Musculoskeletal Disorders

Musculoskeletal disorders (MSDs) are injuries or pain in the body's joints,

ligaments, muscles, nerves, tendons, and structures that support limbs, neck and
back. MSDs can arise from a sudden exertion (e.g., lifting a heavy object), or they
can arise from making the same motions repeatedly repetitive strain, or from
repeated exposure to force, vibration, or awkward posture. Injuries and pain in
the musculoskeletal system caused by acute traumatic events like a car accident
or fall are not considered musculoskeletal disorders. MSDs can affect many
different parts of the body including upper and lower back, neck, shoulders and
extremities (arms, legs, feet, and hands). Examples of MSDs include carpal
tunnel syndrome, epicondylitis, tendinitis, back pain, tension neck syndrome,
and hand-arm vibration syndrome.

Diagnosis
Assessment of MSDs are based on self-reports of symptoms and pain as well as
physical examination by a doctor. Doctors rely on medical history, recreational
and occupational hazards, intensity of pain, a physical exam to locate the source
of the pain, and sometimes lab tests, x-rays, or an MRI[5] Doctors look for specific
criteria to diagnose each different musculoskeletal disorder, based on location,
type, and intensity of pain, as well as what kind of restricted or painful
movement a patient is experiencing. A popular measure of MSDs is the Nordic
Questionnaire that has a picture of the body with various areas labeled and asks
the individual to indicate in which areas they have experienced pain, and in
which areas has the pain interfered with normal activity.

Causes
MSDs can arise from the interaction of physical factors with ergonomic, psychological,
social, and occupational factors.

Biomechanical
MSDs are caused by biomechanical load which is the force that must be applied to do tasks,
the duration of the force applied, and the frequency with which tasks are performed.[7]
Activities involving heavy loads can result in acute injury, but most occupation-related MSDs
are from motions that are repetitive, or from maintaining a static position.[8] Even activities
that do not require a lot of force can result in muscle damage if the activity is repeated often
enough at short intervals.[8] MSD risk factors involve doing tasks with heavy force, repetition,
or maintaining a nonneutral posture.[8] Of particular concern is the combination of heavy load
with repetition.[8] Although awkward posture is often blamed for lower back pain, a systematic
review of the literature failed to find a consistent connection.[9]

Psychosocial

There is a growing consensus that psychosocial factors are another cause of some MSDs.
Some theories for this causal relationship found by many researchers include increased
muscle tension, increased blood and fluid pressure, reduction of growth functions, pain
sensitivity reduction, pupil dilation, body remaining at heightened state of sensitivity.

Occupational
Because workers maintain the same posture over long work days and often several years,
even natural postures like standing can lead to MSDs like low back pain, but postures which
are less natural like twisting or tension in the upper body are typically contributors to the
development of MSDs because of the unnatural biomechanical load of these postures. There
is evidence that posture contributes to MSDs of the neck, shoulder, and back.Repeated
motion is another risk factor for MSDs of occupational origin because workers can perform
the same movements repeatedly over long periods of time (e.g. typing leading to carpal
tunnel syndrome), which can wear on the joints and muscles involved in the motion in
question. Workers doing repetitive motions at a high pace of work with little recovery time
and workers with little to no control over the timing of motions (e.g. workers on assembly
lines) are also prone to MSDs due to the motion of their work. Force needed to perform
actions on the job can also be associated with higher MSD risk in workers, because
movements which require more force can fatigue muscles quicker which can lead to injury
and/or pain. Additionally, exposure to vibration (as in truck drivers or construction workers,
for example) and extreme hot or cold temperatures can affect a worker's ability to judge force
and strength, which can lead to development of MSDs. Vibration exposure is also associated
with hand-arm vibration syndrome, which has symptoms of lack of blood circulation to the
fingers, nerve compression, tingling, and/or numbness.

Prevention
Prevention of MSDs relies upon identification of risk factors, either by self-report,
observation on the job, or measurement of posture which could lead to MSDs. Once risk
factors have been determined, there are several intervention methods which could be used to
prevent the development of MSDs. The target of MSD prevention efforts is often the
workplace in order to identify incidence rates of both disorders and exposure to unsafe
conditions.

Workplace controls
Groups who are at particular risk can be identified, and modifications to the physical and
psychosocial environment can be made. Approaches to prevention in workplace settings
include matching the person's physical abilities to the tasks, increasing the person's
capabilities, changing how tasks are performed, or changing the tasks. Employers can also
utilize engineering and administrative controls to prevent injury happening on the job.
Implementation of engineering controls is the process of designing or redesigning the
workplace to account for strengths, weaknesses, and needs of the working populationexamples would be workstation layout changes to be more efficient or reducing bending over,
or moving necessary tools within shorter reach of the worker's station. Employers may also
utilize administrative controls like reducing number of hours in a certain position, limiting
overtime, or including more breaks during shifts in order to reduce amount of time at risk for
each worker.

Ergonomics
Encouraging the use of proper ergonomics not only includes matching the physical ability of
the worker with the correct job, but it deals with designing equipment that is correct for the
task. Limiting heavy lifting, training, and reporting early signs of injury are examples that can
prevent MSD. Employers can provide support for employees in order to prevent MSD in the
workplace by involving the employees in planning, assessing, and developing standards of
procedures that will support proper ergonomics and prevent injury.
The National Institute of Occupational Safety and Health (NIOSH) has published ergonomic
recommendations for several industries, including construction, mining, agriculture,
healthcare, and retail, among others.

Epidemiology
General population
MSDs are an increasing healthcare issue globally, being the second leading cause of
disability. For example, in the U.S. there were more than 16 million strains and sprains
treated in 2004, and the total cost for treating MSDs is estimated to be more than $125 billion
per year. In 2006 approximately 14.3% of the Canadian population was living with a
disability, with nearly half due to MSDs. Neck pain is one of the most common complaints,
with about one fifth of adults worldwide reporting pain annually.

Workplace
Most workplace MSD episodes involve multiple parts of the body. MSDs are the most
frequent health complaint by European, United States and Asian Pacific workers. and the
third leading reason for disability and early retirement in the U.S. The incidence rate for
MSDs among the working population in 2014 was 31.9 newly diagnosed MSDs per 10,000
full-time workers. In 2014, the median days away from work due to MSDs was 13, and there
were 10.4 cases per 10,000 full-time workers in which an MSD caused a worker to be away
from work for 31 or more days. MSDs are widespread in many occupations, including those
with heavy biomechanical load like construction and factory work, and those with lighter
loads like office work. The transportation and warehousing industries have the highest
incidence rate of musculoskeletal disorders, with an incidence rate of 89.9 cases per 10,000
full-time workers. Healthcare, manufacturing, agriculture, wholesale trade, retail, and
recreation industries all have incidence rates above 35 per 10,000 full-time workers.

Causes of Musculoskeletal disorder

Fractures
Osteomyelitis
Septic arthritis

 Rheumatoid arthritis
Osteoarthritis
Gout
Pseudogout
SLE
Seronegtive arthropathy
Reiter's syndrome
Diabetes
Dermatomyosistis
Polymyositis
Slipped upper femoral epiphysis
Perthes disease
Pagets disease

Transient synovitis

Carpel tunnel syndrome

Myasthenia gravis

Duchenne muscular dystrophy

Gullian Barre syndrome

Motor neuron disease

Ostesarcoma

Osteochondroma

Osteoma

Chondroma

Ewing's sarcoma

Rhadomyosarcoma