Psychological and physical aspects of occupational arm pain.
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Adult↗
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'Repetition strain injury': an Australian epidemic of upper limb pain.
An analysis is provided of a recent Australian epidemic of an upper limb regional pain syndrome known as 'repetition strain injury' (RSI). 'RSI' was originally attributed to occupational over-use of the upper limb and biomechanical and ergonomic solutions were sought. More sceptical commentators argued that 'RSI' was an epidemic form of hysteria. More recently, a consensus has emerged that the epidemic is attributable to a combination of factors: a change in the perception of endemic symptoms of upper limb pain; the iatrogenic effects of the term 'RSI' and the methods used to manage it; and complications of the medico-legal process in which many sufferers became entangled.
Arm Injuries↗
The social recognition of repetition strain injuries: an Australian/American comparison.
In the mid 1980s the problem of occupational overuse injuries, particularly among keyboard operators, gained widespread recognition in Australia. The country appeared to be experiencing an epidemic, the like of which was unknown elsewhere in the world. Three explanations are canvassed in the paper: first, the psychiatric theory that it was a case of 'epidemic hysteria'; second the hypothesis that there really were more such injuries in Australia than elsewhere; and third, the hypothesis that the institutions of Australian society facilitated recognition of the problem, while those of other countries repress awareness of it. The paper focuses on this last hypothesis and seeks to demonstrate it by means of a comparison between Australia and the United States. It shows how, in particular, the system of workers' compensation in the Australian public service facilitated recognition of the problem, while the compensation system in the United States makes it very difficult for sufferers to have their disability acknowledged. Since workers' compensation is virtually the only source of injury statistics, this has led to the visibility of the problem in Australia and its invisibility in the United States.
Australia↗
Pilgrimage of pain: the illness experiences of women with repetition strain injury and the search for credibility.
Repetition strain injury (RSI), a non-specific and controversial constellation of work-related hand, arm and neck symptoms, became epidemic in Australian industry in the early 1980s. Fifty-two women who worked in a telecommunications organisation and a chicken processing factory and had been diagnosed as having RSI were interviewed about their perceptions and experiences of the illness. Their accounts of the search for caring and treatment, including their encounter with health and medical practitioners, suggest that the need to be believed and to establish their integrity dominated their 'pilgrimage'. The failure of the dominant explanations of RSI to accommodate the psychosocial and political dimensions of the illness thwarted this quest and, it is argued, contributed to its chronicity.
Adult↗
Cerebral event-related responses induced by CO2 laser stimulation in subjects suffering from cervico-brachial syndrome.
The present study was undertaken to examine possible changes in subjective appraisal and central nervous system processing, indexed by pain-related cerebral evoked potentials (N290, P400), of incoming noxious information in 20 pain-free control volunteers and 18 subjects suffering from right-side cervico-brachial pain (CBS). Detection threshold and cerebral evoked potentials were recorded in response to noxious CO2 laser stimulation of the right and left hands. The results indicate that when compared to controls, CBS subjects exhibit an elevation in detection threshold intensity and a reduction in the amplitude of the P400 peak following laser stimulation of the pain affected side. There were also differences in the choice of qualitative descriptor for laser stimuli although not in the subjective rating of stimulus intensity. These changes were not apparent for responses on the unaffected limb. The severity of clinical pain was found to be related to the magnitude of reduction in P400 amplitude only on the pain affected side. Conversely, feelings of anxiety were associated with higher amplitude responses on both the right and left sides, suggesting a more generalized relationship between these factors. We interpret these findings to indicate an alteration in central nervous system processing and subjective appraisal of acute experimental pain in subjects with chronic CBS. Moreover, these alterations appear to be restricted to pain affected pathways and are more related to the severity of clinical pain than to general mood state.
Adult↗
Provocative testing in the diagnosis of dynamic carpal tunnel syndrome.
This study measures the effects of provocative testing on a series of patients with latent symptoms of carpal tunnel syndrome. Forty patients were studied for change in hand volume and loss of sensibility after stress. Thirty-four patients demonstrated significant measurable increase in hand volume after a 7-minute stress test. In 17 of 34 patients impaired sensibility associated with swelling developed and they were considered to have dynamic carpal tunnel syndrome. Surgical treatment was effective in correcting symptoms and sensory defects in these 17 individuals despite postoperative hand swelling that continued after the operation when the hand was subjected to stress.
Adult↗
Stress fracture of the finger in a bowler.
A 28-year-old semiprofessional bowler was seen initially with pain in the right ring finger that was aggravated by bowling and relieved by rest. He had localized tenderness of the middle phalanx; x-ray films revealed a stress fracture. The fracture healed with restriction of activity and he was able to gradually resume bowling. Although rare, stress fracture should be considered in the differential diagnosis of finger pain in a patient with a history of overuse.
Adult↗
Rupture of the flexor digitorum profundus tendon in the palm caused by repeated, chronic direct trauma.
Nonrheumatoid ruptures of the flexor tendons in the palm are rare. We report a case in which excessive exertion caused rupture of the flexor digitorum profundus tendon to the small finger in the palm at the level of the lumbrical origin. The patient had been practicing Japanese fencing for many years. The hard butt end of a bamboo sword impinged precisely on the region in the palm where the rupture occurred.
Adolescent↗
The effect of wearing a flexible wrist splint on carpal tunnel pressure during repetitive hand activity.
We investigated how repetitive hand activity normally affects carpal tunnel pressure and whether a flexible wrist splint can influence this effect. Nineteen healthy subjects were evaluated under four test conditions: at rest with and without a wrist splint (baseline) and while performing a repetitive task with and without a wrist splint. The task involved loading and unloading 1 lb. cans from a box at a rate of 20 cans per minute for period of 5 minutes. Carpal tunnel pressure and wrist angles were continuously monitored by means of a fluid-filled catheter inserted into the carpal canal and a two-channel electrogoniometer mounted on the dorsum of the hand and forearm. Without the splint, carpal tunnel pressure rose from a median baseline level of 8 +/- 6 mmHg to 18 +/- 13 mmHg during activity. With the splint, carpal tunnel pressure rose from a baseline of 13 +/- 5 mmHg to 21 +/- 12 mmHg during activity. Median carpal tunnel pressure during activity with the splint was no different from that without the splint. Our data indicate that the median nerve is subjected to increased pressure within the carpal tunnel during repetitive hand activity. Wearing a flexible wrist splint during activity limits the range of wrist motion but has no significant effect on carpal tunnel pressure.
Adult↗
Rhabdomyolysis secondary to keyboard overuse: occupational hazard of the computer age.
A 33-year-old man presented with rhabdomyolysis with bilateral forearm pain and a profoundly elevated creatine phosphokinase. The cause of his illness appears to be computer keyboard overuse soon after a viral illness. This is the first case report directly linking rhabdomyolysis with keyboard overuse.
Adult↗
Posterior superior glenoid impingement: expanded spectrum.
Posterior superior glenoid impingement is a recently recognized mechanism of injury producing rotator cuff injury in athletes. Usually the mechanism is repetitive overhand activity such as throwing. A survey of the author's practice was undertaken to show a wider spectrum of this mechanism both in the activity that caused it and the number of structures at risk of injury from this mechanism. The survey revealed 11 patients who had a clear recollection of their mechanism of injury and an objective documentation of the injury by arthroscopy or imaging studies. The majority of shoulders had damage to more than one of the five structures at risk from this mechanism of injury. Six cases were not sports related. Glenoid impingement may injure one or more of the following: (1) superior labrum, (2) rotator cuff tendon, (3) greater tuberosity, (4) inferior glenohumeral ligament or labrum, and (5) superior glenoid bone. Injury to more than one structure may be the rule and injury to one structure may indicate investigation of the other four.
Adult↗
Evaluation of Hjorth parameters in forearm surface EMG analysis during an occupational repetitive task.
The Hjorth parameters are normalized slope descriptors (NSDs) usually used in sleep EEG processing for data reducing and/or automatic sleep stage scoring. In the present study NSDs of forearm surface EMG recorded from 9 subjects performing occupational repetitive movements are compared to conventional FFT spectral analysis. The correlation coefficients between the NSD labelled mobility and the FFT mean frequency range from 0.81 to 0.93. Results show that these time domain properties can also describe the spectral content of surface EMG during repetitive movements. Moreover, the NSD method offers a low cost calculation time since it is based on the sole concept of variance.
Adult↗
Femoral bone density in young male adults with stress fractures.
Femoral bone mineral density (BMD) was measured by dualphoton absorptiometry in 41 young military recruits who had one or several stress fractures, during their physical training program. These fractures involved the following locations: Femur (neck: n = 10, diaphysis: n = 2), calcaneus (n = 10), tibia (n = 8), fibula (n = 3), metatarsus (n = 8). The stress fracture group generally had a lower bone density than that of a control group, consisting of 48 young military recruits matched for age, height and weight. However, the BMD was significantly lower (-10%) in patients with femoral and calcaneal locations, but it did not differ for other locations. To determine the possible effect of this intense physical activity on bone mineral mass, bone mass was measured again in 35 subjects from the control group at the end of their training. The BMD remained stable or increased in 28 subjects, but decreased significantly (greater than 2%) in 7 subjects, demonstrating the individual variability in the adaptation of bone to this stress. Our results suggest that lowered bone mass could be a factor that encourages the development of stress fractures (femoral and calcaneal) in young subjects submitted to intense physical activity to which they are not accustomed.
Adolescent↗
Test-retest repeatability of the Strain Index.
Fifteen raters individually, and in five teams of three, evaluated the test-retest repeatability of published data collection and rating methods of the Strain Index by analyzing 61 job video files twice over a 5-month period. Raters estimated average and peak hand forces, measured Duration of Exertion, cycle time, and exertions per job cycle, calculated percent Duration of Exertion and Efforts per Minute, and assigned ratings for five of the six Strain Index task variables. Twelve additional jobs were analyzed to determine Strain Index Score and hazard classification. Intraclass correlation (ICC) coefficients for task variable ratings and accompanying data ranged from 0.66 to 0.95 for both individuals and teams. The Strain Index Score ICC(2,1) for individuals and teams were 0.56 and 0.82, respectively. Intra-rater reliability for the hazard classification was 0.81 for individuals and 0.88 for teams. The results indicate that the Strain Index has good test-retest reliability.
Cumulative Trauma Disorders↗
Effects of a vertical keyboard design on typing performance, user comfort and muscle tension.
To circumvent the awkward pronated hand position inherent to conventional horizontal keyboards, a vertical, split keyboard was designed with flexible cushions supporting the wrists, allowing relaxed hand and arm postures. During eight twice-weekly 30-min training sessions, the performance and subjective comfort of nine experienced typists were tested. Typing speed and error percentage, and surface electromyographic activity of six forearm muscles and two postural muscles were recorded in separate sessions at the end of each week. Typing speed rapidly recovered to the preset rate of 300 keystrokes/min and error percentages were similar for the two keyboards. The vertical keyboard caused lower muscular activity in especially finger extensor muscles, did not increase postural muscle activity, and self-reported comfort was higher. Thus, the vertical keyboard was easily mastered, was experienced as comfortable, and caused less stress on muscles sensitive to repetitive strain injuries.
Adolescent↗
The effects of cycle time on the physical demands of a repetitive pick-and-place task.
This study seeks to elucidate the effects of the cycle time of a pick-and-place task on muscle activity, grip force, posture, and perception-based measures (discomfort and difficulty). Six healthy adults (3 males, 3 females) participated. A 4 x 2 repeated measures design was used with cycle time (1, 2, 5, and 10s) and grip (power and chuck) as independent variables. The task consists of repetitively picking a 0.7 kg part and placing it into a bin. A reduction in cycle time (CT) resulted in both a decrease of task time and physical rest time (p<0.001). The physiological muscle rest was much lower than the physical rest time (p<0.05). An increase in static muscle loading (p<0.01), grip force (p<0.001), and discomfort (p<0.001) were also observed. These results suggest that a pace threshold (between 2 and 5s for this task) is reached at a higher CT than that defined by the ability to perform the task.
Adult↗