Carpal Tunnel Syndrome: Clinical Application

Carpal tunnel syndrome (CTS) causes irritation or compression of the median nerve within the carpal tunnel at the wrist. CTS is caused by factors including bony abnormalities, neuropathic conditions, inflammatory conditions, and most commonly, cumulative trauma. The trauma involves excessive repetition, force, bending, vibration, and impact activities performed at home or at work. As a result, the median nerve becomes irritated and intermittent sensory deficits occur initially leading to motor dysfunction with advanced disease. Once CTS is diagnosed, the first line of defense is conservative treatment which may result in operative care if unsuccessful. Modified activity and early postoperative hand therapy is the key to a good prognosis, although no treatment is a reliable cure. CTS is a growing epidemic with increasing treatment cost demands due to the growing use of computers which lead to repetitive motion. Physical therapists must stay current on the causes, diagnosis, treatment, and prevention of CTS to reduce the incidence. The focus of this paper remains on the therapist\u27s role in treating CTS conservatively and postoperatively utilizing various clinical techniques with emphasis on preventing CTS using ergonomics in the workplace

A Comparative Assessment of Ergonomic Risk Factors in University Personnel Using RULA and REBA Aiming to Study the Cause and Effect Relationship

The aim of this research was to conduct an ergonomic assessment of working postures and the design of computer workstations of the employees in Louisiana State University. The purpose of the study was threefold- (1) to determine the major ergonomic issues in university employees while working on computer workstations, (2) to compare the two ergonomic assessment tools (RULA and REBA) to see how similarly or differently they assess the risks present in the same working condition and (3) to develop a model that correlates between working condition, work posture and computer workstation design with their effects on musculoskeletal system. This research was constituted of a comprehensive survey (5 minutes) and a quantitative risk assessment session (20 minutes) conducted over 72 participants and their workstations in the university workplace. Along with the pre-assessment questionnaire; the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) and two ergonomic assessment tools REBA (Rapid Entire Body Assessment) and RULA (Rapid Upper Limb Assessment) were used to quantify the ergonomic risk factors. To evaluate the computer work stations “OSHA Computer Workstations eTool - Evaluation Checklist” was used. The most number of participants (75.71%) reported to suffer from upper and lower back pain. Next to it was shoulder and upper arm (45.71%) and then forearm and wrist (42.85%) discomfort. Average RULA score (5) was more than that of REBA (4) making RULA an assessment tool with better consistency while evaluating activities of upper limb, as working on computer workstation. In 85.48% of cases RULA score was the same or more than that of REBA which indicates the strenuous work of office employees cause a disorder more in the upper limbs than that of the lower limbs. Proportional odds ordinal regression model was used to identify the most significant factors contributing towards the WMSD symptoms which are, (1) inappropriate positioning of computer monitor and exposure to prolonged awkward posture of the (2) trunk or torso, (3) shoulder-upper arm, (4) forearm-elbows and (5) wrist and hand. Three equations were developed for predicting the probabilities of a user having slightly, moderately or very uncomfortable pain when the postural and design factors are given

Uporaba računala na radu i sindrom karpalnog kanala: osvrt na sustavne studije

There are many discussions regarding the impact of computer work, especially computer mouse use, in the development of carpal tunnel syndrome (CTS). The mechanism of such damage could be pressure or stretching of the median nerve in the carpal canal area. There is evidence that repetitive motion along with the use of force is a factor that contributes to the development of CTS, but computer work consists of mostly repetitive movements, without the use of force. Studies show that the prevalence of CTS in computer workers is similar to its prevalence in the general population. The general aim of this paper is to perform a literature search on the topic of whether there is a causal link between computer work and the development of CTS. The first specific goal is to try to quantitatively determine a relationship between exposure time and the development of symptoms, and the second specific goal is to try to set criteria, or guidelines, for the recognition of CTS as an occupational disease for those working on computers. A literature search on the databases ProQuest, PubMed, Google Scholar, and Cochrane Library. The key words used were: carpal tunnel syndrome AND computer work OR computer exposure OR keyboard use OR mouse use AND systematic review OR prospective cohort. The last search was performed on March 15, 2021. A total of 12 studies were included in this paper. The results were contradictory. Nine studies state that computer work does not pose an increased risk of CTS development. Two studies found that longer-term mouse use of more than 20 hours per week and keyboard use of more than 240,500,000 strokes per year may be associated with the development of CTS. One study showed people have a lower risk of developing CTSwhen working on a computer. We cannot determine with certainty the connection between computer work and the development of carpal tunnel syndrome. This calls into question the recognition of CTS as an occupational disease among those working on computers. Better planning and structured studies are needed to determine the intensity and duration of computer exposure and the level of damage to the median nerve, and then set criteria for the recognition of CTS as an occupational disease in these circumstances. Regardless of whether we recognize a particular disease as occupational, it is necessary to carry out preventive measures so that these health problems do not even occur, thereby keeping workers healthy and productive for as long as possible.Mnoge rasprave bave se utjecajem rada na računalu, napose rada s mišem, u nastajanju sindroma karpalnog kanala. Mehanizam oštećenja mogao bi se pripisati pritisku ili istezanju medijalnog živca u području karpalnog kanala. Postoje dokazi da ponavljajuće radnje i uporaba sile čine faktor koji pridonosi nastanku sindroma karpalnog kanala, no rad na računalu koji se većinom sastoji od ponavljajućih radnji ne zahtijeva uporabu sile. Studije pokazuju da je učestalost ovog sindroma kod osoba koje rade na računalu slična onoj u općoj populaciji. Glavni cilj rada je istražiti literaturu povezanu s ovaim problemom, tj. utvrditi postoji li uzročna veza između rada na računalu i nastanka sindroma karpalnog kanala. Prvi cilj je kvantitativno utvrditi odnos vremenske izloženosti i pojavu simptoma, a drugi cilj je utvrditi skupinu kriterija ili uputa za priznavanje sindroma karpalnog kanala kao profesionalne bolesti u osoba koje rade na računalima. Pretraga literature temeljena je na bazama podataka ProQuest, PubMed, Google Scholar i Cochrane Library. Korištene su sljedeće ključne riječi: sindrom karpalnog kanala I rad na računalu ILI izloženost računalu ILI uporaba računala ILI uporaba miša I sustavni pregled ILI prospektivna kohortna studija. Posljednja pretraga izvršena je 15. ožujka 2021. Ukupno je istraženo 12 studija. Rezultati su bili kontradiktorni. Devet studija navelo je da rad na računalu ne predstavlja povećani rizik nastanka sindroma karpalnog kanala. Dvije studije utvrdile su da dugotrajna uporaba miša, dulja od 20 sati tjedno, i rad na tipkovnici veći od 240.500.000 udaraca godišnje mogu biti povezani s nastankom sindroma karpalnog kanala. Jedna je pak studija utvrdila da osobe koje rade na računalu imaju manji rizik nastanka sindroma. Dakle, ne može se sa sigurnošću tvrditi da postoji veza između rada na računalu i nastanka sindroma karpalnog kanala. Upitno je stoga može li se sindrom priznati kao profesionalna bolest osobama koje rade na računalu. Potrebno je bolje planirati i bolje strukturirati studije za utvrđivanje intenziteta i trajanja izloženosti računalu i razine oštećenja medijalnog živca kako bi se mogli utvrditi kriteriji za priznavanje sindroma kao profesionalne bolesti. Bez obzira može li se određena bolest priznati kao profesionalna ili ne, potrebno je uvesti preventivne mjere kojima bi se izbjegla pojava zdravstvenih teškoća a sve kako bi djelatnici ostali zdravi i produktivni koliko god je moguće dulje

Documenting postural changes and repetition among violin players and their influence in the development of musculoskeletal disorders

The objective of this study was to document the changes in posture and the number of wrist and forearm repetitions among violin/viola players during an experiment session to attempt to understand the development of musculoskeletal disorders. Also, the perception of discomfort and pain felt by the violin/viola players in the past and the number that had been diagnosed with a disorder was documented. Finally, possible correlations were calculated between pain/discomfort with variables like the number of years playing the violin, hours of practice/day, frequency of pain, gender, and dominant hand and among different pain/discomfort variables (pain/discomfort before the experiment, after the experiment and the change in pain/discomfort throughout the experiment) and ultimately possible relationships were determined between posture and repetition with pain/discomfort. Playing a musical instrument places the highest of demands on the musculoskeletal system of musicians and is considered one of the most complex tasks the human body can perform (Steinmetz, Seidel, & Muche, 2010). This places musicians at a high risk for the development of musculoskeletal disorders. Studies have shown how musicians are at high risk for developing PRMDs ranging in prevalence from approximately 30% to almost 90% (Zaza, 1998). These high statistics was the rationale for using musicians as the focus group. This study’s population was violin/viola players (students and professionals) above the age of 18. Electrogoniometers were used to measure the postural changes and the software used with the equipment provided a count of the repetitions. The independent variables accounted for pain and discomfort while the dependent variables accounted for the demographics as well as posture and repetition. Descriptive statistics were computed for the postural changes and averages for the number of repetitions. Left Radial, Left Flexion and Left Supination displayed the most extreme postural changes, while the right hand repetitions in the radial/ulnar plane had the highest number of repetitions. Ratings for the level of pain/discomfort were averaged and a paired t-test showed that there was a significant difference between the level of pain before and after the experiment session. Correlation analyses confirmed that extreme postures of the left hand and high number of repetitions on the right hand are associated with a higher change in discomfort. Finally, predictors in the regression models for the number of pain days in a year, the level of discomfort after the experiment and the change in discomfort included repetitions of the right hand in radial/ulnar plane and gender indicating that repetitive motions and being a female could lead to increased discomfort. Future research should focus on other physical risk factors (i.e. force) as well as psychosocial factors. Future studies could also look at the differences in postural changes and repetition between genders as well as differences in how forces are applied. Other studies could focus on the difference in how both genders report pain/discomfort and which are the most affected body parts. Studies can also attempt to document postural changes in different instrument cohorts to determine which instrument could lead to higher displacements, or which postures cause more strain. In summary, this study helped conclude that more extreme postural deviations, higher number of repetitions, more hours of practice per day are and even shorter periods of practice can lead to an increase in discomfort or pain

Work-related musculoskeletal disorders in the automotive industry due to repetitive work - implications for rehabilitation

<p>Abstract</p> <p>Background</p> <p>Musculoskeletal disorders (MSDs) due to repetitive work are common in manufacturing industries, such as the automotive industry. However, it's still unclear which MSDs of the upper limb are to be expected in the automotive industry in a first aid unit as well as in occupational precaution examinations. It is also unclear which examination method could be performed effectively for practical reasons and under rehabilitation aspects. Additionally, it was to discuss whether the conception of unspecific description for MSDs has advantages or disadvantages in contrast to a precise medical diagnosis.</p> <p>Methods</p> <p>We investigated the health status of two study populations working at two automotive plants in Germany. The first part included 67 consecutive patients who were seen for acute or chronic MSDs at the forearm over a 4-month period at the plants' medical services. Information about patients' working conditions and musculoskeletal symptoms was obtained during a standardized interview, which was followed by a standardized orthopedic-chiropractic physical examination. In the second part, 209 workers with daily exposure to video display terminals (VDT) completed a standardized questionnaire and were examined with function-oriented muscular tests on the occasion of their routine occupational precaution medical check-up.</p> <p>Results</p> <p>The majority of the 67 patients seen by the company's medical services were blue-collar works from the assembly lines and trainees rather than white-collar workers from offices. Rates of musculoskeletal complaints were disproportionately higher among experienced people performing new tasks and younger trainees. The most common MSD in this group were disorders of flexor tendons of the forearm. By contrast, among the 209 employees working at VDT disorders of the neck and shoulders were more common than discomfort in the forearm. A positive tendency between restricted rotation of the cervical vertebrae and years worked at VDT was observed. In addition, only less than 8% of unspecific disorders of the upper limb (esp. wrist and forearm) were found.</p> <p>Conclusions</p> <p>Functional tests for the upper limb seemed to be very helpful to give precise medical advice to the employees to prevent individual complaints. The results are also helpful for developing specific training programs before beginning new tasks as well as for rehabilitation reasons. There's no need to use uncertain terminology (such as RSI) as it may not be representative of the actual underlying disorders as diagnosed by more thorough physical examinations.</p

Optometric management of video display terminal related vision problems

The growth of the digital market is progressively leaving a big impact on eye care professionals’ practice, whose rule is to permit a comfortable vision to their patients. Video display terminal related vision problems have drawn a particular attention, since the number of computer workers have increased over the last years. The popularity of smaller digital devices, such as smart phones and tablets, is increasing also among younger generations, as almost every child own one by the start of elementary school. Computers have also become an irreplaceable accessory, when talking about students in higher education institutes. The main objective of the thesis is to analyse Computer Vision Syndrome along with other vision related problems induced by other digital devices and a proper management of those. To alleviate the symptoms and to provide a comfortable vision, while using digital screens for several hours, optometrists have a wide selection of different treatment methods. Various researches, that approve better visual performance after the consultation with an eye care professional, have been studied. Prevention, including a proper positioning of the computer workstation or ergonomic mobile phone and tablet use, plays a significant rule. However, in the presence of the symptoms, depending on the nature of those, different approaches should be considered; the most common solutions to combat CVS are correction of refraction error, binocular and accommodative dysfunction, decreasing the amount of blue light entering the eye and dry eye management. Since the rapidly digitized world is changing people’s behaviour, the visual demands required for operating modern technology will continue to increase

Effects of ergonomic worksite changes on risks for cumulative trauma disorders of the upper body in an assembly and press operation job

Cumulative trauma of the upper body is associated with a variety of individual and job factors. An effort to optimize the human-hardware interface to minimize cumulative trauma is favored. Workers in a set of jobs had complained about hand/wrist and shoulder discomfort. One job was selected for testing alternate machine controls and worksite layout. Electromyography was used to test muscle activity, and photogoniometry was used to measure posture. For the group of ten worker-subjects, statistically significant decreases in hand/wrist and shoulder muscle activity were found. A marginal, but significant increase in neck muscle activity was also found. When one subject was excluded, improvements were unchanged and the increase in neck muscle activity was not significant for three of four types of analysis of variance. While statistical improvement was identified, the question of clinical significance cannot be answered at this time