[Diagnostic guidlines for occupational epicondylitis]. / Przewlekle zapalenie nadklykci kosci ramiennej wywolane sposobem wykonywania pracy--wytyczne diagnostyczno-orzecznicze.

Making final decisions on the occupational etiology of musculoskeletal diseases is often difficult and problematic at every stage of the diagnostic procedure. Taking into account the need to facilitate decision-making about the causal relationship between the diagnosed disease entity and the working conditions guidelines for the recognition of work-related musculoskeletal diseases have been developed. This paper presents the guidelines for the diagnosis of occupational etiology of humeral epicondylitis, one of the most common occupational disease of the musculoskeletal system in Poland. The developed guidelines have been based on the literature data concerning occupational risk factors of humeral epicondylitis, workload classification, including repetitive movements, awkward postures, and force. Some criteria applied in ergonomic evaluation methods were also included. The presented diagnostic guidelines define approximate benchmarks for stating (after excluding non-occupational etiology) that the identified humeral epicondylitis, is related to the way of working. Crucial work factors that should be analyzed include an operating time of movements overloading tendons connecting to the epicondyle, repetition and force used to perform occupational activities. The developed guidelines are aimed to facilitate occupational physicians diagnostic and certification procedures in case of humeral epicondylitis and determination whether there is a likelihood of its occupational etiology.

Utilidad de la ultrasonografía en el diagnóstico de dolor de codo secundario a plica sinovial / Utility of ultrasonography in the diagnosis of elbow´s pain secondary to synovial plica

Introducción: El dolor en el epicóndilo lateral del codo es uno de los síntomas clínicos más frecuentes en la extremidad superior. La presencia de la plica sinovial como causa de chasquido doloroso en el codo fue descrito por primera vez por Clarke. Esta plica es una estructura anatómica normal, remanente del desarrollo embriológico de la membrana articular sinovial, pero cuando ésta se encuentra engrosada, es una causa potencial de dolor de codo. Caso clínico: Se presenta el caso clínico de un varón de 42 años, médico traumatólogo, sin antecedente de interés, con dominancia derecha, que practica de forma habitual el pádel y el golf. Diagnosticado de epicondilitis pero sin respuesta al tratamiento conservador durante 9 meses y tras estudio mediante ecografía y RM se objetiva la presencia de una plica sinovial en el codo, que mediante artroscopia se extirpó con buenos resultados. Discusión: La plica sinovial en el codo suele estar infradiagnosticada por tratarse de una entidad poco conocida para el clínico, lo que dificulta el diagnóstico diferencial. Además debido a las características del proceso, que produce escasos signos subjetivos y objetivos, suele etiquetarse erróneamente como epicondilitis lateral rebelde al tratamiento. Para conseguir los mejores resultados en el alivio del dolor y la recuperación de la funcionalidad articular, se debe descartar patología asociada y el tratamiento quirúrgico debe ir acompañado de una rehabilitación específica. Conclusión: La presencia de plica sinovial en el codo es una causa de dolor de codo habitualmente mal diagnosticada. La ultrasonografía es una herramienta útil para el diagnóstico de esta entidad (AU)

Introduction: Lateral elbow pain is one of the most common pain syndromes of the upper extremity. The presence of synovial fold or radial fringe as the cause of painful snapping elbow was first described by Clarke. This plica is a normal anatomic structure, embryological development like remaining articular synovial membrane, but when it is thickened, is a potential cause elbow pain. Case report: The case of a 42 year old male, orthopedic doctor has no history of interest, right dominance, practicing regularly paddle, tennis and golf. He was diagnosed as radial epicondylitis, but with no response to the conservatory management. Ultrasound and MR imaging found the presence of synovial fold in the elbow. This fold was removed arthroscopically, and resulting in pain relief. Discussion: The synovial fold in the elbow is often under diagnosed because it is a little known, making it difficult differential diagnosis. Also due to the characteristics of the process that produces few subjective and objective signs, often erroneous labeled as lateral epicondylitis resistant to treatment. For best results in relieving pain and recovery of joint function, exclude associated pathology and surgical treatment should be accompanied by a specific rehabilitation. Conclusion: The presence of synovial plica in the elbow is one of the most under-diagnosed causes of a painful elbow. The ultrasound is a useful tool for the diagnosis of this entity (AU)

Lateral and medial epicondylitis: role of occupational factors.

Epicondylitis is a common upper-extremity musculoskeletal disorder. It is most common at the age of 40-60 years. Epicondylitis seems to affect women more frequently than men. Diagnosis of epicondylitis is clinical and based on symptoms and findings of physical examination. The prevalence of lateral epicondylitis in the general populations is approximately 1.0-1.3% in men and 1.1-4.0% in women and that of medial epicondylitis is nearly 0.3-0.6% in men and 0.3-1.1% in women. The incidence rate of medical consultations has been estimated at 0.3-1.1 for lateral and 0.1 for medial epicondylitis per year per 100 subjects of general practice populations. Of occupational risk factors, forceful activities, high force combined with high repetition or awkward posture and awkward postures are associated with epicondylitis. The number of studies is limited to work-related psychosocial factors and the effects are not as consistent as those of physical load factors. Topical non-steroidal anti-inflammatory drugs, corticosteroid injections and acupuncture provide short-term beneficial effects. Workload modification should be considered, especially in manually strenuous jobs. According to clinical case series, surgical treatment has shown fair to good results; however, the efficacy of surgical treatment has not been evaluated in randomised controlled trials. Poorer prognosis of epicondylitis has been reported for individuals with high level of physical strain at work, non-neutral wrist postures during work activity and for those with the condition on the dominant elbow. Modification of physical factors could reduce the risk or improve the prognosis of epicondylitis.

Interactive effects of acute experimental pain in trapezius and sored wrist extensor on the electromyography of the forearm muscles during computer work.

We investigated the interactive effects of shoulder pain and wrist extensor muscle soreness on surface electromyography (EMG) during computer mouse work. On day one, subjects (N = 12) performed computer work with/without acute muscle pain induced in the trapezius muscle. Subsequently, eccentric exercise was performed to induce delayed onset muscle soreness (DOMS) in wrist extensor muscles. In presence of DOMS on day two, computer work recordings with/without pain were repeated. EMG signals were recorded from the descending part of trapezius bilaterally, flexor carpi ulnaris and extensor carpi radialis brevis. Experimental muscle pain in trapezius led to a decrease in the muscular activity of the wrist extensor (P < 0.02) and decreased the relative rest time in the wrist flexor even in presence of DOMS (P < 0.01). The present result suggests that shoulder pain plays a role in the coordination of wrist flexors and extensors during computer work.

Overuse injuries in female athletes.

The last three decades have witnessed a tremendous increase in female sports participation at all levels. However, increased sports participation of female athletes has also increased the incidence of sport-related injuries, which can be either acute trauma or overuse injuries. Overuse injuries may be defined as an imbalance caused by overly intensive training and inadequate recovery, which subsequently leads to a breakdown in tissue reparative mechanisms. This article will review the most frequent overuse injuries in female athletes in the context of anatomical, physiological, and psychological differences between genders.

Lateral epicondylitis in a hospital phlebotomist--an ergonomic solution.

This report outlines a case of lateral epicondylitis in a hospital phlebotomist thought to be due to the forceful gripping, and repetitive twisting, involved in breaking the seals on green vacutainer needles. An ergonomic solution in the form of a device to aid breaking of the vacutainer seals is presented. The importance of seeking ergonomic solutions with manufacturers is highlighted.

Common sports injuries in young tennis players.

Tennis is a popular racquet sport played by boys, girls, men and women. Tennis players frequently begin playing in childhood and may continue playing into late adulthood. Preadolescent and adolescent players have open growth plates and a reduced muscle power, lower level of coordination and smaller stature compared with adult players. The physical characteristics of the young tennis player mean that unique demands are placed on the developing athlete which can, in turn, be associated with different types and patterns of injury. The most common types of injury in tennis players of all ages are muscle sprains and ligament sprains secondary to overuse. These are a particular problem in the adolescent age group because, in general, this group begin playing with a lower level of physical conditioning. Fortunately, injuries in younger players are usually not longstanding and the overuse (chronic) problems seen in older players, such as patellar tendinosis and tennis elbow, are less common in younger players. Anatomically, lower extremity injuries are twice as common as those to the upper extremity or spine, with ankle injury being the most common. Prevention of injury in young tennis players, or at least a reduction in the incidence, is possible. Some traumatic injuries, including contusions, abrasions, lacerations and fractures, may be unavoidable as a result of aggressive play, but others may be prevented by monitoring equipment and the court surface to ensure a safe field of play. The prime target of prevention in young tennis players should be overuse injuries. The principles of 'overload' and staged involvement are of particular importance in this age group. A gradual, progressive increase in the intensity of tennis practice, the slow introduction of new court surfaces and a staged progression in the teaching of tennis skills can help to reduce the incidence of injury in young tennis players.

Tennis racket shock mitigation experiments.

Measured in this study was the effectiveness of two types of retrofits in mitigating shocks in tennis rackets with ideally high grip fixity. The retrofits were a cushioned grip tape and a string implant device. Three types of rackets were investigated: wood, graphite composite, and metal. For low speed ball impact, neither retrofit changed significantly the magnitude and distribution of e, the coefficient of restitution on the racket heads. For moderate ball speeds impacting the rackets along the vertical centerline, three dynamic racket responses were measured: the free vibration damping based on racket head acceleration, the root-mean-square (rms) grip reaction force, and the fast Fourier transform (FFT) of the grip force. These latter experiments showed that the string implant device had a negligible effect on the three dynamic measures of racket response. However, the cushioned grip tape increased racket damping by up to 100 percent, reduced the rms grip force by about 20 percent, and reduced the magnitude of the FFT of this force by about 40 percent.

Upper limb musculoskeletal disorders in highly repetitive industries: precise anatomical physical findings.

Physical assessment of 146 female workers in highly repetitive jobs found 54% to have evidence of musculoskeletal disorders in the upper limb that are potentially work-related. Many workers had multiple problems, and many were affected bilaterally (33% of workers). Muscle pain and tenderness was the largest problem, both in the neck/shoulder area (31%) as expected and in the forearm/hand musculature (23%), a previously unreported site. Most forearm muscle problems were found on the extensor side. Carpal tunnel syndrome was the most common form of neuritis with 16 people affected (7 people affected bilaterally). De Quervain's tenosynovitis and wrist flexor tendinitis were the most commonly found tendon disorders in the distal forearm (12 people affected for each diagnosis). The results suggest that exposure should be measured bilaterally. They also suggest that muscle tissue is highly vulnerable to overuse. Stressors that affect muscle tissue, such as static loading, should be studied in the forearm as well as in the shoulder.

Electromyographic and cinematographic analysis of elbow function in tennis players using single- and double-handed backhand strokes.

It is generally believed that tennis players using a double-handed backhand rarely develop lateral epicondylitis since the helping arm appears to absorb more energy and changes the mechanics of the swing. The purpose of this paper was to compare muscle activity about the elbow in single- and double-handed backhand strokes in competitive tennis players. Muscle activity in 3 elbow extensors, a wrist flexor, and a forearm pronator of the dominant arm was compared during the single-handed (N = 14) and double-handed (N = 13) backhand ground strokes using indwelling electromyography and high-speed cinematography. Significantly higher activity was seen in the double-handed technique in the flexor carpi radialis muscle in the preparation phase and in the pronator teres muscle in the acceleration phase. Higher flexor carpi radialis muscle activity in preparation of the double-handed stroke appeared to be a function of the double-handed grip used on the racquet, and the increased pronator teres muscle activity in acceleration indicated maintenance of greater pronation provided by the grip of the non-dominant hand. The decreased occurrence of lateral epicondylitis in players using a double-handed backhand may not be caused by decreased extensor activity, but rather by factors associated with flawed stroke mechanics more often seen in the single-handed technique.

The effectiveness of grip bands in reducing racquet vibration transfer and slipping.

The effectiveness of cushion grip bands in reducing impact shock and vibration transfer, and slipping in tennis racquets has been investigated. The results also apply, in principle, to badminton and squash racquets, and to golf clubs. An artificial arm (manusimulator) replicating the structure and all the important properties of the real human arm (shoulder, upper- and forearm, hand, soft tissue- and muscle simulators, etc.) was used together with a standard tennis racquet for the investigation. Laser beams were employed for precision adjustment of the spatial racquet position and the ball impact location. The impact velocity was standardized at 20 m.s-1 +/- 1.2%, while the impact point was located 32.5 +/- 2 mm distal to the sweet spot (the nodal point of the fundamental transverse vibration mode) on the racquet long axis. The grip circumference for the 26 different grip bands tested was controlled at 116 +/- 1 mm (grip size 5), and the adjustable manusimulator grip pressure was kept at preset values. Impact shock and post-impact racquet vibrations were determined by manusimulator-accelerometry, while slipping resistance was measured by friction methods. The major finding was that cushion grip bands do statistically significant (at P = 0.05) reduce impact shock and vibration transfer in tennis racquets, albeit to varying degrees depending on the brand. At present, there is no clear indication whether these reductions are, in fact, biologically relevant. Very large differences were found to exist between the various grip band types as regards the reduction of slipping.

Factors affecting force loading on the hand in the tennis forehand.

The effect of preimpact hand forces and impact location on the postimpact force loading on the hand in the tennis forehand drive was examined. Force sensing resistors and strain gauges were mounted on a midsized tennis racket. Three-dimensional cinematography was used to reconstruct the motion of the ball, racket, and upper extremity of two varsity tennis players. One subject performed fifteen strokes using his normal grip while another performed sixteen, eight with a normal grip and eight with a significantly firmer grip. Postimpact peak forces on the hand were significantly (p less than 0.01) related to force at the base of the index finger in preparation for impact and the distance the ball impacted from the longitudinal axis of the racket. Impact location and preimpact force on the hand were found to account for 66% of the variability of postimpact peak force loading in the tennis forehand drive, and are important factors related to force loading in the tennis forehand. Smaller grip forces and rackets minimizing the effect of off-center impacts should be considered as intervention to reduce the risk of tennis elbow.

[Medical advice for golfers]. / Medizinische Ratschläge für Golfspieler.

Although golf is an ideal form of exercise for all age groups, complete mastery of the specific movements involved is a prerequisite. The typical golfing injuries and and pathological sequelae are usually the results of faulty driving and hitting techniques. Apart from golfer's shoulder and golfer's elbow, complaints affecting the lumber spine predominate.

Prevention and treatment of elbow and shoulder injuries in the tennis player.

Tennis injuries are common in both the upper and lower extremities. The most common, and often most difficult, upper extremity injuries are shoulder tendinitis and tennis elbow (lateral and medial). Key considerations in the treatment of tendinitis include an understanding of the injury process and the resultant character and quantity of the pathologic spectrums. Tendon degeneration rather than tendon repair is the primary pathologic entity secondary to intrinsic muscle-tendon overload. For best treatment results, the protocols of treatment, both surgical and nonsurgical, must be individualized.

Proposed screening tool for the detection of cumulative trauma disorders of the upper extremity.

The incidence of cumulative trauma disorder (CTD) has become noteworthy in plants that rely on automated production. This rise was evident in an Ohio poultry company. The purpose of this study was to develop a screening tool to detect employees who might be at risk of sustaining a CTD injury and to identify trends of CTD at specific workstations. Thirty-five employees at three workstations completed a questionnaire and underwent a physical examination. Results identified 24 employees with a potential for CTD, and these employees were recommended for remediation. Job modifications and supportive devices were placed in the workplace. A newly designed industrial wrist splint was developed for this study. The personnel department has noted that employee complaints of upper extremity discomfort have decreased.

Injuries of exercise.

This article presents a brief overview of a few of the conditions that may affect the exercising individual. An accurate diagnosis and a positive attitude toward exercise on the part of the physician is stressed.