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PubMed1997

Predictors of work disability in work-related upper-extremity disorders.

The aim of this study was to compare symptoms, signs, grip strength, passive wrist flexion angle, and self-rated disability in work-related upper extremity disorders (WRUEDs) to determine predictors of work disability in 106 consecutive patients. Age, gender, and duration of symptoms were unrelated to current work status. The best predictors of current work hours were, in descending order, the Fibromyalgia Impact Questionnaire (FIQ), Modified Stanford Health Assessment Questionnaire (SHAQ), weeks of work absence, passive wrist flexion angle of the affected arm, neck pain or stiffness on movement, and grip in affected arm. FIQ and SHAQ scores were significantly correlated with objective measures of upper-extremity function. FIQ and SHAQ scores are valid measures of work disability in WRUEDs, which are more closely related to current work hours than to time off work, symptoms, or physical signs.

Adult↗
PubMed1992

Work related upper limb disorder: the relationship between pain, cumulative load, disability, and psychological factors.

Repetitive strain injury, or work related upper limb disorder, provides an interesting paradigm for the study of the relative contribution of physical and psychological factors to the resulting pain and disability. Sixty three subjects were studied, comprising the work-force of a subsection of a large local industrial company, in whom pain in the arm related to work was known to be common. Ergonomic data were obtained by estimating the cumulative daily load on the wrist joint for each of four identified tasks. Data on the occurrence of pain, treatment sought, and disability were obtained by a structured self administered questionnaire. Psychological data were obtained by administering the Hospital Anxiety and Depression (HAD) scale, a self reported measure of anxiety and depression, and the Bradford Somatic Inventory (BSI), an inventory of somatic symptoms associated with anxiety and depression. The employment specific period prevalence of work related upper limb disorder was 81%, with 30% of the subjects having pain at the time of the study. Domestic disability was minimal in all but two subjects, though the use of devices such as jar openers at home was common (12 of 51 subjects). Medical advice was seldom sought. Twenty per cent of subjects had received anti-inflammatory drugs, 10% had received physiotherapy, and 47% had wrist splints. Pain was related to the tasks with the highest estimated daily loads, but a history of pain and current pain were associated with higher scores on the HAD and BSI scales, suggesting an interaction between physical and psychological factors.

Adolescent↗
PubMed1991

Upper-extremity musculoskeletal disorders of occupational origin.

Sufficient evidence is available at this time to conclude that several well-defined soft-tissue disorders of the upper extremities are etiologically related to occupational factors. These disorders include tendinitis of the hand and wrist, CTS, and hand-arm vibration syndrome. Force, repetition, and vibration have been established as risk factors in the etiology of these disorders. Evidence exists that other, poorly understood factors also may contribute to etiology. At this time no firm guidelines can be established regarding maximum no-effect exposure levels. We agree, however, with Armstrong (3): "Although there are no standards for excessively repetitive or forceful work, common sense dictates that these tasks be minimized to the extent possible." Tool and job redesign may be required in many situations to accomplish these goals. In addition to appropriate reductions in risk factors, medical surveillance is required and will allow greater appreciation of the extent of this growing problem, as well as ongoing assessment of the efficacy of preventive intervention.

Arm↗
PubMed1993

Working at the loom and musculoskeletal disorders in a female population of Crete, Greece.

The influence of the working at the loom on the appearance of musculoskeletal disorders has been studied in the adult female population of a highland community of Crete, in which home-based handicraft has an important place in the economic activity. Information about symptoms and clinical signs related to the musculoskeletal system, as well as about socioeconomic characteristics was collected by means of a personal interview and a medical examination. Regression analysis shows that there is a statistically significant association between the intensity of symptoms from the upper extremities and the shoulder-neck region and the number of years of working at the loom, independently from other studied variables, such as BMI, age and number of children per woman.

Adult↗
PubMed2003

The integration of electromyography (SEMG) at the workstation: assessment, treatment, and prevention of repetitive strain injury (RSI).

This paper reviews the ergonomic and psychosocial factors that affect musculoskeletal disorders at the workstation. First is a model of a physiological assessment protocol that incorporated SEMG monitoring while working at the computer. Next is a study that showed that participants lack awareness of their muscle tension as compared to the actual SEMG levels. The final study illustrated how an intervention program can reduce RSI symptoms, decrease respiration rate, and lower SEMG activity. Recommendations include suggestions that successful safety and prevention programs need multiple components and that participants should to be trained to control physiological responses with respiration and SEMG biofeedback. All participants should master these physiological skills just as they learn how to use the computer.

Adolescent↗
PubMed2006

Ergonomic and physiotherapeutic interventions for treating work-related complaints of the arm, neck or shoulder in adults.

BACKGROUND: Conservative interventions such as physiotherapy and ergonomic adjustments (such as keyboard adjustments or ergonomic advice) play a major role in the treatment of most work-related complaints of the arm, neck or shoulder (CANS). OBJECTIVES: This systematic review aims to determine whether conservative interventions have a significant impact on outcomes for work-related CANS in adults. SEARCH STRATEGY: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (March 2005) and Cochrane Rehabilitation and Related Therapies Field Specialised Register (March 2005), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 1, 2005), PubMed, EMBASE, CINAHL, AMED and reference lists of articles. The date of the last search was March 2005. No language restrictions were applied. SELECTION CRITERIA: We included randomised and non-randomised controlled trials studying conservative interventions (e.g. exercises, relaxation, physical applications, biofeedback, myofeedback and work-place adjustments) for adults suffering CANS. DATA COLLECTION AND ANALYSIS: Two authors independently selected trials from the search yield, assessed the methodological quality using the Delphi list, and extracted relevant data. We pooled data or, in the event of clinical heterogeneity or lack of data, we used a rating system to assess levels of evidence. MAIN RESULTS: For this update we included six additional studies; 21 trials in total. Seventeen trials included people with chronic non-specific neck or shoulder complaints, or non-specific upper extremity disorders. Over 25 interventions were evaluated; five main subgroups of interventions could be determined: exercises, manual therapy, massage, ergonomics, and energised splint. Overall, the quality of the studies was poor. In 14 studies a form of exercise was evaluated, and contrary to the previous review we now found limited evidence about the effectiveness of exercises when compared to massage and conflicting evidence when exercises are compared to no treatment. In this update there is limited evidence for adding breaks during computer work; massage as add-on treatment on manual therapy, manual therapy as add-on treatment on exercises; and some keyboard designs when compared to other keyboards or placebo in participants with carpal tunnel syndrome. AUTHORS' CONCLUSIONS: There is limited evidence for the effectiveness of keyboards with an alternative force-displacement of the keys or an alternative geometry, and limited evidence for the effectiveness of exercises compared to massage; breaks during computer work compared to no breaks; massage as an add-on treatment to manual therapy; and manual therapy as an add-on treatment to exercises.

Adult↗
PubMed1995

Work-related upper-extremity disorders and work disability: clinical and psychosocial presentation.

Work-related upper-extremity disorders (WRUEDs) are an increasingly common cause of work-related symptoms and disability. Although most upper-extremity disorders are acute and self-limited, a small percentage of workers with symptoms go on to permanent disability and account for the majority of costs associated with these conditions. Little is known, however, about this progression from symptoms to disability and how it might be prevented. In this study, we evaluate the demographic, vocational, medical, and psychosocial characteristics of patients with WRUEDs and examine several hypotheses regarding the differences between working and work-disabled patients. One hundred twenty-four consecutive patients were evaluated in a clinic specializing in occupational upper-extremity disorders. Patients currently working (n = 55) and work-disabled patients (n = 59) were similar with regard to age, gender, and reported job demands. The work-disabled group reported less time on the job, more surgeries, a higher frequency of acute antecedent trauma, and more commonly had "indeterminate" musculoskeletal diagnoses. They also reported higher pain levels, more anger with their employer, and a greater psychological response or reactivity to pain. These findings, though cross-sectional in nature, suggest that, in addition to medical management, more aggressive approaches to pain control, prevention of unnecessary surgery, directed efforts to improve patients' abilities to manage residual pain and distress, and attention to employer-employee conflicts may be important in preventing the development of prolonged work disability in this population.

Adult↗
PubMed1998

Focal dystonia and repetitive motion disorders.

It commonly is observed that focal hand dystonias, such as writer's cramp or musician's cramp, are associated with repetitive movements, although definitive proof of a causal relationship is lacking. These focal dystonias are often task specific, with involuntary muscle contractions occurring only when patients perform specific acts such as writing or playing a musical instrument. Physiologic studies show deficiencies in spinal reciprocal inhibition and abnormalities of central sensory processing and motor output that may be related to reduced cortical inhibition. Recent studies in primates support the notion that repetitive motions can induce plasticity changes in the sensory cortex leading to degradation of topographic representations of the hand, and raise the possibility that sensory training may be beneficial. Current treatment options for focal dystonia include botulinum toxin injections, anticholinergics, baclofen, benzodiazepines, and occupational therapy.

Cumulative Trauma Disorders↗
PubMed2001

Equal opportunities, equal risks? Overuse injuries in female military recruits.

BACKGROUND: The rate of female personnel medically discharged from service in the British Army has been rising steadily since 1992 from around 3 per 1,000 per year to over 35 per 1,000 in 1996, although there has been only a minor increase in medical discharges for males over the same period. This paper examines the increasing rate of medical discharge in young female members of the British Army from an aetiological perspective and reviews the literature to identify risk factors that may be relevant. METHODS: Data from published military medical statistical reports were reviewed and the clinical records of a 10 per cent sample of females medically discharged for relevant conditions were examined. RESULTS: The majority of the excess medical discharges had occurred in females under the age of 22 and were due to musculoskeletal disorders and injuries caused by military training. Data from the clinical records showed that 75.5 per cent (37/49) of those medically discharged for these conditions were recruits. Stress fractures and other overuse syndromes accounted for 70.2 per cent of medical discharges among the recruits in the sample. CONCLUSION: Females undertaking strenuous exercise alongside males are at increased risk of injury. Risk factors include smoking, short stature, restricted dietary intake and menstrual disturbance. Equal opportunities legislation has been interpreted to require identical training for males and females, but some segregation of training may be acceptable provided the outcome of training is no less favourable to either gender, and this may reduce the excess risk of injury to females.

Adult↗
PubMed2003

Ergonomic initiatives for machine operators by the Swedish logging industry.

In 1994, the Swedish Work Environment Authority (SWEA) considered to regulate the amount of working hours in a logging machine in order to force an increased use of job rotation. Occupational neck and shoulder disorders had been threatening machine operators' health ever since the late 1970s. Representatives of the logging industry argued that detailed regulations would not solve the problem. SWEA agreed to shelve the matter for 2 years and industry promised to take necessary measures. In 1996, the Labour Inspectorate investigated the industry's ergonomic initiatives. They found that awareness in combating health problems had increased. However, there was a gap between awareness and the ability to carry out improvements. In 1999, SWEA decided not to regulate working hours but strongly recommended the work teams to use job rotation. A minor follow-up in the year 2000 found work teams with both high production and low health risk, but also more specialised teams.

Cumulative Trauma Disorders↗
PubMed2003

Biomechanical stresses in computer-aided design and in data entry.

A study of the risk factors of musculoskeletal disorders (MSDs) of the upper limbs was carried out on 2 populations, 1 performing a computer-aided design (CAD) task and the other performing a data entry task. A questionnaire on MSD complaints and working life was completed by a sample of each population. Biomechanical measurements of the forces, the angles, and the repetitiveness of movements of the upper limbs were carried out on some operators in each sample. It emerged that complaints of the upper limbs seem to be linked to the use of input devices. The grip forces exerted when using the keyboard and mouse were higher in CAD than in data entry.

Adult↗
PubMedDate not supplied

[Musculoskeletal disorders of upper extremities caused by biomechanical overload: methods and criteria for the description of occupational exposure].

This article presents and discusses a model for describing and evaluating the principal risk factors characterising occupational exposure: frequency and repetitiveness of movements, use of force, type of posture and movements, distribution of recovery periods, presence of other influential (complementary) factors. For each risk factor, the authors propose a method of practical detection in the field, as well as criteria for classifying and interpreting the results based on a critical review of the available literature on the subject. Numerous examples are supplied to better illustrate the concepts presented. The various factors considered are classified using numbers or indexes, so that they can be integrated into a concise exposure index described by the authors elsewhere in this volume.

Arm↗
PubMed2006

Punding and computer addiction in Parkinson's disease.

Punding is a stereotypical behavior in which there is an intense fascination with repetitive handling and examining of mechanical objects, such as taking apart watches and radios or arranging common objects (lining up pebbles, rocks, or other small objects). This disabling condition, different from both obsessive-compulsive disorder and mania, is probably underreported. Punding is thought to be related to dopaminergic stimulation, although only a few observations of this condition in patients with Parkinson's disease (PD) under therapy has been reported. We report a man with PD who developed an unusual, severe, repetitive behavior characterized by spending most of his time on his computer; this abnormal behavior was concomitant with the introduction of L-dopa (400 mg per day) and was not associated to a pattern of chronic inappropriate overuse of dopaminergic medication or other psychiatric symptoms. The patient had the feeling he was forced into a disruptive and unproductive behavior, and he made several attempts to quit without succeeding.

Attitude to Computers↗
PubMedDate not supplied

The neural consequences of repetition: clinical implications of a learning hypothesis.

Repetitive strain injuries (RSIs) are difficult to treat. Some individuals with RSIs may ultimately develop chronic pain syndromes or movement problems like focal hand dystonia (FDh), a disorder of motor control manifested in a specific context during skilled, hand tasks. This paper reports on the results of four neuroplasticity studies suggesting that repetitive hand opening and closing can lead to motor control problems, measurable somatosensory changes, and problems in graphesthesia and stereognosis. The experiments support a learning hypothesis for the origin of severe RSIs, particularly FDh. This degradation in the sensory representation of the hand may not only explain the therapeutic challenge of returning these patients to work, but also provide a foundation for developing more effective physical rehabilitation strategies. Implications and conjectures for the applications of this learning hypothesis to conditions of chronic pain are also discussed.

Adult↗
PubMed2006

Diversity and variation in biomechanical exposure: what is it, and why would we like to know?

Trends in global working life suggest that the occurrence of jobs characterized by long-lasting low-level loads or repetitive operations is increasing. More physical "variation" is commonly believed to be a remedy against musculoskeletal disorders in such jobs. One aim of the present paper was to shortly review the validity of this conviction. An examination of the available epidemiologic literature pointed out that the effectiveness of initiatives like job rotation or more breaks is weakly supported by empirical evidence, and only for short-term psychophysical outcomes. Only a limited number of studies have been devoted to physical variation, and concepts and metrics for variation in biomechanical exposure are not well developed. Thus, as a second objective, the paper proposes a framework for investigating and evaluating aspects of exposure variation, based on explicit definitions of variation as "the change in exposure across time" and diversity as "the extent that exposure entities differ". Operational methods for assessing these concepts are also discussed.

Biomechanical Phenomena↗
PubMed1999

Hand and arm injuries associated with repetitive manual work in industry: a review of disorders, risk factors and preventive measures.

Musculoskeletal disorders are the most common self-reported, work-related illness in the UK, with upper limb disorders ranking second only to back complaints. The rapid increase in disablement cases, the reduced productivity resulting from the disorders, and, perhaps, the threat of litigation which is on the increase, has led to an increased awareness of the problems and an increasing desire to reduce the incidence of such disorders. This paper reviews the problem of upper limb disorders and focuses on those disorders that could be associated with repetitive manual work in industry. The disorders are described and categorized, and potential occupational risk factors are discussed and related to the injuries. In addition, a number of preventive measures, in the form of ergonomics design changes and changes in workplace practice are reviewed. There are frequent calls for well-designed epidemiological studies, so that meaningful dose-response relationships can be drawn up. A significant part of good study design is associated with measurement and analysis of the user-tool interface and the working environment. With this in mind, a variety of measurement techniques are described. Furthermore, this paper highlights the need for study designs to be founded on a better understanding of the potential damage mechanisms, and points the way towards which areas should be investigated.

Arm Injuries↗
PubMed2005

[Criteria for classification of upper limb work-related musculo-skeletal disorders due to biomechanical overload in occupational health. Consensus document by an Italian Working Group].

BACKGROUND AND OBJECTIVE: In a preliminary consensus document the authors proposed criteria and methods to identify upper limb work-related MSDs due to biomechanical overload. With this document they intend to define severity according to shared models and procedures so as to fit behaviours to diagnostic procedures and their medical-legal assessment. This becomes especially important in view of Ministerial Decree of April 27 2004 fixing the new lists of diseases having a possible work-related origin that must be reported by law in accordance with art. 139 of law n. 1124, and also on account of the impact of such diseases which, for the first time in Italy, are regulated by law. CONTENTS: The working group, which included INAIL and ISPESL experts and was fully supported by SIMFER (Italian Society of Physical Medicine and Rehabilitation) and SINC (Italian Society of Clinical Neurophysiology), defined a general clinical procedure (anamnesis, objective examination and instrumental assessment) regarding each portion of the concerned upper limb (shoulder, elbow and wrist/hand). Once the presence and characteristics of anatomic and functional damages are established, the results allow a classification scheme to be proposed of upper limb diseases (tendon disorders and entrapment neuropathy) divided into 6 increasing severity stages: initial, medium, medium-severe, severe and extremely severe. Special attention was paid to two instrumental examinations that proved to be of great clinical interest, at least in occupational health: echography of soft tissues (in appendix) and electroneurography for entrapment neuropathy. The limitations of this proposal are discussed but the main goal was achieved: to standardize terms and provide homogeneous criteria to achieve classification of upper limb damage due to biomechanical overload for increasing severity levels. The working group research activity is part of a research project funded by ISPESL.

Biomechanical Phenomena↗
PubMed1993

Biochemical indicators of hazardous shoulder-neck loads in light industry.

Prolonged, repetitive handling of light material is known to increase the risk of shoulder-neck disorders. Biological risk indicators related to musculoskeletal exposure, applicable by the general practitioner in the workplace, could provide an instrument for early intervention and rehabilitation. Eight women were studied, all full-time workers performing assembly tasks associated with a high prevalence of shoulder-neck complaints. All subjects were more tender in the shoulder region than young women in low-risk occupations. Heart rate recordings indicated a low general metabolic load during work. Concentrations in antecubital venous blood of several markers for metabolic stress and cellular damage (lactate, ammonia, hypoxanthine, urate, malondialdehyde, potassium, creatine kinase) were normal for all subjects, and showed no increase during 3 consecutive working days. Thus, the blood markers did not reflect hazardous shoulder-neck exposure.

Adult↗