Application of the Strain Index in multiple task jobs

Six different methods to calculate the Strain Index (SI) scores for jobs with multiple forces/tasks were developed. Exposure data of 733 subjects from 12 different worksites were used to calculate these SI scores. Results show that using different SI computation methods could result in different SI scores, hence different risk level classifications. However, some simpler methods generated SI scores were comparable to the more complicated composite SI method. Despite differences in the scores between the six different SI computation methods, Spearman rank-order correlation coefficients of 0.61-0.97 were found between the methods. With some confidence, ergonomic practitioners may use simpler methods, depending on their specificity requirement in job evaluations and available resources. Some SI computation methods may tend to over-estimate job risk levels, while others may tend to under-estimate job risk levels, due to different ways used in obtaining the various SI parameters and computations.

Patterns of skeletal fractures in child abuse: systematic review

OBJECTIVES

To systematically review published studies to identify the characteristics that distinguish fractures in children resulting from abuse and those not resulting from abuse, and to calculate a probability of abuse for individual fracture types.

DESIGN

Systematic review.

DATA SOURCES

All language literature search of Medline, Medline in Process, Embase, Assia, Caredata, Child Data, CINAHL, ISI Proceedings, Sciences Citation, Social Science Citation Index, SIGLE, Scopus, TRIP, and Social Care Online for original study articles, references, textbooks, and conference abstracts until May 2007.

STUDY SELECTION

Comparative studies of fracture at different bony sites, sustained in physical abuse and from other causes in children <18 years old were included. Review articles, expert opinion, postmortem studies, and studies in adults were excluded. Data extraction and synthesis Each study had two independent reviews (three if disputed) by specialist reviewers including paediatricians, paediatric radiologists, orthopaedic surgeons, and named nurses in child protection. Each study was critically appraised by using data extraction sheets, critical appraisal forms, and evidence sheets based on NHS Centre for Reviews and Dissemination guidance. Meta-analysis was done where possible. A random effects model was fitted to account for the heterogeneity between studies.

RESULTS

In total, 32 studies were included. Fractures resulting from abuse were recorded throughout the skeletal system, most commonly in infants (<1 year) and toddlers (between 1 and 3 years old). Multiple fractures were more common in cases of abuse. Once major trauma was excluded, rib fractures had the highest probability for abuse (0.71, 95% confidence interval 0.42 to 0.91). The probability of abuse given a humeral fracture lay between 0.48 (0.06 to 0.94) and 0.54 (0.20 to 0.88), depending on the definition of abuse used. Analysis of fracture type showed that supracondylar humeral fractures were less likely to be inflicted. For femoral fractures, the probability was between 0.28 (0.15 to 0.44) and 0.43 (0.32 to 0.54), depending on the definition of abuse used, and the developmental stage of the child was an important discriminator. The probability for skull fractures was 0.30 (0.19 to 0.46); the most common fractures in abuse and non-abuse were linear fractures. Insufficient comparative studies were available to allow calculation of a probability of abuse for other fracture types.

CONCLUSION

When infants and toddlers present with a fracture in the absence of a confirmed cause, physical abuse should be considered as a potential cause. No fracture, on its own, can distinguish an abusive from a non-abusive cause. During the assessment of individual fractures, the site, fracture type, and developmental stage of the child can help to determine the likelihood of abuse. The number of high quality comparative research studies in this field is limited, and further prospective epidemiology is indicated.

[Upper-limb work-related musculoskeletal disorders (UL-WMSDs) and latency of effect]

BACKGROUND

Trends in work-related upper limb musculoskeletal disorders appear to be in constant increase in industrialized countries. In Europe claims and compensation for these disorders have significantly increased.

OBJECTIVE

The aim of this study was to investigate the temporal relationship between the beginning of occupational exposure to repetitive movements and exertions of upper limbs, assessed through the OCRA index, and the manifestation of the disorders.

METHODS

Clinical and questionnaire information about 557 cases of UL-WMSDs in the upholstered furniture industry were analyzed in order to investigate the mean latency period of the disorders and to verify to what extent different levels of exposure influence the latency time.

RESULTS AND CONCLUSIONS

The latency of UL-WMSDs is influenced by the level of exposure to risk, measured by means of the OCRA index. Shorter latency times were found for wrist/hand tendonitis, with a mean latency time of 5.4 years and with a greater sensitivity to the level of exposure assessed with the OCRA index value. This might support a sort of predictive value with reference to other UL-WMSDs with longer latency. Probably a latency period of 12 years may be suggested as the cut-off limit to assess a causal relationship between tendon or canalicular WMISDs and occupational exposure to repetitive movements and exertions of upper limbs.

Prevention of arm injury in youth baseball pitchers

The advent of youth year-round baseball has come with an increased incidence of pitching related injury and surgery, most notably involving the shoulder and elbow (ulnar collateral ligament). These injuries become evident in high school and college, but begin at the youth level. Several studies have identified baseball pitching risk factors during youth that increase likelihood for injury and surgery in subsequent years. Based on these studies, the USA Baseball Medical & Safety Advisory Committee has published guidelines for pitching that include limits on pitch count and pitches per week and season as well as recommendations for number of rest days between pitching. Also, recommendations include the restriction of breaking balls prior to puberty, the importance of instruction for proper pitching mechanics as early as possible in development, and at least three months of rest after a season. This review is intended to help guide primary care physicians and pediatricians when discussing youth pitching and injury prevention with parents and coaches.

Simultaneous bilateral distal biceps tendon rupture during a preacher curl exercise: a case report

Complete rupture of the distal biceps tendon is a rare injury, the overwhelming majority occurring in the dominant arm of males during the fourth to sixth decades of life. Simultaneous bilateral rupture of the distal biceps tendon is an extremely rare occurrence, with only three cases reported in the literature. This unusual injury occurred in a recreational weightlifter during a preacher curl exercise. In this particular case, a 6-week delay in presentation necessitated a staged procedure in which a primary repair was feasible in one elbow, while reconstruction using allograft tissue was required in the contralateral elbow. Satisfactory results for both elbows were achieved, with return to weightlifting by one year following surgery.

The incidence of upper extremity injuries in endoscopy nurses

Endoscopy nurses are at risk for upper extremity injury because of the nature of their work, yet there has been little attention to this problem in the literature. The purpose of this study was to explore whether endoscopy nurses commonly experience upper extremity injuries and to identify factors associated with upper extremity injuries in this population. Results reveal that for this sample, endoscopy nurses working full-time are at the highest risk for injury, suggesting the importance of ergonomics in the endoscopy suite.

Rehabilitation of children after elbow injuries

OBJECTIVES

To review the efficiency of early physical therapy to achieve successful rehabilitation after elbow injuries in children.

SETTING

Tertiary medical institution, Department of Physical Therapy, University Clinical Center of Kosovo, rr. Spitalit pn. 10000 Prishtina, Kosovo.

METHODS

We retrospectively reviewed the patients with elbow injuries, (ICD, Rev. 10, Elbow Fractures code) merely as a consequence of trauma, who had undergone rehabilitation program from June 2000 December 2001.

RESULTS

In this study 140 cases with elbow injuries are analyzed. The majority of the injured are with fracture 132 cases (94.29%), whereas only 8 cases or 5.72% are with non displaced fracture or dislocation. Analysis based on the most frequent injury localization in the elbow region, among all fractures, supracondylar fracture is present with 78 cases or 56%. The majority of cases, 49 or 35% have had injuries caused by fall from height, up to 6 cases or 4.3% injured in MVA. Timely initiation of rehabilitation program is influential factor in successful rehabilitation, whereas correlation between time of initiation and rehabilitation success have demonstrated important statistical significance, very high correlation r = 0.75 p < 0.01.

CONCLUSION

The children that did not have continuous rehabilitation program, due to huge interruptions during rehabilitation, have not achieved excellent success in rehabilitation. Early start of rehabilitation, since the arm is immobilized, can cause complete regaining of elbow functions, therefore any delay in the beginning of rehabilitation will leave consequences, from the must minor ones up to disability.

Hay baler injuries to the upper extremity

BACKGROUND

Hay baler injuries to the upper extremity have not been well documented in the medical literature. In this series, we analyze the functional results of reconstruction, replantation, or amputation in relation to the severity of the injury.

METHODS

Twenty-one patients treated after a hay baler injury to an upper extremity were included in the study. Mean follow-up was 30.6 months. Patients were categorized into five different groups according to the anatomic location of injury, the presence of vascularity, and the severity of tissue injury: (1) single digit injury, (2) viable hand with limited tissue loss, (3) viable hand with extensive tissue loss, (4) amputation or devascularization with limited tissue loss, or (5) amputation or devascularization with extensive tissue loss. The functional results were assessed based on the usefulness of the injured extremity.

RESULTS

Patients underwent an average of three operative procedures and 11.5 days of hospitalization. The overall infection rate was 33%. Eleven patients had good functional results, four had fair results, and six had poor results. Higher infection rates, increased number of operative procedures, prolonged hospital stays, and poor functional scores correlated with the increased severity of the injury.

CONCLUSION

The degree of initial tissue loss seemed to correlate with both the ability to replant the extremity and the functional outcome of the reconstruction. Free tissue transfers or replantation improved results in selected cases. All patients in this series who underwent replantation and concurrent free tissue transfer ultimately obligated a revision amputation.

[Risk assessment of biomechanical load for the upper limbs in housework]

BACKGROUND

There are few studies in the literature on work-related musculoskeletal disorders among housewives, also due to the difficulties encountered during risk assessment.

OBJECTIVES

The aim of this study was evaluation of the biomechanical load for the upper limbs in housewives' tasks, using the different methods described in the literature.

METHODS

A questionnaire was submitted to 104 women (aged 25-60 years), 62 of whom were housewives only. Twelve subjects accepted to be filmed on video-cameras while working, which was necessary for risk evaluation. A number of tasks were chosen to be evaluated (loading the dishwasher, cleaning kitchen work surfaces, sweeping, cleaning floors, using the vacuum cleaner, dusting, cleaning the bathroom, ironing, making beds) because they were more frequently performed over a day or a week and because they involved specific physical risk factors. The preliminary analysis was based on the search for such risks, identification of "caution zone" housework, and subsequent evaluation by advanced level tools.

RESULTS

Biomechanical risk analysis showed that higher overloads were detected in ironing, cleaning floors and cleaning kitchen worktops but all housework analyzed in this study involved exposure to biomechanical risk when performed for four hours in a day.

CONCLUSION

Housework involves exposure to several risk factors for the musculoskeletal system. Nevertheless, housewives are able to self-organise work and recovery times (even with the limits imposed by family demands) but their activities are characterised by repetitiveness and often by high hand/arm force associated with awkward postures.

Prediction of absolute risk of non-spinal fractures using clinical risk factors and heel quantitative ultrasound

The relationship between osteoporosis risk factors, bone quantitative ultrasound (QUS) and non-spinal fracture risk was estimated in a cohort of 5,201 postmenopausal women from Spain who were prospectively evaluated during three years. Several clinical risk factors and low heel QUS values were independently associated with non-spinal fracture risk.

INTRODUCTION

Low-trauma, non-spinal fractures are a growing source of morbidity and mortality in the elderly. The aim of the present study was to examine the association of heel quantitative ultrasound (QUS) and a series of osteoporosis and fracture risk factors, with incident low energy non-spinal fractures in a population of elderly women, and to incorporate them into fracture prediction models.

METHODS

5,201 women aged 65 or older were enrolled in a three-year cohort study. Participants completed an osteoporosis and fracture risk factors questionnaire. QUS was measured at the heel with a gel-coupled device. Cox-proportional hazard analyses were performed to evaluate the association with the first incident low-trauma non-spinal fracture.

RESULTS

Three hundred and eleven women (6.0%) sustained a total of 363 low-trauma fractures, including 133 forearm/wrist, 54 hip, 50 humerus, 37 leg and 17 pelvic fractures. For every standard deviation decrease in the quantitative ultrasound index, the adjusted hazard ratios (95% CI) for any non-vertebral, hip, forearm/wrist, and humerus fractures were 1.31 (1.15-1.49), 1.40 (1.01-1.95), 1.50 (1.19-1.89) and 1.35 (0.97-1.87), respectively. Similar results were observed with other QUS variables. The best predictive models indicated that age, a history of falls, a previous low-trauma fracture, a family history of fracture, a calcium intake from dairy products of less than 250 mg/day, and lower values of QUS parameters were independently associated with the risk of non-spinal fractures.

CONCLUSIONS

Both clinical risk factors and QUS are independent predictors of risk of fragility non-spinal fractures. A prediction algorithm using these variables was developed to estimate the absolute risk of non-spinal fractures in elderly women in Spain.

Work-related physical and psychosocial risk factors for sick leave in patients with neck or upper extremity complaints

Objectives

To study work-related physical and psychosocial risk factors for sick leave among patients who have visited their general practitioner for neck or upper extremity complaints.

Methods

Three hundred and forty two patients with neck or upper extremity complaints completed self-report questionnaires at baseline and after 3 months. Cox regression models were used to investigate the association between work-related risk factors and sick leave (i.e., lost days from work due to neck or upper extremity complaints in 3 months). Effect modification by sick leave at baseline, sex, worrying and musculoskeletal co-morbidity was evaluated by adding product terms to the regression models.

Results

In the subgroup of patients who scored high on the pain copying scale “worrying” the hazard ratio of sick leave was 1.32 (95% CI 1.07–1.62) per 10% increase in heavy physical work. The subgroup of patients who were sitting for long periods of time had a reduced risk of sick leave as compared to patients who did not spend a lot of time sitting, again only in patients who scored high on the pain coping scale “worrying” (adjusted HR = 0.17, 95%-CI 0.04–0.72). Other work-related risk factors were not significantly related to sick leave.

Conclusions

Heavy physical work increased the risk of sick leave and prolonged sitting reduced the risk of sick leave in a subgroup of patients who worried much about their pain. Additional large longitudinal studies of sufficiently large size among employees with neck or upper extremity complaints are needed to confirm our results.

Stroke pattern and handrim biomechanics for level and uphill wheelchair propulsion at self-selected speeds

OBJECTIVES

To investigate the natural stroke patterns of wheelchair users pushing on a level surface, to determine if users adapt their stroke patterns for pushing uphill, and to assess whether there are biomechanic advantages to one or more of the stroke patterns.

DESIGN

Case series.

SETTING

Biomechanics laboratory.

PARTICIPANTS

Twenty-six manual wheelchair users with a spinal cord injury.

INTERVENTION

Subjects pushed their own wheelchairs at self-selected speeds on a research treadmill set to level, 3 degrees , and 6 degrees grades. Stroke patterns were measured using a motion capture system. Handrim biomechanics were measured using an instrumented wheel.

MAIN OUTCOME MEASURES

Stroke patterns were classified for both level and uphill propulsion according to 1 of 4 common classifications: arcing, semi-circular, single-looping (SLOP), and double-looping (DLOP). Biomechanic outcomes of speed, peak handrim force, cadence, and push angle were all compared across stroke classifications using an analysis of variance.

RESULTS

Only 3 of the 4 stroke patterns were observed. None of the subjects used the semi-circular pattern. For level propulsion, the stroke patterns were fairly balanced between arcing (42%), SLOP (31%), and DLOP (27%). Subjects tended to change their stroke pattern for pushing uphill, with 73% of the subjects choosing the arcing pattern by the 6 degrees grade. No statistically significant differences were found in handrim biomechanics or subject characteristics across stroke pattern groups.

CONCLUSIONS

Wheelchair users likely adapt their stroke pattern to accommodate their propulsion environment. Based on the large percentage of subjects who adopted the arcing pattern for pushing uphill, there may be benefits to the arcing pattern for pushing uphill. In light of this and other recent work, it is recommended that clinicians not instruct users to utilize a single stroke pattern in their everyday propulsion environments.

Consequences of a Cross Slope on Wheelchair Handrim Biomechanics

OBJECTIVE

To test the hypothesis that pushing on a cross slope leads to increased handrim loading compared with that found on a level surface.

DESIGN

Case series.

SETTING

Biomechanics laboratory.

PARTICIPANTS

Twenty-six manual wheelchair users.

INTERVENTION

Subjects pushed their own wheelchairs on a research treadmill set to level, 3 degrees , and 6 degrees cross slopes. Propulsion speed was self-selected for each cross-slope condition. Handrim biomechanics were measured for the downhill wheel, using an instrumented wheelchair wheel and a motion capture system.

MAIN OUTCOME MEASURES

Speed, peak kinetics (force, rate of loading, torque), push angle, cadence, push distance, and power output were averaged over a 20-push set for each subject and each cross-slope condition. Outcomes were compared across cross slopes using a repeated-measures analysis of variance.

RESULTS

Push angle and cadence were unaffected by cross slope. A trend of decreasing self-selected speeds with increasing cross slope was not significant. There were considerable increases in the peak kinetic measures, with the axial moment increasing by a factor of 1.8 on the 6 degrees cross slope (P=.000). More pushes were required to cover the same distance when on a cross slope (P<.034). The power required for propulsion increased by a factor of 2.3 on the 6 degrees cross slope (P=.000).

CONCLUSIONS

Users must push harder when on a cross slope. This increased loading is borne by the users' arms, which are at risk for overuse injuries. Exposure to biomechanic loading can be reduced by avoiding cross slopes when possible.

Clinical forensic evidence in burns: rescuer burns

In the literature no systematic study is available on rescuer burn for victims of burn injury. This is a retrospective study of nine patients (five admitted and four outpatients) were treated in this hospital as rescuer burns in 3.5 years. All nine patients were males. Average age of the patient treated on outpatient basis was 47 years (ranging between 44 and 52) and total burn area ranged for 1-4%. Average age of the five patients treated on inpatient basis was 32.6 years (ranging between 30 and 34). The total burn area ranged from 14.5 to 38%. During the period of study, in addition to nine rescuer burns, one patient sustained burn before the rescue attempt due to the victim hugging the rescuer. Based on the study of patterns of burn, these patients were found to have three grades of burn injury: Grade 1--upper extremity involvement only. (A) only one upper extremity involvement, (B) both upper extremities involvement, Grade 2--upper extremity/extremities and face involvement, Grade 3--upper extremity/extremities, face-neck, adjacent chest and lower extremity involvement.

Differences in the risk associated with head injury for pediatric ice skaters, roller skaters, and in-line skaters

OBJECTIVE

The goals were to describe the epidemiologic features of pediatric skating-related injuries sustained from 1993 to 2003 and to compare ice skating-related injuries with roller skating--and in-line skating-related injuries.

METHODS

An analysis of pediatric skating-related injury data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission was performed.

RESULTS

An estimated 1 235 467 pediatric skating participants presented to hospital emergency departments with injuries between 1993 and 2003. These children had a mean age of 10.9 years (SD: 3.2 years; range: 1-18 years), and 50.0% were male. The most common mechanism of injury was a fall (83.1%). Ice skaters sustained a greater proportion of head injuries (13.3%), compared with roller skaters (4.4%) and in-line skaters (5.0%). Ice skaters also experienced a greater proportion of concussions (4.3%), compared with roller skaters (0.6%) and in-line skaters (0.8%). The proportion of facial injuries among ice skaters was greater than the proportions among roller skaters and in-line skaters. The majority of roller skating-and in-line skating-related injuries were upper-extremity fractures (53.9% and 59.7%, respectively). Children < or = 6 years of age experienced a greater proportion of head and facial injuries than did older children in each skating activity.

CONCLUSIONS

The epidemiologic features of pediatric ice skating-related injuries differ from those of roller skating--and in-line skating-related injuries. Children should wear helmets during all recreational skating activities, especially ice skating, because of the risk of serious head injuries. Wrist guards should be worn to protect against the common upper-extremity fractures sustained during skating.

Golf injuries: a review of the literature

Golf is one of a few activities that people of all ages and skill level can play. Injury as with all sports can occur. The low back is the most common injury sustained whilst playing golf, and the dynamic action of the golf swing is a major contributing factor to injury. The golf swing is a complex movement that utilises the whole body in a coordinated fashion and when repeated frequently can result in injury. Injury can be overuse or traumatic in nature. Overuse injuries predominate in the professional golfer, and amateur golfer injury tends to occur secondary to an incorrect golf swing. Upper limb injuries are also common due to their role in linking the fast moving golf club with the power-generating torso. Fortunately, injury from a club or ball strike is rare. More common are the overuse injuries associated with the back, neck and shoulder. Most golf injury data have been collected retrospectively and further epidemiological study of a prospective nature is required to determine injury incidence and factor relating to the onset of injury.

Prospective research on musculoskeletal disorders in office workers (PROMO): study protocol

Background

This article describes the background and study design of the PROMO study (Prospective Research on Musculoskeletal disorders in Office workers). Few longitudinal studies have been performed to investigate the risk factors responsible for the incidence of hand, arm, shoulder and neck symptoms among office workers, given the observation that a large group of office workers might be at risk worldwide. Therefore, the PROMO study was designed. The main aim is to quantify the contribution of exposure to occupational computer use to the incidence of hand, arm, shoulder and neck symptoms. The results of this study might lead to more effective and/or cost-efficient preventive interventions among office workers.

Methods/Design

A prospective cohort study is conducted, with a follow-up of 24 months. In total, 1821 participants filled out the first questionnaire (response rate of 74%). Data on exposure and outcome is collected using web-based self-reports. Outcome assessment takes place every three months during the follow-up period. Data on computer use are collected at baseline and continuously during follow-up using a software program.

Discussion

The advantages of the PROMO study include the long follow-up period, the repeated measurement of both exposure and outcome, and the objective measurement of the duration of computer use. In the PROMO study, hypotheses stemming from lab-based and field-based research will be investigated.