Upper-limb Disorders Research Articles

De Quervain's tenosynovitis as an occupational disease in agricultural worker: A case report.

De Quervain's tenosynovitis is upper-limb disorder, more frequent in women. It is rarely recognized as an occupational disease. In this paper we reported work related de Quervain's tenosynovitis in cow milker. Ergonomic risk factors were assessed by utilizing assessment of repetitive tasks (ART) of the upper limbs method. Physical examination and imaging exams were used. We presented a 36-year-old female agricultural worker (workplace cow milker) exposed to work factors (forceful hand/wrist exertions, repetition, extreme postures) for 14 years. She was suffering the pain in the right hand, mainly near the thumb for few years. She was treated conservatively and surgically, however disability was permanent. Clinical examination showed slight edema of the right hand, increased palm's sweating. Patient had reduced range of movements and grip strength. Report shows that work-related factors were strongly associated with diagnosed de Quervain's tenosynovitis. Hand function plays an essential role in carrying out activities of daily living and this disorder pose a relevant burden of disease. Exposure to biomechanical factors should be an important initial target for the prevention of De Quervain's tenosynovitis in the working population.

The Effect of Chronic Dietary Protein Manipulation on Amino Acids' Profile and Position Sense in the Elderly Suffering from Type 2 Diabetes Mellitus.

Dietary protein with adequate essential amino acids effectively stimulates protein synthesis and improves muscle mass. Musculoskeletal disorders in lower or upper limbs are not uncommon among patients with type II diabetes mellitus (T2DM). Therefore, this study primarily examines the effects of chronic dietary protein manipulation on amino acids' profile and position sense in the elderly suffering from T2DM. A total of 26 individuals suffering from non-insulin-dependent T2DM (age > 55 years old) participated in a 12 week nutritional intervention. The subjects were randomly assigned and the control group received 0.8-1.0 g protein/kg/day, while the intervention group received 1.2-1.5 g protein/kg/day. Lean body mass, muscle strength, and position sense were assessed at baseline, as well as at the 6th and 12th week of the intervention. Only in the intervention group, the essential amino acids intake met the current nutritional recommendations (p < 0.05), while, by the 12th week, only the intervention group showed significant improvement in the muscle strength of knee (p < 0.05) and shoulder (p < 0.05) extension. On the contrary, in the control group, a significant decline in appendicular lean mass (p < 0.05) was observed by the 12th week. Position sense at the knee joint revealed a tendency for improvement in the intervention group by the 12th week (main effect of time p = 0.072). In the present investigation, it was revealed that the higher protein intake in the intervention group seemed to have positive effects on muscle strength and nearly positive effects on position sense.

Health risk assessment and prevalence of work-related musculoskeletal disorders among the aged brick molders, in India.

The Brickfield Industry is the major and oldest informal industry in India, where millions of brickfield workers make their livelihood. Aged brickfield workers are also involved in different activities in the brickfield, especially in brick mold activities owing to poor socioeconomic conditions. A cross-sectional study was designed to determine the prevalence of work-related musculoskeletal disorders among the aged brick molders and compare them with aged control subjects. A Nordic Questionnaire was applied to assess the discomfort felt among both groups of workers and the Rapid Upper Limb Assessment (RULA) method was used to evaluate posture during their job. The RULA posture analysis showed that the posture adopted by aged brick molders required changes immediately. The result of the ART tool also stated that the brick molding activities' exposure level was high and required further investigation urgently. The study concluded that due to working in a forward bending posture for a prolonged period, aged brickmolders suffered from severe low back and knee pain along with upper-limb disorders due to repetitive activities.

Work-related upper limb disorders in health workers: a case of de Quervain’s tenosynovitis with ongoing hand pain

Work-related upper limb disorders in health workers: a case of de Quervain’s tenosynovitis with ongoing hand pain

Musculoskeletal disorders, associated factors, and literature review for intervention according to gender.

The relationship of risk factors with musculoskeletal disorders and their intervention is a topic of interest, given their prevalence among workers. Thus, analyzing risk factors from approaches such as the gender perspective may be an alternative. To analyze risk factors in a health entity with a high prevalence of musculoskeletal disorders in upper limbs and to describe possible intervention measures according to scientific evidence, from a gender perspective. This is an analytical study. A questionnaire was applied to 93 workers on demographic aspects, presence of factors related to the environment, the task, and the organization, extra-work activities related to musculoskeletal disorders in the upper limbs. Chi-square was used to identify significant relationships between the sex variable and individual, occupational, and non-occupational factors, corroborated by Fisher's test and prevalence ratio. According to the associations identified, a literature review was carried out to establish possible strategies. Significant relationships were found between the sex variable and task-related factors such as the presence of repetitive or sudden movements (p < 0.05), supporting postulates of labor segregation. According to the literature consulted, the effectiveness of activities such as physical preparation and adaptation of the workplace under professional guidance, training activities, and breaks is discussed. It is important to review organizational factors. By identifying significant relationships between the sex variable and task-related factors, the present study contributes to the postulate of labor segregation, in terms of concentration of female labor in activities with particular working conditions. Regarding literature and actions, it is important to generate more studies from this perspective.

Risk of Upper Limb Diseases in Osteoarthritis Patients: A Propensity-score-matched Cohort Study.

Osteoarthritis (OA) is a prevalent degenerative joint disease that significantly impacts quality of life, particularly when affecting the hands. However, whether patients with OA are associated with higher risk of developing upper limb disorders, specifically trigger finger (TF) and carpal tunnel syndrome (CTS), remains unclear. This study aimed to evaluate the risk of upper limb disease in OA patients. Using the US Collaborative Network, a subset of the TriNetX research network, we identified patients diagnosed with OA and matched them 1:1 with non-OA controls based on propensity scores. Matching covariates included age, sex, race, and comorbidities. The cohort consisted of 1,554,182 patients in each group. The hazard ratio of TF and CTS, as well as related surgical interventions, was assessed over a 5-year follow-up period. Patients with OA had a 1.30-fold increased risk of TF [95% confidence interval (CI)=1.27-1.33] and a 1.50-fold increased risk of CTS (95%CI=1.48-1.53) compared to controls. The hazard ratios for undergoing surgical interventions were 1.61 for TF (95%CI=1.51-1.71) and 1.97 for CTS (95%CI=1.78-2.19). These risks remained significant across various sensitivity analyses and stratifications according to age and sex. OA significantly increases the risk of TF and CTS. These findings highlight the need for vigilant monitoring and management of upper limb disorders in OA patients to improve overall patient care and outcomes. Future research is warranted to focus on pathological mechanisms of OA and their impact on upper limb health to develop targeted interventions.

Development of a Rehabilitation Chair Design Based on a Functional Technology Matrix and Multilevel Evaluation Methods

In order to meet the diversified rehabilitation needs of people, it is necessary to design a product for the active rehabilitation of patients. Existing rehabilitation chairs use intelligent massage, which can cause problems such as large massage areas, inability to massage locally, large chair size, and inability to meet the continuous use of the damaged parts. In this paper, the modular design method and multi-layer evaluation method are used to solve the problems related to rehabilitation chairs. The authors use the questionnaire survey method and the functional technology matrix method to determine the functional requirements of the rehabilitation chair, and then use the multilevel evaluation methods, including the AHP method, entropy weight method, and grey correlation analysis, to optimize the functional solutions of the rehabilitation chair, and finally obtain a chair for the rehabilitation of patients with upper and lower limb disorders. Problems such as the generalization of rehabilitation scope and non-durable use of components were solved, and the purpose of active exercise was achieved. This study verifies that the use of the multilevel decision evaluation method can effectively improve the efficiency of program decision-making and provides a theoretical and practical basis for the design of similar products.

Neck and upper extremity musculoskeletal problems in cosmetologists caused by work-related ergonomic risk factors in Denizli, Turkey.

Work-related musculoskeletal disorders (MSDs) of the neck and upper limbs are a common health problem among cosmetologists. Hairdressing requires bending, twisting, static postures, prolonged standing, repetitive motions, and vigorous movements of the hands and fingers. In order to determine the proper ergonomic measures, identifying the factors and hairdressing jobs that increase the risk of work-related neck and upper limb disorders is needed. The objective of this study was to determine the prevalence of MSDs in the neck and upper extremities of cosmetologists and to investigate the association with ergonomic risk factors and hairdressing work. The cross-sectional study was conducted on cosmetologists in Denizli, Turkey province (n = 504). Data collected through a survey included questions on sociodemographic characteristics, work organization, equipment, and hairdressing work, items on work posture, the Extended Nordic Musculoskeletal Questionnaire, and the Demand-Control-Support Questionnaire. Work posture in hairdressing was assessed using the Rapid Upper Limb Assessment (RULA). The prevalence of MSDs of the neck and upper limbs in the previous twelve months ranged from 7.7-55.8%. There was high, or very high, risk in 56.1% of work postures, and the median RULA score was 5.0 (4.0-6.0). The significant predictors of pain were work experience, gender, marital status, risk perception, awkward posture, psychological demand, and hair coloring. It is necessary to take control measures in hairdressing salons promptly to adopt more suitable working posture and to design workplaces ergonomically.

Frequency of Work-Related Musculoskeletal Disorders of Upper Limb among Dentists of Division Gujranwala

Background: Faulty and poor posture has been a cause of musculoskeletal disorders (MSDs) among dentists. Due to the nature of their work, they are more prone to develop upper limb MSDs in the upper limbs. Objectives: To find out the frequency of work-related musculoskeletal disorders of upper limbs among dentists of division Gujranwala. Methods: It was a cross-sectional study conducted in Gujranwala Division, Pakistan, from April 2022 to July 2022. Convenience sampling technique was used to collect the data. The study included 250 male and female dentists, aged 25-40 years, having working hours &gt; 5 hours and with work experience of at least 1-2 years, both from the public and private sectors of the Gujranwala Division. The work-related musculoskeletal disorders were determined using Nordic Musculoskeletal Questionnaire. The data were analyzed by SPSS version 23. Results: Among the study participants, there were 127(50.8%) females and 123 (49.2%) males. The mean age of the participants was 32.77±6.23 years. Musculoskeletal disorders of the upper limbs were found in 231(92.2%) participants. The most common region involved were; the shoulder in 141 (56.4%), the wrist in 82 (32.2%) followed by the elbow in 8 (3.2%). Among the participants, 141(56.4%) worked in different work slots of 8-10 hours. One hundred and seventy-one participants were habitual of working in a sitting posture. Conclusion: Upper Limb Musculoskeletal disorders are highly prevalent among dentists of the Gujranwala Division with the major regions involved being the shoulder and wrist

Assessment of Pain Treatments in Disorders of Upper Limbs: A Qualitative Study Protocol Based on Patients' Experiences.

Chronic musculoskeletal pain (CMP) is one of the most common symptoms of musculoskeletal disorders. Carpal tunnel syndrome (CTS) and subacromial syndrome (SAS) are the most prevalent musculoskeletal disorders of the upper limbs. By collecting the opinions of patients with CTS and SAS, we aim to identify variables that could be introduced in the follow-up of CMP, and to detect barriers and facilitators of its treatments to improve their acceptance. This qualitative study is being conducted in Lleida, Spain, and explores the experiences and feelings of patients, and their acceptance of the standard of care. It follows the consolidated criteria for reporting qualitative research (COREQ) through focus groups, addressing issues with rigor and representativeness. By collecting patients' opinions, we expect to obtain valuable information to complement the set of variables previously used by health professionals in the follow-up of CMP, and to understand treatment barriers and facilitators.

Validation of the Upper Limb Functional Index on Breast Cancer Survivor

A psychometric validation study of the ULFI-Sp was conducted on 216 voluntary breast cancer survivors. The psychometric properties were as follows: analysis of the factor structure by maximum likelihood extraction (MLE), internal consistency, and construct validity by confirmatory factor analysis (CFA). The factor structure was one-dimensional. ULFI-Sp showed a high internal consistency for the total score (α = 0.916) and the regression score obtained from MLE (α = 0.996). CFA revealed a poor fit, and a new 14-item model (short version) was further tested. The developed short version of the ULFI-SP is preferable to assess upper limb function in Spanish BCS. Given the high prevalence of ULD in this population and the broader versions of ULFI across different languages, this study's results may be transferred to clinical practice and integrated as part of upper limb assessment after breast cancer.

Do Knee Joint Orthoses Affect the Functional Status of Stroke Patients? A Literature Review

Stroke is the leading cause of adult disability in developed countries. As a result of damage to the central nervous system, the patient's independence in performing everyday activities is reduced, which often leads to dependence on the environment. The symptoms of syndromes affect many functions, including: speech, the upper limb, gait, balance and coordination disorders. These disorders lead to a decrease in the patient's quality of life. Many patients require knee braces to learn to walk. In this review article, the most commonly used scales used to assess the functional status of patients after stroke are discussed, with particular attention being paid to gait assessment. We described simple (basic ADL) and instrumental (extended) scales of activities of daily living (instrumental, extended ADL), methods of clinical gait and balance assessment, International Classification of Functioning, Disability and Health, ICF), as well as recommendations of the European Stroke Organisation (ESO, Neurorehabilitation Committee). These guidelines regard methods of evaluating the results of post-stroke rehabilitation for clinical use - Outcome Measures for Clinical Use, in which, among others, the Berg scale and the timed Up &amp; Go test are recommended for the lower limb, the Barthel scale and the Functional Independence Measure for ADL, and the Stroke Impact Scale for the participation column in all 3 ICF domains. In the article, the current state of knowledge is presented regarding the impact of knee braces on the functional status of people after stroke. Mechanical knee and ankle orthoses are called KAFO (Knee Ankle Foot Orthosis). Their main tasks include immobilisation of the knee joint and aid in learning to walk.

Upper Limb Disorders in Catering Workers

The literature reports that catering workers are exposed to various occupational health hazardsé. This study aims to assess a cohort of catering workers in relation to upper limb disorders, thus contributing to the quantification of work-related musculoskeletal disorders in this occupational sector. Here, 500 employees, of which 130 were males and 370 were females, with an overall mean age of 50.7 years and an average length of service of 24.8 years, were examined. All subjects completed a standardized questionnaire: the medical history questionnaire of diseases of the upper limbs and spine proposed in "Health surveillance of workers", third edition, EPC. The obtained data enables the following conclusions to be drawn. Musculoskeletal disorders affect a wide range of catering workers. The most affected anatomical region is the shoulder. These disorders increase with advancing age, specifically shoulder, wrist/hand disorders and daytime and nighttime paresthesias. Employment seniority in the catering sector increases the likelihood of all considered conditions. An increase in weekly workload exclusively affects the shoulder region. This study aims to serve as an impetus for further research that seeks to better analyze musculoskeletal problems in the catering sector.

Factors associated with referral to physiotherapists for adult patients consulting for musculoskeletal disorders in primary care; an ancillary study to ECOGEN

BackgroundMusculoskeletal disorders (MSD) are multifactorial requiring multidisciplinary treatment including physiotherapy. General practitioners (GP) have a central role in managing MSDs and mostly solicit physiotherapists accounting for 76.1% of physiotherapy referrals in France. Patient, physician, and contextual factors, including healthcare accessibility, can influence physiotherapy referral rates.ObjectiveTo identify patient, physician, and contextual factors associated with physiotherapy referral in adult patients with MSDs in general practice.MethodsThis study is based on the 2011/2012 French cross-sectional ECOGEN study. Analyses included working-age patients consulting their GP for any MSD. Physiotherapy referral was assessed initially, then adjusted multilevel logistic model analysis of patient, physician, geographical area-related factors associated with these referrals was performed.ResultsAmong the 2305 patients included, 456 (19.8%) were referred to a physiotherapist. Following multilevel multivariate analyses, physiotherapist referral was more frequent for female patients (OR 1.28; 95% CI [1.03, 1.59]) with spinal (OR 1.47; 95% CI [1.18, 1.83]) and upper limb disorders (OR 1.66; 95% CI [1.20, 2.29]), and less frequent for patients ≥ 50 years (OR 0.69; 95% CI [0.52, 0.91]), living in deprived geographical areas (OR 0.60; 95% CI [0.40, 0.90]). GPs referred to a physiotherapist less frequently if they were ≥ 50 years (OR 0.50; 95% CI [0.39, 0.63]), had a high number of annual consultations, or were practicing in semi-urban area in a multidisciplinary team.ConclusionThis multilevel analysis identifies factors associated with physiotherapy referral for patients with MSDs, including living in deprived geographical areas. This constitutes an original contribution towards addressing healthcare disparities.

A Review on Grip and Pinch Strength Tests

Grip strength measurement data has many applications in health assessment and ergonomic strategies. However, this issue has been neglected by wellness researchers and activists in Iran. Therefore, this study was designed to review the factors affecting grip strength, the protocol and tools necessary for grip strength tests, the validity and reliability of grip strength tests, as well as the databases and forward-looking equations of grip strength. This is a review study. The required information was obtained by searching the International Information Banks of Science Direct, Web of Science, Scopus, Springer, ProQuest, Google Scholar and PubMed (between 1980to2022). Search keywords were "hand strength, grip strength, pinch strength, normative data, dynamometer, regression models, and anthropometric measurements". One hindered and forty relevant articles were found in total 45 of them were reviewed and finally used in this study. In this study, effective demographic and anthropometric factors, measurement instruments, test protocols, validity and reliability of measurement, principles of creating databases of grip strength, and also forward-looking models of these databases were reviewed and results were presented. The measurement of grip strength is performed with the purpose of investigating upper limb disorders, designing hand tools, designing workstations, and determination of the improvement level of different treatments. Demographic characteristics and anthropometric factors, particularly the upper anthropometric dimensions, affected the grip strength. Researchers, ergonomists, therapists, and physicians can benefit from the results of this study

Understanding the Technology Acceptance and Usability of a New Device for Hand Therapy: Qualitative Descriptive Study.

Upper extremity function plays a critical role in completing activities of daily living, employment, and participating in recreational activities. The FEPSim device is a medical device for hand and wrist rehabilitation that can be adjusted according to the patient's requirements in rehabilitation. Furthermore, the FEPSim can be used to assess the patient's strength and range of motion of the forearm, wrist, and hand. At present, the acceptance and usability of the FEPSim have not been tested in a clinical setting, with limited perspectives from rehabilitation-providing clinicians. This study aims to understand the factors related to the acceptance and usability of the FEPSim device. Upper limb disorders are prevalent across populations. The impact of upper limb disorders, both acute and chronic, puts a significant burden on the Canadian health care system. A qualitative descriptive study was conducted that involved face-to-face semistructured interviews with hand therapists from hand therapy services who used the FEPSim device. We used purposive sampling to recruit 10 participants over a period of 14 months. Semistructured interview questions (topic-guided) examined the technology acceptance and usability of the FEPSim device. We found 6 factors to be critical aspects of the acceptance and usability of the FEPSim device. These factors were (1) useful for therapy, (2) effortlessness, (3) environmental conditions, (4) internal encouragement, (5) technological aesthetics, and (6) use. The FEPSim device was widely accepted by the therapists. The use of the FEPSim device is a feasible alternative for supporting hand therapy. ISRCTN Registry ISRCTN13656014; https://www.isrctn.com/ISRCTN13656014.

Quality of life and upper limb disability in Charcot-Marie-Tooth disease: A pilot study.

Charcot-Marie-Tooth (CMT) patients present mainly lower limbs disability, with slowly progressive distal muscle weakness and atrophy, but hands impairment is a relevant problem affecting the quality of life (QoL). The evaluation of the upper limb is of primary importance. Often these patients present subclinical disorders or report difficulties in manipulating objects, with little evidence in the most used outcome measures. We aim to investigate the impact of hand impairment in the perceived QoL of CMT persons and secondly whether the Disability of Arm, Shoulder and Hand (DASH) scale can be useful in assessing upper limb abilities in CMT. We recruited 23 patients with confirmed genetic diagnosis of CMT. We performed a clinical evaluation with Sollerman Hand Function Test (SHFT), Thumb Opposition Test (TOT) and CMT examination score (CMTES). We completed the clinical assessment with DASH scale and the Short form 36 (SF36) questionnaire for a subjective evaluation of upper limb disability and quality of life. All patients also underwent an instrumental evaluation with a hand-held dynamometer measuring hand grip and tripod pinch and a sensor-engineered glove test (SEGT) to evaluate finger opposition movements in a quantitative spatial-temporal way. As expected, we found significant differences between CMT and control group performances in both clinical and instrumental assessment. Concerning QoL, we found that total score of SF36 and the SF36 Physical Composite Score (PCS) correlate with all clinical and instrumental Outcome Measures (OMs), particularly with Tripod pinch strength and TOT, which are considered major determinants of manual dexterity in CMT. DASH scale correlates with most clinical and instrumental OMs. Not surprisingly, we also found a correlation with DASH work, because CMT affects young patients engaged in work activities. However, we found a low correlation with the TOT and the dynamometer suggesting that DASH may not be the best scale for remote monitoring of upper limb disorders in CMT patients. Nevertheless, the results of our study confirm the usefulness of SF36 in recognizing the impact of upper limb disability in these subjects suggesting its use even in the remote monitoring of physical functioning.

Ergonomists’ experiences of executing occupational health surveillance for workers exposed to hand-intensive work: a qualitative exploration

BackgroundIn order to reduce work-related upper limb disorders, the Swedish Work Environment Authority introduced an occupational health surveillance targeting hand-intensive work. A process model, aimed at supporting the employers as well as the occupational health service provider (i.e., ergonomist) in the work process with the occupational health surveillance, was developed. The objective of this qualitative study was to explore ergonomists’ experiences of the execution of occupational health surveillance for hand-intensive work when following the novel process model as well as factors influencing the execution.MethodsSemi-structured individual interviews were conducted with ten ergonomists on one occasion regarding their experience of following the work process. Qualitative content analysis with an inductive approach was used for analyzing the data.ResultsThe ergonomists’ experiences were summarized in one theme “A joint roadmap supporting a participatory process” and two categories “Clear structure provided by the components” and “The process influenced by collaboration and context”. The ergonomists valued being guided by the systematics of the model, which provided structure and clarity in their work. Factors affecting the execution were related to communication deficiencies and uncertainties regarding expectations between different roles and functions (e.g., ergonomists and contact person, lack of information to workers). Additional factors, for instance, companies’ routines and the ergonomist’s intra-organizational support, such as access to IT-resources, could also affect the process.ConclusionsThe findings reveal that this process model facilitates the ergonomists’ work and cooperation with a client company. However, the process model needs to be developed and accompanied by a guideline with information related to the process, including e.g., description of a start-up meeting and of the roles/functions of the involved parties.

Ergonomic Working Design Model in Reducing Fatigue due to Air Traffic Control (ATC) at Kuala Namu Airport, Indonesia

Generally, humans can work properly and achieve optimal results when supported by good environmental conditions. The effect associated with the inconvenience of the working environment can be experienced over a prolonged period. Therefore, this study aims to determine the ergonomic working design model in reducing fatigue due to Air Traffic Control (ATC) at Kuala Namu Airport, Deli Serdang – Medan, Indonesia. This is because it is necessary to consider the physical condition or health conditions of controllers to enable the company to extend its services' life and profitability. Rapid Upper Limb Assessment (RULA) is the research method used to investigate upper limb disorders. RULA was developed as a method to detect posture, which is a risk factor. This method is designed to assess workers and determine the musculoskeletal loads likely to disrupt upper limbs. Under such conditions, the management is advised to develop 'open management' based on political will, which involves operators in every step of the improvement, because they have adequate ideas of the problems at hand. Participation in ergonomics enables employees with their supervisors and managers to apply adequate knowledge in their workplace to enhance working environment conditions.

FarmDay: A Gamified Virtual Reality Neurorehabilitation Application for Upper Limb Based on Activities of Daily Living

Patients with upper limb disorders are limited in their activities of daily living and impose an important healthcare burden due to the repetitive rehabilitation they require. A way to reduce this burden is through home-based therapy using virtual reality solutions, since they are readily available, provide immersion, and enable accurate motion tracking, and custom applications can be developed for them. However, there is lack of guidelines for the design of effective VR rehabilitation applications in the literature, particularly for bimanual training. This work introduces a VR telerehabilitation system that uses off-the-shelf hardware, a real-time remote setup, and a bimanual training application that aims to improve upper extremity motor function. It is made of six activities and was evaluated by five physiotherapists specialised in (2) neuromotor disorders and (3) functional rehabilitation and occupational therapy. A descriptive analysis of the results obtained from the System Usability Scale test of the application and a collection of qualitative assessments of each game have been carried out. The application obtained a mean score of 86.25 (±8.96 SD) in the System Usability Scale, and the experts concluded that it accurately reproduces activities of daily living movements except for wrist and finger movements. They also offer a set of design guidelines.