This document discusses neck pain and disorders in occupational medicine. It covers the epidemiology of neck and upper limb disorders, including common conditions like tendinitis and nerve entrapments. It discusses risk factors to consider like force, posture, repetition, and contact stress. It also discusses approaches to risk assessment, screening, and surveillance of musculoskeletal disorders in the workplace. The goal is to identify risks, target high-risk jobs, and track trends over time to implement preventative controls and ergonomic changes.

1. بسم الله الرحمن الرحیم

2. NECK PAIN
&DISORDERS IN
OCCUPATIONAL
MEDICINE
(VIRTUAL WORKSHOP)

3. CONTENTS
1-EPIDEMIOLOGY(1,4)
2-PSYCHOSOCIAL FACTORS AT WORK(4)
3-ANALYSIS&DESIGN OF THE JOB(1)
4-JOB HAZARD ANALYSIS(JHA)(OSHA)
5-FITNESS FOR WORK(4)
6-RISK(ASSESSMENT,REDUCTION,ERGONOMY)(3)
7-SCREENING(4)
8-SURVIALANCE(4)

4. A Systematic
Approach
Through
Problem
Oriented
Research

5. 1-EPIDEMIOLOGY
1.1WHAT ARE THE NECK AND UPPER LIMB DISORDERS?
1.2 WHY IS THE EPIDEMIOLOGY IMPORTANT?
1.3 WHAT ARE THE EXPOSURES TO BE CONSIDERED?
1.4 WHAT ARE THE EXPOSURE RESPONSE
RELATIONSHIPS FOR NECK AND UPPER LIMB
DISORDERS?
1.5 EXPOSURE RESPONSE RELATIONSHIP ACCORDING
TO A NIOSH DOCUMENT ON MUSCULOSKELETAL
DISORDERS AND WORKPLACE FACTORS

6. ?

7. 1.1 WHAT ARE THE NECK AND UPPER LIMB DISORDERS?
1.1.1 Non-specific musculoskeletal pain
- Pain in the neck/shoulder region with or without neck stiffness
and with tenderness over the descending part of the trapezius muscle (non-specific
neck/shoulder pain)
-Tension neck syndrome in literature
-cervical brachial pain syndrome(M53.1)in ICD-10

9. 1.1 WHAT ARE THE NECK AND UPPER LIMB DISORDERS?
1.1.2 Tendinitis
-Tendinitis is inflammation of the muscle tendon, the attachment
of the muscle to the bone.
-Common locations for tendinitis are the shoulder
(Rotator cuff,biceps-tendinitis), the elbow as a lateral epicondylitis
or to the wrist as De Quervains disease (tendinitis in the long thumb abductor
and the short thumb extensor)

11. 1.1 WHAT ARE THE NECK AND UPPER LIMB DISORDERS?
1.1.3 Nerve entrapments
-Nerve entrapments occur where a nerve may come under pressure or is
exposed to mechanical friction(CTS-Neurogenic TOS)

13. 1.1 WHAT ARE THE NECK AND UPPER LIMB DISORDERS?
1.1.4 Degenerative joint disease and osteoarthritis
-Degenerative changes in the cervical spine (spondylosis, i.e. spurs and/or
disc degeneration) are common and 80% of the population may have
degenerative changes at the age of 50 years on radiographs.
-Cervical spondylosis is related to job titles with high load on the cervical spine
(Hagberg and Wegman 1987). However, the correlation between symptoms
and cervical spondylosis is poor (Friedenberg and Mileer 1963; Lawrence 1969).

15. 1.2WHY IS THE EPIDEMIOLOGY IMPORTANT?
1-In the general working
population in Sweden, as many as one-third of women and one-quarter of
men reported pain in the neck and shoulder that was present every day or
every other day.
2-In some surveys up to 17-20% of people complain of neck-shoulder pain and 20% of hand-wrist
pain during the past 7 days.
3-The HSE estimates an incidence of work-attributed upper limb and neck complaints in the UK
of 186/1000 adults/year with 4.7 million lost working days per annum.

17. 1.3 WHAT ARE THE EXPOSURES TO BE CONSIDERED?
-Conditions external to the workers, such as job demands and job
requirements
-Generic physical risk factors for the neck and upper limb
Disorders(not only job title) are force, posture, repetition, contact stress
and temperature.(intensity, duration and frequency)

18. 1.4 WHAT ARE THE EXPOSURE RESPONSE
RELATIONSHIPS FOR NECK AND UPPER LIMB
DISORDERS?
-1995:‘Work related musculoskeletal disorders (WMSDS): a reference book for
Prevention-Institute Recherche, Santé et Securité de Travail de
Quebec (IRSST)
-1995:American Academy of Orthopedic
Surgeons was published ‘Repetitive motion disorders of the upper extremity
-1997:NIOSH published
‘Musculoskeletal disorders and workplace factors—a critical review of the
epidemiological evidence for work related musculoskeletal disorders of
the neck, upper extremity and low back.’
-The evidence was grouped into four categories: strong evidence, evidence,
insufficient evidence or evidence of no effect.
-1999:‘Risk factors for work-related neck and upper limb musculoskeletal disorders’
was published by the European Agency for Health at Work

19. 1.5 EXPOSURE RESPONSE RELATIONSHIP ACCORDING
TO A NIOSH DOCUMENT ON MUSCULOSKELETAL
DISORDERS AND WORKPLACE FACTORS

20. 2-PSYCHOLOGICAL FACTORS AT WORK
1.2.1 The demand-control model:Organic changes(Catabolism&Anabolism)
-High demands high psychological demands-
-Increasing job strain:-
- Increasing sleep disturbance and gastrointestinal symptoms-
- Decreasing testosterone blood concentration-
-Increasing blood pressure during activities at work-
2.2.1 pain perception: Chronic pain syndromes (Depression)-
- Adrenocortical axis& turnover of endorphins-
-3.2.1 possibility to cope with the illness-
- Lack of possibility to influence decisions at work (authority over decisions) and sick leave

21. 3-ANALYSIS&DESIGN OF THE JOB

28. 5-FITNESS FOR WORK
Fitness requirements:
These include good eyesight, adequate hearing, and reasonable head/neck mobility. The
ability to look over the shoulder is important. An operator should not have a condition that
predisposes to sudden loss of conciousness.

29. 6-RISK (ASSESSMENT,REDUCTION,ERGONOMIC
CONSIDERATIONS)
-Suspected Hazard
-Unsuspected Hazard:
-Gender: Almost 90 per cent of fatal and 78 per cent of other reportable industrial injuries
occur in males, even though the numbers employed are roughly equal.
-Age: It might be thought that the young employee is at greater risk of industrial accident
than the older worker, as is clearly the case with respect to traffic accidents.
When age and gender are considered together, there is a tendency for male accidents
to peak in the 25- to 34-year age group and for females this is in the 45- to 55-yeargroup. -

30. 6-RISK (ASSESSMENT,REDUCTION,ERGONOMIC
CONSIDERATIONS)

31. 6-RISK (ASSESSMENT,REDUCTION,ERGONOMIC
CONSIDERATIONS)

32. 6-RISK (ASSESSMENT,REDUCTION,ERGONOMIC
CONSIDERATIONS)

33. 6-RISK (ASSESSMENT,REDUCTION,ERGONOMIC
CONSIDERATIONS)

34. 6-RISK (ASSESSMENT,REDUCTION,ERGONOMIC
CONSIDERATIONS)
HOSTILITY
POSSIBILITY
COMPETITION

35. 6-RISK (ASSESSMENT,REDUCTION,ERGONOMIC CONSIDERATIONS)
Physical (examples)
Loading (lifting and handling)
Poor posture
Repetition, particularly at high speed
High forces
Individual differences, e.g. extremes of anthropometry
Poor equipment and workplace design
Psychological (examples)
Task overload/underload
Mental workload
Control over work
Social support
Individual differences (e.g. poor reaction times, mental ill health)
Poor design of information, displays, controls
Poor system reliability
Human error
Organizational (examples)
Long working hours
Shift work
Short deadlines
Excessive workload
Poor staffing levels
Lack of worker involvement in system design

36. 6-RISK (ASSESSMENT,REDUCTION,ERGONOMIC
CONSIDERATIONS)
1.6Substitution
2.6Segregation
3.6Exhaust ventilation
4.6Dilution
5.6Personal protection
6.6Education and good housekeeping

37. 6-RISK (ASSESSMENT,REDUCTION,ERGONOMIC
CONSIDERATIONS)

38. 7-SCREENING

39. 7-SCREENING

40. 7-SCREENING

41. 7-SCREENING

42. 7-SCREENING

43. 7-SCREENING

44. 8-SURVIALANCE

45. 8-SURVIALANCE

46. 8-SURVIALANCE

47. 8-SURVIALANCE
GOALS OF SURVEILLANCE
-Detection of new problems
Determine the magnitude of musculoskeletal disorders-
-Track trends over time-(Surveillance evaluations may involve both the levels of occupational-
exposures (hazard) and health outcome-
- Identify occupational groups, work sites to target control measures-
-Describe health and risk factors to initiate ergonomic change-

48. REFRENCES:
1-Francesco V,Thomas A,Asa K.
Occupational Ergonomics 2003
2-Waldermar K,William S.Marrs.
Occupational Ergonomics 2003
3-Raymond A,Anthony S.
Practical Occupational Medicine 2005
4-Julia S,Steven S.
Oxford Handbook of Occupational Health
2007