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Upper Limb Musculoskeletal Disorders: Quantifying Risk Factors



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  • Personal Author:
  • Description:
    A large scale, multi-site prospective cohort study of carpal tunnel syndrome (CTS) and other distal upper extremity (DUE) muscle-tendon disorders (MSDs) was incepted in 2002 with follow-up of the workers through 2009. The primary aims of the study were to quantify relationships between job physical factors and risk of CTS, as well as other DUE muscle-tendon disorders. A total of 1,205 workers from 21 different industries in three states (WI, IL and UT) were enrolled in the study. Overall participation rate was 81.4%. Complete baseline data were available on 1,099 workers and complete follow-up data on 1,065 workers with a total follow-up of 3,385.7 person-years. To date data have been analyzed on 536 workers and are reported here. All workers were rendered a questionnaire, structured interview, physical examination and bilateral nerve-conduction study (NCS) at the baseline to document and quantify demographic data, social history, psychosocial factors, past medical history, and CTS and other DUE muscle-tendon disorders status at the time of enrollment. A comprehensive job physical exposure assessment was made for each worker using worker interview, observations of job, measurements of job physical exposure variables and videotaping of the job. The cohort was followed monthly to ascertain CTS and other DUE muscle-tendon disorders status. Approximately every six months, those workers who were symptomatic were administered follow-up NCS tests. Workers were followed quarterly to ascertain a change in job physical exposure. The health outcome assessment team and job physical exposure assessment team were blinded to each other. CTS and lateral epicondylitis were analyzed for the first lifetime occurrence for each disease. First occurrence of any distal upper extremity disorder was analyzed in a virgin cohort with no prior history of distal upper extremity disorders (Any DUE MSD). At baseline point prevalence was 10.3% for CTS (symptoms + abnormal NCS), 14.9% for lateral epicondylitis and 35.8% for any DUE MSD; and lifetime prevalence was 19.8%, 23.1% and 56.5%, respectively. During an average of 38.2 months of follow-up there were 35 new CTS cases (10.3% of females and 4.5% of males). The incidence rates for CTS, lateral epicondylitis and any DUE MSD were 2.55, 5.75, and 13.67 per 100 person-years respectively. The multivariate Cox regression model with time-varying covariates that predicted increased risk of CTS included the Strain Index (SI) score > 6 (p = 0.008) BMI > 35kg/m2 (p <0.001), a diagnosis of one or more DUE muscle-tendon disorders (other than CTS) at baseline (p = 0.021), self-reported rheumatoid/inflammatory arthritis (p =0.007), gardening (p = 0.007), and feelings of mental exhaustion (p 0.035). SI scores demonstrated a dose-response relationship up to a SI score of 24 and two SI score categories, > 12 to ? 18 and > 18 to ? 24, had 3.7- and 9.1-fold increased risk (HR). There was no evidence of association between TLV for HAL as published and risk of CTS (p = 0.25), however a simplified, two-category model for the TLV for HAL (peak force/(10-HAL) raised from 0.78 to 0.84) showed evidence of association (p = 0.04) with a HR of 2.06 (95% CI = 1.04-4.10). For lateral epicondylitis the multivariate Cox regression model with time-varying covariates that predicted increased risk included Strain Index (SI) score > 8 (HR = 1.8, 95% CI = 1.02-3.16, p ? 0.043), age > 35, playing baseball, and feelings of depression. The TLV for HAL predicted increased risk of lateral epicondylitis (p = 0.028) for exposure above TLV (HR = 1.68, 95% CI = 0.87-3.24, p = 0.122) but reduced risk for exposure above AL and below TLV (HR = 0.7, 95% CI = 0.29 - 1.69, p =0.423). In the adjusted models for any DUE MSD, variables that predicted increased risk included worker peak force rating > 5 on Borg CR-10 scale, efforts/min > 22, Strain Index (SI) score > 7 calculated using worker peak force rating (overall p = 0.004) (HR = 1.41, 95% CI = 0.50 - 3.97, p =0.511 for SI > 7 and ? 36, HR = 2.88, 95% CI = 1.02-8.09, p 0.046), simplified 2-category TLV for HAL with TLV raised to 0.87 (HR = 1.73, 95% CI 1.10-2.71, p =0.017), age > 38 years and female gender. This study suggests a multifactor etiology for risk of CTS, lateral epicondylitis and any DUE MSD in general. Job physical factors play an important role. The results of this study should be useful to employers, engineers, and occupational health and safety professionals to analyze and design jobs to reduce cases of CTS, lateral epicondylitis as well as any DUE MSD. [Description provided by NIOSH]
  • Subjects:
  • Keywords:
  • Series:
    Grant Final Reports
  • Publisher:
    National Institute for Occupational Safety and Health
  • Document Type:
    Text
  • Funding:
    Cooperative Agreement
  • Genre:
    Final Cooperative Agreement Report
  • Place as Subject:
  • CIO:
    National Institute for Occupational Safety and Health (NIOSH)
  • Division:
    OEP - Office of Extramural Programs
  • Topic:
    Workplace Safety & Health
  • Location:
    North America
  • Pages in Document:
    1-149
  • NIOSHTIC Number:
    nn:20050200
  • NTIS Accession Number:
    PB2018-100188
  • Citation:
    Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, U01-OH-007917, 2010 Dec; :1-149
  • Contact Point Address:
    A. Garg, Center for Ergonomics, University of Wisconsin-Milwaukee, P.O. Box 784, Milwaukee, WI 53201, USA
  • Email:
    arun@uwm.edu
  • Federal Fiscal Year:
    2011
  • Performing Organization:
    University of Wisconsin
  • Peer Reviewed:
    False
  • Start Date:
    20020930
  • Source Full Name:
    National Institute for Occupational Safety and Health
  • End Date:
    20100929
  • Collection(s):
  • Main Document Checksum:
    urn:sha-512:48d78635ee2a79c88ea0b40fa4f41e89a4098f67e191b59a1e4c8ca71db8fed0f9b1509becb0e9c24e2da51332018d358287b88a27b73c3d24a09103baf053ee
  • Download URL:
  • File Type:
    Filetype[PDF - 6.53 MB ]
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