CUMMULATIVE DISORDERS OF UPPER EXTIMITY

DR HABIBOLLAHI

Definition• Musculoskeletal disorder (MSD) is an injury or disorder of the

muscles, nerves, tendons, joints, cartilage,ligament and spinal discs.

• It is not an acute injury, rather a chronic disease which develops over time.

• MSD is related to manual tasks • It has been recognized as a source of significant pain,

disability and disadvantage for the injured person and a substantial burden on modern societies. Statistics suggest that more than 30% of all occupational injuries are musculoskeletal injuries associated with manual tasks)

ERGONOMICS

Nationally, almost 60% of all work-related illnesses are MSDs

WMSDsAll

other claims

26%

74%

WMSDs

40%

60%

All other claims

Number of Claims Cost of Claims

ERGONOMICS

WMSDs are sometimes referred to using other unfamiliar terms such as :

1. Cumulative Trauma Disorders – CTD2. Repetitive Trauma Disorders – RTD3. Repetitive Strain Injuries – RSI4. Repeated Motion Disorders – RMD5. Overuse Syndromes

ERGONOMICS

What is The Musculoskeletal System?

The Musculoskeletal System includes the following:

1. Bones – The load-bearing structure of the body

2. Muscles- Tissue that contract to create movement

3. Tendons – Tissues that connect muscles to bones

4. Ligaments – Tissues that connect bones to bones

5. Cartilage – Tissue that provides cushioning and reduces friction between bones

6. Nerves – Communication system that links muscles, tendons and other tissue with the brain

7. Blood Vessels – Tubes that circulate nutrients throughout the body

ERGONOMICSWhat Are Examples of WMSDs?

1. Strain – Overstretching or overexertion of a muscle or tendon

2. Sprain _Overstretching or overexertion of a ligament that results in a tear or rupture of the ligament

3. Tendonitis – Inflammation of the tendon inside the sheath

4. Tenosynovitis – Inflammation of the sheath around the tendon

5. Carpal Tunnel Syndrome – Compression of the median nerve as it passes through the carpal tunnel in the heel of the hand

ERGONOMICSWhat are Examples of WMSDs?

6. Tennis elbow or Golfer’s elbow – Medical term is Epicondylitis – inflammation of the tendons at the elbow.

7. Trigger Finger – Common term for tendonitis or tenosynovitis that causes painful locking of the finger(s) while flexing

8. Pitcher’s Shoulder – Rotator cuff tendonitis – inflammation of one or more tendons at the shoulder

9. White Finger – Medical term is Reynaud’s Phenomenon – constriction of the blood vessels in the hands and fingers

10. Digital Neuritis – Compression of the nerves along the sides of the fingers or thumbs

Cumulative Trauma DisorderDiagnoses

Nerves: Peripheral Entrapment

– Carpal Tunnel Syndrome

– Cubital Tunnel Syndrome

– Thoracic Outlet Syndrome

Tendons– Trigger Digits– de Quervain’s

TendonitisSkin

– Blisters– Calluses

Muscles (Enthesopathy)– Lateral Epicondylitis

(Tennis Elbow)– Shoulder Impingement

(Rotator Cuff Disease)Joint & Bone

– Arthritis– Stress Fractures– Ganglions

Vascular– White Finger

Syndrome

ERGONOMICSSigns or Symptoms of WMSDs

Painful joints Pain in wrists, shoulders, forearms, knees, etc. Pain, tingling or numbness in hands or feet Fingers or toes turning white Shooting or stabbing pains in arms or legs Back or neck pain Swelling or inflammation Stiffness Burning sensations Weakness or clumsiness in hands; dropping things

INCREASED RISK FACTORS

Awkward Postures High Hand Force Highly Repetitive Motion Repeated Impact Heavy, Frequent or Awkward

Lifting Moderate to High Hand-Arm

Vibration

CautionZone

Look for These Indicators:

Awkward PosturesBeing in these work positions for more than 2-4 hours total per day

– Hands above head– Elbows above shoulder– Back bent forward more than 30 degrees– Neck bent more than 30 degrees– Squatting– Kneeling

Working with the Hands Above Head

For more than 2 hours per day

Working with the Elbows Above Shoulders

For more than 2 hours per day

Neck or Back Bent Forward More than 30ºFor more than 2 hours per day

Neck or Back Bent Forward More than 30

For more than 2 hours per day

Neck or Back Bent Forward More than 30

For more than 2 hours per day

SquattingFor more than 2 hours per day

KneelingFor more than 2 hours per day

High Hand ForceMore than 2 hours per day of:

Pinching 2 or more pounds weight or 4 or more pounds force

High Hand ForceMore than 2 hours per day of:

Gripping 10 or more pounds weight or force

Highly Repetitive MotionWorkers repeat same motion every few seconds for more than 2 hours per day with:– neck– shoulders– elbows– wrists– hands

Highly Repetitive MotionIntensive keying for more than 4 hours per day

Repeated ImpactUsing hands or knees as a hammer– more than 10 times per

hour– more than 2 hours per day

Repeated ImpactUsing hands or knees as a hammer– more than 10 times per

hour– more than 2 hours per day

Heavy, Frequent, or Awkward Lifting

Lifting objects more than:– 75 lbs. once/day– 55 lbs. more than ten

times/day– 10 lbs. more than

twice/minute for more than 2 hours per day

– 25 lbs. above shoulders, below knees, or at arms length for more than 25 times/day

Heavy, Frequent, or Awkward Lifting

Heavy, Frequent, or Awkward Lifting

Moderate to High Hand-Arm Vibration

Moderate Levelmore than 2 hours/day

Moderate to High Hand-Arm Vibration

High LevelMore than 30 Min/day

Upper Extremity Disorders

Carpel tunnel syndrome Cubital tunnel syndrome Thoracic outlet syndrome Raynaud’s syndrome (white finger) Rotator cuff syndrome DeQuervain’s disease Tendinitis Tenosynovitis Trigger finger Ganglion cyst

Neurovascular Disorders

• Carpal Tunnel Syndrome– Impingement of the median nerve caused by irritation

and swelling of the tendons in the carpal tunnel

• Cubital Tunnel Syndrome– Pressure on the ulnar nerve when the elbows are exposed

to hard surfaces

Neurovascular Disorders

• Thoracic Outlet Syndrome– Compression of the blood vessels between the neck and

shoulder caused by reaching above shoulder level or carrying heavy objects

• Raynaud’s Syndrome– Also known as Vibration White Finger ; Blood vessels of

the hand are damaged (narrowed) from repeated exposure to vibration for long periods of time

Tendon Disorders

• Rotator Cuff Syndrome• DeQuervain’s Disease

– Combination of tendinitis and tenosynovitis

• Tendinitis– Irritation of the tendon

• Tenosynovitis– Irritation of the synovial sheath

• Ganglion Cyst– Accumulation of fluid within the tendon sheaths

Tendinitis

Common Occupational CTDsof the Upper Extremities

Carpal Tunnel Syndrome occurs from chronic swelling of the flexor tendons in the wrist.

The median nerve, which feeds the first three fingers and the thumb, can become impaired from pressure in the carpal tunnel in the wrist.

Symptoms include:· pain in the first three fingers and the thumb· numbness in these areas· tingling in these areas

Carpal Tunnel Syndrome

a

MEDIANNERVE

CARPALLIGAMENT

TENDONSBONES

Carpal Tunnel Syndrome

Common Occupational CTDsof the Upper Extremities

Raynaud’s Syndrome is when blood vessels of the hand are damaged (narrowed) from repeated exposure to vibration for long periods of time

This is connected with use of vibrating tools, such as hair clippers and jack hammers.

Raynaud’s Syndrome

Symptoms Numbness and tingling in the fingers during vibration exposure;

may continue after exposure has been discontinued Blanching (whitening) of one fingertip because of a temporary

constriction of blood flow Other fingers also blanch Intensity of pain & frequency of attacks increase in time

Common Occupational CTDsof the Upper Extremities

Cubital Tunnel Syndrome is caused by resting the elbows on hard surfaces such as unpadded tables or armrests.

The ulnar nerve, which feeds the ring and little fingers, can become impaired from pressure near the elbows.

Symptoms include:· pain in the ring and little fingers· tingling in these areas· numbness in these areas

Cubital Tunnel Syndrome

Common Occupational CTDsof the Upper Extremities

Thoracic Outlet Syndrome is caused by frequent reaching above shoulder level, by carrying heavy objects, or poor posture involving a forward head tilt.

A Neurovascular bundle called the brachial plexus, which passes between the collar bone and the top rib, can become impaired from pressure associated with movements that causes these two bones to be positioned close together.

Symptoms include:· the arms “falling asleep”· weakened pulse· numbness in the fingers

Thoracic Outlet Syndrome

Common Occupational CTDsof the Upper Extremities

Rotator cuff syndrome is a disorder involving swelling and pain of tendons comprising the rotator cuff muscle group:

subscapularis, supraspinatus, infraspinatus, & teres minor

Symptoms include:• Pain when you bend the arm and rotate it outwards against resistance  • Pain on the outside of the shoulder possibly radiating down into the arm  • Pain in the shoulder, which is worse at night  • Stiffness in the shoulder joint.

Prevention

• Avoidance of prolonged or repeated overhead work may help lessen the incidence of impingement type pain. In addition, rotator cuff strengthening exercises can sometimes improve the symptoms associated with pathology in this area.

Common Occupational CTDsof the Upper Extremities

Tendinitis is a common CTD for the wrist, elbow, and shoulder. It occurs when we continually stress the tendon cables, causing them to become irritable and sore.

Lateral Epicondylitis - “Tennis elbow” Medial Epicondylitis - “Golfer’s elbow”

Symptoms include:· point tenderness· swelling· tennis elbow, pain radiates down to back of hand· golfer’s elbow, pain radiates down to back of hand

Tendinitis

Common Occupational CTDsof the Upper Extremities

Tenosynovitis is swelling of the sheath that covers the tendon from constant rubbing against the tendon.

Symptoms include: swelling pain loss of motion loss of strength

Tenosynovitis

Common Occupational CTDsof the Upper Extremities

Trigger Finger is a tendon disorder that occurs when there is a groove in the flexing tendon of the finger

If the tendon becomes locked in the sheath, attempts to move the finger cause snapping or jerking movements

Usually associated with using tools that have handles with hard or sharp edges.

Trigger Finger

Ganglion Cyst is a bump under the skin caused by an accumulation of fluid within the tendon sheath. It is commonly found at the hand and wrist.

Common Occupational CTDsof the Upper Extremities

Ganglion Cyst

De Quervain’s Disease is an inflammation of the tendon sheath of the thumb attributed to excessive friction between two thumb tendons and their common sheath.

It’s a combination of Tendonitis and Tenosynovitis.

May be caused by twisting and forceful gripping

Symptoms include:• swelling • pain at the base of the thumb.

Common Occupational CTDsof the Upper Extremities

De Quervain’s Disease

De Quervain’s Disease