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職業性腕隧道症候群之診斷

Diagnostic Methods for Occupational Carpal Tunnel Syndrome

摘要


目前肌肉骨骼疾病有越來越多之趨勢,幾乎許多行業都會發生肌肉骨骼方面的疾病,如製造業之包裝者、醫院批價人員、百貨業的收銀員等。肌肉骨骼疾病發生的主要原因,大都是工作姿勢不正確、長時間固定或重複性姿勢、工作負荷過重及不當用力等因素所引起;其他影響因子如年齡、肥胖、新陳代謝失調等因素都有可能促使疾病的發生。由於工作人員對於職業災害認知提高,因肌肉骨骼疾病的勞工也越來越多。此疾病是否為職業所引起,在認定上是有困難度。目前針對肌肉骨骼疾病是否由職業引起評估方法包括問卷、醫師問診、理學檢查及實驗室檢查等方法。本報告是以腕隧道症候群(Carpal Tunnel Syndrome;CTS)為例,下列幾項認定方法可供參考: 1.先請職業病專科醫師或其他專科醫師以臨床評估(Tinel's sign 和Phalen's Test)及實驗檢查(神經傳導檢查)來做確認診斷。 2.再以問卷方式了解工作人員之基本資料、工作狀況及疼痛情形。 3.以V8攝影機拍攝工作人員之工作姿勢及記錄工作時間,並與問卷之工作狀況,實際評估工作之暴露量。 依上述步驟分別確定工作人員是否患有CTS此疾病,及了解工作年資、工作姿勢及工作負荷是否會造成CTS的發生,當排除鑑別診斷後,方可確定與其工作環境有關。因此,作者結論勞工應了解肌肉骨骼疾病並防止其發生職業災害,同時職業病專業醫師應與其他專科醫師共同訂定CTS職業病認定之參考依據。

並列摘要


Musculoskeletal disorders among Taiwanese workers have increased considerably over recent years, and affect a wide variety of workers, such as packers in manufacturing plants, hospital administrators, and clerks. Some of the causes of musculoskeletal disorders include incorrect posture, repetitive strain, heavy workload, and inappropriate operation in the workplace. Other factors such as age, obesity and metabolic problems can exacerbate the disorder. With the recognition in recent years of musculoskeletal disorders as an occupational hazard, there has been a sharp increase in the number of applications for compensation. However, it is often difficult to demonstrate the causality of these disorders. The problem of musculoskeletal disorders in the workplace needs to be considered from the point of view of both employer and employee. The objective of this study was to evaluate the methodology for determining carpal tunnel syndrome. There were four were four main stages: 1) Clinical assessment (Tinel’s sign or Phalen’s test ) by an occupational specialist or other specialist, and nerve conduction velocity test were performed. 2) Questionnaires were used to collect workers’ demographic data, work status, and location and severity of pain. 3) A video camera was used to determine ergonomic hazards by evaluating workers’ posture and movement in the workplace. 4) Data were analyzed to show correlations of ergonomic hazards with musculoskeletal disorders. In addition to the four steps described above, other potential confounding factors were investigated, such as non-occupational activities, surgery and disease. In conclusion, workers must be made aware of the risks of musculoskeletal disorders in the workplace. The diagnostic methodology for carpal tunnel syndrome needs to be improved in order to help protect workers’ from this common, disabling disorder.

被引用紀錄


劉珮吟(2011)。台灣之上肢職業性肌肉骨骼疾病致因探討:職業傷病通報系統與工作環境安全衛生狀況認知調查分析〔碩士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342%2fNTU.2011.01792

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