[Changes of the spine in working populations. 1. Data on a male control group].
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Adolescent↗
Biomedical subjects
O Menoni
Publications and source records attributed to O Menoni.
[Bad work posture and the pathology of the locomotor system].
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Adult↗
[Further experience with a new method for risk evaluation in work postures (author's transl)].
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Adult↗
[Diseases of the dorsal-lumbar spine and manual handling of loads: guidelines for fitness assessment].
In occupational medicine, degenerative diseases and malformations of the spine are one of the main reasons for requests for fitness assessment for specific jobs, especially among workers involved in manual handling tasks. By means of a selected review of the specialised literature, the authors identify analysis procedures and precise criteria for assessing compatibility between the clinical condition of the spine and manual handling tasks. Attention is drawn in particular to the diseases caused or at least aggravated by mechanical overloading of the spine. For each of these a set of diagnostic criteria is established which could be useful in defining the various levels of severity. On another front, by using tried and tested methods and criteria to identify the weight limits that can be lifted by healthy subjects in various manual handling situations, an approach was developed that can be applied to establish the weight limits that can be lifted by subjects with spinal diseases. By combining the two factors, risk level and damage level, a set of disorders was established that correspond to three different fitness levels. At each level, manual load handling was only allowed up to certain weights and for handling conditions that became increasingly stringent as the severity of the disorder increased. The paper outlines the clinical protocols and the protocols for reconstructing work exposure. The procedural differences involved in the case of fitness assessments in the pre-employment stage are also briefly discussed.
Female↗
[Clinical studies in working populations: a model for the anamnestic investigation of the pathology of the upper limbs and its practical application].
Following a brief review of the principal clinical characteristics of musculo-skeletal disorders of the upper limbs, the authors propose a protocol for a structured anamnestic examination featuring a series of set questions. The anamnestic model is based on a detailed listing of the symptoms to be analysed, which are divided into four categories: pain, paraesthesia, symptoms attributable to hyposthenia, and neurovegetative disorders. Regarding pain and paraesthesia, the authors list the localisation, pattern of onset, duration and number of episodes, irradiation, and treatment. The patients can thus be classified as anamnestic cases based on the following criteria: presence of pain or paraesthesia during the last 12 months, with episodes lasting for at least one week, or occurring at least once a month, with no previous acute trauma. For hyposthenia, the authors report on the conditions under which the disorder may develop. The neurovegetative disorders considered are modifications in colour of the fingers and reaction to exposure to low temperatures. The structure of the proposed anamnestic chart permits all findings to be easily encoded for subsequent storage in a dedicated database. The Appendix contains an annotated facsimile of the anamnestic chart.
Arm↗
[Clinical studies in working populations: value and significance of anamnestic findings, clinical tests and instrumental tests for the diagnosis of musculoskeletal disorders of the upper extremities].
The authors discuss the value and significance of symptoms in WMSDs, considering that the anamnestic threshold proposed in epidemiological investigations cannot be used as clinical and diagnosing criteria. Some useful clinical procedures are suggested for cases where there is a suspicion of musculo-skeletal disorders of the cervical spine and upper limbs, bearing in mind that they are to be applied within the framework of health surveillance programmes undertaken by health care practitioners who are not specialists in orthopaedics, physiatrics or neurology. The recommendations for instrumental tests and specialist referrals are also discussed for the various disorders. The authors also provide flow charts for the diagnostic procedures pertaining to WMSDs. The Appendix shows a sample patient chart illustrating the proposed procedures; it also permits the findings to be encoded so that they can be stored in a dedicated database. The codes for diagnosing WMSDs are also reported for the same epidemiological purposes.
Arm↗
[Occurrence of musculoskeletal disorders in working populations not exposed to repetitive tasks of the upper arms].
A total of 749 workers (males: 139 aged between 15 and 35 years, and 171 aged over 35 years; females: 176 aged between 15 and 35 years, and 263 aged over 35 years) performing tasks not at risk for work-related musculo-skeletal disorders of the upper limbs (WMSDs) underwent a clinical examination using a standardised method. The "anamnetics cases" were defined on the basis of pain or paraesthesia present for at least one week during the previous 12 months, or appearing at least once a month, and not subsequent to acute trauma. The anamnestic cases among the males amounted to 4.4% (age 15 divided by 35 years) and 12.3% (age > 35); among the females 4.6% (age 15 divided by 35 years) and 14.2% (age > 35). Of the 1498 limbs examined, the prevalent pathologies reported were: suspect narrow chest syndrome: 0.3% among the males > 35 years, 0.6% among the females aged 15 divided by 35 years, 1% among the females > 35 years; scapulo-humeral periarthritis: 0.3% among the males aged > 35 years, 0.3% among the females aged 15 divided by 35 years, 1.3% among the females aged > 35 years; lateral epicondylitis: 0.3% among the males aged > 35 years, 0.2% among the females aged > 35 years; trapezio-metacarpal arthrosis: 0.8% among the females aged > 35 years; wrist-hand tendinitis: 0.9% among the males aged > 35 years, 0.9% among the females aged 15 divided by 35 years; carpal tunnel syndrome: 2.5% among the females aged > 35 years. No disorders were detected outside of the age ranges indicated. Several workers reported more than one disorder. The number of workers with at least one WMSD was: males 0% in the 15 divided by 35 years age range, 3.5% in the > 35 year age range; females 2.3% in the 15 divided by 35 year age range, 7.2% in the > 35 year age range; 3.9% of the total sample population. The prevalences were on average quite low, particularly among the older workers, hence the authors recommend that even minimal prevalences detected in particular work environments should not be underestimated.
Adolescent↗
[Criteria for the health surveillance of WMSDs in exposed working populations].
In the light of the experiences and guidelines developed by other countries and of Italian legislative and operational conditions, the authors outline a strategy for a health surveillance programme for work-related musculo-skeletal disorders of the upper limbs. In particular, the paper defines the various aims of the health surveillance programme and identifies significant relevant criteria for its implementation (i.e. existence of risks or effects). A screening schedule is presented based on successive investigations (1st and 2nd level surveillance); the authors discuss the principal methods used for processing the results of the health surveillance programme, in collective (i.e. statistical comparisons; planning of periodical investigations) and individual terms (job fitness judgements; reporting of suspected occupational diseases.
Arm↗
[Guidelines for redesigning jobs with repetitive tasks].
Preventive measures aimed at minimising the occurrence of work-related musculo-skeletal disorders of the upper limbs (WMSDs) associated with repetitive tasks can be divided into 3 categories: structural, organisational and educational. Whenever specific risk and injury assessments have shown the need for preventive action, this is most often implemented within the framework of a range of assorted measures. In particular, structural measures pertain to optimising the layout of the work area and furnishings, and the "ergonomic" properties of work tools and equipment. Such measures serve to alleviate the problems caused by the use of excessive force and improper postures. The authors refer to the principles guiding such structural measures, in the light of the extensive literature that has been published on the subject. Organisational (or re-organisational) measures essentially relate to job design (i.e. distribution of tasks, speeds and pauses). They serve to alleviate problems connected with highly repetitive and frequent actions, excessively lengthy tasks and inadequate recovery periods. Very few relevant findings are available: the authors therefore illustrate in some detail a practical trial conducted in a major engineering firm. The objective was to lower to acceptable limits the frequency of certain repetitive tasks performed by workers using their upper limbs. The trial made it possible to identify a suitable plan and schedule of measures taking into due consideration the impact of the plan on production levels (and costs). The fundamental principles guiding the adoption of specific educational and training programmes for the workers and their supervisors are presented and discussed.
Arm↗
[Criteria for the reintegration to their jobs of workers with musculoskeletal pathologies of the upper limbs based on preliminary practical experiences].
The report presents a preliminary study on the return to the workforce of employees with WMSDs of the upper limbs, and their reallocation to jobs with "low exposure". The study, which is still underway, involves a large engineering firm and includes some 100 workers affected by WMSDs. The trial envisages: providing a definition of the criteria for characterising "accommodating" jobs (i.e. frequency of action < or = 20 actions per minute; virtual absence of other risk factors such as force, posture, inadequate pauses, etc.); concretely identifying jobs meeting such criteria (or jobs which, with minimal modifications, could be made suitable); classifying WMSDs workers, according to the type and severity of the disorder; matching WMSDs workers with the jobs best suited to them; specific training for the workers and their supervisors; carrying out a follow-up of the return of WMSDs workers to the workforce in organisational terms (i.e. need for further modifications to equipment or procedures) and clinical terms (i.e. symptom patterns, acceptability of the condition). The preliminary results, 6-12 months after the start of the trial, are extremely encouraging, and show that when workers return to the workforce in jobs that fully meet defined criteria, a significant prevalence of "improvements" are reported among the involved workers. The investigation will need to be extended, but already it shows quite convincingly that it is possible for workers with what can be described as a "reduced working capacity" to remain "productive" (albeit in jobs featuring a lower exposure potential than the acceptable threshold for "healthy" workers).
Arm↗