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Orthopedic problems of the upper extremities. Assessment and diagnosis.

1. Cumulative trauma or repetitive motion disorders are among the most commonly reported occupational illness, and mainly affect the neck and upper extremities. 2. The etiology of cumulative trauma disorders includes nerve compression secondary to inflammation and tendinitis secondary to microtearing at tendon insertions and/or friction irritation of the tendons. 3. Work postures, such as forward flexed position of head, neck, and shoulders; static loading of muscles; as well as repetitive motions can cause cumulative trauma disorders or aggravate pre-existing problems. 4. The occupational health nurse is in a unique position to encourage early reporting of these problems so that conservative treatment can be initiated, identify ergonomic issues at the worksite and institute change, and work closely with the orthopedist to manage clients effectively with clear communication and collaboration.

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Ergonomic disorders.

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Cumulative Trauma Disorders↗

Biobehavioral mechanisms of work-related upper extremity disorders: a new agenda for research and practice.

BACKGROUND: Epidemiological studies provide support for the role of organizational and individual psychosocial stressors in work-related upper extremity disorders (WRUEDs). Despite this evidence, the biological plausibility of a relationship between exposure to various psychosocial and work organizational stressors and WRUEDs remains unclear METHODS: The Georgetown Symposium on Biobehavioral Mechanisms of Work-Related Upper Extremity Disorders was held in Washington D.C. on November 6-7, 2000 to improve the understanding of potential biobehavioral mechanisms, identify future areas for research and discuss the implications of this body of knowledge for intervention. This meeting involved presentations and discussions by researchers and clinicians from a number of disciplines (epidemiology, occupational medicine, rheumatology, orthopedics, surgery, internal medicine, psychoneuroimmunology, occupational health psychology, behavioral medicine, psychophysiology and experimental and organizational psychology). RESULTS: The symposium generated several papers addressing the following topics: definitions and job stress models; epidemiological foundations; musculoskeletal and biomechanical models; central nervous system models of recurrent and persistent clinical pain; psychophysiology of work; and implications for intervention. These papers comprise this special issue. DISCUSSION: The present paper summarizes the various contributions to this special issue and provides direction for future research on potential biobehavioral pathways.

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The prevalence of work-related upper limb disorders in a printing factory.

The association between problems of the upper limb and the workplace is complex. A large printing manufacturer in the North West of England sought the advice of both a surgeon, specializing in problems of the upper limb and an ergonomist in an attempt to control the frequency of these abnormalities amongst its workforce. The prevalence of these problems prior to and after the introduction of a number of recommendations was collated and the results are discussed. Effectively the introduction of sensible and sympathetic modifications to the workplace appeared to reduce the number of upper limb disorders.

Adult↗

Professional voice users: the evaluation of voice disorders.

Substantial advances in understanding the anatomy and physiology of phonation, and the new technology that has improved voice measurement and voice surgery, have led to marked improvement in the standard-of-care for patients with voice disorders. Expert voice care is essential for all patients, but especially crucial for voice professionals. Professional voice users include not only singers and actors, but also clergy, teachers, receptionists, sales personnel, physicians, and anyone else whose ability to earn a living is impacted negatively by loss of vocal quality and endurance. Physicians should be familiar with the latest concepts in voice diagnosis and treatment, and with the management of common voice disorders.

Aging↗

Muscle injury in repetitive motion disorders.

Documentation of causality between repetitive motions and musculoskeletal disorders calls for detailed understanding of the exposure variables and the corresponding physiologic responses in the biologic tissues. Quantification of the kinetics in some jobs characterized by repetitive motions is summarized with the physiologic responses in the muscles. Muscle activity pattern was studied in different shoulder muscles or muscle parts, and in elbow and wrist flexor muscles. Activity pattern was dependent on the kinetics of the work requirements. This holds true for the compound electromyographic signal and for single motor units. Low threshold motor units have been identified that are recruited continuously, the so called Cinderella fibers. The physiologic consequences of prolonged muscle fiber activity are reviewed, revealing mechanisms for the development of necrotic changes in the muscle, which support the likelihood of work relatedness for musculoskeletal disorders.

Cumulative Trauma Disorders↗

Working postures: a literature review.

Working postures are addressed in many papers in the ergonomics field but, surprisingly, scientific literature dealing with working posture itself is not common; knowledge has been elusive. This article reviews the working postures literature. Selected papers published in the English language before March 2003 including the phrase "working postures" in the title, abstract, or keywords were searched in the PubMed, Scirus, and Science Direct databases and reviewed. The literature provides evidence that working postures and musculoskeletal health are related. This relationship is supported by the overexertion, differential fatigue, and cumulative load theories of musculoskeletal injuries' precipitation. Goniometers, inclinometers, photographic techniques, electrogoniometers, and video recording systems are the means that are most often used to measure working postures. Information about working postures need to be collected and analyzed in a more systematic way in order to contribute for a deeper understanding of the relationship between working postures and work-related musculoskeletal disorders. This information will help to improve the control and rehabilitation of these highly prevalent disorders.

Cumulative Trauma Disorders↗

Operative management of patellofemoral pain.

In short, the surgical treatment of patients with patellofemoral pain will depend on understanding each specific disorder and the pattern of articular degeneration. Tilt alone generally responds well to lateral release. Subluxation, particularly when more severe, may require medial imbrication and/or a distal (Trillat) procedure in addition to lateral release to achieve extensor mechanism balance. When there is significant patellar arthrosis, an oblique osteotomy deep to the tibial tubercle will permit unloading of the patellar articular surface in addition to realignment. A small amount of metaphyseal bone placed in this oblique osteotomy will permit straight anterior displacement of the tibial tubercle of 15-20 mm with minimal bone graft when necessary. These basic surgical procedures will permit adequate treatment of most patients with resistant patellofemoral pain (with or without arthrosis) when non-operative measures have failed and the appropriate procedure is selected for a specific mechanical disorder.

Athletic Injuries↗

[Insurance coverage in repetitive strain injury of the upper limbs as provided by the National Insurance Institute for Occupational Diseases].

A brief outline is given of the current status of the insurance "coverage" provided by INAIL for WMSDs. In breach of a specific European Union recommendation, in Italy various WMSDs can be recognised as occupational only based upon sentence No 179/88 of the Constitutional Court, since such disorders are not included in the list attached to DPR law 336/94. At present, during the period 1990-95, INAIL awarded indemnities in only a handful of cases. Details are provided concerning the evidence that must be submitted in the specific case of claims pertaining to suspected occupational diseases. The authors discuss the problems associated with quantifying injuries for the purposes of claiming indemnities for work-related musculo-skeletal disorders.

Causality↗