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Between the state of well-being and that of illness, an intermediary state often occurs, characterized by feelings of uneasiness, fatigue and pains. The study of these intermediary states in function of the work load (posture, noises, heat, etc.) constitutes an important feature of ergonomics. In this study we present the results of two polls showing pains due to inappropriate postures. Many observations of occupational medicine lead us to believe that pathological troubles of rheumatic order (arthritis, periathritis, tendinitis, myalgias, arthroses) can appear as a result of inappropriate postures and repetitive movements over a number of years. Thus, the ergonomic analysis of the work place can help to determine the risk of illness.
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PMID:[Management of the work place. Erogonomics and occupational medicine for the benefit of prevention]. 15 76

Upper extremity cumulative trauma disorders became a potentially significant occupational hazard among sign language interpreters at the National Technical Institute for the Deaf in the 1988-89 academic year. The following case control study was conducted to identify factors that might play a role in developing, exacerbating, and maintaining upper extremity cumulative trauma disorders among interpreters. Investigations were conducted to determine whether medical status, physical capacities, interpreting styles, pain, fatigue, and job stress differed among NTID's sign language interpreters. This report provides a general summary of selected findings as well as a conceptual framework that should help clarify the factors associated with upper extremity cumulative trauma disorders in sign language interpreters. The results indicated that the upper extremity cumulative trauma disorder diagnosed most often is tendinitis rather than a nerve entrapment syndrome (e.g., carpal tunnel syndrome). Analysis of the frequency of potential biomechanical risk factors indicated that those reporting pain demonstrated higher frequency of hand and wrist deviations from the neutral position, higher frequency of the upper extremities leaving a predefined work space, fewer rest breaks during interpreting sessions, and higher evaluator ratings of pace of finger and hand movements. Specific features of interpreting styles were associated with increased pain and fatigue.
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PMID:Cumulative trauma disorders among educational interpreters. Contributing factors and intervention. 141 70

Serum creatine kinase (SCK) was measured in ten subjects in the laboratory before and after the performance of bicycle ergometry and a lifting task. SCK was significantly increased 24 h and 48 h after the lifting work but not after the bicycle ergometry, although the work performed on the latter was four-times as great as on the former. The lifting work resulted in muscle pain and tenderness and, for six subjects, in clinical signs of shoulder tendinitis. In a field study, an increase in SCK was noted among assemblers/welders and cash-register operators, but not among controllers and forklift-truck drivers. A health interview revealed that musculo-skeletal complaints were most often located in the upper extremity in the cases of the assemblers/welders and the cash-register operators. It is proposed that the SCK increase during work is a result of a high local muscular load due to fatigue and energy depletion of muscle cells producing a greater efflux of muscle enzymes. The evaluation of SCK changes during work may be an important tool in occupational health for early detection of work tasks producing local muscular strain.
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PMID:Serum creatine kinase as an indicator of local muscular strain in experimental and occupational work. 717 22

Surface electromyography was performed for both heads of the biceps brachii in 11 healthy men while the muscles were under 30% maximum isometric shoulder flexion and abduction. Elbow related biceps activity was minimized by using a brace locked in neutral forearm rotation. Electromyographic activity was normalized as a percentage of maximal muscle contraction during 24 shoulder motions. Electromyographic activity was detected in all motions examined, suggesting that the biceps muscle acts as a flexor and an abductor of the shoulder. Both heads of the biceps muscle had higher activities during external rotation than during internal rotation for most motions. Activities of both heads increased with arm elevation, but showed little dependence on elbow position. The long head was still active during internal rotation of the shoulder. These findings also suggest that the biceps muscle is a flexor and an abductor of the shoulder, and that the long head can act as a humeral head stabilizer in superior and anterior directions. Muscle fatigue of the biceps and the deltoid muscle also was determined at 30% of maximum isometric flexion. All muscles had significantly decreased mean power frequency and turns count, and increased amplitude and integrated electromyography. The rate of decrease in mean power frequency was larger for the biceps than for the deltoid muscle, and the rate of increase in amplitude was larger for the long head of the biceps than for the short head or for the deltoid muscle. These findings suggest that the long head of the biceps must increase its mechanical output to keep the arm in elevation to a greater extent than do the short head and the deltoid muscle. This may be one of the causes of tendinitis or rupture of the long head.
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PMID:Electromyographic analysis of shoulder joint function of the biceps brachii muscle during isometric contraction. 975 71

Over-strain injury of the superficial digital flexor tendon (SDFT) is a common injury in the horse. Tendon appears to adapt to loads placed on it during development, but fatigue damage accumulates after skeletal maturity, which is inadequately repaired and predisposes to clinical tendinitis. In any population of horses, there is a wide variation in SDFT mechanical properties. A noncollagenous protein, cartilage oligomeric matrix protein (COMP), is particularly abundant during growth in the equine SDFT and has been proposed to have an organisational role in the formation of collagenous matrices. This study aimed to determine whether COMP levels were correlated to mechanical properties at skeletal maturity. Tendons from 2 groups of 12 horses were analysed: Group 1 horses with restricted age, 2 years +/- 2 months, showed a significant correlation between both ultimate tensile stress modulus of elasticity and stiffness and COMP, while Group 2 mature horses with varying age did not, because of age- and exercise-induced loss of COMP. These data supports the hypothesis that COMP is an important mediator in the growth of tendon. This data would suggest that the identification of low COMP levels in tendon during growth would indicate horses prone to tendon injury and methods of promoting COMP synthesis during growth would potentially improve tendon quality and reduce the risk of subsequent tendinitis.
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PMID:Correlation of cartilage oligomeric matrix protein (COMP) levels in equine tendon with mechanical properties: a proposed role for COMP in determining function-specific mechanical characteristics of locomotor tendons. 1240 94

The in vitro and in vivo mechanical properties of the superficial digital flexor tendon have been described. To date the focus has been on single load to failure testing, however refined in vivo methods may prove useful to evaluate the effects of treatment and exercise on tendons. During maximal exercise, the adult superficial digital flexor tendon operates close to its functional limits with a narrow biomechanical safety margin. This combined with exercise and age associated microdamage, and a limited adaptive ability may increase the risk of fatigue failure. Studies evaluating treatment regimens for tendonitis have focused on repair and regeneration and yielded varying results. It would appear that the superficial digital flexor tendon has a limited ability if any to adapt positively to exercise after maturity. In contrast, the foal's superficial digital flexor tendon may have a greater adaptive ability and may respond to an appropriate exercise regimen to produce a more functionally adapted tendon. Recent studies have shown that foals allowed free pasture exercise develop a larger, stronger, more elastic tendon compared to foals that were confined or subjected to a training program. Effects on the non-collagenous matrix appear to be responsible for these differences. In contrast, training or excess exercise may have permanent detrimental effects on the biomechanical and functional properties of the superficial digital flexor tendon in the foal. The implication is that the determination of optimum exercise intensity and timing, and the role of the non-collagenous matrix in tendon physiology in the young horse may hold the key to developing tendons more capable of resisting injury.
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PMID:Mechanical and functional properties of the equine superficial digital flexor tendon. 1612 39

Polymyalgia rheumatica is a disorder that affects people over 50 years of age. The etiology of the disease has not been hitherto clarified exactly. Its incidence among people over 50 is in the range of 0.1-0.5%. The incidence rate peaks in the age group of 60-70 years. It is also found in younger people, but far less frequently. The diagnosis is based primarily on locomotor complains--namely on pronounced pain, morning stiffness of the shoulder girdle, pelvic girdle and neck. Complaints relating to the arms and legs (such as muscular weakness, oedema, tendonitis etc.) are also observed, however, in one third of the cases. The diagnostic criteria are defined empirically. Polymyalgia rheumatica was formerly considered to be a form of elderly onset rheumatoid arthritis. The progressive erosion process is absent in the case of polymyalgia rheumatica unlike in the case of rheumatoid arthritis. Numerous factors are known, which point to a link between polymyalgia rheumatica and giant cell vasculitis, arthritis, but the precise nature of this relationship remains unknown. Both conditions affect the same age group in the general population and they are even found--not infrequently--in the same patient. Polymyalgia rheumatica can be found in 40% of the patients suffering from arthritis while the histological examination detected mild vasculitis in approximately 10% of the patients suffering for "isolated" polymyalgia rheumatica. The response to be given to the acute phase is similar in both disorders. Scandinavian authors consider polymyalgia rheumatica as the appearance of generalised arthritis. Arthroscopic, nuclear magnetic resonance imaging as well as isotopic studies show unequivocally, that in the background of the osteo-muscular symptoms, complaints, inflammation is to be found partly of the joints but primarily that of the periarticular synovial structures. The above mentioned--dominant--proximal symptoms can often mask the distal locomotor disorders (pitting oedema of the hands and feet, tendonitis, tendosynovitis, carpal tunnel syndrome). The disorder may be accompanied by atypical generalised symptoms (loss of appetite, weight loss, fever, fatigue). An excellent indicators of the acute phase reactions are erythrocyte sedimentation rate, C-reactive protein and interleukin-6. These are suitable for monitoring the effectiveness of the therapy, for indicating a relapse/recurrence. It should be noted, that polymyalgia rheumatica may also be present if the erythrocyte sedimentation rate and C-reactive protein values are low. This disorder is also characterised by fast and effective response to corticosteroid, which should be administered for 1-2 years. In some individual cases a different dosage regime may be necessary: steroid administered in low dosage over a longer period of time. Administration of methotrexate and anti-tumor necrotic factor-alpha may also be considered as alternative or adjuvant therapy for lowering the quantity of corticosteroid. Further multicenter, double blind studies should, however, be performed on large number of patients in this regard.
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PMID:[Polymyalgia rheumatica]. 1713 99

Work-related upper extremity disorders as epycondylitis and tendonitis are closely related to localized muscle fatigue of extensor forearm muscles. The aim of this work is to evaluate levels of activity, fatigue and interactions between the main extensor muscles of the wrist. Surface EMG signals were acquired from extensor carpi radialis (ECR), extensor digitorum comunis (EDC) and extensor carpi ulnaris (ECU) muscles during isometric contractions using linear electrode array technique. Parameters such as muscle fiber conduction velocity (CV), EMG average rectified value (ARV) and frequency parameters were estimated to study muscle activity during selective contractions, during a non specific task at different percentage of the maximum voluntary contraction (MVC) level and during a fatiguing exercise at 50% MVC. Results show that it is possible to enhance significantly ECR and ECU muscle ARV during their selective activation. Moreover, in the non selective task, ECU muscle ARV significantly decreases with respect to the other muscles with the increase of the MVC level. The activity of ECR muscle in a non specific task is predominant with respect to the other muscles at 80%MVC. EMG spectral parameters and CV show fatigue in all muscles during a sustained contraction at 50%MVC.
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PMID:Evaluation of muscle activity and fatigue in extensor forearm muscles during isometric contractions. 1728 83

Hypothyroidism usually presents insidiously with symptoms such as fatigue, cold intolerance, and weight gain. Less common findings include myalgia, arthralgia, and joint effusion. In the patient described here, a triathlete, interpretation of early signs and symptoms as typical tendinitis led to months of treatment failure. Considering hypothyroidism in the differential diagnosis for patients who have overuse syndromes can expedite treatment. Definitive diagnosis rests on testing of serum thyroid hormone levels. Treatment, which is usually quickly effective, consists of gradually adjusted thyroid hormone replacement.
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PMID:Hypothyroidism presenting as tendinitis. 2008 65

This longitudinal follow-up study of 203 patients with serologically confirmed chikungunya (CHIK) virus infection describes the clinical features of CHIK fever during the first and tenth months of illness. During the acute stage CHIK fever presents with a wide array of symptoms. The foremost chronic symptoms at the end of a month were rheumatism (75%) and fatigue (30%). During the tenth month of follow-up the symptoms/signs observed were joint pain/swelling (46%), fatigue (13%) and neuritis (6%). The cure rate at the end of 9 months was 51%. Among the patients who had joint pain, 36% (34/94) met the American College of Rheumatology criteria to classify them as having rheumatoid arthritis. A subpopulation of the patients with joint pain (20/94) was tested for rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibody, and the joints were imaged by X-ray and magnetic resonance imaging (MRI). All tested negative for RF and one tested positive for anti-CCP. A radiolucent lesion in the X-ray was seen in the bones of five patients. The MRI findings were joint effusion, bony erosion, marrow oedema, synovial thickening, tendinitis and tenosynovitis. The study proves with relative certainty that CHIK arthritis is chronic inflammatory erosive arthritis, which has implications for management of the infection.
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PMID:Clinical progression of chikungunya fever during acute and chronic arthritic stages and the changes in joint morphology as revealed by imaging. 2017 8


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