CUMMULATIVE DISORDERS OF UPPER EXTIMITY DR HABIBOLLAHI

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1 CUMMULATIVE DISORDERS OF UPPER EXTIMITY DR HABIBOLLAHI

2 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)

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

4 Number of Claims Cost of Claims All other claims WMSDs 26% All other claims 74% 60% WMSDs 40%

5 ERGONOMICS WMSDs are sometimes referred to using other unfamiliar terms such as : 1. Cumulative Trauma Disorders CTD 2. Repetitive Trauma Disorders RTD 3. Repetitive Strain Injuries RSI 4. Repeated Motion Disorders RMD 5. Overuse Syndromes

6 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

7 ERGONOMICS What Are Examples of WMSDs? 1. Sprain Overstretching or overexertion of a ligament that results in a tear or rupture of the ligament 2. Strain Overstretching or overexertion of a muscle or tendon 3. Tendonitis Inflammation of the tendon inside the sheath h 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

8 ERGONOMICS What 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

9 ERGONOMICS Signs 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

10 INCREASED RISK FACTORS

11 Look for These Indicators: Caution Zone Awkward Postures High Hand Force Highly g yrepetitive Motion Repeated Impact Heavy, y Frequent or Awkward Lifting Moderate to High Hand-Arm Vibration

12 Awkward Postures Being in these work positions for more than 2 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

13 Working with the Hands Above Head For more than 2 hours per day

14 Working with the Elbows Above Shoulders For more than 2 hours per day

15 Neck or Back Bent Forward More than 30º For more than 2 hours per day

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

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

18 Squatting For more than 2 hours per day

19 Kneeling For more than 2 hours per day

20 High Hand Force More than 2 hours per day of: Pinching 2 or more pounds weight or 4 or more pounds force

21 High Hand Force More than 2 hours per day of: Gripping 10 or Gripping 10 or more pounds weight or force

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

23 Highly Repetitive Motion Intensive keying for more than 4 hours per day

24 Repeated Impact Using hands or knees as a hammer more than 10 times per hour more than 2 hours per day

25 Repeated Impact Using hands or knees as a hammer more than 10 times per hour more than 2 hours per day

26 Heavy, Frequent, or Awkward Lifting i 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

27 Heavy, Frequent, or Awkward Lifting

28 Heavy, Frequent, or Awkward Lifting

29 Moderate to High Hand-Arm Vibration Moderate Level more than 2 hours/day

30 Moderate to High Hand-Arm Vibration High Level g More than 30 Min/day

31 Awkward Postures Shoulders: Hands above Head Elbows above shoulders For More Than 4 hrs/day

32 Awkward Postures Shoulders Repetitive : raising ii >once/minute For More Than 4 hrs/day

33 Awkward Positions Neck Bent >45 without support or ability to vary posture More than 4 hrs/day

34 Back Awkward Positions Bent forward >30 Without support or ability to vary posture More than 4 hrs/day Bent forward >45 Without support or ability to vary posture More than 2 hrs/day

35 Awkward Positions Knees - Squatting More than 4 hrs/day

36 Awkward Positions Knees -kneeling More than 4 hrs/day

37 Arms, Wrists, Hands Pinching gunsupported object 2 or more pounds/hand Or High Hand Force Pinching with force of 4 or more pounds/hand (1/2 ream of paper) + Highly repetitive motion More than 3 hrs/day

38 Arms, A Wrists, Hands High Hand Force Pinching unsupported object 2 or more pounds/hand Or Pinching with force of 4 or more pounds/hand (1/2 ream of paper) + Wrists bent in flexion 30 or more, or in extension 45 or more, or in ulnar deviation 30 or more More than 3 hrs/day

39 Arms, Wrists, Hands Pinching unsupported object 2 or more pounds/hand Or High Hand Force Pinching with force of 4 or more pounds/hand (1/2 ream of paper) + No other risk factors More than 4 hrs/day

40 Arms, Wrists, Hands High Hand Force Gripping an unsupported object 10 lbs or > per hand Or Gripping with force of 10 lbs or > per hand (clamping light duty jumper cables onto battery) + Highly repetitive motion More than 3 hrs/day

41 High Hand Force Arms, Wrists, Hands Gripping Gi i an unsupported td object 10 lbs or > per hand Or Gripping with force of 10 lbs or > per hand (clamping light duty jumper cables onto battery) + Wrists bent in flexion 30 or more, or in extension 45 or more, or in ulnar deviation 30 or more More than 3 hrs/day

42 High Hand Force Arms, Wrists, Hands Gripping an unsupported object 10 lbs or > per hand Or Gripping with force of 10 lbs or > per hand (clamping light duty jumper cables onto battery) + No other Risk Factors More than 4 hrs/day

43 Wrists Bent Extension Ulnar Deviation Flexion

44 Tendonitis Risk Factors Repetition Forceful exertion Awkward / sustained postures Mechanical Stress

45 Awkward / Sustained Postures Neutral posture is the goal Built-up handles Avoid wrist deviation flexion / extension radial/ulnar deviation

46 Mechanical Stress

47 Highly Repetitive Motion Neck, Shoulders, Elbows, Wrists, Hands Same motion every few seconds with little variation + (Except Keying) -No Other Risk Factors More than 6 hrs/day

48 Highly Repetitive Motion Neck, Shoulders, Elbows, Wrists, Hands Same motion every few seconds with little variation + (Except Keying) -Wrists bent in flexion 30 or more, or in extension 45 or more, or in ulnar deviation 30 or more AND High, forceful exertions with the hands More than 2 hrs/day

49 Highly Repetitive Motion Intensive Keying Awkward posture, including wrists bent in flexion 30 or more, or in extenson 45 or more, or in ulnar deviation 30 or more More than 4 hrs/day

50 Highly Repetitive Motion Intensive Keying No Other Factors More than 7 hrs/day

51 Repeated Impact Hands Using Hand (heel/base of palm) as a Hammer more than once per minute More than 2 hrs /day

52 Repeated Impact Knees Using Knee as Hammer more than once per minute More than 2 hrs /day

53 Upper Extremity Disorders Carpel tunnel syndrome Cubital tunnel syndrome Thoracic outlet syndrome Raynaud s syndrome (white finger) Rotator t cuff syndrome DeQuervain s disease Tendinitis Tenosynovitis Trigger finger Ganglion cyst

54 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

55 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

56 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

57 Tendinitis

58 Hand and Wrist

59 Common Occupational CTDs of the Upper Extremities i 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

60 Carpal Tunnel Syndrome CARPAL LIGAMENT BONES TENDONS MEDIAN NERVE

61

62 Carpal Tunnel Syndrome

63 Common Occupational CTDs of the Upper Extremities i 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.

64 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

65 Common Occupational CTDs of 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 i from pressure near the elbows. Symptoms include: pain in the ring and little fingers tingling in these areas numbness in these areas

66 Cubital Tunnel Syndrome

67 Common Occupational CTDs of 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

68 Thoracic Outlet Syndrome

69 Common Occupational CTDs of the Upper Extremities i 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.

70

71 Rotator Cuff Syndrome Anterior View Posterior View

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

73 Common Occupational CTDs of the Upper Extremities i 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

74 Tendinitis

75 Common Occupational CTDs of the Upper Extremities i 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

76 Tenosynovitis

77 Common Occupational CTDs of 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.

78 Trigger Finger

79 Common Occupational CTDs of the Upper Extremities Ganglion Cyst tis a bump under the skin caused by an accumulation of fluid within the tendon sheath. It is commonly found at the hand and wrist.

80 Ganglion Cyst

81 Common Occupational CTDs of the Upper Extremities 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: Symptoms include: swelling pain at the base of the thumb.

82 De Quervain s Disease

83 De Quervain s Disease

84

85

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