Systemic inflammatory mediators contribute to widespread effects in work-related musculoskeletal disorders.
Systemic inflammatory mediators contribute to widespread effects in work-related musculoskeletal disorders.
复制标题
全身炎症介质对与工作相关的肌肉骨骼疾病产生广泛影响。
DOI：
10.1097/00003677-200410000-00003
复制
发表时间：
2004
期刊：
影响因子：
--
通讯作者：
Clark,BrianD
中科院分区：
文献类型：
--
作者：
Barr,AnnE;Barbe,MaryF;Clark,BrianD
Highly repetitive and forceful hand-intensive occupational tasks have been associated with a number of severe and chronic disorders of the musculoskeletal and neuromuscular systems, including carpal tunnel syndrome, tendinitis, and osteoarthritis. These so-called work-related musculoskeletal disorders (WMSDs) account for the majority of all occupational illnesses in the United States (4) and represent substantial economic cost. Despite ample epidemiological evidence for the role of repetition and force in the onset and progression of WMSDs (11), complete understanding of these important occupational health problems requires elucidation of the pathophysiological mechanisms of the tissue response. Of particular concern is the controversy surrounding the degree of work-relatedness of activity-induced musculoskeletal disorders. Workers may be exposed to high-risk tasks in both workplace and nonworkplace settings. Health problems or overall fitness may also affect the susceptibility of individuals to development of WMSDs. Such comorbidities cloud the debate concerning appropriate interventions for WMSDs not only because they confuse clinicians about the causal factors underlying these disorders, but also because they make it difficult for third party payers to partition costs associated with treatment and indemnity payments. One signal that health care providers or insurance adjustors may use to estimate the contribution of workplace risk factors to a WMSD case is the anatomical location of signs and symptoms in the context of the work task believed to contribute to the disorder. If a task requires heavy use of the dominant hand, for example, one would expect symptoms to be restricted to that side. Such reasoning has routinely been used to argue against the designation of bilateral carpal tunnel syndrome as a WMSD. However, in recent studies in our laboratory using a rat model of a repetitive motion disorder, we have discovered the presence of circulating pro-inflammatory cytokines as well as evidence of tissue inflammation in anatomical regions not directly associated with the performance of an intensive unilateral reaching and grasping task (1). We conclude that the presence of cytokines in the blood stream of affected animals, initiated by a unilateral upper limb task, contributes to the development of widespread and bilateral pathophysiological and behavioral changes. This hypothesis explains the presence of widespread symptoms, a central controversy in the management of WMSDs.
