Hospital South West Jutland, Esbjerg, Denmark (Department of Occupational Medicine).
Int J Occup Med Environ Health. 2021 Sep 3;34(5):679-691. doi: 10.13075/ijomeh.1896.01734. Epub 2021 Apr 23.
The character of upper limb disorders in computer operators is subject to debate. While nerve involvement is suggested by the presence of pain, paresthesia and subjective weakness, these symptoms are mainly interpreted as related to pathologies outside the nervous system. Findings in a previous study involving computer operators indicated peripheral nerve afflictions with specific locations in symptomatic subjects. Based on the same sample, this study addresses the relation of non-neurogenic findings to pain and neurological findings.
Overall, 96 computer operators scored their perceived pain in the neck, shoulder, elbow, and wrist/hand on a of 0-9. They underwent 2 sets of blinded physical examinations of selected non-neurogenic and neurological items, respectively. The authors analyzed correlations between the scores of each non-neuropathic finding, and a) mean pain scores for each and all regions, and b) scores for neurological patterns reflecting brachial plexopathy, median neuropathy (the elbow), and posterior interosseous neuropathy, respectively, and their combination. Kendall's rank correlation test was applied for all statistical analyses.
A median pain level of 1 or 0.5 was reported by 80 and 57 participants on the mouse-operating or contralateral side, respectively. Non-neurogenic and neurological findings were frequent. The mean overall pain correlated with palpation soreness of the neck insertions, and of the trapezius and supraspinatus muscles. Neck and elbow pain correlated with palpation soreness at the neck insertions and the lateral epicondyles, respectively. Significant correlations on the mouse-operating side were identified between posterior interosseous neuropathy and lateral epicondyle soreness, and between median neuropathy and any neurological pattern, and trapezius and lateral epicondyle soreness.
Pain correlated with palpation soreness, which again correlated with the neurological patterns. Palpation soreness may be less significant as a marker of a painful disorder as it correlated no better with regional than with overall pain. The physical examination of computer operators should include a sufficient neurological assessment. Int J Occup Med Environ Health. 2021;34(5):679-91.
计算机操作人员上肢疾病的特征存在争议。虽然疼痛、感觉异常和主观无力表明存在神经受累，但这些症状主要被解释为与神经系统以外的病变有关。先前一项涉及计算机操作人员的研究发现，症状患者存在特定部位的周围神经疾病。基于相同的样本，本研究探讨了非神经源性发现与疼痛和神经学发现的关系。
共有 96 名计算机操作人员对其颈部、肩部、肘部和腕部/手部的疼痛程度进行了评分，评分为 0-9。他们分别接受了 2 组非神经源性和神经源性项目的盲法体格检查。作者分析了每个非神经病变发现与以下各项之间的相关性：a）每个和所有区域的平均疼痛评分，以及 b）反映臂丛神经病、正中神经病变（肘部）和后骨间神经病的神经学模式评分，以及它们的组合。所有统计分析均应用 Kendall 等级相关检验。
80 名和 57 名参与者分别报告鼠标操作侧和对侧的中位数疼痛水平为 1 或 0.5。非神经源性和神经源性发现均很常见。总体疼痛平均值与颈部附着点和斜方肌和三角肌压痛相关。颈部和肘部疼痛与颈部附着点和外上髁压痛相关。鼠标操作侧的显著相关性包括后骨间神经病与外上髁压痛，以及正中神经病变与任何神经学模式，以及斜方肌和外上髁压痛。
疼痛与压痛相关，压痛又与神经学模式相关。压痛作为疼痛障碍的标志物可能意义不大，因为它与区域性疼痛的相关性并不优于总体疼痛。应对计算机操作人员进行充分的神经学评估。国际职业医学与环境卫生杂志。2021；34（5）：679-91。
