Overview of occupational overuse syndromes

Last reviewed: November 2017
Last updated: November  2017

Introduction

Condition
Description

Low back pain (LBP) is the primary cause of disability in individuals under the age of 50. The aetiologies can be subdivided into 3 groups: mechanical, systemic, and referred. By far, the most common cause is mechanical (97%). [1] Even after a thorough work-up, 85% of patients with isolated LBP still do not have a definitive cause identified for their symptoms. [2]

Occupations requiring physical exertion have been associated with LBP. These occupational activities result in LBP because of both acute injuries and cumulative stresses to the spinal anatomy. [3]

The aetiology of cervical spondylosis is underlying spontaneous joint degeneration. It is related to age, and to wear and tear. [4] [5] However, concordant twin studies note a significant genetic predisposition to development of cervical degeneration, in addition to occupational and activity-related factors. [6]

Lumbar discogenic back pain is the presence of activity-related low back pain with or without the concurrence of radicular lower limb symptoms in the presence of radiologically confirmed degenerative disc disease. An association has long been noted between occupation-related postures and stresses due to abnormal loading and lifting mechanics. [7] The use of vibrating equipment is considered particularly hazardous. [8]

This condition typically results from degenerative changes in the lumbar spine. People who perform heavy-duty work may develop degenerative changes in the spine earlier in life because of increased mechanical wear of the spine and higher risk of traumatic injury.

Presents with insidious onset of anterior chest-wall pain exacerbated by certain movements of the chest and deep inspiration. A history of unaccustomed repetitive upper-limb movement is commonly associated. [9]

The history can give useful information as to the type of injury the patient may have. Important details to ask about are location of contact, location of pain, and any previous injuries. A patient's description of their mechanism of injury is another important part of the history. For example, most anterior cruciate ligament tears are non-contact twisting injuries.

Popliteal (Baker's) cyst is usually the result of a pathology of the knee joint, such as arthritis or a cartilage tear. Trauma in the knee joint, specifically injury of the medial meniscus, chondral lesions, and tears of the anterior cruciate ligament, is a significant risk factor in the development of popliteal cysts.

Examples of mononeuropathies in the lower extremities caused by occupational overuse include common peroneal mononeuropathy (squatting for long periods - carpet layers, farm workers), mononeuropathy of the later cutaneous nerve of the thigh (wearing a heavy belt - carpenters), and sciatic mononeuropathy (sitting on a hard surface). [10]

Excessive friction of the distal iliotibial band sliding over the lateral femoral epicondyle when the knee is in flexion and extension causes irritation. It is unusual in non-athletes.

There are more than 10 individual nerves in the arm distal to the brachial plexus, and so many different mononeuropathies can occur. Osteoarthritis, tendinitis, or repetitive strain symptoms are often confused with carpal tunnel syndrome and/or ulnar neuropathy, as the distribution of pain can be similar in these entities. Electrophysiological studies can help identify or rule out an associated mononeuropathy in these cases.

This is a common shoulder condition, especially in older and active patients. An episode of vigorous overhead activity, such as painting or overhead lifting, may incite subacromial bursitis or impingement symptoms, which can be prodromes to tearing and failure of the rotator cuff.

With a prevalence of approximately 1 in 25, this is the most common entrapment neuropathy. Occupations involving exposure to repetitive bending or twisting of the hands or wrists, or the use of vibrating tools, represent a particular risk.

Patients describe a history of activities contributing to overuse of the forearm muscles that originate at the elbow. Both medial and lateral epicondylitis have been associated with repetitive elbow and forearm activities, such as hammering, typing, meat-cutting, plumbing, and painting, as well as leisure activities including tennis and golf.

A group of entities with a common pathology involving the extrinsic tendons of the hand and wrist and their corresponding retinacular sheaths. Repetitive shear stress through the retinacular sheath causes irritation to the tendon and its synovial lining (tenosynovium), and subsequent inflammation followed by hypertrophy and fibrosis, which may lead to the development of trigger finger.

This condition causes an acute or chronic pain in the inferior heel at the attachment of the medial band of the plantar fascia to the medial calcaneal tubercle. It is commonly seen in people who work in a standing position, especially those who are standing on a hard, unforgiving surface such as concrete (e.g., factory or postal workers). [11] [12]

Heavy lifting does not predispose to hernia formation, but rather brings the hernia to the attention of the patient.

Any occupation that causes repetitive mechanical stress over a bursa may result in bursitis. In primary care, bursitis most commonly presents in the knee, and as subacromial (subdeltoid), trochanteric, retrocalcaneal, and olecranon bursae.

Jackhammer operation and other causes of vibration injury increase the risk of developing secondary Raynaud's phenomenon.

Tendon degeneration characterised by a combination of pain, swelling, and impaired performance is described by the general term 'tendinopathy'. The exact aetiology is unclear. Studies suggest it is an overuse condition leading to inadequate tendon repair that predisposes the tendon to microtears and degeneration.

Strain is an injury to the muscle or musculotendinous junction, whereas sprain is an injury to the ligament. Predisposing factors are type of muscle architecture (i.e., pennate muscle, type II fast twitch muscle fibres, and muscle-tendon units that span 2 joints) and previous injury.

Extended periods of mental tension or psychological stress may play a role in central sensitisation and the development of chronic tension-type headache.

Trauma to the eye is a leading cause of visual loss and blindness that frequently affects young individuals. Injuries may be due to mechanical trauma (blunt or penetrating), chemical agents, or ultraviolet and ionising radiations.

Pain persisting longer than 3 months is deemed to be chronic. High-risk occupations are healthcare workers (e.g., nurses' aides, nurses, dentists, and chiropractors), construction workers, automobile mechanics, housekeepers/cleaners, and hairstylists. Unemployment and previous job change due to pain are also risk factors for pain chronicity.

Repetitive use and overuse of muscles are likely to result in musculoskeletal pain.

Sport-related injuries may be generally categorised as acute or chronic. The range of medical conditions potentially resulting from sport- or exercise-related injuries is wide. More than 90% of all sport-related injuries are either contusions or strains. [13] Contact sports may increase the risk of contusion, whereas sprinting and jumping are the most common activities associated with muscle strains. [14] [15]

Contributors

Authors

BMJ Publishing Group

Disclosures

This overview has been compiled using the information in existing sub-topics.

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