The WISTAH hand study: A prospective cohort study of distal upper extremity musculoskeletal disorders

Abstract

BackgroundFew prospective cohort studies of distal upper extremity musculoskeletal disorders have been performed. Past studies have provided somewhat conflicting evidence for occupational risk factors and have largely reported data without adjustments for many personal and psychosocial factors.Methods/designA multi-center prospective cohort study was incepted to quantify risk factors for distal upper extremity musculoskeletal disorders and potentially develop improved methods for analyzing jobs. Disorders to analyze included carpal tunnel syndrome, lateral epicondylalgia, medial epicondylalgia, trigger digit, deQuervain’s stenosing tenosynovitis and other tendinoses. Workers have thus far been enrolled from 17 different employment settings in 3 diverse US states and performed widely varying work. At baseline, workers undergo laptop administered questionnaires, structured interviews, two standardized physical examinations and nerve conduction studies to ascertain demographic, medical history, psychosocial factors and current musculoskeletal disorders. All workers’ jobs are individually measured for physical factors and are videotaped. Workers are followed monthly for the development of musculoskeletal disorders. Repeat nerve conduction studies are performed for those with symptoms of tingling and numbness in the prior six months. Changes in jobs necessitate re-measure and re-videotaping of job physical factors. Case definitions have been established. Point prevalence of carpal tunnel syndrome is a combination of paraesthesias in at least two median nerve-served digits plus an abnormal nerve conduction study at baseline. The lifetime cumulative incidence of carpal tunnel syndrome will also include those with a past history of carpal tunnel syndrome. Incident cases will exclude those with either a past history or prevalent cases at baseline. Statistical methods planned include survival analyses and logistic regression.DiscussionA prospective cohort study of distal upper extremity musculoskeletal disorders is underway and has successfully enrolled over 1,000 workers to date.

Factors Associated With Truck Crashes in a Large Cross Section of Commercial Motor Vehicle Drivers

“…Most of these items have been used elsewhere. 24,25 Reportable crashes were self-reported in response to the question ''Have you ever had any reportable motor vehicle crashes as a professional driver?'' Snoring was self-reported in response to the question ''Do you snore at night?''…”

Association Between Cardiovascular Risk Factors and Carpal Tunnel Syndrome in Pooled Occupational Cohorts

“…Strain Index scores, a combination of six job physical variables (force, repetition rate, duration of exertion, posture, speed of work, and task duration per day), were computed from these analyses. 12,43,44 CVD variables of age, treated and untreated, measured or self-reported past diagnosis of hypertension, tobacco use, and DM assigned a point value, stratified by gender, in accordance with the Framingham Heart Study (Table 1). 45 The Framingham score does not use BMI and cholesterol was excluded from the score metric because it was not measured.…”

“…[1][2][3][4][5][6][7][8] These factors have now been confirmed in several prospective cohort studies. [9][10][11][12][13][14][15][16] Whereas some have suggested work-related factors are the greatest risks, a population-based estimate of risk of CTS in the state of Wisconsin with an approximate population of 5 million demonstrated both high and increased risk among those over 65 years of age 17 apparently at least partially contradicting the assumption of a large overall magnitude of impact of occupational factors.…”

“…29 A recent meta-analysis reported tobacco use doubled risk of CTS in cross-sectional studies, but was not found to increase risk in either case-control or cohort studies. 37 Yet, many of the occupational epidemiological studies reported [9][10][11][12][13][14][15]38 are severely underpowered for diseases such as DM, as the prevalence of various diseases are naturally low in younger, employed workforces. The occupational cohorts were also largely not designed to test associations with CVD disease.…”

Tendinosis in Trigger Finger

“…A Cochrane protocol has been published, but no results have been reported so far 171 . Unfortunately, as already noted, the trigger finger diagnosis has often disappeared behind diffuse definitions e.g.…”