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Epidemiological evidence for developing a new paradigm for the common musculoskeletal disorders.
Am J Epidemiol 2005 Jun; 161(11)(Suppl):S86
Common musculoskeletal disorders (MSDs), including carpal tunnel syndrome (CTS) and shoulder impingement have been thought to be related to physical factors, such as force and repetition. Supportive evidence for relationships with those physical factors is available from some cross sectional studies, and the most common construct may be simplistically labeled 'wear and tear.' However a large prospective cohort study failed to confirm relationships with physical factors, instead suggesting that there are non-occupational, non-physical factors, such as obesity and smoking that are the independent risks, thus questioning the mechanisms of the MSDs. A large, multi-center cross sectional study (n=860) of MSDs was analyzed for a series of non-occupntional factors. Factors associated with CTS in the right hand in univariate analyses, e.g., include age Odds Ratio (OR)=1.03 [95% Confidence Interval (95% C.I.) 1.01, 1.05], diabetes mellitus OR=3.00 (95% C.I., 1.52, 5.90), obesity OR=2.39 (95% C.I., 1.59, 3.59 ), high cholesterol OR=2.51 (95% C.I., 1.58, 4.00), and hypertension OR=2.12 (95% C.l., 1.32, 3.39). Univariate factors associated with shoulder impingement on the right side, e.g., include age OR=1.04 (95% C.I., 1.02, 1.07), diabetes mellitus OR=3.00 (95% C.I., 1.27, 7.07), obesity OR=1.58 (95% C.I., 0.91, 2.74), high cholesterol OR=1.63 (95% C.I., 0.83, 3.18), and hypertension OR=1.94 (95% C.I., 1.02, 3.66). Logistic regression shows similar results, however with fewer statistically significant findings. Similar relationships are not found in these datasets for all other MSDs. The results for CTS and shoulder impingement are comparable to those for cardiovascular disorders and suggest that the underlying cause of these MSDs may actually be primarily vascular. Supportive anatomic studies are available elsewhere for vascular problems. The extent to which physical factors are associated with these MSDs and whether there is interaction with physical factors remains to be demonstrated.
Epidemiology; Musculoskeletal-system-disorders; Body-weight; Weight-factors; Smoking; Risk-factors; Carpal-tunnel-syndrome; Age-factors; Hypertension; Statistical-analysis
Issue of Publication
American Journal of Epidemiology
University of Utah, Salt Lake City, Utah