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BPK 180W > Week 2 - Work Related Musculoskeletal Disorders (WRMSD) > Flashcards

Week 2 - Work Related Musculoskeletal Disorders (WRMSD) Flashcards

1
Q

Define: WRMSIs

A

work related musculoskeletal injuries
- activity related disorders that affect muscles, tendons and other soft tissues (nerves or arteries) developed as a result of work related activities

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2
Q

List different types of WRMSIs (7)

A
  • Tendinitis: inflammation of the tendon
    • Tenosynovitis: inflammation of the tendon sheath
    • Stenosing Tenovaginitis “Trigger Finger”
    • DeQuervain’s disease: inflammation of the thumb
    • Carpal Tunnel Syndrome
    • Vibration White Finger:
    • Neck /back pain
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3
Q

Fill in the blank: WRMSIs make up ___ of WCB costs

A

33%

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4
Q

Fill in the blank: __ of the working population experiences symptoms at least __ per year

A
  • 50%

- 1

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5
Q

__ workers report back pain for at least one week over the previous 12 months worked

A

20%

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6
Q

__ reported hand pain from work

A

17%

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7
Q

estimated cost to _____ / year in medical costs and lost days to Canadian economy

A

$3 billion

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8
Q 
CTDS: 
ASTD:
O/E: 
RSI: 
OOI:
A 
CTDS: cumulative trauma disorders
Accustomed soft tissue disorders (ASTD)
O/E: over exertion
RSI: repetitive strain injury
OOI: occupational overuse injury
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9
Q

Major industries affected in BC by WRMSIs (7)

A
  • Health Industry
  • Retail
  • Forest Industry
  • Office Environments
  • Mining
  • Construction
  • Food Processing
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10
Q

10 Characteristics of WRMSIs

A
  1. Effect muscles, tendons, nerves or vascular system
  2. Are beginning to plateau in the workplace
  3. Mechanical and physiological process
  4. Related to work duration and intensity
  5. Requires weeks, months or years to develop
  6. Requires weeks, months or years to recover; little is known about the recovery process
  7. Poorly localized, non-specific and episodic
  8. Often unreported
  9. Multiple work and personal causes, the interaction of which is poorly understood
  10. Repair leaves tissue stronger and more suited to the task (adaptation)
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11
Q

When muscle is injured, it is often at the _____. Why?

A

myotendinous junction

- concentration of force (where most of the force is) and there is less elasticity

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12
Q

contusion

A

bruise

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13
Q

avulsion

A

rupture

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14
Q

MVC

A

MVC = maximum voluntary contraction up to 15% or up to 5% for static contractions will result in muscle fatigue if sustained for a full work day 8 hours

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15
Q

Tendon and ligaments:

  • tendon
  • ligament
  • function of both (2)
A

Matrix of ground substance, cells and mix of collagen and elastin

  • tendon: muscle-bone
  • ligament: bone-bone
  1. fibrous connector for soft tissues
    transmitting mechanical forces (tension)
  2. highway for blood vessels & nerves
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16
Q

Collagen

A

High tensile strength, resists elongation

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17
Q

Elastin

A

Low tensile strength, deforms greatly

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18
Q

Sprain

A

injury to ligament

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19
Q

Joint capsule

A

sheet of collagen fibres, proteoglycans and elastic fibres surrounding joint

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20
Q

What does it mean when the synovial fluid is described as a thixotropic lubricant?

A

rapid motion, low viscosity; slow motion, high viscosity

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21
Q

What are 3 ways sensory and motor nerves can be injured?

A
  • compression
  • tension
  • severed
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22
Q

Occupational Biomechanics

A

“the study of motion and forces in the human body due to the interaction of workers with their tools, machines and environment.”
Chaffin, 2016
- Allows understanding of loading on the body
- Assists in understanding of WRMSI mechanisms
- Provides guidance for solutions

23
Q

Cumulative load equation

A

Cumulative load = load x time x repetitions

24
Q

Repeated or sustained loading results in _______

A

a reduced threshold stress (stress at which failure occurs)

25
Q

Cumulative laod theory of injury/ Material fatigue concept

A

– wear and tear balanced by self repair (stress-recovery)

26
Q

Physiological changes due to WRMSIs

A
  • Inflammation and swelling
  • Stimulate nocioceptors (pain)
  • Increased muscle tension to reduce motion • Increased synovial fluid in tendon sheath
  • Chronic joint pain
27
Q

Specific hand/wrist anatomy

A 
Flexors inserts on medial epicondyle
Extensors insert on lateral epicondyle
Abduction
Anatomical snuff box
Brachial plexus, median nerve, ulnar nerve, radial nerve
Radial nerve: everything on thumb side
Transverse carpal ligament
28
Q

Tendinitis
Tenosynovitis
- signs and symptoms

A
  • Tendinitis: inflammation of the tendon
  • Tenosynovitis: inflammation of the tendon sheath
    Across the radiocarpal joint
  • Ssx: Swelling, pain, crepitus on passive motion, local tenderness, pain increased by resistive motions
    = Signs: Palpable tendon nodule, inflammatory signs, palpable tendon nodule that is point tender, Vascular disruption, hematoma, Pronounced asymmetric grip strength (4kg)
29
Q

Stenosing tenovaginitis

- signs and symptoms

A
  • Fibrous thickening of the tendon sheath in the flexor tendons of the hand
  • Symptoms:
    Results in snapping movement of finger due to swelling and restricted gliding of the tendon
    “Locking usually occurs” during flexion/extension
  • Signs: nodule present on tendon
  • Stenosing: stopping
30
Q

DeQuervain’s disease

- signs and symptoms

A

DeQuervain’s disease: Fibrous thickening of the tendon sheath in the flexor tendons of the thumb
Symptom: pain in the anatomical snuffbox with possible radiation up forearm
Positive Finkelstein test (passive ulnar deviation - positive = pain)

31
Q

Carpal Tunnel Syndrome

- signs and symptoms

A
  • Entrapment or injury of the median nerve in the carpal tunnel (formed by the transverse carpal ligament and carpal bones); Result of edema in tissues around the tunnel; impingement of the median nerve due to swelling (pregnancy can cause this, diabetes)
  • Symptoms: Pain, numbness, or tingling in the median nerve distribution of hand and fingers, atrophy or decreased strength if motor branch is involved
  • Symptoms: Nocturnal exacerbation
  • Sign: Increased compression in tunnel (normal 3mmHg); Reduced nerve conduction velocity (normal 45-75 m/sec)
32
Q

What are 2 tests that would be positive if you had carpal tunnel syndrome

A
  • Phalen’s test

- Tinel’s sign

33
Q

Raynaud’s Disease

A

some areas of your body — such as your fingers and toes — feel numb and cold in response to cold temperatures or stress genetics

34
Q

Vibration White Finger

A
  • vascular disturbance of fingers due to exposure to vibrating frequency (using handheld power tools); balancing of extremities
  • Severe cases can be occlusion and tissue atrophy
35
Q

Epicondylitis

A
  • Tenderness at lateral epicondyle
  • Pain upon gripping
  • Decreased grip strength
  • Increased pain with wrist flexion
36
Q

Medial epicondylitis

A
  • Medial Epicondylitis: Tendinitis of the common flexor origin, including pronator teres
  • Tendinitis of the common flexor origin, including pronator teres
37
Q

Describe the pros and cons of the shoulder

A
  • mobility at expense of stability; ball and socket joint
38
Q

Shoulder tendinitis

A

Inflammation or degeneration of the tendons of the rotator cuff or biceps

  • Inflammation or degeneration of the tendons of the rotator cuff or biceps
  • Painful arc, more apparent on active restricted movement than passive
  • Nocturnal symptoms,
  • Crepitus
  • Subacromial tenderness
  • Referred pain along C5 distribution
  • Pain in anterior shoulder which increases with abduction
  • positive Speed’s test and Yergason’s
39
Q

Describe: Speed’s test

A

resisted elbow flexion: pain in long head of biceps

40
Q

Describe Yergason’s test

A

Resisted supination: pain in long head of biceps

41
Q

Bursitis

A
  • Inflammation of the bursa sac in the joint
  • Small fluid-filled sacs in joint
  • Cushion pressure points between bone and tendon
42
Q

Thoracic outlet syndrome

A
  • Neurovasular disturbances caused by compression of the neurovascular bundle at the thoracic outlet; can also be caused by Fibrous bands/ or extra cervical rib (malformations)
  • Wide variety of symptoms depending on compression
    • Pain in fingers
    • Numbness in fingers
    • Weak pulse at wrist
    • Vascular forms are rare: s/s blanching, cold extremities
  • Roos test - pain,heaviness or profound arm weakness or numbness and tingling of the hand
  • Allen test - radial pulse is palpated and if it disappears as the patient’s head is rotated the test is considered positive.
43
Q

Risk Factors cited in Literature

A 
• Personal Factors
• Repetition
• Force
• Awkward Postures 
- Duration
• Vibration
• Cold
• ContactStresses
• Psychosocial Issues
44
Q

Personal factors (7)

A
  • Age (wound healing slows with age)
  • Moderate to heavy smoking
  • Previous similar history
  • Inflammatory disorders (arthritis)
  • Pregnancy (for CTS)
  • Diabetes mellitus
  • Body Mass Index (BMI)
45
Q

Describe repetition as a risk factor

A
  • Refers to a series of motions performed over and over again by the same muscle groups
    • Expressed as movement or exertions/time
    • Macro and microtrauma as a result of tendon deformation
  • Cycle time less than 30 sec. and/or
    • 50% of cycle time involved in same motion pattern
46
Q

Factors affecting force

A 
Force
Lever arm (torque)
• Internal vs external load
• Force velocity
• Strength-endurance
• Rest time
• Tolerance of tissue
• Grip type
• Posture
• Grip size
• Gloves
47
Q

Force guidelines

A
  • Reduce required force
  • Exertion >60%MVC avoided
  • Greater than 4Kg grip force increases risk
  • Greater than 2kg pinch grip increases risk
  • Decrease the lever arm and consider mechanical advantage Reduce velocity
  • Reduce endurance
  • Frequent action up to 30% MVC
  • Continuous action up to 15% MVC
  • Sustained static exertions greater than 5% MVC problematic
48
Q

Awkward Postures

A 
Flexion
Extension
Radial deviation
Ulnar deviation
Pronation
supination
  • increase internal load on tendons
  • increase pressure in carpal tunnel
  • increased friction over bones
49
Q

Which wrist posture has the smallest safe angle

A

radial deviation - <10 degrees

50
Q

Contact stresses

A
  • Mechanical tissue stresses produced in the area of contact with external object
  • Some evidence for CTS and digital neuritis
51
Q

Vibration

A

mechanism - occlusion of blood vessels

  • 15 to 800m/sec2 and frequencies of 8 to 500Hz are of concern
  • Are exposure limits set by ISO
52
Q

Cold

A
  • Appears to be related to reduced tactile sensation (same mechanisms as gloves) creating increased force
  • External temperature, compressed air, or conductive cold
53
Q

Psychosocial Issues

A
  • Contribute to etiology of disorders, Influence whether workers report injuries, Success of rehabilitation or return to work programs

BPK 180W (3 decks)

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