Work-related Upper Limb Disorders Research Articles

Work-related Upper Limb Disorder: A Sonographer's Survival Guide

This article reviews the problem of work-related upper limb disorders (WRULD) and outlines action that sonographers can take to minimize their risk. By preparing for the task, learning from experience and mistakes, and by heeding the warning signs sonographers can implement simple strategies and daily routines that will help prevent and protect them from musculo-skeletal injury. One such strategy is the use of a prevention and recovery exercise routine—an example is provided.

Why are manual workers at high risk of upper limb disorders? The role of physical work factors in a random sample of workers in France (the Pays de la Loire study)

Objective: To investigate the reasons for the excess risk of upper limb musculoskeletal disorders among manual workers compared with other workers in a random sample of 2656 French men and...

Unravelling the mystery of work-related upper limb disorder

Unravelling the mystery of work-related upper limb disorder

Basis for an FCE Methodology for Patients With Work-Related Upper Limb Disorders

A reported reduction in work-related functional capacity in Work-related Upper Limb Disorders (WRULD) patients is among the most common problems in WRULD. The extent to which this reduction in functional capacity can be objectified remains unknown. A validated instrument to test functional capacity in this patient group is unavailable. The objective of this study was to design a Functional Capacity Evaluation (FCE) for WRULD patients working with Visual Display Units (VDU) and provide evidence for content validity. A review to epidemiological literature was conducted to identify physical risk factors for VDU-related WRULD. The results indicate that physical risk factors were related to repetition, duration, working in awkward and static positions and forceful movements of the upper extremity and neck. An FCE was designed based on the risk factors identified. Eight tests were selected to cover all risk factors: the overhead lift, overhead work, repetitive reaching, handgrip strength, finger strength, wrist extension strength, fingertip dexterity, and a hand and forearm dexterity test. Content validity of this FCE was established by providing the rationale, specific objectives and operational definitions of the FCE. Further research is needed to establish reliability and other aspects of validity of the WRULD FCE.

Chronic compartment syndrome, an important cause of work-related upper limb disorder

Work-related upper limb disorders (WRULD) are common and disabling complaints in industry, but a tissue diagnosis can be difficult where the pain is diffuse and variable, and this prevents effective treatment. Diffuse arm pain is frequently found in those doing rapid or strenuous repetitive work, such as factory assembly workers or keyboard operators. Similar symptoms occur in the legs in athletes, where chronic compartment syndrome (CCS) is a recognized entity, so we investigated the possibility that this might also be caused by prolonged repetitive work. Patients were selected if they were unable to continue with work because of chronic forearm pain. They were divided into three groups: 42 patients with symptoms consistent with CCS as defined in the text, 15 volunteers and patients with other arm complaints, and 10 asymptomatic arms of patients with unilateral CCS. We measured the pressure inside the extensor muscle compartment of the forearm at rest and after a 2 min repetitive gripping exercise using an electronic pressure-sensitive probe. The results show that CCS is a common and disabling forearm complaint associated with prolonged repetitive work. Fifteen patients have now had decompressive surgery on the extensor muscle compartment with good relief of symptoms. CCS is responsible for chronic peripheral neurological dysfunction in addition to muscle pain, and awareness of this diagnosis allows early identification and treatment of a currently unrecognized disorder with potential resolution of a long-lasting arm disability.

Use of the ‘Typing Capacity Cycle’ Test as an Assessment Tool for Keyboard Users with Work-Related Upper Limb Disorder

This paper describes a ‘typing capacity cycle’ test (first typing period + recovery time) for keyboard users with Type II Work-Related Upper Limb Disorder. The test was implemented on both control and patient groups on a standardised VDU in a neutral location. The patients’ test results showed that the typing speed and the typing endurance were not directly correlated with the required recovery period. This is a new finding. We therefore suggest that measuring the ‘typing capacity cycle’ represents true work capacity more accurately than recording typing speed in patients with Type II Work Related Upper Limb Disorder. Performance of a small group of Type II WRULD patients following rehabilitation is also reported.

Development of risk filter and risk assessment worksheets for HSE guidance—‘Upper Limb Disorders in the Workplace’ 2002

Upper limb disorders (ULDs) in the workplace represent a significant cause of ill health in Great Britain. As part of the Health and Safety Commission's strategy for the prevention of musculoskeletal disorders (MSDs), the well known guidance document on ULDs—“Work-related Upper Limb Disorders: a Guide to Prevention” (HSG60), (HMSO, London.), has been extensively revised. This revision (Upper limb disorders in the workplace. HSG60 (rev), HSE Books, Sudbury.) includes the development of new risk assessment tools that can be used by employers to identify ULD risk factors in work activities and more importantly to take action to reduce or eliminate ULD risks. The risk assessment tools form part of a seven stage management approach that underpins the new guidance. This paper outlines the development of the risk assessment tools contained in the revised guidance.

Development of risk filter and risk assessment worksheets for HSE guidance??Upper Limb Disorders in the Workplace? 2002

Upper limb disorders (ULDs) in the workplace represent a significant cause of ill health in Great Britain. As part of the Health and Safety Commission's strategy for the prevention of musculoskeletal disorders (MSDs), the well known guidance document on ULDs—“Work-related Upper Limb Disorders: a Guide to Prevention” (HSG60), (HMSO, London.), has been extensively revised. This revision (Upper limb disorders in the workplace. HSG60 (rev), HSE Books, Sudbury.) includes the development of new risk assessment tools that can be used by employers to identify ULD risk factors in work activities and more importantly to take action to reduce or eliminate ULD risks. The risk assessment tools form part of a seven stage management approach that underpins the new guidance. This paper outlines the development of the risk assessment tools contained in the revised guidance.

Perfectionism and coping strategies as risk factors for the development of non-specific work-related upper limb disorders (WRULD).

The incidence of non-specific work-related upper limb disorders (WRULD) is rising throughout western society. Literature and our own WRULD file (>1200 patients) revealed that both physical and psychosocial work-related factors are major causes of non-specific WRULD. It also appeared that non-specific WRULD was more likely to develop in patients with neurotic-perfectionist personalities. To see if, alongside physical and psychosocial work-related factors, personality factors play an important role in developing non-specific WRULD. This was a case-control study with two control groups, comparing 45 computer workers with non-specific WRULD with 45 computer workers free from upper limb disorder (first control group) and 42 chronic pain patients (second control group). Main questionnaires administered were: the Utrecht Coping List (UCL), measuring coping-styles; the Multidimensional Perfectionism Scale (MPS), measuring neurotic perfectionism; and the Symptom Check List (SCL-90), measuring general psychological complaints (psychoneuroticism). The SCL-90 was added because of its known high correlation with neurotic perfectionism. Logistic regression analysis revealed significant differences in SCL-90 scores (chi(2) = 17.2, P < 0.0001), thereby potentially negating the significance of the higher neurotic perfectionism in the non-specific WRULD group. A second control group of chronic pain patients, with prospective high score on the SCL-90, was added. Logistic regression showed that, after controlling for psychoneuroticism, non-specific WRULD patients had more neurotic perfectionist traits (chi(2) = 22.83, P < 0.0001). There were no significant differences in mean UCL scores (P > 0.05). Alongside physical and psychosocial work-related factors, psychoneuroticism and neurotic perfectionism appear to be important risk factors for developing non-specific WRULD.

Rehabilitation of Work-Related Upper Limb Disorders and Ergonomic Workplace Assessment – Can more be done?

The incidence of work-related upper limb disorders remains high. This paper explores current understanding of aetiology and management of these disorders and highlights opportunities for an increased collaborative approach within the health care team which can enhance the contribution of the work of hand therapists.

Investigation of work-related disorders in truck drivers using RULA method

A high incidence of spinal disorders is observed in professional drivers; in particular, back and neck pain result in high rates of morbidity and low retirement age. A sample of 77 drivers , of rubbish-collection vehicles who sit in a standard posture and of road-washing vehicles, who drive with the neck and trunk flexed, bent and twisted, was studied using RULA, a method for the evaluation of the exposure to risk factors associated with work-related upper-limb disorders. Results showed a significant association between trunk and neck scores and all self-reported pains, aches or discomforts in the trunk or neck regions in all subjects. In particular, the neck score was significant in both postures, reflecting high loading of the neck. Significantly different posture scores were also recorded for drivers using an adjustable vs. a non-adjustable seat. In this first RULA study of the working posture of professional truck drivers, the method proved to be a suitable tool for the rapid evaluation of the loading of neck and trunk.

The effects and reality of WRULD (work-related upper limb disorder)

“There is substantial literature denying the existence of non-specific WRULD, largely because of the absence of tissue pathology. In general terms, therefore, if the medical model of injury (damage, followed by repair, healing and, finally, cure) is invoked then non-specific WRULD cannot be identified as a disease” (www.hse.gov.uk). Evidence shows an alarmingly high percentage of sonographers/sonologists worldwide are experiencing, or have experienced at some time, a work-related muskuloskeletal problem. Repetitive overloading of the upper body muscles results in rapid fatigue. The ultimate effect of this persistent abuse is “work- related upper limb disorder” (WRULD). The severity of any injury can range from a simple ache to potential loss of function of the upper limb. Pathological problems range from tendinopathy, spinal and peripheral nerve inflammation, muscle and joint disorders, and vision impairment. Diffuse pain is commonly reported (“non-specific arm pain”) or myofascial pain, which is pain in the muskuloskeletal system without any obvious cause. The impact of WRULD is that simple tasks cannot be performed and that continuing to work becomes increasingly difficult. This limitation and persistent pain can then result in depression. In UK ultrasound, we are not taking pre-emptive action by thorough planning of ergonomics, workload, and most importantly, staff awareness. We wait until it has happened. This presentation is designed to warn that this debilitating problem can affect anyone who scans and to give some advice on how to recover.

Effects of Cued Micro-Breaks on Self-Reported Severity and Recovery of Upper Limb Disorders in Computer Operators

Software programs cueing computer workers to apply regular breaks and physical exercises may help in reducing work-related upper limb disorders. The effects of such a program was investigated among 268 computer workers with upper limb disorders, who were randomised into a control group, a group cued to take extra breaks and a group cued to perform exercises during the extra breaks. A comparison between pre- and post-intervention scores on the severity of the complaints showed no significant differences among the three groups. However, data on the self-reported recovery, obtained after the intervention, showed that, as compared to the controls, more subjects in the experimental groups reported recovery (55% vs. 34%) and less reported deterioration (4% vs. 20%). Hence, people who are cued to take extra breaks, perceive more recovery, although the effect on the severity level of the complaint was not detected. No effect was found of the physical exercises.

Duration of computer use and mouse use in relation to musculoskeletal disorders of neck or upper limb

The objectives of this study were to examine the association between work-related upper limb disorders (WRULDs) and duration of computer and mouse use, to investigate differences in these associations between men and women, and to examine whether a possible relationship between duration of computer use and WRULDs was explained by physical or psychosocial risk factors. The study population in this cross-sectional questionnaire study consisted of 5400 office employees. Participants had filled out a questionnaire on job characteristics, job content, physical workload, psychosocial workload and musculoskeletal symptoms. Working with a computer during more than 6 h/day was associated with WRULDs in all body regions. Stratified analyses showed that the strength of the associations differed between men and women. In men, only moderate associations were seen for computer use more than 6 h/day. In women, moderately increased ORs were observed for a duration of computer use of more than 4 h/day and strongly increased risks for a computer use during more than 6 h/day. Frequent computer users who often used a mouse did not report more WRULDs or neck or shoulder disorders than frequent computer users who did not use a mouse. Only for arm, elbow or wrist or hand problems a moderately increased OR among the mouse users was observed, but this was not statistically significant. Relevance to industry Recent increases in the number of employees working with computers and in the durations of computer and mouse use coincide with a huge prevalence increase of work-related disorders of neck and upper limb (WRULDs) and sick leave, which poses financial burdens on companies. Research on risk factors and preventive measures is relevant for these companies.

Multilevel nerve compression and muscle imbalance in work-related neuromuscular disorders.

Work-related upper limb disorders have come under increasing scrutiny and become a frustrating problem. A unifying hypothesis to explain the multiplicity of symptoms with work related neuromuscular disorders is outlined. This multifactorial problem includes physical, individual, and psychosocial factors. Abnormal postures and positions may compress nerves or may alter muscle length resulting in secondary compressive forces on nerves or in muscle imbalances. Evaluation should identify all nerve compression levels and muscle imbalance in the arm and cervicoscapular region. Management must include patient education, postural correction, and an exercise program to address the multiple nerve compression levels and muscle imbalance. The etiology of work related neuromusculoskeletal disorders is multifactorial and successful management must address all contributing factors. Appropriate conservative management will relieve symptoms in most patients. Surgery should be reserved for those few patients with evidence of a specific diagnosis who have failed conservative management.

Sonographers and Work Related Upper Limb Disorders (WRULD): An Overview of Current Knowledge

Sonographers and Work Related Upper Limb Disorders (WRULD): An Overview of Current Knowledge

DeQuervain's Disease: Clinical Features, Precipitating Factors and Treatment – A Literature Review

DeQuervain's disease is classified as a Work Related Upper Limb Disorder (WRULD) which is frequently treated by therapists in hand and rheumatology units. In order to maximise efficacy of therapy intervention, it is essential that therapists understand relevant anatomy, aetiology, clinical features including the most important criteria used for diagnosis, and treatment strategies. Knowledge of these ensures therapy intervention is focused and designed specifically to meet the individual's need. This paper presents a literature review of deQuervain's disease: anatomy and aetiology are described; clinical features and the important criteria for diagnosis are identified; and treatment is discussed.

A review of current literature on physiological tests and soft tissue biomarkers applicable to work-related upper limb disorders.

Work-related upper limb disorders (WRULD) are among the most commonly reported occupational illnesses. Epidemiological evidence of work-relatedness has been reported for a number of conditions, including carpal tunnel syndrome, hand/wrist tendinitis, shoulder tendinitis and hand-arm vibration syndrome. A range of electrodiagnostic techniques and psychophysical tests has been used to assess neurological dysfunction associated with WRULD, whereas only very few studies have examined biochemical markers of soft tissue injury. This report reviews key literature on physiological tests and biochemical markers of musculoskeletal stress/injury, which are applicable to studies of WRULD. The paper concludes by proposing new ways that testing might be implemented during occupational health surveillance to enable early warning of impending problems and to provide more insight into the underlying nature of soft tissue disorders.

Sensory neural processing in work-related upper limb disorders.

Pain in the upper limb is a common complaint in adults, and is often attributed to or exacerbated by occupational activities. In many patients there is no demonstrable pathology in the neck or arm to account for the symptom, and this has prompted the hypothesis that such cases might arise through abnormal neural processing of sensory information with a lowering of pain thresholds. In this paper we review the evidence in support of this theory and suggest directions for future research.

Do repetitive tasks give rise to musculoskeletal disorders?

Repetitive tasks can undoubtedly cause discomfort and pain, but whether they cause or worsen the pathology causing the pain is most uncertain. Research in this area is difficult as the 'work-related upper limb disorders' do not occur exclusively in workers and because there is no simple, reliable and reproducible test for most 'work-related upper limb disorders'. Furthermore many studies are difficult to interpret as they detect disease by the presence of symptoms: one would expect manual workers to complain of more symptoms than sedentary workers and symptom aggravation does not tell one anything about the causation of the underlying pathology.