Prevalence of Self-Reported Work-related Musculoskeletal Symptoms among Software Employees in Hyderabad, India

Background: This study has been carried out to analyze the prevalence of self-reported work-related musculoskeletal symptoms among software professionals and to utilize the findings to design an effective preventive interventional program for WRMSDs. Subjects & Methods: This cross-sectional descriptive data analysis was done among 665 software employees both male and female from various companies in Q city Tech Park, Hyderabad. Data collected with “Cornell Musculoskeletal Discomfort Questionnaire” (CMDQ). Results: A total of 640 subjects were eligible for this study. Prevalence of WRMSDs to be 67%. The most common sites of reported symptoms are neck (65.0%), upper back (56.4%), lower back (62.6%), right shoulder (41.4%), left shoulder (35.4%) and right thigh (41.4%). Women were more likely to report symptoms in neck, lower back and both shoulder region than men (p<0.05). Discomforts in neck, lower back and right shoulder are greatly shown impact on work performance. Conclusion: WRMSDs are highly prevalent is software professionals and women at more risk than men. These findings indicate the need for more attention to WRMSDs and design of effective preventive strategies. Keywords: musculoskeletal pain, Prevalence, software professionals, work related musculoskeletal disorders.

Standard reference values of the upper body posture in healthy male adults aged between 31 and 40 years in Germany-an observational study

Background In order to classify and analyze the parameters of upper body posture, a baseline in the form of standard values is demanded. To this date, standard values have only been published for healthy men aged 18–35 and 41–50 years. Data for male adults aged between 31 and 40 years are lacking. Methods The postural parameters of 101 symptom-free male volunteers aged 31–40 (35.58 ± 2.88) years were studied. The mean height of the men was 179.89 ± 7.38 cm, with a mean body weight of 86.36 ± 11.58 kg and an average BMI of 26.70 ± 3.35 kg/m2. By means of video rasterstereography, a 3-dimensional scan of the upper back surface was measured in a habitual standing position. The means or medians, confidence interval, tolerance range, and group comparisons and correlations of BMI and physical activity were calculated for all parameters. Results The habitual standing position was found to be almost symmetrical and the axis aligned in the spine, pelvis, and shoulder region, while the spine position was marginally inclined ventrally. The kyphosis angle of the thoracic spine was greater than the lordosis angle of the lumbar spine. All deviations fell under the measurement error margin of 1 mm/1°. The greater the BMI, the greater was the pelvic and scapular distance. The lower the BMI, the further caudally positioned was the right shoulder. The pelvic and scapular distances were also lower with the increasing athleticism of the participants. Conclusion The upper body posture of men between the ages of 31 and 40 years was found to be almost symmetrical and axis-conforming, with the kyphosis angle, pelvic distance, and shoulder distance enlarging with increasing BMI. Consequently, postural parameters presented in this survey allow for comparisons with other studies, as well as the evaluation of clinical diagnostics and applications.

Signs of Central Hypersensitivity, Stress, and Anxiety following Treatment for Breast Cancer: A Case Control Study

Background. With treatment for breast cancer, women treated may present significant sensory abnormalities in the upper extremity. However, there are no conclusive studies that have evaluated pressure pain thresholds (PPT) in the shoulder of postoperated women for breast cancer. The aim of this study was to compare PPT in the shoulder, stress, anxiety, depression symptoms, and quality of sleep among postoperated women for breast cancer (PO group) and asymptomatic women of shoulder pain (control group). Methods. 40 women participated ( n = 20 , PO group, age: average ± standard deviation , 49.2 ± 8.3 years; body mass index (BMI): 27.5 ± 3.0 kg/cm2; surgery time: 22.2 ± 34.4 months; n = 20 , control group, 46.9 ± 8.1 years; BMI: 26.8 ± 3.5 kg/cm2). The PPT was evaluated with a digital algometer at 32 points in the shoulder region and one control point in the tibialis anterior. Stress, anxiety, and depression were evaluated with the Depression, Anxiety and Stress Scale 21 (DASS-21) and the quality of sleep by the Pittsburgh Sleep Quality Index. Results. Significant differences were observed over 1.5 kgf/cm2 in 33 points evaluated ( p < 0.01 ) with a small to high effect size (Cliff’s delta range = 0.16 ; 0.92) and higher levels of anxiety and stress in the PO group (anxiety: median [first; third quartile], 5[3; 12.5]; stress: 9.7 ± 4.7 (7.8; 11.8)) in comparison with the control group (anxiety: 2.5[1; 4.8]; stress: 6.7 ± 3.31 (5.2; 8.3), ( p < 0.05 )). No significant differences were found between the groups in depression and sleep quality ( p > 0.05 ). Conclusion. Postoperated women for breast cancer present hyperalgesia in the shoulder anterior and posterior region, low PPT in the tibialis anterior, and higher levels of stress and anxiety compared to the control group.

The Injured Shoulder in High-Level Male Gymnasts, Part 1: Epidemiology and Pathoanatomy of Surgically Treated Lesions

Background: Weightbearing and traction-suspension movements with the upper limbs put considerable demands upon the shoulder region of high-level gymnasts. The diagnosis of instability in these gymnasts may be difficult because voluntary inferior shoulder subluxation is part of their training and is needed to perform some acrobatic figures. Purpose: To (1) assess the epidemiology of shoulder lesions requiring surgery, (2) describe the types of injuries and assess which maneuvers and equipment put the gymnast most at risk, and (3) present a pathoanatomic classification of the injured shoulder in high-level male gymnasts. Study Design: Case series; Level of evidence, 4. Methods: Over a 20-year period (1994-2014), 26 high-level male gymnasts (30 shoulders; mean age, 22 years; range, 16-33 years) were referred to our surgical center for shoulder pain or instability. Four gymnasts underwent surgery on both shoulders. All shoulders were evaluated clinically, radiologically, and arthroscopically. An independent observer evaluated the circumstances in which these lesions occurred, including the apparatus used and the maneuvers performed. Results: The mean duration of symptoms before surgery was 8 months (range, 6-24 months). Eighteen injured shoulders (60%) had chronic overuse injuries. In 27 shoulders (90%), the mechanism of injury was traction of the arm in forced flexion-rotation while using suspension equipment with locked hands on the bars or the rings. In the remaining 3 shoulders, the traumatic position was one of an isometric muscle contraction against gravity, sustained while performing strength-and-hold positions on the rings. Based on the main presenting symptoms (pain and/or instability) and main anatomic lesions found during arthroscopy, the injured gymnasts’ shoulders were classified into 2 categories: painful shoulders (n = 13) with no clinical, radiological, or arthroscopic findings of instability (mainly superior cuff and biceps anchor lesions) and unstable shoulders (n = 17) with isolated inferior capsule labral tears or mixed lesions (tendinous and capsulolabral). Some gymnasts with inferior labral tears had no recall of having suffered a dislocation or subluxation. Conclusion: The majority of injuries requiring surgery in this population occurred during traction in forced flexion-rotation using suspension equipment. Injured shoulders were classified as either painful or unstable shoulders.

Case Report: Perspective of a Caregiver on Functional Outcomes Following Bilateral Lateral Pectoral Nerve Cryoneurotomy to Treat Spasticity in a Pediatric Patient With Cerebral Palsy

Spasticity is common and difficult to manage complication of cerebral palsy that significantly affects the function and quality of life of patients. This case study reports a 15-year-old male with quadriplegic cerebral palsy, Gross Motor Function Classification System 5 (GMFCS 5), who presented with significant bilateral adducted and internally rotated shoulders as a component of generalized spasticity. Spasticity in the lower limb of the patient had been treated with botulinum toxin A (BoNT-A) injections; however, the shoulder region was spared due to concerns of toxin spread and aspiration risk. Following diagnostic nerve blocks, the patient underwent bilateral cryoneurotomies of the right and left lateral pectoral nerves (LPNs) lasting 3.5 min for each lesion. One month after the cryoneurotomies, the range of motion (ROM) had improved from 86° to 133° on the right and 90° to 139° on the left. Improvements in ROM were retained at 9 months post-procedure. At 8.5 months following the cryoneurotomies, the caregiver reported improvements in upper body dressing, upper body washing, transferring, and the ability of the patient to remain sitting in his wheelchair for extended periods. Cryoneurotomy may be an effective procedure for improving shoulder ROM and specific functional outcomes for caregivers of patients with spasticity arising from cerebral palsy.

A Study on Suprascapular Foramen and Its Clinical Importance: A Cadaveric Study in Western Part of Tamilnadu, India

Background: Suprascapular notch is present along the superior border of the scapula close to the lateral angle, which is converted into a Suprascapular foramen by the transverse Suprascapular ligament. Normally the Suprascapular nerve and vein pass through the foramen below the ligament, while the Suprascapular artery runs above the ligament. Suprascapular nerve entrapment is an interesting clinical condition which is widely involved in this area. Aim of the study: To find out the presence of Suprascapular artery passing along with the Suprascapular nerve and vein within the foramen and any pathology associated with it. Materials and Methods: The proposed study is carried out in the Department of Anatomy, Karpagam Faculty of Medical Sciences and Research, Coimbatore, where 51 well embalmed cadavers of both the sexes and various age groups was utilised. Results: Out of 51 cadavers dissected, we found Suprascapular artery was found passing along with the Suprascapular nerve and vein in 2 of the cadavers, of which one each is found in a male and a female cadaver with an incidence of 3.92%. Conclusion: Studies done earlier pointed out the importance of Suprascapular nerve entrapment, the various causes and predisposing factors responsible for it ,and a knowledge of safe zone around the shoulder region should be known well to the operating surgeon and the available imaging techniques should be utilised by the radiologists in order to avoid the complications while dealing with the Suprascapular nerve entrapment. KEY WORDS: Cadaver, Suprascapular foramen, Suprascapular artery, Nerve entrapment, Transverse Suprascapular ligament.

Cutaneous mucormycosis or black fungus of right shoulder region- rare case report

Cutaneous mucormycosis or black fungus is a fungal infection which is caused by fungi of class zygomycetes and having high morbidity and mortality. It is an opportunistic infection, which is prevalent in immunocompromised patients. Risk factors associated with mucormycosis are diabetes mellitus, organ transplant, trauma, burn and long-term steroid use. Here author reports a case of mucormycosis of right shoulder complicated with necrotizing fasciitis in a diabetic patient. Patient underwent multiple sittings of radical debridement along with empirical therapy of liposomal Amphotericin B followed by skin grafting.

Unusual pectoral apparatus in a predatory dinosaur resolves avian wishbone homology

The furcula is a distinctive element of the pectoral skeleton in birds, which strengthens the shoulder region to withstand the rigor of flight. Although its origin among theropod dinosaurs is now well-supported, the homology of the furcula relative to the elements of the tetrapod pectoral girdle (i.e., interclavicle vs clavicles) remains controversial. Here, we report the identification of the furcula in the birdlike theropod Halszkaraptor escuilliei. The bone is unique among furculae in non-avian dinosaurs in bearing a visceral articular facet in the hypocleideal end firmly joined to and overlapped by the sternal plates, a topographical pattern that supports the primary homology of the furcula with the interclavicle. The transformation of the interclavicle into the furcula in early theropods is correlated to the loss of the clavicles, and reinforced the interconnection between the contralateral scapulocoracoids, while relaxing the bridge between the scapulocoracoids with the sternum. The function of the forelimbs in theropod ancestors shifted from being a component of the locomotory quadrupedal module to an independent module specialized to grasping. The later evolution of novel locomotory modules among maniraptoran theropods, involving the forelimbs, drove the re-acquisition of a tighter connection between the scapulocoracoids and the interclavicle with the sternal complex.

Association between working in awkward postures, in particular overhead work, and pain in the shoulder region in the context of the 2018 BIBB/BAuA Employment Survey

Background Musculoskeletal disorders are the leading cause of work-related sick leave and incur substantial socioeconomic costs. With the aging of our society and employees, the problem is exacerbating, and prevention is becoming increasingly important. According to previous studies, exposure to awkward postures, such as overhead work, is associated with musculoskeletal problems. Objective This study aimed to determine the current prevalence of employees who work in awkward postures, specifically overhead, stratified by age, gender and occupation in the context of the 2018 BIBB/BAuA Employment Survey and to analyze associations between awkward working postures, in particular overhead work, and pain in the shoulder region. Method The study is based on secondary data from the German 2018 BIBB/BAuA Employment Survey. We have included 14,327 of the 20,012 employees aged < 67 years who work at least 35 h per week who took part in the survey. The classification of participants in occupational groups is based on the Blossfeld classification. The multivariate analysis was conducted by applying robust Poisson regression models adjusted block by block to obtain the relation between the self-reported frequency of working in awkward postures, in particular overhead work, and the occurrence of arm pain and neck and shoulder pain. Prevalence ratios (PR) are reported as effect estimates. Results 12.7% of participants indicated that they are often exposed to awkward postures at work; 5.0% stated they often performed overhead work. The majority of these employees worked in agricultural, unskilled and skilled manual occupations. The crude prevalence is 17.4% for arm pain and 48.4% for neck and shoulder pain. If subjects reported that they often performed overhead work, the risk of arm pain increased by 18% (PR 1.18, CI 1.04–1.34, final model). Conclusion Working in awkward postures, especially overhead work, is a risk factor for upper extremity musculoskeletal disorders. The development of prevention strategies should focus on the workforce in agricultural, unskilled and skilled manual occupations.