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PubMed1997

Repetitive strain injuries.

Repetitive strain injuries (RSI) present an increasingly common challenge to clinicians. They consist of variety of musculoskeletal disorders, generally related to tendons, muscles, or joints, as well as some common peripheral-nerve-entrapment and vascular syndromes. These disorders generally affect the back, neck, and upper limbs, although lower limbs may also be involved. Although RSI may occur as a result of sports and recreational activities, occupational RSIs, affecting the patient's livelihood, are particularly important. These injuries result from repetitive and forceful motions, awkward postures, and other work-related conditions and ergonomic hazards. Occupationally induced RSIs are generally costly, creating a strong incentive for physicians to become familiar with the symptoms, signs, and risk factors so that they can be diagnosed early and appropriate interventions facilitated.

Carpal Tunnel Syndrome↗
PubMed1997

Proposal: trauma as the cause of the Peyronie's lesion.

PURPOSE: We define the cause of the occurrence of Peyronie's disease. MATERIALS AND METHODS: Clinical evaluation of a large number of patients with Peyronie's disease, while taking into account the pathological and biochemical findings of the penis in patients who have been treated by surgery, has led to an understanding of the relationship of the anatomical structure of the penis to its rigidity during erection, and how the effect of the stress imposed upon those structures during intercourse is modified by the loss of compliance resulting from aging of the collagen composing those structures. Peyronie's disease occurs most frequently in middle-aged men, less frequently in older men and infrequently in younger men who have more elastic tissues. During erection, when full tumescence has occurred and the elastic tissues of the penis have reached the limit of their compliance, the strands of the septum give vertical rigidity to the penis. Bending the erect penis out of column stresses the attachment of the septal strands to the tunica albuginea. RESULTS: Plaques of Peyronie's disease are found where the strands of the septum are attached in the dorsal or ventral aspect of the penis. The pathological scar in the tunica albuginea of the corpora cavernosa in Peyronie's disease is characterized by excessive collagen accumulation, fibrin deposition and disordered elastic fibers in the plaque. CONCLUSIONS: We suggest that Peyronie's disease results from repetitive microvascular injury, with fibrin deposition and trapping in the tissue space that is not adequately cleared during the normal remodeling and repair of the tear in the tunica. Fibroblast activation and proliferation, enhanced vessel permeability and generation of chemotactic factors for leukocytes are stimulated by fibrin deposited in the normal process of wound healing. However, in Peyronie's disease the lesion fails to resolve either due to an inability to clear the original stimulus or due to further deposition of fibrin subsequent to repeated trauma. Collagen is also trapped and pathological fibrosis ensues.

Cumulative Trauma Disorders↗
PubMed1993

OSHA regulation of ergonomic health.

The occupational illnesses most frequently reported to the Occupational Safety and Health Administration (OSHA) are "disorders associated with repeated trauma," a category including noise-induced hearing loss and illnesses caused by ergonomic exposure. In response, OSHA has begun "rule-making" for a standard to control ergonomic exposures. This paper defines ergonomic illness as any diagnosis of gradual onset for which ergonomic exposure increases relative risk. The "Red Meat Guidelines," the model for OSHA's proposed "Ergonomic Safety and Health Program standard," are critically reviewed in terms of basic clinical and epidemiologic concepts. The OSHA 200 log is a cohort study which reaches its entire target population. The use of selected case definitions with the OSHA 200 log is recommended as a powerful, comparable, and cost-effective epidemiologic basis for ergonomic regulation.

Cumulative Trauma Disorders↗
PubMed2000

Repetitive stress injury: diagnosis or self-fulfilling prophecy?

* The vague definitions of so-called repetitive stress injuries are indicative of the fact that scientific studies have failed to show that repetitive motion causes injury. * Given the uncertainty about causation, work-related musculoskeletal disorders (WRMSDs) is a more readily accepted term to describe these phenomena. * There is little doubt that most ergonomic interventions increase comfort in the work environment, which is of great benefit to the worker. Many proponents of ergonomics assert that the elimination of certain risk factors related to force, repetition, and posture can prevent or even cure work-related musculoskeletal disorders of the upper extremity. However, there is little scientific support for this position. * Undue reliance on ergonomics to treat musculoskeletal disorders, to the exclusion of proper diagnosis and attention to medical and health risk factors, can have adverse consequences for the patient. * Science rather than politics and public policy should determine what causes injury and disease. * The failure of numerous plaintiffs in litigation regarding repetitive stress injury due to use of computer keyboards is important because, when judges and lay jurors were presented with both sides of the issue, they rejected these claims in a forum (the judicial system) that traditionally compensates individuals bringing so-called mass-tort cases.

Cumulative Trauma Disorders↗
PubMedDate not supplied

[Longitudinal study of a population exposed to risk of biomechanical overload of the upper limb].

One of the most important factors of the work-related musculoskeletal disorders of the upper extremities (WMSDs) is the biomechanical overload. The purpose of this study is to evaluate the possibility of the worker fitting to the job, to decrease the upper limb repetitive stress. In order to this aim, we have collected and compared, in different controls at the distance of two years, the clinical-anamnestic and instrumental data of a cohort of workers in a car industry.

Adult↗
PubMed2002

Integration of ergonomics into hand tool design: principle and presentation of an example.

The development of ergonomic tools responds to health protection needs on the part of workers, especially the work related musculoskeletal disorders of the upper limbs and to the development of ergonomic tools to take into account the needs of the factories. Only an ergonomic design process can enable tool manufacturers to meet these requirements. Three factors are involved: integration of ergonomics into the design process, definition of the different ergonomic stages involved, and finally knowledge of the different factors involved in hand tool design. This document examines these 3 elements in more detail and presents briefly a project of research whose main purpose is to integrate ergonomic criteria into a design process.

Cumulative Trauma Disorders↗
PubMedDate not supplied

The RSI syndrome in historical perspective.

The pain syndrome repetition strain injury (RSI) has been variously interpreted as a psychogenic disorder, an overuse injury of upper limb musculature, and a state of peripheral neural irritability. A review of the history of work-related upper limb disorders was undertaken to ascertain whether RSI is a new medical phenomenon or an older syndrome in a new guise. In the mid-nineteenth century these disorders were known as either craft palsies or writer's and other occupational cramps. Not withstanding clinical evidence suggesting that most were associated with peripheral neural or muscular dysfunction, a body of influential medical opinion considered them all to be disorders of the central nervous system, appropriately termed the occupation(al) neuroses. During the twentieth century, as discrete occupational upper limb nerve lesions were delineated and the spasmodic form of writer's cramp was recognized as a torsion dystonia, a unifying concept of aetiology for the occupational neuroses of the nineteenth century became untenable. The RSI syndrome of the 1980s can be identified from early case descriptions of both scrivener's palsy and the neuralgic variety of writer's cramp. Contemporary hypotheses proposed to explain RSI are remarkably similar to those proposed for the occupation(al) neuroses.

Causality↗
PubMed2004

Longer static flexion duration elicits a neuromuscular disorder in the lumbar spine.

The objective of this study was to assess the impact of two sequential long, static, anterior lumbar flexions on the development of a neuromuscular disorder and to compare it with previously obtained data from a series of short static flexion periods of the same cumulative time (Sbriccoli P, Solomonow M, Zhou BH, Baratta RV, Lu Y, Zhu MP, and Burger EL, Muscle Nerve 29: 300-308, 2004). Static flexions with loads of 20, 40, and 60 N were applied to the lumbar spine over two 30-min periods with a 10-min rest in between. The reflex EMG activity from the multifidus muscles and supraspinous ligament displacement (creep) was recorded during the flexion periods. Creep and EMG were also monitored over 7 h of rest following the work-rest-work cycle. It was found that the creep that developed in the first 30-min flexion period 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-work session. Spasms were frequently seen within the EMG during the static flexion. Initial and delayed hyperexcitabilities were observed in all of the preparations at any of the three loads explored during the 7-h rest period. ANOVA revealed a significant effect of time (P < 0.0001) on the postloading data. Larger loads elicited larger magnitudes of the initial and delayed hyperexcitabilities, yet were not statistically different. It was concluded that the 3:1 work-to-rest duration ratio resulted in a neuromuscular disorder, regardless of the load magnitude. The conclusions are reinforced in view of the results from a previous study using 60 min of flexion overall but at 1:1 work-to-rest ratio in which only the highest load elicited a delayed hyperexcitability (Sbriccoli et al., Muscle Nerve 29: 300-308, 2004). An optimal dose-to-duration ratio needs to be established to limit, attenuate, or prevent the adverse effects of static load on the lumbar spine while considering the loading duration as a major risk factor.

Animals↗
PubMed1998

Clinical evaluation of hand-arm-vibration syndrome in shipyard workers: sensitivity and specificity as compared to Stockholm classification and vibrometry testing.

The hand-arm-vibration syndrome (HAVS) is a complex entity composed of circulatory, sensory, and motor disturbances, as well as associated musculoskeletal components. This study was performed to find a diagnostic testing modality with sufficient sensitivity, specificity, and predictive value to be utilized as a screening test for this disorder in a working population. A full range of testing modalities was utilized in the shipyard medical department. In addition, a clinical diagnosis of vascular and sensorineural disease was established in the workers by a combination of plethysmography, vibrometry, two point discrimination, and monofilament testing in an independent occupational medicine clinic. No one test modality met the requirements for such a definitive diagnostic test. Rather, a range of modalities was required to reach any acceptable level of predictive value, with sufficient degrees of specificity and sensitivity.

Adult↗
PubMed2001

Multidisciplinary team evaluation of upper extremity injuries in a single visit: the UPPER Program.

Musculoskeletal disorders are the leading cause of disability among people between 18 and 64 years of age. Patients with musculoskeletal injuries of the upper extremities are usually evaluated and treated by an individual physician and therapist. However, for patients who have problems, especially after being treated by a hand surgeon and a certified hand therapist, there are few other management options. A multidisciplinary assessment program for patients with chronic upper limb pain has not been described in the literature. As part of The University of Michigan RERC (Rehabilitation Engineering Research Center), the UPPER Program (UPper extremity Protocol Evaluation in Rehabilitation) was developed to evaluate patients who have disabling upper limb musculoskeletal disorders. At the center of the program is a multidisciplinary team composed of a physiatrist (physical medicine and rehabilitation specialist), occupational therapist, physical therapist, exercise physiologist, vocational counselor and pain psychologist. The UPPER Program elements include a pre-evaluation questionnaire, individual team member assessments and a team meeting. It is followed by a patient appointment with the team physician to review the results and recommendations. The essential details of the program are presented in this article so it can be reproduced elsewhere.

Adolescent↗
PubMedDate not supplied

[A pilot study on training and information of workers exposed to biomechanical overload of the upper limb].

Health education (HE) is very important in the prevention of occupational diseases, particularly when exposure to risk factors can be reduced through working procedures and hygienic behaviours. This pilot study refers to a HE program for prevention of work related muscle-skeletal disorders of upper limbs, carried out in two groups of 15 and 12 workers, respectively employed in trimming and assembling of plastic and metal parts. The first phase of the program consisted of worksite inspections and video recording of working procedures, characteristics of tools and machinery. This was followed by an informative meeting with the workers, which began with the administration of a multiple choice questionnaire, designed to evaluate the baseline knowledge about risk factors, work related muscle-skeletal disorders of upper limbs, working specific procedures and preventive actions. Questionnaires and video recording were repeated after two months in the second phase of the program, as subjective and objective methods of evaluation of HE effectiveness. In both groups, the questionnaire score was significantly increased after the program and a clear improvement was shown in the correct working procedures. This HE program contributed to increase the level of knowledge of the workers and fostered the adoption of working behaviours suitable to reduce the strain for the upper limbs.

Adult↗
PubMed1999

Wrist positions and movements as possible risk factors during machine milking.

High prevalence of hand and wrist symptoms has been found in females working with machine milking. Therefore the aim of this study was to quantify the positions and movements of the wrist during machine milking, and to compare tethering and loose-housing systems with respect to this. Biaxial electrogoniometers and data loggers were used for recording flexion and deviation angles of both the right and left wrists in 11 healthy milkers. For each individual 25 min of representative work was recorded in each system. High values of dorsiflexion and radial deviation were found, which might induce an increased risk of carpal tunnel syndrome. Moreover, the velocity and repetitiveness were close to those values described in repetitive work with a high risk of elbow and hand disorders in the fish-processing industry and giro-form data entry work. According to our findings, the load on the upper extremities has increased with respect to dorsiflexed hand position and repetitiveness when milking in the modern loose-housing milking system. This is probably due to the change of the working position and/or the higher productivity (number of cows that milked per time unit) in the loose-housing system as compared to the old-fashioned tethering system. These negative effects on wrist positions and movements should be considered when building new milking systems.

Adult↗
PubMed1992

Occupational repetitive strain injury.

Repetitive strain injuries include a group of disorders that most commonly develop in workers using excessive and repetitious motions of the neck and upper extremity. A careful occupational history, physical examination and specific diagnostic maneuvers can help distinguish these musculoskeletal injuries from rheumatologic diseases, psychologic disorders, acute joint or tendon inflammation from other causes and single-event traumatic sprains and strains. Repetitive strain injury may be manifested by cervical syndrome, tension neck syndrome, thoracic outlet syndrome and frozen shoulder syndrome. Common injuries involving the elbow, wrist and hand include epicondylitis, carpal tunnel syndrome and ulnar nerve entrapment. Conservative treatment consisting of rest, application of ice or heat and anti-inflammatory drugs is usually effective, but the injury may take weeks or months to resolve. Modifications in the workplace can prevent many of these injuries and may be required to prevent reinjury after the patient returns to work.

Arm↗
PubMed2002

Psychophysiology of work: stress, gender, endocrine response, and work-related upper extremity disorders.

BACKGROUND: Mental stress may induce muscle tension and has been proposed to contribute to the development of work related upper extremity disorders (WRUEDs) by driving low threshold motor units into degenerative processes by overload. METHODS AND RESULTS: Measurements of perceived stress, catecholamines, blood pressure, and heart rate are associated with stress induced elevation of trapezius electromyographic activity. In repetitive tasks, where WRUEDs are common, psychophysiological arousal is generally high both during and after work. A possible explanation of the high prevalence of WRUEDs among women could be that women often are performing repetitive tasks and are exposed to additional stress from unpaid work. CONCLUSIONS: It is concluded that both physical and psychosocial work conditions may contribute to WRUEDs by inducing physiological stress and muscle tension.

Adult↗
PubMed1995

Repetitive strain injury: an overview of the condition and its implications for occupational therapy practice.

The incidence of occupationally induced upper extremity disorders, often referred to as Repetitive Strain Injury (RSI), has increased dramatically in the last decade. An overview of recently published literature is presented which discusses economic impact, etiology, and historical and sociopolitical factors influencing these conditions. A number of prospective studies which conceptualize RSI as a complex biopsychosocial phenomenon framed within a chronic pain model offer some insights into the importance of a multidisciplinary, multifactorial approach to treatment. Opportunities exist for occupational therapists to make a significant contribution to enhancing the health of the worker in the workplace through participation in a team approach to treatment and in health promotion through workplace education with a view to prevention.

Canada↗
PubMed2001

[Musculoskeletal disorders in instrumental musicians: epidemiological study].

OBJECTIVES: To evaluate the frequency and types of musculoskeletal problems of French instrumental musicians. METHODS: Voluntary musicians answered an anonymous questionnaire about their musical practices, their medical history, and the evaluation of the troubles they feel during playing music. The musicians have been contacted in music schools, professional and not-professional orchestras. RESULTS: During this study 635 musicians received a questionnaire. 141 answered it (22.5%): 76.6% suffer from overuse syndrome, 17% from entrapment neuropathies, 5.7% from occupational hand cramp. The main topographies are spine (60.9%) and wrist and hand (52.5%). Instrumental characteristics are exposed. CONCLUSION: Instrumental musicians often present musculoskeletal problems. A specific management would be useful to limit eventual drammatical consequences.

Adolescent↗
PubMed2003

Towards epidemiological criteria for soft-tissue disorders of the arm.

BACKGROUND: The lack of universally agreed criteria has hampered population studies of the prevalence and causation of soft-tissue disorders of the upper limb. OBJECTIVES: To establish core variables for classification of the commonest disorders seen in population samples. METHODS: Consecutive new cases seen in clinical practice in five different centres were evaluated with respect to 30 variables shown to have discriminatory value in univariate analysis. Multivariate analysis using logistic regression modelling was carried out with these as the independent variables and with the clinical diagnosis as the dependent variable. RESULTS: A total of 1382 cases of soft-tissue disorder were recorded and only those diagnostic groups with 50 or more cases were included. In multivariate logistic regression, significant variables positively discriminating for each disorder were identified for carpal tunnel syndrome (n = 56), lateral epicondylitis (n = 87), tenosynovitis (n = 63), shoulder tendonitis (n = 157), non-specific upper limb disorder (n = 458), fibromyalgia (n = 124) and inflammatory arthritis (n = 100), which was used for comparison purposes. Significant discrimination for each model was demonstrated by the construction of receiver operating characteristic (ROC) curves and appropriate area under the curve statistics. CONCLUSIONS: This approach to classification criteria is based on multivariate modelling rather than on a consensus statement. This includes the effects of negative as well as positive associations. Further work is required on both the reproducibility of the clinical signs and the application of the criteria to other datasets.

Adolescent↗
PubMed2003

Prognosis of shoulder tendonitis in repetitive work: a follow up study in a cohort of Danish industrial and service workers.

BACKGROUND: The physical and psychosocial work environment is expected to modify recovery from shoulder disorders, but knowledge is limited. METHODS: In a follow up study of musculoskeletal disorders in industrial and service workers, 113 employees were identified with a history of shoulder pain combined with clinical signs of shoulder tendonitis. The workers had yearly re-examinations up to three times. Quantitative estimates of duration, repetitiveness, and forcefulness of current tasks were obtained from video recordings. Perception of job demands, decision latitude, and social support was recorded by a job content questionnaire. Recovery of shoulder tendonitis was analysed by Kaplan-Meier survival technique and by logistic regression on exposure variables and individual characteristics in models, allowing for time varying exposures. RESULTS: Some 50% of workers recovered within 10 months (95% CI 6 to 14 months). Higher age was strongly related to slow recovery, while physical job exposures were not. Perception of demands, control, and social support at the time when the shoulder disorder was diagnosed, were associated with delayed recovery, but these psychosocial factors did not predict slow recovery in incident cases identified during follow up. CONCLUSION: The median duration of shoulder tendonitis in a cross sectional sample of industrial and service workers was in the order of 10 months. This estimate is most likely biased towards too high a value. Recovery was strongly reduced in higher age. Physical workplace exposures and perceived psychosocial job characteristics during the period preceding diagnosis seem not to be important prognostic factors.

Aged↗