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PubMed1996

True aneurysms of the palmar arch of the hand: a report of two cases.

We report on two cases of true aneurysms of the palmar arch, both of which were post-traumatic. One was due to repetitive blunt trauma and the other to a glass cut wound. Both aneurysms were detected clinically as pulsating masses without functional disorders. The presence of elastic fibres and smooth muscle in the aneurysm wall proved it to be a true aneurysm. Both aneurysms were excised and replaced by a vein graft from the foot.

Adult↗
PubMed2005

Chronic compartment syndrome, an important cause of work-related upper limb disorder.

OBJECTIVES: Work-related upper limb disorders (WRULD) are common and disabling complaints in industry, but a tissue diagnosis can be difficult where the pain is diffuse and variable, and this prevents effective treatment. Diffuse arm pain is frequently found in those doing rapid or strenuous repetitive work, such as factory assembly workers or keyboard operators. Similar symptoms occur in the legs in athletes, where chronic compartment syndrome (CCS) is a recognized entity, so we investigated the possibility that this might also be caused by prolonged repetitive work. METHODS: Patients were selected if they were unable to continue with work because of chronic forearm pain. They were divided into three groups: 42 patients with symptoms consistent with CCS as defined in the text, 15 volunteers and patients with other arm complaints, and 10 asymptomatic arms of patients with unilateral CCS. We measured the pressure inside the extensor muscle compartment of the forearm at rest and after a 2 min repetitive gripping exercise using an electronic pressure-sensitive probe. RESULTS: The results show that CCS is a common and disabling forearm complaint associated with prolonged repetitive work. Fifteen patients have now had decompressive surgery on the extensor muscle compartment with good relief of symptoms. CONCLUSION: CCS is responsible for chronic peripheral neurological dysfunction in addition to muscle pain, and awareness of this diagnosis allows early identification and treatment of a currently unrecognized disorder with potential resolution of a long-lasting arm disability.

Adult↗
PubMed1996

Lack of concordance between the ICD-9 classification of soft tissue disorders of the neck and upper limb and chart review diagnosis: one steel mill's experience.

The aim of this study is to determine the validity of the ICD-9 for diagnostic classification of soft tissue disorders of the neck and upper limb, using routinely collected data at a large steel company. The documentation in the clinical chart served as the gold standard. First, the overall accuracy of identifying these disorders from the ICD-9 was examined. Second, we examined whether the codes themselves, on an individual basis, accurately reflected the underlying problems as documented in the medical records. There were 1,267 new cases identified in 1991 by inclusion of all potentially applicable ICD-9 codes. Only 805 (63.5%) fulfilled the definition of a soft tissue disorder of the neck or upper limb as determined by chart review. A more restrictive strategy that only included cases coded by those ICD-9 codes that specifically pertain to these disorders yielded a higher proportion of true cases 458/480 cases (95.4%), but failed to identify the other 347 cases. The anatomical site of the problem could not be identified from the codes describing 651/1,267 cases (51.4%). There was poor agreement between the diagnostic labels recorded in the medical records and the ICD-9 codes, suggesting that many of the terms are being used interchangeably. Our results suggest that conclusions about these disorders drawn from analysis of administrative data which rely upon the ICD-9 for diagnostic classification must be interpreted cautiously. For these soft tissue disorders, researchers will need to develop strategies which would improve upon and supplement the ICD-9.

Adult↗
PubMedDate not supplied

[Risks and health problems caused by the use of video terminals].

OBJECTIVE: To evaluate the association between video display terminal (VDT) use and health hazards, occupational risks, and psychosocial factors, in newspaper workers. MATERIALS AND METHODS: A cross-sectional study was conducted in 1998 in a representative sample (n = 68) drawn from a population of 218 VDT operators in Mexico City. Data were collected using a self-administered questionnaire. Data were confirmed by performing physical examinations. The research hypothesis was that both the current and cumulative use of VDT are associated with visual, musculoskeletal system, and skin illnesses, as well as with fatigue and mental or psychosomatic disorders. Occupational health hazards were assessed (visual problems, postural risks, sedentary work, computer mouse use, excessive heat, and overcrowding), as well as psychosocial factors related to work organization (psychological demands, work control, and social support). Prevalence ratios were adjusted for confounding variables like age, sex and schooling. RESULTS: Women were more likely than men to have upper extremity musculoskeletal disorders (MSD), dermatitis, and seborrheic eczema. VDT use was associated with neuro-visual fatigue, upper extremity MSD, dermatitis, and seborrheic eczema. Computer mouse use and postural risks were significantly associated with health problems. Psychosocial factors were mainly associated with mental problems, psychosomatic disorders, and fatigue. CONCLUSIONS: Intense use of video screens has been found to cause musculoskeletal disorders of the hand. The diversification of tasks and control of labor processes itself had a protective effect against psychosomatic disorders and pathological fatigue.

Adult↗
PubMed1995

Musculoskeletal disorders among operators of visual display terminals.

Using a visual display terminal (VDT) is today a common occupational task with both benefits and hazards. One of the hazards is the occurrence of musculoskeletal disorders. This paper examines the possible causes of such disorders and suggests some preventive strategies. The debate on the relationship between musculoskeletal disorders and VDT usage usually centers around occupational factors (eg, constrained posture, poor ergonomic design of the workplace, equipment design), work-related psychological factors (eg, perceived high job demands, mundane, boring and repetitive job activity, little control, poor support from colleagues and superiors), and psychosocial factors (eg, biodemographic characteristics such as age, previous musculoskeletal injuries, emotional stress, family burden, environmental factors). Improving the ergonomic design of VDT workstations, changing occupational legislation, and improving occupational health services have been suggested as means to decrease the incidence of musculoskeletal disorders among VDT workers. Much research with a multidisciplinary approach is still needed.

Computer Terminals↗
PubMed1991

Outcome of the abduction external rotation test among manual and office workers.

Reactions during the Abduction External Rotation (AER) test were studied among 71 platers and 70 assemblers exposed to vibratory tools and manual work and 45 unexposed white collar workers. The frequency of positive neurological reactions was 31% among the platers, 6% among the assemblers, and 16% among the white collar workers. Platers reported the highest fatigue rates in the shoulder regions during the test. A positive association was noted between a pathological AER test and current problems in the neck/scapula or shoulder/upper arm regions, day- or night-time numbness in the hands, tension neck, and carpal tunnel syndrome. Age, length of daily vibration exposure, and vibration acceleration level were also positively associated with a positive AER test outcome. The results indicate that the outcome of the AER test is sensitive to neck and shoulder disorders but also, to some extent, to the carpal tunnel syndrome.

Adult↗
PubMed1994

Job task and psychosocial risk factors for work-related musculoskeletal disorders among newspaper employees.

OBJECTIVES: A cross-sectional study was conducted to assess the association of upper extremity musculoskeletal disorders and work-related factors among employees using video display terminals at a large metropolitan newspaper. METHODS: The study included 1050 randomly selected workers from four departments. The workers were asked to complete questionnaires on symptoms, job tasks, and psychosocial and work organization conditions. Musculoskeletal disorders of the upper extremities were defined by frequency, duration, and intensity of symptoms not attributable to acute injury. Data were analyzed with the use of logistic regression. RESULTS: A total of 973 workers completed the survey. The one-year period prevalence rate for any musculoskeletal disorder of the upper extremities was 41%. Neck symptoms (26%) were the most frequently reported, followed by hand or wrist (22%), shoulder (17%), and elbow (10%) symptoms. Greater time working at the video display station was associated with increased hand or wrist symptoms in a dose-response relationship. In addition, variables corresponding to increased work-load demands (eg, increased time working under deadline and increased job pressure) were associated with increased neck, shoulder, and hand or wrist disorders. Women were more likely to report symptoms in several areas, but this finding may reflect the concentration of women in jobs involving more risk factors. CONCLUSIONS: The results suggest a high prevalence of musculoskeletal disorders of the upper extremities among newspaper employees, and they provide additional evidence that increased work load, time pressure, and greater hours of computer use are related to the occurrence of work-related musculoskeletal disorders among these workers, particularly for disorders in the hand or wrist area.

Adult↗
PubMed2002

Maladies in musicians.

Certain medical ailments occur with increased frequency among musicians and can affect musicians of all ages and ability. These maladies range in severity from incidental, asymptomatic findings among casual a nd occasional players to serious injuries that significantly disable professional musicians from practicing or performing. The most prevalent problems involve overuse of muscles resulting from repetitive movements of playing, often in combination with prolonged weight bearing in an awkward position. Other common problems include dermatologic irritation, peripheral neuropathies, focal dystonias, and otolaryngologic disorders. This review organizes the musical maladies according to section of the orchestra with further subclassification by pathologic process. By becoming familiar with the disorders associated with specific instruments, physicians will be better able to make the correct diagnosis in musicians with medical complaints.

Cardiovascular Diseases↗
PubMed1997

Confusion surrounding repetitive strain injury highlighted at conference.

Uncertainty about disorders that account for many of the claims related to job injury at work became clear during a recent meeting, when speakers referred to the same disorders by several different names, including repetitive strain injury. Speakers discussed different types of injuries and reasons why they appear to be coming more common.

Cumulative Trauma Disorders↗
PubMed2000

Surface EMG and psychophysiological stress reactions in women during repetitive work.

In order to understand the high prevalence of musculoskeletal disorders associated with stressful work, it is important to explore the relationship between muscle activity and psychophysiological stress responses. The present real-life study examines surface trapezius electromyographic (sEMG) activity, heart rate, blood pressure, and levels of urinary catecholamines and salivary cortisol among 31 female employees working at supermarkets, where the prevalence of neck and shoulder disorders is high (60-70%). As expected, the results show that psychophysiological arousal was high during work. Significant correlations were found between self-reports indicating negative stress (stressed, exhausted, tense) and sEMG activity during work. No significant correlations were found between self-reports of positive reactions (stimulated, concentrated, happy) and sEMG activity. No associations were found between sEMG activity and pain or between negative stress ratings and pain. Objectively measured workload and physiological stress responses did not correlate significantly with sEMG activity. Thus, our data indicate that perceived negative stress may have a specific influence on muscle activity, which may be of importance for musculoskeletal disorders in jobs with low-to-moderate physical load and negative psychosocial factors.

Adult↗
PubMed1995

Age-related evaluation of peripheral circulation of workers with vibration exposure.

This study was designed to clarify the age variation of the indices in the accelerated plethysmography (APG) for fingers and set the standard ageing curve. The indices of APG of workers with exposure to vibration were compared with those of the standard ageing curves. The subjects were 815 male workers, ranging in age from 18 to 66, without exposure to vibration and without history of hypertension, circulatory diseases or diabetes. Their indices of APG are used establishing the standard ageing curves. The workers occupationally exposed to hand-arm vibration were also the subjects to evaluate peripheral circulation of hand. The APG was measured on the index finger tip of his dominant side by an accelerated plethysmometer. The subjects were divided into age groups at intervals of 5 years. In all age groups from 18 to 64 years, each index of APG showed an approximately normal distribution in a logarithmic scale. The mode of the distribution shifted to a lower value with increasing age. The standard ageing curves were drawn by calculating 25th, 50th and 75th percentiles by a nonparametric method for each group. Each index of the standard ageing curves dropped with increasing age. The significant age effect was slightly marked below 30 years, but marked between 30 and 50 years. The indices of APG of workers with exposure to vibration were also compared with those of the standard ageing curve. The indices of -b/a and a/d of workers with exposure to vibration were deteriorated beyond physiological change. We established the standard ageing curves for APG for male men. The technique is good for the evaluation of peripheral circulation disorder of aged workers with occupational exposure to vibration.

Adult↗
PubMed2004

Incidence of ulnar nerve entrapment at the elbow in repetitive work.

OBJECTIVES: Despite the high frequency of work-related musculoskeletal disorders, the relation between work conditions and ulnar nerve entrapment at the elbow has not been the object of much research. In the present study, the predictive factors for such ulnar nerve entrapment were determined in a 3-year prospective survey of upper-limb work-related musculoskeletal disorders in repetitive work. METHODS: In 1993-1994 and 3 years later, 598 workers whose jobs involved repetitive work underwent an examination by their occupational health physicians and completed a self-administered questionnaire. Predictive factors associated with the onset of ulnar nerve entrapment at the elbow were studied with bivariate and multivariate analyses. RESULTS: The annual incidence was estimated at 0.8% per person-year, on the basis of 15 new cases during the 3-year period. Holding a tool in position was the only predictive biomechanical factor [odds ratio (OR) 4.1, 95% confidence interval (95% CI) 1.4-12.0]. Obesity increased the risk of ulnar nerve entrapment at the elbow (OR 4.3, 95% CI 1.2-16.2), as did the presence of medial epicondylitis, carpal tunnel syndrome, radial tunnel syndrome, and cervicobrachial neuralgia. The associations with "holding a tool in position" and obesity were unchanged when the presence of other diagnoses was taken into account. CONCLUSIONS: Despite the limitations of the study, the results suggest that the incidence of ulnar nerve entrapment at the elbow is associated with one biomechanical risk factor (holding a tool in position, repetitively), overweight, and other upper-limb work-related musculoskeletal disorders, especially medial epicondylitis and other nerve entrapment disorders (cervicobrachial neuralgia and carpal and radial tunnel syndromes).

Adult↗
PubMed1997

Upper limb disorders and work: the importance of physical and psychosocial factors.

Upper limb, shoulder, and neck disorders cause both acute and chronic pain, as well as significant functional impairment. They impose a heavy financial burden on societies, industries, and individuals. Our understanding of the pathology of many of the disorders is poor. The epidemiological pursuit of causal relationships is hampered by the nature of the disorders and by the diverse and interactive exposures both at, and away from, the workplace. Current studies suggest that forceful, repetitive manual work, along with prolonged static loading and exposure to vibration are established areas of risk. Much less is known about the possible contribution of psychological factors. Perception of work characteristics, for example, low decision latitude and lack of social support, appear to show increased associations with a number of upper limb disorders, although mechanisms to explain these observations are still broadly theoretical. Research into individual factors is limited, but age and gender both appear to be important.

Arm Injuries↗
PubMed2006

Quantifying repetitive hand activity for epidemiological research on musculoskeletal disorders--part I: individual exposure assessment.

An exposure measurement approach is described for quantifying repetitive hand activity of individual workers in a prospective epidemiological study on work-related upper extremity musculoskeletal disorders. A total of 733 subjects were involved in this study at the baseline. Hand activities were quantified by force and repetition. Force levels were measured by workers' self-reports, ergonomists' estimates based on observation and measurements with instrumentation. Repetition levels were measured by detailed time-motion analyses using two repetitive hand activity definitions and ergonomists' estimates using scales for the American Conference of Governmental Industrial Hygienists hand activity level and the Strain Index. Results showed that the present exposure assessment approach seems to be able to quantify force level and repetitiveness of hand activities. Repetitive hand activity is quantified differently depending on whether forceful hand exertion or repetitive muscle activity is used as the definition. These hand activity definitions may quantify different physical exposure phenomena. Individual exposure assessment is important in epidemiological research of musculoskeletal disorders as there are interactions between the individual subjects and the measured parameters. These interactions may vary between exposure parameters.

Adolescent↗
PubMed1993

A conceptual model for work-related neck and upper-limb musculoskeletal disorders.

This paper presents a conceptual model for the pathogenesis of work-related musculoskeletal disorders. The model contains sets of cascading exposure, dose, capacity, and response variables, such that response at one level can act as dose at the next. Response to one or more doses can diminish or increase the capacity for responding to successive doses. The model is used as a framework for discussing the development of work-related muscle, tendon, and nerve disorders. It is intended as a beginning, to be modified to explain new findings as they become available. In research, it can help to identify areas needing additional data for the development and expression of work-related musculoskeletal disorders. Researchers can use it to design laboratory and field studies. In practice, it demonstrates the relationship between common exposure factors and different responses. This information can be used to evaluate and design jobs for the prevention of work-related musculoskeletal disorders.

Arm Injuries↗
PubMed1993

Prevalence of shoulder and upper-limb disorders among workers in the fish-processing industry.

A cross-sectional study was conducted among fish-processing workers to evaluate the prevalence of shoulder and upper-limb discomforts and to assess the associated ergonomic risk factors. A prestructured interview, a medical check-up, and job analyses were performed to determine musculoskeletal disorders among 207 workers in eight factories. The results showed shoulder girdle pain (30.9%), epicondylitis (14.5%), and carpal tunnel syndrome (15.0%) as the three most common soft-tissue disorders. The odds ratio of shoulder girdle pain was 1.6 (95% CI 1.1-2.5) among the workers who performed tasks with repetitive movement of their upper limbs, while it was 1.8 (95% CI 1.2-2.5) for the workers who sustained forceful movement of their upper limbs during work. Women taking oral contraceptives had a 2.0 times higher odds ratio for carpal tunnel syndrome than did other women. It would appear that untrained or unskilled workers were prone to suffer from musculoskeletal disorders.

Adult↗
PubMed2001

Repetitive strain injury.

Repetitive strain injury is a group of musculoskeletal disorders affecting muscles, tendons, nerves and blood vessels. These disorders could be attributed to occupational causes; however non-occupational causes should be excluded. The management of these cases required a multidisciplinary team approach.

Aftercare↗