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PubMedDate not supplied

Clinical assessment, prognosis and return to work with reference to work related neck and upper limb disorders.

OBJECTIVES: To describe the clinical assessment and management of work related neck and upper limb disorders. METHODS: A total of 65 references in English were found in Pub Med for the years 1980-2002 that dealt with clinical assessment, prognosis and return to work with reference to neck and upper limb original research that dealt with test performance in diagnostic procedures. Few studies were randomised studies of prognosis and return to work with reference to neck and upper limb disorders. RESULTS: The clinical assessment consists of the clinical and exposure history, the evaluation of the physical and laboratory findings. The physical examination should include the following steps: (1) inspection; (2) testing for range of motion (3) testing for muscle contraction pain and muscle strength (4) palpation of muscle tendons and insertions and (5) specific tests. The characteristics of clinical tests in terms of likelihood ratio for confirming and ruling out disease have to be considered for the diagnosis. The use of terms such as RSI (repetitive strain injuries) and CTD (cumulative trauma disorders) should be avoided. If the different musculoskeletal symptoms and signs do not completely comply with criteria for a disease, it is recommended to choose an ICD (International Classification of Disease) label that focuses on the symptoms rather than the pathology. The prognosis for most work related disorders are variable. The general experience is for non-specific neck and upper arm that pain and discomfort may be decreased but not eliminated in the majority of cases. It is important to start rehabilitation early. Long periods of sick leave are generally counterproductive. Disputed workers' compensation claims and an adverse work setting also are likely to impede successful rehabilitation. Since most patients with musculoskeletal disorders are also exposed to ergonomic stressors accommodation of the injured worker has to take the whole work system into account (task, technology, environment and organization). CONCLUSIONS: Despite the large number of patients with neck and upper limb disorders the scientific evidence for clinical assessment, to determine the prognosis and for successful procedures for return to work are few.

Arm↗

PubMed1991

Occupational musculoskeletal disorders in the neck and upper limbs of forestry workers exposed to hand-arm vibration.

An epidemiologic and clinical study of neck and upper limb musculoskeletal disorders was carried out on 65 vibration-exposed forestry operators using chain-saws and 31 comparable control subjects (maintenance workers) performing manual activity and not exposed to vibration. Upper limb function was evaluated by measuring finger and wrist circumference size, maximal hand grip strength and range of motion manoeuvres in both the controls and the exposed workers. Vibration from two chain-saws was measured, and vibration exposure for each forestry worker was assessed in terms of 4 h energy-equivalent frequency-weighted acceleration according to ISO 5349. Job analysis indicated a slight excess risk of upper extremity cumulative trauma disorders (CTDs) in the forestry operators compared with the control workers. After adjustment for age and body constitution, significantly higher prevalence rates of persistent upper limb pain, muscle-tendon syndromes and carpal tunnel syndrome were observed among the forestry workers than among the controls. In the forestry operators, the occurrence of upper limb musculoskeletal disorders increased with increasing vibration exposure. Upper limb function was found to be impaired in the forestry workers compared with the controls. Vibration exposure was significantly related to increased finger circumference size, diminished muscle force and reduced joint function. Even though it is difficult to establish the relative importance of vibration and ergonomic factors in the aetiology of CTDs, nevertheless the results of this study indicate that musculoskeletal impairment to the upper limbs was more severe in the forestry operators than in the controls who did solely manual work. This finding and the observed dose-effect relationships suggest that vibration stress is an important contributor to the development of musculoskeletal disorders in workers using hand-held vibrating tools.

Adult↗

PubMed1990

Evolving concerns relating to occupational disorders of the upper extremity.

Occupational disorders of the upper extremity have become a problem of increasing concern around the world. The management of these problems must be understood in light of current social trends that influence patient management. Workers' compensation is one of these continually developing trends. This article describes the historical aspects of compensation and bodily injury or loss occurring in the work place. Changes in workers' attitudes during the development of workers' compensation have been observed since the turn of the century. The influence of the legal system in this regard is also noteworthy. The modern surgeon is faced with these confounding influences when treating a patient with a work-related injury or cumulative trauma disorder.

Arm Injuries↗

PubMed1987

Upper extremity musculoskeletal disorders in hospital workers.

Seventy-six women who worked in a hospital were surveyed for symptoms and signs of upper limb musculoskeletal disorders. The investigation was originally intended to study the effects of repetitive manual work that was performed by a group of garment assembly workers. Hospital workers were selected as the referent group on the assumption that they were unexposed to ergonomic stressors. However, the study showed that the prevalence of shoulder, wrist, and hand pain in these workers was sufficiently high (32%) to require that this assumption be reexamined. The hospital workers that were affected the most were employed in the nursing field and in manual work, i.e., food preparation, serving, and laundry. The women with upper limb pain were older and had been employed somewhat longer in hospital work than those without pain. Several jobs were observed to identify possible occupational risk factors for cumulative trauma disorders (CTDs). In addition to repetitive motion, these factors included forceful manual exertions and awkward postures required by work station design and layout.

Adult↗

PubMed1999

Wrist and forearm postures and motions during typing.

Awkward upper extremity postures and repetitive wrist motions have been identified by some studies as risk factors for upper extremity musculoskeletal disorders during keyboard work. However, accurate body postures and joint motions of typists typing on standardized workstations are not known. A laboratory study was conducted to continuously measure wrist and forearm postures and motions of 25 subjects while they typed for 10-15 min at a standard computer workstation adjusted to the subjects' anthropometry. Electrogoniometers continuously recorded wrist and forearm angles. Joint angular velocities and accelerations were calculated from the postural data. The results indicate that wrist and forearm postures during typing were sustained at non-neutral angles; mean wrist extension angle was 23.4 +/- 10.9 degrees on the left and 19.9 +/- 8.6 degrees on the right. Mean ulnar deviation was 14.7 +/- 10.1 degrees on the left and 18.6 +/- 5.8 degrees on the right. More than 73% of subjects typed with the left or right wrist in greater than 15 degrees extension and more than 20% typed with the left or right wrist in greater than 20 degrees ulnar deviation. Joint angles and motions while typing on an adjusted computer workstation were not predictable based on anthropometry or typing speed and varied widely between subjects. Wrist motions are rapid and are similar in magnitude to wrist motions of industrial workers performing jobs having a high risk for developing cumulative trauma disorders. The magnitude of the dynamic components suggests that wrist joint motions may need to be evaluated as a risk factor for musculoskeletal disorders during typing.

Adult↗

PubMed1998

Use of ultrasonography in monitoring work-related carpal tunnel syndrome: a case report.

Carpal tunnel syndrome (CTS) is a syndrome whose diagnosis is well established. One cause could be occupational factors, while others have no relation to work or the work environment. We present in this article a case report regarding a worker affected by CTS, which is of interest concerning the sensitivity of ultrasonography and electroneurography, applied as diagnostic methods, related in our protocol to the variations in occupational exposures. The case reports an agricultural worker, whose tasks required repetitive and high frequency movements of the hand-arm. Diagnosis of CTS used ultrasonography and electroneurography techniques. In our opinion, the clinical evolution of CTS encompasses three "work-related" phases (preclinical phase; phase of nerve compression; phase of irreversible damage). Ultrasonography provides greater information about the evolution of CTS, as well as other cumulative trauma disorders, and is able to discern tendinitis of flexors causing a compression on the median nerve in the carpal tunnel.

Carpal Tunnel Syndrome↗

PubMed2002

Self-reported hand and wrist arthritis and occupation: data from the U.S. National Health Interview Survey-Occupational Health Supplement.

BACKGROUND: There is a paucity of population-based studies examining occupational hand-wrist arthritis. We examined relationships between hand-wrist arthritis, occupation, and biomechanical exposures in the U.S. National Health Interview Survey-Occupational Health Supplement. METHODS: A randomized, multi-stage, and cross-sectional national prevalence survey was carried out. RESULTS: Self-reported, medically attended hand-wrist arthritis was common among employed persons (period prevalence 1.58%; lifetime prevalence 3.58%). Highest prevalences occurred among technicians, machine operators, assemblers, and farmers, and in the mining, agriculture, and construction industries. Work requiring repetitive hand bending and twisting was associated with hand-wrist arthritis (Odds Ratio 1.43; 95%CI: 1.11-1.84; P = 0.005). Among workers with hand arthritis, 7.4% had made major changes in their work, 7.6% missed work, and 4.5% stopped working or changed jobs because of the problem. CONCLUSIONS: Our study links hand-wrist arthritis to occupation and potentially modifiable workplace ergonomic factors. The spectrum of hand-wrist "cumulative trauma" disorders may considerably exceed that of soft-tissue injuries like carpal tunnel syndrome and tendonitis, and may include arthritis, a widely prevalent, disabling condition.

Arthritis↗

PubMed1992

Use of provincial health insurance plan billing data to estimate carpal tunnel syndrome morbidity and surgery rates.

Following a work refusal at a plant manufacturing ice cream novelties in Ontario, we were asked to document cases of cumulative trauma disorders (CTDs) and carpal tunnel syndrome (CTS) in this workplace. There were 17 employees with possible hand and wrist problems identified from Workers Compensation Board (WCB) Forms, and from a list prepared at the time of the refusal. After obtaining consents, confirmations of the diagnoses of CTDs, CTS, and of surgical procedures for CTS were obtained from the physicians involved. The relative risk for these disorders among plant employees was estimated in two ways: 1) the rate of CTS operations between 1979 and 1990 was compared to that in the general population using Ontario Health Insurance Plan (OHIP) data on physicians' billings for these operations; and 2) the frequency of WCB first payment claims for tendinitis and CTS during 1987 to 1989 at the plant was compared to that among the entire labor force of Ontario. CTDs had been diagnosed in all 17 workers: 9 had had operations for CTS, but one had had this operation prior to working at the plant. Compared to the remaining 8 workers who had CTS operations, an estimated 0.08 CTS operations would be expected among the 150 employees on the plant's seniority lists between 1979 and 1990, if the estimated rates in the general population were present at the plant, giving a Standardized Morbidity Ratio of 10.0 (95% confidence interval [CI] 4.3-19.7; one-sided p = 2.1 x 10(-6)). There were 6 WCB claims for tendinitis and CTS among plant employees during 1987 through 1989. This frequency was about 68 times that in the entire Ontario labor force (95% CI 24.7-150). This investigation has shown that CTDs, and particularly CTS, documented by medical records, have occurred at least 10 times more frequently than expected at this plant. Use of health insurance billing data to estimate CTS operation rates represents a simple method for estimating the burden of illness at the individual plant level due to CTS (at least for that portion proceeding to surgery), using an objective outcome that can be confirmed from medical records.

Adult↗

PubMed1996

Fibrosis and intercellular collagen connections from four weeks of muscle strains.

The effect of repeated cycles of muscle strain was studied in the soleus muscle of female rats. Muscle strains were repeated 3X/week for 1 month using two different strain protocols. Striking changes, including marked variability in fiber size, evidence of degradation and regeneration, and an expanded extracellular matrix were pronounced in the fast-stretched muscles but not in the slow-stretched muscles. However, the slow-stretched muscles did contain struts of connective tissue joining adjacent myofibers. Therefore, repeated muscle strains at high strain rates produced morphological changes similar to many myopathies, including fibrosis, whereas adaptation occurred in response to the same number of strains at slow strain rates. Such diverse tissue responses have relevance to the understanding of the mechanisms of skeletal muscle dysfunction in cumulative trauma disorders and in the design of preventive actions and treatments.

Animals↗

PubMed2004

Changes in job stress, musculoskeletal symptoms, and complaints of unfavorable working conditions among nurses after the adoption of a computerized order communication system.

OBJECTIVES: Order communication system (OCS) is a real-time computerized hospital information system that supports communication of orders from the ward users to the service departments. The adoption of an OCS may profoundly alter the service patterns of healthcare workers. As a result, job stress, musculoskeletal symptoms, and complaints of unfavorable working conditions can be expected to increase. This study investigated changes in job stress, musculoskeletal symptoms, and complaints of unfavorable working conditions among nurses after an OCS had been adopted and whether adoption of the system affected the changes. METHODS: A group of nurses employed in a university hospital in Korea was surveyed 1 month before and 3 months after the OCS had been adopted. We used Karasek's job contents questionnaire (JCQ) to evaluate job stress. The cumulative trauma disorder (CTD) questionnaire was used to assess the presence of musculoskeletal symptoms. The presence of unfavorable working conditions was also assessed. Next, we evaluated whether non-work factors (such as demographic factors and life events) had influence on job stress, musculoskeletal symptoms, and complaints of unfavorable working conditions after adoption of the OCS. RESULTS: One hundred thirty nurses from the hospital (51.2%) responded to both surveys. Several JCQ scales were notably altered after OCS adoption; psychological job demand was significantly decreased (P < 0.01), although subjective assessment for hazardous conditions was significantly increased (P < 0.01). There was a significant increase in back complaints (P < 0.05). There was considerable decrease in the number of nurses who complained of 'increase in work intensity' (P < 0.05), 'increase of staying time to deal with remaining duties' (P < 0.05), and 'abrupt change of duties' (P < 0.01). According to the analysis for the associations between non-work factors and significantly changed variables, only two non-work factors, 'tenure' and 'conflicts with friend(s)', showed statistical significance with complaints of 'increase in work intensity' (P < 0.05) CONCLUSIONS. This study suggests that a newly adopted computerized system might have provoked changes in job stress, musculoskeletal symptoms, and the complaints of unfavorable working conditions. It was found that, despite the overall favorable changes, complaints of hazardous conditions and back symptoms increased.

Adult↗

PubMed1990

Use of computer aided drafting for analysis and control of posture in manual work.

Computer aided design (CAD) in conjunction with digitised anthropometric manikins can be used for analysis and control of stressful work postures, one of the most frequently cited occupational risk factors of upper extremity cumulative trauma disorders. This paper describes the use of macros for manipulating manikins and workstation components and for designing the workplace. AutoCAD, a popular computer aided design software package, was used to demonstrate the feasibility of these concepts. Specifically, macros are used for drawing work equipment using parametric designs, manipulating manikins and analysing jobs. In comparing the macros to the use of primitive CAD commands, the macros not only decrease the amount of time needed to create workstation components, but they also make the task easier for the user and decrease the risk of errors. Despite the limitation of anthropometric data and manikins, CAD is an effective method for identifying postural stresses and redesigning the workstation to control the identified stresses.

Journal Article↗

PubMed1993

An approach to ergonomics evaluation of hand tools.

Based on current knowledge of cumulative trauma disorders in the hand and forearm, related to the use of hand tools, an analysis was undertaken of variables to be considered in ergonomics evaluation of hand tools. Measurement methods were developed and an evaluation station was implemented. Measurement methods are physical, physiological or psychophysical. They focus on the tool, and on the effect of typical use of the tool on the operator. The evaluation station serves as a resource in the development, selection, and testing of tools for a given purpose.

Journal Article↗

PubMed1994

A field methodology for the control of musculoskeletal injuries.

A methodology is presented for the evaluation of jobs prone to cumulative trauma disorders (CTDs) and manual material handling (MMH) injuries, which combines various tested ergonomics methodologies into a single, coherent programme. This multi-step procedure is based upon the collection of quantitative data that are used to evaluate ergonomic changes with respect to biomechanical risk, perceived comfort, productivity and quality. A method for prioritizing changes, related to cost-benefit analysis, is proposed to guide the selection of ergonomic changes in order to maximize the potential for injury reduction under specified cost constraints. The ten-step methodology has been extensively applied in industry, leading to examples and a case study.

Journal Article↗

PubMed1995

Packing products for customers: an ergonomics evaluation of three supermarket checkouts.

The introduction of laser scanners at supermarket checkout areas has resulted in previous ergonomics studies focusing specifically on the scanning process and associated cumulative trauma disorders in the hands and arms. Few studies have evaluated the increased musculoskeletal load and exertion of checkout staff when they are also expected to pack the products into bags for the customers. This paper describes an ergonomics evaluation of three different designs of checkout workstation, which require the operator to stand when they scan the products, pack them into plastic bags and transfer the packed bags to the customer. Musculoskeletal load and exertion associated with the different checkouts were measured using OWAS, heart rate recordings and ratings of perceived exertion. In addition, subjective rankings of the workstations were obtained and the productivity associated with each design examined as part of the evaluation. Some of the variables measured showed significant differences in postural load between the workstations. The results of the evaluation formed the basis of recommendations for an improved workstation design. Some of the suggestions made to reduce postural load and increase productivity include positioning the weigh scale to the side and the bag frame beneath the scanner.

Journal Article↗

PubMed1995

Computer workstation adjustment: a novel process and large sample study.

The use of computers in the US workforce is expected to grow throughout the 1990s. Prolonged computer use, repetitive keying, awkward postures and psychosocial issues have been associated with injuries described as cumulative trauma disorders (CTDs). The incidence and reporting of occupationally induced CTDs has increased dramatically since 1980. Proper adjustment of individual computer workstations requires time and technical knowledge. An automated process for computer workstation adjustment was developed using linked-segment anthropometry. Over 3300 employees in a large industrial complex voluntarily participated in this programme by completing a computer workstation questionnaire. Significant relationships were demonstrated comparing both hours and years of computer use with symptoms. A followup questionnaire was completed by 531 programme participants. Ninety percent indicated an improved understanding of proper computer adjustment. Eighty percent of those making recommended adjustments indicated benefits in reduced symptoms and greater work efficiency.

Journal Article↗

PubMed1994

Lumbrical muscle incursion into the carpal tunnel during finger flexion.

Carpal tunnel syndrome is one of the many so-called cumulative trauma disorders thought by some to be related to the performance of repetitive tasks in the work-place. The cause of this disorder is unknown. We have observed lumbrical muscle incursion into the carpal tunnel during finger flexion. This study was conducted to determine the amount of this incursion in normal wrists. Five cadaver upper limbs were analyzed radiographically with radiopaque markers on the flexor retinaculum and the lumbrical muscle origins in four finger positions: full extension, 50% flexion, 75% flexion, and 100% finger flexion. The lumbrical muscle origins were an average of 7.8 mm distal to the carpal tunnel in full finger extension. They moved an average of 14 mm into the carpal tunnel with 50% finger flexion, 25.5 mm with 75% flexion, and 30 mm with 100% flexion. Abnormal lumbrical muscles have been cited as a possible cause of carpal tunnel syndrome. These findings suggest that lumbrical muscle incursion during finger flexion is a normal occurrence and is a possible cause of work-related carpal tunnel syndrome.

Carpal Bones↗

PubMed2005

Tendon and nerve displacement at the wrist during finger movements.

BACKGROUND: Repetitive motion of the hand has been suggested as a major factor of pathogenesis of cumulative trauma disorders (e.g., carpal tunnel syndrome). The purpose of this study was to investigate the 3D displacement of the median nerve and extrinsic finger flexor tendons (flexor digitorum superficialis; flexor digitorum profundus) as a function of flexion/extension of metacarpophalangeal joints of the index and middle fingers. METHODS: Shim markers were placed on the median nerve, flexor digitorum superficialis, and flexor digitorum profundus tendons at the wrist region of seven cadaveric specimens for the purpose of digitization of tendon and nerve locations. The metacarpophalangeal joint of the index or middle finger was moved from 15 degrees extension to 75 degrees of flexion while the markers were digitized at increments of 15 degrees. Marker displacements were determined in the longitudinal, radial-ulnar, and dorsal-palmar directions. FINDINGS: Movement of metacarpophalangeal joint of the index or middle finger caused tendon and nerve displacements in the longitudinal, radial-ulnar, and dorsal-palmar directions. The longitudinal displacements of the median nerve and the flexor tendons were linearly correlated with angular movement of the metacarpophalangeal joint. The maximum longitudinal displacements of the flexor digitorum superficialis tendon, flexor digitorum profundus tendon, and median nerve were, on average, 14.7 mm, 11.9 mm, and 3.0 mm, respectively, for the index finger; and 18.4 mm, 14.5 mm, and 4.0 mm, respectively, for the middle finger. The radial-ulnar and dorsal-palmar displacements were irregular and relatively small. The maximum displacements in these transverse directions fell in the range of 1.4-5.1 mm for the median nerve and 1.9-7.3 mm for the flexor tendons. INTERPRETATIONS: Finger flexor tendons and median nerve move not only concurrently, but also differentially, in all anatomical directions. Tendon and nerve movement during prolonged repetitive hand movement may cause hand disorders such as carpal tunnel syndrome.

Aged↗

PubMed2002

Ergonomics study on the handle length and lift angle for the culinary spatula.

The culinary spatula (turning shovel) is one of the most common cooking tools used in the kitchen in Asia. However, the culinary spatula has seldom been ergonomically investigated. When a person uses a spatula to cook food, the operations involve repetitive bent-wrist motions, such as dorsiflexion, palmary flexion, and radial and ulnar deviations. These movements may cause cumulative trauma disorders in the upper extremities, and in particular carpal tunnel syndrome. A poorly designed culinary spatula will be ergonomically inefficient and cause injury to the hand and wrist. The purpose of this study was to investigate the effects of spatula handle length and lift angle on food-frying, food-turning, and food-shoveling performance. Eight female subjects were tested using 16 different culinary spatulas, with four different handle lengths (20, 25, 30 and 35 cm) and four different lift angles (15 degrees, 25 degrees, 35 degrees and 45 ). The criterion measures included cooking performance, and rating of perceived exertion. The subjects ranked their preference after all of the tasks in the tests were completed. The results showed that: (1) The handle length had a significant influence on the cooking performance, and rating of perceived exertion. The optimal handle lengths for frying food, turning food, and shoveling food were 20, 25 and 25 cm, respectively. (2) The lift angle significantly affected the cooking performance, and rating of perceived exertion. The optimal lift angles for frying food, turning food, and shoveling food were 15 degrees, 15 degrees and 25 degrees, respectively. (3) Both the handle length and lift angle had significant effects on subjective preference. For the handle length, the 20 cm length was the best. For the lift angle, the 25 angle was the best. (4) In general, a spatula with a 20 cm handle length and 25 degrees lift angle was the best. A spatula with a 25 cm handle length and 15 lift angle was the second most preferred. (5) However, to prevent subjects from touching the edge of a hot pan, a spatula with a 25 cm handle length and 25 lift angle is suggested.

Adult↗