A dynamic model for simulating movements of the elbow, forearm, an wrist

We developed a dynamic model of the upper extremity to simulate forearm and wrist movements. The model is based on the skeletal structure of the arm and is capable of elbow flexion/extension, forearm pronosupination, and wrist flexion/extension and radial/ulnar deviation movements. Movements are produced by activation of a Hill-type model of muscle, and limits on joint motion are imposed by passive moments modeled after experimental results. We investigated the muscle output force sensitivity, as well as wrist flexion/extension motion sensitivity to parameter variations. The tendon slack length and muscle fiber length were found to have the greatest influence on muscle output and flexion/extension wrist motion. The model captured the direction of the moment vectors at the wrist well, but predicted much higher moments than were measured by stimulating the paralyzed muscles of one tetraplegic subject.     

Moment arms and lengths of human upper limb muscles as functions of joint angles

Modeling of musculoskeletal structures requires accurate data on anatomical parameters such as muscle lengths (MLs), moment arms (MAs) and those describing the upper limb position. Using a geometrical model of planar arm movements with three degrees of freedom, we present, in an analytical form, the available information on the relationship between MAs and MLs and joint angles for thirteen human upper limb muscles. The degrees of freedom included are shoulder flexion/extension, elbow flexion/extension, and either wrist flexion/extension (the forearm in supination) or radial/ulnar deviation (the forearm in mid-pronation). Previously published MA/angle curves were approximated by polynomials. ML/angle curves were obtained by combining the constant values of MLs (defined by the distance between the origin and insertion points for a specific upper limb position) with a variable part obtained by multiplying the MA (joint radius) and the joint angle. The MAs of the prime wrist movers in radial/ulnar deviation were linear functions of the joint angle (R2 > or = 0.9954), while quadratic polynomials accurately described their MAs during wrist flexion/extensions. The relationship between MAs and the elbow angle was described by 2nd, 3rd or 5th-order polynomials (R2 > or = 0.9904), with a lesser quality of fit for the anconeus (R2 = 0.9349). In the full range of angular displacements, the length of wrist, elbow and shoulder muscles can change by 8.5, 55 and 200%, respectively.     

Ankle, knee, and hip moments during standing with and without joint contractures: simulation study for functional electrical stimulation

Joint contractures have been one of the contraindications for use of functional electrical stimulation for standing in paraplegic patients. A simulation study using a three-segment link mechanical model of the human body was performed to calculate the muscle moments at the ankles, knees, and hips during standing with and without having joint contractures. The knee and hip angles were varied in 5 degrees increments, whereas the ankle angles were varied in 1 degree increments. It was assumed that energy efficient posture was obtained with the least sum of the squared moments of the ankles, knees, and hips joints by the muscles. Ankles at 5 degrees of dorsiflexion, knees at 0 degrees, and hips at 15 degrees of extension resulted in the most energy efficient posture without joint contractures. The muscle moments increased with the increase in angle of contractures. The joint contractures at ankle angles > or = 6 degrees of plantar flexion, knee angles > or = 20 degrees of flexion, and/or hip angles > or = 20 degrees of flexion produce a potentially unstable posture. These findings suggest that some degree of joint contractures can be tolerated in paraplegic patients using functional electrical stimulation for standing.     

Organizing principles for voluntary movement: extending single-joint rules

1. Four subjects performed fast flexions of the elbow or shoulder over three different distances. Elbow flexions were performed both in a horizontal, single-degree-of-freedom manipulandum and in a sagittal plane with the limb unconstrained. Shoulder flexions were only performed in the sagittal plane by the unconstrained limb. We simultaneously recorded kinematic and electromyographic (EMG) patterns at the "focal" joint, that which the subject intentionally flexed, and at the other, "nonfocal" joint that the subject had been instructed to not flex. 2. Comparisons of the elbow EMG patterns across tasks show that agonist and antagonist muscles were similar in pattern but not size, reflecting the net muscle torque patterns. Comparisons at the shoulder also revealed similar EMG patterns across tasks that reflected net muscle torques. 3. Comparisons of EMG patterns across joints show that elbow and shoulder flexors behaved similarly. This was not true of the extensors. The triceps EMG burst was delayed for longer distances but the posterior deltoid had an early, distance-invariant onset. 4. Similarities in EMG reflect torque demands required at the focal joint to produce flexion and at the nonfocal joint to reduce extension induced by dynamic interactions with the focal, flexing joint. These similarities appear despite very different kinematic intentions and outcomes. This argues against a strong role for length-sensitive reflexes in their generation. 5. These results support the hypothesis that movements are controlled by muscle activation patterns that are planned for the expected torque requirements of the task. This general rule is true whether we are performing single-joint or multiple-joint movements, with or without external constraints. The similarities between single-joint and multijoint movement control may be a consequence of ontogenetic development of multijoint movement strategies that prove useful and are therefore also expressed under the constrained conditions of specialized tasks such as those performed in single-joint manipulanda.     

Obstetrical brachial plexus palsy: results following neurolysis of conducting neuromas-in-continuity

Sixteen infants with conducting neuromas-in-continuity at primary brachial plexus exploration underwent microsurgical neurolysis of their lesions. For each patient, the immediate preoperative scores for individual joint movements were compared with scores at the last examination. In the Erb's palsy group (n = 9), significant improvement was seen in shoulder movements, elbow flexion, supination, and wrist extension (paired t test, p < 0.05). Clinically useful improvements in function was seen at the shoulder and elbow (Fisher's exact test, p < 0.05). In the total palsy group (n = 7), significant improvement in shoulder abduction, shoulder adduction, elbow flexion, and extension of the wrist, fingers, and thumb was seen (paired t test, p < 0.05), but there was no significant improvement in the proportion of patients with useful functional outcomes. Neurolysis in Erb's palsy improves both muscle grade and the functional ability of patients. Neurolysis does not provide useful functional recovery in patients with total plexus palsy.     

Coronary hemodynamics in aging spontaneously hypertensive and normotensive Wistar-Kyoto rats

Conventionally, the hamstring:quadriceps strength ratio is calculated by dividing the maximal knee flexor (hamstring) moment by the maximal knee extensor (quadriceps) moment measured at identical angular velocity and contraction mode. The agonist-antagonist strength relationship for knee extension and flexion may, however, be better described by the more functional ratios of eccentric hamstring to concentric quadriceps moments (extension), and concentric hamstring to eccentric quadriceps moments (flexion). We compared functional and conventional isokinetic hamstring: quadriceps strength ratios and examined their relation to knee joint angle and joint angular velocity. Peak and angle-specific (50 degrees, 40 degrees, and 30 degrees of knee flexion) moments were determined during maximal concentric and eccentric muscle contractions (10 degrees to 90 degrees of motion; 30 and 240 deg/sec). Across movement speeds and contraction modes the functional ratios for different moments varied between 0.3 and 1.0 (peak and 50 degrees), 0.4 and 1.1 (40 degrees), and 0.4 and 1.4 (30 degrees). In contrast, conventional hamstring:quadriceps ratios were 0.5 to 0.6 based on peak and 50 degrees moments, 0.6 to 0.7 based on 40 degrees moment, and 0.6 to 0.8 based on 30 degrees moment. The functional hamstring:quadriceps ratio for fast knee extension yielded a 1:1 relationship, which increased with extended knee joint position, indicating a significant capacity of the hamstring muscles to provide dynamic knee joint stability in these conditions. The evaluation of knee joint function by use of isokinetic dynamometry should comprise data on functional and conventional hamstring:quadriceps ratios as well as data on absolute muscle strength.     

Biomechanics of windmill softball pitching with implications about injury mechanisms at the shoulder and elbow

Underhand pitching has received minimal attention in the sports medicine literature. This may be due to the perception that, compared with overhead pitching, the underhand motion creates less stress on the arm, which results in fewer injuries. The purpose of this study was to calculate kinematic and kinetic parameters for the pitching motion used in fast pitch softball. Eight female fast pitch softball pitchers were recorded with a four-camera system (200 Hz). The results indicated that high forces and torques were experienced at the shoulder and elbow during the delivery phase. Peak compressive forces at the elbow and shoulder equal to 70-98% of body weight were produced. Shoulder extension and abduction torques equal to 9-10% of body weight x height were calculated. Elbow flexion torque was exerted to control elbow extension and initiate elbow flexion. The demand on the biceps labrum complex to simultaneously resist glenohumeral distraction and produce elbow flexion makes this structure susceptible to overuse injury.     

Carcinoids of unknown origin: comparative analysis with foregut, midgut, and hindgut carcinoids

The purpose of this study was to analyze our results of surgical treatment of arthrogryposis of the elbow and to compare our tendon transfer results using range of motion (ROM) criteria versus functional use criteria. Eighteen tendon transfers for elbow flexion in 14 children with arthrogryposis with an average follow-up period of 4 years (range, 1-14 years) and 6 elbow capsulotomies with triceps lengthening in 6 children with arthrogryposis with an average follow-up period of 5 years (range, 2-9 years) were evaluated. Each child was assessed by a questionnaire regarding functional use of the upper extremity, physical examination of ROM and strength, and a videotaped activities of daily living evaluation. Tendon transfer results were classified and compared using 2 methods of evaluation: postoperative strength and ROM and effective functional use of the tendon transfer to perform activities of daily living. The 6 elbow capsulotomies improved from an average preoperative arc of 17 degrees of motion (average extension, -2 degrees; average flexion, 19 degrees) to an average final follow-up arc of 67 degrees (average extension, -25 degrees; average flexion, 92 degrees). The 18 tendon transfers evaluated by strength and ROM criteria showed 9 triceps to biceps transfers in 9 arms (7 good, 1 fair, and 1 poor), 5 pectoralis to biceps transfers in 4 arms (1 good, 3 fair, and 1 poor), and 4 latissimus dorsi to biceps transfers in 3 arms (2 good and 2 fair). Evaluation by functional use criteria gave the same result in 13 transfers and downgraded the result in 5; the downgraded results were due to resultant flexion contracture or limited functional use because the transfer was in the nondominant arm. Based on this review, optimal surgical candidates for tendon transfer are children older than 4 years, who have full passive ROM of the elbow in the dominant arm, and at least grade 4 strength of the muscle to be transferred.     

Fibrous contracture of muscles following intramuscular injections in adults

Periarticular fibrous muscle contractures in adults from repeated injections in the same site is predictable. The causes of joint contracture in children are many and complex, but in adults it seems certain that this phenomenon is the result of repeated injections of analgesics or other agents into 1 muscle area. Any drug if repeatedly injected locally may cause fibrosis of the muscle and subsequent joint contracture. Five cases of bilateral abduction contracture of the shoulder in adults including the first case of bilateral abduction contractures of shoulder and hip plus bilateral flexion contracture of elbow and extension contracture of a knee are reported. No underlying disease which might predispose to this fibrosis of muscles was noted. The frequency and period of injections were variable over several years. In all patients the interference in activtities of daily living were serious, but the deformities were corrected by release of the fibrous band with relief of discomfort and restoration of joint motion without recurrence. Noting the potential complication of repeated intramuscular injections in one area, this practice should be avoided whenever possible in adults, as well as in children.     

Leptin is an endogenous protective protein against the toxicity exerted by tumor necrosis factor

Decrements in muscle strength as a result of prolonged bed rest are well defined, but little is known about potential countermeasures for preventing loss of strength under this condition. The purpose of this study was to determine whether testosterone administration would preserve protein balance and muscle strength during prolonged bed rest. Ten healthy men (age, 36 +/- 2 yr; height, 177.2 +/- 3.4 cm; weight, 80.5 +/- 3.9 kg; mean +/- SE) were admitted to our in-patient metabolic unit. After a 1-week ambulatory run-in period, each subject was confined to bed for 28 days at 6 degree head-down tilt while receiving a daily oral dose of T3 (50 microg/day). During the bed rest/T3 period, six of the men were randomized to receive testosterone enanthate by i.m. injection (T; 200 mg/week) while four received placebo in a double blind fashion. Nitrogen balance was determined throughout, and whole body [13C]leucine kinetics were assessed at baseline and on day 26 of bed rest. Before bed rest and on the third day of reambulation, the muscle strength of the knee extensors and flexors and shoulder extensors and flexors was determined at 60 degrees/s on a Cybex isokinetic dynamometer. Despite improved [13C]leucine kinetics and maintenance of nitrogen balance and lean body mass in T-treated subjects, little preservation of muscle strength, particularly in the knee extensors, was noted. Muscle strength [reported as the best work repetition in foot-pounds (FtLb)] for right knee extensors declined (P = 0.011) similarly in both groups; from 165 +/- 15 to 126 +/- 18 FtLb in T-treated men and from 179 +/- 22 to 149 +/- 13 FtLb in placebo-treated men. Overall, there was less of a decline in extension and flexion strength of the shoulder compared to the knee, with no benefit from T. These results suggest that in the absence of daily ambulatory activity, T administration will not increase or, in the case of this bed rest model, preserve muscle strength.     

Muscle strength, task performance and low back load in nurses

Poor muscle strength, relative to the physical demands of specific jobs, is considered a risk factor for low back pain. To gain an understanding of the underlying mechanisms, this study questioned whether muscle strength was related to task performance and low back load in nursing tasks. Trunk extension, elbow flexion and knee extension strength were therefore measured in 17 nurses. The independent effects of muscle strength on task duration, jerkiness of effort and L5-S1 torque were investigated as the nurses performed several patient handling tasks. Despite a large variation in muscle strength within the subject population, no effect of strength on task duration, jerkiness or L5-S1 torques was observed. In conclusion, poor muscle strength was found not to be related to increased low back load. If 'weaker' nurses were to be at a higher risk, it would be due to a reduced capability to withstand the mechanical load, rather than to an increased mechanical load.     

The effect of wrist and arm postures on peak pinch strength

This paper examines the effect of various arm postures on peak pinch strength. Twenty (20) able-bodied, male subjects volunteered to participate in a set of two experiments. The first experiment examined the effect of shoulder and elbow posture on peak pinch strength. The second experiment examined the effect of forearm posture, wrist posture, and pinch type on peak pinch strength. Results from the first experiment indicated that elbow posture had a significant effect on pinch strength. It was documented that extreme elbow flexion decreased pinch strength by up to 9%. Results from the second experiment indicated that deviated wrist postures, forearm postures, and pinch type significantly decreased pinch strength as much as 33%. Ergonomic guidelines which utilize the above factors as significant modifiers of pinch strength capacity may assist ergonomists to reduce the risk of injury and development of cumulative trauma disorders in the workplace.     

Muscle strength in rheumatoid elbow: quantitative measurement and comparison to Larsen's X-ray grade

Accurate assessment of elbow function is important to determine the total ability of the arm. The purpose of this study was to clarify the relationship between isometric muscle strength of the elbows of patients with rheumatoid arthritis (RA) and Larsen's X-ray evaluation. Fifty-six elbows of 45 RA patients aged 47 to 77 years (mean age, 63 years) were tested. Muscle strength was measured with an isometric torque-cell dynamometer. Test-retest reliability of the dynamometer was proven by measuring 12 elbows of 6 healthy young men. In RA patients, elbow flexion and extension strength decreased in proportion to increases in the severity of Larsen's grades from Grade 1 to 4. However, Grade 5 elbows had greater muscle strength than those in Grade 4. Forearm pronation and supination strength also decreased in proportion to increases in the severity of Larsen's grades from Grade 1 to 5. This quantitative study made it clear that the muscle strength of RA patients' elbows almost completely correlates to X-ray finding according to the grade of Larsen's evaluation based on X-rays. With regard to muscle strength of postoperative elbows, both flexion strength and supination strength after total elbow replacement (TER) were about two times greater than before TER, and after synovectomy it was as great as those in non-operative RA patients of Grade 2.     

Contribution on substitution of lost elbow flexion in atypical post-partum paresis of the plexus brachialis

In a ten-year-old boy with an atypical partial post-partum paresis of the dextrolateral plexus brachialis the function of the shoulder was affected substantially and the flexion of the elbow completely. The musculature of the forearm and hand was preserved completely from the anatomical and functional aspect. In compliance with the parents wish, the possibility of replacement with a muscle from a remote site by microsurgical transfer was abandoned and the authors used the well known method of transposition of the insertion of the m. pectoralis major and new retrograde transposition of the tendon of the m. flexor carpi radialis into this muscle to restore the function of the m. biceps brachii. Through postoperative rehabilitation, 90 degrees flexion of the elbow in a supine position was achieved.     

Reducing maternal smoking and relapse: long-term evaluation of a pediatric intervention

Simultaneous recordings of action potentials (APs) of multiple single motor units (MUs) were obtained in brachialis and biceps (caput breve) muscles during sinusoidally modulated isometric contractions of elbow flexor muscles and during sinusoidal flexion/extension movements in the elbow against a preload in the extension direction. The results show that MUs typically fire in one short burst for each sinusoidal cycle. The mean phase lead of the bursts of APs relative to a sinusoidally modulated isometric torque in the elbow joint or relative to sinusoidal movements in the elbow increases gradually with frequency. The increase of the mean phase lead during isometric contractions was very similar for all MUs and could be explained well by modeling the force production of MUs with a second-order linear low-pass system. For sinusoidal flexion/extension movements each MU reveals a specific, reproducible phase lead as a function of frequency. However, there is a large variability in phase behavior between MUs. Also, the modulation of the firing rate for sinusoidal isometric contractions versus sinusoidal movements appeared to be different for various MUs. In simultaneous recordings some MUs clearly revealed a larger firing rate in each burst for movements relative to isometric contractions, whereas other MUs revealed a smaller firing rate. This suggests that some MUs are preferentially activated during movements whereas others are preferably activated during isometric contractions. The results demonstrate task-dependent changes in the relative activation of MUs within a single muscle for sinusoidal isometric contractions and movements.     

Intradiscal pressure recordings in the cervical spine

OBJECTIVE: Experimental investigations analyzing the biomechanics of the cervical spine are less common than similar studies of other regions of the spine. There are no reports on cervical intradiscal pressure (PID) measurements in vitro. We therefore wanted to establish normal values for PID under physiological conditions by simultaneous muscle force simulation. Moreover, the impact of ventral cervical fusion should be elucidated, because in clinical studies, it is a well-known phenomenon that the adjacent segments often show increased degenerative changes. We present a pilot study. METHODS: Seven human cervical spine specimens were tested biomechanically in a specially developed spine tester. Only pure moments were used for flexion/extension, axial rotation, and lateral bending (maximal moment +/- 0.5 Nm). PID was measured simultaneously in C3-C4 and C5-C6. The specimens were tested as intact specimens and after discectomy and fusion in C4-C5. Both test situations were repeated with simulation of muscle forces. RESULTS: We found characteristic load-pressure curves for each of the three motion axes. In neutral position, PID correlated well with former published data from in vivo measurements. After fusion of C4-C5, there was a marked increase of PID in both adjacent segments (e.g., < or = 180% for axial rotation). With muscle force simulation, the increase was even higher (e.g., < or = 400% for axial rotation). CONCLUSION: For the first time, PID could be measured in the cervical spine in an experimental setting. The results obtained using normal specimens under physiological conditions confirmed those reported in two clinical studies. After cervical fusion, a marked increase in PID could be found in both adjacent segments. Presuming that an increase in PID had a negative effect on metabolism of the intervertebral disc, our results may help to explain why progressive degeneration occurs in these segments.     

Distribution and characteristics of poststimulus effects in proximal and distal forelimb muscles from red nucleus in the monkey

We used stimulus-triggered averaging (StTA) of electromyographic (EMG) activity to investigate two major questions concerning the functional organization of the magnocellular red nucleus (RNm) for reaching movements in the macaque monkey. The first is whether the clear preference toward facilitation of extensor muscles we have reported in previous studies for distal (wrist and digit) forelimb muscles also exists for proximal muscles (shoulder and elbow). The second question is whether distal and proximal muscles may be cofacilitated from RNm suggesting the representation of functional muscle synergies for coordinated reaching movements. Two monkeys were trained to perform a prehension task requiring multijoint coordination of the forelimb. EMG activity was recorded from 24 forelimb muscles including 5 shoulder, 7 elbow, 5 wrist, 5 digit, and 2 intrinsic hand muscles. Microstimulation (20 microA at 20 Hz) was delivered throughout the movement task. From 137 microstimulation sites in the RNm, a total of 977 poststimulus effects was obtained including 733 poststimulus facilitation effects (PStF) and 244 poststimulus suppression effects (PStS). Of the PStF effects, 58% were obtained from distal muscles; 42% from proximal muscles. Digit muscles were more frequently facilitated (35%) than the wrist, elbow, or shoulder muscles (20, 24, and 18%, respectively). The intrinsic hand muscles were infrequently facilitated (3%). At all joints tested, PStF was more common in extensor muscles than flexor muscles. This extensor preference was very strong for shoulder (85%), wrist (85%), and digit muscles (94%) and weaker for elbow muscles (60%). Of the PStS effects, 65% were in distal muscles and 35% in proximal muscles. Interestingly, the flexor muscles were more frequently inhibited from RNm than extensor muscles. At 72% of stimulation sites, at least two muscles were facilitated. The majority of these sites (61%) cofacilitated both proximal and distal muscles. At the remaining sites (39%), PStF was observed in either the proximal (17%) or distal muscles (22%). Facilitation most often involved combinations of shoulder, elbow, and distal muscles (30%) or shoulder and distal muscles (26%). Only rarely were intrinsic hand muscles part of the total muscle synergy. Our results show that the RNm 1) controls both proximal and distal muscles but the strength of influence is biased toward distal muscles, 2) preferentially controls extensor muscles not only at distal forelimb joints but also at proximal joints, and 3) output zones cofacilitate synergies of proximal and distal muscles involved in the control of forelimb reaching movements.     

Genotoxicity of trophosphamide in mouse germ cells: assessment of micronuclei in spermatids and chromosome aberrations in one-cell zygotes

We have used the muscle history dependence of the sensitivity of muscle spindles to stretch, to provide evidence for their contribution to kinaesthesia, the sense of position and movement. Stretch sensitivity is altered depending on whether or not slack has been introduced in intrafusal fibres [13]. At the human elbow joint detection threshold was measured to passive movements applied at different speeds to the forearm after a conditioning co-contraction of muscles of the upper arm, with the arm held either flexed ('hold short') or extended ('hold long'). Test measurements were made with the elbow joint at 90 degrees. For the three speeds of movement, 2 degrees s-1, 0.2 degree s-1 and 0.02 degree s-1, after 'hold short' conditioning thresholds were lower for movements into extension, after 'hold long' conditioning they were lower for movements into flexion. It is concluded that when muscle conditioning introduces slack in the intrafusal fibres of muscle spindles, this must be taken up by the test movements before they can be detected by the subject. It means that whenever detection thresholds to passive movements are measured at a joint, the contraction history of the muscles acting at that joint must be taken into account.     

Persistence of quinalphos and occurrence of its primary metabolite in soils

PURPOSE: This study focuses on the quantification of genetic and environmental factors in arm strength after high-resistance strength training. METHODS: Male monozygotic (MZ, N = 25) and dizygotic (DZ, N = 16) twins (22.4 +/- 3.7 yr) participated in a 10-wk resistance training program for the elbow flexors. The evidence for genotype*training interaction, or association of interindividual differences in training effects with the genotype, was tested by a two-way ANOVA in the MZ twins and using a bivariate model-fitting approach on pre- and post-training phenotypes in MZ and DZ twins. One repetition maximum (1RM), isometric strength, and concentric and eccentric moments in 110 degree arm flexion at velocities of 30 degrees x s(-1), 60 degrees x s(-1), and 12 degrees x s(-1) were evaluated as well as arm muscle cross-sectional area (MCSA). RESULTS: Results indicated significant positive training effects for all measures except for maximal eccentric moments. Evidence for genotype*training interaction was found for 1RM and isometric strength, with MZ intra-pair correlations of 0.46 and 0.30, respectively. Bivariate model-fitting indicated that about 20% of the variation in post-training 1RM, isometric strength, and concentric moment at 120 degrees x s(-1) was explained by training-specific genetic factors that were independent from genetic factors that explained variation in the pretraining phenotype (30-77%). CONCLUSIONS: Genetic correlations between measures of pre- and post-training strength were indicative for high pleiotropic gene action and minor activation of training-specific genes during training.     

One view of the Japanese work ethic

Elbow joint disorders were studied in relation to vibration exposure and age in 74 male stone quarry workers who operated mainly chipping hammers and sometimes rock drills. They were examined for range of active motion in elbow extension and flexion, and by means of radiographs of the elbow joint. Effects of age and vibratory tool operation on the elbow joint were statistically estimated using multiple regression analysis. In the analysis of all subjects, including those aged over 60 years, age was significantly related to the range of motion in extension and to radiographic changes in both elbows, and the duration of vibratory tool operation was associated with the range of right elbow flexion. Among subjects under the age of 60 years, duration of vibratory tool operation showed a significant dose-effect relationship to the range of flexion and radiographic changes in the right elbow, but there was no significant relationship with age. The present results suggest that the operation of chipping hammers and rock drills contributes to elbow joint disorders or osteoarthrosis, even when the effect of age is taken into account. Besides vibration exposure, it may be necessary to consider various loads on the elbow joint such as firmly grasping and pressing the tool against stones with the arm bent at about 90 degrees, and carrying stones.