Fredrik Bajers Vej 5
P.O. Box 159 DK-9100 Aalborg
Phone: +45 9940 9940
I forbindelse med Jørgen Riis Jepsens forsvar af sin doktorafhandling, inviterer Klinisk Institut til disputatsforvar af afhandlingen: Studies of upper limb pain in occupational medicine, in general practice, and among computer operators. Diagnostic contribution from manual muscle testing and assessment of cutaneous sensibility and nerve trunk mechanosensitivity.
02.03.2018 kl. 13.00 - 02.03.2018 kl. 18.00
Forsvaret foregår på engelsk og finder sted:
Fredag den 2. marts 2018 kl. 13.00
I Auditoriet, Medicinerhuset, Mølleparkvej 4, 9000 Aalborg
Prof. Pascal Madeleine, PhD, dr scient (Chairman)
Head of Physical Activity and Human Performance group - SMI
Dept. of Health Science and Technology
Professor Yves Roquelaure
Institute for Research in Health, Environment and Work
University of Angers, Faculty of Medicine, Angers France
David Rempel, MD, MPH
Professor Emeritus, Department of Medicine
University of California, San Francisco
Diagnostic consensus criteria do not cover a major proportion of upper limb patients (“non-specific arm pain”). Three empirical studies in this thesis aimed to address this diagnostic challenge by incorporating representative neurological qualities in the physical examination.
Patterns of muscle weakness, sensory abnormalities and nerve trunk allodynia based on the nerves’ topography and their motor and cutaneous innervation were defined to reflect and locate peripheral nerve afflictions. A physical examination was validated on patients in clinical occupational medicine and neurological patterns studied in computer operators in order to better characterize their disorder. Work exposures for patients in general practice with symptoms and findings consistent with brachial plexopathy were compared with those of matched controls.
The inter-rater reliability of individual neurological items and patterns at ten locations was moderate to good and reflected symptoms. Computer operators with severe upper limb complaints displayed typical patterns (infraclavicular brachial plexopathy, median (elbow) and posterior interosseous neuropathy) and suffered a serious prognosis. Similar patterns were found in symptomatic active computer operators, in particular on the dominant side. In spite of pain of low intensity physical findings were frequent and related to pain. Stretching reduced pain levels but physical findings persisted. This study indicates the role of nerve afflictions in computer-related upper limb disorders.
The most frequent neurological pattern in these studies was in accordance with brachial plexopathy. A case-control study demonstrated the relation of this pattern to many mechanical work exposures, e.g. adverse positions, repetitive work, work pace, and use of force, with clear dose–response relationships.
Neurological patterns reflecting peripheral nerve-afflictions were frequent. A systematic examination of representative neurological items contributes to characterize work-related upper limb conditions. Pattern-identification is a rewarding diagnostic approach, which may eventually improve their management and prevention.
Aalborg Universitet, Det Sundhedsvidenskabelige Fakultet, Klinisk Institut
Auditoriet, Medicinerhuset, Mølleparkvej 4, 9000 Aalborg