Musculoskeletal Disorders � a pain in the neck?

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Musculoskeletal Disorders � a pain in the neck? Powered By Docstoc
					Musculoskeletal Disorders
 – a pain in the neck?
             Dr Euan J Thompson

          BSc (Hons) MBChB MRCGP

  Specialist Registrar in Occupational Medicine
               How common?
   Very!

   In a year - 10% of people consult their doctor
     How common? (cont…/)
Over a lifetime:
 30% complain of arm pain

 50-70% back pain

At any point in time:
 13-20% have shoulder pain

 11-13% elbow pain

 4-10% pain in the neck
        How common? (cont…/)

According to HSE:

   Most common disorder affecting people in work
   1.5 million people feel that work is causing their
    musculoskeletal problem
   8% of workers report an enforced job change
    due to work-related musculoskeletal disorder
        How common? (cont…/)

   Only the second most common reason for time
    off (behind “stress”)

   For “stress” only 0.5 million feel work to blame.
Costs to the workplace and society:

Back pain

   50m lost working days annually
   £2billion
   3 million GP consultations
   1.5 million hospital referrals
   100,000 hospital admissions each year
                What causes them?

Many factors:

   Factors personal to the sufferer
   (Incl activities outside work)

   Factors in the workplace
    Factors personal to the sufferer
 Genetic and Developmental Causes
   E.g. slipped upper femoral epiphysis
   Inflammatory / Systemic Diseases
   E.g. Rheumatoid Arthritis
   Biomechanical Risk Factors
   E.g. obesity, joint laxity, recreational activities, etc
   Constitutional Factors
   E.g. age, sex, mental health
       Factors in the workplace

Main risk factors:

   Force
   Repetition (e.g. cycle time<30s)
   Posture
   Insufficient rest or recovery time

   High productivity targets

   Machine Pacing

   Static Loading, uncomfortable postures
           Things to consider:

Work capacity:
 ? Fit to work

 ? Fit to perform specific duties?

   Rehabilitation
   Prognosis
   The Law

   Overview of some common conditions

   The Law

   Occupational Health Approaches

   Back Pain
   Osteoarthritis (OA)
   Rheumatological Disorders
   Carpal Tunnel Syndrome
   Work-Related Upper Limb Disorder
   Hand-Arm Vibration Syndrome
                  Back Pain

   Very common

   Variable in severity

   Often relapsing / remitting
             Back Pain (cont…./)
Occupational risk factors:

   Job type (miners, fire-fighters, nurses, construction)

   Manual Handling (esp. lifting->25-60% of injuries)
   “Twist and shout”
   Static posture / sedentary job
   Whole-body vibration (truck drivers, crane ops, pilots)
           Back Pain (cont…./)

   Mental stress
   Job dissatisfaction
   Monotony
   Time pressure
   High workload
   Little autonomy

In general, the longer someone is off work,
  the longer they will remain off work

   Early mobilisation VITAL
   Bed rest for no more than 1-2 days
   Early return to work if uncomplicated

   May need to modify very heavy physical
   Most common joint disorder in the world
   “wear and tear” / “TMB”

   Personal factors

   Work-related factors
   6 times more common in miners than clerical workers
   High in dockers, cement workers, firemen
     Work-related factors (knee)

Related to use:
 Prolonged kneeling, squatting

   Repeated stair-climbing

   Regular lifting with knee flexion
      Work-related factors (hip)

Again, related to usage:
 Regular heavy lifting

   Prolonged standing

   Walking over rough ground
        Osteoarthritis (cont…./)

Work limitations:
 Consider access to worksite

   Work itself – modified duties / redesign
      Rheumatological Disorders -
         Shoulder Tendonitis

   overhead work (e.g. shipyards, assembly
    lines, painters, etc)
   Repetition, prolonged uncomfortable
       Rheumatological Disorders -
          Disorders of the Neck
   Tension-neck syndrome – headache,
    tender neck – assembly line workers,
    computer operators
   Cervical Spondylosis – “wear and tear” -
    dentists, meat carriers, etc
   Particular problem in jobs needing a full
    range of neck movements (e.g. truck
    drivers, FLT-drivers, electricians)
         Neck Pain - Treatment

Acute exacerbations

   soft collar – for short periods only
   Analgesia
   Physio
       Carpal Tunnel Syndrome

   Compression of medial nerve at the wrist

   1-2% of industrial workers (on average)
   0.6 – 61% depending on occupation
   High risk in grocery stores, frozen food
    workers, platers
Carpal Tunnel Syndrome (cont…./)

   Common link is repetition and forceful

   Frequent flexion or extension of wrist

   Use of hand-held vibratory tools
Carpal Tunnel Syndrome (cont…./)

 Avoidance of potential hazards

   Release operation
       Rheumatological Disorders –
Otherwise known as

   Fibrositis

   Myofascial Pain syndrome
      Rheumatological Disorders –
        Fibromyalgia (cont…./)
   2% of all patients in General Practice

   20% of people referred to Rheumatologist
    Rheumatological Disorders –
      Fibromyalgia (cont…./)
Poorly defined syndrome:
 Diffuse muscle pains, stiffness and fatigue

 Sore pressure points

Crossover with:
 anxiety / depression

 Irritable Bowel Syndrome

 Tension headaches
      Rheumatological Disorders –
        Fibromyalgia (cont…./)
   Tests largely normal, ie functional
    problem, not anatomy / biochemical

 Physio, Graduated exercise programme

   Tends to wax and wane, long-lasting
Work-Related Upper Limb Disorder

125 different clinical names, including:

   Repetitive Strain Injury
   Clerk’s palsy
   Writer’s cramp
Work-Related Upper Limb Disorder
   Higher in blue-collar workers than in
    clerical workers
   High rates of reporting in women in
    manufacturing sector
   Men in textile, clothing and footwear, food
Work-Related Upper Limb Disorder
   Dramatic changes in prevalence over time

“Epidemics” occurred
 1984 (Australia) – five-fold increase

 1958-82 (Japan)

 Claims reduced by alteration of compensation
 Definite disorder, but can be amplified by
  compensation on offer
Work-Related Upper Limb Disorder
   Most occur gradually

   Anxiety, mood swings, sleep disturbance

   (subjective) swelling of arm (75%)

   Tender at multiple sites
Work-Related Upper Limb Disorder
Management is by structured rehabilitation
 Graduated exercises

   Behavioural approaches to pain control


   Hand-Arm Vibration Syndrome
   Prev. “Vibration white finger”
   Affects nerves and blood vessels

   Whole Body Vibration
          Vibration (cont…./)

Organ Resonance:

   Back - 10Hz
   Head / Shoulder – 20-30Hz
   Arms 200-500Hz

   <1 Hz => motion sickness
           Vibration (cont…./)

   Vibration dependant on acceleration (often
    in multiple directions)
           Vibration (cont…./)

Who gets it?

   HAVS – angle grinders, pneumatic drills,
    rivet guns

   Whole body – truck drivers, pilots
               Vibration (cont…./)


   History and Examination:
   Stockholm grading scale

   Specific tests:
   HSE Laboratory (Renfrew)
           Vibration (cont…./)

 Treat as a hazard

   Heated gloves?
   Antivibration gloves
   Smoking
                     The Law
   Management of Health and Safety at Work
   Manual Handling Regulations
   Display Screen Equipment Regulations

   Disability Discrimination Act

   UKOOA Guidelines
   Statutory Medicals
The Health and Safety at Work Act
   Employer has a “duty of care to the
    employee as far as is reasonably practical”

   Employee has a responsibility to comply
    with the employer’s requests to work in a
    specified manner, with regard to safety
           The Law (cont…./)

   Management of Health and Safety at Work

   Manual Handling Regulations

   Display Screen Equipment Regulations
     Disability Discrimination Act

   “Physical or mental impairment which has
    a substantial and long-term adverse effect
    on his ability to carry out normal day-to-
    day activities”

   Substantial = more than trivial / minor
   Long-term = lasting more than 12 months
        Disability Discrimination Act
NB This does NOT include:
 “Antisocial” conditions (e.g. fire-setting, stealing, etc)
 Drug / alcohol addiction

   Armed Forces
   Prison officers
   Firefighters
   Police officers
   Employment on a ship / aircraft / offshore
   Admission as a partner to partnerships
    Disability Discrimination Act
Otherwise, applies to:-
 employees

 apprentices

 self-employed people who contract
  personally to do work
 contract workers
       Disability Discrimination Act
   Employer has to make “reasonable
   Can only be decided in court (!)

   “Benchmark” recommendations by
    occupational physicians
           UKOOA Guidelines

   Offshore workers not covered by DDA
   Special medical category, given
    remoteness from medical attention

   Can they work unhindered?

   Can they evacuate in an emergency?
          Statutory Medicals –
      Ionising Radiation, Asbestos

   No specific recommendations
   Should be able to discharge duties
   Should be able to don protective
   Should be able to undertake emergency
Occupational Health Approaches

   Hazard
   Risk
   Risk assessment
   Controls
   Disease Surveillance
   Audit (by industrial hygiene assessment
   Reappraisal at regular intervals

   Physical

   Administrative
           Controls (cont…/)

   Elimination
   Substitution
   Limitation of exposure
   Education / training
   Task rotation
   Personal Protective Equipment
  Occupational Health Approaches
Advice on DDA and “reasonable adjustments”
 Access to Work (via Job Centre plus)

 Advice on suppliers for equipment

Early retirement on Ill-Health Grounds
 Certain criteria must be met

 Depends on company / insurance policy
Any questions?

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