Are Work Disability Prevention Interventions Effective for the Management of Neck Pain or Upper Extremity Disorders? A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration Impact of Case Manager Training on Worksite Accommodations in Workers’ Compensation Claimants With Upper Extremity Disorders Epidemiologic surveillance of upper-extremity musculoskeletal disorders in the working population. Effect of yogic exercises on symptoms of musculoskeletal disorders of upper limbs among computer users: a randomised controlled trial. Upper extremity tourniquet effects in carpal tunnel release. An Aggressive Return‐to‐Work Program in Surgical Treatment of Carpal Tunnel Syndrome: A Comparison of Costs Job task and psychosocial risk factors for work-related musculoskeletal disorders among newspaper employees. Computer Professionals and Carpal Tunnel Syndrome (CTS) Pain in the neck and arm: a multicentre trial of the effects of physiotherapy, arranged by the British Association of Physical Medicine. Carpal tunnel syndrome pain treated with low-level laser and microamperes transcutaneous electric nerve stimulation: A controlled study. A randomised controlled trial evaluating the effects of two workstation interventions on upper body pain and incident musculoskeletal disorders among computer operators Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trail. Sickness Absence from Work among Persons with New Physician-Diagnosed Carpal Tunnel Syndrome: A Population-Based Matched-Cohort Study Single-Portal Endoscopic Carpal Tunnel Release Compared with Open Release: A Prospective, Randomized Trial Prospective, Randomized Evaluation of Endoscopic Versus Open Carpal Tunnel Release in Bilateral Carpal Tunnel Syndrome: An Interim Analysis Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomised controlled trial
Abstract Purpose We conducted a systematic review to critically appraise and synthesize literature on the effectiveness of work disability prevention ( WDP ) interventions in workers with neck pain , whiplash-associated disorders ( WAD ) , or upper extremity disorders . Methods We search ed electronic data bases from 1990 to 2012 . R and om pairs of independent review ers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria . Scientifically admissible studies were summarized and synthesized following best- evidence synthesis methodology . Results Of the 6,359 articles retrieved , 16 r and omized controlled trials were eligible for critical appraisal and five were admissible . We found that a return-to-work coordination program ( including workplace-based work hardening ) was superior to clinic-based work hardening for persistent rotator cuff tendinitis . Workplace high-intensity strength training and workplace advice had similar outcomes for neck and shoulder pain . Mensendieck/Cesar postural exercises and strength and fitness exercises had similar outcomes for non-specific work-related upper limb complaints . Adding a brief job stress education program to a workplace ergonomic intervention was not beneficial for persistent upper extremity symptoms . Adding computer-prompted work breaks to ergonomic adjustments and workplace education benefited workers ’ recovery from recent work-related neck and upper extremity complaints . Conclusions At present , no firm conclusions can be drawn regarding the effectiveness of WDP interventions for managing neck pain , WAD , and upper extremity disorders . Our review suggests a return-to-work coordination program is more effective than clinic-based work hardening . Also , adding computer-prompted breaks to ergonomic and workplace interventions benefits workers ’ recovery . The current quality of evidence does not allow for a definitive evaluation of the effectiveness of ergonomic interventions Management of the return-to-work process in cl aim ants with work-related upper extremity disorders often poses challenges to the health care provider , cl aim ant , and employer . Modifying workplace ergonomic risk factors as a component of the workplace accommodation process may improve return-to-work outcomes by reducing recurrent pain and discomfort . The present study is a case-control evaluation of the effects of a 2-day training program for nurse case managers  that was design ed to facilitate the implementation of workplace accommodations within a workers ’ compensation health care delivery system . After the training , 101 cl aim ants with compensable upper extremity disorders were r and omly assigned to case mangers with and without training . Overall , 208 accommodations were recommended and 155 of these were implemented ( 75 % ) . Cl aim ants of trained nurses received 1.5 times as many recommendations for accommodations  as cl aim ants managed by nurses not trained in the process , and 1.4 times as many accommodations were implemented , although no differences were found between the two groups in implementation rates . Trained nurses were more likely to recommend accommodations addressing workstation layout , computer-related improvements , furnishings , accessories , and lifting/carrying aids , whereas the untrained nurses were more likely to suggest light duty and lifting restrictions . This study indicates that the training was associated with a change in the practice behavior of case managers regarding the workplace accommodation process . More research is needed to identify barriers to implementation and develop more effective approaches to facilitate worksite accommodations in disabled workers with carpal tunnel syndrome and other persistent upper extremity disorders OBJECTIVE Since 2002 , an epidemiologic surveillance system of work-related , upper-limb musculoskeletal disorders ( MSDs ) has been implemented in France 's Pays de la Loire region to assess the prevalence of MSDs and their risk factors in the working population . METHODS The surveillance was based on a network of occupational physicians ( OPs ) and used the recommendations of a group of European experts ( criteria document consensus ) . In 2002 - 2003 , 80 of 400 OPs volunteered to participate . All underwent a training program to st and ardize the physical examination .  Health status was assessed by self-administered question naire and physical examination . Occupational risk factors were assessed by self-administered question naire .  Exposure scores were computed for each anatomic zone by summing the risk factors taken into account by the criteria document . RESULTS More than 50 % of the 2,685 men and women r and omly included in 2002 - 2003 experienced nonspecific musculoskeletal symptoms during the preceeding 12 months and approximately 30 % experienced them in the preceeding week . The prevalence of clinical ly diagnosed MSDs was high : approximately 13 % of workers experienced at least 1 of the MSDs . The most frequent disorder was rotator cuff syndrome followed by carpal tunnel syndrome and lateral epicondylitis . The prevalence of MSDs increased with age and varied widely across economic sectors and occupations . More than half of the workers were exposed to at least 2 risk factors of MSDs . Exposure varied according to industrial activity and occupation . According to the criteria document , a high percentage of MSD cases could be classified as probably work related ( 95 % in men and 89 % in women age < 50 , and 87 % in men and 69 % in women age > 50 ) . CONCLUSION Nonspecific upper-limb symptoms and specific upper-limb MSDs are common in the working population . These results show the need to implement prevention programs in most sectors to reduce the prevalence of MSDs BACKGROUND AND OBJECTIVES Upper extremity musculoskeletal disorders ( MSD ) are very common in regular computer users and leading cause of work related illness . The objective of the present study is to evaluate effectiveness of yogic exercises in the improvement of symptoms of MSDs of upper limbs . MATERIAL S AND METHODS 60 study participants were r and omly divided into two groups that is yoga with counselling and only counselling group for 12 weeks . Symptom severity and functional status were assessed using the self administered Boston Carpal Tunnel Question naire and pre design ed symptom question naire before and after intervention . RESULTS There was significant reduction in symptom severity score ( P = 0.002 ) and improvement in functional status score in yoga with counselling group when compared to only counselling group . There is also a significant decrease in self reported symptoms like CT myalgia symptom ( P = 0.019 ) and improvement in weakness . CONCLUSION The present study showed a yoga based regimen is more effective than counselling alone in relieving symptoms of computer related musculoskeletal disorders We studied the presence and extent of upper extremity denervation in limb muscles after surgical release of the carpal tunnel . Sixty consecutive patients were r and omly assigned to have the procedure performed with ( 31 patients ) or without ( 29 patients ) tourniquet application . Cervical paraspinal and upper extremity muscles were examined electromyographically 3 weeks before and 3 weeks after carpal tunnel release . Three weeks after the operation 77 % of the patients in the tourniquet group had denervation in other than thenar muscles . Only one patient in the control ( no tourniquet ) group had similar electromyographic abnormalities after surgery . Tourniquet time and pressure did not vary significantly between those patients with or without postoperative forearm denervation . Mean operative time for the tourniquet and control groups was nearly identical . These findings indicate that upper extremity tourniquet application results in sub clinical , temporary changes in the muscles of the forearm , probably on the basis of nerve changes and denervation Carpal tunnel syndrome is a common malady associated with modern manufacturing . An aggressive return-to-work program was begun in 1980 . A prospect i ve study was begun in 1982 , and data matured through 1988 comparing the costs of a control group of patients treated by the more traditional method ( in the author 's geographic area ) and the author 's aggressive return-to-work policy .  Sixty-seven patients with 94 carpal tunnel surgeries were studied . The results reveal that the aggressively treated group had 1 of 44 patients fail to return to work following surgery , and 3 of 23 failed to return to work from the control group . One patient of each group developed a recurrence . The tangible costs that could be computed were found to be 58 percent less in the aggressively treated group than in the control group . At the same time , the patients can maintain their st and ard of living OBJECTIVES A cross-sectional study was conducted to assess the association of upper extremity musculoskeletal disorders and work-related factors among employees using video display terminals at a large metropolitan newspaper . METHODS The study included 1050 r and omly selected workers from four departments . The workers were asked to complete question naires on symptoms , job tasks , and psychosocial and work organization conditions . Musculoskeletal disorders of the upper extremities were defined by frequency , duration , and intensity of symptoms not attributable to acute injury . Data were analyzed with the use of logistic regression . RESULTS A total of 973 workers completed the survey . The one-year period prevalence rate for any musculoskeletal disorder of the upper extremities was 41 % . Neck symptoms ( 26 % ) were the most frequently reported , followed by h and or wrist ( 22 % ) , shoulder ( 17 % ) , and elbow ( 10 % ) symptoms . Greater time working at the video display station was associated with increased h and or wrist symptoms in a dose-response relationship . In addition , variables corresponding to increased work-load dem and s ( eg , increased time working under deadline and increased job pressure ) were associated with increased neck , shoulder , and h and or wrist disorders . Women were more likely to report symptoms in several areas , but this finding may reflect the concentration of women in jobs involving more risk factors . CONCLUSIONS The results suggest a high prevalence of musculoskeletal disorders of the upper extremities among newspaper employees , and they provide additional evidence that increased work load , time pressure , and greater hours of computer use are related to the occurrence of work-related musculoskeletal disorders among these workers , particularly for disorders in the h and or wrist area Carpal Tunnel Syndrome ( CTS ) is an important problem among computer professionals . Hence the prevalence of CTS among computer professionals and risk factors were studied . 648 subjects were selected from 4,276 computer professionals from 21 companies with a simple r and om sampling method . CTS was diagnosed based on clinical features . The prevalence of CTS was found to be 13.1 % ( 95 % CI 10.5–15.7 % ) . Subjects with over 8 years of computer work , over 12 hrs of work per day and system administrators were at a higher risk for CTS ( OR 3.3 , 4.9 and 2.5 respectively ) . Flexed or extended h and position had higher risk for CTS . Higher risk for CTS was found with higher exposure to computer work . Ergonomic considerations are important in facilitating proper positioning of h and while working with a computer . Further studies on CTS risk factors among computer professionals are essential for planning prevention The British Association of Physical Medicine is planning to Though fulfilling these criteria the follo carry out a series of multicentre trials of physical treatments . excluded from the trial : The present paper is a report of the first trial , which was devoted 1 . Patients in whom the symptoms were to the conservative management of pain in tle upper limb to local lesions such as cervicalrib , rotate believed to arise within the neck . This syndrome was chosen shoulder , tennis-elbow  , or a  carpal-tunnel sy ] because it is very common and often treated by physical 2 . Patients who had definitive disorders methods , though with little evidence of their value . Furthersuch asrheumatoid arthritis or Paget 's di , more , it has been the subject of a preliminary -studf ( Steinberg bony injury to the cervical spine in the prec and Mason , 1959 ) . 3 . Patients with abnormal neurological s An advisory committee1 was set up to plan the trial , and nine compression . London hospitals ' agreed to take part . 4 . Patients currently being treated phenylbutazone OBJECTIVE To investigate whether real or sham low-level laser therapy ( LLLT ) plus microamperes transcutaneous electric nerve stimulation ( TENS ) applied to acupuncture points significantly reduces pain in carpal tunnel syndrome ( CTS ) . DESIGN R and omized , double-blind , placebo-control , crossover trial . Patients and staff administered outcome measures blinded . SETTING Outpatient , university-affiliated Department of Veterans Affairs medical center . PARTICIPANTS Eleven mild to moderate CTS cases ( nerve conduction study , clinical examination ) who failed st and ard medical or surgical treatment for 3 to 30 months . INTERVENTION Patients received real and sham treatment series ( each for 3 - 4wk ) , in a r and omized order . Real treatments used red-beam laser ( continuous wave , 15mW , 632.8 nm ) on shallow acupuncture points on the affected h and , infrared laser ( pulsed , 9.4W , 904 nm ) on deeper points on upper extremity and cervical paraspinal areas , and microamps TENS on the affected wrist . Devices were painless , noninvasive , and produced no sensation whether they were real or sham . The h and was treated behind a hanging black curtain without the patient knowing if devices were on ( real ) or off ( sham ) . MAIN OUTCOME MEASURES McGill Pain Question naire ( MPQ ) score , sensory and motor latencies , and Phalen and Tinel signs . RESULTS Significant decreases in MPQ score , median nerve sensory latency , and Phalen and Tinel signs after the real treatment series but not after the sham treatment series . Patients could perform their previous work ( computer typist , h and yman ) and were stable for 1 to 3 years . CONCLUSIONS This new , conservative treatment was effective in treating CTS pain ; larger studies are recommended Background : Call centre work with computers is associated with increased rates of upper body pain and musculoskeletal disorders . Methods : This one year , r and omised controlled intervention trial evaluated the effects of a wide forearm support surface and a trackball on upper body pain severity and incident musculoskeletal disorders among 182 call centre operators at a large healthcare company . Participants were r and omised to receive ( 1  ) ergonomics training only , ( 2 ) training plus a trackball , ( 3 ) training plus a forearm support , or ( 4 ) training plus a trackball and forearm support . Outcome measures were weekly pain severity scores and diagnosis of incident musculoskeletal disorder in the upper extremities or the neck/shoulder region based on physical examination performed by a physician blinded to intervention . Analyses using Cox proportional hazard models and linear regression models adjusted for demographic factors , baseline pain levels , and psychosocial job factors . Results : Post-intervention , 63 participants were diagnosed with one or more incident musculoskeletal disorders  . Hazard rate ratios showed a protective effect of the armboard for neck/shoulder disorders ( HR = 0.49 , 95 % CI 0.24 to 0.97 ) after adjusting for baseline pain levels and demographic and psychosocial factors . The armboard also significantly reduced neck/shoulder pain ( p = 0.01 ) and right upper extremity pain ( p = 0.002 ) in comparison to the control group . A return-on-investment model predicted a full return of armboard and installation costs within 10.6 months . Conclusion : Providing a large forearm support combined with ergonomic training is an effective intervention to prevent upper body musculoskeletal disorders and reduce upper body pain associated with computer work among call centre employees OBJECTIVE To compare the efficacy of conservative medical care with chiropractic care in the treatment of carpal tunnel syndrome . DESIGN Two-group , r and omized , single-blind trial with 9 wk of treatment and a 1-month follow-up interview . SETTING Wolfe-Harris Center for Clinical Studies at Northwestern College of Chiropractic in Bloomington , Minnesota . PATIENTS Ninety-one of 96 eligible subjects who reported symptoms that were confirmed by clinical exam and nerve conduction studies . INTERVENTIONS Interventions included ibuprofen ( 800 mg 3 times a day for 1 wk , 800 mg twice a day for 1 wk and 800 mg as needed to a maximum daily dose of 2400 mg for 7 wk ) and nocturnal wrist supports for medical treatment . Chiropractic treatment included manipulation of the soft tissues and bony joints of the upper extremities and spine ( three treatments/week for 2 wk , two treatments/week for 3 wk and one treatment/week for 4 wk ) , ultrasound over the carpal tunnel and nocturnal wrist supports . MAIN OUTCOME MEASURES Outcome measures were pre- and post assessment s of self-reported physical and mental distress , nerve conduction studies and vibrometry . RESULTS There was significant improvement in perceived comfort and function , nerve conduction and finger sensation overall , but no significant differences between groups in the efficacy of either treatment . CONCLUSIONS Carpal tunnel syndrome associated with median nerve demyelination but not axonal degeneration may be treated with commonly used components of conservative medical or chiropractic care Background Carpal tunnel syndrome is common among employed persons . Data on sickness absence from work in relation to carpal tunnel syndrome have been usually based on self-report and derived from clinical or occupational population s. We aim ed to determine sickness absence among persons with physician-diagnosed carpal tunnel syndrome as compared to the general population . Methods In Skåne region in Sweden we identified all subjects , aged 17–57 years , with new physician-made diagnosis of carpal tunnel syndrome during 5 years ( 2004–2008 ) . For each subject we r and omly sample d , from the general population , 4 matched reference subjects without carpal tunnel syndrome ; the two cohorts comprised 5456 and 21,667 subjects , respectively ( 73 % women ; mean age 43 years ) . We retrieved social insurance register data on all sickness absence periods longer than 2 weeks from 12 months before to 24 months after diagnosis . Of those with carpal tunnel syndrome 2111 women ( 53 % ) and 710 men ( 48 % ) underwent surgery within 24 months of diagnosis . We compared all-cause sickness absence and analyzed sickness absence in conjunction with diagnosis and surgery . Results Mean number of all-cause sickness absence days per each 30-day period from 12 months before to 24 months after diagnosis was significantly higher in the carpal tunnel syndrome than in the reference cohort . A new sickness absence period longer than 2 weeks in conjunction with diagnosis was recorded in 12 % of the women ( n = 492 ) and 11 % of the men ( n = 170 ) and with surgery in 53 % ( n = 1121 ) and 58 % ( n = 408 ) of the surgically treated , respectively ; median duration in conjunction with surgery was 35 days ( IQR 27–45 ) for women and 41 days ( IQR 28–50 ) for men . Conclusions Persons with physician-diagnosed carpal tunnel syndrome have substantially more sickness absence from work than age and sex-matched persons from the general population from1 year before to 2 years after diagnosis . Gender differences were small Background : Carpal tunnel syndrome is a common condition causing h and pain and numbness .  Endoscopic carpal tunnel release has been demonstrated to reduce recovery time , although previous studies have raised concerns about an increased rate of complications . The purpose of this prospect i ve , r and omized study was to compare open carpal tunnel release with single-portal endoscopic carpal tunnel release . Methods : A prospect i ve , r and omized , multicenter center study was performed on 192 h and s in 147 patients . The open method was performed in ninety-five h and s in seventy-two patients , and the  endoscopic method  was performed in ninety-seven h and s in seventy-five patients . All of the patients had clinical signs or symptoms and electrodiagnostic findings consistent with carpal tunnel syndrome and had not responded to , or had refused , nonoperative management . Follow-up evaluations with use of vali date d outcome instruments and quantitative measurements of grip strength , pinch strength , and h and dexterity were performed at two , four , eight , twelve , twenty-six , and fifty-two weeks after the surgery . Complications were identified . The cost of the procedures and the time until return to work were recorded and compared between the groups . Results : During the first three months after surgery , the patients treated with the endoscopic method had better Carpal Tunnel Syndrome Symptom Severity Scores , better Carpal Tunnel Syndrome Functional Status Scores , and better subjective satisfaction scores . During the first three months after surgery , they also had significantly ( p < 0.05 ) greater grip strength , pinch strength , and h and dexterity . The open technique result ed in greater scar tenderness during the first three months after surgery as well as a longer time until the patients could return to work ( median , thirty-eight days compared with eighteen days after the endoscopic release ) . No technical problems with respect to nerve , tendon , or artery injuries were noted in either group . There was no significant difference in the rate of complications or the cost of surgery between the two groups . Conclusion : Good clinical outcomes and patient satisfaction are achieved more quickly when the endoscopic method of carpal tunnel release is used . Single-portal endoscopic surgery is a safe and effective method of treating carpal tunnel syndrome Background Most r and omized trials have shown similar results with endoscopic carpal tunnel release ( ECTR ) and open carpal tunnel release ( OCTR ) ; however , there are studies suggesting less postoperative pain , faster improvement in grip and pinch strength , and earlier return to work with the endoscopic technique . The goal of this study was to prospect ively examine subjective and functional outcomes , satisfaction , and complications after both ECTR and OCTR in the opposite h and s of the same patient , serving as their own control . Methods This was a prospect i ve , r and omized study in which patients underwent surgery for bilateral carpal tunnel syndrome . The first carpal tunnel release was performed on the most symptomatic h and —determined by the patient . Operative approach was r and omly assigned and , approximately 1 month later , the alternative technique was performed on the contralateral side . Demographic data were obtained , and functional outcomes were recorded preoperatively and postoperatively , including pain score , 2-point discrimination , Semmes-Weinstein monofilament testing , thenar strength , and overall grip strength . The carpal tunnel syndrome-functional status score and carpal tunnel syndrome-symptom severity score were recorded before surgery and at 2 , 4 , 8 , 12 , and 24 weeks postoperatively . Overall satisfaction with each technique was recorded at the conclusion of the study . Results Currently , 25 subjects have completed final visit testing . There were no differences in pain score , 2-point discrimination , Semmes-Weinstein monofilament testing , thenar strength , or overall grip strength at any of the postoperative time points . Carpal tunnel syndrome-symptom severity score and carpal tunnel syndrome-functional status score were not significantly different between groups at any of the evaluations . Overall satisfaction , where patients recorded a number from 0 to 100 , was significantly greater in the ECTR group ( 95.95 vs 91.60 , P = 0.04 ) . There were no complications with either technique . Discussion This interim analysis , using the same patient as an internal control , suggests that both OCTR and ECTR are well tolerated with no differences in functional outcomes , symptom severity and functional status question naires , or complications . Although there were no differences between groups using our study metrics , patients still preferred the ECTR , demonstrated by significantly higher overall satisfaction scores at the conclusion of the study Abstract Objectives To compare endoscopic and open carpal tunnel release surgery among employed patients with carpal tunnel syndrome . Design and setting R and omised controlled trial at a single orthopaedic department . Participants 128 employed patients aged 25 - 60 years with clinical ly diagnosed and electrophysiologically confirmed idiopathic carpal tunnel syndrome . Main outcome measures The primary outcome was severity of postoperative pain in the scar or proximal palm and the degree to which pain or tenderness limits activities , each rated on a 4 point scale , transformed into a combined score of 0 ( none ) to 100 ( severe pain or tenderness causing severe activity limitation ) . The secondary outcomes were length of postoperative work absence , severity of symptoms of carpal tunnel syndrome and functional status scores , SF-12 quality of life score , and h and sensation and strength ( blinded examiner ) ; follow-up at three and six weeks and three and 12 months . Results 63 patients were allocated to endoscopic surgery and 65 patients to open surgery , with no withdrawals or dropouts . Pain in the scar or proximal palm was less prevalent or severe after endoscopic surgery than after open surgery but the differences were generally small . At three months , pain in the scar or palm was reported by 33 patients ( 52 % ) in the endoscopic group and 53 patients ( 82 % ) in the open group ( number needed to treat 3.4 , 95 % confidence interval 2.3 to 7.7 ) and the mean score difference for severity of pain in scar or palm and limitation of activity was 13.3 ( 5.3 to 21.3 ) . No differences between the groups were found in the other outcomes . The median length of work absence after surgery was 28 days in both groups . Quality of life measures improved substantially . Conclusions In carpal tunnel syndrome , endoscopic surgery was associated with less postoperative pain than open surgery , but the small size of the benefit and similarity in other outcomes make its cost effectiveness uncertain
Limited evidence was also found for a causal relationship between  computer work per se and computer mouse time related to tension neck syndrome , but the evidence for keyboard time was insufficient .
Insufficient evidence was found for an association between other musculoskeletal diagnoses of the neck and upper extremities , including shoulder tendonitis and epicondylitis , and any aspect of computer work .
Conclusions There is limited epidemiological evidence for an association between aspects of computer work and some of the clinical diagnoses studied .
Background This review examines the evidence for an association between  computer work and neck and upper extremity disorders ( except carpal tunnel syndrome ) .