An investigation of somatosensory profiles in work related upper limb disorders: a case-control observational study protocol

Niamh Moloney, Toby Hall, Catherine Doody, Niamh Moloney, Toby Hall, Catherine Doody

Abstract

Background: Work related upper limb disorders constitute 45% of all occupational diseases and are a significant public health problem. A subgroup, non specific arm pain (NSAP), remains elusive in terms of understanding its pathophysiological mechanisms with its diagnosis based on the absence of specific clinical findings. One commonly proposed theory is that a neural tissue disorder is the primary dysfunction in NSAP and findings from previous studies lend some support to this theory. However, it is not clear if changes identified are simply a consequence of ongoing pain rather than due to specific neural changes. The presence of neuropathic pain has been investigated in several other musculoskeletal conditions but currently, there is no specific diagnostic tool or gold standard which permits an unequivocal diagnosis of neuropathic pain. The purpose of this study is to further describe the somatosensory profiles in patients with NSAP and to compare these profiles to a group of patients with MRI confirmed cervical radiculopathy who have been previously classified as having neuropathic pain.

Methods/design: Three groups of participants will be investigated: Groups 1 and 2 will be office workers with either NSAP or cervical radiculopathy and Group 3 will be a control group of non office workers without upper limb pain. Participants will undergo a clinical assessment, pain questionnaires (LANSS, Short Form McGill, DASH and TSK) and quantitative sensory testing comprising thermal detection and pain thresholds, vibration thresholds and pressure pain thresholds.

Discussion: The spectrum of clinically suspected neuropathic pain ranges from more obvious conditions such as trigeminal neuralgia to those with vague signs of nerve disorder such as NSAP. A thorough description of the somatosensory profiles of NSAP patients and a comparison with a more defined group of patients with evidence of neuropathic pain will help in the understanding of underlying neurophysiology in NSAP and may influence future classification and intervention studies relating to this condition.

Figures

Figure 1
Figure 1
Study Protocol.

References

    1. Eurostat work and health in the European Union: A statistical portrait, office for official publications of the European communities. Luxemburg. 2004.
    1. Boocock MG, Collier JM, McNair PJ, Simmonds M, Larmer PJ, Armstrong B. A Framework for the Classification and Diagnosis of Work- Related Upper Extremity Conditions: Systematic Review. Seminars in Arthritis and Rheumatism. 2009;38:296–311. doi: 10.1016/j.semarthrit.2007.10.006.
    1. Harrington J, Carter J, Birrell L, Gromptez D. Surveillance case definitions for work related upper limb pain syndromes. Occupational and Environmental Medicine. 1998;55:264–271. doi: 10.1136/oem.55.4.264.
    1. Palmer KT. Pain in the forearm, wrist and hand. Best Practice and Research Clinical Rheumatology. 2003;17:113–115. doi: 10.1016/S1521-6942(02)00100-6.
    1. Sluiter J, Rest K, Frings-Dresen M. Criteria Document for evaluating work relatedness of upper extremity musculoskeletal disorders. Scandinavian Journal of Work Environmental Health. 2001;27:1–102.
    1. Greening J, Lynn B. Minor peripheral nerve injuries: an underestimated source of pain? Manual Therapy. 1998;3(4):187–194. doi: 10.1016/S1356-689X(98)80047-7.
    1. Cohen ML, Arroyo JF, Champion DG, Browne CD. In search of the pathogenesis of refractory cervicobrachial pain syndrome: A deconstruction of the RSI phenomenon. The Medical Journal of Australia. 1992;156:432–436.
    1. Novak CB, Mackinnon SE. Nerve Injury in Repetitive Motion Disorders. Clinical Orthopaedics and Related Research. 1998;351:10–20. doi: 10.1097/00003086-199806000-00003.
    1. Woodward C. Repetitive Strain Injury: A Diagnostic Model and Management Guidelines. The Australian Journal of Physiotherapy. 1987;33(2):96–99.
    1. Woolf CJ, Bennett GJ, Doherty M, Dubner R, Kidd BL, Koltzenberg M, Lipton R, Loeser JD, Payne R, Torebjork E. Towards a mechanism-based-classification of pain? Pain. 1998;77:227–229. doi: 10.1016/S0304-3959(98)00099-2.
    1. Cook C, Brismee jM, Sizer PS. Subjective and objective clinical lumbar spine instability: a Delphi study. Manual Therapy. 2006;11:11–21. doi: 10.1016/j.math.2005.01.002.
    1. Schafer A, Hall T, Briffa K. Classification of low back- related leg pain- A proposed patho-mechanism based approach. Manual Therapy. 2009;14(2):222–230. doi: 10.1016/j.math.2007.10.003.
    1. Smart KM, Blake C, Staines A, Doody C. Clinical indicators of 'nociceptive', 'peripheral neuropathic' and 'central' mechanisms of musculoskeletal pain. A Delphi survey of expert clinicians. Manual Therapy. 2009;15(1):80–87. doi: 10.1016/j.math.2009.07.005.
    1. Treede R-D, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, Hansson P, Hughes R, Nurmikko T, Serra J. Neuropathic Pain: Redefinition and a grading system for clinical and research purposes. Neurology. 2008;70:1630–1635. doi: 10.1212/01.wnl.0000282763.29778.59.
    1. Cruccu G, Anand P, Attal N, Garcia-Larrea L, Haanpaa M, Jorum E, Serra J, Jensen T. EFNS guidelines on neuropathic pain assessment. European Journal of Pain. 2004;11:153–162.
    1. Byng J. Overuse syndromes of the upper limb and the upper limb tension test: a comparison between patients, asymptomatic keyboard workers and asymptomatic non-keyboard workers. Manual Therapy. 1997;2(3):157–164. doi: 10.1054/math.1997.0296.
    1. Champion DG, Cornell J, Browne CD. Clinical observations in patients with the clinical syndrome "repetitive strain injury". Journal of Occupational Health and Safety. 1986;2:107–113.
    1. Elvey RL, Quintner JL. A clinical study of RSI. Australian Family Physician. 1986;15:1312–1314.
    1. Greening J, Dilley A, Lynn B. In vivo study of nerve movement and mechanosensitivity of the median nerve in whiplash and non-specific arm pain patients. Pain. 2005;115:248–253. doi: 10.1016/j.pain.2005.02.023.
    1. Sterling M, Pedler A. A neuropathic component is common in acute whiplash and associated with a more complex clinical presentation. Manual Therapy. 2009;14(2):173–179. doi: 10.1016/j.math.2008.01.009.
    1. Dilley A, Bove GM. Disruption of axoplasmic transport induces mechanical sensitivity in intact rat C-fibre nociceptor axons. Journal of Physiology. 2008;586(2):593–604. doi: 10.1113/jphysiol.2007.144105.
    1. Scholz J, Mannion RJ, Hord DE, Griffin RS, Rawal B, Zheng H, Scoffings D, Phillips A, Guo J, Laing RJC. A Novel Tool for the Assessment of Pain: Validation in Low Back Pain. PLoS Medicine. 2009;6(4):e1000047. doi: 10.1371/journal.pmed.1000047.
    1. Greening J, Lynn B. Vibration sense in the upper limbs of patients with RSI and at risk workers. International Archives of Occupational and Environmental Health. 1998;71:29–34. doi: 10.1007/s004200050246.
    1. Greening J, Lynn B, Leary R. Sensory and autonomic function in the hands of patients with non-specific arm pain (NSAP) and asymptomatic office workers. Pain. 2003;104:275–281. doi: 10.1016/S0304-3959(03)00010-1.
    1. Jepsen JR, Thomsen G. A cross sectional study of the relation between symptoms and physical findings in computer operators. BMC Neurology. 2006;6(40)
    1. Laursen LH, Jepsen JR, Sjogaard G. Vibrotactile sense in patients with different upper limb disorders compared with a control group. International Archives of Occupational and Environmental Health. 2006;79:593–601. doi: 10.1007/s00420-006-0094-7.
    1. Pilegaard M, Jensen BR. An 18-month follow-up study on vibrotactile sense, muscle strength and symptoms in computer users with and without symptoms. International Archives of Occupational and Environmental Health. 2005;78:48–492. doi: 10.1007/s00420-005-0626-6.
    1. Tucker AT, White PD, Kosek E, Pearson RM, Henderson M, Coldrick AR, Cooke ED, Kidd BL. Comparison of vibration perception thresholds in individuals with diffuse upper limb pain and carpal tunnel syndrome. Pain. 2007;127:263–269. doi: 10.1016/j.pain.2006.08.024.
    1. Overgaard E, Brandt LPA, Ellemann K, Mikkelsen S, Andersen JH. Tingling/numbness in the hands of computer users: neurophysiological findings from the NUDATA study. International Archives of Occupational and Environmental Health. 2004;77:S21–S25. doi: 10.1007/s00420-004-0545-y.
    1. Sanden H, Edblom M, Ekman A, Terenbaum A, Wallin GB, Hagberg M. Normal nerve conduction velocity and vibrotactile perception thresholds in computer users. Int Arch Occup Environ Health. 2005;78:239–242. doi: 10.1007/s00420-005-0606-x.
    1. Madeleine P, Lundager B, Voigt M, Arendt-Nielsen L. Sensory manifestations in experimental and work-related chronic neck-shoulder pain. European Journal of Pain. 1998;2:251–260. doi: 10.1016/S1090-3801(98)90021-0.
    1. Hagg GM, Sastrom A. Load pattern and pressure pain threshold in the upper trapezius muscle and psychosocial factors in medical secretaries with and without shoulder neck disorders. International Archives of Occupational and Environmental Health. 1997;69:423–432. doi: 10.1007/s004200050170.
    1. Gold JE, Punnett L, Katz JN. Pressure pain thresholds and musculoskeletal morbidity in automobile manufacturing workers. International Archives of Occupational and Environmental Health. 2006;79:128–134. doi: 10.1007/s00420-005-0005-3.
    1. Johnston V, Jimmieson NL, Jull G, Souvlis T. Quantitative sensory measures distinguish office workers with varying levels of neck pain and disability. Pain. 2008;137:257–265. doi: 10.1016/j.pain.2007.08.037.
    1. Chien A, Eliav E, Sterling M. Hypoesthesia occurs in acute whiplash irrespective of pain and disability levels and the presence of sensory hypersensitivity. Clinical Journal of Pain. 2008;24(9):759–766.
    1. Chien A, Eliav E, Sterling M. Hypoaesthesia occurs with sensory hypersensitivity in chronic whiplash - Further evidence of a neuropathic condition. Manual Therapy. 2009;14(2):138–146. doi: 10.1016/j.math.2007.12.004.
    1. Chien A, Eliav E, Sterling M. Whiplash (grade II) and cervical radiculopathy share a similar sensory presentation: An investigation using quantitative sensory testing. Clinical Journal of Pain. 2008;24(7):595–603. doi: 10.1097/AJP.0b013e31816ed4fc.
    1. Freynhagan R, Rolke R, Baron R, Tolle TR, Rutjes A, Schu S, Treede R-D. Pseudoradicular and radicular low- back pain- A disease continuum rather than different entities? Answers from quantitative sensory testing. Pain. 2008;135(1-2):65–74. doi: 10.1016/j.pain.2007.05.004.
    1. Jensen R, Hystad T, Kvale A, Baerheim A. Quantitative sensory testing of patients with long lasting patellofemoral pain syndrome. European Journal of Pain. 2007;11(6):665–676. doi: 10.1016/j.ejpain.2006.10.007.
    1. Fishbain D, Lewis J, Cutler R, Cole B, Rosomoff H, Rosomoff R. Can the neuropathic pain scale disciminate between non-neuropathic and neuropathic pain? Pain Medicine. 2008;9(1):49–60.
    1. Agostinho CMS, Scherens A, Richter H, Schaub C, Rolke R, Treede R-D, Maier C. Habituation and short-term repeatability of thermal testing in healthy human subjects and patients with chronic non-neuropathic pain. European Journal of Pain. 2008;13(8):779–785. doi: 10.1016/j.ejpain.2008.10.002.
    1. Radhakrishnan K, Litchy W, O'Fallon W, Kurland L. Epidemiology of cervical radiculopathy. A population- based study from Rochester, Minnesota, 1976 through 1990. Brain. 1994;117(Pt 2):325–335. doi: 10.1093/brain/117.2.325.
    1. Rubinstein SM, Pool JJM, van Tulder MW, Riphagen II, de Vet HCW. A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. Eur Spine J. 2007;16:307–319. doi: 10.1007/s00586-006-0225-6.
    1. Beattie P, Meyers S, Strandford P. Associations between patient report of symptoms and anatomic impairment visible on lumbar magnetic resonance imaging. Spine. 2000;25:819–828. doi: 10.1097/00007632-200004010-00010.
    1. Maitland G, Hengeveld E, Banks K, English K, Edwards B. In: Maitland's Vertebral Manipulation. Six. Maitland G, Hengeveld E, Banks K, English K, editor. Oxford: Butterworth-Heinemann; 2001. Examination; pp. 133–139.
    1. Malanga GA, Campagnolo DI. Clarification of the pronator reflex. American Journal of Physical Medicine and Rehabilitation. 1994;73:338–340. doi: 10.1097/00002060-199409000-00006.
    1. Malanga GA. The diagnosis and treatment of cervical radiculopathy. Medicine and Science in Sports and Exercise. 1997;29(7):236–245.
    1. Schmid AB, Brunner F, Luomajoki H, Held U, Bachmann LM, Kunzer S, Coppieters MW. Reliability of clinical tests to evaluate nerve function and mechanosensitivity of the upper limb peripheral nervous system. BMC Musculoskeletal Disorders. 2009;10(11)
    1. American Association of Electrodiagnostic Medicine AAoPMaR. Practice parameter for needle electromyographic evaluation of patients with suspected cervical radiculopathy: summary statement. Muscle Nerve. 1999;22(Suppl):209–211.
    1. Jepsen JR, Laursen LH, Hagert C-G, Kreiner Sv, Larsen AI. Diagnostic accuracy of the neurological upper limb examination I: Inter-rater reproducibility of selected findings and patterns. BMC Neurology. 2006;6(8)
    1. Rainville J, Noto DJ, Jouve C, Jenis L. Assessment of Forearm Pronation Strength in C6 and C7 Radiculopathies. Spine. 2007;32(1):72–75. doi: 10.1097/01.brs.0000251002.39417.2c.
    1. Yaar I. The logical choice of muscles for the needle-electromyography evaluation of cervical radiculopathy. Archives of Physical Medicine and Rehabilitation. 2005;86:521–526. doi: 10.1016/j.apmr.2004.10.003.
    1. Netter FH, Hansen JT. Atlas of Human Anatomy. 3. Teterboro, New Jersey: Icon Learning Systems; 2003.
    1. Travell JC. Myofascial pain and dysfunction: The Trigger Point Manual. Baltimore: Williams and Wilkins; 1983.
    1. Selvaratnam P, Glasgow E, Matyas T. Discriminative validity of the brachial plexus tension test. Fifth Biennial Conference of the MPAA. 1988.
    1. Coppieters MW, Alshami AM, Hodges PW. An experimental pain model to investigate the specificity of the neurodynamic test for the median nerve in the differential diagnosis of hand symptoms. Archives of Physical Medicine and Rehabilitation. 2006;87:1412–1417. doi: 10.1016/j.apmr.2006.06.012.
    1. Dilley A, Lynn B, Greening J, DeLeon N. Quantitative in vivo studies of median nerve sliding in respnse to wrist, elbow, shoulder and neck movements. Clinical Biomechanics. 2003;18:899–907. doi: 10.1016/S0268-0033(03)00176-1.
    1. Jepsen JR. Upper limb neuropathy in computer operators? A clinical case study of 21 patients. BMC Musculoskeletal Disorders. 2004;5(26)
    1. Sterling M, Jull GA, Vincenzino B, Kenardy J. Characterisation of Acute Whiplash-Associated Disorders. Spine. 2004;29(2):182–188. doi: 10.1097/.
    1. Sterling M, Treleaven J, Jull G. Responses to a clinical test of mechanical provocation of nerve tissue in whiplash associated disorder. Manual Therapy. 2002;7(2):89–94. doi: 10.1054/math.2002.0443.
    1. Balstar S, Jull G. Upper trapezius activity during the brachial plexus tension test in asymptomatic subjects. Manual Therapy. 1997;2:144–149. doi: 10.1054/math.1997.0294.
    1. Gifford L. Acute low cervical nerve root conditions: symptom presentations and pathobiological reasoning. Manual Therapy. 2001;6(2):106–115. doi: 10.1054/math.2000.0386.
    1. Butler DS. The Sensitive Nervous System. Adelaide: Noigroup Publications; 2000.
    1. Mazurek MT, Shin AY. Upper Extremity Peripheral Nerve Anatomy - current concepts and applications. Clinical Orthopaedics and Related Research. 2001;383:7–20. doi: 10.1097/00003086-200102000-00004.
    1. Sterling M, Treleaven J, Edwards S, Jull G. Pressure pain thresholds of upper limb peripheral nerve trunks in asymptomatic subjects. Physiotherapy Research International. 2000;5(4):220–229. doi: 10.1002/pri.202.
    1. Yarnitsky D, Sprecher E. Thermal testing: normative data and repeatability for various test algorithms. Journal of Neurological Sciences. 1994;125:39–45. doi: 10.1016/0022-510X(94)90239-9.
    1. Wainner LR, Fritz JM, Irrgang JJ, Boninger ML, Delitto A, Allison CS. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine. 2003;28(1):52–62. doi: 10.1097/00007632-200301010-00014.
    1. Geber C, Klein T, Rolke R, Magerl W, Dieterich M, Birklein F, Treede R-D. Test retest and interobserver reliability in quantitative sensory testing according to the protocol of the german network of neuropathic pain (DFNS): Poster Presentation. European Journal of Pain. 2007;11(S1):S87. doi: 10.1016/j.ejpain.2007.03.215.
    1. Gelber DA, Pfeifer MA, Broadstone VL, Munster EW, Peterson M, Arezzo JC, Shamoon H, Zeidler A, Clements R, Greene DA. Components of Variance for Vibratory and Thermal Threshold Tesing in Normal and Diabetic Subjects. Journal of Diabetes and its Complications. 1995;9(3):170–176. doi: 10.1016/1056-8727(94)00042-M.
    1. Grunert BK, Wertsch JJ, Matloub HS, McCallum-Burke S. Reliability of sensory threshold measurement using a digital vibrogram. Journal of Occupational Medicine. 1990;32(2):100–102.
    1. Meier PM, Berde CB, DiCanzio J, Zurakowski d, Sethna NF. Quantitative assessment of cutaneous thermal and vibration sensation and thermal pain detection thresholds in healthy children and adolescents. Muscle and Nerve. 2001;24:1339–1345. doi: 10.1002/mus.1153.
    1. Rosecrance JC, Cook TM, Goode JD, Schroder MJ. Vibration sensibility testing in the workplace. Day to day reliability. Journal of Medicine. 1994;36(9):1032–1037.
    1. Vatine J, Shapira S, Magora F. Electronic pressure algometry of deep pain in volunteers. Archives of Physical Medicine and Rehabilitation. 1993;74:526–530. doi: 10.1016/0003-9993(93)90118-T.
    1. Antoconi F, Sand T, Lucas GA. Pressure algometry in healthy subjects: interexaminer variability. Scandinavian Journal of Rehabilitation Medicine. 1998;30:3–8. doi: 10.1080/003655098444255.
    1. Jones DH, Kilgour RD, Comtois AS. Test- retest reliability of pressure pain threshold measurements of the upper limb and torso in young healthhy women. The Journal of Pain. 2007;8(8):650–656. doi: 10.1016/j.jpain.2007.04.003.
    1. Nussbaum EL, Downes L. Reliability of clinical pressure-pain algometric measurements obtained on consecutive days. Physical Therapy. 1996;78(2):161–169.
    1. Perrson AL, Brogardh C, Sjolund BH. Tender or not tender: Test-retest repeatability of pressure pain thresholds in the trapezius and deltoid muscles of healthy women. Journal of Rehabilitation Medicine. 2004;36:17–27. doi: 10.1080/16501970310015218.
    1. Vanderweeen R, Oostendorp RAB, Vaes P, Duquet W. Pressure algometry in manual therapy. Manual Therapy. 1996;1(5):258–265. doi: 10.1054/math.1996.0276.
    1. Kaki AM, El-Yaski AZ, Youseif E. Identifying neuropathic pain among patients with chronic low-back pain: use of the Leeds Assessment of Neuropathic Symptoms and Signs pain scale. Regional Anesthesia and Pain Medicine. 2005;30:422–428.
    1. Potter J, Higgenson IJ, Scadding JW, Quigley CW. Identifying neuropathic pain in patients with head and neck cancer: use of the Leeds Assessment of Neuropathic Symptoms and Signs pain scale. Journal of the Royal Society of Medicine. 2003;96:379–383. doi: 10.1258/jrsm.96.8.379.
    1. Yuccel A, Senocak M, Kocasoy OE, Cimen A, Ertas M. Results of the Leeds Assessment of Neuropathic Symptoms and Signs pain scale in Turkey: a validation study. Journal of Pain. 2004;5:427–432. doi: 10.1016/j.jpain.2004.07.001.
    1. McGill R. The short - form McGill pain questionnaire. Pain. 1987;30:191–197. doi: 10.1016/0304-3959(87)91074-8.
    1. Wright KD, Asmundson GJG, McCreary DR. Factorial validity of the short-form McGill pain questionnaire (SF-MPQ) European Journal of Pain. 2001;5(3):279–284. doi: 10.1053/eujp.2001.0243.
    1. Huskisson EC. Measurement of Pain. The Lancet. 1974;9(2):1127–1131. doi: 10.1016/S0140-6736(74)90884-8.
    1. Crombez G, Vlaeyan JW, Heuts PH, Lysens R. Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability. Pain. 1999;80:329–339. doi: 10.1016/S0304-3959(98)00229-2.
    1. Kori S, Miller R, Todd D. Kinesphobia: a new view of chronic pain behaviour. Pain Management. 1990;3(35-43)
    1. Vlaeyan JW, Haazen IW, Schuerman JA, Kole-Snijders AB, van Eel H. Behavioural rehabilitation of chronic low back pain: comparison of an operant treatment, an operant-cognitive treatment and an operant-respondent treatment. British Journal of Clinical Psychology. 1995;35(Pt 1):95–118.
    1. Kitis A, Celik E, Aslan UB, Zencir M. DASH questionnaire for the analysis of musucloskeletal symptoms in industrial workers: A validity and reliability study. Applied Ergonomics. 2009;40:251–255. doi: 10.1016/j.apergo.2008.04.005.
    1. Viikara-Juntura E. Interexaminer reliability of observations in physical examinations of the neck. Physical Therapy. 1987;67(10):1526–1132.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe