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Perspectives in Disease Prevention and Health Promotion Leading Work-Related Diseases and Injuries -- United States

The National Institute for Occupational Safety and Health (NIOSH) has developed a suggested list of the 10 leading work-related diseases and injuries (Table 1). Problems in the first category, occupational lung diseases, were recently described (1); a discussion of the second category, musculoskeletal injuries, appears below. MUSCULOSKELETAL INJURIES

In 1982, musculoskeletal injuries accounted for 580,000 (18%) of the estimated 3.2 million emergency-room-treated occupational injuries in the United States (2). Physical demands of many jobs make the musculoskeletal system highly vulnerable to a variety of occupational injuries and illnesses. Manual handling of materials, repetitive motions, and vibration are especially important etiologic factors in the development of these disorders.

Injuries associated with the manual handling of materials (e.g., unaided lifting and lowering): Low back injuries, often due to improper manual handling of materials, are the largest single subset of musculoskeletal injuries. The Bureau of Labor Statistics recently reported that approximately one million workers sustained back injuries in 1980 and that back injuries account for one of every five injuries and illnesses in the workplace. Approximately one-fourth of all workers' compensation indemnity expenditures in eight states were for back injuries (3).

Repetitive motion-associated trauma: Repetitive motion can cause "cumulative trauma disorders," including carpal tunnel syndrome, tendinitis, ganglionitis, tenosynovitis, bursitis, and epicondylitis. These disorders may be caused or aggravated by repeated twisting or awkward postures, particularly when combined with high force. The population at risk includes persons employed in such industries or occupations as construction, food preparation, clerical work, product fabrication, and mining.

Data from the National Occupational Hazard Survey suggest that 15%-20% of workers in these jobs are potentially at risk of cumulative trauma disorders (4). Data from the Bureau of Labor Statistics indicate that in 1980 approximately 23,200 occupational injuries were associated with repeated trauma (5).

Vibration-associated injuries: An estimated seven million workers in such occupations as vehicle operation are intermittently exposed to whole-body vibration, which significantly stresses the musculoskeletal system (6). Although the effects are poorly understood, preliminary data suggest that low back pain, vertebrogenic pain, and degenerative disk disease may be associated with whole-body vibration (7,8).

An estimated 1.2 million workers are exposed to "segmental" vibration, i.e., vibration principally of a part or parts of the body, of which the principal sources are handheld power tools, such as chain saws and jackhammers (9). These exposures are associated with "vibration syndrome," characterized by intermittent numbness and blanching of the fingers with reduced sensitivity to heat, cold, and pain (10). Vibration syndrome may affect up to 90% of workers in such occupations as chipping, grinding, and chain sawing (11). Reported by Div of Surveillance, Hazard Evaluations, and Field Studies, Div of Safety Research, NIOSH, CDC

Editorial Note

Editorial Note: Musculoskeletal injuries can be prevented or reduced with such appropriate intervention measures as:

  1. Substitution. Machines, such as hoists, cranes, and dollies, can substitute for workers in some aspects of the manual handling of materials.

  2. Improved equipment design. Research has shown that improved design of some vibrating tools virtually eliminates hazardous vibration; suspension or isolation systems may be added to vehicles to greatly reduce whole-body vibration.

  3. Task design. Manual tasks can be altered to minimize biomechanical stress to the worker (12).

  4. Worker education. Injuries due to musculoskeletal stresses may be reduced by preplacement strength testing, training in proper ways to do a task, and on-site programs of exercise and physical therapy.

  5. Variation of work practices. Periodic rotation of workers into jobs with different physical demands may help reduce the sequelae of biomechanical stress.

References

  1. CDC. Leading work-related diseases and injuries--United States. MMWR 1983;32(2):24-6, 32.

  2. NIOSH, Division of Safety Research. Unpublished data.

  3. Bureau of Labor Statistics. Back injuries associated with lifting (work injury report). Washington, D.C.: U.S. Government Printing Office. Bulletin 2144:August, 1982;1.

  4. National Institute for Occupational Safety and Health. National occupational hazard survey, 1972-1974. Cincinnati: National Institute for Occupational Safety and Health, 1977. (DHEW (NIOSH) publication no. 78-114).

  5. Bureau of Labor Statistics. Occupational injuries and illnesses in the United States by industry, 1980. Washington, D.C.: U.S. Government Printing Office. Bulletin 2130:April 1982;32.

  6. Haber LD. Disabling effects of chronic disease and impairment. J Chronic Dis 1971:24(6-7):469-87.

  7. Armstrong TJ, Foulke JA, Joseph BS, Goldstein SA. Investigation of cumulative trauma disorders in a poultry processing plant. Am Ind Hyg Assoc J 1982;43(2):103-16.

  8. Gruber GJ, Ziperman HH. Relationship between whole-body vibration and morbidity patterns among motor coach operators. Cincinnati: National Institute for Occupational Safety and Health, Sept. 1974. (NIOSH publication no. 75-104.)

  9. Gruber GJ. Relationship between whole-body vibration and morbidity patterns among interstate truck drivers. Cincinnati: National Institute for Occupational Safety and Health, Sept. 1974. (NIOSH publication no. 75-104.)

  10. Wasserman DE, Badger DW, Doyle TE, Margolies L. Industrial vibration--an overview. ASSE (American Society of Safety Engineers) Journal 1974;19:38-43.

  11. Taylor W, Pelmear PL. Raynaud's phenomenon of occupational origin: An epidemiological survey. Acta Chir Scand 1976;(Suppl)(465):27-32.

  12. National Institute for Occupational Safety and Health. Work practices for manual lifting. Cincinnati: National Institute for Occupational Safety and Health, March 1981. (DHHS (NIOSH) publication no. 81-122.



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