Work Related Musculoskeletal Disorders Dr Majid Golabadi Occupational
Work Related Musculoskeletal Disorders Dr. Majid Golabadi Occupational Medicine Specialist
Musculoskeletal Disorders • Articular, Non Articular • Inflammatory, Non Inflammatory • Acute, Chronic • Traumatic, Non Traumatic • Occupational, Non Occupational
Musculoskeletal Exam Fitness for work (Capability) • Person without MSD • Person with MSD Work induced MSD
Job Risk Factors Ergonomic • Repetition • Force • Awkward posture • Static pusture • Contact stress Non ergonomic • Vibration • Noise • Job stress
Upper Extremity Disorders
The Most Important Disorders • Shoulder: • Rotator cuff tendinitis • Bicipital tendinitis • Elbow: • • Lateral Epicondylitis Medial Epicondylitis Olecranon Bursitis Cubital Tunnel Syndrome • Wrist: • • Carpal tunnel syndrome De. Quervain disease Ganglion cyst Trigger wrist • Hand: • • • Guyon`s canal syndrome Hypothenar hammer syndrome Trigger finger Trigger thumb Occupational hand cramp
Lateral Epicondylitis (Tennis Elbow)
Lateral Epicondylitis (Tennis Elbow) Inflammation, at the muscular origin of the extensor carpi radialis brevis (ECRB). the most common overuse injury of the elbow up to 10 times more frequently than medial epicondylitis most often occurs between the third and fifth decades of life.
Ergonomic Stressors • Frequent lifting • Repetitive wrist dorsiflexion with force • Sustained power gripping. • Repetitive forearm supination • Sudden elbow extension • Tool use, shaking hand, twisting movement
Clinical Presentations lateral elbow pain of gradual onset. pain generally increases with activity Picking up a cup of coffee or a gallon of milk Heavy lifting Gripping Pain may be present at night. Symptoms are typically unilateral.
Area of Pain
Physical Examination localized tenderness to palpation just distal and anterior to the lateral epicondyle.
Presumptive Diagnosis Requires: • Local tenderness directly over the lateral epicondyle • Pain aggravated by resisted wrist extension and radial deviation • Pain aggravated by strong gripping • Normal elbow range of motion
Paraclinical Testing • No specific test is required
Splints for Tennis Elbow
Carpal Tunnel Syndrome
• Carpal tunnel syndrome is a traumatic or pressure neuropathy of the median nerve in the wrist • The most common entrapment neuropathy in the body • Compression of the median nerve as it passes through the carpal tunnel • Overall prevalence is 2. 7% • Is more common in women and between ages 40 to 60 years
Etiology
Work Related Risk Factors Occupations that require Repetitive Flexion and extension of the fingers and wrist
Symptoms • Paresthesias in the median nerve distribution, gradually and spontaneously • With progression: pain, numbness, tingling and burning • In more progressed cases: Reduced force, Skin sensory deficit and Thenar Atrophy
Diagnosis • History: Night-time and morning symptoms, sometimes occurring with driving, and relief by shaking or movement (Flick sign) • Intermittent Nocturnal Brachalgia • Clumsiness • Rule out of systemic causes
Physical Exam: • Phalen’s Test and Tinnel’s sign • Two-Point Discrimination Test • thumb abduction • thumb opposition • pinch movements
Phalen Test
Tinnel sign
• Electrodiagnostic studies: EMG/NCV confirm diagnosis • Thenar weakness should warrant full EMG studies
Treatment 1 - Treatment of associated conditions 2 - Splinting the wrist in a neutral position at night and during the day. For 2 to 4 weeks Job task modification is often critical in this phase 3 - Corticosteroid injection into the carpal tunnel 4 - Surgery. After 3 month of conservative treatment
Surgery indications • Progressive symptoms • Persistent symptoms • Thenar Atrophy • EMG abnormalities
De Quervain’s Disease
De Quervain’s Disease • Inflammation of the tendon sheath of the extensor pollicis brevis and abductor pollicis longus • Combination of Tendonitis and Tenosynovitis. • In individuals between 30 and 50 years of age and is ten times more prevalent among women than men • May be caused by OVER USE of thumb, like repetitive work and forceful gripping
Symptoms • pain at the base of the thumb. • swelling Differential diagnosis • Old nonunion of navicular bone • Osteoartritis of first carpometacarpal joint
Finkelstein test
Treatment • Modifying hand activity • Immubilization of thumb (3 -6 weeks) • NSAIDs • Local Injection of Lidocain-triamcinolone into tendon sheat (Standard Treatment) • Surgical decompression
Trigger Finger
• Stenosing tenosinovitis of the flexor tendon of the finger • Painful snap or jerking movements in PIP • Collapse the joint suddenly like a trigger • Usually associated with using tools that have handles with hard or sharp edges.
• Trauma, • Rheumatoid arthritis, • CTS Differential diagnosis • De Qurvein • Dupuytren Contractures
Dupuytren's Contracture • A localized scar tissue formation in the palm. • The precise cause of a Dupuytren's contracture is not known. • A Dupuytren's contracture is sometimes inherited. • A Dupuytren's contracture can limit extension of the affected finger. • The treatment include stretching, heat, ultrasound, local cortisone injection, surgical procedures, and collagen injection • The precise cause of a Dupuytren's contracture is not known. However, it is known that it occurs more frequently in patients with diabetes mellitus, seizure disorders (epilepsy), and alcoholism.
Dupuytren Contractures
Treatment • Local Injection of Lidocain-triamcinolone into tendon sheet (Standard Treatment) • Surgical decompression
Osteoarthritis of the first carpometacarpal joint
• In 25% of women older than 55 years • Unknown cause • Pain at the base of thumb when grasping • Squaring of the base of thumb • Diagnosis with radiographs
Tratment • Avoid repetitive painful activities • Immobilization • NSAIDs • Arthroplasty or arthrodesis
Scaphoid Fractures
• Occur in younger people • Pain at the base of the thumb or wrist pain • Tenderness of the tuberosity of scaphoid • PA, Lateral and Scaphoid view Ragiographs • MRI or Bone Scan
Treatment • Nondisplaced 12 weaks immobilization • Displased Open reduction and Internal Fixation
Mallet Finger
• Disruption of extensor tendon at the distal interphalangial (DIP) joint
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