Ulnar neuropathy at the elbow

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106702/1/mus24138.pd

The prevalence of cubital tunnel syndrome: A cross-sectional study in a U.S. metropolitan cohort

BACKGROUND: Although cubital tunnel syndrome is the second most common peripheral mononeuropathy (after carpal tunnel syndrome) encountered in clinical practice, its prevalence in the population is unknown. The objective of this study was to evaluate the prevalence of cubital tunnel syndrome in the general population. METHODS: We surveyed a cohort of adult residents of the St. Louis metropolitan area to assess for the severity and localization of hand symptoms using the Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SSS) and the Katz hand diagram. We identified subjects who met our case definitions for cubital tunnel syndrome and carpal tunnel syndrome: self-reported hand symptoms associated with a BCTQ-SSS score of >2 and localization of symptoms to the ulnar nerve or median nerve distributions. RESULTS: Of 1,001 individuals who participated in the cross-sectional survey, 75% were women and 79% of the cohort was white; the mean age (and standard deviation) was 46 ± 15.7 years. Using a more sensitive case definition (lax criteria), we identified 59 subjects (5.9%) with cubital tunnel syndrome and 68 subjects (6.8%) with carpal tunnel syndrome. Using a more specific case definition (strict criteria), we identified 18 subjects (1.8%) with cubital tunnel syndrome and 27 subjects (2.7%) with carpal tunnel syndrome. CONCLUSIONS: The prevalence of cubital tunnel syndrome in the general population may be higher than that reported previously. When compared with previous estimates of disease burden, the active surveillance technique used in this study may account for the higher reported prevalence. This finding suggests that a proportion of symptomatic subjects may not self-identify and may not seek medical treatment. CLINICAL RELEVANCE: This baseline estimate of prevalence for cubital tunnel syndrome provides a valuable reference for future diagnostic and prognostic study research and for the development of clinical practice guidelines

Rythmes de travail imposés et douleurs aux coudes, effets directs et indirects, rôle des facteurs psycho-sociaux et biomécaniques

Objectifs Évaluer les effets directs et indirects du rythme de travail imposé sur les douleurs aux coudes (DoulC). Méthodes On dispose de données sur 3710 salariés qui ont participé à un programme de surveillance des troubles musculo-squelettiques (TMS) dans la région Pays de la Loire entre 2002 et 2005 (réseau pilote de surveillance des TMS). Lors d’examens cliniques standardisés, 83 médecins du travail ont diagnostiqué les éventuels TMS, dont la présence de douleurs au niveau de l’épicondyle (DoulC). Les expositions professionnelles (rythme de travail imposé, effort important combiné aux mouvements répétitifs aux coudes, tâches répétitives, faible soutien social, faible latitude décisionnelle) et les facteurs personnels (âge, sexe, indice de masse corporel) ont été évalués par auto-questionnaire. Les associations univariées entre les DoulC et les facteurs de risques ont été quantifiées par des odds ratios (ORs) issus de modèles logistiques. La part directe et indirecte de l’association avec le rythme de travail imposé sur les DoulC a été estimée par un modèle à équations structurelles (EQ) et par des calculs causaux basés sur une méthode proposée par Van Der Weele et al. de 2014 (méthode VDW). Résultats L’OR entre le rythme de travail imposé et les DoulC est de 1,49 [1,22;1,82] (en comparaison, l’OR pour « faible soutien social » est 1,30 [1,07;1,58] et pour les efforts combinées aux mouvements aux coudes, 1,94 [1,59;2,36]). La part de l’association entre le rythme de travail imposé et les DoulC médiée par les autres facteurs professionnels est estimée à 36,5 % [14,1 %;59,0 %] par la méthode EQ et à 30,6 % [15,7 %;57,0 %] par la méthode VDW. Dans l’analyse EQ, cette association indirecte est principalement expliquée par l’association passant par les facteurs biomécaniques (correspondant à 82,1 % [44,4 %;119,9 %] de l’effet indirect). Conclusions Cette analyse exploratoire basée sur des données transversales donne des pistes pour l’évaluation des différents mécanismes causaux à l’origine des liens entre les facteurs organisationnels et les TMS. L’effet du rythme de travail est certes plus faible que celui des contraintes biomécaniques, il est cependant significatif. Les résultats montrent qu’une intervention visant à diminuer la fréquence de l’exposition aux rythmes de travail imposés aurait un effet direct et aussi indirect sur les douleurs par la diminution des expositions professionnelles psychosociales et biomécaniques

Prevalence of knee bursitis in the workforce

BACKGROUND: Knee bursitis (KB) is a common disorder in specific occupations requiring frequent and/or sustained kneeling postures.AIMS: To assess the prevalence of KB in the general working population. METHODS: Between 2002 and 2005, a total of 3710 workers of a French region were randomly included in the study. A standardized physical examination of the knee was performed when knee pain was reported by the worker during the preceding 12 months. The criteria for diagnosis of KB were (i) the presence of pain and/or tenderness in the anterior face of the knee at the date of the examination (or for at least 4 days in the preceding week) and (ii) the presence of swelling and/or pressure-induced pain of the pre- or infra-patellar bursa. Occupational risk factors were assessed by a self-administered questionnaire. RESULTS: The prevalence of uni- or bilateral cases of knee bursitis was low: 0.6% [0.2-0.9] in men and 0.2% [0.0-0.6] in women. The highest prevalence was observed in the construction sector (2.3% [0.8-5.4]) and in the food and meat processing industries (1.4% [0.4-3.5)]. More blue-collar workers were affected than other occupation categories (0.8% [0.3-1.2] versus 0.1% [0.0-0.4]). CONCLUSIONS: The study showed a concentration of cases among male workers exposed to heavy workloads and frequent kneeling

Self-reported physical exposure association with medial and lateral epicondylitis incidence in a large longitudinal study

INTRODUCTION: Although previous studies have related occupational exposure and epicondylitis, the evidence is moderate, and mostly based on cross-sectional studies. Suspected physical exposures were tested over a three year period in a large longitudinal cohort study of workers in the United States. METHOD: In a population-based study including a variety of industries, 1107 newly employed workers were examined; only workers without elbow symptoms at baseline were included. Baseline questionnaires collected information on personal characteristics and self-reported physical work exposures and psychosocial measures for the current or most recent job at 6 months. Epicondylitis (lateral and medial) was the main outcome, assessed at 36 months based on symptoms and physical examination (palpation or provocation test). Logistic models included the most relevant associated variables. RESULTS: Of 699 workers tested after 36 months who did not have elbow symptoms at baseline, 48 suffered from medial or lateral epicondylitis (6.9%), with 34 cases of lateral epicondylitis (4.9%), 30 cases of medial epicondylitis (4.3%), and 16 workers who had both. After adjusting for age, lack of social support, and obesity, consistent associations were observed between self-reported wrist bending/twisting and forearm twisting/rotating/screwing motion and future cases of medial or lateral epicondylitis (odds ratios 2.8 [1.2;6.2] and 3.6 [1.2;11.0] respectively in men and women). CONCLUSION: Self-reported physical exposures that implicate repetitive and extensive/prolonged wrist bend/twisting and forearm movements were associated with incident cases of lateral and medial epicondylitis in a large longitudinal study, although other studies are needed to better specify the exposures involved