RESUMO
INTRODUCTION: Nail guns are commonly used in the construction industry. They represent an occupational hazard, and in the context of mental illness can pose a threat to life. AIM: To determine the number of patients admitted to Auckland City Hospital (ACH) with a nail gun injury, and to review the current New Zealand legislation surrounding nail guns. METHODS: A 25-year retrospective review of patients admitted to ACH with a nail gun injury was performed by searching the ACH Trauma Registry. New Zealand legislation was reviewed. RESULTS: Between 1994 and 2019, 45 patients were admitted to ACH with a nail gun injury. Two subgroups were identified: 31% with an intentional injury; 69% with an unintentional injury. All patients were male. The mean age was 36.3. Patients with an intentional injury had a higher mortality rate (21.4% vs 9.5%), Injury Severity Scores (24.2 vs 3.4) and ICU admission rate (50% vs 3%) and required more intensive post-injury care when compared to unintentional injuries. There is currently no legislation in New Zealand specifically governing the use of nail guns. Only powder-actuated nail guns require certification. CONCLUSION: The continued occurrence of unintentional nail gun injuries and the high lethality of intentional injuries represent two distinct areas of concern. The Government should publish guidance aimed at improving safety and reducing the rate of intentional injury.
Assuntos
Indústria da Construção/instrumentação , Extremidades/lesões , Traumatismos Cranianos Penetrantes/epidemiologia , Traumatismos Ocupacionais/epidemiologia , Comportamento Autodestrutivo/epidemiologia , Ferimentos Penetrantes/epidemiologia , Adulto , Segurança de Equipamentos , Feminino , Traumatismos Cranianos Penetrantes/terapia , Hospitalização , Humanos , Escala de Gravidade do Ferimento , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Mortalidade , Havaiano Nativo ou Outro Ilhéu do Pacífico , Nova Zelândia , Traumatismos Ocupacionais/terapia , Comportamento Autodestrutivo/terapia , Procedimentos Cirúrgicos Operatórios , População Branca , Ferimentos Penetrantes/terapiaRESUMO
Closed traumatic rupture of forearm flexor muscles has been reported rarely. Previous reports have included ruptures of the flexor digitorum profundus, flexor digitorum superficialis, flexor pollicis longus, flexor carpi radialis, pronator quadratus and the palmaris longus. We report a patient with a closed traumatic rupture through the muscle belly of the flexor carpi ulnaris and summarise the published literature on ruptures involving the forearm flexor muscles. Overall, conservative treatment can result in excellent outcomes. Early surgical intervention is recommended in patients with nerve involvement and compartment syndrome and delayed reconstruction may be considered for patients with functional deficits.
Assuntos
Traumatismos do Antebraço/terapia , Músculo Esquelético/lesões , Ruptura/terapia , Adulto , Terapia por Exercício , Traumatismos do Antebraço/diagnóstico por imagem , Humanos , Imobilização , Imageamento por Ressonância Magnética , Masculino , Músculo Esquelético/diagnóstico por imagem , Traumatismos Ocupacionais/terapia , Ruptura/diagnóstico por imagem , ContençõesRESUMO
Each day, about 2000 U.S. workers have a job-related eye injury requiring medical treatment. Corneal diseases are the fifth cause of blindness worldwide. Most of these diseases can be cured using one form or another of corneal transplantation, which is the most successful transplantation in humans. In 2012, it was estimated that 12.7 million people were waiting for a corneal transplantation worldwide. Unfortunately, only 1 in 70 patients received a corneal graft that same year. In order to provide alternatives to the shortage of graftable corneas, considerable progress has been achieved in the development of living corneal substitutes produced by tissue engineering and designed to mimic their in vivo counterpart in terms of cell phenotype and tissue architecture. Most of these substitutes use synthetic biomaterials combined with immortalized cells, which makes them dissimilar from the native cornea. However, studies have emerged that describe the production of tridimensional (3D) tissue-engineered corneas using untransformed human corneal epithelial cells grown on a totally natural stroma synthesized by living corneal fibroblasts, that also show appropriate histology and expression of both extracellular matrix (ECM) components and integrins. This review highlights contributions from laboratories working on the production of human tissue-engineered corneas (hTECs) as future substitutes for grafting purposes. It overviews alternative models to the grafting of cadaveric corneas where cell organization is provided by the substrate, and then focuses on their 3D counterparts that are closer to the native human corneal architecture because of their tissue development and cell arrangement properties. These completely biological hTECs are therefore very promising as models that may help understand many aspects of the molecular and cellular mechanistic response of the cornea toward different types of diseases or wounds, as well as assist in the development of novel drugs that might be promising for therapeutic purposes.
Assuntos
Córnea/citologia , Lesões da Córnea/terapia , Traumatismos Ocupacionais/terapia , Engenharia Tecidual/métodos , Transplante de Córnea , Humanos , Modelos Biológicos , Alicerces TeciduaisRESUMO
This case report presents a 21-year-old male construction worker with ipsilateral inferior shoulder and posterior elbow dislocations, accompanied with other injuries. Such a combination of injury undoubtedly occurs; however, to the best of our knowledge, this is the first reported case. The prompt closed reductions without waiting for anesthesia were accomplished without the help of an assistant using a novel technique. The patient returned to his job with considerable recovery of motion and strength despite his permanent paralysis of the deltoid muscle and he was still employed as a worker after four years. He was abducting his arm by using his accessory muscles, which contribute to abduction when arm is externally rotated. The maneuver described in the report can be used to reduce all inferior shoulder dislocations and it is worth to know that working at a job requiring high level of activity is still possible despite a permanent loss of axillary nerve function.
Assuntos
Indústria da Construção , Lesões no Cotovelo , Traumatismo Múltiplo/terapia , Traumatismos Ocupacionais/terapia , Procedimentos Ortopédicos/métodos , Luxação do Ombro/terapia , Plexo Braquial/lesões , Humanos , Masculino , Retorno ao Trabalho , Adulto JovemRESUMO
OBJECTIVE: To quantify the association between physical therapy (PT) visits and workers' compensation costs and lost time. METHOD: A total of 40,203 lost-time claims (1998 to 2018) were analyzed. RESULTS: The odds ratio of total paid claim costs more than or equal to $100,000 increased with the number of PT visits from 1.91 with 1 to 3 PT visits (95% confidence interval [CI]: 1.62 to 2.26) to 5.56 (95% CI: 4.86 to 6.37) for workers with a surgical procedure and more than or equal to 50 PT visits versus those without PT visits, when controlling for confounding factors. The risk of remaining at an off work status is greatest among claims involving surgery, escalating among claims with 15 or more PT visits (hazard ratio more than or equal to 3.76). CONCLUSIONS: PT visits may be used as a marker for high workers' compensation cost and delayed return-to-work.
Assuntos
Modalidades de Fisioterapia/estatística & dados numéricos , Licença Médica/economia , Indenização aos Trabalhadores/economia , Feminino , Humanos , Revisão da Utilização de Seguros , Louisiana/epidemiologia , Masculino , Traumatismos Ocupacionais/economia , Traumatismos Ocupacionais/epidemiologia , Traumatismos Ocupacionais/terapia , Razão de Chances , Modalidades de Fisioterapia/economia , Licença Médica/estatística & dados numéricos , Indenização aos Trabalhadores/estatística & dados numéricosRESUMO
BACKGROUND: High voltage electrical injury (HVEI) of more than 1000 V is a potentially devastating form of a multisystem injury associated with high morbidity and mortality. We present the first case of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a life saving device for treating a patient with severe cardiogenic shock after a high voltage electrical injury. CASE PRESENTATION: A 26-year-old male sustained HVEI while working with a concrete mixer pump that came in contact with a high voltage cable of 10,000 V. He was immediately disconnected from the mixer pump, underwent cardiopulmonary resuscitation and was transported to the nearest medical centre with severe cardiogenic shock with an ejection fraction (EF) of < 10%. Upon arrival, he was in critical condition, sedated and mechanically ventilated, haemodynamically unstable and supported by intravenous (IV) inotropes after a few events of ventricular fibrillation, with an electrical entry point on the left hand and an exit point located on his right leg. Blood pH was 6.8, PCO2 53 mmHg, PaO2 of 57 mmHg, lactate 8 mmol/L, and Troponin 38,000 ng/dl. The EF was 10% with global severe left ventricular dysfunction. During cardiopulmonary resuscitation (CPR), including cardiac massage and few electrical shocks, he was immediately connected to the VA-ECMO via open right femoral approach with distal arterial leg perfusion. He was treated with IV broad spectrum antibiotics, and high volume fluids to prevent rhabdomyolysis-induced acute kidney injury, total parenteral nutrition, topical silver sulfadiazine cream, and Granuflex for severe electrical burns. He was gradually weaned from inotropes over the next 3 days, during which his clinical condition and bloodwork improved tremendously. His EF gradually increased to 50% and he was weaned from the VA-ECMO, and underwent decannulation 86 h after initialization. He was discharged on day 27 without any sequelae. CONCLUSION: The VA-ECMO treatment can be a lifesaving device for treating severe cardiogenic shock caused by high voltage electrical injury, and should be considered while treating these "high-mortality risk" patients.
Assuntos
Reanimação Cardiopulmonar , Traumatismos por Eletricidade/terapia , Oxigenação por Membrana Extracorpórea , Hemodinâmica , Choque Cardiogênico/terapia , Adulto , Queimaduras por Corrente Elétrica , Ecocardiografia , Massagem Cardíaca , Humanos , Masculino , Traumatismos Ocupacionais/terapia , Radiografia Torácica , Choque Cardiogênico/etiologiaRESUMO
Work-related hand injuries are the primary cause of disability and prolonged time away from work. This prospective cohort study was conducted to determine the predictors of return to work (RTW) after traumatic work-related hand injuries. Our study included 280 patients who were referred to the Plastic and Reconstructive Center for treatment of their occupational hand injuries from July 2017 to February 2018. Several functional questionnaires were completed, and they were followed up at 1, 3 and 8 weeks. Telephone interviews were done 3 months later. Approximately half the subjects had returned to work during the first 3 months after a median time away of 57 days. No relationship was found between age, gender, marital status, hand dominance and RTW time. Nevertheless, there was correlation between RTW time with cigarette smoking, injury severity and disability. Our study findings suggest that injury severity and higher work disability scores are prognostic factors for RTW. Also, smoking was associated with later RTW, which could be the result of poor circulation and delayed healing. Employers should implement injury prevention programs with appropriate rehabilitation that takes into consideration the severity of the hand injury, and health strategies to improve unhealthy lifestyle factors such as smoking.
Assuntos
Traumatismos da Mão/terapia , Traumatismos Ocupacionais/terapia , Retorno ao Trabalho , Adolescente , Adulto , Idoso , Estudos de Coortes , Avaliação da Deficiência , Feminino , Humanos , Escala de Gravidade do Ferimento , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Prognóstico , Fumar/efeitos adversos , Adulto JovemRESUMO
The damages caused by high-pressure injuries are often underestimated. Such incidents are characterised by a small punctiform entry wound and the normal colour of skin. The internal damage caused by these injuries can be severely devastating in nature. These injuries required emergent surgical debridement and irrigation. Postoperatively intensive physiotherapy is required for the successful return of hand function. The final functional outcome depends on the initial latency to treatment, nature of injected material, location and volume of injection and postoperative physiotherapy.
Assuntos
Desbridamento , Compostos Férricos , Corpos Estranhos/terapia , Traumatismos da Mão/terapia , Traumatismos Ocupacionais/terapia , Modalidades de Fisioterapia , Pressão , Ferimentos Penetrantes/terapia , Adulto , Analgésicos/uso terapêutico , Antibacterianos/uso terapêutico , Fasciotomia , Antebraço/diagnóstico por imagem , Antebraço/cirurgia , Corpos Estranhos/diagnóstico por imagem , Mãos/diagnóstico por imagem , Mãos/cirurgia , Traumatismos da Mão/diagnóstico por imagem , Humanos , Masculino , Traumatismos Ocupacionais/diagnóstico por imagem , Radiografia , Contenções , Irrigação Terapêutica , Técnicas de Fechamento de Ferimentos , Ferimentos Penetrantes/diagnóstico por imagemRESUMO
Transient shoulder pain is a common complaint following intramuscular vaccine administration into the deltoid. More severe vaccination-associated shoulder complications comprising of weakness and decreased range of motion are categorized under the construct "shoulder injury related to vaccine administration" (SIRVA) that subsumes both subjective and objective findings consistent with injury. We describe the presentation and management of a case of SIRVA in a health care worker following seasonal influenza vaccine administration as part of a hospital-based employee health program and review the relevant biomedical literature. We present a case from a single medical center. All data were collected by professionals in occupational health by interviewing, performing physical examinations, and reviewing medical records associated with the injured worker. Severe pain and limited range of shoulder motion developed following an influenza vaccination that was administered using a poorly positioned, larger than recommended needle. Magnetic resonance imaging (MRI) demonstrated moderate glenohumeral joint effusion and synovitis, with fluid accumulating in the subscapularis recess within 1 week of injury. At 8 months after initial injury, MRI showed persistent mild tenosynovitis of the long head of the biceps tendon, interval accumulation of a large glenohumeral joint effusion, and infraspinatus tendinitis with subjacent reactive bone marrow edema. The affected worker experienced work restrictions but had no complete lost workdays to date due to the injury. Occupationally related SIRVA is a preventable adverse event that should be considered in workplace vaccine administration programs, and appropriate education and training provided to vaccine administrators to address this.
Assuntos
Vacinas contra Influenza/efeitos adversos , Traumatismos Ocupacionais/induzido quimicamente , Lesões do Ombro , Adulto , Medula Óssea/patologia , Feminino , Pessoal de Saúde , Humanos , Vacinas contra Influenza/administração & dosagem , Imageamento por Ressonância Magnética , Traumatismos Ocupacionais/diagnóstico por imagem , Traumatismos Ocupacionais/terapia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/patologia , Dor de Ombro/induzido quimicamente , Tenossinovite/induzido quimicamenteRESUMO
: Physical therapy (PT) is perceived as a cost driver in the US workers' compensation system. We conducted a 5-year (2013 to 2017) retrospective analysis utilizing 192,197 claims from a large Texas based workers' compensation insurance company to describe the relationship between the amount of physical therapy delivered and workers' compensation costs and lost-time. Closed, indemnity claims with 15 or more PT visits were six times more likely (95% confidence interval [CI]: 5.50, 86.58) to result in high medical costs (>$7000, excluding PT costs) and were four times more likely (95% CI: 3.77, 4.42) to result in more than or equal to 6 months of lost-time, when controlling for confounders. When the number of PT visits more than or equal to 15 visits for a lost time claim, this level of PT exceeds all other predictors (opioid use, comorbidities, legal involvement, surgery, etc) of medical cost and extended time out from work.
Assuntos
Doenças Profissionais/economia , Traumatismos Ocupacionais/economia , Modalidades de Fisioterapia/economia , Licença Médica/economia , Indenização aos Trabalhadores/economia , Adulto , Idoso , Feminino , Humanos , Revisão da Utilização de Seguros , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/terapia , Traumatismos Ocupacionais/terapia , Modalidades de Fisioterapia/estatística & dados numéricos , Estudos Retrospectivos , Licença Médica/estatística & dados numéricos , Texas , Fatores de Tempo , Indenização aos Trabalhadores/estatística & dados numéricosRESUMO
BACKGROUND: Industrial high-pressure fluid injection injuries (IHPFII) are largely occupational in nature, where these injuries are most often sustained by male manual workers. Such traumatic injuries are largely sustained with water, grease, paint, gasoline or paint thinner. IHPFII are extremely serious injuries with life and limb-threatening potential carrying the risk of life-long disability. METHODS: We reviewed the Water Jetting Association© adverse incident database of advisory alerts detailing cases from around the world that have been brought to the association's attention and the English-language literature on high-pressure hydrostatic injuries from 1937 to 2018. RESULTS: Accidents involving high-pressure water jets in the industry are uncommon. The clinical impact in all of the cases reviewed and the effects of water jet impacts range from instant fatalities at scene to loss of limb function and amputation. The majority of observed fatalities are due to major hemorrhage (exsanguination) secondary to the direct dissection of great vessels or high-energy blunt soft tissue injury and traumatic brain injury. CONCLUSIONS: As with any other trauma, IHPWJI commonly result in amputation or death. Nonetheless, a lack of comprehension of the potential severity of injuries and range of infective complications appears to be largely due to the apparent benignity of the initial presentation of the wound. This in turn leads to delays (both avoidable and unavoidable) in the transfer to appropriate medical facilities and definitive care. There is an identifiable need for education (including for health care providers across multiple levels), training and the availability of personal trauma kits for the timely and effective management of IHPWJI from the initial jet impact on the scene, as well as a need for an established referral system.
Assuntos
Lesões Encefálicas Traumáticas/terapia , Exsanguinação/terapia , Pressão Hidrostática/efeitos adversos , Traumatismos Ocupacionais/terapia , Lesões dos Tecidos Moles/terapia , Infecção dos Ferimentos/terapia , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/terapia , Amputação Cirúrgica , Lesões Encefálicas Traumáticas/etiologia , Lesões Encefálicas Traumáticas/mortalidade , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/terapia , Edema/etiologia , Exsanguinação/etiologia , Exsanguinação/mortalidade , Humanos , Traumatismos Ocupacionais/etiologia , Traumatismos Ocupacionais/mortalidade , Rabdomiólise/etiologia , Rabdomiólise/terapia , Lesões dos Tecidos Moles/etiologia , Enfisema Subcutâneo/diagnóstico por imagem , Enfisema Subcutâneo/etiologia , Infecção dos Ferimentos/etiologiaAssuntos
Fazendeiros , Ferimentos Penetrantes Produzidos por Agulha/diagnóstico , Ferimentos Penetrantes Produzidos por Agulha/terapia , Traumatismos Ocupacionais/diagnóstico , Traumatismos Ocupacionais/terapia , Adjuvantes Imunológicos/efeitos adversos , Austrália , Humanos , Vacinação/veterinária , Médicos VeterináriosRESUMO
Meniscal injuries in the young, active patient are often challenging injuries for the orthopaedic surgeon whose goal is to provide pain-free return to play/military duty and preserve maximal meniscal integrity. In the U.S. military, the incidence rate of meniscal tears is almost 10 times higher than that of the civilian population; although, the rates of reoperation following meniscal repair are fairly similar. The decision to pursue meniscal debridement versus repair is multifactorial depending on tear characteristics, concomitant injury, patient characteristics, and goals. Meniscal allograft transplantation remains reserved as a salvage procedure but with limited goals for potential to return to complete unrestricted military duties. The purpose of this article is to review treatment principles for the military athlete with meniscal pathology.
Assuntos
Militares , Traumatismos Ocupacionais/epidemiologia , Traumatismos Ocupacionais/terapia , Lesões do Menisco Tibial/epidemiologia , Lesões do Menisco Tibial/terapia , Artroscopia , Tratamento Conservador , Humanos , Meniscectomia , Retorno ao TrabalhoRESUMO
Kienböck's disease is characterised by avascular necrosis of the lunate bone, and over the years it has been a challenging disease to manage, with differing opinions on the best intervention. We present an interesting case of a metallic unconstrained lunate replacement that is still functioning well in a patient 40 years after surgery. This case report represents the longest follow-up of any such prosthesis.
Assuntos
Osso Semilunar/cirurgia , Traumatismos Ocupacionais/diagnóstico , Osteocondrite/diagnóstico , Osteonecrose , Traumatismos do Punho/diagnóstico , Articulação do Punho , Idoso , Diagnóstico Diferencial , Humanos , Masculino , Traumatismos Ocupacionais/diagnóstico por imagem , Traumatismos Ocupacionais/terapia , Osteocondrite/diagnóstico por imagem , Osteocondrite/terapia , Desenho de Prótese , Amplitude de Movimento Articular , Contenções , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/terapiaRESUMO
HYPOTHESIS: We hypothesized that National Football League (NFL) players sustaining a shoulder destabilizing injury could return to play (RTP) successfully at a high rate regardless of treatment type. METHODS: We identified and evaluated 83 NFL players who sustained an in-season shoulder instability event while playing in the NFL. NFL RTP, incidence of surgery, time to RTP, recurrent instability events, seasons/games played after the injury, and demographic data were collected. Overall RTP was determined, and players who did and did not undergo operative repair were compared. RESULTS: Ninety-two percent of NFL players returned to NFL regular season play at a median of 0.0 weeks in those sustaining a shoulder subluxation and 3.0 weeks in those sustaining a dislocation who did not undergo surgical repair (P = .029). Players who underwent operative repair returned to play at a median of 39.3 weeks. Forty-seven percent of players had a recurrent instability event. For players who were able to RTP, those who underwent surgical repair (31%) had a lower recurrence rate (26% vs. 55%, P = .021) and longer interval between a recurrent instability event after RTP (14.7 vs. 2.5 weeks, P = .050). CONCLUSION: There is a high rate of RTP after shoulder instability events in NFL players. Players who sustain shoulder subluxations RTP faster but are more likely to experience recurrent instability than those with shoulder dislocations. Surgical stabilization of the shoulder after an instability event decreases the chances of a second instability event and affords a player a greater interval between the initial injury and a recurrent event.
Assuntos
Tratamento Conservador , Futebol Americano/lesões , Instabilidade Articular/terapia , Traumatismos Ocupacionais/terapia , Volta ao Esporte , Luxação do Ombro/terapia , Lesões do Ombro/terapia , Adulto , Humanos , Instabilidade Articular/cirurgia , Masculino , Traumatismos Ocupacionais/cirurgia , Recidiva , Luxação do Ombro/cirurgia , Lesões do Ombro/cirurgia , Fatores de Tempo , Adulto JovemRESUMO
INTRODUCTION: Agricultural workers' health depends on many factors: working conditions, security arrangements, medicine, quality of drugs, the environment, etc. Occupational injuries and diseases are also among the factors that can negatively affect their health. THE AIM: To analyze provisions of the international legislation and scientific literature concerning existence of restrictions on impact of occupational injuries and diseases on agricultural workers' health. MATERIALS AND METHODS: International acts, data of international organizations and conclusions of scientists have been examined and used in the study. The article also integrates information from scientific journals and monographs from a medical and legal point of view with scientific methods. This article is based on dialectical, comparative, analytic, synthetic and comprehensive research methods. Impact of occupational injuries and diseases on agricultural workers' health has been studied within the system approach, as well as analysis and synthesis. CONCLUSIONS: The level of occupational morbidity, traumatism and above all standard of agricultural workers' health depends on the way of occupational safety organization. Working conditions and safety in agricultural industry and therefore the appropriate standard of health remain unsatisfactory in many countries.
Assuntos
Saúde Ocupacional/legislação & jurisprudência , Traumatismos Ocupacionais/terapia , Medicina do Trabalho/legislação & jurisprudência , Indenização aos Trabalhadores/legislação & jurisprudência , Agricultura/legislação & jurisprudência , Eficiência Organizacional/legislação & jurisprudência , Feminino , Humanos , Masculino , Indicadores de Qualidade em Assistência à Saúde , Local de Trabalho/legislação & jurisprudênciaRESUMO
CASE: A patient was struck by an agricultural vehicle and sustained ipsilateral hip and knee dislocations. Closed reduction of the hip was accomplished in the emergency department; the patient required general anesthesia in the operating room to reduce the knee dislocation. Nonoperative treatment was used for both injuries, with a good long-term outcome. CONCLUSION: Simultaneous ipsilateral hip and knee dislocations are rare and complex injuries that usually result from high-energy trauma. In order to avoid severe neurovascular complications, they need prompt management. Nonoperative treatment followed by an intensive rehabilitation program should be considered as an alternative treatment to surgery in older patients with a low-demand lifestyle.
Assuntos
Redução Fechada/métodos , Tratamento Conservador/métodos , Luxação do Quadril/terapia , Luxação do Joelho/terapia , Traumatismos Ocupacionais/terapia , Agricultura , Luxação do Quadril/etiologia , Humanos , Luxação do Joelho/etiologia , Masculino , Pessoa de Meia-Idade , Traumatismos Ocupacionais/etiologiaRESUMO
OBJECTIVE: To perform a systematic review of randomized controlled trials (RCTs) on the efficacy of therapeutic exercises for workers suffering from rotator cuff (RC) tendinopathy. METHODS: A literature search in four bibliographical databases (Pubmed, CINAHL, EMBASE, and PEDro) was conducted from inception up to February 2015. RCTs were included if participants were workers suffering from RC tendinopathy, the outcome measures included work-related outcomes, and at least one of the interventions under study included exercises. The methodological quality of the studies was evaluated with the Cochrane Risk of Bias Assessment tool. RESULTS: The mean methodological score of the ten included studies was 54.4%±17.2%. Types of workers included were often not defined, and work-related outcome measures were heterogeneous and often not validated. Three RCTs of moderate methodological quality concluded that exercises were superior to a placebo or no intervention in terms of function and return-to-work outcomes. No significant difference was found between surgery and exercises based on the results of two studies of low to moderate methodological quality. One study of low methodological quality, comparing a workplace-based exercise program focusing on the participants' work demands to an exercise program delivered in a clinical setting, concluded that the work-based intervention was superior in terms of function and return-to-work outcomes. CONCLUSION: There is low to moderate-grade evidence that therapeutic exercises provided in a clinical setting are an effective modality to treat workers suffering from RC tendinopathy and to promote return-to-work. Further high quality studies comparing different rehabilitation programs including exercises in different settings with defined workers populations are needed to draw firm conclusions on the optimal program to treat workers.
Assuntos
Terapia por Exercício , Traumatismos Ocupacionais/terapia , Lesões do Manguito Rotador/terapia , Tendinopatia/terapia , Exercício Físico , Terapia por Exercício/métodos , Humanos , Traumatismos Ocupacionais/cirurgia , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Retorno ao Trabalho , Manguito Rotador , Lesões do Manguito Rotador/etiologia , Lesões do Manguito Rotador/cirurgia , Tendinopatia/etiologia , Tendinopatia/cirurgia , Resultado do TratamentoRESUMO
As a result of some deviations in the installation of the X-ray inspection plant 'Extravolt-225/1600' two workers of an X-ray inspection laboratory were exposed to the radiation in a dose enough to cause an acute local radiolesions (LRs). The first patient was diagnosed with an acute LR of the hands of severe and extremely severe degree. The second patient was diagnosed with a mild LR of her right hand. The first patient received a surgical treatment followed by subcutaneous introduction of the autologous mesenchymal stem cells. The second patient received only conservative treatment. The complete epithelization of the traumatic surface was achieved. Modeling the incident with the following EPR analysis of the compact substance of the ablated bone structures made it possible to specify the spatial-temporal properties of the exposure.