The prevalence of cubital tunnel syndrome: A cross-sectional study in a U.S. metropolitan cohort

BACKGROUND: Although cubital tunnel syndrome is the second most common peripheral mononeuropathy (after carpal tunnel syndrome) encountered in clinical practice, its prevalence in the population is unknown. The objective of this study was to evaluate the prevalence of cubital tunnel syndrome in the general population. METHODS: We surveyed a cohort of adult residents of the St. Louis metropolitan area to assess for the severity and localization of hand symptoms using the Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SSS) and the Katz hand diagram. We identified subjects who met our case definitions for cubital tunnel syndrome and carpal tunnel syndrome: self-reported hand symptoms associated with a BCTQ-SSS score of >2 and localization of symptoms to the ulnar nerve or median nerve distributions. RESULTS: Of 1,001 individuals who participated in the cross-sectional survey, 75% were women and 79% of the cohort was white; the mean age (and standard deviation) was 46 ± 15.7 years. Using a more sensitive case definition (lax criteria), we identified 59 subjects (5.9%) with cubital tunnel syndrome and 68 subjects (6.8%) with carpal tunnel syndrome. Using a more specific case definition (strict criteria), we identified 18 subjects (1.8%) with cubital tunnel syndrome and 27 subjects (2.7%) with carpal tunnel syndrome. CONCLUSIONS: The prevalence of cubital tunnel syndrome in the general population may be higher than that reported previously. When compared with previous estimates of disease burden, the active surveillance technique used in this study may account for the higher reported prevalence. This finding suggests that a proportion of symptomatic subjects may not self-identify and may not seek medical treatment. CLINICAL RELEVANCE: This baseline estimate of prevalence for cubital tunnel syndrome provides a valuable reference for future diagnostic and prognostic study research and for the development of clinical practice guidelines

Rythmes de travail imposés et douleurs aux coudes, effets directs et indirects, rôle des facteurs psycho-sociaux et biomécaniques

Objectifs Évaluer les effets directs et indirects du rythme de travail imposé sur les douleurs aux coudes (DoulC). Méthodes On dispose de données sur 3710 salariés qui ont participé à un programme de surveillance des troubles musculo-squelettiques (TMS) dans la région Pays de la Loire entre 2002 et 2005 (réseau pilote de surveillance des TMS). Lors d’examens cliniques standardisés, 83 médecins du travail ont diagnostiqué les éventuels TMS, dont la présence de douleurs au niveau de l’épicondyle (DoulC). Les expositions professionnelles (rythme de travail imposé, effort important combiné aux mouvements répétitifs aux coudes, tâches répétitives, faible soutien social, faible latitude décisionnelle) et les facteurs personnels (âge, sexe, indice de masse corporel) ont été évalués par auto-questionnaire. Les associations univariées entre les DoulC et les facteurs de risques ont été quantifiées par des odds ratios (ORs) issus de modèles logistiques. La part directe et indirecte de l’association avec le rythme de travail imposé sur les DoulC a été estimée par un modèle à équations structurelles (EQ) et par des calculs causaux basés sur une méthode proposée par Van Der Weele et al. de 2014 (méthode VDW). Résultats L’OR entre le rythme de travail imposé et les DoulC est de 1,49 [1,22;1,82] (en comparaison, l’OR pour « faible soutien social » est 1,30 [1,07;1,58] et pour les efforts combinées aux mouvements aux coudes, 1,94 [1,59;2,36]). La part de l’association entre le rythme de travail imposé et les DoulC médiée par les autres facteurs professionnels est estimée à 36,5 % [14,1 %;59,0 %] par la méthode EQ et à 30,6 % [15,7 %;57,0 %] par la méthode VDW. Dans l’analyse EQ, cette association indirecte est principalement expliquée par l’association passant par les facteurs biomécaniques (correspondant à 82,1 % [44,4 %;119,9 %] de l’effet indirect). Conclusions Cette analyse exploratoire basée sur des données transversales donne des pistes pour l’évaluation des différents mécanismes causaux à l’origine des liens entre les facteurs organisationnels et les TMS. L’effet du rythme de travail est certes plus faible que celui des contraintes biomécaniques, il est cependant significatif. Les résultats montrent qu’une intervention visant à diminuer la fréquence de l’exposition aux rythmes de travail imposés aurait un effet direct et aussi indirect sur les douleurs par la diminution des expositions professionnelles psychosociales et biomécaniques

The effect of exposure to long working hours on stroke: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury

BACKGROUND: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large network of individual experts. Evidence from mechanistic data and prior studies suggests that exposure to long working hours may cause stroke. In this paper, we present a systematic review and meta-analysis of parameters for estimating the number of deaths and disability-adjusted life years from stroke that are attributable to exposure to long working hours, for the development of the WHO/ILO Joint Estimates. OBJECTIVES: We aimed to systematically review and meta-analyse estimates of the effect of exposure to long working hours (three categories: 41-48, 49-54 and ≥55 h/week), compared with exposure to standard working hours (35-40 h/week), on stroke (three outcomes: prevalence, incidence, and mortality). DATA SOURCES: A protocol was developed and published, applying the Navigation Guide to systematic reviews as an organizing framework where feasible. We searched electronic databases for potentially relevant records from published and unpublished studies, including Ovid MEDLINE, PubMed, EMBASE, Scopus, Web of Science, CISDOC, PsycINFO, and WHO ICTRP. We also searched grey literature databases, Internet search engines, and organizational websites; hand-searched reference lists of previous systematic reviews; and consulted additional experts. STUDY ELIGIBILITY AND CRITERIA: We included working-age (≥15 years) individuals in the formal and informal economy in any WHO and/or ILO Member State but excluded children (aged \u3c 15 years) and unpaid domestic workers. We included randomized controlled trials, cohort studies, case-control studies and other non-randomized intervention studies with an estimate of the effect of exposure to long working hours (41-48, 49-54 and ≥55 h/week), compared with exposure to standard working hours (35-40 h/week), on stroke (prevalence, incidence or mortality). STUDY APPRAISAL AND SYNTHESIS METHODS: At least two review authors independently screened titles and abstracts against the eligibility criteria at a first review stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. Missing data were requested from principal study authors. We combined relative risks using random-effects meta-analysis. Two or more review authors assessed the risk of bias, quality of evidence and strength of evidence, using the Navigation Guide and GRADE tools and approaches adapted to this project. RESULTS: Twenty-two studies (20 cohort studies, 2 case-control studies) met the inclusion criteria, comprising a total of 839,680 participants (364,616 females) in eight countries from three WHO regions (Americas, Europe, and Western Pacific). The exposure was measured using self-reports in all studies, and the outcome was assessed with administrative health records (13 studies), self-reported physician diagnosis (7 studies), direct diagnosis by a physician (1 study) or during a medical interview (1 study). The outcome was defined as an incident non-fatal stroke event in nine studies (7 cohort studies, 2 case-control studies), incident fatal stroke event in one cohort study and incident non-fatal or fatal ( mixed ) event in 12 studies (all cohort studies). Cohort studies were judged to have a relatively low risk of bias; therefore, we prioritized evidence from these studies, but synthesised evidence from case-control studies as supporting evidence. For the bodies of evidence for both outcomes with any eligible studies (i.e. stroke incidence and mortality), we did not have serious concerns for risk of bias (at least for the cohort studies). Eligible studies were found on the effects of long working hours on stroke incidence and mortality, but not prevalence. Compared with working 35-40 h/week, we were uncertain about the effect on incidence of stroke due to working 41-48 h/week (relative risk (RR) 1.04, 95% confidence interval (CI) 0.94-1.14, 18 studies, 277,202 participants, I CONCLUSIONS: We judged the existing bodies of evidence for human evidence as inadequate evidence for harmfulness for all exposure categories for stroke prevalence and mortality and for exposure to 41-48 h/week for stroke incidence. Evidence on exposure to 48-54 h/week and ≥55 h/week was judged as limited evidence for harmfulness and sufficient evidence for harmfulness for stroke incidence, respectively. Producing estimates for the burden of stroke attributable to exposures to working 48-54 and ≥55 h/week appears evidence-based, and the pooled effect estimates presented in this systematic review could be used as input data for the WHO/ILO Joint Estimates. PROTOCOL IDENTIFIER: https://doi.org/10.1016/j.envint.2018.06.016. PROSPERO REGISTRATION NUMBER: CRD42017060124

Prevalence of knee bursitis in the workforce

BACKGROUND: Knee bursitis (KB) is a common disorder in specific occupations requiring frequent and/or sustained kneeling postures.AIMS: To assess the prevalence of KB in the general working population. METHODS: Between 2002 and 2005, a total of 3710 workers of a French region were randomly included in the study. A standardized physical examination of the knee was performed when knee pain was reported by the worker during the preceding 12 months. The criteria for diagnosis of KB were (i) the presence of pain and/or tenderness in the anterior face of the knee at the date of the examination (or for at least 4 days in the preceding week) and (ii) the presence of swelling and/or pressure-induced pain of the pre- or infra-patellar bursa. Occupational risk factors were assessed by a self-administered questionnaire. RESULTS: The prevalence of uni- or bilateral cases of knee bursitis was low: 0.6% [0.2-0.9] in men and 0.2% [0.0-0.6] in women. The highest prevalence was observed in the construction sector (2.3% [0.8-5.4]) and in the food and meat processing industries (1.4% [0.4-3.5)]. More blue-collar workers were affected than other occupation categories (0.8% [0.3-1.2] versus 0.1% [0.0-0.4]). CONCLUSIONS: The study showed a concentration of cases among male workers exposed to heavy workloads and frequent kneeling

Natural history and predictors of long-term pain and function among workers with hand symptoms

OBJECTIVE: To evaluate predictors of hand symptoms and functional impairment after three years of follow-up among workers with different types of hand symptoms including carpal tunnel syndrome (CTS). Functional status and job limitations were also analyzed as key secondary objectives. DESIGN: Cohort design of 3-years duration SETTING: Working population-based study PARTICIPANTS: 1107 newly employed workers without a pre-existing diagnosis of CTS. Subjects were categorized into four groups at baseline examination: no hand symptoms, any hand symptoms but not CTS (recurring symptoms in hands, wrist or fingers without neuropathic symptoms), any hand symptoms of CTS (neuropathic symptoms in the fingers and normal nerve conduction study), or confirmed CTS (CTS symptoms and abnormal nerve conduction study). Among workers with hand pain at baseline, subject and job characteristics were assessed as prognostic factors for outcomes, using bivariate and multivariate regression models. INTERVENTIONS: Not applicable MAIN OUTCOME MEASURE: The primary outcome assessed by questionnaire at 3 years was “severe hand pain” in the past 30 days. RESULTS: At baseline, 155 workers (17.5% of 888 followed workers) reported hand symptoms, 21 had confirmed CTS. Presence of hand pain at baseline was a strong predictor of future hand pain and job impairment. Subjects with confirmed CTS at baseline were more likely to report severe hand pain, (adjusted prevalence ratios 1.98 [1.11 – 3.52]) and functional status impairment (adjusted prevalence ratios 3.37 [1.01 – 11.29]) than workers with other hand pain. Among subjects meeting our case definition for CTS at baseline, only 4 (19.1%) reported seeing a physician in the 3 year period. CONCLUSIONS: Hand symptoms persisted among many workers after 3 year follow-up, especially among those with CTS, yet few symptomatic workers had seen a physician

Prevalence of multisite musculoskeletal symptoms: a French cross-sectional working population-based study

BACKGROUND: The musculoskeletal disorders in working population represent one of the most worrying work-related health issues at the present time and although the very great majority of available data on the subject focus on musculoskeletal disorders defined by anatomical site, a growing number of studies indicate the low prevalence of disorders strictly confined to a specific anatomical site. The objective of this study was to describe the prevalence and characteristics of multisite musculoskeletal symptoms (multisite MS) in a large French working population.METHODS: This study was performed on surveillance data of the cross-sectional survey (2002-2005) conducted by a network of occupational physicians in the working population of the Loire Valley region (from 20 to 59 years old). Data concerning MS were collected in the waiting room of the occupational physicians by means of the self-administrated standardized NORDIC questionnaire. RESULTS: The study population comprised 3,710 workers (2,162 men (58%) and 1,548 women (42%)) with a mean age of 38.4 years (standard deviation: 10.4 years). The prevalence of MS during the past 12 months was 83.8% with 95% confidence interval of [82.8-85.3] for men and 83.9% [82.0-85.7] for women. The prevalence of subacute MS (lasting at least 30 days) over the past 12 months was 32.8% [30.9-34.8] for men and 37.3% [34.9-39.7] for women. Two-thirds of workers reported MS in more than one anatomical site and about 20% reported MS lasting at least 30 days in more than one anatomical site. The anatomical sites most frequently associated with other MS were the upper back, hip, elbow and neck. The majority of these multisite MS were widespread, involving at least two of the three anatomical regions (upper limb, axial region and lower limb). CONCLUSIONS: The frequency and extent of multisite MS reported by workers are considerable. Further research must be conducted in this field in order to provide a better understanding of the characteristics and determinants of these multisite MS