Background: We have previously assessed the reproducibility of manual testing of the strength in 14 individual upper limb muscles in patients with or without upper limb complaints. This investigation aimed at additionally studying sensory disturbances, the mechanosensitivity of nerve trunks, and the occurrence of physical findings in patterns which may potentially reflect a peripheral neuropathy. The reproducibility of this part of the neurological examination has never been reported.

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Background Manual muscle testing has been termed a "lost art" and is often considered to be of minor value. The aim of this investigation was to study the inter-rater reliability of manual examination of the maximal voluntary strength in a sample of upper limb muscles.Patients and methods The material consisted of a series of 41 consecutive patients (82 limbs) who had been referred to a clinic of occupational medicine for various reasons. Two examiners who were blinded as to patient-related information classifi ed 14 muscles in terms of normal or reduced strength. In order to optimize the evaluation, the individual strength was assessed simultaneously on the right and left sides with the limbs in standardized positions that were specifi c for each muscle. Information on upper limb complaints (pain, weakness and/or numbness/tingling) collected by two other examiners resulted in 38 limbs being classifi ed as symptomatic and 44 as asymptomatic. For each muscle the inter-rater reliability of the assessment of strength into normal or reduced was estimated by κ-statistics. In addition, the odds ratio for the relation to symptoms of the defi nition in agreement of strength was calculated.Results The median κ-value for strength in the muscles examined was 0.54 (0.25-0.72). With a median odds ratio of 4.0 (2.5-7.7), reduced strength was signifi cantly associated with the presence of symptoms.Interpretation This study suggests that manual muscle testing in upper limb disorders has diagnostic potential.

BackgroundIn a sample of patients in clinical occupational medicine we have demonstrated that an upper limb neurological examination can reliably identify patterns of findings suggesting upper limb focal neuropathies. This further study aimed at approaching the diagnostic accuracy of the examination.Methods82 limbs were semi-quantitatively assessed by two blinded examiners (strength in 14 individual muscles, sensibility in 7 homonymous territories, and mechanosensitivity at 10 locations along nerves). Based on the topography of nerves and their muscular and sensory innervation we defined 10 neurological patterns each suggesting a localized nerve affliction. Information on complaints (pain, weakness and/or numbness/tingling) collected by others served as a reference for comparison. The relation between the presence of pattern(s) and complaints was assessed by κ-statistics. Sensitivity, specificity, and positive/negative predictive values were calculated, and pre-test odds were compared to post-test probability.ResultsThe two examiners identified pattern(s) suggesting focal neuropathy in 34/36 out of 38 symptomatic limbs, respectively (κ = 0.70/0.75), with agreement in 28 limbs. Out of 44 non-symptomatic limbs the examiners agreed on absence of any pattern in 38 limbs. With concordance between the examiners with regard to the presence or absence of any pattern, the sensitivity, specificity, positive and negative predictive values were 0.73, 0.86, 0.93 and 0.90, respectively. While the pre-test odds for a limb to be symptomatic amounted to 0.46 the post-test probability was 0.81. For each examiner the post-test probability was 0.87 and 0.88, respectively.ConclusionThe improved diagnostic confidence is an indication of one aspect of construct validity of the physical examination. For determination of clinical feasibility of the examination further studies are required, most importantly 1) studies of validity by means of comparison with additional references and 2) studies of the potential benefit that can be attained from its use.

BackgroundThe character of upper limb disorder in computer operators is subject to debate. A peripheral nerve-involvement is suggested from the common presence of a triad of symptoms consisting of pain, paraestesiae and subjective weakness, and from physical findings suggesting neuropathy. This study aimed to examine the outcome of a detailed neurological examination in computer operators and to compare findings with the presence of symptoms.Methods96 graphical computer operators answered a modified Nordic Questionnaire including information on perceived pain in the shoulder, elbow, and wrist/hand scored for each region on a VAS-scale 0 – 9. In addition, they underwent a physical examination including the subjective assessment of the individual function of 11 upper limb muscles, of algesia in five and vibratory threshold in three territories, respectively, and of mechanosensitivity of nerves at seven locations. In order to reflect an involvement of the brachial plexus (chord level), the posterior interosseous nerve and the median nerve at elbow level we defined three patterns of neurological findings illustrating the course of nerves and their innervation. The pain scores summarized for the three upper limb regions (min. = 0, max = 27) in the mouse-operating and contralateral limbs were compared by a Wilcoxon test and the relation to each physical item analyzed by Kendall's rank correlation. The relation of summarized pain to each pattern was studied by application of a test of the trend across ordered groups (patterns).ResultsPain, paraestesiae and subjective weakness was reported for 67, 23, and 7 mouse-operating limbs, respectively, with the summarized pain scores exceeding 4 in 33 limbs. Abnormal physical findings were prevalent. The summarized pain was significantly related to a reduced function in five muscles, to mechanical allodynia at one location and to elevated threshold to vibration in two territories. Brachial plexopathy was diagnosed in 9/2, median neuropathy in 13/5 and posterior interosseous neuropathy in 13/8 mouse operating/contralateral limbs, respectively. The summarized pain was significantly higher in the mouse-operating limbs and in limbs with any of the defined patterns. There was a significant trend between the summarized pain and the summarized scores for the items contained in each pattern.ConclusionThis small-scale study of a group of computer-operators currently in work and with no or minor upper limb symptoms has indicated in symptomatic subjects the presence of peripheral nerve-afflictions with specific locations.

This study aims to identify risk factors and their prevalence in long-term sickness absence. The study is designed as a case-referent study which comprises 481 participants who have experienced a sickness absence lasting >10 weeks and a reference group of 1326 individuals in active employment. Multivariate analysis identified the following significant risk factors for men: (i) age >50 years [odds ratio (OR) = 2.4]; (ii) short period of education (OR = 2.3); (iii) unemployment within the last 3 years (OR = 1.7); (iv) heavy-duty work (OR = 2.1); (v) monotonous, repetitive work (OR = 1.7); (vi) lack of job satisfaction (OR = 2.1); and (vii) much back pain during the last 3 years (OR = 2.1). The following risk factors were identified for women: (i) leaving school without graduation (OR = 2.6); (ii) unemployment within the last 3 years (OR = 1.5); (iii) heavy-duty work (OR = 2.8); (iv) lack of influence on own job situation (OR = 2.1); and (v) much back pain within the last 3 years (OR = 1.8). It is concluded that the identification of working environment risk factors constitutes a case for improvement of the working environment which may be instrumental in reducing long-term sickness absence.

In spite of safety measures and significant structural changes in the Danish merchant and fishing fleet, the spectrum of health indicators continues to indicate considerable risk factors in the maritime environment and/or the lifestyle of seafarers and fishermen. Future monitoring of fishermen's and seafarers' health will remain essential for implementing appropriate preventive measures.

BackgroundFishermen work in a physically challenging work environment. The aim of this analysis was to estimate the prevalence and predictors of musculoskeletal pain among Danish fishermen.MethodA cross-sectional survey in a random sample of Danish fishermen was done with application of the Nordic questionnaire regarding musculoskeletal pain considering lower back, shoulders, hand neck, knee, upper back elbow, hip and feet. In total, 270 fishermen participated in the study (response rate: 28%). Workload, vessel type, skipper, duration of work, sideline occupation, days/weeks of fishing at sea, age, BMI and education were used as predictors for the overall musculoskeletal pain score (multiple linear regression) and for each single pain site (multinomial logistic regression).ResultsThe prevalence of pain was high for all musculoskeletal locations. Overall, more than 80% of the responding Danish fishermen reported low back pain, which in 37% lasted for a minimum of 30 days during the past year. In the multiple linear regression analysis, middle workload was associated with a 32% (95% CI: 19-46%) and high workload with 60% (95% CI: 46-73%) increased musculoskeletal pain score compared to low work load. Multinomial logistic regression models showed that workload was the only predictor for all pain sites, in particular regarding upper and lower limb pain.ConclusionAlthough changes were implemented to improve the fishermen’s work environment, the work continues to be physically demanding and impacting their musculoskeletal pain. Potential explanation for this unexpected result like increased work pressure and reduced financial attractiveness in small scale commercial fishery needs to be confirmed in future research.