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Diagnosing soft tissue rheumatic disorders of the upper limb in epidemiological studies of vibration-exposed populations

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Abstract

Objectives

To investigate approaches adopted to diagnose soft tissue rheumatic disorders of the upper limb (ULDs) in vibration-exposed populations and in other settings, and to compare their methodological qualities.

Methods

Systematic searches were made of the Medline, Embase, and CINAHL electronic bibliographic databases, and of various supplementary sources (textbooks, reviews, conference and workshop proceedings, personal files). For vibration-exposed populations, qualifying papers were scored in terms of the provenance of their measuring instruments (adequacy of documentation, standardisation, reliability, criterion-related and content validity). Similar criteria were applied to general proposals for whole diagnostic schemes, and evidence was collated on the test–retest reliability of symptom histories and clinical signs.

Results

In total, 23 relevant reports were identified concerning vibration-exposed populations—21 involving symptoms and 9 involving examination/diagnosis. Most of the instruments employed scored poorly in terms of methodological quality. The search also identified, from the wider literature, more than a dozen schemes directed at classifying ULDs, and 18 studies of test–retest reliability of symptoms and physical signs in the upper limb. Findings support the use of the standardised Nordic questionnaire for symptom inquiry and suggest that a range of physical signs can be elicited with reasonable between-observer agreement. Four classification schemes rated well in terms of content validity. One of these had excellent documentation, and one had been tested for repeatability, agreement with an external reference standard, and utility in distinguishing groups that differed in disability, prognosis and associated risk factors.

Conclusions

Hitherto, most studies of ULDs in vibration-exposed populations have used custom-specified diagnostic methods, poorly documented, and non-stringent in terms of standardisation and supporting evidence of reliability and/or validity. The broader literature contains several question sets and procedures that improve upon this, and offer scope in vibration-exposed populations to diagnose ULDs more systematically.

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Acknowledgments

Clare Harris kindly offered advice on the search strategy. The Medical Research Council provided core funding and infrastructure support. Denise Gould typed this manuscript.

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Authors and Affiliations

  1. MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK

    Keith T. Palmer

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  1. Keith T. Palmer
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Correspondence to Keith T. Palmer.

Additional information

Work presented at the 2nd international workshop 2006 on diagnosis of hand-arm vibration syndrome in Göteborg, Sweden.

Appendix

Appendix

Search strategy 1: Hand-transmitted vibration and upper limb disorders

  1. 1.

    ((hand-transmitted or hand-arm) adj2 vibrat$).tw

  2. 2.

    (hand-powered adj3 tool$).tw

  3. 3.

    (forest$ or grinder$ or plater$ or chainsaw$ or (hammer adj1 drill$) or ((jig or circular) adj1 saw$) or (impact adj1 (wrench$ or screwdriver$)) or mower$ or (chipping adj1 hammer$) or ((road or concrete) adj1 breaker$) or roadbreaker$ or ((nailing or stapling) adj1 gun$) or (metal adj1 drill$) or sander$ or polisher$ or vibrotamper$ or tamper$ or grinding or riveting or riveter$ or caulking or (bucking adj1 bar$) or pneumatic or fettling or fettler$ or clinching or flanging or swager or swaging or scaler or scaling or descaler or descaling or (vibratory adj1 compactor$) or wacker$ or (elephant adj1 foot) or (kango adj1 hammer$) or breaker$ or scabbl$ or rammer$ or stoneworking or (jack adj1 leg) or rotorary or polishing or polisher$ or stihl or pedestal or buffer$ or buffing or (engraving adj1 pen$) or poker$ or dolly or linisher$ or (brush adj1 (saw$ or cutter$)) or (hedge adj1 trimmer$) or linish$ or reamer$ or barking or router$ or routing or (pounding adj1 machine$) or (vibratory adj1 (plate$ or roller$)) or nibbling or (water adj1 jetting) or handlebar$ or snowmobile$ or (snow adj1 mobile$) or vibrothickener$ or (metal adj1 shear$)).tw

  4. 4.

    1 or 2 or 3

  5. 5.

    (upper limb pain or upper extremity pain or ((arm or shoulder or elbow or wrist or hand or forearm) adj1 pain$) or shoulder tendonitis or ((shoulder or adhesive) adj1 capsulitis) or epicondylitis or tenosynovitis or tendinitis or de quervains or olecranon bursitis or carpal tunnel syndrome or ulnar nerve compression or ulnar nerve neuropathy).tw

  6. 6.

    5 and 4

  7. 7.

    Remove duplicates from 7

Search strategy 2: Diagnosis of upper limb disorders

2A. Schemes and systems

  1. 1.

    exp Carpal tunnel syndrome/[classification, diagnosis]

  2. 2.

    exp Tenosynovitis/[classification, diagnosis]

  3. 3.

    exp Tendinopathy/[classification, diagnosis]

  4. 4.

    Capsulitis.mp

  5. 5.

    exp Bursitis/[classification, diagnosis]

  6. 6.

    exp Tennis elbow/[classification, diagnosis]

  7. 7.

    epicondylitis.mp

  8. 8.

    de Quervains.mp

  9. 9.

    exp Ulnar nerve compression syndromes/[classification, diagnosis]

  10. 10.

    exp Ulnar neuropathies/[classification, diagnosis]

  11. 11.

    exp Cumulative trauma disorders/[classification, diagnosis]

  12. 12.

    1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11

  13. 13.

    Upper extremity/or upper limb.mp

  14. 14.

    12 and 13

  15. 15.

    exp Musculoskeletal diseases/[classification]

  16. 16.

    exp Occupational diseases/[classification, diagnosis]

  17. 17.

    15 or 16

  18. 18.

    14 and 17

  19. 19.

    (Between-observer or within-observer or inter-observer or intra-observer or inter-rater or intra-rater or reliability or repeatability or reproducibility or reliable or repeatable or reproducible or kappa or coefficient or consistency or sensitivity or specificity or validity or ((predictive or prognostic) adj1 value) or standardised or standardized or standardisation or standardization or (classification adj1 (scheme$ or system$ or criterion or criteria)) or (case adj1 definition) or (diagnostic adj1 (criteria or criterion)) or (consensus adj1 (criteria or criterion)) or (evidence-based adj1 (criteria or criterion))).tw

  20. 20.

    18 and 19

  21. 21.

    Remove duplicates from 20

2B. Diagnostic properties of individual tests and procedures

  1. 22.

    ((upper adj1 (limb$ adj1 pain)) or ((arm or shoulder or elbow or wrist or hand or forearm) adj pain$) or (shoulder adj1 (tendonitis or capsulitis)) or epicondylitis or tenosynovitis or tendonitis or tendinitis).tw.

  2. 23.

    Carpal tunnel syndrome.mp.

  3. 24.

    22 or 23

  4. 25.

    19 and 24

  5. 26.

    diagnosis.mp. [mp = ti, hw, ab, it, sh, tn, ot, dm, mf, nm]

  6. 27.

    classification.mp. [mp = ti, hw, ab, it, sh, tn, ot, dm, mf, nm]

  7. 28.

    26 or 27

  8. 29.

    25 and 28

  9. 30.

    remove duplicates from 29

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Palmer, K.T. Diagnosing soft tissue rheumatic disorders of the upper limb in epidemiological studies of vibration-exposed populations. Int Arch Occup Environ Health 81, 575–593 (2008). https://doi.org/10.1007/s00420-007-0254-4

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