Prevención de tendinitis

Sluiter et al

Introduction
Upper-extremity musculoskeletal disorders (UEMSD) have been recognized to occur in relation to work for hundreds of years. They were described by Bernardini Ramazzini, an Italian physician and father of occupational medicine, in the 18th century, when he said the diseases: “… arise from three causes; first constant sitting, the perpetual motion of the hand in thesame manner, and thirdly the attention and the application of the mind ...” (as quoted in Euro Review, Issue on Repetitive Strain Injuries, European Foundation for the Improvement of Living and Working Conditions, 1994). Today, there is growing concern in Europe and elsewhere both about the effects of workrelated upper-extremity musculoskeletal disorders (WRUEMSD) on the health and well-being ofworkers and about the economic and social impact of these conditions (1—4). Musculoskeletal disorders, in general, are considered a major cause of sickness absence, disability, and health care (5—7), and many studies have found high prevalences of musculoskeletal symptoms and disorders in a wide range of occupational groups. These studies have been described or systematically reviewed or both in manypublications. [See, for example, the reports of Hagberg & Wegman (8), Armstrong (9), Hagberg et al (10), Gorden et al (11), Bernard (12), National Research Council (13), Punnett & Bergqvist (14).] A variety of umbrella terms has been used in different countries to describe UEMSD thought to be related to repeated trauma. These include repetitive strain injury (RSI), occupational overuse syndrome(OOS), occupational cervicobrachial disorder (OCD), and cumulative trauma disorder (CTD). These terms assume a link between the clinical disorder(s) and the suspected causal factor or mechanism of injury. Like many researchers (1, 9, 12, 15), we use the term work-related to reflect the multifactorial nature of most UEMSD. According to the World Health Organization (WHO), work-related diseases aredefined as multifactorial when the work environment and the performance of work contribute significantly, but as one of a number of factors, to the causation of disease (16). Although different abbreviations and acronyms are used to identify work-related upper-extremity musculoskeletal disorders (eg, WMSD, WRUED, WMD), we use WRUEMSD in this document in order to be as precise and descriptive aspossible. Despite the impressive number of studies on WRUEMSD, considerable uncertainty and even controversy still exist about the extent and etiology of these problems, the contribution of work and nonwork risk factors to their development and resolution, the criteria used to diagnose them, the outcomes of various treatment methods, and the appropriate strategies for intervention and prevention.Progress in advancing our understanding of these problems has been hampered by a number of things. These include (i) the acknowledged multifactorial nature of WRUEMSD, (ii) the uncertainty of pathophysiological mechanisms, and (iii) the methodological and practical challenges associated with epidemiologic research on WRUEMSD, the last on this list including the following:
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•choice and use of different case definitions and diagnostic criteria for assessing health effects lack of “gold standards” for the clinical diagnosis of most UEMSD problems associated with the meaningful measurement of exposure inherent biases associated with different study designs and study populations inability or failure to control for known or suspected confounders unfortunate adversarialand acrimonious climate in some countries due, in large part, to issues surrounding compensation.

Although many hypotheses have been suggested in the last few decades about possible underlying mechanisms for the development of nonspecific musculoskeletal symptoms in particular and (chronic) pain in general, definitive knowledge is still lacking. One wellknown potential mechanism at the...