Surveillance case definitions for work related upper limb pain syndromes.

Abstract

Objectives-To establish consensus case definitions for several common work related upper limb pain syndromes for use in surveillance or studies of the aetiology of these conditions. Methods-A group of healthcare professionals from the disciplines interested in the prevention and management of upper limb disorders were recruited for a Delphi exercise. A questionnaire was used to establish case definitions from the participants, followed by a consensus conference involving the core group of 29 people. The draft conclusions were recirculated for review. Results-Consensus case definitions were agreed for carpal tunnel syndrome, tenosynovitis of the wrist, de Quervain's disease of the wrist, epicondylitis, shoulder capsulitis (frozen shoulder), and shoulder tendonitis. The consensus group also identified a condition defined as "non-specific diVuse forearm pain" although this is essentially a diagnosis made by exclusion. The group did not have enough experience of the thoracic outlet syndrome to make recommendations. Conclusions-There was enough consensus between several health professionals from diVerent disciplines to establish case definitions suitable for use in the studies of several work related upper limb pain syndromes. The use of these criteria should allow comparability between studies and centres and facilitate research in this field. The criteria may also be useful in surveillance programmes and as aids to case management. (Occup Environ Med 1998;55:264-271)

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

“…Finkelstein's test is widely accepted and used by clinicians for the diagnosis of DQD (20). However, it lacks specificity and may be positive in cases of osteoarthritis of the wrist or first carpometaphalangeal joint and flexor/extensor hand-wrist tendonitis (37), which frequently overlap with DQD (8,25). We cannot therefore exclude the possibility that some cases diagnosed as DQD were symptomatic of osteoarthritis or flexor/extensor hand-wrist tendinitis in the absence of imaging of the wrist.…”

Role of physical load factors in carpal tunnel syndrome

“…Using the Delphi method, another group developed consensus criteria for CTS in surveillance and etiologic studies. Typical symptoms combined with 1 clinical finding or 1 abnormal nerve conduction time were considered sufficient for the diagnosis of CTS (5). In clinical practice, fairly similar criteria are used, with the exclusion of other diseases as the source for the symptoms as an important element of differential diagnosis.…”

Structure of retracted tendons after staged repair following continuous traction

“…Tear of the rotator cuff tendons is a common cause of musculoskeletal morbidity, increasing in prevalence with advancing age [8,20,31,32]. If not recognized early, the affected musculotendinous unit retracts progressively and an attempted repair to bone becomes increasingly difficult due to tension associated with a shortened musculotendinous unit [22].…”