Abstract
BackgroundThe character of upper limb disorder in computer operators remains obscure and their treatment and prevention have had limited success. Symptoms tend to be mostly perceived as relating to pathology in muscles, tendons or insertions. However, the conception of a neuropathic disorder would be supported by objective findings reflecting the common complaints of pain, subjective weakness, and numbness/tingling. By examining characteristics in terms of symptoms, signs, and course, this study aimed at forming a hypothesis concerning the nature and consequences of the disorder.MethodsI have studied a consecutive series of 21 heavily exposed and severely handicapped computer-aided designers. Their history was recorded and questionnaire information was collected, encompassing their status 1/2 – 1 1/2 years after the initial clinical contact. The physical examination included an assessment of the following items: Isometric strength in ten upper limb muscles; sensibility in five homonymously innervated territories; and the presence of abnormal tenderness along nerve trunks at 14 locations.ResultsRather uniform physical findings in all patients suggested a brachial plexus neuropathy combined with median and posterior interosseous neuropathy at elbow level. In spite of reduced symptoms at follow-up, the prognosis was serious in terms of work-status and persisting pain.ConclusionsThis small-scale study of a clinical case series suggests the association of symptoms to focal neuropathy with specific locations. The inclusion of a detailed neurological examination would appear to be advantageous with upper limb symptoms in computer operators.
Highlights
The character of upper limb disorder in computer operators remains obscure and their treatment and prevention have had limited success
There is a general consensus that reduced muscle strength, sensory deviations from normal, and localized mechanical allodynia are related to afflicted peripheral nerves [19]
In a recent validation of the physical tests applied we have found that blinded examiners could reliably assess the individual items, as well as the occurrence of findings in patterns in accordance with the course of nerves and the innervated tissue
Summary
The character of upper limb disorder in computer operators remains obscure and their treatment and prevention have had limited success. Symptoms tend to be mostly perceived as relating to pathology in muscles, tendons or insertions. The involvement of the nerves in "non-specific" upper limb disorder, e.g. in computer operators, is suggested by various observations: The demonstration of an elevated threshold to vibratory stimulation [1,2,3]; abnormal upper limb tension tests [4,5]; reduced nerve mobility [6,7]; abnormal nerve tenderness (mechanical allodynia) [8]; changed axonal flare reaction [9]; allodynic response to supra-threshold vibration [2]; reduced muscle strength (page number not for citation purposes). Clinical practice and epidemiological studies tend to attribute upper limb symptoms in computer operators to a disorder in muscle, tendon, or insertion [14]. Focal neuropathy including carpal tunnel syndrome is infrequently reported [15,16]
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