Wmsd's Revisi - Dr Ridwan

8/19/2019 Wmsd's Revisi - Dr Ridwan

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Work Related MusculoskeletalDisorders (WMSDs)

dr. Ridwan Harrianto MHSc (OM), Sp.Ok


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uscle skeletal disorders


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Work Related Musculoskeletal

Disorders (WMSDs)

Occupational Overuse Syndrome (OOS)Repetitif Strain Injury (RSI)

umulative !rauma disorders (!")

Hand#$rm %i&ration Syndrome (H$%S)

%i&ration#Induced 'ite in*er +ow ack -ain


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WMSDs


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Occupational Overuse Syndrome

(OOS)

Sekumpulan penyakit den*an *ejala rasanyeri pada an**auta &adan atas, &au

atau leer karena pen**unaan strukturtendo, otot dan tulan* &elulan* yan*&erle&ian aki&at pekerjaan

Repetitif Strain Injury (RSI) $ustralia,/01 umulative !rauma disorders (!") 2S$, anada1 Occupational ervico&racial "isorders (O") 3apan,Scandinavia1


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Occupational Overuse Syndrome 456 dana tuntutan jaminan asuransi di sektor

industri 2S &erasal dari OOS.

$n*ka a&sensi di elanda mencapai 784

3umla pekerja den*an OOS di -erancis 499:ternyata ; < le&i tin**i di&andin* 477=,mencapai =>8 dari seluru penyakit aki&atkerja saat itu.?

$wal t 7>#an epidemi OOS di $ustralia !untutan jaminan asuransi OOS 497:#7=tenyata = < le&i tin**i di&andin* 497>#74.Insiden kum. 4974#7= san*at tin**i (6:654>>>pekerja)6

OOS M@/A$BI$!B$/CB@!@R$M-I+$/ , -RO"2B!II!$S ,B@$$!$/, $/AB$ $S@/SI .

#########################################################4. +acerda @M et $ll. M -u&lic Healt ?>>=

?. assau, et $ll. Occup @nviron Med ?>>?

6. o**on ", et $ll. Reumatolo*y ?>>>


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Faktor resiko1. Sikap kerja erdiri statis -en**unaan otot

jan*ka lama untukmempertaankan sikapkerja

Sikap jan**al &atan*&adan

Mendoron*,menarik,men*an*kat &e&an

Stres kontak mekanis jari#jari5telapak tan*an

Sikap len*an5tan*ansulit (memutar, jan*kauan jau, deviasiper*elan*an tan*an,

mencu&it

3. Suhulingkunganyang ekstrim

4.Vibrasisegmetal

5. Psikososial


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Faktor resiko


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Jenis pekerjaan beresiko tinggi

-en*ola,pen*emas,penyeleksi &aanindustri

-emeliara mesin#mesin

$ssem&lin* peralatanelektronik

-emain musik -etu*as ke&ersian -en*ola data

komputer Operator mesin

akontin*

!ukan* ketik Basir !ukan* jait !ukan* kayu -en**ulun* rol film5

tali#temali !ukan* leden*

Buli pen*an*kut&e&an


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Faktor individu:

Indeks massa tubuh

Pendidikan

Umur

Faktor pekerjaan:

Jenis pekerjaan

Masa kerja

Penyakit

De Quervain’s

Beban biomekanis

pada

jaringan lunak

Respon mekanis, metabolikdan biokimiawi

Nyeri nonspesi!ik

lengan bawa"

Shoulder

capsulitis

Myofacial pain

syndrome

Rotator cuff

tendinitis

Lateral

epicondilitis

Medial

epicondilitis

Carpal Tunnel

Syndrome

ccupational

!eruse

Syndrome

PatogenesisPatogenesis


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emungkinan terjadinya penyakit

tergantung dari !

!er*antun* dari frekuensi danlamanya pemaparan teradap faktorresiko

aktor resiko individu, pekerjaan,o&&y dan pekerjaan diruma


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Rotator cu$$ tendinitis


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Rotator cu$$ tendinitis


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"endinitis # "enosynovitis

icipital tendinitis ( tendo m. &iceps&racii caput lon*um)


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+ateral epicondilitis (ori*o mm.e


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"e Ouervaindisease

(tendo m.

a&d.-ollicis lon*us,m.e


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+ntrapment ,europat-y

arpal tunnel syndrome (n. Medianus diper*elan*an tan*an D tendomm.fl


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&arpal tunnel syndrome

arpal tunnel syndrome (!S) is a work#related injury associated wit sucum&rella term as Repetitive Strain Injury.

Specifically, it is a painful disorder tataffects te and, wrist, and occasionallyte entire upper e


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#natomy


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Patop"ysiology

!e tendon of te ands are wrapped witlinin* tat produce a slippery fluid (synovium)wit in turn, lu&ricates te tendons.

Repetitive movement of te and, telu&rication system may malfunction (decreaseof volume E &ad Fuality).

!issues surroundin* te fle


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Risk !a$torsPersonal/physial riskfator

'omen are ? # = timesmore likely tan men

a*es 6> #;>.

dominant and pre*nancy o&esity menopause

Hi* caffeine intake to&acco alcool intake ormonal contraception

orticosteroid

!upational fators

repetitive andmotion

$wkward andpositions

Stron* *rippin* Mecanical stress on

te palm vi&ration


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Non %$$upational !a$tors

Most likely te disorder is due to a con*enitalpredisposition # te carpal tunnel is simply smallerin some people tan in oters.

trauma or injury to te wrist tat cause swellin*,suc as sprain or fractureC

over activity of te pituitary *landCypotyroidismC reumatoid artritisC

mecanical pro&lems in te wrist jointC workstressC repeated use of wrist , vi&ratin* and tools

fluid retention durin* pre*nancy or menopause or te development of a cyst or tumor in te canal dia&etes, tyroid disease, or reumatoid artritis.


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&"e risk o! developing

$arpal tunnel syndrome

In tose performin* assem&ly line work Gmanufacturin*Sewin*inisin*leanin*meat, poultry, or fis packin*.

In fact C arpal tunnel syndrome is tree times more common

amon* assem&lers tan amon* data#entry personnel. $ ?>>4 study &y te Mayo linic found eavy computer

use (up to ours a day) did not increase a persons

risk of developin* carpal tunnel syndrome.


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Diagnosis o! '&(

"onsensus Statement #$% & Pub 'ealth 1(()* @" test (#), lassic s< (J) !S (K) @" test (J), lassic s< (#) !S (#)

S+abo, 1(((

/i*t pain (J), S' (J), "urkanLs (J)

7; 8 pro&a&ly of!S

$ll test a&ove (#) >,;7 8 pro&a&ly of !S @" tests did not add to dia*nostic power

"-S is a linial diagnosis

@" test can elp G Identify periperal neuropaty +ocate oter sites of compression @sta&lis severity


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(igns and symptoms urnin*, tin*lin*, or itcin* num&ness of te tum&

inde< and middle and rin* fin*ers /i*ttime or after usin* ands painful tin*lin* (ands

prone to fle< durin* sleep wic cause ! compressed) eelin* of uselessness in te fin*ers

$ sense tat fin*ers are swollen even no swellin* isapparent

"ecreased a&ility to sFueee tin*s +oss of stren*t in te muscle at te &ase of te

tum&, near te palm -ain sootin* from te and up te arm as far as te

soulder Relieved &y sakin* (lick Si*n), an*in* and

massa*in* te and.


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P"ysi$al e)amination%otori funtion !enar atropy 'eakness of $- (most sensitive motor si*n)

palmar a&duction 5 tum& supination1 'eakness of opponen pollicis +utys si*n (&ottles si*n) (cant do &ottle

circlin* &y ands)

Sensibility funtion !wo#point discrimination Semmens#'einstein5S' monofilament

(vi&rometry) (sensi&ility of distal fin*ers)

$utonomi funtion

-erspirin* difference (di*ital anydrosis)


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Provo$ative testing

-alens test, !inels si*n E "urkan compressiontest Reverse -alenLs5'rist e


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%t"er met"ods used to diagnose '&(

rays N !ese elp rule out oterconditions suc as artritis, fractures,spondilolistesis

0letrodiagnosti studies #0% "S * N !ese studies are used toFuantify median nerve conduction andseverity of !S

ltrasonography %agneti resonane imaging #%6*


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Diagnosis prin$iples

@arly dia*nosis and treatment areimportant to avoid permanent dama*e tote median nerve.

!S is a clinical dia*nosis ( @" test areconfirmatory) ( fi&rosis risk #irreversi&le)

Operative procedure

o ailure of non#operative treatmento 'eakness of $-


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Prevention@r*onomic modifications

-erform stretcin* e


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"-oracic outlet


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"-oracic outlet

syndrome

, i t t ( l i )


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,yeri otot (myalgia) !ension neck syndrome (myofacial pain

syndrome) D nyeri tekan m.trapeius, m.levator scapula, m. supraspinatus, m.infraspinatus, m.teres mayor, m.teres minor)

+ow &ack pain (myofacial pain syndrome didaera pun**un* &a*ian &awa) # nyeri tekanmm.paralum&al, mm.*lutealis)

Okl i b l - d -


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Oklusi pembulu- dara- Hypotenar ammer syndrome (oklusi

a.ulnaris5acrus palmaris superficialis dipalma manus)


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n$lamasi bursa

ursitis siku D proses friksi mekanis&ursa olecranon

ursitis &au # proses de*enerasimm.rotatorcuff

ursitis lutut # proses friksi mekanis&ursa prepatelar5infrapatellarsuperficialis (preacers knee)


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.ssosiasi klinis dan pekerjaan

Rotator cu$$ tendinitis Myo$acial pain syndrome

"-oracic outlet syndrome S-oulder capsulitis

%ateral epicondilitis

Medial epicondilitis

&arpal "unnel Syndrome De 'uervains disease

/ypot-enar -ammer syndrome

0anglia

-ronator syndrome u&ital tunnel

syndrome

Auyon tunnelsyndrome

ursitis siku /yeri nonspesifik

len*an &awa

Jelas 1elum jelas

*R+&R+# D+#-N%(+( 23/S+ Works-op4 Sout-amtom # /amps-ire local et-ic committee 566 8 t .ll . R- Di 9:::


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: Myofacial pain syndrome

/yeri &au5leer nyeri tekan m. trapeius pars ascendens, m.supra5infraspinatus5 m.rom&oidea5 m.lev. scapulae

Lateral epicondilitis/yeriEnyeri tekan epikondilus lateral umeri, nyeri pada taanan *erak ekstensiper*elan*an tan*an

Medial epicondilitis/yeriEnyeri tekan epikondilus medial umeri, nyeri pada taanan *erak fleksiper*elan*an tan*an

Carpal Tunnel Syndrome/yeri 5 kesemutan 5 &aal pada distri&usi n.Medianus, (tes !inel J 5 tes -alen J), eksase&asi malam ari, kelemaan m. a&d.poll.&revis

De Quervain’s disease/yeri di prosesus stiloideus, pem&en*kakkan E nyeri &*.ekstensor i&u jari, nyeripada taanan *erak ekstensi i&u jari (tes inkelstein)

Nyeri nonspfk lengan bawa !NNS"

/yeri di len*an &awa tanpa dia*nosis5patolo*i yan* spesifik (rasa lema, kram,nyeri tekan *erakan alus melam&at)

8amer et3.ll3 .nn R-eum Dis 9:::


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Rotator cuff tendinitis

/yeri &au Pelevasilen*an

nyeri tekan tu&.mayusumeri nyeri pada taanan *erak

aktif a&duksi, rotasieksternal, rotasi internaltes impin*ement /eer 5

tes Hawkin E Bennedy J

/yeri &au,nyeri pada taanan *erak

aktif E pasif den*an polacapsuler ( rotasi eksternal a&duksi rotasiinternal )

Shoulder capsulitis

D+R.J." 8RO0R+SF".S


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D+R.J." 8RO0R+SF".S

8+,;."

Stadium 4/yeri5rasa lema selama &ekerja, ilan* waktutidur5li&uran, reversi&el

Stadium ?

/yeri serin*kali tim&ul waktu malam, penampilankerja menurun, kadan*#kadan* irreversi&el

Stadium 6/yeri selalu tim&ul waktu malam atau waktuli&uran, pekerjaan rin*an saja menim&ulkannyeri, irreversi&el

##########################################################"-e Occupational Repetitition Strain injuries

.dvisory &ommittee4 (1ro


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8encega-an

$nalisis lin*kun*an tempat kerja (tin**imeja kerja, tempat duduk, desain mesin#mesin dan peralatan kerja)

$nalisis tu*as *una meneliti u&un*an*ejala dan faktor pekerjaan (evaluasisikap kerja, *erakan monotoon, an*kat&e&an, faktor psikolo*is)

Redesain tu*as kerja (frekuensi,durasi,sikap kerja, tu*as monotoon, jam

istiraat, adaptasi pekerja &aru5a&sen ?min**u) -elatian untuk per&aikan teknik kerja


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8enatalaksanaan

Buran*i aktifitas (kasus akut) $nal*esik, anti inflamasi "ecompressi saraf#saraf tepi isioterapy


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Low Back Pain

The second most prevalent disorderworldwide, beaten only by commoncold

Up to 85% of people suer at leastone bout of LBP durin! their lifetime

Low Back Pain is one of the most

common causes of disability


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Low Back Pain

"ccupational episodes of back pain areoften self limited, heal spontaneus

#$ % still had low back pain after four

weeks, 8% after 8 weeks , &5% after '(weeks, '$ % after ( years) *Low Back Pain that persist for more than

& month weeks is considered chronic+

($ % recurrent rate - ' years after a.rst episode /, 8$ % -'$ years after a .rstepisode /


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LBP in "ccupational 0ealth

LBP are in 12 3ermany the cause of($ % of absenteeism and 5$% ofpremature retirements)

"vere4ertion claimed to be cause oflow back pain -LBP/ by over $% ofsuerers6 less than '7& of these

return to work '$( million workdays lost, health

care cost &$$$7claim -U)9)/


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Low back pain

:4cessive physical stress -over

use/ on normal spine structure

;ormal physical stress actin!on abnormal lumbar structures

Low back pain


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Low back pain 9peci.c low back pain

9ymptoms caused by speci.c path physiolo!ic mechanism

;onspeci.c low back pain

9ymptoms without a clear speci.ccause

> 9pondylolisthesis -& %/> Tumor7metastasis -$)# %/> =nkylosin! spondylitis -$,& %/> >nfection -$)$' %/

-?oes B@,($$/


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;onspeci.c low back pain

9edentary people -sittin! for A &hour/

Prolon!ed standin! anual material handlin! tasks

-liftin!, bendin!, twistin! ,pushin!, pullin!/

3ender=!e -&$ C $ years old/

Risk factors :

Back strain associated with


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Back strain associated with0

5$ % occur while liftin! obDects

E % pushin! and pullin! obDects % holdin!, wieldin!, throwin!, or carryin!

obDects

The occupational cate!ories with a prevalenceof liftin! -!arba!e collectin!, construction,warehouse material handlin!, and nursin!/

have '$ times the avera!enumber of claim -$)# claims7'$$workers years/ of non liftin! Dobs)

;onspec c ow ac


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;onspec c ow acpain

pressure on a nerve root F MusclesMuscles

Gierentiatin! features of


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Gierentiatin! features of;9LBP

Injury Condition

uscle 7Li!ament

liolumbar syndrome

9acroiliac Doint 9acroiliac syndrome

1acet Doint 1acet Doint syndrome

=nnulus of disc Gisco!enic pain

;erve root *0erniated disc+

Di


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Biomechanics of 0

:ven no obDect ishandled, very often abendin! moments acts

on the vertebralcollum because of thelocation of the centermass of the body)

The erector muscles ofthe trunk counter actthis -sacrospinalis,!lutei, hamstrin!/

Disc

Lever arm LF

Di


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Back muscle force 1can !eneratecompressive stressand torHue on thediscs)

F

F

T = FL

DiscCompressive

force

G s


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G sc

1le4ion7:4tension I Lateral -sideways/

bendin!


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Disc


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Gisc inDury caused by multiple splitsand tears -radial,

tan!ential andmar!inal/, followed bytissue repair

>n nucleus manifested

by dehydration andfra!mentation intoseHuestrate7 theconsistency of

crabmeat, and thenreplace by !as/

Gi i D


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Gisc inDury

The stretched or torn of the

outer annulus and theposterior lon!itudinal li!ament,which are supplied with .nesensory unmyelinated .bers

Tears or stretchin! of the outerannulus without actual discprolapsed or nerve rootinvolvement can themselvesproduces mechanical pain

Gisco!enicpain

idline tenderness2elieved by e4tension

1acet Doint


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1acet Doint

The function of the lumbar facet Doints is to resist theintervertebral shear force,whereas the function of disk is

to resist the compressive force)

9acroiliac Doint


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= rin! shape of pelvis

Kiew from rear

the sacrum resembles the keystone of the arch -the load fromabove is transmitted throu!h the innominated bones tofemoral head

Kiew from abovethe sacrum has a wron! shape for a keystone it tend to slideforward, out of the arch, particularly under wei!h bearin!

9acroiliac Doint

-rolon*ed

9 ili D i t


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The standin! postureincrease the tendencyfor the sacrum to beanteriorly, increasin!the tension in thesacroiliac li!ament

9mall displacements ofthe sacrum , causin!soft tissue to bepinched, which causepain

-rolon*edstandin*

sacroiliac syndrome

9acroiliac Doint


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Muscle activityMuscle fati*ueRecoveryInadeFuate recoveryrampMecanical dama*e-ain


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Pyriformis syndrome

-ain in te sacraland *luteal areas

-ain increased &y

sittin*5walkin* -ain relieved &y

e o um a


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> o um asyndrome

$cute onset of +-after aninappropriate

movement ore


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Muscle ronic

!oracolum&ar pain

(ack Strain)

@


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/and arm vibration syndrome

SinonimG "ead Hand, "ead in*er, 'ite in*er,atau %i&ration#Induced 'ite in*er

-atofisiolo*inya masi &elum diketaui secara

tepat, tetapi didu*a kelainan ini men*aki&atkankerusakan saraf dan otot#otot alus daripem&ulu dara di tan*an.

Fenomena yang kompleks ditandai dengan gejala jari?jari yang memucat disertai baal atau kesemutan

akibat pengunaan alat?alat bantu genggam

yang bergetar untuk jangka


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/and arm vibration syndrome $lat#alat &antu *en**am yan* &erefek vi&rasi

seperti *urinda, palu pneumatik, mesin &or, dll -ada taun 49>>#an mulai dilaporkan adanya

kaitan pen**unaan alat#alat terse&ut den*anspasme pem&ulu dara di tan*an.

/ammer pneumatic

8neumatic drill


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Jenis?jenis pekerjaan berisiko

!ukan* &atu5pemaat !ukan* &an*unan -etani !ukan* las

-en*etes mesin -ekerja jalan !ukan* *urinda -enjait !eknisi *i*i Ortopedik "ll


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0ejala dan "anda

3ari memucat /yeri dan oedem pada jari dan tan*an -arastesia atau kesemutan

Bekuatan *en**aman &erkuran* Beilan*an kontrol otot5kejan* otot Seran*an menin*kat pada kondisi din*in

Seran*an dapat &erlan*sun* &ermenit#menit atau &erjam#jam


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Diagnosa

"ia*nosa yan* tepat den*an meli&atkan&er&a*ai aspek, antara lainG anatomi,fisiolo*i, dan klinis, riwayat pekerjaan,riwayat paparan, dan keterli&atan nervus

ulnaris. -emeriksaan den*an meli&atkanpemeriksaan vaskular, sensorineural danmuskuloskletal

%askularG test kompresi, provokasi din*in SensorineuralG test persepsi den*an

kapas, jarum, suu MuskuloskletalG kekuatan *en**aman


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8enanganan

!idak ada penan*anan yan* &aik Sifat paliatif okusG

4) preparat calcium anta*onis ?) kemoterapi untuk men*uran*i adesi

dan a*re*asi pem&ekuan dara

6) men*uran*i viskositas dara danpem&entukan em&oli


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2tama@ pencega-an

Modifikasi alat atau kerjaGdisainulan*, istiraat

@valuasi keseatanG cek prakerja ara kerja seari#ariG cara

men**en**am,suu tan*an -endidikanG merokok

Wmsd's Revisi - Dr Ridwan

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