Occupational diseases caused by overexertion of individual organs and systems . Diseases of the musculoskeletal system are often encountered when working in such industries as construction, mining, engineering, etc., as well as in agriculture. They are caused by chronic functional overexertion, microtraumatism, the performance of fast, same-type movements. The most common diseases of the muscles, ligaments and joints of the upper limbs are: myositis, forearm tenosynovitis, stenosing ligamentitis (stenosing tendovaginitis), epicondylitis of the shoulder, bursitis, deforming osteoarthritis, periarthrosis of the shoulder joint, spinal osteochondrosis (discogenic lumbosacral radiculitis). Diseases develop subacute, have a recurring or chronic course.

Myositis, creping tendovaginitis (often the right forearm) are found in ironers, polishers, grinders, carpenters, blacksmiths, etc. Flow subacute (2 to 3 weeks). Pain in the forearm is burning, intensified during work, the muscle and the place of its attachment are painful, puffiness, crepitus is noted.

Stenosing ligamentitis (stiloiditis, carpal tunnel syndrome, snapping finger) is often found in polishers, painters, plasterers, masons, tailors, etc. In these occupations, chronic microtraumatism of the brush leads to scarring of the ligaments, compression of the neuromuscular bundle and as a result of this - to impaired function of the hand.

Styloiditis is characterized by pain and swelling in the styloid process of the radius, during the work the pain intensifies and irradiates into the wrist and forearm. Sharply. Painfully retracting the thumb. On the radiograph of the brush - deformation or periostitis of the styloid process.

Carpal tunnel syndrome is characterized by densification of the transverse ligament and narrowing of the carpal tunnel. In this case, the median nerve, the tendons of the flexor and the vessels of the hand are compressed. Characteristic are night paresthesias and pain in the hands, strengthening paresthesia at the pressure of the shoulder, on the transverse ligament, when the arm is raised upwards (in the supine position). The hypoesthesia of the tips of the II-III fingers is revealed, the atrophy of the proximal part of the tenar, the violation of the opposition of the thumb.

The snapping finger arises from prolonged traumatisation of the palm at the level of the metacarpophalangeal joints. In this case, the ring-shaped ligaments become denser, the free slip of the finger flexors becomes difficult (the finger suddenly "snaps" when flexing, the extension is difficult, painful). When the process is growing, extension is possible only with the help of another hand, with further deterioration, flexion contracture may develop.

Bursitis develops slowly (5-15 years) with prolonged traumatization of the joint. The ulnar bursitis is often observed in chasers, engravers, and shoemakers; Pre-patellar - from miners, tilers, parquet makers. Bursitis is characterized by a fluctuating painful swelling in the joint area: an effusion accumulates in the joint bag. Movement in the joint is not limited, but painful.

Epicondylitis of the shoulder (often external) occurs in occupations whose labor requires prolonged tense supination and pronation of the forearm (smiths, ironers, masons, plasterers, etc.). It is characterized by gradually growing pain in the region of the external epicondyle; During work the pain intensifies, spreading all over the arm. Gradually, weakness grows in the hand. Characterized by pain at the pressure on the epicondyle and Thomsen's symptom (sharp pain in the supracondylum area with a strained brush extention). On the roentgenogram, edge resorption or parasseal seals in the supracondylar region are revealed.

Deforming osteoarthritis of the joints of the hand often occurs when the hand is injured (shoemakers, carpenters, skolotchiki boxes). Large joints are more often affected in persons performing heavy physical work (miners, blacksmiths, drafters, masons). The clinical picture is close to non-professional osteoarthritis.

Periarthrosis of the shoulder joint-degenerative-dystrophic changes (with elements of reactive inflammation) of the soft periarticular tissues of the shoulder. It occurs with a permanent traumatization of periarticular tissues due to sharp movements in the shoulder joint (painters, plasterers, woermakers, etc.). The clinical picture is identical to periarthrosis of the shoulder joint of nonprofessional etiology.

Osteochondrosis of the spine is a polyethological disease caused by a degenerative-dystrophic lesion of intervertebral discs and other spinal tissues. Osteochondrosis of the lumbar region is more common in representatives of professions associated with heavy physical labor (miners, metallurgists, choppers, loggers, tractor drivers, excavators, bulldozers). When an atom is overstrained and microtrauma of the spine is often combined with uncomfortable posture, cooling, vibration. The combination of unfavorable factors can cause the development in a relatively young age of complicated forms of osteochondrosis (recurrent lumbago, discogenic radiculitis).

Diagnosis. Establishing the connection of the listed diseases of the musculoskeletal system with the profession requires a careful analysis of the working conditions, excepting other causes. The connection between the onset of exacerbation and the overstrain of certain muscle groups, with the performance of certain operations, is of great importance. Establishing a connection between complicated forms of osteochondrosis and the profession is based on taking into account the duration of work (not less than 10 years) associated with a heavy load on the spine in the "forced" posture, cooling, vibration.

Treatment is carried out according to generally accepted schemes. Widely appointed physiotherapy, non-steroidal anti-inflammatory drugs, blockades, massage, exercise therapy, acupuncture. At the time of treatment, it is recommended to transfer to a facilitated working environment. The issues of work capacity are solved taking into account the severity of the disease, the frequency of relapses, the effect of the treatment, the safety of the function, the possibility of rational employment. In the case of persistent decline in the ability to work, patients are referred to the WTEC.

Professional dyskinesia (coordinative neuroses) are found among professions, the work of which requires fast movements, precise coordination, nervous and emotional stress (musicians, telegraphists, typists). Pathogenesis: violation of the coordinated reflex activity of the motor analyzer.

Professional dyskinesia refers to functional diseases. The most frequent forms: writing spasm, dyskinesia of the musician's hand; Streets playing on wind instruments can develop dyskinesia of the lips. Characteristic is the selective defeat of the function of the working hand: a professional skill (writing, playing a musical instrument) is violated, but other functions of the hand remain preserved. Dyskinesia develops slowly, initially worried about a feeling of fatigue in the hand, weakness, trembling or embarrassment. Then during the game (writing) in individual fingers appears weakness (paretic form of dyskinesia) or convulsive contraction (convulsive form). Trying to "adjust", change the position of the hand (fingers) only exacerbates the defect. Often, dyskinesia is combined with myositis, neurasthenia.

The diagnosis is made taking into account the characteristic disorders of coordination of movement, take into account the nature of the work performed. Differentiate follows from hysterical paresis (or cramps) of the hand, dyskinesia of an organic nature (with torsion dystonia, tremor paralysis, hepatolenticular degeneration). Dyskinesia can be a symptom of cervical osteochondrosis, tuberculosis of the cervical vertebrae, and a craniovertebral tumor. Treatment is carried out under the condition of a temporary (2 months) break in the game (letter) with simultaneous treatment of neurotic disorders. Showing massage, exercise therapy, acupuncture; Elimination of trigger zones, electrosleep, psychotherapy, auto-training. The professional forecast is unfavorable. Patients remain able-bodied in a wide range of professions (musicians-performers recommend teaching activities, if necessary, a long letter-learning typing).

Prevention of dyskinesia provides for general hygiene measures (adherence to the regime of work and rest), timely treatment of neurotic disorders, and recreational activities. Professional polyneuropathies (vegetative, vegetative-sensory) are a common group of diseases that occur when exposed to vibration, intoxications with lead, carbon disulfide, arsenic, functional hand-re-tutoring (microtraumatism, pressure), cooling - local and general (fishermen, fish processors, meat and refrigerators, Loggers, timber rafters).

Pathogenesis: affection of autonomic and sensitive (less motor) fibers of peripheral nerves, less often rootlets; Violation of microcirculation and biochemistry of tissues due to chronic effects of adverse production factors. Clinical picture. Complaints of dull pain and paresthesia in the hands (with general cooling - in the legs), "chilliness" of the limbs. This feeling is more disturbing at night. Symptoms: puffiness, cyanosis and hypothermia of the fingers or the whole hand, hyperhidrosis of the palms, fingers. Trophic disorders: dry skin, cracks in the terminal phalanges, brittle nails. Reduced pain and temperature sensitivity in the form of gloves and socks. A sharp decrease in temperature sensitivity is characteristic of cold polyneuritis (cold polyneuritis is widely known as neurovasculitis, angiotrophoneurosis). In severe cases of polyneuropathy, pain and weakness in the limbs increase, hypotrophy (atrophy) of small muscles joins, and the strength and function of the limb decreases. The puffiness of the hands grows, the flexural contracture of the fingers is formed. Join persistent pain, often radicular syndromes. Sensitive disorders develop. Significantly decreases the intensity of pulse blood filling, making it difficult for tissue blood flow; Aneurysms or desolation of capillaries are revealed.

The diagnosis should be based on the confirmed data on the chronic effects of adverse production factors. The disease should be differentiated from other forms of polyneuropathy (infectious, alcoholic, drug, etc.). Treatment is carried out according to generally accepted principles and schemes. In order to improve hemodynamics and microcirculation appoint halidor, drugs nicotinic acid, trental. To improve the trophism: vitamins B1, B6, B12, phosphaden, ATP, injections of humisol, electrophoresis of novocaine, chamber galvanic baths, radon or hydrogen sulfide baths, massage, exercise therapy. Etiological treatment involves the termination or mitigation of the impact of a harmful factor.

Issues of work capacity are decided depending on the severity of the disease. Work ability for a long time remains safe. In the initial period, a temporary transfer (1-2 months) to work without exposure to harmful factors is recommended, outpatient treatment. In the case of persistent pain syndrome, the growth of sensitive and trophic disorders, inpatient treatment is recommended, followed by rational employment. With the restriction of professional work capacity - the direction of the WTEC.

Prevention. In addition to hygienic measures (use of insulated gloves, shoes), the health measures (self-massage, gymnastics, dry-air thermal baths for hands during the interchangeable breaks), preventive courses of treatment in the factory dispensaries are important.