Women's wrist and elbow at work: analysis of acute injuries and cumulative trauma disorders to improve ergonomics in female-dominated activities.

The aim of this study is to analyse women's wrist and elbow acute work injuries together with cumulative trauma disorders, such as carpal tunnel syndrome (CTS) and epicondylitis. Five years records (2015-2019) on women's wrist/elbow acute work injuries and CTS/epicondilytis, from Italian National Compensation Authority, were collected and pooled all together as 'dis-ac' (disorders + acute) events. A statistical analysis was performed in comparing the different female-dominated work sectors. Results showed that hairdressing/laundry sector was associated with the highest risk for wrist acute work injuries and cleaning for elbow while manufacturing for CTS and epicondylitis. Hairdressing/laundry and manufacturing were associated with the highest risk for dis-ac events (hairdressing: wrist dis-ac OR: 4.89; CI 95% 4.22-5.67; elbow dis-ac OR: 3.70; CI 95% 2.99-4.58; manufacturing: wrist dis-ac OR: 3.39; CI 95% 3.13-3.66; elbow dis-ac OR: 2.45; CI 95% 2.20-2.73). The relationship between acute injuries and cumulative trauma disorders is discussed to preserve women's safety and health in ergonomics.Practitioner Summary: Women's wrist and elbow acute work injuries and cumulative trauma disorders (carpal tunnel syndrome and epicondylitis) were analysed and studied all together (dis-ac events) in female-dominated activities. Hairdressing and manufacturing work sectors were associated with the highest risk, showing the need to safeguard the health and safety of female workers.

Case-Control Study of Ultrasound Evaluation of Acute Median Nerve Response to Upper Extremity Circuit Training in Spinal Cord Injury.

OBJECTIVE: Individuals with spinal cord injury (SCI) often present signs and symptoms of median nerve (MN) pathology. Preclinical signs identification of MN pathology might facilitate early intervention to prevent or delay carpal tunnel syndrome in SCI. We assessed if ultrasound parameters changed in response to upper extremity (UE) circuit training exercise in individuals with paraplegia and able-bodied individuals. DESIGN: Case-control study. PARTICIPANTS: Adults (N=32) with paraplegia (n=16) and age- and sex-matched able-bodied controls (n=16). INTERVENTION: Circuit training exercise. MAIN OUTCOME MEASURES: MN ultrasound evaluation at the pisiform and radius before and after UE exercise. Ultrasound parameters included cross-sectional area (CSA), and gray scale (GS). Data presented as mean ± SD. RESULTS: Pre-exercise CSAs were larger in SCI at the radius (12.0±2.9 vs 9.0±2.1; P=.003), but not the pisiform (9.8±3.1 vs 9.1±1.7; P=.431). There were no statistical differences in MN response to exercise between groups (all P≥.293). Across participants, CSA changes were inversely associated with their pre-exercise values at the pisiform (r=-0.648; P<.001) and the radius (r=-0.366; P=.043). Participants with pre-exercise CSA values ≥10.00 mm2 at the pisiform responded to exercise with decreases in CSA (mean change ± SD, -2.0±1.5; P=.002) and GS (-2.8±6.2; P=.029). Participants with pre-exercise CSA ≤9.99 mm2 at the pisiform responded to exercise with no change in CSA (mean change ± SD, 0.7±2.5; P=.002) and increased GS (3.2±7.2; P=.029). CONCLUSIONS: CSA exercise response was more strongly related to pre-exercise MN values than presence or absence of SCI.

Ergonomics and musculoskeletal disorders in neurosurgery: a systematic review.

BACKGROUND: Work-related musculoskeletal disorders (WMSDs) are a growing and probably undervalued concern for neurosurgeons and spine surgeons, as they can impact their quality of life and career length. This systematic review aims to ascertain this association and to search for preventive measures. METHODS: We conducted a PRISMA-P-based review on ergonomics and WMSDs in neurosurgery over the last 15 years. Twelve original articles were included, of which 6 focused on spine surgery ergonomics, 5 cranio-facial surgery (mainly endoscopic), and one on both domains. RESULTS: We found a huge methodological and content diversity among studies with 5 surveys, 3 cross-sectional studies, 2 retrospective cohorts, and 2 technical notes. Spine surgeons have sustained neck flexion and neglect their posture during surgery. In a survey, low back pain was found in 62% of surgeons, 31% of them with a diagnosed lumbar disc herniation, and 23% of surgery rate. Pain in the neck (59%), shoulder (49%), finger (31%), and wrist (25%) are more frequent than in the general population. Carpal tunnel syndrome showed a linear relationship with increasing cumulative hours of spine surgery practice. Among cranial procedures, endoscopy was also significantly related to shoulder pain while pineal region surgery received some attempts to optimize ergonomics. CONCLUSIONS: Ergonomics in neurosurgery remains underreported and lack attention from surgeons and authorities. Improvements shall target postural ergonomics, equipment design, weekly schedule adaptation, and exercise.

Theoretical impact of simulated workplace-based primary prevention of carpal tunnel syndrome in a French region.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy in the working-age population. The reduction of CTS incidence in the workforce is a priority for policy makers due to the human, social and economic costs. To assess the theoretical impact of workplace-based primary interventions designed to reduce exposure to personal and/or work-related risk factors for CTS. METHODS: Surgical CTS were assessed using regional hospital discharge records for persons aged 20-59 in 2009. Using work-related attributable fractions (AFEs), we estimated the number of work-related CTS (WR-CTS) in high-risk jobs. We simulated three theoretical scenarios of workplace-based primary prevention for jobs at risk: a mono-component work-centered intervention reducing the incidence of WR-CTS arbitrarily by 10% (10%-WI), and multicomponent global interventions reducing the incidence of all surgical CTS by 5% and 10% by targeting personal and work risk factors. RESULTS: A limited proportion of CTS were work-related in the region's population. WR-CTS were concentrated in nine jobs at high risk of CTS, amounting to 1603 [1137-2212] CTS, of which 906 [450-1522] were WR-CTS. The 10%-WI, 5%-GI and 10%-GI hypothetically prevented 90 [46-153], 81 [58-111] and 159 [114-223] CTS, respectively. The 10%-GI had the greatest impact regardless of the job. The impact of the 10%-WI interventions was high only in jobs at highest risk and AFEs (e.g. food industry jobs). The 10%-WI and 5%-GI had a similar impact for moderate-risk jobs (e.g. healthcare jobs). CONCLUSION: The impact of simulated workplace-based interventions suggests that prevention efforts to reduce exposure to work-related risk factors should focus on high-risk jobs. Reducing CTS rates will also require integrated strategies to reduce personal risk factors, particularly in jobs with low levels of work-related risk of CTS.

In the Clinic. Carpal Tunnel Syndrome.

This issue provides a clinical overview of carpal tunnel syndrome, focusing on screening and prevention, diagnosis, and treatment. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

Do exposure limits for hand-transmitted vibration prevent carpal tunnel syndrome?

BACKGROUND: An apparently high frequency of carpal tunnel syndrome (CTS) among shipyard workers undergoing health surveillance because of exposure to hand-transmitted vibration (HTV) prompted concerns that current regulatory limits on exposure might not protect adequately against the disorder. AIMS: To explore whether within regulatory limits, higher exposures to HTV predispose to CTS. METHODS: As part of a retrospective audit, we compared duration and current intensity of exposure to HTV in cases with new-onset CTS and controls matched for age. Conditional logistic regression was used to quantify associations, which were summarized by odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: There were 23 cases and 55 controls. After adjustment for body mass index and previous diagnosis of diabetes, no clear associations were observed either with duration of exposure to HTV or with current intensity of exposure. Risk was non-significantly elevated in men with ≥30 years' exposure to HTV (OR 1.6), but in the highest category of current exposure [8-h energy-equivalent frequency-weighted acceleration (A8) ≥ 4.0 m/s(2)], risk was lower than that in the reference category (A8 < 2.5 m/s(2)). Moreover, there was a significantly reduced risk of CTS in men with a previous diagnosis of hand-arm vibration syndrome (HAVS) (OR 0.2, 95% CI 0.1-0.9). CONCLUSIONS: We found no evidence that below the current limit for A(8) of 5 m/s(2), higher exposures to HTV predispose to CTS. However, care should be taken not to overlook the possibility of treatable CTS when workers with diagnosed HAVS present with new or worsening sensory symptoms in the hand.

The surveillance of occupational diseases in Italy: the MALPROF system.

BACKGROUND: Occupational diseases data can guide efforts to improve worker's health and safety. AIMS: To describe MALPROF, the Italian system for surveillance of work-related diseases collected by the subregional Department of Prevention. METHODS: The MALPROF system started in 1999 with contributions from Lombardy and Tuscany and spread in the following years to collect contributions from 14 out of the 20 Italian regions. MALPROF data were explored to follow-up work-related diseases and to detect emerging occupational health risks by calculating proportional reporting ratio (PRR), as in pharmacosurveillance. It classified work-related diseases according to economic sector and job activity in which the exposure occurred. Occupational physicians of the Italian National Health Service evaluate the possible causal relationship with occupational exposures and store the data in a centralized database. RESULTS: From 1999 to 2012, the MALPROF system collected about 112000 cases of workers' diseases. In 2010, more than 13000 cases of occupational diseases were reported. The most frequently reported diseases were hearing loss (n = 4378, 32%), spine disorders (n = 2394, 17%) and carpal tunnel syndrome (n = 1560, 11%). The PRR calculated for cervical disc herniation, a disease whose occupational origin has to be studied, in 1999-2010 was 2.47 [95% confidence interval (CI) 1.76-3.47] for drivers and 36.64 (95% CI 22.03-60.93) for air transport workers. CONCLUSIONS: MALPROF is a sensitive system for identifying possible associations between occupational risks and diseases, it can contribute to the development of preventive measures, to evaluate the effectiveness of preventive interventions and to stimulate research on new occupational risks and diseases.

The Extended Flexor Carpi Radialis Approach for Concurrent Carpal Tunnel Release and Volar Plate Osteosynthesis for Distal Radius Fracture.

PURPOSE: To determine the relative benefits of an extended flexor carpi radialis (FCR) (eFCR) approach with prophylactic carpal tunnel release at the time of volar plate osteosynthesis for distal radius fracture via a single incision into the traditional volar Henry (VH) approach. METHODS: This was a prospective cohort comparison of preoperative and postoperative median nerve function of 27 patients (15 eFCR and 12 VH) with unilateral, isolated distal radius fractures requiring open reduction internal fixation without preoperative acute carpal tunnel syndrome. Patients were operated on via either the eFCR or VH approach. The validated Levine-Katz Carpal Tunnel Questionnaire (symptom and functional severity scores) was administered and Semmes-Weinstein monofilament and 2-point discrimination testing were conducted preoperatively and at 6 weeks and 3 months postoperatively. Grip and pinch strength were measured at 6 weeks and 3 months. The groups were comparable in terms of age, sex, and fracture type and displacement. RESULTS: Comparing across groups, there were no statistically significant differences in any outcome measured preoperatively or postoperatively. The eFCR and VH groups demonstrated significant improvement in functional severity scores, symptom severity, and grip strength. The symptom severity score improved to statistical significance at 6 weeks in the eFCR group and at 3 months in the VH group. CONCLUSIONS: In this small comparative study, the eFCR approach was found to be safe and efficacious. There was no increased surgical morbidity, which suggests that this technique can be used safely for all patients undergoing volar plating and not just in cases of concurrent carpal tunnel syndrome. It allows easier retraction of carpal tunnel contents; therefore, it is our preferred approach.

[Health surveillance and suitability: the role of the company physician in maintaining work ability]. / Sorveglianza sanitaria e idoneità: ruolo del medico competente a sostegno della capacità lavorativa.

The ageing workforce is one of the major issues in Europe. Ageing has an important effect on work ability, especially in manual jobs where physical demand is high. Musculoskeletal disorders are the most common health problems among European workers and are able to affect work ability. In order to increase the employment rate of people aged 45-65, measures to sustain work ability and proper age management should be promoted: return to work strategies include adjustment of the job to the worker's health conditions and abilities. The contribution of health surveillance.programs in the management of workers affected by musculoskeletal disorders is discussed.

Effectiveness of prevention exercises protocol among office workers with symptoms of carpal tunnel syndrome.

OBJECTIVES: Carpal tunnel syndrome (CTS) is common among office workers and limits functional hand ability and the ability to work. Carpal tunnel syndrome prevention programs implementation are still insufficient among office workers. In view of the fact that physical activity is the best method of preventing musculoskeletal complaints the aim of the study was to evaluate the effectiveness of prevention exercises protocol for hand and wrist pain among office workers. MATERIAL AND METHODS: Study group consists form 62 office workers, reporting complaints of hand and wrist pain. Exercise group it was 49 subjects who performed the exercise protocol and the non-exercise group consisted of 13 subjects. An exercises program, consisting of 7 exercises. The program was planned for daily routine during 8 weeks. The effectiveness of the exercise program was assessed by physical parameters (hand grip and pinch grip strength, force of forearm muscles) and questionnaires (Visual Analog Scale pain scale, Carpal Tunnel Syndrome Symptom Severity Scale, and Carpal Tunnel Syndrome Functional Status Scale functional hand assessment questionnaires) were performed. Assessment was performed before and after the intervention. RESULTS: Statistical analysis of the data showed significant changes in the value of measured hand grip of the right hand (Z = -2.85, p < 0.01). For pinch grip, changes were significant for both the right (Z = -2.12, p < 0.05) and the left hands (Z = -2.35, p < 0.05). Functional performance improved significantly in bought groups. There was no statistically significant change in the intensity of experienced pain. CONCLUSIONS: The results of the study indicate that performing a preventive exercise program regularly has an effect on increasing forearm muscle strength in a group of office workers. Office workers with symptoms of CTS who exercised regularly had higher results in hand grip and pincer grip strength. Exercises do not affect the level of pain complaints, which may indicate a more complex etiology of pain perception in this study group. Int J Occup Med Environ Health. 2024;37(1):45-57.

Personal and workplace psychosocial risk factors for carpal tunnel syndrome: a pooled study cohort.

BACKGROUND: Between 2001 and 2010, six research groups conducted coordinated multiyear, prospective studies of carpal tunnel syndrome (CTS) incidence in US workers from various industries and collected detailed subject-level exposure information with follow-up symptom, physical examination, electrophysiological measures and job changes. OBJECTIVE: This analysis of the pooled cohort examined the incidence of dominant-hand CTS in relation to demographic characteristics and estimated associations with occupational psychosocial factors and years worked, adjusting for confounding by personal risk factors. METHODS: 3515 participants, without baseline CTS, were followed-up to 7 years. Case criteria included symptoms and an electrodiagnostic study consistent with CTS. Adjusted HRs were estimated in Cox proportional hazard models. Workplace biomechanical factors were collected but not evaluated in this analysis. RESULTS: Women were at elevated risk for CTS (HR=1.30; 95% CI 0.98 to 1.72), and the incidence of CTS increased linearly with both age and body mass index (BMI) over most of the observed range. High job strain increased risk (HR=1.86; 95% CI 1.11 to 3.14), and social support was protective (HR=0.54; 95% CI 0.31 to 0.95). There was an inverse relationship with years worked among recent hires with the highest incidence in the first 3.5 years of work (HR=3.08; 95% CI 1.55 to 6.12). CONCLUSIONS: Personal factors associated with an increased risk of developing CTS were BMI, age and being a woman. Workplace risk factors were high job strain, while social support was protective. The inverse relationship between CTS incidence and years worked among recent hires suggests the presence of a healthy worker survivor effect in the cohort.

How to prevent injury to the palmar cutaneous branch of median nerve and ulnar nerve in a palmar incision in carpal tunnel release, a cadaveric study.

OBJECTIVE: To identify palmar cutaneous branches of median nerve and ulnar nerve (PCBMN and PCBUN) and try to find a safe path at wrist and forearm in the decompression procedure of carpal tunnel syndrome. MATERIALS AND METHODS: Ten formalin-fixed and five fresh-frozen cadaveric forearms were included in the study. The cross point of longitude of middle finger and distal wrist crease was defined as 0 point. Distal wrist crease (DWC) and 0 point were chosen as references for measurements. Several points on the pathway of PCBMN and PCBUN were measured. RESULTS: The average distance between the origin of the PCBMN and PCBUN to the DWC was 4.95 ± 0.88 cm, 10.12 ± 1.50 cm, separately. The average distance between DWC and the point where PCBMN and PCBUN separated from their trunk was found to be 2.09 ± 0.31 cm, 2.90 ± 0.50 cm, separately. The distances between PCBMN, PCBUN and 0 point at DWC level was found to be 0.61 ± 0.12 cm, 0.47 ± 0.31 cm, separately. The diameters of two cutaneous branches were 0.10 ± 0.02 cm, 0.11 ± 0.04 cm, separately. CONCLUSION: The general longitudinal palmar incision could avoid injuries to recurrent branch of median nerve and distal branches of palmar cutaneous nerve can be avoided macroscopically. The area about 5 mm ulnar and 6 mm radial to 0 point at wrist level was a relatively safe area.

Device to relate the superficial temperature of the forearm and the muscular conditioning of the flexor muscle for prevention of carpal tunnel syndrome in E-sports.

Currently, various labor and competitive sectors use computing devices as the primary development tool, one of them being e-sports or electronic sports. Constant use of the computer involves repetitive use of the fingers' superficial and deep flexor muscles, which causes the median nerve to squeeze and irritate in the carpal tunnel space causing carpal tunnel syndrome (CTS). There are methods that can minimize stress on the hands and wrists through muscle conditioning. However, there are no quantifiable indicators of the conditioning performed. Therefore, this work aims to develop a device capable of conditioning the flexor muscles and indicate in a quantifiable way the conditioning carried out as prevention of carpal tunnel syndrome. After the analysis of these data, a direct relationship between the surface temperature of the forearm and the muscular conditioning of the flexors is observed. The temperature variation during conditioning is greatest in the distal forearm with a range of [32.76-34.38]°. Post-conditioning temperature retention is greater in the distal forearm over time.

Bassoonists' medical problems-current state of knowledge.

Specific musical instruments can be a source of physical problems to their players. Based on reviews of the literature and personal experience, this paper summarizes current knowledge of problems affecting musicians who play instruments in the bassoon family (including the bassoon, contrabassoon, and several other instruments). Prevalence rates are higher in reports of surveys (ranging up to 86%), compared to clinical reports of patients seen and treated. Significant risk factors include young age, small body size, female gender, and use of large instruments. Problems unique to bassoonists are rare; most physical difficulties also are seen in general musculoskeletal clinical practices and in musicians playing all types of instruments. The left upper extremity is more commonly affected by overuse-related conditions in bassoonists. Non-playing-related problems are equally important for consideration (such as degenerative disorders and acute trauma), since they also affect practice and performance. Little experimental data exist to validate current and widely-held principles of treatment, rehabilitation, and prevention.

Strategies for the prevention of carpal tunnel syndrome in the workplace: A systematic review.

Carpal Tunnel Syndrome (CTS) is one of the most frequently occurring musculoskeletal disorders of the upper limbs. Strategies for preventing CTS in the workplace include interventions such as ergonomics, education, exercise, physical therapy, and occupational health. The purpose of this study was to provide a general overview based on the review of scientific literature regarding strategies used for preventing CTS in working populations. From September to October 2018, the MEDLINE, PUBMED, EMBASE and SCOPUS (1990 to December 2017) databases were searched for evidence. The risk of bias assessment in the selected papers was evaluated using the criteria recommended by The Cochrane Handbook and the methodological quality of the included studies was evaluated using Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. A total of 11 studies were included in the present review. A total of 1,061 subjects participated in the studies. The quality of the included studies was limited in three studies, appropriate in three studies, good in three studies, and strong in two studies. The overall results suggest a mixed level of evidence of the effect of applying strategies for preventing CTS in the workplace. The bias assessment was primarily due to incomplete result data, selective reporting of results, and blinding. In this review, interventions focused on the modification or change of accessories (keyboard, mouse, wrist rest, and the overall workstation), education in ergonomics, exercise, and physical therapies, among others, were analyzed. The findings of this review show different possibilities when choosing an intervention strategy for the workplace. However, it was challenging to analyze each of the papers owing to the heterogeneity of the studies included.

Volar plate osteosynthesis of distal radius fractures with concurrent prophylactic carpal tunnel release using a hybrid flexor carpi radialis approach.

PURPOSE: To evaluate the safety and efficacy of a hybrid flexor carpi radialis (FCR) approach for volar plate osteosynthesis of displaced distal radius fractures with concurrent prophylactic carpal tunnel release (CTR) in patients without preoperative signs or symptoms of acute carpal tunnel syndrome secondary to the fracture. METHODS: A total of 68 displaced distal radius fractures in 65 eligible adult patients (35 men, 30 women; mean age, 48.6 +/- 15.4 y) who had volar plate osteosynthesis and concomitant prophylactic CTR through a hybrid FCR approach by a single surgeon were included in this study. A systematic chart review and subsequent telephone questionnaire were performed to identify any postoperative median nerve dysfunction, recurrent motor or palmar cutaneous branch injury, tendon injury, or other complications directly related to the approach. RESULTS: Reported symptoms consistent with late median nerve dysfunction were identified in 2 cases; however, no patients in this series required additional surgery for early or late median neuropathy. Furthermore, no cases of median nerve sensory or motor branch injury or tendon injury were identified. No other unforeseen complications specifically related to the approach were observed. CONCLUSIONS: Volar plate osteosynthesis of distal radius fractures with a concurrent prophylactic CTR can be safely performed through the described hybrid FCR approach in patients without signs or symptoms of acute CTS. Routine release of the transverse carpal ligament with the hybrid FCR approach at the time of fracture fixation might reduce the incidence of postoperative median nerve dysfunction. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Attributable risk of carpal tunnel syndrome in the general population: implications for intervention programs in the workplace.

OBJECTIVE: Carpal tunnel syndrome (CTS) represents one of the most significant and costly health problems occurring in the working population. An estimation of the potential impact of CTS prevention programs in the workplace would be useful for public policy. The aim of this study was to assess the work-related population-attributable fraction (PAF) of CTS in industrial sectors and occupational categories at high risk of CTS in the general population. METHODS: All cases of CTS occurring in patients living in a French region were included prospectively between 2002-2004. Using a mailed questionnaire, we gathered medical and occupational history from 815 women and 320 men. We calculated the age-adjusted relative risks and PAF of CTS in relation to industrial sectors and occupational categories. RESULTS: The PAF for women was higher in lower-grade, white-collar workers (24%, 95% CI 19-29) than blue-collar workers (19%, 95% CI 15-22). The PAF was higher for the service industries sector (16%, 95% CI 8-22) than manufacturing (10%, 95% CI 7-13) or agricultural (5%, 95% CI 3-7) sectors. The PAF was high for men in blue-collar workers (50%, 95% CI 41-57) and in the construction (13%, 95% CI 9-18) and manufacturing industries (17%, 95% CI 10-23). CONCLUSION: The study suggested that 5-50% of CTS cases might be avoided in the whole population if totally effective intervention programs were implemented in specific occupational categories or industrial sectors.

[Carpal tunnel syndrome: diagnosis, treatment, prevention and its relevance to dentistry]. / Diagnostiek en behandeling van het carpaletunnelsyndroom.

Nocturnal pins and needles and other sensory disturbances in the median nerve innervated fingers are caused by local pressure on this nerve in the carpal tunnel. Carpal tunnel syndrome is the most frequently encountered peripheral nerve entrapment. In The Netherlands, the prevalence of carpal tunnel syndrome is estimated 9% among adult women and 0.6% among adult men. Several risk factors have been identified. For dental professionals, the most relevant seem forceful use of the hand during scaling and extractions, use of vibrating ultrasonic equipment and frequent working with the wrist in flexion or in extension. The diagnosis of carpal tunnel syndrome is based on the characteristic complaints, confirmed preferably by abnormal electrophysiological tests. Depending on the degree of impact on daily functioning, treatment for carpal tunnel syndrome may be expectative, conservative or surgical. Adjustment of the working conditions may prevent the development of a carpal tunnel syndrome.