Musculoskeletal symptoms, including those affecting the arms, legs, low back and neck, are the most common reasons that workers seek care in the occupational medicine setting. Symptoms may arise suddenly after a fall or a crush injury or as a sudden onset of pain during routine activities. Some symptoms arise gradually or episodically, where there is no association with a single work event. In those cases, whether the musculoskeletal symptom is related to the workplace may not be obvious.
Mechanism of Injury
A single event can cause an injury if it involves high energy forces, such as impact from a fall, a forceful pull while handling a heavy patient, or from intensive power tool use. In other setting, a routine exposure may be repetitive. This is often the case with soft tissue and joint pain, or with nerve compression, such as the carpal tunnel syndrome. The risk of injury may be completely associated with workplace health and safety factors or influenced by age, general health or prior injury.
Spine conditions usually in the neck (cervical spine) or low back, are a leading reason for all medical visits, and especially to Occupational Medicine clinics. Upper extremity injuries may involve the shoulder (rotator cuff, a-c joint arthritis, bursitis), the elbow (‘tennis elbow’ of lateral epicondylitis, ulnar nerve entrapment), the wrist (carpal tunnel syndrome), and hand. In some cases there is direct damage to the nerves and circulation of the entire arm, as in symptoms caused by vibrating tools. Some conditions are unusually common in workers in a particular field, such as elbow pain in ultrasonographers and knee pain in roofers; clinics may set up special services for those workers, as we have done for musicians.
Evaluation and Management
Sometimes the ‘narrative’ of an injury is very straight-forward, but when a condition arises without a discrete event, the clinician will want to know about the work environment: what is the person’s job, what does the worker do all day, what are the working postures, and what kind of tools are used? Other questions include whether the worker can change tasks during the day, and take rest breaks? Physical examination may include specialized testing of strength and sensation. In some cases the worker is referred for electrical studies of the nerves and muscles, and for imaging studies, by x-ray, CT and MRI. There may be referral to consultation with specialists in neurology, orthopedics, sports medicine, neurosurgery, and physical therapy. Whenever possible, we help the worker and the employer make modifications to the work tasks and work station to allow healing and prevent recurrence. In many cases we use structured exercises, medications, splinting, and local injections to promote recovery. Treatment of musculoskeletal injuries involves some combination of workplace modification and individual therapy. A goal of the clinic is to select best treatments and to avoid fractured or disorganized care that may lead to unnecessary surgery or excessive reliance on opiates.
It is in the interest of both the worker and the employer to prevent occupational injuries. We offer formal ergonomic analysis of the workplace; our ergonomists and industrial hygienists can visit a workplace, observe how workers interact with equipment, and recommend modifications. We also provide a group of online tools to assist employers and employees in maximizing their internal resources to prevent occupational disease and maintain the musculoskeletal health and fitness of the workforce.
Work-related musculoskeletal diseases are often difficult to understand, because workplace risk factors may not be obvious, and musculoskeletal pain is not specific to the workplace. You can learn more at the website of The Canadian Centre for Occupational Health and Safety.