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PubMed2000

Epidemic occupational pseudo-illness: the plague of acronyms.

Genuine disorder caused by repetitive movement has unmistakable features vitally different from occupational pseudo-illness, which comes and goes in new guises and massive epidemics wherever the label legitimizes gain from compensation. The assumption of an existing label such as the carpal tunnel syndrome gives the false idea of greater potential for deception. The solution to the menace lies in logical reasoning, which recognizes falsity before it begins to dominate the minds of the community.

Carpal Tunnel Syndrome↗
PubMed2001

Ergonomic job design to accommodate and prevent musculoskeletal disabilities.

Work-related musculoskeletal disorders (MSDs) account for a major portion of the cost of work-related injury and illness in the United States. Many of these injuries and illnesses lead to temporary or permanent disability. It is generally accepted that the incidence of MSDs increases when the demands of the job exceed the capabilities of the worker. As the workforce ages and physical capabilities decline, it is anticipated that many more Americans will request disability-related leave resulting from musculoskeletal disorders because they are unable to meet the demands of the job. To prevent these disabilities and to accommodate a wider range of people in the workforce, physical job demands may have to be reduced so that a larger portion of the population will be capable of working. Providing engineering controls or alternative work arrangements allows for accommodation of workers with a wide range of capabilities and can assist in rehabilitation and early return to work following injury.

Cumulative Trauma Disorders↗
PubMed1988

The treatment of overuse syndrome in musicians. Results in 175 patients.

Overuse syndrome, a condition of pain and loss of function in muscle groups and ligaments through excessive use, is common in musicians. In this series, the less serious cases of the disorder have been successfully treated by a modification of physical activity while allowing the musician to continue to play. The more serious cases were treated by a radical rest programme, first described last century, usually up to 12 months, until the patient is pain free and the muscles and ligaments are no longer tender. Performance is then very gradually resumed. The criterion for total success is a return to music performance free of pain with sustainable practice habits.

Adolescent↗
PubMed1996

Review of applicability of existing functional status measures to the study of workers with musculoskeletal disorders of the neck and upper limb.

Both epidemiologic studies of the factors that contribute to the development of work-related musculoskeletal disorders of the neck and upper limb and intervention studies that test the effectiveness of workplace ergonomic and organizational changes are needed to provide empiric evidence for preventive strategies. This study reviews the relevance and comprehensiveness of existing functional status instruments for epidemiologic studies of work-related neck and upper limb disorders. Twelve domains were identified as the major areas of life affected by workers' neck and upper extremity disorder(s): work, household and family responsibilities, self-care, transportation/driving, sexual activity, sleep, social activities, recreational activities, mood, self-esteem, financial effects, and iatrogenic effects of assessments and treatment. Fifty-two functional status instruments were identified. Of these, 21 met the specified criteria as potentially relevant and were rated on the 3-point scale for relevance and comprehensiveness for each domain. None of the instruments covered all 12 domains adequately.

Arm Injuries↗
PubMed1996

Can Dupuytren's contracture be work-related?: review of the evidence.

Dupuytren's contracture (DC) is a disease of the palmar fascia resulting in thickening and contracture of fibrous bands on the palmar surface of the hands and fingers. For decades, a controversy has existed regarding whether acute traumatic injury or cumulative biomechanical work exposure can contribute to the development of this disorder. To address this controversy, this review considers the following questions: Is there evidence that DC is associated with 1) frequent or repetitive manual work; and 2) hand vibration? The published literature was searched for studies meeting the following criteria: 1) in English or having an English abstract; 2) controlled studies; 3) DC an identified health outcome studied; and 4) the study group exposed to repetitive or frequent manual work, vibration, or acute traumatic injury. Relevant non-English articles identified through English abstracts were translated. The validity of studies meeting the selection criteria was assessed using a series of questions adapted from those of Stock [1991: Am J Ind Med 19:87-107]. Studies that met a priori minimum levels of methodologic quality were taken into account to reach conclusions with respect to the above questions. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each study. Ten studies met the initial selection criteria. Of these, four studies met the criteria for methodologic quality, one addressing the relationship between manual work and DC, and three studies of vibration and DC. No controlled studies of acute trauma and DC were identified. Bennett [1982: Br J Ind Med 39:98-100] found the prevalence of DC at a British PVC bagging and packing plant in which workers were exposed to repetitive manual work to be 5.5 times that at a local plant without packing, and twice the expected prevalence in a U.K. working population previously studied by Early [1962: J Bone Joint Surg 44B:602-613]. DC was observed more frequently among vibration white finger claimants than controls by Thomas and Clarke [1992: J Soc Occup Med 42:155-158] (OR, 2.1; 95% CI, 1.1-3-9), and more frequently among vibration-exposed workers than controls by Bovenzi et al. [1994: Occup Environ Med 51:603-611] (OR, 2.6 95% CI, 1.2-5.5). Cocco et al [1987: Med Lav 78:386-392] found that a history of vibration exposure occurred more frequently among cases of DC than among controls (OR, 2.3; 95% CI, 1.5-4.4). The latter two studies presented some evidence of a dose-response relationship. There is good support for an association between vibration exposure and DC.

Causality↗
PubMed2003

MRI features of intersection syndrome of the forearm.

OBJECTIVE: The purpose of this original report is to describe the MRI findings in patients with intersection syndrome of the forearm. CONCLUSION: Intersection syndrome is an overuse disorder of the dorsal distal forearm, presenting with particular symptoms and signs that may be clinically misdiagnosed. MRI can perform an important role in establishing the diagnosis. Peritendinous edema (peritendinitis) around the first and second extensor compartment tendons, extending proximally from the crossover point, is the most characteristic finding that should suggest a diagnosis of intersection syndrome. Chronic cases may be subtle and not show substantial MRI findings likely reflecting the development of a stenosing tenosynovitis.

Adult↗
PubMed1996

Dental office ergonomics: how to reduce stress factors and increase efficiency.

Ergonomics, the science that studies human stress and strain related to activities, has one primary objective-to prevent work related musculoskeletal disorders, or symptoms that aggravate these disorders. Smart business owners have adopted the practice of ergonomics as an integral element in their ongoing strategies to increase productivity and ensure reduced workers' compensation liability. In British Columbia, however, potentially expensive ergonomic draft regulations created by the province's Workers' Compensation Board in 1993, have been put on hold. These ergonomic standards-described as the stiffest in the world -were to have been implemented across the province in early 1995. Nonetheless, ergonomic practices are alive and thriving in Canadian businesses that are devoted to ensuring a reduction in work-related injuries and salvaging potentially lost productivity. Although it is difficult to document lost productivity, Ontario's Workers' Compensation Board reported that it received 707 repetitive stress injury claims from office workers in 1992, with a per person cost of $7,703. In addition to these costs, each claimant took about 93 days off work. In dentistry, poor working habits, along with repetitive tasks, such as scaling and root planing, contribute greatly to musculoskeletal disorders, stress claims and lost productivity. Our tendency is to adapt awkward and illogical physical postures to access the oral cavity. The key objective for clinicians is to find a position that allows them to achieve optimum access, visibility, comfort and control at all times. With the professional goal to deliver the highest quality of care for a reasonable profit, the practice of ergonomics becomes a core focus in determining how to achieve practice success with less stress.

Absenteeism↗
PubMed1992

Peripheral nerve entrapment, occupation-related syndromes, and sports injuries.

The use of magnetic resonance imaging to detect nerve entrapment disorders is described in this review as well as more basic clinical tests for the carpal tunnel syndrome. Overuse syndrome remains controversial. Symptoms may arise from overuse outside the workplace; prospective electrodiagnostic study of median nerve latency shows no difference between persons doing repetitive hand tasks and those applying for these jobs. Conditioning for young and old sports participants is reviewed as well as the injuries they suffer. Magnetic resonance imaging of asymptomatic knees reveals meniscus lesions more often than not.

Athletic Injuries↗
PubMed2004

Prevalence of musculoskeletal disorders in dentists.

BACKGROUND: The prevalence of musculoskeletal complaints in dentists is high although relatively few studies had focus in this profession. The aim of this study was to investigate the relations between physical, psychosocial, and individual characteristics and different endpoints of musculoskeletal complaints of low back, neck, shoulders and hand/wrist. METHODS: A questionnaire survey was carried out among 430 dentists (response 88%) in Thessaloniki, Greece. Questions include data on physical and psychosocial workload, need for recovery, perceived general health and (i) the occurrence of musculoskeletal complaints in the past 12 months, (ii) chronic complaints during at least 1 month, complaints which led to (iii) sickness absence, and (iv) medical care seeking. In logistic regression analysis odds ratios were estimated for all relevant risk factors. RESULTS: 62% of dentists reported at least one musculoskeletal complaint, 30% chronic complaints, 16% had spells of absence and, 32% sought medical care. Self-reported factors of physical load were associated with the occurrence of back pain (OR = 1.59), shoulder pain (OR = 2.57) and, hand/wrist pain (OR = 3.46). With the exception of hand/wrist complaints, the physical factors were not associated with chronic complaints and musculoskeletal sickness absence. Physical load showed a trend with the number of musculoskeletal complaints with ORs of 2.50, 3.07 and 4.40 for two, three and four musculoskeletal complaints, respectively. No consistent influence of psychosocial factors on complaints, chronicity, sickness absence and medical care seeking was observed. A perceived moderate general health was a significant factor for chronic complaints, comorbidity and medical care seeking where high perceived exertion was significant for absenteeism. Living alone was also related with increased absenteeism due to shoulder pain (OR = 5.01) and hand/wrist (OR = 4.07). CONCLUSIONS: The physical load among dentists seems to put them at risk for the occurrence of musculoskeletal disorders. More than one and severe complaints are related to perceived general health while high perceived exertion and social characteristics are associated with sickness absence. Chronic symptoms seem to determine medical care seeking. Ergonomic interventions may have a greater impact in prevention of hand/wrist complaints. When investigating the influence of work-related risk factors on musculoskeletal health, psychosocial and other personal characteristics should be taken into account.

Absenteeism↗
PubMed1991

Working hours as a risk factor in the development of musculoskeletal complaints.

The length of daily working hours as a risk factor for the development of musculoskeletal complaints was studied by comparing the sick leave statistics of 408 sewing machine operators on full-time schedules (8 h working day) with 210 operators on part-time schedules (5 h working day). Working part-time was shown to postpone the occurrence of sick leave due to musculoskeletal disorders by approximately half a year. There was no lasting effect on the reduction in working hours on sick leave due to shoulder-neck complaints, but a reduction in low back complaints was indicated. It is suggested that any reorganization of work activities to counteract musculoskeletal injuries from repetitive work should aim to break up the muscular activity patterns over time periods considerably shorter than the 5 h working day of the part-time workers in the present study.

Absenteeism↗
PubMed1995

Repetitive motion injuries.

Repetitive motion injuries have presented clinicians with a significant challenge over the past two and a half decades. Acceptable treatment of inflammatory disorders is well established, but compressive neuropathies and nonspecific complaints of numbness, tingling, and discomfort in the upper extremity present vexing dilemmas. Current research and experience point to multilevel problems, including posturally induced muscular imbalance. Although surgical solutions to these problems are sometimes indicated, conservative approaches successfully treat many individuals and have narrowed the scope and indications for surgical intervention. These approaches include ergonomic changes at the workstation, postural changes, and muscle stretching and strengthening to correct imbalance.

Arm↗
PubMed1998

Nerve injury in repetitive motion disorders.

Nerve compression in repetitive motion disorders is being recognized with increasing frequency. The pathophysiology of chronic nerve compression spans a broad spectrum beginning with subperineurial edema and progressing to axonal degeneration. These changes depend on the amount and duration of the compressive forces. Certain postures or positions in the upper extremity will increase pressures around certain nerves increasing pressure exposure. Evaluation of these patients with chronic nerve compression should include examination at all levels of potential entrapment in the upper extremity to identify all sites of compression.

Chronic Disease↗
PubMed1998

Bacterial osteitis pubis in a weight lifter without invasive trauma.

Osteitis pubis is a well-known complication of invasive procedures about the pelvis which is caused by a bacterial infection. It is also now known that osteitis pubis in athletes is an inflammatory disorder rather than infectious as previously thought. It occurs in athletes who place significant repetitive stresses across the symphysis in such activities as running, race walking, gymnastics, soccer, rugby, basketball, and tennis. This case report, however, describes a weight lifter who developed a bacterially caused osteitis pubis without any invasive trauma. He was evaluated thoroughly and no other focus of infection was found. He was treated conservatively with intravenous antibiotics and physical therapy. At 3 months follow-up he had returned to his usual fitness activities without limitations. Although most osteitis pubis in athletes is inflammatory in nature, health care providers must keep an index of suspicion that an infectious etiology is possible in this population even without invasive trauma.

Cumulative Trauma Disorders↗
PubMed1997

Work-related musculoskeletal disorders: comparison of data sources for surveillance.

Work-related upper extremity musculoskeletal disorders "associated with repeated trauma" account for more than 60% of all newly reported occupational illness, 332,000 in 1994 according to the U.S. Department of Labor. These numbers do not include, for example, those disorders categorized as "injuries due to overexertion in lifting," approximately 370,000. Early identification of potential disorders and associated risk factors is needed to reduce these disorders. There are a number of possible methods for conducting surveillance for work-related musculoskeletal disorders (WMDs) based on health outcome: workers' compensation, sickness and accident insurance, OSHA 200 logs, plant medical records, self-administered questionnaires, professional interviews, and physical examinations. In addition, hazard surveillance based on evaluation of job exposures to physical stressors by nonoccupational health personnel is possible. As part of a large labor-management-initiated intervention study to reduce the incidence of WMDs in four automotive plants, we were able to compare the strengths and limitations of each of these surveillance tools. University administered health interviews yielded the highest rate of symptoms; combined physical examinations plus interview (point prevalence) rates were similar to self-administered questionnaires (period prevalence) rates. Plant medical records yielded the lowest rate of WMDs. WMD status on self-administered questionnaire and on physical examination were associated with risk factor exposure scores. This study suggests that symptoms questionnaires and checklist-based hazard surveillance are feasible within the context of joint labor-management ergonomics programs and are more sensitive indicators of ergonomic problems than pre-existing data sources.

Cumulative Trauma Disorders↗
PubMed1998

Impingement syndrome and rotator cuff disease as repetitive motion disorders.

The relationship between repetitive motion and subacromial impingement and rotator cuff disease is controversial and poorly understood. The potential etiology is multifactorial and involves patient related factors (age, supraspinatus outlet anatomy, and preexisting rotator cuff pathology) and worker related factors (arm position, lifting requirements, numbers of repetitions). Radiographic and magnetic resonance imaging abnormalities may represent preexisting disease that could have predisposed the patient to the development of impingement syndrome, but should be interpreted cautiously within the context of the remainder of the clinical picture. Treatment often involves temporary or permanent modifications of the work environment.

Biomechanical Phenomena↗
PubMed2003

The skeletally immature knee: what's new in overuse injuries.

Overuse and growth-related disorders of the knee occur frequently among children and adolescents. The vast majority of these disorders are self-limited and respond well to a therapeutic exercise program that includes restoring or attaining normal lower extremity strength and flexibility and good dynamic lower extremity alignment. Other causes of knee pain, such as training errors and inadequate footgear, may need to be corrected. Bracing may be useful for temporary amelioration of knee pain in order to allow successful performance of the therapeutic exercise program. Surgical intervention is rarely necessary for adolescents with knee pain resulting from overuse.

Adolescent↗
PubMed1996

The dynamics of changes of upper extremities caused by vibrations and unilateral excessive load after discontinued risk exposure.

The main aim of our research was evaluation of changes affecting vessels and peripheral nerves of patients with disorder of the upper extremities caused by vibrations and also peripheral nerves due to excessive loads. We evaluated both groups of these patients after two and five years' discontinued exposure. During both examinations 90% of these subjects reported persistence or deterioration of their complaints. We found by objective examination of persons with disorders caused by an excessive load in 80% cases significant improvement of the neuropathy already after two years. But five years after absence from risk exposure we found only a slight further regression of disorders. In the group of patients with disorders caused by vibrations we found normalization of neurological changes after two years in 33%, but in 21% of these patients we proved progress to a more serious affections, however after five years there were almost no further changes. The vasospastic changes on vessels persist after two years in 83% and after five years in 51% of the examined patients. In both examined groups significant improvement of neural and vascular changes during the two years after absence from exposure was found. After five years only slight regression occurred.

Adult↗
PubMed2006

Prevention of delayed recovery and disability of work-related upper extremity disorders.

There is always a psychological component to any illness or injury, and unless it is appropriately addressed, such factors can complicate or delay the recovery from a work-related illness or injury. When a worker experiences delayed recovery and unexpected disability, significant contributing psychosocial factors must be assessed for and managed appropriately. A maladaptive belief or understanding about the condition and disability by a patient presents an obstacle to successful treatment. Using cognitive behavioral therapy techniques may be an effective means of managing this challenge for the clinician.

Adaptation, Psychological↗