Understanding work-related upper extremity disorders: Clinical findings in485 computer users, musicians, and others

Four hundred eighty five patients whose chief complaints were work related pain and other symptoms received a comprehensive upper-body clinical evalua tion to determine the extent of their illness. The group had a mean age of 38.5 years. Sixty-three percent of patients were females. Seventy percent w ere computer users, 28% were musicians, and 2% were others engaged in repet itive work. The time between the onset of symptoms and our initial visit ra nged from 2 weeks to over 17 years. A majority sought care within 30 months with the greatest number of them seeking care before 12 months. Fifty nine percent of subjects were still working when seen despite increasing pain a nd symptoms such as weakness, numbness, tingling, and stiffness. Following a history, a physical assessment utilizing commonly employed clinical tests were performed including evaluation of joint range of motion, hyperlaxity, muscle tenderness, pain, strength, and imbalance. Neurologic tests include d Tinel's sign performed in wrist, elbow, tricipital sulcus, and neck and t ests for thoracic out syndrome (TOS). Specific tests such as Finkelstein's test for deQuervain's tenosynovitis, Phalen's test for carpal tunnel syndro me and grip strengths were included in the examination protocol. Significan t findings included postural misalignment with protracted shoulders (78%), head forward position (71%), neurogenic TOS (70%), cervical radiculopathy ( 0.03%), evidence of sympathetic dysfunction (20%), and complex regional pai n syndrome (RSD) (0.6%). Hyperplaxity of fingers and elbows was found in ov er 50%, carpal tunnel syndrome in 8%, radial tunnel syndrome in 7%, cubital tunnel in 64%, shoulder impingement in 13%, medial epicondylitis in 60%, l ateral epicondylitis in 33%, and peripheral muscle weakness in 70%. We conc lude that despite initial presentation distally, work-related upper-extremi ty disorders are a diffuse neuromuscular illness with significant proximal upper-body findings that affect distal function. While neurogenic TOS remai ns a controversial diagnosis, the substantial number of patients with posit ive clinical findings in this study lends weight to the concept that postur e related neurogenic TOS is a key factor in the cascading series of physica l events that characterize this illness. A comprehensive upper-body examina tion produces findings that cannot be obtained through laboratory tests and surveys alone and lays the ground work for generating hypotheses about the etiology of work related upper-extremity disorders that can be tested in c ontrolled investigations.