Providing Quality Orthopaedic Care
Filed under: Patient Information
Answer: All aspects of upper limb conditions can be associated with work. In general, however, most conditions have a multifactorial cause. If we look at the shoulder, conditions such as bursitis or rotator cuff tears often present as a work related incident with pain that starts after reaching for an item or working overhead, or even after a fall. The patient often presents with pain felt on the top of their shoulder running down the arm, worse at night or when lifting the arm, when it suddenly grabs. The patient may try to put up with it for a period of time but then presents to the General Practitioner who tries physiotherapy and orders an ultrasound.
In those patients who don’t respond with time, physiotherapy (with exercise program and incorporating rubber bands (Therabands)) and a trial of several steroid injections, then they may be referred to a surgeon for consideration of surgery. In such a scenario the temptation is for the patient to believe that work is the major cause but in reality there are multiple factors including genetics, ageing, smoking, excessive weight and domestic duties that may play a factor.
In such a scenario, the treating doctor may find it important to take a full history to understand why work may be a contributing factor. Such information may be required should a return to work claim be considered.
Other conditions which may present include distal biceps tendon tears which presents with the tendon in the elbow suddenly rupturing, with sudden onset of pain perhaps after lifting a heavy item or grasping at something falling. In such a scenario ageing is always a factor, but on occaddions such a condition can occur in younger age and certainly if the patient undertakes manual work, excessive force placed through the tendon over time, can lead to attrition (degeneration or wear and tear). Once again there is a multifactorial cause with ageing, smoking and genetics, all playing a part.
Answer: A common presentation is carpal tunnel, with someone using their hands for gripping or typing may present with pins and needles felt in the index finger, long finger and thumb. In this case the General Practitioner may consider carpal tunnel as the cause and the patient may notice the pins and needles and numbness occurring regularly but not all of the time and often worse at night, waking them from sleep. In such a scenario they may consider seeking treatment and the General Practitioner would normally consider an investigation if there was any uncertainty of the diagnosis, such as Nerve Conduction Studies where electrodes are placed along the arm to confirm the nerve is not working as well. This is usually performed by a Neurologist and can be quite definitive in the diagnosis. Carpal tunnel is a common presentation to Glenelg Orthopaedics and in a work related scenario there may be a factor secondary to tendon thickening from use, which reduces the space in the carpal tunnel region, which then leads to pressure on the nerve. There is however a significant factor that also relates to degeneration, age, genetics and the size of the wrist itself ( the latter may lead to less space in the carpal tunnel region. It is also a more common condition occurring in man ladies in their 40’s and 50’s. Once again it is important to keep an open mind and take a thorough history so that a full and appropriate explanation for the causation can be explained to the patient.
At Glenelg Orthopaedics there are many other work related injuries that present to us and we pride ourselves on a balanced approach with sensible options for treatment, with the aim of providing quality orthopaedic care.