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PubMed2005

Musculoskeletal pain associated with the use of computer systems in Nigeria.

INTRODUCTION: Computer related musculoskeletal disorders affect millions of computer users yearly in developed nations as reported in the literature. With proliferation of computer systems in the developing nations, the associated musculoskeletal pain has yet to be investigated. This serves as impetus for this study. METHODS: A structured questionnaire was used to obtain information from computer users across six federal university campuses in Nigeria. The questionnaire contained two sections of 35 items each. The questions requested the respondents to provide information on age, sex, years of computer usage, hour spent on computer per week, associated musculoskeletal pain, pain severity and knowledge of preventive measures. 1041 questionnaires were analyzed using descriptive statistics. RESULT: Low back pain and neck pain were found to be the highest pain complaint with 74% and 73% respectively. 67% of the respondents complained of wrist pain, followed by finger pain (65%), shoulder pain 63% and general body pain 61%. The knee and foot pains were the least reported complaints with 26% and 25% respectively. In terms of pain severity, low back pain, finger pain, neck pain and shoulder pain are rated to be moderate, while all other joints were said to be of mild pain. DISCUSSION: The results of this study indicated that low back pain, neck pain and upper limbs are the common disorders complaints among the users. The cause of the pain may be attributed to bad ergonomics among the users.

Adult↗
PubMed1996

Soft-tissue injuries of the wrist.

The wide spectrum of athletic activities places demands of different magnitudes, orientations, and degrees of repetition on the wrists of athletes. These demands can result in injuries to the soft tissues of the wrist, which may make optimal athletic performance difficult if not impossible. With the advent of increased awareness of injuries particular to a sport and advances in diagnostic acumen, both technologic and clinical, these once enigmatic pathologic entities can be approached with a treatment plan that often can return the athlete to competition quickly. A number of these injuries and their pathomechanics, diagnosis, and treatment options have been described in this article. Although adequate treatment of the subject of athletic soft-tissue injuries to the wrist requires a more lengthy discussion than is appropriate here, the material presented on dorsal pain disorders, carpal instability, and the triangular fibrocartilage complex should serve as a starting point for increasing cognizance and understanding of the injured wrist in the athlete.

Athletic Injuries↗
PubMed1996

A team approach to reduce disability in work-related disorders.

Work-related disorders require a multidisciplinary approach. One must understand musculoskeletal disorders, job issues, and psychosocial issues that prolong disability. This introductory article presents an overview of the approaches to management that will be detailed in the articles that follow.

Cumulative Trauma Disorders↗
PubMed2005

The effect of wearing a wrist splint on shoulder kinematics during object manipulation.

OBJECTIVES: To test the hypotheses that (1) wearing a flexible wrist splint while taking an object from a box increases known postural risk factors for shoulder disorders and (2) that the height of the front of the box modulates the effect on shoulder kinematics of wearing a wrist splint. DESIGN: A controlled laboratory experiment with 2 factors (splint wearing, box height). SETTING: Human performance laboratory. PARTICIPANTS: Ten consecutive healthy volunteers (5 men, 5 women; age range, 19-32 y). INTERVENTIONS: Experimental manipulation of wrist immobilization and box height. MAIN OUTCOME MEASURES: Humeral plane of elevation, humeral elevation, and humeral axial rotation. RESULTS: Wearing a wrist splint increased the maximum humeral elevation angle (P<.001), and the height of the barrier also increased the maximum humeral elevation angle (P<.001). The average difference in maximum humeral elevation between the splint and the no splint conditions was 6.8 degrees . CONCLUSIONS: Wearing a wrist splint while performing a job that requires removing objects from a box can increase risk factors for shoulder disorders. Workplace analysis should be performed to avoid secondary injuries before a patient wearing a wrist splint returns to work.

Adult↗
PubMed1998

Correlation of carpal tunnel size and conduction velocity of the sensory median and ulnar nerves of male and female controls and carpet weavers.

The relation of the carpal tunnel parameters (area, width, and depth) measured by computerized axial tomography to the conduction velocity of the sensory median and ulnar nerves was studied in the right and left hands of the 24 male and 32 female controls and 64 carpet weavers (40 women, 24 men). There were sex- and hand-related differences in these relationships in the two groups. Analysis suggested that carpal tunnel size cannot be responsible for the disorders of sensory nerve conduction in hands; repetitive hand movements, such as carpet weaving, may destroy the normal relation of carpal canal size to velocity of sensory nerve conduction.

Carpal Bones↗
PubMedDate not supplied

Ergonomics in the health care environment.

This article introduces the history and current applications of workplace ergonomics, basic principles of biomechanics, the types of workplace risks and injuries encountered in the health care environment and risk-reduction strategies. After completing it, the reader should be able to: Describe the biomechanics and physiology of muscle and bone. Explain the different types of muscular work. List major musculoskeletal disorders and their symptoms. Recognize workplace risk factors for musculoskeletal damage and identify prevention strategies. Explain how technological advances in the radiology workplace will reduce the musculoskeletal strain suffered by radiologic technologists.

Accidents, Occupational↗
PubMed2003

A pilot study of hand and arm musculoskeletal disorders in dental hygiene students.

PURPOSE: This study was designed to determine the relationship between musculoskeletal disorder symptoms and vibration in dental hygiene students as a pilot for a larger scale study. METHODS: A custom-designed questionnaire was distributed to three intact student groups: those accepted for admission, those at the end of the first year, and graduating students at the end of the second year. Data were analyzed using tabular and multivariate analysis. Students increased their use of ultrasonic instruments from 0.2 to 2.8 to 7.3 hours per week over the three years. Dental hygiene students with symptoms of numbness in the upper extremities used ultrasonic scalers a mean of 8.2 hours per week compared to 2.8 hours of use by students with no upper extremity numbness. These students also used manual instruments 10.1 hours and 4.8 hours per week, respectively. RESULTS: Logistic regression revealed a significant association between hours of use of ultrasonics and upper extremity numbness/tingling, with an odds ratio of 1.10 for each increased hour of use (95% CI 1.01-1.19; chi-square = 4.9). A similar result was found for manual instrument use. CONCLUSION: Results indicate that musculoskeletal disorder symptoms may increase with the use of ultrasonic and/or manual instruments.

Adult↗
PubMed2002

Relationship between stress and pain in work-related upper extremity disorders: the hidden role of chronic multisymptom illnesses.

BACKGROUND: Pain and fatigue are commonly associated with work-related upper extremity disorders. Occasionally these symptoms persist beyond a reasonable healing period. One potential explanation for prolonged symptom expression is the concurrent development of a stress-mediated illness or CMI (Chronic Multi-Symptom Illness). In such a scenario, the chronic regional pain and other symptoms that the individual is experiencing would be attributable to the CMI rather than to tissue damage or a biomechanical dysfunction of the upper-extremity. METHODS: This article critically reviews the case definitions of the new class of CMI disorders and evaluates the existing evidence supporting centrally mediated physiological changes (e.g., sensory hypervigilance, dysautonomia) that manifest as symptoms of pain and fatigue in some individuals experiencing chronic stressors. RESULTS: While explanations for prolonged pain and fatigue have historically focused on mechanisms involving peripheral pathology or psychiatric explanations, ample evidences support the role of altered Central Nervous System function in accounting for symptom manifestation in CMI. CONCLUSIONS: A model is presented that unites seemingly disparate findings across numerous investigations and provides a framework for understanding how genetics, triggering events, stressors, and early life events can affect CNS activity. Resultant symptom expression (e.g., pain and fatigue) from central dysregulation would be expected to occur in a subset of individuals in the population, including a subset of individuals with work-related upper extremity disorders. Thus when symptoms such as pain and fatigue persist beyond a reasonable period, consideration of CMI and associated assessment and interventions focused on central mechanisms may be worthwhile.

Arm Injuries↗
PubMed2004

Static load magnitude is a risk factor in the development of cumulative low back disorder.

Occupations requiring frequent periods of static lumbar flexion are known epidemiologically to be risk factors for the development of cumulative low back disorder. The impact of the load magnitude sustained during a series of short static lumbar flexions followed by an equally long rest period on the development of a cumulative low back disorder was addressed in an in vivo feline model. Static loads of 20, 40, and 60 N were applied over 10 min of flexion followed by 10-min rest sessions that were repeated six times (for a total of 2 h) while monitoring lumbar viscoelastic creep (laxity) and reflex electromyographic (EMG) activity from the multifidus muscles. Creep and EMG were also monitored over 7 h of rest following the six flexion-rest sessions. It was found that the creep developed in the 10-min flexion periods did not recover completely during the following 10 min of rest, giving rise to a large cumulative creep at the end of the work-rest session. Muscle activity demonstrated spasms during the static flexion periods as well as initial and delayed hyperexcitability during the 7-h rest period. Loads of 20 and 40 N did not result in delayed hyperexcitability, whereas loads of 60 N resulted in delayed hyperexcitability. Statistical analysis demonstrated that increased load significantly intensified the magnitude of the hyperexcitabilities (P < 0.05). Thus, repeated periods of static lumbar flexion were found to result in a transient neuromuscular disorder with an intensity directly related to the load magnitude, which should be considered a compounding risk factor.

Animals↗
PubMed1998

Knee impingement syndromes.

INTRODUCTION: The so-called knee impingement syndromes are very frequently reported in both professional and amateur sportsmen. PURPOSE: The objective of our study was to classify the most frequent knee changes responsible for such syndromes considering both pathology and diagnostic work-up. MATERIAL AND METHODS: Our patients complained of aspecific symptoms related to articular meniscal, ligament or cartilage, conditions. The site of pain was periarticular and there was no apparent sign of acute traumatic events. All individuals, aged 16-55, practised sports at different levels and women were the majority of the sample. The study was carried out from 1995 to 1997 and all the medical records presented in occasion of the sports-medicine check-up were reviewed. RESULTS: The sites of symptom onset were divided into medial, lateral, anterior and posterior. For each of them the most frequent conditions which could be defined as impingement syndromes, were defined paying particular attention to the possible methods of diagnosis useful to classify the disorder. As for anterior syndromes, patellofemoral disorders were the most frequent findings. They were associated with either incorrect torsion movements of the lower limbs or local dysplasia. Alterations in the single skeletal and cartilage structures were reported. Always referring to anterior syndromes, Hoffa's fat pad imflammation and the jumper's knee were a less frequent finding. As for posterior impingement syndromes, the most frequent abnormalities involved the insertional tract of the midcalf muscle associated with bursa reaction and insertional popliteus hypertrophy. As for medial syndromes, the most frequent abnormality involved the parapatellar synovial fold whose symptoms can be often mistaken for a meniscal injury. Less frequent is the involvement of the 'pes anserinus' tendinitis and the insertional enthesopathy of the semimembranosus muscle. As for lateral syndromes, the phlogistic involvement of the distal insertional tract of the broad fascia tensor tendon with bursa reaction is very frequently reported, while the inflammation of the popliteal tendon and of the femoral bicipital tendon is less common. CONCLUSIONS: Although less frequent than meniscal and ligament injuries, impingement syndromes must be taken into due consideration when looking for knee disorders resorting to different diagnosis methods. Diagnostic imaging is very useful in this regard as it allows a proper and correct diagnosis procedure for any single condition.

Adolescent↗
PubMedDate not supplied

Carpal tunnel syndrome and occupation in U.S. Navy enlisted personnel.

The objectives of this study were to (a) describe demographic factors associated with high rates of carpal tunnel syndrome (CTS), cubital tunnel syndrome, and other neuritis of the arm and hand, and (2) identify the high-risk occupations associated with these disorders in the Navy. Computerized records of first hospitalizations of all active-duty Navy-enlisted personnel were searched for all cases of CTS, cubital tunnel syndrome, and other neuritis of the arm and hand (ICD-9 CM codes 354.0-354.9) during 1980-1988. There were 1039 first hospitalizations (including 493 cases of CTS) for all neuritis of the arm and hand in 4095708 person-years in men and 186 first hospitalizations (including 90 cases of CTS) in 365668 person-years in women. Incidence rates of hospitalized cases with CTS rose with age for both sexes. Rates in white women were approximately three times those in white men (p < .0001), but rates in black women were not significantly different from those in black men. Rates of cubital tunnel syndrome also increased with age in both sexes and were higher in white women than white men (p < .05). Occupations with significantly high standardized incidence ratios (p < .05) for CTS in men included aviation-support equipment technician, engineman, hull-maintenance technician, boatswain's mate, and machinist's mate. In women, occupations with significantly high standardized incidence ratios included boatswain's mate, engineman, hospital corpsman, ocean-systems technician, and personnelman. Several occupations for each sex had significantly high standardized incidence ratios for cubital tunnel syndrome, with high rates in hospital corpsmen of both sexes (p < .05). Gender and race differences according to occupation did not account for the occupations at highest risk. Further research is needed to determine the extent to which CTS and related disorders could be prevented by modifying the motions currently performed in occupations with the highest standardized incidence ratios.

Adolescent↗
PubMed1992

Workplace upper limb disorders: a prospective study with intervention.

A prospective longitudinal study was carried out to investigate the occurrence of upper limb disorders in an electromechanical plant between 1980 and 1988. It included clinical and epidemiological studies, measurement of vibration produced by the power tools used, ergonomic assessment of the works and time and motion studies. Simultaneously during the same period remedial actions were taken through multidisciplinary interventions when the specific causal factors were known. The study shows the clinical entities of the disorder, identifies the risk factors and evaluates the results of the interventions. It assists in establishing a cause and effect relationship for the condition and demonstrates the way a preventive strategy could be developed.

Adult↗
PubMed2004

Design features of alternative computer keyboards: a review of experimental data.

Design of computer keyboards no longer is limited to the flat keyboards that are typically shipped with personal computers. Keyboards now exist that are split into halves and these halves can be slanted away from each other (creating a triangle between the halves), sloped downward toward the visual display terminal, tilted upward like a tent, or simply separated. These design features are intended to alleviate discomfort and possible musculoskeletal disorders that have been suggested to be associated with the extensive use of conventional computer keyboards. The geometry of conventional keyboards requires the wrists to be in 10 degrees to 15 degrees of ulnar deviation and 20 degrees of extension and the forearms to be nearly fully pronated while typing. A review of the available experimental data collected on 10-digit touch typists indicates that (1) keyboards with a slant angle (half of the opening angle) of 10 degrees to 12.5 degrees or keyboards with halves separated to approximately shoulder width are both effective in placing the wrist in near neutral (0 degree) ulnar/radial deviation when typing, (2) wrist extension can be reduced to near neutral (0 degrees) when a keyboard with a negative slope of 7.5 degrees is used, contingent on the wrist rest also sloping with the keyboard, and (3) tilting the keyboard halves 20 degrees to 30 degrees is effective in reducing forearm pronation to approximately 45 degrees. These studies also indicate that experienced 10-digit touch typists readily adapt (within 10 minutes) to these individual alternative keyboard features, and can type with approximately the same speed and accuracy as with the conventional keyboard. While placing the wrist and forearm in a more neutral position could, in theory, reduce the incidence of musculoskeletal disorders, randomized controlled trials are necessary before strong recommendations can be made on the effectiveness of alternative keyboards for the prevention and/or treatment of musculoskeletal disorders. In the absence of these randomized controlled trials, the information in this article provides preliminary guidance to clinicians in their evaluation of computer keyboards and workstations and their recommendations to patients.

Computer Peripherals↗
PubMedDate not supplied

Ergonomics and dentistry.

Since 1992 the Occupational Safety and Health Administration (OSHA) has been preparing Federal legislation concerned with ergonomic hazards in at-risk workplaces. Although multifactorial in nature, there is sufficient evidence in the scientific literature to document an association between the practice of dentistry and a variety of musculoskeletal disorders. There are preventive strategies already known and available to us. Should dentistry be considered an at-risk profession and be required to comply with the forthcoming standard, or is self-monitoring sufficient?

Bone Diseases↗
PubMed1993

Repetitive motion disorders: the design of optimal rate-rest profiles.

Repetitive motion disorders of the upper extremities are the primary cause of lost time in hand-intensive industries. Typical remedies include the introduction of job aids and the redesign of the job. An alternative approach is considered here. Procedures are developed that can be used to determine the parameters of a job (e.g., the rate of work and the number and duration of the rest breaks) that minimize repetitive motion disorders and maximize productivity. It is shown that in theory the job parameters can be set so that one can achieve not only a decrease in repetitive motion disorders but also an increase in productivity. The application of the procedures to an actual manufacturing job requiring high-repetitive, high-force hand motions is discussed in detail.

Cumulative Trauma Disorders↗
PubMed2002

Are psychosocial factors, risk factors for symptoms and signs of the shoulder, elbow, or hand/wrist?: A review of the epidemiological literature.

BACKGROUND: In 1993, an extensive review on the role of psychosocial factors in the development of musculoskeletal problems was published by Bongers et al (1993). Since then, additional reviews on this topic have been published; however, none of these focussed on upper limb problems. METHODS: In this systematic review, the methodological quality of all studies was assessed and levels of evidence were apriori defined. RESULTS: The large majority of the studies reported an association between at least one work-related psychosocial factor and adverse upper extremity symptoms or signs. High-perceived job stress was consistently associated with all upper extremity problems (UEP) in high and lower quality studies. Although not often studied, non-work-related stress was also consistently associated with UEP. In addition, there was some evidence for a relationship between high job demands and UEP, although the results did not meet the pre-set criterion for consistency. CONCLUSIONS: High job stress and non-work-related stress reactions are consistently associated with UEP. In addition, high job demands is also in most studies associated with these disorders. Firm conclusions on the role of these factors in the etiology of UEP are not possible due to the cross-sectional nature of most studies.

Arm Injuries↗
PubMed1994

Disorders of the neck and upper limbs in women in the fish processing industry.

OBJECTIVE: The aim was to study the association between personal factors and physical and psychosocial work environment factors and disorders of the neck or upper limbs among women in the fish processing industry. METHODS: A cross sectional study was performed on 206 women in the fish processing industry and 208 control women. Several physical and psychosocial work environment factors were evaluated. Subjective complaints about the neck or upper limbs were assessed by questionnaire and by a clinical examination. RESULTS: The study showed a high prevalence (35%) of diagnoses in the neck or shoulders of the exposed women. All prevalence odds ratios (POR's) were substantially higher in young women. There was a pronounced dose-response relation between disorders of the neck or shoulders and duration of employment for women < 45 years old. When studying 322 former workers, the proportion who claimed musculoskeletal complaints as the reason for leaving was highest among the older women. Muscular tension, stress or worry, work strain, and the largest fraction of the work time spent with highly repetitive work tasks were clearly associated with disorders of the neck or shoulders. The measurements of the wrist movements also showed that the work was performed almost without any pauses and that the median flexion and extension velocity was high (41 degree/s). The results of observation showed good agreement with the measurements of wrist motion. CONCLUSION: Work in the fish processing industry is a risk factor for disorders of the neck and upper limbs. Due to the homogenity of the physical work load in the exposed group, we could not show any associations between the objective measurements and disorders. In cross sectional studies the risk may be underestimated due to a healthy worker effect.

Adolescent↗
PubMedDate not supplied

[Evaluation of the exposure to biomechanical overload of the upper limbs and clinical investigation in a female population employed in the manual loading of production lines in 2 ceramics factories].

The aim of this study was to assess the presence of an increased risk of biomechanical overload of the upper limbs in the ceramics industry, among workers manually loading production lines. The study focused on two factories: in the first, most of the work was performed manually, whilst in the second the manufacturing process had been almost entirely automated. A total of 46 female workers were examined in both factories, to check for the presence of any disorders of the shoulder, elbow and wrist, as well as for any signs of carpal tunnel medial nerve pain. Approximately two thirds of the workers had positive results of the examinations and went on to undergo 2nd level testing (physiatric examination, muscle tendon US, electromyography) to confirm the diagnosis. In both factories, an increased risk was detected in terms of intensity of exertion, frequency of actions and inadequate recovery times. The posture and movements analysis showed that each of the segments of the upper limbs studied were involved. In both factories, at least 3 out of every 4 workers tested positive for a disorder of at least one segment. Diagnoses were almost invariably confirmed by the 2nd level tests. The progressive automation of the ceramics industry over recent years does not seem therefore to have reduced the risk of biomechanical overload disorders in the upper limbs, at least in relation to those jobs which still feature manual tasks. In view of the social costs associated with such disorders, it would appear mandatory to pursue the investigation further, particularly focusing on those jobs (e.g. polishing, cutting, special shapes, etc.) which can be expected to feature manual tasks.

Adult↗