Epidemiologic surveillance of upper-extremity musculoskeletal disorders in the working population

Efficacy of Ultrasound-Guided Hydrodissection for Treating De Quervain's Tenosynovitis

Objective

This study evaluated the effectiveness of ultrasound-guided hydrodissection treatment for De Quervain's stenosing tenosynovitis, characterized by the narrowing of the first extensor compartment of the wrist. Notably, approximately 2% of cases involve a fibrous septum that divides the compartment.

Subjects and Methods

Ninety-five patients diagnosed with De Quervain's disease using ultrasound underwent hydrodissection treatment. When a septum was present, the needle was redirected into each sub-compartment to distribute the therapeutic solution evenly and facilitate the breaking of the septum.

Results

Ninety patients reported significant improvements in pain and functionality within 2 months of the initial treatment, with a marked decrease in the mean visual analog scale score from 7.65 ± 1.31 to 1.65 ± 2.32. A second infiltration, administered 2 months later, further alleviated pain and enhanced hand functionality. However, 5 patients with septum required surgical intervention after nonconclusive results from the infiltrative treatment.

Conclusions

This study confirms that ultrasound-guided hydrodissection is an effective treatment for approximately 95% of patients with De Quervain's disease, achieving substantial pain relief and improved joint mobility after the first treatment. These findings support the continued use of ultrasound guidance to enhance the precision and efficacy of treatment in complex cases.

Registry cost description of carpal tunnel release in Finland in 2011-2015

OBJECTIVES

In this study, we evaluated the amount of public funds spent on the operative treatment of carpal tunnel syndrome (CTS) in Finland in 2011-2015.

DESIGN

A registry-based cost burden study.

SETTING

The data were collected in primary and secondary care in both private and public hospitals, covering the whole population of Finland.

PARTICIPANTS

We collected the total number of patients with new CTS diagnoses and the total number of patients undergoing surgery from the Care Register for Health Care, Finland's national register.

INTERVENTIONS

Open carpal tunnel release (OCTR).

OUTCOME MEASURES

We collected the costs of the OCTR procedure from diagnosis-related group prices. The Social Insurance Institution of Finland provided the total amount of euros reimbursed for sick leaves. We then combined the average amount of reimbursed sick leave with our estimated cost of the treatment chain to approximate the average cost per patient.

RESULTS

The average amount of public funds used for diagnosing and surgically treating new CTS in 2011-2015 in Finland, including reimbursements for sick leaves, was €2759 per patient in 2015 currency. The average direct procedure cost was €1020. We found no clear trend in total cost per patient, but the proportion of surgically treated patients rose from 63.14% to 73.09%. The total annual cost of these treatments was between €18 128 420 and €22 569 973.

CONCLUSIONS

The average amount of public funds used to surgically treat one patient with new CTS in 2011-2015 in Finland was €2759, making the total annual burden €20.7 million.

States of contra-lateral rotator cuff - Based on bilateral shoulder ultrasound results of 401 patients

BACKGROUND

For patients with rotator cuff tear (RCT), the contra-lateral shoulders have higher risk of RCT than general population. It has been proved by several previous studies. The focus of this study is to obtain the data of contra-lateral rotator cuff tear in Chinese population, and to find the rules of contra-lateral rotator cuff tear through statistical analysis.

METHODS

From March 2016 to January 2020, patients who underwent shoulder arthroscopic surgery were included in the study, we conduct bilateral shoulder ultrasound before surgery, patients information collection include gender, age, occupation and whether received contra-lateral rotator cuff surgery within 1-3 years. The above information was statistically analyzed.

RESULTS

According to the inclusion and exclusion criteria, 401 patients were included. The incidence of contra-lateral rotator cuff tear was 24.3%, 5.58% of them underwent contra-lateral rotator cuff repair surgery within 3 years. The degree of contra-lateral rotator cuff tear was positively correlated with the degree of the primary side; Patients with full-thickness rotator cuff tear were more likely to have contra-lateral rotator cuff tear than patients with partial rotator cuff tear. For patients with supraspinatus tendon tear, the contra-lateral rotator cuff tear risk increases, For patients with subscapularis muscle tear, the contra-lateral rotator cuff tear risk doesn't increases. Contra-lateral rotator cuff tear is related to age, the risk of contra-lateral rotator cuff tear is higher in elderly patients.

CONCLUSIONS

The contra-lateral RCT data obtained in our study was 24.3%, significantly lower than that of previous studies. The reasons may include ethnic variation, lifestyle, and proportion of heavy physical labor. The condition of contra-lateral rotator cuff is closely related to affected side rotator cuff tear.

Symptoms and Risk Factors of Carpal Tunnel Syndrome among Schoolteachers in Al-Ahsa, Saudi Arabia: A Cross-sectional Study

CONTEXT

Carpal tunnel syndrome (CTS) is caused by compression of the median nerve as it travels through the carpal tunnel into the wrist. It is the most common peripheral mononeuropathy and accounts for a large proportion of occupational upper extremity disorders. Teaching is an occupation associated with musculoskeletal disorders.

AIMS

This study aimed to investigate the prevalence of CTS symptoms and related risk factors among schoolteachers in Al-Ahsa.

SETTINGS AND DESIGN

A cross-sectional study was conducted on schoolteachers in Al-Ahsa, Saudi Arabia, during 2023.

SUBJECTS AND METHODS

We distributed the Boston Carpal Tunnel Questionnaire to the teachers' groups through social media in the form of an online questionnaire, and we visited schools to encourage participation.

STATISTICAL ANALYSIS USED

Data were analyzed using the Statistical Package for the Social Sciences. P < 0.05 was considered statistically significant.

RESULTS

Our study included 619 schoolteachers. The syndrome symptoms were present in 71.1% of individuals, and functional disruption was present in 52.7%. The likelihood of exhibiting the symptoms is increased by being female, not participating in sports, having a chronic illness, writing for more than 4 h, and having symptoms in both hands.

CONCLUSIONS

We found a comparatively high percentage (71.1%) of the syndrome symptoms among schoolteachers working in Al-Ahsa, Saudi Arabia, which suggests that any signs of CTS in schoolteachers should be evaluated to ensure proper diagnosis and treatment.

A systematic review and meta-analysis of acupuncture for De Quervain's tenosynovitis treatment

BACKGROUND

De Quervain's tenosynovitis (DQt) is a prevalent chronic inflammatory musculoskeletal disorder predominantly affecting the radial aspect of the wrist. This study conducted a comprehensive review of the efficacy of acupuncture in treating De Quervain's tenosynovitis (DQt). Although there is evidence suggesting that acupuncture can alleviate symptoms of DQt-characterized by pain, swelling, and functional impairment-higher-level evidence is still required to further substantiate its efficacy and safety. This study conducted a comprehensive review of the efficacy of acupuncture in treating De Quervain's tenosynovitis (DQt).

METHODS

By systematically searching databases such as PubMed, Science Direct, Web of Science, Google Scholar, EMbase, PEDro, China National Knowledge Infrastructure Database (CNKI), Wanfang Database, and Chongqing VIP China Science, Technology Journal Database (VIP), we retrieved randomized controlled trial (RCT) literature on acupuncture for DQt, with the search period extending to November 1, 2023. After extracting and assessing data from the included literature, we performed Meta-analysis using RevMan 5.4.1 software.

RESULTS

The results encompassed 14 RCT papers, involving 851 patients. The Meta-analysis findings indicated that, when compared to topical analgesics, acupuncture demonstrated a significant increase in treatment effectiveness (RR = 1.24; 95% CI = 1.11, 1.39, P = 0.0002) and a notable reduction in VAS pain scores (MD = -1.06; 95% CI = -1.51, -0.61, P < 0.00001). However, no statistically significant difference was observed in conney wrist joint scores. Furthermore, acupuncture was found to reduce VAS pain scores compared to the waiting list group. In comparison to corticosteroid injections (CSI), acupuncture did not show statistical significance in VAS, effectiveness rate, and conney wrist scores.

CONCLUSION

Acupuncture exhibited a promising trend in alleviating pain associated with DQt and enhancing treatment effectiveness. Nonetheless, due to limitations in the quantity and quality of the included studies, these findings warrant further validation through additional research.

De Quervain's tenosynovitis as an occupational disease in agricultural worker: A case report

BACKGROUND

De Quervain's tenosynovitis is upper-limb disorder, more frequent in women. It is rarely recognized as an occupational disease.

OBJECTIVE

In this paper we reported work related de Quervain's tenosynovitis in cow milker.

METHODS

Ergonomic risk factors were assessed by utilizing assessment of repetitive tasks (ART) of the upper limbs method. Physical examination and imaging exams were used.

RESULTS

We presented a 36-year-old female agricultural worker (workplace cow milker) exposed to work factors (forceful hand/wrist exertions, repetition, extreme postures) for 14 years. She was suffering the pain in the right hand, mainly near the thumb for few years. She was treated conservatively and surgically, however disability was permanent. Clinical examination showed slight edema of the right hand, increased palm's sweating. Patient had reduced range of movements and grip strength.

CONCLUSIONS

Report shows that work-related factors were strongly associated with diagnosed de Quervain's tenosynovitis. Hand function plays an essential role in carrying out activities of daily living and this disorder pose a relevant burden of disease. Exposure to biomechanical factors should be an important initial target for the prevention of De Quervain's tenosynovitis in the working population.

Comparison of self-management and spa therapy for upper-extremity musculoskeletal disorders: A randomized controlled trial

BACKGROUND

Musculoskeletal disorders (MSDs) are common in the workplace and are a public health issue. Persistent pain despite conservative treatment or surgery may lead to poor long-term outcomes.

OBJECTIVE

To compare the effect of a combined 6-day program of exercise, self-management workshops and spa therapy with self-management on functional capacity in personal and professional daily life at 3 months in people with musculoskeletal disorders.

METHODS

We conducted a prospective, randomized controlled trial. Participants were employed (any type of work) and aged between 18 and 65 years, with latent or symptomatic upper extremity MSDs, with or without a history of sick leave. They were randomized to participate in 6 days (2 h per day) of spa therapy, exercise, and self-management workshops immediately (intervention) or at 3 months (control). The control group performed self-management until 3 months. The primary outcome was the score on the self-reported Quick Disability of Arm-Shoulder-Hand (QuickDASH) at 3 months. The primary analysis was conducted using analysis of covariance with baseline QuickDASH score as the covariate.

RESULTS

In total, 150 participants were randomized (85 % women): 78 to the control group and 72 to the intervention group. At 3 months, the QuickDASH total and work scores did not differ between groups (effect-size [ES] = -0.15, 95 %CI, -0.38 to 0.09, p = 0.215, and ES = -0.11, 95 % CI, -0.35 to 0.12, p = 0.343). However, QuickDASH sport/performing arts score was significantly different between randomization groups at 3 months (ES =-0.25, 95 % CI, -0.48 to -0.02, p = 0.035).

CONCLUSIONS

This study provided no evidence in favor of a short-course, personalized self-management, intensive spa therapy intervention over self-management alone for the management of upper-extremity MSDs.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT02702466) retrospectively registered.

Muscle Activations of the Upper Extremity and Core during Elevation and Rotational Movements in Overhead Throwing Athletes

Background

A strong body of literature has been published outlining muscle activity differences during sports performance in groups of overhead athletes. However, there are limited studies that have directly compared the muscle activity in overhead athletes with and without history of shoulder injury during functional everyday tasks.

Purpose

This study aimed to identify muscle activities across fourteen upper extremity and core muscles during three functional everyday movements in athletes with and without history of shoulder injury.

Study Design

Cross-Sectional Study.

Methods

Thirty-two male overhead throwing athletes (fifteen healthy and seventeen injured) were recruited and completed three everyday functional movements of high elevation, low elevation, and rotation, using their dominant arm to move an object between two fixed positions. Electromyography (EMG) was recorded for fourteen muscles including: biceps brachii, deltoids (anterior, medial, and posterior), trapezius (upper and lower), pectoralis major, latissimus dorsi, serratus anterior, infraspinatus, external obliques, and gluteus maximus (all surface electrodes) and supraspinatus (fine wire electrode). Mixed model repeated measures ANOVA and post-hoc analysis assessed mean muscle activity (%MVC) between groups and each movement phase.

Results

Upper trapezius elicited higher mean activity in healthy athletes during both phases of the arm rotation task (p \< 0.05). No differences between groups were evident for arm elevation tasks. Qualitative analysis of muscle patterns during functional tasks reflected a temporal shift in muscle activation timings and magnitudes between athlete groups, suggesting potential compensatory mechanisms in injured athletes.

Conclusion

Injured overhead athletes appear to utilize other upper limb and shoulder girdle muscles to compensate for lower upper trapezius activity during functional everyday tasks.

Level of Evidence

3.

Role of Lifestyle in Thoracic Outlet Syndrome: A Narrative Review

INTRODUCTION

The presence of a positional compression of the neurovascular bundle in the outlet between the thorax and the upper limb during arm movements (mainly abduction) is common but remains asymptomatic in most adults. Nevertheless, a certain number of subjects with thoracic outlet positional compression will develop incapacitating symptoms or clinical complications as a result of this condition. Symptomatic forms of positional neurovascular bundle compression are referred to as "thoracic outlet syndrome" (TOS).

MATERIALS AND METHODS

This paper aims to review the literature and discuss the interactions between aspects of patients' lifestyles in TOS. The manuscript will be organized to report (1) the historical importance of lifestyle evolution on TOS; (2) the evaluation of lifestyle in the clinical routine of TOS-suspected patients, with a description of both the methods for lifestyle evaluation in the clinical routine and the role of lifestyle in the occurrence and characteristics of TOS; and (3) the influence of lifestyle on the treatment options of TOS, with a description of both the treatment of TOS through lifestyle changes and the influence of lifestyle on the invasive treatment options of TOS.

RESULTS

We report that in patients with TOS, lifestyle (1) is closely related to anatomical changes with human evolution; (2) is poorly evaluated by questionnaires and is one of the factors that may induce symptoms; (3) influences the sex ratio in symptomatic athletes and likely explains why so many people with positional compression remain asymptomatic; and (4) can sometimes be modified to improve symptoms and potentially alter the range of interventional treatment options available.

CONCLUSIONS

Detailed descriptions of the lifestyles of patients with suspected TOS should be carefully analysed and reported.

Effects of a passive shoulder exoskeleton on muscle activity among Danish slaughterhouse workers

AIM

To evaluate the effect of a shoulder exoskeleton on muscle activity and to compare the effect with a lifting glove among slaughterhouse workers in occupational settings.

MATERIALS AND METHODS

We conducted a crossover study of 26 workers measured during two work days with and without the use of a passive shoulder exoskeleton and a lifting glove at a Danish slaughterhouse. Electromyography sensors were placed bilateral on 5 shoulder muscles. The 10th, 50th, and 90th percentiles of muscle activity normalized by maximal voluntary contractions were measured and analyzed using mixed effect models.

RESULTS

For the 50th percentiles of the agonist muscles, the exoskeleton reduced muscle activity bilaterally for deltoid anterior with up to 29.47%, deltoid middle with 10.22%, and upper trapezius with 22.21%. The lifting glove only reduced muscle activity for right deltoid anterior (36.59%) and upper trapezius (7.11%), but generally increased left muscle activity with up to 15.58%.

DISCUSSION

The exoskeleton showed larger reductions in muscle activity compared to the lifting glove.

A meta-analysis of the risk factors for lateral epicondylitis

BACKGROUND

Very few meta-analyses discussed risk factors for lateral epicondylitis (LE), and previous meta-analyses reached conflicting conclusions with each other on some specific risk factors.

PURPOSE

To investigate the risk factors for LE through meta-analysis.

STUDY DESIGN

Meta-analysis.

METHODS

PubMed, Embase, and Web of Science databases were searched for relevant studies in January 2022. Raw data were extracted into a predefined worksheet, and quality analysis was conducted by the Quality in Prognosis Studies (QUIPS) tool. Pooled effect sizes and 95% confidence intervals were calculated. R package "meta" was used for statistical analysis.

RESULTS

22 studies were included in the meta-analysis. Female sex (odds ratio [OR]=1.33 and p-value<0.05), smoking history (OR=1.46 and p-value<0.001), manual labor (OR=2.39 and p-value<0.001), and hypercholesterolemia (OR=1.67 and p-value<0.05) were significant risk factors for LE.

CONCLUSIONS

Female gender, smoking history, manual labor, and hypercholesterolemia could increase the risk of LE. According to an additional literature review, statin treatment for hypercholesterolemia is described as potentially related to the development of LE.

Sensitization-associated and neuropathic-associated symptoms in patients with unilateral lateral elbow tendinopathy: an exploratory study

OBJECTIVES

We evaluate the presence of sensitization-associated symptoms and neuropathic pain features and identify if there is an association between these symptoms and pressure pain sensitivity, pain, and related-disability in lateral elbow tendinopathy.

METHODS

Thirty-seven (43% women, age: 45.5 ± 9.5 years) patients with lateral elbow tendinopathy completed: demographic (i.e. age, height, and weight); clinical (i.e. pain history, pain intensity, and Disabilities of the Arm, Shoulder and Hand); and psychophysical (i.e. pressure pain thresholds at the elbow, cervical spine, hand, and leg) outcomes, and the Central Sensitization Inventory and Self-administered Leeds Assessment of Neuropathic Symptoms and Signs questionnaires. Step-wise multiple linear regression models were performed to identify predictors of sensitization- or neuropathic-associated symptoms.

RESULTS

Six (16%) patients exhibited sensitization-associated symptoms (mean: 46.5, SD: 6.1), whereas 13 (35%) patients showed neuropathic-associated symptoms (mean: 13.5; SD: 1.4). Sensitization-associated symptoms were positively associated with neuropathic-associated symptoms (r = 0.538, P = .001) and negatively associated with pressure pain thresholds at the leg (r = -0.378, P = .021). Neuropathic-associated symptoms were positively associated with related-disability (r = 0.479, P = .003) and negatively associated with pressure pain threshold at the elbow (r = -0.394, P = .017). Stepwise regression analyses revealed that neuropathic-like symptoms explained 26.8% of the variance of sensitization symptoms (r2: 0.268), whereas pressure pain threshold at the elbow explained an additional 6.6% to neuropathic-like symptoms (r2: 0.334).

CONCLUSION

This explorative study identified sensitization- and neuropathic-associated symptoms in 16% and 35% of the people with lateral elbow tendinopathy. Sensitization- and neuropathic-associated symptoms were associated. Pressure pain sensitivity at the elbow (peripheral sensitization) was associated with neuropathic -associated symptoms.

"I wanted to know what was hurting so much": a qualitative study exploring patients' expectations and experiences with primary care management

BACKGROUND

The management of shoulder pain is challenging for primary care clinicians considering that 40% of affected individuals remain symptomatic one year after initial consultation. Developing tailored knowledge mobilization interventions founded on evidence-based recommendations while also considering patients' expectations could improve primary care for shoulder pain. The aim of this qualitative study is to explore patients' expectations and experiences of their primary care consultation for shoulder pain.

METHODS

In this qualitative study, participants with shoulder pain and having consulted a primary care clinician in the past year were interviewed. All the semi-structured interviews were transcribed verbatim, and inductive thematic analysis was performed to identify themes related to the participants' expectations and experiences of primary care consultations for shoulder pain.

RESULTS

Thirteen participants with shoulder pain were interviewed (8 women, 5 men; mean age 50 ± 12 years). Eleven of them initially consulted a family physician or an emergency physician, and two participants initially consulted a physiotherapist. Four overarching themes related to patients' expectations and experiences were identified from our thematic analysis: 1) I can't sleep because of my shoulder; 2) I need to know what is happening with my shoulder; 3) But… we need to really see what is going on to help me!; and 4) Please take some time with me so I can understand what to do!. Several participants waited until they experienced a high level of shoulder pain before making an appointment since they were not confident about what their family physician could do to manage their condition. Although some participants felt that their physician took the time to listen to their concerns, many were dissatisfied with the limited assessment and education provided by the clinician.

CONCLUSIONS

Implementing evidence-based recommendations while considering patients' expectations is important as it may improve patients' satisfaction with healthcare. Several participants reported that their expectations were not met, especially when it came to the explanations provided. One unexpected finding that emerged from this study was the waiting period between the onset of shoulder pain and when patients decided to consult their primary care clinician.

Longitudinal Analysis of the ASES and Constant-Murley Scores, and the Internal Rotation/Shift and Jobe Tests Following Arthroscopic Repair of Supraspinatus Lesions

It is essential to investigate patients post-surgery using functional surveys like the American Shoulder and Elbow Surgeons Shoulder (ASES) and the Constant-Murley shoulder (CMS) scores, as well as clinical tests, such as the Internal Rotation and Shift (IRO/Shift) and Jobe tests. In this study, 51 out of an initial 87 patients underwent an arthroscopic supraspinatus repair (22 single-row, 16 double-row, 13 debridement). Testing occurred pre-surgery, and 3 and 6 months post-surgery. Both surveys showed significant improvements over time among all 87 patients, but there were no differences between groups (lesion/no lesion) (p > 0.815) or time × group (p > 0.895). The IRO/Shift test showed a stronger ability to distinguish between both groups (positive vs. negative) with respect to the ASES and CMS scores over time, but the Jobe test did not (p > 0.100). Improvements in the CMS scores and the Jobe test were lower following repair compared to the ASES and IRO/Shift test. Most patients returned to adequate levels of functional abilities at 6 months post-surgery. The time required to return to activities of daily living and negative clinical tests was longer for the double-row repair patients compared to the single-row and debridement groups. In conclusion, both the functional surveys and the clinical tests demonstrated improvements following surgery.

Identifying physical and psychological risk factors for musculoskeletal pain in student musicians to tailor the curriculum: a cross-sectional study protocol

INTRODUCTION

Insufficient identification and understanding of risk factors make musicians engaging in professional practice particularly vulnerable to musculoskeletal pain. To support positive music learning and good mental, physical, and social health, student musicians need health support tailored to their needs and their instrumental practice. However, these preventive actions must be based on sound scientific approaches that reliably identify the most relevant risk factors. MuSa is a cross-sectional study examining contextual and internal risk variables associated with playing-related musculoskeletal disorders in student musicians.

METHOD AND ANALYSIS

The design is a monocentric cross-sectional study involving student musicians in Bachelor's 1, 2, 3 and Master's 1, 2. Free-form questions will identify students' lifestyle characteristics and work habits, and validated questionnaires will evaluate the interaction between pain due to music practice and psychological and physical risk factors. All data will first be analysed descriptively. Psychological network analysis will be used to explore the overall correlational structure of the dataset. A subgroup comparative analysis will be then applied according to the instrumental subcategories and work postures, including singers.

ETHICS AND DISSEMINATION

The full protocol was approved by the Swiss Ethics Committee 'Commission Cantonale d'Ethique de la Recherche sur l'être humain de Genève' (CCER, no. 2022-02206) on 13 February 2023. Outcomes will be disseminated through publication in peer-reviewed journals and presentations at conferences.

Effect of Insurance Reimbursement Status on Pre- and Postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) Scores After Arthroscopic Rotator Cuff Repair

BACKGROUND

Previous studies reported inferior patient-reported outcomes (PROs) after arthroscopic rotator cuff repair for patients receiving workers' compensation (WC) relative to patients with commercial insurance. The extent to which alternative insurance reimbursement, including Medicaid and Medicare, influences outcomes after arthroscopic rotator cuff repair remains understudied.

HYPOTHESIS

Compared with patients with commercial insurance reimbursement, patients with WC or government-issued reimbursement would report lower pre- and postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) scores, report higher pre- and postoperative PROMIS Depression (D) and Pain Interference (PI) scores, and experience smaller levels of improvement in all PROMIS domains with surgical intervention.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Demographic and surgical data were extracted from the medical record, and PROMIS domains were prospectively collected. Patients were divided into cohorts based on insurance reimbursement status. Differences between insurance-based cohorts for baseline variables, pre- and postoperative PROMIS scores, and change from baseline to final follow-up (delta) for PROMIS scores were evaluated using Kruskal-Wallis or chi-square tests. Mixed-effects linear regression models were performed to assess the influence of insurance while controlling for other variables. Survival analysis was performed to determine time to achieve minimal clinically important difference (MCID) for each PROMIS domain per cohort.

RESULTS

1252 patients underwent arthroscopic rotator cuff repair, met inclusion criteria, and completed PROMIS questionnaires. Statistically significant differences were noted in demographic variables including age (P < .001), sex (P < .001), ethnicity (P < .001), and body mass index (P < .001) between insurance-based cohorts. Unadjusted analysis revealed significantly higher PF scores and lower PI and D scores for the group with commercial insurance relative to those with Medicare, Medicaid, and WC at 6- and 12-month follow-up (P < .01 all comparisons), except for the Medicare versus commercial subcohort analysis for PI at 6 months (P = .28). These differences persisted for the Medicare, Medicaid, and WC groups (P < .03 all comparisons) after adjustment for confounding variables in linear regression.

CONCLUSIONS

The baseline characteristics of patients undergoing arthroscopic rotator cuff repair differed based on insurance reimbursement. Patients with commercial insurance reported improved physical function, decreased pain interference, and improved mood (less depression) relative to patients with government-issued and WC insurance, with maximum improvement 6 to 12 months postoperatively. There were few significant differences between insurance groups in change of PROMIS scores from preoperative to postoperative intervals, indicating that differences in the baseline demographic and surgical characteristics of these groups accounted for differences in response to surgery.

Cardiovascular Disease Risk Factors Predict the Development and Numbers of Common Musculoskeletal Disorders in a Prospective Cohort

OBJECTIVE

The aim of the study is to assess risk of common musculoskeletal disorders (MSDs) based on cardiovascular disease (CVD) risk scores.

METHODS

Data from a 9-year prospective cohort of 1224 workers in three states were analyzed. Baseline data included questionnaires, structured interviews, physical examinations, anthropometric measurements, nerve conduction studies, and individualized measurement of job physical factors. Monthly follow-ups were conducted. Framingham risk scores were calculated. A priori case definitions were constructed for carpal tunnel syndrome, lateral epicondylopathy, medial epicondylopathy, and rotator cuff tendinopathy.

RESULTS

Adjusted RRs for one or more MSDs increased to 3.90 (95% confidence interval, 2.20-6.90) among those with 10-year cardiovascular disease risk scores greater than 15% and 17.4 (95% confidence interval, 3.85-78.62) among those with more than 4 disorders.

CONCLUSIONS

Cardiovascular disease factors are strongly associated with the subsequent development of common MSDs. Risks among those with multiple MSDs are considerably stronger.

Improved suture pullout through genipin-coated sutures in human biceps tendons with spatially confined changes in cell viability

BACKGROUND

The suture-tendon interface often constitutes the point of failure in tendon suture repair. In the present study, we investigated the mechanical benefit of coating the suture with a cross-linking agent to strengthen the nearby tissue after suture placement in human tendons and we assessed the biological implications regarding tendon cell survival in-vitro.

METHODS

Freshly harvested human biceps long head tendons were randomly allocated to control (n = 17) or intervention (n = 19) group. According to the assigned group, either an untreated or a genipin-coated suture was inserted into the tendon. 24 h after suturing, mechanical testing composed of cyclic and ramp-to-failure loading was performed. Additionally, 11 freshly harvested tendons were used for short-term in vitro cell viability assessment in response to genipin-loaded suture placement. These specimens were analyzed in a paired-sample setting as stained histological sections using combined fluorescent/light microscopy.

FINDINGS

Tendons stitched with a genipin-coated suture sustained higher forces to failure. Cyclic and ultimate displacement of the tendon-suture construct remained unaltered by the local tissue crosslinking. Tissue crosslinking resulted in significant cytotoxicity in the direct vicinity of the suture (<3 mm). At larger distances from the suture, however, no difference in cell viability between the test and the control group was discernable.

INTERPRETATION

The repair strength of a tendon-suture construct can be augmented by loading the suture with genipin. At this mechanically relevant dosage, crosslinking-induced cell death is confined to a radius of <3 mm from the suture in the short-term in-vitro setting. These promising results warrant further examination in-vivo.

Low Back Pain and Upper-Extremity Musculoskeletal Disorders in French Postal Workers Driving Light-Duty Vehicles for Mail and Parcel Delivery

Occupational driving of light-duty vehicles (LDVs) became increasingly important in parcel delivery faced with the explosive growth of e-commerce. Since musculoskeletal disorders (MSDs) represent the most reported driving-related health problem, we aimed to analyze the risk of low back pain (LBP) and upper-extremity musculoskeletal disorders (UEMSDs) associated with driving LDVs for parcel delivery. In 306 postal workers exposed to driving and 100 unexposed workers, information on occupational driving, physical/psychosocial constraints, and work organization were collected via a questionnaire. MSDs were assessed using the Nordic Questionnaire, 14 additional questions regarding LBP, and a standardized clinical examination for UEMSDs. Statistical modeling consisted of multivariable logistic regression for UEMSDs and the item response theory approach for LBP. UEMSDs were associated with the distance of rural rounds and inversely associated with urban/mixed delivery rounds. Handling heavy loads was associated with LBP, and high physical demands during delivery rounds were related to MSDs. Karasek dimensions and mobbing actions were associated with MSDs. Work recognition, driving training, using an automatic gearbox, and the utilization of additional staff during peak periods were inversely associated with MSDs. Our results suggest that the distance driven in rural settings and high physical demands were associated with MSDs, while some organizational factors could protect from MSDs.

Work-Related De Quervain's Tensosynovitis (DQT): The Diagnosis Dilemma

A female presented with right wrist pain for nine months. The diagnosis was De Quervain's tenosynovitis; her condition was initially managed conservatively, but later she needed surgery due to the lack of improvement. No workplace intervention had been implemented because her hand surgeons did not consider her occupational exposures. It was later discovered that there was significant exposure to ergonomic hazards at her workplace. She received accommodations in her workplace that led to reduction of exposure to ergonomic hazards and the subsequent dramatic improvement in her condition. This case report indicates that some orthopedists do not appreciate the role of occupational exposure to ergonomic hazards in the pathogenesis of similar conditions. Occupational medicine specialists and orthopedists should, therefore, communicate with each other to reach a consensus regarding the association between occupational exposures to ergonomic hazards and work-related upper limb disorders (WRULDs).

Ethnicity, sex, and socioeconomic disparities in the treatment of traumatic rotator cuff injuries in Aotearoa/New Zealand

HYPOTHESIS AND BACKGROUND

Traumatic rotator cuff injuries can be a leading cause of prolonged shoulder pain and disability and contribute to significant morbidity and health care costs. Previous studies have shown evidence of sociodemographic disparities with these injuries. The purpose of this nationwide study was to better understand these disparities based on ethnicity, sex, and socioeconomic status, in order to inform future health care strategies.

METHODS

Accident Compensation Corporation (ACC) is a no-fault comprehensive compensation scheme encompassing all of Aotearoa/New Zealand (population in 2018, 4.7 million). Using the ACC database, traumatic rotator cuff injuries were identified between January 2010 and December 2018. Injuries were categorized by sex, ethnicity, age, and socioeconomic deprivation index of the claimant.

RESULTS

During the 9-year study period, there were 351,554 claims accepted for traumatic rotator cuff injury, which totaled more than NZ$960 million. The greatest proportion of costs was spent on vocational support (49.8%), then surgery (26.3%), rehabilitation (13.1%), radiology (8.1%), general practitioner (1.6%), and "Other" (1.1%). Asian, Māori (indigenous New Zealanders), and Pacific peoples were under-represented in the age-standardized proportion of total claims and had lower rates of surgery than Europeans. Māori had higher proportion of costs spent on vocational support and lower proportions spent on radiology, rehabilitation, and surgery than Europeans. Males had higher number and costs of claims and were more likely to have surgery than females. There were considerably fewer claims from areas of high socioeconomic deprivation.

DISCUSSION AND CONCLUSION

This large nationwide study demonstrates the important and growing economic burden of rotator cuff injuries. Indirect costs, such as vocational supports, are a major contributor to the cost, suggesting improving treatment and rehabilitation protocols would have the greatest economic impact. This study has also identified sociodemographic disparities that need to be addressed in order to achieve equity in health outcomes.

Neck and upper extremity musculoskeletal problems in cosmetologists caused by work-related ergonomic risk factors in Denizli, Turkey

BACKGROUND

Work-related musculoskeletal disorders (MSDs) of the neck and upper limbs are a common health problem among cosmetologists. Hairdressing requires bending, twisting, static postures, prolonged standing, repetitive motions, and vigorous movements of the hands and fingers. In order to determine the proper ergonomic measures, identifying the factors and hairdressing jobs that increase the risk of work-related neck and upper limb disorders is needed.

OBJECTIVE

The objective of this study was to determine the prevalence of MSDs in the neck and upper extremities of cosmetologists and to investigate the association with ergonomic risk factors and hairdressing work.

METHODS

The cross-sectional study was conducted on cosmetologists in Denizli, Turkey province (n = 504). Data collected through a survey included questions on sociodemographic characteristics, work organization, equipment, and hairdressing work, items on work posture, the Extended Nordic Musculoskeletal Questionnaire, and the Demand-Control-Support Questionnaire. Work posture in hairdressing was assessed using the Rapid Upper Limb Assessment (RULA).

RESULTS

The prevalence of MSDs of the neck and upper limbs in the previous twelve months ranged from 7.7-55.8%. There was high, or very high, risk in 56.1% of work postures, and the median RULA score was 5.0 (4.0-6.0). The significant predictors of pain were work experience, gender, marital status, risk perception, awkward posture, psychological demand, and hair coloring.

CONCLUSION

It is necessary to take control measures in hairdressing salons promptly to adopt more suitable working posture and to design workplaces ergonomically.

The role of progressive, therapeutic exercise in the management of upper limb tendinopathies: A systematic review and meta-analysis

BACKGROUND

Among upper limb tendinopathies, rotator cuff-related shoulder pain and lateral elbow tendinopathy are the most representative disorders. Therapeutic exercise arises as an effective approach, but there is no consensus about the optimal progression criteria.

OBJECTIVE

To compare progression criteria and effectiveness of isolated, progressive exercises in the management of upper limb tendinopathies. Additionally, to perform a meta-analysis of pain/function for the selected programs.

DESIGN

Systematic Review and Meta-Analysis.

METHOD

Database search of randomized-controlled-trials including progressive exercise was conducted in PubMed and Scopus until October 2020. Meta-analysis' inclusion criteria were: no data duplicity; 3-months follow-up; comparison between any type of progressive exercise program. Risk of bias was assessed with PEDro score, and level of evidence followed GRADE guidelines. Effect size was calculated with Cohen's d.

RESULTS

Eleven studies were included. GRADE revealed low-quality evidence for meta-analysis of pain during activity (d = 0.29) and function (d = 0.33) at 3 months. Progression criteria were categorised into two divisions, being pain the central concept. Pain (rest/activity/night) and function improved significantly within-group, but between-group changes were heterogeneous. Meta-analysis regarding pain showed good homogeneity with significant, moderate effects (I² = 20%; p = 0.005; mean d = 0.29); function yielded important heterogeneity with non-significant, moderate effects (I² = 81%; p = 0.17; mean d = 0.33).

CONCLUSIONS

Pain was the most frequent benchmark when modulating and progressing the exercises, although other criteria were found such as fatigue or self-perceived ability. Progressive exercise seems effective to manage upper limb tendinopathies, but the superiority of a progression criterion against others remains unclear. Low-quality evidence supported progressive exercise with eccentric components in adding a significant and moderate effect on pain/function at short-term.

Lateral elbow tendinopathy and artificial intelligence: Binary and multilabel findings detection using machine learning algorithms

Background

Ultrasound (US) is a valuable technique to detect degenerative findings and intrasubstance tears in lateral elbow tendinopathy (LET). Machine learning methods allow supporting this radiological diagnosis.

Aim

To assess multilabel classification models using machine learning models to detect degenerative findings and intrasubstance tears in US images with LET diagnosis.

Materials and methods

A retrospective study was performed. US images and medical records from patients with LET diagnosis from January 1st, 2017, to December 30th, 2018, were selected. Datasets were built for training and testing models. For image analysis, features extraction, texture characteristics, intensity distribution, pixel-pixel co-occurrence patterns, and scales granularity were implemented. Six different supervised learning models were implemented for binary and multilabel classification. All models were trained to classify four tendon findings (hypoechogenicity, neovascularity, enthesopathy, and intrasubstance tear). Accuracy indicators and their confidence intervals (CI) were obtained for all models following a K-fold-repeated-cross-validation method. To measure multilabel prediction, multilabel accuracy, sensitivity, specificity, and receiver operating characteristic (ROC) with 95% CI were used.

Results

A total of 30,007 US images (4,324 exams, 2,917 patients) were included in the analysis. The RF model presented the highest mean values in the area under the curve (AUC), sensitivity, and also specificity by each degenerative finding in the binary classification. The AUC and sensitivity showed the best performance in intrasubstance tear with 0.991 [95% CI, 099, 0.99], and 0.775 [95% CI, 0.77, 0.77], respectively. Instead, specificity showed upper values in hypoechogenicity with 0.821 [95% CI, 0.82, −0.82]. In the multilabel classifier, RF also presented the highest performance. The accuracy was 0.772 [95% CI, 0.771, 0.773], a great macro of 0.948 [95% CI, 0.94, 0.94], and a micro of 0.962 [95% CI, 0.96, 0.96] AUC scores were detected. Diagnostic accuracy, sensitivity, and specificity with 95% CI were calculated.

Conclusion

Machine learning algorithms based on US images with LET presented high diagnosis accuracy. Mainly the random forest model shows the best performance in binary and multilabel classifiers, particularly for intrasubstance tears.

Prevalence of rotator cuff tendon tears and symptoms in a Chingford general population cohort, and the resultant impact on UK health services: a cross-sectional observational study

OBJECTIVES

To define the population prevalence of rotator cuff tears and test their association with pain and function loss; determine if severity symptom correlates with tear stage severity, and quantify the impact of symptomatic rotator cuff tears on primary healthcare services in a general population cohort of women.

DESIGN

Cross-sectional observational study.

PARTICIPANTS

Individuals were part of the Chingford 1000 Women cohort, a 20-year-old longitudinal population study comprising 1003 women aged between 64 and 87, and representative of the population of the UK.

MAIN OUTCOME MEASURES

Rotator cuff pathology prevalence on ultrasound, shoulder symptoms using the Oxford Shoulder Score and resultant number of general practitioner (GP) consultations.

RESULTS

The population prevalence of full-thickness tears was 22.2%, which increased with age (p=0.004) and whether it was the dominant arm (Relative Risk 1.64, OR 1.58, 95% CI 1.07 to 2.33, p=0.021).Although 48.4% of full-thickness tears were asymptomatic, there was an association between rotator cuff tears and patient-reported symptoms. Individuals with at least one full-thickness tear were 1.97 times more likely than those with bilateral normal tendons (OR 3.53, 95% CI 2.00 to 5.61, p<0.001) to have symptoms. Severity of symptoms was not related to the severity of the pathology until tears are >2.5 cm (p=0.009).In the cohort, 8.9% had seen their GP with shoulder pain and a full-thickness rotator cuff tear, 18.8% with shoulder pain and an abnormality and 29.3% with shoulder pain.

CONCLUSION

Rotator cuff tears are common, and primary care services are heavily impacted. As 50% of tears remain asymptomatic, future research may investigate the cause of pain and whether different treatment modalities, aside from addressing the pathology, need further investigation.

Clinical and MRI outcomes of subacromial impingement syndrome with conservative treatment: a 21-month prospective study

BACKGROUND

Information is lacking on the natural history of early stages of degenerative rotator cuff disease. Such information can be obtained by using clinical and imaging assessment after conservative treatment in affected patients.

HYPOTHESIS

Subacromial impingement syndrome is a clinical presentation that can be associated with early stages of the disease. We aimed to describe the natural history of degenerative rotator cuff disease from the early stages by studying clinical and imaging outcomes in non-operated patients with subacromial impingement syndrome.

PATIENTS AND METHODS

Patients with subacromial impingement syndrome were prospectively included. They had conservative treatment and were assessed before treatment and during at least 12-month follow-up. Assessment included clinical evaluation on a 0- to 100-point Constant scale and subscales as well as MRI of the rotator cuff. Clinical results were compared to baseline MRI findings and according to lesional progression.

RESULTS

We included 26 patients with mean age 59.1 (SD 9.6), mean pain duration 23.1 (31.3) months; mean total Constant score 39.1 (12.1). Overall, 9 patients had no tear, 9 had a partial tear and 8 had a full-thickness tear. Mean follow-up was 21 (SD 10) months. Total Constant score and subscores improved at follow-up in the overall sample. Patients without tear and those with partial or full-thickness tear at baseline showed clinical improvement. MRI of the rotator cuff at follow-up indicated lesional worsening in 7 patients. However, clinical improvement did not differ by lesional progression or not.

CONCLUSION

We report on 21-month clinical and MRI assessments of degenerative rotator cuff disorders including early stages of the disease. Clinical improvement was not related to MRI changes over time. Further investigations are needed to verify our findings in larger study populations.

Differences in Coracohumeral Distance Between the Symptomatic and the Asymptomatic Shoulder in Patients With Unilateral Shoulder Pain and in Healthy Participants: A Cross-Sectional Study

OBJECTIVES

The aim of this study was to analyze whether differences in the coracohumeral distance (CHD) exist between the symptomatic and the asymptomatic shoulder in patients with subacromial pain syndrome and compare with the shoulder of control participants.

METHODS

This was a cross-sectional, observational study. A sample comprising 62 participants with subacromial pain syndrome was recruited from 3 different primary care centers. The CHD was determined from standardized ultrasonography measures performed on both shoulders at 0° and 60° of shoulder abduction, whereas the dominant arm was measured for the control participants.

RESULTS

Statistically significant differences in CHD at 0° and 60° were found between the symptomatic and control shoulders (P = .011/P = .002) and between the contralateral asymptomatic shoulder and controls (P = .026/P = .007).

CONCLUSION

We found differences in CHD at 0° and 60° of shoulder elevation between both the affected and the nonaffected shoulders when compared with healthy shoulders. These results suggest that CHD may be a contributing factor in chronic shoulder pain.

IRO/Shift Test Is Comparable to the Jobe Test for Detection of Supraspinatus Lesions

To determine how the internal rotation and shift (IRO/shift) test compares to the gold standard of clinical tests (Jobe test) for diagnosing supraspinatus lesions and to confirm these clinical results with surgical findings, 100 symptomatic patients were clinically examined between October 2018 and November 2019. All 100 patients were evaluated using both the IRO/shift test and Jobe test. A total of 48 of these patients received surgical intervention. Based on these data, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for both the IRO/shift test and Jobe test were calculated. The IRO/shift test had a sensitivity of 96% (95% CI: 82–100%), specificity of 50% (95% CI: 27–73%), PPV of 73% (95% CI: 56–86%), NPV of 91% (95% CI: 59–100%), and an accuracy of 77% (95% CI: 63–88%). The Jobe test had a sensitivity of 89% (95% CI: 72–98%), specificity of 60% (95% CI: 36–81%), PPV of 76% (95% CI: 58–89%), NPV of 80% (95% CI: 52–96%), and an accuracy of 77% (95% CI: 54–81%). These results suggest that the IRO/shift test is comparable to the Jobe test, which is often viewed as the gold standard clinical examination for assessing supraspinatus lesions. This study was approved by the Ethics Commission of the Martin Luther University Halle-Wittenberg (reference number: 2018-05).

Factors associated with limitations in daily life and at work in a population with shoulder pain

Background

Shoulder pain, which is a widespread condition, can lead to participation restrictions in daily and professional life. However, there are few studies focusing on the differences between daily life limitations and work limitations. This study aims at identifying the factors associated with limitations in personal and professional life in a population of working age suffering from shoulder pain.

Methods

A sample of working age job seekers and workers with shoulder pain was drawn from the last general population cross-sectional French study on disability. Limitations were categorized depending on whether they related to daily life and/or work. The variables assessed were age, sex, state of health, activity restrictions, need for accommodation, and aggravating living conditions or aggravating working conditions. Separate Quasi-Poisson regressions were performed for each type of limitation.

Results

The sample consisted of 795 individuals of which 33.7% had no limitation, 21.7% were limited in daily life, 6.0% at work, and 38.6% in both. Factors significantly associated with daily life limitations and work limitations and their computed Prevalence Ratios (PR) were the need for accommodation (PR = 2.16), activity restrictions (PR = 2.28), perceived poor health (PR = 2.42) and low income (PR = 1.64). Aggravating living conditions and aggravating working conditions were associated with daily life limitations (PR of 1.69 and 0.63 respectively).

Conclusions

The present study identifies factors associated with disability in a population with shoulder pain. Further research should be carried out in order to study health-related periods of cessation of work.

A Survey of Musculoskeletal Disorders in the Orthopaedic Surgeon: Identifying Injuries, Exacerbating Workplace Factors, and Treatment Patterns in the Orthopaedic Community

Introduction:

As demand for orthopaedic care increases, the orthopaedic community must preserve access to skilled physicians. Workplace hazards and related injuries or conditions contribute to musculoskeletal (MSK) stress on orthopaedic surgeons, which can lead to undesirable medical leaves of absence or early retirement. The purpose of this study was to identify and characterize work-related and non–work-related MSK conditions that affect orthopaedic surgeons and differential injury patterns among male and female surgeons. This study hypothesized that MSK conditions would be exacerbated by work, correlate with age, and show gender-based disparities. Identifying MSK conditions and associated workplace hazards may ultimately help guide preventive or protective efforts.

Methods:

Following IRB and society approvals, a modified 15-question physical discomfort survey was emailed to a randomized selection of American Academy of Orthopaedic Surgeons (AAOS) members and all Ruth Jackson Orthopaedic Society members. Data were deidentified and merged by AAOS; analyses were performed by the authors.

Results:

Most surgeons reported at least one MSK condition (86%; 95% male versus 82% female, P = 0.317), with an average of two conditions per surgeon. Low back pain (56%) and neck pain (42%) were the two most common conditions reported. Male surgeons were more likely to report medial epicondylitis (P = 0.040), lateral epicondylitis (P ≤ 0.001), low back pain (P = 0.001), and lumbar radiculopathy (P = 0.001); however, male respondents were significantly older than female respondents (57 versus 43 years, P ≤ 0.0001), and some conditions were age-correlated. Most respondents reported at least one work-attributed MSK condition (64%; 68% male versus 62% female, P = 0.806). Caseload was not associated with an increased number of work-related MSK conditions; yet, 60% of surgeons reported that work worsened symptoms. Surgical treatment was sought most often for lumbar radiculopathy (6%) and carpal tunnel syndrome (6%). Sixty-nine leaves of absence were reported; most less than 1 month (55%). Exacerbating workplace factors included positioning (patient/surgeon), instruments, and personal protective equipment.

Discussion:

Work-related MSK conditions are common among orthopaedic surgeons. Greater awareness of potential workplace-related hazards and conditions is needed to address and mitigate negative MSK health effects on orthopaedic surgeons.

The internal rotation and shift-test for the detection of superior lesions of the rotator cuff: reliability and clinical performance

Background

Using reliable and valid clinical tests are essential for proper diagnosis and clinical outcomes among injuries involving the rotator cuff. The addition of a new clinical examination test could improve the clinical diagnosis and informative value of the sensitivity and specificity of pathology. This study of diagnostic accuracy evaluated the use of a new rotator cuff test, called the internal rotation and shift-test (IRO/shift-test), to determine its reliability and clinical performance (sensitivity, specificity, positive (PPV)/negative predictive value (NPV)). Clinical diagnostic outcomes were confirmed with radiological findings (MRI).

Methods

100 patients from a specialized shoulder unit participated (64 male, 36 female, mean age: 55 ± 13.5 years). A single-blinded (no knowledge of prior clinical or technical diagnostics) study design was used with two experienced physicians performing the IRO/shift-test. For clinical performance, all clinical testing was compared with MRI.

Results

The intra-rater (ICC = 0.73, 95% CI: 60-82) and inter-rater (ICC = 0.89, 95% CI: 81-94) coefficients for the IRO/shift-test showed good-to-excellent reliability. 75% of the patients showed a positive IRO/shift-test, while 65% had a radiologically diagnosed superior rotator cuff tear. 60% of these patients had both a positive IRO/shift-test and objective rotator cuff tear via MRI. The sensitivity of the IRO/shift-test to detect superior rotator cuff lesions based on MRI diagnosis was calculated at 92% (95% CI: 86-99%), while specificity was 67% (95% CI: 50-84%). Predictive values were also found to be high with 86% PPV (95% CI: 78-94%) and 80% NPV (95% CI: 64-96%).

Conclusion

Our results demonstrate that the IRO/shift-test is a reliable and valid tool for assessing superior rotator cuff pathology. With good-to-excellent intrarater and inter-rater reliability and strong sensitivity and specificity this test should be considered a valuable addition to clinicians' cadre of clinical evaluation tools.

Risk factors for shoulder disorders among French workers: prospective cohort study

Objectives

Shoulder disorders are common in the working population. This longitudinal study aimed to explore the relationships between personal factors and occupational organisational, psychosocial, and biomechanical factors and the incidence of shoulder disorders.

Methods

A total of 3710 workers in the Pays de la Loire region (Loire Valley area, France) were randomly included by their occupational physician in the Cosali cohort between 2002 and 2005. All workers completed a self-administered questionnaire about personal factors and work exposure, and using a standardised physical examination, occupational physicians diagnosed shoulder disorders. Between 2007 and 2010, 1611 workers were re-examined by their occupational physician. The 1,320 workers free of shoulder disorders at baseline were studied. A conceptual model was developed in which relationships between organisational, psychosocial, biomechanical, and personal factors at baseline and the incidence of shoulder disorders were assumed. Structural equation modelling was used to test the model.

Results

Shoulder disorders were directly associated with biomechanical factors and age but not with psychosocial factors. However, skill discretion and psychological demand influenced shoulder disorders indirectly through biomechanical factors. Exposure to a work pace dependent on an automatic rate and to a work pace dependent on customers’ demands were associated with biomechanical and psychosocial factors, but not directly to shoulder disorders.

Conclusions

This study identified the complex direct and indirect relationships between occupational factors and shoulder disorders. Our data confirmed our conceptual causation model: organisational and psychosocial factors were associated with biomechanical factors, while biomechanical factors were associated with the incidence of shoulder disorders.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00420-022-01853-9.

Weight-Related and Personal Risk Factors of Carpal Tunnel Syndrome in the Northern Finland Birth Cohort 1966

BACKGROUND

Excess body mass is a risk factor for carpal tunnel syndrome (CTS), but the mechanisms of this are unclear. This study aimed to evaluate the association between CTS and personal risk factors of body mass index (BMI), waist circumference and waist-to-hip ratio (WHR).

METHODS

The study sample consisted of the Northern Finland Birth Cohort 1966 (n = 9246). At the age of 31 in 1997 and at the age of 46 in 2012, the participants underwent a clinical examination. Cohort A consisted of complete cases with a follow-up from 1997 to 2012 (n = 4701), and Cohort B was followed up from 2012 to 2018 (n = 4548). The data on diagnosed CTS were provided by the Care Register for Health Care until the end of 2018.

RESULTS

After an adjustment for confounding factors, BMI was associated with CTS among women (hazard ratio (HR) 1.47, 95% Cl 0.98-2.20 for overweight women and HR 2.22, 95% Cl 1.29-3.83 for obese women) and among both sexes combined (HR 1.35 95% Cl 0.96-1.90 for overweight and HR 1.98 95% Cl 1.22-3.22 for obese participants). Neither waist circumference nor WHR was associated with CTS.

CONCLUSIONS

BMI is an independent risk factor for CTS and is more relevant for estimating the increased risk of CTS due to excess body mass than waist circumference or WHR.

A retrospective study of electrodiagnostically evaluated ulnar neuropathies with special guidelines for ulnar neuropathies at elbow

Background

The diagnosis of type, severity of ulnar neuropathy based on symptoms and clinical tests are unsatisfactory. This study aimed to retrospectively analyze ulnar neuropathies at different sites evaluated through electrodiagnostic studies (EDx), especially for ulnar neuropathy at elbow (UNE).

Results

Total 270 ulnar neuropathy patients’ data were recruited from laboratory record over a five-year period (2016–2021).Their demographic data, clinical history and EDx parameters were analyzed focusing on etiology, nerve lesion types, 5th-digit sensory, dorsal ulnar cutaneous nerve (DUCN) conduction, motor nerve conduction velocity (NCV) across elbow along with EMG of ADM, FDI, FCU, FDP muscles. The patients grouped into traumatic injuries—27.8% (T) and 72.2% non-traumatic (NT) had varied sensory-motor symptoms: pain—10%, altered sensation—28.1%, pain-paresthesia—14.8%, atrophy—25.2% and clawing—8.9%. UNE was the most prevalent (82.75%-NT, 66.67% -T) with < 50 m/s motor and sensory NCV across elbow. Compound muscle action potential (CMAP) amplitude > 50% drop across elbow was seen in 55.17%-NT and 54.16%-T groups. Abnormal DUCN and short-segment inching NCV were less frequently noted. In EMG, ADM (T-83.33% and NT-65.51%) and FDI (T-70.83% and NT-68.96%) muscles were evaluated the most and FDP the least.

Conclusion

UNE was the most common followed by forearm and wrist. NCV and CMAP across elbow are stronger EDx parameters for UNE. Neuropathy was irrespective of gender and prevalent at early of middle age. The EDx could be considered as one of the most valuable tests in confirming the localization, severity and type of ulnar nerve lesion, which favors management and prognosis of patient.

Upper extremity field tests and isokinetic shoulder internal and external strength and power in sports active males

BACKGROUND: In order to guide sports active subjects with musculoskeletal (MSK) shoulder dysfunctions itis essential to have precise insights of possible weak links in the kinetic chain of their shoulder girdle with access to reference data. Equally, it is uncertain whether so-called functional shoulder strength tests are complementary to an isokinetic shoulder strength test. OBJECTIVE: To establish reference values and to clarify the relationship between two upper extremity field tests – the Scapular Muscle Endurance test (SME) and the Closed Kinetic Chain Upper Extremity Test (CKCUEST) and the isokinetic strength test of the shoulder internal (IR) and external rotators (ER). METHODS: Seventy-six male sport active men performed the CKCUEST, the SME, and underwent a bilateral isokinetic strength test to establish reference values of the isokinetic shoulder relative to body mass Peak Moment (PM/kg) and Power (Power/kg) for the IR and ER. A mixed-design ANOVA calculated possible side-to-side differences and one-way ANOVA was applied for eventually age group differences. Additionally, the relationship between the three tests was examined with a Spearman rank-order correlation coefficient. RESULTS: No significant correlations were indicated between the SME and the criterion isokinetic test and between the SME and CKCUEST. CONCLUSIONS: The main outcome parameters in this study warrant individual assessment as they measure different constructs, leading to a diverse profile of the shoulder.

Prevalence of upper limb musculoskeletal disorders and its associated risk factors among janitorial workers: A cross-sectional study

Introduction

Methods

Results

Conclusions

•

WRMSDs is one of the causes of disability globally with significant economic impact.

•

The prevalence of WRMSDs among janitorial workers in university setting is scarce.

•

Regular screening is essential for monitoring the progress of severity of musculoskeletal symptoms.

•

WRMSDs surveillance will be beneficial for improvement of work procedures and practices.

Work-relatedness of lateral epicondylitis: Systematic review including meta-analysis and GRADE work-relatedness of lateral epicondylitis

Background

Lateral epicondylitis (LE) is a highly prevalent musculoskeletal disorder in workers, often associated with physically demanding work. Knowledge of work‐relatedness of LE is crucial to develop appropriate preventive measures. This study investigates the prospective association between work‐related physical risk factors and LE.

Methods

A systematic literature review was conducted in MedLine using PubMed from January 1, 2010 until February 16, 2021. Published reports were included if: (1) LE was clinically assessed, (2) exposure to work‐related physical risk factors was assessed, and (3) associations between LE and work‐related physical risk factors were reported in prospective studies. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation.

Results

In total, 318 workers with LE from a population of 5036 workers in five studies were included. Meta‐analyses revealed high‐quality evidence for associations between LE and a Strain Index (SI) score >5.1 (odds ratio [OR]: 1.75, 95% confidence interval (CI): 1.11–2.78) and moderate‐quality evidence for forearm rotation >4 h/day or forearm rotation ≥45° for ≥45% time (OR: 1.85, 95% CI: 1.10–3.10). Gripping, flexion and extension of the wrist, and repetitive movements showed no significant associations with LE.

Conclusion

High‐quality evidence was found indicating that a higher SI increased the risk of LE. Moderate‐quality evidence was found for an association between forearm rotation and LE. No associations were found between other physical risk factors and LE. Primary preventive interventions should focus on a reduction of the SI and of high forearm rotation in work.

[The influence of occupational activity on diseases of the musculoskeletal system of the upper extremity]

Einleitung

Erkrankungen des Bewegungsapparates der oberen Extremität sind Grund für zunehmende krankheitsbedingte Fehlzeiten bei Erwerbspersonen.

Zielsetzung

Ziel dieser Studie ist es, den Einfluss der Berufsabhängigkeit auf die Entstehung von Erkrankungen des Bewegungsapparates der oberen Extremität zu untersuchen und neben berufsspezifischen Faktoren, gesundheitsbezogene Risiken darzustellen.

Material und Methoden

Es wurden 1070 Patienten eingeschlossen, bei denen zwischen 2016 und 2019 bei einer Läsion der Rotatorenmanschette (RM) eine operative RM-Rekonstruktion durchgeführt wurde. Die relevanten Daten wurden retrospektiv aus dem Krankenhausinformationssystem dokumentiert. Die Berufszweige der Patienten wurden nach der Klassifikation der Berufe 2010 (KldB 2010) eingeteilt und mit routinemäßig erfassten und anonymisierten, frei verfügbaren Daten (Statistisches Bundesamt, Bundesagentur für Arbeit) verglichen.

Ergebnisse

Von den 1070 Patienten waren 844 Patienten im arbeitsfähigen Alter. Die Altersstruktur der einzelnen Bereiche zeigten keine signifikanten Unterschiede. Anhand der Vergleiche der Patientendaten mit der Bevölkerung ergaben sich signifikant höhere RM-Erkrankungsraten in den Bereichen Land‑, Forst- und Tierwirtschaft sowie Gartenbau (p = 0,003); Bau, Architektur, Vermessung und Gebäudetechnik (p < 0,001); Verkehr, Logistik, Schutz und Sicherheit (p < 0,001) und Unternehmensorganisation, Buchhaltung, Recht und Verwaltung (p < 0,001). Ein signifikant reduziertes Risiko bestand in Naturwissenshaft, Geografie und Informatik (p = 0,015); kaufmännische Dienstleistungen, Warenhandel, Vertrieb, Hotel und Tourismus (p < 0,001); Gesundheit, Soziales, Lehre und Erziehung (p < 0,001).

Schlussfolgerung

Die Prävalenz von RM-Läsionen zeigt einen statistischen Zusammenhang zur ausgeführten Berufstätigkeit in Abhängigkeit von den Berufszweigen. Neben der Berufsabhängigkeit spielen geschlechtsspezifische Arbeitsfaktoren eine Rolle. Schulterschmerzen bei Erwerbstätigkeiten sollten differenzierter betrachtet werden. Dadurch sollen gezielt Präventivmaßnahmen eingeleitet werden können, um vorzubeugen.

Work ability in aging office workers with musculoskeletal disorders and non-communicable diseases and its associated factors: a cross-sectional study

Objectives. The prevalence of musculoskeletal disorders (MSDs) and non-communicable diseases (NCDs) increases with age. This study examined the impact of MSDs and NCDs on work ability, using the work ability index (WAI), among aging office workers (between 45 and 60 years old) and determined factors associated with WAI scores. Methods. A cross-sectional study was conducted in office workers from 27 government offices in Bangkok and nearby provinces using an online questionnaire. Analyses were conducted using the Mann-Whitney U test and a multivariable logistic regression model. Results. Of 689 workers (452 females and 237 males), 34, 13, 12 and 41% reported MSDs, NCDs, MSDs + NCDs and no MSDs/NCDs, respectively, in the past year. Median scores (interquartile range) of WAI were 37.0 (6) for MSDs, 37.0 (4) for NCDs, 34.5 (6) for MSDs + NCDs and 40.0 (4) for no MSDs/NCDs. Significant difference in WAI scores was found between the MSDs and MSDs + NCDs groups (p = 0.005); and between the NCDs and MSDs + NCDs groups (p < 0.001). Female, high work experience and low job control were significantly associated with reduced WAI scores (WAI ≤ 36). Conclusion. The presence of MSDs or NCDs reduced work ability among aging office workers compared to their healthy counterparts. Having MSDs + NCDs further reduced work ability.

Can platelet-rich plasma injections provide better pain relief and functional outcomes in persons with common shoulder diseases: a meta-analysis of randomized controlled trials

Background

To evaluate the efficacy of autologous platelet-rich plasma (PRP) injections in the treatment of common shoulder diseases.

Methods

The PubMed, Medline, and Central databases and trial registries were searched from their inception to October 2020 for randomized controlled trials of autologous PRP injections for shoulder diseases versus placebo or any control intervention. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed in the selection, analysis, and reporting of findings. The primary outcome was pain intensity (visual analog scale), and secondary outcomes were changes in function and quality of life (QoL).

Results

A total of 17 randomized controlled trials of PRP versus control were analyzed. From 8–12 weeks to ≥1 year, PRP injections were associated with better pain relief and functional outcomes than control interventions. PRP injections were also associated with greater QoL, with an effect size of 2.61 (95% confidence interval, 2.01–14.17) at medium-term follow-up. Compared with placebo and corticosteroid injections, PRP injections provided better pain relief and functional improvement. In subgroup analyses, trials in which PRP was prepared by the double centrifugation technique, the platelet concentration in the PRP was enriched ≥5 times, leucocyte-rich PRP was used, or an activating agent was used before application reported the most effective pain relief at 6–7 months.

Conclusions

PRP injections could provide better pain relief and functional outcomes than other treatments for persons presenting with common shoulder diseases. PRP injections have a greater capacity to improve shoulder-related QoL than other interventions.

Impact of different work organizational models on gender differences in exposure to psychosocial and ergonomic hazards at work and in mental and physical health

PURPOSE

To examine differences between genders in exposure to psychosocial and ergonomic factors at work and in work-related health, according to different work organization models.

METHODS

The study population included a sample of 9749 (women: 37.1%) and 10,374 (women: 39.9%) employees who participated in the 2010 and 2015 European Working Conditions Surveys, respectively. Multiple Correspondence Analysis was applied to work characteristics reported by workers to estimate principal components, followed by Hierarchical Clustering on principal components to identify clusters of work organization models. Gender differences in exposure to work hazards and health outcomes were assessed through Poisson robust regression. Differences of PRs across organizational models were tested through interaction between gender and type of work organization.

RESULTS

Three organizational models were identified in 2010, including lean production, Tayloristic production, and a "reflexive production" model, whereas in 2015, a "simple" or traditional model was also found. In 2010, women employed in companies adopting the Tayloristic or the lean production models were more likely than men to be exposed to unfavourable psychosocial and physical work factors, and to report musculoskeletal pain, compared to those belonging to reflexive production. In 2015, a significantly higher female/male ratio persisted in lean production for exposure to high job strain and for carrying/moving heavy loads, whereas gender differences in Tayloristic and traditional production were quite similar to those of reflexive production.

CONCLUSIONS

Our results suggest that employment in workplaces characterized by lower monotony, repetitiveness, and production constraints may contribute to reduce exposure to job strain among working women.

Musculoskeletal Disorder Symptoms in Saudi Allied Dental Professionals: Is there an Underestimation of Related Occupational Risk Factors?

This study aims to examine the prevalence of musculoskeletal disorder (MSD) symptoms in allied dental professionals (ADPs) in Saudi Arabia and risk factors for MSDs. The study also explores ADPs' opinions and attitudes about the effect of MSD symptoms on the quality of life and potential mitigatory measures. This is a prospective cross-sectional study. Participants were 355 licensed dental staff (average age 33.6 ± 8.1 years, 69% women) working as assistants, lab technicians, radiology technicians, or sterilization technicians with at least six months' work experience. The self-administrated questionnaire comprised socio-demographics, work-related factors, and items from the Nordic Musculoskeletal Questionnaire. Multivariate and univariate logistic regressions were conducted to investigate risk factors for MSD symptoms. Overall, 93% of ADPs complained of MSD symptoms in at least one body site in the past 12 months. Factors related to work conditions (e.g., 'keeping an uncomfortable posture for long periods of time', 'lifting heavy objects') and years of experience were proven to be significant risk factor for developing MSDs. The cohort of ADPs showed a high MSD symptoms prevalence. Efforts are imperative in addressing the risk factors of ergonomics and the workplace environment, and more rigorous studies are needed to further investigate risk factors.

Prevalence and incidence of work-related musculoskeletal disorders in secondary industries of 21st century Europe: a systematic review and meta-analysis

OBJECTIVE

Over the course of the twenty-first century, work-related musculoskeletal disorders are still persisting among blue collar workers. At present, no epidemiological overview exists. Therefore, a systematic review and meta-analysis was performed on the epidemiology of work-related musculoskeletal disorders (WMSD) within Europe's secondary industries.

METHODS

Five databases were screened, yielding 34 studies for the qualitative analysis and 17 for the quantitative analysis. Twelve subgroups of WMSDs were obtained for the meta-analysis by means of predefined inclusion criteria: back (overall), upper back, lower back, neck, shoulder, neck/shoulder, elbow, wrist/hand, leg (overall), hip, knee, and ankle/feet.

RESULTS

The most prevalent WMSDs were located at the back (overall), shoulder/neck, neck, shoulder, lower back and wrist WMSDs with mean 12-month prevalence values of 60, 54, 51, 50, 47, and 42%, respectively. The food industry was in the majority of subgroups the most prominent researched sector and was frequently associated with high prevalence values of WMSDs. Incidence ratios of upper limb WMSDs ranged between 0.04 and 0.26. Incidence ratios could not be calculated for other anatomical regions due to the lack of sufficient articles.

CONCLUSION

WMSDs are still highly present among blue collar workers. Relatively high prevalence values and low incidence ratios indicate a limited onset of WMSDs with however long-term complaints.

Landscaping Work: Work-related Musculoskeletal Problems and Ergonomic Risk Factors

Background

Work-related musculoskeletal disorders (WRMSDs) are considered one of the foremost reason of disability globally with significant economic impact due to loss of productivity. Landscaping work is considered a high-risk industry in the service sector. Landscape workers are susceptible to WRMSDs as they are exposed to high physical demands at work, and exert significant physical effort to complete daily repetitive tasks during long working hours. The aim of this study was to determine the prevalence of WRMSDs and to identify the ergonomic risk factors among landscape workers in a university setting.

Methods

This was a cross-sectional study conducted among landscape workers at a public university in Kota Kinabalu, Sabah. Interviews were conducted due to low literacy of the participants, using structured questionnaires which consist of personal characteristics, work descriptions, ergonomic risk factors, as well as self-reported WRMSD symptoms using NORDIC questionnaire. Ergonomic risk assessment (ERA) using rapid entire body assessment (REBA) was then conducted.

Results

Fifty-five of 60 landscape workers agreed to participate (92% response rate). The overall prevalence of WRMSDs among landscape workers was 85.5%. The highest prevalence involving the shoulder (65.5%), followed by neck (23.6%), wrist/hand (23.6%), and lower back (20.0%) regions based on their self-reported WRMSD symptoms over the past 12 months. Awkward posture was the risk factor identified through ergonomic risk assessment (ERA) conducted by ERA trained personnel. None of the working postures during assessment was noted to be appropriate. Although no significant difference was associated with self-reported WRMSDs, majority of the landscape workers (71%) were classified as medium ergonomic risk group using REBA, with the remaining 29% considered to be high ergonomic risk group.

Conclusion

Improvement in awareness campaigns, modification of working tools, and enhanced administrative approaches are among the control and prevention measures recommended to delay or prevent the occurrence of WRMSDs.

Touch® double mobility arthroplasty for trapeziometacarpal osteoarthritis: outcomes for 92 prostheses

Trapeziometacarpal prostheses have been used in the treatment of first carpometacarpal joint osteoarthritis for many years. No studies have demonstrated statistical superiority over gold-standard trapeziectomy, but they have been proved to enable shorter convalescence, better pain relief and faster functional recovery. The aims of the present study were to report functional results in a large cohort treated with the Touch® new-generation dual mobility trapeziometacarpal prosthesis, with comparison to results in the literature. A retrospective study included 92 Touch® prostheses. Assessment comprised pre- and post-operative pain, QuickDASH score and satisfaction rate. Mean follow-up was 1.33 ± 0.4 years. Pain significantly improved after surgery. Functional QuickDASH scores did not significantly differ from those reported in the age-matched general population. Return to work was fast, at 2.6 months. Satisfaction scores were high. There were no major complications such as dislocation, fracture or loosening, but the rate of De Quervain's tenosynovitis was higher than in other studies. The Touch® prosthesis appeared to be a safe and stable implant, providing good satisfaction and very good functional scores and fast return to work and leisure activity. Considering the high rate of postoperative De Quervain's tenosynovitis, we suggest opening the first sheath of the extensors tendons while positioning the prosthesis.

Are any radiologic parameters independently associated with degenerative postero-superior rotator cuff tears?

BACKGROUND

Several radiologic parameters representing scapular morphology have been proposed as risk factors for degenerative posterosuperior rotator cuff tear (PSRCT). The causes of PSRCT are multifactorial; many reported risk factors are compound entities. However, no determination, made after adjustment with previously reported risk factors, of which radiologic parameters are independent risk factors for degenerative PSRCT, has been reported. Therefore, this study's purpose was to determine which radiologic parameters representing scapular morphology are independent risk factors for degenerative PSRCT in a general population after adjustment with previously suggested risk factors.

METHODS

This study involved 629 subjects (629 shoulders) drawn from a cohort of rural residents. PSRCT diagnoses were based on magnetic resonance imaging findings. Logistic regression analysis was used to determine the odds ratios and 95% confidence intervals for the following variables: sex, age, height, weight, waist circumference, dominant-side involvement, smoking, alcohol consumption, manual labor, diabetes, hypertension, metabolic syndrome, thyroid dysfunction, serum lipid profile, high-sensitivity C-reactive protein, and radiologic parameters. The evaluated radiologic parameters were the superior displacement of the humeral head (SDHH) and those representing the scapular morphology. The radiologic parameters representing the scapular morphology were lateral acromial angle, acromial slope, acromial tilt, acromial index, and critical shoulder angle (CSA). Univariate logistic regression analyses for all variables, as well as multivariable logistic regression analyses for variables with significant associations and clinical effect sizes in the univariate logistic regression analyses, were performed. In order to determine the cutoff value for significant radiologic parameters, each pair of candidate cutoff values was obtained as follows: 1 candidate, as the lowest significant ordinal value in a univariate analysis, and the other candidate, according to a receiver operating characteristic curve analysis. Then, the cutoff values were determined by selecting the value in each candidate pair that had the larger area under the receiver operating characteristic curve, using the DeLong test.

RESULTS

In the multivariable analyses, CSA was significantly associated with degenerative PSRCT after controlling for the following factors: age, waist circumference, dominant-side involvement, manual labor, diabetes, metabolic syndrome, hypo-high-density lipoproteinemia, and SDHH (P ≤ .033). CSA (odds ratio, 1.58 [95% confidence interval, 1.45-1.72]; P < .001) was the only significantly associated radiologic parameter among the studied radiologic parameters representing scapular morphology.

CONCLUSION

CSA (≥35°) is an independent associated factor for degenerative PSRCT after adjustment for the following suggested risk factors: age, waist circumference, dominant-side involvement, manual labor, diabetes, metabolic syndrome, hypo-high-density lipoproteinemia, and SDHH.

Screening of Work-Related Musculoskeletal Upper Limb Disorders Using the SALTSA Protocol: A Work-Site Study in Belgium

BACKGROUND

Long-term absenteeism continues to rise in Belgium and musculoskeletal disorders (MSDs) have been considered a primary cause. However, there is still uncertainty about the prevalence of MSDs, and about the contribution of work-related factors in the etiology of MSDs. SALTSA, which was developed in 2001, is a European diagnostic criterion document that aims to standardize the reporting of work-related upper limb MSDs (ULMSDs). The purpose of this work-site study was to implement SALTSA in daily occupational health practice and to determine the prevalence of ULMSDs in a Belgian company.

METHODS

During health examinations, occupational health nurses and an occupational health physician screened employees in a company with ergonomically high-risk activities for the occurrence of ULMSDs using the SALTSA protocol. In order to explore associations between ULMSDs and lifestyle and work-related factors, bivariate and logistic regression analyses were performed.

FINDINGS

Three hundred and eight (94.0%, 308/328) employees were screened resulting in an ULMSD prevalence of 20.5% (95% CI = [16.0-25.3]). Rotator cuff syndrome was the most common condition. Prevalence varied significantly between men (9.6%, 95% CI = [5.6-14.9]) and women (35.0%, 95% CI = [26.9-43.9]). Being female (p < .001) and working in the cabling assembly unit (p = .002) were found to be significant predictors of ULMSDs.

CONCLUSION/APPLICATION TO PRACTICE

By using the SALTSA protocol in occupational health practices, ULMSDs can be screened unequivocally, enabling comparisons between different occupational sectors and countries. Occupational health nurses can play an important role in detecting and screening MSDs among workers.

Effects of cycling workstation to get tertiary employee moving on their overall health: study protocol for a REMOVE trial

BACKGROUND

Sedentary behaviour (SB) and low levels of physical activity (PA) are predictors of morbidity and mortality. Tertiary employees spend a considerable amount of their daily time seated and new efficient strategies to both reduce sedentary time and increase physical activity are needed. In that context, the REMOVE study aims at evaluating the health effects of a 24-week cycling desk intervention among office workers.

METHODS

A prospective, open-label, multicentre, two-arm parallel, randomized controlled trial (RCT) will be conducted in office-sitting desk workers. Office workers (N = 80) who have 0.8 full time equivalent hours (FTE) and 75% of this time in a sitting position will be recruited from tertiary worksites in Clermont-Ferrand, France. Subjects will be randomly assigned to one of the two following interventions: (i) PPM6: performance of two 30 min of cycling desk (using portable pedal exercise machine-PPM) per working day for 6 months or (ii) CTL_PPM3: 3 months with no intervention (control) followed by 3 months during which workers will be asked to complete two 30 min of PPM per working day. At baseline (T0), at 3 months (T1) and at 6 months (T2) after the start of the interventions, primary outcomes; 7-day PA and SB (3D-accelerometers), secondary outcomes; body composition (bioelectrical impedance), physical fitness (aerobic fitness, upper and lower limb strength), metabolic outcomes (fasting blood samples), self-perceived stress, anxiety, quality of life at work and job strain (questionnaires), tertiary outcomes; resting metabolic rate and cycling energy expenditure (indirect calorimetry) and eating behaviours (questionnaires) will be measured. An ergonomic approach based on observations and individual interviews will be used to identify parameters that could determine adherence.

DISCUSSION

The REMOVE study will be the first RCT to assess the effects of cycling workstations on objectively measured PA and SB during working and non-working hours and on key physiological and psychological health outcomes. This study will provide important information regarding the implementation of such cycling workstations in office workers and on the associated potential health benefits.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04153214 . Registered on November 2019, version 1.

Platelet-rich plasma for rotator cuff tendinopathy: A systematic review and meta-analysis

Shoulder rotator cuff tendinopathy is a common debilitating condition that affects a person daily function and the quality of life. Despite its frequent occurrence, the best treatment is still inconclusive. This review assessed the clinical effect of platelet-rich plasma injection for rotator cuff tendinopathy. A systematic literature search was conducted using CINAHL, Medline, SCOPUS, SPORTSDiscus and Web of Science databases to retrieve articles published in peer-reviewed journals until December 2020. Randomised controlled trials (RCTs), which compared clinical effects of PRP injection to the usual care among adults diagnosed with rotator cuff conditions were reviewed. The main outcomes of interest were changes in shoulder pain symptoms and shoulder functions. All variables were analysed using random effects meta-analyses. Eight RCTs were reviewed in this study. The risk of bias for randomization was low for 6 RCTs, one study had unclear risk and the other was a high risk. Studies vary on the PRP techniques including preparation and injections. Moreover, the control intervention also differs. Four studies compared PRP with normal saline injection while in the remaining 4 RCTs the control intervention were rehabilitation program and dry needling. Meta-analysis of selected studies showed that PRP injection was safe and effective intervention for long-term pain control and shoulder function in patients with RC disorders.