| Musculoskeletal Disorders |  | |
Safety & Health Assessment & Research for Prevention (SHARP) — Research for Safe Work
- Public health importance of work-related musculoskeletal disorders.
- Purpose and operation.
- System components.
- Work-related musculoskeletal disorder (WMSD) resources.
- Links to other WMSD information.
Public health importance of work-related musculoskeletal disorders
The magnitude, cost and burden of work-related musculoskeletal disorders (WMSDs) are enormous. From 1992 - 2000, there were 380,485 Washington State accepted workers' compensation state fund claims for non-traumatic soft tissue musculoskeletal disorders of the neck, back and upper extremity. These claims resulted in $2.9 billion in direct costs, and 26.9% of all state fund workers' compensation claims. Of WMSD claims during this time period, 32.4% were compensable with an average of 123 lost time days per compensable claim.
Work related musculoskeletal disorders occur when there is a mismatch between the physical requirements of the job and the physical capacity of the human body. More than 100 different work-related musculoskeletal disorders may stem from repetitive motions that produce wear and tear on the body. Specific risk factors associated with WMSDs include repetitive motion, heavy lifting, forceful exertion, contact stress, vibration and awkward posture among others.
Purpose and operation
Purpose
The purpose of this system is the identification of patterns and trends that can be used to reduce, through prevention, the occupational risks associated with nontraumatic soft tissue musculoskeletal disorders of the neck, back, and upper extremity.
Objectives
- Describe the incidence and prevalence of neck, back and upper extremity WMSDs.
- Identify high risk occupations and industries.
- Identify useful prevention strategies.
- Generate hypotheses about causative agents and factors.
Planned uses
- Identifying outbreaks of WMSDs.
- Analyzing risks by occupation and industry.
- Tracking trends in incidence, prevalence and cost of WMSDs.
- Sharing information with the public, legislature, health care providers, public health professionals, and labor and industry stakeholders.
- Evaluating efforts to reduce WMSDs as an occupational risk.
- Measuring progress toward meeting Healthy People 2010 objective 20-3, reducing the risk of injury and illness involving days away from work due to overexertion or repetitive motion.
Case definition
An accepted claim is a case of nontraumatic soft tissue (NTST) WMSD of the neck, back or upper extremities if either one of two conditions is met.
- The first report of injury contains references to a body part in Table 1, to an affected soft tissue identified as a nature of injury in Table 2, and to a type of injury associated musculoskeletal disorders as shown in Table 3, OR
- The medical bills associated with the claim includes one or more of the diagnosis/procedure codes shown in Table 4, and the type of injury is listed in Table 3 for that body part *.
An example of the first case definition, an injury described as a shoulder sprain resulting from breaking concrete with a jack hammer, would be a case because 450 (the code for shoulder) is in Table 1, 310 (the code for strain or sprain) is in Table 2, and 083 (the code for abraded by vibrating object) is contained in Table 3. It would also be counted as a case under upper extremity because this body group contains shoulder as a subgroup.
* The workers' compensation costs associated with this case definition are included only if the body part also matches those listed in Table 1. This is done to avoid inflating the costs by including cases with multiple injuries of which MSD is not the major reason for the lost work time.
| Table 1 - Composition of body groups | |
|---|---|
| Body group | Group composition |
| Hand/Wrist | 320(hand), 330(wrist), 340(fingers), 350(hand and fingers) |
| Elbow | 313(elbow), 315(forearm) |
| Shoulder | 311(upper arm), 450(shoulder) |
| Back | 420(back) |
| Neck | 200(neck) |
| Multiple | 498(trunk-multiple), 600(back and neck), 700(multiple) |
| Upper Extremity | 300(upper extremity), 310(arm unspecified), 318(arm multiple), 398 (upper extremity, nec), and Body Groups (SHOULDER, ELBOW, and HAND/WRIST) |
| Table 2 - Nature of injury codes and type of musculoskeletal disorder | ||||
|---|---|---|---|---|
| Code | Description | NTST neck | NTST back | NTST upper extremity |
| 190 | dislocation/herniation of discs | X | X | |
| 260 | inflammation or irritation of joints, tendons or muscles | X | X | X |
| 310 | strains and sprains | X | X | X |
| 400 | multiple injuries | X | ||
| 560 | injuries to the nervous system | X | X | X |
| 562 | diseases of the nerves and peripheral ganglia | X | X | X |
| 580 | ill defined symptoms and conditions | X | X | X |
| 999 | not classified | X | X | X |
| Table 3 - Types of Injury and Associated Body Groups | ||||
|---|---|---|---|---|
| Code | Description | Neck | Back | Upper Extremity |
| 81 | abraded by kneeling/sitting | X | ||
| 82 | abraded by object handling | X | X | |
| 83 | abraded by vibrating object | X | X | |
| 85 | abraded by foreign object | X | X | |
| 86 | abraded by motion | X | X | |
| 100 | bodily reaction | X | X | X |
| 120 | overexertion unspecified | X | X | X |
| 121 | overexertion lifting | X | X | X |
| 122 | overexertion pushing/pulling | X | X | X |
| 123 | overexertion wielding/ throwing | X | X | X |
| 124 | overexertion carrying | X | X | X |
| 129 | overexertion NEC | X | X | X |
| 899 | type NEC | X | X | X |
| 999 | not classified | X | X | X |
| Table 4 - ICD 9 Diagnosis and Procedure Codes Used in Defining Cases of WMSD | ||
|---|---|---|
| Body Part | Diagnosis | Description |
| Neck | 722.00 | Neuritis or radiculitis due to displacement of cervical disc |
| 722.71 | Invertebral disc disorder with myelopathy | |
| 723.00 | Other disorders of cervical region | |
| 723.10 | Cervicalgia (pain in the neck) | |
| 723.30 | Cervicabrachial syndrome | |
| 723.40 | Cervical radiculitis, radicular syndrome | |
| 723.50 | Torticollis | |
| 847.00 | Sprain and strain of neck | |
| Back | 722.10 | Lumbago or sciatica due to displacement of intervertebral disc |
| 722.73 | Intervertebral disc disorder with myelopathy | |
| 724.00 | Other disorders of back | |
| 724.20 | Lumbago, lumbalgia, low back pain | |
| 724.30 | Sciatica | |
| 724.50 | Backache, unspecified | |
| Upper Extremity | ||
| Body Part | Diagnosis | Description |
| Shoulder-Rotator Cuff Syndrome | 726.1 | Rotator cuff syndrome |
| 726.10 | Rotator cuff, supraspinatus syndrome | |
| 727.61 | Complete rupture of rotator cuff | |
| 840.40 | Sprains and strains of rotator cuff capsule | |
| Procedure | Description | |
| 23410 | Repair ruptured rotator cuff - acute | |
| 23412 | Repair ruptured rotator cuff - chronic | |
| 23415 | Coracoacromial ligament release - chronic ruptured rotator cuff | |
| 23420 | Repair of complete rotator cuff avulsion, chronic | |
| Upper Extremity | Diagnosis | Description |
| Elbow-Epicondylitis | 726.31 | Medial epicondylitis |
| 726.32 | Lateral epicondylitis | |
| Procedure | Description | |
| 24350 | Lateral or medial fasciotomy | |
| Upper Extremity | Diagnosis | Description |
| Hand/wrist-Carpal tunnel syndrome | 354.00 | Carpal tunnel syndrome |
| Procedure | Description | |
| 64721 | Median nerve decompression at carpal tunnel | |
| Upper Extremity | Diagnosis | Description |
|
Tenosynovitis/ tendinitis |
727.03 | Trigger finger |
| 727.04 | DeQuervain's disease | |
| 727.05 | Other tenosynovitis of hand and wrist | |
| 727.4 | Ganglion & cyst of synovium, bursa, tendon | |
| 727.42 | Ganglion of the tendon sheath | |
Legal authority
No specific legal authority was needed to create this surveillance system.
Organizational location
The surveillance system is located within the Safety and Health Assessment and Research for Prevention (SHARP) Program of the Washington State Department of Labor and Industries.
System components
Population under surveillance
The population under surveillance is the workers employed in the State of Washington who have workers compensation insurance under state law.
Time period of data collection
January 1, 1991 through December 31, 1999
Collection and reporting sources
Workers' compensation claims data are available from the data warehouse. It contains information from the Labor and Industries Industrial Insurance System (LINIIS), the computer system for processing workers' compensation claims and the Medical Insurance Payment System (MIPS) that is used by providers of health services to submit bills for payment of services rendered under workers' compensation.
Data management
A query is used to create an analysis database in SAS from the data warehouse. A SAS record containing data from LINIIS and MIPS is created if at least one of the MSD case definitions is met. The record indicates which of the other case definitions used in the query are also met.
Data analysis and dissemination
A variety of tables are created using standard procedures in SAS. A technical report is produced and disseminated annually.
Patient privacy, data confidentiality, and system security
All records containing or accompanied by patient identifying information are confidential. These records are used solely for surveillance and prevention purposes. Physical access to the building and access to individual computers are controlled as part of the security systems of the Department of Labor and Industries.
Work-related musculoskeletal disorder (WMSD) resources developed by the SHARP program
Publications
WMSD reports are available from SHARP's Publications page.
Links to other WMSD information
External hyperlinks are provided as a public service by the SHARP Program. Neither L&I nor SHARP are responsible for the reliability or accuracy of the information found on other Web sites. (Disclaimer)
- California Occupational Health Surveillance and Evaluation Program - Surveillance of Occupational Disease and Injury (www.dhs.ca.gov).
- Massachusetts Department of Public Health - Carpal Tunnel Syndrome Facts (www.mass.gov).
- National Institute for Occupational Safety and Health - Musculoskeletal Disorders and Workplace Factors (www.cdc.gov).
- National Institute for Occupational Safety and Health - National Occupational Research Agenda: Musculoskeletal Disorders (www.cdc.gov).
- Washington State Department of Health - The Health of Washington State, 2002 - Work-Related Musculoskeletal Disorders (www.doh.wa.gov).
