Occupational Diseases

and their prevention

Doç. Dr. Selin Özen
BÜTF FTR
 Terminology
• Repetetive strain injury (RSI)
• Cumulative trauma disorder
• Overuse injury
• Work-related musculoskeletal disorder
 Definition
• Repetetive strain injury (RSI)
– a broad range of conditions
affecting muscles, tendons, tendon sheath,nerves, joi
nts particularly resulting from excessive and forceful
use. Strain, rapid movement, or constrained or
constricted posture may be other causes.
Examples:- tendonitis, neuritis, fascitis, carpal tunnel
syndrome, thoracic outlet syndrome, cubital tunnel
syndrome, degenerative arthritis,
tendinosis, fibromyalgia, herniated disk….
 Risk Factors
• Repetitive activities
• Long exposure to vibrations
• Longstanding static postures
• Wrong posture, working in a non-neutral
position
• Workload: Risk of RSI increases with
increased force/load exposure
• Poor condition of working environment
 Risk Factors
• Psychosocial factors
– Job satisfaction
– Feeling of wellbeing
– Mental health, psychological stress
– Patient and family coping mechanisms
– Lack of work –workplace control
– Monotony of work
– Bad workplace relationships
– Anxiety
 Risk factors
• Factors unrelated to work
– Age
– Sex
– Anthropometric factors (weight, height, BMI, body
circumference, waist to hip ratio, elbow amplitude
and knee-heel length)
– Smoking
– Physical fitness, muscle power
– Joint and spine mobility
– Structural abnormality
 Low Back Pain
• Low back problems: most commonly occuring problem
alongside neck pain and myofascial pain syndrome
– Most prominent risk factors: heavy physical workload, poor static and
dynamic posture and heavy lifting most.

– Psychosocial factors and all over body vibrations also important

– X3 as likely in workers who heavy lift, load, push,pull, carry

– Factors unrelated to work: BMI, age, sex, smoking, physical

fitness, lumbar mobility, power and structural abnormalities
 Clinical Diagnosis
• In most cases there is no standard diagnostic test,
diagnosis is made based on history and examination
findings
• History
– Time of symptom onset and symptom frequency
– Associated symptoms
– Exacerbating and relieving factors
– Systemic symptoms
– Activities responsible for symptoms
– Eliciting risk factors
 General Clinical Features
• Insidious onset of symptoms
• Association of sx with work intensity and
performance
• Disabling
• Preventable
• Diagnosis and treatment expenditure and loss
of working days economic burden is high
 Irony

– The culprit is the biomechanical

problem, the victim is the damaged
tissue; even so, clinicians often focus
on the victim rather than looking for
the culprit!
Prevalance of Musculoskeletal Problems amongst
Dentists
Prevalance of Musculoskeletal Problems amongst
Dentists
 Clinical Syndrome
• Low back pain
– Strain, intervertebral disc pathologies,
facet syndrome
• Lower extremity pain
– Hip pain
– Knee pain
– Radicular problems
• Myofascial pain syndrome
 Clinical Syndromes
• Neck pain
– Strain, intervertebral disk pathologies
• Upper extremity pain
– Shoulder girdle pain: rotator cuff problems,
capsulitis, bursitis
– Elbow pain: Epicondylitis
– Tendinitis: DeQuervain tendinitis…
– Entrapment neuropathies
– Non-specific upper extremity pain
 Lumber strain / sprain
Damage to varying stuctures depends on the weight of the
load applied. Large force applied to disproportionately
small area

Uncontrolled, excessive movement of vertebra

Damage to supporting tissues

Small force applied to large load

Muscle damage
↑ Risk of injury during flexion/rotation postures
Lomber strain / sprain
 Lomber strain / sprain
Working in sitting positiong with lower
back flexed
Low back extensors static contraction

Muscle fatigue

Ischaemia and injury

Intervertebral disk herniation
 Avoiding Low Back Pain
• Support normal lumbar lordosis
– 5-15° forward sloping of chair

– Saddle shaped chair will increase hip flexion to up

to 130° and help maintain lumbar lordosis

– Keep both feet fully placed on ground with weight

evenly distributed
 Avoiding Low Back Pain
• Maintain lumbar lordosis
– Stand close to patient, keep knees
underneath examination couch/ chair

– Slope upper back support forward so it also

makes contact with the lower back
 Avoiding Low Back Pain
• Avoid frequent turning and reaching

• Avoid static postures

– There is no single perfect working posture
– Frequently change your working posture
– Moving from sitting to standing position will
work different muscle groups and allow
recovery time for fatigued muscle
 Neck pain
• Life long prevalence > 70%
• Point prevalence 12-34%
• Results of epidemiological studies:
Neck pain is associated with
continued incorrect postures,
repetitive activities, hostile working
environment, heavy workload,
psychosocial factors and smoking
Incorrect Cervical Postures

Physiological spinal
curvature
Incorrect Cervical Postures
Forward head position

Scapular stabilizors, neck extensors

elongate, neck flexors shorten

Rounded shoulders, thoracic outlet

syndrome, disc degeneration
Sitting Position
 Incorrect Cervical Posture
Rotation and lateral flexion of head, neck and
body

Muscle imbalance

Ischaemia and pain of shortened muscles

Vertebral malalignment, reduced range of

movement
 Prevention of Neck Pain
• Use of forward sloping telescope will
reduced necessity for neck flexion
• Arm support reduces neck and shoulder
fatigue
• Stretching in opposite direction of poor
positioning
• Taking frequent short breaks, rest
periods should last longer than 50 seconds
 Shoulder Pain
• Shoulder problems: rotator cuff
tendinities, bicipital tendinitis,
capsulitis…
– Lifelong prevalence of shoulder pain: 7-10%
– Point prevalence up to 26%
– Risk factors: overhead activities, repetitive
activities
– Others: work intensity and stress
 Rotator cuff and subacromial bursa
• Muscles: Supraspinatus, infraspinatus,
Teres minor, Subscapularis
• Depression of head of humerus alongside
Biceps tendon
Impingement
syndrome
Thoracic Outlet Syndromes
Thoracic Outlet Syndromes

Hiperabdüksiyon
sendromu

Servikal kosta Skalenius antikus

sendromu
 Elbow Pain
• Elbow problems: epicondylitis (Lateral >
medial), bursitis
– Risk increases due to difficult manual activities
(especially nail screwing), repetitive activities and
vibrational activities
– Hand-wrist problems: tenosynovitis, trigger
finger….
– Risk factors: typewriting, vibration, female sex,
repetitive use, heavy physical activities
 Epicondylitis
• At essence a Temelde bir
tenoperiostitis
– Lateral epicondylitis: tennis elbow
– Medial epicondylitis: Golfer’s elbow
Lateral epikondilit
Medial epikondilit
Olecranon bursitis
 DeQuervaine tendinitis
• Abductor pollicis longus and extensor
pollicis brevis entrapment tenosynovitis
Trigger Finger
 Clinical Picture
• Non-specific arm/forearm pain
– Especially related to mechanical factors such as use of
keyboards. Also found to be as related to psychosocial
factors

• Entrapment neuropathies
– Carpal tunnel syndrome, cubital tunnel syndrome,
radial tunnel syndrome
• Workplace factors, exposure to forces and vibrations,
repetitive movements, inappropriate placement of
forearm, wrist and hand
 Entrapment
Neuropathies
 Clinical Picture
• Non-spesicif lower extremity problems
– Biomechanic risk factors have not been deciphered
Increased risk in those with high BMI, smoker,
chronic illness

• Hip and knee problems: Tendinitis, bursitis …

– Use of stairs, heavy lifting and carrying, working in
crouched positions are risk factors
Myofascial Pain
Syndrome (MPS)
 MPS: Patterns
of referred pain
MPS: Patterns of referred pain
 Laboratory Findings
 Non specific, important to rule out
differential diagnoses
 Imaging
 X-Ray
 Electroneuromyography
 Acute phase reactants
 MPS: Treatment
• Medical treatment
• Mostly symptomatic treatment
– Systemic agents
– Local injections
• Rehabilitation
• Paying attention to ergonomy
• Improve working conditions
• Psychosocial approach
 Rehabilitation Program
• Patient education
• Physiotherapy
– Controlled physical activity, avoid triggering activity

• Correction of posture
• Use of physical therapy modalities
• Home exercise program: stretching, strengthening, range of
motion and posture exercises
• Workplace ergonomics
Correct Desktop Ergonomy
Sitting Position
 Stretching exercises

• Anterior chest wall, hamstring,

paravertebral and hip flexor stretching
Stretching exercises
Stretching exercises
 Strengthening Exercises
• To maintain correct posture, perform
trunk, abdominal and shoulder girdle
strengthening exercises

• Avoid strengthening of anterior chest

walkk, anterior neck muscles, upper
trapezius and deltoids
 Prognosis
• Once cause of RSI has been identified, it can
be treated in 3-6 months, however recurrence
is frequent
• Patient education, motivation and preventative
measures are key to effective rehabilitation
• Home exercise program specific to patient’s
biomechanical needs is very important
Thank you