Orthopedics - Oleksa A.P. 2006

Occupational musculoskeletal disorders
Occupational tendinopathies

Occupational paratenonitis, tenosynovitis, and crepitant tenosynovitis are commonly observed among typists, piece-rate seasonal workers, ballet dancers, and athletes. They affect both the upper and lower extremities As a result of sudden overload (particularly after a vacation, when deadaptation has occurred) or during intensive training for competitions. Tendon ruptures are less common—such as a rupture of the Achilles tendon in ballet dancers—though it should be noted that rupture typically occurs in pathologically altered, degenerated tendons.

All of these types of tendon pathology are pathogenetically interrelated.

Patients complain of pain in the lower third of the forearm, the arch of the FOOT, or the Achilles tendon region. Local tissue Swelling and thickening of the Achilles tendon appear, while the Skin overlying the area remains normal. Extremely rarely, mild hyperemia may occur along the course of the tendon on the forearm. The patient holds the fingers of the hand in a semi-flexed, guarded position and avoids full range of motion due to pain. On Palpation, local tenderness is detected in cases of tenosynovitis and paratenonitis, whereas the Diagnosis of crepitant tenosynovitis is established by feeling the characteristic crepitus (crunching sensation) of the tendons in the lower third of the forearm during finger movements. Tendon disorders may be accompanied by neurotrophic disturbances, such as increased sweating or dryness of the skin of the fingers or toes, as well as mild puffiness (doughy swelling).

The management of occupational tendon disorders involves: 1) ensuring rest by immobilizing the fingers with a plaster splint extending from the fingertips to the upper third of the forearm for 7–10 days; 2) prescribing anti-inflammatory medications; and 3) applying physical therapy Procedures until complete recovery is achieved.

Tendon ruptures require surgical intervention. To prevent occupational tendon disorders, exercises and physical loads should be increased gradually in terms of both intensity and rhythm.