KIVIMA.KI J, RIIHIMAKI H, HA.NNINEN K. Knee disorders in carpet and floor layers and painters. Scand J Work Environ Health 1992;18:310-6. In an evaluation of the effect of kneeling work on the knees, 168 actively working carpet and floor layers and 146 house painters were examined with the aid of a questionnaire, a clinical examination, and radiography. Reported knee pain, knee accidents, and treatment regimens for the knees were more common among the carpet and floor layers than among the painters. Radiographic changes of the tibiofemoral joint were noted equally in the two occupational groups, but osteophytes of the patella were more common among the carpet and floor layers than among the painters. In a multivariate analysis, the determinants of osteophytosis of the knee were age, occupation, knee accidents, and smoking , and osteophytosis may be due to more frequent workbreaks from kneeling postures among smoking workers. This study indicates that kneeling work increases the risk of knee disorders and such radiographic changes that might be an initial sign of knee degeneration.

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RIIHIMAKI H, WICKSTROM G, HANNINEN K, LUOPAJARVI T . Predictors of sciatic pain among concrete reinforcement workers and house painter s -a five-year follow-up. Scand J Work En viron Health 1989;15:415-423. In a study of the assoc iation of occupation and several other determinants with the occurrence of sciatic pain, 167 concrete reinforcement workers and 161 house painters were follow ed for five years. Base-line data were obtained with a questionnaire, an interview on back symptoms, a clinical exam ination , and a radiograph of the lumbar spine . Follow-up data on back symptoms were obtained with a post al questionnaire. Concrete reinforcement work was associated with an increase in the risk of sciatic pain , in both a cro ss-section al and a pro specti ve study. Reported back accidents contributed to the risk of sciatic pa in. Previous history of back sympto ms was the most powerful predictor of sciatic pain prospectively. Degenerative changes were related to sciati c pain in retrospect, but prospectively this relationship was weaker. Body height and history of stres s episodes showed some asso ciation with sciatic pain; abdominal muscle strength, body mass index, and smoking did not; and back muscle strength was asso ciated only retrospectively.

TaLA S, RIIHIMAK I H , VIDEMAN T , VIIKARl-JUNTURA E, HANNINEN K. Neck and sho ulde r symptoms among men in ma chine operating, dynami c ph ysical work and sedenta ry work . Scand J Work En viron Health 14 (1988) 299-305. Data on the occurrence of neck and sho ulder symptoms and some qualities of work and leisure-time activities were gathered with a postal questionna ire sent to I 174 machine operators, I 045 ca rpenters, and I 013 office worker s. They were all men in the age ra nge of 25-49 years. The respon se rate was 67-76 fllo. The lifetime cumulative incidence of neck and sho ulder symptoms was 81 fllo for the machine oper ators, 73 fllo for the car pent ers, an d 57 fllo for the office wor kers. About half of the two gro ups of man ual work ers and 24 fllo of th e office wor kers had had symptoms dur ing th e last 7 d. Pain in the arm s was indicated by 14-17 fJ70 of the manual work ers and 4 fllo of th e offi ce workers . Symptoms during more than 30 d within the last 12 months were also more common among the manual workers than among the office wo rkers. Within the manual worker gro ups, the machine operators had more symptoms than the carpenters. In a mult ivariate logistic regression an alysis occup ation, workin g in twisted or bent posture s, age, draft, and job satisfaction pro ved to be significant risk indicators for neck and shoulder sympto ms.

RllHIMAKI II, WICKSTROM G, HANNINEN K, MATTSSON T, WARIS P, ZITIING A. Radiographically detectable lumbar degenerative changes as risk indicators of back pain: a cross-sectional epidemiologic study of concrete reinforcement workers and house painters. Scand J Work Environ Health 1989;15:280-285. The association between radiographically detectable degenerative changes in the lumbar spine and back symptoms was studied, along with the possible effect of occupational work load. The subjects were 216 concrete reinforcement workers and 201 house painters. A questionnaire provided information on work history and earlier back accidents, and a standardized interview produced data on back symptoms. The occurrence of disc space narrowing, anterior and posterior spondylophytes, and endplate sclerosis was recorded separately for each intervertebral space from lateral lumbar radiographs. Moderate to severe degenerative changes were associated with increased risk of sciatic pain but not with the occurrence of lumbago or nonspecific back pain. The different types of degenerative changes provided no further information. In a multivariate logistic regression analysis degenerative changes and earlier back accidents were significant independent predictors of sciatic pain. When these two variates were allowed for, the effect of occupation was not significant.

The loads on the knees in concrete reinforcement work and maintenance painting were analysed on eight construction work sites. A total of 352 reinforcement workers and 231 painters, Finnish men aged 20-64, were clinically and radiologically examined to determine the condition of the knee joints in active workers. The loads on the knees and the occurrence of minor injuries and accidents were higher in reinforcement work than in painting, but the occurrence of symptoms, clinical signs, and radiological findings was equally common in both groups. Reinforcement work seemed to provoke more symptoms from degenerated knees than painting.There are few studies of the occurrence of meniscal lesions and arthritic changes in the knee joints in specific occupational groups. Coal miners have been studied extensively and been found to have an unusually common occurrence of bursitis around the knee' 2 as well as meniscal lesions and arthrosis.3-9 Workers doing heavy carrying also have radiological signs of knee arthrosis more commonly than would be expected.'"We have carried out a large epidemiological study to determine the effects of concrete reinforcement work on the musculoskeletal system of the workers." We report the findings from the knee joints.Material and methods ANALYSIS OF WORK LOADSThe physical loads on the musculoskeletal system in the reinforcement trade were determined through systematic observation on six work sites (two bridge, two building, and two dwelling house construction sites). An The examination of the workers consisted of an interview, and a physical and a radiological examination. The interview was carried out according to a standardised questionnaire immediately before the clinical examination of the musculoskeletal system. The questions concerned previous and present knee symptoms, knee accidents, and sick leave due to knee disorders. The clinical examination was performed by two experienced physiotherapists, espe-216

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Obvious differences occurred in back and joint pain by indicators of social class that were not due to socioeconomic differences in lifestyle, height or mental distress.