Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
J Occup Health. 2021 Jan;63(1):e12186. doi: 10.1002/1348-9585.12186.
To evaluate the evidence of an association between occupational and non-occupational exposure to biomechanical risk factors and lateral elbow tendinopathy, medial elbow tendinopathy, and olecranon bursitis.
We carried out a systematic review of the literature. We searched MEDLINE (up to November 2019) and checked the reference lists of relevant articles/reviews. We aimed to include studies where (a) the diagnosis was based on physical examination (symptoms plus clinical signs) and imaging data (if any); and (b) the exposure was evaluated with video analysis and/or direct measurements. A quality assessment of the included studies was performed along with an evaluation of the level of evidence of a causal relationship.
We included four studies in the qualitative synthesis: two prospective cohorts and two cross-sectional studies. All the included studies investigated "lateral/medial epicondylitis", albeit the diagnosis was not supported by imaging techniques. Two cohort studies suggested that a combination of biomechanical risk factors for wrist/forearm is associated with increased risk of "lateral epicondylitis". This association was not observed in the two included cross-sectional studies. The cohort studies suggested that a Strain Index score higher than 5 or 6.1 could double the risk of "lateral epicondylitis". No association with increased risk of "medial epicondylitis" was observed.
There is limited evidence of a causal relationship between occupational exposure to biomechanical risk factors and lateral elbow tendinopathy. For medial elbow tendinopathy, the evidence is insufficient to support this causal relationship. No studies on olecranon bursitis and biomechanical overload were identified.
评估职业和非职业暴露于生物力学危险因素与外侧肘肌腱病、内侧肘肌腱病和鹰嘴滑囊炎之间的关联证据。
我们进行了文献系统评价。我们检索了 MEDLINE（截至 2019 年 11 月）并检查了相关文章/综述的参考文献列表。我们的目标是纳入以下研究：（a）诊断基于体格检查（症状加临床体征）和影像学数据（如有）；（b）使用视频分析和/或直接测量评估暴露情况。对纳入的研究进行质量评估，并评估因果关系的证据水平。
我们对定性综合分析纳入了四项研究：两项前瞻性队列研究和两项横断面研究。所有纳入的研究都调查了“外侧/内侧肱骨上髁炎”，尽管诊断未得到影像学技术的支持。两项队列研究表明，手腕/前臂的生物力学危险因素组合与“外侧肱骨上髁炎”的风险增加有关。在两项纳入的横断面研究中未观察到这种关联。队列研究表明，应变指数评分高于 5 或 6.1 可能使“外侧肱骨上髁炎”的风险增加一倍。没有观察到与“内侧肱骨上髁炎”风险增加相关的证据。
职业暴露于生物力学危险因素与外侧肘肌腱病之间存在因果关系的证据有限。对于内侧肘肌腱病，证据不足以支持这种因果关系。没有发现与生物力学过载有关的鹰嘴滑囊炎的研究。
