Abstract

---

Wide spread usage and heavy dependence on computers and computer based gadgets and life styles have given rise to a number of musculoskeletal disorders [MSD’s] associated with computer usage. These health problems are not yet described in standard text books for their etiological association with computer usage.On one hand not many orthopaedists are aware of these conditions, on the other, very few studies have been carried out. The studies are on computer professionals and university students. Needs are felt for studies on other subpopulations and for sensitization of treating health care professionals.

Introduction

---

In 21^st century world computers have become essential as well as ubiquitous in every aspect of life. They have become an epitome of modern life. Mankind’s dependence on computers is ever increasing owing to their dwindling prices, and their being embedded in various forms in numerous gadgets. Computers have become an indispensable tool in everyone’s hands and life. However, it does not come without a price. Computer usage is lately being associated with a wide group of health problems covered under  Musculoskeletal Disorders (MSD’s)

Review

---

Heretofore MSD’s associated with computer usage have not been described in standard orthopaedic text books but during the last couple of decades some interesting and eye-opening articles  related to ophthalmology as well as other specialties have been published online, in national and international journals. 

Musculoskeletal disorders are sometimes called ergonomic injuries and illnesses. Ergonomics is the study of the worker’s interaction with tools, equipments, jobs, tasks, work methods, work rates, and other systems. The USA – BLS [Bureau of Labour Statistics] defined musculoskeletal disorders as injuries and disorders to muscles, nerves, tendons, ligaments, joints, cartilage, and spinal discs. MSD’s do not include injuries resulting from slips, trips, falls, or similar accidents. Examples of MSD’s include  many kinds of sprains and strains, carpal tunnel syndrome,  tendonitis, sciatica, and low back pain ^[10]

MSD’s result from bodily reactions due to bending, climbing, crawling, reaching, or twisting, and from overexertion and repetitive motions. Majority of MSD’s have been sprains, strains, and tears caused by overexertion. These claims alone accounted for 60 per cent of all MSD’s between 1996 and 2000 in a study. Recently the share of MSD’s due to overexertion has been shrinking as the proportion of disorders resulting from repetitive motion and bodily reaction is on the rise.

The term work- related musculoskeletal disorders [WMSD’s] comprises various conditions both clinically defined (e.g. carpal tunnel syndrome) and clinically undefined that affect nerves, tendons, muscles and support structures: the aforementioned conditions are products of the accumulated effect of repeated traumas associated with labour risk factors. The most common causes for these disorders are static body positions, repetitive motions, prolonged muscular contractions, and the use of force ^[02,12]

Complaints of Arm, Neck and Shoulder [CANS] were recognized in the early seventies as an important cause of work disability. The term CANS was introduced in Netherlands and indicated  “ musculoskeletal complaints of arm, neck and/or shoulder not caused by acute trauma or by any systemic disease “They were introduced as ‘ occupational cramps ‘or‘ occupational myalgia ‘ and suspected of being associated with numerous occupations and work activities. The relative time spent in front of computers and the use of a computer mouse has increased rapidly over the years. It is likely that these developments may have contributed to the increasing burden of CANS ^[07,01]

Over half of American adults own a laptop computer. In Australia laptop prevalence was 63% of all households in 2008 and is increasing. India has been in the forefront of cyber world with IT industry developing into a major service provider. Work place risk factors  of daily computer use include number of hours per week of computer usage, working in non–neutral body postures [e.g. reaching for mouse, looking up at a  computer monitor], increasing age, and being female. Generally non-neutral postures are considered detrimental. In a systematic review of epidemiologic studies of video display terminal work the following specific risk factors were identified: wrist ulnar deviation, wrist extension, elbow flexion, shoulder flexion, as well as neck flexion and rotation. A growing body of epidemiologic evidence supports a causal relationship between repetition, force, posture, upper extremity musculoskeletal disorders ^{[18,11,14 ]} 

Today’s university students are part of millennial generation sometimes called generation Y or the Net generation and are the first truly digital generation. The use of notebook computers has become integral to these talented and net-savvy students as they become immersed in technology in both their academic and social networking daily lives . From 2006 to 2009 ownership of  notebook computers by university students increased from 66% to 88%  and the trend is expected to continue as students embrace their portability, light weight and pace saving features ^[08,15] 

Discussion

---

Clinical features of CANS  include severe and debilitating pain, numbness and tingling. In the Netherlands alone the incidences of CANS varied between 20% and  40% a year ^[04]. It resulted in reduced worker productivity, inability to perform job tasks, and an increase in workers compensation costs. The identification of risk factors for the development of CANS before they develop into  disabling musculoskeletal disorders is an important step in order to recognize relevant subgroups who have a high risk profile for CANS and also, in the longer run, to develop targeted and effective screening and interventions. Hence , targeting computer workers as the selected case population on which to base and to develop measurement tools specifying the risk factors of CANS  seemed an  appropriate first step ^[05]

Groups such as  university/college/high school students with extensive computer usage have been identified that are potentially at risk for developing similar MSD’s. With the increased use of notebooks comes the increased risk for students to develop upper extremity musculoskeletal disorders [UEMSD’s ] ^[09]. We have observed that patients present themselves, are diagnosed and identified by a specialist aware of these conditions in routine general or specialty OPD’s or even at medical relief camps set up during disaster management ^[13].

Studies on MSD’s associated with computer usage have been carried out on university students, engineering students, computer office workers, mobile company workers and IT professionals ^{[03,06,08,09,16,17]}. 

Conclusion

---

A twofold need is felt:

1. To create awareness and sensitize  orthopaedists and other specialists to keep in mind computer usage as one of the causative factors related to musculoskeletal disorders. Patients may be spared from many expensive and avoidable investigations by a proper history taking. 

2. Absence of a study on MSD’s associated with computer usage among health care professionals and / or  health care college students as well as many other  vulnerable subpopulations is a strong indication for undertaking  such studies without further delay.

Bibliography

---

1. Bergqvist U , Wolgast E , Nilsson B et al : Musculoskeletal disorders among visual display terminal workers : individual , ergonomic and work organizational factors : Ergonomics : 1995: 38 :763 -776
2. Bernard BP  : Musculoskeletal disorders and workplace factors : A critical review of epidemiologic evidence for work related musculoskeletal disorders : USA : DHHS [NIOSH ] : 1997 : publication no. 97 B 141
3. Bhanderi D , Chaudhary SK , Parmar L , et al : Influence of psychosocial workplace factors on occurrence of musculoskeletal discomfort in computer operators : Indian J Community Med : 2007 : 32 (3) : 225 - 226
4. Bongers PM ,Kremer AM , ter Laak J : Are psychosocial factors , risk factors for symptoms and signs of shoulder , elbow or hand / wrist ? A review of epidemiological literature : Am J In Med : 2002 :41 :315 -342
5. Eltayeb S , Staal JB, Kennes J , et al : Prevalence of complaints of arm , neck and shoulder among computer office workers and psychometric evaluation of a risk factor questionnaire : BMC Musculoskeletal Disorders : 2007 : 8 : 68 – 78
6. Eltayeb S , Staal JB , Hassan AA , et al : Complaints of the arm, neck and shoulder among computer office workers in Sudan : a prevalence study with validation of an Arabic risk factor questionnaire : Environ Health : 2008 : 7 : 33 – 43
7. Huisstede BM , Miedema HS , Verhagen AP et al : Multidisciplinary consensus on the terminology and classification of complaints of arm , neck and/or shoulder : Occup Environ Med : 2007 : 64 : 313 – 319
8. Jacobs K , Foley G , Punnett L , et al : University students’ notebook computer use : lessons learned using e-diaries to report musculoskeletal discomfort :Ergonomics : 2011: 54 :2:206 – 219
9. Jenkins M : Undergraduate college students’ upper extremity symptoms and functional limitations related to computer use : A replication study : Work : 2007 : 28 : 231 - 238
10. Maier M , Ross mota J : Work related musculoskeletal disorders : Oregon :1990 – 2000 available at http://www.cbs.state.or.us/external/imd/rasmus/resalert/msd.html
11. Marcus M , Gerr F, Monteilh C et al : A prospective study of computer users : II Postural risk factors for musculoskeletal symptoms and disorders: Am J In Med : 2002 :41 : 236 - 249
12. Ong CN ,Chia SE ,Jeyaratnam J , Tan KC : Musculoskeletal disorders among operators of visual display terminals : Scand J Work Environ  Health :1995 :21 : 60 – 64
13. Prakash JS , Deolalikar S , Prakash J , Thomas M , Singh D , Choudhary K :  Disaster Mitigation & Capacity Development : Need for Specialized   Preparedness [ Following December 26 , 2004 Indian Ocean Tsunamis ]:       Webmedcentral Disaster Medicine : 2013 : 4 [7] :WMC004336
14. Sharma  AK , Khera S , Khandekar J : Computer related health problems among information technology professionals in Delhi : Indian J Community  Med  : 2006 : 31 : 36- 38
15. Smith S , Salaway G , Caruso BJ : The ECAR study of undergraduate students and information technology : 2009 : Research study : EDUCAUSE center for applied research  available at http:// educause.edu/ecar
16. Suparna K , Sharma AK , Khandekar J : Occupational health problems and role of ergonomics in information technology professionals in national capital region : Indian J Occup Environ Med : 2005: 9 : 111 – 114
17. Talwar R , Kapoor R , Puri K , et al : A study of visual and musculoskeletal health disorders among computer professionals in NCR Delhi : Indian J Community Med : 2009 : 34(4) : 326 - 329
18. Tittiranonda P , Burastero S , Rempel D :Risk factors for musculoskeletal disorders among computer users : Occup Med : 1999 :14 [1] : 17 - 38

Source(s) of Funding

---

Self funded

Competing Interests

---

Nil