Upper-extremity Musculoskeletal Symptoms Research Articles

Neck and Upper Extremity Musculoskeletal Symptoms Secondary to Maladaptive Postures Caused by Cell Phones and Backpacks in School-Aged Children and Adolescents.

Technology is an essential part of our lives. Nowadays, it is almost impossible to leave the house without a cell phone. Despite the wide range of benefits of cell phones and handheld electronic devices, this evolution of technology has not come without a price. The pandemic of cell phone use among children and young adolescents has led to the emergence of a set of musculoskeletal (MSK) symptoms that have not been seen before in this age group. These symptoms can range from neck and shoulder discomfort to pain, peripheral neurological symptoms of the upper extremity, and long-term complications such as disk prolapse and degenerative disk disease of the cervical spine. This clinical presentation is known as "text neck syndrome." In addition to MSK symptoms, text neck syndrome could also include eye and ear symptoms, psychological problems, peripheral neurological symptoms, and poor academic performance. Multiple mechanisms have been discussed by which cell phone use causes MSK symptoms. Maladaptive postures, a decrease in physical activity leading to obesity, and the direct effect of electromagnetic radiation are some of the mechanisms by which long-term use of cell phones leads to the clinical presentation of text neck syndrome and its long-term consequences. The purpose of this article is to review the literature, discuss the epidemiology of cell phone use and MSK symptoms associated with its use in children and adolescents, describe its clinical presentation, explain the pathophysiology behind it, and provide preventative guidelines that can be used by this age group to allow for the continued use of these electronics without harmful effects on their posture and long-term health.

Upper extremity musculoskeletal symptoms among Iranian hand-woven shoe workers.

Studies have demonstrated that upper extremity musculoskeletal disorders (UEMSDs) are highly prevalent among weavers. In Iran, little information is available regarding the prevalence of MSDs and their causal risk factors among hand-woven shoe workers. This cross-sectional study aimed to determine the prevalence of UEMSDs and to identify risk factors associated with UEMSDs symptoms among 586 Iranian hand-woven shoe workers. The data were collected using the Nordic Musculoskeletal Questionnaire and by direct observation of working postures via the Rapid Upper Limb Assessment (RULA) technique to determine ergonomic risks. The prevalence of MSDs symptoms was high among the hand-woven shoe workers. The mean RULA grand score of 6.3 indicated that in most cases the workers' postures at their workstations needs to be investigated and changed immediately to prevent musculoskeletal injuries. The highest prevalence rates of MSDs were observed in the shoulders, wrists and arms. The result of multiple logistic regression modeling showed that risk factors associated with UEMSD symptoms were job experience, daily working hours, job satisfaction, working posture, work pressure, and discomfort at workstation, as well as individual factors, such as age, gender, BMI, material status, working conditions, education level, and lack of regular sport/physical activities. The findings of the present study emphasize that any interventional program in this industry has to focus on improving working conditions particularly by designing ergonomics-oriented workstations and hand tools.

Prevalence of Upper Extremity Musculoskeletal Symptoms in Computer Users

Prevalence of Upper Extremity Musculoskeletal Symptoms in Computer Users

Psychometric Evaluation of the Workstyle Short Form among Nursing Assistants with Work-Related Musculoskeletal Symptoms.

The Workstyle Short Form (24 items) (WSF-24) has been tested for its psychometric properties on work-related upper-extremity musculoskeletal symptoms (WRUEMSs) among office workers. However, the impact of workstyle should not only be limited to WRUEMSs and the sedentary workforce. The purpose of this study was to test the psychometric properties of the modified 24-item Chinese WSF (C-WSF-24) to identify work-related musculoskeletal symptoms (WRMSs) in various body parts among nursing assistants (NAs) working in nursing homes. Four hundred and thirty-nine NAs participated in the study. The results of the factor analysis were that a four-factor solution (working through pain, social reactivity at work, demands at work and breaks) accounted for 56.45% of the total variance. Furthermore, validation against known groups showed that the total score and subscale scores of the C-WSF-24 had the ability to discriminate between NAs with and without WRMSs in various body parts (such as low back and lower extremities). Additionally, C-WSF-24 had a statistically significant association with the contributing factors to WRMSs. This is the first study to examine the psychometric properties of the C-WSF-24 in the non-sedentary workforce, with a focus on various body parts of WRMSs. The results demonstrated that C-WSF-24 is reliable and valid for assessing WRMSs in various body parts among NAs.

ACCUMULATIVE REPETITIVE STRAIN INJURY AMONG BUSINESS PROCESS OUTSOURCING EMPLOYEES: A SURVEY STUDY

Objective: Computer overuse syndrome or repetitive strain injury is the most common problem among the people in all age groups. Several studies have found the adverse effect of using computers for a long duration. In the modern tech-savvy world, usage of computers is something unavoidable. The objective of this survey study is to find out the accumulative repetitive strain injury among the business process outsourcing employees.Methods: This study was conducted in different business process outsourcings in Noida, and a convenient sampling method was used to collect data through Neck Pain Disability Index (NPDI) and disabilities of the arm, shoulder and hand (DASH) questionnaire. The study comprised of total 230 subjects.Results: The mean and standard deviation (SD) of NPDI score was found to be 32.12 and 11.26, respectively, whereas the mean and SD for DASH score was 24.34 and 7.44, respectively. The Chi-square value for NPDI and DASH was found to be 263.043 and 139.461. The study shows that upper extremity pain is a common problem in employees working in the IT sector. The employees showed high rates of computer use–associated with upper extremity musculoskeletal symptoms and symptom-related functional limitation.Conclusion: The findings of the study suggest a need to begin to evaluate interventions and to reduce the risks of developing computer overuse syndrome such as developing upper extremity symptoms, disability, and disorders among employees working in the IT sector who use computers for more than 40 hrs/week. Intervention to reduce symptoms should include effective training in work rest patterns, good-working postures coupled with availability of appropriate equipment.

Prevelans of Upper Extremity Musculoskeletal Complaints and Its Relationship with Risk Factors for Bank Employees Working with Computer

Aim: To determine the frequency and risk factors of upper extremity musculoskeletal complaints (UE-WMSCs) of the bank employees working with computer. Method: This cross-sectional observational study was conducted among 221 bank employees between July and September 2013 in Aydin, Turkey. For data collection socio-demographic characteristics and working environment form, evaluation of upper extremity musculoskeletal symptoms with visual analogue scale (VAS) form, MSC (Musculoskeletal complaints) preventive behaviors and Karasek job strain scale was used. Results: The rate of existence of a symptom anywhere in upper body area is 61.1%, and the average VAS pain intensity is 1.8±2.8. The most common complaint is reported in the left neck (66.5%) and left shoulder (28.5%) areas. The least existence of symptoms is found out in left elbow region (13.1%). Average scale points for psycho-social elements of workload, control over the work and social support are determined as 72.3±19.4, 69.1±19.6 and 74.7±19.8 respectively. The average score for work stress is determined to be 1.0±0.26 (0.61-2.0). There has been found out a close relationship between the risk for musculoskeletal complaints on one hand and age, the number of children, working time and work control on the other hand. Conclusion: Neck and shoulders are most affected areas in the bodies of bank employees working with a computer. It is found out that socio-demographic characteristics, working conditions, and work control are closely connected with UE-WMSC.

Responsiveness of a 1-Year Recall Modified DASH Work Module in Active Workers with Upper Extremity Musculoskeletal Symptoms.

To evaluate the responsiveness to change of a modified version of the Work module of the Disabilities of the Arm, Shoulder, and Hand (DASH-W) in a prospective, longitudinal cohort study of active workers. We compared change on a 1-year recall modified DASH-W to change on work ability, work productivity, and symptom severity, according to predetermined hypotheses following the Consensus-based standards for the selection of health measurement instruments (COSMIN). We evaluated concordance in the direction of change, and magnitude of change using Spearman rank correlations, effect sizes (ES), standardized response means (SRM), and area under the receiver operating characteristic curves (AUC). In a sample of 551 workers, change in 1-year recall modified DASH-W scores showed moderate correlations with changes in work ability, work productivity, and symptom severity (r = 0.47, 0.44, and 0.36, respectively). ES and SRM were moderate for 1-year recall modified DASH-W scores in workers whose work ability (ES = -0.58, SRM = -0.52) and work productivity improved (ES = -0.59, SRM = -0.56), and larger for workers whose work ability (ES = 1.24, SRM = 0.68) and work productivity worsened (ES = 1.02, SRM = 0.61). ES and SRM were small for 1-year recall modified DASH-W scores of workers whose symptom severity improved (-0.32 and -0.29, respectively). Responsiveness of the 1-year recall modified DASH-W was moderate for those whose symptom severity worsened (ES = 0.77, SRM = 0.50). AUC met responsiveness criteria for work ability and work productivity. The 1-year recall modified DASH-W is responsive to changes in work ability and work productivity in active workers with upper extremity symptoms.

0356 Transitions between upper extremity musculoskeletal symptoms and work limitation outcomes: a prospective study

ObjectivesSelection of appropriate outcome measures in studies of work-related musculoskeletal disorders (MSDs) directly affects the observed exposure-response relationship. Considering that many different factors might affect different stages of disease severity,...

Natural history of upper extremity musculoskeletal symptoms and resulting work limitations over 3 years in a newly hired working population.

To describe the proportions of workers with upper extremity (UE) symptoms and work limitations because of symptoms in a newly hired working population over a 3-year study period and to describe transitions between various outcome states. A total of 827 subjects completed repeat self-reported questionnaires including demographics, medical and work history, symptoms, and work status. Outcomes of interest were UE symptoms and work limitations because of symptoms. Up to 72% of workers reported symptoms at least once during the study, with 12% reporting persistent symptoms and 27% reporting fluctuating symptoms; 31% reported work limitations at least once, with 3% reporting consistent work limitations and 8% reporting fluctuating limitations. UE symptoms and work limitations are common among workers and dynamic in their course. A better understanding of the natural course of symptoms is necessary for targeted interventions.

Weak Grip Strength Does not Predict Upper Extremity Musculoskeletal Symptoms or Injuries Among New Workers

Grip strength is often tested during post-offer pre-placement screening for workers in hand-intensive jobs. The purpose of this study was to evaluate the association between grip strength and upper extremity symptoms, work disability, and upper extremity musculoskeletal disorders (UE MSDs) in a group of workers newly employed in both high and low hand intensive work. 1,107 recently-hired workers completed physical examinations including grip strength measurements. Repeated surveys obtained over 3 years described the presence of upper extremity symptoms, report of physician-diagnosed musculoskeletal disorders (MSDs), and job titles. Baseline measured grip values were used in analytic models as continuous and categorized values to predict upper extremity symptoms, work disability, or UE MSD diagnosis. Twenty-six percent of males and 20 % of females had low baseline hand strength compared to normative data. Multivariate logistic regression analyses showed no consistent associations between grip strength and three health outcomes (UE symptoms, work disability, and MSDs) in this young cohort (mean age 30 years). Past MSD and work type were significant predictors of these outcomes. Physical hand strength testing was not useful for identifying workers at risk for developing UE MSDs, and may be an inappropriate measure for post-offer job screens.

A Prospective Study of Musculoskeletal Outcomes Among Manufacturing Workers

To better characterize associations between physical risk factors and upper-extremity musculoskeletal symptoms and disorders, a prospective epidemiologic study of 386 manufacturing workers was performed. Methodological limitations of previous studies have resulted in inconsistent associations. An individual, task-based exposure assessment strategy was used to assess upper-extremity exertion intensity, repetition, and time-in-posture categories. Participants recorded time spent performing daily work tasks on a preprinted log, which was then used to calculate time-weighted-average exposures across each week of follow-up. In addition, a weekly Strain Index (SI) risk category was assigned to each participant. Incident musculoskeletal symptoms and disorders were assessed weekly. Proportional hazards analyses were used to examine associations between exposure measures and incident hand/arm and neck/shoulder symptoms and disorders. Incident symptoms and disorders were common (incident hand/arm symptoms = 58/100 person-years (PY), incident hand/arm disorders = 19/100 PY, incident neck/shoulder symptoms = 54/100 PY, incident neck/shoulder disorders = 14/100 PY). Few associations between separate estimates of physical exposure and hand/arm and neck/shoulder outcomes were observed. However, associations were observed between dichotomized SI risk category and incident hand/arm symptoms (hazard ratio [HR] = 1.73, 95% confidence interval [CI] = [0.99, 3.04]) and disorders (HR = 1.93,95% CI = [0.85,4.40]). Evidence of associations between physical risk factors and musculoskeletal outcome was strongest when exposure was estimated with the SI, in comparison to other metrics of exposure. The results of this study provide evidence that physical exposures in the workplace contribute to musculoskeletal disorder incidence. Musculoskeletal disorder prevention efforts should include mitigation of these occupational risk factors.

A Prospective Study of Musculoskeletal Outcomes Among Manufacturing Workers

The aim of this study was to characterize associations between psychosocial and work organizational risk factors and upper-extremity musculoskeletal symptoms and disorders. Methodological limitations of previous studies of psychosocial and work organizational risk factors and musculoskeletal outcomes have produced inconsistent associations. In this prospective epidemiologic study of 386 workers, questionnaires to assess decision latitude ("control") and psychological job demands ("demand") were administered to study participants and were used to classify them into job strain "quadrants". Measures of job stress and job change were collected during each week of follow-up. Incident hand/arm and neck/shoulder symptoms and disorders were ascertained weekly. Associations between exposure measures and musculoskeletal outcomes were estimated with proportional hazard methods. When compared to the low-demand/high-control job strain referent category, large increases in risk of hand/arm disorders were observed for both high-demand/high-control (hazard ratio [HR] = 4.49, 95% confidence interval [CI] = [1.23, 16.4]) and high-demand/low-control job strain categories (HR = 5.18,95% CI = [1.39, 19.4]). Similar associations were observed for hand/arm symptoms. A strong association was also observed between the low-demand/low-control job strain category and neck/shoulder disorders (HR = 6.46, 95% CI = [1.46, 28.6]). Statistically significant associations were also observed between weekly stress level and weekly job change and several musculoskeletal outcomes. Associations between psychosocial risk factors and work organizational factors and musculoskeletal outcomes were large and in the hypothesized direction. Prevention of occupational musculoskeletal disorders may require attention to psychosocial and work organizational factors in addition to physical factors. Methods to control adverse effects of psychosocial and work organizational risk factors should be explored.

Effects of ergonomic intervention on work-related upper extremity musculoskeletal disorders among computer workers: a randomized controlled trial

The aim of the study was to determine effects of ergonomic intervention on work-related upper extremity musculoskeletal disorders (WUEMSDs) among computer workers. Four hundred computer workers answered a questionnaire on work-related upper extremity musculoskeletal symptoms (WUEMSS). Ninety-four subjects with WUEMSS using computers at least 3 h a day participated in a prospective, randomized controlled 6-month intervention. Body posture and workstation layouts were assessed by the Ergonomic Questionnaire. We used the Visual Analogue Scale to assess the intensity of WUEMSS. The Upper Extremity Function Scale was used to evaluate functional limitations at the neck and upper extremities. Health-related quality of life was assessed with the Short Form-36. After baseline assessment, those in the intervention group participated in a multicomponent ergonomic intervention program including a comprehensive ergonomic training consisting of two interactive sessions, an ergonomic training brochure, and workplace visits with workstation adjustments. Follow-up assessment was conducted after 6 months. In the intervention group, body posture (p < 0.001) and workstation layout (p = 0.002) improved over 6 months; furthermore, intensity (p < 0.001), duration (p < 0.001), and frequency (p = 0.009) of WUEMSS decreased significantly in the intervention group compared with the control group. Additionally, the functional status (p = 0.001), and physical (p < 0.001), and mental (p = 0.035) health-related quality of life improved significantly compared with the controls. There was no improvement of work day loss due to WUEMSS (p > 0.05). Ergonomic intervention programs may be effective in reducing ergonomic risk factors among computer workers and consequently in the secondary prevention of WUEMSDs.

Evaluation of objectivity, reliability and criterion validity of the Key Indicator Method for Manual Handling Operations (KIM-MHO), draft 2007

Upper extremity musculoskeletal symptoms and disorders are common in the working population. The economic and social impact of such disorders is considerable. Long-time, dynamic repetitive exposure of the hand-arm system during manual handling operations (MHO) alone or in combination with static and postural effort are recognised as causes of musculoskeletal symptoms and disorders. The assessment of these manual work tasks is crucial to estimate health risks of exposed employees. For these work tasks, a new method for the assessment of the working conditions was developed and a validation study was performed. The results suggest satisfying criterion validity and moderate objectivity of the KIM-MHO draft 2007. The method was modified and evaluated again. It is planned to release a new version of KIM-MHO in spring 2012.

A validation study comparing two self-reported upper extremity symptom surveys with clinical examinations for upper extremity musculoskeletal disorders

Evaluate the validity of two self-report symptoms surveys with two disorder classification protocols. 100 graduate students at a private school in the Southwest United States. Study participants completed two self-report upper extremity musculoskeletal symptoms surveys: a nine item 10 cm Visual Analogue Scale (VAS) and a nine item Likert categorical scale anchored from "None" to "Very severe". Clinical examinations were administered using two musculoskeletal disorder classification protocols. For the nine body regions, concordance between the two self-report symptoms scales ranged from 0.49-0.75. Overall there was greater than 80% agreement for the two disorder classification protocols. Using either symptom survey with either disorder classification protocol provided high sensitivities and specificities (Youden's J ≥ 0.70). Three of possible six symptom survey/classification protocol pairings provided high sensitivities and specificities across all disorder groups. In this graduate student sample, none of the self-report symptom survey-classification protocol pairings was demonstratively more useful than any other pairing for studies of musculoskeletal disorders among computer users.

Musculoskeletal disorders among female carpet weavers in Iran

The aim of this study was to determine factors associated with self-reported upper extremity musculoskeletal disorders (UEMSDs) among female carpet weavers. Data on demographic characteristics and workplace factors were collected from 626 female carpet weavers. Type of carpet weaving looms, weaving style (Persian vs. Turkish), daily working hours and work experience as well as personal factors including age and marital status were significantly and independently associated with self-reported UEMSDs (p < 0.05), while education, handedness and weight of weaving comb were not. A major finding of this study was the significant association between weaving style and UEMSDs. Better measures of the biomechanical requirements of carpet weaving tasks in Persian and Turkish weaving types are required to understand better their influences on the health of weavers and on UEMSDs in particular. Poor workstation design, in particular, design inappropriate for the anthropometric dimensions of weavers, was a major risk factor for musculoskeletal symptoms in carpet weaving. Therefore, this industry should develop equipment adapted to women's sizes and shapes. Practitioner Summary: This article provides an insight into the risk factors associated with self-reported UEMSDs among female carpet weavers, identifying major factors associated with upper extremity musculoskeletal symptoms and exploring guidelines for designing weaving workstations.

Research Letters

Upper extremity musculoskeletal symptoms (UEMSs) lead workplace injuries nationwide,1 incur the longest absence among service sector workplace injuries (28 days median, exceeding fractures and amputations),2,3 and can foster multiple spells of lost work time, so that work loss per episode underestimates the impact of UEMSs (by approximately 32% at 5 years).4 Numerous studies link computer use to UEMSs.3,5–8 However, to our knowledge, whether such symptoms affect physicians practicing at facilities using integrated electronic medical records (EMRs) has not been assessed. We evaluated the prevalence of UEMSs attributed to computer workstation use in 2 medical facilities with different EMR systems.

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.

Systematic Review of the Role of Occupational Health and Safety Interventions in the Prevention of Upper Extremity Musculoskeletal Symptoms, Signs, Disorders, Injuries, Claims and Lost Time

Little is known about the most effective occupational health and safety (OHS) interventions to reduce upper extremity musculoskeletal disorders (MSDs) and injuries. A systematic review used a best evidence synthesis approach to address the question: "do occupational health and safety interventions have an effect on upper extremity musculoskeletal symptoms, signs, disorders, injuries, claims and lost time?" The search identified 36 studies of sufficient methodological quality to be included in data extraction and evidence synthesis. Overall, a mixed level of evidence was found for OHS interventions. Levels of evidence for interventions associated with positive effects were: Moderate evidence for arm supports; and Limited evidence for ergonomics training plus workstation adjustments, new chair and rest breaks. Levels of evidence for interventions associated with "no effect" were: Strong evidence for workstation adjustment alone; Moderate evidence for biofeedback training and job stress management training; and Limited evidence for cognitive behavioral training. No interventions were associated with "negative effects". It is difficult to make strong evidenced-based recommendations about what practitioners should do to prevent or manage upper extremity MSDs. There is a paucity of high quality OHS interventions evaluating upper extremity MSDs and none focused on traumatic injury outcomes or workplace mandated pre-placement screening exams. We recommend that worksites not engage in OHS activities that include only workstation adjustments. However, when combined with ergonomics training, there is limited evidence that workstation adjustments are beneficial. A practice to consider is using arm supports to reduce upper extremity MSDs.