Cumulative trauma illness currently accounts for over half of all occupational illness in the United States. From 1987 to 1989 there was a 100% increase in the reported number of cases of cumulative trauma illness (Bureau of Labor Statistics 1990). Shoulder region pain ranks second only to low back and neck pain in clinical frequency, and the occurrence of occupational shoulder illness is on the rise. This paper summarizes findings of a subset of recent epidemiologic, laboratory, and field studies conducted in order to identify occupational risk factors for cumulative trauma disorders (CTDs) of the shoulder region. These studies have identified the following risk factors as being associated with particular shoulder pain syndromes: awkward or static postures, heavy work, direct load bearing, repetitive arm movements, working with hands above shoulder height, and lack of rest. The paper begins with a discussion of several shoulder disorders, includes problems in studying cumulative trauma, presents results of recent studies, and concludes with suggested ergonomic controls that could help to reduce the incidence of shoulder disorders, by eliminating or reducing exposure to the associated risk factors.

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Objectives To characterize the burden of care and musculoskeletal discomfort associated with caring for adults with chronic physical disability among informal caregivers and to describe the most physically demanding caregiving activities, and contributing factors, as perceived by informal caregivers of adults with physical disabilities. Methods A mixed methods approach was used for the study. Forty-six informal caregivers of adults with physical disability participated in the study. Results Most of the caregivers were classified as “high burden” caregivers. They reported high levels of physical strain and musculoskeletal discomfort. Caregivers identified several activities related to mobility and self-care as the most physically demanding. Factors affecting physical demand included caregiver and care recipeint characteristics, activity requirements, and the physical environment. Conclusion Interventions that specifically target high demand caregiving activities, including all three aspects of caregiving activity performance, are necessary to support, in the home, adults with disabilities and their caregivers.

Objectives The use of sonography in musculoskeletal research and clinical applications is increasing; however, measurement techniques for diagnosing carpal tunnel syndrome with sonography continue to be inconsistent. Novel methods of measurement using internal comparisons to identify swelling of the median nerve require investigation and comparison to currently used techniques. Methods The flattening ratio of the median nerve, bowing of the flexor retinaculum, and cross-sectional area of the median nerve were collected in the forearm, at the radio-carpal joint, and at the level of the pisiform in both symptomatic patients and asymptomatic control participants. Electrodiagnostic testing was completed in symptomatic patients as a diagnostic standard. Results Median nerve measurements were collected from 166 wrists of symptomatic and asymptomatic participants. The flattening ratio did not show any correlation to electrodiagnostic testing and was identical between both symptomatic and asymptomatic participants. Moderate to strong correlations were noted between electrodiagnostic testing results and sonographic measurements of the cross-sectional area at the pisiform, retinacular bowing, and both the ratio and change of the cross-sectional area between the forearm and pisiform. The area under the curve was large for all receiver operating characteristic curves for each measurement (0.759–0.899), and sensitivity was high (80.4%–82.4%). Conclusions Measurement of swelling through a ratio or absolute change had similar diagnostic accuracy as individual measurement of the cross-sectional area within the carpal tunnel. These measures may be useful for improving accuracy in more diverse clinical populations. Further refinement of protocols to identify the largest cross-sectional area within the carpal tunnel region and statistical methods to analyze clustered, multilevel outcome data are recommended to improve diagnostics.

A model of visual and musculoskeletal strain associated with computer monitor placement was developed. The main premise of which is that monitor placement decisions must take into consideration development of both visual and musculoskeletal strains. Certain factors in the model that were thought to affect one or both types of strain. or that were considered important to rule out for effect, were tested in a lab setting. These factors were viewing angle (eye level, midlevel, low level), monitor size (14 in., 19 in.), keyboard familiarity (touch typist, nontouch typist), and task (reading, mousing, typing). Outcomes included indicators of visual and musculoskeletal strain, preference, and performance. Muscle activity was generally greater for the low viewing angle, for the standard monitor (14 in.), and for non-touch typists. Participants preferred the midlevel placement. Task performance was slightly diminished with eye-level placement. Results are interpreted in relation to the model and to several hypotheses that were formed to focus the inquiry. Actual or potential applications of this research include monitor placement decisions in the design or modification of computer workstations.