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PubMed2003

Highly repetitive work operations in a modern milking system. A case study of wrist positions and movements in a rotary system.

With the use of electrogoniometers wrist positions and movements were measured in 13 milkers while working in a modern rotary milking system. The rotary system put considerable demands on the wrists and hands regarding both velocities and repetitiveness. Values were found close to those described in other repetitive industrial work with high risk of wrist and hand disorders. For the right hand the repetitiveness was 0.57 Hz and 0.46 Hz for the left hand. In addition, the median value (50th percentile) of the angular velocity distribution was also high, being 36 degrees /s for the right hand and 26 degrees /s for the left, and with respect to the peak value (90th percentile) the corresponding values were 155 degrees /s and 135 degrees /s, respectively. Furthermore, when milking in the rotary system, there was less possibility to hold the hands still than in the other milking systems. The right hand rested only 1.4% of the milking time and the left only 1.0%. The hands were therefore moving throughout almost the entire milking procedure. High velocity, repetitiveness and fewer opportunities for rest are risk factors that might lead to disorders in the wrists and hands. Regarding wrist positions, the left wrist was held in a more dorsiflexed position than the right, 37 degrees and 29 degrees, respectively. Compared with tethering and loose-housing parlour milking, the wrist positions were, however, improved in the rotary system. When introducing new milking systems these negative effects on wrist and hand movements must be borne in mind in order to minimize the prevalence of wrist and hand disorders.

Adult↗
PubMed1997

Imaging in sports-medicine--knee.

Since the last decade, the introduction of Magnetic Resonance Imaging has provided a powerful new tool for the clinician to diagnose sports-related knee injuries. The main objective of this paper is to familiarise the relevant specialists with the proven clinical indications and semiology of MRI of the knee. At the present time, the knee joint is the area in which the advantages of MRI are most spectacularly apparent. The MR appearances of meniscal tears in particular, are first discussed in detail, referring to recent literature and personal experience based on more than ten thousands MR examinations of traumatic knees. Also the mechanisms of injuries and the most commonly involved sports are described. The precise types of meniscal lesions, as visualised at arthroscopy, are abundantly illustrated on MR images: e.g., bucket-handle, radial and horizontal cleavage tears, meniscocapsular separations, discoid menisci and meniscal cysts. We discuss the numerous pitfalls due to neighbouring anatomical structures as well as non clinically or surgically significant intrameniscal hypersignals in athletes. Towards other imaging techniques, MRI is particularly suited for the diagnosis of ligamentous injuries, especially the cruciate ligaments. We develop the currently used direct and indirect signs of rupture, the diagnostic difficulties related to the age of trauma and the detection of associated lesions. Sport-induced tendinous and bursal pathology is another interesting indication of MRI, not only lesions of the more superficial extensor tendons but also the pes anserinus or hamstring tendons. We finally treat the recent developments of MRI in assessment of cartilage, subchondral and medullary bone disorders of traumatic or microtraumatic origin.

Athletic Injuries↗
PubMed2003

Wrist movements among females in a repetitive, non-forceful work.

Wrist positions and movements were measured and a physical examination was conducted in 12 female operators in an industrial quality-control work. The handled products are of very low weight, thus, the work can be considered as non-forceful. The work was highly repetitive; 0.54Hz for the right wrist/hand and 0.41Hz for the left. The angular velocities were also high; for the right wrist/hand median value was 30 degrees /s and peak value 108 degrees /s, for the left wrist/hand 24 degrees /s and 88 degrees /s, respectively. The frequency of musculoskeletal disorders was high, especially for the right wrist/hand. Although the work was non-forceful and there were minor extreme positions in the wrists, the results are consistent with reported exposure-response relations in other high-risk jobs. Thus, the repetitiveness and the high velocities are the likely causes for the high prevalence of disorders in the wrists/hands among the operators.

Adult↗
PubMed1996

Musculoskeletal problems among VDU workers in a Hong Kong bank.

A survey of musculoskeletal problems among visual display unit (VDU) users was carried out in a bank using a self-administered questionnaire. The prevalence of complaints in various body parts were: neck--31.4%, back 30.6%, shoulder--16.5%, hand and wrist--14.9% and arm--6.6%. Frequent users of VDU had significantly more musculoskeletal problems in the neck and shoulder regions than infrequent users. Individual musculoskeltal complaints were associated with various risk factors including personal attributes, working posture, repetitive movements and work station design. Back, neck and shoulder problems were more related to unfavourable working postures, white arm, hand and wrist problems were more affected by repetitive movements. Some risk factors for musculoskeletal problems were specifically related to the nature or design of VDU work. Modification of the workstation design and improvement in work organization should be able to reduce the prevalence of these disorders.

Adolescent↗
PubMed1998

Efficacy of vibration, electric current and thermal perception tests in diagnosis of hand-arm vibration syndrome.

Vibration perception test is usually proposed as a useful tool for quantitative assessment of neurological disturbances induced by hand-arm vibration syndrome (HAVS). The increased mean vibration perception threshold (VPT) is an early manifestation of this syndrome. However, we have identified a group of exposed subjects with normal VPT who showed electric current and/or thermal sensitivity impairment. The use of three tests instead of a single vibration test increased by 27% the number of persons with detected quantitative skin sensory disorders. The intensity of quantitative disorders of vibration and electric current sensitivity was closely related to the duration of vibration exposure. The thermal perception was diminished in subjects working for a longer period of time, but there was no relationship between intensity of disorders and the duration of exposure. In an early stage of hand-arm vibration syndrome (prevention of HAVS) the use of three tests helps to identify a larger number of workers at risk who should undergo thorough diagnostic examinations. In our study the proportion of identified workers increased from 27% (32 subjects with vibration sensory impairment) to 45% (53 persons with disorders detected in one, two or even three tests).

Adult↗
PubMed1990

Raynaud's phenomenon of occupational origin.

Vibration delivered to the hand and arm by industrial pneumatic tools is a common cause of vascular and neurovascular problems, including cold-induced vascular spasm (vibration white finger) and peripheral neuropathies with paresthesias, dysesthesias, and sensory abnormalities. A decade ago, the US Public Health Service estimated that 1.2 million American workers were at risk. Differentiation of primary and secondary Raynaud's phenomenon from the thoracic outlet syndrome and from the carpal tunnel syndrome pose potential diagnostic difficulties. Despite growing public recognition of upper extremity problems caused by repetitive trauma, there have been few investigations of vibration-induced disorders in the United States. This is not true worldwide, particularly in Northern Europe, where there has been significant intervention in medical surveillance and tool design. There does appear to be, however, frequent misdiagnosis and misdirected surgery. This has particular significance for the clinician, since in the 1990s, cumulative trauma injuries are expected to exceed all other work-related injuries.

Cumulative Trauma Disorders↗
PubMed1989

Orthopaedic basis for occupationally related arm and neck pain.

A prospective clinical study of 204 individuals with occupationally related upper limb or neck pain was initiated to determine the major symptom patterns, the physical findings, and changes in laboratory tests that are exhibited by these subjects. On the basis of this information it was possible to determine the proportion that was suffering from a recognizable, pathologically discrete, musculoskeletal disorder. The study shows that in the majority (58%) of these people, a discrete musculoskeletal disorder exists. The most common diagnoses were peripheral nerve entrapments (19%) and arthropathies (16%). In 42% a discrete diagnosis was not made and the nature of the disorder, in these, is discussed.

Adult↗
PubMed2001

Effect of computer keyboard slope and height on wrist extension angle.

The goal of this study was to determine the systematic effect that varying the slope angle of a computer keyboard along with varying keyboard height (relative to elbow height) have on wrist extension angle while typing. Thirty participants typed on a keyboard whose slope was adjusted to +15 degrees, +7.5 degrees, 0 degrees, -7.5 degrees, and -15 degrees. The height of the keyboard was set up such that participants' wrists were at the same height as their elbows, above their elbows, and four cm below their elbows. Results showed that as keyboard slope angle moved downward from +15 degrees to -15 degrees, mean wrist extension decreased approximately 13 degrees (22 degrees at +15 degrees slope to 9 degrees at -15 degrees slope). Keyboard height had a similar effect with mean wrist extension decreasing from 21.8 degrees when the keyboard was lower than elbow height, to 7.3 degrees when the keyboard was higher than elbow height. Potential application of this research includes the downward sloping of computer keyboards, which could possibly be beneficial in the prevention of musculoskeletal disorders affecting the wrist.

Adult↗
PubMed1999

[Frequency of musculoskeletal symptoms in diagnostic medical sonographers. Results of a pilot survey].

INTRODUCTION: We report the results of a pilot survey in diagnostic medical sonographers. Aim of the study was to evaluate the frequency of musculoskeletal disorders in sonologists and the relationship of these symptoms to ergonomic factors. MATERIALS AND METHODS: 340 sonographers (258 male, 82 female doctors; mean age 41.5 +/- 7.2 years) were given a questionnaire to fill out. The questionnaire asked questions about the sonologist's age, gender, technique of ultrasound procedure, physical activity, and work-related musculoskeletal complaints. Two symptom lists regarded carpal tunnel syndrome (CTS) symptoms (8 items) and other work-related musculoskeletal symptoms (13 items). The categorized response variables "have now" or "in the past" were provided. The symptoms experienced were categorized into three levels as no symptoms, few symptoms (1-4 symptoms), and many symptoms (> 5 symptoms). RESULTS: One third of the respondents reported having at least one or more work-related symptoms in the upper extremities. The most frequent symptoms were tingling (17.6%), numbness or finger pain (13.5%). Carpal tunnel syndrome had been diagnosed in 5 cases (1.5%). More than 60% of all respondents have experienced one or more musculoskeletal symptoms in the cervical or lumbar spine. The commonest symptom was neck and low back pain (67%). The pain was generally intermittent and occurred at the end of the workday. Motion impairment in the neck and/or back was present in 23.5% of cases. Twenty-five percent of respondents had received treatments for their symptoms and 10% reported having stopped work because of their symptoms. Data analysis showed that muscular efforts such as gripping the transducer, applying sustained pressure, and scanning with a correlated flexed or hyperextended wrist were significantly correlated with increasing severity of symptoms in the hand, wrist, and forearm area. On the other hand, low back pain appeared to be negatively correlated with correct position of the body. CONCLUSIONS: Several physical risk factors (e.g., repetitive work and force exertion, twisting of the body and poorly-adjustable chairs) have been identified for work-related upper extremity and spine disorders. Ergonomic redesign of the workstation configuration as well as allowing sufficient recovery time to body and arm muscles appear to be the main goals to achieve prevention of musculoskeletal disorders in sonographers.

Adult↗
PubMed2006

Determining causation of work-related upper extremity disorders.

To determine causation in work-related upper extremity disorders, one must appreciate the philosophical constructs used in establishing causation and have clear definitions of the disorder in question. The preponderance of evidence does not support repetition as a major risk factor for physical injury. Terms such as "repetitive stress," "repetitive strain," and "cumulative trauma" should be abandoned, and we should educate our patients as to the multiple risk factors for upper extremity pain.

Arm Injuries↗
PubMed2001

Effect of musculoskeletal disorders on prehension strength.

The purpose of this study was to compare the maximum and job simulated hand grip strength in both healthy workers and those suffering from mild and severe stages of musculoskeletal disorders. Three groups of 10 female industrial workers each were recruited after a detailed screening for musculoskeletal disorders: one group of 10 healthy workers (GI) and two other groups (GII and GIII) consisting of workers suffering from mild and severe upper limbs disorders, respectively. A special device was built to reproduce a similar prehension pattern (open palmar) to that used on the job. This was calibrated against a Jamar dynamometer. Job simulated and maximum prehension strength were tested in three consecutive trials. Pearson's correlation coefficient was calculated for the calibration procedure. Descriptive analysis of the musculoskeletal data was computed. ANOVA and Duncan post hoc multiple comparisons were conducted to test the main effects on muscular strength and interactions. Significant differences between types of strength (p<0.00001) and groups of subject (p<0.0001) were identified. The maximum strength decreased progressively from groups I to III. Although job simulated strength also decreased as disorder severity increased, this trend was weaker than the one observed for the maximum strength. These results suggest that a re-allocation of workers suffering from musculoskeletal disorders be considered.

Adult↗
PubMed2002

Impact of case manager training on worksite accommodations in workers' compensation claimants with upper extremity disorders.

Management of the return-to-work process in claimants with work-related upper extremity disorders often poses challenges to the health care provider, claimant, and employer. Modifying workplace ergonomic risk factors as a component of the workplace accommodation process may improve return-to-work outcomes by reducing recurrent pain and discomfort. The present study is a case-control evaluation of the effects of a 2-day training program for nurse case managers that was designed to facilitate the implementation of workplace accommodations within a workers' compensation health care delivery system. After the training, 101 claimants with compensable upper extremity disorders were randomly assigned to case managers with and without training. Overall, 208 accommodations were recommended and 155 of these were implemented (75%). Claimants of trained nurses received 1.5 times as many recommendations for accommodations as claimants managed by nurses not trained in the process, and 1.4 times as many accommodations were implemented, although no differences were found between the two groups in implementation rates. Trained nurses were more likely to recommend accommodations addressing workstation layout, computer-related improvements, furnishings, accessories, and lifting/carrying aids, whereas the untrained nurses were more likely to suggest light duty and lifting restrictions. This study indicates that the training was associated with a change in the practice behavior of case managers regarding the workplace accommodation process. More research is needed to identify barriers to implementation and develop more effective approaches to facilitate worksite accommodations in disabled workers with carpal tunnel syndrome and other persistent upper extremity disorders.

Adult↗
PubMed2004

Job enlargement and mechanical exposure variability in cyclic assembly work.

Cyclic assembly work is known to imply a high risk for musculoskeletal disorders. To have operators rotate between work tasks is believed to be one way of decreasing this risk, since it is expected to increase variation in mechanical and psychological exposures (physical and mental loads). This assumption was investigated by assessing mechanical exposure variability in three assembly tasks in an electronics assembly plant, each on a separate workstation, as well as in a 'job enlargement' scenario combining all three stations. Five experienced operators worked for 1 h on each station. Data on upper trapezius and forearm extensor muscle activity were obtained by means of electromyography (EMG), and working postures of the head and upper arms were assessed by inclinometry. The cycle-to-cycle variance of parameters representing the three exposure dimensions: level, frequency and duration was estimated using ANOVA algorithms for each workstation separately as well as for a balanced combination of all three. For a particular station, the variability of trapezius EMG activity levels relative to the mean was higher than for extensor EMG: between-cycles coefficients of variation (CV) about 0.15 and 0.10, respectively. A similar relationship between CV applied to the parameter describing frequency of EMG activity. Except for head inclination levels, the between-cycles CV was larger for posture parameters than for EMG. The between-cycles variance increased up to six fold in the job enlargement scenario, as compared to working at only one station. The difference in mean exposure between workstations was larger for trapezius EMG parameters than for forearm extensor EMG and postures, and hence the effect of job enlargement on exposure variability was more pronounced for the trapezius. For some stations, job enlargement even implied less cycle-to-cycle variability in forearm extensor EMG parameters than working at that station only. Whether the changes in exposure variability associated with job enlargement were sufficient to imply a decreased risk for musculoskeletal disorders is not known.

Adult↗
PubMedDate not supplied

[The experience of the EPM (Ergonomics of Posture and Movement) Research Unit in risk analysis and the prevention of work-related musculo-skeletal diseases (WMSDs)].

The twenty-year experience of the "Ergonomics of Posture and Movement (epm)" Research Unit for prevention of work-related musculoskeletal disorders (WMSDs) is briefly summarized. The epm research unit is the outcome of an agreement between Milan University (Clinica del Lavoro Luigi Devoto), Milan Polytechnic, Don Gnocchi Foundation IRCCS (Bioengineering Centre) and the Regional Health Service (CEMOC of ICP Hospital). Early activities of epm (1985-1993) are first outlined: they are characterized by a wide range of laboratory studies allowing the development of original methods and criteria for on-site analysis of fixed postures and awkward movements and for ad hoc clinical examination of the musculoskeletal apparatus in working populations. Epm contributions are reviewed for the analysis of working activity involving manual load handling (adapted NIOSH method) and hospital patients (MAPO method) as well as for standardization of health surveillance protocols of spinal diseases. Updated contributions are reported on analysis and prevention of upper limb MSDs connected with upper limb repetitive movements (OCRA method). Finally epm's main collaborations with national and international Authorities are summarized as well as the major technical (health promotion) publications addressed to operators and workers, in different working situations, for prevention of musculoskeletal disorders due to biomechanical overload.

Ambulatory Care Facilities↗