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At least 1,207 records · Page 67Linked to original sources
PubMed2003

A critique of a UK standardized test of finger rewarming after cold provocation in the diagnosis and staging of hand-arm vibration syndrome.

BACKGROUND: Accurate diagnosis and staging of hand-arm vibration syndrome (HAVS) is important in health surveillance of vibration-exposed workers and the substantial number of related medico-legal cases. The measurement of the rewarming rate of fingers after cold provocation to the hands (CPT) has been suggested as a useful test in diagnosing HAVS. AIM: To investigate the diagnostic value of a standardized version of the CPT test using a 15 degrees C cold challenge for 5 min applied in the recent compensation assessment of UK miners. METHODS: Analysis of a subset of UK miners assessed at our unit, together with data from a small repeatability study of the standardized CPT in normal subjects. RESULTS: Rewarming time in the CPT was significantly lower in those subjects classified as vascular Stockholm stage 0 compared with Stockholm stages 1-3 combined, but did not discriminate between the stages of abnormality. Using the suggested cut-off in the CPT test, the sensitivity and specificity were calculated as 43 and 78%, respectively. Receiver operator characteristic analysis suggested that the rewarming time of highest accuracy gave a sensitivity of 66% and specificity of 59%. In 10 miners who reported unilateral hand blanching, there was no significant difference in CPT measurements between blanching and non-blanching hands. Repeat CPT measurements in normal subjects suggested mean differences of 52 and 107 s for each hand, and the Bland-Altman coefficient of repeatability was approximately 600 s for all fingers. CONCLUSION: Single application of this standardized CPT test may have limited value in diagnosing the vascular component of HAVS in an individual.

Adult↗
PubMed2003

Thoracic outlet syndrome--aspects of diagnosis in the differential diagnosis of hand-arm vibration syndrome.

BACKGROUND: Thoracic outlet syndrome (TOS) is a cause of vascular and neurological compromise to the arm and hand, and may manifest as Raynaud's phenomenon. It may be under-diagnosed. AIM: This review was undertaken in order to clarify the diagnostic and investigative features of TOS that may differentiate it from hand-arm vibration syndrome. METHODS: A tiered review of the world literature was undertaken using Medline and Embase as the primary search engines. CONCLUSION: Thoracic outlet syndrome most commonly presents with neurological symptoms in the arm. Vascular symptoms, including Raynaud's phenomenon, may occur in approximately 10% of cases. Careful clinical assessment by history and examination may reveal the elements of forearm and upper arm symptoms with postural exacerbation, which distinguish this condition from hand-arm vibration syndrome. The usefulness of investigation is unclear, but Doppler and neuroelectric studies may be valuable. Magnetic resonance imaging scan is the investigation of choice.

Arm↗
PubMed2006

Hand-arm vibration syndrome with concomitant arterial thrombosis in the hands.

BACKGROUND: Hand-arm vibration syndrome (HAVS) refers to the vascular, neurological and musculoskeletal effects that may occur in workers with prolonged exposure to vibrating tools. Hypothenar hammer syndrome (HHS) is a lesion of the ulnar artery at the level of the hamate bone secondary to single or repeated episodes of trauma to the hypothenar eminence. The literature suggests that digital arterial thrombosis and HHS may be associated with the use of vibrating tools. AIM: This study will familiarize investigators with the range of vascular abnormalities seen in workers using vibrating tools, and highlight the importance of screening for arterial thrombosis in the hand when assessing hand-arm vibration-exposed patients. METHODS: In the patients referred to our clinic for HAVS assessment, three were identified during the period 2001 to 2004 who had vascular occlusions in the hands in addition to HAVS. In addition to standardized HAVS vascular investigations, all three patients had arteriograms based on a significantly positive Allen's test. RESULTS: All three cases had documented HAVS based on vascular testing. Arteriograms revealed a spectrum of severity of arterial thromboses from severe HHS, to occlusion limited to the digital arteries. CONCLUSION: Our study reports three cases of HAVS with concomitant HHS and/or digital artery thrombosis. These findings support previous reports of an association between HAVS and vascular thrombosis in the hands. Screening for arterial occlusive problems in the hands should be included in the HAVS work up.

Adult↗
PubMed2006

Modification of the Stockholm Vascular Scale.

BACKGROUND: Staging hand-arm vibration syndrome (HAVS) depends upon accurate reporting of the extent and frequency of blanching attacks. Reporting may not be repeatable and not all individuals classifiable using the Stockholm Workshop Scale (SWS). For Department of Trade and Industry (Dti) coal miners' assessments, the SWS was modified to include a blanching score. Further modifications, which involve splitting Stage 2V into 'early' and 'late' have been proposed but the impact of this on classification has not been investigated. AIM: To investigate the impact of modifications in the SWS on HAVS classification. METHODS: Staging of individuals with HAVS according to the SWS using two modified scales. Two different cut-offs for defining 'frequent' blanching attacks (>or=3 or >or=7 attacks/week, respectively) were used. RESULTS: One hundred and sixty-five individuals were staged. Using the SWS, 58 and 31% of the population were unclassifiable using the two cut-offs, respectively. The modification splitting Stage 2V reduced the proportions that were unclassifiable to 2 and 9%, respectively, and increased those classified as Stage 2V. The cut-off for frequent attacks used (3 or 7) affected the proportion of individuals falling into the subdivisions of Stage 2 with 17 and 42% being classified as 2Vearly and 45 and 20% as 2Vlate, respectively. CONCLUSIONS: Subdividing Stage 2V enables more individuals to be classified, but the proportion falling into each category is susceptible to the cut-off used for defining frequent attacks. Caution may need to be applied if this categorization is used to make decisions regarding fitness to work.

Arm↗
PubMed1988

Determining predictor variables for running-related pain.

The purpose of this study was to determine whether specific predictor variables exist for particular running-related injuries. Data on 134 patients with running-related injuries were evaluated to establish the factors that were associated with specific pain sites. Patient data consisted of a brief running history and measurements of 72 anatomical variables that have been cited in the literature as predisposers to running-related injuries. The descriptive statistics indicated certain associations of variables with each pain group. A factor analysis was used to eliminate multicollinearity and to reduce the 72 variables to 9 factors. The results of a discriminant function analysis using factor scores indicated that patients' membership in one of six pain groups could be predicted correctly in 29.1% of the cases. We concluded that the factors used in this study were not good predictors of pain groups. Physical therapists, however, should publish their data on runners' injuries, treatment, and rehabilitation to supplement the published data that relate anatomical and biomechanical factors to running-related injuries.

Athletic Injuries↗
PubMed1989

Evaluation of eccentric exercise in treatment of patellar tendinitis.

The purpose of this study was to analyze the effects of a quadriceps femoris muscle eccentric training program on strength gain in patients with patellar tendinitis. The effect of an eight-week eccentric exercise program on quadriceps femoris muscle work was evaluated in four groups of subjects--two groups of "normal" (healthy) subjects and two groups of patients with patellar tendinitis. All four groups participated in a home muscle stretching exercise program, but only two groups--one group of normal subjects (N-A) and one group of subjects with tendinitis (T-A)--received additional eccentric training on an eccentric isokinetic dynamometer. The eccentric quadriceps femoris muscle work ratio (involved limb/uninvolved limb x 100) was used to quantify strength in the N-A and T-A Groups. Pain ratings were recorded for subjects with tendinitis before and after the eight-week experiment and were correlated with the dependent variable using a Spearman rank-order correlation coefficient. The N-A Group performed significantly better than all subjects with tendinitis (p less than .05). Subjects in the T-A Group, however, showed a trend toward increasing eccentric quadriceps femoris muscle work capacity over the eight-week training period. As pain ratings in the T-A Group increased, work ratios decreased. We concluded that eccentric exercise may be an effective treatment for patellar tendinitis, but that knee pain may limit optimal gains in strength.

Adult↗
PubMed1997

A primate model for studying focal dystonia and repetitive strain injury: effects on the primary somatosensory cortex.

BACKGROUND AND PURPOSE: Job-related repetitive strain injuries (RSIs) are increasing, and current treatment strategies often fail to return injured people to work. This study documented the neural consequences of using two different movement strategies for active, repetitive hand closing and opening. METHODS: Two owl monkeys were trained for 20 weeks to repetitively close a handpiece against an 80-g force (3-400 trials per day, training at 80%-90% accuracy). One monkey used a highly articulated hand-squeezing strategy, and the other monkey used a proximal arm-pulling strategy. Changes in motor performance were analyzed, and the electrophysiological maps of the hand representation on the trained primary sensory cortex (area 3b) were compared with those of untrained control animals and the untrained sides of the trained monkeys. RESULTS: The monkey using the articulated hand-squeezing strategy showed motor deterioration and dedifferentiation of the normally sharply segregated areas of the hand representation in area 3b. Mild degradation of the hand representation was measured in the monkey using the proximal arm-pulling strategy, but there was no motor dysfunction. CONCLUSION AND DISCUSSION: Attended, highly articulated, repetitive finger squeezing degrades the hand representation and interferes with motor control. A proximal, more variable repetitive strategy minimized the sensory degradation and preserved motor control. Restoring the hand representation may be a critical part of treatment for patients with chronic RSI and focal hand dystonia.

Animals↗
PubMed1998

The relationship between head and neck posture and VDT screen height in keyboard operators.

BACKGROUND AND PURPOSE: The purpose of this study was to determine the effect of change in video display terminal (VDT) height from desktop height (96.5 cm [38 in]) to an elevated position (109.2 cm [43 in]) on postural angles of the head and neck and the effect on cervical spine flexion moments. SUBJECTS: Twenty-seven persons (3 male, 24 female) who spent at least 3 hours per day using a computer while seated were the subjects. The subjects had a mean age of 36.7 years (SD=6.0, range=25-47). METHODS: Subjects were photographed over two 10-minute periods while seated using a computer with the VDT at two different heights. Later, a goniometer was used over images to record angles. RESULTS: There was no difference in cervical flexion moment between the two screen positions. Several postural angles of the head and neck showed changes, but the clinical relevance of these changes is questionable. CONCLUSION AND DISCUSSION: Changing the VDT height from 96.5 to 109.2 cm (floor to midscreen) has no effect on flexion moment on the cervical spine during short periods of VDT operation. If flexion moment is considered a biomechanical indicator of postural stress, it does not appear that the elevated screen position reduces postural stress on the cervical spine during short periods of VDT operation.

Adult↗
PubMed2006

Structure and biomechanics of peripheral nerves: nerve responses to physical stresses and implications for physical therapist practice.

The structural organization of peripheral nerves enables them to function while tolerating and adapting to stresses placed upon them by postures and movements of the trunk, head, and limbs. They are exposed to combinations of tensile, shear, and compressive stresses that result in nerve excursion, strain, and transverse contraction. The purpose of this appraisal is to review the structural and biomechanical modifications seen in peripheral nerves exposed to various levels of physical stress. We have followed the primary tenet of the Physical Stress Theory presented by Mueller and Maluf (2002), specifically, that the level of physical stress placed upon biological tissue determines the adaptive response of the tissue. A thorough understanding of the biomechanical properties of normal and injured nerves and the stresses placed upon them in daily activities will help guide physical therapists in making diagnoses and decisions regarding interventions.

Animals↗
PubMed1987

Work-related shoulder-neck complaints in industry: a pilot study.

Twenty-six industrial workers, selected from employment records, were examined with a questionnaire, anthropometric measures, muscle strength measurements and filming during work cycles to study the influence of ergonomic factors on shoulder-neck complaints. No differences were observed when comparing age or anthropometric measurements between the nine workers with and the 17 without shoulder-neck complaints. Significantly weaker shoulder muscles were found in workers with shoulder-neck complaints than in those without. A higher median strain on the shoulders in the working situation of workers with shoulder-neck complaints than in the group with no complaints was suggested from the results of a biomechanical analysis of the different work tasks.

Absenteeism↗
PubMed1999

A vascular basis for repetitive strain injury.

OBJECTIVE: The blanket term 'repetitive strain injury' (RSI) covers a wide variety of work-related clinical syndromes, most of which are localized lesions. However, some patients complain of diffuse forearm pain, a clinically distinct form of RSI, the aetiology of which is unknown. METHODS: Using Doppler ultrasound, we measured the vascular responses to muscular work in the radial artery in 13 patients with bilateral diffuse forearm pain, seven with unilateral diffuse pain and 19 controls with localized arm pain. RESULTS: We found that in diffuse forearm pain the radial artery is relatively constricted compared to the controls and fails to vasodilate with exercise, which suggests that diffuse forearm pain may be due to physiological claudication of the working forearm muscle. CONCLUSION: A possible explanation is inhibition of local endothelial nitric oxide function, and this may be an unusual secondary, but self-perpetuating, pain condition which can follow other more specific, but chronic, arm pain syndromes in susceptible individuals.

Adolescent↗
PubMed2003

The role of workplace low-level mechanical trauma, posture and environment in the onset of chronic widespread pain.

BACKGROUND: We have recently demonstrated that individual psychosocial factors are important predictors of the onset of chronic widespread pain. It has been hypothesized that excessive mechanical exposure may also be associated with symptom onset, although this has not been formally examined. We therefore determined the relative contributions of individual psychosocial and work-related mechanical, posture and environment factors in symptom onset. METHODS: We conducted a population-based prospective survey and identified 1658 adults aged 18-65 yr who were symptom-free. At baseline, detailed information was obtained on work-related mechanical and environment factors using validated instruments. Individual psychosocial features were also measured. Subjects free of chronic widespread pain at baseline were followed up at 12 and 36 months to identify those reporting the onset of new symptoms. RESULTS: In all, 1445 (91%) returned the questionnaire at 12 months and 978 (89%) at 36 months. Of these, 81 and 92 respectively reported new chronic widespread pain. Symptom onset was predicted by workplace factors [pushing/pulling heavy weights [relative risk (RR) = 1.8, 95% confidence interval (CI) 1.1, 3.0]; repetitive movements of the wrists (RR = 1.8, 95% CI 1.2, 2.7); kneeling (RR = 2.2, 95% CI 1.2, 4.1)] and individual factors [aspects of illness behaviour (RR = 2.9, 95% CI 1.6, 5.3); somatic symptoms (RR = 1.9 95% CI 1.1, 3.3); fatigue (RR = 1.9, 95% CI 1.2, 3.1); baseline pain symptoms (RR = 2.5, 95% CI 1.6, 3.9)]. In multivariate analysis, pushing/pulling heavy weights, repetitive wrist movements, kneeling and other pain at baseline were associated with new-onset chronic widespread pain. However, the strongest predictor was a high score on the illness behaviour scale. CONCLUSION: This study provides only limited support for the hypothesis that low-level mechanical injury may be a risk factor for developing chronic widespread pain. The onset of chronic widespread pain appears to be multifactorial and is strongly predicted by individual psychosocial factors.

Adult↗
PubMed1989

Chronic compartment syndrome. An unusual cause for claudication.

Chronic Compartment Syndrome (CCS) is usually caused by overuse injury in well-conditioned athletes (particularly runners). Less common causes of CCS include blunt trauma, venous insufficiency, and tumor. CCS is clinically manifested as claudication, tightness, and occasional paresthesia. Unlike other forms of overuse injury (tendonitis, stress fracture), CCS does not respond to rest, anti-inflammatory medications, or physical therapy. The diagnosis of this condition is confirmed by elevated compartment pressures (normal less than 15 mmHg; CCS greater than 20 mmHg). The only effective treatment is surgical compartment release. Two hundred nine patients have been surgically treated for CCS, 100 by subcutaneous fasciotomy (group I) and 109 by open fasciectomy (group II). These procedures were usually performed in ambulatory surgery using local anesthesia. Patients treated by open faciectomy instead of subcutaneous fasciotomy had fewer early postoperative wound complications (6% vs. 11%) and fewer late recurrences (2% vs. 11%).

Adult↗
PubMedDate not supplied

Upper limb nerve entrapments in elite wheelchair racers.

The prevalence of upper limb nerve injuries has been reported to be as high as 73% in individuals who rely on manual wheelchairs for mobility. Many authors hypothesize that the repetitive trauma to carpal canal structures caused by propelling a wheelchair is the reason for this high prevalence. The purpose of this study was to determine the prevalence of nerve conduction abnormalities in a group of elite wheelchair racers whose wrists are exposed to additional propulsion-related trauma during training and competition. We performed bilateral upper limb nerve conduction studies on each athlete (n = 12). The racers pushed their chairs an average of 56 miles a week for training purposes. Fifty percent of the athletes (n = 6) had evidence of median mononeuropathy by nerve conduction. Of these 6 racers, 5 had evidence of mononeuropathy bilaterally, making a total of 11 positive hands of the 23 tested. Twenty-five percent of the athletes had evidence of ulnar mononeuropathy at the wrist, and 25% had evidence of ulnar mononeuropathy at the elbow. Seventeen percent of athletes had evidence of radial nerve injury. Years with a disability accounted for a significant amount of the variance in the mean median sensory amplitude (R2 = 0.511; P = 0.020) and the mean ulnar palmar amplitude (R2 = 0.605; P = 0.008). Variables not correlated with nerve conduction studies include age, hours per day in a wheelchair not spent training, years competing, and number of miles pushed in training. Despite the amount of time spent training these wheelchair athletes have a similar or lower prevalence of median mononeuropathy then reported in the general wheelchair-using population.

Adult↗