SlideShare a Scribd company logo
1 of 42
Work Related Shoulder Disorders
Dr. Sanjay Wadhwa
Professor,
Dept. of Physical Medicine and Rehabilitation,
AIIMS, New Delhi
• Why talk about it?
• What is it?
• Who gets it?
• When does it occur?
• Where does it occur?
• How can we manage it?
Work Related Shoulder Disorders
• Introduction
• Definition(s)
• Classification(s)
• Evaluation
• Prevention
• Management
Work Related Shoulder Disorders
• Work-related Musculoskeletal Disorders
(WMSDs) are common disorders.
• Economic costs are enormous.
• Considered by some as an ‘umbrella’ term.
• Also known as
repetitive motion disorders,
occupational overuse injuries,
repetitive strain injuries etc.
Work Related Shoulder Disorders
• Account for over 50% of all workers’
compensation claims in USA.
• Upper limb disorders are far more common
than lower limb disorders.
• The mainstay of management involves
ergonomic interventions.
Work Related Shoulder Disorders
WHO defines these disorders as multifactorial,
with work contributing significantly, though not
exclusively, to causing the disease.
The term disorder is more appropriate when
some of the outcomes are of uncertain
pathogenesis and may consist of symptoms
without clinical signs.
The term work related musculoskeletal disorders
has come to replace repetitive strain injuries or
cumulative trauma disorders.
Work Related Shoulder Disorders
Work-related musculoskeletal disorders are
MSDs that may be caused, aggravated, or
precipitated by intense, repeated, or sustained
work activities with insufficient recovery; they
generally develop over a period of weeks,
months, and years.
Work Related Shoulder Disorders
It follows that MSDs can be partially caused by
adverse work conditions, can be exacerbated by
work place exposure, and can impair work
capacity.
Work Related Shoulder Disorders
The diagnoses of WMSDs consist of
• Trapezial and parascapular myalgia,
• Rotator cuff and bicipital tendinitis,
• Impingement syndrome, and
• Subacromial and subdeltoid bursitis.
Work Related Shoulder Disorders
Sustained contractions result in increased
intramuscular pressure and decreased blood flow.
Ischemic conditions occur when intramuscular
pressure exceeds capillary closing pressure at
about 30 mm Hg.
The increased metabolic demands of the working
muscle and the relative ischemia caused by
increased intramuscular pressure can contribute
to derangements in intracellular pH, lactic acid,
calcium, potassium balance, PGE2 etc.
Work Related Shoulder Disorders
High levels of muscle enzymes, including creatine
phosphokinase and aldolase.
Work Related Shoulder Disorders
Work Related Shoulder Disorders
Work Related Shoulder Disorders
Work Related Shoulder Disorders
Different Systems of Grading/ Staging
• Japanese Grading System (Japanese
Association of Industrial Health)
• Australian Staging System (Occupational
Repetition Strain Advisory Committee in
Australia)
• Pathophysiologic Grading System (Luck and
Anderson)
Work Related Shoulder Disorders
Japanese Grading System
• Grade I
• Grade II
• Grade III
• Grade IV
• Grade V
Work Related Shoulder Disorders
Japanese Grading System
• Grade I
• Subjective complaints without clinical findings
Work Related Shoulder Disorders
Japanese Grading System
• Grade II
• Subjective complaints with induration and
tenderness of the neck, shoulder, and arm
muscles
Work Related Shoulder Disorders
Japanese Grading System
• Grade III
Includes grade II and any of the following:
• Increased tenderness or enlargement of
affected muscles
• Positive neurologic tests
• Paresthesia
• Decrease in muscle strength
• Tenderness of spinous processes of vertebrae
• Tenderness of the paravertebral muscles
Work Related Shoulder Disorders
Japanese Grading System
• Grade III contd.
• Tenderness of the nerve plexus
• Tremor of the hand or eyelid
• Cinesalgia of the neck, shoulder, and arm
• Functional disturbance of the peripheral
circulation
• Severe pain or subjective complaints of the
neck, shoulder, or upper extremity
Work Related Shoulder Disorders
Japanese Grading System
• Grade IV
• Type I
• Severe type of grade III
• Type 2
• Direct development from grade II without
passing through grade III, but having specific
findings as follows:
Work Related Shoulder Disorders
Japanese Grading System
• Grade IV Type 2
• Orthopaedic diagnosis of the neck-shoulder-
arm syndrome
• Organic disturbances such as tendinitis or
tenosynovitis
• Autonomic nervous disturbances such as
Raynaud’s phenomenon, passive hyperemia,
or disequilibrium
• Mental disturbance such as anxiety,
sleeplessness, thinking dysfunction, hysteria,
or depression
Work Related Shoulder Disorders
Japanese Grading System
• Grade V
• Disturbance at work and in daily life
Work Related Shoulder Disorders
Australian Staging System
• Stage I
• Stage II
• Stage III
Work Related Shoulder Disorders
Australian Staging System
• Stage I
• Aching and tiredness of the affected limb that
occurs during the work shift but subsides
overnight and during days off work.
• There is no significant reduction in work
performance, and there are no physical signs.
• This condition can persist for months and is
reversible.
Work Related Shoulder Disorders
Australian Staging System
• Stage II
• Symptoms fail to settle overnight, cause a
sleep disturbance, and are associated with a
reduced capacity for repetitive work.
• Physical signs may be present.
• The condition usually persists for months.
Work Related Shoulder Disorders
Australian Staging System
• Stage III
• Symptoms persist at rest.
• Sleep is disturbed, and pain occurs with
nonrepetitive movement.
• The person is unable to perform light duties
and has difficulty with nonoccupational tasks.
• Physical signs are present.
• The condition may persist for months to years.
Work Related Shoulder Disorders
Pathophysiologic Grading System
• Grade I (mild)
• Grade II (moderate)
• Grade III (severe)
Work Related Shoulder Disorders
Pathophysiologic Grading System
• Grade I (mild)
• Shoulder girdle muscle pain that occurs during
work or similar activities and resolves a few
hours later
• No findings on physical examination
Work Related Shoulder Disorders
Pathophysiologic Grading System
• Grade II (moderate)
• Shoulder girdle muscle pain that persists for
several days after work
• Muscle belly and insertional tenderness on
examination
Work Related Shoulder Disorders
Pathophysiologic Grading System
• Grade III (severe)
• Shoulder girdle muscle pain that is constant for
weeks or longer
• Multiple tender areas
• Palpable induration indicating muscle fibrosis
• Muscle belly contracture
• Reduced range of motion of myogenic origin
Work Related Shoulder Disorders
Internal stress due to exposure to environmental
and organizational risk factors in the workplace:
• Poor lighting
• High background noise
• Cramped working conditions
• Inadequate work breaks
• Job dissatisfaction
• Excessive productivity demands
Work Related Shoulder Disorders
• Symptoms are common.
• Diagnosis is essentially clinical.
• Investigations have some role to play.
• Recurrence is common if treatment is not
comprehensive.
Work Related Shoulder Disorders
Dentists seem to be particularly susceptible to
work related shoulder disorder as a result of
sustained static loads while maintaining the
shoulder in a position of flexion and abduction
with elevation of the scapula.
Work Related Shoulder Disorders
In a Finnish study that included 40 dentists,
Katevuo and coworkers found that 46% had
radiographic evidence of osteoarthritis and 44%
had bilateral disease. In contrast, only 13% in the
control group- 82 farmers presumably unexposed
to static load- had findings consistent with
osteoarthritis.
Work Related Shoulder Disorders
Other groups:
• Musicians
• Healthcare workers
• Factory workers
• Sheet metal workers
• Garment workers
• Electricians
• Fish industry
Work Related Shoulder Disorders
Work Related Shoulder Disorders
• According to the WHO approved ICF model
OSDs are structural and functional body
impairments.
• A disability occurs when various activities are
limited.
Work Related Shoulder Disorders
Management is best carried out by a
multidisciplinary team.
The team includes:
• clinical psychologist,
• physical therapist,
• occupational therapist,
• physical education teacher,
• vocational counselor,
• physician (physiatrist), and
• nurse.
Work Related Shoulder Disorders
Management includes
• Ice/ Heat
• Exercises
• NSAIDs
• Tricyclic antidepressants
• Local interventions (steroids)
• Stress management
• Ergonomic interventions
Work Related Shoulder Disorders
Conclusion
• A very big challenge for India
• ‘Make in India’
• Rehabilitation
• Prevention
Work Related Shoulder Disorders
Work Related Shoulder Disorders
THANK YOU

More Related Content

What's hot

Inter vertebral disc prolapse
Inter vertebral disc prolapseInter vertebral disc prolapse
Inter vertebral disc prolapseShruti Shirke
 
Lumbar pain - Mrinal Joshi
Lumbar pain - Mrinal JoshiLumbar pain - Mrinal Joshi
Lumbar pain - Mrinal Joshimrinal joshi
 
Ankylosing Spondylitis
Ankylosing SpondylitisAnkylosing Spondylitis
Ankylosing Spondylitisshotbyaginger
 
Spondylosis by advance spine surgery
Spondylosis by advance spine surgerySpondylosis by advance spine surgery
Spondylosis by advance spine surgeryAdvance Spine Surgery
 
lower back and leg pain approaches
 lower back and leg pain approaches lower back and leg pain approaches
lower back and leg pain approachesrzgar hamed
 
Evaluation of low back ache
Evaluation of low back acheEvaluation of low back ache
Evaluation of low back acheDr Himanshu Soni
 
Post polio residual paralysis PPT
Post polio residual paralysis PPTPost polio residual paralysis PPT
Post polio residual paralysis PPTSAI KRISHNA
 
Basics of Chronic Pain - Dr Venugopal Kochiyil
Basics of Chronic Pain - Dr Venugopal KochiyilBasics of Chronic Pain - Dr Venugopal Kochiyil
Basics of Chronic Pain - Dr Venugopal Kochiyilmrinal joshi
 
Lumbar Spondylosis, Spondylolisthesis and Radiculopathy
Lumbar Spondylosis, Spondylolisthesis and RadiculopathyLumbar Spondylosis, Spondylolisthesis and Radiculopathy
Lumbar Spondylosis, Spondylolisthesis and RadiculopathyShamadeep Kaur (PT)
 
Dance regional interrelationships
Dance regional interrelationshipsDance regional interrelationships
Dance regional interrelationshipsAndrew Cannon
 

What's hot (20)

Low back pain
Low back painLow back pain
Low back pain
 
Inter vertebral disc prolapse
Inter vertebral disc prolapseInter vertebral disc prolapse
Inter vertebral disc prolapse
 
Lumbar pain - Mrinal Joshi
Lumbar pain - Mrinal JoshiLumbar pain - Mrinal Joshi
Lumbar pain - Mrinal Joshi
 
Low back pain or Backache
Low back pain or Backache Low back pain or Backache
Low back pain or Backache
 
Ankylosing Spondylitis
Ankylosing SpondylitisAnkylosing Spondylitis
Ankylosing Spondylitis
 
Spondylosis by advance spine surgery
Spondylosis by advance spine surgerySpondylosis by advance spine surgery
Spondylosis by advance spine surgery
 
lower back and leg pain approaches
 lower back and leg pain approaches lower back and leg pain approaches
lower back and leg pain approaches
 
Evaluation of low back ache
Evaluation of low back acheEvaluation of low back ache
Evaluation of low back ache
 
Neck and back pain
Neck and back painNeck and back pain
Neck and back pain
 
Post polio residual paralysis PPT
Post polio residual paralysis PPTPost polio residual paralysis PPT
Post polio residual paralysis PPT
 
Low backache
Low backacheLow backache
Low backache
 
Basics of Chronic Pain - Dr Venugopal Kochiyil
Basics of Chronic Pain - Dr Venugopal KochiyilBasics of Chronic Pain - Dr Venugopal Kochiyil
Basics of Chronic Pain - Dr Venugopal Kochiyil
 
Spinal cord injuries
Spinal cord injuriesSpinal cord injuries
Spinal cord injuries
 
Spinal cord injury
Spinal cord injurySpinal cord injury
Spinal cord injury
 
Spondylolisthesis and DDx
Spondylolisthesis and DDxSpondylolisthesis and DDx
Spondylolisthesis and DDx
 
Lumbar Spondylosis, Spondylolisthesis and Radiculopathy
Lumbar Spondylosis, Spondylolisthesis and RadiculopathyLumbar Spondylosis, Spondylolisthesis and Radiculopathy
Lumbar Spondylosis, Spondylolisthesis and Radiculopathy
 
Back pain
Back painBack pain
Back pain
 
Dance regional interrelationships
Dance regional interrelationshipsDance regional interrelationships
Dance regional interrelationships
 
cranial manipulation
cranial manipulation cranial manipulation
cranial manipulation
 
Spinal cord injury
Spinal cord injurySpinal cord injury
Spinal cord injury
 

Viewers also liked

Sciatica Self Care
Sciatica Self CareSciatica Self Care
Sciatica Self Carejefi411qca
 
work related elbow disorders
work related elbow disorderswork related elbow disorders
work related elbow disordersmrinal joshi
 
Heel Pain and Plantar Fasciitis
Heel Pain and Plantar FasciitisHeel Pain and Plantar Fasciitis
Heel Pain and Plantar FasciitisKevin Ambadan
 
Hammer toe
Hammer toeHammer toe
Hammer toemiser15
 
Prevention and management of sports injury
Prevention and management of sports injuryPrevention and management of sports injury
Prevention and management of sports injuryjainamit
 
Plantar fasciitis presentation
Plantar fasciitis presentationPlantar fasciitis presentation
Plantar fasciitis presentationDonald Pelto
 
hallux valgus & hallux rigidus
hallux valgus & hallux rigidushallux valgus & hallux rigidus
hallux valgus & hallux rigidusAhmad Jafar
 
Lumbar Intervertebral disc prolapse
Lumbar Intervertebral disc prolapseLumbar Intervertebral disc prolapse
Lumbar Intervertebral disc prolapseDrAvinash Mahender
 
Ankylosing spondylitis
Ankylosing spondylitisAnkylosing spondylitis
Ankylosing spondylitisAbigail Abalos
 
examination of Musculoskeletal system
examination of Musculoskeletal systemexamination of Musculoskeletal system
examination of Musculoskeletal systemAIIMS, Rishikesh
 
Musculoskeletal System Disorders
Musculoskeletal System DisordersMusculoskeletal System Disorders
Musculoskeletal System DisordersMaria Guia Nelson
 
Presentatie RSI (Repetitive Strain Injury)
Presentatie RSI (Repetitive Strain Injury)Presentatie RSI (Repetitive Strain Injury)
Presentatie RSI (Repetitive Strain Injury)speeters
 

Viewers also liked (20)

Sciatica Self Care
Sciatica Self CareSciatica Self Care
Sciatica Self Care
 
work related elbow disorders
work related elbow disorderswork related elbow disorders
work related elbow disorders
 
Hallux rigidus
Hallux rigidus Hallux rigidus
Hallux rigidus
 
Traumatic Paraplegia
Traumatic ParaplegiaTraumatic Paraplegia
Traumatic Paraplegia
 
Heel Pain and Plantar Fasciitis
Heel Pain and Plantar FasciitisHeel Pain and Plantar Fasciitis
Heel Pain and Plantar Fasciitis
 
Flat foot 2 dnbid
Flat foot 2 dnbidFlat foot 2 dnbid
Flat foot 2 dnbid
 
Lecture 45 shah hallux rigidus
Lecture 45 shah hallux rigidusLecture 45 shah hallux rigidus
Lecture 45 shah hallux rigidus
 
Hammer toe
Hammer toeHammer toe
Hammer toe
 
Prevention and management of sports injury
Prevention and management of sports injuryPrevention and management of sports injury
Prevention and management of sports injury
 
Plantar fasciitis presentation
Plantar fasciitis presentationPlantar fasciitis presentation
Plantar fasciitis presentation
 
Hallux Rigidus
Hallux RigidusHallux Rigidus
Hallux Rigidus
 
hallux valgus & hallux rigidus
hallux valgus & hallux rigidushallux valgus & hallux rigidus
hallux valgus & hallux rigidus
 
Musculoskeletal Disorders
Musculoskeletal DisordersMusculoskeletal Disorders
Musculoskeletal Disorders
 
Lumbar Intervertebral disc prolapse
Lumbar Intervertebral disc prolapseLumbar Intervertebral disc prolapse
Lumbar Intervertebral disc prolapse
 
Ankylosing spondylitis
Ankylosing spondylitisAnkylosing spondylitis
Ankylosing spondylitis
 
Sports injury
Sports injurySports injury
Sports injury
 
examination of Musculoskeletal system
examination of Musculoskeletal systemexamination of Musculoskeletal system
examination of Musculoskeletal system
 
Flat foot
Flat footFlat foot
Flat foot
 
Musculoskeletal System Disorders
Musculoskeletal System DisordersMusculoskeletal System Disorders
Musculoskeletal System Disorders
 
Presentatie RSI (Repetitive Strain Injury)
Presentatie RSI (Repetitive Strain Injury)Presentatie RSI (Repetitive Strain Injury)
Presentatie RSI (Repetitive Strain Injury)
 

Similar to Work related shoulder disorders

FATIGUE ASSESMENT & MANGEMENT BY- DR. ANJALI RAI
FATIGUE ASSESMENT & MANGEMENT BY- DR. ANJALI RAIFATIGUE ASSESMENT & MANGEMENT BY- DR. ANJALI RAI
FATIGUE ASSESMENT & MANGEMENT BY- DR. ANJALI RAIGoogle
 
Yoga for computer professionals
Yoga for computer professionalsYoga for computer professionals
Yoga for computer professionalsMeera Nandan
 
Subacromial pain daniel
Subacromial pain danielSubacromial pain daniel
Subacromial pain danielDaniel Major
 
low back pain chinmayee.pdf
low back pain chinmayee.pdflow back pain chinmayee.pdf
low back pain chinmayee.pdfChinmayeeSahu16
 
Ergonomics healthcare professinals
Ergonomics healthcare professinalsErgonomics healthcare professinals
Ergonomics healthcare professinalsVivek Singh Rathore
 
曹昭懿物理治療師-復健與安寧緩和照護20130922
曹昭懿物理治療師-復健與安寧緩和照護20130922曹昭懿物理治療師-復健與安寧緩和照護20130922
曹昭懿物理治療師-復健與安寧緩和照護20130922ptaroc PT
 
Low back pain (lumbago)
Low back pain (lumbago) Low back pain (lumbago)
Low back pain (lumbago) SHERIFFMUIDEEN1
 
Heather Smith, NYULMC Inservice - FINAL
Heather Smith, NYULMC Inservice - FINALHeather Smith, NYULMC Inservice - FINAL
Heather Smith, NYULMC Inservice - FINALHeather Smith
 
癌症病人常見症狀之物理治療 王儷穎
癌症病人常見症狀之物理治療 王儷穎癌症病人常見症狀之物理治療 王儷穎
癌症病人常見症狀之物理治療 王儷穎Kit Leong
 
repetetive strain injury
repetetive strain injuryrepetetive strain injury
repetetive strain injuryAakash jainth
 
posture.MGH.Ap.2022.ppsx
posture.MGH.Ap.2022.ppsxposture.MGH.Ap.2022.ppsx
posture.MGH.Ap.2022.ppsxmrinal joshi
 
Components of Physical Fitness BSC 6 SEm Fit & Exs Mgt.pptx
Components of Physical Fitness BSC 6 SEm Fit & Exs Mgt.pptxComponents of Physical Fitness BSC 6 SEm Fit & Exs Mgt.pptx
Components of Physical Fitness BSC 6 SEm Fit & Exs Mgt.pptxChandanRaj58
 
Spinal decompression
Spinal decompressionSpinal decompression
Spinal decompressionSean Konrad
 
What is Physiotherapy.pptx
What is Physiotherapy.pptxWhat is Physiotherapy.pptx
What is Physiotherapy.pptxParthaRanjanDas
 
林慧芬物理治療師-復健與安寧緩和照顧20131013
林慧芬物理治療師-復健與安寧緩和照顧20131013林慧芬物理治療師-復健與安寧緩和照顧20131013
林慧芬物理治療師-復健與安寧緩和照顧20131013ptaroc PT
 
Low Back Pain abc A review of anatomy and treatment options for low back pain.
Low Back Pain abc A review of anatomy and treatment options for low back pain.Low Back Pain abc A review of anatomy and treatment options for low back pain.
Low Back Pain abc A review of anatomy and treatment options for low back pain.raedalimd
 

Similar to Work related shoulder disorders (20)

FATIGUE ASSESMENT & MANGEMENT BY- DR. ANJALI RAI
FATIGUE ASSESMENT & MANGEMENT BY- DR. ANJALI RAIFATIGUE ASSESMENT & MANGEMENT BY- DR. ANJALI RAI
FATIGUE ASSESMENT & MANGEMENT BY- DR. ANJALI RAI
 
Yoga for computer professionals
Yoga for computer professionalsYoga for computer professionals
Yoga for computer professionals
 
Subacromial pain daniel
Subacromial pain danielSubacromial pain daniel
Subacromial pain daniel
 
low back pain chinmayee.pdf
low back pain chinmayee.pdflow back pain chinmayee.pdf
low back pain chinmayee.pdf
 
Immobility
ImmobilityImmobility
Immobility
 
Joining up occupational health and safety with rehabilitation
Joining up occupational health and safety with rehabilitationJoining up occupational health and safety with rehabilitation
Joining up occupational health and safety with rehabilitation
 
Ergonomics healthcare professinals
Ergonomics healthcare professinalsErgonomics healthcare professinals
Ergonomics healthcare professinals
 
曹昭懿物理治療師-復健與安寧緩和照護20130922
曹昭懿物理治療師-復健與安寧緩和照護20130922曹昭懿物理治療師-復健與安寧緩和照護20130922
曹昭懿物理治療師-復健與安寧緩和照護20130922
 
Low back pain (lumbago)
Low back pain (lumbago) Low back pain (lumbago)
Low back pain (lumbago)
 
Heather Smith, NYULMC Inservice - FINAL
Heather Smith, NYULMC Inservice - FINALHeather Smith, NYULMC Inservice - FINAL
Heather Smith, NYULMC Inservice - FINAL
 
癌症病人常見症狀之物理治療 王儷穎
癌症病人常見症狀之物理治療 王儷穎癌症病人常見症狀之物理治療 王儷穎
癌症病人常見症狀之物理治療 王儷穎
 
repetetive strain injury
repetetive strain injuryrepetetive strain injury
repetetive strain injury
 
posture.MGH.Ap.2022.ppsx
posture.MGH.Ap.2022.ppsxposture.MGH.Ap.2022.ppsx
posture.MGH.Ap.2022.ppsx
 
Components of Physical Fitness BSC 6 SEm Fit & Exs Mgt.pptx
Components of Physical Fitness BSC 6 SEm Fit & Exs Mgt.pptxComponents of Physical Fitness BSC 6 SEm Fit & Exs Mgt.pptx
Components of Physical Fitness BSC 6 SEm Fit & Exs Mgt.pptx
 
Spinal decompression
Spinal decompressionSpinal decompression
Spinal decompression
 
What is Physiotherapy.pptx
What is Physiotherapy.pptxWhat is Physiotherapy.pptx
What is Physiotherapy.pptx
 
林慧芬物理治療師-復健與安寧緩和照顧20131013
林慧芬物理治療師-復健與安寧緩和照顧20131013林慧芬物理治療師-復健與安寧緩和照顧20131013
林慧芬物理治療師-復健與安寧緩和照顧20131013
 
Low Back Pain abc A review of anatomy and treatment options for low back pain.
Low Back Pain abc A review of anatomy and treatment options for low back pain.Low Back Pain abc A review of anatomy and treatment options for low back pain.
Low Back Pain abc A review of anatomy and treatment options for low back pain.
 
Physio 11
Physio 11Physio 11
Physio 11
 
Low back pain
Low back painLow back pain
Low back pain
 

More from mrinal joshi

materclass.patna.2023.ppsx
materclass.patna.2023.ppsxmaterclass.patna.2023.ppsx
materclass.patna.2023.ppsxmrinal joshi
 
PMR Buzz Magazine_Oct 2022.pdf
PMR Buzz Magazine_Oct 2022.pdfPMR Buzz Magazine_Oct 2022.pdf
PMR Buzz Magazine_Oct 2022.pdfmrinal joshi
 
PMR Buzz Magazine_July 2022.pdf
PMR Buzz Magazine_July 2022.pdfPMR Buzz Magazine_July 2022.pdf
PMR Buzz Magazine_July 2022.pdfmrinal joshi
 
PMR Buzz Magazine_April 2022.pdf
PMR Buzz Magazine_April 2022.pdfPMR Buzz Magazine_April 2022.pdf
PMR Buzz Magazine_April 2022.pdfmrinal joshi
 
community inclusion of people with disabilities
community inclusion of people with disabilities community inclusion of people with disabilities
community inclusion of people with disabilities mrinal joshi
 
PMR Buzz Magazine_Jan2022.pdf
PMR Buzz Magazine_Jan2022.pdfPMR Buzz Magazine_Jan2022.pdf
PMR Buzz Magazine_Jan2022.pdfmrinal joshi
 
PMR Buzz Volume 4.2021
PMR Buzz Volume 4.2021PMR Buzz Volume 4.2021
PMR Buzz Volume 4.2021mrinal joshi
 
Phenol blocks for spasticity
Phenol blocks for spasticity Phenol blocks for spasticity
Phenol blocks for spasticity mrinal joshi
 
Pmr buzz magazine july 2021
Pmr buzz magazine july 2021Pmr buzz magazine july 2021
Pmr buzz magazine july 2021mrinal joshi
 
Rehabilitation in spastic paresis
Rehabilitation in spastic paresisRehabilitation in spastic paresis
Rehabilitation in spastic paresismrinal joshi
 
Pmr buzz magazine april 2021
Pmr buzz magazine april 2021Pmr buzz magazine april 2021
Pmr buzz magazine april 2021mrinal joshi
 
Shoulder Impingement - conservative management overview
Shoulder Impingement - conservative management overviewShoulder Impingement - conservative management overview
Shoulder Impingement - conservative management overviewmrinal joshi
 
Pmr buzz magazine oct 2020
Pmr buzz magazine oct 2020Pmr buzz magazine oct 2020
Pmr buzz magazine oct 2020mrinal joshi
 
Pmr buzz magazine aug 2020 rt all
Pmr buzz magazine aug 2020 rt  allPmr buzz magazine aug 2020 rt  all
Pmr buzz magazine aug 2020 rt allmrinal joshi
 
Urodynamics - PMR - Dr Henry Prakash
Urodynamics  - PMR - Dr Henry PrakashUrodynamics  - PMR - Dr Henry Prakash
Urodynamics - PMR - Dr Henry Prakashmrinal joshi
 
Prosthetics - Dr Anil Jain
Prosthetics - Dr Anil JainProsthetics - Dr Anil Jain
Prosthetics - Dr Anil Jainmrinal joshi
 
Lower Limb Orthotics - Dr Rajendra Sharma
Lower Limb Orthotics - Dr Rajendra SharmaLower Limb Orthotics - Dr Rajendra Sharma
Lower Limb Orthotics - Dr Rajendra Sharmamrinal joshi
 

More from mrinal joshi (20)

materclass.patna.2023.ppsx
materclass.patna.2023.ppsxmaterclass.patna.2023.ppsx
materclass.patna.2023.ppsx
 
PMR Buzz Magazine_Oct 2022.pdf
PMR Buzz Magazine_Oct 2022.pdfPMR Buzz Magazine_Oct 2022.pdf
PMR Buzz Magazine_Oct 2022.pdf
 
PMR Buzz Magazine_July 2022.pdf
PMR Buzz Magazine_July 2022.pdfPMR Buzz Magazine_July 2022.pdf
PMR Buzz Magazine_July 2022.pdf
 
PMR Buzz Magazine_April 2022.pdf
PMR Buzz Magazine_April 2022.pdfPMR Buzz Magazine_April 2022.pdf
PMR Buzz Magazine_April 2022.pdf
 
community inclusion of people with disabilities
community inclusion of people with disabilities community inclusion of people with disabilities
community inclusion of people with disabilities
 
PMR Buzz Magazine_Jan2022.pdf
PMR Buzz Magazine_Jan2022.pdfPMR Buzz Magazine_Jan2022.pdf
PMR Buzz Magazine_Jan2022.pdf
 
PMR Buzz Volume 4.2021
PMR Buzz Volume 4.2021PMR Buzz Volume 4.2021
PMR Buzz Volume 4.2021
 
Phenol blocks for spasticity
Phenol blocks for spasticity Phenol blocks for spasticity
Phenol blocks for spasticity
 
Pmr buzz magazine july 2021
Pmr buzz magazine july 2021Pmr buzz magazine july 2021
Pmr buzz magazine july 2021
 
Rehabilitation in spastic paresis
Rehabilitation in spastic paresisRehabilitation in spastic paresis
Rehabilitation in spastic paresis
 
Pmr buzz magazine april 2021
Pmr buzz magazine april 2021Pmr buzz magazine april 2021
Pmr buzz magazine april 2021
 
Shoulder Impingement - conservative management overview
Shoulder Impingement - conservative management overviewShoulder Impingement - conservative management overview
Shoulder Impingement - conservative management overview
 
Pmr buzz-jan21
Pmr buzz-jan21Pmr buzz-jan21
Pmr buzz-jan21
 
Pmr buzz magazine oct 2020
Pmr buzz magazine oct 2020Pmr buzz magazine oct 2020
Pmr buzz magazine oct 2020
 
Pmr buzz magazine aug 2020 rt all
Pmr buzz magazine aug 2020 rt  allPmr buzz magazine aug 2020 rt  all
Pmr buzz magazine aug 2020 rt all
 
PMR Buzz
PMR BuzzPMR Buzz
PMR Buzz
 
Cancer.rehab
Cancer.rehabCancer.rehab
Cancer.rehab
 
Urodynamics - PMR - Dr Henry Prakash
Urodynamics  - PMR - Dr Henry PrakashUrodynamics  - PMR - Dr Henry Prakash
Urodynamics - PMR - Dr Henry Prakash
 
Prosthetics - Dr Anil Jain
Prosthetics - Dr Anil JainProsthetics - Dr Anil Jain
Prosthetics - Dr Anil Jain
 
Lower Limb Orthotics - Dr Rajendra Sharma
Lower Limb Orthotics - Dr Rajendra SharmaLower Limb Orthotics - Dr Rajendra Sharma
Lower Limb Orthotics - Dr Rajendra Sharma
 

Recently uploaded

The 2024 Outlook for Older Adults: Healthcare Consumer Survey
The 2024 Outlook for Older Adults: Healthcare Consumer SurveyThe 2024 Outlook for Older Adults: Healthcare Consumer Survey
The 2024 Outlook for Older Adults: Healthcare Consumer SurveyMedia Logic
 
❤️ Chandigarh Call Girls ☎️99158-51334☎️ Escort service in Chandigarh ☎️ Chan...
❤️ Chandigarh Call Girls ☎️99158-51334☎️ Escort service in Chandigarh ☎️ Chan...❤️ Chandigarh Call Girls ☎️99158-51334☎️ Escort service in Chandigarh ☎️ Chan...
❤️ Chandigarh Call Girls ☎️99158-51334☎️ Escort service in Chandigarh ☎️ Chan...rajveerescorts2022
 
clostridiumbotulinum- BY Muzammil Ahmed Siddiqui.pptx
clostridiumbotulinum- BY Muzammil Ahmed Siddiqui.pptxclostridiumbotulinum- BY Muzammil Ahmed Siddiqui.pptx
clostridiumbotulinum- BY Muzammil Ahmed Siddiqui.pptxMuzammil Ahmed Siddiqui
 
Post marketing surveillance in Japan, legislation and.pptx
Post marketing surveillance in Japan, legislation and.pptxPost marketing surveillance in Japan, legislation and.pptx
Post marketing surveillance in Japan, legislation and.pptxDimple Marathe
 
Cash Payment 😋 +9316020077 Goa Call Girl No Advance *Full Service
Cash Payment 😋  +9316020077 Goa Call Girl No Advance *Full ServiceCash Payment 😋  +9316020077 Goa Call Girl No Advance *Full Service
Cash Payment 😋 +9316020077 Goa Call Girl No Advance *Full ServiceReal Sex Provide In Goa
 
The Power of Technology and Collaboration in Research - Rheumatology Research...
The Power of Technology and Collaboration in Research - Rheumatology Research...The Power of Technology and Collaboration in Research - Rheumatology Research...
The Power of Technology and Collaboration in Research - Rheumatology Research...Paul Sufka
 
ISO 15189 2022 standards for laboratory quality and competence
ISO 15189 2022 standards for laboratory quality and competenceISO 15189 2022 standards for laboratory quality and competence
ISO 15189 2022 standards for laboratory quality and competencePathKind Labs
 
VIP ℂall Girls Tambaram Chennai 7427069034 WhatsApp: Me All Time Serviℂe Avai...
VIP ℂall Girls Tambaram Chennai 7427069034 WhatsApp: Me All Time Serviℂe Avai...VIP ℂall Girls Tambaram Chennai 7427069034 WhatsApp: Me All Time Serviℂe Avai...
VIP ℂall Girls Tambaram Chennai 7427069034 WhatsApp: Me All Time Serviℂe Avai...chaddakomal #v08
 
ITM HOSPITAL The hospital has also been recognised as the best emerging hosp...
ITM  HOSPITAL The hospital has also been recognised as the best emerging hosp...ITM  HOSPITAL The hospital has also been recognised as the best emerging hosp...
ITM HOSPITAL The hospital has also been recognised as the best emerging hosp...jvomprakash
 
Coach Dan Quinn Commanders Feather T Shirts
Coach Dan Quinn Commanders Feather T ShirtsCoach Dan Quinn Commanders Feather T Shirts
Coach Dan Quinn Commanders Feather T Shirtsrahman018755
 
Spauldings classification ppt by Dr C P PRINCE
Spauldings classification ppt by Dr C P PRINCESpauldings classification ppt by Dr C P PRINCE
Spauldings classification ppt by Dr C P PRINCEDR.PRINCE C P
 
Goa Call Girl Oyo Hotel ♡ ˚ 🦢・ ✧ +9316020077 Call gIRL in Goa
Goa Call Girl Oyo Hotel ♡ ˚ 🦢・ ✧ +9316020077 Call gIRL in GoaGoa Call Girl Oyo Hotel ♡ ˚ 🦢・ ✧ +9316020077 Call gIRL in Goa
Goa Call Girl Oyo Hotel ♡ ˚ 🦢・ ✧ +9316020077 Call gIRL in GoaReal Sex Provide In Goa
 
Etiology for RRT and Code Blue Workshop.
Etiology for RRT and Code Blue Workshop.Etiology for RRT and Code Blue Workshop.
Etiology for RRT and Code Blue Workshop.Brian Locke
 
Obat aborsi Jakarta Timur Wa 081225888346 Jual Obat aborsi Cytotec asli Di Ja...
Obat aborsi Jakarta Timur Wa 081225888346 Jual Obat aborsi Cytotec asli Di Ja...Obat aborsi Jakarta Timur Wa 081225888346 Jual Obat aborsi Cytotec asli Di Ja...
Obat aborsi Jakarta Timur Wa 081225888346 Jual Obat aborsi Cytotec asli Di Ja...icha27638
 
VIP ℂall Girls Bodakdev Ahmedabad 7427069034 WhatsApp: Me All Time Serviℂe Av...
VIP ℂall Girls Bodakdev Ahmedabad 7427069034 WhatsApp: Me All Time Serviℂe Av...VIP ℂall Girls Bodakdev Ahmedabad 7427069034 WhatsApp: Me All Time Serviℂe Av...
VIP ℂall Girls Bodakdev Ahmedabad 7427069034 WhatsApp: Me All Time Serviℂe Av...gargkajal2024#G05
 
The Events of Cardiac Cycle - Wigger's Diagram
The Events of Cardiac Cycle - Wigger's DiagramThe Events of Cardiac Cycle - Wigger's Diagram
The Events of Cardiac Cycle - Wigger's DiagramMedicoseAcademics
 
Session-1-MBFHI-A-part-of-the-Global-Strategy.ppt
Session-1-MBFHI-A-part-of-the-Global-Strategy.pptSession-1-MBFHI-A-part-of-the-Global-Strategy.ppt
Session-1-MBFHI-A-part-of-the-Global-Strategy.pptMedidas Medical Center INC
 
Leadership Style - Code and Rapid Response Workshop
Leadership Style - Code and Rapid Response WorkshopLeadership Style - Code and Rapid Response Workshop
Leadership Style - Code and Rapid Response WorkshopBrian Locke
 
TEST BANK For Leddy & Pepper’s Professional Nursing, 10th Edition by Lucy Hoo...
TEST BANK For Leddy & Pepper’s Professional Nursing, 10th Edition by Lucy Hoo...TEST BANK For Leddy & Pepper’s Professional Nursing, 10th Edition by Lucy Hoo...
TEST BANK For Leddy & Pepper’s Professional Nursing, 10th Edition by Lucy Hoo...rightmanforbloodline
 
Independent Call Girl in 😋 Goa +9316020077 Goa Call Girl
Independent Call Girl in 😋 Goa  +9316020077 Goa Call GirlIndependent Call Girl in 😋 Goa  +9316020077 Goa Call Girl
Independent Call Girl in 😋 Goa +9316020077 Goa Call GirlReal Sex Provide In Goa
 

Recently uploaded (20)

The 2024 Outlook for Older Adults: Healthcare Consumer Survey
The 2024 Outlook for Older Adults: Healthcare Consumer SurveyThe 2024 Outlook for Older Adults: Healthcare Consumer Survey
The 2024 Outlook for Older Adults: Healthcare Consumer Survey
 
❤️ Chandigarh Call Girls ☎️99158-51334☎️ Escort service in Chandigarh ☎️ Chan...
❤️ Chandigarh Call Girls ☎️99158-51334☎️ Escort service in Chandigarh ☎️ Chan...❤️ Chandigarh Call Girls ☎️99158-51334☎️ Escort service in Chandigarh ☎️ Chan...
❤️ Chandigarh Call Girls ☎️99158-51334☎️ Escort service in Chandigarh ☎️ Chan...
 
clostridiumbotulinum- BY Muzammil Ahmed Siddiqui.pptx
clostridiumbotulinum- BY Muzammil Ahmed Siddiqui.pptxclostridiumbotulinum- BY Muzammil Ahmed Siddiqui.pptx
clostridiumbotulinum- BY Muzammil Ahmed Siddiqui.pptx
 
Post marketing surveillance in Japan, legislation and.pptx
Post marketing surveillance in Japan, legislation and.pptxPost marketing surveillance in Japan, legislation and.pptx
Post marketing surveillance in Japan, legislation and.pptx
 
Cash Payment 😋 +9316020077 Goa Call Girl No Advance *Full Service
Cash Payment 😋  +9316020077 Goa Call Girl No Advance *Full ServiceCash Payment 😋  +9316020077 Goa Call Girl No Advance *Full Service
Cash Payment 😋 +9316020077 Goa Call Girl No Advance *Full Service
 
The Power of Technology and Collaboration in Research - Rheumatology Research...
The Power of Technology and Collaboration in Research - Rheumatology Research...The Power of Technology and Collaboration in Research - Rheumatology Research...
The Power of Technology and Collaboration in Research - Rheumatology Research...
 
ISO 15189 2022 standards for laboratory quality and competence
ISO 15189 2022 standards for laboratory quality and competenceISO 15189 2022 standards for laboratory quality and competence
ISO 15189 2022 standards for laboratory quality and competence
 
VIP ℂall Girls Tambaram Chennai 7427069034 WhatsApp: Me All Time Serviℂe Avai...
VIP ℂall Girls Tambaram Chennai 7427069034 WhatsApp: Me All Time Serviℂe Avai...VIP ℂall Girls Tambaram Chennai 7427069034 WhatsApp: Me All Time Serviℂe Avai...
VIP ℂall Girls Tambaram Chennai 7427069034 WhatsApp: Me All Time Serviℂe Avai...
 
ITM HOSPITAL The hospital has also been recognised as the best emerging hosp...
ITM  HOSPITAL The hospital has also been recognised as the best emerging hosp...ITM  HOSPITAL The hospital has also been recognised as the best emerging hosp...
ITM HOSPITAL The hospital has also been recognised as the best emerging hosp...
 
Coach Dan Quinn Commanders Feather T Shirts
Coach Dan Quinn Commanders Feather T ShirtsCoach Dan Quinn Commanders Feather T Shirts
Coach Dan Quinn Commanders Feather T Shirts
 
Spauldings classification ppt by Dr C P PRINCE
Spauldings classification ppt by Dr C P PRINCESpauldings classification ppt by Dr C P PRINCE
Spauldings classification ppt by Dr C P PRINCE
 
Goa Call Girl Oyo Hotel ♡ ˚ 🦢・ ✧ +9316020077 Call gIRL in Goa
Goa Call Girl Oyo Hotel ♡ ˚ 🦢・ ✧ +9316020077 Call gIRL in GoaGoa Call Girl Oyo Hotel ♡ ˚ 🦢・ ✧ +9316020077 Call gIRL in Goa
Goa Call Girl Oyo Hotel ♡ ˚ 🦢・ ✧ +9316020077 Call gIRL in Goa
 
Etiology for RRT and Code Blue Workshop.
Etiology for RRT and Code Blue Workshop.Etiology for RRT and Code Blue Workshop.
Etiology for RRT and Code Blue Workshop.
 
Obat aborsi Jakarta Timur Wa 081225888346 Jual Obat aborsi Cytotec asli Di Ja...
Obat aborsi Jakarta Timur Wa 081225888346 Jual Obat aborsi Cytotec asli Di Ja...Obat aborsi Jakarta Timur Wa 081225888346 Jual Obat aborsi Cytotec asli Di Ja...
Obat aborsi Jakarta Timur Wa 081225888346 Jual Obat aborsi Cytotec asli Di Ja...
 
VIP ℂall Girls Bodakdev Ahmedabad 7427069034 WhatsApp: Me All Time Serviℂe Av...
VIP ℂall Girls Bodakdev Ahmedabad 7427069034 WhatsApp: Me All Time Serviℂe Av...VIP ℂall Girls Bodakdev Ahmedabad 7427069034 WhatsApp: Me All Time Serviℂe Av...
VIP ℂall Girls Bodakdev Ahmedabad 7427069034 WhatsApp: Me All Time Serviℂe Av...
 
The Events of Cardiac Cycle - Wigger's Diagram
The Events of Cardiac Cycle - Wigger's DiagramThe Events of Cardiac Cycle - Wigger's Diagram
The Events of Cardiac Cycle - Wigger's Diagram
 
Session-1-MBFHI-A-part-of-the-Global-Strategy.ppt
Session-1-MBFHI-A-part-of-the-Global-Strategy.pptSession-1-MBFHI-A-part-of-the-Global-Strategy.ppt
Session-1-MBFHI-A-part-of-the-Global-Strategy.ppt
 
Leadership Style - Code and Rapid Response Workshop
Leadership Style - Code and Rapid Response WorkshopLeadership Style - Code and Rapid Response Workshop
Leadership Style - Code and Rapid Response Workshop
 
TEST BANK For Leddy & Pepper’s Professional Nursing, 10th Edition by Lucy Hoo...
TEST BANK For Leddy & Pepper’s Professional Nursing, 10th Edition by Lucy Hoo...TEST BANK For Leddy & Pepper’s Professional Nursing, 10th Edition by Lucy Hoo...
TEST BANK For Leddy & Pepper’s Professional Nursing, 10th Edition by Lucy Hoo...
 
Independent Call Girl in 😋 Goa +9316020077 Goa Call Girl
Independent Call Girl in 😋 Goa  +9316020077 Goa Call GirlIndependent Call Girl in 😋 Goa  +9316020077 Goa Call Girl
Independent Call Girl in 😋 Goa +9316020077 Goa Call Girl
 

Work related shoulder disorders

  • 1. Work Related Shoulder Disorders Dr. Sanjay Wadhwa Professor, Dept. of Physical Medicine and Rehabilitation, AIIMS, New Delhi
  • 2. • Why talk about it? • What is it? • Who gets it? • When does it occur? • Where does it occur? • How can we manage it? Work Related Shoulder Disorders
  • 3. • Introduction • Definition(s) • Classification(s) • Evaluation • Prevention • Management Work Related Shoulder Disorders
  • 4. • Work-related Musculoskeletal Disorders (WMSDs) are common disorders. • Economic costs are enormous. • Considered by some as an ‘umbrella’ term. • Also known as repetitive motion disorders, occupational overuse injuries, repetitive strain injuries etc. Work Related Shoulder Disorders
  • 5. • Account for over 50% of all workers’ compensation claims in USA. • Upper limb disorders are far more common than lower limb disorders. • The mainstay of management involves ergonomic interventions. Work Related Shoulder Disorders
  • 6. WHO defines these disorders as multifactorial, with work contributing significantly, though not exclusively, to causing the disease. The term disorder is more appropriate when some of the outcomes are of uncertain pathogenesis and may consist of symptoms without clinical signs. The term work related musculoskeletal disorders has come to replace repetitive strain injuries or cumulative trauma disorders. Work Related Shoulder Disorders
  • 7. Work-related musculoskeletal disorders are MSDs that may be caused, aggravated, or precipitated by intense, repeated, or sustained work activities with insufficient recovery; they generally develop over a period of weeks, months, and years. Work Related Shoulder Disorders
  • 8. It follows that MSDs can be partially caused by adverse work conditions, can be exacerbated by work place exposure, and can impair work capacity. Work Related Shoulder Disorders
  • 9. The diagnoses of WMSDs consist of • Trapezial and parascapular myalgia, • Rotator cuff and bicipital tendinitis, • Impingement syndrome, and • Subacromial and subdeltoid bursitis. Work Related Shoulder Disorders
  • 10. Sustained contractions result in increased intramuscular pressure and decreased blood flow. Ischemic conditions occur when intramuscular pressure exceeds capillary closing pressure at about 30 mm Hg. The increased metabolic demands of the working muscle and the relative ischemia caused by increased intramuscular pressure can contribute to derangements in intracellular pH, lactic acid, calcium, potassium balance, PGE2 etc. Work Related Shoulder Disorders
  • 11. High levels of muscle enzymes, including creatine phosphokinase and aldolase. Work Related Shoulder Disorders
  • 15. Different Systems of Grading/ Staging • Japanese Grading System (Japanese Association of Industrial Health) • Australian Staging System (Occupational Repetition Strain Advisory Committee in Australia) • Pathophysiologic Grading System (Luck and Anderson) Work Related Shoulder Disorders
  • 16. Japanese Grading System • Grade I • Grade II • Grade III • Grade IV • Grade V Work Related Shoulder Disorders
  • 17. Japanese Grading System • Grade I • Subjective complaints without clinical findings Work Related Shoulder Disorders
  • 18. Japanese Grading System • Grade II • Subjective complaints with induration and tenderness of the neck, shoulder, and arm muscles Work Related Shoulder Disorders
  • 19. Japanese Grading System • Grade III Includes grade II and any of the following: • Increased tenderness or enlargement of affected muscles • Positive neurologic tests • Paresthesia • Decrease in muscle strength • Tenderness of spinous processes of vertebrae • Tenderness of the paravertebral muscles Work Related Shoulder Disorders
  • 20. Japanese Grading System • Grade III contd. • Tenderness of the nerve plexus • Tremor of the hand or eyelid • Cinesalgia of the neck, shoulder, and arm • Functional disturbance of the peripheral circulation • Severe pain or subjective complaints of the neck, shoulder, or upper extremity Work Related Shoulder Disorders
  • 21. Japanese Grading System • Grade IV • Type I • Severe type of grade III • Type 2 • Direct development from grade II without passing through grade III, but having specific findings as follows: Work Related Shoulder Disorders
  • 22. Japanese Grading System • Grade IV Type 2 • Orthopaedic diagnosis of the neck-shoulder- arm syndrome • Organic disturbances such as tendinitis or tenosynovitis • Autonomic nervous disturbances such as Raynaud’s phenomenon, passive hyperemia, or disequilibrium • Mental disturbance such as anxiety, sleeplessness, thinking dysfunction, hysteria, or depression Work Related Shoulder Disorders
  • 23. Japanese Grading System • Grade V • Disturbance at work and in daily life Work Related Shoulder Disorders
  • 24. Australian Staging System • Stage I • Stage II • Stage III Work Related Shoulder Disorders
  • 25. Australian Staging System • Stage I • Aching and tiredness of the affected limb that occurs during the work shift but subsides overnight and during days off work. • There is no significant reduction in work performance, and there are no physical signs. • This condition can persist for months and is reversible. Work Related Shoulder Disorders
  • 26. Australian Staging System • Stage II • Symptoms fail to settle overnight, cause a sleep disturbance, and are associated with a reduced capacity for repetitive work. • Physical signs may be present. • The condition usually persists for months. Work Related Shoulder Disorders
  • 27. Australian Staging System • Stage III • Symptoms persist at rest. • Sleep is disturbed, and pain occurs with nonrepetitive movement. • The person is unable to perform light duties and has difficulty with nonoccupational tasks. • Physical signs are present. • The condition may persist for months to years. Work Related Shoulder Disorders
  • 28. Pathophysiologic Grading System • Grade I (mild) • Grade II (moderate) • Grade III (severe) Work Related Shoulder Disorders
  • 29. Pathophysiologic Grading System • Grade I (mild) • Shoulder girdle muscle pain that occurs during work or similar activities and resolves a few hours later • No findings on physical examination Work Related Shoulder Disorders
  • 30. Pathophysiologic Grading System • Grade II (moderate) • Shoulder girdle muscle pain that persists for several days after work • Muscle belly and insertional tenderness on examination Work Related Shoulder Disorders
  • 31. Pathophysiologic Grading System • Grade III (severe) • Shoulder girdle muscle pain that is constant for weeks or longer • Multiple tender areas • Palpable induration indicating muscle fibrosis • Muscle belly contracture • Reduced range of motion of myogenic origin Work Related Shoulder Disorders
  • 32. Internal stress due to exposure to environmental and organizational risk factors in the workplace: • Poor lighting • High background noise • Cramped working conditions • Inadequate work breaks • Job dissatisfaction • Excessive productivity demands Work Related Shoulder Disorders
  • 33. • Symptoms are common. • Diagnosis is essentially clinical. • Investigations have some role to play. • Recurrence is common if treatment is not comprehensive. Work Related Shoulder Disorders
  • 34. Dentists seem to be particularly susceptible to work related shoulder disorder as a result of sustained static loads while maintaining the shoulder in a position of flexion and abduction with elevation of the scapula. Work Related Shoulder Disorders
  • 35. In a Finnish study that included 40 dentists, Katevuo and coworkers found that 46% had radiographic evidence of osteoarthritis and 44% had bilateral disease. In contrast, only 13% in the control group- 82 farmers presumably unexposed to static load- had findings consistent with osteoarthritis. Work Related Shoulder Disorders
  • 36. Other groups: • Musicians • Healthcare workers • Factory workers • Sheet metal workers • Garment workers • Electricians • Fish industry Work Related Shoulder Disorders
  • 38. • According to the WHO approved ICF model OSDs are structural and functional body impairments. • A disability occurs when various activities are limited. Work Related Shoulder Disorders
  • 39. Management is best carried out by a multidisciplinary team. The team includes: • clinical psychologist, • physical therapist, • occupational therapist, • physical education teacher, • vocational counselor, • physician (physiatrist), and • nurse. Work Related Shoulder Disorders
  • 40. Management includes • Ice/ Heat • Exercises • NSAIDs • Tricyclic antidepressants • Local interventions (steroids) • Stress management • Ergonomic interventions Work Related Shoulder Disorders
  • 41. Conclusion • A very big challenge for India • ‘Make in India’ • Rehabilitation • Prevention Work Related Shoulder Disorders
  • 42. Work Related Shoulder Disorders THANK YOU