PARE MUSCULOSKELETAL DISORDERS IN THE ERA OF THE COVID-19 PANDEMIC

BackgroundIn Tunisia, during the last decade, the number of MSDs declared as compensable occupational diseases has been increasing. So, what is the impact of the COVID-19 pandemic on the MSD reporting rate.ObjectivesTo describe the socio-professional characteristics of workers with musculoskeletal disorders (MSDs) and to determine the reporting rate of MSDs as occupational diseases.MethodsA descriptive cross-sectional study among workers with work-related MSDs who consulted the occupational medicine department of the Charles Nicolle Hospital for medical advice between January 2021 and September 2022.ResultsA total of 109 workers with MSDs were included in this study. The workers were 64.2% female. The average age was 46 ± [21-61 years]. The sectors most prone to MSDs were the health sector (27.5%), food processing (16.5%) and textiles (15.6%). The workers reported MSDs of the upper limb in 31.2%, MSDs of the lower limb in 33.9% and of the spine in 69.7%. These MSDs reported included 5/13 cases of rotator cuff tendinopathy, 6/13 cases of carpal tunnel syndrome, one case of achilles tendonitis and one case of Dequervain's tenosynovitis.ConclusionDuring the COVID-19 pandemic, the reporting of MSDs as occupational diseases has declined considerably. This decline can be explained by the difficult access to hospital facilities.References[1]https://www.emro.who.int/emhj-volume-23-2017/volume-23-issue-11/prevalence-et-determinants-des-troubles-musculo-squelettiques-des-membres-superieurs-chez-les-artisans-tunisiens.html.[2]http://medecinetravail.canalblog.com/archives/2011/10/04/22196851.htmlAcknowledgements:NIL.Disclosure of InterestsNone Declared.

Awareness and Knowledge of Carpal Tunnel Syndrome among Adult Saudi Population

Introductions: The median nerve's occasional or persistent compression or entrapment in the carpal tunnel from the wrist to the hand causes carpal tunnel syndrome (CTS). The main symptoms are pain, tingling, swelling, and loss of grip strength and function in the thumb, index finger, middle finger, and thumb of thumb. This study examined Saudi adults' awareness and understanding of Carpal Tunnel Syndrome and its link with demographics and chronic conditions. Material(s) and Method(s): This cross-sectional study examined adults' knowledge, attitudes, and practices regarding carpal tunnel syndrome from 2021 to 2022 in different Saudi Arabian regions. This study used a researcher-created questionnaire. In the awareness category, general public questions included CTS clinical aspects, etiology, and effects on daily life. Practice questions covered CTS preventive and chronic diseases. Volunteers were selected following informed consent. Result(s): 420 participants aged 34.8 +/- 13.49 years. 280 (66.6%) were male, 140 (33.3%) females. 38 (9.04%) were non-Saudi workers, while 384 were Saudis. 235 (55.9%) individuals knew about wrist CTS and 161 (38.3%) about pain. 157 (37.3%) individuals experienced thumb tingling or numbness, while 117 and 142 agreed that CTS may produce thumb weakness (27.8%) and hand grip (35.2%). The older age group reported more thumb numbness or tingling than the other groups, although there was no statistical difference (p= 0.09). CTS was not associated with chronic disease;however, diabetes was the main comorbidity in all age groups (44;45.3%), especially in the middle age group (21;60%). 5.4% had CTS. CTS was rare during pregnancy (0.7%), however all age groups agreed that it could influence their employment and social life (p= 0.014 and < 0.00001). The average knowledge score was 43.3 +/- 40.5, whereas the awareness score was 50.1 +/- 44.2. These findings indicate that Saudis were aware of CTS clinical symptoms. Conclusion(s): The study examined Saudi adults' awareness and understanding of CTS and estimated the association between CTS and demographics and chronic conditions. The study found that adult CTS awareness and knowledge were sufficient and associated with age and quality of life. CTS awareness campaigns may lower risk and raise knowledge of prevention and treatment. People who work with discomfort or use computers for long periods of time without breaks are more prone to develop CTS. Larger research is needed to understand how physical exercise causes CTS.Copyright © 2023, Ibn Sina Trust. All rights reserved.

Online Learning and Its Short-term Impact on Digital Engagement and Digital-related Health Symptoms Amongst University Students During the COVID-19 Pandemic

Introduction: The COVID-19 pandemic has precipitated a rapid shift of learning and education from traditional means to digital platforms. This paper aims to examine the impact of online learning on digital engagement and digital-related health symptoms among university students one year into the coronavirus pandemic. Methods: Data was collected through a self-administered online questionnaire after ethical approval. The questionnaire was adapted from the previously published Lifestyle Study in Youth Questionnaire. Through the questionnaire, the perception of students toward online learning was probed and recorded. Digital engagement and digital-related health symptoms were compared before and during the COVID-19 lockdown. Results: The majority (97.5%) of respondents preferred face-to-face learning. The time spent on digital devices was 1.8 times higher during COVID-19 than before the COVID-19 lockdown (t-test = -18.86, p<0.0001). The total hours of sleep were reduced during COVID-19 lockdown (0.6 hours lesser) (t-test = -3.92, p<0.0001). The Wilcoxon Signed Ranks Test revealed significant changes in digital-related health symptoms (15 out of 17) due to the COVID-19 lockdown. Digital eye strain, dry eye syndrome, carpal tunnel syndrome, and upper quadrant postural and muscle strain emerged (p<0.05). Conclusion: Most university students favoured face-to-face learning compared to online learning. There was a two-fold rise in digital engagement during the COVID-19 lockdown. As a result, it has seemed to translate into reduced sleeping hours. The short-term impact of the coronavirus pandemic on digital-related health symptoms amongst university students was apparent. The long-term effects require further investigations to facilitate fact-based decision-making. [ FROM AUTHOR] Copyright of Malaysian Journal of Medicine & Health Sciences is the property of Universiti Putra Malaysia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Bilateral Carpal Tunnel Syndrome Following COVID-19 Vaccination: A Case Report.

Coronavirus disease 2019 (COVID-19) continues to pose significant health challenges, with insights into long-term disease sequelae emerging. The post-viral effects resulting from COVID-19 are being investigated and 'long COVID-19' is now a recognised phenomenon. As part of the spectrum of comorbidities, acute-onset neuropathy is associated with infection. The public health response aimed at limiting morbidity and mortality is rooted in vaccination programmes. With the extensive roll-out of novel vaccinations, there has been careful monitoring of temporally associated health problems. Some of the documented associations include neuropathy and entrapment neuropathies. This case report details a patient presenting with bilateral carpal tunnel syndrome (CTS) post their second dose of AZD1222 (ChAdOx1 nCoV-19) vaccination. Though we do not claim causality, the emerging post-vaccination immune-mediated effects may ultimately be proven to include neuropathy exacerbation. Meticulous recording of such associations is required as it is of great relevance to the hand surgeon managing CTS. Level of Evidence: Level V (Therapeutic).

TH-146. Neuromuscular involvement in severe Covid-19 patients. Our experience in EMG unit of terciary hospital

Introduction: Since the coronavirus disease 2019 (COVID-19) emerged in Wuhan, neurological complications affecting both the central and peripheral nervous systems have been reported. Multiple etiological mechanisms as immuno-mediation, direct nerve infection, prolonged intensive care units (ICU) hospitalization and prolonged positioning have been proposed as a cause of peripheral lesion. The aim of this study is to report an observational description of peripheral nervous system complications in patients with severe COVID-19. Method(s): We include patients with COVID-19 infections with weakness or sensory deficit, with one or more EMG tests carried out between April 2020 and December 2021. Standard neurophysiological techniques with motor and sensory nerve conductions, F responses and needle EMG exam in representative upper and lower limb muscles were performed. Result(s): A total of 89 patients were included, 66 males (74%) and 23 females (26%), with an average age of 55.7 years old (range from 11 to 90). Most of them (74%) were studied during hospitalization (16 of them during ICU admission). Nearly all patients (90%) had a prolonged ICU hospitalization (between 8 and 120 days). The reason for consultation was diffuse or focal weakness, difficulty in weaning, facial palsy or sensory deficits. The results of EMG tests showed myopathic findings in 61% of patients, focal peripheral nerve lesions in 64%, Guillain-Barre syndrome (GBS) in 5 (6%), and other types of peripheral polyneuropathy in 24%. From peripheral nerve injuries, peroneal neuropathy was the most frequent (58%), brachial plexopathy was found in 26%, median neuropathy in 25%, ulnar in 11%, lateral femoral cutaneous in 9%, axillary and spinal in 5%, radial and hypoglossal in 4% and musculocutaneous in 2%. Tapia's syndrome was diagnosed in two patients. Peripheral nerve injuries correlated with longer admissions in ICU and prone positioning. The follow-up studies showed a good recovery from myopathy but persistent motor sequelae in axonal GBS patients and in most peroneal nerve injuries. Neurophysiological findings are described. Conclusion(s): Peripheral nerve complications are frequent in patients affected by severe COVID-19 and prolonged hospitalization, mainly focal nerve injuries (61%), critical illness myopathy (64%) and peripheral polyneuropathy (30%) including GBS (5 patients). Prone and prolonged positioning in ICU may be associated with peripheral nerve injuries although other mechanisms cannot be excluded. Copyright © 2022

COVID-19-Related Neuropathy in Colombia: The Experience During the First 23 Months of Pandemic

COVID-19-related neuropathy in Colombia: The experience during the first 23 months of pandemic Introduction: The SARS-CoV-2 virus has a high neuroinvasive capacity due to the increased expression of angiotensin-converting enzyme receptor 2 (ACE-2) in neurons (1) and it is believed that the mechanism by which it can cause injury to the nervous system peripheral nervous system is immunemediated, although a direct cytotoxic effect of the virus cannot be ruled out (2). Multiple types of neuropathy associated with SARS-CoV-2 infection have been described, the most frequent being Guillain- Barré syndrome, pre-existing diabetes, compression neuropathies and drugs used to treat symptoms of COVID-19 (3). Objetives: To characterize the patients who were referred to the electromyography laboratory at the Fundacion Santa Fé de Bogotá, Colombia due to suspected COVID-19-related neuropathy Methods: Descriptive observational study, case series type. The electrodiagnostic studies carried out between January 2020 and December 2022 in the electromyography laboratory at the Fundacion Santa Fé de Bogotá, Colombia with suspected COVID- 19-related neuropathy were reviewed. Results: 94 patients were evaluated in the electromyography laboratory with suspected COVID 19-related neuropathy between January 2020 and December 2021, of which 53% (50/94) were men. The average age was 54.8 years. 32% (30/94) had severe COVID and 31% (29/94) were hospitalized in the ICU. Most of the studies were normal: 35% (33/94). of the abnormal findings, it was found in order of frequency: Symmetric motor and sensory axonal polyneuropathy in 21.2%, and of this group of patients, 55% were in the ICU, 35% had no data and 20% were hospitalized-not ICU. 18% presented compression neuropathy of the median nerve in the carpal tunnel, 6.3% asymmetric motor and sensory axonal neuropathy, 6.3% suggestive findings of cervical and/or lumbosacral root involvement, 4.2% Guillain Barré syndrome, 4.2% compression neuropathy of the peroneal nerve , 2.1% brachial plexus axonal injury, 2.1% peroneal nerve axonal injury, 2.1% radial axonal injury, 2.1% myopathic changes, 1% hypoglossal nerve axonal injury, 1% symmetric axonal and demyelinating polyneuropathy, 1% hereditary neuropathy, 1% asymmetric demyelinating neuropathy, 1% axonal injury of the sciatic nerve, 1% axonal injury of the median nerve in the forearm, 1% axonal injury of the lumbosacral plexus, 1% compression neuropathy of the ulnar nerve in the elbow and 1% axonal injury from a sensory branch of the median nerve. Conclusions: The most frequent abnormality in the study was symmetric motor and sensory axonal polyneuropathy, which can be explained by the prolonged ICU stay, which increases the risk of Critical illnes Neuropathy.

Optimization of Carpal Tunnel Syndrome Using WALANT Method.

As surgical management of carpal tunnel release (CTR) becomes ever more common, extensive research has emerged to optimize the contextualization of this procedure. In particular, CTR under the wide-awake, local-anesthesia, no-tourniquet (WALANT) technique has emerged as a cost-effective, safe, and straightforward option for the millions who undergo this procedure worldwide. CTR under WALANT is associated with considerable cost savings and workflow efficiencies; it can be safely and effectively executed in an outpatient clinic under field sterility with less use of resources and production of waste, and it has consistently demonstrated standard or better post-operative pain control and satisfaction among patients. In this review of the literature, we describe the current findings on CTR using the WALANT technique.

Neuromuscular Manifestations of COVID-19

Objective: Determine neuromuscular manifestation incidence in COVID-19 patients from the longitudinal electronic health record database Optum. Background: Both central and peripheral nervous system (PNS) manifestations of COVID-19 have been reported. A Chinese retrospective case series, on 214 hospitalized COVID-19 patients, found that 8.9% presented with peripheral nerve disease and 7% had muscular injuries. Other studies looking at the prevalence of PNS manifestations are limited and have significantly lower numbers. Design/Methods: The COVID-19 data is sourced from more than 700 hospitals and 7000 clinics in the US. Patients with numerous neuromuscular diagnoses were identified based on ICD-10 coding. Examples include carpal tunnel syndrome, radial nerve lesion, sciatic nerve lesion, myasthenia gravis, acute transverse myelitis, Bell's palsy, and trigeminal neuralgia. Results: We reviewed a total of 598,847 patients with positive COVID-19 PCR and/or diagnosis coding. Neuromuscular complications must have been within 45 days of diagnosis to be included. Incidence of similar neuromuscular complaints was evaluated in 3,001,153 controls without COVID-19. Critical illness neuropathy was found in 35,782 COVID-positive patients and 6,281 of those without. Retrospective study limitations include temporal relationship to COVID-19 does not necessarily indicate causality and inability to confirm the coding by record review or EMG/NCS. Conclusions: Incidence of neuromuscular disorders is generally lower or equivalent in COVID19 patients than in the general population, except for critical illness neuropathy and myopathy. This finding may be explained by more COVID-19 patients being in the intensive care unit and bedbound for longer periods. It is worth noting that a small case series of COVID-related critical illness neuropathy and myopathy patients showed no histopathological or clinical differences compared to non-COVID patients. To our knowledge, this report includes an analysis of neuromuscular manifestations in one of the largest cohorts of COVID-19 patients. This can assist with risk-benefit discussions regarding treatment initiation, etiology of diagnoses, and counseling for COVID-19 questions.

Are health professionals vulnerable to workrelated musculoskeletal disorders

Introduction: Work-related musculoskeletal disorders (MSDs) are a group of disorders confined basicly to muscles, tendons, ligaments, nerves, joints, and bones and occur in relation to occupational activities. These disorders are reported to be common in health professionals and affect their quality of life. Carpal tunnel syndrome, tendinitis, degenerative spine disease, thoracic outlet syndrome, and strained neck syndrome are common in health workers. These problems often arise due to nonneutral postures, unsuitable instruments, nonergonomic working conditions. In addition, repetitive challenging activities are common risk factors. Medical students: MSDs can begin in medical students at even educational stage, especially during laboratory studies. Researches showed that the most common sites of problems are;lower back, neck, and upper back. Lower back, neck, and upper back prevented daily activities in the majority of cases. Strategies are suggested to address ergonomic and postural training, as part of university curriculums, including the identification of problems for early intervention to facilitate sustainable workforces. Health professionals: Work-related MSDs were found to be relatively highly prevalent among health care and hospital workers in general and nurses in particular. Both disorders were reported to be largely workrelated and stress-related. Moreover, they were found to be a result of both psychological stress and physical strain from work. Surgeons: Compared with disease estimates in the general population, surgeons have a higher prevalence of MSDs. Surgeons, hospital administrations, surgical material designers, and health insurance schemes have a role to play in taking action to protect surgeons from this potential burden and occupational health hazard. Dentistry: Professional practice and dental training have many risk factors, and the dental team should be able to recognize these factors to protect themselves. The most common sites for MSDs are neck, lower back, and shoulders. Women show a higher frequency of intense pain involving the cervical, lumbar, dorsal, and wrist areas placing them at a higher risk of injury. Nurses: Because of the specificity of their work tasks and the long duration of tasks in health institutions, nurses are quite vulnerable to various occupational risk factors. In addition to the physical risk factors connected to the work tasks, there are also individual risk factors, related to each individual's susceptibility and organizational/psychosocial risk factors (although these occupational risk factors are often addressed separately), whose control is critical. During the pandemic: Physicians and nurses can be considered to have MSDs because of: (1) the difficulties they experience, especially while using Personal Protective Equipment for Covid-19 in Intensive Care Unit/Settings. (2) the difficulties they experience by having to spend a long time at the computer to provide telemedicine services to the patients they monitor. Long and intensive studies leading up to these periods may have also caused MSDs. Conclusion: Areas of action can be ergonomic equipment, training, and consulting for workplaces at home and ergonomic risk assessments. In cases where protection is not provided and early treatment is not performed, they can cause temporary or permanent work disability.

Is psychological distress associated with carpal tunnel syndrome symptoms and nerve conduction study findings? A case-control study from Syria.

BACKGROUND: Carpal tunnel syndrome (CTS) is a common entrapment neuropathy of the median nerve at the wrist which causes severe symptoms. However, psychological aspects can affect patients' perception of this pain and can cause similar pain in some instances. This study aims to determine the association between symptoms severity, functional status, and nerve conduction studies (NCS) of adult patients with CTS and their anger, anxiety, and depression status. METHODS: This case-control study was conducted in clinics in Damascus, Syria. Controls were frequency matched by gender and age from a general clinic. Interviews based on questionnaires were used that included the Boston Carpal Tunnel Questionnaire (BCTQ-A), Hospital Anxiety and Depression Scale (HADS), Dimensions of Anger Reactions Scale-5 (DAR-5), and NCS. RESULTS: Overall, 242 patients (121 cases) were included in this study. Cases with CTS had significantly higher anxiety and depression when compared to controls, but not higher anger. Cases with higher anxiety, depression, and anger had significantly more CTS symptoms and less functional status. Anxiety was also higher in cases with normal NCS in the case group. When using regression, anxiety and depression remained significantly associated with having CTS. CONCLUSION: Anxiety and depression are more prominent with CTS. Furthermore, having anxiety and depression were associated with more CTS symptoms in the hand. Having anger was also associated with more CTS symptoms among cases. These findings emphasize the importance of psychological aspects when having hand pain or CTS symptoms as these patients might have these symptoms despite having normal NCS.

ACUTE MOTOR AXONAL NEUROPATHY GUILLAIN-BARRÉ SYNDROME IN COVID-19 PATIENT

B Introduction: b Guillain-Barré syndrome (GBS) has been described as a rare complication of COVID-19. The muscle weakness aggravated within 48 hours and electromyography and nerve conduction studies demonstrated acute motor polyneuropathy with predominant axonal features, without conduction blocks so acute motor axonal neuropathy (AMAN) GBS variant was diagnosed. 214: ACUTE MOTOR AXONAL NEUROPATHY GUILLAIN-BARRÉ SYNDROME IN COVID-19 PATIENT. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

BENEFITS OF THE WALANT TECHNIQUE AGAINST THE COVID-19 PANDEMIC.

OBJECTIVE: Evaluate the experience of private and public health services with the WALANT procedure in the COVID-19 pandemic. METHODS: This is a retrospective, multicenter longitudinal study gathering cases of hand surgery subjected to the WALANT technique in the Hospitals Dr. Radamés Nardini and IFOR during the COVID-19 pandemic (August 2020). As a parameter, the verbal numerical rating scale for twenty patients referring to the preoperative, intraoperative and postoperative periods was applied. RESULTS: The patients did not feel any pain during surgery, which showed the efficiency of the anesthetic technique in its purpose. CONCLUSION: The results indicate the WALANT technique as beneficial when facing the COVID-19 pandemic, as the main differential of the technique is that it is applied by a well-trained orthopedic hand surgeon. Level of Evidence IV, Case Series.

OBJECTIVE: Avaliar a experiência dos serviços privado e público de saúde com o procedimento WALANT frente à pandemia COVID-19. MÉTODOS: Trata-se de um estudo longitudinal retrospectivo, multicêntrico, de casos de cirurgia de mão submetidos à técnica WALANT nos hospitais Dr. Radamés Nardini e IFOR, durante a pandemia da COVID-19, em agosto de 2020. Como parâmetro, foi aplicada a Escala Verbal de Dor para 20 pacientes referente ao pré-operatório, intra-operatório e no pós-operatório. RESULTADOS: Os pacientes não sentiram nenhuma dor durante a cirurgia, tendo a técnica anestésica de mostrado eficaz. CONCLUSÃO: Pelas análises, foi possível considerar segura e benéfica a técnica WALANT diante da pandemia da COVID-19, que apresenta o diferencial de ser aplicada por um cirurgião ortopédico especialista em mão bem treinado. Nível de Evidência IV, Série de Casos.

Carpal, cubital or tarsal tunnel syndrome after SARS-CoV-2 infection: A causal link?

COVID-19 is a complex disease with many clinicopathological issues, including respiratory, gastrointestinal, neurological, renal, cutaneous, and coagulative ones; in addition, reactive arthritis has been reported by different authors. Here, we hypothesize that a peripheral microangiopathy involving nerve supply, a viral demyelination, or an immune-mediated irritating antigenic stimulus on synovial sheaths after SARS-CoV-2 infection may all induce a carpal, cubital or tarsal tunnel syndrome of variable entity in genetically predisposed subjects associated with myxoid nerve degeneration.

Approaching "Elective" Surgery in the Era of COVID-19.

The coronavirus disease 2019 pandemic created unprecedented challenges for the health care system. To meet capacity demands, hospitals around the world suspended surgeries deemed to be elective. In hand surgery, numerous pathologies are treated on an elective basis, but a delay or absence of care may result in poorer outcomes. Here, we present an ethical framework for prioritizing elective surgery during a period of resource scarcity. Instead of using the term "elective," we define procedures that can be safely delayed on the basis of 3 considerations. First, a safe delay is possible only if deferral will not result in permanent injury. Second, a delay in care will come with tolerable costs and impositions that can be appropriately managed in the future. Third, a safe delay will preserve the bioethical principle of patient autonomy. In considering these criteria, 3 case examples are discussed considering individual patient characteristics and the pathophysiology of the condition. This framework design is applicable to ambulatory surgery in any period of crisis that may strain resources, but further considerations may be important if an operation requires hospital admission.