Work Related Musculoskeletal Disorders

1. Work Related Musculoskeletal Disorders Dr. Majid Golabadi Occupational Medicine Specialist

2. Musculoskeletal Disorders • Articular, Non Articular • Inflammatory, Non Inflammatory • Acute, Chronic • Traumatic, Non Traumatic • Occupational, Non Occupational

3. Musculoskeletal Exam Fitness for work (Capability) • Person without MSD • Person with MSD Work induced MSD

4. Job Risk Factors Ergonomic • Repetition • Force • Awkward posture • Static pusture • Contact stress Non ergonomic • Vibration • Noise • Job stress

5. Upper Extremity Disorders

6. The Most Important Disorders • Shoulder: • Rotator cuff tendinitis • Bicipital tendinitis • Elbow: • Lateral Epicondylitis • Medial Epicondylitis • Olecranon Bursitis • Cubital Tunnel Syndrome • Wrist: • Carpal tunnel syndrome • DeQuervain disease • Ganglion cyst • Trigger wrist • Hand: • Guyon`s canal syndrome • Hypothenar hammer syndrome • Trigger finger • Trigger thumb • Occupational hand cramp

7. Lateral Epicondylitis (Tennis Elbow)

8. Lateral Epicondylitis (Tennis Elbow) • Inflammation, at the muscular origin of the extensorcarpiradialisbrevis (ECRB). • the most common overuse injury of the elbow • up to 10 times more frequently than medial epicondylitis • most often occurs between the third and fifth decades of life.

10. Ergonomic Stressors • Frequent lifting • Repetitive wrist dorsiflexion with force • Sustained power gripping. • Repetitive forearm supination • Sudden elbow extension • Tool use, shaking hand, twisting movement

11. Clinical Presentations • lateral elbow pain of gradual onset. • pain generally increases with activity • Picking up a cup of coffee or a gallon of milk • Heavy lifting • Gripping • Pain may be present at night. • Symptoms are typically unilateral.

12. Area of Pain

13. Physical Examination localized tenderness to palpation just distal and anterior to the lateral epicondyle.

15. Presumptive Diagnosis Requires: • Local tenderness directly over the lateral epicondyle • Pain aggravated by resisted wrist extension and radial deviation • Pain aggravated by strong gripping • Normal elbow range of motion

16. Paraclinical Testing • No specific test is required

19. Splints for Tennis Elbow

20. Carpal Tunnel Syndrome

21. Carpal tunnel syndrome is a traumatic or pressure neuropathy of the median nerve in the wrist • The most common entrapment neuropathy in the body • Compression of the median nerve as it passes through the carpal tunnel • Overall prevalence is 2.7% • Is more common in women and between ages 40 to 60 years

23. Etiology

24. Work Related Risk Factors Occupations that require Repetitive Flexion and extension of the fingers and wrist

27. Symptoms • Paresthesias in the median nerve distribution, gradually and spontaneously • With progression: pain, numbness, tingling and burning • In more progressed cases: Reduced force, Skin sensory deficit and Thenar Atrophy

28. Diagnosis • History: Night-time and morning symptoms, sometimes occurring with driving, and relief by shaking or movement (Flick sign) • Intermittent Nocturnal Brachalgia • Clumsiness • Rule out of systemic causes

29. Physical Exam: • Phalen’s Test and Tinnel’s sign • Two-Point Discrimination Test • thumb abduction • thumb opposition • pinch movements

30. Phalen Test

31. Tinnel sign

32. Electrodiagnostic studies: EMG/NCV confirm diagnosis • Thenar weakness should warrant full EMG studies

33. Treatment 1- Treatment of associated conditions 2-Splintingthe wrist in a neutral position at night and during the day . For 2 to 4 weeks Job task modification is often critical in this phase 3-Corticosteroidinjection into the carpal tunnel 4- Surgery. After 3 month of conservative treatment

34. Surgery indications • Progressive symptoms • Persistent symptoms • Thenar Atrophy • EMG abnormalities

35. De Quervain’s Disease

36. De Quervain’s Disease • Inflammation of the tendon sheath of the extensor pollicis brevis and abductor pollicis longus • Combination of Tendonitis and Tenosynovitis. • In individuals between 30 and 50 years of age and is ten times more prevalent among women than men • May be caused by OVER USE of thumb, like repetitive work and forceful gripping

39. Symptoms • pain at the base of the thumb. • swelling Differential diagnosis • Old nonunion of navicular bone • Osteoartritis of first carpometacarpal joint

40. Finkelstein test

42. Treatment • Modifying hand activity • Immubilization of thumb (3-6 weeks) • NSAIDs • Local Injection of Lidocain-triamcinolone into tendon sheat (Standard Treatment) • Surgical decompression

43. Trigger Finger

44. Stenosing tenosinovitis of the flexor tendon of the finger • Painful snap or jerking movements in PIP • Collapse the joint suddenly like a trigger • Usually associated with using tools that have handles with hard or sharp edges.

46. Trauma, • Rheumatoid arthritis, • CTS Differential diagnosis • De Qurvein • Dupuytren Contractures

47. Dupuytren's Contracture • A localized scar tissue formation in the palm. • The precise cause of a Dupuytren's contracture is not known. • A Dupuytren's contracture is sometimes inherited. • A Dupuytren's contracture can limit extension of the affected finger. • The treatment include stretching, heat, ultrasound, local cortisone injection, surgical procedures, and collagen injection • The precise cause of a Dupuytren's contracture is not known. However, it is known that it occurs more frequently in patients with diabetes mellitus, seizure disorders (epilepsy), and alcoholism.

50. Dupuytren Contractures