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PubMed2001

Case management services for work related upper extremity disorders. Integrating workplace accommodation and problem solving.

A case manager's ability to obtain worksite accommodations and engage workers in active problem solving may improve health and return to work outcomes for clients with work related upper extremity disorders (WRUEDs). This study examines the feasibility of a 2 day training seminar to help nurse case managers identify ergonomic risk factors, provide accommodation, and conduct problem solving skills training with workers' compensation claimants recovering from WRUEDs. Eight procedural steps to this case management approach were identified, translated into a training workshop format, and conveyed to 65 randomly selected case managers. Results indicate moderate to high self ratings of confidence to perform ergonomic assessments (mean = 7.5 of 10) and to provide problem solving skills training (mean = 7.2 of 10) after the seminar. This training format was suitable to experienced case managers and generated a moderate to high level of confidence to use this case management approach.

Arm↗
PubMed1989

Effect of overuse injury and the importance of training on the use of adjustable workstations by keyboard operators.

The introduction of adjustable workstations for keyboard operators has been widely recommended to eradicate constrained working postures leading to the development of musculoskeletal disorders. A questionnaire evaluating the use of adjustable workstations was analyzed for 514 keyboard operators. Anthropometric dimensions and workstation settings were measured for 15 operators. There was no difference between sufferers and nonsufferers of overuse injury on the basis of adjustability of their equipment. However, sufferers were less satisfied with their equipment and there was evidence that inappropriate postures were being adopted. The availability of adjustable equipment per se does not necessarily solve the problem. The design of the equipment must be based on suitable anthropometric data and operators must be trained in the correct use of the equipment. The results of this study indicate a perceived need for training and/or information on workstation adjustment among operators, with a preference for information that is supplied verbally, rather than in literature form.

Anthropometry↗
PubMedDate not supplied

[Investigation in a slaughter house and processing of pork meat. Repetitive task work and osteo-articular and musculotendinous pathology of the upper limbs].

The investigation concerned 47 workers (43 males and 4 females), whose average age was 41.5 years and average length of service 12 years. The aim of the study was to quantify the presence in an abattoir and meat processing plant of risk factors represented by repetitive movements requiring the use of force, and to describe the work-related musculo-skeletal disorders (WMSDs) of the upper limbs found in a group of workers exposed to such risk factors. The work was found to feature high speeds and very particular operations which, for most of the workers, required highly repetitive actions often associated with the use of force. Almost all the tasks had duration cycles of less than 30 seconds and a medium-high rate of actions/minute (from 20 to 60), with peak rates reached in the boning operations; the postural involvement was also considerable, particularly for the right wrist. The amount of force employed-calculated as a percentage of the Maximum Voluntary Contraction-averaged 50%. With very few exceptions, there were no significant pauses during the cycle. The group displayed a high prevalence of pain and paraesthesia and joint disorders, particularly in the over 35 age groups; statistically significant differences emerged with respect to the data from a matched population sample given the same anamnestic and clinical protocol. The group also exhibited significantly different Carpal Tunnel Syndromes with respect to the control population: 7 right-hand CTSs and five left-hand. CTS affected two out of every three women aged over 35 and 3 out of every 23 men over 35. The authors discuss the results in the light of previous studies and of the definition of CTS. The study concludes that investigating and preventing WMSDs in the meat processing industry is a justified, albeit very difficult, task whilst the protection afforded by current legislation appears to be most inadequate.

Abattoirs↗
PubMed2000

Controlling dental hygiene work-related musculoskeletal disorders: the ergonomic process.

Work-related musculoskeletal disorders (WMSDs) have been reported frequently by dental hygienists. The practice of dental hygiene exposes practitioners to WMSD risk factors of repetitive motion, pinch-grasp, force, vibration, and prolonged awkward positions. The objective of an ergonomic program is to fit the job to the worker, rather than the worker to the work. Principles of the ergonomic process can be applied in private dental practice to design a program that meets the needs of each practitioner. The ergonomic process includes data collection, assessment, the ergonomic plan itself, and evaluation of strategies. The worker (dental hygienist), work processes, and the work environment are integral parts in the ergonomic process. The purpose of this article is to provide basic information on the ergonomic process so that individuals can develop a program that meets their need to reduce WMSDs.

Cumulative Trauma Disorders↗
PubMed2003

[Evaluative research on occupational rehabilitation: the effectiveness of a health care service subject to dismantlement].

This article deals with the results obtained from 1995 to 1997 by an innovative occupational rehabilitation model for individuals with repetitive strain injury/work related musculoskeletal disorder (RSI/WRMD), developed by the Campinas Occupational Rehabilitation Center under the Brazilian National Institute for Social Security. The study had two objectives: 1) to reconstruct the program as a precondition for evaluation and 2) to evaluate the model's effectiveness in reestablishing the autonomy of individuals with RSI/WRMD. The methodology involved document analysis in order to reconstruct the program's background in terms of problem identification, organizational participation, awareness-raising, staff characteristics and responsibilities, and profile of the clientele. An analysis of 221 patient files provided the basis for constructing an evaluative instrument consisting of different dimensions, variables, and indicators, which was applied to a sample of 47 patient histories prior and subsequent to rehabilitative intervention. High effectiveness was observed in the model, with variations in the different target dimensions.

Adult↗
PubMed1997

Upper limb work-related musculoskeletal disorders among newspaper employees: cross-sectional survey results.

At a metropolitan newspaper office in Canada with extensive video display terminal (VDT) use, researchers carried out a survey (n = 1,007, 84% response) to establish baseline prevalence of work-related musculoskeletal disorders (WMSDs) and to identify demographic, postural, task, and psychosocial factors associated with WMSD symptoms. One-fifth of the respondents reported moderate or worse upper limb pain recurring at least monthly or lasting more than a week over the previous year. Logistic regression showed that employees who faced frequent deadlines and high psychological demands (fast work pace and conflicting demands), had low skill discretion and social support, spent more time keyboarding, or who had their screen in a non-optimal position were more likely to report moderate to severe symptoms. Women reported significantly higher levels of symptoms than men.

Adult↗
PubMed2005

Paddling upstream: a contextual analysis of implementation of a workplace ergonomic policy at a large newspaper.

Efforts to implement workplace ergonomic programs aimed at reducing the burden of work-related musculoskeletal disorders (WMSD) have to address multiple physical and psychosocial aspects of work environments yet often contextual factors limit their success. We describe the processes involved in an ergonomic program to reduce neck and upper limb WMSDs at a large Canadian newspaper. Using qualitative data collection and analysis methods, we illustrate the impact of key contextual characteristics of: (1) the program (management commitment, union involvement, experience and skill of program leaders, and researcher involvement); (2) the organization (drive for productivity, management control, organizational culture); and (3) the broader social context (economic climate, nature of newspaper work, technology and nature of WMSD). We argue for increased attention to identification and response to the contextual factors affecting program implementation in order to more successfully address upstream determinants of WMSD.

Canada↗
PubMed1995

Upper extremity disorders: a literature review to determine work-relatedness.

The objective of this review is to establish whether the medical literature validates a causal relationship between upper extremity disorders and work activities. Selected articles were reviewed using a Diagnostic Medical Criteria. Articles meeting this criteria were further reviewed for validity. Only 14 of 52 reviewed articles were felt to encompass medical criteria. However, these articles also contained what appear to be major validity flaws. Very little of the written material dealing with the issue of work-related upper extremity conditions incorporates what are felt to be sound medical diagnostic criteria in the definition and identification of these conditions. None of the reviewed studies have established a causal relationship between distinct medical entities and work activities. Further research using well constructed studies that incorporate reliable epidemiologic and accepted diagnostic criteria is needed. In this manner, the best of the medical and epidemiologic fields can be applied to solving these problems.

Arm Injuries↗
PubMed1997

Somatization and fashionable diagnoses: illness as a way of life.

The history of "nondisease" dates back, at least 4000 years, to early descriptions of hysteria. More recently somatization became a part of the official diagnostic nomenclature by creation of the DSM III category, "somatoform disorders." Somatization can serve as a rationalization for psychosocial problems or as a coping mechanism, and for some illness, becomes a way of life. One variation of somatization can be the "fashionable diagnosis", for example, fibromyalgia, multiple chemical sensitivities, dysautonomia, and, in the past, "reactive hypoglycemia". These disorders are phenomenologically related to environmental or occupational syndromes and mass psychogenic illness. Fashionable illnesses are characterized by (i) vague, subjective multisystem complaints, (ii) a lack of objective laboratory findings, (iii) quasi-scientific explanations, (iv) overlap from one fashionable diagnosis to another, (v) symptoms consistent with depression or anxiety or both, (vi) denial of psychosocial distress or attribution of it to the illness. Fashionable diagnoses represent a heterogeneous collection of physical diseases, somatization, and anxiety or depression. They are final common symptomatic pathways for a variety of influences including environmental factors, intrapersonal distress and solutions to social problems. A fashionable diagnosis allows psychosocial distress to be comfortably hidden from both the patient and the physician, but premature labeling can also mask significant physical disease. Hysteria remains alive and well and one contemporary hiding place is fashionable illness.

Adaptation, Psychological↗
PubMed1998

Gender and neurogenic variables in tendon biology and repetitive motion disorders.

The incidence of repetitive motion disorders is increasing. Numerous studies have indicated that the incidence in females exceeds that in males. Some of the evidence regarding gender related factors in tendon biology is discussed and new data related to the regulation of gene expression in an animal model of tendon overuse, the determination of sex hormone receptors in tendons, and the influence of pregnancy associated factors on gene expression in four different tendons is provided. Furthermore, because neurogenic mechanisms may contribute to inflammatory conditions, new evidence is provided that supports the concept that neurotransmitters can influence expression of genes that could participate in such inflammation. By increasing our understanding of the regulation of tendon cellular and molecular biology, new approaches to preventing disease development and treatment of existing disease may evolve.

Animals↗
PubMed2002

Ergonomic exposure case studies in Massachusetts fishing vessels.

BACKGROUND: Musculoskeletal disorders may not have been studied as much as greater risks in the dangerous environment of commercial fishing. Primary prevention of risk for these kinds of injuries and illnesses begins by a detailed understanding of what risks are likely to be common in the different fisheries, and how those risks might be reduced. METHODS: Ergonomic job analyses were conducted on three different types of fishing vessels in Massachusetts: gillnetting, otter trawling, and lobstering. Direct observation was used to link posture to task. Noise measurements, tool analysis, and cycle time measurements were also included. RESULTS: Production speed, materials handling, and vessel movement contributed to musculoskeletal stress by affecting observable postural deviation, repetition, and forceful exertions. CONCLUSIONS: Interventions to reduce ergonomic risk factors might be possible through utilization of below deck space in certain boats, through better technology, or through simple tool adjustments.

Cumulative Trauma Disorders↗
PubMed1997

Quantifying work load in neck, shoulders and wrists in female dentists.

OBJECTIVE: To assess the work load in neck and upper limbs of dentists. METHODS: Twelve right-handed female dentists (six with and six without a history of definite neck/shoulder disorders, pair-wise matched for age) were studied when performing authentic dental work. Electromyography (EMG) was used to quantify the muscular load of the shoulders bilaterally and of the right forearm. Positions and movements of the head and wrists were measured, using inclinometers and electrogoniometers. RESULTS: During work, the median load for the right upper trapezium muscle was 8.4% of the maximal voluntary EMG activity (MVE); during 90% of the time the load was > or = 3.3% MVE ("static" load). The figures were somewhat lower on the left side (7.0% and 2.5% MVE, respectively). Subjects with disorders had over all lower load levels for the trapezius muscles, although not statistically significant at < 0.05, than those without disorders. During a standardized reference contraction for the trapezius, the load was 17% MVE, and the quotient between MVE and torque [normalized to maximal voluntary torque (MVC)] was 0.5. These figures may be used for transformations. The muscular load on the right forearm was similar to the loads on the trapezius. The head was, on average, forward tilted > or = to 39 degrees, and during 10% of the time > or = 49 degrees. The left hand was held in more static positions, with palmar flexion and ulnar deviation, also reflected by lower angular velocities and repetitiveness, as compared with the right one, which was dorsiflexed. CONCLUSIONS: Dentists are exposed to high load on the trapezius muscles bilaterally, and steep, prolonged forward bending of the head. Further, for the wrists the postures were constrained, but the dynamic demands were low.

Adult↗
PubMed2001

Predictive validity of the Strain Index in turkey processing.

The Strain Index is a job analysis method for determining if workers are exposed to increased risk of developing distal upper extremity disorders. Its predictive and external validity was initially demonstrated in a pork processing plant. The purpose of this study was to evaluate the predictive validity of the Strain Index in one turkey processing plant. While blinded to health outcomes, investigators analyzed the right and left sides of workers in 28 jobs using the Strain Index and classified them as "hazardous" or "safe" based on the Strain Index score. Subsequently, OSHA 200 logs were used to ascertain the occurrence of distal upper extremity disorders retrospectively. If at least one such disorder had occurred on the right or left side during the previous 3 years, that side was classified as "positive." If no such disorder was reported during the previous 3 years, that side was classified as "negative." When comparing sides, symmetry between morbidity and hazard classification was required. When comparing jobs, such symmetry was not required. Evidence of association between the hazard classifications and the morbidity classifications for the 56 sides and the 28 jobs was evaluated using 2 x 2 contingency tables. For the sides, the association between hazard classification and morbidity classification was statistically significant, with an odds ratio of 22.0. The sensitivity, specificity, positive predictive value, and negative predictive value were 0.86, 0.79, 0.92, and 0.65, respectively. Similar results were noted for the jobs--the odds ratio was 50.0, and the sensitivity, specificity, positive predictive value, and negative predictive value were 0.91, 0.83, 0.95, and 0.71. These results provide additional evidence of the external validity and predictive validity of the Strain Index.

Animals↗
PubMed2005

Ergonomic evaluation: part of a treatment protocol for musculoskeletal injuries.

Ergonomic analyses and interventions are used as primary prevention methods to reduce physical stressors in the workplace and to prevent work-related musculoskeletal disorders (WMSDs). These methods can also be used for the treatment of injured employees. In this study, 103 employees with WMSDs resulting in more than 5 days away from usual work received an ergonomic evaluation which consisted of observation of usual work tasks, recommendations to minimize identified stressors, and case coordination. The goal of the intervention was to make simple job changes that would assist employees to return safely to usual job duties. The process for implementing this protocol for health care, airline, and university employees is described. The results show that after ergonomic evaluations were performed, the majority of recommendations were fully or partially (89%) implemented. Behavior changes were more likely to occur than administrative and equipment changes (p < .001). Occupational health nurses can use a similar program to enhance treatment plans for clients with WMSDs.

Aviation↗
PubMedDate not supplied

Inflammatory and angiogenic mRNA levels are altered in a supraspinatus tendon overuse animal model.

Shoulder overuse injuries, especially those to the supraspinatus tendon of the rotator cuff, are common musculoskeletal disorders. Unfortunately, little is known about the disease etiology and pathogenesis. The objective of this study was to determine the levels of specific inflammatory and angiogenic markers in a rat supraspinatus tendon overuse injury model. We hypothesized that inflammation would not be present early in the overuse protocol. Conversely, we hypothesized that the overuse protocol would result in increased angiogenesis early. Increases in five-lipoxygenase activating protein, cyclooxygenase-2, vascular endothelial growth factor, and von Willebrand factor were evaluated by use of reverse transcription-polymerase chain reaction from 1 day through 16 weeks of treadmill running (overuse protocol). These results provide important information on the role of angiogenesis and inflammation in the disease process. Future studies will further evaluate the mechanisms of the disease process as well as potential targeted treatment modalities.

5-Lipoxygenase-Activating Proteins↗
PubMed1999

Force and repetition measurement of ham boning. Relationship to musculoskeletal symptoms.

The purpose of this study was to develop a valid methodology for comparing measured torque repetition data along a ham boning line to symptoms reported in an established clinical database, which included history of cumulative stress disorder symptoms. A musculoskeletal stress measurement system was used to measure torque and repetition data associated with boning hams. Twenty-two surveys were conducted across a representative sample of employees performing this task on three different production lines. Two different knife grips were compared in the study to determine if one method produced lower torque. The data were analyzed and work (in-lb) and power (in-lb/sec) calculations were made. Evidence showed an increased rate of reported symptoms by subjects exerting more power as compared to other subjects performing the same task. One method was found to require less power than another. Operators managed a microbreak in the cycle ranging from .88% to 4% of the survey time. Operators not reporting symptoms averaged longer microbreaks than those reporting. The study provided data for structuring a line rotation program for moving people to positions requiring less "power."

Cumulative Trauma Disorders↗
PubMed2004

Work-related musculoskeletal disorders of the hand and wrist: epidemiology, pathophysiology, and sensorimotor changes.

The purpose of this commentary is to present recent epidemiological findings regarding work-related musculoskeletal disorders (WMSDs) of the hand and wrist, and to summarize experimental evidence of underlying tissue pathophysiology and sensorimotor changes in WMSDs. Sixty-five percent of the 333 800 newly reported cases of occupational illness in 2001 were attributed to repeated trauma. WMSDs of the hand and wrist are associated with the longest absences from work and are, therefore, associated with greater lost productivity and wages than those of other anatomical regions. Selected epidemiological studies of hand/wrist WMSDs published since 1998 are reviewed and summarized. Results from selected animal studies concerning underlying tissue pathophysiology in response to repetitive movement or tissue loading are reviewed and summarized. To the extent possible, corroborating evidence in human studies for various tissue pathomechanisms suggested in animal models is presented. Repetitive, hand-intensive movements, alone or in combination with other physical, nonphysical, and nonoccupational risk factors, contribute to the development of hand/wrist WMSDs. Possible pathophysiological mechanisms of tissue injury include inflammation followed by repair and/or fibrotic scarring, peripheral nerve injury, and central nervous system reorganization. Clinicians should consider all of these pathomechanisms when examining and treating patients with hand/wrist WMSDs.

Cumulative Trauma Disorders↗
PubMed2002

Pathophysiological tissue changes associated with repetitive movement: a review of the evidence.

Work-related musculoskeletal disorders (WMSDs) represent approximately one third of workers' compensation costs in US private industry, yet estimates of acceptable exposure levels for forceful and repetitive tasks are imprecise, in part, due to lack of measures of tissue injury in humans. In this review, the authors discuss the scope of upper-extremity WMSDs, the relationship between repetition rate and forcefulness of reaching tasks and WMSDs, cellular responses to injury in vivo and in vitro, and animal injury models of repetitive, forceful tasks. The authors describe a model using albino rats and present evidence related to tissue injury and inflammation due to a highly repetitive reaching task. A conceptual schematic for WMSD development and suggestions for further research are presented. Animal models can enhance our ability to predict risk and to manage WMSDs in humans because such models permit the direct observation of exposed tissues as well as motor behavior.

Animals↗