Occurrence Of Musculoskeletal Symptoms Research Articles

Productivity Loss and Musculoskeletal Symptoms in Brazilian Presenteeism: A Cross-sectional Study

Background: The work has been brought to nursing professionals, denoting an increase in illness and consequent decrease in productivity. Objective: This study aims to verify the relationship between productivity and the presence of musculoskeletal symptoms in presenteeism. Methods: This is a cross-sectional and analytical study conducted with 305 Nursing workers from an emergency hospital in the Brazilian Midwest region. For data collection, four self-applied instruments were used, namely: the Sociodemographic Work and Health Conditions Questionnaire (QSCTS), the Stanford Presenteeism Scale (SPS-6), the Work Limitations Questionnaire (WLQ), and the Brazilian version of the Nordic Musculoskeletal Questionnaire (NMQ), Nordic Musculoskeletal Symptom Questionnaire (QNSO). The “presenteeism” and “presenteeism degree” dependent variables were related to the independent variables using the logistic regression model. Results: Presenteeism was identified in 134 (43.8%) workers. Overall productivity loss was 8.8%. Regarding the relationship between presenteeism and the occurrence of musculoskeletal symptoms, workers with problems in the upper back, knees, and neck in the last year were 6.5, 2.7, and 2.2 more likely to be presenteeism, respectively. Conclusion: The study confirmed the relationship between greater productivity losses and the incidence of musculoskeletal symptoms with presenteeism events in the Nursing team.

The influence of working/learning remotely on the prevalence of musculoskeletal complaints in a group of university staff and students

The COVID-19 pandemic has led to a fundamental change in the lifestyle and the ways of learning and working patterns which in turn might lead to health consequences including musculoskeletal disorders. The aim of this study was to evaluate the conditions of e-learning and remote working and the impact of the learning/working modality on the occurrence of musculoskeletal symptoms among university students and workers in Poland. This study covered 914 students and 451 employees who filled in an anonymous online questionnaire. The questions covered 2 periods: before the COVID-19 pandemic and during the period from October 2020 to June 2021 and were aimed at obtaining information about lifestyle (including physical activity, perceived stress and sleep pattern), ergonomic of computer workstations, the incidence and severity of musculoskeletal symptoms and headaches. During the outbreak, the severity of musculoskeletal complaints increased significantly in the teaching staff group (3.2±2.5 vs. 4.1±3.0 VAS pts), in the administrative staff group (3.1±2.5 vs. 4.0±3.1 VAS pts), and in the student group (2.8±2.4 vs. 3.5±2.8 VAS pts). The average level of burden and risk of musculoskeletal complaints was revealed by the assessment using the ROSA method, in all 3 study groups. In light of current results, it is very important to educate people on the rational use of new technology devices, including the appropriate design of computer workstations, planning breaks and time for recovery and physical activity. Med Pr. 2023;74(1):63-78.

Ergonomics of E-Learning Workstations and the Prevalence of Musculoskeletal Disorders-Study among University Students.

The prevalence of musculoskeletal disorders (MSD) has increased significantly in recent years. The COVID-19 pandemic has led to a fundamental change in the lifestyles, ways of learning and working patterns of the general population, which in turn, might lead to health consequences. The aim of this study was to evaluate the conditions of e-learning and the impact of the learning modality on the occurrence of musculoskeletal symptoms among university students in Poland. This cross-sectional study included 914 students who completed an anonymous questionnaire. The questions covered two time periods (before and during the COVID-19 pandemic) and were aimed at obtaining information about lifestyle (including physical activity using the modified International Physical Activity Questionnaire, 2007 (IPAQ), perceived stress and sleep patterns), the ergonomics of computer workstations (by Rapid Office Strain Assessment, 2012 (ROSA) method), the incidence and severity of musculoskeletal symptoms (by the Nordic Musculoskeletal Questionnaire, 2018 (NMQ)) and headaches. The main differences between the two periods were statistically significant according to the Wilcoxon test in terms of physical activity, computer use time, and severity of headaches. During the COVID-19 pandemic, there was a significant increase in MSD (68.2% vs. 74.6%) and their intensity (2.83 ± 2.36 vs. 3.50 ± 2.79 points) among the student population (p < 0.001). In the group of students with MSD, there was a high musculoskeletal load, due to the lack of ergonomic remote learning workstations. In future, a thorough study should be carried out, and there is an urgent need to raise students' awareness of arranging learning workstations according to ergonomic principles in order to prevent the occurrence of musculoskeletal problems.

Influence of Job Insecurity on Musculoskeletal Disorders: A Mediation Model with Nursing Aides.

Work-related musculoskeletal disorders are some of the most prevalent diseases in the world. They have a multifactorial aetiology encompassing ergonomic and psychosocial risk factors. The aim of this study is to analyse the way job insecurity and physical workload are linked to musculoskeletal disorders, as well as the mediating role other psychosocial work risks can have on this potential relationship. A parallel mediation path regression analysis was designed using a sample of 457 nursing aides. The influence job insecurity and physical workload has on the onset of musculoskeletal symptoms together with the variables which mediate this relationship were examined. The results prove that both independent variables explain the onset of musculoskeletal symptoms in these professionals. The influence exerted by job insecurity is mediated by the social support received at work and the demands of the job. However, when analysing the physical workload, the social support received at work is not relevant as a mediator in this relationship. Job insecurity and physical workload are significant variables on the occurrence of musculoskeletal symptoms. The data obtained supports the need to focus on physical and psychosocial factors in order to prevent these disorders.

Development and validation of a tool for the comprehensive risk assessment of musculoskeletal disorders (CRAMUD) among employees of a steel industry

This study aimed to develop and validate a tool for the comprehensive risk assessment of musculoskeletal disorders (CRAMUD). In this cross-sectional study, 300 male workers participated. Data related to personal, psychosocial and physical items and musculoskeletal symptoms were gathered by a designed questionnaire and Cornell musculoskeletal discomfort questionnaire (CMDQ), respectively. Then, the effect coefficients of the items were computed for developing the CRAMUD equation. The total score of the CRAMUD tool was classified by receiver operator curves (ROCs), and it was validated by linear regression analysis. The values of the content validity ratio (CVR), content validity index (CVI) and Cronbach’s coefficient alpha (α) of the CRAMUD questionnaire with 38 items were calculated as 0.773, 0.934 and 0.940, respectively. The personal, psychosocial and physical items with the coefficients of 0.265, 0.175 and 0.478 had significant effects on the occurrence of musculoskeletal symptoms, respectively. The equation of the novel tool was written by these coefficients. The CRAMUD score was grouped into four levels by optimal cut-off points of 8.51, 11.03 and 15.31. This tool could predict 75% of variations of musculoskeletal symptoms. This tool can be exploited to accurately estimate the risk level of musculoskeletal symptoms in various jobs.

Occupational stress and musculoskeletal symptoms in a Tunisian footwear industry

IntroductionA growing body of literature has documented that occupational stress is associated with increased risks of musculoskeletal injuries or symptoms.ObjectivesThe purpose of this study was to assess the effect of occupational stress on the occurrence of musculoskeletal symptoms among workers in a Tunisian footwear industry.MethodsMaterial and methods: This was an exhaustive and cross-sectional study including workers in a footwear industry. Musculoskeletal symptoms were assessed using a modified Nordic questionnaire. We used the Job Demand/Control model of Karasek to measure occupational stress. The Quick Exposure Check (QEC) method was used as an ergonomic risk assessment tool. Data were analysed using R software.ResultsA total of 337 workers participated in the survey (the age range: 18-60 years). A total of 83.7 of workers reported musculoskeletal symptoms at one site or more. Elbows and upper back were the most symptomatic sites in respectively 84% and 65%. We noted job-strain and iso-strain situations in respectively 57% and 32%. In 78.1% of the workers studied, the QEC score was high and very high in 21.9%. Multivariable-adjusted logistic regression model showed that iso-strain situation was associated with the number of symptomatic sites (p= 0.0003, OR=1.34), having musculoskeletal symptoms in elbows (p= 0.03, OR=2.33) and upper back (p=0.009, OR=2.40), and the final QEC score (p= 0.018, OR= 1.04).ConclusionsOccupational stress constitutes a significant risk for this leather industry. It is associated with a higher prevalence of musculoskeletal symptoms in the workplace and with work-related biomechanical exposure.DisclosureNo significant relationships.

Low Occurrence of Musculoskeletal Symptoms in Swimming? Musculoskeletal Symptoms and Sports Participation in Adolescents: Cross Sectional Study (ABCD-Growth Study).

The purpose of this paper was to identify the association between the occurrence of musculoskeletal symptoms (MS) and sports participation in adolescents. The sample included 193 adolescents (11 to 17 years of age; 131 boys and 62 girls). For this cross-sectional study, participants were categorized into four groups: “no-sports”, “repetitive non-impact sports”, “high-impact sports”, and “odd-impact sports”. A questionnaire was used, which defined MS as pain or any musculoskeletal complaint that led to restriction of current normal activities. In the entire sample, 112 adolescents reported at least one episode of MS during the recording, representing 58% of the sample. Our findings highlight that adolescents regularly engaged in odd-impact sports, such as martial arts, report a higher occurrence of MS than swimmers and adolescents who do not participate in any physical activity.

Prevalence of Musculoskeletal Diseases of the Upper Extremity Among Dental Professionals in Germany

ObjectiveAlthough many findings on occupational musculoskeletal complaints are available from American and European dentists, the corresponding data from Germany are still scarce. Therefore, the aim of this study was to provide additional information on the prevalence of and risk factors for musculoskeletal disorders of the upper extremity, particularly the shoulder in this specific population.MethodsA written survey was carried out among 600 dentists in the state of North Rhine-Westphalia, Germany. Questionnaire items included physical and psychosocial workload, general health, and the occurrence of musculoskeletal symptoms during the previous 12 months that led to sick leave and medical care according to a modified version of the Nordic Musculoskeletal Questionnaire (NMQ). Regression analysis was used to evaluate relevant risk factors for severe musculoskeletal disorders.ResultsA total of 229 dentists were participated in the study (response rate 38%). Overall, 92.6% of the participants had already suffered from musculoskeletal symptoms in at least one body region. Symptoms were mostly reported in the neck (65.1%) and in the shoulder (58.1%). Limitations in daily activities were experienced by 15.9% due to neck pain and by 15.4% due to shoulder pain. Medical care was sought by 23.7% because of neck pain and by 21.1% due to shoulder pain. Risk factors for symptoms in the upper extremity regions were gender (female), increased physical load, and numerous comorbidities.ConclusionThere is a high prevalence of musculoskeletal disorders among dentists. Suitable interventions are therefore needed to prevent musculoskeletal diseases and pain among dental professionals, with particular attention to female dentists.

Socio-Demography, Working Conditions, and Musculoskeletal Ailments among Pineapple Farmers in Northeast India

ABSTRACT This study was conducted to examine the socio-demography, working conditions, and consequential musculoskeletal ailments of pineapple farmers in northeast India. A total of 152 pineapple farmers (92 males and 60 females) participated in the study. Data were collected using a pre-tested structured schedule and a standard Nordic questionnaire through personal interviews followed by direct observation. Chi-square (χ2) analysis and multiple logistic regression were conducted using SPSS software 16.0 to explore the association of various independent factors and their influences on the musculoskeletal symptoms (MSS) scores. The study revealed that a majority (>85%) of the pineapple farmers in northeast India had low to medium annual income, with more than 95% of the farmers belonging to small and marginal categories. Moreover, MSS were highly prevalent among the farmers (79.61%), and the low-back (76.32%) was the most affected body part. The results of the Chi-square (χ2) analysis highlighted that age, education level, and farming experience were significantly associated (p < 0.05) with the prevalence of overall MSS among the pineapple farmers. Among the factors, only age and gender significantly influenced the risk of complaints for the farmers’ neck (OR = 6.62, 95% CI: 1.29–34.02, p ≤ 0.05) and low back (OR = 2.54, 95% CI: 1.00–6.47, p ≤ 0.05). This study’s findings demonstrated the need for the urgent exploration of sustainable and innovative interventions to reduce the occurrence of MSS and improve the working conditions of the pineapple farmers in northeast India.

Evaluation of physical and environmental working conditions of underground coal mines within the framework of ergonomics

This study evaluated the physical and environmental working conditions of underground coal mines and the occurrence of musculoskeletal symptoms (MSS). The data from 236 miners were collected and analysed by using the chi-squared test, Fisher's exact test, and the Mann-Whitney U test. Results showed that mine design was inappropriate (e.g., lack of appropriate tools and inadequate working conditions, etc.). Miners had to deal with excessive job demands (e.g., inappropriate work pace, high manual material handling (MMH), and repetitive tasks). Most miners (85.5%) experienced pain/discomfort in at least five body regions. Low back (82.6%), upper back (80.9%), shoulder (77.5%), knee (67.8%), and ankle/foot (62.3%) complaints were the most frequently reported symptoms. The low back symptoms were associated with MMH tasks, shoulder symptoms were associated with poor lighting conditions, and ankle/foot symptoms were associated with inappropriate work pace, inadequate space, pushing/pulling/dragging tasks, and bending/twisting activities. The findings help to understand the working conditions of miners and highlight the need for multifaceted interventions to improve the workstation design and work organisation.

The Occurrence of Musculoskeletal Symptoms during a Long Drive in a Driving Simulator

The Occurrence of Musculoskeletal Symptoms during a Long Drive in a Driving Simulator

Is physical capacity associated with the occurrence of musculoskeletal symptoms among office workers? A cross-sectional study.

Low physical capacity is hypothesized to be associated with the presence of musculoskeletal symptoms. Therefore, our aim was to investigate whether physical capacity is associated with the presence of musculoskeletal symptoms in the neck, shoulders, and thoracic and lumbar spine among office workers. Sixty-seven office workers, recruited at the university, were evaluated regarding the presence of musculoskeletal symptoms through the Nordic Musculoskeletal Questionnaire (NMQ). Measurements of muscle strength and endurance of shoulder abduction, endurance of trunk flexion and extension, and back and leg flexibility were obtained. Data were analysed through a binomial logistic regression model, considering physical capacity as the independent variable and symptoms as the dependent variable. An adjusted model was also applied that controlled for individual and occupational covariates. The basic model showed a significant association between reduced shoulder abduction strength and neck (OR: 0.87; 95% CI 0.78-0.98) and shoulder symptoms (OR: 0.88; 95% CI 0.78-0.99), and between reduced back and leg flexibility and thoracic spine symptoms (OR: 0.92; 95% CI 0.85-0.99). The adjusted model, after controlling for the covariates, demonstrated that reduced shoulder abduction strength (OR: 0.70; 95% CI 0.52-0.94) and reduced back and leg flexibility (OR: 0.81; 95% CI 0.66-0.99) were associated, instead, with the occurrence of neck and low back symptoms, respectively, in the last 12 months. Physical capacity is associated with the presence of neck and low back symptoms in office workers. Furthermore, individual and occupational characteristics affect the relationship between physical capacity and musculoskeletal symptoms and should be considered for understanding and managing musculoskeletal symptoms among office workers.

Musculoskeletal symptoms and quality of life among workers at an intensive care unit in Teresina, Piauí, Brazil.

ABSTRACT |Background: Having more than job and physical exhaustion derived from the job demands considerably overload workers and impair their quality of life (QoL). These factors might interfere with the health of this population of workers reflecting as work-related musculoskeletal disorders.Aim: To investigate the correlation between musculoskeletal symptoms and QoL among workers at the intensive care unit of a public hospital in Teresina, Piauí, Brazil.Methods: Cross-sectional quantitative, observational and analytical study performed with 30 workers at a public hospital ICU. WHOQOL-BREF, the Nordic Musculoskeletal Questionnaire and a sample profile instrument were administered by the investigators during the working hours.Results: 86.7% of the sample reported pain in at least one body side, particularly in the knees in the past 7 seven days (23.3%) and in the lower back in the past 12 months (50%). The participants’ QoL was reasonable. We found significant moderate correlation between pain and WHOQOL domains physical health (p=0.10) and social relationships (p=0.011) but no correlation with the participants general characteristics.Conclusion: Occurrence of musculoskeletal symptoms might interfere with the QoL, social life and performance at work of ICU workers.

Musculoskeletal pain: comparison between administrative and production employees of a poultry farming company.

Work-related musculoskeletal disorders are the most frequently reported group of diseases in Brazil, their occurrence being favored by work in the industrial sector. The present study is justified by the need to investigate more thoroughly the occurrence of musculoskeletal symptoms among poultry farming workers, since this subject is scarcely explored in the Brazilian literature. To analyze the prevalence of musculoskeletal symptoms among production and administrative employees of a poultry farming company, describe the sociodemographic and occupational profile of both groups of workers and test associations between pain and sociodemographic and occupational variables. Cross-sectional correlational study which included sociodemographic and occupational characterization and administration of the Nordic Musculoskeletal Questionnaire and a numeric pain rating scale. The sample comprised 154 production employees and 24 administrative workers. Pain was the single musculoskeletal symptom reported, with prevalence of over 85% in both groups. Female production employees exhibited 2.9 times higher odds of pain compared to the males. The body sites most frequently involved were the neck and upper and lower back among the administrative employees and the shoulders and the upper and lower back among the production workers. Pain was the most prevalent musculoskeletal symptom in the analyzed sample of poultry farming workers. Statistically significant difference was not found between the groups despite their different work processes. Both groups exhibited extremely high rates of illness, which points to the need for more thorough investigation of the causal relationships of musculoskeletal symptoms.

Effect of a posture correction–based intervention on musculoskeletal symptoms and fatigue among control room operators

This study was conducted to examine the effect of a posture correction–based intervention (with a biofeedback device) on the occurrence of musculoskeletal symptoms (MSS) and fatigue among control room operators in a petrochemical plant in Iran. A total of 188 office workers (91 in the case group and 97 in the control group) participated at baseline as well as at 6- and 12-month follow-up. A questionnaire survey (including the Nordic Musculoskeletal Questionnaire and Multidimensional Fatigue Inventory) and direct observations of working postures by using the Rapid Upper Limb Assessment (RULA) method were used. The occurrence of MSS in the shoulders, upper back, neck, and low back areas, as well as the mental and physical dimensions of fatigue were found to be the most common problems. The results showed considerable improvements in working postures (in the neck, trunk, and RULA grand scores) and the occurrence of MSS (particularly in the neck, shoulders, and upper back and low back areas) and fatigue (in particular the mental and physical aspects) after the intervention. The overall mean RULA grand score for the case group was significantly decreased after the intervention (mean scores of 5.1, 4.4, and 4.6 at pre-intervention, post-intervention 1, and post-intervention 2, respectively). A total of 81 operators (89.0%) reported some kind of MSS at baseline, which were reduced to 75 operators (82.4%) and 77 operators (84.6%) at post-interventions 1 and 2, respectively. Significant differences were also found between the pre- and post-intervention scores for the physical fatigue (mean of 12.19, 10.16, and 9.99 at pre-intervention, post-intervention 1, and post-intervention 2, respectively) and mental fatigue (mean of 14.03, 12.05, and 12.16 at pre-intervention, post-intervention 1, and post-intervention 2, respectively) dimensions. The findings confirm the effectiveness of this low-cost, simple, and easy-to-use ergonomic intervention.

Occurrence Of Osteomuscular Symptoms In Teachers Of A Higher Education Institution

The objective of this study was to investigate the occurrence of musculoskeletal symptoms in teachers of a Higher Education Institution (HEI) located in João Pessoa – PB. This is a descriptive research with a quantitative approach, held at the Faculties of Nursing and Medicine (FACENE/FAMENE), in the city of João Pessoa-PB. The instrument for data collection consisted of a form with objective questions and divided into two parts, the first with data characterizing the sample and the second with the Nordic Musculoskeletal Symptoms Questionnaire. The data were analyzed quantitatively in percentage numbers and distributed in graphs. The results indicated that 30 teachers accepted to participate in the study with female predominance (67%). The regions most affected in the last 12 months were: dorsal (60%), lumbar (53%), neck, shoulders, wrists and hands (47%). Of the teachers interviewed, 20% reported having had difficulties in routine activities due to discomfort in the cervical region and 27% reported having sought medical or physiotherapeutic care due to neck pain, while 20% due to pain in the shoulders, dorsal, wrist/hands and hip/thighs. As for the occurrence of symptoms in the last week, the regions with the highest frequency of pain were shoulders (40%), neck and dorsal (27%). The significant percentage in the regions cited certifies that they are the regions most burdened in the professors and, therefore, deserve special attention in possible projects of occupational preventive action. This research evidences the necessity of new approaches and deepening on the subject, including the formulation of intervention strategies in the process of sickness of teachers.&#x0D; Descriptors: Work-Related Musculoskeletal Disorders. University Teachers. Worker's Health.

Associação entre desordens musculoesqueléticas e gastos com cuidado à saúde entre pacientes do Sistema Único de Saúde

Delineamento: transversal. Objetivos: (i) Identificar a ocorrência de desordens musculoesqueléticas, (ii) identificar seus determinantes e (iii) suas relações com gastos com saúde em adultos atendidos pelo Sistema Único de Saúde. Métodos: Estudo transversal com 963 adultos, com 50 anos e de ambos os sexos tratados em unidades básicas de saúde. Participantes responderam questionários sobre doenças, condição econômica, desordens musculoesqueléticas, atividade ocupacional, consultas de fisioterapia e compra de medicamentos; peso e estatura foram mensurados para calcular o índice de massa corporal. Custos com saúde foram computados retroagindo 12 meses. Resultados: A prevalência de desordens musculoesqueléticas foi 65%, sendo maior em pacientes com doenças do tecido conjuntivo (OR=4,11 [2,98-5,67]) e pessoas que levantam cargas no trabalho (OR=1,45 [1,27-1,66]). Além disso, a ocorrência de desordens musculoesqueléticas nos ombros, região lombar, joelhos e tornozelos/pés foram relacionados a maiores gastos com medicamentos e consultas médicas. Conclusão: A ocorrência de desordens musculoesqueléticas foi elevada entre estes pacientes, é afetada por sexo e atividade ocupacional e positivamente relacionada com gastos com saúde.

Association of Parental Awareness of Using Schoolbags With Musculoskeletal Symptoms and Carrying Habits of Schoolchildren

The association between parental awareness of using schoolbags and the occurrence of musculoskeletal symptoms and carrying habits of children was investigated in a cross-sectional study in Tabriz, Iran. Data on 454 students aged 11-14 years and their parents (n = 358) were analyzed. The awareness of the recommended weight limit, appropriate method of carrying schoolbags, and schoolbag strap adjustments was generally low among the respondents. A higher parental awareness of the schoolbag weight was associated with a lower prevalence of upper back and shoulder complaints among children and carrying loads less than 10% of their body weight. The findings suggest that parental awareness should have a more prominent role in changing the schoolbag carrying habits of children and particularly in reducing the weight of loads carried by them. This highlights the need to incorporate guidelines and recommendations into practice to ensure that the health and safety of schoolchildren are not compromised when using schoolbags.

Carpal tunnel syndrome and musculoskeletal symptoms in postmenopausal women with early breast cancer treated with exemestane or tamoxifen after 2–3 years of tamoxifen: a retrospective analysis of the Intergroup Exemestane Study

Aromatase inhibitors are more effective than is tamoxifen in prevention of breast-cancer recurrence, but at the expense of increased musculoskeletal side-effects, such as carpal tunnel syndrome. The aim of this study was to assess risk factors and the prognostic value of musculoskeletal symptoms during treatment with the steroidal aromatase inhibitor exemestane or with tamoxifen after 2-3 years of tamoxifen. In the Intergroup Exemestane Study, postmenopausal women treated for early invasive breast cancer who remained disease free and on treatment after 2-3 years of tamoxifen were randomised to switch to exemestane or to continue tamoxifen for the remainder of the 5-year period of endocrine treatment. The primary endpoint for this retrospective analysis was occurrence of carpal tunnel syndrome and any musculoskeletal events, analysed in the safety population, which consisted of all patients who had received any trial treatment. As well as case-report forms, questionnaires were distributed retrospectively to gain more details of cases of carpal tunnel syndrome. The relation between musculoskeletal symptoms reported by 6 months from randomisation and survival from 9 months onwards was assessed by Cox proportional hazards models. The trial is registered, number ISRCTN11883920. It has completed accrual and follow-up is continuing for enrolled participants. After a median follow-up of 91·0 months (IQR 83·0-99·2), carpal tunnel syndrome had been reported for 66 (2·8%) of 2319 patients in the exemestane group compared with 13 (0·6%) of 2338 in the tamoxifen group (odds ratio [OR] 5·23, 99% CI 2·39-11·49; p<0·0001). More events occurred during treatment in the exemestane group than in the tamoxifen group (66 [2·8%] vs seven [0·3%], adjusted OR 9·90, 99% CI 3·52-27·82; p<0·0001). There was no significant difference between groups in events in the post-treatment period (ten with exemestane [0·4%] vs seven with tamoxifen [0·3%]; p=0·46). More patients in the exemestane group (1082 of 2319 patients, 46·7%) had musculoskeletal symptoms than in the tamoxifen group (901 of 2338, 38·5%; OR 1·48, 99% CI 1·32-1·67, p<0·0001). More events occurred during treatment in the exemestane group than in the tamoxifen group (984 [42·4%] vs 776 [33·2%], adjusted OR 1·59, 99% CI 1·32-1·91; p<0·0001), with this difference persisting to some extent in the post-treatment period (449 [19·4%] vs 390 [16·7%]; p=0·017). Of 73 on-treatment cases of carpal tunnel syndrome, 58 (79·5%) completed questionnaires were available. 27 patients (46·6%) had bilateral carpal tunnel syndrome and 31 (53·4%) had unilateral disease; 40 (69·0%) underwent surgical release. The disorder greatly affected daily-life activities in 21 (36·2%) cases. Occurrence of musculoskeletal symptoms, including carpal tunnel syndrome, was associated with improved disease-free survival in unadjusted analysis (p=0·023), but not with overall survival (p=0·36). However, after adjustment for possible confounding factors, musculoskeletal symptoms were not associated with disease-free survival (hazard ratio [HR] 0·96, 95% CI 0·82-1·14, p=0·67) or overall survival (HR 1·02, 95% CI 0·84-1·25, p=0·82). Occurrence of carpal tunnel syndrome is higher in patients with breast cancer given exemestane than in those treated with tamoxifen, and surgical release might be necessary in most cases. Development of musculoskeletal symptoms in the first 6 months of treatment is not an independent biomarker of improved disease outcome. Further investigation is warranted into the relation between treatment-emergent musculoskeletal symptoms and clinical outcome in patients with breast cancer receiving hormonal therapy. Pfizer.

Joint hypermobility syndrome pain

Joint hypermobility syndrome (JHS) was initially defined as the occurrence of musculoskeletal symptoms in the presence of joint laxity and hypermobility in otherwise healthy individuals. It is now perceived as a commonly overlooked, underdiagnosed, multifaceted, and multisystemic heritable disorder of connective tissue (HDCT), which shares many of the phenotypic features of other HDCTs such as Marfan syndrome and Ehlers-Danlos syndrome. Whereas the additional flexibility can confer benefits in terms of mobility and agility, adverse effects of tissue laxity and fragility can give rise to clinical consequences that resonate far beyond the confines of the musculoskeletal system. There is hardly a clinical specialty to be found that is not touched in one way or another by JHS. Over the past decade, it has become evident that of all the complications that may arise in JHS, chronic pain is arguably the most menacing and difficult to treat.