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PubMed2006

[Work, exclusion, pain, suffering, and gender relations: a survey of female workers treated for repetitive strain injury at a public health clinic].

This article presents the results of a qualitative study based on patient records from a public health clinic and focusing on four therapeutic groups from 1995 to 1997. The study aimed to reconstruct the life and work history of women with repetitive strain injury (RSI) in relation to family, friends, company, workmates, health services, and impacts on daily life. The results corroborate the data in the scientific literature pointing to greater frequency of RSI among women, and allow us to list the needs related to the resulting biopsychosocial distress, suggesting the need for new research and intervention aimed at producing preventive and therapeutic technologies for such injuries.

Adult↗
PubMed2001

[Changes in the work and life of bank employees with repetitive strain injury: RSI].

Nowadays, Repetitive Strain Injury (RSI) has been one of the most serious problems concerning workers' health. Aiming at analyzing the main changes in the work and life of RSI bearers from an RSI Bearers Association in Cascavel--Paraná, we developed this qualitative study. Semi-structured interviews were applied to nine bank employees. The first symptoms had appeared during the period of automation and introduction of new technology in the Brazilian financial system, which was when changes in work organization took place. The main elements in this process were the increase in work load, use of computers, overtime work, absence of intervals, monotony, repetitive actions, intense work and productivity control, pressure and tension. The aggravation of injuries affected productivity and caused dependence to carry out activities at work and out of it. A challenge lies in ensuring these worker's rights.

Adult↗
PubMedDate not supplied

Medical reports recommending work restrictions at a teaching hospital in Brazil.

This non-experimental and cross-sectional descriptive study aimed to evaluate medical reports recommending work restrictions for workers at a teaching hospital in Brazil. A form was used for data collection, characterizing the medical reports and work restrictions, with its content previously validated. A total of 176 medical reports was analyzed, containing 337 work restrictions, recommended from January 2001 to January 2004. The results demonstrated a high rate of work restrictions in the study hospital. The most restrictions frequent were ergonomic (78.6%), and the most often prescribed were: no weight lifting or carrying and no repetitive movements. There was an average of two restrictions per medical report, 79.5% of which were definitive and the mean restriction period was 13 months.

Brazil↗
PubMedDate not supplied

[The construction of the "sick-subject" in RSI].

There is a running debate over the relationship between work and disease, namely the disease known as repetitive strain injury (RSI), or else work-related osteomuscular disturbances (in Portuguese DORT), as it was renamed in 1997 by the Instituto Nacional de Seguridade Social (INSS) in accordance with the Disability Assessment Norms. Standing out among the signs brought about by this new infirmity process is its restricted focus on the subjective aspects in the analysis of the disease. Underlying the INSS stance is the view of a sickness-prone subject and the notion of health as capacity for work. This paper analyzes the historical context which characterizes these health/work and body/disease notions. It also discusses the construction of the 'sick-subject' and the way in which such a subjectivizing process entraps the subject itself. Finally, we show the way in which the INSS in Rio de Janeiro has managed to stop this disease of its work-related characteristics, fighting and reducing the occurrences of RSI as well as the costs with work compensation claims.

Brazil↗
PubMed2006

Low sensitivity of three-phase bone scintigraphy for the diagnosis of repetitive strain injury.

CONTEXT AND OBJECTIVE: The diagnosis of repetitive strain injury (RSI) is subjective and solely based on clinical signs and physical examination. The aim of this paper was to assess the usefulness of three-phase bone scintigraphy (TPBS) in diagnosing RSI. DESIGN AND SETTING: Prospective study at the Division of Nuclear Medicine, Department of Radiology, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP). METHODS: Seventy-three patients (mean age 31.2 years; 47 males) with clinical suspicion of RSI in the upper limbs were studied. A total of 127 joints with suspicion of RSI were studied. The shoulders, elbows and wrists were analyzed semi-quantitatively, using the shafts of the humeri and ulnae as references. The results were compared with a control group of 40 normal individuals. The patients signs and symptoms were used as the "gold standard" for calculating the probabilities. RESULTS: From visual analysis, abnormalities were observed in the flow phase for four joints, in the blood pool phase for 11 joints and in the delayed images for 26 joints. Visual analysis of the joints of the control group did not show any abnormalities. Semi-quantitative analysis showed that most of the patients joint ratios were normal. The exceptions were the wrists of patients with left-sided RSI (p = 0.0216). However, the sensitivity (9%) and accuracy (41%) were very low. CONCLUSION: TPBS with semi-quantitative analysis has very low sensitivity and accuracy in the detection of RSI abnormalities in the upper limbs.

Adult↗
PubMed2005

Predictors of work-related repetitive strain injuries in a population cohort.

OBJECTIVES: We assessed predictors of work-related repetitive strain injuries using data from 4 waves of the Canadian National Population Health Survey. METHODS: Participants were 2806 working adults who completed an abbreviated version of the Job Content Questionnaire in 1994-1995 and did not experience repetitive strain injuries prior to 2000-2001. Potential previous wave predictors of work-related repetitive strain injuries were modeled via multivariate logistic regression. RESULTS: Female gender (odds ratio [OR] = 1.98; 95% confidence interval [CI]=1.24, 3.18), some college or university education (OR=1.98; 95% CI=1.06, 3.70), job insecurity (OR=1.76; 95% CI=1.07, 2.91), high physical exertion levels (OR = 2.00; 95% CI = 1.29, 3.12), and high levels of psychological demands (OR = 1.61; 95% CI = 1.02, 2.52) were all positively associated with work-related repetitive strain injuries, whereas working less than 30 hours per week exhibited a negative association with such injuries (OR=0.2; 95% CI=0.1, 0.7). CONCLUSIONS: Modifiable job characteristics are important predictors of work-related repetitive strain injuries.

Adult↗
PubMed2006

Assistive technology use among adolescents and young adults with spina bifida.

OBJECTIVES: We sought to determine the use of assistive technology among a population of individuals with spina bifida. METHODS: We performed a descriptive analysis of individuals aged 13 to 27 years diagnosed with myelomeningocele (n=348) using data obtained from an existing database at Children's Hospital and Regional Medical Center, Seattle, Washington. We summarized disease characteristics, utilization of assistive technology, community and self-care independence, and other variables. RESULTS: Eighty-four percent of the respondents lived with at least 1 of their natural parents. Fifty-seven percent used wheelchairs, 35% used braces, and 23% used walking aids. Independent self-care was a common skill, but 72% reported limited participation in structured activities. Half were aged 18 years or older; of those, only 50% had completed high school and 71% were unemployed. Those aged younger than 18 years were all still in school (100%). CONCLUSIONS: Adolescents and young adults with spina bifida rely on assistive technology and specialized care routines to maintain their health. Assistive technology use for mobility is common; little is known about secondary complications associated with use of these technologies or the use of assistive technology to address learning disabilities and other societal barriers. Underutilization of assistive technology could delay successful transitions to independent living and community participation.

Activities of Daily Living↗
PubMed1995

Findings in post-poliomyelitis syndrome. Weakness of muscles of the calf as a source of late pain and fatigue of muscles of the thigh after poliomyelitis.

The purpose of this study was to identify overuse of muscles and other alterations in the mechanics of gait in twenty-one patients who had muscular dysfunction as a late consequence of poliomyelitis. All of the patients had good or normal strength (grade 4 or 5) of the vastus lateralis and zero to fair strength (grade 0 to 3) of the calf, as determined by manual testing. Dynamic electromyography was used, while the patients were walking, to quantify the intensity and duration of contraction of the inferior part of the gluteus maximus, the long head of the biceps femoris, the vastus lateralis, and the soleus muscles. Patterns of contact of the foot with the floor, temporal-spatial parameters, and motion of the knee and ankle were recorded. The principal mechanisms of substitution for a weak calf muscle fell into three groups: overuse of the quadriceps (twelve patients) or a hip extensor (the inferior part of the gluteus maximus in eight patients and the long head of the biceps femoris in four), or both; equinus contracture (twelve patients); and avoidance of loading-response flexion of the knee (five patients). Most patients used more than one method of substitution. These observations support the theory that post-poliomyelitis syndrome results from long-term substitutions for muscular weakness that place increased demands on joints, ligaments, and muscles and that treatment--based on the early identification of overuse of muscles and ligamentous strain--should aim at modification of lifestyle and include use of a brace.

Ankle Joint↗
PubMed1996

Pain in the posterior aspect of the ankle in dancers. Differential diagnosis and operative treatment.

A retrospective review was performed of the results of operative treatment of stenosing tenosynovitis of the flexor hallucis longus tendon or posterior impingement syndrome, or both, in thirty-seven dancers (forty-one operations). The average duration of follow-up was seven years (range, two to thirteen years). The results were assessed with use of a questionnaire for all patients, and a clinical evaluation was performed for twenty-one patients (twenty-two ankles). Twenty-six operations were performed for tendinitis and posterior impingement; nine, for isolated tendinitis; and six, for isolated posterior impingement syndrome. A medial incision was used in thirty-three procedures; a lateral incision, in six; an anterior and a medial incision, in one; and a lateral and a medial incision, in one. Thirty ankles had a good or excellent result; six, a fair result; and four, a poor result. (The result of the second procedure on an ankle that was operated on twice was not included.) The result was good or excellent for twenty-eight of the thirty-four ankles in professional dancers, compared with only two of the six ankles in amateur dancers.

Adolescent↗
PubMed1996

Carpal instability in the weight-bearing upper extremity.

The prevalence of carpal instability in a paraplegic population was investigated to establish an association between chronic repetitive stress on the wrist and the development of such instability. Nine of 162 paraplegic patients had static carpal instability and no history of an acute injury of the wrist. The predominant pattern of instability, found in eleven wrists (six patients), was non-dissociative volar intercalated segmental instability. The prevalence of carpal instability increased with the duration of weight-bearing on the upper extremity. Eighteen per cent of the patients in whom the spinal cord injury had occurred more than twenty years before the study had carpal instability. Carpal instability in these weight-bearing upper extremities and the increase in its prevalence with the duration of the forces across the wrist demonstrate an association between chronic repetitive stress on the wrist and carpal instability.

Adult↗
PubMed1999

Strains in the metatarsals during the stance phase of gait: implications for stress fractures.

BACKGROUND: Stress fractures of the metatarsals are common overuse injuries in athletes and military cadets, yet their etiology remains unclear. In vitro, high bone strains have been associated with the accumulation of microdamage and shortened fatigue life. It is therefore postulated that stress fractures in vivo are caused by elevated strains, which lead to the accumulation of excessive damage. We used a cadaver model to test the hypothesis that strains in the metatarsals increase with simulated muscle fatigue and plantar fasciotomy. METHODS: A dynamic gait simulator was used to load fifteen cadaveric feet during the entire stance phase of gait under conditions simulating normal walking, walking with fatigue of the auxiliary plantar flexors, and walking after a plantar fasciotomy. Strains were measured, with use of axial strain-gauges, in the dorsal, medial, and lateral aspects of the diaphysis of the second and fifth metatarsals as well as in the proximal metaphysis of the fifth metatarsal. RESULTS: When the feet were loaded under normal walking conditions, the mean peak strain in the dorsal aspect of the second metatarsal (-1897 microstrain) was more than twice that in the medial aspect of the fifth metatarsal (-908 microstrain). Simulated muscle fatigue significantly increased peak strain in the second metatarsal and decreased peak strain in the fifth metatarsal. Release of the plantar fascia caused significant alterations in strain in both metatarsal bones; these alterations were greater than those caused by muscle fatigue. After the plantar fasciotomy, the mean peak strain in the dorsal aspect of the second metatarsal (-3797 microstrain) was twice that under normal walking conditions. CONCLUSIONS: The peak axial strain in the diaphysis of the second metatarsal is significantly (p < 0.0001) higher than that in the diaphysis of the fifth metatarsal during normal gait. The plantar fascia and the auxiliary plantar flexors are important for maintaining normal strains in the metatarsals during gait.

Adult↗
PubMed2003

Outcome of surgical treatment of medial tibial stress syndrome.

BACKGROUND: Medial tibial stress syndrome is a common chronic sports injury characterized by exercise-induced pain along the posteromedial border of the tibia. The reported outcomes of surgical treatment of this condition have varied. METHODS: Of seventy-eight patients who underwent surgery for medial tibial stress syndrome, forty-six (thirty-one men and fifteen women) returned for follow-up. The outcomes of the surgery were determined by comparing preoperative and postoperative pain levels as indicated on a visual analog pain scale and ascertaining the ability of the athletes to return to presymptom levels of exercise. RESULTS: The mean duration of postoperative follow-up was thirty months (range, six to sixty-three months). Surgery significantly reduced pain levels (p < 0.001) by an average of 72% as indicated on the visual analog pain scale. An excellent result was achieved in 35% of the limbs; a good result, in 34%; a fair result, in 22%; and a poor result, in 9%. Despite the success with regard to pain reduction, for a variety of reasons only nineteen (41%) of the athletes fully returned to their presymptom sports activity. CONCLUSIONS: Surgery can significantly reduce the pain associated with medial tibial stress syndrome. Despite this reduction in pain, athletes should be counseled that a full uninhibited return to sports is not always achieved.

Adolescent↗
PubMed2005

Vascular changes of the hand in professional baseball players with emphasis on digital ischemia in catchers.

BACKGROUND: Repetitive trauma to the hand is a concern for baseball players. The present study investigated the effects of repetitive trauma and the prevalence of microvascular pathological changes in the hands of minor league professional baseball players. In contrast to previous investigators, we documented the presence of abnormalities in younger, asymptomatic individuals. METHODS: Thirty-six baseball players on active minor league rosters underwent a history and physical examination of both hands as well as additional specialized tests, including Doppler ultrasound, a timed Allen test, determination of digital brachial pressure indices, and ring sizing of fingers. Data were compared between gloved hands and throwing hands, hitters and nonhitters, and players at four different positions (catcher [nine subjects], outfielder [seven subjects], infielder [five subjects], and pitcher [fifteen subjects]). RESULTS: Digital brachial indices in the ring fingers of the gloved (p < 0.05) and throwing hands (p < 0.02) of catchers were significantly diminished compared with those in all other players. Doppler testing showed a significantly greater prevalence of abnormal flow in the ulnar artery at Guyon's canal when catchers were compared with other position players (p < 0.01). Doppler abnormalities were significantly more common in the gloved hand compared with the throwing hand (p < 0.05). Seven of nine catchers (and only catchers) were found to have index finger hypertrophy (average change, two ring sizes; p < 0.01); the hypertrophy occurred at the proximal phalanx and the proximal interphalangeal joint of the gloved hand. Catchers had a significantly higher prevalence of subjective hand symptoms (specifically, weakness in the gloved hand) compared with pitchers and infielders/outfielders (44% compared with 7% and 17%, respectively; p < 0.05). CONCLUSIONS: Microvascular changes are present in the hands of otherwise healthy professional baseball players in all positions, with a significantly higher prevalence in catchers, prior to the development of clinically important ischemia. Repetitive trauma resulting from the impact of the baseball also leads to digital hypertrophy in the index finger of the gloved hand of catchers. Gloves currently used by professional catchers do not adequately protect the hand from repetitive trauma.

Adult↗
PubMed1988

The role of biomechanics in the epidemiology of injuries.

In this paper a review of the epidemiology of both traumatic and overuse injuries is presented with special emphasis on the role of biomechanics. Biomechanical analysis of injuries and the specific sports has increased in sophistication to such a degree we have a much better understanding of both aetiology and management. Particularly in the area of overuse injuries this biomechanical data can also be utilised in prevention. This paper discusses acute traumatic injuries with emphasis on knee injuries. A detailed examination of knee injuries during skiing is explored. In addition, cervical injuries in gridiron football and rugby are outlined. Overuse injuries occurring during running are next discussed. Aetiological factors including training errors, muscular dysfunction and inflexibility, footwear, running gait and lower extremity malalignment are considered. Overuse injuries in swimming, dance, gymnastics and throwing sports are briefly discussed. Biochemical analysis is felt to be important in developing strategies that lead to rule changes, alteration of training techniques and improvement in equipment and footwear.

Athletic Injuries↗
PubMed1989

Prevention and treatment of overuse tendon injuries.

Overuse injuries are common in recreational and competitive sports as well as in day-to-day activities. The musculotendinous unit comprises the tissue most frequently involved: structural damage to the tendon occurs from repetitive strain and loading, from either endurance or skill activities that require technique and power. The potential for injury is enhanced by a great variety of predisposing intrinsic or extrinsic factors. Tendinous tissue will become fatigued as its basal reparative ability is overwhelmed by repetitive dysfunctional and microtraumatic processes. Tendinitis is the earliest recognisable manifestation of overuse injury: as damage progresses, partial tears and complete ruptures may ensue. The diagnosis of overuse injury rests with identification not only of the affected tendinous unit, but also of the underlying predisposing condition or conditions. Treatment can then proceed with elimination or correction, if possible, of these conditions, together with control of inflammation and programmes of modalities designed to restore the structural and functional integrity of the tendon. Knowledge of overuse problems has grown exponentially in the past 3 decades, as evidenced by the outpouring of scientific and medical literature. Sophisticated analytical techniques, supplementing a sound history and physical examination, have greatly facilitated the diagnosis of overuse problems and allowed the application of scientific therapeutic principles. As the number of participants in recreational activities continues to grow, the application of these techniques in ever more innovative ways holds the greatest promise for the prevention of overuse tendon injuries.

Athletic Injuries↗