Musculoskeletal Diseases Commons^™

An Ultrasonographic Analysis Of The Structures Of The Subacromial Space, As They Relate To The Postures Of Upper String Musicians, Elliot V. Smithson

Theses, Dissertations and Capstones

Background: The leading source of general population shoulder pain is subacromial impingement syndrome (SAIS) which can contribute to rotator cuff disease (RCD). 1 It has been reported that up to 12% of musicians end their musical career due to musculoskeletal injury.2 SAIS is a common source of shoulder pain in the bowing arm of upper string musicians.3 However, the mechanisms leading to shoulder pain in upper string musicians are not well known.

Purpose: The purpose of this study was to characterize aspects of the subacromial space anatomy while in standard playing positions of upper string musicians, specifically measurements …

Discovery Of Metabolic Biomarkers For Duchenne Muscular Dystrophy Within A Natural History Study., Simina M. Boca, Maki Nishida, Michael Harris, Shruti Rao, Amrita Cheema, Kirandeep Gill, Haeri Seol, Lauren P. Morgenroth, Erik Henricson, Craig M. Mcdonald, Jean K. Mah, Paula R. Clemens, Eric P. Hoffman, Yetrib Hathout, Subha Madhavan

Pediatrics Faculty Publications

Serum metabolite profiling in Duchenne muscular dystrophy (DMD) may enable discovery of valuable molecular markers for disease progression and treatment response. Serum samples from 51 DMD patients from a natural history study and 22 age-matched healthy volunteers were profiled using liquid chromatography coupled to mass spectrometry (LC-MS) for discovery of novel circulating serum metabolites associated with DMD. Fourteen metabolites were found significantly altered (1% false discovery rate) in their levels between DMD patients and healthy controls while adjusting for age and study site and allowing for an interaction between disease status and age. Increased metabolites included arginine, creatine and unknown …

Crispr/Cas9 As A Therapeutic Approach To Duchenne Muscular Dystrophy, Abraham Daniel Levitman

The Science Journal of the Lander College of Arts and Sciences

Transhumanism, designer babies, gene therapy, and super-soldiers are founded upon the same concept—genetic engineering. Clustered Regularly-Interspersed Short Palindromic Repeats (CRISPR) is a natural bacterial immune response method that takes advantage of gene manipulation to prevent an infection from mobile genetic elements. Since Mojica et al. (2005) first suggested the relationship between the CRISPR/Cas system and prokaryotic immunity, significant advancements have been made in understanding the mechanism and subsequent applications of CRISPR. CRISPR, has three main subtypes based on unique proteins and interference pathways and serves as an accurate and effective method for gene editing. Its mechanism consists of spacer acquisition, …

The Effect Of Varying Bisphosphonate Treatment On Changes In Bone Microdamage In Osteoporotic Women, Stefanie L. Pagano

Theses and Dissertations--Biomedical Engineering

Bisphosphonates (BPs) are used for the treatment of osteoporosis. This study evaluated changes in bone microdamage with BP treatment duration. Fifty-one iliac crest biopsies were obtained from Caucasian women, ages 41 to 87 years, who were previously diagnosed and treated for osteoporosis with oral BPs for 1-16 years duration. Patients diagnosed with any disease, drug, or substance abuse that may affect bone metabolism were excluded.

Bone samples were sectioned, stained, and histologically examined using light and fluorescence microscopy. Bone area, number and length of microcracks were quantified. Following adjustment for age, BMD, BV/TV, trabecular thickness, and turnover, regression analysis revealed …

Intra-Articular Interleukin-1 Receptor Antagonist (Il1-Ra) Microspheres For Posttraumatic Osteoarthritis: In Vitro Biological Activity And In Vivo Disease Modifying Effect, Khaled A. Elsaid, Anand Ubhe, Ziyad Shaman, Gerard D'Souza

Pharmacy Faculty Articles and Research

Background: Interleukin-1 receptor antagonist (IL-1 ra) can be disease-modifying in posttraumatic osteoarthritis (PTOA). One limitation is its short joint residence time. We hypothesized that IL-1 ra encapsulation in poly (lactide-co-glycolide) (PLGA) microspheres reduces IL-1 ra systemic absorption and provides an enhanced anti-PTOA effect.

Methods: IL-1 ra release kinetics and biological activity: IL-1 ra encapsulation into PLGA microsphere was performed using double emulsion solvent extraction. Lyophilized PLGA IL-1 ra microspheres were resuspended in PBS and supernatant IL-1 ra concentrations were assayed. The biological activity of IL-1 ra from PLGA IL-1 ra microspheres was performed using IL-1 induced lymphocyte proliferation …

A Mechanistic Study Of An Ipsc Model For Leigh’S Disease Caused By Mtdna Mutataion (8993 T>G), John P. Galdun

Theses and Dissertations

Mitochondrial diseases encompass a broad range of devastating disorders that typically affect tissues with high-energy requirements. These disorders have been difficult to diagnose and research because of the complexity of mitochondrial genetics, and the large variability seen among patient populations. We have devised and carried out a mechanistic study to generate a cell based model for Leigh’s disease caused by mitochondrial DNA mutation 8993 T>G. Leigh’s disease is a multi-organ system disorder that depends heavily on the mutation burden seen within various tissues. Using new reprogramming and sequencing technologies, we were able to show that Leigh’s disease patient fibroblasts …

Relief Of Cervicogenic Headaches After Single-Level And Multilevel Anterior Cervical Diskectomy: A 5-Year Post Hoc Analysis, Jonathan J. Liu, Gilbert Cadena, Ripul R. Panchal, Rudolph J. Schrot, Kee D. Kim

Faculty Publications & Research of the TUC College of Osteopathic Medicine

Study Design Prospective study.

Objective Because single-level disk arthroplasty or arthrodesis in the lower subaxial spine improves headaches after surgery, we studied whether this effect may be better appreciated after two-level arthroplasty.

Methods We performed an independent post hoc analysis of two concurrent prospective randomized investigational device exemption trials for cervical spondylosis, one for single-level treatment and the other for two adjacent-level treatments.

Results For the one-level study, baseline mean headache scores significantly improved at 60 months for both the cervical disk arthroplasty (CDA) and anterior cervical diskectomy and fusion (ACDF) groups (p < 0.0001). However, mean improvement in headache scores was not statistically different between the investigational and control groups from 6 months through 60 months. For the two-level study, baseline mean headache scores significantly improved at 60 months for both the CDA and ACDF groups (p < 0.0001). The CDA group demonstrated greater improvement from baseline at all points; this difference was statistically significant at 6, 12, 24, 36, and 48 months but not at 18 and 60 months.

Conclusion Both CDA and ACDF at either …

Is Acupuncture, Including Electroacupuncture, Effective In Treating Pain In Plantar Fasciitis?, Alicia Campiglia

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether the use of acupuncture, including electroacupuncture, is effective in treating pain in patients with plantar fasciitis.

STUDY DESIGN: Review of 3 RCTs published between 2011-current, all in the English language.

DATA SOURCES: Three RCTs analyzed the effectiveness of acupuncture therapy compared to a control group using alternate analgesic therapies. All studies were found using EBSCOhost and PubMed and were selected based on relevance to the proposed clinical question.

OUTCOMES MEASURED: Each of the 3 articles analyzed the effectiveness of treating pain with acupuncture treatment in patients diagnosed with …

Is Vitamin D Supplementation Effective At Reducing Idiopathic Musculoskeletal (Mss) Pain?, Darra O. Markland

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine “Is Vitamin D supplementation effective at reducing idiopathic musculoskeletal (MSS) pain?”

Study Design: Review of primary studies published between the years 2012-2014.

Data Sources: One double blind randomized controlled trial (RCT), one semi-crossover RCT, and one before and after observational study. These were found using Cochrane Review and PubMed databases.

Outcomes Measured: Clinical outcomes were measured in these studies utilizing the Visual Analogue Scale for Pain, the 5-point Likert Pain Scale, the Standard Nordic Questionnaires and numerical grading of pain level, and number of pain sites before and after …

Do Epidural Injections With Local Anesthetic With Steroids Have Superiority Over Injections With Local Anesthetic Alone When Treating Chronic Back Pain Due To An Intervertebral Disc Herniation In Men And Women Over 18 Years Old?, Julia S. Ross

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not, “Do epidural injections with local anesthetic with steroids have superiority over injections with local anesthetic alone when treating chronic back pain due to an intervertebral disc herniation in men and women over 18 years old?”

STUDY DESIGN: Review of three, double blind, randomized controlled trials (RCTs) published between 2011-2014, all in English language. The articles compared epidural injections containing local anesthetic with steroids to epidural injections containing local anesthetics alone.

DATA SOURCES: Three Randomized controlled trials found using PubMed. All articles were published in peer-reviewed journals …

Is Laser Therapy An Effective Alternative Treatment For Women With Fibromyalgia?, Michelle B. Astrove

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not, “Is the use of laser therapy an effective alternative treatment for women with fibromyalgia?”

STUDY DESIGN: Review of three English language primary studies, published between 2002 and 2013.

DATA SOURCES: Three randomized controlled trials (RCTs) were found using Cochrane Systematic Reviews. These studies analyzed the effectiveness of laser therapy in women with fibromyalgia.

OUTCOMES MEASURED: Main outcomes measured were improvement in pain, number of tender points, muscular spasm, skinfold tenderness, sleep disturbance, fatigue and morning stiffness measured by an ordinal likert scale, Pain and FM impact …

Is Viscosupplementation Effective In Reducing Osteoarthritis Knee Pain?, Amalia Antonoplos

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not viscosupplementation is effective in reducing osteoarthritis knee pain

STUDY DESIGN: Review of three randomized, double blind, placebo control trials between 2009- 2010

DATA SOURCES: Three randomized, double blind, placebo control trials were found via PubMed and NCBI

OUTCOMES MEASURED: Each randomized control trial measured knee pain and/or patient satisfaction following their intervention (placebo or hyaluronic acid) in patients with knee osteoarthritis, which was measured via WOMAC pain scale and patient global assessment forms.

RESULTS: (P<0.05) for change in pain at 14-26 weeks after injection (NNT=6- 8 for Chevalier et al and 4 for Kul-Panza & Berker). Patient satisfaction was higher in the experimental groups as compared to the control with conclusions of NNT between 11 and 20 for Chevalier et al and Kul-Panza & Berker respectively. Chavelier et al found adverse events such as arthralgias and joint effusion in <10% of their study population (NNH=39). No dichotomous data was presented in Diacoglu et al; however an ANOVA was deemed statistically significant (p<0.01).

CONCLUSION: Review of these articles concludes that the use of hyaluronic …

Whole Body Cryotherapy Vs. Cold Water Immersion, Brett M. Johnson

Physician Assistant Scholarly Project Posters

In this country a significant percentage of the population present to clinics with generalized musculoskeletal disorders related to pain. More than one-quarter of Americans (26%) age 20 years and over, or an estimated 76.5 million Americans report a problem with general musculoskeletal disorders related to pain that persisted for more than 24 hours in duration. The treatment for various musculoskeletal disorders related to pain are anti-inflammatory agents or opioid analgesics. Another form of anti-inflammatory /analgesia for such ailments is cold therapy.

The purpose of this literature review is to compare Whole Body Cryotherapy (WBCt) to Cold Water Immersion (CWI) in …

Academic Preparation In Cleft Palate For Speech-Language Pathologists: Is The Icf-Cy (Who, 2007) Alive And Well?, Mary B. Graham, Jackie Palmer, Brenda Louw

ETSU Faculty Works

The purpose of this project is to determine inclusion of the ICF-CY in CLP training curricula for SLPs. Survey research was conducted with course instructors across the nation. Results describe the application of the ICF-CY in CLP courses at the graduate level. Recommendations for including the ICF-CY framework are made.

Perceptions Of Medical Students Of The Role Of The Speech-Language Pathologist In Hiv/Aids Intervention, Kendal Klein, Emily Wagner, Kristi Moore, Tanvi Amin, Brenda Louw

ETSU Faculty Works

Survey research was utilized to explore Medical students’ perceptions of Speech-Language Pathologists’(SLP) and Medical Practitioner’s roles in meeting the healthcare needs of people living with HIV/AIDS(PLWHA). Results identified participants’ knowledge and perceptions. Recommendations suggest interprofessional education and training for both professions, at the pre-professional and professional levels.

The Physiology And Psychology Of Exercise And Parkinson's Disease, Jess Gibson

Senior Honors Theses

Parkinson’s disease is one of the most common degenerative neurological disorders and is currently lacking a cure. While physicians have long debated over the best treatment for Parkinson’s symptoms, treatments such as oral medication and deep brain stimulation have not yet shown to be a permanent solution to the disease. Recently, exercise has emerged as a contender in the fight against Parkinson’s and physicians and physiotherapists have been investigating the benefits of prescribing exercise programs to patients in an effort to slow progression of Parkinson’s symptoms. The following presents an analysis of the effects of exercise on Parkinson’s symptoms and …

Malignant Hyperthermia: A Clinical Crisis, Eric Reing

Nursing Student Class Projects (Formerly MSN)

Malignant hyperthermia, though uncommon, is a serious and life threatening condition. Malignant hyperthermia is an autosomal dominant disorder that affects skeletal muscle. It can be caused by various general anesthetic agents like succinylcholine and several inhaled anesthetics. Malignant hyperthermia is a relevant topic to certified registered nurse anesthetists due to the potentially fatal result if not recognized and treated promptly. In understanding the pathophysiology, risk factors, signs and symptoms, epidemiology, and current treatments the health care provider can help to prevent complications due to this disorder (Nagelhout, 2014).

Investigating Duchenne’S Muscular Dystrophy, Ashley Beaujon

Nursing Student Class Projects (Formerly MSN)

Young boys usually present with disordered or delayed motor development, muscle weakness, and possible speech delays in early childhood (Ruiten et al, 2014). The first symptoms almost always show up prior to the age of six years. Parents may notice their young child with DMD having a hard time standing up, walking, or climbing stairs, and many will eventually need a wheelchair to get around (Brennan, 2014). Initial blood tests obtained are remarkable for an elevated creatine kinase (CK) and then diagnosis is typically confirmed with a genetic test showing a mutation in the dystrophin gene (Ruiten et al, 2014). …

Myasthenia Gravis And Implications For The Certified Registered Nurse Anesthetist, Matthew Predick

Nursing Student Class Projects (Formerly MSN)

In healthcare and, specifically anesthesia, there are many conditions that require various considerations by the prudent provider. An example of a condition requiring special attention is myasthenia gravis. Myasthenia gravis is an autoimmune disease in which skeletal muscle weakness and rapid fatigue result from destruction of nicotinic acetylcholine receptors [7]. Although the prevalence is not overwhelmingly high with most recent estimates of prevalence around 14 to 20 per 100,000 people in the United States [5] and 20 per 100,000 worldwide [9], inappropriate perioperative management of those with this ailment can result in serious consequences. Understanding the pathophysiology, various treatments (both …

Structural Studies Of The Ig58 Domain Of The Giant Muscle Protein Obscurin, Matthew C. Oehler

Senior Honors Projects, 2010-2019

Obscurin (720-900 kD) is a giant sarcomeric signaling protein that is the only known link

between the cytoskeleton and the surrounding membrane structure. Mutations to obscurin

and to obscurin binding partners have been linked to human muscle diseases such as

hypertrophic cardiomyopathies and muscular dystrophy. These diseases likely occur due

to the abrogation of specific molecular interactions necessary for suitable function. To

more fully understand how specific mutations lead to disease, here we solve the highresolution

structure of obscurin Ig58. The literature shows that an Arg8Gln mutation to

the Ig58 domain of obscurin is associated with hypertrophic cardiomyopathy (HCM).

Chemical …

The Role Of Occupational Therapy In The Prevention Of Infant Torticollis & Plagiocephaly, Anne H. Zachry

Faculty Presentations

AOTA includes health promotion as an Intervention approach in the Occupational Therapy Practice Framework: Domain and Process. As health care professionals, occupational therapy practitioners are responsible for promoting public health and wellness. Occupational therapists need to educate parents and caregivers about the importance of varying infant positions, providing tummy time, and limiting infant time spent in baby gear.

Fibromyalgia Syndrome: Considerations For Dental Hygienists, Amber Walters, Susan L. Tolle, Gayle M. Mccombs

Dental Hygiene Faculty Publications

PURPOSE: Fibromyalgia syndrome (FMS) is a neurosensory disorder characterized by widespread musculoskeletal pain. Typically persistent fatigue, depression, limb stiffness, non-refreshing sleep and cognitive deficiencies are also experienced. Oral symptoms and pain are common, requiring adaptations in patient management strategies and treatment interventions. Appropriate dental hygiene care of patients suffering with this disorder is contingent upon an understanding of disease epidemiology, pathophysiology, clinical characteristics, oral signs and symptoms, as well as treatment approaches. With this information dental hygienists will be better prepared to provide appropriate and effective treatment to patients with FMS.

Acupuncture: A Comparison Study Of Sham Acupuncture, Traditional Chinese Acupuncture And Current Practice Guidelines For The Treatment Of Chronic Musculoskeletal Pain In Adults, Kayla Olson

Physician Assistant Scholarly Project Posters

• Chronic pain is one of the most difficult conditions to treat.

---Close monitoring of controlled medications

---Unnecessary, expensive surgeries

• Alternatives to medication is increasingly necessary.

• Integrative medicine incorporates traditional western medicine with unconventional therapies, such as acupuncture.

---Evaluate the treatments’ efficacy for chronic neck and back pain by evaluating meta-analysis studies and randomized controlled trials.

• Physiology is a large component of understanding how and if the acupuncture works.

---Non-invasive functional magnetic resonance imaging

---Neurotransmitters and their response to acupuncture

• Acupuncture therapy for improvement of chronic musculoskeletal pain

Effect Of Monophasic Pulsed Current On Heel Pain And Functional Activities Caused By Plantar Fasciitis, Abdullah K. Alotaibi, Jerrold S. Petrofsky, Noha S. Daher, Everett Lohman, Michael S. Laymon, Hasan M. Syed

College of Health & Human Services (TUN) Publications and Research

Background: Plantar fasciitis (PF) is a soft tissue disorder considered to be one of the most common causes of inferior heel pain. The aim of this study was to investigate the effect of monophasic pulsed current (MPC) and MPC coupled with plantar fascia-specific stretching exercises (SE) on the treatment of PF.

Material and Methods: Forty-four participants (22 women and 22 men, with a mean age of 49 years) diagnosed with PF were randomly assigned to receive MPC (n=22) or MPC coupled with plantar fascia-specific SE (n=22). Prior to and after 4 weeks of treatment, participants underwent baseline evaluation; …

Is Regenerative Injection Therapy (Prolotherapy) Effective At Reducing Pain Associated With Knee Osteoarthritis?, Ashley Aloi

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not “Is regenerative injection therapy (prolotherapy) effective at reducing pain associated with knee osteoarthritis?”

Study Design: Review of all English language primary studies published in 2012 and 2013.

Data Sources: One randomized control trial, one randomized crossover study and one single-arm uncontrolled study were found using PubMed and Ebscohost.

Outcomes Measured: Clinical outcome for all three articles was measured using the Western Ontario McMaster University Osteoarthritis Index (WOMAC); which specifically focuses on quality of life, function, and pain reduction after the use of prolotherapy versus the saline …

Is Treatment With Topical Glyceryl Trinitrate Effective In Reducing Elbow Pain In Patients With Lateral Epicondylitis?, Benjamin Chartier

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not treatment with topical glyceryl trinitrate is effective in reducing elbow pain in patients with lateral epicondylitis.

Study Design: Review of two English language randomized controlled trials and one primary study published 2003, 2009, 2011.

Data Sources: Two double blind randomized controlled and one prospective comparison study comparing the effectiveness of gylceryl trinitrate to placebo in the treatment of pain related to lateral epicondylitis, found using PubMed, EBSCOhost, and CINAHL Plus.

Outcome(s) Measured: The outcome studied was patient self-rated elbow pain at rest, pain with activity, pain …

In The Treatment Of Patients With Knee Joint Osteoarthritis, Are Platelet Rich Plasma Injections More Effective Than Hyaluronic Acid Injections?, Darshit Gandhi

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not "In the treatment of patients with knee joint osteoarthritis, are Platelet Rich Plasma injections more effective than Hyaluronic acid injections?"

Study Design: Review of one randomized double-blind trial, one randomized cohort study, and one randomized control trial published in the English language in the year 2012.

Data Sources: All studies were published in peer-reviewed journals found via the use of PubMed.

Outcome(s) Measured: Patients were divided into two groups: those who received platelet rich plasma injections (PRP) and those who received hyaluronic injections (HA). Efficacy of …

Is Ginger Effective In Reducing Knee Pain In Adults With Osteoarthritis?, Joseph Heng

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this evidence based medicine review is to determine whether ginger is effective in reducing knee pain in adults with osteoarthritis.

Study Design: Three double blind, randomized controlled trials were reviewed and selected based on their relevance to the clinical question and their inclusion of patient oriented outcomes (POEMS).

Data Sources: Each study was obtained by searching Cochrane and PubMed database.

Outcomes Measured: The outcomes were measured using the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) via Likert scale and Knee Pain rated via Knee injury and knee Osteoarthritis Outcome score (KOOS) questionnaire which is a …

Is Red Yeast Rice Tolerable In Treating Patients With Dyslipidemia Who Have Statin-Associated Myalgia?, Carie Lam

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not patients who have statin-associated myalgia have improved tolerability for red yeast rice (RYR) as an alternative treatment.

Study Design: This review consists of three double blinded randomized controlled trials published in English in 2009, 2010, 2013.

Data Sources: Three randomized, controlled, double blinded clinical trials on the tolerability of red yeast rice were found on PubMed and Ebsco Host. Two trials comparing red yeast rice to placebo and the third trial comparing red yeast rice to pravastatin.

Outcomes Measured: Each of the three articles analyzed whether …

Is Ayurvedic Effective In Reducing Osteoarthritis Pain In Adults?, Reja Khan

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not Ayurvedic is effective in reducing osteoarthritis pain in adults.

Study Design: Review of three English language randomized controlled trials published between from 2004-2013.

Data Sources: Two double blind randomized controlled trials and one open label randomized controlled clinical trial were found using PubMed and Cochrane Library databases.

Outcomes Measured: To measure the effectiveness, the following parameters were utilized visual analog scale (VAS) reported by the patient to assess reduction in pain symptoms of osteoarthritis.

Results: Three randomized controlled studies results found that Ayurvedic medicine was beneficial …