Hagberg M
Department of Occupational and Environmental Medicine, Sahlgrenska Academy and University Hospital Göteborg, Sweden.
G Ital Med Lav Ergon. 2005 Jan-Mar;27(1):51-7.
To describe the clinical assessment and management of work related neck and upper limb disorders.
A total of 65 references in English were found in Pub Med for the years 1980-2002 that dealt with clinical assessment, prognosis and return to work with reference to neck and upper limb original research that dealt with test performance in diagnostic procedures. Few studies were randomised studies of prognosis and return to work with reference to neck and upper limb disorders.
The clinical assessment consists of the clinical and exposure history, the evaluation of the physical and laboratory findings. The physical examination should include the following steps: (1) inspection; (2) testing for range of motion (3) testing for muscle contraction pain and muscle strength (4) palpation of muscle tendons and insertions and (5) specific tests. The characteristics of clinical tests in terms of likelihood ratio for confirming and ruling out disease have to be considered for the diagnosis. The use of terms such as RSI (repetitive strain injuries) and CTD (cumulative trauma disorders) should be avoided. If the different musculoskeletal symptoms and signs do not completely comply with criteria for a disease, it is recommended to choose an ICD (International Classification of Disease) label that focuses on the symptoms rather than the pathology. The prognosis for most work related disorders are variable. The general experience is for non-specific neck and upper arm that pain and discomfort may be decreased but not eliminated in the majority of cases. It is important to start rehabilitation early. Long periods of sick leave are generally counterproductive. Disputed workers' compensation claims and an adverse work setting also are likely to impede successful rehabilitation. Since most patients with musculoskeletal disorders are also exposed to ergonomic stressors accommodation of the injured worker has to take the whole work system into account (task, technology, environment and organization).
Despite the large number of patients with neck and upper limb disorders the scientific evidence for clinical assessment, to determine the prognosis and for successful procedures for return to work are few.
描述与工作相关的颈部和上肢疾病的临床评估与管理。
1980年至2002年期间，在PubMed中总共找到了65篇英文参考文献，这些文献涉及临床评估、预后以及重返工作岗位，并参考了有关颈部和上肢的原始研究，这些研究涉及诊断程序中的测试表现。很少有研究是关于颈部和上肢疾病预后及重返工作岗位的随机研究。
临床评估包括临床病史和接触史、体格检查和实验室检查结果的评估。体格检查应包括以下步骤：（1）视诊；（2）活动范围测试；（3）肌肉收缩疼痛和肌肉力量测试；（4）肌肉肌腱和附着点触诊；（5）特殊测试。诊断时必须考虑临床测试在确诊和排除疾病方面的似然比特征。应避免使用诸如重复性劳损（RSI）和累积性创伤疾病（CTD）等术语。如果不同的肌肉骨骼症状和体征不完全符合某种疾病的标准，建议选择一个侧重于症状而非病理的国际疾病分类（ICD）标签。大多数与工作相关疾病的预后各不相同。一般经验是，对于非特异性颈部和上臂疾病，大多数情况下疼痛和不适可能会减轻，但不会消除。尽早开始康复治疗很重要。长时间病假通常会适得其反。有争议的工伤赔偿索赔和不利的工作环境也可能阻碍成功康复。由于大多数肌肉骨骼疾病患者也面临人体工程学压力源，受伤工人的适应必须考虑整个工作系统（任务、技术、环境和组织）。
尽管有大量颈部和上肢疾病患者，但关于临床评估、确定预后以及成功重返工作岗位程序的科学证据却很少。
