Objectives-To investigate the prevalence and risk factors of epicondylitis among cooks in nursery schools in a cross sectional study because they are suspected to have strenuous workloads on the hands and arms. Methods-Prevalence of epicondylitis among 209 nursery school cooks and 366 control workers aged 40-59 were studied. Both groups consisted of women workers chosen from 1299 subjects who agreed to participate from 1329 social welfare employees in a city. All workers were interviewed with a questionnaire and had a clinical examination of the tenderness to palpation of epicondyles and epicondylar pain provoked by resisted extension and flexion of the wrist. Results-Nursery school cooks had a significantly higher prevalence of epicondylitis (11.5%) than the controls (2.5%). In a logistic regression model, job title of the cook was also found to have a strong association with epicondylitis (odds ratio (OR) 5.4, 95% confidence interval (95% CI) 2.4 to 11.9) after adjustment for age, body length, and body mass index. Weaker associations were also found between epicondylitis and suspected job stress or workload scores for mechanical workload and psychosocial stressors based on factor analysis. Conclusions-This study supported the hypothesis that nursery school cooks had a higher prevalence of epicondylitis than other workers with less strenuous hand and arm tasks. It was suggested that risk factors of epicondylitis would be multifactorial, including mechanical workload and psychosocial factors. (Occup Environ Med 1998;55:172-179) Keywords: epicondylitis; cooks; cross sectional There have been several studies reporting a higher prevalence of musculoskeletal problems in cooks than in other occupational workers.

The Sauvé-Kapandji procedure has been performed in 15 non-rheumatoid patients with chronic distal radio-ulnar joint dislocation accompanied by joint damage or deformity. The clinical results were favourable; wrist pain improved in all patients, wrist flexion-extension was increased by more than 10 degrees in nine patients, grip strength of at least 80% of the contralateral wrist was achieved in 11 patients, and forearm rotation was more than 150 degrees in 12 patients. However, X-ray examination revealed an unstable proximal ulnar stump and radio-ulnar convergence in all patients similar to that associated with the Darrach procedure. Although the Sauvé-Kapandji procedure can preserve ulnar support of the wrist and is believed to yield more satisfactory results than the Darrach procedure, its extensive use is not recommended for non-rheumatoid distal radio-ulnar joint disorders, but it is recommended for chronic distal radio-ulnar joint dislocation with articular injury or deformity.

Forty-five patients with persistent ulnar-sided wrist pain and a positive ulnocarpal stress test were investigated by X-ray, arthrography, 99mTechnetium bone scanning, magnetic resonance imaging and wrist arthroscopy. Ulnar wrist pathology was positively identified in nine of 45 patients by X-ray, 18 of 37 by arthrography, 19 of 27 by bone scan, four of 33 by MRI, and in all 45 patients by arthroscopy. The final diagnosis was ulnocarpal abutment syndrome in 28 patients, traumatic triangular fibrocartilage (TFC) tear in six, lunotriquetral (LT) ligament tear in five, TFC and LT ligament tear in one, wrist arthritis in four and cartilaginous free body in one. The ulnocarpal stress test is a useful provocative test, and a positive test suggests the presence of ulnar-sided wrist pathology. The test is sufficiently sensitive to warrant further investigation by arthroscopy.

Ulnar variance was measured in 325 normal wrists and 41 wrists with Kienböck's disease. A positive correlation between ulnar variance and age was confirmed in normal wrists, and it was lower in males than in females. Therefore, studies comparing ulnar variance in abnormal and normal wrists require carefully selected age- and sex-matched controls. There was no significant difference in ulnar variance between Japanese with normal wrists and those affected by Kienböck's disease, when the effects of sex and age were taken into account. Based on these results, we believe that ulnar variance is highly unlikely to be an important predisposing factor in Kienböck's disease.

Most ulnar impaction syndrome cases have characteristic focal signal intensity changes in the ulnar part of the lunate. The signal intensity often returns to normal after ulnar recession arthroplasty.