Elbow joint disorders in relation to vibration exposure and age in stone quarry workers

Work-Related Musculoskeletal Disorders: A Systematic Review and Meta-Analysis

Background: Musculoskeletal disorders (MSDs) involve muscles, nerves, tendons, joints, cartilage, and spinal discs. These conditions can be triggered by both the work environment and the type of work performed, factors that, in some cases, can also exacerbate pre-existing conditions. This systematic review aims to provide an overview of the impact that different work-related activities have on the musculoskeletal system. Methods: A global search of publications was conducted using the following international bibliographic web databases: PubMed and Web of Science. The search strategies combined terms for musculoskeletal disorders and workers. In addition, a meta-analysis was conducted to estimate the prevalence of MSDs within the healthcare sector. Results: A total of 10,805 non-duplicated articles were identified, and finally, 32 studies were reviewed in this article. Once the literature search was completed, occupational figures were categorized into healthcare, farming, industrial, and computer sectors. In the healthcare sector, the prevalence estimate for degenerative diseases of the lumbar spine was 21% (497 out of 2547 physicians and dentists) (95% CI, 17-26%), while for osteoarthritis of the hand, it was 37% (382 out of 1013 dentists) (95% CI, 23-51%). Conclusions: Musculoskeletal disorders significantly impair workers' quality of life, especially in healthcare sector. These conditions are also associated with high costs for employers, such as absenteeism, lost productivity, and increased costs for healthcare, disability, and workers' compensation.

Primary Elbow Osteoarthritis: An Updated Review

Primary elbow arthritis predominantly affects middle aged men undertaking heavy manual work. Patients present with pain and limited movement but may also complain of ulnar nerve sensory or motor symptoms. Radiographic features include osteophytes at the tip of the olecranon and coronoid processes, loose bodies, narrowing of the radiocapitellar joint space and thickening of the olecranon fossa membrane. Treatment options range from conservative management using oral analgaesics and non-steroidal anti-inflammatory drugs through to open debridement procedures, arthroscopy and occasionaly in selected patients total elbow arthroplasty.

Ulnohumeral Arthroplasty in the Management of the Arthritic Elbow

Background

Osteoarthritis of the elbow is a difficult problem to treat. The results of total joint arthroplasty have historically been poor.

Methods

Seventy-nine patients who underwent ulnohumeral arthroplasty between 1994 and 2002 were included in the study. Fifty-nine elbows in 58 patients were available for clinical assessment. There were 14 females and 44 males with an average age of 63 years (32 to 80) and a mean follow-up of 7.8 years (5 to 12). There were 39 (67%) patients with primary osteoarthritis, 18 (31%) with post-traumatic and 1 patient with post-septic arthritis of the elbow.

Results

Using the visual analogue scale (VAS) (0 to 10), the pain score was seen to improve from 8 (6 to 10) to 3.8 (0 to 9). Twenty six patients (44%) were on minimal or no analgesia. The arc regarding flexion/extension was found to increase by 18°. Twenty-four percent of patients suffered an adverse incident. Radiologically 28 (6%) patients had recurrent bone formation in the olecranon fossa. This however did not correspond to the clinical outcome. Patients with loose bodies seemed to do better in the post-operative phase.

Conclusion

Ulnohumeral arthroplasty has a role in the management of the arthritic elbow as it provides pain relief in the post-operative period. However the improvement in the range of movement is limited particularly with regard to the arc of extension. This improvement in pain appears to diminish with time.

Arthroscopic joint debridement and capsular release in primary and post-traumatic elbow osteoarthritis: a retrospective blinded cohort study with minimum 24-month follow-up

BACKGROUND

Elbow osteoarthritis (OA) is a degenerative condition which in the advanced stage can severely impair joint mobility. Conservative treatment remains the first choice; surgery should be considered in case of failure in patients prepared to adhere to a demanding rehabilitation protocol. We assess the effectiveness of arthroscopic joint debridement and capsular release in a series of patients with primary and post-traumatic elbow arthritis.

MATERIALS AND METHODS

Forty-eight subjects (40 males, eight females; mean age 48 years) with a preoperative diagnosis of primary (19, 40 %) or post-traumatic OA (29, 60 %) were evaluated at a mean follow-up of 44 months. Outcome measures were active range of motion (ROM), pain score, Oxford elbow score (OES), and Mayo elbow performance score (MEPS). OA severity was graded into three classes (I-III) based on X-ray findings. Statistical significance was set at 5 %.

RESULTS

At the final follow-up evaluation, active flexion/extension increased significantly (p < 0.01); pronation and supination improved, but the difference was not significant (p > 0.05). The pain score improved from 7.2 to 4.3 (p < 0.01). Both OES and MEPS improved significantly (p < 0.001). Patients with post-traumatic OA had better ROM (p = 0.0391) and clinical scores (OES, p = 0.011; MEPS, p = 0.010). ROM and clinical scores were lower but not significantly so in class II than in class I patients. A smooth coronoid and olecranon fossa was found in 38 (79 %) patients and a preserved ulnotrochlear joint space in 40 (80 %).

CONCLUSIONS

Elbow OA has become more common as a result of earlier diagnosis and an increased number of acute injuries involving the joint. Arthroscopy is an effective technique to treat OA which provides the best results with the correct indications. Prospective studies are needed to help develop guidelines enabling selection of the best treatment option.

Surgical alternatives for elbow arthritis in the young adult

Most surgeons agree that total elbow arthroplasty is best avoided or deferred in patients younger than 60 years of age, although, at times, there may be no reasonable alternative. Other reconstructive options are available that may provide years of useful function, even if they are sometimes considered a surgical bridge to allow the patient to achieve the age at which implant arthroplasty would be appropriate. The patient and surgeon must have a clear understanding of the expectations and limitations of any proposed procedure. The key to success in reconstructive elbow surgery is the choice of the option that best addresses the articular pathology and the needs and desires of the specific patient.

Acute effects of vibration from a chipping hammer and a grinder on the hand-arm system

OBJECTIVES

The purpose of this study was to compare various effects on the hand-arm system of vibration exposure from a chipping hammer and a grinder with the same frequency weighted acceleration. Grip and push forces were measured and monitored during the exposure. The various effects were: muscle activity (measured with surface electrodes), discomfort ratings for different parts of the hand-arm system (made during and after exposure), and vibration perception threshold (for 10 minutes before and 10 minutes after the exposure).

RESULTS

No increase in muscle activity due to exposure to vibration was found in the hand muscle studied. In the forearm, conversely, there was an increase in both muscle studied. For the upper arm the muscle activity only increased when exposed to impact vibration. Subjective ratings in the hand and shift in vibration perception threshold were effected more by the grinder than the hammer exposure.

CONCLUSION

These results show that the reaction of the hand-arm system to vibration varies with frequency quantitatively as well as qualitatively. They do not support the notion that one single frequency weighted curve would be valid for the different health effects of hand-arm vibration (vascular, musculoskeletal, neurological, and psychophysiological).