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A-1138 Occupationally induced hand and wrist disorders
Jane F. Thomsen, Copenhagen, Denmark
Thursday, June 14, 2018 · 10:36 a.m. · 21m 15s
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the yeah thank you very much for the invitation the are not the
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i'm not going to speak much apart for men and acceptance
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uh eh i'm going to tell you the elite mall about what you could email that
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you uh the tells us about courses for occupational diseases in the hand and wrist
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so i will the will tell you a little about um these disorders couple
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times and and just cut and dried his trigger finger now starts roses
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and to put function factor but i'll focus mostly on carpal tunnel syndrome that's them
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to test started to do sort of to hand it to the mail to redeem your to lead to
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and are going to use to to what kinds of exposures that are connected to these uh disorders
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that considerable the uh um methodological issues you know when you start you these yeah
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problems a in epistemology and i'll introduce you to some of them
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that can the issues uh and the you could say all the all
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the work that we do in my field eh in the video
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multi i ignored due aims to prevent these diseases so the more
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we know about courses the better we can aim to prevention
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and the lastly i'll just give you a little about uh tell you
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a little about the workers compensation they said from denmark and you
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um
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this is an overview of uh the relevant expulsions and exposes and how they are associated with uh
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different disorders
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they're the most frequent the exposures are a repetition the use of hand force and to
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all the positions of the hand and the uh and and these exposes have been quite extensively studied
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and they are associated with carpal tunnel syndrome understand tonight this and also trigger finger
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had um by prisons are primarily yet i'm associated with couple
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times syndrome and of course in all uh uh to
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the most final with the white white fingers what i want to i don't tell anything about that today
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but also i start roses uh also off the first a couple miss a couple joint
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the and the two cats once the contractor
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external pressure has not actually been started to it you know logically
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but it's a clinical experience that to people working with handheld
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tools the that put the pressure on a a
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on the palm of the hand may the costs a couple times interim it is less the
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as a in the we have less to association with two part time contractor up
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with couple transcend only seems like a it is and uh important facts off
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so i'll give you the conclusions now in the beginning of the presentation what we
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have uh what is the evidence of a causal relation between these disorders
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and i'm in between these uh exposes and disorders
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and uh it if we wait if it in so that
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three stars either the those with to put evidence
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zero zero was no evidence and a one size only limited evidence then
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you can see that the that the also would reflecting what's best thought is that the the the
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eh we're petitioned enforce and the most of all
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the combination of repetition enforce the these are
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eh well recognised their courses for couple town syndrome understand the night this
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we don't have very much evidence that other disorders of the
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hand uh there are associated with the occupational exposures
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we we recently made a review off the problem is a couple
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of yeah throws us off the to of the thumb
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uh and it's very mixes uh it even though there
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are the several studies the evidence is very limited
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so but i'll go a little into it uh if we look at the what's
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repetitive work this is a this is a an example of repetitive work
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uh with low force requirements later sorting
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and another example of a very uh very common uh task the
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to building painters uh mm with repetitive and
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uh some of that task are to
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uh yeah yeah but they have supply and moderate forced
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this is an example of a highly repetitive uh to work
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with some force requirements for those lifting the boxes and this is an example of
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a it i also highly repetitive work with my high false requirements and it's
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i was when you see the picture you can see that
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it's a a that cutting meat eh require as
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it quite a lot of force of both hands spot the one hand uh holding the knife
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can see the the the the the person has to dean over
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the task in order to also used to body forces
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to to do the job and also the the left hand is the doing good
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job because the the left hand is turning the f. often quite heavy meat
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so this is that this need cutting is actually an example of
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one of the most the screen is what tasks we have
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at least in denmark probably receive yeah and they've got a very
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streams tasks the other places in the well i didn't
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so how do we how do we you study these sick unto sin so heartily
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find out if it has some any association say do
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they have an increased risk of hand wrist disorders
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this has been studied for many yes but many of the studies have been a um a a
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a not very well conducted they have weekly time to expose and we to determine the outcome
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mostly most assistant minister is having fast section other than that
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makes a causal inference read different difficult to do
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and if you have in the same if you just uh ask people well do you have a stream is job and do you have
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painting the the rest in these monsters will influence each other and if you have a a pain in the bayes then you will
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eventually the also to report mostly miss work then the person without
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the wrist pain we know that and this is what court reporting bias
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so what is needed to in order to make also influences
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is a perspective this as post prospective design and the
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and we often need not school what's the to to have enough power in
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the study at enough cases to to
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have statistical the enough statistical power
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we need to have objectively measured out come the and the hat and here in denmark we have wait
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but just as the patient hospital pays registers that can be used
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and a we need to have a and objectively measured exposure and in this uh
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methods have come into use in multi he praxis eh for the last let's say ten yes
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now we can measure the most like to bits in the
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form this uh is uh with superficial uh electrodes
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so we can have an uh it emission for the most the contraction
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we can mess up the the had all the hand movements the velocity of the list movements
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uh electronically with continuous data the sampling
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and we can do that for a whole day mission men's this place an enormous amount
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of data but we also have increased computer power at the last ten years
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so now it's possible like to to analysts these a. m. i. a this to catch quite huge amounts of the user
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so uh so this is um
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a presentation off at thirty three different kinds of jobs you
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can see it's uh all kinds of uh of jobs
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uh from the bank clerk to the lawn to work out with
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plumbers carpenters darkness insulate us and so on in between
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and this is a real measurements of the mean wrist angular velocity uh it from hold emission lines
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in degrees per second and as you can see it to it it's but it's quite nicely
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so we actually have a quake into the next post equation to mister
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uh was just see if the the bank plaque has less to
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rest for hand these disorders than the law to work
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oh
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we uh analysts that in a in a in a large
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school board of thirty jobs withhold amish immense uh um
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of this uh is that i just a show i uh the so we we
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had echoed off the approximate a eight hundred thousand people that could have
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individual s. i'm exposed to values from these uh in the whole day measurements the um
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um well we uptight you could say all that the same values
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fall on the promise to in the code and so on
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uh yeah and then we yeah and looked at a couple times
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in them cases from the from our national patient register
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and a identified eleven thousand cases during the period and
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then we could and allies if the the exposure
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talk to the to the disease
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instead of somehow uh explain how uh the risk of carpal tunnel
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syndrome and we were also able to uh control fall
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several potential confound was also a a through register information
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so what we found was that the angular but the last to
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which is a like a mean of repeated and repeated tunis
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we found very nice uh exposure response pattern with the toppling of
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the risk uh in the highs percentile the of exposure
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was when we looked off to look at the position of the wrist mischievous range of
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motion of the rest we found no association so it seems like eh it
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in in our data that the british and is uh an important message yeah
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and probably also force that was which was not a part of this i didn't
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we also looked at doc tasks within a and his talk to cool what of house painters
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approximately five thousand house painters have question uh and they were all our
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stuff on nine to the top tasks within the building painting trade
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so they reported how many hours in a typical week if
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they had these kinds of these nine typical tasks
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and again we had hold a mission and stuff uh twenty five female line twenty five need he does
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it's continued us and they also eh hello book where they they
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put down which task they had to me during the day and and for how long
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and then we looked at the exposure variables again with lawsuits in
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and then not on a mission for it but it's it's an s. mean pa frequency and also pasta
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and again we found a a a a a a similar picture of uh
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that then exposure response relationship uh with the risk of
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forty four percent for each stick we increase
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stuff with university and the same peasant farming power frequency and again we could not
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find a a an association with cost but with posture of the best
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so is this a a in some uh is this a coherent
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with other start is well in sweden uh in you don't
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they have a measured based exposure the for at least the last fifteen years
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and based on a large amount of a mess immense there suggested
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uh some action levels for prevention of wrist disorders then asked to all
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those the mesh at about this pain and based on information on
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the mission men's and best pain they suggest that uh um you should
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the you should stay and uh a movement the necessity of twenty degrees per second
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and if you look at house painters that median
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movement the last c. was fifteen degrees per second so they
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had it on down so so we were wondering if
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these sweetie sky dies perhaps but too strict all the
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because it's the same way with mesh at um
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we've missed at the at the exposure they also on
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a message at a a through e. m. t.
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the the uh the uh or add suggested an action level for the for prevention
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the off ten percent of the maximum voluntary cunt contraction as a median load
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and when they said that how speakers to and they and
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they our house painters actually yeah yeah reach this level
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they also suggest that uh s. and there was four peak load and also for time for recovery
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so if we
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put this into the ah the all the other measurements of many different jobs
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then we see that the if we uh if you if it to the the kitchen assistant
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we'll reach this eh action level and and all those um stops about this
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huh and uh it here we have our house painter of um uh approximately fifteen
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degrees per second so they have a a bit of a a below this the action level emit
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and again that's it maybe they'll this limit should be you know
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what i but this would need for further studies so
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another aspect that this is just in the matter
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this is just say it to what we see at different uh expose response
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relationship dependent on you are if you are a male or female
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that is what this will be the same for the farm neil
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painter for instance that's for a female painter one quote um
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i think that may be a eh yeah a woman would be mall
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the one that girl to to the six process than men
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we know all from a different studies that male and female painters have almost the same task
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distribution they're on this the same task specific specific movements and pasta stuff the rest
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but we also know that female the pain does that make things that are more less fifty percent stronger
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then female so they will use a much higher relative muscular load
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so the when we started this eh we could not find a
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and a a multiplicative into x. in between sex and exposure
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but indeed uh it and in an ad it's even saxon was indicated
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so when we plotted a a the the actual number off
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a incident cases
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in women and the men in the with regard to word based intercity then
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we actually saw this eh steepest slope for women than for men
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so yes that may be at at and the usual also for carpal tunnel syndrome
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not just because of the the the female it's period that how times to them is more prevalent
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in the females are then in males but also because they may be more vulnerable
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so uh did finally ah just show you a little about a a workers compensation claims uh it
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the european union has a recommended list of occupational painters all those uh it
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which are it is uses jews almost training of the tendencies and so on
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it's a couple times and from an disaster throws us off the hands
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interest cost from mechanical vibration then actually these three conditions to um
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are also that conditions that can be recognised in denmark
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this would be that i would be very if different from country can to control of course but to look at
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denmark eh compensation claims in denmark in two thousand seventeen
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just to put it in perspective you know we're a small country population of about
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five point seven million people and the labour force of the approximately three million
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total planes for occupational diseases not accidents but on
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only disorders and diseases the white eighteen thousand
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and common hand and that includes the elbow eh was fifteen
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hundred claims in two thousand and seven it's thing
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and of those uh approximately ten of ten percent of them were recognised
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cases so you see it's maybe more there's a hundred and fifty cases
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recognised in a country like denmark every yeah so it's not
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very many
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but there's some so we have quite strict exposure criteria for recognition in denmark
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so tools to sum up um we have good evidence
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that couple times engine and best ten tonight this
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are associated with a certain exposures like the petition and
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the use of force and combinations of this
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but we have only marker to providence that i throw stuff the hand
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and type to buy times contractor and trigger finger the associated
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we now have improved methods with objective measurements and uh to use of lattices that can i i
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see that can to provide us with evidence based guidelines for prevention but we're not still
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but they are a um that that's another start is going on
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uh for the time being to status these the guidelines
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we can see that gender matters and one should take that into consideration
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both to when you're talking about prevention at our sole compensation
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thank you how
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hi
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i think you're doing we would occur proceed to the next one
