1. CUMMULATIVE DISORDERS OF UPPER EXTIMITY DR HABIBOLLAHI

2. Definition Musculoskeletal disorder (MSD) is an injury or disorder of the muscles, nerves, tendons, joints, cartilage,ligament and spinal discs. It is not an acute injury, rather a chronic disease which develops over time. MSD is related to manual tasks It has been recognized as a source of significant pain, disability and disadvantage for the injured person and a substantial burden on modern societies. Statistics suggest that more than 30% of all occupational injuries are musculoskeletal injuries associated with manual tasks )

3. ERGONOMICS Nationally, almost 60% of all work-related illnesses are MSDs

4. WMSDs All other claims 26% 74% WMSDs 40% 60% All other claims Number of ClaimsCost of Claims

5. ERGONOMICS WMSDs are sometimes referred to using other unfamiliar terms such as : 1.Cumulative Trauma Disorders – CTD 2.Repetitive Trauma Disorders – RTD 3.Repetitive Strain Injuries – RSI 4.Repeated Motion Disorders – RMD 5.Overuse Syndromes

6. ERGONOMICS What is The Musculoskeletal System? The Musculoskeletal System includes the following: 1.Bones – The load-bearing structure of the body 2.Muscles- Tissue that contract to create movement 3.Tendons – Tissues that connect muscles to bones 4.Ligaments – Tissues that connect bones to bones 5.Cartilage – Tissue that provides cushioning and reduces friction between bones 6.Nerves – Communication system that links muscles, tendons and other tissue with the brain 7.Blood Vessels – Tubes that circulate nutrients throughout the body

7. ERGONOMICS What Are Examples of WMSDs? 1.Strain – Overstretching or overexertion of a muscle or tendon 2.Sprain _Overstretching or overexertion of a ligament that results in a tear or rupture of the ligament 3.Tendonitis – Inflammation of the tendon inside the sheath 4.Tenosynovitis – Inflammation of the sheath around the tendon 5.Carpal Tunnel Syndrome – Compression of the median nerve as it passes through the carpal tunnel in the heel of the hand

8. ERGONOMICS What are Examples of WMSDs? 6.Tennis elbow or Golfer’s elbow – Medical term is Epicondylitis – inflammation of the tendons at the elbow. 7.Trigger Finger – Common term for tendonitis or tenosynovitis that causes painful locking of the finger(s) while flexing 8.Pitcher’s Shoulder – Rotator cuff tendonitis – inflammation of one or more tendons at the shoulder 9.White Finger – Medical term is Reynaud’s Phenomenon – constriction of the blood vessels in the hands and fingers 10.Digital Neuritis – Compression of the nerves along the sides of the fingers or thumbs

9. Cumulative Trauma Disorder Diagnoses Nerves : Peripheral Entrapment – Carpal Tunnel Syndrome – Cubital Tunnel Syndrome – Thoracic Outlet Syndrome Tendons – Trigger Digits – de Quervain’s Tendonitis Skin – Blisters – Calluses Muscles (Enthesopathy) – Lateral Epicondylitis (Tennis Elbow) – Shoulder Impingement (Rotator Cuff Disease) Joint & Bone – Arthritis – Stress Fractures – Ganglions Vascular – White Finger Syndrome

10. ERGONOMICS Signs or Symptoms of WMSDs  Painful joints  Pain in wrists, shoulders, forearms, knees, etc.  Pain, tingling or numbness in hands or feet  Fingers or toes turning white  Shooting or stabbing pains in arms or legs  Back or neck pain  Swelling or inflammation  Stiffness  Burning sensations  Weakness or clumsiness in hands; dropping things

11. INCREASED RISK FACTORS

12.  Awkward Postures  High Hand Force  Highly Repetitive Motion  Repeated Impact  Heavy, Frequent or Awkward Lifting  Moderate to High Hand-Arm Vibration Caution Zone Look for These Indicators:

13. Awkward Postures Being in these work positions for more than 2-4 hours total per day – Hands above head – Elbows above shoulder – Back bent forward more than 30 degrees – Neck bent more than 30 degrees – Squatting – Kneeling

14. Working with the Hands Above Head For more than 2 hours per day

15. Working with the Elbows Above Shoulders For more than 2 hours per day

16. Neck or Back Bent Forward More than 30º For more than 2 hours per day

17. Neck or Back Bent Forward More than 30  For more than 2 hours per day

18. Neck or Back Bent Forward More than 30  For more than 2 hours per day

19. Squatting For more than 2 hours per day

20. Kneeling For more than 2 hours per day

21. High Hand Force More than 2 hours per day of: Pinching 2 or more pounds weight or 4 or more pounds force

22. High Hand Force More than 2 hours per day of: Gripping 10 or more pounds weight or force

23. Highly Repetitive Motion Workers repeat same motion every few seconds for more than 2 hours per day with: –neck –shoulders –elbows –wrists –hands

24. Highly Repetitive Motion Intensive keying for more than 4 hours per day

25. Repeated Impact Using hands or knees as a hammer – more than 10 times per hour – more than 2 hours per day

26. Repeated Impact Using hands or knees as a hammer – more than 10 times per hour – more than 2 hours per day

27. Heavy, Frequent, or Awkward Lifting Lifting objects more than: – 75 lbs. once/day – 55 lbs. more than ten times/day – 10 lbs. more than twice/minute for more than 2 hours per day – 25 lbs. above shoulders, below knees, or at arms length for more than 25 times/day

28. Heavy, Frequent, or Awkward Lifting

30. Moderate to High Hand-Arm Vibration Moderate Level more than 2 hours/day

31. Moderate to High Hand-Arm Vibration High Level More than 30 Min/day

32. Upper Extremity Disorders Carpel tunnel syndrome Cubital tunnel syndrome Thoracic outlet syndrome Raynaud’s syndrome (white finger) Rotator cuff syndrome DeQuervain’s disease Tendinitis Tenosynovitis Trigger finger Ganglion cyst

33. Neurovascular Disorders Carpal Tunnel Syndrome –Impingement of the median nerve caused by irritation and swelling of the tendons in the carpal tunnel Cubital Tunnel Syndrome –Pressure on the ulnar nerve when the elbows are exposed to hard surfaces

34. Neurovascular Disorders Thoracic Outlet Syndrome –Compression of the blood vessels between the neck and shoulder caused by reaching above shoulder level or carrying heavy objects Raynaud’s Syndrome –Also known as Vibration White Finger –Also known as Vibration White Finger ; Blood vessels of the hand are damaged (narrowed) from repeated exposure to vibration for long periods of time

35. Tendon Disorders Rotator Cuff Syndrome DeQuervain’s Disease –Combination of tendinitis and tenosynovitis Tendinitis –Irritation of the tendon Tenosynovitis –Irritation of the synovial sheath Ganglion Cyst –Accumulation of fluid within the tendon sheaths

36. Tendinitis

37. Common Occupational CTDs of the Upper Extremities Carpal Tunnel Syndrome occurs from chronic swelling of the flexor tendons in the wrist. The median nerve, which feeds the first three fingers and the thumb, can become impaired from pressure in the carpal tunnel in the wrist. Symptoms include:  pain in the first three fingers and the thumb  numbness in these areas  tingling in these areas

38. Carpal Tunnel Syndrome

41. Common Occupational CTDs of the Upper Extremities Raynaud’s Syndrome is when blood vessels of the hand are damaged (narrowed) from repeated exposure to vibration for long periods of time This is connected with use of vibrating tools, such as hair clippers and jack hammers.

42. Raynaud’s Syndrome Symptoms Numbness and tingling in the fingers during vibration exposure; may continue after exposure has been discontinued Blanching (whitening) of one fingertip because of a temporary constriction of blood flow Other fingers also blanch Intensity of pain & frequency of attacks increase in time

43. Common Occupational CTDs of the Upper Extremities Cubital Tunnel Syndrome is caused by resting the elbows on hard surfaces such as unpadded tables or armrests. The ulnar nerve, which feeds the ring and little fingers, can become impaired from pressure near the elbows. Symptoms include:  pain in the ring and little fingers  tingling in these areas  numbness in these areas

44. Cubital Tunnel Syndrome

45. Common Occupational CTDs of the Upper Extremities Thoracic Outlet Syndrome is caused by frequent reaching above shoulder level, by carrying heavy objects, or poor posture involving a forward head tilt. A Neurovascular bundle called the brachial plexus, which passes between the collar bone and the top rib, can become impaired from pressure associated with movements that causes these two bones to be positioned close together. Symptoms include:  the arms “falling asleep”  weakened pulse  numbness in the fingers

46. Thoracic Outlet Syndrome

47. Common Occupational CTDs of the Upper Extremities Rotator cuff syndrome is a disorder involving swelling and pain of tendons comprising the rotator cuff muscle group: subscapularis, supraspinatus, infraspinatus, & teres minor Symptoms include: Pain when you bend the arm and rotate it outwards against resistance Pain on the outside of the shoulder possibly radiating down into the arm Pain in the shoulder, which is worse at night Stiffness in the shoulder joint.

52. Prevention Avoidance of prolonged or repeated overhead work may help lessen the incidence of impingement type pain. In addition, rotator cuff strengthening exercises can sometimes improve the symptoms associated with pathology in this area.

53. Common Occupational CTDs of the Upper Extremities Tendinitis is a common CTD for the wrist, elbow, and shoulder. It occurs when we continually stress the tendon cables, causing them to become irritable and sore. Lateral Epicondylitis - “Tennis elbow” Medial Epicondylitis - “Golfer’s elbow” Symptoms include:  point tenderness  swelling  tennis elbow, pain radiates down to back of hand  golfer’s elbow, pain radiates down to back of hand

54. Tendinitis

55. Common Occupational CTDs of the Upper Extremities Tenosynovitis is swelling of the sheath that covers the tendon from constant rubbing against the tendon. Symptoms include: swelling pain loss of motion loss of strength

56. Tenosynovitis

57. Common Occupational CTDs of the Upper Extremities Trigger Finger is a t endon disorder that occurs when there is a groove in the flexing tendon of the finger If the tendon becomes locked in the sheath, attempts to move the finger cause snapping or jerking movements Usually associated with using tools that have handles with hard or sharp edges.

58. Trigger Finger

59. Ganglion Cyst is a bump under the skin caused by an accumulation of fluid within the tendon sheath. It is commonly found at the hand and wrist. Common Occupational CTDs of the Upper Extremities

60. Ganglion Cyst

61. De Quervain’s Disease is an inflammation of the tendon sheath of the thumb attributed to excessive friction between two thumb tendons and their common sheath. It’s a combination of Tendonitis and Tenosynovitis. May be caused by twisting and forceful gripping Symptoms include: swelling pain at the base of the thumb. Common Occupational CTDs of the Upper Extremities

62. De Quervain’s Disease