Musculoskeletal Pain and Right Leg Paresthesia Revealed as Large Ovarian Mucinous Cystadenoma: A Case Report.

BACKGROUND Epithelial neoplasms are the most common and heterogenous group of ovarian tumors. Approximately 10-15% are primary ovarian mucinous neoplasms. Almost 80% of these consist of benign mucinous neoplasms, while the rest are borderline neoplasms, non-invasive (intraepithelial and intraglandular) carcinomas, and invasive carcinomas. Small ovarian cystadenomas are generally asymptomatic and are mainly found incidentally during an ultrasound examination for another gynecologic disorder. As their size increases, nonspecific symptoms and clinical signs develop as a result of mass effect to adjacent structures or because of tumor torsion. The main clinical symptoms are abdominal and/or pelvic pain, fullness, and discomfort. Large cystadenomas have also been associated with nausea and vomiting, urinary problems, persistent cough, back pain, metrorrhagia, and feminization. CASE REPORT We report a case of a 31-year-old woman with a body mass index of 39 who presented with increasing sacrococcygeal pain and right leg paresthesia over a 2-year period. She was treated for possible musculoskeletal and spine problems. She was finally diagnosed with a large right ovarian mucinous cystadenoma expanding in the sacrococcygeal region. She was successfully treated with complete excision of the tumor and achieved complete remission of all her symptoms. CONCLUSIONS Large ovarian mucinous cystadenomas, which develop in the sacrococcygeal region, can lead to symptoms that mimic musculoskeletal and spine problems. Early diagnosis is of great importance towards the goal of implementing proper therapeutic approaches and achieve complete remission of all clinical symptoms.

What Is Plantar Fasciitis?

This JAMA Patient Page describes the condition of plantar fasciitis and its diagnosis and treatment.

Work-restricting musculoskeletal pain after bariatric surgery or usual obesity care in the Swedish Obese Subjects study.

OBJECTIVE: The objective of this study was to study the recovery from, and incidence of, work-restricting musculoskeletal pain after bariatric surgery compared with usual obesity care. METHODS: Pain in different body regions was monitored using questionnaires in the nonrandomized, prospective, controlled Swedish Obese Subjects (SOS) study, which included 2007 participants treated with bariatric surgery and a matched control group of 2040 participants receiving usual obesity care at primary health care centers. Self-reported pain in the neck and shoulders, back, hips, knees, and ankles was captured from questionnaires administered at baseline and after 1, 2, 3, 4, 6, 8, 10, 15, and 20 years. RESULTS: Compared with matched controls, bariatric surgery was associated with better recovery from baseline work-restricting knee and ankle pain in both the short (1-4 years) and long term (up to 20 years), as well as from back and hip pain in the short term. In participants without pain at baseline, bariatric surgery was associated with a lower incidence of developing new pain in the knee and ankle in the short and long term. CONCLUSIONS: Bariatric surgery was associated with better recovery from pain, primarily in weight-bearing joints, as well as with prevention of pain development in the knee and ankle compared with matched controls receiving usual obesity care.

Aetiologies of Leg Pain among Patients Presenting to a Vascular Surgery Clinic.

OBJECTIVE: To determine the frequency and pattern of different aetiologies of leg pain among patients visiting vascular surgery clinics. STUDY DESIGN: Cross-sectional study. Place and Duration of the Study: Vascular Surgery Clinics of the Aga Khan University Hospital, Karachi, Pakistan, between February 2021 and June 2023. METHODOLOGY: This study examined patients presenting with leg pain for the first time at vascular surgery clinics. The socio-demographic and clinical data including the clinical symptoms, physical examination findings, and management of leg pain were noted using a specially designed proforma. RESULTS: In a total of 142 patients (200 limbs), 82 (57.7%) were females and 60 (42.3%) were males, with a mean age of 46.8 ± 15.1 years. The patients' mean body mass index (BMI) was 30.2 ± 7.9 kg/m2. Ninety-one (64.1%) patients had a predominantly standing job compared to 51 (35.9%) patients who had a predominantly sitting job. The most common aetiology of leg pain was chronic venous insufficiency (CVI), diagnosed in 107 (53.5%) patients, followed by neurogenic pain [41 (20.5%)], musculoskeletal pain including knee osteoarthritis [30 (15.0%)], and arterial insufficiency [22 (11.0%)].  Conclusion: CVI followed by neuropathic pain was the leading cause of leg pain in vascular surgery clinics at a tertiary care hospital. KEY WORDS: Chronic venous insufficiency, Arterial insufficiency, Vascular surgery, Leg pain, Musculoskeletal pain, Neuralgia.

The impact of smartphone use duration and posture on the prevalence of hand pain among college students.

BACKGROUND: Excessive smartphone usage among students can lead to discomfort in their hands and fingers. This study investigates the impact of smartphone holding posture, duration of usage, and the prevalence of wrist and finger pain among university students. METHODS: This cross-sectional study involved 213 university students who were selected based on inclusion criteria. Data was collected through a demographic information questionnaire. Participants self-reported five different postures for holding and interacting with a smartphone. The prevalence, frequency, severity, and interference of wrist and finger discomfort were assessed using the Cornell Hand Discomfort Questionnaires (CHDQ). RESULTS: The study revealed that the average age of participants was 21.3 ± 2.2 years. On average, they had been using smartphones for 7.9 ± 3.1 years and spent an average of 4.9 ± 2.5 h daily holding them in their hands. In terms of discomfort, more than 25% of students reported pain in areas C (thumb finger), E (Palm Pollicis), and F (wrist) of the right hand, which was significantly related to the duration of holding the smartphone in that hand. Additionally, smartphone holding duration significantly affected areas D (palm) and F of the left hand, with over 11% of students experiencing discomfort. The most prevalent posture among students (41% of participants) involved holding the smartphone with the right hand only, with the thumb touching the screen. Notably, areas B (χ2 = 21.7), C (χ2 = 10.27), D (χ2 = 65.54), and E (χ2 = 59.49) of the right hand, as well as areas C (χ2 = 6.58) and E (χ2 = 44.28) of the left hand, exhibited significant associations with the postures of holding the smartphone. CONCLUSIONS: The duration of smartphone use and the postures in which it is held contribute to the prevalence of discomfort in the thumb area and related muscles among right-handed students.

Therapeutic Interventions for Prevention of Musculoskeletal Pain Among Orthopedic Surgeons.

Orthopedic surgery is a physically demanding specialty. The factors contributing to musculoskeletal injury among surgeons often stem from positioning the patient, using non-ergonomic instruments, maintaining static postures, and performing repetitive movements. This article focuses on exercise techniques intended to combat the most common problematic static postures held during procedures. Each exercise explained in this article is organized into "preop," "intraop," and "postop" components. Preop includes strengthening movements, intraop provides postural recommendations, and postop focuses on mobilization and recovery. This article aims for efficient body conditioning, targeting the muscular posterior chain and supporting elements. [Orthopedics. 2024;47(4):e214-e216.].

Virtual Reality for Subacute Pain After Orthopedic Traumatic Musculoskeletal Injuries: A Mixed Methods Pilot Study.

OBJECTIVES: Acute orthopedic traumatic musculoskeletal injuries are prevalent, costly, and often lead to persistent pain and functional limitations. Psychological risk factors (eg, pain catastrophizing and anxiety) exacerbate these outcomes but are often overlooked in acute orthopedic care. Addressing gaps in current treatment approaches, this mixed-methods pilot study explored the use of a therapeutic virtual reality (VR; RelieVRx ), integrating principles of mindfulness and cognitive-behavioral therapy, for pain self-management at home following orthopedic injury. METHODS: We enrolled 10 adults with acute orthopedic injuries and elevated pain catastrophizing or pain anxiety from Level 1 Trauma Clinics within the Mass General Brigham health care system. Participants completed daily RelieVRx sessions at home for 8 weeks, which included pain education, relaxation, mindfulness, games, and dynamic breathing biofeedback. Primary outcomes were a priori feasibility, appropriateness, acceptability, satisfaction, and safety. Secondary outcomes were pre-post measures of pain, physical function, sleep, depression, and hypothesized mechanisms (pain self-efficacy, mindfulness, and coping). RESULTS: The VR and study procedures met or exceeded all benchmarks. We observed preliminary improvements in pain, physical functioning, sleep, depression, and mechanisms. Qualitative exit interviews confirmed high satisfaction with RelieVRx and yielded recommendations for promoting VR-based trials with orthopedic patients. DISCUSSION: The results support a larger randomized clinical trial of RelieVRx versus a sham placebo control to replicate the findings and explore mechanisms. There is potential for self-guided VR to promote evidence-based pain management strategies and address the critical mental health care gap for patients following acute orthopedic injuries.

[THE MUSCULAR COMPONENT OF FIBROMYALGIA PATHOPHYSIOLOGY].

INTRODUCTION: Fibromyalgia syndrome (FMS) is a chronic pain syndrome, prevalent in women more than men. The main symptoms are widespread musculoskeletal pain, fatigue, and weakness. To date, the pathophysiological mechanisms are unclear, and there are several pathogenic theories elucidating this condition. In this review, we summarized articles published in the past few years, regarding the effect of musculoskeletal dysfunction on FMS. We focused on the musculoskeletal system and central nervous system (CNS) disarrays.

Ergonomic risks and musculoskeletal pain in hospital cleaning workers: Convergent Care Research with mixed methods.

OBJECTIVE: to analyze exposure to ergonomic risks and the occurrence of musculoskeletal pain in workers in the Hospital Cleaning Service. METHOD: Convergent Care Research, with data production designed using mixed methods, implemented with 149 hospital cleaning workers. The methodological strategy of the convergent parallel project was employed, using observation, photographic records, questionnaires and convergence groups. The results were integrated through joint display. Data analysis with descriptive and inferential statistics and content analysis. RESULTS: the mixing of data highlighted the multifactorial nature of exposure to ergonomic risks (uncomfortable work postures; repetitive movements; prolonged orthostatism; use of equipment not adapted to the psychophysiological needs of workers) and musculoskeletal pain in the population investigated. The latter was prevalent in the lumbar spine, ankles or feet, wrists or hands, thoracic spine and shoulders. The concept of ergonomic risk was expanded and was influenced by the psychosocial aspects of work. CONCLUSION: the workers investigated are exposed to modifiable multifactorial ergonomic risks related to musculoskeletal pain. It is possible to promote innovations and teaching-learning actions to minimize them, such as the continuing education program, collectively constructed with recommendations for improvements.

A 3-Year-Old With Gingival Hemorrhage and Musculoskeletal Pain.

A 3-year-old had spontaneous gingival hemorrhage and bilateral limb weakness with inability to bear weight. He had no preceding oral trauma or recent infection, took no regular medications, and had no recent use of aspirin or nonsteroidal anti-inflammatory drugs; his diet was limited to primarily chicken nuggets and milk. What is the diagnosis and what would you do next?

Ergonomic interventions to reduce upper limb musculoskeletal pain during robotic surgery: a narrative review.

There is a high prevalence of upper limb musculoskeletal pain among robotic surgeons. Poor upper limb ergonomic positioning during robotic surgery occurs when the shoulders are abducted, and the elbows are lifted off the console armrest. The validated rapid upper limb assessment can quantify ergonomic efficacy. Surface electromyography and hand dynamometer assessment of strength are the most common methods to assess muscle fatigue. A literature review was performed to find evidence of ergonomic interventions which reduce upper limb musculoskeletal pain during robotic surgery. There is a paucity of studies which have reported on this topic. In other occupations, there is strong evidence for the use of resistance training to prevent upper extremity pain. Use of forearm compression sleeves, stretching, and massage may help reduce forearm fatigue. Microbreaks with targeted stretching, active ergonomic training, improved use of armrest, and optimal hand controller design have been shown to reduce upper limb musculoskeletal pain. Future studies should assess which interventions are beneficial in reducing surgeon upper limb pain during robotic surgery.

Work-related musculoskeletal pain among physical therapists: a cross-sectional study in Kyoto and Shiga prefectures, Japan.

OBJECTIVES: This study aimed to determine the actual working conditions and prevalence of musculoskeletal pain among physical therapists in Japan, and the risk factors associated with low back pain (LBP) and upper limb pain (ULP). METHODS: A cross-sectional study of physical therapists in the Kyoto and Shiga prefectures was conducted using a self-administered questionnaire. The survey contents included questions regarding personal, work-related, and musculoskeletal pain factors. Logistic regression models were used to analyze factors associated with LBP and ULP. RESULTS: Responses from 1479 participants were included in the analyses. The prevalence of LBP at the time of the survey and in the past year was 40.1% and 74.3% in females, and 37.8% and 69.9% in males, respectively. The prevalence of ULP was 34.8% and 64.2% in females, and 27.2% and 53.3% in males. The numbers of patients who performed manual therapy per day, worked using a fixed-height bed, performed manual therapy, had job dissatisfaction and stress, were over 40 years old, and slept less than 6 hours were associated with LBP and ULP. Assistance task was a risk factor only for LBP, and female sex a risk factor only for ULP. CONCLUSIONS: The prevalence of LBP and ULP among physical therapists in Japan was as high as that in nurses and care workers. Work-related factors associated with LBP and ULP were identified among physical therapists. Thus, to prevent work-related musculoskeletal disorders, measures to reduce the physical burden from the perspective of occupational health are required.

Association between musculoskeletal pain and exposures to awkward postures during work: a compositional analysis approach.

OBJECTIVES: This study aimed to explore the association between arm elevation and neck/shoulder pain, and trunk forwarding bending and low back pain among home care workers. METHODS: Home care workers (N = 116) from 11 home care units in Trondheim, Norway, filled in pain assessment and working hours questionnaire, and wore 3 accelerometers for up to 7 consecutive days. Work time was partitioned into upright awkward posture, nonawkward posture, and nonupright time, i.e. sitting. Within a compositional approach framework, posture time compositions were expressed in terms of log-ratio coordinates for statistical analysis and modeling. Poisson generalized linear mixed models were used to analyze the relationship between arm elevation in upright postures and neck/shoulder pain, and between trunk forward bending in upright postures and low back pain, respectively. Isotemporal substitution analysis was used to investigate the association of pain assessment with the reallocation of time spent in the different postures. RESULTS: Time spent in awkward postures was modest, especially for the more extreme angles (60° and 90°). Adjusting for age, gender, and body mass index, our study suggested that the compositions of time spent by home care workers in awkward postures were significantly associated with pain assessment (P < 0.01). Isotemporal substitution analysis showed that reallocating 5 min from upright posture with arms elevated below to above 60° and 90° was associated with a 6.8% and 19.9% increase in the neck/shoulder pain score, respectively. Reallocating 5 min from a forward bending posture while upright below to above 30°, 60°, and 90° was associated with 1.8%, 3.5%, and 4.0% increase in low back pain, respectively. CONCLUSIONS: Although the exposure to awkward postures was modest, our results showed an association between increased time spent in awkward postures and an increase in neck/shoulder pain and low back pain in home care workers. As musculoskeletal pain is the leading cause of sickness absence, these findings suggest that home care units could benefit from re-organizing work to avoid excessive arm elevation and trunk forward bending in workers.

A case of NMDAR Encephalitis with muscular pain as the main presentation.

BACKGROUND: Persistent somatoform pain disorder (PSPD) is often the initial diagnosis in patients seeking treatment in psychiatric departments, making it challenging to consider organic nervous system diseases. However, autoimmune encephalitis can present with atypical initial symptoms, leading to misdiagnosis or missed diagnosis. Lumbar puncture, with antibody support, plays a crucial role in diagnosing autoimmune encephalitis. CASE PRESENTATION: This report describes a 40-year-old male adult patient who was initially diagnosed with persistent somatoform pain disorder in 2022. The patient reported a reduction in pain while resting on his back. There were no fever or relevant medical history. Despite 8 months of symptomatic treatment, the symptoms did not improve. Moreover, the patient developed confusion, gibberish speech, non-cooperation during questioning, and increased frequency and amplitude of upper limb convulsions. Lumbar puncture revealed elevated protein levels and protein-cell dissociation. The autoimmune encephalitis antibody NMDAR (+) was detected, leading to a diagnosis of autoimmune encephalitis (NMDAR). CONCLUSION: Autoimmune encephalitis (NMDAR), starting with persistent somatoform pain (PSPD), often presents with atypical symptoms and can be easily misdiagnosed. Therefore, it is important to consider the possibility of organic nervous system disease in time, and to test serum or cerebrospinal fluid antibodies to rule out organic nervous system disease after symptomatic treatment of mental disorders is ineffective. This approach facilitates the early diagnosis of autoimmune encephalitis and other underlying organic neurological disorders.

Understanding the pattern of musculoskeletal pain and its contributing factors among Hajj pilgrims.

BACKGROUND: Hajj is a series of rituals that are done in specific areas and periods in Mecca. Performing Hajj requires a great amount of physical demand which may result in musculoskeletal pain (MSP) in different age groups. OBJECTIVE: To estimate the prevalence of MSP and understand its pattern via exploring the factors that could be associated with muscular pain among pilgrims in the 2022 Hajj. METHODS: A web-based survey was distributed during the annual Hajj mass gathering. Pilgrims were recruited from Hajj ritual sites. The collected data included demographics, musculoskeletal pain at ten anatomical body sites, and physical activity (PA) level. Descriptive and inferential statistics were used to analyze the data at a 0.05 significance level. RESULTS: A total of 248 pilgrims participated in the study. The mean age of the sample was 43.49±12.70 years. Of all pilgrims, 78.6% had reported MSP in at least one anatomical body site during performing Hajj. Results revealed that Pilgrims were more likely to have MSP in the lower limb while performing Hajj rituals where the most prevalent reported pain was in the legs (46%), followed by the lower back (45%), knees (37%), and ankles/feet (30%). Age, sex, and PA were not significantly associated with MSP except the BMI was found to be a significant factor related to MSP among pilgrims (p <0.05). CONCLUSION: Many pilgrims exhibited pain in at least one body part. Although physical fitness recommendations are published in the Saudi Ministry of Health, MSP preventative measures need to be disseminated by organizations and interested parties worldwide.

Transcatheter arterial tendinopathy embolization as a treatment for painful and refractory tendinopathy: a systematic review and meta-analysis.

OBJECTIVE: Transcatheter arterial embolization (TAE) is a novel minimally invasive therapy for painful tendinopathy in patients with pain refractory to conservative management. The purpose of this study was to evaluate evidence on the efficacy of TAE for tendinopathy related pain. MATERIALS AND METHODS: Using Embase, PubMed, and Web of Science, a systematic review and meta-analysis was performed to identify studies evaluating TAE for painful tendinopathy. The primary outcome measure was change in pain scale score at 6 months. A Ratio of Means (ROM) was used to compare the effect size post treatment as compared to baseline. The Visual Analog Scale (VAS) was used as the metric for comparison. RESULTS: After screening titles, abstracts, and the full text, 5 studies met inclusion criteria. A total of 97 tendinopathy embolization procedures performed in 74 patients were included. Patients who underwent TAE demonstrated declines in VAS ROM at 1 day 0.53 [95% CI 0.31,0.88], 1 week (0.51 [95% CI 0.32,0.79]), 1 month (0.45 [95% CI 0.29, 0.71]), 3-4 months (0.33 [95% CI 0.22,0.48]), and 6 months following embolization (0.18[95% CI 0.13,0.26]), respectively. DISCUSSION: TAE provides substantial short-term reductions in pain scores for patients suffering with refractory tendinopathy related pain of the rotator cuff, elbow extensor and flexor, Achilles, and patellar tendons.

Musculoskeletal pain among medical residents: role of workplace safety climate and sexual harassment.

BACKGROUND: Workplace factors are important predictors of occurrence of musculoskeletal pain among different occupational populations. In healthcare, a psychologically unsafe work environment can negatively affect the emotional, physical and psychological well-being of physicians. This study aimed to examine the relationship between workplace violence, sexual harassment and musculoskeletal pain among Egyptian physicians in their years of residency. METHODS: We distributed an online self-administered questionnaire to 101 residents working in various healthcare sectors in Egypt. It included sections on demographic data, working conditions, widespread pain index (WPI), pain interference short-form, workplace violence and harassment questionnaire, psychosocial safety climate questionnaire (PSC) and sexual harassment climate questionnaire. RESULTS: All residents had at least one painful site on the WPI (range 1-11). The mean WPI was 3.5 ± 2.4, and 39.6% satisfied the criteria of having widespread pain by having at least 4 pain sites. Widespread pain index showed a weak statistically significant negative correlation with workplace PSC score (rho = - 0.272, p = 0.006), and a statistically significant weak positive correlation with the calculated total abuse index (rho = 0.305, p = 0.002). Workplace violence and abuse, as measured by a calculated abuse index was the only significant predictors of widespread pain among residents. CONCLUSION: WPV was found to be a predictor of musculoskeletal pain among medical residents. Healthcare organizations need to address WPV by employing preventive strategies to minimize its hazardous effects and ensure a safe working environment for physicians.

Association between ergonomic risk exposures and insomnia symptoms: a mediation analysis of the 5th Korean working conditions survey.

BACKGROUND: This study investigates the relationship between ergonomic risk exposures and insomnia symptoms, using data representative of Korea's general working population. METHODS: Data from the 5th Korean Working Conditions Survey were used for this study. The eligible population (employees) for the current study was 37,026. Insomnia symptoms were estimated using the minimal insomnia symptom scale (MISS) questionnaire. Logistic regression analysis was conducted to explore the association between ergonomic risks and insomnia symptoms. RESULTS: All the investigated ergonomic risks increased odd ratios (ORs) for insomnia symptoms: Tiring or painful positions (OR, 1.64; 95% CI, 1.43-1.88); lifting or moving heavy loads (OR, 2.33; 95% CI, 1.99-2.71); long periods of standing (OR, 1.47; 95% CI, 1.29-1.69); and repetitive hand or arm movements (OR, 1.46; 95% CI, 1.29-1.67). The mediated proportion of musculoskeletal pain was 7.4% (95% CI, 5.81-10.13), and the mediated proportion of feeling of exhaustion was 17.5% (95% CI, 5.81-10.13). CONCLUSIONS: This study provides evidence for the relationship between ergonomic risks and insomnia symptoms, for which musculoskeletal pains and the feeling of exhaustion may be potential mediators.