Work Related Musculoskeletal Disorders

Work Related Musculoskeletal Disorders

Upper Extremity Disorders
* Carpel tunnel syndrome
* Cubital tunnel syndrome
* Thoracic outlet syndrome
* Raynaud’s syndrome (white finger)
* Rotator cuff syndrome
* DeQuervain’s disease
* Tendinitis
* Tenosynovitis
* Trigger finger
* Ganglion cyst

Neurovascular Disorders
* Carpal Tunnel Syndrome
o Impingement of the median nerve caused by irritation and swelling of the tendons in the carpal tunnel
* Cubital Tunnel Syndrome
o Pressure on the ulnar nerve when the elbows are exposed to hard surfaces

Neurovascular Disorders
* Thoracic Outlet Syndrome
o Compression of the blood vessels between the neck and shoulder caused by reaching above shoulder level or carrying heavy objects

* Raynaud’s Syndrome
o Also known as Vibration White Finger ; Blood vessels of the hand are damaged (narrowed) from repeated exposure to vibration for long periods of time

Tendon Disorders
* Rotator Cuff Syndrome
* DeQuervain’s Disease
o Combination of tendinitis and tenosynovitis
* Tendinitis
o Irritation of the tendon
* Tenosynovitis
o Irritation of the synovial sheath
* Ganglion Cyst
o Accumulation of fluid within the tendon sheaths

Tendinitis
Hand and Wrist
Common Occupational CTDs of the Upper Extremities

Carpal Tunnel Syndrome occurs from chronic swelling of the flexor tendons in the wrist.

The median nerve, which feeds the first three fingers and the thumb, can become impaired from pressure in the carpal tunnel in the wrist.

Symptoms include:

# pain in the first three fingers and the thumb
# numbness in these areas
# tingling in these areas

Carpal Tunnel Syndrome
Common Occupational CTDs of the Upper Extremities

Raynaud’s Syndrome is when blood vessels of the hand are damaged (narrowed) from repeated exposure to vibration for long periods of time

This is connected with use of vibrating tools, such as hair clippers and jack hammers.

Raynaud’s Syndrome
Symptoms

o Numbness and tingling in the fingers during vibration exposure; may continue after exposure has been discontinued
o Blanching (whitening) of one fingertip because of a temporary constriction of blood flow
o Other fingers also blanch
o Intensity of pain & frequency of attacks increase in time

Common Occupational CTDs of the Upper Extremities

Cubital Tunnel Syndrome is caused by resting the elbows on hard surfaces such as unpadded tables or armrests.

The ulnar nerve, which feeds the ring and little fingers, can become impaired from pressure near the elbows.

Symptoms include:
+ pain in the ring and little fingers
+ tingling in these areas
+ numbness in these areas


Cubital Tunnel Syndrome
Common Occupational CTDs of the Upper Extremities
Thoracic Outlet Syndrome is caused by frequent reaching above shoulder level, by carrying heavy objects, or poor posture involving a forward head tilt.

A Neurovascular bundle called the brachial plexus, which passes between the collar bone and the top rib, can become impaired from pressure associated with movements that causes these two bones to be positioned close together.

Symptoms include:
+ the arms “falling asleep”
+ weakened pulse
+ numbness in the fingers

Thoracic Outlet Syndrome
Common Occupational CTDs of the Upper Extremities
Rotator cuff syndrome is a disorder involving swelling and pain of tendons comprising the rotator cuff muscle group:

subscapularis, supraspinatus, infraspinatus, & teres minor

Symptoms include:

o Pain when you bend the arm and rotate it outwards against resistance
o Pain on the outside of the shoulder possibly radiating down into the arm
o Pain in the shoulder, which is worse at night
o Stiffness in the shoulder joint.

Rotator Cuff Syndrome Anterior View Posterior View
Common Occupational CTDs of the Upper Extremities

Tendinitis is a common CTD for the wrist, elbow, and shoulder. It occurs when we continually stress the tendon cables, causing them to become irritable and sore.

Lateral Epicondylitis - “Tennis elbow”

Medial Epicondylitis - “Golfer’s elbow”

Symptoms include:

# point tenderness
# swelling
# tennis elbow, pain radiates down to back of hand
# golfer’s elbow, pain radiates down to back of hand

Tendinitis

Tenosynovitis is swelling of the sheath that covers the tendon from constant rubbing against the tendon.

Symptoms include:
swelling
pain
loss of motion
loss of strength
Tenosynovitis
Trigger Finger is a tendon disorder that occurs when there is a groove in the flexing tendon of the finger

If the tendon becomes locked in the sheath, attempts to move the finger cause snapping or jerking movements

Usually associated with using tools that have handles with hard or sharp edges.

Trigger Finger
Ganglion Cyst is a bump under the skin caused by an accumulation of fluid within the tendon sheath. It is commonly found at the hand and wrist.

Ganglion Cyst

De Quervain’s Disease is an inflammation of the tendon sheath of the thumb attributed to excessive friction between two thumb tendons and their common sheath.

It’s a combination of Tendonitis and Tenosynovitis.

May be caused by twisting and forceful gripping

Symptoms include:

* swelling
* pain at the base of the thumb.

De Quervain’s Disease
Prospective Study of Computer Users
Fredric Gerr, et. al., 2002, “A Prospective Study of Computer Users: 1. Study Design and Incidence of Musculoskeletal Symptoms and Disorders”.

o 632 individuals
o Newly hired into jobs requiring  15 hr/week of computer use
o Were followed for up to 3 years

Primary Results
* Hand/Arm (H/A) & Neck/Shoulder (N/S) MSS and MSD were common among computer users
* More than 50% of users reported MSS during the 1st year after starting a new job
* Most common H/A disorder was DeQuervain’s tendonitis
* Most common N/S disorder was somatic pain syndrome

Common Occupational Injuries of the Back

Strains and sprains are damage to the tendons and ligaments caused by one time exertions such as lifting or carrying heavy objects.

These can lead to very noticeable back pain, but the pain usually begins to subside within a few days

Facet joint pain results from irritation of the area where the ribs meet the spinal column.

Typically, there is muscle swelling in the affected area and it can become very painful to sit or stand up straight. In some cases it may also be difficult to breath deeply.

Disk erosion occurs from prolonged pressure on the spinal disks, which causes them to become permanently compressed.

The space between the vertebrae becomes smaller, which can lead to impingement of the nerve roots leading out from the spine.

Sitting puts more pressure on the spinal disks than standing, and sitting with the back unsupported can lead to high levels of disk pressure.

Disc Erosion

Sciatic nerve impingement, also called sciatica, is common for people who sit for prolonged periods of time.

The sciatic nerve runs from your lower back down the back of your leg and into to your feet.
Swelling in certain muscles in the buttocks can put pressure on the sciatic nerve, causing pain down the leg.

Herniated discs occur when the inner portion of the disc protrudes, putting pressure on the nerve roots leading from the spine.

Pain or numbness in the legs is a common symptom of herniated discs in the lower back.

Herniated/Bulging Disc
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Work Related Musculoskeletal Disorders.ppt