Evaluation and management of chronic work-related musculoskeletal disorders of the distal upper extremity

Abstract

This clinical review will describe the epidemiology, clinical presentation, and management of the following work‐related musculoskeletal disorders (WMSDs) of the distal upper extremity: deQuervain's disease, extensor and flexor forearm tendinitis/tendinosis, lateral and medial epicondylitis, cubital tunnel syndrome, and hand‐arm vibration syndrome (HAVS). These conditions were selected for review either because they were among the most common WMSDs among patients attending the New York State Occupational Health Clinics (NYSOHC) network, or because there is strong evidence for work‐relatedness in the clinical literature. Work‐related carpal tunnel syndrome is discussed in an accompanying paper. In an attempt to provide evidence‐based treatment recommendations, literature searches on the treatment of each condition were conducted via Medline for the years 1985–1999. There was a dearth of studies evaluating the efficacy of specific clinical treatments and ergonomic interventions for WMSDs. Therefore, many of the treatment recommendations presented here are based on a consensus of experienced public health‐oriented occupational medicine physicians from the NYSOHC network after review of the pertinent literature. A summary table of the clinical features of the disorders is presented as a reference resource. Am. J. Ind. Med. 37:75–93, 2000. © 2000 Wiley‐Liss, Inc.

Risk factors for de Quervain’s disease in a French working population

“…This is consistent with the epidemiological literature (4,12,13,26,27). The higher risk of DQD among women could reflect both biological predispositions (sex effect) and greater exposure to biomechanical repetitive work-related constraints (gender-effect) (28).…”

Incidence of ulnar nerve entrapment at the elbow in repetitive work

“…While some authors (2) consider ulnar nerve entrapment at the elbow difficult to diagnose, even with EMG, definitions based on symptoms and signs are available for epidemiologic studies (2,3). Nonetheless, as Bozentka (4) mentioned in his physiological study of this disorder, epidemiologic studies of occupational ulnar nerve entrapment at the elbow are rare (4).…”

Hand-arm vibration syndrome

“…Pathologic changes have also been described in the digital tuft mechanoreceptors (Pacinian corpuscles) and among myelinated digital fibres. 1 Physical characteristics of exposure that appear to play a role in the development of HAVS include the type of vibration (frequency, amplitude and direction), the vibratory force and impulse type, the cumulative hours of exposure, the intermittency of exposure, the state of tool maintenance and a cold environment. 2 Biodynamic factors such as the grip force required to use the tool, the operator's control of the tool and the surface area of the tool handle, as well as factors such as the patient's medical history of injury, susceptibility and protective practices also play a role (www .ccohs.ca/oshanswers/phys_agents /vibration/vibration_effects.html #_1_3).…”

“…Plethysmography before and after cold provocation is the laboratory test accepted for evaluating vascular manifestations of HAVS by the Stockholm Hand-arm Committee. 1 Additional tests include digital thermometry at baseline and after cold-water immersion and Doppler blood pressure and flow measurement. However, a recent review of the diagnostics of vascular symptoms concluded that taking a good patient history was the best method for diagnosing blanched fingers triggered by cold.…”

“…This oxidation results in a characteristic gradual darkening of the urine downward from the surface on standing. 1 To appreciate the relation of this to photography, we need a (somewhat simplified) explanation of the processes involved in the creation of a photographic image. The photographic emulsion consists of microscopic crystals of silver bromide embedded in a gelatin matrix.…”