RESUMEN
BACKGROUND: General anesthesia (GA) was the usual anesthetic technique used for laparoscopic interventions, however regional anesthesia in the laparoscopic field started to gain familiarity. Shoulder pain is a major intraoperative problem that might hinder facilitation of laparoscopic interventions under spinal anesthesia. AIM OF THE STUDY: Evaluate the effect of intrathecal addition of dexamethasone versus fentanyl on incidence and severity of intraoperative shoulder tip pain during gynecological laparoscopic asurgeries. Methods: 120 patients, were randomly assigned into three groups. Group D: 40 patients received 15 mg bupivacaine and 8 mg dexamethasone intrathecally. Group F: 40 patients received 15 mg bupivacaine and 25 pg fentanyle intrathecally. Group C: 40 patients received 15 mg bupivacaine and normal saline intrathecally. RESULTS: Number of patients who experienced intraoperative shoulder pain was significantly lower in Group F (17) and Group D (19) than Group C (31); P = 0.008. with no ststistical difference detected between Group D and C (p value 1). Only 2 patients in Group D and F suffered moderate pain intensity in comparison to 9 patients in Group C; P =0.02. Incidence of postspinal shivering was lower in Group D and F in comparison to Group C; P 0.02. CONCLUSION: Intrathecal dexamethasone is as effective as intrathecal fentanyle in reducing incidence and severity of shoulder tip pain during laparoscopic ovarian cystectomy under spinal anesthesia.
INTRODUCCIÓN: La anestesia general (AG) era la técnica anestésica habitual utilizada para las intervenciones laparoscópicas, sin embargo, la anestesia regional en el campo laparoscópico comenzó a ganar familiaridad. El dolor de hombro es un problema intraoperatorio importante que podría dificultar la facilitación de las intervenciones laparoscópicas bajo anestesia espinal. OBJETIVO DEL ESTUDIO: Evaluar el efecto de la adición intratecal de dexametasona versus fentanilo sobre la incidencia y severidad del dolor intraoperatorio en la punta del hombro durante cirugías laparoscópicas ginecológicas. MÉTODOS: 120 pacientes, fueron asignados aleatoriamente en tres grupos. Grupo D: 40 pacientes recibieron 15 mg de bupivacaína y 8 mg de dexametasona por vía intratecal. Grupo F: 40 pacientes recibieron 15 mg de bupivacaína y 25 pg de fentanilo por vía intratecal. Grupo C: 40 pacientes recibieron 15 mg de bupivacaína y solución salina normal por vía intratecal. RESULTADOS: El número de pacientes que experimentaron dolor de hombro intraoperatorio fue significativamente menor en el Grupo F (17) y el Grupo D (19) que en el Grupo C (31); P = 0,008. sin diferencia estadística detectada entre el Grupo D y C (valor de p 1). Solo 2 pacientes del Grupo D y F sufrieron dolor de intensidad moderada en comparación con 9 pacientes del Grupo C; P = 0,02. La incidencia de escalofríos posespinales fue menor en el Grupo D y F en comparación con el Grupo C; P 0,02. CONCLUSIÓN: La dexametasona intratecal es tan eficaz como el fentanilo intratecal para reducir la incidencia y la gravedad del dolor en la punta del hombro durante la cistectomía ovárica laparoscópica bajo anestesia espinal.
Asunto(s)
Humanos , Femenino , Adulto , Dexametasona/administración & dosificación , Fentanilo/administración & dosificación , Laparoscopía/métodos , Dolor de Hombro/prevención & control , Complicaciones Intraoperatorias/prevención & control , Inyecciones Espinales , Cistectomía , Dolor de Hombro/epidemiologíaRESUMEN
COVID-19 has caused a certain proportion of patients to be hospitalized in intensive care units (ICU) and may cause musculoskeletal and neurological deficits following intubation and mechanical ventilation. The aim of this study was to quantify and describe the presence of shoulder pain in patients released from hospitals after suffering COVID-19. Patients with positive Apley tests were sent to a physiatrist for a clinical evaluation, ultrasound and electromyography (EMG). This evaluation was completed with a pain scale, joint range and shoulder muscle strength evaluations. Of the one-hundred-sixteen patients, seventy eight entered the respiratory rehabilitation program. Twenty patients were sent to the multidisciplinary shoulder team for positive Apley scratch tests. Of these twenty patients, one had only an EMG, ten had only ultrasounds, seven had an EMG and ultrasound and two did not need complementary tests. The twenty patients were sent to the physical therapist, with all presenting pain and diminished joint range and muscle strength in the affected shoulder. In this context, shoulder pain could be associated with the prone position in the ICU. We suggest time control and position change for patients on mechanical ventilation in a prone position with COVID-19.
Asunto(s)
COVID-19 , Respiración Artificial , Humanos , Respiración Artificial/efectos adversos , SARS-CoV-2 , Dolor de Hombro/epidemiología , Dolor de Hombro/etiología , SobrevivientesRESUMEN
AIM: To determine the prevalence of computer vision syndrome (CVS) and ergonomic practices among students in the Faculty of Medical Sciences at The University of the West Indies (UWI), Jamaica. METHOD: A cross-sectional study was done with a self-administered questionnaire. RESULTS: Four hundred and nine students participated; 78% were females. The mean age was 21.6 years. Neck pain (75.1%), eye strain (67%), shoulder pain (65.5%) and eye burn (61.9%) were the most common CVS symptoms. Dry eyes (26.2%), double vision (28.9%) and blurred vision (51.6%) were the least commonly experienced symptoms. Eye burning (P = .001), eye strain (P = .041) and neck pain (P = .023) were significantly related to level of viewing. Moderate eye burning (55.1%) and double vision (56%) occurred in those who used handheld devices (P = .001 and .007, respectively). Moderate blurred vision was reported in 52% who looked down at the device compared with 14.8% who held it at an angle. Severe eye strain occurred in 63% of those who looked down at a device compared with 21% who kept the device at eye level. Shoulder pain was not related to pattern of use. CONCLUSION: Ocular symptoms and neck pain were less likely if the device was held just below eye level. There is a high prevalence of Symptoms of CVS amongst university students which could be reduced, in particular neck pain and eye strain and burning, with improved ergonomic practices.
Asunto(s)
Astenopía/etiología , Computadores , Diplopía/etiología , Ergonomía , Dolor de Cuello/etiología , Dolor de Hombro/etiología , Estudiantes , Adolescente , Adulto , Astenopía/diagnóstico , Astenopía/epidemiología , Estudios Transversales , Diplopía/diagnóstico , Diplopía/epidemiología , Femenino , Humanos , Jamaica/epidemiología , Masculino , Dolor de Cuello/diagnóstico , Dolor de Cuello/epidemiología , Prevalencia , Factores de Riesgo , Índice de Severidad de la Enfermedad , Dolor de Hombro/diagnóstico , Dolor de Hombro/epidemiología , Estudiantes/psicología , Estudiantes/estadística & datos numéricos , Encuestas y Cuestionarios , Síndrome , Universidades , Adulto JovenRESUMEN
INTRODUCCIÓN: la prevalencia de dolor de hombro en pacientes parapléjicos usuarios de silla de ruedas es elevada. existe consenso en que el uso de la silla de ruedas manual es un factor importante en el origen de este dolor. no existen estudios en Chile acerca del tema. OBJETIVO: determinar la prevalencia y factores asociados a dolor de hombro en personas con paraplejia secundaria a lesión medular traumática, usuarios de sillas de ruedas, describiendo también las características del dolor. MATERIALES Y MÉTODOS: estudio descriptivo transversal en personas adultas con paraplejia secundaria a lesión medular traumática, que cumplieron los criterios de inclusión. previo consentimiento informado, se les aplicó un cuestionario ISCIPDS:B, enfocado a dolor de hombro. además de preguntar qué tipo de silla de ruedas utilizan, tiempo de autopropulsión, uso de guantes de propulsión y ocupación previa a la lesión medular. se recuperaron datos de registros en ficha clínica para identificar sexo, edad, fecha del accidente, ASIA impairment scale (AIS) y nivel neurológico de la lesión. RESULTADOS: 59 pacientes cumplieron los criterios de inclusión. de ellos, el 61% de ellos refirió dolor en hombro (s). no hubo una asociación estadísticamente significativa entre el dolor en el hombro y la edad, tiempo de evolución de lesión medular, AIS, nivel de lesión neurológica, tipo de silla de ruedas ni el tiempo de uso de la silla de ruedas manual. hubo una asociación estadísticamente significativa entre uso de guantes de propulsión y el dolor de hombro. la afectación bilateral es más frecuente que unilateral. el dolor promedio fue de NRS 5,6. la duración fue referida principalmente como constante, mayor a 1 hora pero menor a 24 horas. la mayor intensidad de dolor se reportó como vespertina. CONCLUSIONES: la prevalencia de dolor de hombro en pacientes chilenos con paraplejia secundaria a lesión medular traumática es alta. es necesaria mayor investigación para determinar si los hallazgos de este estudio se extrapolan a la población general con lesión medular traumática.
INTRODUCCIÓN: the prevalence of shoulder pain in paraplegic patients using wheelchair is high. there is consensus that the use of manual wheelchair is an important factor in the origin of this pain. there are no studies in Chile about this. OBJECTIVE: to determine the prevalence and factors associated with shoulder pain in paraplegic patients for traumatism with spinal cord injury (SCI) wheelchair users, also describing the characteristics of pain. MATERIALS AND METHODS: descriptive transversal study in adults paraplegic patients for traumatism with SCI, who met inclusion criteria. an ISCIPDS:B questionnaire was previously informed, focused on shoulder pain, also asking what kind of wheelchair is being used, time of propulsion, use of propulsion gloves, and if it was being used before the spinal cord injury. further clinical record data were retrieved to identify gender, age, date of accident, ASIA, and neurological injury level. RESULTS: 59 patients met the inclusion criteria, 61% of them reported shoulder pain. there was no statistically significant association between shoulder pain and age, duration of SCI, ASIA, neurological level of injury, type of wheelchair, nor usage time of the manual wheelchair. there was a statistically significant association between the use of gloves propulsion and shoulder pain. bilateral involvement is more often. the average pain was NRS 5.6. the duration was mainly referred as a constant greater than 1hour but less than 24hours. the greater intensity of pain was reported during the evening. CONCLUSIONS: the prevalence of shoulder pain in chilean paraplegic for spinal cord traumatic injury is high. more research is needed to determine whether the findings of this study are extrapolated to the general population.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Traumatismos de la Médula Espinal/complicaciones , Silla de Ruedas , Dolor de Hombro/etiología , Dolor de Hombro/epidemiología , Paraplejía/complicaciones , Dimensión del Dolor , Prevalencia , Estudios Transversales , Análisis Multivariante , Encuestas y Cuestionarios , Factores de RiesgoRESUMEN
A moléstia dolorosa do ombro é uma das afecções mais comuns do ombro, sendo de alta prevalência na população e com o número de casos aumentando com o envelhecimento da população. Existem diversas linhas de tratamento a esta doença, desde tratamentos conservadores até cirúrgicos. Objetivo. Avaliar a ocorrência desta doença nos funcionários do Hospital do Servidor Público Municipal de São Paulo. Métodos. Trata-se de um estudo observacional e transversal, as informações serão obtidas através de um questionário contendo dados pessoais, presença de dor no ombro e realização de exame físico ortopédico especifico pelo autor do trabalho. Caso o paciente concorde com o trabalho deverá assinar um termo livre e esclarecido, seguindo as normas de confidencialidade, aprovadas pelo Comitê de Ética. Resultados. Resultados: Foram entrevistados 75 funcionários, 57 (76%) do gênero feminino e 18 (24%) masculino, com idades que variaram de 22 anos a 69 anos, com uma média de 47,9 anos. A SDO foi encontrada em 62,7% dos trabalhadores do HSPM, 35 trabalhadores apresentaram manobras diagnósticas positivas para SDO após trabalhar no HSPM. Conclusões. A faixa etária identificada como portadores de SDO neste estudo, foi compatível com a encontrada na literatura pesquisada, assim como a predominância no sexo feminino. A ocorrência de SDO foi de 62,7% na população avaliada neste projeto.
Asunto(s)
Dolor de Hombro/epidemiologíaRESUMEN
OBJECTIVES: To evaluate how transfer technique and subject characteristics relate to ultrasound measures of shoulder soft tissue pathology and self-reported shoulder pain during transfers in a sample of wheelchair users with spinal cord injury (SCI). DESIGN: Cross-sectional observational study. SETTING: Research laboratory, national and local veterans' wheelchair sporting events. PARTICIPANTS: A convenience sample of wheelchair users (N=76) with nonprogressive SCI. Participants were aged >18 years, >1 year postinjury, and could complete repeated independent wheelchair transfers without the use of their leg muscles. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Transfer pain items from the Wheelchair User's Shoulder Pain Index; transfer technique assessed using the Transfer Assessment Instrument (TAI); and shoulder pathology markers examined using the Ultrasound Shoulder Pathology Rating Scale (USPRS). RESULTS: Better transfer technique (higher TAI) correlated with less injury (lower USPRS) (partial η(2)=.062, P<.05) and less pain during transfers (partial η(2)=.049, P<.10). Greater age was the strongest predictor of greater pathology (USPRS total: partial η(2)=.225, supraspinatus grade: partial η(2)=.174, P<.01). An interaction between technique and weight was found (P<.10): participants with lower body weights showed a decrease in pathology markers with better transfer technique (low weight: R(2)=.422, P<.05; middle weight: R(2)=.200, P<.01), while those with higher weight showed little change with technique (R(2)=.018, P>.05). CONCLUSIONS: Participants with better transfer technique exhibited less shoulder pathology and reported less pain during transfers. The relationship between technique and pathology was strongest in lower-weight participants. While causation cannot be proven because of study design, it is possible that using a better transfer technique and optimizing body weight could reduce the incidence of shoulder pathology and pain.
Asunto(s)
Modalidades de Fisioterapia , Lesiones del Manguito de los Rotadores/epidemiología , Dolor de Hombro/epidemiología , Traumatismos de la Médula Espinal/rehabilitación , Silla de Ruedas , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Manguito de los Rotadores/diagnóstico por imagen , Manguito de los Rotadores/fisiopatología , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Lesiones del Manguito de los Rotadores/fisiopatología , Dolor de Hombro/diagnóstico por imagen , Dolor de Hombro/fisiopatología , Ultrasonografía , Adulto JovenRESUMEN
BACKGROUND: Myofascial pain syndrome (MPS) of the shoulder girdle and cervical region is a common musculoskeletal problem that is often chronic or recurrent. Physical therapy (PT) and lidocaine injections (LI) are two treatments with demonstrated effectiveness compared to a control group, however little is known about their combined value. The objective of this study was to determine whether LI into trigger points combined with a PT program would be more effective than each separate treatment alone in improving pain, function, and quality of life in a group of patients with MPS of the shoulder girdle and cervical region. METHODS: A single-blind, randomized, controlled clinical trial (RCT) was conducted with three parallel groups in the Departments of Physical Medicine and Rehabilitation of two urban hospitals in Medellin, Colombia. One hundred and twenty seven patients with shoulder girdle MPS for more than 6 weeks and pain greater than 40 mm on the visual analog scale (VAS) were assigned to 1 of 3 intervention groups: PT, LI, or the combination of both (PT + LI). The primary outcome was VAS pain rating at 1-month post-treatment. The secondary outcomes included VAS pain rating at 3 months, and, at both 1 and 3 months post-treatment: (a) function, evaluated by hand-back maneuver and the hand-mouth maneuver, (b) quality of life, as measured by sub-scales of the Short Form - 36 (SF-36), and (c) depressive symptoms, as measured by the Patient Health Questionnaire - 9 (PHQ-9). Independent t-tests were used to compare outcomes between groups at 1 month and 3 months post-treatment. RESULTS: In the per protocol analysis, there were no significant intergroup differences in VAS at 1 month PT + LI, 40.8 [25.3] vs. PT, 37.8 [21.9], p = 0.560 and vs. LI, 44.2 [24.9], p = 0.545. There were also no differences between groups on secondary outcomes except that the PT and PT + LI groups had higher right upper limb hand-back maneuver scores compared to the LI alone group at both 1 and 3 months (p = 0.013 and p = 0.016 respectively). CONCLUSIONS: The results of this RCT showed that no differences in pain ratings were observed between the individual treatments (PT or LI) compared to the combined treatment of PT and LI. In general, no difference in primary or secondary outcomes was observed between treatments. TRIAL REGISTRATION: NTC01250184 November 27, 2010.
Asunto(s)
Lidocaína/administración & dosificación , Síndromes del Dolor Miofascial/diagnóstico , Síndromes del Dolor Miofascial/terapia , Modalidades de Fisioterapia , Dolor de Hombro/diagnóstico , Dolor de Hombro/terapia , Adulto , Terapia Combinada/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Síndromes del Dolor Miofascial/epidemiología , Dimensión del Dolor/efectos de los fármacos , Dimensión del Dolor/métodos , Dolor de Hombro/epidemiología , Método Simple Ciego , Resultado del Tratamiento , Puntos Disparadores/patologíaRESUMEN
The aim of the present study was to assess the relationship between physical load and musculoskeletal complaints in dentistry and to analyze the prevalence and severity of such complaints in nine anatomical regions using a cross-sectional study of 387 dentists from Natal, Brazil. The highest prevalence of complaints was related to the lower back (58.4%) and the lowest prevalence was found in the elbow (10.3%). In general, symptoms were classified as mild because they did not cause absence due to illness. Pain complaints were associated with the following characteristics: awkward posture at work; prolonged standing or sitting; strenuous position of the upper limbs; excessive tightening of the hands during clinical treatment; and the use of vibrating tools. The results of the present study suggest a high prevalence of musculoskeletal complaints in dentists that are significantly associated with variables related to their physical workload.
Asunto(s)
Odontología , Dolor Musculoesquelético/epidemiología , Enfermedades Profesionales/epidemiología , Postura , Carga de Trabajo , Adulto , Tobillo , Brasil/epidemiología , Estudios Transversales , Codo , Femenino , Cadera , Humanos , Dolor de la Región Lumbar/epidemiología , Masculino , Persona de Mediana Edad , Dolor de Cuello/epidemiología , Prevalencia , Factores de Riesgo , Índice de Severidad de la Enfermedad , Dolor de Hombro/epidemiología , Encuestas y Cuestionarios , Vibración , Soporte de Peso/fisiologíaRESUMEN
Introducción: Los factores psicosociales y ergonómicos interactúan generando dolor musculoesquelético, frecuente en trabajadores de salud. Existen pocos estudios relacionando ambas condiciones, especialmente en médicos. Objetivo: Examinar la asociación entre factores psicosociales de estrés laboral (modelos demanda-control-apoyo (DC) y desequilibrio esfuerzo/recompensa (ERI)) y dolor musculoesquelético en médicos y enfermeras de un hospital público de Lima, Perú. Diseño: Estudio transversal con cuestionarios autorreportados anónimos: datos sociodemográficos, Cuestionario Nórdico (dolor musculoesquelético) y cuestionarios JCQ (Karasek) y ERI (Siegrist), en 54 médicos y 48 enfermeras del Hospital San Juan Bautista Huaral en el año 2013. Resultados: Los médicos varones presentaron un IMC medio de 28,45 y la media de horas trabajadas semanales fue de 66,86 (valores superiores a los de médicos mujeres y enfermeras). La prevalencia global de dolor musculoesquelético fue 93,1 por cento, más frecuente en cuello (72,5 por cento), hombros (46,1 por cento), muñecas y manos (44,1 por cento), dorso (52 por cento) y región lumbar (51 por cento). El dolor interfirió con las actividades en 53,9 por cento. Las enfermeras reportaron más regiones corporales afectadas por dolor (1,71 vs 0,98, p = 0,036). Hubo asociación entre dorsalgia y desequilibrio esfuerzo/recompensa (médicos: OR = 4,91, IC 95 por cento: 1,32-18,22; enfermeras: OR = 5,58 e IC 95 por cento: 1,09-28,45). Conclusiones: La prevalencia de dolor musculoesquelético, en especial cervical, dorsal y lumbar, es elevada, similar a otros reportes. Las dimensiones del modelo ERI se asociaron con dolor en cuello, hombros, dorsalgia y lumbago...
Background: Psychosocial and ergonomic factors interaction generates musculoskeletal pain, common in health care workers. There are few studies relating both conditions, especially in physicians. Objective: To evaluate the association between psychosocial factors of work stress (demand-control-support (DC) and effort-reward imbalance (ERI) models) and musculoskeletal pain on physicians and nurses from a public hospital at Lima, Peru. Design: Observational cross-sectional study employing anonymous questionnaires: socio-demographic data, Nordic Questionnaire (for musculoskeletal pain), and psychometric inventories for psychosocial factors: JCQ (Karasek) and ERI (Siegrist) on 54 physicians and 48 nurses from the Hospital San Juan Bautista Huaral at 2013. Results: Male physicians were overweight more frequently and worked more hours per week, without showing association with pain. Musculoskeletal pain prevalence was 93.1 per cent, with significant pain in 53.9 per cent of the cases. The most frequently affected sites were neck (72.5 per cent), shoulders (46.1 per cent), wrists and hands (44.1 per cent), upper back (52 per cent) and low back (51 per cent). Nurses reported more affected regions (1.71 vs. 0.98, p = 0.036). It was seen a significant association between upper back pain and the effort / reward coefficient (physicians: OR = 4.91, IC 95 per cent: 1.32-18.22; nurses: OR = 5.58, IC 95 per cent: 1.09-28.45). Conclusions: Reported prevalence of musculoskeletal pain, specially cervical, dorsal and lumbar is high and similar to other reports. The dimensions of the ERI model have shown a better association with neck pain, shoulder pain and upper/lower back pain presentation...
Introdução: Os fatores psicossociais e ergonômicos interagem gerando dor musculoesquelética, freqüente em trabalhadores de saúde. Existem poucos estudos que relacionam as duas condições, especialmente em médicos. Objetivo: Examinar a associação entre fatores psicossociais de estresse laboral (modelos demanda - controle - apoio (DC) e desequilíbrio esforço / recompensa (ERI)) e dor musculoesquelética em médicos e enfermeiras de um hospital público de Lima, Peru. Desenho: Estudo seccional com questionários auto-reportados anônimos: dados sócio-demográficos, Questionário Nórdico (dor musculoesquelética) e questionários JCQ (Karasek) e ERI (Siegrist), em 54 médicos e 48 enfermeiras do Hospital San Juan Bautista Huaral no ano 2013. Resultados: Os médicos varões apresentaram um IMC médio de 28,45 e a média de horas laboradas semanais foram 66,86 (valores superiores aos dos médicos mulheres e enfermeiras). A prevalência global da dor musculoesquelética foi 93,1 por cento, mais freqüente em pescoço (72,5 por cento), ombros (46,1 por cento), pulsos e mãos (44,1 por cento), coluna torácica (52 por cento) e coluna lombar (51 por cento). A dor atrapalhou as atividades em 53,9 por cento. As enfermeiras reportaram mais regiões corporais afetadas por dor (1,71 versus 0,98, p = 0,036). Houve associação entre dorsalgia e desequilíbrio esforço/recompensa (médicos: OR = 4,91, IC 95 por cento: 1,32-18,22; enfermeiras: OR = 5,58, IC 95 por cento: 1,09-28,45). Conclusões: A prevalência da dor musculoesquelética, especialmente cervical, dorsal e lombar é elevada, similar a outros reportes. As dimensões do modelo ERI se associaram com dor cervical, dor em ombros dorsalgia e dor lombar...
Asunto(s)
Humanos , Agotamiento Profesional , Dolor de Cuello/epidemiología , Dolor de la Región Lumbar/epidemiología , Dolor de Hombro/epidemiología , Personal de Salud , Hospitales Públicos , Salud Laboral , Personal de Hospital , Condiciones de Trabajo , Prevalencia , Estrés PsicológicoRESUMEN
As part of the international CUPID investigation, we compared physical and psychosocial risk factors for musculoskeletal disorders among nurses in Brazil and Italy. Using questionnaires, we collected information on musculoskeletal disorders and potential risk factors from 751 nurses employed in public hospitals. By fitting countryspecific multiple logistic regression models, we investigated the association of stressful physical activities and psychosocial characteristics with site-specific and multisite pain, and associated sickness absence. We found no clear relationship between low back pain and occupational lifting, but neck and shoulder pain were more common among nurses who reported prolonged work with the arms in an elevated position. After adjustment for potential confounding variables, pain in the low back, neck and shoulder, multisite pain, and sickness absence were all associated with somatizing tendency in both countries. Our findings support a role of somatizing tendency in predisposition to musculoskeletal disorders, acting as an important mediator of the individual response to triggering exposures, such as workload.
Asunto(s)
Enfermedades Musculoesqueléticas/epidemiología , Personal de Enfermería en Hospital/estadística & datos numéricos , Enfermedades Profesionales/epidemiología , Absentismo , Adulto , Brasil/epidemiología , Estudios Transversales , Femenino , Hospitales Públicos/estadística & datos numéricos , Humanos , Italia/epidemiología , Modelos Logísticos , Dolor de la Región Lumbar/epidemiología , Dolor de la Región Lumbar/psicología , Masculino , Persona de Mediana Edad , Enfermedades Musculoesqueléticas/psicología , Dolor de Cuello/epidemiología , Dolor de Cuello/psicología , Personal de Enfermería en Hospital/psicología , Enfermedades Profesionales/psicología , Factores de Riesgo , Dolor de Hombro/epidemiología , Dolor de Hombro/psicología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
As part of the international CUPID investigation, we compared physical and psychosocial risk factors for musculoskeletal disorders among nurses in Brazil and Italy. Using questionnaires, we collected information on musculoskeletal disorders and potential risk factors from 751 nurses employed in public hospitals. By fitting countryspecific multiple logistic regression models, we investigated the association of stressful physical activities and psychosocial characteristics with site-specific and multisite pain, and associated sickness absence. We found no clear relationship between low back pain and occupational lifting, but neck and shoulder pain were more common among nurses who reported prolonged work with the arms in an elevated position. After adjustment for potential confounding variables, pain in the low back, neck and shoulder, multisite pain, and sickness absence were all associated with somatizing tendency in both countries. Our findings support a role of somatizing tendency in predisposition to musculoskeletal disorders, acting as an important mediator of the individual response to triggering exposures, such as workload.
Como parte da pesquisa internacional CUPID, comparamos os fatores de risco físico e psicossocial para distúrbios osteomusculares entre enfermeiras no Brasil e na Itália. Foram coletados dados com questionários sobre distúrbios osteomusculares e seus fatores de risco potenciais com 751 enfermeiros de hospitais públicos. Com modelos de regressão logística específicas para cada país, investigamos a associação entre atividades físicas estressantes e as características psicossociais, com dores em sítios específicos e múltiplos, assim como ausências motivadas por doença. Não encontramos clara relação entre dor lombar e levantamento de pesos, porém dores no pescoço e ombros foram as mais relatadas entre as enfermeiras que realizam trabalho prolongado, com braços elevados. As dores na lombar, pescoço, ombros e em múltiplos sítios foram associadas à tendência somatizante e à ausência por doença em ambos os países. Nossos achados reforçam o papel da tendência somatizante como fator predisponente para distúrbios osteomusculares, atuando como um importante mediador da resposta individual.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Enfermedades Musculoesqueléticas/epidemiología , Personal de Enfermería en Hospital/estadística & datos numéricos , Enfermedades Profesionales/epidemiología , Absentismo , Brasil/epidemiología , Estudios Transversales , Hospitales Públicos/estadística & datos numéricos , Italia/epidemiología , Modelos Logísticos , Dolor de la Región Lumbar/epidemiología , Dolor de la Región Lumbar/psicología , Enfermedades Musculoesqueléticas/psicología , Dolor de Cuello/epidemiología , Dolor de Cuello/psicología , Personal de Enfermería en Hospital/psicología , Enfermedades Profesionales/psicología , Factores de Riesgo , Encuestas y Cuestionarios , Dolor de Hombro/epidemiología , Dolor de Hombro/psicologíaRESUMEN
OBJECTIVE: To study the prevalence of shoulder pain and dysfunction in patients from Southern Brazil with diabetes mellitus (DM) and to evaluate the association of pain and dysfunction with diabetes control and epidemiological factors. SUBJECTS AND METHODS: We studied 150 patients with type 2 DM for pain and shoulder dysfunction with the UCLA-m (modified University of California at Los Angeles Shoulder Rating Scale); for epidemiological and treatment data, values of Hb A(1C) and plasma glucose were analyzed. RESULTS: Pain was present in 63.4%, and dysfunction in 53.4% of the studied sample; 26.6% of the patients rated shoulder performance as bad. No association was found between Hb A(1C) or plasma glucose and joint function, except for active flexion of the shoulder and fasting glucose (p = 0.026). Women had worse shoulder performance (p = 0.0043), as did elderly patients (p < 0.0001). CONCLUSIONS: Shoulder pain and dysfunction is highly prevalent in patients with type 2 diabetes; these disorders affect more women and the elderly.
Asunto(s)
Diabetes Mellitus Tipo 2/fisiopatología , Dimensión del Dolor/métodos , Dolor de Hombro/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Glucemia/análisis , Brasil/epidemiología , Estudios Transversales , Diabetes Mellitus Tipo 2/sangre , Femenino , Hemoglobina Glucada/análisis , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Rango del Movimiento Articular/fisiología , Dolor de Hombro/sangre , Dolor de Hombro/epidemiología , Estadísticas no Paramétricas , Factores de TiempoRESUMEN
OBJECTIVE: To study the prevalence of shoulder pain and dysfunction in patients from Southern Brazil with diabetes mellitus (DM) and to evaluate the association of pain and dysfunction with diabetes control and epidemiological factors. SUBJECTS AND METHODS: We studied 150 patients with type 2 DM for pain and shoulder dysfunction with the UCLA-m (modified University of California at Los Angeles Shoulder Rating Scale); for epidemiological and treatment data, values of Hb A1C and plasma glucose were analyzed. RESULTS: Pain was present in 63.4%, and dysfunction in 53.4% of the studied sample; 26.6% of the patients rated shoulder performance as bad. No association was found between Hb A1C or plasma glucose and joint function, except for active flexion of the shoulder and fasting glucose (p = 0.026). Women had worse shoulder performance (p = 0.0043), as did elderly patients (p < 0.0001). CONCLUSIONS: Shoulder pain and dysfunction is highly prevalent in patients with type 2 diabetes; these disorders affect more women and the elderly.
OBJETIVO: Estudar a prevalência de dor e disfunção do ombro em pacientes com diabetes melito (DM) do sul do Brasil e verificar a possível associação com controle glicêmico e fatores epidemiológicos. SUJEITOS E MÉTODOS: Estudaram-se 150 pacientes com DM tipo 2 para dor e disfunção do ombro pelo instrumento UCLAm (University of California at Los Angeles Shoulder Rating Scale modificada), dados epidemiológicos e de tratamento, valores de Hb A1C e glicemia de jejum. RESULTADOS: Verificou-se que havia dor em 63,4% e disfunção em 53,4% da amostra estudada. Em 26,6% dos pacientes, o desempenho do ombro foi considerado ruim. Não se encontrou associação de Hb A1C e glicemia de jejum com dor e disfunção do ombro salvo pela associação entre flexão ativa dessa articulação com glicemia de jejum (p = 0,026). As mulheres tinham pior desempenho do ombro (p = 0,0043), assim como os mais idosos (p < 0,0001). CONCLUSÕES: Existe uma prevalência muito alta de dor e disfunção do ombro em pacientes com DM tipo 2, sendo maior em mulheres e idosos.
Asunto(s)
Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , /fisiopatología , Dimensión del Dolor/métodos , Dolor de Hombro/fisiopatología , Glucemia/análisis , Brasil/epidemiología , Estudios Transversales , /sangre , Hemoglobina Glucada/análisis , Prevalencia , Rango del Movimiento Articular/fisiología , Estadísticas no Paramétricas , Dolor de Hombro/sangre , Dolor de Hombro/epidemiología , Factores de TiempoRESUMEN
STUDY DESIGN: Clinical and radiographic evaluation of the shoulders of tetraplegic and paraplegic patients who attend rehabilitation program. OBJECTIVES: The objective of this study is to establish the usefulness of radiography as a trial exam for shoulder pain in spinal cord injured patients. SETTING: Hospital das Clinicas-UNICAMP. Campinas, Sao Paulo, Brazil. METHODS: Thirty-two shoulders of 16 patients were evaluated by clinical exam and radiography. Patients were divided into two groups: paraplegic and tetraplegic. A control group of 16 normal volunteer subjects was selected. RESULTS: Shoulder pain was reported in 88.89% of tetraplegic and 42.85% of paraplegic. The time of injury ranged from 1.5-22 years (mean 7.88 years); patients had a mean age of 34.68 years (range, 21-57 years). The acromioclavicular joint (ACJ) space ranged from 0.03-0.7 cm on the right side and 0.15-0.7 cm on the left side, with a mean of 0.37 and 0.41 cm, respectively. No correlation was found between shoulder pain and gender, age or time since injury. There was a trend to correlation between shoulder pain and type of injury with tetraplegic having a tendency to pain symptoms. On average, tetraplegic had smaller ACJ. CONCLUSIONS: The small number of patients in this study did not allow us to confirm the hypothesis that X-ray finding may indicate risk for shoulder pain in spinal cord injury patients. A work with a greater number of subjects could demonstrate association between shoulder pain and the reduced acromioclavicular distance, making plain radiography a trial exam for spinal cord-injured patients.
Asunto(s)
Parálisis/epidemiología , Dolor de Hombro/diagnóstico por imagen , Dolor de Hombro/epidemiología , Traumatismos de la Médula Espinal/epidemiología , Adulto , Comorbilidad/tendencias , Femenino , Humanos , Masculino , Persona de Mediana Edad , Parálisis/diagnóstico por imagen , Parálisis/rehabilitación , Paraplejía/diagnóstico por imagen , Paraplejía/epidemiología , Cuadriplejía/diagnóstico por imagen , Cuadriplejía/epidemiología , Radiografía , Dolor de Hombro/fisiopatología , Traumatismos de la Médula Espinal/diagnóstico por imagen , Adulto JovenRESUMEN
The prevalence of musculoskeletal disorders among workers in the plastics industry in Salvador, Bahia State, Brazil was estimated. Cases were defined by reported symptoms of pain in the previous 12 months, lasting more than a week or having monthly minimum frequency, which had given rise to restrictions at work or to seeking medical attention, or where respondents had a severity score greater than or equal to 3 (on a numerical scale of 0 to 5). A stratified proportional random sample of 577 workers was studied. The prevalence of musculoskeletal disorders, considering of all body segments, was 50.1%. The prevalence of musculoskeletal disorders was higher among women than among men at distal upper extremities (34.6% and 11.6% respectively) and also in the region of the neck, shoulder or upper part of the back (27.4% and 17.6% respectively). There was no difference between genders for the prevalence of lower back pain (21.2% and 21.4% respectively); 65% of cases in this region had reports of pain in the previous seven days. Due to the importance and prevalence of musculoskeletal disorders, it is necessary that their measurement in epidemiological studies be done properly.
Asunto(s)
Enfermedades Musculoesqueléticas/epidemiología , Enfermedades Profesionales/epidemiología , Brasil/epidemiología , Femenino , Humanos , Dolor de la Región Lumbar/epidemiología , Masculino , Dolor de Cuello/epidemiología , Dimensión del Dolor , Plásticos , Prevalencia , Factores de Riesgo , Dolor de Hombro/epidemiologíaRESUMEN
Se realizó un estudio experimental, tipo ensayo clínico controlado, en el período comprendido entre enero del 2007 hasta enero del 2008, con el fin de comparar la respuesta al tratamiento con farmacopuntura en el hombro doloroso con respecto al bloqueo del nervio supraescapular y proponer un algoritmo de tratamiento. La muestra quedó constituida por 60 pacientes, los cuales fueron aleatorizados y divididos en dos grupos, a uno se le realizó bloqueo del nervio supraescapular con betametasona y lidocaína al 2 por ciento en dosis habituales y al otro grupo se les aplicó farmacopuntura con pequeñas dosis de betametasona diluida con agua para inyección. El tratamiento fue aplicado dos veces por semana y hasta seis sesiones como máximo. Se evaluaron semanalmente por un equipo de trabajo teniendo en cuenta el criterio del paciente según la escala visual análoga, según criterio médico basado en el examen clínico, explorándose el dolor, la limitación de la movilidad articular y el balance funcional . Se observó una evolución satisfactoria más rápida en los pacientes tratados con farmacopuntura. El tratamiento con farmacopuntura en el hombro doloroso es de alta eficacia frente al bloqueo del nervio supraescapular.
We carried out an experimental, longitudinal and prospective study, at the Provincial Centre for the Development of Natural and Traditional Medicine Dr Mario E Dihigo, during the period from January 2007 to January 2008, with the objective of treating the increased incidence of patients with painful affections of the shoulder, requiring in many cases the usage of long, risk treatments, with results not always satisfactory. The sample was formed by 60 patients who were randomized and divided in two groups. A blockade of the supraescapular nerve with betamethasone and lidocain 2 per cent in habitual doses was applied to one group; the second one received pharmacopuncture with low doses of betamethasone diluted in water for injection. The treatment was applied 2 times a week and up to the maximum of 6 sessions. They were evaluated weakly for a working group, taking into account the patient's criteria according to the visual analogous scale, according to the medical criteria based on the clinical examination looking for pain, joint mobility limitation and functional balance. Among the studied patients there was a predominance of the female sex beginning from the third and fourth decades of life. Tendinitis of the rotator cuff was the most frequent diagnosis. There was a faster satisfactory recovery in patients treated with pharmacopuncture. Pharmacopuncture therapy in painful shoulder is of higher efficacy than the blockade of the supraescapular nerve.
Asunto(s)
Humanos , Adulto , Femenino , Betametasona/uso terapéutico , Bloqueo Nervioso , Dolor de Hombro/epidemiología , Dolor de Hombro/tratamiento farmacológico , Lidocaína/uso terapéutico , Manguito de los Rotadores/patología , Resultado del Tratamiento , Tendinopatía/diagnóstico , Terapia por Acupuntura/métodos , Ensayos Clínicos Controlados como Asunto , Estudios Longitudinales , Estudios ProspectivosRESUMEN
Se realizó un estudio experimental, tipo ensayo clínico controlado, en el período comprendido entre enero del 2007 hasta enero del 2008, con el fin de comparar la respuesta al tratamiento con farmacopuntura en el hombro doloroso con respecto al bloqueo del nervio supraescapular y proponer un algoritmo de tratamiento. La muestra quedó constituida por 60 pacientes, los cuales fueron aleatorizados y divididos en dos grupos, a uno se le realizó bloqueo del nervio supraescapular con betametasona y lidocaína al 2 por ciento en dosis habituales y al otro grupo se les aplicó farmacopuntura con pequeñas dosis de betametasona diluida con agua para inyección. El tratamiento fue aplicado dos veces por semana y hasta seis sesiones como máximo. Se evaluaron semanalmente por un equipo de trabajo teniendo en cuenta el criterio del paciente según la escala visual análoga, según criterio médico basado en el examen clínico, explorándose el dolor, la limitación de la movilidad articular y el balance funcional . Se observó una evolución satisfactoria más rápida en los pacientes tratados con farmacopuntura. El tratamiento con farmacopuntura en el hombro doloroso es de alta eficacia frente al bloqueo del nervio supraescapular...(AU)
We carried out an experimental, longitudinal and prospective study, at the Provincial Centre for the Development of Natural and Traditional Medicine Dr Mario E Dihigo, during the period from January 2007 to January 2008, with the objective of treating the increased incidence of patients with painful affections of the shoulder, requiring in many cases the usage of long, risk treatments, with results not always satisfactory. The sample was formed by 60 patients who were randomized and divided in two groups. A blockade of the supraescapular nerve with betamethasone and lidocain 2 per cent in habitual doses was applied to one group; the second one received pharmacopuncture with low doses of betamethasone diluted in water for injection. The treatment was applied 2 times a week and up to the maximum of 6 sessions. They were evaluated weakly for a working group, taking into account the patient's criteria according to the visual analogous scale, according to the medical criteria based on the clinical examination looking for pain, joint mobility limitation and functional balance. Among the studied patients there was a predominance of the female sex beginning from the third and fourth decades of life. Tendinitis of the rotator cuff was the most frequent diagnosis. There was a faster satisfactory recovery in patients treated with pharmacopuncture. Pharmacopuncture therapy in painful shoulder is of higher efficacy than the blockade of the supraescapular nerve...(AU)
Asunto(s)
Humanos , Femenino , Adulto , Terapia por Acupuntura/métodos , Dolor de Hombro/tratamiento farmacológico , Dolor de Hombro/epidemiología , Betametasona/uso terapéutico , Lidocaína/uso terapéutico , Bloqueo Nervioso , Tendinopatía/diagnóstico , Manguito de los Rotadores/patología , Resultado del Tratamiento , Ensayo Clínico , Estudios Longitudinales , Estudios Prospectivos , Ensayos Clínicos Controlados como AsuntoRESUMEN
Com objetivo de estudar os possíveis achados ultra-sonográficos na Síndrome do Ombro Doloroso (SOD), foram avaliados 77 pacientes com diagnóstico clínico de ombro doloroso encaminhados para investigação através da ultra-sonografia (USG). Além dos achados de exame, procurou-se identificar variáveis clínicas e epidemiológicas, as quais, pudessem estar associadas à presença de alterações patológicas. Dos 77 pacientes incluídos no estudo foram encontradas alterações no exame de USG de 47(61%), destes 38 (80%) apresentaram algum tipô de lesão no manguito rotador (MR), classificadas de tendinose ou tendinopatia, ruptura parcial e ruptura completa. Dentre os outros nove (20%) pacientes, cinco (11%) apresentaram bursite e quatro (9%) derrame articular como diagnósticos isolados. Dentre as variáveis clínicas e epidemiológicas avaliadas, a idade acima de 51 anos e limitação funcional articular estiveram associadas a presença de alterações no exame ultra-sonográfico destes pacientes. A lesão do MR além de ter sido a alteração mais freqüente, esteve associada ao diagnóstico ultra-sonográfico de derrame articular e a necessidade de uso de drogas antiinflamatórias. Concluiu-se que a USG é um importante método de avaliação de pacientes com SOD e que fatores como idade, limitação funcional articular apresentam associação com a presença de lesão do manguito rotador.
Asunto(s)
Humanos , Masculino , Femenino , Dolor de Hombro/diagnóstico , Dolor de Hombro/epidemiología , Dolor de Hombro , Ultrasonografía , Bursitis/diagnóstico , Bursitis , Informes de Casos , Tendinopatía/diagnóstico , TendinopatíaRESUMEN
The authors interviewed an age- and occupation-stratified sample of 466 women, aged 18-40, from 12 Tijuana neighborhoods, about sociodemographic characteristics, work and reproductive history, and musculoskeletal complaints. A total of 29.8% reported experiencing aches or pain in the low back, 38.3% in the upper back, 26.4% in the neck/shoulders, 18.2% in the hand/wrist, and 28.3% in the legs in the preceding year. Both sociodemographic and occupational factors were associated with these complaints. Very low educational attainment, having substandard housing, being the head of household, and being a migrant were each associated with an increased prevalence of one or more musculoskeletal complaints. In general, working outside the home increased the risk of musculoskeletal complaints. Compared with women who had not worked in the preceding 30-month period, those working in the maquiladora had 40-90% higher risks of upper back, neck/shoulder, and hand/wrist pain. Compared with women working outside the maquiladora, maquiladora women workers had 20% higher risks of low back, upper back, and neck/shoulder complaints. More detailed studies of the incidences of musculoskeletal disorders and of specific etiologic risk factors within the maquiladora industry are warranted. Future studies should concurrently evaluate sociodemographic risk factors.