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REVIEW ARTICLE
Year : 2014  |  Volume : 9  |  Issue : 6  |  Page : 6-12

Work related upper limb disorders


The Royal London Hospital for Integrated Medicine, Queen Square, London; International Federation of Manual/Musculoskeletal Medicine, British Institute of Musculoskeletal Medicine, UK

Correspondence Address:
Michael Hutson
The Royal London Hospital for Integrated Medicine, Queen Square, London; International Federation of Manual/Musculoskeletal Medicine, British Institute of Musculoskeletal Medicine, UK

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Source of Support: None, Conflict of Interest: None


DOI: 10.1016/j.injr.2014.09.016

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Neuropathic arm pain (NAP), commonly referred to as 'RSI', diffuse upper limb disorder or type II work related upper limb disorder (WRULD) is a regional pain syndrome affecting the upper limb(s), characterized by persistent pain and dysaesthesiae. It is commonly associ- ated with long periods of keyboard use, though may also occur in workers engaged in other types of repetitive stereotyped activities of the hands. Adverse ergonomics is commonly present. Sleep pattern is usually disturbed, and depression, headaches, chronic fatigue, and frustration are frequently experienced. The pathogenesis of NAP is probably linked to overloading of sensorineural mechanisms responsible for pain production and perception. Clinical findings include muscle tension and hyperalgesia in the upper limbs and shoulder girdles, adverse neural dynamics, and frequently (and importantly) proximal dorsal spinal dysfunction. Other factors that are often associated with the development of neuro- sensitisation include premorbid psychological profile, environmental stresses, mis- attributions and beliefs, adverse posture and ergonomics, iatrogenesis, and litigation. Conventional investigations such as cervicodorsal spinal radiographs, nerve conduction studies, and MRI are negative. Clinical management is structured on reduction of pro- vocative stresses and treatment of neuromusculoskeletal dysfunction. The differential diagnosis is discussed in this article.


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