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Pressure pain thresholds and musculoskeletal morbidity in automobile manufacturing workers

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Abstract

Objectives: Reduced pressure pain thresholds (PPTs) have been reported in occupational groups with symptoms of upper extremity musculoskeletal disorders (UEMSDs). The purpose of this study was to determine whether automobile manufacturing workers (n=460) with signs and symptoms of UEMSDs had reduced PPTs (greater sensitivity to pain through pressure applied to the skin) when compared with unaffected members of the cohort, which served as the reference group. The association of PPTs with symptom severity and localization of PE findings was investigated, as was the hypothesis that reduced thresholds would be found on the affected side in those with unilateral physical examination (PE) findings. Methods: PPTs were measured during the workday at 12 upper extremity sites. A PE for signs of UEMSDs and symptom questionnaire was administered. After comparison of potential covariates using t tests, linear regression multivariable models were constructed with the average of 12 sites (avgPPT) as the outcome. Results: Subjects with PE findings and/or symptoms had a statistically significant lower avgPPT than non-cases. AvgPPT was reduced in those with more widespread PE findings and in those with greater symptom severity (test for trend, P≤0.05). No difference between side-specific avgPPT was found in those with unilateral PE findings. Reduced PPTs were associated with female gender, increasing age, and grip strength below the gender-adjusted mean. After adjusting for the above confounders, avgPPT was associated with muscle/tendon PE findings and symptom severity in multivariable models. Conclusions: PPTs were associated with signs and symptoms of UEMSDs, after adjusting for gender, age and grip strength. The utility of this noninvasive testing modality should be assessed on the basis of prospective large cohort studies to determine if low PPTs are predictive of UEMSDs in asymptomatic individuals or of progression and spread of UEMSDs from localized to more diffuse disorders.

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Acknowledgements

This research was supported by the National Institute for Occupational Safety and Health (NIOSH R01-OH03514). Twila Eshelman and Trudy Johnson Hall conducted the physical examinations and interviews. We thank Dr. Rebecca Moreland, the UAW-Chrysler National Training Center staff, plant managers, safety directors, UAW ergonomics trainers and health and safety committee members for their valuable assistance. Dr. Katz is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS K24 02123 and NIAMS P60 AR 47782) and the Arthritis Foundation.

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Authors and Affiliations

  1. Department of Public Health, Temple University, 3rd floor, Vivacqua Hall, 1700 N. Broad Street, Philadelphia, PA, 19122, USA

    Judith E. Gold

  2. Department of Work Environment, University of Massachusetts Lowell, 1 University Ave., Lowell, MA, 01854, USA

    Judith E. Gold & Laura Punnett

  3. Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy and Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 75 Francis St., Boston, MA, 02115, USA

    Jeffrey N. Katz

Authors
  1. Judith E. Gold
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  2. Laura Punnett
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  3. Jeffrey N. Katz
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Corresponding author

Correspondence to Judith E. Gold.

Appendices

Appendix

Definition of points for PPT measurements

  1. 1.

    Trapezius: find largest cervical vertebrae (C7 or T1 depending on individual) and move laterally three fingers.

  2. 2.

    Rhomboids: find medial border of scapula below spine of scapula. Pressure point is located midway between medial border and thoracic spine (about T3).

  3. 3.

    Teres major: find inferior angle of scapula and drop off laterally. Resist humoral external rotation to locate muscle.

  4. 4.

    Deltoid: find lateral edge of acromium and drop off three fingers onto deltoid muscle.

  5. 5.

    Wrist extensors: with forearm supported, have subject extend wrist and locate muscle mass in proximal and lateral forearm. Apply resistance if needed.

  6. 6.

    Wrist flexors: with forearm supported, have subject flex wrist and locate muscle mass in proximal and medial forearm. Apply resistance if needed.

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Gold, J.E., Punnett, L. & Katz, J.N. Pressure pain thresholds and musculoskeletal morbidity in automobile manufacturing workers. Int Arch Occup Environ Health 79, 128–134 (2006). https://doi.org/10.1007/s00420-005-0005-3

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  • DOI: https://doi.org/10.1007/s00420-005-0005-3

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