LECTURE 6 -

WORK-RELATED
MUSCULOSKEL
ETAL
DISORDERS
(WMSDS)
1- Nunes, I., Bush, M., Ergonomics; a Systems Approach, IntechOpen, 2012
2 - Bridger, R.S., Introduction to Ergonomics 3rd Edition, CRC Press, 2009
3 - Bridger, R.S., Introduction to Ergonomics and Human Factors, 4 th Edition, CRC Press, 2018
4 – Workplace Safety and Insurance Board WMSD Fact Sheet, 2006
5 - https://orthoinfo.aaos.org/
6 – Canadian Centre for Occupational Health and Safety
7 – WSIBstatistics.ca
 KEY TOPICS
 Introduction (what are the numbers?)
 What are WMSD’S
 Structures impacted by WMSD’S
 Types of WMSD’S
 Stages of work-related musculoskeletal disorders and principles of
prevention
WHAT IS A WMSD?
 WMSD’s are diseases related and/or
aggravated by work that can affect the upper
limb extremities, the lower back area, and the
lower limbs. WMSD can be defined by
impairments of bodily structures such as
muscles, joints, tendons, ligaments, nerves,
bones and the localized blood circulation
system, caused or aggravated primarily by
work itself or by the work environment
INTRODUCTIO
N AND
BACKGROUND
 The World Health
Organization (WHO),
recognizing the impact of
“work-related”
musculoskeletal diseases,
has characterized
WMSDs as multifactorial
 INTRODUCTION

WSIB – Ontario - 2019

NUMBER OF CLAIMS
LET’S PUT THIS IN
PERSPECTIVE…

= 48429 + 83449
= 131878 claims

Avg. cost per claim = $2,484,000,000 / 131878

Avg. cost per claim = $18835.59
WHAT THE
LAW SAYS
ABOUT WMSD
INTRODUCTION
AND BACKGROUND
 The mechanism of WMSDs
is thought to be repeated
microtrauma at the cellular
level
 Repair capacity is exceeded
 'WMSD' is NOT a
diagnosis
  Cumulative trauma disorders (US)
 Repetitive strain injuries (RSIs;
Great Britian)
 Overuse disorders (ODs; sports
A ROSE medicine)
BY ANY  Occupational cervicobrachial
disorders (OCDs; Scandinavia)
OTHER  Regional musculoskeletal disorders
NAME... (rheumatologists)
 Work related disorders (World
Health Organization)
 RISK
FACTORS
Physical

Individual Psychosocial
 PHYSICAL
RISK FACTORS
 Epidemiological
studies have shown
that in the presence of
known risk factors; the
muscles, joints,
tendons, blood vessels,
and nerves are at risk
for musculoskeletal
disorders.

(Occupational Health and Safety Council of Ontario (2007). Musculoskeletal Disorders Prevention Series Part 3: MSD Prevention Toolbox - Final Draft.
Retrieved on February 11, 2013 from www.iapa.on.ca/documents/MSD_2006%20_Prevention_Toolbox.pdf).
ENIVRONMENTA
L-RELATED RISK
FACTORS
COLD ENVIRONMENTS

Compromise muscle efficiency and may

cause vascular and neurological
damage.
May require gloves that have been
shown to impact sensation thus leading
to additional force exertion.
VIBRATION
 Whole body vibration—WBV refers to mechanical
energy oscillations that are transferred to the body as
a whole (in contrast to specific body regions),
usually through a supporting system such as a seat or
platform.
 Typical exposures include driving automobiles
and trucks, and operating industrial vehicles.
 4Hz Low back, GI Issues
 Hand arm vibration (HAV)—manual work involving
vibrating power hand tools. HAV is the transfer of
vibration from a tool to a worker’s hand and arm.
The level of HAV is a function of the acceleration
level of the tool when grasped by the worker when in
use.
 <500 Hz
INDIVIDUAL RISK
FACTORS
INDIVIDUAL RISK FACTORS
 The field of ergonomics does not attempt to
screen workers for elimination as potential
employees.
 These factors vary depending on the study
but may include age, gender, smoking,
physical activity, strength, anthropometry
and previous WMSD, and degenerative joint
diseases.
AGE
 Although WMSD can impact workers
at any age, musculoskeletal
impairments, particularly of the back,
are among the most prevalent
occupational problems of middle aged
and older (Buckwalter et al., 1993)
workers.
 In addition to decreases in
musculoskeletal function due to the
development of age-related
degenerative disorders (i.e., arthritis),
loss of muscle fiber and degradation
of tissue strength with age may
increase the likelihood and severity of
soft tissue damage
SEXE
 Women are three times more
likely to have CTS than men
(Women.gov, 2011).
 Other reasons for the increased
presence of WMSDs in women
may be attributed to differences
in muscular strength and
anthropometry.
 Generally, women are at higher
risk of CTS between the ages of
45 and 54.
STRENGTH
 Epidemiologic evidence exists for the
relationship between back injury and
weak back strength in job tasks.
 Chaffin and Park (1973) found a
substantial increase in back injury
rates in subjects performing jobs
requiring strength that was greater
or equal to their isometric strength-
test values.
 The risk was three times greater in
weaker subjects.
ANTHROPOMETRY
 Weight, height, body mass index
(BMI) (a ratio of weight to height
squared), and obesity have all
been identified in studies as
potential risk factors for certain
WMSDs
 particularly CTS and lumbar
disc herniation.
 Vessey et al. (1990) found that the
risk for CTS among obese women
was double that of slender women.
 SMOKING
 Several studies have presented
evidence that smoking is
associated with low-back
pain, sciatica, or intervertebral
herniated disc (Finkelstein, 1995;
Frymoyer et al., 1983; Kelsey et al.,
1984; Owen and Damron, 1984;
Svensson and Anderson, 1983);
 Boshuizen et al. (1993) found
a relationship between
smoking and back pain only in
those occupations that
required physical exertion.
TRAINING
 An important part of a
successful ergonomic program
is training.
 The training of employees is
essential and should include
training employees:
• When the job is identified
as a hazard
• When employee is
assigned to the problem job
- Best time!
• Periodically, at least every
3 years
STRUCTURES
IMPACTED BY
WMSD’S
STRUCTURES IMPACTED BY
WMSD - MUSCLE

 Excessively stretching a
muscle can lead to a
strain.
 Obstruction of blood or
nerve supply to the
muscle can lead to
complete deterioration of
the muscle
STRUCTURES
IMPACTED BY WMSD -
MUSCLE (CONTINUED)

 Muscles can “cramp”

based on their inability to
remove waste products
 May also exhibit DOMS
which is a natural
response to abnormal
loading
 Stress may lead to an
increase in tension, past
normal resting tone
STRUCT  Collagen fibers in
tendons neither stretch
URES nor contract

IMPACTE  Scar tissue can develop,

making tendons more
D BY prone to repeated
injuries and chronic
WMSD - tension.
TENDON  The surfaces on a
tendon can become
S rough
 STRUCTURES IMPACTED BY
WMSD
TENDONS (cont.)
 Inflammation of a tendon can occur when
there is not enough synovial fluid in the
tendon sheath for lubrication and easy
gliding.
 This causes friction between the tendon
and its sheath
 These feelings result from an influx of
blood

ILO.ORG
STRUCTURES IMPACTED BY WMSD -
NERVES

Nerves are “blood-

thirsty” structures
Nervous system is
also the most extended
and connected system
in the body
STRUCTURES IMPACTED BY
WMSD - NERVES

Problem areas?
- Tunnels
- Branches
- Fixed
- Close to
unyielding
surfaces
 STRUCTURES
IMPACTED BY
WMSD - NERVES
 Increased pressure within the body occurs
when the position of a body part decreases
the size of the opening through which
nerves run.
 Nerve compression is primarily caused by
pressure from ligaments, tendons, muscles,
and bones
 “Pressure points”

 Hard surfaces and sharp edges

of workplaces, tools,
and
equipment can also trigger
nerve compression.

http://www.statefundca.com/safety/ErgoMatters/LaptopErgo.asp
STRUCTURES IMPACTED BY WMSD -
VASCULAR COMPRESSION

 Occurs when there is a constriction or

obstruction of blood flow supply
 Vascular compression can result in
ischemia which affects:
 Duration of muscular activities
 Recovery time of a fatigued muscle
 Vasospasm may also occur from
vibrations in certain body parts,
particularly in the hands and fingers.
  WMSDs can impact all areas of the body

SPECIFIC  The frequency of work-related

musculoskeletal injuries has led to
WORK- classification and definition of these
RELATED conditions in the medical and
occupational environments.
MUSCULOSK  The classification of the conditions allows
the scientific community to understand
ELETAL how to treat the conditions, as well as
provides information we can utilize to
DISORDERS design processes and equipment to
mitigate the risk factors.
SPECIFIC
WMSD’S
  The median nerve is
compressed when
CARPAL passing through the
TUNNEL bony carpal tunnel
(wrist).
SYNDR  The carpal tunnel
comprises eight carpal
OME bones at the wrist,
arranged in two
(CTS) transverse rows of four
bones each.
CARPAL
TUNNEL
SYNDROME
CTS is associated
with forceful and
repetitive work
 An increase in
pressure in the carpal
tunnel can cause CTS
if it affects the median
nerve or reduces
blood supply by
compressing
capillaries
 Symptoms include;
pain, numbness,
tingling, burning
sensations at the base
of the thumb
TENDINITIS
 When highly repetitive
movements are required, the
increase in blood supply to the
muscles may be associated
with decreased blood supply to
the tendon
 Tendinitis can result from
trauma or excessive use of a
joint and can afflict the wrist,
elbow, and shoulder joints.
  Overexertion of the
extensor muscles of the
LATERAL wrist
EPICONDY  Risk of injury is
LITIS increased by activities
requiring large or
(TENNIS prolonged grasping
ELBOW) forces
 Combined stressors
LATERAL EPICONDYLITIS
(TENNIS ELBOW)
  Tenosynovitis is a
repetition-induced
tendon injury that
involves the swelling of
TENOSYNO tendon sheaths
VITIS
 The most widely
recognized
tenosynovitis De
Quervain’s syndrome.
DEQUERVAIN’S
SYNDROME
 Occurs in hand-intensive
workplaces.
 Symptoms of these conditions
include pain, tingling, swelling,
numbness, and discomfort when
moving the thumb.
 DEQUERVAIN’S SYNDROME
 Characterized by pain on the
thumb side of the wrist and
impaired thumb function
 Activities requiring extensive
thumb use are associated with
this disorder
 Avoidance of ulnar deviation
when operating tools is
indicated

Finkelstein test. Arrow indicates location of pain when test is positive.

from the American Society for Surgery of the Hand: Brochure: de Quervain's Stenosing Tenosynovitis. Engelwood, CO, 1995.
TRIGGER
FINGER
Trigger finger occurs in
individual or multiple fingers
and results when the tendon
thickens or sheath swells
The finger then gets stuck in
a flexed position
 Catches as it runs in and out of
the sheath.
 Must passively straighten
http://www.andorrapediatrics.com/ap_folders/hand-outs/knowledge/finger_sprain.htm
 ISCHEMIA
Ischemia is a condition
that occurs when blood
supply to a tissue is
lacking.
A common cause of
ischemia is compressive
force in the palm of the
http://www.nhlbi.nih.gov/health/health-
hand.
topics/topics/raynaud/
  Vibration syndrome is
often referred to as
white finger, dead
finger, or Raynaud’s
HAND ARM disease.
VIBRATION  Excessive exposure to
SYNDROM vibrating
ES forces(<500Hz) and
cold temperatures may
lead to the development
of these disorders.
 RAYNAUD’S
DISEASE
Affects blood vessels
and nerves of the hands
or feet
If detected early it can
be prevented, if not there
can be permanent
damage

http://www.gerbing.com/RaynaudsRelief.com/index.html
THORACIC
OUTLET
SYNDROME
 Compression of nerves (brachial plexus)
and/or vessels (subclavian artery and vein) to
the upper limb.
 Symptoms of TOS include
 aching pain in the shoulder or arm,
 heaviness or easy fatigability of the arm
 numbness and tingling of the outside of the
arm or especially the fourth and fifth
fingers
 swelling of the hand or arm accompanied
by finger stiffness and coolness or pallor of
the hand.
 THORACIC OUTLET
SYNDROME
 Work activities such as
 carrying heavy shoulder loads
 pulling shoulders back and down
 reaching above shoulder level

 Can cause the inflammation and swelling of tendons and muscles in the shoulders
and upper arms.
 Weak shoulder muscles, long necks and sloped shoulders, poor posture and obesity
may contribute to thoracic outlet syndrome.
STAGES OF WMSD
STAGES OF WMSD
 Although WMSDs are cumulative in
nature, the recognition of these
disorders varies from person to
person.
 The signs and symptoms of
musculoskeletal disorders can appear
either slowly or suddenly.
 Three stages have been established to
categorize
these disorders gradually
STAGES OF WMSD
• Stage 1 (Early)
• Workers experience momentary aches and
tiredness during normal working hours.
• Symptoms go away on their own overnight and
over days off from work.
• Work performance is not affected during this
stage, but the symptoms can continue for weeks
or even months.
STAGES OF WMSD
• Stage 2 (Intermdiate)
• Symptoms include tenderness, swelling,
weakness, numbness, and pain that begins early
in the work shift and does not go away
overnight.
• Difficulty sleeping due to the pain and
discomfort.
• Reduction in work performance, specifically
repetitive work.
- Stage 2 symptoms usually last for
months.
STAGES OF WMSD
• Stage 3 (Late)
• Symptoms persist even when the
person is at complete rest.
• Frequently, sleep is disturbed and
pain is felt even with non-repetitive
motions.
• Work performance is highly
affected, even when performing
light tasks in daily life.
• Stage 3 symptoms persist for
months or years.
HOW ARE WMSD’S TREATED?
 Restriction of movement
 Application of heat or cold
 Exercise / Rehabilitation
 Medication
 Surgery
How can we tell if a job may cause WMSDs

RULA, REBA
Strain Index and NIOSH, etc…
 SUMMARY
 Awkward postures, repetitive work, or
handling heavy loads are among the
risk factors that studies have shown to
damage the bones, joints, muscles,
tendons, ligaments, nerves, and blood
vessels, leading to fatigue, pain, and
WMSDs.
 WMSDs are mostly cumulative,
resulting from repeated exposure to
loads at work over a period of time.
 Upper limbs (the hand, wrist, elbow,
and shoulder), the neck, and lower
back are particularly vulnerable to
MSDs.
 The design of tools, equipment,
processes, and work spaces can have a
tremendous effect on the risks and
occurrence of WMSD.