Upper-extremity Symptoms Research Articles

Abstract P2-11-13: The Effect of Positive Axillary Lymph Nodes on Symptoms, Physical Impairments, and Function

Abstract Purpose/Objective(s): The role of axillary lymph node (ALN) sampling in breast cancer (BC) treatment continues to evolve, and BC patients are recommended for post-operative regional nodal radiation therapy (RNRT) based on the number of positive ALN. RNRT is recommended for patients with 4 or more positive ALN, but it remains controversial in patients with 1–3 positive ALN and is rarely recommended for patients without positive ALN. Consideration of anticipated functional impairments often guides decision making. The purpose of this analysis is to investigate functional impairments in BC patients with varying numbers of positive ALN. Materials/Methods: 166 women were diagnosed with BC between 2001–05 and enrolled and treated in a prospective surveillance physical therapy program. 110 had zero positive ALN, 37 had 1–3 positive ALN, and 19 had 4 or more positive ALN on either sentinel LN biopsy or ALN dissection. Participants' upper extremity (UE) range of motion, strength, and limb volume were assessed pre-operatively and at 1, 3, 6, 9, and 12+ months post-operatively by a physical therapist. Limb volume was assessed using infrared optoelectronic perometry. At 12+ months, overall health status, UE symptoms and function, and physical activity levels were reported using standardized questionnaires. Chi-square tests and one-way ANOVA analyses were used to determine significance between groups (p ≤ 0.05). Results: Of these 166 patients, 94 received mastectomy and 72 received lumpectomy, while 41 received RNRT and 58 received whole breast tangent RT. No significant differences were found between groups with regard to age or race. The number of dissected LN was not significantly different between those patients with 1–3 positive ALN and 4 or more positive ALN. Rates of lymphedema and seroma were not significantly different between those patients with zero positive ALN and 1–3 positive ALN, and rates of cording were not significantly different between any of the groups. Increased lymphedema (p = 0.03) and seroma (p = 0.005) were seen in those patients with 4 or more positive ALN compared to those patients with zero positive ALN, but this may also be related to a significantly greater number of dissected LN in the former group. By 12+ months post-operatively, there were no differences in shoulder abduction, shoulder flexion, internal rotation, or external rotation between groups. No differences were seen between groups in self-reported fatigue, UE swelling or weakness, arm stiffness, or ability to climb stairs. Conclusions: Functional impairments represent an important category of morbidity for BC survivors and should be considered in pre-treatment decision making. The number of positive ALN may not correlate with increased impairment over the first year of treatment when a prospective surveillance physical therapy program is part of the plan of care. Additional research is needed to assess longer-term changes and the impact of axillary surgery and/or radiation in the context of aggregate effects of other BC treatment modalities. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-11-13.

Abstract P2-11-14: Symptoms, Physical Impairments, and Function in Breast Cancer Patients with Negative Axillary Lymph Nodes

Abstract Purpose/Objective(s): Breast cancer (BC) patients are recommended for post-operative regional nodal radiation therapy (RNRT) based on the number of positive axillary lymph nodes (LN). While RNRT is recommended for patients with 4 or more positive LN, it remains controversial in patients with 1–3 positive LN. For these patients, consideration of anticipated functional impairments often guides decision making, but these considerations are confounded by the inseparable effects of disease in and treatment of the axilla. The purpose of this analysis is to investigate the effect of various therapies on functional impairments in BC patients without axillary disease. Materials/Methods: 166 women were diagnosed with BC between 2001–05 and enrolled and treated in a prospective surveillance physical therapy program. 110 had zero positive axillary LN on either sentinel LN biopsy or axillary LN dissection and were analyzed for this report. Participants' upper extremity (UE) range of motion, strength, and limb volume were assessed pre-operatively and at 1, 3, 6, 9, and 12+ months post-operatively by a physical therapist. Limb volume was assessed using infrared optoelectronic perometry. At 12+ months, overall health status, UE symptoms and function, and physical activity levels were reported using standardized questionnaires. Chi-square tests and one-way ANOVA analyses were used to determine significance between groups (p ≤ 0.05). Results: Of these 110 patients, 34 received mastectomy without RT, 21 received mastectomy with RNRT, 10 received lumpectomy alone, and 45 received lumpectomy with whole breast tangent RT. No significant differences were found between groups with regard to stage, ER/PR status, and number of dissected LN. Rates of lymphedema, cording, and seroma were not significantly different between groups. By 12+ months post-operatively, there were no differences in shoulder abduction, shoulder flexion, internal rotation, or external rotation between groups. No differences were seen between groups in self-reported fatigue, UE swelling or weakness, arm stiffness, or ability to climb stairs. Conclusions: Functional impairments represent an important category of morbidity for BC survivors and should be considered in pre-treatment decision making. In patients without axillary disease, post-operative RNRT or whole breast tangent RT may not contribute significantly to impairment over the first year of treatment when a prospective surveillance physical therapy program is part of the plan of care. Additional research is needed to assess longer-term changes and the impact of radiation in the context of the aggregate effect of disease burden combined with other BC treatment modalities. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-11-14.

A Review of Thoracic Outlet Syndrome and the Possible Role of Botulinum Toxin in the Treatment of This Syndrome

The objective of this paper is to discuss the classification, diagnosis, pathophysiology and management of Thoracic outlet syndrome (TOS). Thoracic outlet syndrome (TOS) is a complex entity that is characterized by different neurovascular signs and symptoms involving the upper limb. TOS is defined as upper extremity symptoms due to compression of the neurovascular bundle in the area of the neck just above the first rib. Compression is thought to occur at one or more of the three anatomical compartments: the interscalene triangle, the costoclavicular space and the retropectoralis minor spaces. The clinical presentation can include both neurogenic and vascular symptoms. TOS can be difficult to diagnose because there is no standardized objective test that can be used and the clinician must rely on history and several positive findings on physical exam. The medial antebrachial cutaneous nerve conduction may be a sensitive way to detect pathology in the lower trunks of the brachial plexus which is promising for future research. Treatment options continue to be conservative and surgical. However, for those who have failed physical therapy there is research to suggest that botulinum toxin may help with symptom relief. However, given that there has been conflicting evidence, further research is required using randomized controlled trials.

치과위생사의 직무스트레스와 상지 근골격계 증상의 관련성

치과위생사의 직무스트레스와 상지 근골격계 증상의 관련성

Outcome of giant cell arteritis of the arm arteries managed with medical treatment alone: cross-sectional follow-up study

To assess the long-term outcome of GCA of the arm arteries under medical treatment alone. Retrospective cross-sectional study of 34 patients with a diagnosis of GCA involving the arm arteries (i.e. subclavian, axillary and/or brachial arteries). All patients were managed with immunosuppressive treatment and antiplatelet agents and followed clinically and with colour duplex sonography. Characteristics of patients with and without relief of ischaemic upper extremity symptoms during follow-up were compared using Fisher's exact test and the Mann-Whitney U-test. Sixteen of 34 patients (47.1%) suffered from arm claudication at the time of diagnosis (bilateral symptoms in 8 patients). During a mean follow-up of 21.9 (17.1) months, none of the patients developed new ischaemic symptoms of the upper extremities, and five patients became asymptomatic. Critical limb ischaemia did not occur. Symptom relief was significantly less frequent in patients with symptomatic ischaemia of the right arm vs the left arm and was negatively associated with the presence of anaemia and subclavian artery involvement (all P < 0.05). In 32.4% of patients, the vasculitic wall thickening, as depicted by colour duplex sonography, completely disappeared. With medical treatment alone, the prognosis of GCA of the arm arteries is benign. Patients with unilateral left-sided ischaemic symptoms may have a higher probability of complete symptom relief than patients with right-sided or bilateral arm claudication.

Endovascular Management of Aortic Arch Vessel Occlusion

A 56-year-old female presented with pain in her bilateral upper extremities. Angiogram demonstrated occlusion of her left subclavian and innominate arteries (IAs). The patient's left subclavian occlusion was successfully treated with percutaneous mechanical thrombectomy, angioplasty, and stenting. One month later, endovascular revascularization of the IA was performed. Initially the lesion could not be directly transversed from neither an antegrade nor a retrograde approach. Wires were passed from the brachial and femoral arteries into the right common carotid artery where the femoral wire was snared and brought out through the right brachial access. Over this through-and-through wire access, angioplasty and stenting of the IA was performed with an excellent angiographic result. In follow-up, the patient remained free of upper extremity symptoms. Occlusive lesions of the aortic arch vessels can be successfully managed with antegrade and retrograde endovascular techniques.

Perceived exertion, comfort and working technique in professional computer users and associations with the incidence of neck and upper extremity symptoms

BackgroundThe aim of this study was to investigate whether perceived exertion, perceived comfort and working technique is associated with the incidence of neck and upper extremity symptoms among professional computer users.MethodsAt baseline a self-administered questionnaire was distributed to 853 participants from 46 different work sites (382 men and 471 women) who, at baseline, had been free from neck and upper extremity symptoms during the preceding month. Work-related exposures, individual factors, and symptoms from the neck and upper extremities were assessed. Observations of working technique were performed by ergonomists using an ergonomic checklist. Incidence data were collected by means of 10 monthly questionnaires, asking for information on the occurrence of neck, shoulder and arm/hand symptoms. Perceived exertion was rated on a modified Borg RPE scale ranging from 0 (very, very light) to 14 (very, very strenuous). Perceived comfort was rated on a 9-point scale ranging from -4 (very, very poor) to +4 (very, very good) in relation to the chair, computer screen, keyboard, and computer mouse.ResultsThe median follow up time was 10.3 months. The incidence of symptoms from the neck, shoulders and arm/hands were 50, 24 and 34 cases per 100 person years, respectively.Higher perceived exertion in the neck, shoulder or arm/hands was associated with an increased risk of developing symptoms in the corresponding body region. Moreover, a dose-response relationship between the level of exertion and the risk of developing symptoms was recorded for all three regions. There was an association between low comfort and an increased risk for neck symptoms, but not for shoulder and arm/hand symptoms, although a trend towards such an association (not statistically significant) could be seen. Working technique was, in this study, not associated with the risk of developing symptoms in any of the investigated body regions.ConclusionThere was a strong association between high perceived exertion and the development of neck, shoulder, and arm/hand symptoms. Moreover, there was an association between poor perceived comfort and neck pain. Surveillance of computer users may include perceived exertion and comfort to target individuals at risk for neck and upper extremity symptoms.

Endovascular Stenting vs. Extrathoracic Surgical Bypass for Symptomatic Subclavian Steal Syndrome

To analyze the immediate and long-term outcomes of endovascular stenting vs. extrathoracic surgical bypass for subclavian steal syndrome. From 1989 to 2010, 252 consecutive patients (173 men; mean age 62 years) with vertebrobasilar and upper extremity symptoms of subclavian steal were treated with balloon-expandable stents (n=148) or extrathoracic surgical bypasses (n=104: 71 axilloaxillary and 33 carotid-subclavian) using polytetrafluoroethylene grafts. The technical success rate was 97.3% in the stent group vs. 99.0% for the bypass group (p=0.605). There was no perioperative mortality or any permanent neurological deficit in either group. The overall perioperative complication rate was 6.1% in the stent group vs. 9.6% in the bypass group (p=0.295). The 10-year target vessel revascularization rate was 46.6% for stenting vs. 5.8% for bypass (p<0.001). The cumulative primary patency rates at 1, 3, 5, and 10 years were 91%, 78%, 67%, and 49% for the stent group vs. 99%, 97%, 95%, and 89% for the bypass group (p<0.001). The cumulative secondary patency rates were 95%, 91%, 86%, and 64%, respectively, for the stent group vs. 99%, 99%, 98%, and 94% for the bypass group (p=0.001). No difference was detected in overall survival curves between the groups (p=0.527). Both endovascular stenting and extrathoracic surgical bypass are safe and effective treatments for subclavian steal syndrome in the short and medium term; however, extrathoracic surgical bypasses are more durable in the long term.

Clinical reasoning for a patient with neck and upper extremity symptoms: A case requiring referral

The purpose of this case report is to describe a 56-year old female patient with a bizarre pattern of cervicobrachial symptoms. The patient was managed according to the McKenzie "Mechanical Diagnosis and Therapy" principles and the physical examination alongside the movement testing showed inconsistent findings. Due to the patient's cancer-related medical history, presence of night pain, general weakness and the non-response to treatment, a referral to a medical specialist was immediately made. Imaging studies revealed metastases to the axial skeleton in multiple sites and a metastatic lesion was established as a medical diagnosis. With many physical therapists becoming first-entry providers it is likely that encounters with cases other than the purely musculoskeletal will increase. Serious pathologies can mimic musculoskeletal disorders, confusing even the most experienced therapist and as a result, pernicious and possibly life-threatening disease might easily be missed. This would be crucial especially in cases when the patient should immediately be referred to a medical specialist. Physical therapists should hone their clinical skills not only in treatment aspects but also in screening procedures in order to prompt a referral when it is required.

The Relationship of Physical and Psychosocial Risk Factors to Work-related Musculoskeletal Upper Extremity Symptoms amongst Male Automobile Manufacturing Workers

Objectives: The objective of this study was to determine the relationship of physical and psychosocial risk factors to work-related musculoskeletal upper extremity symptoms amongst automobile manufacturing workers. Methods: The cross-sectional study was conducted using male automobile manufacturing workers in order to examine the relationship of physical and psychosocial risk factors to work-related musculoskeletal upper extremity symptoms. A total of 1,793 male workers were asked to complete a self-administered questionnaire. The questionnaire consisted of questions regarding general characteristics, health related behaviors, work-related characteristics, job stress, ergonomic risk factors, and the presence of musculoskeletal symptoms (neck, shoulder, arm, and hand). Work-related musculoskeletal symptoms were evaluated using the National Institute of Occupational Safety and Health (NIOSH) surveillance criteria. In order to measure the physical risk factors, the American National Standard Institute (ANSI) Z-365 Quick checklist was incorporated into the questionnaire. Job stressors were measured using the Korean Occupational Stress Scale (KOSS). A binary logistic regression analysis was performed that examined the relationship of physical and psychosocial risk factors to musculoskeletal symptoms. Results: The result showed that the physical and psychosocial risk factors were associated with musculoskeletal upper extremity symptoms. The workers with high physical risk factors reported more musculoskeletal symptoms than those having low physical risk factors (OR: 2.37, 95% CI: 1.56~3.62). The workers with high job stress were more likely to have an increased risk of musculoskeletal upper extremity symptom compared to those with normal job stress (OR: 2.65, 95% CI: 2.03~3.47). A significant relationship between the combined effects of physical and psychosocial risk factors on musculoskeletal upper extremity symptoms was also found. The workers exposed to high physical risk factors, high job stress, and long working hours were more likely to report musculoskeletal symptoms than those having low physical risk factors, normal job stress and moderate working hours(OR: 2.37, 95% CI: 1.56~3.62). Conclusions: The results suggest that some physical and psychosocial risk factors increase the risk of work-related musculoskeletal upper extremity symptoms amongst automobile manufacturing workers. In order to prevent or reduce musculoskeletal disorders amongst automobile manufacturing workers, it is strongly recommended to manage the physical psychosocial risks occurring in the workplace.

PD02-03: The Effect of Breast Conservation Therapy vs Mastectomy on Symptoms, Physical Impairments, and Function.

Abstract Background: Early-stage breast cancer (BC) patients choose between breast conservation therapy (BCT) and mastectomy based on comparable recurrence rates and overall survival. In the absence of mortality benefit, consideration of anticipated functional impairments could guide decision making. Although BCT offers less extensive surgery, the administration of radiation therapy (RT) may adversely impact upper extremity (UE) function. The purpose of this analysis is to investigate the effect of BCT vs modified radical mastectomy (MRM) without RT on functional impairments among BC survivors. Materials and Methods: 196 women diagnosed with BC between 200105 were enrolled and treated in a prospective surveillance physical therapy program. 115 received either BCT, including lumpectomy and whole breast RT, or MRM without RT and were analyzed for this report. Participants’ UE range of motion (ROM), strength, and limb volume were assessed pre-operatively and at 1, 3, 6, 9, and 12+ months post-operatively by a physical therapist. Limb volume was assessed using infrared optoelectronic perometry. At 12+ months, overall health status, UE symptoms and function, and physical activity levels were reported using standardized questionnaires. Analysis of variance estimated differences in impairments and self-reported symptoms and function. One-way ANOVA analysis was used to determine significance between groups (p ≤ 0.05). Results: 65 women (57.5%) received BCT and 50 women (42.5%) received MRM. No significant differences in age, BMI, stage, ER/PR status, and number of dissected lymph nodes were found between groups. At 1 month post-operatively, shoulder internal rotation (p=0.03), abduction (p=0.01), and flexion (p=0.004) were worse in post-MRM patients, with a trend towards worse external rotation (p=0.06). A higher rate of axillary cording was seen in patients post-MRM (p=0.02). By 12+ months post-operatively, there were no differences in any of the shoulder ROM variables. BCT patients reported, however, greater weakness (p=0.03) and diminished ability to perform heavy household tasks (p=0.03). There was no significant difference between BCT vs. MRM in rates of early lymphedema (40% vs 38%) or seroma (14% vs 22%). Conclusion: Functional impairments represent an important category of morbidity for BC survivors and should be considered in pre-treatment decision making. Post-operative RT as part of BCT may not contribute significantly to impairment over the first year of treatment. The presence of self-reported weakness and difficulty performing heavy household tasks at 12+ months suggest possible future functional deficits, especially considering the potentially progressive nature of RT-associated tissue changes. Additional research is needed to assess longer-term changes and the impact of RT in the context of aggregate effects of other BC treatment modalities. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr PD02-03.

The relative contribution of work exposure, leisure time exposure, and individual characteristics in the onset of arm–wrist–hand and neck–shoulder symptoms among office workers

To identify the risk factors for the onset of arm-wrist-hand and neck-shoulder symptoms among office workers and to estimate the relative contribution of these risk factors by calculating Population Attributable Fractions (PAFs). A prospective cohort study was conducted among 1951 office workers with a follow-up duration of 2 years. Data on self-reported risk factors were collected at baseline and after 1 year of follow-up. Every 3 months, the occurrence of upper extremity symptoms was assessed using questionnaires. PAFs for individual risk factors were estimated based on Rate ratios (RRs) obtained from Poisson regression using Generalized Estimation Equations. Previous disabling symptoms were identified as the most important risk factor for the onset of arm-wrist-hand and neck-shoulder symptoms. Modifiable risk factors for arm-wrist-hand symptoms with relatively large PAFs were: at least 4 h per day of self-reported computer use at work, high level of overcommitment, and low task variation and for neck-shoulder symptoms: supporting the arms during keyboard use and at least 4 h per day of self-reported mouse use at work. Compared to having 0 or 1 risk factor, the RR for arm-wrist-hand symptoms increased to 6.2 (95% CI 3.7-10.5) for having 5-7 potentially modifiable risk factors and for neck-shoulder symptoms to 3.0 (95% CI 2.1-4.4) for having 4 or 5 potentially modifiable risk factors. Preventive interventions at the population level should be aimed at changing modifiable risk factors with large PAFs. At the individual level, preventive interventions should be aimed at changing multiple modifiable risk factors simultaneously.

Is peak exposure to computer use a risk factor for neck and upper-extremity symptoms?

Epidemiologic studies on physical exposure during computer use have mainly focused on average exposure duration. In this study, we aimed to relate periods of high peak exposure during computer use with the occurrence of neck-shoulder (NS) and arm-wrist-hand (AWH) symptoms. A prospective cohort study among 1951 office workers was carried out for two years, with periodical questionnaires and continuous measurements of computer input use. To define peak exposure, a distinction was made between peak days and weeks. Peak days were defined as days with a long duration of computer (ie, ≥4 hours) or mouse use (ie, ≥2.5 hours) or days with high frequency of mouse (ie, ≥20 clicks per minute) or keyboard use (ie, ≥160 keystrokes per minute). Weeks containing ≥3 peak days were considered peak weeks. Independent variables were numbers of peak days and peak weeks during a 3-month measurement period; dependent variables were self-reported NS and AWH symptoms during the following 3-month measurement period. Valid data were available for 2116 measurements of 774 office workers. No relation was found between any of the peak exposure parameters and AWH symptoms or with peak exposure in duration and NS symptoms. Most parameters referring to high frequency-related peak exposure were associated with less NS symptoms, but the effect estimates were very small and the confidence intervals close to the null. In this study, we found no indication that high peaks in computer use were related to the occurrence of NS or AWH symptoms.

Are peaks in computer use a risk factor for neck and upper extremity symptoms?

ObjectivesEpidemiologic studies on physical exposure during computer use have mainly focused on average exposure duration. In the current study, we aimed to relate periods of high peak exposure during computer...

The effect of workplace intervention on pain and sickness absence caused by upper-extremity musculoskeletal disorders

The aim of this study was to assess the effect of an ergonomic intervention on pain and sickness absence caused by upper-extremity musculoskeletal disorders. In this randomized controlled study, subjects aged 18-60 years (N=177) seeking medical advice due to upper-extremity symptoms were included if their symptoms, or the exacerbation of symptoms, had started <30 days prior to the medical consultation and immediate sick leave was not required. Workplace ergonomic improvements were made in the intervention group. Data on symptoms and sickness absences were gathered during one-year follow-up. Pain intensity, pain interference with work, leisure time, or sleep did not differ between the intervention and control group during the one-year follow-up. During the first three months of follow-up, the percentage of employees with sickness absence due to upper-extremity or other musculoskeletal disorders did not differ between the intervention (N=89) and control (N=84) group, but the total number of sickness absence days in the intervention group was about half of that in the control group (mean 6.2 versus 9.8 days for upper-extremity disorder and 6.0 versus 11.5 days for upper-extremity and other musculoskeletal disorders combined). During 4-12 months of follow-up, the percentage of employees with sickness absence due to upper-extremity disorder (10.1% versus 16.7%, P=0.20) or upper-extremity and other musculoskeletal disorders combined (20.2% versus 32.1%, P=0.07) was lower in the intervention than the control group. Our findings suggest that an early ergonomic intervention reduces sickness absence due to upper-extremity or other musculoskeletal disorders.

Accuracy of In-Office Nerve Conduction Studies for Median Neuropathy: A Meta-Analysis

Carpal tunnel syndrome is the most common focal neuropathy. It is typically diagnosed clinically and confirmed by abnormal median nerve conduction across the wrist (median neuropathy [MN]). In-office nerve conduction testing devices facilitate performance of nerve conduction studies (NCS) and are used by hand surgeons in the evaluation of patients with upper extremity symptoms. The purpose of this meta-analysis was to determine the diagnostic accuracy of this testing method for MN in symptomatic patients. We searched the MEDLINE database for prospective cohort studies that evaluated the diagnostic accuracy of in-office NCS for MN in symptomatic patients with traditional electrodiagnostic laboratories as reference standards. We assessed included studies for quality and heterogeneity in diagnostic performance and determined pooled statistical outcome measures when appropriate. We identified 5 studies with a total of 448 symptomatic hands. The pooled sensitivity and specificity were 0.88 (95% confidence interval [CI], 0.83-0.91) and 0.93 (95% CI, 0.88-0.96), respectively. Specificities exhibited heterogeneity. The diagnostic odds ratios were homogeneous, with a pooled value of 62.0 (95% CI, 30.1-127). This meta-analysis showed that in-office NCS detects MN with clinically relevant accuracy. Performance was similar to interexaminer agreement for MN within a traditional electrodiagnostic laboratory. There was some variation in diagnostic operating characteristics. Therefore, physicians using this technology should interpret test results within a clinical context and with attention to the pretest probability of MN, rather than in absolute terms.

Error in Text in: Electronic Medical Records and Upper Extremity Symptoms: Pain With the Gain

Error in Text in: Electronic Medical Records and Upper Extremity Symptoms: Pain With the Gain

Upper extremity impairments in women with or without lymphedema following breast cancer treatment

IntroductionBreast-cancer-related lymphedema affects ∼25% of breast cancer (BC) survivors and may impact use of the upper limb during activity. The purpose of this study is to compare upper extremity (UE) impairment and activity between women with and without lymphedema after BC treatment.Methods144 women post BC treatment completed demographic, symptom, and Disability of Arm-Shoulder-Hand (DASH) questionnaires. Objective measures included Purdue pegboard, finger-tapper, Semmes-Weinstein monofilaments, vibration perception threshold, strength, range of motion (ROM), and volume.ResultsWomen with lymphedema had more lymph nodes removed (p < .001), more UE symptoms (p < .001), higher BMI (p = .041), and higher DASH scores (greater limitation) (p < .001). For all participants there was less strength (elbow flexion, wrist flexion, grip), less shoulder ROM, and decreased sensation at the medial upper arm (p < .05) in the affected UE. These differences were greater in women with lymphedema, particularly in shoulder abduction ROM (p < .05). Women with lymphedema had bilaterally less elbow flexion strength and shoulder ROM (p < .05). Past diagnosis of lymphedema, grip strength, shoulder abduction ROM, and number of comorbidities contributed to the variance in DASH scores (R 2 of 0.463, p < .001).Implications for cancer survivorsUE impairments are found in women following treatment for BC. Women with lymphedema have greater UE impairment and limitation in activities than women without. Many of these impairments are amenable to prevention measures or treatment, so early detection by health care providers is essential.

Correlates of Upper Extremity Disability in Medical Transcriptionists

To investigate the association between disability and personal/lifestyle, medical, and psychosocial risk factors for upper extremity musculoskeletal symptoms and disorders (UEMSDs) in medical transcriptionists. A web-based survey involving the Disabilities of the Arm, Shoulder and Hand (DASH), Perceived Stress Scale (PSS) and Overall Job Satisfaction (OJS) questionnaires of all medical transcriptionists working at a large healthcare facility. Responses were received from 80% (251 of 314) possible participants. Mean DASH, PSS, and OJS scores for those working at their current position for at least 1 year were 8.5 +/- 10.1, 14.3 +/- 6.7 and 5.3 +/- 0.9. Personal/lifestyle factors including age (P < 0.001), lower educational level (P = 0.014), current or previous smoking (P = 0.012), and limited exercise (P = 0.013); medical conditions including diabetes mellitus (P = 0.015), carpal tunnel syndrome (P < 0.001), prior treatment for upper extremity symptoms (P < 0.001); prior workstation evaluation (P < 0.001) and psychosocial factors of perceived stress (P < 0.001), are associated with increased DASH scores. In these workers, multivariate analysis suggests that medical conditions (finger or other upper extremity symptoms requiring treatment or workstation evaluation; and diabetes mellitus) have a larger effect on the DASH than personal/lifestyle or psychosocial factors (age; previous or current smoking; and perceived stress). Prior upper extremity musculoskeletal symptoms requiring treatment or ergonomic assessment, high perceived stress and a history of smoking are associated with self-reported disability. Diabetics have significantly higher levels of upper extremity disability than non-diabetics. Prospective studies are needed to see if interventions addressing these factors will prevent future work disability.

Risk Factors for Upper Extremity Musculoskeletal Symptoms among Call Center Employees

To investigate the prevalence of musculoskeletal symptoms in the upper extremity (UE) in a sample of Italian call center (CC) operators, and the relationship between the symptoms and potential workplace risk factors. During 2005-2006, 775 workers from seven CCs in the Turin area participated in a questionnaire survey of exposure to ergonomic, organizational and psychosocial factors at work, socio-demographics, lifestyle, symptoms and diseases. Musculoskeletal symptoms were defined as self-reported musculoskeletal symptoms in the UE during the previous 28 days, for which a physician was consulted and/or drugs were taken. Relative risks were estimated through Poisson regression models with the Huber-White sandwich estimator of variance. Overall, 45% of workers reported UE symptoms in the last four weeks. Symptoms in the neck were the most prevalent (39%), followed by the shoulder (22%), hand-wrist (10%) and elbow (4%). Among workplace risk factors, neck-shoulder symptoms were associated with low job control, elevated noise, poor desk lighting and impossibility to lean back while sitting; whereas elbow-hand/wrist symptoms were associated with short intervals between calls, insufficient working space, lack of forearm support, job insecurity and long seniority in the CC industry. The high prevalence of UE symptoms in this sample was similar to that reported by other studies conducted in this industry. Our results confirm previously reported associations, such as poor characteristics of the workstation and psychological stressors. The striking difference between the set of risk factors for neck-shoulder and elbow/wrist-hand symptoms indicates that the two regions should be investigated separately.