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PubMedDate not supplied

[Comparative analysis of the use of 4 methods in the evaluation of the biomechanical risk to the upper limb].

In the last years notices of Work Related Musculo-Skeletal Disorders are significantly increased, for a much widespread mechanism of disease and risk identification. About the last, the methods of assessment, even if in great number, are not universally recognized. This study reports the application of four methods (Check list OCRA, OREGE, Strain Index, ACGIH) to evaluate 12 work emplacements at a different biomechanical overload level. The comparison revealed variability between the methods in situations of middle risk, while the methods substantially gave similar results in situations without any risk or with high risk. Methods could not reveal every component of the risk in a reproducible and univocal way also when the risk assessment was accordant. It is necessary a following analytical evaluation of each risk factor contributing to define the sintetic index. In the complex of biomechanical risk factors these ones might not be considered able to define unequivocally "accettable" or "not accettable" components.

Arm↗
PubMed1991

Carpal tunnel syndrome among ski manufacturing workers.

Carpal tunnel syndrome is a common disorder marked by pain and dysesthesias of the upper extremities. As a test of the hypothesis that carpal tunnel syndrome is associated with occupational risk factors, jobs at a ski assembly plant were classified as repetitive and nonrepetitive. The prevalence of carpal tunnel syndrome among 106 employees with repetitive jobs was compared with that among 67 employees with nonrepetitive jobs. The data collection included a questionnaire, a physical examination, and the measurement of distal sensory latencies of the median and ulnar nerves. Carpal tunnel syndrome was present in either or both hands in 15.4% of those workers with repetitive jobs, but only in 3.1% of those workers with nonrepetitive jobs (crude prevalence ratio 4.92, 95% confidence interval 1.17-20.7). The conclusion was drawn that carpal tunnel syndrome is associated with jobs requiring frequent and sustained hand work.

Adult↗
PubMedDate not supplied

Functional assessment of repetitive strain injuries: two case studies.

More patients with repetitive strain injuries (RSIs) are being seen in occupational therapy clinics in Hong Kong. To reduce the incidence of work-related RSIs, it is necessary to identify problem jobs and/or specific tasks that are associated with an increased risk of these disorders. Physical assessment, videotaping, ergonomic evaluations, and analyses of workstation designs are used for this purpose. In Hong Kong, however, these methods cannot be implemented at the jobsite without the approval of the employer. This restriction constitutes a major problem in planning the rehabilitation of workers who have RSIs. A self-assessment method using the Work Evaluation Systems Technology (WEST) Tool Sort and the LLUMC Activity Sort was adopted as part of the evaluation of clients with RSIs. The questionnaires were translated into Chinese and reviewed and revised for content validity by ten occupational therapists. Two case studies are presented to illustrate the occupational therapy intervention program based on this self-report instrument. The questionnaires were found to be efficient and useful in assessing the client's abilities at work and in explaining to the client the relationship of his or her working conditions to the RSIs.

Cumulative Trauma Disorders↗
PubMed2003

Mechanisms leading to musculoskeletal disorders in dentistry.

BACKGROUND: The authors reviewed the implications of prolonged, seated working postures on dental operator health and the potential development of musculoskeletal disorders, or MSDs. TYPES OF STUDIES REVIEWED: The authors reviewed studies to assess the mechanisms associated with the development of musculoskeletal pain and MSDs among dental operators. Some studies investigated work duration, operator positioning and the physiological effects of various static sitting postures. Others explored the relationships between prolonged muscle contraction and muscle imbalances, as related to the development of pain and MSDs. RESULTS: This review advances the idea that the causes of musculoskeletal pain and disorders common to dental operators are multifactorial. Physiological changes that accompany these disorders can be related to practices used by today's operators-primarily being seated for prolonged periods. Studies associated such postures with increased disk pressures and spinal hypomobility, which are factors that may lead to degenerative changes within the lumbar spine and low back pain or injury. There is a relationship shown between prolonged, static (motionless) muscle contractions and muscle ischemia or necrosis. Weak postural muscles of the trunk and shoulder may lead to poor operator posture. As muscles adapt by lengthening or shortening to accommodate these postures, a muscle imbalance may result, leading to structural damage and pain. CLINICAL IMPLICATIONS: A significant number of today's dental operators experience musculoskeletal pain and are at risk of developing serious MSDs. A thorough understanding of the underlying physiological mechanisms leading to these problems is necessary to develop and implement a comprehensive approach to minimize the risks of a work-related injury.

Chronic Disease↗
PubMed2002

Predictive validity of the strain index in manufacturing facilities.

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 its predictive validity in two manufacturing plants. While blinded to health outcomes, investigators analyzed the right and left sides of 28 single-task 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 occurred on the right or left side during the prior three years, that side was classified as "positive." If no such disorder was reported during the prior three 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 empirical odds ratio of 73.2. The sensitivity, specificity, positive predictive value, and negative predictive value were 1.00, 0.84, 0.47, and 1.00. Similar results were noted for the jobs--the empirical odds ratio was 106.6, and the sensitivity, specificity, positive predictive value, and negative predictive value were 1.00, 0.91, 0.75, and 1.00. While these results provide additional evidence of the Strain Index's external validity and predictive validity, it should be noted that these jobs involved the performance of single tasks.

Arm Injuries↗
PubMed2006

Ergonomic evaluation of winegrape trellis systems pruning operation.

The winegrape industry suffers from high incidence rates of work-related musculoskeletal disorders. Pruning of dormant vines is a significant task, requiring long periods of highly repetitive and physically demanding work. The purpose of this study is to quantitatively evaluate five commonly used winegrape trellis systems with regard to the risk of developing musculoskeletal injuries to the wrist and lower back while pruning. Eleven subjects participated in this study. Subjects performed a simulated pruning task as wrist and trunk postures were gathered using electrogoniometers. The results showed significant postural differences among the trellis systems. Compared to the other systems, the VSP was determined to be the optimal system in terms of decreasing relative MSD risk. These results will assist vineyards in the selection process of suitable trellis systems that will include the worker health aspect in conjunction with other trellis-related parameters such as grape quality and productivity.

Adult↗
PubMed2002

Occupational stress and work-related upper extremity disorders: concepts and models.

BACKGROUND: While research has suggested that interventions targeted at occupational stress (job stress) factors may improve clinical and work outcomes related to work-related musculoskeletal disorders, the emerging hypotheses relating occupational stress to work-related upper extremity disorders (WRUEDs) are not particularly well known among occupational health providers and researchers. METHODS: Generic job stress and health models and multivariable models of WRUEDs were described and evaluated. RESULTS: Models on occupational stress and health/WRUEDs offer unique perspectives on the role of occupational stressors on WRUEDs. However, the limited support for the structure and proposed mechanisms of these models suggest that investigations examining and validating proposed biobehavioral pathways are still needed. DISCUSSION: Difficulties in conceptualizing occupational stress have, in the past, hindered its systematic incorporation into occupational health research and prevention/intervention strategies. The present paper provides a common basis for researchers and practitioners with diverse backgrounds to understand job stress and its relation to WRUEDs in order to enhance future efforts. Given the present limitations in the field and the need for comprehensive approaches to WRUEDs, there is great potential for occupational health researchers and clinicians to advance knowledge in this area.

Arm↗
PubMed2006

Clinical expression profiles of complex regional pain syndrome, fibromyalgia and a-specific repetitive strain injury: more common denominators than pain?

PURPOSE: To systematically evaluate and compare the clinical manifestations, disease course, risk factors and demographic characteristics of Complex Regional Pain Syndrome type 1 (CRPS), fibromyalgia (FM) and a-specific Repetitive Strain Injury (RSI). METHOD: A literature search was performed using terms related to the aforementioned topics and diseases. Only original clinical studies that included at least 20 subjects were eligible. RESULTS: Fifty-nine studies on CRPS, 73 on FM and 7 on a-specific RSI were identified. The diseases show similarities in age distribution, male-female ratio, pain characteristics and sensory signs and symptoms. Motor, autonomic and trophic changes are frequently reported in CRPS, but only occasionally in FM and RSI. Systemic symptoms are found in patients with CRPS and FM, and in a subgroup of patients with RSI. In all three disorders, symptoms usually start locally, but may spread to other body regions later, which, in the case of FM, is a prerequisite for diagnosis. Disease onset is always, usually, or occasionally of traumatic origin in RSI, CRPS and FM, respectively. Anxiety and depression are more frequent in patients compared to controls, but probably not very different from patients with other pain conditions or chronic diseases. CONCLUSIONS: Apart from some obvious differences between CRPS, FM and RSI, the similarities are conspicuous. The common features of CRPS, FM and a-specific RSI may suggest that a common pathway is involved, but until patients with these type of symptoms are assessed with a uniform assessment procedure, a thorough comparison cannot be made. A systematic evaluation of patients with a suspected diagnosis of CRPS, FM or RSI, may lead to a better appreciation of the differences and similarities in these diseases and help to unravel the underlying mechanisms.

Complex Regional Pain Syndromes↗
PubMed2002

Musculoskeletal disorders among floor layers: is prevention possible?

The purpose of this study was to describe possibilities for the prevention of work-related musculoskeletal disorders among floor layers and to analyze the factors that promote or constrain innovation in prevention. A questionnaire study included 102 floor layers and 180 apprentice floor layers. Questionnaires were used to register musculoskeletal complaints, psychosocial factors, and proposals for prevention. Interviews were carried out of key persons from the trade, selected from the floor layers, employers, and their trade association, with the purpose of getting more knowledge about the barriers to innovation. The results indicate that musculoskeletal disorders are still a great problem in skilled floor layers, and also in apprentices. Primary prevention of work-related knee disorders and accompanying stress requires a reduction in work tasks performed in kneeling positions. Tools that can be used in standing positions for floor laying work tasks are considered useful for prevention of musculoskeletal disorders. Throughout their training, young apprentice floor layers slowly become socialized into the group, and absorb the same identity, attitude to problem-solving, and use of tools and working methods as the adult floor layers. Deep-rooted habits are very resistant to change. The intensity of the work, time pressures, frequent changes of work locations, and the trade's pattern of working in small firms are also factors that make it difficult to introduce good practice innovations in the floor laying trade. Work-related strain can be decreased in the trade by combining changes in tools, materials, and working methods. It is necessary to include educational training of apprentices and skilled floor layers, and also foremen and employers. Breaking down the barriers to change demands education and instruction by people who know the trade well, who can communicate effectively with the floor layers, and who are accepted by the trade.

Adolescent↗
PubMed1993

Occlusive arterial disease of the hand due to repetitive blunt trauma: a review with illustrative cases.

OBJECTIVE: to increase clinical awareness of the role of repetitive blunt trauma, often occupational, in the development of occlusive arterial disease of the hand. STUDY DESIGN: illustrative cases are presented to emphasize the varied etiology and clinical features of occlusive arterial disease of the hand resulting from repetitive blunt trauma and an historical review of the literature is presented. RESULTS: Occlusive arterial disease of the hand due to repetitive blunt trauma is a common but often preventable disorder. The superficial location of many of the arteries of the hands and digits plus their close proximity to the bones of the hand makes them uniquely susceptible to injury from repetitive blunt trauma. An ever increasing number of occupations and leisure activities have been causally related to occlusive arterial disease of the hand. The diagnosis of occupational occlusive arterial disease due to blunt trauma is suggested by eliciting a history of repetitive blunt trauma to the hand in a patient with symptoms and/or signs of digital ischemia. The dominant hand is most commonly involved, but the non-dominant hand or both hands are affected in certain occupations. Possible predisposing or aggravating factors include tobacco use and working in a cold environment. The diagnosis of occlusive arterial disease confined to the hand or digits is confirmed by non-invasive studies in the vascular laboratory and demonstrated by arteriography. Conservative measures and protection of the hand from further trauma is sufficient for most patients, with surgical therapy being reserved for patients refractory to medical therapy or those with more severe ischemia. CONCLUSION: occlusive arterial disease of the hand may be more common than formerly thought and is often preventable by the proper use of hand tools or instruments and hand protection. This is another type of occlusive arterial disease in which tobacco may be a predisposing or aggravating factor.

Adult↗
PubMed1999

Transducer user syndrome: an occupational hazard of the ultrasonographer.

Since no study to date has assessed the prevalence of scanning-related disorders amongst sonographers in Obstetrics and Gynecology, we distributed a survey to all trained personnel in our ultrasound division. We evaluated the correlation between injuries sustained in the workplace, and factors such as age, gender, work load and intensity, scanning techniques, previous medical problems, and physical activity. Injuries included one or more of the following: carpal tunnel syndrome; carpal instability; tendinitis; back, shoulder, and neck pain; tingling and/or numbness in the extremities; weakness; and motion restriction. Of the 44 respondents, 29 (65%) have experienced some type of injury or symptom over the course of their scanning career. Five (12%) reported having missed work because of their symptoms, 15 (34%) have received orthopedic treatment (medication or physiotherapy), two (4.5%) have been diagnosed with carpal tunnel syndrome, and one (2.3%) with carpal instability based on electrophysiological examinations. These results demonstrate that ultrasound scanning in Obstetrics and Gynecology may pose an occupational risk for doctors and technicians.

Adult↗
PubMed2003

[Improving the quality of work life. Awkward and strained postures among scrub nurses].

Latest statistics show worrying figures about labour accidents and illnesses in surgical nursery, due to the lack of preventing measures or unsuitable working conditions. Actually the duties of a scrub nurse bring an important static physical burden and the fulfilment of reiterative movements, as well as environmental conditions that may raise the provability of the development of skeletal muscular diseases in a medium-long time. In order to monitor the correct accomplishment of preventing rules related to working postures and the handling of heavy loads and identify risk factors that may lead to these disorders and asses symptoms related to inadequate positions and/or heavy efforts, a descriptive quantitative study was carried out over 24 theatre nurses from 2 hospitals in Murcia. According to the gathered information, analysed with the statistic program SPSS, the adopted measures to avoid risks are inadequate and insufficient. The inquired population adopt unsuitable postures in a high proportion moreover, what let us establish a significant correlation with the obtained information referred to the posture adopted. As a result, we cannot any longer state that scrub nurses are undergoing the established preventive rules in order to avoid those symptoms associated to the kind of job they carry out. To sum up we believe as very necessary to improve the scrub nurses' quality of work life, the removal of risk factors and the supply of suitable instrumental, drawing up a protocol of safety and working behaviours as well as offering seminars to teach that protocol.

Adult↗
PubMedDate not supplied

[Work-related musculoskeletal diseases: experience of INAIL of the Apulia region 1998-2001].

The insurance recognition of Work related Muscolo Skeletal Disorders (WMSDs) has been introduced in Italy by the sentences of Constitutional Court n. 179/1988 and 208/1988. Afterwards the National Insurance Institute against work injuries (INAIL) tried to make homogeneous, in the different INAIL regional Departments, the diagnostic protocol of the work related illness associated with repetitive manual activities. Since 1998, indeed, a clinical diagnostic protocol has been used in the different departments. This report describes the Work related Muscolo Skeletal Disorders submitted to the Apulian INAIL Regional Direction in the period 1998-2001. Among 84 cases of disease reported to the Regional Direction, 21 were recognised as professional illness, the most part of which in workers employed in services sector and mining activities. The most represented disease was carpal tunnel syndrome and it was more recurrent in men than in women, in which the first symptoms were earlier than in men. The most represented risk factor, both in reported and in recognised cases, was the presence of repetitive working movements of the upper extremities, or the combination of the previous one with other risk factors such as high frequency of working activities, postural risk, strength demand, vibrations, climatic conditions. The development of specific diagnostic criteria, the detailed job analysis and the use of specific questionnaires seem to be the main elements for the WMSDs diagnosis and for the recognition of their professional etiology.

Adult↗
PubMedDate not supplied

[Musculoskeletal disorders in piano students of a conservatory].

A four parts questionnaire administered to piano students of Conservatory "T. Schipa" of Lecce, southern Italy, was used to determine the prevalence of instrument-related problems. Among 121 responders, 48 (39.6%) were considered affected according to pre-established criteria. Univariate analyses showed statistical differences for mean age, number of hours spent playing per week, interval without breaks, lack of sport practice and acceptability of "No pain, no gain" criteria in students with music-related pains compared with not affected pianists. No association with hand site was found in pianists with only upper limbs diseases. The multivariate analyses performed by logistic regression confirmed the independent association for the risk factors age, lack of sport practice and acceptability of "No pain, no gain" criteria. Differently from several studies older students were more frequently affected and no difference in the prevalence rate was found in females. Findings suggest a probable causal contribution of fixed postures in the development of PRMDs in pianists in addition to repetitive movements of upper limbs.

Adolescent↗
PubMed2003

Methodological issues in evaluating workplace interventions to reduce work-related musculoskeletal disorders through mechanical exposure reduction.

Researchers of work-related musculoskeletal disorders are increasingly asked about the evidentiary base for mechanical exposure reductions. Mixed messages can arise from the different disciplinary cultures of evidence, and these mixed messages make different sets of findings incommensurate. Interventions also operate at different levels within workplaces and result in different intensities of mechanical exposure reduction. Heterogeneity in reporting intervention processes and in measuring relevant outcomes makes the synthesis of research reports difficult. As a means of synthesizing the current understanding of measures, this paper describes a set of intervention and observation nodes for which relevant workplace indicators prior to, during, and after mechanical exposure reduction can provide useful information. On the basis of this path of impacts from exposure reduction, an approach to the evaluation of multilevel ergonomic interventions is described that can assist fellow researchers in producing evidence relevant to the challenges faced by workplace parties and policy makers.

Biomechanical Phenomena↗
PubMed2006

Study of hand function in a group of shoe factory workers engaged in repetitive work.

BACKGROUND: Work related hand and wrist musculoskeletal disorders are well known. The contributing factors could be repetitive movements, forceful work and awkward posture. It is not known how these movements affect grip or pinch strength and other functional aspects of the hand. AIMS: To study a group of shoe factory workers doing repetitive thumb and wrist movements for prevalence of musculoskeletal disorders and consequence on grip and pinch strength, two-point discrimination and perceived disability. METHODS: 39 shoe factory workers who put straps into 900 to 1000 pairs of rubber sandals per day and 29 hospital clerks as a control group were evaluated for musculoskeletal disorders, grip and pinch strength, two-point discrimination and perceived disability (by questionnaire). Proportions were compared by chi squared or Fisher Exact test and quantitative outcome by t-test or multiple linear regressions. RESULTS: Common musculoskeletal diseases of thumb/wrist were absent among shoe factory workers as in the clerks. Increased two-point discrimination over thumb (p=0.01, right; p=0.02, left) and a clear trend for reduced pinch strength between thumb and index finger (p=0.06, right; p=0.07, left) were noted compared to clerks after adjusting for years on the job. Perceived disabilities included pain and localised dermal thickening over the thumb. DISCUSSION: No case of carpal tunnel syndrome or hand/wrist tendinitis was detected among workers doing highly repetitive thumb/wrist movement. Pinch strength decreased and two-point discrimination was adversely affected while grip strength remained unaffected. The main perceived disabilities of pain and skin changes over the thumb adversely affected their day-to-day life.

Adult↗
PubMed1997

Work organization is significantly associated with upper extremities musculoskeletal disorders among employees engaged in interactive computer-telephone tasks of an international bank subsidiary in São Paulo, Brazil.

This study was designed to verify the risk factors for developing upper extremities musculoskeletal disorders (UEMD) among workers engaged in customer service tasks performed by telephone at a private banking corporation in São Paulo, Brazil. The monthly incidence of UEMD in hands and/or wrists in this group was studied retrospectively from January 1993 to June 1995. The statistical analysis was done by using multiple linear regression with the monthly incidence of UEMD considered as dependent variable in models controlled for age, seniority, mean daily regular worktime and overtime per operator, time pressure at work, rest/work schedule, management status, personnel training on postural and muscle stretching, and ergonomic hazards. The variables associated with UEMD were the following: time pressure at work (coefficient = 0.049; p = 0.008) and rest/work schedule (coefficient = -0.047; p = 0.02). The results indicate that working conditions are significantly associated with UEMD, and changes in the working schedule may decrease the incidence of this problem in workers assigned to tasks related to the interactive use of computer-accessible databases during telephone contacts.

Adult↗
PubMed1996

Prognosis of nonspecific work-related musculoskeletal disorders of the neck and upper extremity.

Reviews of work-related musculoskeletal disorders (WMD) of the neck and upper extremity have typically supplied little information on prognosis. This paper reports on the methods and results of a systematic search for evidence on clinical course and prognosis of nonspecific WMD i.e., those without specific clinical diagnoses. Articles were deemed relevant if they provided primary data on current or former worker cases of WMD followed over time. WMD status had to be based on clinical evaluations. The 13 studies which met these criteria were evaluated using clinical epidemiological criteria for validity of prognostic studies. None of the studies was sufficiently strong across the criteria to provide more than weaker evidence on prognosis. Prognostic factors with promise include duration of symptoms and workplace demands. In order to improve the evidence on prognosis of WMD, we recommend closer attention to the following: clear operational definition of cases; documentation of prognostic factors including duration of symptoms and severity at baseline; incorporation of multiple follow-up assessments; inclusion of a range of outcomes; and analysis using stratified or multivariate methods.

Arm Injuries↗