職業病的診斷原則-中華職業醫學會.pptVIP

職業病的診斷原則 疾病的證據 職業暴露的證據 符合時序性 符合人類流行病學已知的證據 排除其他可能的致病因素 * 時序性 1980-1992 裁剪皮革 1992–now營造工作,砌磚,粉刷,鋼筋組合,植筋,敲磚和電動鑽打洞等。 於2008年開始出現雙手腕酸痛、無力和麻的情形 職業病的診斷原則 疾病的證據 職業暴露的證據 符合時序性 符合人類流行病學已知的證據 排除其他可能的致病因素 * Reviews The median nerve is formed from parts of the medial and lateral cords of the brachial plexus. It continues down the arm to enter the forearm with the brachial artery. It originates from the brachial plexus with roots from C5, C6, C7, C8, T1. Carpal Tunnel Syndrome Median nerve compression at the wrist is the most common peripheral nerve entrapment disorder. Constellation of specific symptoms and signs, described as CTS. Annual incidence in the general population = 1/1000 Epidemiology of CTS most often in people 30 to 60 years old more common in women than men. common in people who perform repetitive motions of the hand and wrist. Repetitive motions of the hand and wrist Typing on a computer keyboard Sewing Driving Assembly line work Painting Writing Use of hand tools that vibrate Sports such as racquetball or handball Playing some musical instruments Work-related CTS most often associated with activities requiring extensive, forceful, repeated, or prolonged use of the hands and wrists, (NIOSH Publication no. 97–141.US Department of Health and Human Services, 1997) (Palmer KT et al.Occup Environ Med 2007; 57:57–66)。 職業性腕隧道症候群 工作時,手腕必須 經常反覆地動作, 經常持續地以一種不自然的姿勢工作, 或經常用力地作出扭轉的動作等 長時間累積的傷害造成 手腕部軟組織的病變或功能異常, 以及造成附近肌腱的發炎和週邊神經之壓迫. Occupational Carpal Tunnel Syndrome (OCTS) Forceful hand use, particularly if repeated for prolonged periods Constant firm gripping of objects Moving or using the hand and wrist against resistance or with force Exposing the hand and wrist to strong regular vibrations Regular or intermittent pressure on the wrist Work Exposures and the Probability of Work-Relatedness Exposure Examples of types of jobs Probability of work-relatedness Combinations of high force with high repetition and awkward posture; regu