1/8. Repetitive strain injuries. How to deal with 'the epidemic of the 1990s'.Occupational trends, especially the mushrooming of computer use in the united states, have brought with them a virtual epidemic of repetitive strain injury of the upper limb. What can you as a primary care physician do to stem the tide? In this article, the authors fill you in on treatment of the most common injuries as well as remark on the ramifications for business and industry.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. Successful management of female office workers with "repetitive stress injury" or "carpal tunnel syndrome" by a new treatment modality--application of low level laser.female office workers with desk jobs who are incapacitated by pain and tingling in the hands and fingers are often diagnosed by physicians as "repetitive stress injury" (RSI) or "carpal tunnel syndrome" (CTS). These patients usually have poor posture with their head and neck stooped forward and shoulders rounded; upon palpation, they have pain and tenderness at the spinous processes C5-T1 and the medial angle of the scapula. In 35 such patients we focused the treatment primarily at the posterior neck area and not the wrists and hands. A low level laser (100 mW) was used and directed at the tips of the spinous processes C5-T1. The laser rapidly alleviated the pain and tingling in the arms, hands and fingers, and diminished tenderness at the involved spinous processes. Thereby, it has become apparent that many patients labelled as having RSI or CTS have predominantly cervical radicular dysfunction resulting in pain to the upper extremities which can be managed by low level laser. Successful long-term management involves treating the soft tissue lesions in the neck combined with correcting the abnormal head, neck and shoulder posture by taping, cervical collars, and clavicle harnesses as well as improved work ergonomics.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/8. Musculoskeletal problems of performing artists.We have reviewed the frequency and variety of rheumatic problems among performing artists. For instrumentalists, injuries are related to the type of instrument played, the technique used and the effort expended in the quest for excellence. For dancers, musculoskeletal problems too reflect technique and effort. We should not be surprised at the frequency of these problems. Rheumatologists, as well as orthopaedic surgeons, physiotherapists, neurologists and other physicians, encounter performing artists as patients. We should be familiar with their problems and be able to knowledgeably diagnose and manage them. This may include observing the artist during actual performances. How is the instrument being held? What is the posture of the artist? What are the comments of the coach or teacher. What type of shoes does the ballerina wear? What movements in particular cause discomfort? These and similar observations will have direct bearing on the musculoskeletal problems of these artists. Published studies have related the variety, frequency and disabling nature of performance-related musculoskeletal problems. Unfortunately few if any of these are controlled, blinded or prospective. We need more and better information. We will want clear information about prevalence of problems, better definition of the musculoskeletal ailments, classification of the relationship of problems with performance and individual biomechanical features, information about response of specific problems to interventions, and data about the long-term consequences, if any, of these rheumatic problems to the musculoskeletal system. Artists as patients are unique. Minor problems can become potentially career-ending disabilities. Making music or performing dance may provide us with delightful entertainment but represents a source of livelihood to artists. Understanding their medical needs and enabling them to continue to perform is the challenge before us.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/8. Myofascial release of carpal tunnel syndrome.Current treatment for carpal tunnel syndrome may be ineffective or associated with complications or recurrence. In the case reported here, a myofascial release by the physician combined with the patient's self-stretch reduced pain and numbness and improved electromyographic results. The manipulative approach releases the transverse carpal ligament,-and "opens" or dilates the canal. The patient stretches the wrist, digits, and thumb, including myofascial components. An aggressive, conservative approach lessens the need for surgery in mild to moderate cases. Studies with magnetic resonance imaging may be helpful to document canal size before and after treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/8. Medical problems affecting musicians.The physical demands of performing on musical instruments can cause pain, sensory loss, and lack of coordination. Five cases illustrate common problems. knowledge of the interaction between the technique of playing the instrument and the particular musician can help physicians diagnose and resolve problems.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/8. Is skull sawing by autopsy assistants overlooked as a cause of vibration-induced white fingers?BACKGROUND: Workers using vibrating tools have an increased prevalence of vibration-induced white fingers. One example of such workers is autopsy assistants, who use vibration for skull sawing. CASE history: A previously healthy 42-year-old Swedish male smoker had worked as an autopsy assistant at a forensic department between 1977 and 1991. He prepared corpses for autopsy, including sawing the skulls with an electric saw. Beginning in 1983, his right index finger blanched in cold. During subsequent years the blanching spread to the other fingers on the right hand, except for the thumb. The findings in the physical examination and the results of blood tests were normal. Digital blood pressure after cooling showed a severe vasospastic reaction in both middle fingers. vibration measurements during skull sawing showed a frequency-weighted acceleration level of 8.9 m.s-2. QUESTIONNAIRE SURVEY: A questionnaire was mailed to all assistants (N = 17) preparing autopsies and to all medical examiners, as referents (N = 18), at the Swedish Institutes of forensic medicine. It was answered by 13 assistants (76%), 1 woman and 12 men, and 16 medical examiners (89%), 3 women and 13 men. Eleven of the assistants (85%), including one woman, and one of the physicians (6%), a men, reported a history of blanching fingers provoked by chill (difference 79%, P = 0.00003, Fisher's exact test). CONCLUSIONS: autopsy assistants at forensic departments seem to have an increased prevalence of self-reported blanching fingers, which may be an effect of exposure to high levels of vibration.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/8. Factors prolonging disability in work-related cumulative trauma disorders.workers' compensation costs for management of soft tissue disorders continue to increase. The complexity of medical management of these cases has increased due to social factors. The purpose of this study is to improve the physician's ability to recognize nonmedical issues that prevent a rapid return to employment. A classification system is presented that will allow the clinician to identify administrative and pyschosocial issues that prolong disability. Additionally, the patients' job demands were classified by known ergonomic risk factors. The system was applied retrospectively to 50 random cases referred to two occupational hand clinics over a 1-year period. The results indicated that the psychosocial classification of the patient and the current employment status are the most important factors in prolonging disability workers.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/8. The Union Health Center: a working model of clinical care linked to preventive occupational health services.As health care provision in the united states shifts to primary care settings, it is vital that new models of occupational health services be developed that link clinical care to prevention. The model program described in this paper was developed at the Union Health Center (UHC), a comprehensive health care center supported by the International Ladies Garment Workers Union (now the Union of Needletrades, Industrial and Textile Employees) serving a population of approximately 50,000 primarily minority, female garment workers in new york city. The objective of this paper is to describe a model occupational medicine program in a union-based comprehensive health center linking accessible clinical care with primary and secondary disease prevention efforts. To assess the presence of symptoms suggestive of occupational disease, a health status questionnaire was administered to female workers attending the UHC for routine health maintenance. Based on the results of this survey, an occupational medicine clinic was developed that integrated direct clinical care with worker and employer education and workplace hazard abatement. To assess the success of this new approach, selected cases of sentinel health events were tracked and a chart review was conducted after 3 years of clinic operation. Prior to initiation of the occupational medicine clinic, 64% (648) of the workers surveyed reported symptoms indicative of occupational illnesses. However, only 42 (4%) reported having been told by a physician that they had an occupational illness and only 4 (.4%) reported having field a workers' compensation claim for an occupational disease. In the occupational medicine clinic established at the UHC, a health and safety specialist acts as a case manager, coordinating worker and employer education as well as workplace hazard abatement focused on disease prevention, ensuring that every case of occupational disease is treated as a potential sentinel health event. As examples of the success of this approach, index cases of rotator cuff tendonitis, lead poisoning, and formaldehyde overexposure in three patients and their preventative workplace follow-up, affecting approximately 150 workers at three worksites, are described. Work-related conditions diagnosed during the first 3 years of clinic operation included cumulative trauma disorders (141 cases), carpal tunnel syndrome (47 cases), low back disorders (33 cases), lead poisoning (20 cases), and respiratory disease (9 cases). This pilot project represents a new model for effective integration of clinical care and occupational disease prevention efforts within a primary care center. It could serve as a prototype for development of such services in other managed and primary care settings.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |