Academic journal article Scandinavian Journal of Work, Environment & Health

Associations of Work Activities Requiring Pinch or Hand Grip or Exposure to Hand-Arm Vibration with Finger and Wrist Osteoarthritis: A Meta-Analysis

Academic journal article Scandinavian Journal of Work, Environment & Health

Associations of Work Activities Requiring Pinch or Hand Grip or Exposure to Hand-Arm Vibration with Finger and Wrist Osteoarthritis: A Meta-Analysis

Article excerpt

Osteoarthritis (OA) is a progressive joint disease char- acterized by focal erosive lesions, loss of cartilage, and bone hypertrophy underneath the cartilage (1). Radiographic OA changes are joint-space narrowing, osteophytes, subchondral sclerosis, and subchondral cysts (1). Using clinical and radiological criteria, OA of the wrist and fingers (hereafter "hand OA") comprise one third of all joints affected by OA (2, 3). The preva- lence of radiographically diagnosed hand OA is about 10% in the age group of 40-49 years, reaching 80% and 90% among men and women >70 years, respec- tively (4). These numbers most likely overestimate the clinical occurrence of hand OA as many people with radiographic evidence of OA have no symptoms (5). Mannoni et al showed that the prevalence of symptom- atic hand OA among subjects >65 years of age is only 15% (6, 7). The cause of pain in OA is still unclear (8, 9). The aetiology of OA is multi-factorial. In addition to age and gender, metabolic, genetic, and biomechanical risk factors have been studied (10-12). Physical activ- ity of moderate intensity has been suggested to protect against the development of hand OA by strengthening muscles and ligaments (13). However, the findings of unusual patterns of joint involvement in hand OA in certain occupations have supported the hypothesis that biomechanical forces may contribute to development of hand OA (14-17). It has been suggested that continuous overload of hand joints resulting from highly monoto- nous usage may lead to joint impairment, for instance by interference with nutrition of the joint cartilage (18, 19). This probably requires pressure exerted on the cartilage by muscular contraction. Supporting this assertion is the observation that arthritis does not develop in paralyzed limbs in spite of immobile positions, and that hands weakened by hemiplegia or peripheral nerve injury do not generate Heberden's nodes (20, 21).

If biomechanical load of the hand joints is indeed contributing to the aetiology of hand OA, it is expected that this disorder is more prevalent in some occupations. Even so, it is still unresolved whether the development of hand OA can be caused by work-related activities, or whether occupational exposures only precipitate the symptoms among subjects with radiographic OA (22). Jensen et al (12) published a review on occupational activities involving gripping in relation to finger OA. However, this narrative review did not perform a sys- tematic evaluation of the evidence level.

The objective of this paper was to review the avail- able evidence on the association of hand OA with work activities involving repeated and/or sustained pinch grip, hand grip, or exposure to hand-arm vibration (HAV). Manual work, when mentioned in this document, refers to any work activity that involves primarily the use of the hands.

Methods

Literature search

We performed a systematic search in PubMed and Embase to identify original papers in English that pro- vide risk estimates of radiologic hand OA in relation to manual work. We used four search strings detailed in a footnote to Supplementary table A (www.sjweh.fi/data_ repository.php). After merging to omit duplicates, the combined searches resulted in 1951 hits. Eligible papers were identified according to specified exclusion criteria (Supplementary table A). Studies were included regard- less of their design or quality. Finally 19 original studies (20 papers) were qualified for the meta-analysis. A semi- nal paper addressing the influence of pattern of usage on the structure and function of the hands in female textile workers was not included because appropriate measures of association could not be computed (23).

Outcome definition

The defining criterion for wrist and finger OA was radio- graphically detected OA regardless of symptoms and clinical signs. Finger OA denotes OA in ≥1 of the follow- ing joints: distal interphalangeal (DIP), proximal inter- phalangeal (PIP), and metacarpophalangeal (MCP). …

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