Work-related musculoskeletal symptoms among sheet metal workers

We report results of two pilot studies of the relationship between musculoskeletal disorders and work tasks in sheet metal workers. These two studies were undertaken as pilot investigations to determine if symptoms of carpal tunnel syndrome or other work-related musculoskeletal symptoms are present in sheet metal workers, and to determine if we could begin to identify the factors in sheet metal work that cause them. In the first study, telephone interviews were conducted with 18 disabled sheet metal workers; the second survey entailed self-administered questionnaires completed by 47 active and retired sheet metal workers. Among the disabled workers, rotator cuff cases reported the greatest percent of time spent hanging duct, an overhead task commonly carried out during field work. Carpal tunnel cases reported more hand tool use than the rotator cuff cases. The questionnaire survey of active and retired workers found the proportion of time spent in a sheet metal shop (contrasted with field work) to be positively associated with hand symptoms; sheet metal workers who spent at least 65% of their time in the shop had an odds ratio of 3.4 for symptomatic hand cumulative trauma disorder (CTD) (p = 0.12). The proportion of time spent hanging duct was positively associated with both neck and shoulder symptoms, with odds ratios of 7.9 (p = 0.08) and 2.7 (p = 0.16), respectively. The results show that symptoms of neck, arm, and hand pain are common in sheet metal workers who are actively working, that carpal tunnel syndrome or hand pain is positively associated with more time spent working in the shop, and that shoulder pain or shoulder injuries is associated with work overhead (hanging duct). Ergonomic risks and cumulative trauma disorders have not been well characterized in the construction industry; these data strongly suggest that a subset of work tasks in construction increase the risk of cumulative trauma disorders.     

The Economic and Social Consequences of Work-related Musculoskeletal Disorders: The Connecticut Upper-extremity Surveillance Project (CUSP)

Abstract

A population-based telephone survey was conducted in Connecticut to determine the social and economic impact of work-related musculoskeletal disorders (WRMSDs). Only 10.6% of cases had filed for workers' compensation. Respondents had spent an average of 489 annually out-of-pocket. Only 21% of individuals who had had medical visitsor procedures reported having them paid for by workers' compensation. The WRMSDcases reported much higher levels of difficulty in daily tasks rated by the activities of daily living (ADL) scale, with odds ratios (ORs) ranging from 8.2 (child care) to 35.2 (bathing). The cases were significantly more likely to have moved for financial reasons (OR = 2.41), including having lost a home (OR = 3.44). The caseswere also significantly more likely to have lost a car due to finances (OR = 2.45), more likely to have been divorced (OR = 1.91), and less likely to have been promoted (OR = 0.45). The study supports significant externalization of costs for WRMSD out of the workers' compensation system and a substantial social and economic impact on workers.     

Development of a Physical Examination for a Company-Based Management Program for Work-Related Upper Extremity Cumulative Trauma Disorders

The purpose of this project was to develop a streamlined upper extremity examination to be used in a company-based upper extremity CTD management program. Thirty-six symptomatic employees were examined by an occupational health nurse and categorized into those requiring further medical evaluation or those appropriate for conservative management. Backward logistic regression showed that the Appearance and Symmetry (AS) and the Neurological and Special Tests (NST) sections of the examination together explained 86.1% (p = 0.002) of the nurses categorical decisions. Based on these preliminary development data, a short screening examination was proposed.     

Upper extremity symptoms in supermarket workers.

Upper extremity symptoms in supermarket workers, particularly those who performed checking using laser scanners, were evaluated using a questionnaire administered by trained interviewers to 124 supermarket workers. Summary indices of exposure (short-term and long-term) as well as indices of past personal illnesses and personal activities were employed. Outcome data were summarized by four composite symptom indices. Chi square and logistic regression analyses demonstrated that hours of checking work in the preceding 2 weeks and cumulative weighted years of work were associated with adverse upper extremity symptoms. Symptoms involved both the proximal and distal parts of the upper extremities.     

Cumulative trauma disorders: An overview of the problem

Cumulative trauma disorders—which result from highly-repetitive job activities, sustained loads, and exposure to vibratory forces—are rapidly spreading through the industrialized world. As their prevalence increases, so do the economic and social consequences. This paper provides an overview of the problem to illustrate the fact that addressing the rising incidence of CTDs requires a multidisciplinary approach involving research and programmatic efforts directed on many fronts, most notably medicine, engineering, management, occupational health, and government. After a review of the diagnosis and treatment of cumulative trauma disorders is presented, the importance of ergonomic analysis for identifying workers at risk is discussed. Some prevention strategies currently being implemented in workplaces around the country are also described. Finally, we raise important industry and public policy issues which need to be confronted if the incidence of CTDs is to be reduced and costs of the workers' compensation system contained.     

Musculoskeletal symptoms among truck assembly workers

BACKGROUND: Concerns were raised about the possibility of a high prevalence of musculoskeletal symptoms in a truck assembly plant. AIM: The aim of this study was to investigate the prevalence of musculoskeletal symptoms in a group of truck assembly workers. METHOD: A cross-sectional study of 461 truck assembly workers was carried out using a modified version of the Nordic questionnaire and the General Health Questionnaire (GHQ12). Employees were further subdivided into three distinct occupational subgroups: skilled line workers (252), bench subassembly workers (108) and material handlers (101). Responses were analysed according to occupational subgroup. RESULTS: Seventy per cent of 461 truck assembly workers responded to the questionnaires. Seventy-nine per cent of respondents had been troubled with musculoskeletal symptoms in the last 12 months. The commonest musculoskeletal symptoms were from the lower back (65%), neck (60%) and shoulders (57%). Musculoskeletal symptoms were related to age, length of service, occupational subgroup and GHQ12 score. CONCLUSION: There was a high reported prevalence of musculoskeletal symptoms in this group of truck assembly workers, with a differing pattern of symptom reporting depending on occupational subgroup. Risk reduction recommendations were made to the site management. A further study investigating the relationship between symptoms and specific hazards is planned.     

Relations between upper limb soft tissue disorders and repetitive movements at work

To make a preliminary assessment of whether upper limb soft tissue disorders might be associated with activities at work, we have conducted a case-control study of subjects attending orthopedic clinics in three cities. All subjects between the ages of 16 and 65 years, in whom defined soft tissue conditions of the upper limb were diagnosed by the participating orthopedic surgeons, were invited to take part. Controls were subjects attending the same clinics within the same age range whose clinical diagnosis did not include disease of the upper limb, cervical or thoracic spine. Information concerning repetitive movements of the upper limbs at work was elicited by questionnaire. Five hundred eighty cases and 996 controls were studied, representing 96% and 93%, respectively, of those invited to participate. The diagnoses of the cases included soft tissue conditions affecting the shoulder, elbow, forearm, wrist, thumb, hand, and fingers. The diagnoses of the controls included traumatic, degenerative, and inflammatory conditions, mostly of the legs and lower back. Women predominated among the cases (70%) and men among the controls (56%). Of 221 female cases with injury to the wrist and forearm, 32 were cleaner/domestics (14.5%) compared to 35 of 439 controls (8%), a difference statistically significant at the 2 1/2% level. Other jobs significantly overrepresented (5% level) among female cases with injuries at various anatomical sites included hairdressers, secretary/temps, assembly line workers, and machine operators (type unspecified). Among male cases, electricians were significantly overrepresented (5% level). Jobs for which there was a suggestion (p < 0.1) of overrepresentation among cases included butchers and teacher/ lecturers (both males only) and the combined job groups (chosen a priori for analysis) of keyboard operators, machine operators, and music teachers (all three jobs, females only).     

Work-related musculoskeletal disorders: Comparison of data sources for surveillance

Work-related upper extremity musculoskeletal disorders “associated with repeated trauma” account for more than 60% of all newly reported occupational illness, 332,000 in 1994 according to the U.S. Department of Labor. These numbers do not include, for example, those disorders categorized as “injuries due to overexertion in lifting,” approximately 370,000. Early identification of potential disorders and associated risk factors is needed to reduce these disorders. There are a number of possible methods for conducting surveillance for work-related musculoskeletal disorders (WMDs) based on health outcome: workers' compensation, sickness and accident insurance, OSHA 200 logs, plant medical records, self-administered questionnaires, professional interviews, and physical examinations. In addition, hazard surveillance based on evaluation of job exposures to physical stressors by nonoccupational health personnel is possible. As part of a large labor-management-initiated intervention study to reduce the incidence of WMDs in four automotive plants, we were able to compare the strengths and limitations of each of these surveillance tools. University administered health interviews yielded the highest rate of symptoms; combined physical examinations plus interview (point prevalence) rates were similar to self-administered questionnaires (period prevalence) rates. Plant medical records yielded the lowest rate of WMDs. WMD status on self-administered questionnaire and on physical examination were associated with risk factor exposure scores. This study suggests that symptoms questionnaires associated with risk factor exposure scores. This study suggests that symptoms questionnaires and checklist-based hazard surveillance are feasible within the context of joint labor-management ergonomics programs and are more sensitive indicators of ergonomic problems than pre-existing data sources. Am. J. Ind. Med. 31:600–608, 1997. © 1997 Wiley-Liss, Inc.     

Musculoskeletal symptoms and associated risk factors among African hair braiders

African hair braiders are potentially subject to work-related musculoskeletal disorders (WMSDs) because they perform repetitive hand motions for many hours a day together with prolonged standing and/or prolonged sitting. A complete enumeration of African hair braiders was attempted in Oklahoma City (OKC) and Dallas/Fort Worth (DFW). Braiders were identified through the channels they typically use to offer services to clients. Potential risk factors and symptoms of WMSDs were assessed using an oral interview. Participation rates were 95% (18/19) in OKC and 83% (83/101) in DFW. More than 75% of braiders reported discomfort in the fingers, wrist/hand, upper back, and lower back. In multivariate analysis, years worked as a braider but not age was a significant risk factor (p < 0.005) for reported pain in the wrist/hand, time spent sitting during the work day was found to be a significant predictor (p < 0.05) of upper back pain and lower back pain, and time spent sitting and time spent standing during the work day were both significant predictors (p < 0.05) of shoulder pain. Braiders in OKC, where licensing requirements were stricter, were significantly more likely than braiders in DFW to work at home (67% vs. 4%, p < 0.001) and to report pain in the lower leg (p < 0.005) and ankle/foot (p < 0.05). The close-knit nature of the African hair braiding community makes it an appealing candidate for community-based participatory research aimed at further elucidating occupational health concerns and reducing risk.     

Prevalence and Work-Relatedness of Self-Reported Carpal Tunnel Syndrome Among U.S. Workers: Analysis of the Occupational Health Supplement Data of 1988 National Health Interview Survey

To estimate the prevalence and work-relatedness of self-reported carpal tunnel syndrome (CTS) among U.S. workers, data from the Occupational Health Supplement of 1988 National Health Interview Survey (NHIS) were analyzed. Among 127 million “recent workers” who worked during the 12 months prior to the survey, 1.47% (95% CI: 1.30; 1.65), or 1.87 million self-reported CTS, and 0.53% (95% CI: 0.42; 0.65), or 675,000, stated that their prolonged hand discomfort was called CTS by a medical person. Occupations with the highest prevalence of self-reported CTS were mail service, health care, construction, and assembly and fabrication. Industries with the highest prevalence were food products, repair services, transportation, and construction. The risk factor most strongly associated with medically called CTS was exposure to repetitive bending/ twisting of the hands/wrists at work (OR = 5.2), followed by race (OR = 4.2; whites higher than nonwhites), gender (OR = 2.2; females higher than males), use of vibrating hand tools (OR = 1.8), and age (OR = 1.03; risk increasing per year). This result is consistent with previous reports in that repeated bending/twisting of the hands and wrists during manual work is etiologically related to occupational carpal tunnel syndrome.     

Predictors of Persistent Elbow Tendonitis Among Auto Assembly Workers

INTRODUCTION: Lateral and medial epicondylitis associated with work activity is a common upper extremity musculoskeletal disorder with a prevalence of 4-30% depending upon the work setting and diagnostic criteria. The influence of treatment, ergonomic factors, medical history, psychosocial variables, and aging on the improvement of symptoms has not been well defined. METHODS: This was a prospective cohort study of a cohort of 45 workers with active elbow tendonitis for an average of 13 months. Complete resolution of symptoms was the defined outcome measure. RESULTS: The predictive factors for persistent elbow tendonitis included older age (OR = 1.1, 95% CI: 0.99, 1.33), higher hand repetition level for their job(s) (OR = 2.5, 95% CI: 1.00, 6.25), more deviation from a neutral wrist position during the work activity (OR = 2.0, 95% CI: 0.80, 5.56), and lower perceived decision authority on the job (OR = 0.9, 95% CI: 0.79, 0.98). Other ergonomic, psychosocial, and electrophysiologic measures were not predictive. The models had relatively high sensitivity and specificity. Treatment effects could not be evaluated due to incomplete data available. CONCLUSIONS: Older workers with jobs requiring more repetition and awkward wrist postures, and less decision authority were less likely to have resolution of their elbow tendonitis. IMPLICATIONS: Workers at highest risk for persistent elbow tendonitis should be placed at jobs with lower repetition levels and that use more neutral wrist postures. Effective interventions must address both the ergonomic and psychosocial risk factors in a multifaceted approach to this problem.     

Computerized exercise program does not affect stress levels of asymptomatic VDT users

The purpose of this study was to determine whether a computerized exercise program could reduce stress levels in office workers who use video display terminals (VDTs). Fifty workers were randomly assigned to either an exercise or a control group. Twenty-four subjects were instructed to exercise twice a day for 15 minutes per session for a period of 8 weeks; the remaining 26 subjects in the control group were given no exercise program. Four dimensions of stress were measured before and after the exercise period using the Personal Strain Questionnaire (PSQ), a self-reported measure of physical and psychological stress. A multivariate T-test (Hotelling’s T ² ) was used to compare changes in stress levels between the two groups of workers, but no significant differences were found. Further analysis of the exercise group revealed that difference in compliance rates among workers did not significantly influence changes in stress levels. These results indicate that this type of exercise program does not reduce stress in asymptomatic VDT users.     

A Longitudinal Study of Industrial and Clerical Workers: Predictors of Upper Extremity Tendonitis

Upper extremity tendonitis (UET) associated with work activity is common but the true incidence and risk factors can best be determined by a prospective cohort study. This study followed a cohort of 501 active workers for an average of 5.4 years. Incident cases were defined as workers who were asymptomatic at baseline testing and had no prior history of UET and went on to be diagnosed with an UET during the follow-up period or at the follow-up evaluation. The incident cases were compared to the subset of the cohort who also had no history of an UET and did not develop tendonitis during the study. The cumulative incidence in this cohort was 24.3% or 4.5% annually. The factors found to have the highest predictive value for identifying a person who is likely to develop an UET in the near future included age over 40, a BMI over 30, a complaint at baseline of a shoulder or neck discomfort, a history of CTS and a job with a higher shoulder posture rating. The risk profile identifies both ergonomic and personal health factors as risks and both categories of factors may be amenable to prevention strategies.     

Effect of MSDs and scope of ergonomic interventions among rubber processing workers: a systematic review

Background:The rubber processing workers experience various types of musculoskeletal disorders (MSDs) due to awkward postures, repetitive movements, and manual loads etc. Research on MSDs and ergonomic interventions in this area is limited. Therefore, the present systematic review aims to (i) identify various operations done by rubber processing workers and their associated MSDs, (ii) explore the ergonomic intervention and post-intervention study and its impact among the workers, (iii) identify the research gaps in MSDs and ergonomic interventions through bibliometric analysis.Methods:Comprehensive electronic searches were conducted in Web of Science, ScienceDirect and PubMed for the search term “Ergonomics” or “Musculoskeletal disorder” and “Rubber” for the article published before 2020. Eleven papers were identified for the review of MSDs and ergonomic interventions; data were extracted to summarize sample size, data collection methods, analyzing tools, various operations, MSDs, and ergonomic interventions.Results:The reviewed article is classified according to various operations such as rubber tapping, latex collection, rubber sheeting and sheet pressing. The review reveals that most of the workers experience lower back pain, which involved a traditional way of operating. Every author is trying to recommend some interventions, but post-intervention studies are limited.Conclusions:Due to the limited post-intervention study, there is a scope of ergonomic interventions in every operation. So, the implementation of a proper ergonomic tool with adequate awareness improves the MSDs among the rubber processing workers. The review will help to identify the various intervention gaps in different operations associated with rubber farming.     

Workplace surveillance for carpal tunnel syndrome: A comparison of methods

A variety of screening procedures for carpal tunnel syndrome (CTS) were applied among workers in a manufacturing plant, and results were compared. The test procedures included a symptom survey, physical examination, limited electrodiagnostic testing at the wrists, quantitative vibratory threshold testing, 2-point discrimination, palmar pinch grip, and hand grip strength testing. When electrodiagnostic testing alone was used as gold standard, the sensitivity and positive predictive value (PPV) of physical examination findings and quantitative test procedures were no better than, and usually worse than, the results on the symptom survey alone. Variation of the constellation of symptoms (i.e., numbness, tingling, pain or burning) and the anatomic distribution of reported symptoms (i.e., fingers, hand, wrist, or forearm) for inclusion in the screening symptom definition of CTS yielded modest changes in the sensitivity and PPV of the symptom survey. However, addition of the requirement for nocturnal symptoms as part of the screening symptom definition for CTS resulted in substantially higher PPV with only slight reduction in sensitivity. These results suggest that, in the absence of electrodiagnostic testing, the simplest test, and the procedure with the highest sensitivity and PPV for CTS is a symptom survey alone. Quantitative test procedures (vibrometry, pinch grip strength, hand grip strength) and physical examination for findings consistent with CTS (e.g., Phalen's test, Tinel's test, thenar muscle wasting, 2-point discrimination) appear to contribute little, if any, additional information when screening subjects in the work setting.     

Occupational upper extremity conditions: a detailed analysis of work-related outcomes

While work-related upper extremity conditions (WRUECs) cause almost 25% of lost time cases in the US, little is known about their long-term occupational consequences. A self-report survey was mailed to New Hampshire workers reporting a WRUEC one year prior to the study. Of the 72 (52%) valid respondents, 60% had lost 1 week of work and 90% had returned to work. Almost 70% reported acute injury onset, and 26% had experienced a recurrence of their WRUEC. Both gradual-onset injuries and recurrences had worse outcomes. Recurrence was related to shorter job tenure, lower job satisfaction, and less satisfaction with medical care and insurer responses. Results imply that a single measure is insufficient to assess occupational outcomes subsequent to a WRUEC. The importance of secondary prevention was highlighted. There is a need for focus on gradual-onset injuries, as well as those acute-onset injuries with risk for recurrence.     

采油工人健康状况和工作有关肌肉骨骼疾患的现况调查

目的调查采油工人健康状况和工作有关肌肉骨骼疾患(work-related musculoskeletal disorders,WMSDs)的患病情况。方法采用自填式调查表方法,对某采油厂工人的健康状况和WMSDs患病情况进行调查和分析。结果采油工人健康状况较好,因病就诊和缺勤较少见,常见疾患为肌肉骨骼疾患、高血压(病)和胃病,吸烟和锻炼与自评健康状况明显相关(P<0.05)。采油工人WMSDs的高发部位前3位是腰、颈和肩部,女性工人的颈肩疾患显著高于男性,髋(臀)和膝WMSDs年患病率随着年龄增长而增加,不同工种之间的膝WMSDs年患病率的差异有统计学意义(P<0.05)。结论采油工人健康状况较好,WMSDs对工人的危害较为常见,应深入探讨工人的健康影响因素,加强工人安全防护和疾病预防措施。