Treatment of lateral epicondylitis in general practice

Mechanical low back pain creates a significant economic burden in the industrial world. The costs of treating mechanical back pain in terms of sickness absenteeism and compensation claims are increasing rapidly.^1-3 There is robust evidence that staying active and continuing or resuming ordinary activities is more effective than rest in the management of mechanical back pain.⁴ This evidence in the international literature has been incorporated in a set of Clinical Guidelines produced by the Royal College of General Practitioners (RCGP).⁵ These guidelines recommend that early investigation and referral to a specialist for simple mechanical back pain are unwarranted in most cases. Positive advice to stay active and continue ordinary activities is emphasised. The RCGP guidelines recommend the use of educational material for patients in the form of The Back Book, to reinforce positive messages.⁶ This book has been shown to be clinically effective in a randomised, controlled trial.⁷ A comparative study from Australia⁸ showed that a public education campaign based on The Back Book had a positive effect on GP management of mechanical back pain and related morbidity.     

Effects of manual work on recovery from lateral epicondylitis

OBJECTIVES: This study investigates the influence of manual work on the persistence of lateral epicondylitis during a 12-month follow-up period after consultation in general practice. METHODS: A cohort study was made of 164 adult consulters with tennis elbow, who had initially been recruited to a randomized controlled trial from 23 general practices in North Staffordshire and South Cheshire. As part of the recruitment process prior to treatment randomization, self-reported questionnaires on symptoms and sociodemographic characteristics were completed. Four weeks, six months, and twelve months later, the schedules were repeated. The main outcomes were measures of elbow symptoms (pain and function) based on a ten-point Likert scale. Total pain and function for the whole 12-month period were assessed using an area-under-the-curve (AUC) analysis. The pain and function scores were analyzed according to employment status (manual versus nonmanual work) and severe versus mild upper-limb stress in manual occupations. RESULTS: The AUC scores for elbow pain and function were significantly higher for the manual workers, and manual work was associated with increased elbow pain and decreased function in the 4-week and 6-month follow-ups. The greater the severity of upper-limb stresses, the worse the outcome. CONCLUSIONS: Previous epidemiologic studies have shown that manual occupations are a risk factor for developing lateral epicondylitis. It is feasible that resuming manual work after treatment may hinder recovery or increase the risk of relapse. The study lends support to this hypothesis.     

Prevalence and determinants of lateral and medial epicondylitis: a population study

Epicondylitis is a common disorder of the arm, yet the role of individual- and work-related factors has not been addressed in a population study. The aims of this study were to estimate the prevalence of lateral and medial epicondylitis and to investigate their risk factors. The target population of this study comprised a representative sample of people aged 30-64 years residing in Finland during 2000-2001. Of the 5,871 subjects, 4,783 (81.5%) were included in this study. The prevalence of definite lateral epicondylitis was 1.3%, and that of medial epicondylitis was 0.4%. The prevalence did not differ between men and women and was highest in subjects aged 45-54 years. Current smoking (adjusted odds ratio (OR) = 3.4, 95% confidence interval (CI): 1.4, 8.3) and former smoking (OR = 3.0, 95% CI: 1.3, 6.6) were associated with definite lateral epicondylitis. An interaction (p = 0.002) was found between repetitive movements of the arms and forceful activities for the risk of possible or definite lateral epicondylitis (for both repetitive and forceful activities vs. no such activity: OR = 5.6, 95% CI: 1.9, 16.5). Smoking, obesity, repetitive movements, and forceful activities independently of each other showed significant associations with medial epicondylitis. Epicondylitis is relatively common among working-age individuals in the general population. Physical load factors, smoking, and obesity are strong determinants of epicondylitis.     

Physical and psychosocial risk factors for lateral epicondylitis: a population based case-referent study

Aims: To assess the importance of physical and psychosocial risk factors for lateral epicondylitis (tennis elbow).

Methods: Case-referent study of 267 new cases of tennis elbow and 388 referents from the background population enrolled from general practices in Ringkjoebing County, Denmark.

Results: Manual job tasks were associated with tennis elbow (odds ratio (OR) 3.1, 95% confidence interval (CI) 1.9 to 5.1). The self reported physical risk factors "posture" and "forceful work" were related to tennis elbow. Among women, work involving performing repeated movements of the arms was related to tennis elbow (OR 3.7, CI 1.7 to 8.3). Among men, work with precision demanding movements was related to tennis elbow (OR 5.2, CI 1.5 to 17.9). Among both males and females, the results for work with hand held vibrating tools were inconsistent, partly because of few exposed subjects. A physical strain index was established based on posture, repetition, and force. The adjusted ORs for tennis elbow at low, medium, and high strain were 1.4 (CI 0.8 to 2.7), 2.0 (CI 1.1 to 3.7), and 4.4 (CI 2.3 to 8.7). Low social support at work, adjusted for physical strain, was a risk factor among women (OR 2.4, CI 1.3 to 4.6).

Conclusion: Results indicate that being a new case of tennis elbow is associated with non-neutral postures of hands and arms, use of heavy hand held tools, and high physical strain measured as a combination of forceful work, non-neutral posture of hands and arms, and repetition. Furthermore, tennis elbow among women was associated with low social support at work. The results for precision demanding movements and for vibration were less consistent.

     

Prevalence of epicondylitis and tenosynovitis among meatcutters

The prevalence of epicondylitis and tenosynovitis was assessed among 90 meatcutters and 77 referents (construction foremen). All the participants filled out a self-administered questionnaire about subjective symptoms of the upper extremities. The questionnaire was part of the Nordic standardized questionnaire for rheumatic symptoms. The subjects were examined by the authors, who did not have prior knowledge of the subjects' occupations. The prevalence of epicondylitis and tenosynovitis among the meatcutters was 8.9 and 4.5%, respectively. One referent had epicondylitis, and none suffered from tenosynovitis. The results indicate that the meatcutters had a higher risk for epicondylitis in comparison with the referents. The risk increased with age and number of exposure years.     

Lateral epicondylitis in a hospital phlebotomist--an ergonomic solution.

This report outlines a case of lateral epicondylitis in a hospital phlebotomist thought to be due to the forceful gripping, and repetitive twisting, involved in breaking the seals on green vacutainer needles. An ergonomic solution in the form of a device to aid breaking of the vacutainer seals is presented. The importance of seeking ergonomic solutions with manufacturers is highlighted.     

2019—2021年淮安区职业健康检查结果分析

目的 评价职业病危害防治工作现状,为制定本区相关防治措施,明确职业健康工作重点和方向提供数据支撑及对策建议。方法 通过江苏省职业病防治信息管理平台收集2019—2021年淮安区职业健康监护资料,包括企业基本信息、人员体检情况、职业禁忌证及疑似职业病等数据,采用描述流行病学方法进行分析。结果 2019—2021年淮安区共有20 018名作业工人开展了职业健康检查,其中上岗前检查4 253人、在岗期间检查15 425人、离岗检查340人。接触物理因素体检9 672人,占48.32%;接触化学物质4 189人,占 20.92%,接触粉尘6 157人,占30.76%。共检出疑似职业病 14 人,其中12人接触物理因素(职业性噪声聋)、2人接触化学物质;检出职业禁忌证277人,其中接触粉尘11人,接触物理因素256人,接触化学物质10人;不同危害因素间疑似职业病、职业禁忌证检出率比较差异均有统计学意义(χ2疑似职业病=9.216,P<0.01、χ2职业禁忌证=218.845,P<0.01),检出率由高到低分别为物理因素、化学物质、粉尘。结论 本区职业健康检查企业及人数逐年上升,但与本区摸底调查数仍有差距,应重点关注由噪声引起的职业目标疾病,做好防治工作。     

2009年成都市职业人群健康监护评价

目的了解成都市职业人群的健康状况,确定职业卫生工作防治的重点。方法收集2009年度本市职业人群的职业健康监护资料,并进行统计分析。结果苯作业人员的血常规异常、噪声作业人员的听力下降、电离辐射作业人员的晶体混浊及硫化氢、氨作业人员的鼻炎、咽炎等检出率最高,全年职业禁忌证检出率为4.02%,检出慢性职业性苯中毒5例,矽肺1例。结论本市2009年度职业人群的健康状况大部分良好（85%左右）,但部分苯、粉尘、噪声以及刺激性气体等职业病危害因素作业人员职业健康状况不容乐观,应将其职业健康监护作为成都市职业病防治工作的重点。     

国际职业卫生联盟声援工作安全与健康世界日

在今年的4月28日工作安全与健康世界日之际,国际职业卫生联盟(International Congress on Occupational Health,ICOH)主席Kazutaka Kogi代表ICOH发表专文,支持国际劳工组织这一重要的世界日.全文如下: ICOH呼吁加强防治职业病、工作相关性疾病和职业伤害的行动,以期满足经济全球化背景下的工作场所变化的需要. 有效识别和防治职业病及工作相关疾病,是实现全体工人体面工作的最基本工作.职业病在全球范围内非常普遍,对工人、企业和社会造成了不可估量的痛苦和损失.2013年的工作安全与健康世界日将预防职业病作为职业健康和安全国际合作的核心话题,ICOH完全支持国际劳工组织(ILO)的战略,确保合理的国家政策和项目方案、强化职业病防治工作的合作.     

西南地区不同性别、学历、年龄、工龄人群职业紧张比较

目的探讨不同性别、学历、年龄、工龄人群的职业紧张。方法采用职业紧张量表(OSI-R),测试4278例职工的职业紧张、紧张反应、应对资源。结果职业任务、紧张反应总均分及各子项得分(除工作环境、业务、心理紧张反应外):男性均高于女性,且差异有显著性(P<0·01)。自我保健子项:女性显著高于男性(P<0·01),同时在社会支持、人际关系和工作满意度方面女性也高于男性。在年龄方面,40岁~及≥50岁两个组,职业任务总均分及任务过重、任务冲突、责任感、任务不适四个子项得分均显著高,而应对资源子项中,≥50岁组,在社会支持子项得分最低(P<0·05)。在工龄方面,也表现出最长工龄组:≥30年组职业任务总均分及任务过重、任务冲突、责任感等子项得分均高,而应对资源子项中:20年~组在社会支持子项得分最低(P<0·05)。在文化程度方面,低学历组职业任务、紧张反应得分高,而应对资源得分却最低(P<0·05)。结论针对不同性别、年龄、工龄、学历群体的职业紧张源、紧张反应、应对资源,采取有效的干预措施,降低不同职工,特别是中、老年职工的职业紧张,提高职工的劳动能力及生活质量是职业卫生面临的重要任务之一。     

Prevalence of epicondylitis and elbow pain in the meat-processing industry

To determine the etiologic role of strenuous manual tasks in relation to epicondylitis, three clinical cross-sectional examinations were performed on meatcutters (N = 102), sausage makers (N = 125), packers (N = 150), and workers in nonstrenuous tasks (N = 332). The workers in strenuous jobs reported elbow symptoms 1.6-1.8 times as often as those in nonstrenuous jobs. Female sausage makers also showed epicondylar tenderness more often than the women in nonstrenuous jobs. In all the cross-sectional examinations combined, seven cases (0.8%) of epicondylitis were detected in both the strenuous and nonstrenuous jobs. A control for the possible sources of bias (leaving the company, changing task, being on sick leave) did not suggest a marked loss of potential cases of epicondylitis. A major role of strenuous tasks in the etiology of epicondylitis was not shown. However, because the number of clinical cases was small, the power of the study was low.     

我国职业病防治法律体系的历史、现状和发展

归纳梳理我国职业病防治法律体系发展历史,具体描述目前我国初步形成的职业病防治法律体系的内容,探讨该法律体系在立法目的、体系、内容和规划等方面存在的问题,提出针对性建议。