Relationships and Mechanisms Between Occupational Risk Factors and Distal Upper Extremity Disorders (original) (raw)
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Journal of Occupational …
Upper extremity tendonitis (UET) associated with work activity is common but the true incidence and risk factors can best be determined by a prospective cohort study. This study followed a cohort of 501 active workers for an average of 5.4 years. Incident cases were defined as workers who were asymptomatic at baseline testing and had no prior history of UET and went on to be diagnosed with an UET during the follow-up period or at the followup evaluation. The incident cases were compared to the subset of the cohort who also had no history of an UET and did not develop tendonitis during the study. The cumulative incidence in this cohort was 24.3% or 4.5% annually. The factors found to have the highest predictive value for identifying a person who is likely to develop an UET in the near future included age over 40, a BMI over 30, a complaint at baseline of a shoulder or neck discomfort, a history of CTS and a job with a higher shoulder posture rating. The risk profile identifies both ergonomic and personal health factors as risks and both categories of factors may be amenable to prevention strategies.
Ergonomics, 2013
Pooling data from different epidemiological studies of musculoskeletal disorders (MSDs) is necessary to improve statistical power and to more precisely quantify exposure-response relationships for MSDs. The pooling process is difficult and timeconsuming, and small methodological differences could lead to different exposure-response relationships. A subcommittee of a six-study research consortium studying carpal tunnel syndrome: (i) visited each study site, (ii) documented methods used to collect physical exposure data and (iii) determined compatibility of exposure variables across studies. Certain measures of force, frequency of exertion and duty cycle were collected by all studies and were largely compatible. A portion of studies had detailed data to investigate simultaneous combinations of force, frequency and duration of exertions. Limited compatibility was found for hand/wrist posture. Only two studies could calculate compatible Strain Index scores, but Threshold Limit Value for Hand Activity Level could be determined for all studies. Challenges of pooling data, resources required and recommendations for future researchers are discussed.
Journal of Occupational Rehabilitation, 2005
Upper extremity tendonitis (UET) associated with work activity is common but the true incidence and risk factors can best be determined by a prospective cohort study. This study followed a cohort of 501 active workers for an average of 5.4 years. Incident cases were defined as workers who were asymptomatic at baseline testing and had no prior history of UET and went on to be diagnosed with an UET during the follow-up period or at the followup evaluation. The incident cases were compared to the subset of the cohort who also had no history of an UET and did not develop tendonitis during the study. The cumulative incidence in this cohort was 24.3% or 4.5% annually. The factors found to have the highest predictive value for identifying a person who is likely to develop an UET in the near future included age over 40, a BMI over 30, a complaint at baseline of a shoulder or neck discomfort, a history of CTS and a job with a higher shoulder posture rating. The risk profile identifies both ergonomic and personal health factors as risks and both categories of factors may be amenable to prevention strategies.
Workplace and individual risk factors for carpal tunnel syndrome
Occupational and Environmental Medicine, 2011
Objectives To quantify the relationship between workplace physical factors, particularly hand activity level (HAL) and forceful exertion and carpal tunnel syndrome (CTS), while taking into account individual factors. To compare quantitative exposure assessment measures with more practical ratings-based measures.
Human Factors the Journal of the Human Factors and Ergonomics Society, 2014
To better characterize associations between physical risk factors and upper-extremity musculoskeletal symptoms and disorders, a prospective epidemiologic study of 386 manufacturing workers was performed. Background: Methodological limitations of previous studies have resulted in inconsistent associations. Method: An individual, task-based exposure assessment strategy was used to assess upper-extremity exertion intensity, repetition, and time-in-posture categories. Participants recorded time spent performing daily work tasks on a preprinted log, which was then used to calculate time-weightedaverage exposures across each week of follow-up. In addition, a weekly Strain Index (SI) risk category was assigned to each participant. Incident musculoskeletal symptoms and disorders were assessed weekly. Proportional hazards analyses were used to examine associations between exposure measures and incident hand/arm and neck/shoulder symptoms and disorders. Results: Incident symptoms and disorders were common (incident hand/arm symptoms = 58/100 person-years (PY), incident hand/arm disorders = 19/100 PY, incident neck/shoulder symptoms = 54/100 PY, incident neck/shoulder disorders = 14/100 PY). Few associations between separate estimates of physical exposure and hand/arm and neck/shoulder outcomes were observed. However, associations were observed between dichotomized SI risk category and incident hand/arm symptoms (hazard ratio [HR] = 1.73, 95% confidence interval [CI] = [0.99, 3.04]) and disorders (HR = 1.93, 95% CI = [0.85, 4.40]). Conclusion: Evidence of associations between physical risk factors and musculoskeletal outcome was strongest when exposure was estimated with the SI, in comparison to other metrics of exposure. Application: The results of this study provide evidence that physical exposures in the workplace contribute to musculoskeletal disorder incidence. Musculoskeletal disorder prevention efforts should include mitigation of these occupational risk factors.
Journal of Orthopaedic & Sports Physical Therapy, 2004
The purpose of this commentary is to present recent epidemiological findings regarding work-related musculoskeletal disorders (WMSDs) of the hand and wrist, and to summarize experimental evidence of underlying tissue pathophysiology and sensorimotor changes in WMSDs. Sixty-five percent of the 333 800 newly reported cases of occupational illness in 2001 were attributed to repeated trauma. WMSDs of the hand and wrist are associated with the longest absences from work and are, therefore, associated with greater lost productivity and wages than those of other anatomical regions. Selected epidemiological studies of hand/wrist WMSDs published since 1998 are reviewed and summarized. Results from selected animal studies concerning underlying tissue pathophysiology in response to repetitive movement or tissue loading are reviewed and summarized. To the extent possible, corroborating evidence in human studies for various tissue pathomechanisms suggested in animal models is presented. Repetitive, handintensive movements, alone or in combination with other physical, nonphysical, and nonoccupational risk factors, contribute to the development of hand/wrist WMSDs. Possible pathophysiological mechanisms of tissue injury include inflammation followed by repair and/or fibrotic scarring, peripheral nerve injury, and central nervous system reorganization. Clinicians should consider all of these pathomechanisms when examining and treating patients with hand/wrist WMSDs.
Upper-limb disorders in repetitive work
Scandinavian Journal of Work, Environment & Health, 2001
Objectives A longitudinal study was conducted to determine the predictability of personal and occupational factors with respect to the incidence of upper-limb disorders in occupations requiring repetitive work. Methods A sample of 598 workers in five activity sectors completed a self-administered questionnaire; the workers were examined by an occupational health physician in 1993-1994 and 3 years later. Three disorders were considered, carpal tunnel syndrome (CTS), lateral epicondylitis and wrist tendinitis. Results The results of this longitudinal study indicated that the following three sets of risk factors independently affect the incidence of upper-limb disorders: (i) biomechanical constraints, (ii) psychosocial factors, and (iii) personal factors. The combination of risk factors differed between CTS, lateral epicondylitis, and wrist tendinitis. The presence of psychosomatic problems was a strong predictor of wrist tendinitis. Social support at work was also associated with the incidence of wrist tendinitis. The presence of depressive symptoms and other upper-limb disorders predicted the first occurrence of lateral epicondylitis. Age was associated only with epicondylitis. The results were consistent with those concerning the role of forceful movements of the elbow for epicondylitis and confirmed the role of forceful movements for CTS. Conclusions This study considered different sets of risk factors simultaneously with a longitudinal approach, in a population with a high level of occupational exposure. The results indicate that three sets of risk factors independently affect the incidence of upper-limb disorders. In addition to biomechanical constraints, psychosocial and personal factors play a role.