OCCUPATIONAL MUSCULOSKELETAL DISORDERS Musculoskeletal Disorders Hands wrists elbows
OCCUPATIONAL MUSCULOSKELETAL DISORDERS
Musculoskeletal Disorders ØHands , wrists, elbows and shoulders ØBack and neck ØHips, knees and ankles ØMuscle Strains ØTendonitis ØBursitis ØLow Back Pain ØCarpal Tunnel ØRaynauds Syndrome
• Muscles • Tendons • Ligaments • Bones • Nerves • Blood Vessels • Disks
Musculoskeletal Disorders • Occupational Low Back Pain (LBP) • Cumulative Trauma Disorders (C. T. D)
Introduction • LBP is common health complaints. • LBP is second most common symptomatic reason for visit physicians. • LBP is major cause of disability, compensation, limitation, and economic loss.
Occupational Low Back Pain • • Definition Epidemiology Cost Risk Factors Biomechanics Prevention Treatment Red flags
Low Back Pain • Definition: A pain that occurs in the lumbar region , buttocks, or proximal posterior thighs • Low back pain (LBP): – Specific LBP: specific cause can be found (disease, injury) – Non Specific LBP: specific cause cannot be found(80%of all)
Occupational Low Back Pain • • Definition Epidemiology Cost Risk Factors Biomechanics Prevention Treatment Red flags
Occupational Low Back Pain EPIDEMIOLOGY • Point Prevalence 18% • Life Long Prevalence 80% - 90%
Occupational Low Back Pain • • Definition Epidemiology Cost Risk Factors Biomechanics Prevention Treatment Red flags
Occupational Low Back Pain COSTS • DIRECT COST 12 BILION $ • INDIRECT COST 50 BILION $
Occupational Low Back Pain • • Definition Epidemiology Cost Risk Factors Biomechanics Prevention Treatment Red flags
Risk factors for the onset of LBP • Individual: Age, smoking, general health status, high birth weight (male) • Psychosocial: high levels of stress • Occupational: heavy lifting , prolonged forward flexion, Lateral bending, twisting, prolonged standing or sitting, whole body vibration
Occupational Low Back Pain • • Definition Epidemiology Cost Risk Factors Biomechanics Prevention Treatment Red flags
Keeping loads close to the body reduces forces on the low back.
Avoid high and low object placement, especially as the weight and/or size of the object increases. Too high Too low
Occupational Low Back Pain • • Definition Epidemiology Cost Risk Factors Biomechanics Prevention Treatment Red flags
Recommended Weight Limit (RWL) RWL=LC x HM x VM x DM x AM x FM x CM • LC=Load Constant = 23 Kg • HM=Horizontal Modifier=25/H • VM=Vertical Modifier=1 -(0. 003[V-75]) • DM=Distance Modifier=0. 82+(4. 5/D) • AM=Asymmetric Modifier=1 -(0. 0032 A) • FM=Frequency Modifier=Table • CM=Coupling Modifier=Table
Occupational Low Back Pain • • Definition Epidemiology Cost Risk Factors Biomechanics Prevention Treatment Red flags
Management of NSLBP • A careful medical evaluation : for R/O serious • spinal or non-spinal pathology In the absence of red flags: – Over-the-counter drugs (NSAIDs, Muscle relaxant, TCA, Steroid? ) – Incomplete bed rest for 48 h, (as active as possible) – Leisure and work activities should be resumed as soon as possible – Spinal manipulation is helpful in acute NSLBP – Temporary symptomatic relief from heat and cold
Laboratory & Imaging • • • X-rays: no routine evaluation within the first 4 weeks. Unless a red flag and high index of suspicion. CBC & ESR: If symptoms >4 weeks MRI: persistent or progressive neurological deficits and an exam consistent with a nerve root impingement (asymptomatic adults, prevalence of disk herniation 22 -40%)
Prognosis • Up to 90%: recover within 4 weeks and 96% • • • recover between 4 -12 weeks 4% of all patients remain disabled after 12 weeks Recurrence: 8. 9% to 44% (social system, culture, type of work) Patients do not recover after 4 weeks: At risk for delayed recovery and prolonged disability
Occupational Low Back Pain • • Definition Epidemiology Cost Risk Factors Biomechanics Prevention Treatment Red flags
Occupational Low Back Pain RED FLAGS • • • Presentation Age <20 or >55 Non mechanical pain Constitutional symptoms (fever, weight loss) Widespread neurology Structural deformity Systemic disease History of cancer Systemic steroid use Recent bowel or bladder dysfunction Saddle anesthesia Violent trauma
Any Questions?
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