Document Text Contents
Page 1
MUSCULOSKELETAL
DISORDER
Edited by Marie Alricsson
Page 2
Musculoskeletal Disorder
Edited by Marie Alricsson
Published by InTech
Janeza Trdine 9, 51000 Rijeka, Croatia
Copyright © 2012 InTech
All chapters are Open Access distributed under the Creative Commons Attribution 3.0
license, which allows users to download, copy and build upon published articles even for
commercial purposes, as long as the author and publisher are properly credited, which
ensures maximum dissemination and a wider impact of our publications. After this work
has been published by InTech, authors have the right to republish it, in whole or part, in
any publication of which they are the author, and to make other personal use of the
work. Any republication, referencing or personal use of the work must explicitly identify
the original source.
As for readers, this license allows users to download, copy and build upon published
chapters even for commercial purposes, as long as the author and publisher are properly
credited, which ensures maximum dissemination and a wider impact of our publications.
Notice
Statements and opinions expressed in the chapters are these of the individual contributors
and not necessarily those of the editors or publisher. No responsibility is accepted for the
accuracy of information contained in the published chapters. The publisher assumes no
responsibility for any damage or injury to persons or property arising out of the use of any
materials, instructions, methods or ideas contained in the book.
Publishing Process Manager Jana Sertic
Technical Editor Teodora Smiljanic
Cover Designer InTech Design Team
First published April, 2012
Printed in Croatia
A free online edition of this book is available at www.intechopen.com
Additional hard copies can be obtained from [email protected]
Musculoskeletal Disorder, Edited by Marie Alricsson
p. cm.
ISBN 978-953-51-0485-8
Page 46
Musculoskeletal Disorder 36
The diagnosis BPPV is objectified by demonstrating nystagmus when the patient is positioned
in a Dix-Hallpike position or in the first position of a Brandt-Daroff maneuver, i.e., lying down
on one side [51]. The nystagmus is registered by video-oculography (Interacoustics A/S,
Assens, Denmark) (Figure 3). This technique allows identification of nystagmus occurring
intermittently, as well as after a long latency. Each positioning is done in slow motion, and the
subject is kept for three minutes in each position. The gravity constituted the acceleration.
Otoliths in one SSC give a specific nystagmus pattern. Otoliths in more than one SSC give
various nystagmus patterns depending on which SSC is activated and the amount of debris
present. The resulting nystagmus is expressed as a vector. Divergence from one-SSC pattern is
interpreted as a BPPV with otoliths in more than one SSC.
Fig. 3. The video-oculography documents a BPPV (Interacoustics A/S, Assens, Denmark).
The patient was tested in the Brandt Daroff position for three minutes; no nystagmus was
registered when she was lying down, neither in the Dix-Hallpike position. First in the sitting
position nystagmus occurred. The illustration demonstrates a sequence after one minute in
the sitting position. The intensive nystagmus was ongoing and after three minutes the
patient was allowed to gaze to control the dizziness and nausea.
The patient is a 35 year old woman with a head and neck trauma ten years back and she has
had intermittent symptoms. She has the clinical picture of a long lasting BPPV. Her earlier
given diagnosis was phobic postural vertigo.
Page 47
Postural Mismatch in Musculoskeletal Disorders 37
Video-oculography for Smooth Pursuit Neck Torsion (SPNT) test [52,53]. This test is relevant to
perform, if there is a history of neck trauma. The registration is done by binocular video-
oculography (Interacoustics A/S, Assens, Denmark). This equipment is full digital without
any analogue parts. The SPNT test is partly a conventional test of the smooth pursuit eye
movement test and partly a test of the proprioceptives of the neck. We used a moving
sinusoid stimulus with a maximum velocity of 20 degrees per second. This test has to be
performed after at least five minutes of rest without any movement of the head. The test
starts with the subject facing the target (a yellow dot on a screen) without turning the head
in relation to the torso (neutral position). Six cycles were performed. The torso of the subject
was then actively turned away from the screen and kept in a static position at a maximum
angle of 45 degrees – or at some angle which did not increase pain, stress and / or
discomfort in this position – with the head held in a horizontal position facing the screen.
After a short pause, the visual stimulus was again presented. The test was then repeated in
the opposite direction. The ability to follow the target is expressed as a gain, i.e. the
proportion between the movement of the eyes and the movement of the target. The average
gain of each head position in relation to torso and direction of the eye movements were
recorded. The test parameter chosen to represent the SPNT test was called the SPNT (diff) is
defined by the algorithm:
SPNT (diff) =
neutral position (gain R + gain L) right turn (gain R + gain L) + left turn (gain R + gain L)
2 4
Gain R represents the gain of smooth pursuits, tracking a target which moves to the right;
gain L represents the corresponding gain to the left.
A positive SPNT test seems to be an expression of a serious neck dysfunction. In our study
only 30 % of patients who fulfill the Quebec Task Force criteria of a WAD have a positive
SPNT test [54]. If the patient has not rested for five minutes before the start of the test, there
is a risk of a false positive test result. This is due to the effects of BPPV.
7. Treatment
7.1 General principle of treatment
A balance disorder is either due to abnormal afferent signals from the periphery or
abnormal processing in the CNS. If a balance disorder is static, the central postural control
system will compensate and the condition will improve. This is the normal course after a
vestibular neuritis, labyrintitis and lacunar brain stem- or cerebellar infarcts. In the opposite
situation where the activity of the peripheral balance organ varies from time to time, the
central postural control system has limited possibility to compensate. This is a well-known
phenomenon in Ménière ´s disease and in BPPV. When the otoliths are displaced from the
semicircular canals in BPPV, the signals from the labyrinth will be ameliorated. The more
normalized a balance unit can function; the less stabilizing vestibulo-spinal and vestibulo-ocular
reflex activity is needed [3].
A neck with an abnormal movement pattern gives an inappropriate afferent signal activity
from the gamma-muscle spindles to the central postural control system primarily via the
cervico-collic reflex (CCR) [25-27]. Static muscle contraction leads to increased pain [35-38].
Page 91
Upper Limb Work-Related Musculoskeletal Disorders in the Manufacturing Industry 81
assessment and ergonomic interventions of larger companies to small-medium firms also
through the use of simple tools for risk identification.
Ergonomic interventions not only concur in the management and control of negative events
for workers health but also in achieving advantages in terms of lower costs and greater
productivity. A complete intervention that uses all available instruments such as risk
assessment, health surveillance, education, task analysis, reorganization and technological
innovation can achieve appreciable results.
9. References
Bohr PC. Systematic review and analysis of work-related injuries to and conditions of the
elbow. Am J Occup Ther 2011;65(1):24-8.
Carino M et al. Occupational health education in a large district of the Italian industry. In
‘Leading-Edge Health Education Issues’ Lennard V. Sebeki (Ed.) ISBN: 1-60021-874-1,
2008, Nova Science Publisher Inc, New York
Colombini D, Occhipinti E. [Development of simple tools for risk identification and
prevention of work related muscular-skeletal disorders: application experience in
small and craft industries] Med Lav 2011;102(1):3-5.
Islam SS, Velilla AM, Doyle EJ, Ducatman AM. Gender differences in work-related
injury/illness: analysis of workers compensation claims. Am J Ind Med 2001;39:84–
91
Martimo KP, Shiri R, Miranda H, Ketola R, Varonen H, Viikari-Juntura E. Effectiveness of
ergonomic intervention on productivity of workers with upper-extremity
disorders- randomized controlled trial. Scand J Work Environ Health 2010;36(1):25-
33.
Morse T, Dillon C, Kenta-Bibi E, Weber J, Diva U, Warren N, Grey M. Trends in work-
related musculoskeletal disorder reports by year, type, and industrial sector: a
capture-recapture analysis. Am J Ind Med 2005;48(1):40-49.
Nicoletti S, Carino M, Di Leone G, Trani G, Colombini D, Occhipinti E. [ Risk assessment of
work- related upper limb musculoskeletal disorders in thirty factories in the
upholstered furniture industry] Med Lav 2008; 99(4)262-70.
Nicoletti S, Consonni D, Carino M et al [Upper limb work-related musculoskeletal
disorders: a retrospective cohort study in three large factories of the upholstered
furniture industry]. Med Lav 2008;99(4):271-80.
Nicoletti S, Castoro V, Iacobellis M, Loizzo N, Monopoli L. [Upper limb work-related
musculoskeletal disorders in a large factory of the upholstered furniture industry:
risk management] Med Lav 2008;99(4):297-313.
Nicoletti S, Battevi N. [Upper-limb work-related musculoskeletal disorders and latency of
effect]. Med Lav 2008; 99(5):352-61.
Occhipinti E. OCRA: a concise index for the assessment of exposure to repetitive movements
of the upper limbs. Ergonomics 1998; 41,9:1290-311.
Occhipinti E. Colombini D. Updating reference values and predictive models of the OCRA
method in the risk assessment of work-related musculoskeletal diseases of the
upper limbs. Ergonomics 2007 ; 50(11):1727-39.
Page 92
Musculoskeletal Disorder 82
Occhipinti E, Colombini D.[From complexity to simplification: contribution of the EPM
Research Unit to producing a toolkit for risk assessment and management of
biomechanical overload and WMSDs prevention] Med Lav 2011; 102, 2: 174-192.
Palmer KT, Harris EC, Coggon D. Carpal tunnel syndrome and its relation to occupation: a
systematic literature review. Occup Med 2007; 57:57–66
Punnett L, Wegman DH Work-related musculoskeletal disorders: the epidemiologic
evidence and the debate J Electromyogr Kinesiol 2004;14 (1):13-23.
Sala E, Torri D, Tomasi C, Apostoli P. [Risk assessment for upper extremity work related
muscoloskeletal disorders in different manufactures by applying six methods of
ergonomic analysis] G Ital Med Lav Ergon 2010;32(2):162-73.
Spallek M, Kuhn W, Uibel S, van Mark A, Quarcoo D. Work-related musculoskeletal
disorders in the automotive industry due to repetitive work - implications for
rehabilitation. J Occup Med Toxicol 2010, 7;5:6.
Takala EP, Pehkonen I, Forsman M et al. Systematic evaluation of observational methods
assessing biomechanical exposures at work. Scand J Work Environ Health
2010,36(1):3-24.
Von der Heyde RL. Occupational therapy interventions for shoulder conditions: a
systematic review. Am J Occup Ther 2011;65(1):16-23.
Waters TR, Dick RB, Krieg EF. Trends in work-related musculoskeletal disorders: a
comparison of risk factors for symptoms using quality of work life data from the
2002 and 2006 general social survey. J Occup Environ Med 2011;53(9):1013-24.
MUSCULOSKELETAL
DISORDER
Edited by Marie Alricsson
Page 2
Musculoskeletal Disorder
Edited by Marie Alricsson
Published by InTech
Janeza Trdine 9, 51000 Rijeka, Croatia
Copyright © 2012 InTech
All chapters are Open Access distributed under the Creative Commons Attribution 3.0
license, which allows users to download, copy and build upon published articles even for
commercial purposes, as long as the author and publisher are properly credited, which
ensures maximum dissemination and a wider impact of our publications. After this work
has been published by InTech, authors have the right to republish it, in whole or part, in
any publication of which they are the author, and to make other personal use of the
work. Any republication, referencing or personal use of the work must explicitly identify
the original source.
As for readers, this license allows users to download, copy and build upon published
chapters even for commercial purposes, as long as the author and publisher are properly
credited, which ensures maximum dissemination and a wider impact of our publications.
Notice
Statements and opinions expressed in the chapters are these of the individual contributors
and not necessarily those of the editors or publisher. No responsibility is accepted for the
accuracy of information contained in the published chapters. The publisher assumes no
responsibility for any damage or injury to persons or property arising out of the use of any
materials, instructions, methods or ideas contained in the book.
Publishing Process Manager Jana Sertic
Technical Editor Teodora Smiljanic
Cover Designer InTech Design Team
First published April, 2012
Printed in Croatia
A free online edition of this book is available at www.intechopen.com
Additional hard copies can be obtained from [email protected]
Musculoskeletal Disorder, Edited by Marie Alricsson
p. cm.
ISBN 978-953-51-0485-8
Page 46
Musculoskeletal Disorder 36
The diagnosis BPPV is objectified by demonstrating nystagmus when the patient is positioned
in a Dix-Hallpike position or in the first position of a Brandt-Daroff maneuver, i.e., lying down
on one side [51]. The nystagmus is registered by video-oculography (Interacoustics A/S,
Assens, Denmark) (Figure 3). This technique allows identification of nystagmus occurring
intermittently, as well as after a long latency. Each positioning is done in slow motion, and the
subject is kept for three minutes in each position. The gravity constituted the acceleration.
Otoliths in one SSC give a specific nystagmus pattern. Otoliths in more than one SSC give
various nystagmus patterns depending on which SSC is activated and the amount of debris
present. The resulting nystagmus is expressed as a vector. Divergence from one-SSC pattern is
interpreted as a BPPV with otoliths in more than one SSC.
Fig. 3. The video-oculography documents a BPPV (Interacoustics A/S, Assens, Denmark).
The patient was tested in the Brandt Daroff position for three minutes; no nystagmus was
registered when she was lying down, neither in the Dix-Hallpike position. First in the sitting
position nystagmus occurred. The illustration demonstrates a sequence after one minute in
the sitting position. The intensive nystagmus was ongoing and after three minutes the
patient was allowed to gaze to control the dizziness and nausea.
The patient is a 35 year old woman with a head and neck trauma ten years back and she has
had intermittent symptoms. She has the clinical picture of a long lasting BPPV. Her earlier
given diagnosis was phobic postural vertigo.
Page 47
Postural Mismatch in Musculoskeletal Disorders 37
Video-oculography for Smooth Pursuit Neck Torsion (SPNT) test [52,53]. This test is relevant to
perform, if there is a history of neck trauma. The registration is done by binocular video-
oculography (Interacoustics A/S, Assens, Denmark). This equipment is full digital without
any analogue parts. The SPNT test is partly a conventional test of the smooth pursuit eye
movement test and partly a test of the proprioceptives of the neck. We used a moving
sinusoid stimulus with a maximum velocity of 20 degrees per second. This test has to be
performed after at least five minutes of rest without any movement of the head. The test
starts with the subject facing the target (a yellow dot on a screen) without turning the head
in relation to the torso (neutral position). Six cycles were performed. The torso of the subject
was then actively turned away from the screen and kept in a static position at a maximum
angle of 45 degrees – or at some angle which did not increase pain, stress and / or
discomfort in this position – with the head held in a horizontal position facing the screen.
After a short pause, the visual stimulus was again presented. The test was then repeated in
the opposite direction. The ability to follow the target is expressed as a gain, i.e. the
proportion between the movement of the eyes and the movement of the target. The average
gain of each head position in relation to torso and direction of the eye movements were
recorded. The test parameter chosen to represent the SPNT test was called the SPNT (diff) is
defined by the algorithm:
SPNT (diff) =
neutral position (gain R + gain L) right turn (gain R + gain L) + left turn (gain R + gain L)
2 4
Gain R represents the gain of smooth pursuits, tracking a target which moves to the right;
gain L represents the corresponding gain to the left.
A positive SPNT test seems to be an expression of a serious neck dysfunction. In our study
only 30 % of patients who fulfill the Quebec Task Force criteria of a WAD have a positive
SPNT test [54]. If the patient has not rested for five minutes before the start of the test, there
is a risk of a false positive test result. This is due to the effects of BPPV.
7. Treatment
7.1 General principle of treatment
A balance disorder is either due to abnormal afferent signals from the periphery or
abnormal processing in the CNS. If a balance disorder is static, the central postural control
system will compensate and the condition will improve. This is the normal course after a
vestibular neuritis, labyrintitis and lacunar brain stem- or cerebellar infarcts. In the opposite
situation where the activity of the peripheral balance organ varies from time to time, the
central postural control system has limited possibility to compensate. This is a well-known
phenomenon in Ménière ´s disease and in BPPV. When the otoliths are displaced from the
semicircular canals in BPPV, the signals from the labyrinth will be ameliorated. The more
normalized a balance unit can function; the less stabilizing vestibulo-spinal and vestibulo-ocular
reflex activity is needed [3].
A neck with an abnormal movement pattern gives an inappropriate afferent signal activity
from the gamma-muscle spindles to the central postural control system primarily via the
cervico-collic reflex (CCR) [25-27]. Static muscle contraction leads to increased pain [35-38].
Page 91
Upper Limb Work-Related Musculoskeletal Disorders in the Manufacturing Industry 81
assessment and ergonomic interventions of larger companies to small-medium firms also
through the use of simple tools for risk identification.
Ergonomic interventions not only concur in the management and control of negative events
for workers health but also in achieving advantages in terms of lower costs and greater
productivity. A complete intervention that uses all available instruments such as risk
assessment, health surveillance, education, task analysis, reorganization and technological
innovation can achieve appreciable results.
9. References
Bohr PC. Systematic review and analysis of work-related injuries to and conditions of the
elbow. Am J Occup Ther 2011;65(1):24-8.
Carino M et al. Occupational health education in a large district of the Italian industry. In
‘Leading-Edge Health Education Issues’ Lennard V. Sebeki (Ed.) ISBN: 1-60021-874-1,
2008, Nova Science Publisher Inc, New York
Colombini D, Occhipinti E. [Development of simple tools for risk identification and
prevention of work related muscular-skeletal disorders: application experience in
small and craft industries] Med Lav 2011;102(1):3-5.
Islam SS, Velilla AM, Doyle EJ, Ducatman AM. Gender differences in work-related
injury/illness: analysis of workers compensation claims. Am J Ind Med 2001;39:84–
91
Martimo KP, Shiri R, Miranda H, Ketola R, Varonen H, Viikari-Juntura E. Effectiveness of
ergonomic intervention on productivity of workers with upper-extremity
disorders- randomized controlled trial. Scand J Work Environ Health 2010;36(1):25-
33.
Morse T, Dillon C, Kenta-Bibi E, Weber J, Diva U, Warren N, Grey M. Trends in work-
related musculoskeletal disorder reports by year, type, and industrial sector: a
capture-recapture analysis. Am J Ind Med 2005;48(1):40-49.
Nicoletti S, Carino M, Di Leone G, Trani G, Colombini D, Occhipinti E. [ Risk assessment of
work- related upper limb musculoskeletal disorders in thirty factories in the
upholstered furniture industry] Med Lav 2008; 99(4)262-70.
Nicoletti S, Consonni D, Carino M et al [Upper limb work-related musculoskeletal
disorders: a retrospective cohort study in three large factories of the upholstered
furniture industry]. Med Lav 2008;99(4):271-80.
Nicoletti S, Castoro V, Iacobellis M, Loizzo N, Monopoli L. [Upper limb work-related
musculoskeletal disorders in a large factory of the upholstered furniture industry:
risk management] Med Lav 2008;99(4):297-313.
Nicoletti S, Battevi N. [Upper-limb work-related musculoskeletal disorders and latency of
effect]. Med Lav 2008; 99(5):352-61.
Occhipinti E. OCRA: a concise index for the assessment of exposure to repetitive movements
of the upper limbs. Ergonomics 1998; 41,9:1290-311.
Occhipinti E. Colombini D. Updating reference values and predictive models of the OCRA
method in the risk assessment of work-related musculoskeletal diseases of the
upper limbs. Ergonomics 2007 ; 50(11):1727-39.
Page 92
Musculoskeletal Disorder 82
Occhipinti E, Colombini D.[From complexity to simplification: contribution of the EPM
Research Unit to producing a toolkit for risk assessment and management of
biomechanical overload and WMSDs prevention] Med Lav 2011; 102, 2: 174-192.
Palmer KT, Harris EC, Coggon D. Carpal tunnel syndrome and its relation to occupation: a
systematic literature review. Occup Med 2007; 57:57–66
Punnett L, Wegman DH Work-related musculoskeletal disorders: the epidemiologic
evidence and the debate J Electromyogr Kinesiol 2004;14 (1):13-23.
Sala E, Torri D, Tomasi C, Apostoli P. [Risk assessment for upper extremity work related
muscoloskeletal disorders in different manufactures by applying six methods of
ergonomic analysis] G Ital Med Lav Ergon 2010;32(2):162-73.
Spallek M, Kuhn W, Uibel S, van Mark A, Quarcoo D. Work-related musculoskeletal
disorders in the automotive industry due to repetitive work - implications for
rehabilitation. J Occup Med Toxicol 2010, 7;5:6.
Takala EP, Pehkonen I, Forsman M et al. Systematic evaluation of observational methods
assessing biomechanical exposures at work. Scand J Work Environ Health
2010,36(1):3-24.
Von der Heyde RL. Occupational therapy interventions for shoulder conditions: a
systematic review. Am J Occup Ther 2011;65(1):16-23.
Waters TR, Dick RB, Krieg EF. Trends in work-related musculoskeletal disorders: a
comparison of risk factors for symptoms using quality of work life data from the
2002 and 2006 general social survey. J Occup Environ Med 2011;53(9):1013-24.
