Dr Subhashis BasuMBChB, BMedSci, MA, MPH, MRCP, DOccMed

Specialist Registrar

Work-Related Musculoskeletal Disorders

Introduction

Common ConditionsErgonomics Case Studies

Mechanical“Tension Neck”

Second most common (after back pain)Chronic (>6months) in 10-17% population

Whiplash…..Relationship with X-ray changes unclear

Don’t miss the RED FLAGSYELLOW FLAGS?

Why is occupational neck pain on the increase???

Thoracic Outlet Syndrome

Rare

Can manifest as:

Sensory – Pain and Tingling

Musculoskeletal –Wasting of Hands

Vascular - +veAdson’s Test

Shoulder – Rotator Cuff Tendinitis TestsEmpty/Full Can (Jobe’s) – Elevate extended arm against resistance

Specific tests for SSIT muscles

- Do you know any?

Frozen Shoulder (Adhesive Capsulitis)

2:1 Women to Men

Unknown Cause

At Risk Groups – Diabetic, Thyroid, Adrenal Insufficiency, Parkinsons

Equal Restriction of Active and Passive Movements in Capsular Patterns (Ext Rot> Abduction> Internal Rotation

BICIPITAL TENDONITIS

HAWKINS-KENNEDY TEST FOR SUBACROMIAL IMPINGEMENT

Elbows, Wrist and Hand

Medial & Lateral EpicondylitisOlecranon Bursitis

Medial (Common Flexor Tendon)Pain against resisted flexion of the wrist “MF”

Lateral (Common Extensor Tendon) “LE”Pain against resisted extension of the wrist

Repetitive bending and straightening of elbow

Consider olecranon bursitis in people that lean on their elbows (students, DSE, miners)

Carpal Tunnel SyndromeWomen> Men

Pain/Tingling/Numbness in Median Distribution

Risk Factors -Pregnancy Obesity Endocrine Disease COCP/HRT

Prevalent in occupations with repetitive wrist movements/ forceful wrist movements, adverse wrist postures (DSE)

TINEL’s and PHALEN’s SIGNS (Durkan’s)

Tenosynovitis

Local Tenderness & Swelling

Pain on Resisted Movements

Women > Men

Manual Workers

DeQuervain’s Tenosynovitis (Wrist)

Local Tenderness & Swelling of Tendon Sheaths

For Wrist, Common Flexor Tendon to Thumb (Extensor Pol Brevis & Abductor Poll Longus)

Pain on Resisted Movements

Women > Men

Manual Workers, Rowers for Wrist

Trigger Finger and Depuytren’s

Inflammation and hypertrophy of the retinacular sheath progressively restricts the motion of the flexor tendon

Tissue between the skin and the tendons known as the fascia becomes thickened due to a proliferation of collagen. Nodules or cords are formed and the elasticity of the fascia is reduced

Hand – Arm Vibration Syndrome

Need to be exposed to sufficient vibration

Vascular HAVS – BlanchingSensorineural HAVS – Pain Numbness Tingling of the Fingers

Musculoskeletal – Wasting, Dexterity

Usually asymmetrical (c.f. Raynaud’s)Vibration can cause CTS

Both eligible for State Benefit

Back Pain

Mechanical

Neurological

OR

Genuine or Malingering?

Biomechanics

VERSUS

Case Studies