Lecture 2 : Occupational Overuse Syndromes Flashcards

1
Q

Multifactorial injuries refers to

A

injuries with many risk factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

most commonly injured age group

A

15-24

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

high risk population for OOS’s

A

females
casual
shift

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Most common areas involved in WRMDs

A
Neck 
Shoulder
Elbow
Wrist and Hand
LBP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

4 categories of risk factors involving cervical spine dysfunction

A

Physical
Psychosocial
Sociodemographic
Clinical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Risk factors for neck pain

A
previous Hx of neck pain 
Hx of LBP and pain at other sites 
Female 
>50 yo
High job demands
low social or work support 
ex smokers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Cervicogenic HA clinical presentation

A

pain

  • typically in occipital, parietal, temporal, frontal or orbital regions of the head
  • any combination of above regions, unilaterally or bilaterally
  • Chronic
Cx Spine symptoms
-neck pain
-focal tenderness
-decrease Cx ROM 
aggrav of HA by Cx ROM 
-Degenerative changes of the z-joints 
-Cx hypomobility syndrome
 - C1-C3 segments
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Tension headaches

A

sustained contraction of neck and scalp muscles
- leads to Cx hypomobility
State of anxiety or chronic depression
-tender points on palpation of pericranial muscles
underlying joint pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Physio treatment options for neck pain

A
mobilisation 
manipulation 
exercise therapy 
muscle conditioning 
-DNF
neurodynamics 
postural & ergonomic re-education 
-get patients to sit well
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Most common shoulder OOS

A

rotator cuff tendinopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

extrinic factors leading to rotator cuff tendinopathy

A
origin external to tendon 
compression and shear forces 
occupation with force and postural factors 
- manual material handling 
- vibrations
-working with hands above shoulder level 
- trunk flexion with rotation 
Overhead sports
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Intrinsic factors leading to rotator cuff tendinopathy

A

degenerative tendon process

age - *important consideration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Consequences of rotator cuff tendinopathy

A

subacromial impingement

internal impingement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

clinical presentation of rotator cuff tendinopathy

A
pain in area of rotator cuff
- slow gradual onset
tenderness in shoulder - dull ache 
pain lifting, reaching overhead and behind back 
- painful arc 
pain sleeping on affected side 
pain with many ADLs 
increasing weakness 
often limited to 90 degrees ROM - pattern>abd>HBB
-Symptoms induced with impingement tests
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Physiotherapy treatment rotator cuff tendinopathy

A
advice and education 
pain relief and swelling? Mx
Avoid painful activities 
- easier said than done 
correction of 
- scapulohumeral rhythm abnormalities 
-training/technique 
ROM exercises 
- pain free
Stretching 
- post cuff and capsule 
Strengthening 
- essential + pain free
Mobilisation 
soft tissue therapy 
Tx spine mobility 

no good evidence to support and any specific rehab strategy
patient compliance is the key

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Lateral epicondylalgia

A

localised pain over lat elbow +- forearm

  • varying severity
  • sudden or gradual onset

increased by specific activities such as backhand stroke, tightly gripping object. writing, shaking hands
- may be repetitive activities or minor ADL’s(lifting cup)

17
Q

Occupational exposure for LE

A

link to certain occupational activities and/or sports that involve gripping

  • forceful grip
  • wrist extensors
  • Repetition
  • Vibration
  • Combination of above factors is the problem
18
Q

LE research

A
increasingly thought that LE is not inflammatory in nature 
- may be degenerative 
- neurogenic inflammation may play role
Hyperalgesia 
Evidence suggests the combination of 
-local tendon pathology 
 changes in pain system - central changes & Cx spine 
Motor system impairments
19
Q

Clinical presentation of LE

A
evidence shows deficits in
- gripping capacity 
-pain free deficits > maximal grip deficit 
muscle strength 
- wrist flexors ansd extensors 
wrist extensors more affected than finger extensors 
morphological changes 
-ECRB
Motor control deficits 
- ECRB 
-Consider CEO
Remember your seminal tests
20
Q

what needs to be assessed beyond ECRB in LE cases

A
elbow joint mobility (passive ext/abd)
-RH joint
Cervical and /or thoracic spine mobility 
-C6. Tx autonomic contribution 
Neurodynamics (ULNTT2) 
-Radial nerve 
Shoulder movement 
- check rotation - restricted?
Unstable or stiff wrist
Training : technique, intensity, volume, equipement 
work duties, equipment
21
Q

Physiotherapy management of LE

A

sources of symptoms
SSTM, friction, massage, MWM, joint/neural mobes, ET
exerccises/advice - opposite arm
counterforce brace
taping to unload and support radial head
self mobs and stretching
cervical spine - central and sensitisation mechanisms

Contributing factors

  • Cx spine
  • shoulder
  • wrist
  • Training factors
22
Q

CTS clinical presentation

A

most common peripheral neuropathy

often linked to neck, shoulder, forearm and elbow

23
Q

Carpal Tunnel clinical presentation

A

Burning volar wrist pain
numbness/paraesthesia- thumb, index finger, middle finger & radial side ring finger
Nocturnal paraesthesia
pain may radiate
- forearm, elbow and shoulder
Flick sign - shaking or flicking wrist relieves symptoms
may get volar wrist swelling
-often report sensation of swelling though not present
possible positive tinel’s sign at wrist

24
Q

Clinical presentation of CTS cont’

A

Stage 1, 2, 3
-mild to severe

mild to moderate
- substantial symptoms but mild Fxal limitations

Severe presentation
- severe functional limitations but less severe symptoms
- compromise of nerve impairs sensory fx
profound numbness - decrease sense of tingling and pain
By this stage you will note atrophy of thenar eminence

25
Occupational exposure (CTS)
link to certain occupational activities remains controversial but associations have been noted between - force - increased hand force repetition vibration prolonged and highly repetitious flexion and extension (particularly +radial deviation) 2x increased with forceful grip or handheld vibratory tools Combination of above factors is the problem potential need for more systematic reviews and meta- analysis of data available- particular recent evidence
26
Increased risks of CTS
links in age gender obesity ``` associated with a number of medical conditions RA Acromegaly Hypothyroidism Pregnancy Trauma ```
27
Diagnostic factors
``` Hx and P/E -24 hour pattern - positions or movements that provoke pain - vibratory tools at work symptoms in adjacent regions easing factors predisposing and/or risk factors ``` Investigations may be used to confirm diagnoses -nerve conduction studies US, MRI play potentially useful role - Xray play very limited diagnostic role No one reliable standard diagnostic test
28
CTS treatment
``` Mild to moderate - splinting or bracing - night or constant - corticosteroids mobilisation STT Pain free flexibility and strength exercises education, ergonomics and technique correction heat and ice largely dependant on patient compliance ```