Work-Related Musculoskeletal Disorders Flashcards
where are Musculoskeletal disorders the predominant occupational health problem ?
industrialized countries
what are WRMD’s?
Painful disorder of muscles, tendons, nerves due to overuse, repetitive injury NOT traumatic
what do WRMD result in?
loss of productivity
on both the working and non-working lives
what are the body regions usually involved?
hands, wrists, elbows, shoulders & neck
what are the 2nd most injured body regions?
back, lower extremities
what are other names for WRMD?
Cumulative Trauma Disorders (CTD) (north america)
Repetitive Strain/Stress Injuries (RSI)
Occupational Cerviobrachial Disorder (OCD)
Overuse Syndrome
Repetitive Motion Disorders
Regional MS Disorders
Soft tissue disorders
are WRMD a diagnosis?
no just a general category
what % of WMSD represent registered occupational disease?
1/3 or more
what % of WMSD are UE symptoms?
20-30%
what do WMSD cause more of than any other group of diseases?
work absenteeism or disability
what are general high risk sectors?
Nursing facilities Air transportation Mining Food processing Leather tanning Heavy/light manufacturing
what are high risk UE sectors?
Clerical work Postal service Cleaning Industrial inspection Packaging
what are high risk LE sectors?
Truck drivers Warehouse workers Baggage handlers Construction Health care workers
what is the most common category of injury?
overexertion (25%)
how much do indirect costs affect cost?
Indirect costs are estimated to be from 2-5 times the direct costs
what are WMSD risk factors?
Repetition High force Awkward postures Direct pressure Vibration Prolonged static positioning
what does repetition cause?
tissue micro trauma & fatigue
what is fatigue proportional to?
the amount of force & duration of force application
i.e. hazardous movements hand & wrist
what does intr-muscular pressure cause?
decreased blood flow -> muscle energy crises & pain
what are the results of sufficient vs insufficient recovery?
sufficient recovery is permitted after trauma, results may be stronger tissue. If recovery in insufficient, muscle injury may occur
what are txs for repetition and force?
Rest
Splinting
Anti-inflammatory meds
what can awkward postures lead to?
muscle imbalance
pressure around, stretch of nerves
what are issues of muscle imbalance?
weakness, pain
overuse, underused
muscle lengthening, shortening
how do you tx awkward postures?
Ergonomic modification
breaks,
alternative postures,
fitness
what are psychological risk factors?
Job repetition, dissatisfaction
Anxiety
Depression
Pain
how do you tx psychological causes for WMSD?
Goal directed & educational gives people control and relief
What are characteristics of WMSD?
Mechanical & physiological Related to work intensity & duration Develops/recovers over weeks, months, years unreported multifactorial
what are symptoms of WMSD like?
poorly localized, non-specific, episodic
what are the 4 categories of WMSD?
nerve compression (entrapment) syndrome
tendinitis/tenosynovitis
pain syndromes
other
what is nerve compression (entrapment) syndrome?
incompatibility between volume of PN structure & anatomical space available to nerve
what is tendinitis/tenosynovitis?
inflammation of tendon & synovial membrane of tendon sheath
what are nerve compression syndromes?
Cervical radiculopathy Thoracic Outlet Syndrome (TOS) Cubital Tunnel Syndrome Anterior Interosseous Syndrome Pronator Teres Syndrome Carpal Tunnel Syndrome Guyon’s Canal Syndrome
where does tendonitis of the shoulder occur?
Rotator cuff muscles Biceps Brachii (long head)
how does tendonitis of the elbow occur?
Lateral (extensor) Epicondylitis
Medial (flexor) Epicondylitis
how does tendonitis of the wrist occur?
deQuervain’s (APL, EPB)
FCU, FCR, EIP
what are examples of pain syndromes?
Complex Regional Pain Syndrome
Myofascial Pain syndrome
Fibrositis
Fibromyalgia
what are examples of other syndromes?
Vibration white fingers
Osteoarthritis
vascular syndromes
what does nerve compression cause?
Inflammation/thickening of tendon = compression of nerve & vascular supply
what is more involved in nerve compression?
sensory>motor
what is an indication of nerve compression?
hormone changes
what are symptoms of nerve compression?
vague but include pain, tingling, numbness, weakness
what is compressed in carpal tunnel syndrome?
median nerve
what are early symptoms of WMSD?
aching & tiredness of limb during work but disappears at night/days off. No reduction of work
what are intermediate symptoms of WMSD?
aching and tiredness occurs early in work day, persists at night, reduced capacity for repetitive work
what are late symptoms of WMSD?
all symptoms persist at rest, inability to sleep perform even light duties
what occurs during the tendonitis cycle?
overuse = micro trauma = swelling, pain, less motion followed by rest, disuse, and weakness
what is the presentation of tendonitis?
localized pain, swelling, pain on resisted motion, movement limitation, weakness, and crepitation of tendon
what are the symptoms of tendonitis?
pain and limited ROM reproduced with work
what does myofascial pain cause?
Muscle overuse causes hyperirritability with a focal point = “trigger point”
how does muscle overuse present itself?
local inflammatory response, muscular hardness, local ischemia & connective tissue irritation
how do overused muscles palpate?
muscles feel “ropey”
what are symptoms of muscle overuse?
generalized, diffuse pain & weakness, traditional treatment for tendinitis has failed
what are indicators of grade 1 cumulative trauma disorders (CTD)?
pain after activity, resolves with rest
no decrease in amount or speed of work
no objective findings
what are indicators of grade 2 CTDs?
pain while working, resolves with rest
productivity mildly affected
may have objective findings
what are indicators of grade 3 CTDs?
pain in 1 or more sites while working
pain after activity stops
productivity affected, many breaks needed
affect activity outside of work
weakness, loss of dexterity, tingling, numbness
active or latent trigger points
what are indicators of grade 4 CTDs?
all common uses of hand & UE cause pain 50% - 75% of time
can work/works in limited capacity
objective findings: weakness, loss of control & dexterity, tingling, numbness, trigger points
what are indicators of grade 5 CTDs?
loss of ability to use hand/UE due to chronic unrelenting pain
usually unable to work
symptoms may persist indefinitely
how do you tx CTDs?
OT must take active role in investigating relationship between injury (pathology) and activity
what do OT’s do in tx for CTDs?
Restriction of movement Application of heat/cold/modalities Exercise Medication Surgery
what occurs during phase 1 of tx?
Symptom Control: reduce symptoms while teaching self-management
Strengthening: only when symptoms begin to subside
what are some modalities used in tx?
Hot packs, Neuromuscular Electrical Stimulation (NMES), Ultra Sound, Splinting
what occurs during phase 2 of tx?
Conditioning: when acceptable strength has returned but endurance is needed, all symptoms resolved
Ergonomic Assessment: in acute phase
Return to work (job analysis)
what is the vocational model of tx?
person as client
OT works with rehab professionals to find employment for injured worker
as job options are developed, OT reviews for physical appropriateness, suggests supports and adjustments
what occurs in case management model of tx?
OT works as consultant to insurance co
what does OT do as a case manager?
follows injured worker through medical & rehab process
coordinates services, stays in communication with worker
facilitates worker through WC system so time isnt wasted and person returns to work
what occurs in the industrial model of tx?
ergonomic training of employees and supervisors, on site evaluations, prevention of injury
screening of new employees to comply with ADA
how can job design prevent WMSD?
Mechanization
Rotation
Enlargement/enrichment
Teamwork
how can WMSD be prevented?
job design
Workplace Design
Tools & Equipment Design
Work practices
