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Work related shoulder disorders

PMR PG Teaching

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Work related shoulder disorders

  1. 1. Work Related Shoulder Disorders Dr. Sanjay Wadhwa Professor, Dept. of Physical Medicine and Rehabilitation, AIIMS, New Delhi
  2. 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. 3. • Introduction • Definition(s) • Classification(s) • Evaluation • Prevention • Management Work Related Shoulder Disorders
  4. 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. 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. 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. 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. 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. 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. 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. 11. High levels of muscle enzymes, including creatine phosphokinase and aldolase. Work Related Shoulder Disorders
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  15. 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. 16. Japanese Grading System • Grade I • Grade II • Grade III • Grade IV • Grade V Work Related Shoulder Disorders
  17. 17. Japanese Grading System • Grade I • Subjective complaints without clinical findings Work Related Shoulder Disorders
  18. 18. Japanese Grading System • Grade II • Subjective complaints with induration and tenderness of the neck, shoulder, and arm muscles Work Related Shoulder Disorders
  19. 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. 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. 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. 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. 23. Japanese Grading System • Grade V • Disturbance at work and in daily life Work Related Shoulder Disorders
  24. 24. Australian Staging System • Stage I • Stage II • Stage III Work Related Shoulder Disorders
  25. 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. 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. 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. 28. Pathophysiologic Grading System • Grade I (mild) • Grade II (moderate) • Grade III (severe) Work Related Shoulder Disorders
  29. 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. 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. 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. 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. 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. 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. 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. 36. Other groups: • Musicians • Healthcare workers • Factory workers • Sheet metal workers • Garment workers • Electricians • Fish industry Work Related Shoulder Disorders
  37. 37. Work Related Shoulder Disorders
  38. 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. 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. 40. Management includes • Ice/ Heat • Exercises • NSAIDs • Tricyclic antidepressants • Local interventions (steroids) • Stress management • Ergonomic interventions Work Related Shoulder Disorders
  41. 41. Conclusion • A very big challenge for India • ‘Make in India’ • Rehabilitation • Prevention Work Related Shoulder Disorders
  42. 42. Work Related Shoulder Disorders THANK YOU