter episodes, and usually with a traumatic onset. Girls more frequently reported upper extremity pain, whereas there was no sex-related difference in the lower extremities. The most frequently reported locations were 'knee' and 'ankle/ft'.
Project description:<h4>Background</h4>It is difficult to gain an overview of musculoskeletal extremity complaints in childhood although this is essential to develop evidence-based prevention and treatment strategies. The objectives of this systematic review were therefore to describe the prevalence and incidence of musculoskeletal extremity complaints in children and adolescents in both general and clinical populations in relation to age, anatomical site and mode of onset.<h4>Methods</h4>MEDLINE and EMBASE were electronically searched; risk of bias was assessed; and data extraction was individually performed by two authors.<h4>Results</h4>In total, 19 general population studies and three clinical population studies were included with children aged 0-19 years. For most of the analyses, a division between younger children aged 0-12 years, and older children aged 10-19 years was used. Lower extremity complaints were more common than upper extremity complaints regardless of age and type of population, with the most frequent pain site changing from ankle/foot in the youngest to knee in the oldest. There were about twice as many non-traumatic as traumatic complaints in the lower extremities, whereas the opposite relationship was found for the upper extremities in the general population studies. There were relatively more lower extremity complaints in the general population studies than in the clinical population studies. The review showed no pattern of differences in reporting between studies of high and low risk of bias.<h4>Conclusions</h4>This review shows that musculoskeletal complaints are more frequent in the lower extremities than in the upper extremities in childhood, and there are indications of a large amount of non-traumatic low intensity complaints in the population that do not reach threshold for consultation. A meta-analysis, or even a simple overall description of prevalence and incidence of musculoskeletal extremity complaints in children and adolescents was not feasible, due to a large variety in the studies, primarily related to outcome measurements.
Project description:The type and level of physical activity in children vary over seasons and might thus influence the injury patterns. However, very little information is available on the distribution of injuries over the calendar year. This study aims to describe and analyse the seasonal variation in extremity injuries in children.Prospective cohort study.10 public schools in the municipality of Svendborg, Denmark.A total of 1259 school children aged 6-12 years participating in the Childhood Health, Activity, and Motor Performance School Study Denmark.School children were surveyed each week during 2.5 school-years. Musculoskeletal injuries were reported by parents answering automated mobile phone text questions (SMS-Track) on a weekly basis and diagnosed by clinicians. Data were analysed for prevalence and incidence rates over time with adjustments for gender and age.Injuries in the lower extremities were reported most frequently (n=1049). There was a significant seasonal variation in incidence and prevalence for lower extremity injuries and for lower and upper extremity injuries combined (n=1229). For the upper extremities (n=180), seasonal variation had a significant effect on the risk of prevalence. Analysis showed a 46% increase in injury incidence and a 32% increase in injury prevalence during summer relative to winter for lower and upper extremity injuries combined.There are clear seasonal differences in the occurrence of musculoskeletal extremity injuries among children with almost twice as high injury incidence and prevalence estimates during autumn, summer and spring compared with winter. This suggests further research into the underlying causes for seasonal variation and calls for preventive strategies to be implemented in order to actively prepare and supervise children before and during high-risk periods.
Project description:BACKGROUND: Muscle effects are the most common reported adverse effects of 3-hydroxy-3-methylglutaryl coenzyme A inhibitors (statins). However, in placebo-controlled trials the incidence of muscle pain is most often similar for placebo and active control groups. OBJECTIVE: We sought to evaluate whether statin use was associated with a higher prevalence of musculoskeletal pain in a nationally representative sample. METHODS: Cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) 1999-2002. Participants were 3,580 adults > or =40 years without arthritis who were interviewed at home and examined in a mobile examination center. Participants were asked about sociodemographic characteristics, health conditions, medication use, and musculoskeletal pain. Height, weight, blood pressure, ankle brachial index, and cholesterol were measured. MEASUREMENTS AND MAIN RESULTS: Prevalence and adjusted odds ratios (OR) of any musculoskeletal pain and musculoskeletal pain in 4 different anatomical regions (neck/upper back, upper extremities, lower back, and lower extremities) by statin use during the last 30 days. Among statin users (n = 402), 22.0% (95%CI 18.0-26.7%) reported musculoskeletal pain in at least 1 anatomical region during the last 30 days, compared with 16.7% (95%CI 15.1-18.4%) of those who did not use a statin. Compared to persons who did not use statins, those who used statins had multivariable-adjusted odds ratios (95%CI; p value) of 1.50 (1.07-2.11; p = .01) for any musculoskeletal pain, 1.59 (1.04-2.44, p = .03) for lower back pain, and 1.50 (1.02-2.22, p = .03) for lower extremity pain. CONCLUSION: Musculoskeletal pain is common in adults > or =40 years without arthritis. In this nationally representative sample, statin users were significantly more likely to report musculoskeletal pain.
Project description:Background:This study investigated the relationship between verbal aggression against school teachers and upper extremity (neck, shoulder, upper limb, and/or upper back) musculoskeletal pain. Methods:This was a cross-sectional study of 525 elementary school teachers from Jaboatão dos Guararapes, Northeast Brazil. Results:The prevalence of upper extremity musculoskeletal pain among teachers who reported verbal aggression in the past six months (67.7%) was higher than that among those who did not report verbal aggression (51.7%): (prevalence ratio = 1.21; 95% confidence interval = 1.04-1.40). The prevalence of upper extremity musculoskeletal pain was associated with verbal aggression, sex, and common mental disorders, controlled by skin color, age, monthly income, teachers' education, years working as a teacher, workload, and obesity. Furthermore, the measure of the association between verbal aggression and upper extremity musculoskeletal pain was modified by sex and common mental disorders, considered altogether. Teachers who suffered verbal aggression, of the feminine sex, and also having common mental disorders reported high prevalence (85.4%) of upper extremity musculoskeletal pain. Conclusion:The association between verbal violence in the school and complaints of upper extremity musculoskeletal pain was strong and modified by teachers' sex and common mental disorders.
Project description:To investigate non-ossifying fibromas (NOFs) common fibrous bone lesions in children that occur in bones of the lower extremities.We analyzed 44 cases of NOF including 47 lesions, which were referred with a working diagnosis of neoplastic lesions. Lesions were located in the upper extremities (1 proximal humerus, 1 distal radius) and the lower extremities (25 distal femurs, 12 proximal and 4 distal tibias, and 4 proximal fibulas).Three cases had NOFs in multiple anatomical locations (femur and fibula in 1 case, femur and tibia in 2 cases). Overall, larger lesions > 4 cm and lesion expansion at the cortex were seen in 21% and 32% of cases, respectively. Multiple lesions with bilateral symmetry in the lower extremities suggest that these NOFs were developmental bone defects. Two patients suffered from fracture and were treated without surgery, one in the radius and one in the femur. Lesions in the upper extremities (i.e., humerus of a 4-year-old female and radius of a 9-year-old male) expanded at the cortex and lesion size increased with slow ossification.NOFs in the lower extremity had fewer clinical problems, regardless of their size and expansiveness. In these two upper extremity cases, the NOFs had aggressive biological features. It seems that there is a site specific difference, especially between the upper extremity and the lower extremity. Furthermore, NOFs in the radius are predisposed to fracture because of the slender structure of the radius and the susceptibility to stress.
Project description:The main objective was to investigate whether children aged 9-15 years at baseline were more likely to experience an incident event of spinal pain after experiencing lower extremity pain. Children's musculoskeletal pain was monitored by weekly mobile phone text message responses from parents, indicating whether the child had spinal pain, lower extremity pain, or upper extremity pain the preceding week. Data were analyzed using mixed effect logistic regression models and cox regression models. The association between an incident event of spinal pain and LE pain the preceding weeks increased with increasing observation period and was statistically significant for 12 and 20 weeks (OR?=?1.34 (95% CI 1.05 to 1.70) and OR?=?1.39 (95% CI 1.11 to 1.75), respectively). We found that the likelihood increased in children with more frequent or longer duration of lower extremity pain. The reversed relationship was investigated as well, and we also found a positive association between spinal pain and a subsequent incidence event of lower extremity pain, but less pronounced.Conclusion: Children were more likely to experience an incident event of spinal pain after experiencing lower extremity pain. The likelihood increased in children with more frequent or longer duration of lower extremity pain. What is Known: • Both spinal pain and lower extremity pain often start early in life and is common already in adolescence. What is New: • Children were more likely to experience an incident event of spinal pain after experiencing LE pain. • The likelihood increased in children with more frequent or longer duration of LE pain.
Project description:Chronic pain is influenced by biological, psychological, social, and cultural factors. The current study investigated potential roles for combinations of genetic and psychological factors in the development and/or maintenance of chronic musculoskeletal pain. An exercise-induced shoulder injury model was used, and a priori selected genetic (ADRB2, COMT, OPRM1, AVPR1 A, GCH1, and KCNS1) and psychological (anxiety, depressive symptoms, pain catastrophizing, fear of pain, and kinesiophobia) factors were included as predictors. Pain phenotypes were shoulder pain intensity (5-day average and peak reported on numerical rating scale), upper extremity disability (5-day average and peak reported on the QuickDASH), and shoulder pain duration (in days). After controlling for age, sex, and race, the genetic and psychological predictors were entered as main effects and interaction terms in separate regression models for the different pain phenotypes. Results from the recruited cohort (N = 190) indicated strong statistical evidence for interactions between the COMT diplotype and 1) pain catastrophizing for 5-day average upper extremity disability and 2) depressive symptoms for pain duration. There was moderate statistical evidence for interactions for other shoulder pain phenotypes between additional genes (ADRB2, AVPR1 A, and KCNS1) and depressive symptoms, pain catastrophizing, or kinesiophobia. These findings confirm the importance of the combined predictive ability of COMT with psychological distress and reveal other novel combinations of genetic and psychological factors that may merit additional investigation in other pain cohorts.Interactions between genetic and psychological factors were investigated as predictors of different exercise-induced shoulder pain phenotypes. The strongest statistical evidence was for interactions between the COMT diplotype and pain catastrophizing (for upper extremity disability) or depressive symptoms (for pain duration). Other novel genetic and psychological combinations were identified that may merit further investigation.
Project description:Traumatic soft tissue defects of the hand and upper extremities are common and may be challenging to the reconstructive surgeon. Several reconstructive procedures such as use of local, regional, distant, and free flaps have been described. This study aimed to report the techniques, outcomes, and complications of pedicle abdominal flaps in reconstructing hand and upper extremity defects. Methods:In this retrospective study, we included patients with different traumatic defects in the hand and upper extremities who underwent reconstruction by random pedicle abdominal flaps between 2002 and 2017 at Jordan University Hospital, Jordan. Data were collected and analyzed, and the variables studied included patient age and sex, etiology and size of the defect, complications, outcomes, and the need for further revision procedures. Appropriate statistical analysis was used to examine the potential factors affecting flap survival. Results:We included a total of 34 patients with a mean age of 22.2 years, ranging from 1 to 54 years. Finger degloving was seen in approximately half of the patients. Flap survival rate was 85.3%. A small area of defect was the only risk factor that significantly affected the flap failure rate. Conclusions:Thin pedicle abdominal flaps are a valid, affordable, and safe option in upper extremity traumatic defects, especially in situations where microsurgical techniques are unavailable or contraindicated. Extra care should be taken when the defect surface area is small.
Project description:We investigated the incidences and characteristics of pediatric traumatic injuries requiring emergency department visits, through a complementary approach using both nationwide-sample and single-institutional data. Data for children (aged <15 years) identified with traumatic injuries during a 10-year period from the Korean National Health Insurance Sharing Service (n = 35,064 among 10,114,909 randomly sampled cases from the claim records of the National Health Insurance) and the authors' institute (n = 39,228) were retrospectively reviewed. The incidences and characteristics of the injuries were investigated using both datasets; additionally, detailed information regarding the injury environments was investigated using the single-institutional data. The findings were similar across both datasets. The incidence of injuries increased during the study period; the head was most commonly injured, whereas the trunk or proximal extremities were rarely injured; low-energy head injuries accounted for >50% of the cases in children aged <5 years, although the incidences of lower-extremity injuries and fractures increased in older children. Single-institutional data demonstrated that the proportion of indoor playground and trampoline-related injuries increased rapidly during the study period, and outdoor injuries and seasonal variation (with peak incidences in May and June) were more prominent in older children. Based on similarities between both datasets, the detailed results regarding pediatric traumatic injuries obtained from the single-institutional data could be generalized nationally with adequate external validity. To prevent traumatic injuries, it may be more effective to wear protective equipment covering the head and distal extremities rather than the trunk or proximal extremities; simple clothing, such as caps, could prevent many injuries in preschoolers. Among older children, safety guidelines for outdoor sports/leisure activities are needed. The increase in pediatric traumatic injuries may be partially explained by the increased availability of indoor playgrounds and installation of trampolines. Stricter adherence to the preventive guidelines is needed.
Project description:This paper explores changes in musculoskeletal pain among desk-based workers over three months of a workplace-delivered, sitting-reduction intervention. Participants (n = 153, 46% female; mean ± SD aged 38.9 ± 8.0 years) were cluster-randomized (n = 18 work teams) to receive an organizational change intervention, with or without an activity tracker. A modified Nordic Musculoskeletal Questionnaire assessed pain intensity (0?9; none?worst possible) in the neck, upper and lower back, upper and lower extremities, and in total. The activPAL3 (7 days, 24 h/day protocol) measured sitting and prolonged sitting in ?30 min bouts at work. Mixed models adjusting for cluster and intervention arm examined changes in pain (n = 104), and their associations with reductions in sitting and prolonged sitting (h/10 h at work) (n = 90). Changes in pain were nonsignificant (p ? 0.05) and small for total pain (-0.06 [95% CI: -0.27, 0.16]) and for each body area (-0.26 [-0.66, 0.15] for upper back to 0.09 [-0.39, 0.56] for lower back). Sitting reduction was associated with reduced lower back pain (-0.84 [-1.44, -0.25] per hour, p = 0.005); other effects were small and non-significant. No substantial average changes in pain were seen; some improvement in lower back pain might be expected with larger sitting reductions. Larger samples and diverse interventions are required for more definitive evidence.