Overview of work-related musculoskeletal disorders
Introduction
Related conditions
The etiologies of back pain can be subdivided into 3 groups: mechanical, systemic, and referred. Mechanical back pain is defined as pain that is elicited with spinal motion and decreased with rest. The most common cause of mechanical back pain is lumbar strain/sprain, which accounts for around 70% of cases of low back pain.[3]
Musculoskeletal lower back pain is pain, stiffness, and/or soreness of the lumbosacral region (underneath the twelfth rib and above the gluteal folds). Occupations requiring physical exertion have been associated with lower back pain. These occupational activities result in lower back pain because of both acute injuries and cumulative stresses to the spinal anatomy.[4]
The etiology of cervical spondylosis is underlying spontaneous joint degeneration. It is related to age, and to wear and tear.[5][6] However, concordant twin studies note a significant genetic predisposition to development of cervical degeneration, in addition to occupational and activity-related factors.[7]
Lumbar discogenic back pain is characterized by low back pain with or without the concurrence of radicular lower limb symptoms, in the presence of radiologically-confirmed degenerative disk disease. An association has been noted between occupation-related postures and stresses due to abnormal loading and lifting mechanics.[8] The use of vibrating equipment is considered particularly hazardous.[9]
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.[10]
Patient description of the mechanism of injury is an essential part of the history. For example, most anterior cruciate ligament tears are non-contact twisting injuries. Location of contact, location of pain, history of previous injury, and areas of anesthesia/dysaesthesia, should be investigated.
Neck pain is a common condition that causes significant disability. High body mass index, frequent neck extension during the working day, high initial pain intensity, and high psychological job demands are all predictors of chronic neck pain development in office workers.[11]
Popliteal (Baker) 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 work tasks include common peroneal mononeuropathy (squatting for long periods - carpet layers, farm workers), mononeuropathy of the lateral cutaneous nerve of the thigh (wearing a heavy belt - carpenters), and sciatic mononeuropathy (sitting on a hard surface).[12]
Iliotibial band syndrome results from repetitive friction of the iliotibial band sliding over the lateral femoral epicondyle, moving anterior to the epicondyle as the knee extends and posterior as the knee flexes, and remaining tense in both positions. It is unusual in nonathletes.
There are more than 10 individual nerves in the arm distal to the brachial plexus, 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. Electrophysiologic studies can help identify or rule out an associated mononeuropathy in these cases.
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, carpal tunnel syndrome 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).[13][14]
Occurs because of a defect in the structure of the inguinal canal that may be either congenital or acquired. Patients with inguinal hernia have been shown to have abnormal collagen metabolism and decreased collagen levels.
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.
Tendon degeneration characterized by a combination of pain, swelling, and impaired performance is described by the general term "tendinopathy". The exact etiology 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 fibers, and muscle-tendon units that span two joints) and previous injury.
Pain persisting longer than 3 months is deemed to be chronic. High-risk occupations are healthcare workers (e.g., healthcare assistants, nurses, dentists, and chiropractors), construction workers, car mechanics, housekeepers/janitors, and hairstylists. Unemployment and previous job change due to pain are also risk factors for pain chronicity.
Musculoskeletal pain refers to acute or chronic pain in the muscles, bones, tendons, and ligaments. It is very common and is a major cause of morbidity and occupational sickness absence.
Sport-related injuries are generally categorized 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.[15] Contact sports (e.g., soccer, hockey) may increase the risk of contusion, whereas sprinting and jumping are the most common activities associated with muscle strains.[16][17]
Contributors
Authors
Editorial Team
BMJ Publishing Group
Disclosures
This overview has been compiled using the information in existing sub-topics.
Patient leaflets
Back pain (lower back)
Carpal tunnel syndrome
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