Walker-Bone Karen, Reading Isabel, Coggon David, Cooper Cyrus, Palmer Keith T
MRC Epidemiology Resource Centre, Southampton General Hospital, Southampton, UK.
Occup Med (Lond). 2006 Jun;56(4):243-50. doi: 10.1093/occmed/kql016. Epub 2006 Apr 20.
Few community-based epidemiological investigations of upper limb disorders (ULDs) have classified cases by validated procedures involving a structured clinical examination.
To compare risk factor profiles for different diagnostic categories of ULD using one such examination scheme.
A questionnaire about upper limb pain and demographic, occupational and psychosocial risk factors was mailed to 10,264 adults from two English general practices, followed by standardized physical examination in those with arm or neck pain. Logistic regression was used to compare those with specific ULDs and non-specific arm pain with those who had no neck or arm symptoms.
There was a 59% response rate. A total of 1,197 subjects with arm or neck pain underwent standardized physical examination and were classified as having one or more of 11 specific ULDs or non-specific regional pain. Among these, 250 subjects with specific ULDs and 176 with only non-specific arm pain were compared with 2,248 subjects who had no neck or arm symptoms. Certain physical risk factors were more strongly associated with specific disorders than with non-specific pain. In comparison with pain-free subjects, the odds ratios (ORs) in keyboard users (>or=1 h versus <1 h/day) were 3.1 (95% CI 1.3, 7.8) for hand-wrist tendonitis but 1.3 (0.8, 2.1) for non-specific hand-wrist pain. Other differential associations were found with age, sex, manual versus non-manual employment and smoking. Unexpectedly, low vitality was similarly associated with both specific disorders and non-specific pain.
These findings suggest that the schedule may usefully distinguish disorders that differ in their association with physical risk factors.
很少有基于社区的上肢疾病（ULD）流行病学调查通过涉及结构化临床检查的有效程序对病例进行分类。
使用这样一种检查方案比较不同诊断类别的ULD的危险因素概况。
向来自英国两家全科诊所的10264名成年人邮寄了一份关于上肢疼痛以及人口统计学、职业和社会心理危险因素的问卷，随后对有手臂或颈部疼痛的人进行标准化体格检查。使用逻辑回归比较患有特定ULD和非特异性手臂疼痛的人与没有颈部或手臂症状的人。
回复率为59%。共有1197名有手臂或颈部疼痛的受试者接受了标准化体格检查，并被分类为患有11种特定ULD中的一种或多种或非特异性局部疼痛。在这些人中，将250名患有特定ULD的受试者和176名仅有非特异性手臂疼痛的受试者与2248名没有颈部或手臂症状的受试者进行了比较。某些身体危险因素与特定疾病的关联比与非特异性疼痛的关联更强。与无疼痛的受试者相比，键盘使用者（每天≥1小时与<1小时）患手腕腱鞘炎的优势比（OR）为3.1（95%CI 1.3, 7.8），而非特异性手腕疼痛的OR为1.3（0.8, 2.1）。还发现了与年龄、性别、体力劳动与非体力劳动职业以及吸烟的其他差异关联。出乎意料的是，低活力与特定疾病和非特异性疼痛的关联相似。
这些发现表明该检查表可能有助于区分与身体危险因素关联不同的疾病。
