Work-Related Musculoskeletal Disorders of the Hand and Wrist: Epidemiology, Pathophysiology, and Sensorimotor Changes

Abstract

The purpose of this commentary is to present recent epidemiological findings regarding work-related musculoskeletal disorders (WMSDs) of the hand and wrist, and to summarize experimental evidence of underlying tissue pathophysiology and sensorimotor changes in WMSDs. Sixty-five percent of the 333 800 newly reported cases of occupational illness in 2001 were attributed to repeated trauma. WMSDs of the hand and wrist are associated with the longest absences from work and are, therefore, associated with greater lost productivity and wages than those of other anatomical regions. Selected epidemiological studies of hand/wrist WMSDs published since 1998 are reviewed and summarized. Results from selected animal studies concerning underlying tissue pathophysiology in response to repetitive movement or tissue loading are reviewed and summarized. To the extent possible, corroborating evidence in human studies for various tissue pathomechanisms suggested in animal models is presented. Repetitive, handintensive movements, alone or in combination with other physical, nonphysical, and nonoccupational risk factors, contribute to the development of hand/wrist WMSDs. Possible pathophysiological mechanisms of tissue injury include inflammation followed by repair and/or fibrotic scarring, peripheral nerve injury, and central nervous system reorganization. Clinicians should consider all of these pathomechanisms when examining and treating patients with hand/wrist WMSDs.

Risk factors for de Quervain’s disease in a French working population

“…Exposure to workpace dependent on the technical organization, which could represent a measure of the repetitiveness of the task, increased the risk of DQD. This agrees with previous studies on hand-wrist tendonitis (12,13,16,31,34,35). The multifactorial nature of disorders involving several biomechanical and organizational factors is coherent with the literature reporting higher risk of hand-wrist tendinitis for combined exposure to work-related risk factors (13,32).…”

“…This confirms results for hand-wrist tendinitis observed among workers highly exposed to wrist flexion/extension (16), pronation/supination (13) and, more generally, sustained or repeated postures of the hand and wrist (13,25,30,31,32). The influence of postural factors on the risk of DQD seems to be higher and more significant for DQD than for the other upper-extremity MSD in this working population (21).…”

“…The multifactorial nature of disorders involving several biomechanical and organizational factors is coherent with the literature reporting higher risk of hand-wrist tendinitis for combined exposure to work-related risk factors (13,32). Contrary to some studies, no association was found for the physical demands of the task, forceful exertion (12,13,31,34,35) or exposure to hand-wrist vibrations (31). DQD was not associated with computer use in our study, although a high incidence of DQD has been reported in a large cohort of computer users (36).…”

Hard work at home: musculoskeletal pain among female homemakers

“…Barr et al (2004) found that repetitive hand movements contributed in the development of MS disorders in the hand and wrist. In addition, Werner et al (2005) reported that repetitive hand movements were associated with upper extremity pain and discomfort.…”

ASIC3 in muscle mediates mechanical, but not heat, hyperalgesia associated with muscle inflammation

“…Chronic musculoskeletal pain conditions such as repetitive strain injury and tendonitis are clearly associated with peripheral tissue damage that includes inflammation of the muscle (Barr and Barbe, 2002;Barr et al, 2004;Stauber, 2004). Data from the Bureau of Labor and Statistics states that 53% of the private workforce had musculoskeletal pain over the last 2 weeks, and 13% of these lost productive work time with losses estimated at $61 billion per year.…”