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

AbstractCompared to deep vein thrombosis in the lower limbs, upper extremity deep vein thrombosis is uncommon and therefore much less explored or even neglected.We present the case of a 40-year-old female working in the bakery industry, who was admitted for acute onset of upper limb oedema accompanied by pain and functional impairment, affirmative secondary to the sustained and intense effort of the dominant arm. The diagnosis was confirmed by Duplex Ultraso nography on the eighth day after the onset of symptoms. Since clinical examinations and laboratory work excluded any cause of secondary thrombosis, the diagnosis of primary thrombosis was established. The only possible cause of this episode was linked to the woman’s work. The trigger for the thrombotic event was represented most likely by strenuous physical activity with temporary obstruction of the thoracic outlet in the work field. Under anticoagulant treatment, the signs and symptoms gradually resolved. Unfortunately, at the one-year follow-up exam, the patient was diagnosed with post-thrombotic syndrome of the right, dominant arm.

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Upper Extremity Morel-Lavallée Lesion in a Collegiate Football Player: A Case Report

International Journal of Athletic Therapy & Training ◽

10.1123/ijatt.2017-0071 ◽

2019 ◽

Vol 24 (4) ◽

pp. 160-162

Author(s):

Kyle Southall ◽

Matt Price ◽

Courtney Wisler

Keyword(s):

Soft Tissue ◽

Upper Extremity ◽

Structural Damage ◽

Signs And Symptoms ◽

Compression Therapy ◽

Final Diagnosis ◽

Football Player ◽

Associated Symptoms ◽

Crush Injuries ◽

Collegiate Football

A 20-year-old male collegiate football athlete reported a remarkably swollen elbow after direct contact with the ground. Initial radiographs and magnetic resonance imaging were negative for a fracture and soft tissue structural damage. After 2 weeks of conservative treatment, the athlete had no decrease in swelling and associated symptoms. He was diagnosed with a Morel-Lavallée lesion, later confirmed by diagnostic ultrasound imaging. The lesion was initially treated with compression therapy and cryotherapy to reduce swelling. Upon the final diagnosis the lesion was eventually incised, drained, and packed with iodoform sterile strips. It is hypothesized that many minor Morel-Lavallée cases are under- or misdiagnosed due to overlapping of signs and symptoms with other soft tissue traumas common in athletic populations. The procedures of this case can be utilized to optimize outcomes in future cases. While rare, Morel-Lavallée lesions can occur in athletic activities involving the upper extremity, and not solely crush injuries or traumatic and high-intensity accidents. This knowledge, along with the presented signs and symptoms, can give future healthcare professionals knowledge to include this diagnosis in their working differential diagnosis of injuries with similar presentations.

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Screening for Medical Problems in Patients with Upper Extremity Signs and Symptoms

Journal of Hand Therapy ◽

10.1016/j.jht.2009.09.005 ◽

2010 ◽

Vol 23 (2) ◽

pp. 105-126 ◽

Cited By ~ 7

Author(s):

Catherine C. Goodman

Keyword(s):

Upper Extremity ◽

Signs And Symptoms ◽

Medical Problems

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Inflammatory biomarkers increase with severity of upper-extremity overuse disorders

Clinical Science ◽

10.1042/cs20060050 ◽

2007 ◽

Vol 112 (5) ◽

pp. 305-314 ◽

Cited By ~ 58

Author(s):

Stephen J. Carp ◽

Mary F. Barbe ◽

Kathryn A. Winter ◽

Mamta Amin ◽

Ann E. Barr

Keyword(s):

Upper Extremity ◽

Early Onset ◽

Clinical Importance ◽

Signs And Symptoms ◽

Serum Levels ◽

Upper Body ◽

Future Research ◽

Tnf Α ◽

Ordinal Logistic Regression Analysis ◽

Factor Α

MSDs (musculoskeletal disorders) from overuse are common occupational health problems that cause pain, functional loss and loss of work time. The aim of the present study was to determine whether a relationship exists between the severity of early-onset overuse-related MSDs of the upper extremity and serum levels of IL-1β (interleukin-1β), TNF-α (tumour necrosis factor-α), IL-6 (interleukin-6) and CRP (C-reactive protein). Twenty-two subjects with upper-extremity MSDs due to overuse for no longer that 12 weeks were stratified according to the severity of upper-extremity signs and symptoms as determined by a UBMA (upper-body musculoskeletal assessment). Nine asymptomatic subjects also participated. Serum cytokines were analysed using ELISA, and CRP was analysed using a laser nephelometry technique. CRP was strongly correlated, and TNF-α, IL-1β and IL-6 were moderately correlated, with UBMA scores. Only CRP and TNFα were significantly associated with UBMA scores in an ordinal logistic regression analysis in which age and BMI (body mass index) were covariates. These results are of clinical importance as they suggest that early-onset overuse-related MSDs may have an inflammatory component. The possibility of using a combination of serum biomarkers to follow the progression of overuse-related MSDs or their response to therapeutic intervention may be of interest to clinical practitioners and should be the focus of future research.

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“Where is Dementia?” A Systematic Literature Review Exploring Neuroanatomical Aspects of Dementia

Perspectives of the ASHA Special Interest Groups ◽

10.1044/persp2.sig15.9 ◽

2017 ◽

Vol 2 (15) ◽

pp. 9-23 ◽

Cited By ~ 1

Author(s):

Chorong Oh ◽

Leonard LaPointe

Keyword(s):

English Language ◽

Signs And Symptoms ◽

Behavioral Symptoms ◽

Journal Articles ◽

People With Dementia ◽

Different Types ◽

Precise Diagnosis ◽

Physical Changes ◽

The Brain ◽

Language Literature

Dementia is a condition caused by and associated with separate physical changes in the brain. The signs and symptoms of dementia are very similar across the diverse types, and it is difficult to diagnose the category by behavioral symptoms alone. Diagnostic criteria have relied on a constellation of signs and symptoms, but it is critical to understand the neuroanatomical differences among the dementias for a more precise diagnosis and subsequent management. With this regard, this review aims to explore the neuroanatomical aspects of dementia to better understand the nature of distinctive subtypes, signs, and symptoms. This is a review of English language literature published from 1996 to the present day of peer-reviewed academic and medical journal articles that report on older people with dementia. This review examines typical neuroanatomical aspects of dementia and reinforces the importance of a thorough understanding of the neuroanatomical characteristics of the different types of dementia and the differential diagnosis of them.

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Combining Values

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2002.marapr01 ◽

2002 ◽

Vol 7 (2) ◽

pp. 1-4, 12 ◽

Cited By ~ 1

Author(s):

Christopher R. Brigham

Keyword(s):

Lower Extremity ◽

Upper Extremity ◽

Evaluation Method ◽

Proximal Phalanx ◽

Common Error ◽

The Third ◽

Whole Person ◽

Impairment Ratings ◽

Upper Extremity Impairment ◽

The Individual

Abstract To account for the effects of multiple impairments, evaluating physicians must provide a summary value that combines multiple impairments so the whole person impairment is equal to or less than the sum of all the individual impairment values. A common error is to add values that should be combined and typically results in an inflated rating. The Combined Values Chart in the AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition, includes instructions that guide physicians about combining impairment ratings. For example, impairment values within a region generally are combined and converted to a whole person permanent impairment before combination with the results from other regions (exceptions include certain impairments of the spine and extremities). When they combine three or more values, physicians should select and combine the two lowest values; this value is combined with the third value to yield the total value. Upper extremity impairment ratings are combined based on the principle that a second and each succeeding impairment applies not to the whole unit (eg, whole finger) but only to the part that remains (eg, proximal phalanx). Physicians who combine lower extremity impairments usually use only one evaluation method, but, if more than one method is used, the physician should use the Combined Values Chart.

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Impairment Tutorial: Functionally Limiting Upper Extremity Pain: Controversies in Impairment Rating

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2003.sepoct02 ◽

2003 ◽

Vol 8 (5) ◽

pp. 4-12

Author(s):

Lorne Direnfeld ◽

James Talmage ◽

Christopher Brigham

Keyword(s):

Upper Extremity ◽

Radicular Pain ◽

Illness Behavior ◽

Orthopedic Surgeon ◽

First Case ◽

Clinical Presentations ◽

Whole Person ◽

Physical Examinations ◽

Upper Extremity Impairment ◽

The Individual

Abstract This article was prompted by the submission of two challenging cases that exemplify the decision processes involved in using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). In both cases, the physical examinations were normal with no evidence of illness behavior, but, based on their histories and clinical presentations, the patients reported credible symptoms attributable to specific significant injuries. The dilemma for evaluators was whether to adhere to the AMA Guides, as written, or to attempt to rate impairment in these rare cases. In the first case, the evaluating neurologist used alternative approaches to define impairment based on the presence of thoracic outlet syndrome and upper extremity pain, as if there were a nerve injury. An orthopedic surgeon who evaluated the case did not base impairment on pain and used the upper extremity chapters in the AMA Guides. The impairment ratings determined using either the nervous system or upper extremity chapters of the AMA Guides resulted in almost the same rating (9% vs 8% upper extremity impairment), and either value converted to 5% whole person permanent impairment. In the second case, the neurologist evaluated the individual for neuropathic pain (9% WPI), and the orthopedic surgeon rated the patient as Diagnosis-related estimates Cervical Category II for nonverifiable radicular pain (5% to 8% WPI).

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Spinal Impairment Evaluation: Fifth Edition Changes

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2001.janfeb01 ◽

2001 ◽

Vol 6 (1) ◽

pp. 1-3

Author(s):

Robert H. Haralson

Keyword(s):

Spinal Cord ◽

Lower Extremity ◽

Range Of Motion ◽

Upper Extremity ◽

Spinal Cord Injuries ◽

Clinical Findings ◽

Fourth Edition ◽

Treatment Results ◽

Standard Terminology ◽

Made In

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, was published in November 2000 and contains major changes from its predecessor. In the Fourth Edition, all musculoskeletal evaluation and rating was described in a single chapter. In the Fifth Edition, this information has been divided into three separate chapters: Upper Extremity (13), Lower Extremity (14), and Spine (15). This article discusses changes in the spine chapter. The Models for rating spinal impairment now are called Methods. The AMA Guides, Fifth Edition, has reverted to standard terminology for spinal regions in the Diagnosis-related estimates (DRE) Method, and both it and the Range of Motion (ROM) Method now reference cervical, thoracic, and lumbar. Also, the language requiring the use of the DRE, rather than the ROM Method has been strengthened. The biggest change in the DRE Method is that evaluation should include the treatment results. Unfortunately, the Fourth Edition's philosophy regarding when and how to rate impairment using the DRE Model led to a number of problems, including the same rating of all patients with radiculopathy despite some true differences in outcomes. The term differentiator was abandoned and replaced with clinical findings. Significant changes were made in evaluation of patients with spinal cord injuries, and evaluators should become familiar with these and other changes in the Fifth Edition.

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