Conditions

 

Some common conditions that can be caused or aggravated by a lack of workspace ergonomics are:

·         Repetitive Motion Disorders

·         Carpal Tunnel Syndrome

·         Bursitis and Tendonitis

·         Arthritis

 

 

Repetitive Motion Disorders

Synonym(s):   Cumulative Trauma Disorders, Repetitive Stress Injuries, Overuse Syndrome

What are Repetitive Motion Disorders?

Repetitive motion disorders (RMDs) are a family of muscular conditions that result from repeated motions performed in the course of normal work or daily activities. RMDs include carpal tunnel syndrome, bursitis, tendonitis, epicondylitis, ganglion cyst, tenosynovitis, and trigger finger. RMDs are caused by too many uninterrupted repetitions of an activity or motion, unnatural or awkward motions such as twisting the arm or wrist, overexertion, incorrect posture, or muscle fatigue. RMDs occur most commonly in the hands, wrists, elbows, and shoulders, but can also happen in the neck, back, hips, knees, feet, legs, and ankles. The disorders are characterized by pain, tingling, numbness, visible swelling or redness of the affected area, and the loss of flexibility and strength. For some individuals, there may be no visible sign of injury, although they may find it hard to perform easy tasks Over time, RMDs can cause temporary or permanent damage to the soft tissues in the body -- such as the muscles, nerves, tendons, and ligaments - and compression of nerves or tissue. Generally, RMDs affect individuals who perform repetitive tasks such as assembly line work, meatpacking, sewing, playing musical instruments, and computer work. The disorders may also affect individuals who engage in activities such as carpentry, gardening, and tennis.

Is there Any Treatment?

Treatment for RMDs usually includes reducing or stopping the motions that cause symptoms. Options include taking breaks to give the affected area time to rest, and adopting stretching and relaxation exercises. Applying ice to the affected area and using medications such as pain relievers, cortisone, and anti-inflammatory drugs can reduce pain and swelling. Splints may be able to relieve pressure on the muscles and nerves. Physical therapy may relieve the soreness and pain in the muscles and joints. In rare cases, surgery may be required to relieve symptoms and prevent permanent damage. Some employers have developed ergonomic programs to help workers adjust their pace of work and arrange office equipment to minimize problems.

What is the Prognosis?

Most individuals with RMDs recover completely and can avoid re-injury by changing the way they perform repetitive movements, the frequency with which they perform them, and the amount of time they rest between movements. Without treatment, RMDs may result in permanent injury and complete loss of function in the affected area.

What Research is Being Done?

Much of the on-going research on RMDs is aimed at prevention and rehabilitation. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) funds research on RMDs.

This information can be found on the National Institute of Neurological Disorders and Stroke’s website at http://www.ninds.nih.gov/

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Carpal Tunnel Syndrome

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is a painful progressive condition caused by compression of a key nerve in the wrist.   It occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist.  Symptoms usually start gradually, with  pain, weakness, or numbness in the hand and wrist, radiating up the arm.  As symptoms worsen, people might feel tingling during the day, and decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks.  In some cases, no direct cause of the syndrome can be identified.   Most likely the disorder is due to a congenital predisposition - the carpal tunnel is simply smaller in some people than in others.  However, the risk of developing carpal tunnel syndrome is especially common in those performing assembly line work.

Is there Any Treatment?

Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks, avoiding activities that may worsen symptoms, and immobilizing the wrist in a splint to avoid further damage from twisting or bending.    Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and other nonprescription pain relievers, may ease pain.   Cool (ice) packs and prednisone (taken by mouth) or lidocaine (injected directly into the wrist) can relieve swelling and pressure on the median nerve and provide immediate, temporary relief.  

What is the Prognosis?

Recurrence of carpal tunnel syndrome following treatment is rare. The majority of patients recover completely.  To prevent workplace-related carpal tunnel syndrome, workers can do on-the-job conditioning, perform stretching exercises, take frequent rest breaks, wear splints to keep wrists straight, and use correct posture and wrist position. Wearing fingerless gloves can help keep hands warm and flexible.

What Research is Being Done?

The National Institute of Neurological Disorders and Stroke (NINDS) conducts research on nerve-related conditions such as carpal tunnel syndrome in its laboratories at the National Institutes of Health (NIH) and also supports research through grants to major medical institutions across the country.  Current studies include several randomized clinical trials to evaluate the effectiveness of educational interventions in reducing the incidence of carpal tunnel syndrome. Another clinical study involves collecting data about carpal tunnel syndrome among construction apprentices to better understand specific work factors associated with the disorder and develop strategies to prevent its occurrence among construction and other workers.  Scientists are also investigating the use of alternative therapies, such as acupuncture, to prevent and treat this disorder.

This information can be found on the National Institute of Neurological Disorders and Stroke’s website at http://www.ninds.nih.gov/

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Bursitis and Tendonitis

What is Bursitis and What is Tendonitis?

Bursitis and tendonitis are both common conditions that involve inflammation of the soft tissue around muscles and bones, most often in the shoulder, elbow, wrist, hip, knee, or ankle.

A bursa is a small, fluid-filled sac that acts as a cushion between a bone and other moving parts: muscles, tendons, or skin. Bursae are found throughout the body. Bursitis occurs when a bursa becomes inflamed (redness and increased fluid in the bursa).

A tendon is a flexible band of fibrous tissue that connects muscles to bones. Tendonitis is inflammation of a tendon. Tendons transmit the pull of the muscle to the bone to cause movement. They are found throughout the body, including the hands, wrists, elbows, shoulders, hips, knees, ankles, and feet. Tendons can be small, like those found in the hand, or large, like the Achilles tendon in the heel.

What Causes these Conditions?

Bursitis is commonly caused by overuse of, or direct trauma to, a joint. Bursitis may occur at the knee or elbow, for example, from kneeling or leaning on the elbows longer than usual on a hard surface. Tendonitis is most often the result of a repetitive injury in the affected area. These conditions occur more often with age. Tendons become less flexible with age therefore, more prone to injury.

People who perform activities that require repetitive motions or place stress on joints, such as carpenters, gardeners, musicians, and athletes, are at higher risk for tendonitis and bursitis.

Infection, arthritis, gout, thyroid disease, and diabetes can also bring about inflammation of a bursa or tendon.

What Parts of the Body are Affected?

Tendonitis causes pain and tenderness just outside a joint. Some common names for tendonitis are identified by the sport or movement that typically increases risk for tendon inflammation. They include tennis elbow, golfer’s elbow, pitcher’s shoulder, swimmer’s shoulder, and jumper’s knee. Some common examples follow.

Tennis Elbow and Golfer’s Elbow

Figure 1 Structure of the Elbow

Tennis elbow refers to an injury to the outer elbow tendon. Golfer’s elbow is an injury to the inner tendon of the elbow. These conditions can also occur with any activity that involves repetitive wrist turning or hand gripping such as tool use, hand shaking, or twisting movements. Carpenters, gardeners, painters, musicians, manicurists, and dentists are at higher risk for these forms of tendonitis. Pain occurs near the elbow, sometimes radiating into the upper arm or down to the forearm. Another name for tennis elbow is lateral epicondylitis. Golfer’s elbow is also called medial epicondylitis.

Shoulder Tendonitis, Bursitis, and Impingement Syndrome

Figure 2 Structure of the Shoulder

Two types of tendonitis can affect the shoulder. Biceps tendonitis causes pain in the front or side of the shoulder and may travel down to the elbow and forearm. Pain may also occur when the arm is raised overhead. The biceps muscle, in the front of the upper arm, helps stabilize the upper arm bone (humerus) in the shoulder socket. It also helps accelerate and decelerate the arm during overhead movement in activities like tennis or pitching.

Rotator cuff tendonitis causes shoulder pain at the tip of the shoulder and the upper, outer arm. The pain can be aggravated by reaching, pushing, pulling, lifting, raising the arm above shoulder level, or lying on the affected side. The rotator cuff is primarily a group of four muscles that attach the arm to the shoulder girdle/shoulder blade. The rotator cuff attaches the arm to the shoulder joint and allows the arm to rotate and elevate. If the rotator cuff and bursa are irritated, inflamed, and swollen, they may become compressed between the head of the humerus and the acromion, the outer edge of the shoulder blade. Repeated motion involving the arms, or the aging process involving shoulder motion over many years, may also irritate and wear down the tendons, muscles, and surrounding structures. Squeezing of the rotator cuff is called shoulder impingement syndrome.

Inflammation caused by rheumatoid arthritis may cause rotator cuff tendonitis and bursitis. Sports involving overuse of the shoulder and occupations requiring frequent overhead reaching are other potential causes of irritation to the rotator cuff or bursa and may lead to inflammation and impingement.

Knee Tendonitis or Jumper’s Knee

Figure 3 Lateral View of the Knee

If a person overuses a tendon during activities such as dancing, cycling, or running, the tendon may elongate or undergo microscopic tears and become inflamed. Trying to break a fall may also cause the quadriceps muscles to contract and tear the quadriceps tendon above the knee cap (patella) or the patellar tendon below it. This type of injury is most likely to happen in older people whose tendons are often weaker and less flexible. Tendonitis of the patellar tendon is sometimes called jumper’s knee because in sports that require jumping, such as basketball, the muscle contraction and force of hitting the ground after a jump strain the tendon. After repeated stress, the tendon may become inflamed or tear.

People with tendonitis of the knee may feel pain during running, hurried walking, or jumping. Knee tendonitis can increase risk for ruptures or large tears to the tendon. A complete rupture of the quadriceps or patellar tendon is not only painful, but also makes it difficult for a person to bend, extend, or lift the leg or bear weight on the involved leg.

Achilles Tendonitis

Achilles tendon injuries involve an irritation, stretch, or tear to the tendon connecting the calf muscle to the back of the heel. Achilles tendonitis is a common overuse injury, but can also be caused by tight or weak calf muscles or any condition that causes the tendon to become less flexible and more rigid, such as reactive arthritis or normal aging.

Achilles tendon injuries can happen to anyone who regularly participates in an activity that causes the calf muscle to contract, like climbing stairs or using a stair-stepper, but are most common in middle-aged “weekend warriors” who may not exercise regularly or take time to warm up and stretch properly before an activity. Among professional athletes, most Achilles injuries seem to occur in quick-acceleration or jumping sports like football, tennis, and basketball, and almost always end the season’s competition for the athlete.

Figure 4 Lateral View of the Ankle

Achilles tendonitis can be a chronic condition. It can also cause what appears to be a sudden injury. Tendonitis is the most common factor contributing to Achilles tendon tears. When a tendon is weakened by age or overuse, trauma can cause it to rupture. These injuries can be so sudden and agonizing that they have been known to bring down charging football players

How are these Conditions Diagnosed?

Diagnosis of tendonitis and bursitis begins with a medical history and physical examination. The patient will describe the pain and circumstances in which pain occurs. The location and onset of pain, whether it varies in severity throughout the day, and the factors that relieve or aggravate the pain are all important diagnostic clues. Therapists and physicians will use manual tests called ‘selective tissue tension tests’ to determine which tendon is involved, and will then palpate (a form of touching the tendon) specific areas of the tendon to pinpoint the area of inflammation. X-rays do not show tendons or bursae, but may be helpful in ruling out problems in the bone or arthritis. In the case of a torn tendon, x-rays may help show which tendon is affected. In a knee injury, for example, an x-ray will show that the patella is lower than normal in a quadriceps tendon tear and higher than normal in a patellar tendon tear. The doctor may also use magnetic resonance imaging (MRI) to confirm a partial or total tear. MRIs detect both bone and soft tissues like muscles, tendons and their coverings (sheaths), and bursae.

An anesthetic-injection test is another way to confirm a diagnosis of tendonitis. A small amount of anesthetic (lidocaine hydrochloride) is injected into the affected area. If the pain is temporarily relieved, the diagnosis is confirmed.

The doctor may remove and test fluid from the inflamed area, to rule out infection.

What Kind of Health Care Professional Treats these Conditions?

A primary care physician or a physical therapist can treat the common causes of tendonitis and bursitis. Complicated cases, or those resistant to conservative therapies, may require referral to a specialist, such as an orthopedist or rheumatologist.

How are Bursitis and Tendonitis Treated?

Treatment focuses on healing the injured bursa or tendon. The first step in treating both of these conditions is to reduce pain and inflammation with rest, compression, elevation, and anti-inflammatory medicines such as aspirin, naproxen (Naprosyn1, Aleve), or ibuprofen (Advil, Motrin, or Nuprin). Ice may also be used in acute injuries, but most cases of bursitis or tendonitis are considered chronic, and ice is not helpful. When ice is needed, an ice pack can be applied to the affected area for 15-20 minutes every 4-6 hours for 3-5 days. Longer use of ice and a stretching program may be recommended by a health care provider.

Activity involving the affected joint is also restricted to encourage healing and prevent further injury.

In some cases, such as tennis elbow, elbow bands may be used to compress the forearm muscle to provide some pain relief, limiting the pull of the tendon on the bone. Other protective devices, such as foot orthoses for the ankle and foot or splints for the knee or hand, may temporarily reduce stress to the affected tendon or bursa and facilitate quicker healing times while allowing general activity levels to continue as usual.

The doctor or therapist may use ultrasound (gentle sound-wave vibrations) to warm deep tissues and improve blood flow. Iontophoresis may also be used. This involves using an electrical current to push a corticosteroid medication through the skin directly over the inflamed bursa or tendon. Gentle stretching and strengthening exercises are added gradually. Massage of the soft tissue may be helpful. These may be preceded or followed by use of an ice pack. The type of exercises recommended may vary depending on the location of the affected bursa or tendon.

If there is no improvement, the doctor may inject a corticosteroid medicine into the area surrounding the inflamed bursa or tendon. While corticosteroid injections are a common treatment, they must be used with caution because they may lead to weakening or rupture of the tendon, especially weight-bearing tendons such as the Achilles (ankle), posterior tibial (arch of the foot), and patellar (knee) tendons. If there is still no improvement after 6-12 months, the doctor may perform either arthroscopic or open surgery to repair damage and relieve pressure on the tendons and bursae.

If the bursitis is caused by an infection, the doctor will prescribe antibiotics.

If a tendon is completely torn, surgery may be needed to repair the damage. After surgery on a quadriceps or patellar tendon, for example, the patient will wear a cast for 3-6 weeks and use crutches. For a partial tear, the doctor might apply a cast without performing surgery.

Rehabilitating a partial or complete tear of a tendon requires an exercise program to restore the ability to bend and straighten the knee and to strengthen the leg to prevent repeat injury. A rehabilitation program may last 6 months, although the patient can return to many activities before then.

Can Bursitis and Tendonitis Be Prevented?

To help prevent inflammation or reduce the severity of its recurrence:

·         Warm up or stretch before physical activity.

·         Strengthen muscles around the joint.

·         Take frequent breaks from repetitive tasks.

·         Cushion the affected joint. Use foam for kneeling or elbow pads. Increase the gripping surface of tools with gloves or padding. Apply grip tape or an oversized grip to golf clubs.

·         Use two hands to hold heavy tools. Use a two-handed backhand in tennis.

·         Don’t sit still for long periods.

·         Practice good posture and position the body properly when going about daily activities.

·         Begin new activities or exercise regimens slowly. Gradually increase physical demands following several well-tolerated exercise sessions.

If a history of tendonitis is present, consider seeking guidance from your doctor or therapist before engaging in new exercises and activities.

What are Researchers Learning?

Researchers supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) are studying the role of the immune system in the inflammation of tendonitis. Their aim is to develop new strategies to prevent and treat tendonitis effectively. Others are exploring worksite issues in the development of tendonitis and other work-related musculoskeletal disorders.

This information can be found on the National Institute of Arthritis and Musculoskeletal and Skin Diseases’ website at http://www.niams.nih.gov/

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Arthritis

What is Arthritis?

Many people start to feel pain and stiffness in their bodies over time. Sometimes their hands or knees or shoulders get sore and are hard to move and may become swollen. These people may have arthritis. Arthritis may be caused by inflammation, of the tissue lining the joints. Some signs of inflammation include redness, heat, pain, and swelling. These problems suggest that something is wrong.

There are different types of arthritis. In some diseases in which arthritis occurs, other organs, such as your eyes, your chest, or your skin, can also be affected. Some people may worry that arthritis means they won’t be able to work or take care of their children and their families. Others think that you simply have to accept conditions such as arthritis.

What are the Types of Arthritis?

There are several types of arthritis. The two most common ones are osteoarthritis and rheumatoid arthritis.

Osteoarthritis is the most common form of arthritis. This condition usually comes with age and most often affects the fingers, knees, and hips. Sometimes osteoarthritis follows an injury to a joint. For example, a young person might hurt his knee badly playing soccer. Or someone might fall or be injured in a car accident. Then, years after the individual’s knee has apparently healed, he might get arthritis in his knee joint.

Rheumatoid arthritis happens when the body’s own defense system doesn’t work properly. It affects joints and bones (often of the hands and feet), and may also affect internal organs and systems. You may feel sick or tired, and you may have a fever.

Another common type of arthritis, gout, is caused by crystals that build up in the joints. It usually affects the big toe, but many other joints may be affected.

Do I Have Arthritis?

Pain is the way your body tells you that something is wrong. Most types of arthritis cause pain in your joints. You might have trouble moving around. Some kinds of arthritis can affect different parts of your body. So, along with pain in your joints, you may:

·         Have a fever

·         Lose weight

·         Have trouble breathing

·         Get a rash or itch

These symptoms may also be signs of other illnesses.

What Can I Do?

Consult a doctor. Many people use herbs or medicines that you can buy without a prescription for pain. You should tell your doctor if you do. Only a doctor can tell if you have arthritis or a related condition and what to do about it. It’s important not to wait.

You’ll need to tell the doctor how you feel and where you hurt. The doctor will examine you and may take x-rays of your bones or joints. The x-rays don’t hurt and aren’t dangerous. You may also have to give a little blood for tests that will help the doctor decide what kind of arthritis you may have.

How Will the Doctor Help?

After the doctor knows what kind of arthritis you have, he or she will talk with you about the best way to treat it. The doctor may give you a prescription for medicine that will help with the pain, stiffness, and inflammation. Health insurance or public assistance may help you pay for the medicine, doctor visits, tests, and x-rays.

How Can I Treat the Symptoms?

Sometimes you might still have pain after using your medicine. Here are some things to try:

·         Take a warm shower.

·         Do some gentle stretching exercises.

·         Use an ice pack on the sore area.

·         Rest the sore joint.

There are things you can do to keep the damage from getting worse:

·         Try to keep your weight down. Too much weight can make your knees and hips hurt.

·         Exercise. Moving all of your joints will help you. The doctor or nurse can show you how to move more easily. Going for a walk every day will help, too.

·         Take your medicines when and how you are supposed to. They can help reduce pain and stiffness.

·         Try taking a warm shower in the morning.

·         See your doctor regularly.

·         Seek information that can help you.

This information can be found on the National Institute of Arthritis and Musculoskeletal and Skin Diseases’ website at http://www.niams.nih.gov/

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All health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of Zenlap LLC. Advice on the treatment or care of any individual should be obtained through consultation with a physician who has examined that patient or is familiar with that patient's medical history.