MUSCULO-SKELETAL DISORDERS DUE TO POOR ERGONOMICS

CONSIDERATION OF WORK STATION & OTHER FACILITIES

P.C.GHOSH
DIRECTOR (PHYSIOLOGY& ERGONOMICS), RETIRED
DEFENCE ENCLAVE, AIR FORCE STATION
6th STREET, 5th LANE, 38 MES ROAD
AVADI, CHENNAI-600 055
TEL : (044) 2684 1499, MOB: 09790972857 & 09869534184
E-mail: pcg_ghosh @rediffmail.com
cliphysiology@gmail.com
ghoshpareshchandra@yahoo.in

(Views expressed in the article are of author in no way it reflects the official
opinions of neither Govt. Of India, nor Central labour Institute, Mumbai)
 INTRODUCTION

Yes it is true that 80% of our daily work we perform under shed of industry
as occupation. Thus, various occupational diseases have a relationship with
one’s lively hood. Some of which about twenty nine has been declared as
occupationally compensable diseases because of degenatarative nature, non
reversible and other physiological complication as well as medical complication.
Most unfortunate part is the unfortunate physicians as well as patient who have
very limited option to diagnosis & treatment to patients. Man is endured to move
if we confine him / her for eight hour in his uncomfortable seat or work station
them most of the muscles joints tendons ligaments, are in static condition
incurring static fatigue. This static fatigue causes the development of lactic acid
in blood which is responsible for all musculo skeletal disorders. One has to
neutralize this lactic acid to remain healthy by moving, breaking operationm, rest
& Recovery etc.

All such incidence is the result of bad working posture, bad workstation,
and poor mainantenance of working facilities. One has to be responsible to up
keep their gadgets in order daily before on set of work. Thus a sizeable number
of cases can be reduced and human being can be prevented rather treating them
after development. Ergonomics can help in this particular example for significant
reduction of musculo skeletal disorders from shop floor. Modern day’s most
major problem is occupational back pain which is a major block of productivity
detonating health and safety of industrial population. 30% of our productive time
is wasted due to back pain alone besides absenteeism and other causes,
resulting 40% loss of working hours almost daily. These wasted time energy,
health, safety, finance all can be utilizing in productive way to promote health
safety at shop floor thereby management enjoy higher productivity not at the cost
of operator health sweat and fatigue.
 MUSCLE STRAIN

A strain is an injury to either a muscle or a tendon, the tissue that

connects muscles to bones. Depending on the severity of the injury, a strain may
be a simple overstretch of the muscle or tendon, or it can result in a partial or
complete tear. Muscle strain -- or muscle pull or even a muscle tear -- implies
damage to a muscle or its attaching tendons. You can put undue pressure on
muscles during the course of normal daily activities, with sudden heavy lifting,
during sports, or while performing work tasks. Muscle damage can be in the form
of tearing (part or all) of the muscle fibers and the tendons attached to the
muscle. The tearing of the muscle can also damage small blood vessels, causing
local bleeding (bruising) and pain (caused by irritation of the nerve endings in the
area).

SPRAIN

A sprain is an injury to a ligament, the tough, fibrous tissue that connects

bones to other bone. Ligament injuries involve a stretching or a tearing of this
tissue. A sprain typically occurs when people fall and land on an outstretched
arm, slide into base, land on the side of their foot, or twist a knee with the foot
planted firmly on the ground. This results in an overstretch or tear of the ligament
(s) supporting that joint The ankle is one of the most common injuries in
professional and recreational sports and activities. Most ankle sprains happen
when the foot abruptly turns inward (inversion) or outward (eversion) as an
athlete’s runs, turns, falls, or lands after a jump. One or more of the
Grade I-stretch and/or minor tear of the ligament without laxity (loosening).
Grade II - tear of ligament plus some laxity.
Grade III - complete tear of the affected ligament (very loose).
 CRAMP

A muscle cramp is an involuntarily and forcibly contracted muscle that

does not relax. When we use the muscles that can be controlled voluntarily, such
as those of our arms and legs, they alternately contract and relax as we move
our limbs. Muscles that support our head, neck, and trunk contract similarly in a
synchronized fashion to maintain our posture. A muscle (or even a few fibers of a
muscle) that involuntarily (without consciously willing it) contracts is in a "spasm."
If the spasm is forceful and sustained, it becomes a cramp. Muscle cramps
cause a visible or palpable hardening of the involved muscle.

Muscle cramps can last anywhere from a few seconds to a quarter of an

hour or occasionally longer. It is not uncommon for a cramp to recur multiple
times until it finally goes away. The cramp may involve a part of a muscle, the
entire muscle, or several muscles that usually act together, such as those that
flex adjacent fingers. Some cramps involve the simultaneous contraction of
muscles that ordinarily move body parts in opposite directions.

Cramps are extremely common. Almost everyone (one estimate is about

95%) experiences a cramp at some time in their life. Cramps are common in
adults and become increasingly frequent with aging. However, children also
experience cramps.

Any of the muscles that are under our voluntary control (skeletal muscles)
can cramp. Cramps of the extremities, especially the legs and feet, and most
particularly the calf (the classic "charley horse"), are very common. Involuntary
muscles of the various organs (uterus, blood vessel wall, bowels, bile and urine
passages, bronchial tree, etc.) are also subject to cramps. Cramps of the
involuntary muscles will not be further considered in this review. This article
focuses on cramps of skeletal muscle. Muscle cramps causes (vitamin
deficiency, drugs, lactic acid, dehydration, low calcium, potassium or
magnesium), treatment and prevention.

TENOSYNOVITIS

Tenosynovitis is the inflammation of the fluid-filled sheath (called the

synovium) that surrounds a tendon. Symptoms of tenosynovitis include pain,
swelling and difficulty moving the particular joint where the inflammation occurs.
When the condition causes the finger to "stick" in a flexed position, this is called
"stenosing" tenosynovitis, commonly known as "Trigger Finger". This condition
often presents with comorbid tendonitis.

Treatments for tenosynovitis depend on the severity of the inflammation

and location. Mild tenosynovitis causing small scale swelling can be treated with
non-steroidal anti-inflammatory drugs (NSAID) such as Naproxen, ibuprofen or
diclofenac (marketed as Voltaren and other trade names), taken to reduce
inflammation and as an analgesic. Resting the affected tendons is essential for
recovery; a brace is often recommended. [1] Physical or Occupational therapy
may also be beneficial in reducing symptoms. More acute cases are treated with
cortisone (steroid) injections, then a course of paracetamol and ibuprofen for
pain. Outpatient surgery can be used to enlarge the synovium. The sprained
tendon or limb is splinted for a week or so

Causes of tenosynovitis are unknown. Repeated use of hand tools can

precede the condition, as well as arthritis or injury. Tenosynovitis sometimes runs
in families and is generally seen more often in males than in females. The
causes for children are even less well known and have a recurrence rate of less
than 1-5% after treatment.[citation needed. Tenosynovitis is also linked to
infectious arthritis caused by bacteria such as Neisseria gonorrhoae.

Hand & Leg stenosynovities

TENDONITIS

What is tendonitis what causes for it? Tendonitis and tenosynovitis are
types of tendon injury. They can often occur together. Strictly speaking.
Tendonitis means inflammation of a tendon. (It is sometimes spelt tendonitis.)
Tenosynovitis means inflammation of the sheath that surrounds a tendon. (The
sheath is called the synovium.)
 However, more recently, it is thought that inflammation of the tendon and
the tendon sheath is not the whole picture in all cases. It is thought that most of
the time there is an injury, or several repeated small injuries or tears, to the
tendon. This may initially cause some inflammation of the tendon. But, in the
longer term, if these injuries continue, it can lead to tendon damage
(degeneration).

These injuries typically occur when tendons are overused. For example,
this may be after playing a lot of sport, or overuse in the course of your work.
(Tenosynovitis commonly occurs around the wrist. Overuse by lots of writing,
typing, assembly line work, etc, can trigger inflammation. This type of overuse
tendon injury is also known as repetitive strain injury (RSI).

However, in some cases, there is no history of overuse of the tendon, and

tendonitis or tenosynovitis seems to occur for no apparent reason. There are also
some other causes of tendonitis and tenosynovitis:

BURSITIS

Bursitis is inflammation of the fluid-filled sac (bursa) that lies between a

tendon and skin, or between a tendon and bone. The condition may be acute or
chronic. Causes, incidence, and risk factors Bursae are fluid-filled cavities near
joints where tendons or muscles pass over bony projections. They assist
movement and reduce friction between moving parts. Bursitis can be caused by
chronic overuse, trauma, rheumatoid arthritis, gout, or infection. Sometimes the
cause cannot be determined. Bursitis commonly occurs in the shoulder, knee,
elbow, and hip. Other areas that may be affected include the Achilles tendon and
the foot. Chronic inflammation can occur with repeated injuries or attacks of
bursitis. Symptoms you may notice: Joint pain and tenderness when you press
around the joint Stiffness and achiness when you move the affected joint
Swelling, warmth or redness over the joint. Treatment your health care provider
may recommend temporary rest or immobilization of the affected joint.
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may relieve
pain and inflammation. Formal physical therapy may be helpful as well. If the
inflammation does not respond to the initial treatment, it may be necessary to
draw out fluid from the bursa and inject corticosteroids. Surgery is rarely
required. Exercises for the affected area should be started as the pain goes
away. If muscle atrophy (weakness or decrease in size) has occurred, your
health care provider may suggest exercises to build strength and increase
mobility. Bursitis caused by infection is treated with antibiotics. Sometimes the
infected bursa must be drained surgically.

ARTHRITIS

Arthritis - some types of arthritis such as rheumatoid arthritis can

sometimes cause inflammation of tendon sheaths as well as joints. You would
normally have joint pains and swelling in addition to tendon problems. Infection -
this is a rare cause. The infection may occur because a cut or puncture wound to
the skin over a tendon may allow bacteria to get in to infect the tendon and/or
tendon sheath. However, infection sometimes spreads from other parts of the
body via the bloodstream to infect a tendon sheath. For example, a small number
of people who have gonorrhoea (a sexually transmitted infection) develop
tenosynovitis as a complication. Some doctors feel that tendonitis and
tenosynovitis should actually be called tendinosus or tendinopathy.
 LOW BACK PAIN

As we have seen from our introductory discussion the pain is either

electrical, chemical, hormonal impulse in excess of normal physiological
requirement of transmission in human system. The triggering mechanism of pain
is onset once this impulse is beyond the physiological requirement that is above
the threshold limits of impulse. The anatomical structure of human spine is made
of vertebrae put one after another making chain of boney column having a whole
inside through which the spinal cord is passing. The nerves are coming in
between the two vertebral bones known as peripheral nerve or spinal nerve
innervated through out the body. The spinal cords are made of bundles of
various nerves fibers making nervous tract. Each tract is named as per their
electrical functions and behavioral pattern of human. Besides this the spinal cord
is not straight but consists of lordosis and kyphosis which are mainly responsible
for various forwards, backwards and lateral movements. Without this lordosis and
kyphosis all other movements are not possible in human. One must have to be
care full for maintaining these lordosis and kyphosis of spine if one has to
maintain the normal functions of spine. The whole spinal cord is covered with
strong ligaments, and tendon, laminar sheets, unfortunately the lumber region at
L4 & L5 is exposed naturally having no cover. It is because of this anatomical
defective structure of the spine pain is mostly originated at this region and thus
called “low back pain”. In industry, at home and all walks of life we practiced
repetitive nature of industrial, house hold, or other operation causing strain
repetitively in particular parts of the body in this case back at (L4 & l% region)
thus pain occur. Now this particular industrial operation is required to be
maintained for a specific 8 hours work schedules. It is because of this particular
nature of industrial operation practiced for job or occupation the repetitive strain
injury or cervo-vrachial strains are known as occupational back pain. Over the
periods we have seen it has the link with occupations thus the name
“Occupational Back pain “is used for making understandable of this complex
patho-physiological phenomenon to scientist & physicians. The physicians are
linking it to occupational back pain so that the compensation can be linked with
compensable or notifiable disease at shop floor.

CERVICAL SPONDOLOSIS

Cervical spondylosis is a disorder in which there is abnormal wear on the

cartilage and bones of the neck (cervical vertebrae). It is a common cause of
chronic neck pain, pain Herniated disk Spinal stenosis. Cervical spondylosis is
caused by chronic wear on the cervical spine. This includes the disks or cushions
between the neck vertebrae and the joints between the bones of the cervical
spine. There may be abnormal growths or "spurs" on the bones of the spine
(vertebrae). These changes can, over time, press down on (compress) one or
more of the nerve roots. In advanced cases, the spinal cord becomes involved.
This can affect not just the arms, but the legs as well. Everyday wear and tear
may start these changes. People who are very active at work or in sports may be
more likely to have them. The major risk factor is aging. By age 60, most women
and men show signs of cervical spondylosis on x-ray. Other factors that can
make a person more likely to develop spondylosis are: Being overweight and not
exercising, Having a job that requires heavy lifting or a lot of bending and
twisting, Past neck injury (often several years before) Past spine surgery
 IMPIGENT SHOULDER

Impingement syndrome is a common condition affecting the shoulder and

is often seen in aging adults. This condition is closely related to shoulder bursitis
and rotator cuff tendinitis. These conditions may occur alone or in combination.
When an injury occurs to the rotator cuff muscles, which encase the shoulder
joint, they respond by swelling. However, because the rotator cuff muscles are
surrounded by bone, when they swell a series of other events occur. The
pressure within the muscles increases, which results in compression and loss of
blood flow in the small blood vessels. When the blood flow decreases, the
muscle tissue begins to fray like a rope. Motions such as reaching up behind the
back or reaching up overhead to put on a coat or blouse, for example, may cause
pain.
What Are the Symptoms of Shoulder Impingement Syndrome? The typical
symptoms of impingement syndrome include difficulty reaching up behind the
back, pain with overhead use of the arm and weakness of shoulder muscles. If
these muscles are injured for a long period of time, the muscle can actually tear
in two, resulting in a rotator cuff tear. This causes significant weakness and may
make it difficult for the person to elevate his or her arm. Some people will have
rupture of their biceps muscle as part of this continuing impingement process.

THORACIC OUT LET SYNDROME

 Thoracic outlet syndrome is a group of disorders that occur when the
blood vessels or nerves in the thoracic outlet — the space between your
collarbone and your first rib — become compressed. This can cause pain in your
shoulders and neck and numbness in your fingers. Common causes of thoracic
outlet syndrome include physical trauma from a car accident, repetitive injuries
from job- or sports-related activities, certain anatomical defects, such as having
an extra rib, and pregnancy. Even a long-ago injury can lead to thoracic outlet
syndrome in the present. Sometimes doctors can't determine the cause of
thoracic outlet syndrome. Treatment for thoracic outlet syndrome usually
involves physical therapy and pain relief measures. Most people improve with
these conservative approaches. In some cases, however, your doctor may
recommend surgery.

Thoracic outlet syndrome (TOS) is a syndrome involving compression at

the superior thoracic outlet [1] wherein excess pressure placed on a
neurovascular bundle passing between the anterior scalene and middle scalene
muscles.[2] It can affect one or more of the brachial plexus (nerves that pass into
the arm from the neck), the subclavian artery, and - rarely - the vein, which does
not normally pass through the scalene hiatus (blood vessels as they pass
between the chest and upper extremity. Rarely a Pancoast tumor (a rare form of
lung cancer in the apex of the lung may be the cause.

TOS may occur due to a positional cause - for example, by abnormal

compression from the clavicle (collarbone) and shoulder girdle on arm
movement. There are also several static forms, caused by abnormalities,
enlargement, or spasm of the various muscles surrounding the arteries, veins,
and/or brachial plexus, a fixation of a first rib, or a cervical rib.

Common orthopaedic tests used are the Adson's test, the Costoclavicular
Manoeuvre, and the Hands-Up test of East. Careful examination and X-ray are
required to differentially diagnose between the positional and static aetiologies,
first rib fixations, scalene muscle spasm, and a cervical rib or fibrous band.

CARPAL TUNNEL SYNDROME

From Wikipedia, the free encyclopedia Carpal tunnel syndrome

Classification and external resources. Transverse section at the wrist. The
median nerve is colored yellow. The carpal tunnel consists of the bones and
flexor retinaculum. Carpal Tunnel Syndrome (CTS) is an entrapment idiopathic
median neuropathy, causing paresthesia, pain, and other symptoms in the
distribution of the median nerve due to its compression at the wrist in the carpal
tunnel. The pathophysiology is not completely understood but can be considered
compression of the median nerve traveling through the carpal tunnel.[1] The
National Center for Biotechnology Information and highly cited older literature[2]
say the most common cause of CTS is typing.[3] More recent research by
Lozano-Calderón has cited genetics as a larger factor than use,[4] and has
encouraged caution in ascribing causality.[5]
The main symptom of CTS is intermittent numbness of the thumb, index,
long and radial half of the ring finger.[6] The numbness usually occurs at night,
as humans tend to sleep with flexed wrists. It can be relieved by wearing a wrist
splint that prevents flexion.[7] Long-standing CTS leads to permanent nerve
damage with constant numbness, atrophy of some of the muscles of the thenar
eminence, and weakness of palmar abduction.[8] Pain in carpal tunnel syndrome
is primarily numbness that is so intense that it wakes one from sleep. Pain in
electrophysiologically verified CTS is associated with misinterpretation of
nociception and depression.[9]

Carpal tunnel syndrome (CTS) is an entrapment median neuropathy,

causing paresthesia, pain, numbness, and other symptoms in the distribution of
the median nerve due to its compression at the wrist in the carpal tunnel. The
pathophysiology is not completely understood but can be considered
compression of the median nerve traveling through the carpal tunnel.[1] The
National Center for Biotechnology Information and highly cited older literature[2]
say the most common cause of CTS is typing.[3] More recent research by
Lozano-Calderón has cited genetics as a larger factor than use,[4] and has
encouraged caution in ascribing causality.[5]

The main symptom of CTS is intermittent numbness of the thumb, index,

long and radial half of the ring finger.[6] The numbness often occurs at night, with
the hypothesis that the wrists are held flexed during sleep. Recent literature
suggests that sleep positioning, such as sleeping on one's side, might be an
associated factor.[7] It can be relieved by wearing a wrist splint that prevents
flexion.[8] Long-standing CTS leads to permanent nerve damage with constant
numbness, atrophy of some of the muscles of the thenar eminence, and
weakness of palmar abduction.[9]

Pain in carpal tunnel syndrome is primarily numbness that is so intense

that it wakes one from sleep. Pain in electrophysiologically verified CTS is
associated with misinterpretation of nociception and depression.[10] Palliative
treatments for CTS include use of night splints and corticosteroid injection. The
only scientifically established disease modifying treatment is surgery to cut the
transverse carpal ligament.[11]
 REFERENCES

1. Steele M, Norvell JG; eMedicine. Tendonitis. Updated: Mar 31, 2008.

2. van Tulder M, Malmivaara A, Koes B; Repetitive strain injury. Lancet.
2007 May 26;369(9575):1815-22. [abstract]
3. Xu Y, Murrell GA; The basic science of tendinopathy. Clin Orthop Relat
Res. 2008 Jul;466(7):1528-38. Epub 2008 May 14. [abstract]
4. Andres BM, Murrell GA; Treatment of tendinopathy: what works, what
does not, and what is on the horizon. Clin Orthop Relat Res. 2008
Jul;466(7):1539-54. Epub 2008 Apr 30. [abstract]
5. Rees JD, Wilson AM, Wolman RL; Current concepts in the management
of tendon disorders. Rheumatology (Oxford). 2006 May;45(5):508-21.
Epub 2006 Feb 20. [abstract]
6. Autologous blood injection for tendinopathy, NICE Interventional
Procedure Guideline (January 2009)
7. Extracorporeal shockwave therapy for refractory tennis elbow, NICE
Interventional Procedure Guideline (August 2009)
8. Wilson JJ, Best TM; Common overuse tendon problems: A review and
recommendations for treatment. Am Fam Physician. 2005 Sep 1
;72(5):811-8. [abstract]