Riva Matteo Marco, Santini Marisa, Mosconi Giovanni
Unità Operativa Ospedaliera Medicina del Lavoro - Azienda Ospedaliera Papa Giovanni XXIII, Bergamo.
G Ital Med Lav Ergon. 2013 Jan-Mar;35(1):10-6.
In this work the authors analyse the results of the clinical evaluation of patients affected by suspected work related musculo-skeletal disorders (WMSDs), observed throughout 2008-2009 in the specific ambulatory of Occupational Medicine Division of Ospedali Riuaniti di Bergamo. The aim is to illustrate the epidemiological relevance of upper limb (UL) WMSDs.
We observed 430 patients (mean age 46,9 years, DS 9,3; mean working seniority 29 years, DS 10,4), investigating 600 disorders in diferent musculoskeletal segments. Most of the patients (66%) got to the division for a clinical consultation requested by general practitioners, 29,8% by occupational physicians, 4,2% by national insurance for occupational injuries and diseases (INAIL).
Most of the patients (38,4%) were employed in construction industry. Among the 600 disorders investigated, 34,5% was at lumbar spine, 74,5% was at upper limb. The clinical diagnosis was already clear at the first consultation for 81,6% of subjects with low back pain and for 56,5% of patients with upper limb disorders; for the others was necessary to prescribe some instrumental exams or specialistic (neurologic, physiatric, orthopaedic) medical examination. We concluded for a diagnosis of WMSDs in 48,3% of the 600 cases: the percentage is 50,2% if we consider only disorders at lumbar spine and 52,5% among disorders at upper limb. The most frequent reason of refusing occupational aetiology, in the cases of low back pain, was the concomitant presence of other diseases at the segment; on the contrary, for the cases of upper limb disorders, was the lack of correlation between type of disease and professional exposure.
All physicians demonstrate a high attention about upper limb disorders, topical subject of great epidemiological interest. General practitioners and occupational physicians have to take more advantage of diagnostic support and clinical evaluations offered by Occupational Medicine Divisions an Universities about WMSDs. In consideration of the dificulties to diagnose upper limb disorders and proving correlation with professional exposure is useful to promote specific courses for general practitioners and occupational physicians.
在本研究中，作者分析了2008 - 2009年期间在贝加莫里瓦尼蒂医院职业医学科特定门诊观察到的疑似与工作相关的肌肉骨骼疾病（WMSDs）患者的临床评估结果。目的是阐明上肢（UL）WMSDs的流行病学相关性。
我们观察了430例患者（平均年龄46.9岁，标准差9.3；平均工作年限29年，标准差10.4），调查了不同肌肉骨骼部位的600种疾病。大多数患者（66%）是应全科医生的临床会诊要求前来该科室的，29.8%是由职业医生要求的，4.2%是由国家职业伤害和疾病保险（INAIL）要求的。
大多数患者（38.4%）受雇于建筑业。在调查的600种疾病中，34.5%位于腰椎，74.5%位于上肢。对于81.6%的腰痛患者和56.5%的上肢疾病患者，在首次会诊时临床诊断就已明确；对于其他患者，则需要进行一些仪器检查或专科（神经科、理疗科、骨科）医学检查。我们在600例病例中的48.3%得出了WMSDs的诊断结论：如果仅考虑腰椎疾病，这一比例为50.2%，在上肢疾病中为52.5%。在腰痛病例中，拒绝职业病因的最常见原因是该部位同时存在其他疾病；相反，在上肢疾病病例中，是疾病类型与职业暴露之间缺乏相关性。
所有医生都对上肢疾病表现出高度关注，这是一个具有重大流行病学意义的热门话题。全科医生和职业医生必须更多地利用职业医学科和大学提供的关于WMSDs的诊断支持和临床评估。考虑到诊断上肢疾病以及证明其与职业暴露相关性的困难，为全科医生和职业医生开设特定课程是有用的。
