Search results

1

The impact of electronic gaming on upper limb neuropathies among esports athletes

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Basuodan R. M., Aljebreen A. W., Sobih H. A., Majrashi K. A., Almutairi N. H., Alhaqbani S. S., Alanazy M. H.

Medycyna Pracy

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2023

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vol. 74

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issue 4

279-287

EN

Background The authors aimed to explore carpal tunnel syndrome (CTS) among electronic sports (esports) athletes, to compare hand symptoms and their severity between esports athletes and the control group and within the esports athletes, and to study the relationship between esports athletes’ variables. Material and Methods A cross-sectional survey study via telephone with systematic randomized approach was used for esport athletes sampling. Control group were non-esports athletes who do not use computer for prolonged duration. The survey consisted of sports athletes’ characteristics, hand symptoms and functions, and the Boston Carpal Tunnel Questionnaire (BCTQ). The unpaired student’s t-test, Mann-Whitney U test, and χ2 test were utilised for statistical comparison, with p < 0.05. Pearson’s and Spearman’s correlation coefficient tests were used for relationship analyses. Results Eligible participants were 198 out of 229. Compared to control group, esport athletes reported more CTS (p = 0.01), and radiated pain and numbness in their hands (p = 0.05). Males complained of hand symptoms (p < 0.01) and its radiation (p < 0.01) more than females among esports athletes. Higher BCTQ Symptom Severity Scale (BCTQ-SSS) scores were reported for esports athletes who had been playing esports for prolonged periods compared to those who had playing recently (p = 0.003), with a moderate positive correlation (+0.59, p = 0.004). A significant moderate positive correlation was reported for BCTQ Functional Severity Symptoms (BCTQ-FSS) scores in terms of hours of playing (+0.44, p = 0.04). Esports athletes who used armrests and a PC with a controller for gaming reported less hand symptoms and had milder BCTQ scores than those who used a PC with a keyboard/mouse. Generally, esports athletes spend 5–10 h/day on gaming. Conclusions Esports athletes might be at risk of developing upper-extremity nerve compression and CTS. Prolonged playing, hours of playing, type of esports device, and using armrests are possible risk factors.

2

Personal and occupational risk factors for carpal tunnel syndrome in meat processing industry workers in Northern Italy

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Riccò M., Signorelli C.

Medycyna Pracy

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2017

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vol. 68

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issue 2

199-209

EN

Background Carpal tunnel syndrome (CTS) is a musculoskeletal condition that often impairs the fitness to work. Our aim is to retrospectively evaluate the association between physical exposures in meat processing industry in Northern Italy and the CTS, taking into account non-occupational factors. Material and Methods A cross-sectional study was performed to include 434 workers (236 males, 198 females, 37.0±10.6 years old, working age: 12.6±10.8 years) from meat processing industries. Signs and symptoms were collected at the compulsory occupational medical surveillance. Occupational risk factors were assessed through a questionnaire and direct assessment by investigators. Adjusted odds ratios (ORadj) for factors of interest were estimated through binary logistic regression. Results Diagnosis of the CTS was reported for 61 out of 434 subjects (14.1%) for an incidence of 11.3/1000 person- years. In general, signs and symptoms for the CTS were associated with the following demographic factors: smoking history (OR = 1.909, 95% confidence interval (CI): 1.107–3.293), previous traumas of the upper limb (OR = 3.533, 95% CI: 1.743–7.165), hypothyroidism status (OR = 7.897, 95% CI: 2.917–21.38) and, in the case of female participants only, previous pregnancies (OR = 2.807, 95% CI: 1.200–6.566) as well as a personal history of oral contraceptive therapy and/or steroidal replacement therapy (OR = 11.57, 95% CI: 4.689–28.56). The carpal tunnel syndrome cases were associated with the following occupational factors (> 4 h/day): forceful hand exertion (ORadj = 3.548, 95% CI: 1.379–9.131), repeated trauma of the hand (ORadj = 3.602, 95% CI: 1.248– 10.395), repeated movements of the wrist (ORadj = 2.561, 95% CI: 1.100–5.960). Conclusions Increasing levels of hand activity and force were associated with the increased CTS prevalence among participants. Recommendations have to be provided in order to reduce occupational exposure to these risk factors and improve medical surveillance. Med Pr 2017;68(2):199–209

3

Postures of upper extremity correlated with carpal tunnel syndrome (CTS)

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Chiang C.-L., Liao C.-Y., Kuo H.-W.

International Journal of Occupational Medicine and Environmental Health

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2017

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vol. 30

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issue 2

281-290

EN

Objectives Non-medical hospital staff members are in frequent contact with patients and therefore are required to perform a wide variety of repetitive and high-frequency activities. The objective of this study was to assess the relationships between upper extremity activity and carpal tunnel syndrome (CTS) among non-medical hospital staff members. Material and Methods Carpal tunnel syndrome in 144 non-medical hospital staff members was diagnosed using the Nordic Musculoskeletal Questionnaire (NMQ), a physician’s diagnosis, physical examination (Tinel’s signs and Phalen test) and a nerve conduction velocity (NCV) test. In addition, an ergonomic assessment was performed and a video camera was used to record the physical activities at work. Results The prevalence rate of CTS was highest for the NMQ (51.9%), followed by physician’s diagnosis (49.5% for the right hand, 29.9% for the left hand), physical examination (54.7%), and nerve conduction test (motor nerve 27.5% and 25%, sensory nerve 21.7% and 15%, for right and left hands, respectively). Based on logistic regression models for the NMQ and physician’s diagnoses, there was a dose-dependently higher risk of CTS with the upper extremity index among participants, but this was non-significant based on the physical examination and nerve conduction tests. Conclusions Nerve conduction velocity is the gold standard in diagnosis of CTS, but use of NMQ and physician’s diagnosis may overestimate the incidence of CTS in workers who have been engaging in repetitive stress activities for a relatively short time. Int J Occup Med Environ Health 2017;30(2):281–290

4

Personal risk factors for carpal tunnel syndrome in female visual display unit workers

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Riccò M., Cattani S., Signorelli C.

International Journal of Occupational Medicine and Environmental Health

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2016

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vol. 29

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issue 6

927-936

EN

Objectives Carpal tunnel syndrome (CTS) is the most common nerve entrapment syndrome, which since the beginning of the seventies has been linked to the keyboard and visual display unit (VDU). The objective of this study was to investigate the prevalence and personal factors associated with CTS in female VDU workers in Italy. Material and Methods Participants in this study were female adult subjects, working ≥ 20 h/week (N = 631, mean age 38.14±7.81 years, mean working age 12.9±7.24 years). Signs and symptoms were collected during compulsory occupational medical surveillance. The binary logistic regression was used to estimate adjusted odds ratios for the factors of interest. Results Diagnosis of CTS was reported in 48 cases (7.6%, 11 of them or 1.7% after a surgical correction) for the incidence of 5.94/1000 person-years. In general, signs and symptoms of CTS were associated with the following demographic factors: previous trauma of upper limb (adjusted odds ratio (ORa) = 8.093, 95% confidence interval (CI): 2.347–27.904), history (> 5 years) of oral contraceptives therapy/hormone replacement therapy (ORa = 3.77, 95% CI: 1.701–8.354) and cervical spine signs/symptoms (ORa = 4.565, 95% CI: 2.281–9.136). Conclusions The prevalence of CTS was similar to the estimates for the general population of Italy. Among personal risk factors, hormone therapy, previous trauma of the upper limb and signs/symptoms of the cervical spine appeared to be associated with a higher risk of CTS syndrome. Eventually, the results reinforce interpretation of CTS in VDU workers as a work-related musculoskeletal disorder rather than a classical occupational disease. Int J Occup Med Environ Health 2016;29(6):927–936

5

Experiences with preventing carpal tunnel syndrome in an automotive plant

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Žídková V., Nakládalová M., Zapletalová J., Nakládal Z., Kollárová H.

International Journal of Occupational Medicine and Environmental Health

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2017

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vol. 30

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issue 1

45-54

EN

Objectives Carpal tunnel syndrome (CTS) is a common occupational disease. The aim was to assess the effect of preventive measures in automotive assembly workers. Material and Methods The analysis summarizes data from annual crosssectional studies. The 7-year analysis of data was based on medical records obtained from an occupational physician and inspections carried out at the workplace where targeted preventive measures were introduced, including better ergonomic arrangement of the workplace, technical adjustments facilitating the work, preventive nerve conduction studies (NCS) testing of the median nerve once a year, switching of workers and their targeted rotation within the workplace. The NCS testing of median nerve conduction at the wrist was the basic objective method for assessment of the prevalence and severity of CTS. Over the study period, the sample comprised 1804 workers at risk for repetitive overuse of the upper extremities, of whom 281 were females with a mean age of 38.5 years and 1523 were males with a mean age of 31.4 years. Results Over the study period, a total of 13 cases of CTS were recognized as an occupational disease in the plant, 8 of which occurred within the first 2 years from the initiation of production. Introduction of preventive measures decreased the prevalence of median neuropathy from 18.3% of examined extremities in 2011 to 10.5% in 2013 (p = 0.003). In early 2014, the production pace increased and this was accompanied by a rise in abnormal NCS findings to 16.9%. Over the study period, the rate of sensorimotor neuropathy decreased in favor of merely sensory neuropathies, which have been most frequent since 2013. The percentage of employees whose contracts were terminated due to median neuropathy decreased steadily from 5.5% to 0.4%. Conclusions Targeted prevention of work-related CTS is effective as evidenced by the decrease in the prevalence of median neuropathy detected by NCS. Int J Occup Med Environ Health 2017;30(1):45–54

6

National survey of health in the tattoo industry: Observational study of 448 French tattooists

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Kluger N.

International Journal of Occupational Medicine and Environmental Health

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2017

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vol. 30

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issue 1

111-120

EN

Objectives The data regarding the health of professional tattooists is inexistent. Tattooists are usually heavily tattooed and exposed daily to body fluids and skin-to-skin contacts with customers, tattoo inks, solvents, allergens, irritants, and work for hours often in inadequate positions using vibrating tattoo machines. We analyzed the health status of active French professional tattooists. Material and Methods An observational self-reported Internet survey was performed among 448 tattooists who were members of the French Tattoo Union in November 2013. Results The main physical complaints were musculoskeletal: back pain (65%), finger pain (41.5%) and muscular pain (28.8%). Finger pain, back pain, muscular pain and carpal tunnel symptoms/tingling sensations on the fingers occurred among 88%, 61.5%, 68% and 84% of the cases after having started their activity (p < 0.001). Other chronic diseases, autoimmune diseases and cancers remained at a low level here. Conclusions Professional tattooists have a high prevalence of musculoskeletal complaints about back pain due to repetitive movements, awkward postures and use of a vibrating tattoo machine. Tattooists have a unique environment that imply developing intervention and preventive strategies for them. Int J Occup Med Environ Health 2017;30(1):111–120

7

Effectiveness of prevention exercises protocol among office workers with symptoms of carpal tunnel syndrome

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Łach P., Cygańska A. K.

International Journal of Occupational Medicine and Environmental Health

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2024

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vol. 37

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issue 1

45-57

EN

Objectives Carpal tunnel syndrome (CTS) is common among office workers and limits functional hand ability and the ability to work. Carpal tunnel syndrome prevention programs implementation are still insufficient among office workers. In view of the fact that physical activity is the best method of preventing musculoskeletal complaints the aim of the study was to evaluate the effectiveness of prevention exercises protocol for hand and wrist pain among office workers. Material and Methods Study group consists form 62 office workers, reporting complaints of hand and wrist pain. Exercise group it was 49 subjects who performed the exercise protocol and the non-exercise group consisted of 13 subjects. An exercises program, consisting of 7 exercises. The program was planned for daily routine during 8 weeks. The effectiveness of the exercise program was assessed by physical parameters (hand grip and pinch grip strength, force of forearm muscles) and questionnaires (Visual Analog Scale pain scale, Carpal Tunnel Syndrome Symptom Severity Scale, and Carpal Tunnel Syndrome Functional Status Scale functional hand assessment questionnaires) were performed. Assessment was performed before and after the intervention. Results Statistical analysis of the data showed significant changes in the value of measured hand grip of the right hand (Z = –2.85, p < 0.01). For pinch grip, changes were significant for both the right (Z = –2.12, p < 0.05) and the left hands (Z = –2.35, p < 0.05). Functional performance improved significantly in bought groups. There was no statistically significant change in the intensity of experienced pain. Conclusions The results of the study indicate that performing a preventive exercise program regularly has an effect on increasing forearm muscle strength in a group of office workers. Office workers with symptoms of CTS who exercised regularly had higher results in hand grip and pincer grip strength. Exercises do not affect the level of pain complaints, which may indicate a more complex etiology of pain perception in this study group.

8

Is ulnar nerve entrapment at wrist frequent among patients with carpal tunnel syndrome occupationally exposed to monotype wrist movements?

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Lewańska M., Walusiak-Skorupa J.

International Journal of Occupational Medicine and Environmental Health

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2016

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vol. 30

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issue 6

861-874

EN

Objectives Association between carpal tunnel syndrome (CTS) and ulnar nerve entrapment at wrist remains controversial. The aim of the study has been to investigate the prevalence of Guyon’s canal syndrome amongst patients diagnosed with the CTS, occupationally exposed to repetitive wrist movements. Material and Methods The retrospective analysis of 310 patients (268 females, 42 males) representing the mean age of 52±7 years old hospitalized for the suspected occupational CTS was performed. Results In the analyzed cohort, 4 patients had undergone decompression of the Guyon’s canal in the right limbs. Nerve conduction studies (NCS) in the ulnar nerves performed during the hospitalization of those patients did not show any abnormalities. Nerve conduction studies revealed signs of the ulnar neuropathy (UN) at the wrist affecting exclusively sensory fibers for 6 patients. Only those 4 patients who had undergone the operation suffered from clinical symptoms of the UN before the surgery. In the case of the remaining patients, despite the NCS changes, signs suggestive of the UN at the wrist were not detected. In the case of the patients with the occupational CTS, no signs of the ulnar nerve dysfunction were recorded. Conclusions The frequency of ulnar nerve entrapment at the wrist among patients with the CTS is lower than that already reported. The low prevalence of ulnar involvement (3.2%) for the CTS patients in our study may be related to the relatively small number of the CTS hands with the severe changes in the NCS and/or other personal factor including anatomical variation of the Guyon’s canal borders and its contents. Int J Occup Med Environ Health 2017;30(6):861–874

9

Assessment of manual dysfunction in occupationally active women with carpal tunnel syndrome

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Wolny T., Linek P., Saulicz E.

International Journal of Occupational Medicine and Environmental Health

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2019

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vol. 32

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issue 2

185-196

EN

Objectives The aim of this study is to evaluate 2-point discrimination sense (2PD), strength and kinesthetic differentiation of strength (KDS), range of motion (ROM) and kinesthetic differentiation of movement (KDM) dysfunctions in occupationally active women with mild and moderate forms of carpal tunnel syndrome (CTS) compared to a healthy group. Material and Methods The 2PD sense, muscle strength and KDS, as well as the ROM and KDM of the radiocarpal articulation were assessed. Results The results of the 2PD sense assessment showed significantly higher values in all the examined fingers in the CTS women group compared to healthy women (p < 0.01). There was a significant difference in the percentage value of error in the strength and KDS of pincer and cylindrical grips (p < 0.01) in the CTS women group compared to healthy women. There was no difference in the ROM of flexion and extension between studied groups (p > 0.05). There was a significant difference in the percentage value of error in the KDM of flexion and extension movement of the radiocarpal articulation (p < 0.01) between the studied groups. Conclusions There are significant differences in the 2PD sense, KDS and KDM in occupationally active women with mild and moderate forms of CTS compared to healthy women. There are no significant differences in ROM in professionally active women with mild and moderate forms of CTS compared to healthy women. Int J Occup Med Environ Health. 2019;32(2):185–96

10

Prevalence of carpal tunnel syndrome and its correlation with pain amongst female hairdressers

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Demiryurek B. E., Aksoy Gündoğdu A.

International Journal of Occupational Medicine and Environmental Health

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2017

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vol. 31

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issue 3

333-339

EN

Objectives Carpal tunnel syndrome (CTS) may develop with repetitive and forced movements of the hands and wrists. In this study, we have aimed to evaluate whether the frequency of CTS is increased amongst female hairdressers as compared with unemployed women or not. Besides, we have also analyzed whether the functionality and pain intensity levels amongst female hairdressers with CTS are different from the ones of unemployed women with CTS or not. Material and Methods The consecutive female hairdressers and unemployed women who had referred to our electroneuromyography (ENMG) laboratory for the upper extremity nerve conduction studies were included. They were evaluated in terms of clinical and ENMG findings, socio-demographic characteristics, functionality and pain intensity levels determined with the Boston CTS Questionnaire and visual analog scale (VAS). Results In this study, 110 women (70 female hairdressers and 40 unemployed women) were included. The frequency of CTS among hairdressers (74.3%) was higher than the one of the unemployed control group (55%) (p = 0.032). We detected that as the time period of occupation in hairdressing increased, the risk of developing CTS also increased among hairdressers (p < 0.001). Additionally, pain intensity and functional loss levels were higher for hairdressers with CTS than those for the control group with CTS (p = 0.005, p < 0.001, p = 0.028, respectively). Conclusions The frequency of CTS is elevated for female hairdressers with respect to the unemployed women as in many other occupations requiring forced or repetitive hand movements. Besides, the occupational exposure in hairdressing also results in more elevated pain intensity and functional loss levels related with CTS as compared with the unemployed subjects. Int J Occup Med Environ Health 2018;31(3):333–339

11

An advanced stage of carpal tunnel syndrome – is night-time splinting still effective?

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Šošić L., Bojnec V., Lonzarić D., Jesenšek Papež B.

International Journal of Occupational Medicine and Environmental Health

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2020

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vol. 33

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issue 6

771-780

EN

Objectives: There is no consensus on whether conservative treatment with night splints is indicated also in moderate and severe stages of carpal tunnel syndrome (CTS). The goal of this study was to compare the efficacy of night-time splinting at different stages of CTS.Material and MethodsForty-five patients with electrodiagnostic (EDX) features of CTS included in the study were divided into 2 groups based on nerve conduction studies. The patients in the first group had only median nerve sensory fiber involvement, whereas the patients in the second group had also motor fiber involvement. The custom-made volar night splint was the only treatment for all of the included patients. The patients were assessed before the fabrication of orthosis and after 12 weeks of its use. The parameters measured were hand grip strength and the Visual Analogue Scale for pain and paraesthesia. The patients further completed the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) and a shorter version of the Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH).ResultsIn the first group, a statistically significant improvement was established in paraesthesia and hand grip strength (p = 0.019, p = 0.024, respectively), but there was no statistically significant improvement in pain, and the results of both BCTQ and QuickDASH. In the second group, a statistically significant improvement was found in paraesthesia, the BCTQ Symptom Severity Scale and QuickDASH results (p = 0.008, p < 0.001, p = 0.011, respectively), whereas no statistically significant improvement was established in pain, hand grip strength and the BCTQ Functional Status Scale. However, when comparing the change in the outcome measures between the 2 groups, no statistically significant differences were found.ConclusionsThis study has shown that 12-week night-time splinting is beneficial not only for patients with mild CTS but also for those with advanced CTS, and those awaiting surgical treatment. Therefore, splinting is recommended for all patients with CTS.

12

Factors determining the effectiveness of conservative treatment in patients with carpal tunnel syndrome

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Zwolińska J., Kwolek A.

International Journal of Occupational Medicine and Environmental Health

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2019

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vol. 32

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issue 2

197-215

EN

Objectives The study aims to assess selected factors contributing to the long-term effects of the conservative treatment of carpal tunnel syndrome (CTS). Material and Methods Forty-nine individuals diagnosed with CTS were enrolled in the study. The symptoms resulted from occupational hand overuse in 37 patients. The assessment involved 78 hands before the therapy (study 1) and 1 year after the end of the therapy (study 2). The clinical symptoms assessed included: pain, numbness, tingling, morning stiffness, vegetative disorders and difficulties in activities of daily living (ADL). The range of motion (ROM) in the hand joints and the pressure generated during the cylindrical grip were measured. Phalen’s tests, an electrodiagnostic test and a 2-point discrimination study were performed. Results A significant reduction of symptoms and improvement in tested parameters were found in study 2. The largest ROM in the hand, the lowest level of pain and the largest reduction in the frequency of daytime tingling were found in the oldest patients in study 2. In subjects with better initial electrodiagnostic test results, a significant reduction in daytime numbness and daytime tingling was obtained. In individuals previously subjected to conservative therapy, a significant improvement in the ROM of the hand and a better quality of sensation were noted in study 2. A higher level of pain, a lower reduction in the frequency of daytime tingling, and a smaller improvement in ADL capacity were noted in individuals who overused their hands at work after the therapy. Conclusions The effects of conservative CTS treatment after 1 year, expressed as the reduction of subjective symptoms, were independent of the patient’s age. A worse initial electrodiagnostic test result is a predictor of less favorable therapy results. Hand overuse during occupational activity may negatively affect the effects of conservative treatment in individuals with CTS. A change in the nature of occupational activity positively influenced the long-term maintenance of the effects of conservative treatment. Int J Occup Med Environ Health. 2019;32(2):197–215

13

Risk factors for self-reported carpal tunnel syndrome among hairstylists in Gaborone, Botswana

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Erick P., Benjamin K., Raditloko S., Tapera R., Mbongwe B.

International Journal of Occupational Medicine and Environmental Health

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2020

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vol. 34

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issue 3

437-450

EN

ObjectivesHairstylists form an occupational group whose tasks involve repetitive and forced movements of hands and wrists, thus posing a risk of developing carpal tunnel syndrome (CTS). This study assessed the prevalence of and factors associated with CTS symptoms among hairstylists in Gaborone, Botswana.Material and MethodsA cross-sectional study was conducted using a self-administered questionnaire distributed among randomly selected hairstylists. The questionnaire gathered information on demographic characteristics, lifestyle, work-related characteristics and psychosocial factors. The Boston Carpal Tunnel Syndrome Questionnaire was used to determine the severity of CTS symptoms and its functional effects. Data were then analyzed using χ2 and logistic regression models. The level of significance was determined at p < 0.05.ResultsA total of 165 hairstylists took part in the study, with 92 (56%) of the respondents being females. The mean age (M±SD) of the respondents was 35.05±7.54 years with an age range of 22–63 years. Seventy-three (42.2%) hairstylists reported CTS symptoms, with the majority (73%) being females. Out of all the CTS cases, 53 (72.6%) and 16 (21.9%) had mild and moderate symptoms, respectively. Over 80% of the hairstylists did not know about CTS. Among individual factors, CTS symptoms were associated with being female (the odds ratio [OR] of 9.99, and the 95% confidence interval [CI]: 3.64–27.44), increasing age (OR 9.84, 95% CI: 2.74–35.36), the length of employment (OR 3.73, 95% CI: 1.39–9.95), hair washing (OR 2.88, 95% CI: 1.41–5.85), an awkward posture (OR 2.52, 95% CI: 1.03–6.19), and the use of a great muscular effort when performing a task (OR 2.39, 95% CI: 1.01–5.72). Perceived heavy workload and stressful work were also risk factors.ConclusionsThe results suggest a high prevalence of CTS among female hairstylists in Gaborone, and also point out that individual, work-related and psychosocial factors are associated with this syndrome. Future large-scale research is needed to establish the extent of CTS countrywide to influence policy-making. Currently, CTS is not listed amongst occupational health diseases in Botswana.

14

Analiza czynników etiologicznych zespołu cieśni nadgarstka w populacji osób pracujących zawodowo z użyciem komputera

84%

Lewańska M., Wągrowska-Koski E., Walusiak-Skorupa J.

Medycyna Pracy

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2013

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vol. 64

|

issue 1

37-45

EN

Background: Carpal tunnel syndrome (CTS) is the most frequent mononeuropathy of upper extremities. From the early 1990's it has been suggested that intensive work with computers can result in CTS development, however, this relationship has not as yet been proved. The aim of the study was to evaluate occupational and non-occupational risk factors for developing CTS in the population of computer-users. Material and Methods: The study group comprised 60 patients (58 women and 2 men; mean age: 53.8±6.35 years) working with computers and suspected of occupational CTS. A survey as well as both median and ulnar nerve conduction examination (NCS) were performed in all the subjects. Results: The patients worked with use of computer for 6.43±1.71h per day. The mean latency between the beginning of employment and the occurrence of first CTS symptoms was 12.09±5.94 years. All patients met the clinical and electrophysiological diagnostic criteria of CTS. In the majority of patients etiological factors for developing CTS were non-occupational: obesity, hypothyroidism, oophorectomy, past hysterectomy, hormonal replacement therapy or oral contraceptives, recent menopause, diabetes, tendovaginitis. In 7 computer-users etiological factors were not identified. Conclusion: The results of our study show that CTS is usually generated by different causes not related with using computers at work. Med Pr 2013;64(1):37–45

PL

Wstęp: Zespół cieśni nadgarstka (ZCN) jest najczęściej występującą mononeuropatią kończyn górnych. Od wczesnych lat 90. wymieniana jest ona jako możliwy skutek przeciążeń intensywną pracą przy komputerze, choć dotąd nie ma bezspornych dowodów takiej zależności. Celem pracy była analiza zawodowych i pozazawodowych czynników ryzyka ZCN w populacji osób zawodowo używających klawiatury i myszki komputera. Materiał i metody: Badaniem objęto 60 pacjentów - 58 kobiet i 2 mężczyzn (średnia wieku: 53,8±6,35 lat) z podejrzeniem ZCN o etiologii zawodowej, wykonujących pracę zawodową przy użycia komputera. U wszystkich przeprowadzono badanie kwestionariuszowe oraz badanie przewodnictwa nerwowo-mięśniowego (elektroneurografia - ENeG) nerwów pośrodkowych i łokciowych. Wyniki: Badani wykonywali pracę z użyciem komputera przez 6,43±1,71 godzin dziennie. Czas od rozpoczęcia pracy do wystąpienia objawów klinicznych neuropatii wynosił 12,09±5,94 lat. Wszyscy badani spełnili kryteria kliniczne i elektrofizjologiczne rozpoznania ZCN. W badanej grupie dominowały pozazawodowe czynniki ryzyka ZCN - otyłość, niedoczynność tarczycy, przebyta panhisterektomia, owariektomia, hormonalna terapia zastępcza, hormonalna antykoncepcja, menopauza, cukrzyca i zapalenie pochewek ścięgnistych. U 7 chorych nie zidentyfikowano potencjalnego czynnika etiologicznego ZCN. U żadnego z pacjentów nie rozpoznano ZCN o etiologii zawodowej. Wnioski: Wyniki naszego badania wskazują, że przyczyny zespołu cieśni nadgarstka są zwykle inne niż praca z wykorzystaniem komputera. Med. Pr. 2013;64(1):37–45

15

Czynniki etiologiczne zespołu cieśni nadgarstka u osób zawodowo wykonujących monotypowe ruchy w nadgarstku

84%

Lewańska M., Walusiak-Skorupa J.

Medycyna Pracy

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2014

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vol. 65

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issue 2

261-270

EN

Background: Carpal tunnel syndrome (CTS) is the most common neuropathy of upper limbs and a leading cause of upper extremity musculoskeletal disorders, in terms of work exposure, repetitive and forceful exertions of the hand and use of vibrating hand tools. The aim of the study was to evaluate etiological factors of carpal tunnel syndrome in subjects occupationally exposed to monotype movements in wrist. Material and Methods: We conducted the retrospective analysis of 300 patients (261 women, 39 men), mean age 52 years (standard deviation: ±6.93) hospitalized with the suspicion of occupational CTS. Results: The study revealed high percentage (68.7%) of diseases and systemic factors involved in the pathogenesis of CTS in the analyzed population, especially obesity (32%), thyroid diseases (28.7%), hormone replacement therapy and/or oophorectomy (16.3%) and diabetes mellitus (12%). In 111 patients the coexistence of at least a couple of potential etiological factors of the neuropathy was recognized. Clinical analysis and occupational exposure allowed to diagnose occupational carpal tunnel syndrome in 18 (6%) patients only. The undeniable long-term (20.2±9.3 years) occupational exposure to repetitive, forceful movements in the wrist was observed in this group. Conclusion: The results of our study indicated that non-occupational etiological factors of CTS predominated and in 37% of patients at least several factors were found. The analysis showed the high prevalence of CTS in workers employed in various sectors of industry, including so called "blue collar" workers. Our study confirmed the multifactorial etiology of carpal tunnel syndrome, however, occupational agents contributed to only 6% of cases. Med Pr 2014;65(2):261–270

PL

Wstęp: Zespół cieśni nadgarstka (ZCN) jest najczęstszą neuropatią kończyn górnych i najczęstszą chorobą przeciążeniową układu mięśniowo-szkieletowego. Powstaje wskutek ekspozycji zawodowej na powtarzalne, monotypowe ruchy w stawach nadgarstka oraz konieczności użycia siły i narażenia na drgania mechaniczne. Celem pracy była ocena czynników etiologicznych zespołu cieśni nadgarstka u osób zawodowo wykonujących monotypowe ruchy w nadgarstku. Materiał i metody: Zbadano 300 chorych (261 kobiet, 39 mężczyzn) o średniej wieku 52 lata (odchylenie standardowe: ±6,93) hospitalizowanych w Klinice Chorób Zawodowych i Toksykologii Instytutu Medycyny Pracy im. prof. J. Nofera w Łodzi z podejrzeniem etiologii zawodowej ZCN. Wyniki: Badanie ujawniło wysoki odsetek chorób i czynników ogólnoustrojowych uczestniczących w patogenezie ZCN (68,7% badanej populacji). Dominowała otyłość (32%), choroby gruczołu tarczowego (28,7%), hormonalna terapia zastępcza i/lub owariektomia (16,3%) i cukrzyca (12%). U 111 pacjentów współistniało co najmniej kilka potencjalnych czynników etiologicznych powyższej neuropatii. Jedynie u 18 chorych (6%) analiza kliniczna i narażenia zawodowego pozwoliły na rozpoznanie choroby zawodowej - zespołu cieśni nadgarstka. Stwierdzono u nich długotrwałe (20,2±9,3 roku) narażenie zawodowe na monotypowe, wymagające dużej siły ruchy w stawach nadgarstka. Wnioski: W badanej grupie dominowały pozazawodowe czynniki etiologiczne ZCN, a u 37% badanych było ich co najmniej kilka. Wśród pacjentów badanych z powodu podejrzenia zawodowej etiologii ZCN, a także u tych z rozpoznanym zawodowo pochodnym ZCN, przeważały osoby zatrudnione w różnych sektorach przemysłu. Wyniki naszej pracy potwierdzają wieloczynnikową etiologię zespołu cieśni nadgarstka - tylko u 6% badanych miała ona uwarunkowania zawodowe. Med. Pr. 2014;65(2):261–270

16

Tancerka, groomerka, twórczyni ludowa i altowiolistka – opisy przypadków chorób zawodowych układu ruchu i obwodowego układu nerwowego

67%

Najder-Gawlik M., Wiszniewska M., Lipińska-Ojrzanowska A.

Medycyna Pracy

|

2022

|

vol. 73

|

issue 1

EN

Work-related diseases of the musculoskeletal and the peripheral nervous system are classified as overload cumulative microtrauma diseases, resulting from chronic overload and/or damage of specific neuromusculoskeletal structures. Occupational activities which predispose to them are characterised by monotypy (repetition of movements during a significant part of the working shift). Authors described 4 cases of women with musculoskeletal and peripheral nervous system disorders qualified as occupational background just in the 2nd instance of medical certification. Detailed analysis of occupational exposure and medical interview with individual diagnostic approach allowed to determine the occupational etiology of diseases, regardless of non-occupational risk factors in some cases, even if the workstation was not common. Difficulties in estimating the probability of disease process induction on the background of occupational exposure are caused by frequent coexistence of non-occupational risk factors. The 2-tier system of certification provides an independent evaluation of medical history and occupational exposure.

PL

Choroby układu ruchu i obwodowego układu nerwowego wywołane sposobem wykonywania pracy są zaliczane do przeciążeniowych chorób skumulowanych mikrourazów, wynikających z chronicznego przeciążenia i/lub uszkodzenia określonych struktur układu nerwowo-mięśniowo-szkieletowego. Sposób wykonywania pracy, który predysponuje do ich rozwoju, cechuje się monotypią, tj. powtarzalnością ruchów przez istotną część zmiany roboczej. W pracy opisano 4 przypadki odwoławczego postępowania diagnostyczno-orzeczniczego kobiet z chorobami układu ruchu i obwodowego układu nerwowego, u których wykazano związek przyczynowo-skutkowy pomiędzy rozwojem schorzeń a sposobem wykonywania pracy. Ponowna szczegółowa analiza narażenia zawodowego oraz pogłębienie wywiadu zawodowego pozwoliły na ustalenie zawodowej etiologii schorzeń z uwzględnieniem istnienia czynników pozazawodowych czy też w związku z wykonywaniem pracy na rzadko spotykanych stanowiskach. Trudności orzecznicze w ocenie możliwości wystąpienia procesu chorobowego w związku z ekspozycją zawodową powoduje częste współistnienie czynników pozazawodowych predysponujących do powstania choroby wymienionej w wykazie chorób zawodowych, które powinny podlegać szczegółowej ocenie w toku postepowania prowadzonego w związku z podejrzeniem choroby zawodowej. Dwustopniowy system orzeczniczy dający możliwość ponownego badania pozwala na powtórną niezależną ocenę medyczną i dotyczącą narażenia zawodowego oraz na zweryfikowanie przedstawionych wcześniej wniosków.

17

Zespół cieśni nadgarstka

67%

Golabek R., Majcher P.

Sport i Turystyka. Środkowoeuropejskie Czasopismo Naukowe

|

2018

|

vol. 1

|

issue 1

123-140

PL

Zespół cieśni nadgarstka (ZCN) należy do jednej z najczęstszych neuropatii w obrębie kończy-ny górnej. W pracy zostały omówione zagadnienia związane z ogólnymi informacjami na temat występowania, przedstawiono cel pracy, anatomię, patofizjologię, etiologię oraz szeroko pojętą diagnostykę, w tym funkcjonalną i obrazową, oraz leczenie. Występowanie zespołu cieśni nadgarstka może warunkować ucisk na nerw pośrodkowy na po-ziomie więzadła poprzecznego w kanale nadgarstka. Innymi czynnikami mogą być praca zawo-dowa, wiek, otyłość, zaburzenia hormonalne, mięśniowo-szkieletowe i naczynioworuchowe. Diagnostyka opiera się przede wszystkim na dokładnym badaniu pacjenta, w tym – wywiadzie chorobowym i rodzinnym, badaniu klinicznym oraz badaniach pomocniczych. Leczenie ZCN może mieć charakter zachowawczy, polegający na usunięciu czynników odpo-wiedzialnych za rozwój neuropatii w obrębie nerwu pośrodkowego lub czasowym unieruchomie-niu kończyny. Innym rodzajem leczenia mogą być iniekcje steroidowe, szeroko pojęta fizjoterapia czy zabieg chirurgiczny.

EN

Carpal tunnel syndrome belongs to one of the most common neuropathies within the upper limb. Issues discussed in the work are related to: general information about the occurrence of CTS, the purpose of the work, anatomy, pathophysiology, etiology and broadly understood diagnostics including the functional and the pictorial type as well as the treatment. The carpal tunnel syndrome is a consequence of the median nerve compression in the wrist ca-nal at the level of the transverse ligament. The occurrence of CTS may be predisposed by work, age, obesity, hormonal disorders or musculoskeletal and vasomotor disorders. The diagnosis of CTS is based on the detailed medical examination of the patient: a medical in-terview about the history of disease and family, a clinical and other supportive examinations. ZCN treatment may be of a conservative nature consisting of the removal of the factors respon-sible for the development of a nerve neuropathy within median nerve or temporary immobilization of the limb. Another type of the treatment may be steroid injections, broadly understood physio-therapy or a surgery.

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