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PubMed1989

Incidence of upper extremity discomfort among piano students.

The purpose of this study was to determine the incidence of upper extremity discomfort among piano majors at seven Philadelphia-area music schools. A questionnaire was distributed to 232 students, and a 31% return rate was obtained. Thirty (42%) of the 71 respondents reported experiencing discomfort that lasted more than 1 week, and 41 (58%) of the respondents reported experiencing little or no discomfort. Twenty-six (87%) of the students with discomfort suspended practice for a period of time or made adjustments at the piano. Pain/aching was the predominant discomfort reported among students. Students experienced their discomforts most frequently in the band (49% of respondents), the forearm (19% of respondents), and the wrist (16% of respondents). The majority of students reported an impaired ability to play the piano that lasted for 6 months or less. Further research is needed to verify the scope of the problem among student pianists and to substantiate the numerous causes of discomfort that were uncovered in this study. This occupational group could benefit from the knowledge and skills of occupational therapists in the area of occupational performance and physical function.

Adult↗
PubMed2006

Changes in neuromuscular function due to intermittently increased workload during repetitive work in cold conditions.

OBJECTIVES: This study attempted to determine whether repetitive work in the cold affects the number of electromyographic (EMG) gaps and whether cold-induced deterioration in neuromuscular function can be restored by altering work intensity. METHODS: During 2 hours of simulated sausage packing, the occurrence of EMG gaps was studied in eight upper-extremity muscles at 19 degrees C and 4 degrees C. The additional effect of continuous, light repetitive work [wrist flexion-extension 10% of the maximal voluntary contraction (MVC), Cwork] and intermittently increased workload (10% or 30% MVC) (Iwork) on forearm muscle EMG gaps, the median frequency of the EMG spectrum, EMG activity, and muscle fatigue (as indicated by changes in the MVC of wrist flexion) at 4 degrees C was studied. RESULTS: During work simulation, the mean skin temperature decreased from 33.3 (SD 0.1) degrees C to 30.6 (SD 0.2) degrees C (P<0.05), and the number of EMG gaps diminished in seven muscles by 1.4-68.2% (P<0.05). During Iwork there were 44% and 37% more EMG gaps in the forearm flexors and extensors, respectively, and the median frequency shifted to higher frequencies (P<0.05) as compared with the situation in Cwork. The average EMG activity of the forearm flexors was 13% lower (P<0.05) during Iwork than during Cwork. Wrist flexion MVC decreased 18% and 15% in Cwork and Iwork, respectively. CONCLUSIONS: The cold-induced decrease in the number of EMG gaps and increased muscle strain and fatigue can be, at least partially, restored by intermittently increasing the workload (ie, breaking the monotonous work cycle).

Adult↗
PubMed1996

Vibrotactile perception thresholds as determined by two different devices in a working population.

OBJECTIVES: The purpose of this study was to investigate whether two devices for measuring vibrotactile perception thresholds produced similar results on an individual basis and to compare the thresholds in the presence or absence of sensorineural hand symptoms and vibration exposure. METHODS: Vibrotactile perception thresholds were measured with a vibrameter and a tactilometer in 178 men. The tactilometer uses seven discrete frequencies from 8 to 500 Hz, and the vibrameter uses one frequency (100 Hz). Agreement was assessed from the correlations and from a comparison of subjects who had thresholds above the upper quartile of each device as to the presence of sensorineural hand symptoms and occupational vibration exposure. RESULTS: The correlation between the vibrameter and the tactilometer (125 Hz) was 0.59. The agreement between the vibrameter and the tactilometer (63 Hz), when the upper quartile was used as a limit, had a sensitivity of 0.56 and a specificity of 0.85. The sensitivity and specificity for the agreement with symptoms were 0.44 and 0.79, respectively, for the tactilometer and 0.40 and 0.78, respectively, for the vibrameter. The indices combined from the different frequencies of the tactilometer did not improve the agreement. CONCLUSIONS: Some of the discrepancy between the measurement of the vibrameter and tactilometer can be explained by differences in the equipment, the measurement procedures, and the examiner, combined with high inter-and intraindividual variability. Neither of the two devices was superior when the results were compared as to the occurrence of hand symptoms and vibration exposure. As evaluated in this study vibrotactile perception threshold has a restricted value for screening and diagnostic purposes on an individual basis.

Adult↗
PubMed1996

Is skull sawing by autopsy assistants overlooked as a cause of vibration-induced white fingers?

BACKGROUND: Workers using vibrating tools have an increased prevalence of vibration-induced white fingers. One example of such workers is autopsy assistants, who use vibration for skull sawing. CASE HISTORY: A previously healthy 42-year-old Swedish male smoker had worked as an autopsy assistant at a forensic department between 1977 and 1991. He prepared corpses for autopsy, including sawing the skulls with an electric saw. Beginning in 1983, his right index finger blanched in cold. During subsequent years the blanching spread to the other fingers on the right hand, except for the thumb. The findings in the physical examination and the results of blood tests were normal. Digital blood pressure after cooling showed a severe vasospastic reaction in both middle fingers. Vibration measurements during skull sawing showed a frequency-weighted acceleration level of 8.9 m.s-2. QUESTIONNAIRE SURVEY: A questionnaire was mailed to all assistants (N = 17) preparing autopsies and to all medical examiners, as referents (N = 18), at the Swedish Institutes of Forensic Medicine. It was answered by 13 assistants (76%), 1 woman and 12 men, and 16 medical examiners (89%), 3 women and 13 men. Eleven of the assistants (85%), including one woman, and one of the physicians (6%), a men, reported a history of blanching fingers provoked by chill (difference 79%, P = 0.00003, Fisher's exact test). CONCLUSIONS: Autopsy assistants at forensic departments seem to have an increased prevalence of self-reported blanching fingers, which may be an effect of exposure to high levels of vibration.

Adult↗
PubMed1993

Electromyographic evaluation of muscular work pattern as a predictor of trapezius myalgia.

Electromyographic (EMG) measurements and interviews concerning muscular pain and disability were performed prospectively every 10th week on 30 healthy new female employees of a chocolate manufacturing plant. The static muscle activity and rate of short unconscious interruptions in EMG activity (EMG gaps) of the trapezius muscle during repetitive work tasks were evaluated as possible risk factors for patient status with trapezius myalgia. At the start of employment, the static and median contraction levels were significantly higher in future patients than in the rest of the subjects (nonpatients). In subsequent recordings these values were reduced to the level of the nonpatients. Throughout the study, the future patients had a lower frequency of EMG gaps than the nonpatients. A regression analysis showed a significant value for a low rate of EMG gaps to predict future patient status.

Adult↗
PubMed1992

Electromyographic signs of shoulder muscle fatigue in repetitive arm work paced by the Methods-Time Measurement system.

Surface electromyographic (EMG) recordings from the lateral and cervical portions of the descending trapezius muscle and from the infraspinatus muscle were assessed for six female subjects performing a standardized repetitive work simulation task for 1 h. The work pace was determined according to the Methods-Time Measurement system to 2466 cycles.h-1. The variation in load levels were high and indicated dynamic muscle activity. A decrease in the EMG mean power frequency and an increase in the root-mean-square amplitudes, both indicating muscle fatigue, developed in all muscles of most of the subjects. EMG signs of fatigue, analyzed separately for each 5-min period, showed variable fatigue patterns both between muscles and between subjects. It is therefore suggested that dynamic work movements do not protect the muscles of the shoulder and neck from fatiguing processes in highly repetitive work with short cycle times.

Adult↗
PubMed1991

Prevalence of epicondylitis and elbow pain in the meat-processing industry.

To determine the etiologic role of strenuous manual tasks in relation to epicondylitis, three clinical cross-sectional examinations were performed on meatcutters (N = 102), sausage makers (N = 125), packers (N = 150), and workers in nonstrenuous tasks (N = 332). The workers in strenuous jobs reported elbow symptoms 1.6-1.8 times as often as those in nonstrenuous jobs. Female sausage makers also showed epicondylar tenderness more often than the women in nonstrenuous jobs. In all the cross-sectional examinations combined, seven cases (0.8%) of epicondylitis were detected in both the strenuous and nonstrenuous jobs. A control for the possible sources of bias (leaving the company, changing task, being on sick leave) did not suggest a marked loss of potential cases of epicondylitis. A major role of strenuous tasks in the etiology of epicondylitis was not shown. However, because the number of clinical cases was small, the power of the study was low.

Adult↗
PubMed1997

Occupational and personal risk factors for carpal tunnel syndrome in industrial workers.

OBJECTIVES: The purpose of the study was to evaluate both nonoccupational and occupational factors associated with carpal tunnel syndrome (CTS) in industrial workers. METHODS: Sixty-five workers with CTS were compared with 65 referents matched for gender, age, and plant. The medical history and household activities of the workers and the ergonomic and organizational characteristics of the job were analyzed. RESULTS: Exertion of force over 1 kg was associated with CTS [odds ratio (OR) 9.0]. Two risk factors were related to motion repetitiveness: length of the shortest elementary operation of < or = 10 s (OR 8.8) and lack of change in tasks or lack of breaks for at least 15% of the daily worktime (OR 6.0). No posture of the upper limb was associated with CTS. Workstation design involving the manual supply of the workers (OR 5.0) and the lack of job rotation (OR 6.3) were associated with CTS. The only personal factor associated with CTS was a parity of at least 3 (OR 3.2). There was a continuous increase in the odds ratio against the number of risk factors accumulated by the workers; the odds ratio thus ranged from 5.6 when 3 of the 6 risk factors were present to > or = 90 when 4, 5, or 6 risk factors were accumulated. CONCLUSIONS: The results were in agreement with a model for CTS which included 1 personal and 5 occupational risk factors. The number of risk factors cumulated by the workers seems to be a major determinant of CTS.

Adolescent↗
PubMed1998

Vibrotactile sense in the hand-arm vibration syndrome.

OBJECTIVES: The purpose of this study was to investigate disturbances of the vibrotactile sense and their relation to clinical symptoms and findings among male symptomatic workers suffering from the hand-arm vibration syndrome. METHODS: Ninety-six such patients were interviewed and given a clinical and tactilometric examination. The symptoms were classified according to the Stockholm Workshop Scale. A sensibility index was used to quantify vibrotactile sense in the tactilogram. RESULTS: An abnormal sensibility index (<0.8) was recorded for 57.3% of the patients (mean of 4 fingers), at least 1 finger being abnormal in 72.9% of the patients. The sensibility index did not statistically differ between the patients suffering from sensorineural symptoms and those with vibration white finger. The stages of sensorineural symptoms, according to the Stockholm Workshop Scale, corresponded with the sensibility index, whereas the stages of vibration white finger did not. There were significant differences in the sensibility index between the fingers, between the right and left hands, and between the fingers innervated by the ulnar and median nerves. Bilateral symptoms and cold intolerance were associated with considerable impairment of the vibrotactile sense. Clinical median nerve involvement in the carpal tunnel was not reflected by the sensibility index. CONCLUSIONS: There is a considerable degree of neural involvement in all symptomatic vibration-exposed patients irrespective of symptoms. As symptoms progress, the severity of sensorineural symptoms, but not of vibration white finger, is reflected by the sensibility index. Cold intolerance is strongly related to nervous involvement and should be noted in the patient history. Tactilometry should be performed on 1 median and 1 ulnar nerve-innervated finger of both hands, as an examination of 1 finger alone may be misleading.

Adult↗
PubMed2000

Biopsychosocial rehabilitation for repetitive-strain injuries among working-age adults.

The objective of this study was to determine the effectiveness of biopsychosocial rehabilitation for upper-limb repetitive-strain injuries among working-age adults. Studies were identified from electronic bibliographic databases, reference checks, and consultations with experts in rehabilitation. Four blinded reviewers selected randomized controlled and controlled trials. Two experts evaluated the clinical relevance of the findings. Two other reviewers extracted the data and assessed the main results and the methodological quality of the studies. Finally, a qualitative analysis was performed. Only 2 studies satisfied the criteria. They were both considered to be low-quality trials. The clinical relevance of the included studies was also unsatisfactory. The level of scientific evidence was limited, showing that hypnosis as a supplement to comprehensive treatment can decrease the pain intensity of acute repetitive-strain injury in short follow-ups. There appears to be little scientific evidence for the effectiveness of biopsychosocial rehabilitation with respect to repetitive-strain injuries.

Adolescent↗
PubMed2000

Occupational risk factors for radial tunnel syndrome in industrial workers.

OBJECTIVES: The aim of the study was to evaluate both nonoccupational and occupational factors associated with radial tunnel syndrome (RTS) among industrial workers in 3 large plants. METHODS: Twenty-one cases of RTS were compared with 21 referents matched for gender, age, and plant. RTS was associated with carpal tunnel syndrome (CTS) in 9 cases. Past medical history, household activities, and ergonomic and organizational characteristics of the job were analyzed. RESULTS: The study found 3 occupational risk factors for RTS. Exertion of force of over 1 kg [odds ratio (OR) 9.1, 95% confidence interval (95% CI) 1.4-56.9] more than 10 times per hour was the main biomechanical risk factor. Prolonged static load applied to the hand during work was strongly associated with RTS (OR 5.9, 95% CI 1.2-29.9). Work posture with the elbow fully extended (0-45 degrees) was associated with RTS (OR 4.9, 95% CI 1.0-25.0). Full extension of the elbow, associated with a twisted posture of the forearm, stressed the radial nerve at the elbow. However, personal activities, household chores, and sport and leisure activities were not associated with RTS. CONCLUSIONS: The study confirms that RTS occurs in workers performing hard manual labor that requires forceful and repetitive movements involving elbow extension and forearm prosupination.

Adult↗
PubMed2001

Conservative treatment for repetitive strain injury.

Various conservative treatment options for repetitive strain injury are widely used, despite questionable evidence of their effectiveness. This systematic review evaluates the effectiveness of these treatment options for relieving symptoms of repetitive strain injury and improving activities of daily living. Searches in Medline and Embase, with additional reference checking resulted in 15 eligible trials for this review. Methodological quality was assessed, and data-extraction was performed. With the use of a "best-evidence synthesis", no strong evidence was found for the effectiveness of any of the treatment options. There is limited evidence that multidisciplinary rehabilitation, ergonomic intervention measures, exercises, and spinal manipulation combined with soft tissue therapy are effective in providing symptom relief or improving activities of daily living. There is conflicting evidence for the effectiveness of behavioral therapy. In conclusion, little is known about the effectiveness of conservative treatment options for repetitive strain injury. To establish strong evidence, more high-quality trials are needed.

Behavior Therapy↗
PubMed2002

Individually fitted sports shoes for overuse injuries among newspaper carriers.

OBJECTIVES: The aim of the study was to determine the effectiveness of new, individually fitted sports shoes against overuse injuries to the lower limb among newspaper carriers. METHODS: Patients (N = 176) with lower-limb overuse injuries were randomly assigned to use new, individually adjusted footwear with good shock absorbing properties (test group = 86) or the subjects' own, used footwear (control group = 90). The main outcome measurements were lower-limb pain intensity during walking, as rated on a visual analogue scale (0-100), number of painful days, subjective assessment of global improvement, foot fatigue, number of hyperkeratotic skin lesions and diagnosed overuse injuries, and costs of foot care as compared between the treatment groups. RESULTS: At the 6-month follow-up there was a difference in favor of the test group with respect to lower-limb pain intensity and number of painful days, when compared with the control group. At 1 year, 53% and 33% of the test and control groups, respectively, thought they were better than at the time of the baseline examination (number needed to treat being 5 between the test and control groups). The test subjects had less foot fatigue and fewer hyperkeratotic skin lesions. There was no difference in the number of diagnosed overuse injuries between the groups. During the year of follow-up, the all-inclusive mean costs of foot care were USD 70 and USD 158 in the test and control groups, respectively. CONCLUSIONS: Individually adjusted shock-absorbing shoes offer slight health benefits for lower-limb overuse injuries. Proper shoes may decrease the need to use health care resources.

Adolescent↗
PubMed2002

Effect of mental and physical demands on muscular activity during the use of a computer mouse and a keyboard.

OBJECTIVES: This study explores the effects of mental and physical demands on muscular activity in the use of the mouse and keyboard in computer work in a time-pressed situation. METHODS: Twelve female subjects performed a computer task with four combinations of two forms of input device (computer mouse and keyboard) and two levels of mental demand (with and without a color word test). The time available for response was limited. Performance and electromyography (EMG) were recorded for the forearm, shoulder, and neck muscles. RESULTS: The mean static muscular activity was 2-7% of the maximum EMG for the forearm and neck extensor muscles. All the muscles for which recordings were made showed increased muscular activity in the mentally demanding condition. The increase in the static muscular activity level varied from 0.3% of the maximum EMG for the right trapezius muscle to 2.6% for the extensor carpi ulnaris muscle. Significant differences in muscular activity between the use of a computer mouse and a keyboard were only found for the neck extensors; in the computer mouse condition there was a static EMG level of 3.5% for the maximum EMG, compared with 2.8% for the keyboard. CONCLUSIONS: Mental demands during computer work increased muscular activity in all of the recorded muscles. Increased muscular activity was found in the neck during the use of the mouse in comparison with the use of the keyboard; this phenomenon may be related to higher visual demands during the use of a mouse than with a keyboard. These findings may help explain the adverse effects of psychosocial work factors on the musculoskeletal system.

Adult↗
PubMed2003

Development of neck and hand-wrist symptoms in relation to duration of computer use at work.

OBJECTIVES: This study attempted to identify risk factors for musculoskeletal symptoms in the neck and hand-wrist regions among employees using computers at work. METHODS: Computer users (N=5033) first received a questionnaire in the beginning of 1999 (69% response rate, N=3475), and a follow-up questionnaire was mailed in December of 2000 to the 3361 respondents to the baseline survey (77% response rate, N=2576). Health outcome was defined as musculoskeletal symptoms for >7 days within the last year of follow-up among the nonsymptomatic respondents at baseline. RESULTS: Men's and women's previous symptoms, women's low influence at work and high-placed computer screen, and men's short time in the same job and good computer skills were associated with neck symptoms. Hand-wrist symptoms were predicted by previous symptoms and low influence at work for both the men and women and sensorial demands for the women only. The duration of computer use predicted hand-wrist symptoms [eg, odds ratio (OR) of 2.3, 95% confidence interval (95% CI) 1.2-4.3, for almost continual computer use], but not neck symptoms. For those with almost continual computer use, hand-wrist symptoms were associated with mouse use for at least half of the worktime (OR 4.0, 95% CI 1.0-15.5) and not using the mouse at all (OR 4.0, 95% CI 1.1-14.4), as compared with mouse use for one-fourth of the worktime. CONCLUSIONS: Limiting computer use to less than three-fourths of the worktime would help to prevent hand-wrist symptoms. Furthermore, low influence at work predicts both neck and hand-wrist symptoms.

Adolescent↗
PubMed2005

Risk factors for persistent elbow, forearm and hand pain among computer workers.

OBJECTIVES: This study examined the influence of work-related and personal factors on the prognosis of "severe" elbow, forearm, and wrist-hand pain among computer users. METHODS: In a 1-year follow-up study of 6943 computer users, 673 (10%) participants reported "quite a lot" or more trouble due to elbow, forearm, or wrist-hand pain during the 12 months preceding the baseline questionnaire. Pain status (recovery versus persistence) at follow-up was examined in relation to computer work aspects and ergonomic, psychosocial, and personal factors by questionnaire. In addition, data on objectively recorded computer usage were available for 42% of the participants during the follow-up, measured by means of a program (WorkPaceRecorder) installed on their computers. RESULTS: During the follow-up, two-thirds of the baseline cases improved to some degree, but only one-third experienced substantial improvement. The prognosis was not influenced by mouse or keyboard work (time, speed, micropauses, and average activity periods) or ergonomic workplace conditions. Keyboard times, however, were very low. Pain in other regions was a predictor of persistent arm pain. Except for time pressure, female gender, and type-A behavior, the prognosis seemed independent of psychosocial workplace factors and personal factors. A few cases with severe pain were affected at a level which could be compared to clinical pain conditions. CONCLUSIONS: Our results do not support the hypothesis that computer work activity or ergonomic conditions influence the prognosis of severe arm pain. This result is somewhat surprising and should be tested in other studies. Pain in other regions implies a poorer prognosis for arm pain.

Adult↗