Keyboard use and musculoskeletal outcomes among computer users

Background: In this review, the epidemiological evidence examining associations between upper extremity musculoskeletal symptoms and disorders and keyboard use intensity (hours of computer use-per day or per-week) and computer user posture was explored. Methods: An OVID Medline^® literature search was conducted to identify papers published in the peer-reviewed medical literature between 1966 and November, 2005. A total of 558 citations were found and reviewed. Those papers in which associations between musculoskeletal outcomes and (1) posture (ascertained by a study investigator) or (2) computer use, in units of hours-per-day, hours-per-week, or as a percent of work-time, were included in the review. Results: Thirty-nine epidemiological studies examining associations between computer use and MSD outcomes were identified. While the observational epidemiological literature was heterogeneous, some trends did emerge. It appears that the most consistent finding was the association observed between hours keying and hand/arm outcomes. Associations between some postural effects and musculoskeletal outcomes may also be inferred from the literature. In particular, placing the keyboard below the elbow, limiting head rotation, and resting the arms appears to result in reduced risk of neck/shoulder outcomes. Minimizing ulnar deviation and keyboard thickness appears to result in reduced risk of hand/arm outcomes. Conclusions: Several methodological limitations, including non-representative samples, imprecise or biased measures of exposure and health outcome, incomplete control of confounding, and reversal of cause and effect, may contribute to the heterogeneity of observed results. Suggestions are made for improving the validity of future investigations.     

Gender differences in upper extremity musculoskeletal complaints in the working population

Objectives: This study analysed the association between gender and upper extremity musculoskeletal complaints, among the general working population and in various occupational groups. The hypothesis was tested whether the higher risk for women in the general working population for these complaints could partly be explained by differences in the distribution of men and women in occupations with different risks for the onset of upper extremity musculoskeletal complaints. Methods: The data for this study came from cross-sectional questionnaire data from 16,874 employees categorised in 21 different occupational classes. Associations between gender and complaints of the upper extremities were analysed for the total study sample and for each occupational class separately. An adjustment was made for the variable `occupational class' in the final model in order to study the impact of occupational gender segregation on gender differences in upper extremity complaints in the working population. Results: In the total study sample, significantly higher risks of complaints of the neck, shoulder, elbow, and wrist among the women were observed. Within many occupational classes, women reported significantly higher risks than did men, in particular for complaints of the neck and shoulder. Adjustment for occupational class showed increased risks for female workers for complaints of the neck, shoulder, elbow, and wrist, hence, rejecting our hypothesis on occupational gender segregation as an explanation for the higher risks for upper extremity complaints among women in the general working population. Conclusions: This study confirmed the presence of gender differences in upper extremity musculoskeletal complaints among the working population and in many occupational classes, with female workers having the higher risk. The results, however, do not lend support to a differential occupational exposure theory as an explanation for the higher risks for these complaints among women in the general working population. Careful consideration of gender influence in ergonomic epidemiological studies is recommended. Received: 16 February 2000 / Accepted: 10 June 2000     

Biomechanical analysis of upper extremity risk in Sign Langauge Interpreting

Upper extremity cumulative trauma distorders (UECTD) have been identified as an occupational health problem in professional Sign Language Interpreters (SLI). A previous study of UECTD in SLI has indicated significant differences between interpreters working with pain and those working without pain. This earlier research focused on gross measures of hand/wrist movement, work/rest cycles, and deviations from an optimal work envelope. The present paper describes a detailed biomechanical analysis of wrist and forearm activity associated with SLI. This assessment included forearm (flexion and extension) and wrist (flexion/extension and radial/ulnar deviation) measures of movement frequency, counts of individual motion, joint movement velocities and accelerations as well as range of motion. The analyses revealed that the postures required for interpreting result in the signing hand frequently held in a fully pronated position, with the palm facing out. The wrist was most frequently in an ulnar deviation and/or extension while the elbow was flexed more than 90° and held in close to the body with the fingers pointing up. The frequency of motions for the forearm and wrist were observed to be 270 per minute (4.5 Hz), which is equivalent to 13,600 per 50 minute lecture hour. The mean absolute joint movement velocity and acceleration values were relatively high in contrast to industrial jobs with wrist and forearm accelerations between 34,754 degreees/sec² and 36,046 degrees/sec², respectively. The findings from this biomechanical analysis indicates that SLI can involve highly repetitive, awkward movements with significant accelerations of the hand and wrist. Such job characteristics may predispose interpreters to upper extremity CTD-related disorders.     

Peripheral neuropathy caused by incongruous posture in shoe manufacture workers

Nine cases of local neuropathy are described in shoe-manufacture workers. Clinical and electrophysiological examination excluded diseases such as toxic polyneuropathies due to n-hexane. Specific lesions of the ulnar nerve were located near the elbow where the forced and uncomfortable posture facilitated the compression of the nerve in the cubital tunnel. The severity of the neuropathies ranged from relatively slight, with paresthesia of some of the fingers, to evident hypotrophy of the inter-osseous muscles of the hand. All the 9 cases sewed shoe uppers using sewing machines operating 25 cm above the arm support, thus obliging the operator to work with one or both elbows resting on the support, with the arms and shoe-upper held up. Five cases presented a neuropathy of the right arm, 3 of the left arm, and in one case the lesions were bilateral. The features of the work station are described and the possible promoting factors and the ergonomic pathogenesis of these neuropathies are discussed.     

What is known about temperature and complaints in the upper extremity? A systematic review in the VDU work environment

Upper extremity musculoskeletal complaints and disorders are frequently reported among visual display units (VDU) workers. These complaints include cold forearms, hands or fingers. Objective: The aim of this systematic review was to gain an insight into the relationship between objective and subjective temperature decrease and musculoskeletal disorders (MSDs) in the upper extremity in a VDU work environment by (internal or external) cooling of the arm and hand. Two questions were formulated: (1) Is a VDU work environment (temperature between 15 and 25°C) associated with temperature decrease of the arm, hand or fingers in healthy subjects? (2) Is there a difference in arm, hand and finger temperature between patients with upper extremity MSDs and healthy subjects in a VDU work environment? Methods: Through a systematic literature search in six databases between 1989 and October 2005, 327 articles were retrieved and 17 included. Results: Forearm, hand and finger temperature significantly decreases when the ambient temperature (between 15 and 25°C) decreases. The skin temperature in the hand that uses a computer mouse is lower than the other hand in the same ambient temperature. At baseline, no objective temperature differences are found between patient groups and controls, whereas in patients with cold hand complaints, lower skin temperatures are found compared to controls. The association between temperature (changes) in the forearm, hand or fingers during VDU work, and MSDs in the upper extremity is not clear. Conclusion: There is no consistent evidence available for the association between upper extremity MSDs and temperature changes in forearm, hand or fingers in an office work environment.     

Compression neuropathies of the ulnar nerve in occupational diseases of the arms]

Features of forming and course of ulnar nerve compression neuropathy in the cubital and Guyin's canals were studied in 86 subjects, suffering from occupational diseases of the arms due to vibration and functional overstrain. Compression neuropathy of the ulnar nerve aggravates the vibration disease and arm disorders caused by functional overstrain--increases frequency, intensity and duration of paroxysmal paleness of the IV-V fingers, aggravates paresthesia, hypalgesia and hypothermia of the ulnar antebrachium, markedly decrease power of the hand, which must be taken into account when solving exert problems and carrying out treatment and rehabilitation.     

Upper extremity mononeuropathy among engineers

OBJECTIVES: The objectives of this study were to estimate the prevalence of mononeuropathy at the wrist among engineers who use computers and to identify associated risk factors. METHODS: This is a cross-sectional study of 202 engineers using questionnaires and electrophysiological nerve testing. The definition for median or ulnar mononeuropathy required the combination of distal upper extremity discomfort and abnormal distal motor latency. RESULTS: The prevalence of neuropathy at the wrist among engineers was 10.3% (right median), 3.4% (left median), 1.8% (right ulnar), and 2.9% (left ulnar). Logistic regression analysis identified three variables with positive associations (body mass index, hours of computer use, and antihypertensive medication) and three variables with negative associations (typing speed, driving hours, total break time). CONCLUSIONS: Mononeuropathies at the wrist occur among computer-using engineers and are related to a number of factors, including hours of computer use.     

Prevalence and psychosocial risk factors of upper extremity musculoskeletal pain in industries of Taiwan: a nationwide study

Prevalence of upper extremity disorders and their associations with psychosocial factors in the workplace have received more attention recently. A national survey of cross-sectional design was performed to determine the prevalence rates of upper extremity disorders among different industries. Trained interviewers administered questionnaires to 17,669 workers and data on musculoskeletal complaints were obtained along with information on risk factors. Overall the 1-year prevalence of neck (14.8%), shoulder (16.6%), and hand (12.4%) disorders were higher than those of the upper back (7.1%) and elbow (8.3%) among those who sought medical treatment due to the complaint. Workers in construction and agriculture-related industries showed a higher prevalence of upper extremity disorders. After multiple logistic regression adjusted for age, education, and employment duration, we found job content, physical working condition, a harmonious interpersonal relationship at the workplace and organizational problems were significant determinants of upper extremity disorders in manufacturing and service industries. Male workers in manufacturing industries showed more concern about physical working conditions while female workers in public administration emphasized problems of job content and interpersonal relationships. We concluded that these factors were major job stressors contributing to musculoskeletal pain of the upper extremity.     

Systematic Review of the Role of Occupational Health and Safety Interventions in the Prevention of Upper Extremity Musculoskeletal Symptoms, Signs, Disorders, Injuries, Claims and Lost Time

Background Little is known about the most effective occupational health and safety (OHS) interventions to reduce upper extremity musculoskeletal disorders (MSDs) and injuries. Methods A systematic review used a best evidence synthesis approach to address the question: “do occupational health and safety interventions have an effect on upper extremity musculoskeletal symptoms, signs, disorders, injuries, claims and lost time?” Results The search identified 36 studies of sufficient methodological quality to be included in data extraction and evidence synthesis. Overall, a mixed level of evidence was found for OHS interventions. Levels of evidence for interventions associated with positive effects were: Moderate evidence for arm supports; and Limited evidence for ergonomics training plus workstation adjustments, new chair and rest breaks. Levels of evidence for interventions associated with “no effect” were: Strong evidence for workstation adjustment alone; Moderate evidence for biofeedback training and job stress management training; and Limited evidence for cognitive behavioral training. No interventions were associated with “negative effects”. Conclusion It is difficult to make strong evidenced-based recommendations about what practitioners should do to prevent or manage upper extremity MSDs. There is a paucity of high quality OHS interventions evaluating upper extremity MSDs and none focused on traumatic injury outcomes or workplace mandated pre-placement screening exams. We recommend that worksites not engage in OHS activities that include only workstation adjustments. However, when combined with ergonomics training, there is limited evidence that workstation adjustments are beneficial. A practice to consider is using arm supports to reduce upper extremity MSDs.     

The role of imaging of work-related upper extremity disorders

Work-related upper extremity disorders can pose a diagnostic and management challenge because the nontraumatic disorders that are often believed to be caused by repetitive work activities can and do occur without any apparent provoking activity and can be caused or associated with many systemic medical conditions. One mainstay in the assessment of hand and arm disorders remains imaging. Imaging capabilities have made incredible advances with the advent of MRI, CT, ultrasound, bone scan, and numerous technologies that enable clinicians to view fine details of anatomy and pathology. This article reviews the potential imaging choices and clinical indications for work-related injuries of the elbow, hand, and wrist.     

Effect of Virtual Reality‐based Bilateral Upper Extremity Training on Upper Extremity Function after Stroke: A Randomized Controlled Clinical Trial

In the present study, we aimed to investigate the effect of virtual reality‐based bilateral upper extremity training (VRBT) on paretic upper limb function and muscle strength in patients with stroke. Eighteen stroke survivors were assigned to either the VRBT group (n = 10) or the bilateral upper limb training group (BT, n = 8). Patients in the VRBT group performed bilateral upper extremity exercises in a virtual reality environment, whereas those in the BT group performed conventional bilateral upper extremity exercises. All training was conducted for 30 minutes day^?1, 3 days a week, for a period of 6 weeks. Patients were assessed for upper extremity function and hand strength. Compared with the BT group, the VRBT group exhibited significant improvements in upper extremity function and muscle strength (p < 0.05) after the 6‐week training programme. The Box and Block test results revealed that upper extremity function and elbow flexion in hand strength were significantly improved in terms of group, time and interaction effect of group by time. Furthermore, the VRBT group demonstrated significant improvements in upper extremity function, as measured by the Jebsen Hand Function Test and Grooved Pegboard test, and in the hand strength test, as measured by elbow extension, grip, palmar pinch, lateral pinch and tip pinch, in both time and the interaction effect of group by time. These results suggest that VRBT is a feasible and beneficial means of improving upper extremity function and muscle strength in individuals following stroke. Copyright © 2016 John Wiley & Sons, Ltd.     

An ergonomics study on the evaluation of carpal tunnel syndrome among Chikan embroidery workers of West Bengal,India

Abstract

Background:

Chikan embroidery is a popular handicraft in India that involves hand-intensive stitching while seated in a static posture with the upper back curved and the head bent over the fabric. Women perform most Chikan embroidery.

Objectives:

The aim of this study was to analyze the repetitive nature of this work among female Chikan embroiderers by measuring the prevalence of upper extremity discomfort and carpal tunnel syndrome (CTS).

Methods:

The Nordic musculoskeletal questionnaire was used to analyze the extent of upper extremity pain symptomology. The repetitive nature of Chikan embroidery work was evaluated using the Assessment of Repetitive Tasks of the upper limbs tool (ART). Motor nerve conduction studies of median and ulnar nerves were performed with embroidery workers and a control group to determine the risk of CTS.

Results:

Among embroidery workers, the prevalence of wrist pain was 68% and forearm pain was 60%. The embroiderers also commonly reported Tingling and numbness in the hands and fingertips. The ART analysis found that Chikan embroidery is a highly repetitive task and nerve conduction studies showed that the embroidery workers were more likely to experience CTS than women in the control group.

Conclusions:

Chikan embroidery is a hand-intensive occupation involving repetitive use of hands and wrists and this study population is at risk of experiencing CTS. Future research should explore the potential benefits of ergonomics measures including incorporating breaks, stretching exercises, and the use of wrist splints to reduce repetitive strain and the probability of developing CTS.     

Differences in physical workload,psychosocial factors and musculoskeletal disorders between two groups of female hospital cleaners with two diverse organizational models

Objectives To clarify if differences in the physical workload, the psychosocial factors and in musculoskeletal disorders can be attributed to work organizational factors. Methods The physical workload (muscular activity of m. trapezius, positions and movements of the head, upper arms and wrists and heart rate) was assessed in 24 female hospital cleaners working in a traditional work organization (TO) and in 22 working in an extended one (i.e. with an enlarged work content and more responsibilities; EO). The psychosocial work environment was assessed as job demand, decision latitude and social support in 135 (TO) and 111 (EO) cleaners, and disorders of the neck and upper extremity by a physical examination. Results The EO group was associated with lower physical workload, in terms of heart rate ratio (23 vs 32; P < 0.001), head and upper arm positions and movements (right upper arm, 50th percentile, 35°/s vs 71°/s; P < 0.001) and wrist movements (20°/s vs 27°/s; P = 0.001), than the TO group. The EO group reported higher decision latitude and lower work demand than the TO one, while we found no difference in social support. The prevalence of complaints and diagnoses in neck/shoulders were lower in the EO group (diagnoses 35% vs 48%; P = 0.04). Moreover, the prevalence of subjects with at least ten physical finding in elbows/hands was lower in the EO group (10 vs 29; P < 0.001). Conclusion Hospital cleaners have a high prevalence of neck and upper limb disorders and a high physical workload. Comparing two groups of cleaners, with differences in the way of organizing the work, lower physical workload, more beneficial psychosocial factors and a better musculoskeletal health was found in the group with an extended organization. Hence, the differences found can be attributed to the organizational factors.     

Multidisciplinary consensus on the terminology and classification of complaints of the arm, neck and/or shoulder

Background

There is no universally accepted way of labelling or defining upper‐extremity musculoskeletal disorders. A variety of names are used and many different classification systems have been introduced.

Objective

To agree on an “unambiguous language” concerning the terminology and classification that can be used by all relevant medical and paramedical disciplines in the Netherlands.

Methods

A Delphi consensus strategy was initiated. The outcomes of a multidisciplinary conference were used as a starting point. In total, 47 experts in the field of upper‐extremity musculoskeletal disorders were delegated by 11 medical and paramedical professional associations to form the expert panel for the Delphi consensus strategy. Each Delphi round consisted of a questionnaire, an analysis and a feedback report.

Results

After three Delphi rounds, consensus was achieved. The experts reported the consensus in a model. This so‐called CANS model describes the term, definition and classification of complaints of arm, neck and/or shoulder (CANS) and helps professionals to classify patients unambiguously. CANS is defined as “musculoskeletal complaints of arm, neck and/or shoulder not caused by acute trauma or by any systemic disease”. The experts classified 23 disorders as specific CANS, because they were judged as diagnosable disorders. All other complaints were called non‐specific CANS. In addition, the experts defined “alert symptoms” on the top of the model.

Conclusions

The use of the CANS model can increase accurate and meaningful communication among healthcare workers, and may also have a positive influence on the quality of scientific research, by enabling comparison of data of different studies.Multidisciplinary consensus on terminology and classification of upper‐extremity musculoskeletal disorders is a first requirement for accurate and meaningful communication among clinicians. Universal classification of these conditions of the upper limb and neck is necessary to assess prognosis and options for treatment,^1,2 to study the natural course of the conditions, and to compare research findings across geographic regions and time periods within different (working) populations.In a systematic appraisal of worldwide prevalence rates,³ substantial differences in the reported prevalence rates of upper‐extremity disorders were found. Point prevalence estimates ranged from 1.6–53% and the 12‐month prevalence estimates ranged from 2.3–41%. It was concluded that one of the main reasons for the differences found in this latter study is the absence of a universally accepted taxonomy for upper‐extremity musculoskeletal disorders.A variety of terms for upper‐extremity musculoskeletal disorders are used in different countries all over the world, including repetitive strain injury (RSI), upper‐extremity cumulative trauma disorder (UECTD) and work‐related upper‐limb disorder (WRULD). Many different classification systems have been introduced. Van Eerd et al⁴ found 27 different classification systems for the working population. The systems differed in the disorders they included, in the labels used to identify the disorders and in the criteria used to describe the disorders.Two sets of consensus criteria for upper‐extremity disorders were recently proposed in the UK⁵ and in Europe.⁶ Both Harrington et al⁵ and Sluiter et al⁶ gave criteria for a limited number of upper‐extremity disorders only. Despite their efforts, implementation of these criteria would have been easier if the experts, chosen by the researchers in both studies, would have been key persons chosen by representatives of the persons who have to work with the criteria in practice.Until now, none of the proposed classification systems have resulted in a complete overview in which (in principal) all musculoskeletal upper‐extremity disorders are evaluated and discussed for inclusion. Moreover, they did not produce a workable classification tool that can be used in daily practice in an easy way (ie, no special training and/or no substantial time needed to perform) by both researchers and health professionals.Therefore, we concluded that there is a need for a classification system on musculoskeletal upper‐extremity disorders that (1) could be generally accepted and used by all disciplines, (2) can support the diagnosis and classification of (in principal) all upper‐extremity conditions and (3) is reported as a practical tool.Our first aim is to achieve consensus in the Netherlands, with a further intention to use the results of this study to eventually achieve international consensus. The decisions made regarding classification were based on the international literature. To make implementation of the results of the project more feasible, we invited 11 medical and paramedical associations to assign delegates to participate in this consensus project (box 1).An unambiguous classification system that is accepted by all professionals involved may increase multidisciplinary cooperation and have a positive influence on the performance of studies and also allow data to be compared. This paper presents the results of the Delphi consensus strategy used to achieve consensus and the resulting model.

Box 1 Participating disciplines

On behalf of the professional associations:General practitionersPhysical and rehabilitation medicine specialistsOccupational physiciansOrthopaedic surgeonsRheumatologistsNeurologistsPhysical therapistsExercise therapists CesarExercise therapists MensendieckOccupational therapists     

Prevalence and Risk Factors of Work-Related Musculoskeletal Disorders in Massage Practitioners

INTRODUCTION: Massage practitioners are at high risk for work-related musculoskeletal disorders (WMSDs). We investigated the prevalence and risk factors. METHODS: We randomly selected 161 visually impaired practitioners. Demographics, musculoskeletal symptoms, and working postures were analyzed with multivariate logistic regression. RESULTS: Results indicated that about 71.4% had at least one WMSD in 12 months. Prevalence rates were finger or thumb, 50.3%; shoulder, 31.7%; wrist, 28.6%; neck, 25.5%; arm or elbow, 23.6%; forearm, 20.5%; and back, 19.3%. Working duration >20 years had an adjusted odds ratio (OR) for finger or thumb 4.0-4.5 with 95% confidence interval (CI) 1.5-13.8, client contact >4 h/day (adjusted OR for finger = 3.2, 95% CI=1.3-8.1), and < or =7-kg pulp-pinch strength (adjusted OR for upper extremity = 2.9-3.2, 95% CI=1.2-8.3). Adjusted ORs for lower-back symptoms were 3.1 (95% CI=1.3-7.8) and 3.6 (95% CI=1.4-9.6), respectively, for lack of neutral neck posture and for inappropriate working-table height. CONCLUSION: WMSDs were prevalent among massage practitioners.     

A Cross-Sectional Assessment of the ACGIH TLV for Hand Activity Level

The ACGIH Worldwide Threshold Limit Value (TLV) for hand activity considers average hand activity level or HAL and peak hand force. We report cross-sectional data that assess the validity of the TLV with respect to symptoms and selected upper extremity musculoskeletal disorders among workers. The prevalence of symptoms and specific disorders were examined among 908 workers from 7 different job sites in relation to the TLV. Worker exposures were categorized as above the TLV, above the TLV Action Limit but below the TLV, or below the TLV Action Limit. Symptoms in the distal upper extremities did not vary by TLV category. Tendonitis in the wrist/hands/fingers did not vary by TLV category, but elbow/forearm tendonitis was significantly associated with TLV category. All measures of carpal tunnel syndrome were associated with TLV category. In all instances, prevalence of symptoms and specific disorders were substantial in jobs that were below the TLV action limit, suggesting that even at acceptable levels of hand activity, many workers will still experience symptoms and/or upper extremity musculoskeletal disorders, which may be important in the rehabilitation and return to work of injured workers. Future analyses need to examine the incidence of symptoms and upper extremity musculoskeletal disorders prospectively among workers in relation to the TLV for hand activity.     

Effects of work and rest on upper extremity signs and symptoms of workers performing repetitive tasks

The temporal relationship between work and signs and symptoms of upper extremity musculoskeletal disorders among workers at risk is relatively unexplored. The study focused on changes in upper extremity circumference, volume, sensory threshold, and reported symptoms after work and rest. All workers (N=50) performed a repetitive poultry processing task and had exhibited upper extremity signs and symptoms in baseline testing prior to this study. These workers manifested significantly increased upper extremity circumference following a period of rest, with circumferences decreasing during work. Upper extremity volume and reported swelling also decreased during work. Reports of tenderness were significantly greater after work than after rest, while reports of pain were greatest after a short rest interval. Results show that the signs and symptoms observed in these workers were manifestations of occupational cumulative trauma and that further study of the relationship between work and signs and symptoms is needed.     

Prevalence and risk factors of tendinitis and related disorders of the distal upper extremity among U.S. workers: comparison to carpal tunnel syndrome

BACKGROUND: National estimates of tendinitis and related disorders of the distal upper extremity among U.S. workers have not been available with the exception of carpal tunnel syndrome. METHODS: The Occupational Health Supplement Data of the 1988 National Health Interview Survey were analyzed for tendinitis and related disorders of the hand/wrist and elbow (distal upper extremity) using the Survey Data Analysis (SUDAAN) software. RESULTS: Among the 30,074 respondents (statistically weighted population of 127 million) who had worked anytime during the previous 12 months, 0.46% (95% CI: 0.36, 0.56) reported that they experienced a "prolonged" hand discomfort which was called tendinitis, synovitis, tenosynovitis, deQuervain's disease, epicondylitis, ganglion cyst, or trigger finger, by a medical person. This corresponds to 588,000 persons (95% CI: 457,000; 712,000) reporting one of these disorders, 28% (or 164,000) of which were thought to be work-related by the medical person. Among various risk factors examined by multiple logistic regression analysis, bending/twisting of the hands/wrists at work and female gender were significantly associated with reporting of these disorders. CONCLUSIONS: By combining these cases with the previously reported cases of work-related carpal tunnel syndrome, we estimate that there were approximately 520,000 cases of work-related musculoskeletal disorders of the distal upper extremity among US workers in 1988.     

Chronic Health Risks in Commercial Fishermen: A Cross-Sectional Analysis from a Small Rural Fishing Village in Alaska

Objectives: The purpose of this study is to evaluate chronic health risks before and during the fishing season in a sample of commercial fishermen, addressing the NIOSH priority of Total Worker Health^TM.

Methods: Gillnet license holders in Cordova, Alaska (n = 607) were contacted to participate in a preseason survey (March 2015) assessing health behaviors. A mid-season survey (July 2015) was also conducted. Physical exams and additional assessments were performed on a subset of these fishermen.

Results: Sixty-six fishermen participated in the preseason survey and 38 participated in the mid-season survey. The study population was overwhelmingly white males with an average age of 49. The average BMI was 27 with 70% of the participants overweight or obese. Nearly 80% of the sample considered their health good or better. Participants reported longer working hours, less sleep, and less aerobic exercise during the fishing season (P < .05). FitBit^TM monitoring (n = 8) confirmed less sleep and fewer steps during fishing season. In one exam (n = 20), 80% of participants showed measured hearing loss at 4 kz (conversation range), and 70% had one or more upper extremity disorders, including 40% with rotator cuff tendonitis.

Conclusions: The prevalence of hearing loss, upper extremity disorders, and sleep apnea risk factors were higher than in the general population both before and during the fishing season. Occupational factors including exposure to noise, the upper extremity demands of gillnetting, and long working hours while fishing exacerbate these chronic health conditions. Health promotion programs targeted toward these conditions may present opportunities for improving total worker health.     

Anatomical dimensions of anterior bundle of ulnar collateral ligament and its role in elbow stability

OBJECTIVE: To study the anatomical dimensions of the anterior bundle of ulnar collateral ligament and its role in elbow instability. METHODS: We studied 20 elbows of 10 cadavers. Anterior bundle of ulnar collateral ligament was dissected in all elbows and its anatomical length and width were measured. After measuring it, we assessed the role of the anterior bundle of ulnar collateral ligament in the medial elbow joint stability, with the capsule, the radial head and anterior bundle of ulnar collateral ligament being cut. RESULTS: The mean right length of the anterior bundle of ulnar collateral ligament was 21.10 +/- 6.29 mm and the mean left length was 21.70 +/- 5.31 mm. The mean right width of the anterior bundle of ulnar collateral ligament was 12.70 +/- 2.79 mm and the mean left width was 13.90 +/- 2.37 mm. Anterior bundle of ulnar collateral ligament was found to be the main stabilizer of the valgus stress. The anterior capsule and the radial head also make contributions to this stability. However, when anterior bundle of ulnar collateral ligament is cut, the radial head and the anterior capsule fails to maintain the stability against valgus stress. CONCLUSIONS: The anatomical dimensions of the anterior bundle of ulnar collateral ligament are important for a surgeon when graft is used in reconstructing this ligament. Our study is an initiator of this topic and we believe that with larger series, more reliable anatomical measurements can be obtained. We also showed that the anterior bundle of ulnar collateral ligament is the main medial stabilizer of the elbow joint.