The reported incidence of work-related musculoskeletal disease in the UK: MOSS 1997-2000

Incidence of shoulder disorders in a cohort of healthcare workers from 2009 to 2020

PURPOSE

To estimate the incidence of shoulder disorders in a cohort of Health Care Workers (HCWs).

METHODS

4406 workers employed from 2009 to 2020, were included in the study. Occupational risk factors and jobs were assessed according to working history. Incident cases were defined in case of shoulder pain associated with functional limitations during the medical examination. The Cox regression model was used to calculate the Hazard Ratio (HR) for different work activities, adjusted for age, sex, body mass index, and previous musculoskeletal injuries, using clerks as the reference category.

RESULTS

The incidence rates of shoulder musculoskeletal disorder for men and women were 13.1 for 1000 person-years (CI 95% 10.6-16.3) and 20.1 for 1000 person-years (CI 95% 17.8-22.6) respectively. The adjusted HR was significantly increased with age (1.06, CI 95% 1.05-1.07), outpatient health activities (2.82, CI 95% 1.89-4.219), and wards health activity (2.37, CI 95% 1.68-3.33).

CONCLUSION

HCWs with high biomechanical risk such as nurses and healthcare assistants had a higher incidence of shoulder disorders. Actions are needed for better prevention in health care assistance.

Prevalence and incidence of work-related musculoskeletal disorders in secondary industries of 21st century Europe: a systematic review and meta-analysis

OBJECTIVE

Over the course of the twenty-first century, work-related musculoskeletal disorders are still persisting among blue collar workers. At present, no epidemiological overview exists. Therefore, a systematic review and meta-analysis was performed on the epidemiology of work-related musculoskeletal disorders (WMSD) within Europe's secondary industries.

METHODS

Five databases were screened, yielding 34 studies for the qualitative analysis and 17 for the quantitative analysis. Twelve subgroups of WMSDs were obtained for the meta-analysis by means of predefined inclusion criteria: back (overall), upper back, lower back, neck, shoulder, neck/shoulder, elbow, wrist/hand, leg (overall), hip, knee, and ankle/feet.

RESULTS

The most prevalent WMSDs were located at the back (overall), shoulder/neck, neck, shoulder, lower back and wrist WMSDs with mean 12-month prevalence values of 60, 54, 51, 50, 47, and 42%, respectively. The food industry was in the majority of subgroups the most prominent researched sector and was frequently associated with high prevalence values of WMSDs. Incidence ratios of upper limb WMSDs ranged between 0.04 and 0.26. Incidence ratios could not be calculated for other anatomical regions due to the lack of sufficient articles.

CONCLUSION

WMSDs are still highly present among blue collar workers. Relatively high prevalence values and low incidence ratios indicate a limited onset of WMSDs with however long-term complaints.

Prevalence of musculoskeletal pains and effect of work-related factors among employees on offshore oil and gas installations in Iran

BACKGROUND

Work-related musculoskeletal pain is usually caused by poor physical conditions, repetitive motion, and adverse environmental and psychological situations.

OBJECTIVE

This study aims to assess the prevalence of musculoskeletal pain and their work-related factors among employees on offshore oil and gas installations in Iran.

METHODS

Standardized Nordic Questionnaire was used to collect data. The relationship of musculoskeletal pain with job type, rest breaks, exercise, shift program, and work period was studied among employees on offshore installations. T-test and ANOVA were used for data analysis.

RESULTS

Employees on offshore installations were exposed to high levels of risk of musculoskeletal pain in their knees and back. Consequently, they reported the highest level of complaints of pain in the neck and lower back areas. Workers in drilling and tour-scheduling jobs reported the highest level of musculoskeletal pain. In the course of seven days and 12 months, the highest level of significant relationship was observed between the limbs and the work periods (tour scheduling or days-off) of the staff.

CONCLUSION

The findings showed that the prevalence of musculoskeletal disorders among employees of offshore facilities was high due to inappropriate working conditions such as repetitive work, lifting heavy loads and limited rest periods. Therefore, strategies must be considered to reduce the effects of disorders.

Prevalence of cubital tunnel syndrome among dock workers, Saint Sebastian, São Paulo, Brazil

Background

Ports play a substantial role in the Brazilian economy.Despite the large number of port workers, few studies report that the most common musculoskeletal disorders among them involve the upper limbs, including carpal tunnel syndrome, rotator cuff syndrome, cervicalgia and cubital tunnel syndrome.The latter is a neuritis caused by compression of the ulnar nerve at the cubital tunnel (CuTS) on the elbow.

Objective

To estimate the prevalence of a suggestive diagnosis of CuTS among port workers.

Method

Seventy-two independent port workers registered with the Labor Management Organ (Órgão Gestor de Mão de Obra - OGMO), Port of Saint Sebastian, were evaluated based on a semi-structured questionnaire and clinical examination, including investigation of pain on palpation of the middle area of the elbow and two maneuvers specific for CuTS, namely, the pressure provocation and maximal flexion tests.

Results

The average age of the participants was 48.49 years old, and their average length in the job 23.13 years.Suggestive diagnosis of CuTS was established for five participants.In only two cases elbow pain had begun before, and in three after starting work at the port.

Conclusion

The prevalence of a suggestive diagnosis of CuTS was 6.9%, and was higher among the participants with longer length in the job (over one year).

Work-related ill-health in radiographers

Background

In the UK in 2015/16, 1.3 million workers self-reported a work-related illness (WRI) of which an estimated 41% were due to musculoskeletal disorders (incidence rate 550 cases per 100000 people) and 37% were related to stress, anxiety and depression. Little is known about the incidence of WRIs in radiographers.

Aims

To analyse the medically reported incidence of WRIs among radiographers in the UK between 1989 and 2015.

Methods

Incident cases reported by physicians to The Health and Occupation Research (THOR) network through its specialist schemes from 1989 to 2015 were analysed, using the Labour Force Survey as denominator where appropriate.

Results

In total, 218 cases (966 estimated cases) were reported. Of these 190 were in women. The mean age was 40.2 (20-91 years) SD ± 11.8 years. Most cases were reported to the Occupational Physicians Reporting Activity (OPRA) scheme (n = 92). A skin diagnosis was the most frequently reported (n = 77), followed by musculoskeletal (n = 60). Within the EPIDERM scheme, radiographers had the highest incidence rate when compared to all other occupations.

Conclusions

Radiographers had a higher incidence of WRI compared to all other occupations. The most frequently reported WRI was skin conditions. The observed increase in incidence is likely to be due to the increase in the number of radiographers over that time period, although there was no evidence that WRI within radiographers are declining.

Incidence of ill-health related job loss and related social and occupational factors. The "unfit for the job" study: a one-year follow-up study of 51,132 workers

Objective

The analysis of ill-health related job loss may be a relevant indicator for the prioritization of actions in the workplace or in the field of public health, as well as a target for health promotion. The aim of this study was to analyze the medical causes, the incidence, and the characteristics of employees medically unfit to do their job.

Methods

This one-year prospective study included all workers followed by occupational physicians in an occupational health service in the south of France. The incidence of unfitness for work have been grouped according to the main medical causes and analyzed. We performed a multivariate analysis in order to adjust the observed risk of job loss based on the age groups, sex, occupation and the activity sectors.

Results

A total of 17 occupational physicians followed up 51,132 workers. The all-cause incidence of being unfit to return to one’s job was 7.8‰ (n = 398). The two main causes of being unfit for one’s job were musculoskeletal disorders (47.2%, n = 188) and mental ill-health (38.4%, n = 153). Being over 50 years old (Odds ratio (OR) 2.63, confidence interval 95% CI [2.13–3.25]) and being a woman (OR 1.52, 95% CI [1.21–1.91]) were associated with the all-cause unfitness, independent of occupation and activity sector.

Conclusions

Identification of occupational and demographic determinants independently associated with ill-health related job loss may provide significant and cost-effective arguments for health promotion and job loss prevention.

Ill Health-Related Job Loss: A One-Year Follow-Up of 54,026 Employees

INTRODUCTION

The diagnoses of workers being unfit to work may be a relevant health indicator. Therefore, the aim of this study was to analyze the one-year incidence of an unfit to work diagnosis.

METHOD

This one-year prospective study included all workers undergoing annual work medical examination from occupational health services in Troyes, France.

RESULTS

Twenty-one occupational physicians followed 54,026 employees. The all-cause incidence of being unfit to return to work was 0.772%. The two main causes of being unfit to work were musculoskeletal disorders (61%) and psychopathologies (24%). The relative risk (RR) of being unfit to work, independent of the cause, was higher when employees were aged over 50 years (RR = 2.51), and female (RR = 1.51).

CONCLUSIONS

Prospective results from occupational physicians' medical records may provide significant and cost-effective directions to prioritize actions and target health promotion in the workplace.

Work-related psychosocial risk factors and musculoskeletal disorders in hospital nurses and nursing aides: a systematic review and meta-analysis

OBJECTIVES

To estimate the association between psychosocial risk factors in the workplace and musculoskeletal disorders (MSD) in nurses and aides.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

An electronic search was performed using MEDLINE (Pubmed), Psychinfo, Web of Science, Tripdatabase, Cochrane Central Controlled Trials, NIOSHTIC and Joanna Briggs Institute of Systematic Reviews on Nursing and Midwifery, to identify observational studies assessing the role of psychosocial risk factors on MSD in hospital nurses and nursing aides.

REVIEW METHODS

Two reviewers independently assessed eligibility and extracted data. Quality assessment was conducted independently by two reviewers using an adapted version of the Standardized Quality Scale. Random-effects meta-analysis was performed by subsets based on specific anatomical site and the exposure to specific psychosocial risk factors. Heterogeneity for each subset of meta-analysis was assessed and meta-regressions were conducted to examine the source of heterogeneity among studies.

RESULTS

Twenty-four articles were included in the review, seventeen of which were selected for meta-analysis. An association was identified between high psychosocial demands-low job control with prevalent and incident low back pain (OR 1.56; 95% CI 1.22-1.99 and OR 1.52; 95% CI 1.14-2.01, respectively), prevalent shoulder pain (OR 1.89; 95% CI 1.53-2.34), prevalent knee pain (OR 2.21; 95% CI 1.07-4.54), and prevalent pain at any anatomical site (OR 1.38; 95% CI 1.09-1.75). Effort-reward imbalance was associated with prevalent MSD at any anatomical site (OR 6.13; 95% CI 5.32-7.07) and low social support with incident back pain (OR 1.82; 95% CI 1.43-2.32). Heterogeneity was generally low for most subsets of meta-analysis.

CONCLUSION

This meta-analysis suggests that psychosocial risk factors at the workplace are associated with MSD in hospital nurses and nursing aides. Although most preventive strategies at the workplace are focused on ergonomic risk factors, improving the psychosocial work environment might have an impact on reducing MSDs.

Work-related musculoskeletal disorders at two textile factories in edirne, Turkey

OBJECTIVE

"Work-related musculoskeletal disorders" (WMSDs) is a term used to describe a painful or disabling injury to the muscles, tendons or nerves caused or aggravated by work. WMSDs are preventable or at least can be delayed. The aim of this study to determine the work related musculo-skeletal disorders and risk levels of the these factory workers.

STUDY DESIGN

Cross sectional study.

MATERIAL AND METHODS

This is a cross-sectional study conducted at two textile factories in Edirne, Turkey and it involved 381 workers. The questionnaire used for data collection consisted of two parts. The first part described some socio-demographic features, working conditions and health problems of workers in the previous four weeks. In the second part, a Rapid Upper Limb Assessment (RULA) Employer Assessment worksheet was used.

RESULTS

In the assessment of the upper limbs of the workers, the arm/wrist score (AWS) is 5.9±1.7 (3-11); neck, trunk, legs score (NTLS) is 5.3±2.5 (3-11); and total score (TS) is 5.5±1.3 (3-7). The ages of the workers are significantly associated with higher RULA scores (r=0.207, p=0.000). AWS, NTLS and TS of the women workers were found to be statistically significantly lower than for the men.

CONCLUSION

Musculoskeletal disorders are a common problem among textile workers. Employers can prevent WMSD hazards by properly designing the jobs or workstations and selecting the appropriate tools or equipment.

[Cumulative annual incidence of disabling work-related musculoskeletal disorders in an urban area of Brazil]

This study focused on the annual cumulative incidence (ACI) of disabling work-related musculoskeletal disorders affecting the neck and/or upper limbs (ULMSD) among workers covered by the National Social Insurance System in the city of Salvador, Bahia State, Brazil. Cases were workers who received disability compensation benefits when unable to work due to ULMSD, during the year 2008. The data were obtained from the administrative systems of the National Social Insurance Institute and Ministry of Labor and Employment. ACI was 15 per 10,000 workers. Increased ACI of ULMSD was associated with female gender, lower income, and work in financial activities or manufacturing. Women earning the minimum wage (US$ 64.00 per month) or less had the highest ACI of ULMSD (123 per 10,000), suggesting inequalities in the occurrence of these disorders. The study indicates the need to prioritize preventive actions focusing on ergonomics and work organization, early diagnosis, treatment, and rehabilitation.

Self-reported work-related symptoms in hairdressers

BACKGROUND

Detailed studies of current symptoms reported by hairdressers and of the training received to reduce the health risks associated with this work are uncommon.

AIMS

To document current levels of self-reported health problems in hairdressers, compared to non-hairdressing controls.

METHODS

An interviewer-led questionnaire recording demographic information, work history, health training levels and the presence of self-reported respiratory, skin, musculoskeletal and non-specific symptoms was administered.

RESULTS

In total, 147 hairdressers, 86% of whom were female (median age 27 years) and 67 non-hairdressing controls, all female (median age 38 years) were recruited. Following adjustment for age, smoking and years worked, hairdressers reported significantly higher levels of musculoskeletal problems, including work-related shoulder pain (OR 11.6, 95% CI 2.4-55.4), work-related wrist and hand pain (2.8, 1.1-7.6), work-related upper back pain (3.8, 1.0-14.9), work-related lower back pain (4.9, 1.5-15.9) and work-related leg/foot pain (31.0, 3.8-267.4). The frequency of self-reported asthma was similar in both groups (hairdressers 16%, controls 17%) as was chest tightness and wheeze. Work-related cough was significantly more frequently reported in hairdressers than in controls (13.2, 1.3-131.5). While hairdresser training was commonplace, such training did not always appear to have resulted in awareness of potential workplace health risks.

CONCLUSIONS

This study identified frequently reported musculoskeletal, skin and respiratory symptoms in hairdressers. This points to a need to develop training that not only deals with risk assessment but also informs hairdressers about the health risks of their work.

Measurement of a number of indices of hand and movement angles in pianists with overuse disorders

Abduction angles of the thumb and little finger, hand span, length of thumb, middle finger and little finger were measured using radiographs of the right hand with the thumb and the little finger abducted, in a comparative study of 220 pianists with overuse disorder and 62 unaffected pianists. Overuse disorders included tenosynovitis, lateral and medial epicondylitis, forearm flexor muscle pain, distal tendinitis of the wrist extensors and flexors and intrinsic muscle pain. Hand span or other hand size parameters showed significant differences, while abduction angles showed no difference. The patients' group had smaller hand size than the controls when analyzed for tenosynovitis, epicondylitis and muscle pain. From these results we hypothesize that pianists with small hands tend to hyper-abduct and hyper-extend the thumb to attain greater hand span. Their little finger is also stiffer and the hypothenar muscle and the wrist flexors need greater strength to resist the reaction force in each piano key.

Prevalence and risk factors associated with musculoskeletal discomfort in New Zealand veterinarians

A cross-sectional study using a modified Nordic musculoskeletal questionnaire asked 867 New Zealand veterinarians about the presence or absence of musculoskeletal discomfort (MSD). Participants were asked if MSD affected their normal activities and if it required any period(s) of absence from work. Additional questions enquired about work activities, psychosocial factors and workload. A binary logistic regression analysis was used to quantify the association between identified risk factors and the presence of MSD requiring absence from work in the previous 12 months, controlling for the presence of known confounders. The overall period prevalence of MSD was 96%, 67% had normal activities being affected and 18% of participants reported that they had been absent from work due to MSD. The lower back was the body site most commonly reported for MSD (73%). Factors increasing the odds of MSD requiring time off work for clinical veterinarians were 10 year increases in age (OR 1.26, 95% CI 1.05-1.52), work involving awkward grip and hand movements 100% of time (OR 12.91, 95% CI 3.46-4.21) and those who were dissatisfied with the level and difficulty of their work (OR 2.27, 95% CI 1.11-6.56). These findings have implications for health, lifestyle and retention rates for veterinarians.

Prevalence of Work-Related Upper Limbs Symptoms (WRULS) Among Office Workers

An analytical cross-sectional study was carried out to determine the prevalence of work-related upper limbs symptoms (WRULS) among office workers and factors associated with it. A self-administered questionnaire was used to collect the information. A total of 463 (87.7%) office workers from selected government agencies participated in this study. The mean age of the respondents was 34.1 years (range = 18-55 years). Majority (91.6%) were Malay and female (72.8%), and 58.1% were from clerical group. Mean duration of work was 8.7 years. This study found that prevalence of WRULS was 33.0% (95% CI [confidence interval] = 28.8%, 37.3%). Computer users at work had 2.0 (95% CI = 1.1, 3.4) higher odds ratio of developing WRULS and those who used it for 5 hours and more per day had 7.5 (95% CI = 2.3, 24.2) higher odds ratio of developing WRULS. Hand-intensive hobbies and higher education were also found to be associated with WRULS.

Knowledge to action: a challenge for neck pain treatment

SYNOPSIS

For clinicians, systematic reviews can enhance incorporation into practice of the large volumes of information emerging from research on effectiveness and risks. But we believe that these reviews are most useful with simplified tools to facilitate translation of this knowledge into practice. We provide a "Neck Care Tool Kit" that gives a diagrammatic approach to prioritizing intervention. The evidence from a series of 11 systematic reviews by the Cervical Overview Group is depicted in decision flow-charts and tables to enhance clinical interpretation of the overview findings. On simple visual inspection of symbols in a table, the reader can establish where there is evidence of benefit or no benefit, the strength of the recommendation, and if these data represent short- or long-term findings. Where possible, we guide clinicians to dosage of specific treatment methods. There is no consensus as to which outcome measures to prioritize among the large number in use. This clinical commentary guides clinicians to view the evidence in enough detail to integrate it into their clinical practice environment. We conclude by delineating research gaps and proposing future research directions.

LEVEL OF EVIDENCE

Therapy, level 5.

Occupational disease among non-governmental employees in Malaysia: 2002-2006

In the absence of systematic occupational disease surveillance, other data collected by governmental agencies or industry is useful in the identification of occupational diseases and their control. We examined data on occupational diseases reported by non-governmental employees to the national workers' social security organization in Malaysia, 2002-2006. The overall incidence rate of occupational disease was 2.8 per 100,000 workers. There was an increase in the annual number and rates of occupational disease over time. The most frequently reported conditions were hearing impairment (32%) and musculoskeletal disorders (28%). Workers in the non-metallic manufacturing industry had the highest average incidence rate of hearing impairment (12.7 per 100,000 workers) and musculoskeletal disorders (3.5 per 100,000 workers), compared to all other industries. Preventive measures should focus on safety education, engineering control and workplace ergonomics. Enforcing workplace standards and incorporating an ongoing surveillance system will facilitate the control and reduction of occupational disease.

Work-related ill health in general practice, as reported to a UK-wide surveillance scheme

GPs with training in occupational medicine report cases of work-related ill health and sickness absence to The Health and Occupation Reporting network in General Practice (THOR-GP) using an online webform. This report describes the data reported in 2006 and 2007. GPs mainly reported musculoskeletal disorders and mental ill-health. A much larger proportion of the mental ill-health cases were sickness-absence certified, making up 55.9% of the total days certified. Musculoskeletal disorders are the most frequently reported diagnoses of work-related ill health, but mental ill-health is responsible for most work-related sickness absence.

The Cochran-Weiss-Shanteau performance index as an indicator of upper limb risk assessment expertise

Ergonomists and many other professionals apply ergonomics principles to musculoskeletal health problems. This study examines whether there are differences when it comes to judgement expertise concerning upper limb disorders (ULDs) between ergonomists and those with less ergonomics training. The Cochran-Weiss-Shanteau (CWS) performance index combines judgement consistency with discrimination into one CWS index. Fifty-eight professionals working in the musculoskeletal health area, from four different professions, judged the likelihood of staff complaining of ULDs in a number of written work scenarios containing ULD risk factors. A student group (n = 148) taking an introductory ergonomics module was used as a reference. The ergonomists scored higher on the CWS index than all of the other groups, performing significantly better than all but the occupational health advisors. Performance improved with increased training level but not with experience. This study suggests that ergonomists are quantifiably different from other ergonomics advisors in their judgement performance in this context. Given the global cost of musculoskeletal disorders, assessing the expertise of those giving ergonomics advice for the management of musculoskeletal health is of great significance. This study presents a method for assessing judgement performance in ULD risk assessment, an important part of musculoskeletal health management.

The impact of workplace risk factors on the occurrence of neck and upper limb pain: a general population study

Background

Work-related neck and upper limb pain has mainly been studied in specific occupational groups, and little is known about its impact in the general population. The objectives of this study were to estimate the prevalence and population impact of work-related neck and upper limb pain.

Methods

A cross-sectional survey was conducted of 10 000 adults in North Staffordshire, UK, in which there is a common local manual industry. The primary outcome measure was presence or absence of neck and upper limb pain. Participants were asked to give details of up to five recent jobs, and to report exposure to six work activities involving the neck or upper limbs. Psychosocial measures included job control, demand and support. Odds ratios (ORs) and population attributable fractions were calculated for these risk factors.

Results

The age-standardized one-month period prevalence of neck and upper limb pain was 44%. There were significant independent associations between neck and upper limb pain and: repeated lifting of heavy objects (OR = 1.4); prolonged bending of neck (OR = 2.0); working with arms at/above shoulder height (OR = 1.3); little job control (OR = 1.6); and little supervisor support (OR = 1.3). The population attributable fractions were 0.24 (24%) for exposure to work activities and 0.12 (12%) for exposure to psychosocial factors.

Conclusion

Neck and upper limb pain is associated with both physical and psychosocial factors in the work environment. Inferences of cause-and-effect from cross-sectional studies must be made with caution; nonetheless, our findings suggest that modification of the work environment might prevent up to one in three of cases of neck and upper limb pain in the general population, depending on current exposures to occupational risk.

Reported incidence and precipitating factors of work-related stress and mental ill-health in the United Kingdom (1996–2001)

BACKGROUND

Work-related mental ill-health appears to be increasing. Population-based data on incidence are scarce but in the United Kingdom occupational physicians and psychiatrists report these conditions to voluntary surveillance schemes.

AIMS

To estimate the incidence of work-related stress and mental illness reported 1996-2001 by occupational physicians and 1999-2001 by psychiatrists.

METHODS

Estimated annual average incidence rates were calculated by sex, occupation and industry against appropriate populations at risk. An in-house coding scheme was used to classify and analyse data on precipitating events.

RESULTS

An estimated annual average of 3,624 new cases were reported by psychiatrists, and 2,718 by occupational physicians; the rates were higher for men in reports based on the former and for women on the latter. Most diagnoses were of anxiety/depression or work-related stress, with post-traumatic stress accounting for approximately 10% of cases reported by psychiatrists. High rates of ill-health were seen among professional and associated workers and in those in personal and protective services. Factors (such as work overload) intrinsic to the job and issues with interpersonal relations were the most common causes overall.

CONCLUSIONS

The steep increase in new cases of work-related mental ill-health reported by occupational physicians since 1996 may reflect a greater willingness by workers to seek help but may also signify an increasing dissonance between workers' expectations and the work environment. Greater expertise is needed to improve the workplace by adjustment of job demands, improvement of working relations, increasing workers' capacities and management of organizational change.

Incidence and suspected cause of work-related musculoskeletal disorders, United Kingdom, 1996–2001

BACKGROUND

Musculoskeletal conditions are the most common self-reported work-related disease, with high costs incurred from long-term disability. In the United Kingdom, occupational physicians and rheumatologists have been reporting new cases of work-related musculoskeletal disorders to voluntary surveillance schemes since 1996.

AIMS

To estimate population incidence rates for work-related musculoskeletal disorders reported by rheumatologists and occupational physicians by occupation and industry, in relation to tasks and movements suspected as causal.

METHODS

Estimated average annual incidence rates were calculated for nine main job categories and eight industrial groups; Labour Force Survey figures were used as the denominator for rheumatologists, and a special survey for the occupational physicians. These were then related to tasks and movements reported as causal.

RESULTS

Between October 1997 and the end of 2001, an estimated 2,599 new cases/year were reported by rheumatologists, and from January 1996, 5,278 cases/year by occupational physicians. Average annual rates overall were 94 per million for rheumatologists and 1,643 per million for occupational physicians (a 17-fold difference). Jobs at highest risk for the upper limb were primarily clerical, craft-related and machine work. Tasks associated with upper limb disorders and with neck and back problems were predominantly keyboard work and heavy lifting, and in craft-related occupations with gripping or holding tools.

CONCLUSIONS

Jobs at risk and the associate tasks were identified which should assist prevention, but the extent to which these factors were causal or aggravating previous injury requires further study. The much higher rates reported by occupational physicians reflect, in part, the type of industries they served.

A randomised, placebo controlled trial of low level laser therapy for activated Achilles tendinitis with microdialysis measurement of peritendinous prostaglandin E2 concentrations

BACKGROUND

Low level laser therapy (LLLT) has gained increasing popularity in the management of tendinopathy and arthritis. Results from in vitro and in vivo studies have suggested that inflammatory modulation is one of several possible biological mechanisms of LLLT action.

OBJECTIVE

To investigate in situ if LLLT has an anti-inflammatory effect on activated tendinitis of the human Achilles tendon.

SUBJECTS

Seven patients with bilateral Achilles tendinitis (14 tendons) who had aggravated symptoms produced by pain inducing activity immediately before the study.

METHOD

Infrared (904 nm wavelength) LLLT (5.4 J per point, power density 20 mW/cm2) and placebo LLLT (0 J) were administered to both Achilles tendons in random blinded order.

RESULTS

Ultrasonography Doppler measurements at baseline showed minor inflammation through increased intratendinous blood flow in all 14 tendons and measurable resistive index in eight tendons of 0.91 (95% confidence interval 0.87 to 0.95). Prostaglandin E2 concentrations were significantly reduced 75, 90, and 105 minutes after active LLLT compared with concentrations before treatment (p = 0.026) and after placebo LLLT (p = 0.009). Pressure pain threshold had increased significantly (p = 0.012) after active LLLT compared with placebo LLLT: the mean difference in the change between the groups was 0.40 kg/cm2 (95% confidence interval 0.10 to 0.70).

CONCLUSION

LLLT at a dose of 5.4 J per point can reduce inflammation and pain in activated Achilles tendinitis. LLLT may therefore have potential in the management of diseases with an inflammatory component.

Chronic compartment syndrome, an important cause of work-related upper limb disorder

OBJECTIVES

Work-related upper limb disorders (WRULD) are common and disabling complaints in industry, but a tissue diagnosis can be difficult where the pain is diffuse and variable, and this prevents effective treatment. Diffuse arm pain is frequently found in those doing rapid or strenuous repetitive work, such as factory assembly workers or keyboard operators. Similar symptoms occur in the legs in athletes, where chronic compartment syndrome (CCS) is a recognized entity, so we investigated the possibility that this might also be caused by prolonged repetitive work.

METHODS

Patients were selected if they were unable to continue with work because of chronic forearm pain. They were divided into three groups: 42 patients with symptoms consistent with CCS as defined in the text, 15 volunteers and patients with other arm complaints, and 10 asymptomatic arms of patients with unilateral CCS. We measured the pressure inside the extensor muscle compartment of the forearm at rest and after a 2 min repetitive gripping exercise using an electronic pressure-sensitive probe.

RESULTS

The results show that CCS is a common and disabling forearm complaint associated with prolonged repetitive work. Fifteen patients have now had decompressive surgery on the extensor muscle compartment with good relief of symptoms.

CONCLUSION

CCS is responsible for chronic peripheral neurological dysfunction in addition to muscle pain, and awareness of this diagnosis allows early identification and treatment of a currently unrecognized disorder with potential resolution of a long-lasting arm disability.

Development of risk filter and risk assessment worksheets for HSE guidance--'Upper Limb Disorders in the Workplace' 2002

Upper limb disorders (ULDs) in the workplace represent a significant cause of ill health in Great Britain. As part of the Health and Safety Commission's strategy for the prevention of musculoskeletal disorders (MSDs), the well known guidance document on ULDs--"Work-related Upper Limb Disorders: a Guide to Prevention" (HSG60), (HMSO, London.), has been extensively revised. This revision (Upper limb disorders in the workplace. HSG60 (rev), HSE Books, Sudbury.) includes the development of new risk assessment tools that can be used by employers to identify ULD risk factors in work activities and more importantly to take action to reduce or eliminate ULD risks. The risk assessment tools form part of a seven stage management approach that underpins the new guidance. This paper outlines the development of the risk assessment tools contained in the revised guidance.

Self reported musculoskeletal symptoms in the neck/shoulders and/or arms and general health (SF-36): eight year follow up of a case-control study

AIMS

To explore and compare the prevalence after eight years of self reported musculoskeletal symptoms and general health (SF-36) for groups with initially different degrees of severity of symptoms in the neck/shoulders and/or arms.

METHODS

A case-control study was performed in 1989 comprising 129 clinically examined cases and 655 survey controls. The study population was followed up in 1997 with a postal survey. The controls, none of which were clinically examined at baseline (1989), were divided into groups according to degree of severity of self reported symptoms in the neck/shoulders and/or arms at baseline: no symptoms, light symptoms, and severe symptoms. Cases were clinically diagnosed with a musculoskeletal disorder of the neck/shoulders and/or arms at baseline.

RESULTS

At the 1997 follow up, there was a trend of increasing prevalence of musculoskeletal symptoms, as well as decreasing health status as rated in the SF-36 over the three severity groups among controls. Only small differences were seen between the cases and the controls reporting severe musculoskeletal symptoms or the neck/shoulders and/or arms.

CONCLUSION

The degree of questionnaire based self reported musculoskeletal symptoms of the neck/shoulders and/or arms clearly indicate different degrees of future health problems (both in terms of self reported musculoskeletal problems and health in general as captured by the SF-36). Therefore, there is a need for improved intervention and health promotion strategies. Such effort should be implemented before musculoskeletal symptoms have developed to clinical cases, particularly in the realm of the workplace.