Lecture 2 : Occupational Overuse Syndromes Flashcards
Multifactorial injuries refers to
injuries with many risk factors
most commonly injured age group
15-24
high risk population for OOS’s
females
casual
shift
Most common areas involved in WRMDs
Neck Shoulder Elbow Wrist and Hand LBP
4 categories of risk factors involving cervical spine dysfunction
Physical
Psychosocial
Sociodemographic
Clinical
Risk factors for neck pain
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
Cervicogenic HA clinical presentation
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
Tension headaches
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
Physio treatment options for neck pain
mobilisation manipulation exercise therapy muscle conditioning -DNF neurodynamics postural & ergonomic re-education -get patients to sit well
Most common shoulder OOS
rotator cuff tendinopathy
extrinic factors leading to rotator cuff tendinopathy
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
Intrinsic factors leading to rotator cuff tendinopathy
degenerative tendon process
age - *important consideration
Consequences of rotator cuff tendinopathy
subacromial impingement
internal impingement
clinical presentation of rotator cuff tendinopathy
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
Physiotherapy treatment rotator cuff tendinopathy
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
Lateral epicondylalgia
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)
Occupational exposure for LE
link to certain occupational activities and/or sports that involve gripping
- forceful grip
- wrist extensors
- Repetition
- Vibration
- Combination of above factors is the problem
LE research
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
Clinical presentation of LE
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
what needs to be assessed beyond ECRB in LE cases
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
Physiotherapy management of LE
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
CTS clinical presentation
most common peripheral neuropathy
often linked to neck, shoulder, forearm and elbow
Carpal Tunnel clinical presentation
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
Clinical presentation of CTS cont’
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
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
Increased risks of CTS
links in
age
gender
obesity
associated with a number of medical conditions RA Acromegaly Hypothyroidism Pregnancy Trauma
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
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
