Previous studies indicate an increased prevalence of knee disorders in some occupations possibly related to kneeling working positions. The purpose of the present study was to examine the relationship among knee-straining work, self-reported knee-complaints, and physical signs of knee disorders. The duration of knee-straining work was estimated from videotapes of representative work tasks. Floor layers (n = 133), carpenters (n = 506), and compositors (n = 327) aged 26 to 72 years without previous acute knee traumas were examined in a cross-sectional study by questionnaire. A stratified random sample of the questionnaire responders; 67 floor layers, 127 carpenters, and 101 compositors had independent double examinations for physical signs of knee disorders. The videotapes showed that knee-straining work constituted 56% of working time for floor layers, 26% for carpenters, and none for compositors. The prevalences of self-reported knee-complaints were positively associated with the amount of knee-straining work and were significantly different for the three trades. Floor layers and carpenters who were presently working in their trade had a higher prevalence of knee complaints than floor layers and carpenters who had left their trade. Age, seniority, weight, body mass index, smoking, and knee-straining sports activity had no significant effects. The clinical study showed a positive association for knee-straining work, hyperkeratosis, and bursitis. A similar pattern was found for signs of intraarticular knee disorders by one physician but not by another. The reproducibility of these signs was low. More studies are needed to define clinically important knee disorders for epidemiological studies.
Objectives: To identify the risk of hand-wrist disorders related to repetitive movements, use of hand force and wrist position in repetitive monotonous work. Methods: Using questionnaires and physical examinations, the prevalence and incidence of hand-wrist pain and possible extensor tendonitis (wrist pain and palpation tenderness) were determined in 3123 employees in 19 industrial settings. With the use of questionnaires and video recordings of homogenous work tasks number of wrist movements, hand force requirements and wrist position were analysed as risk factors for hand-wrist disorders, controlling for potential personal and psychosocial confounders. All participants were re-examined three times during a follow-up period of three years. Results: Force but not repetition and position was related to hand-wrist pain and possible tendonitis in the baseline analyses showing an exposure-response pattern. Odds ratios for the risk of hand pain was 1.7 (95% CI 1.3 to 2.2) and for possible tendonitis 1.9 (95% CI 1.1 to 3.3). There was no significant interaction between the ergonomic factors. In the follow-up analyses force remained a risk factor for hand pain (OR 1.4, 95% CI 1.1 to 1.8) and for possible tendonitis (OR 2.9, 95% CI 1.3 to 6.8). Repetition was also a risk factor for the onset of hand-wrist pain (OR 1.6, 95% CI 1.2 to 2.3). Conclusions: Increasing levels of force were associated with prevalent and incident hand-wrist pain and possible extensor tendonitis. The results for repetition were less consistent. Working with the hand in a nonneutral position could not be identified as a risk factor. P ain in the hand-wrist region may be a sign of an inflammatory or degenerative process involving the tendons and occasionally the tendon sheaths too. Depending on the structures involved the condition is diagnosed as tendonitis, peritendonitis or tenosynovitis. Hand complaints are common among manual workers with self-reported prevalence around 30-45%. Symptoms are not always accompanied by clinical findings. Several studies found very low prevalence of clinical tenosynovitis with swelling and/or crepitation but with a considerable variation-from no cases of clinical tenosynovitis at all, up to more than 18%, apparently with more or less the same case definition. [1][2][3][4][5] Some studies support the hypothesis that mechanical load put on the wrist could be a factor in the development of wrist tendonitis. According to newer biomechanical models mechanical load is the product of a combination of the intensity of hand use, expressed as the percentage of rest periods, and ergonomic factors (number of wrist movements), force involved in the movements and the position of the wrist. It is, however, quite difficult to get a precise picture of the actual hand load put on a person's hand during the working day because the same person often performs different work tasks with different combinations of possible risk factors. At the same time, personal factors (for example, gender, medical conditions, previous trauma, and leisu...
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