Musculoskeletal Diseases Commons^™

A Comparison Of 4-Year Total Medical Care Costs, Adverse Outcomes, And Opioid/Prescription Analgesic Use For 3 Knee Osteoarthritis Pain Treatments: Intra-Articular Hyaluronic Acid, Intra-Articular Corticosteroids, And Knee Arthroplasty., John Mackowiak, John T Jones, Vinod Dasa

School of Medicine Faculty Publications

To compare the medical costs associated with treatments for knee osteoarthritis (OA): intra-articular corticosteroids (ICS) and intra-articular hyaluronic acid (IHA) primarily, and ICS/IHA vs knee arthroplasty (TKA) secondarily. This was a retrospective analysis of an insurance claims database. Eligible members had diagnosed OA and no claims for ICS, IHA, or TKA during the 6–18-month look-back period. Cohorts of interest over the 4-year observation period were: patients who received ICS only, those who received IHA only, and those who received TKA only. Outcomes assessed included: (1) total allowed medical costs, (2) claims for pre-specified, treatment-related adverse outcomes and costs, and (3) …

Spinal Cord Injury Provider Knowledge And Attitudes Toward Bacteriuria Management And Antibiotic Stewardship, Felicia Skelton, Sarah May, Larissa Grigoryan, Ivy Poon, Sally Ann Holmes, Lindsey Martin, Barbara W Trautner

Faculty, Staff and Students Publications

INTRODUCTION: Bacteriuria, either asymptomatic or urinary tract infection, is common in persons with spinal cord injury or disorder (SCI/D). In the Veterans Health Administration (VHA), conflicting clinical practice guidelines make appropriate bacteriuria management and antibiotic stewardship challenging.

OBJECTIVE: To explore SCI/D provider knowledge, attitudes, and teamwork around bacteriuria management during the VHA SCI/D annual examination.

DESIGN: Mixed methods.

SETTING: VHA SCI/D centers.

PARTICIPANTS: SCI/D staff providers and physical medicine and rehabilitation resident physicians.

MAIN OUTCOME MEASUREMENTS: Knowledge, safety, and teamwork scores on bacteriuria management using a validated questionnaire. Themes on barriers and facilitators to bacteriuria management during the SCI/D annual …

A Functional Three-Dimensional Microphysiological Model Of Myeloma Bone Disease, Richard Visconti

Seton Hall University Dissertations and Theses (ETDs)

Multiple myeloma (MM) is a hematologic cancer caused by a mature B cell neoplasm, or plasmacytoma, that infiltrates the skeleton at several sites. The disease is characterized by uninhibited transformed plasma cell proliferation that disrupts skeletal homeostasis leading to decreased bone modeling and increased bone resorption. Osteolytic lesions (OL) or voids left in the bone, remain long after the treatment of the cancer and indicate disease progression to myeloma bone disease (MBD). Current combinatorial MM therapies inhibit malignant plasma cell proliferation, slow the progression towards MBD, and increase the mean five-year survival rate, but do little to improve osteoblastic function …

Efficacy And Safety Of Abobotulinumtoxina For Upper Limb Spasticity In Children With Cerebral Palsy: A Randomized Repeat-Treatment Study, Mauricio R. Delgado, Ann Tilton, Jorge Carranzo-Del Rio, Nigar Dursun, Marcin Bonikowski, Resa Aydin, Iwona Maciag-Tymecka, Joyce Oleszek, Edward Dabrowski, Anne-Sophie Grandoulier, Philippe Picaut, The Dysport In Pul Study Group

School of Medicine Faculty Publications

Aim: To assess the efficacy and safety of repeat abobotulinumtoxinA injections in reducing upper limb spasticity in children with cerebral palsy (CP). Method: This was a double-blind, repeat-cycle study (NCT02106351) in children with CP (2–17y). Children were randomized to receive 2U/kg (control), 8U/kg, or 16U/kg abobotulinumtoxinA injections into the target muscle group (wrist or elbow flexors) and additional muscles alongside occupational therapy via a home-exercise therapy program (HETP; minimum five 15min sessions/wk). Children received 8U/kg or 16U/kg plus HETP in cycles 2 to 4. Results: During cycle 1, 210 children (126 males, 84 females; mean age [SD] 9y [4y 5mo], …

Does An Empathic Pre-Visit Conversation With Another Team Member Improve Perceived Surgeon Empathy?, Lindy Derkzen, Janna S E Ottenhoff, Carrie Barron, David Ring

Patient Experience Journal

Orthopedic surgeon specialists can help alleviate symptoms and reduce self-reported activity limitations by addressing stress, distress, and unhelpful cognitive biases regarding pain (e.g., “hurt equals harm”). But noticing mental and social health opportunities in specialty care can harm the patient-surgeon relationship. This study evaluated the ability of an empathic pre-visit conversation by another team member to improve the patient-surgeon relationship measured as perceived empathy. Factors associated with pain intensity, magnitude of self-reported activity limitations, symptoms of depression, and satisfaction with the surgeon were also studied. We enrolled 100 patients visiting an orthopedic surgeon for the first time. Prior to the …

Il-1 Inhibitor Anakinra Is An Effective Alternative To Standard Treatments For Reducing Pain Due To Acute Gout Flare, Cheryl Craig

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising Janssen CA, Voshaar MAHO, Vonkeman HE, et al. Anakinra for the treatment of acute gout flares: a randomized, double-blind, placebo-controlled, active-comparator, non-inferiority trial. Rheumatology. 2019;58(8):1344-1352. https://doi.org/10.1093/rheumatology/key402 for a patient with an acute gouty attack refractory to standard treatment.

Upper Vs. Lower Extremity: Does The Site Of Steroid Injection Have A Different Effect On Blood Glucose Levels In Patients With Diabetes?, Emilyn Anderi

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising Twu J, Patel N, Wolf JM, Conti Mica M. Impact of variation of corticosteroid dose, injection site, and multiple injections on blood glucose measurement in diabetic patients. J Hand Surg Am. 2018;43(8):738-744. https://doi.org/10.1016/j.jhsa.2018.06.005 for a patient with diabetes and osteoarthritis.

From Caregiver To Patient And Back Again ... My Covid Experience, Marie B. Thornton

Journal of Interprofessional Practice and Collaboration

As a Registered Nurse and a member of the nursing faculty at a public university, my primary role and instinct is to be a caregiver. Here is my story about becoming a patient with COVID-19 and finally returning to be a caregiver once again.

The Effects Of E-Vapor On The Pathogenesis Of Rheumatoid Arthritis Mouse Models And Potential Implications For Future Generations, Christiana Daas

Selected Honors Theses

Rheumatoid arthritis is the most prevalent autoimmune disease. Rheumatoid arthritis (RA) has no cure, and the direct cause of the disease is still unknown. The two leading hypotheses concerning its etiology are based on the effects of HLA-DRB1 gene expression, and cigarette smoke. Conjunctively, the use of vaping devices amongst adolescents has increased significantly since introduced in 2007. There is no long-term data on the effects of e-vapor and its aerosols on bodily health. Cigarette smoke is the most noteworthy environmental factor contributing to RA therefore the question is raised as to whether or not vaping relates to rheumatoid arthritis …

Musculoskeletal Tumours Throughout History And Beyond: Clinical Features, Imaging, Staging And Biopsy, Akbar Jaleel Zubairi, Obada Hussein Hasan, Mohammad Mustafa, Masood Umer

Section of Orthopaedic Surgery

Background: Over the last century, there has been a remarkable development in the study of bone and soft tissue sarcomas. This is primarily due to the improved knowledge of the nature of these lesions and the improved imaging technology. In literature there are many protocols that are being used and all of them have reported various advantages and disadvantages of each technique used. However, there is no set guideline and whatever has been proposed has been developed on the basis of the experience of different centres and different surgeons.
Objective: The current systematic review was planned to thoroughly evaluate the …

Modulation Of Hedgehog Signaling By Kappa Opioids To Attenuate Osteoarthritis, Alexander E Weber, Omid Jalali, Sean Limfat, Ruzanna Shkhyan, Robert Van Der Horst, Siyoung Lee, Yucheng Lin, Liangliang Li, Erik N Mayer, Liming Wang, Nancy Q Liu, Frank A Petrigliano, Jay R Lieberman, Denis Evseenko

Faculty, Staff and Students Publications

OBJECTIVE: Inhibition of hedgehog (HH) signaling prevents cartilage degeneration and promotes repair in animal models of osteoarthritis (OA). This study, undertaken in OA models and in human OA articular cartilage, was designed to explore whether kappa opioid receptor (KOR) modulation via the inhibition of HH signaling may have therapeutic potential for achieving disease-modifying activity in OA.

METHODS: Primary human articular cartilage and synovial tissue samples from patients with knee OA undergoing total joint replacement and from healthy human subjects were obtained from the National Disease Research Interchange. For in vivo animal studies, a partial medial meniscectomy (PMM) model of knee …

A Fatal Rectus Sheath Hematoma After A Myasthenia Crisis Case Report, Robert G. Michaud, Lesley B. Gordon

Journal of Maine Medical Center

Introduction: Rectus sheath hematomas (RSH) generally occur due to damage to the inferior epigastric artery. They are rare causes of abdominal pain or acute blood loss anemia, but are an important diagnostic consideration because they can be cryptic and are potentially fatal.

Clinical Findings: An 85-year-old female who had been admitted to the hospital for 10 days with a myasthenia crisis was found to be abruptly hypotensive with a tender abdominal mass in the left lower quadrant subtly crossing midline. She was on prophylactic anticoagulation during her hospitalization.

Main diagnosis, therapeutics, interventions, and outcomes: The patient was initially stabilized with …

Failure To Thrive - An Overlooked Manifestation Of Kmt2b-Related Dystonia: A Case Presentation., Andrew Ng, Serena Galosi, Lisa Salz, Terence Wong, Caitlin Schwager, Shivarajan Amudhavalli, Rose N. Gelineau-Morel, Shimul Chowdhury, Rady Children’S Institute For Genomic Medicine Investigators, Jennifer Friedman

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: KMT2B-related dystonia is a recently described form of childhood onset dystonia that may improve with deep brain stimulation. Prior reports have focused on neurologic features including prominent bulbar involvement without detailing general health consequences that may result from orolingual dysfunction. We describe a family with novel KMT2B mutation with several members with failure to thrive to highlight this non-neurologic, but consequential impact of mutation in this gene.

CASE PRESENTATION: We present a case of a 15-year old female who was admitted and evaluated for failure to thrive. On exam, she had severe speech dysfluency, limited ability to protrude the …

A Case Of Pott's Disease: Typical Presentation Of An Uncommon Disease In The United States, Neha Patel, Ravi Patel, Marek Krysztofiak, K V. Sundaresh

West Florida Division GME Research Day 2020

Pott’s disease (PD), also known as tuberculosis spondylitis, is a rare disease of the spine which is typically caused by extraspinal infection. The basic lesion in Pott's disease is a combination of osteomyelitis and arthritis, usually affecting more than one vertebra. The anterior aspect of the vertebral body adjacent to the subchondral plate is commonly involved. Spinal TB can include any of the following: progressive bone destruction leading to vertebral collapse and kyphosis, cold abscess formation (due to extension of infection into adjacent ligaments and soft tissues), spinal canal narrowing by abscesses, granulation tissue or direct dural invasionresulting in spinal …

Prospective Trial Of Sacroiliac Joint Fusion Using 3d-Printed Triangular Titanium Implants, Vikas Patel, Don Kovalsky, S Craig Meyer, Abhineet Chowdhary, Harry Lockstadt, Fernando Techy, Casey Langel, Robert Limoni, Philip S. Yuan, Andy Kranenburg, Daniel Cher, Gabriel Tender, Travis J. Hillen

School of Medicine Faculty Publications

Background: Prior trials provide strong evidence supporting minimally invasive sacroiliac joint (SIJ) fusion using triangular titanium implants (TTI) for chronic SIJ dysfunction.

Objective: To assess the safety and effectiveness of SIJF using a 3D-printed TTI.

Methods: Fifty-one subjects with carefully diagnosed SIJ dysfunction underwent SIJF with 3D TTI. Subjects completed pain, disability and quality of life questionnaires at baseline and 3, 6 and 12 months postoperatively. Functional tests were performed in the clinic at each visit. Pelvic CT scans were independently evaluated for radiolucency, bridging bone and other endpoints.

Results: Ninety percent had 12-month follow-up. Dysfunction due to pain (Oswestry …

Proteoglycan-4 Regulates Fibroblast To Myofibroblast Transition And Expression Of Fibrotic Genes In The Synovium, Marwa Qadri, Gregory D. Jay, Ling X. Zhang, Holly Richendrfer, Tannin A. Schmidt, Khaled A. Elsaid

Pharmacy Faculty Articles and Research

Background: Synovial tissue fibrosis is common in advanced OA with features including the presence of stress fiber-positive myofibroblasts and deposition of cross-linked collagen type-I. Proteoglycan-4 (PRG4) is a mucinous glycoprotein secreted by synovial fibroblasts and is a major component of synovial fluid. PRG4 is a ligand of the CD44 receptor. Our objective was to examine the role of PRG4-CD44 interaction in regulating synovial tissue fibrosis in vitro and in vivo.

Methods: OA synoviocytes were treated with TGF-β ± PRG4 for 24h and α-SMA content was determined using immunofluorescence. Rhodamine-labeled rhPRG4 was incubated with OA synoviocytes ± anti-CD44 or …

The Effect Of Staphylococcus Aureus Exposure On White-Tailed Deer Trabecular Bone Stiffness And Yield, Emily Brooke Long

Graduate Theses

Osteomyelitis is an infection of the bone or bone marrow caused by the infiltration of bacteria, resulting in destructive inflammation, bone necrosis and abnormal bone remolding. With a growing number of osteomyelitis diagnoses, many of which are linked to Staphylococcus aureus (S. aureus), it is imperative to understand the pathology of S. aureus in relation to bone to provide better diagnostics and patient care. While the cellular mechanisms of S. aureus and osteomyelitis have been studied, little information exists on the biomechanical effects of such infections. We postulated that exposure to S. aureus for 72 hours would significantly decrease both …

Teriparatide And Its Bone Healing Power, Aneeta J. Joseph, Jesus L. Penabad, Antonio Pinero-Pilona

West Florida Division GME Research Day 2020

Teriparatide, a parathyroid hormone analog, is an important anabolic agent approved by the U.S. Food and Drug Administration to increase bone mineral density in osteoporotic patients. Parathyroid hormone (PTH) regulates calcium, phosphate, and active vitamin-D metabolites. The amino terminal peptide fragments of PTH has been known to increase bone mass and are being used in clinical practice for osteoporosis management.3 Teriparatide increases bone density of lumbar spine and femoral neck, and decreases the risk of vertebral and non-vertebral fractures both in postmenopausal women and men. It is also known to prevent fractures in patients with osteoporosis and promote healing of …

Associations Of Sickness Absence For Pain In The Low Back, Neck And Shoulders With Wider Propensity To Pain, David Coggon, Georgia Ntani, Karen Walker-Bone, Vanda E. Felli, Raul Harari, Lope H. Barrero, Sarah A. Felknor, Marianela Rojas, Anna Cattrell, Muhammad Masood Kadir

Community Health Sciences

Objectives: To explore the association of sickness absence ascribed to pain at specific anatomical sites with wider propensity to musculoskeletal pain.
Methods: As part of the CUPID (Cultural and Psychosocial Influences on Disability) study, potential risk factors for sickness absence from musculoskeletal pain were determined for 11 922 participants from 45 occupational groups in 18 countries. After approximately 14 months, 9119 (78%) provided follow-up information about sickness in the past month because of musculoskeletal pain, including 8610 who were still in the same job. Associations with absence for pain at specific anatomical sites were assessed by logistic regression and summarised …

Développement D’Outils Pour L’Évaluation Du Processus D’Implantation Et L’Analyse Économique D’Une Intervention Ergonomique : Le Cas D’Une Intervention De Prévention Des Troubles Musculosquelettiques Dans L’Industrie De L’Abattage Et De La Transformation De La Volaille, Émilie Desjardins, Hélène Sultan-Taïeb, France St-Hilaire, Nicole Vézina, Élise Ledoux, Patricia Bélanger, Rita Naji

Rapports de recherche scientifique

Depuis les années 1990, Nicole Vézina et son équipe ont réalisé des travaux de recherche qui ciblent l’apprentissage de l’affilage et de l’aiguisage des couteaux dans un objectif de prévention des troubles musculosquelettiques (TMS). Le cas à l’étude est une intervention implantée dans le département d’éviscération d’une usine d’abattage et de transformation de la volaille située au Québec. Il s’agit d’une intervention ergonomique de prévention des TMS avec plusieurs types de transfert d’apprentissage dans un contexte de travail à la chaîne à cadence élevée. L’objectif général de cette étude était de développer des outils de collecte de données adaptés aux …

What Outcomes Matter To Patients After Joint Or Spine Surgery?, Robin R. Whitebird, Leif I. Solberg, Christine K. Norton, Jeanette Y. Ziegenfuss, Stephen E. Asche, Elizabeth S. Grossman

Journal of Patient-Centered Research and Reviews

Purpose: Patient-reported outcome measures (PROMs) are increasingly used in clinical care, but there have been few studies of what patients identify as the most important outcomes.

Methods: Semi-structured interviews were conducted with 65 patients undergoing hip or knee replacement, spinal discectomy/laminotomy, or a spinal fusion. Interviews focused on outcomes patients identified as important, perceived usefulness of standardized PROMs measures, and contextual situations important to their care. Data were analyzed using a directed content analysis approach.

Results: Patients identified desired outcomes that were unique and important to them. Their preferred outcomes focused in the areas of freedom from pain, getting back …

A Closer Look At Muscle Breakdown: An Overview Of The Causes, Complications, And Diagnostics Of Rhabdomyolysis, Jamie Holchin

Senior Honors Theses

Rhabdomyolysis is the rapid breakdown of myocytes in skeletal muscle. This condition can be triggered by a variety of things including crush injury, drugs, prolonged exercise, and venom. Although the causes can vary, the general pathophysiology of rhabdomyolysis is similar. Increased intracellular calcium ion levels instigate the breakdown of cellular and certain organelle membranes of muscle cells. Reactive oxygen species form, ATP is depleted, and the sarcoplasmic reticulum, which regulates muscle contraction, is also damaged. Necrosis ensues, leading to toxic intracellular components spreading throughout the body. Rhabdomyolysis can then lead to several complications including acute renal injury and heart arrhythmias, …

An Ergonomic Assessment Of Healthcare Rehabilitation Workers, William Shepherd, Laramie Locke, Katherine Archibong

Scholars Week

Patient handling is a common task within the healthcare industry. Rehabilitation Therapists (RTs) and Rehabilitation Therapist Assistants (RTAs) report a significantly high incidence rate of low-back injuries and other musculoskeletal disorders (MSDs). The purpose of this study was to characterize the ergonomic risks associated with patient transfers and assisted gait therapy. Exposure to ergonomic risk factors were assessed using the Strain Index (SI), Rapid Entire Body Assessment (REBA), and 3-Dimensional Static Strength Prediction Program (3DSSPP). Subjects included three RTs and one RTA at a local assisted living and rehabilitation healthcare facility. Preliminary results indicate a high risk of developing MSDs …

Cd44 Receptor Mediates Urate Crystal Phagocytosis By Macrophages And Regulates Inflammation In A Murine Peritoneal Model Of Acute Gout, Emira Bousoik, Marwa Qadri, Khaled A. Elsaid

Pharmacy Faculty Articles and Research

Gout is a chronic arthritis caused by the deposition of poorly soluble monosodium urate monohydrate (MSU) crystals in peripheral joints. Resident macrophages initiate inflammation in response to MSU mediated by NF-κB nuclear translocation and NLRP3 inflammasome activation. We investigated the role of CD44, a transmembrane receptor, in mediating MSU phagocytosis by macrophages. We used an antibody that sheds the extracellular domain (ECD) of CD44 to study the role of the receptor and its associated protein phosphatase 2A (PP2A) in macrophage activation. We also studied the significance of CD44 in mediating MSU inflammation in-vivo. Cd44^−/− BMDMs showed reduced MSU …

Comparison Of Pre- And Post-Operative Shoulder Muscle Emg Profiles In Reverse Total Shoulder Arthroplasty Patients, Emily Lau, Sreten Franovic, Noah Kuhlmann, Eric C. Makhni Md, Stephanie Muh Md

Medical Student Research Symposium

Background: Deltoid muscle function is central in reverse total shoulder arthroplasty (RTSA) function; however, there is limited information available regarding changes in deltoid activity before and after surgery. Few tests exist to evaluate specific muscle metrics pre and post operatively. Surface Electromyographic (EMG) is non-invasive and allows for observation of motions with multifaceted analysis of movement with minimal patient demand. Understanding the changes in shoulder muscle activation, namely in the deltoid, in patients pre and post-RTSA can further advance understanding of the procedure and rehabilitation efforts.

Methods: Nine individuals were recruited for this study: all patients underwent RTSA by a …

Incapacité Due À Un Trouble Musculosquelettique : Les Inquiétudes Liées À L'Environnement De Travail, Marie-France Coutu, Marie-José Durand, Iuliana Nastasia, Fergal O'Hagan, Patrick Gosselin, Marie-Élise Labrecque, Sara Pettigrew, Djamal Berbiche

Rapports de recherche scientifique

Environ une personne sur trois dans le monde vivrait avec un trouble musculosquelettique (TMS) persistant. Plusieurs auteurs soulignent l’influence significative des facteurs psychosociaux, dont l’anxiété, sur le développement de l’incapacité prolongée. Associées à l’anxiété, des inquiétudes excessives ont été documentées chez des travailleurs ayant une douleur persistante d’origine musculosquelettique. Les inquiétudes ne favorisent pas l’adaptation en contexte d’une situation problématique. Cependant, aucune étude n’a jusqu’à présent tenté de comprendre ces inquiétudes, en lien avec l’environnement de travail. Une meilleure compréhension de ce phénomène semble un incontournable pour offrir une action mieux ciblée aux travailleurs ayant une incapacité au travail prolongée. …

Syllabus For Clinical Exercise Physiology (Kine 4700), Phillip Drouet

Q2S Enhancing Pedagogy

The syllabus has newly developed learning objectives that will prepare students entering the field of clinical exercise physiology. This course will cover the etiology and pathophysiology of many chronic diseases that plague the population. Assessments of chronic diseases include but are not limited to understanding symptomology will also be covered. Due to the limitations in time the most prevalent chronic disease will be covered and students will have to present on a disease that was not presented in class. The practical application portion of this course will take place during a lab section. Here students will have the opportunity to …

A Comprehensive Basic Understanding Of Pelvis And Acetabular Fractures After High-Energy Trauma With Associated Injuries: Narrative Review Of Targeted Literature, Muhammad Atif, Obada Hussein Hasan, Naveed Baloch, Masood Umer

Section of Orthopaedic Surgery

Acetabular fractures are caused by energy trauma which is high enough to cause such a fracture with incidence of 3 patients / 100000. In older individuals, most commonmechanism of injury is fall and, in younger individuals, road traffic accidents. Acetabular fractures are usually associated with visceral injuries and other musculoskeletal injuries (about 50% of patient). In this narrative review of targeted English literature from all level of evidences, which is written and supervised by experienced specialized orthopedic and trauma surgeons who were among the pioneers of conducting pelvis fracture management workshops in the country, we aim to describe the mechanism …

Development Of A Sox9 Reporter Cell For High-Throughput Chondrogenic Assessment, Alyssa R. Mickle

Honors Undergraduate Theses

Osteoarthritis (OA) is a debilitating disease caused by the deterioration of articular cartilage and is a leading cause of disability in the United States and worldwide. Much current research into improved treatment for this disease is focused on tissue engineering through the growth of cartilage sheets made by articular chondrocytes. However, as chondrocytes proliferate in vitro, they also lose their ability to produce dense extracellular matrix, a necessary component of articular cartilage conferring mechanical strength. SOX9, a transcriptional activator, increases type II collagen expression, a key articular cartilage extracellular matrix component. Thus, SOX9 promotes an articular cartilage phenotype. Therefore, …

Effet De L’Expertise Et Du Sexe Sur Les Contraintes À L’Épaule En Manutention, Etienne Goubault, Romain Martinez, Najoua Assila, Jennifer Dowling-Medley, Élodie Monga-Dubreuil, Sophie-Anne Scherrer, André Plamondon, Mickaël Begon

Rapports de recherche scientifique

L’atteinte de troubles musculosquelettiques (TMS) parmi les travailleurs et travailleuses au Québec était récemment estimée à 732 000 cas (Stock et al., 2014). Ces TMS sont associés aux activités professionnelles impliquant des efforts physiques prolongés, intenses et/ou répétitifs, telles que des tâches d’assemblage, de manutention, d’aide à la personne ou encore de maintien de posture prolongée sur un poste de travail. Les membres supérieurs, qui représentaient 30,1 % des cas de TMS déclarés et acceptés au Québec de 1998 à 2007 (Michel et al., 2010), sont les plus touchés après le dos. Plus particulièrement, l’épaule figure comme l’articulation …