Relations between upper limb soft tissue disorders and repetitive movements at work

Abstract

To make a preliminary assessment of whether upper limb soft tissue disorders might be associated with activities at work, we have conducted a case-control study of subjects attending orthopedic clinics in three cities. All subjects between the ages of 16 and 65 years, in whom defined soft tissue conditions of the upper limb were diagnosed by the participating orthopedic surgeons, were invited to take part. Controls were subjects attending the same clinics within the same age range whose clinical diagnosis did not include disease of the upper limb, cervical or thoracic spine. Information concerning repetitive movements of the upper limbs at work was elicited by questionnaire. Five hundred eighty cases and 996 controls were studied, representing 96% and 93%, respectively, of those invited to participate. The diagnoses of the cases included soft tissue conditions affecting the shoulder, elbow, forearm, wrist, thumb, hand, and fingers. The diagnoses of the controls included traumatic, degenerative, and inflammatory conditions, mostly of the legs and lower back. Women predominated among the cases (70%) and men among the controls (56%). Of 221 female cases with injury to the wrist and forearm, 32 were cleaner/domestics (14.5%) compared to 35 to 439 controls (8%), a difference statistically significant at the 2 1/2% level. Other jobs significantly overrepresented (5% level) among female cases with injuries at various anatomical sites included hairdressers, secretary/temps, assembly line workers, and machine operators (type unspecified). Among male cases, electricians were significantly overrepresented (5% level). Jobs for which there was a suggestion (p < 0.1) of overrepresentation among cases included butchers and teacher/lecturers (both males only) and the combined job groups (chosen a priori for analysis) of keyboard operators, machine operators, and music teachers (all three jobs, females only).

The Effect of Time after Shear Injury on the Subsynovial Connective Tissue and Median Nerve within the Rabbit Carpal Tunnel

“…The one-time injury that we created with the surgical procedure might be another limitation, as it is widely accepted (although experimental data are limited) that forceful and repetitive finger movements contribute to the development of CTS [1,2]. However, our injury was designed so that the advancement of the FDS3 would stretch its surrounding SSCT.…”

Carpal Tunnel Syndrome As an Occupational Disease

“…They found that subjects with upper extremity disorders were more likely to perform certain occupations (for example, hairdressers, assembly line workers, machine operators, and electricians). 24 However, logistic regression analysis found negative association between CTS and wrist ergonomic factors (OR ϭ 0.39). The study conducted by Werner et al 25 found that the workers who complained of hand symptoms were more likely to have ergonomic risk factors compared with asymptomatic workers who had similar NCV findings (P ϭ .002).…”

“…23 Studies published in recent years have continued to report divergent results. English et al (1995) studied 580 patients attending an orthopedic clinic and matched them with 996 control subjects. They found that subjects with upper extremity disorders were more likely to perform certain occupations (for example, hairdressers, assembly line workers, machine operators, and electricians).…”

“…These questions, and the exposure cutoff limits they establish, have been derived from published studies. 14,[21][22][23][24]35 This tool is to be used AFTER the diagnosis of CTS has been confirmed and will give family physicians a way of weighing the likelihood of the CTS' being work-related. The number of "Yes" answers is directly proportional to the degree of risk.…”

Algumas considerações metodológicas sobre os estudos epidemiológicos das Lesões por Esforços Repetitivos (LER)

“…Apesar dos critérios bem definidos de coleta e diagnóstico, a amostra do estudo foi pequena (79 trabalhadoras expostas). English et al (1995), em um estudo exploratório do tipo caso-controle, encontraram associação entre lesões de membros superiores e movimentos específicos realizados em diferentes atividades de trabalho. Os casos e controles foram selecionados em clínicas ortopédicas, sendo o diagnóstico mais freqüente entre os casos a síndrome do túnel do carpo.…”