Prevalence of cubital tunnel syndrome among dock workers, Saint Sebastian, São Paulo, Brazil

Work-related musculoskeletal disorders in dockworkers. Systematic review and meta-analysis

BACKGROUND

Dockworkers are exposed to physical overloads that can contribute to the development of musculoskeletal disorders, leading to functional disability and absenteeism.

OBJECTIVE

to map, critically appraise, and synthesize the available evidence on the prevalence of musculoskeletal diseases associated with port occupational activities.

METHODS

A comprehensive search was conducted in structured and unstructured databases in August 2023, with no date or language restriction, to identify observational studies evaluating the prevalence of musculoskeletal disorders in dockworkers' occupational activity. The risk of bias was assessed using validated tools based on the included study designs. Data from studies were pooled in meta-analyses. The certainty of the evidence was assessed using the GRADE approach.

RESULTS

We identified 12 analytical cross-sectional studies involving 7821 participants in ports of five countries. Most studies (75%) had a moderate methodological quality according to the Joanna Briggs Institute tool. Considering the overall worker categories and any musculoskeletal disorders, the meta-analysis showed a prevalence of 58% (95% Confidence Interval [95% CI] 37% to 78%), with degenerative spinal diseases 42% (95% CI -0.6% to 91%) and low back pain 36% (95% CI 21% to 50%) being the most prevalent conditions. Symptoms were predominantly in foremen and stevedores. The certainty of the evidence was very low.

CONCLUSIONS

Musculoskeletal disorders seem prevalent among dockworkers, mainly degenerative spinal diseases and low back pain. Studies with greater methodological consistency are still needed to validate these hypotheses and assist in decision-making for implementing preventive and informational policies in maritime port management organizations. PROSPERO registry CRD42021257677.

Evaluation of neurological testing for hand-arm vibration syndrome

BACKGROUND

The neurological component of hand-arm vibration syndrome (HAVS) uses the Stockholm Workshop Scale sensorineural (SWS SN) stages for classification. Proximal compressive neuropathies are common in HAVS and the symptoms are similar to SN HAVS. The SWS may not be a valid staging tool if a patient has comorbid proximal compression neuropathy.

AIMS

To evaluate the prevalence of proximal compression neuropathy in patients presenting for HAVS assessment and examine the association between compressive neuropathies and SWS SN.

METHODS

A standardized assessment protocol was used to assess 431 patients for HAVS at St. Michael's Hospital, Toronto, Ontario. The prevalence of median and ulnar compressive neuropathies was determined. The association between proximal compression neuropathies and SWS SN stage (0/1 versus 2/3) was evaluated using Chi-square and Fisher's exact tests as well as multivariable logistic regression.

RESULTS

Most patients (79%) reported numbness and 20% had reduced sensory perception (SWS SN Stage 2/3). Almost half (45%) had median neuropathy at the wrist and 7% had ulnar neuropathy. There was no association between the SWS SN stage and median or ulnar neuropathy.

CONCLUSIONS

Two neurological lesions should be investigated in patients presenting for HAVS assessment: compressive neuropathy and digital neuropathy. The prevalence of compressive neuropathies is high in patients being assessed for HAVS and therefore nerve conduction studies (NCS) should be included in HAVS assessment protocols. Comorbid proximal neuropathy does not affect the SWS SN stage; therefore, NCS and SWS SN seem to be measuring different neurological outcomes in HAVS patients.

Minimally invasive spine surgery: evaluation of clinical and functional outcomes and their correlation with the return to work

BACKGROUND

Intervertebral disc changes are a multi-factorial problem whose main clinical feature is pain. Studies show that when clinical treatments fail, the proposed surgical treatments frequently present unsatisfactory results. Traditional lumbar arthrodesis causes important clinical and functional changes that can result in complications and jeopardize the patients' quality of life.

OBJECTIVES

This study aims to investigate the clinical and functional results of minimally invasive spine surgery in patients with a clinical diagnosis of low-back or sciatic pain and segmental instability, finally correlating these results with the patients' return to work.

METHODS

Patients signed an informed consent form and were clinical and radiographically re-evaluated by independent professionals in the pre- and postoperative periods. Evaluation methods used the Oswestry disability index, as well as visual analog scale and Medical Outcomes Short Form Health Survey (SF-36) scores. We also retrieved epidemiological data, information on work resumption, and bone consolidation evaluations from the medical records.

RESULTS

We evaluated 19 patients who had been operated on 33 levels; visual analog scale and Oswestry disability index scores were initially reduced from 10% to 2% and from 64% to 28%, respectively. SF-36 scores were significantly higher in 5 of the 7 questionnaire scales at the end of the follow-up period. Most patients (68.4%) did not return to work after surgery; the others returned 2 to 67 months after the procedure. All patients received social security benefits after the surgery.

CONCLUSION

Although the procedure presented positive results, it did not result in a satisfactory return-to-work rate. Our results should be analyzed in view of the low educational level and income of the patients, the manual nature of their labor, and the validity of social security benefits.