Department of PMR
Synonyms
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Cumulative trauma disorder
Repetitive motion syndrome
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Repetitive strain injuryWork related disorder
Myofascial pain
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Overview? Introduction
? Definition
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? Patho-mechanics
? Stages
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? Clinical feature? Clinical Evaluation
? Treatment
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? Ergonomics
Introduction
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A. Cumulative: developed gradually over periods of weeks,months, or even years.
cumulative concept: each repetition of an activity
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produces some trauma or wear and tear on the tissues andjoints of the body.
B. Trauma: bodily injury from mechanical stresses.
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C. Disorders: physical ailments or abnormal conditions.Definition
CTD are work-related musculoskeletal injuries that affect
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the musculoskeletal, peripheral nervous, and neurovascularsystems that are caused or aggravated by occupational
exposure to ergonomic hazards.
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Common CTDs
? Neck tension syndrome
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? Pronator teres syndrome? Rotator cuff syndrome
? Radial tunnel syndrome
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? Epicondylitis
? Carpal tunnel syndrome
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? Tendonitis? Guyon tunnel syndrome
? Tenosynovitis
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? Ganglion
? Trigger finger
Mechanisms of injury
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1) Sustained or constrained Posture
2) Repetition
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3) Forcefull exertions4) vibration
5) combinations
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Patho-physiology
Continuous
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Tissuecontraction of
Physiological
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ischemia and
muscles from long-
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Impairedstrain (muscle
delayed
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term static load
circulation
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fatigue &dissipation of
with insufficient
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pain)
metabolites
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breaksStages
Stage 1
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Stage 2Stage 3
Mild discomfort
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Pain is present
Pain is present
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while workingwhile working
all the time.
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Work is
affected.
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Disappears whenContinues when
not working
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not working. May
be taking pain
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May not be ablemedication.
to complete
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Does not affect
simple daily
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work or dailytasks.
living tasks.
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Begins to affect
work and daily
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living tasks.Not reversible,
Completely
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can improve
reversible.
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(but not a fullCompletely
recovery).
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reversible.
Signs and symptoms
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? Pain? Tenderness
? Swelling
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? Unreasonable fatigue
? Disturbed sleep
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? Tingling & Numbness? Difficulty performing tasks or moving specific parts of the
body
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Clinical Evaluationq Identifying the specific injury
q Determine the degree to which the disorder is work related
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`Each disorder has different cause, treatment & prognosis'
History
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? Elicit the onset, location, duration, frequency, intensityof the symptoms
? Whether symptoms started before or after employment
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? If symptoms exacerbated by the job
? Previous injuries or fracture to that area
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? If any medical condition known to be associated withsymptoms
Physical examination
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? Inspection for sign of inflammation, ganglia cysts ordeformity
? Palpation - warmth
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? Passive, active & resisted ROM
? Special tests e.g. Phalen's test, Finkelstein's test
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Medical conditions associated with CTDI.
Amyloidosis
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II. Arthropathies & connective tissue disorders e.g. RA, SLE,
gout, OA and SpA
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III. CancerIV. Diabetes mellitus
V. Hypothyroidism
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VI. Obesity
VII. Pregnancy
LABORATORY TESTING
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? CBC
? ESR and CRP
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? Serum RF, Antinuclear antigen (ANA), HLA-B27? Diabetic screening
? S. TSH
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? S. calcium, phosphorus, uric acid, alkaline and acid
phosphatase for metabolic, endocrine and neo-plastic
conditions
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? Serum protein electrophoresis
Treatment
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Rehabilitation programmeq Application of Heat and Cold
q NSAIDs
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q Exercises
q Splints
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q Surgical intervention if conservative trail fails.Ergonomics
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"The science of studying people at work and then designingtasks, jobs, information, tools, equipment, facilities and the
working environment so people can be safe and healthy,
effective, productive and comfortable"*
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`Fitting the job to the worker'
*Ergonomic Design Guidelines, Auburn Engineering, Inc., 1998.
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Posture is the most important aspect when looking at
workstation design.
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Chairsq Height
q Back support
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q Seat tilt
q Depth
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q Widthq Armrests
Height
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? Highest point of the seat,
just below your kneecap.
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Feet should rest firmly on thefloor when seated
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Back support & Seat tilt? Lumbar pad should supports the
natural curve of your lower back
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(lumbar curve).Upper body should slightly tilt to
reclined.
*110? is usually recommended.
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Seat tilt of 5? is usually recommended.
Seat Depth & Width
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? The seat pan should support theback without the front of the seat
pressing against the back of your
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knees.
? Wide enough not apply pressure
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to your thighs.? Narrow enough to reach the
armrests.
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Armrests
Armrest should be adjusted to elbow
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height.
v Too high will shrug the shoulders
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v Too low will depressed theshoulders - Affect the posture of
the back and neck.
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Input devices
Position - Upper arms should be relaxed
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and by your side, your elbows bent at aright angle (90 degrees) and your wrists
straight.
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Keyboard ? should promote neutral wrist
and hand posture.
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? Negatively tilted keyboardMouse ?
? same level as the keyboard
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? easy to reach
? switch the side by changing hands
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Monitor
? Distance
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? As far away as possible (60-90cm)
? Increase the size of the font
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? Height and location
? Top of the monitor just below
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eye level? Tilt 15 degrees
Computer & Desk Stretches
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? Approximately four
minutes
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? Do these stretchesevery hour
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Good PostureThank you