Aging is the strongest risk factor for degenerative bone and joint diseases. Clinical therapies for age-related musculoskeletal disorders face significant challenges as their pathogenic mechanisms remain largely unclear. This review article focuses on the recent advances in the understanding of regulatory mechanisms of musculoskeletal aging and their clinical relevance. We begin with the prevalence and socioeconomic impacts of major age-related musculoskeletal disorders such as sarcopenia, osteoporosis, osteoarthritis, and degenerative tendinopathy. The current understanding of responsible biological mechanisms involved in general aging is then summarized. Proposed molecular, cellular, and biomechanical mechanisms relevant to the clinical manifestations of aging in the musculoskeletal system are discussed in detail, with a focus on the disorders affecting muscle, bone, articular cartilage, and tendon. Although musculoskeletal aging processes share many common pathways with the aging of other body systems, unique molecular and cellular mechanisms may be involved in the aging processes of musculoskeletal tissues. Advancements in the understanding of regulatory mechanisms of musculoskeletal aging may promote the development of novel treatments for agerelated musculoskeletal disorders. Finally, future research directions for major musculoskeletal tissues including functional interaction between the tissues and their clinical relevance to age-related musculoskeletal disorders are highlighted in the Future Prospects section. ß

Objective: Considering the heterogeneity of the symptoms shown by patients suffering from chronic tinnitus, there are surprisingly few interdisciplinary treatments available, and mostly available only for inpatients. In order to provide an interdisciplinary treatment, we developed a day care concept in which each patient was treated by an ENT doctor, a cognitive behavioral therapist, a specialist for medical rehabilitation and an audiologist (Jena Interdisciplinary Treatment for Tinnitus, JITT). The aim of this study was to observe the changes of tinnitus related distress due to interdisciplinary day care treatment and to determine which factors mediate this change.Subjects and Methods: Tinnitus annoyance was measured using the Tinnitus Questionnaire on 308 patients with chronic tinnitus. They were treated in the day care unit over five consecutive days between July 2013 and December 2014. Data were collected before treatment when screened (T0), at the beginning (T1) and at the end of the 5 day treatment (T2), as well as 20 days (T3) and 6 months after treatment (T4).Results: Overall, tinnitus annoyance improved significantly from the screening day to the beginning of treatment, and to a much larger degree from the beginning to the end of treatment. The treatment outcome remained stable 6 months after treatment. Patients with the following symptoms displayed higher tinnitus annoyance at T0: dizziness at tinnitus onset, tinnitus sound could not be masked with background noise, tinnitus worsening during physical stress, comorbid psychiatric diagnosis, higher age and higher hearing loss. Loudness of tinnitus perceived in the right ear correlated with tinnitus annoyance significantly. Demographic, tinnitus and strain variables could only explain 12.8% of the variance of the change in tinnitus annoyance from T0 to T4. Out of 39 predictors, the only significant ones were “sick leave 6 months before treatment” and “tinnitus annoyance at T0.”Conclusion: The newly developed JITT represents a valuable treatment for chronic tinnitus patients with improvement remaining stable for at least 6 months after treatment. Using a large number of variables did not allow predicting treatment outcome which underlines the heterogeneity of tinnitus.

Purpose Genome-wide association studies have identified an increasing number of single nucleotide polymorphisms (SNPs) associated with prostate cancer risk. Some of these same genetic variants are also associated with serum PSA levels and lower urinary tract symptoms, raising the question whether the SNPs are truly biomarkers for prostate cancer or simply lead to detection bias. We therefore sought to determine whether the prostate cancer risk SNPs are more strongly associated with tumor volume or prostate volume. Materials and Methods The genotypes of 38 validated prostate cancer risk SNPs were determined in 1,321 Caucasian men who underwent radical prostatectomy. Univariate and multivariate analyses were performed to compare the relationship between SNP frequency, total prostate volume and tumor volume. Results On multivariate analysis, 2 SNPs on chromosome 8q24, rs16901979 (A) (p=0.01) and rs6983267 (G) (p=0.02), were significantly associated with increased tumor volume. In contrast, rs17632542 (T) (p=0.02), near the PSA gene on 19q13, was associated with significantly lower tumor volume, and rs10788160 (A) (p=0.01) on 10q26 was associated with a significantly larger prostate volume. Conclusions Analyses of 38 prostate cancer risk SNPs demonstrates a significant association between several SNPs on chromosome 8q24 and increased tumor volume but not prostate volume, suggesting they are bona fide markers for prostate cancer susceptibility and possibly more aggressive disease. Meanwhile, other “prostate cancer risk SNPs” are associated with PSA levels and either increased prostate volume or decreased tumor volume, suggesting a detection bias due to their phenotypic influence.

» Turf toe is a common injury in athletes. The prevalence of this injury has increased since the implementation of artificial turf and has been reported to be as high as 45% in professional football players.» The mechanism of injury, first described by Bowers and Martin in 1976, is hyperextension of the first metatarsophalangeal (MTP) joint, which causes disruption of the plantar structures. Turf toe can be classified as grade I, II, or III depending on the severity of the injury.» Patients typically present with tenderness, swelling, and/or loss of motion at the MTP joint. Physical examination includes palpation of the key structures surrounding the joint, along with varus and valgus stress and drawer testing of the MTP joint. Weight-bearing radiographs and magnetic resonance imaging are the most commonly utilized imaging modalities.» Turf toe typically is treated nonoperatively with rest, ice, nonsteroidal anti-inflammatory drugs, and compression. Operative treatment may be indicated when nonoperative measures are unsuccessful or in patients with severe disruptions of the plantar structures. Outcomes of turf toe are generally good, but in rare cases, the injury can be career-ending.» The purpose of this review is to highlight the current literature on the epidemiology, risk factors, classifications, diagnosis, treatment, and clinical outcomes of turf toe.

Background: We conducted a retrospective study to compare reoperation/conversion rates and costs between open reduction and internal fixation (ORIF) and radial head arthroplasty (RHA) in patients with radial head/neck fractures. Methods: We examined the Humana Orthopedic data sets using the PearlDiver Application from January 2007 to June 2016 to identify patients with radial head and neck fractures with and without a concurrent elbow dislocation. Time to revision surgery, odds ratios, and survival curves for reoperations/conversions were calculated comparing ORIF and RHA. Results: A total of 7520 patients were identified who had undergone either ORIF or RHA. Overall, ORIF patients were less likely to undergo a conversion procedure (2.76% vs 7.03%) but more likely to undergo any reoperation (21.36% vs 17.63%) with a higher average cost ($19 688.46 vs $11 626.64). Patients who underwent ORIF without a concurrent elbow dislocation were also less likely to undergo a conversion procedure (2.12% vs 7.24%) but more likely to undergo any reoperation (20.22% vs 16.99%) with a higher average cost ($19 420.21 vs $11 123.61). Patients who underwent ORIF with a concurrent elbow dislocation were more likely to undergo both a conversion procedure (15.86% vs 6.39%) and any reoperation (44.98% vs 19.63%) with a higher average cost per patient ($24 999.62 vs $13 192.00). The average time to reoperation/conversion surgery was less than a year for all patient groups. Conclusions: Overall reoperation rates are high in patients undergoing operative treatment of radial head and neck fractures. RHA is less expensive and has fewer reoperations/conversions in short-term follow-up when compared with ORIF in radial head/neck fracture dislocations of the elbow.