Examining the association between musculoskeletal injuries and carpal tunnel syndrome in manual laborers.

INTRODUCTION: The association between musculoskeletal injuries and carpal tunnel syndrome (CTS) has not been investigated in a large, population-based study. METHODS: Latino manual laborers were recruited as part of a study of work-related health conditions. Each had a clinical examination, completed a hand diagram, and had nerve conduction studies. RESULTS: A total of 512 individuals completed all testing. An association was found between rotator cuff syndrome and CTS, with an adjusted odds ratio of 2.25 (P = 0.01) for the right arm, 2.08 (P = 0.03) for the left arm, and 1.84 (P = 0.03) for all individuals. Associations between epicondylitis and CTS did not reach statistical significance. CONCLUSIONS: Individuals with rotator cuff syndrome have a higher prevalence of CTS. Further investigations will be needed to examine for causation and to determine if 1 condition typically occurs first and leads to the other. Muscle Nerve 54: 31-35, 2016.

Musculoskeletal and neurological injuries associated with work organization among immigrant Latino women manual workers in North Carolina.

BACKGROUND: This analysis examines the associations of work organization attributes among Latino women in manual occupations with musculoskeletal and neurological injuries. METHODS: Participants included 234 women in western North Carolina. Outcome measures included epicondylitis, rotator cuff syndrome, back pain, and carpal tunnel syndrome. Independent measures included indicators of job demand, job control, and job support, as well as personal characteristics. RESULTS: Latina workers commonly experienced epicondylitis, rotator cuff syndrome, back pain, and CTS. Awkward posture and decision latitude were associated with epicondylitis. Rotator cuff syndrome was associated with awkward posture and psychological demand. Awkward posture and psychological demand, and decreased skill variety and job control were related to CTS. CONCLUSIONS: Work organization factors are potentially important for musculoskeletal and neurological injury among vulnerable workers. Research is required to understand the associations of work and health outcomes of these women. Policy initiatives need to consider how work organization affects health.

Prevalence of epicondylitis, rotator cuff syndrome, and low back pain in Latino poultry workers and manual laborers.

BACKGROUND: The goal of this study is to improve understanding of immigrant Latino manual workers' occupational health, focusing on upper body musculoskeletal injury. METHODS: Physical exams were conducted with a representative sample of 516 Latino poultry workers and manual laborers in western North Carolina; outcome measures were prevalence of epicondylitis, rotator cuff syndrome, and low back pain. RESULTS: Low back pain (n = 89; 17.2%) and rotator cuff syndrome (n = 76; 14.7%) indicated by physical exam was common. Epicondylitis was less common, but still frequent (n = 30; 5.8%). Prevalence of each outcome did not differ between poultry processing workers and other manual workers. Workers >40 years old had greater incidence of rotator cuff syndrome and epicondylitis. CONCLUSIONS: Epicondylitis, rotator cuff syndrome, and low back pain are common in immigrant Latino workers, and may negatively impact long-term health and contribute to occupational health disparities.

Estimation of injury simulation in international women's football.

This study attempted to determine the frequency of apparent injury incidents in women's international football and estimate what proportion was authentic. Broadcast recordings of 47 games from 2 tournaments were reviewed to identify incidents in which a player behaved as if injured. Apparent injuries were considered definite if a player withdrew from participation within 5 minutes or if bleeding was visible. Remaining incidents were considered questionable. A total of 270 apparent injuries were observed at a rate of 5.74/game compared with 11.26/game previously reported in men's football. The definite injury rate was only 0.78/game vs. 4.96/game for questionable injuries. Definite injuries were associated with on-field treatment (P < 0.010), stretcher (P < 0.010), and second half (P = 0.022), while questionable injuries were associated with fouls (P = 0.036), contact (P < 0.010), and being tackled (P = 0.025). Questionable injuries were not associated with the final third of a half or with team success.

Emergency planning for sudden cardiac events in North Carolina high schools.

BACKGROUND: This study evaluates the state of emergency planning for sudden cardiac arrest (SCA) in North Carolina high schools, primarily focusing on the existence and characteristics of written plans and the presence of automated external defibrillators (AEDs). METHODS: All athletic directors listed in the 2007-2008 North Carolina High School Athletic Association Directory were surveyed via an online survey to determine their level of planning and preparation for SCA. RESULTS: Completed surveys were received from 36.7% (138/376) of the schools. Emergency action plans (EAPs) existed in 55.8% (n = 77) of high schools and were significantly less likely to be present in Divisions 1 and 2 (p < 0.01) than in Divisions 3 and 4 which have higher enrollment. EAPs included aims to initiate CPR within one minute (80.5%), and targets to defibrillate within three-five minutes (66.2%) as recommended by recent guidelines from the National Athletic Trainers Association. AEDs were present in 72.5% (n = 100) of the responding schools, and the presence of an AED was related to the presence of an EAP (p < 0.01). Schools in Division 1 were less likely to possess an AED (p < 0.01) than schools in the larger divisions. Of schools without AEDs, 39.5% (n = 15) reported children or adults attending or working at the school who were at risk for heart disease. Lack of funding was the most commonly reported barrier to obtaining an AED. LIMITATIONS: A low response rate and self-reported data may have biased results in favor of those who adopted plans or purchased an AED. CONCLUSIONS: The majority of responding schools possessed both an EAP and an AED and reported that they met several current recommended guidelines for emergency preparedness for SCA. These results for North Carolina high schools are similar to reports from other states. Significant room for improvement exists, however, as the number of schools without an EAP or AED is still relatively large and some important components of emergency planning are lacking in the EAPs.

Dermatologic disease in family medicine.

BACKGROUND AND OBJECTIVES: Because dermatologic complaints are encountered frequently in primary care, the education of family physicians about skin disorders is important. Data are needed to help define areas of dermatology that deserve the most time and emphasis. This study determined what types of skin problems and medications family physicians most commonly diagnose and prescribe. METHODS: Study researchers analyzed the National Ambulatory Medical Care Survey data from 2002 to 2005 for dermatologic diagnoses and most common prescriptions by family physicians. The data from 2002-2005 were compared to data from 1990-1994. RESULTS: Skin conditions accounted for 8% of all visits to family physicians in 2002-2005. The five most common skin disorders diagnosed by family physicians were dermatitis, pyoderma, tinea, benign neoplasms, and candida. The top 20 diagnoses accounted for 70% of the visits. The three most commonly prescribed medication classes for skin problems from 2002-2005 were antihistamines, topical anti-infectives, and adrenal corticosteroids. Between 1990-1994 and 2002-2005, family physicians increased the number of less common dermatologic diagnoses they make by 10% and have concurrently increased the prescribing of medications they use to treat these disorders. CONCLUSIONS: Family physicians diagnose a wide range of skin disorders and prescribe drugs to treat them. Family physicians make more dermatologic diagnoses and prescribe more treatments than previously.

Abnormalities in Diffusional Kurtosis Metrics Related to Head Impact Exposure in a Season of High School Varsity Football.

The purpose of this study was to determine whether the effects of cumulative head impacts during a season of high school football produce changes in diffusional kurtosis imaging (DKI) metrics in the absence of clinically diagnosed concussion. Subjects were recruited from a high school football team and were outfitted with the Head Impact Telemetry System (HITS) during all practices and games. Biomechanical head impact exposure metrics were calculated, including: total impacts, summed acceleration, and Risk Weighted Cumulative Exposure (RWE). Twenty-four players completed pre- and post-season magnetic resonance imaging, including DKI; players who experienced clinical concussion were excluded. Fourteen subjects completed pre- and post-season Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). DKI-derived metrics included mean kurtosis (MK), axial kurtosis (K axial), and radial kurtosis (K radial), and white matter modeling (WMM) parameters included axonal water fraction, tortuosity of the extra-axonal space, extra-axonal diffusivity (De axial and radial), and intra-axonal diffusivity (Da). These metrics were used to determine the total number of abnormal voxels, defined as 2 standard deviations above or below the group mean. Linear regression analysis revealed a statistically significant relationship between RWE combined probability (RWECP) and MK. Secondary analysis of other DKI-derived and WMM metrics demonstrated statistically significant linear relationships with RWECP after covariate adjustment. These results were compared with the results of DTI-derived metrics from the same imaging sessions in this exact same cohort. Several of the DKI-derived scalars (Da, MK, K axial, and K radial) explained more variance, compared with RWECP, suggesting that DKI may be more sensitive to subconcussive head impacts. No significant relationships between DKI-derived metrics and ImPACT measures were found. It is important to note that the pathological implications of these metrics are not well understood. In summary, we demonstrate a single season of high school football can produce DKI measurable changes in the absence of clinically diagnosed concussion.

Windsurfing injuries: added awareness of diagnosis, treatment, and prevention.

With proper training and safety precautions, windsurfing is a relatively safe sport, but its unique equipment and unpredictable environmental conditions can produce serious injuries. Clinicians are likely to see patients with ankle injuries, tarsometatarsal injuries, or anterior shoulder dislocations sustained during falls; chronic low-back pain from stresses placed on torsos; and skin lacerations and sun damage. The physician's role in preventing injuries is to stress safety, especially using equipment properly and wearing protective gear and sunscreen.

Employer differences in upper-body musculoskeletal disorders and pain among immigrant Latino poultry processing workers.

Between-employer differences in working conditions may lead to variable injury rates. The objective of this paper is to assess the difference in the prevalence of epicondylitis, rotator cuff syndrome, and low back pain among immigrant Latino poultry workers at plants of three different employers. Data were collected from a cross-sectional study among 286 poultry processing workers. Community-based sampling was used to recruit participants in western North Carolina. Rotator cuff syndrome (26.7%) and low back pain (27.9%) were more prevalent among employees of one specific employer. Multivariate analysis showed significant associations of low back pain and rotator cuff syndrome with age, task performed in the processing line, and employer. Employer is a major predictor of musculoskeletal disorders and pain. Line speed and work pace may account for these differences and provide an opportunity for regulation and intervention to protect the health of workers.

Abnormal white matter integrity related to head impact exposure in a season of high school varsity football.

The aim of this study was to determine whether the cumulative effects of head impacts from a season of high school football produce magnetic resonance imaging (MRI) measureable changes in the brain in the absence of clinically diagnosed concussion. Players from a local high school football team were instrumented with the Head Impact Telemetry System (HITS™) during all practices and games. All players received pre- and postseason MRI, including diffusion tensor imaging (DTI). Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) was also conducted. Total impacts and risk-weighted cumulative exposure (RWE), including linear (RWELinear), rotational (RWERotational), and combined components (RWECP), were computed from the sensor data. Fractional, linear, planar, and spherical anisotropies (FA, CL, CP, and CS, respectively), as well as mean diffusivity (MD), were used to determine total number of abnormal white matter voxels defined as 2 standard deviations above or below the group mean. Delta (post-preseason) ImPACT scores for each individual were computed and compared to the DTI measures using Spearman's rank correlation coefficient. None of the players analyzed experienced clinical concussion (N=24). Regression analysis revealed a statistically significant linear relationship between RWECP and FA. Secondary analyses demonstrated additional statistically significant linear associations between RWE (RWECP and RWELinear) and all DTI measures. There was also a strong correlation between DTI measures and change in Verbal Memory subscore of the ImPACT. We demonstrate that a single season of football can produce brain MRI changes in the absence of clinical concussion. Similar brain MRI changes have been previously associated with mild traumatic brain injury.

Work organization and musculoskeletal health: clinical findings from immigrant Latino poultry processing and other manual workers.

OBJECTIVE: To determine the potential role of differential exposure to work organization hazards in musculoskeletal disorders among immigrant Latino workers. METHOD: Self-reported work organization data were obtained from immigrant Latino workers in poultry processing and nonpoultry, manual occupations (N = 742). Clinical evaluations for epicondylitis, rotator cuff syndrome, and back pain were obtained from a subsample (n = 518). RESULTS: Several work organization hazards (eg, low job control, high psychological demands) were elevated among poultry processing workers. Job control predicted epicondylitis (odds ratio [OR] = 0.77) and rotator cuff syndrome (OR = 0.79); psychological demand predicted rotator cuff syndrome (OR = 1.30) and back pain (OR = 1.24); awkward posture and repeated movements predicted all three outcomes; and management safety commitment predicted rotator cuff syndrome (OR = 1.65) and back pain (OR = 1.81). DISCUSSION: Immigrant poultry processing workers are exposed to greater work organization hazards that may contribute to occupational health disparities.

Issues encountered by physicians during international travel with youth national soccer teams.

BACKGROUND: Little information is available to guide the selection, preparation, and support of a traveling team physician. PURPOSE: To determine the types of injuries and medical problems, as well as general team health and performance issues, encountered by physicians traveling internationally with youth national soccer teams. STUDY DESIGN: Descriptive epidemiology. METHODS: Physicians assigned to travel abroad with the under-17 men's and women's US national soccer teams during a 2-year period documented all encounters with team and staff members. Physicians also documented consultations related to team health and performance issues. RESULTS: The 108 cases (5.71 per 10 days) were evenly divided between injuries (n = 54) and noninjuries (n = 54). Players sought care at a higher rate than did staff (2.28 vs 1.09 per 100 person days). Mean severity for all player cases was 5.19 days missed (injuries, 10.48; noninjuries, 0.23). Nearly 69% of injuries involved the lower extremities: strains, sprains, and contusions accounted for 74.1% of injuries. Gastrointestinal, dermatologic, and otolaryngologic complaints accounted for 77.8% of noninjuries. Medications were administered in 71% of cases, with analgesics, cough and cold remedies, antibiotics, and gastrointestinal agents accounting for the majority. The leading team health and performance concerns were nutrition/hydration, conditioning, prevention, and doping control. CONCLUSION: Physicians traveling internationally with youth soccer teams manage an equal proportion of musculoskeletal and medical problems using simple medications.