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Objective: Bassoonists seem to have a high recorded prevalence of performance-related upper limb symptoms. Yet, the background for their symptoms has not been established. This study aimed to diagnose and treat the pathology that caused severe upper limb symptoms in a bassoon/contrabassoon musician in order to allow him to continue his professional career in a symphony orchestra., Methods: A detailed neurological bedside examination was undertaken and targeted physiotherapy offered., Results: The physical examination demonstrated weakness, atrophy, and nerve trunk soreness, indicating an affliction of the posterior interosseous nerve (radial tunnel syndrome) or its muscular branches. The risk factors during bassoon playing are comparable to those reported from industrial exposures. The patient was able to resume playing after treatment by nerve mobilisation.

Background: A previous study demonstrated a high death rate among seafarers signed on Danish ships during the years 1986-1993. This study aimed to examine and analyse the subsequent development until 2009., Material and Methods: A total of 356 fatalities were identified from data supplied from the Danish Maritime Authority, an insurance company, and other sources. Maritime deaths among seafarers signed on Danish ships comprise deaths from 1) accidents, suicides and homicides; and 2) disease on board. Deaths due to 2) occurring ashore within 30 days after signing off were included. The overall and mode-specific death rates were calculated for three eight-year observation periods. The rates for work-related fatal accidents were compared with the rates for land-based trades., Results: All categories of maritime deaths were significantly reduced from 1986 to 2009 - in particular during the last eight-year period (Accidents 1986-1993: 66.6 per 100,000 person years, 2002-2009: 27.0 per 100,000 person years, diseases 49.5-26.1, suicides 14.4-7.8). In spite of the remarkable improvement since 1986, seafarers remain in 2002-2009 more than six times more likely to die from occupational accidents (including shipwrecks) than do workers ashore., Conclusions: The favourable trend of maritime deaths in the Danish merchant fleet may be due to 1) preventive measures - e.g. interventions relating to vessel safety, work environment, and improved medical care on board - and to 2) technological and organizational changes - e.g. newer and larger vessels in the Danish merchant fleet, changed composition of the workforce, and reduced shore leaves. The persisting excess risk warrants further preventive actions.

Reports of a possible relationship between Aleutian mink disease parvovirus (AMDV) and human infection are rare. However, 2 mink farmers with vascular disease and microangiopathy similar to that in mink with Aleutian disease were found to have AMDV-specific antibodies and AMDV DNA. These findings raise the suspicion that AMDV may play a role in human disease.

Objective: We have previously demonstrated that neurological individual findings and patterns can be reliably assessed in the examination of the upper limb and also that they are related to pain, weakness, and/or numbness/tingling. This study aimed to study further aspects of the construct validity of the neurological examination., Methods: Blinded to patient-characteristics, two examiners assessed the function of 16 muscles, the sensibility in 7 territories, and the nerve-mechanosensitivity at 20 locations in 82 upper limbs. Based on anatomical patterns and pre-designed algorithms, one or both examiners rated neuropathy as "possible" or "definite" in 40 limbs and also determined the location( s). We developed and tested hypotheses on anatomically and regionally related locations of nerve afflictions (a selective vulnerability of neurons, double and multiple crush, and a tendency to regional spread) and examined the stability of the internal structure of the constructs in different situations. The interrelations of findings were analyzed by hypothesis testing and factor analyses, and the homogeneity of location profiles was analyzed by a conditional likelihood test., Results: Out of 30 limbs with related locations of neuropathy, the findings of each examiner correlated positively (gamma > 0.35) in 22/25, respectively. The patterns of the interrelations identified by the two examiners were similar, with no evidence of any heterogeneity of location profiles for either examiner., Conclusions: This study supports the validity of the physical examination. However, feasibility of its application requires the demonstration of further aspects of construct validity and a favorable influence on patient-management and/or prevention.

Background: The character of upper limb disorder in computer operators is subject to debate. A peripheral nerve-involvement is suggested from the common presence of a triad of symptoms consisting of pain, paraestesiae and subjective weakness, and from physical findings suggesting neuropathy. This study aimed to examine the outcome of a detailed neurological examination in computer operators and to compare findings with the presence of symptoms., Methods: 96 graphical computer operators answered a modified Nordic Questionnaire including information on perceived pain in the shoulder, elbow, and wrist/hand scored for each region on a VAS-scale 0-9. In addition, they underwent a physical examination including the subjective assessment of the individual function of 11 upper limb muscles, of algesia in five and vibratory threshold in three territories, respectively, and of mechanosensitivity of nerves at seven locations. In order to reflect an involvement of the brachial plexus (chord level), the posterior interosseous nerve and the median nerve at elbow level we defined three patterns of neurological findings illustrating the course of nerves and their innervation. The pain scores summarized for the three upper limb regions (min. = 0, max = 27) in the mouse-operating and contralateral limbs were compared by a Wilcoxon test and the relation to each physical item analyzed by Kendall's rank correlation. The relation of summarized pain to each pattern was studied by application of a test of the trend across ordered groups (patterns)., Results: Pain, paraestesiae and subjective weakness was reported for 67, 23, and 7 mouse-operating limbs, respectively, with the summarized pain scores exceeding 4 in 33 limbs. Abnormal physical findings were prevalent. The summarized pain was significantly related to a reduced function in five muscles, to mechanical allodynia at one location and to elevated threshold to vibration in two territories. Brachial plexopathy was diagnosed in 9/2, median neuropathy in 13/5 and posterior interosseous neuropathy in 13/8 mouse operating/contralateral limbs, respectively. The summarized pain was significantly higher in the mouse-operating limbs and in limbs with any of the defined patterns. There was a significant trend between the summarized pain and the summarized scores for the items contained in each pattern., Conclusion: This small-scale study of a group of computer-operators currently in work and with no or minor upper limb symptoms has indicated in symptomatic subjects the presence of peripheral nerve-afflictions with specific locations.

Background: Upper limb disorders (ULDs) are common, and so are the difficulties with regard to their specific diagnoses. According to diagnostic consensus criteria, specific diagnoses include neuropathy and muscular- and connective-tissue disorders (MCDs). There is a need for valid objective diagnostic tools to reveal underlying mechanisms for specific diagnoses., Objective: To investigate the possible differences in vibration perception threshold (VPT) and tolerance to suprathreshold stimulation (STS) between controls and specific diagnostic ULD patient groups with uni- and bilateral neuropathy and/or MCD., Methods: In 161 ULD patients and 40 controls, the VPT of the median, ulnar, and radial nerves innervating the hand was examined by vibrometry using the "method of limits". The tolerance to STS of the anterior forearm was tested in 128 of the patients and all controls., Results: The ULD patients in all diagnostic groups had significantly higher VPT (P<0.05) in all the nerves in limbs, with and without diagnoses compared with controls. Only patient groups defined with neuropathy demonstrated significantly higher VPT in the limb with diagnoses compared with the contralateral limb without diagnoses. The highest VPTs were found in the patient group with unilateral neuropathy and MCD, and for the radial nerve, VPT was significantly higher than that for patients with unilateral MCD alone. These findings were confirmed by almost similar findings in STS responses., Conclusions: The ULD patients generally demonstrated increased VPT compared with controls, indicating a neurogenous component independent of specific ULD diagnosis. Contralateral significant findings in limbs without diagnoses compared with controls indicate central neurogenous affection and/or the possibility of certain exposures elevating VPT before a positive status of a limb diagnosis is attained. Significantly higher VPT values in limbs with neuropathy diagnoses compared with limbs without and not in MCD alone, may indicate peripheral sensibilization or nerve affection only in the group with a specific diagnosis of neuropathy. These findings underline the importance of specific diagnoses among ULD patients.

Background: In a sample of patients in clinical occupational medicine we have demonstrated that an upper limb neurological examination can reliably identify patterns of findings suggesting upper limb focal neuropathies. This further study aimed at approaching the diagnostic accuracy of the examination., Methods: 82 limbs were semi-quantitatively assessed by two blinded examiners (strength in 14 individual muscles, sensibility in 7 homonymous territories, and mechanosensitivity at 10 locations along nerves). Based on the topography of nerves and their muscular and sensory innervation we defined 10 neurological patterns each suggesting a localized nerve affliction. Information on complaints (pain, weakness and/or numbness/tingling) collected by others served as a reference for comparison. The relation between the presence of pattern(s) and complaints was assessed by kappa-statistics. Sensitivity, specificity, and positive/negative predictive values were calculated, and pre-test odds were compared to post-test probability., Results: The two examiners identified pattern(s) suggesting focal neuropathy in 34/36 out of 38 symptomatic limbs, respectively (kappa = 0.70/0.75), with agreement in 28 limbs. Out of 44 non-symptomatic limbs the examiners agreed on absence of any pattern in 38 limbs. With concordance between the examiners with regard to the presence or absence of any pattern, the sensitivity, specificity, positive and negative predictive values were 0.73, 0.86, 0.93 and 0.90, respectively. While the pre-test odds for a limb to be symptomatic amounted to 0.46 the post-test probability was 0.81. For each examiner the post-test probability was 0.87 and 0.88, respectively., Conclusion: The improved diagnostic confidence is an indication of one aspect of construct validity of the physical examination. For determination of clinical feasibility of the examination further studies are required, most importantly 1) studies of validity by means of comparison with additional references and 2) studies of the potential benefit that can be attained from its use.