Occupational Upper Limb Disorders in Glass Cutters Dr.Cormac Macnamara

The Cutting Process

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Range of Afflictions Musculoskeletal Neurological Dermatological

Musculoskeletal Physiotherapists and Ergonomists suggest the following are aetiological factors: Force + Repetition + Awkward Posture + Insufficient rest Untreated: significant and lasting disability Rowe 1985

Olecranon Bursitis Factors: Postulated Theory: Cumulative microtrauma of repeated flexion and extension* Experience suggests: direct pressure & friction Management: 1. Outrule Septic Arthritis 2. Conservative Rx [Early steroid injection controversial] 3. Prevention

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Lateral Epicondylitis “Dominant” arm Repetitive grasping, pinch movements Repeated and Forcible extension movements at the wrist Repeated supination and pronation Pathology: Microtrauma to the tendon [ECRB] 3 Types of Occupational Group: Type 3:“Heavy”Stress on the Elbows Treatment: Rest +/- Change Activity+/-Steroid

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Tenosynovitis/Tendinitis Commonly : Radial Wrist Extensors Abductor Pollicis Longus Extensor Pollicis Brevis Aetiological Factors: [Thompson & Phelp1990] 1.Changes in usual work practices (Conditioning) 2.Return to work (Holidays) 3.Local “strain” (repetitive or singular) 4.Direct Local blunt trauma 5.Simple repetitive movement BUT associated with intense effort/speed

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Nerve Entrapment Carpal Tunnel Syndrome Ulnar Neuritis

Carpal Tunnel Syndrome Repetitive use of the hand while held in extension at the wrist Results in friction to the passage of the median nerve by the carpus Finger flexor tendons become swollen causing entrapment of the nerve Typically gradual onset Diagnosis: Nerve Conduction Studies Causes: Systemic as well as Occupational Treatment: Reduce Provocative Activity Also: Night-splints, NSAIDs, Steroid Injection Surgery

Ulnar Neuritis 1. Cubital Tunnel: behind Medial Epicondyle Specific Trauma OR Repetitive Compression Diagnosis: Nerve Conduction Studies Management: Avoid further compression Surgery 2. Distal Entrapment: [as nerve enters the hand] Compression between Pisiform & Hamate Hand Held tools, Handlebars, isolated blows Diagnosis: Nerve Conduction Studies Management Local steroid injection/Surgery

Skin Contact irritant dermatitis Exacerbations of Psoriasis Molluscum Contagiosum Warts

Contact Irritant Dermatitis Water : a powerful irritant Weakens natural barrier properties of skin Abrasive glass dust The role of diamond wheels and “Mist” Moisturizers Barrier creams not recommended

Psoriasis Pre-existing disease can be exacerbated “Wet” work Repetitive trauma Role of make-shift personal protective equipment