Work-Related Musculoskeletal Disorders

A visit to the Family Physician/ Occupational Physician for musculoskeletal pain can be largely unsatisfying because of the persistent nature of the problem juxtaposed against routine analgesics that one gets from the doctor after the consult. Commonly, there may not be enough time to explain a particular ailment in detail sufficient for self-management.

It is important to know that musculoskeletal injuries and in particular, repetitive motion injuries (RMI) rarely originate from one event or a particular factor. As a rule, they develop over time from a variety of factors.

Factors predisposing to such injuries can equally attributed to work and non-work related ( for e.g individual practice, age, body build, diabetes, personality and attitudes). Basic office activities involve sitting in front of a computer terminal and operating it by typing or moving a mouse – harmless as it may seem, they do set the stage for injuries that can develop over time

Work-related factors that are associated with greatest risk for musculoskeletal injuries are:

Fixed and constrained postures – awkward, uncomfortable or maintained for too long.
Repetitive and forceful movements – causes “ wear and tear” issues.
High pace of work - determines amount of rest and recovery the muscles get.

We will focus more on the commoner injuries/ diseases seen in the working population from head to toe. Back Pain will be covered in another issue.

The conditions described exist in a spectrum, and their mention is limited to the most common presentation. Treatment modalities take into account that work-related hazards have already been mitigated via Hierarchy of Control.

Condition	Work-Related Factors Involved	Targeted Prevention Day-to-day	Treatment Modalities (other than painkillers.)
Cervical Spondylosis - Flares of neck pain, especially on neck extension.	1	Daily neck stretching ( 6 positions, 10 sec each) – extension, flexion, side rotation x 2, lateral flexion x 2; To do twice a day to reduce flare-ups	- Physiotherapy – Traction - Localised steroid injections - Localised nerve root blocks - Surgery only if there is continued nerve involvement
Frozen Shoulder/ Rotator Cuff Tendinitis - Stiff or painful motion affecting sleep, weakness of shoulders.	2, 3	Avoiding overhead activities that require sudden bursts of power, or repetitive carrying of loads above shoulder height. May follow local trauma – gentle stretching will prevent occurences.	- Passive Range of Motion exercises ( 4 types) - Localised steroid injections - Platelet-Rich Plasma injections - Surgery only if there is a large tendon tear
Trigger Fingers - Pain, followed by triggering of finger joints.	2, 3	Avoiding excessive work with gripping/ twisting motions or repetitive trauma.	- Splints - Localised steroid and anaesthetic injections x 2 - Surgery to release if failed conservative therapy
DeQuervain’s Tenosynovitis - Pain over thumb side of the wrist with pain on gripping.	2, 3	Avoiding excessive lifting with high grip force on hands. Pregnant women are at higher risk.	- Splints - Localised steroid and anaesthetic injections x2 - Platelet Rich Plasma injections - Surgery to release tight bands if failed conservative therapy
Carpal Tunnel Syndrome - Progressive numbness over thumb, index, long and sometimes ring finger.	1, 2, 3	Avoiding awkward resting hand postures. Avoiding repetitive trauma ( jackhammer use).	- Splints - Local Steroid injections into tunnel x 1 - Surgery best BEFORE permanent nerve and muscle wasting has set in.
Plantar Fasciitis - Pain near the heel worst on the first step of the day. - Usually lasts 6 months to 2 years.	2, 3	Avoid excessive impact during heel-strike phase of walking/ running by wearing proper shoes with good cushioning. Stretching of both the calf muscles as well as the tendons on the bottom of the foot.	- Physiotherapy to reduce tension in the calves - Localised steroid and anaesthetic injections into the plantar fascia to speed up healing. - Very Rarely requires surgery.