INTRODUCTION

India being a developing nation is faced with traditional public health problems like communicable diseases, malnutrition, poor environmental sanitation and inadequate medical care. The major occupational diseases/morbidity of concern in India are silicosis, musculo-skeletal injuries, coal workers’ pneumoconiosis, chronic obstructive lung diseases, asbestosis, byssinosis, pesticide poisoning and noise induced hearing loss. Special skill is required in diagnosis, treatment and post- illness management of the cases of occupational diseases. Before allowing the worker to resume his work after sickness, it is essential to consider the work environment adversely affecting the existing medical condition and also the physical demand of the work. Training of physicians working in ESIS, District Hospitals and PHCs is, therefore, essential. Through this interactive material is intended to help undergraduate students to have a primary notion about imusculo skeletal injuries that in their medical practice know how to give a first right to handling these diseases which are more common every day in the medical consultation

SOUNDING

For the students’ prior knowledge of medicine in India on occupational health, and specifically on musculoskeletal shoulder, wrist and knee were surveyed. Below is a fact sheet of the instrument applied.

 

Type of instrument	Poll
Questioning	Questions with multiple-choice answers closed.
Universe	Undergraduate medical students in India of Pravara Institute of Medical Sciences.
Sample	200 medical students
Probe Type	No probabilistic
Way to probe	Through internet platforms.

 

Below are the questions with their respective tab:

1. Important to consider the study of occupational health in the medical curriculum

Yes	179
No	21

 

2. As their knowledge catalogaría musculoskeletal shoulder, wrist and knee as a result of the activity of workers in India

Very bad	14
Bad	21
Regula	118
Good	30
Very good	17

 

3. Currently you have internet access at home or college

Yes	164
No	36

 

4. Have you ever used a virtual classroom for the study of medicine

Yes	86
No	114

 

5. Considers the design of virtual environments for virtual education about musculoskeletal disorders of the shoulder, wrist, knee and spine help undergraduate students of the faculty of medicine in India has improved their understanding of occupational health.

Yes	197
No	3

 

CONCLUSIONS
We can see broadly that undergraduate medical students at the University Pravara Institute of Medical Sciences have not enough knowledge about musculoskeletal disorders of the shoulder, wrist, knee and spine related to occupational health. It further determines that there is a good level of internet access and that students are receptive to the use of virtual classrooms for learning occupational health.

ACTIVIDADADES PROPOSAL
1. Please identify in the puzzle the following concepts:

1. MUSCULO SKELETAL INJURIES

2. CARPAL TUNNEL SYNDROME

3. ANATOMY

4. DE QUERVAIN TENOSYNOVITIS

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2. Please watch the following video and answer the following questions
http://youtu.be/kR06G1aRQX0
Consider occupational health is important, explain why?

Think you need to improve your knowledge of musculoskeletal disorders of the shoulder, wrist and knee applied to occupational health?

Annexes:
Solution wordsearch

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MUSCULO SKELETAL INJURIES

Below we will begin with diseases of the wrist

This material is divided into four modules which each contain an initial explanation about reference links essential to continue to the next module, with some video tutorials and a final activity of each module to assess the learning

WRIST INJURIES

The main pathologies of the wrist can be divided into two major which shown below:

CARPAL TUNNEL SYNDROME

DEFINITION

Your carpal tunnel is a channel in the palm side of your wrist. The bones of your wrist are arranged in a semi-circle. A tough ligament, known as the transverse carpal ligament, forms a roof over these bones, creating a passageway known as your carpal tunnel. The tendons that you use to bend your fingers and wrist pass through your carpal tunnel. You can get carpal tunnel syndrome if there is too much pressure on your median nerve. . About three in 100 men and five in 100 women develop carpal tunnel syndrome at some point in their life.

ANATOMY

 

This table summarizes causes symptoms diagnosis and treatment, conduct click on the link to view certain sections of video that summarizes the pathology and surgical treatment

CAUSES	hand-arm vibration, cumulative trauma, overuse SYNDROMES OTHER: DIABETES, DISEASES AUTOINMUINES, structural abnormalities
SYMPTOMS	Tingling or numbness OF FINGER OR HAND Pain spreading to the arm or shoulder DRY SKIN NUMBNESS
DIAGNOSIS	PHYSICAL EXAM Nerve conduction study Electromyography
TREATMENT	SPLINT STEROIDS INJECTE ANTIINFLAMMATORY SURGICAL TREATMENT http://www.youtube.com/watch?v=C02Nyowvaw8&feature=fvwrel

 

To deepen the previous topic should read the following links:

http://www.mayoclinic.com/health/carpal-tunnel-syndrome/ds00326/dsection=symptoms

http://www.nhs.uk/Conditions/Carpal-tunnel-syndrome/Pages/Symptoms.aspx

http://www.bupa.co.uk/individuals/health-information/directory/c/carpal

DE QUERVAIN’S TENOSYNOVITIS

Definitions

It is a painful condition that affects a couple of tendons of the thumb as they run

through a tunnel on the thumb side of the wrist.

This disease affects the vast majority of women around 40 years on average (between 20 and 65 years). It is related to repetitive movements of the wrist and thumb.

anatomy

 

CAUSES	Repetitive activity on one specific movement Direct injury to your wrist or tendon; scar tissue can restrict movement of the tendons Inflammatory arthritis, such as rheumatoid arthritis
SYMPTOMS	Pain near the base of your thumb Swelling near the base of your thumb Difficulty moving your thumb and wrist when you’re doing activities that involve grasping or pinching A «sticking» or «stop-and-go» sensation in your thumb when trying to move it
DIAGNOSIS	The diagnosis is clinical occasionally used rx
TREATMENT	Rest Nsaid Splint Corticoids injections physiotherapy SURGICAL TREATMENT http://www.breg.com/patient-education/elbow-wrist/treatment-options

 

http://www.mayoclinic.com/health/de-quervains-tenosynovitis/DS00692/DSECTION=tests-and-diagnosis

http://www.chirurgiemain.fr/pathologies/maladie-de-la-main/tendinite-de-de-quervain/

SHOULDER INJURIES

Diseases of the shoulder can be divided into several pathologies but then we will see the most common, which are divided into:

1. ROTATOR CUFF DISORDERS
2. FROZEN SHOULDER
3. ANTERIOR/RECURRENT DISLOCATIONS
4. INESTABILITY DISORDERS
5. AC JOINT SPRAIN

Here we see the anatomy of the shoulder and give a definition of each disease with symptoms causes and treatment, then raised the main link to deepen each pathology

 

ANATOMY

1. ROTATOR CUFF DISORDERS

DEFINITIONS

The rotator cuff is made up of the tendons of four muscles. They are the supraspinatus, infraspinatus, subscapularis, and teres minor. These muscles originate from the scapula, and their tendons merge together to form a «cuff» over the upper end of the arm (head of the humerus). The term «rotator cuff » is an oversimplified description of the work that these muscles and tendons perform. In addition to rotating the humerus (shoulder rotation), the rotator cuff stabilizes the ball of the shoulder (humeral head) within the joint, and it depresses the humeral head as the arm is lifted.

Most rotator cuff tears occur in the supraspinatus tendon, but other parts of the cuff may also be involved.

1. FROZEN SHOULDER

Definitions

Frozen shoulder, also known as adhesive capsulitis, is a disorder characterized by pain, stiffness, and loss of range of motion in the shoulder. It affects about two percent of the general population, and it is most common in women who are over 40 years of age

1. ANTERIOR RECURRENT DISLOCATION

When the two bones of a joint are no longer in contact with one another, the joint is said to be dislocated. For example, when a shoulder joint is dislocated, the ball (humeral head) is no longer sitting in the socket (glenoid)

1. Instability disorders

Definitions

Patients who develop shoulder instability will generally fall into one of three categories:

1. recurrent traumatic instabilty – those with a history of a traumatic shoulder injury or dislocation who now report recurrent dislocation or instability
2. atraumatic or multidirectional instability – patients who are noted to be ligamentously lax or «loose jointed,» not just in their shoulder, but throughout their whole body
3. congenital instability – people with local anomolies such as glenoid dysplasia

Interestingly, traumatic instability has been an observed medical problem throughout the recorded history of humankind. The first report of a shoulder dislocation is found in the world’s oldest book, the Edwin Smith Papyrus (3000-2500 BC). A drawing demonstrating a shoulder reduction technique was discovered in Egypt in the tomb of Upuy (1200 BC). Hippocrates described at least six different techniques to reduce a dislocated shoulder. In contrast, the concept of atraumatic, multidirectional instability was not introduced until 1980 when Dr. Charles Neer, the father of modern shoulder surgery, described it.

http://www.acc.co.nz/PRD_EXT_CSMP/groups/external_communications/documents/guide/wcm001684.pdf

others links

http://www.shouldersurgeon.com/rotator_cuff/index.htm

http://www.breg.com/patient-education/shoulder/treatment-optionsyndrome/Pages/Symptoms.aspx

Musculoskeletal Diseases

Diagnostic Imaging and Interventional Techniques

Zurich, Switzerland

PATHOLOGIES OF THE KNEE

definitions

The knee joint is composed of three bones: the femur, the tibia and the patella. The proximal tibia-fibula joint is included in the knee, but is rarely injured. Articular cartilage covers the joint surface and provides a smooth lubricated gliding surface for knee motion. The shapes of the bony articulation provide very little inherent stability. Proper function depends upon intact ligaments. This includes the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medical collateral ligament (MCL), and the lateral collateral ligament (LCL). While the ACL functions as the main stabilizer to anterior knee translation, the PCL functions as the main stabilizer to posterior translation. The collateral ligaments are the main stabilizers to side to side stress. The medial and lateral menisci are located within the joint between the femur and tibia. At times they have been referred to as the «cartilage» in the knee joint, but it is important to differentiate these structures from articular cartilage which covers the ends of the bones within the joint. The menisci function as «shock absorbers» within the knee joint and also influence knee stability.

The front of the knee is protected by the patella or kneecap, which is attached to the quadriceps muscle by the quadriceps tendon and to the tibia by the patellar tendon. While the quadriceps muscle controls knee extension, knee flexion is controlled by the hamstring muscles.

Among the most common diseases of the knee found the following:

1. PATELLA TENDINITIS
2. BURSITIS
3. PATELLOFEMORAL PAIN AND CONDROMALACIA
4. ANTERIOR CRUCIATE LIGAMENT INJURIES
5. POSTERIOR CRUCIATE LIGAMENT INJURIES
6. MENISCAL TEARS

these pathologies are subdivided into many more other pathologies which if you delve deeper by the student should consult the additional links provided in the references, then give some topics on treatment and management:

http://www.acc.co.nz/PRD_EXT_CSMP/groups/external_communications/documents/guide/wcmz003523.pdf

others links

http://www.wheelessonline.com/ortho/anatomy_and_kinematics_of_the_knee_joint

http://www.aafp.org/afp/1999/1101/p2012.html

http://www.kneesociety.org/web/patienteducation_injuries.html

http://www.niams.nih.gov/Health_Info/Knee_Problems/default.asp#8

http://www.nzgg.org.nz/search?search=knee+injuries

Autor: Marcela Caicedo y www.hacemostesis.com