MBChB, BMedSci, MA, MPH, MRCP, DOccMed Specialist Registrar · MBChB, BMedSci, MA, MPH, MRCP,...
Transcript of MBChB, BMedSci, MA, MPH, MRCP, DOccMed Specialist Registrar · MBChB, BMedSci, MA, MPH, MRCP,...
Dr Subhashis BasuMBChB, BMedSci, MA, MPH, MRCP, DOccMed
Specialist Registrar
Work-Related Musculoskeletal Disorders
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
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)
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