Median nerve trauma in a rat model of work-related musculoskeletal disorder

Increase in inflammatory cytokines in median nerves in a rat model of repetitive motion injury

We examined cytokines in rat median nerves following performance of a high repetition reaching and grasping task at a rate of 8 reaches/min for up to 8 weeks. IL-1alpha, IL-1beta, TNF-alpha, IL-6 and IL-10 were analyzed by immunohistochemistry. Double-labeling immunohistochemistry for ED1, a marker of phagocytic macrophages, was also performed. We found increased immunoexpression of IL-6 by week 3, increases in all 5 cytokines by week 5. This response was transient as all cytokines returned to control levels by 8 weeks of performance of a high repetition negligible force task. Cytokine sources included Schwann cells, fibroblasts and phagocytic macrophages (ED1-immunopositive). These findings suggest that cytokines are involved in the pathophysiology of repetitive motion injuries in peripheral nerves.

Pathomechanics of peripheral nerve loading. Evidence in carpal tunnel syndrome

Peripheral nerve injury is a common occurrence, with carpal tunnel syndrome (CTS) receiving the most attention. Nerve dysfunction associated with compression syndromes results from an interruption or localized interference of microvascular function due to structural changes in the nerves or surrounding tissues. This article reviews the physiologic, pathophysiologic, and histologic effects of compressing peripheral nerves in animal models, and then examines the evidence for similar processes in humans using CTS as a model.

Work-related musculoskeletal disorders of the hand and wrist: epidemiology, pathophysiology, and sensorimotor changes

The purpose of this commentary is to present recent epidemiological findings regarding work-related musculoskeletal disorders (WMSDs) of the hand and wrist, and to summarize experimental evidence of underlying tissue pathophysiology and sensorimotor changes in WMSDs. Sixty-five percent of the 333 800 newly reported cases of occupational illness in 2001 were attributed to repeated trauma. WMSDs of the hand and wrist are associated with the longest absences from work and are, therefore, associated with greater lost productivity and wages than those of other anatomical regions. Selected epidemiological studies of hand/wrist WMSDs published since 1998 are reviewed and summarized. Results from selected animal studies concerning underlying tissue pathophysiology in response to repetitive movement or tissue loading are reviewed and summarized. To the extent possible, corroborating evidence in human studies for various tissue pathomechanisms suggested in animal models is presented. Repetitive, hand-intensive movements, alone or in combination with other physical, nonphysical, and nonoccupational risk factors, contribute to the development of hand/wrist WMSDs. Possible pathophysiological mechanisms of tissue injury include inflammation followed by repair and/or fibrotic scarring, peripheral nerve injury, and central nervous system reorganization. Clinicians should consider all of these pathomechanisms when examining and treating patients with hand/wrist WMSDs.

Performance of a high-repetition, high-force task induces carpal tunnel syndrome in rats

STUDY DESIGN

A randomized controlled prospective experimental study with some repeated measures.

OBJECTIVES

To characterize behavioral, sensory, motor, and nerve conduction decrements, and histological changes in the median nerve in rats trained to perform a high-force repetitive task.

BACKGROUND

Understanding of work-related carpal tunnel syndrome is hampered by the lack of experimental studies of the causes and mechanisms of nerve compression induced by repetitive motion. Most animal models of nerve compression have not employed voluntary repetitive motion as the stimulus for pathophysiological changes.

METHODS AND MEASURES

Thirty Sprague-Dawley rats served as controls for 1 or more studies. Ten rats were trained to pull on a bar with 60% maximum force 4 times per minute, 2 h/d, 3 d/wk for 12 weeks. Motor behavior and limb withdrawal threshold force were characterized weekly. Grip strength and median nerve conduction velocity were measured after 12 weeks. Median nerves were examined immunohistochemically for ED1-positive macrophages, collagen, and connective tissue growth factor.

RESULTS

Reach rate and duration of task performance declined over 12 weeks. Grip strength and nerve conduction velocity were significantly lower after 12 weeks than in controls. Limb withdrawal threshold increased between weeks 6 and 12. Median nerves at the level of the wrist showed increases in macrophages, collagen, and connective-tissue growth-factor-positive cells. These effects were seen in both the reach and nonreach limbs.

CONCLUSIONS

This animal model exhibits all the features of human carpal tunnel syndrome, including impaired sensation, motor weakness, and decreased median nerve conduction velocity. It establishes a causal relationship between performance of a repetitive task and development of carpal tunnel syndrome.

Inflammation reduces physiological tissue tolerance in the development of work-related musculoskeletal disorders

Work-related musculoskeletal disorders (MSDs) cause substantial worker discomfort, disability and loss of productivity. Due to the difficulty in analyzing the tissues of patients in the early stages of work-related MSD, there is controversy concerning the pathomechanisms of the development of these disorders. The pathophysiology of work-related MSD can be studied more easily in animal models. The purpose of this review is to relate theories of the development of tissue injury due to repeated motion to findings of recent investigations in animals that address the role of the inflammatory response in propagating tissue injury and contributing to chronic or recurring tissue injury. These tissue effects are related to behavioral indicators of discomfort and movement dysfunction with the aim of clarifying key time points for specific intervention approaches. The results from animal models of MSD are discussed in the light of findings in patients, whose tissues are examined at a much later phase of MSD development. Finally, a conceptual model of the potentially negative impact of inflammation on tissue tolerance is proposed along with suggestions for future research directions.