Professional illness

Worker of a marine dock.

An professional disease is a disease acquired in the workplace of an employee. Said disease is declared as such by law or the rest of the Law. Examples are pneumoconiosis, allergic alveolitis, low back pain, carpal tunnel syndrome, occupational exposure to pathogenic germs and various types of cancer, among others.

In countries such as Spain, Argentina or El Salvador, for legal purposes, an occupational disease is one that, in addition to having its work origin, is included in an official list published by the Ministry of Labor and therefore gives the right to collection of the appropriate compensation.

The discipline dedicated to its prevention is industrial hygiene; occupational medicine specializes in the healing and rehabilitation of affected workers, and ergonomics and psychosociology is in charge of the productive design of work environments to adapt them to the capabilities of humans.

Occupational diseases, together with work accidents, are known as professional contingencies, compared to common contingencies (common disease and non-work accident). In Spain, CC.OO., considered its information campaign "Your health is not on the payroll" that the twelve most common diseases that require more preventive information are the following: heat stress, silicosis, asbestosis, diseases caused by exposure to chemical agents, voice diseases, respiratory diseases, infectious diseases, dermatitis and allergies, occupational cancer, hearing loss, musculoskeletal diseases and work stress.

Identification as occupational disease

To classify a disease as professional, it is essential that there are basic elements that differentiate it from a common disease:

• Agent: There must be a causal agent in the environment or special working conditions, potentially harmful to health. They can be physical, chemical, biological or physical overload generators for the exposed worker.
• Exhibition: condition sine qua non demonstrate that, as a result of the contact between the worker and the agent or particular working condition, the development of health damage is possible. Demonstration criteria can be:
  1. Qualitatives: It is to establish, in accordance with existing medical knowledge, a taxation list of occupations with risk of exposure, and the statement of the affected person or his or her representatives to be carrying out that occupation or to have done so.
  2. Quantitatives: refers to existing provisions regarding the maximum permissible boundary values or concentrations for each of the listed agents. This criterion is of paramount importance because it allows monitoring programs to be implemented, to determine tolerance levels and to specify groups of people who must be subject to this monitoring. Periodic reviews and specific measurements of the medium are incorporated as the appropriate means for prevention.
• Disease: There must be a disease or damage to the organism clearly defined in its clinical, laboratory, imaging, therapeutic and anatomopathological aspects that come from the worker's exposure to the agents or conditions of exposure already indicated.
• causal link: It must be demonstrated by scientific evidence (clinics, experimental or statistical) that there is an inexcusable link between the disease and the presence at work of the agents or conditions outlined above.

It is not necessary that the pathology has already caused a disability. The current concept is that the right to protect is the worker's health, and Argentine law 24,557 (Work Hazards) aims at prevention rather than economic compensation for the damage generated.

Inclusion on the official list: the restriction on the number of occupational diseases of those that meet certain conditions guarantees the automatic granting of benefits for those who appear on the list, thereby reduces the incidence of litigation and facilitates the administrative medical management of cases.

Because working conditions and harmful agents are variables that change as circumstances in the world of work evolve, there is a permanent advisory committee that analyzes whether or not a new disease merits its inclusion in the list.

Musculoskeletal diseases

In the industrial field, the main source of occupational diseases corresponds to the exposure of musculoskeletal segments of workers to ailments from activities that require repetition, strength and dysfunctional postures for prolonged periods of time. An additional factor, no less important, is the vibration that handling some tools or machines can cause to these body segments.

Most frequent musculoskeletal diseases

Physiopathology of musculoskeletal injuries of occupational origin

Muscle tissues require adequate oxygenation and sufficient tissue perfusion to achieve physiological metabolism for muscle function.

In the case of high repetition activities, the associated muscle masses do not reach complete relaxation, therefore the level of perfusion of muscle cells and tendon ends decreases significantly, giving rise to anaerobic metabolism and an accumulation of waste substances that cause pain in the short term, and the progressive decrease of muscular capacity. The prolongation of this situation begins to cause inflammation of the affected structures.

Cervical Degenerative Disc Disease

It constitutes a disease that is rarely diagnosed as an occupational disease and is often confused with muscle spasm, due to stress; It occurs when performing tasks that require uncomfortable neck postures or remaining in a static position, such as operating computers or driving.

Within the group under 40 years of age, pain manifests itself before finding radiographic changes; however, in those over 40 years of age, in whom this disease is less common, the first thing to be found are radiographic abnormalities.

The characteristic symptoms are sharp or gradually increasing pain at the level of the neck or upper interscapular, more intense at night or when holding the head still, which on physical examination may only show some restriction of movement. Regional symptoms may also be found in the shoulder and arm, such as radiating pain or paresthesias below the elbow or up to the fingers, but without involving the entire hand or even manifesting as a non-specific headache.

To diagnose it, an anteroposterior and lateral cervical spine X-ray is necessary if a significant problem such as disc space stenosis or osteophytes is suspected.

Differential diagnosis should be made with thoracic spine disease, tumor, infections, cervical spasm, pancoast tumor, or brachial neuritis due to radiculopathy.

Initially, general measures should be taken such as avoiding positions that trigger pain and performing exercises before and during activities in which the neck is kept in an uncomfortable position or positions, as well as sleeping in a soft chair with the torso at 45°. If this is not enough, the use of a soft cervical collar, non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen + codeine can be implemented, together with the application of heat and massage during the first week.

If accompanied by radiculopathy, disc removal, corpectomy, or laminoplasty may be considered.

Shoulder Impingement Syndrome

It occurs predominantly in activities in which there is excess use or after sudden overloads of this joint.

It begins with subacromial bursitis when it or the rotator cuff tendons are pinched against the coracoacromial ligament when performing movements above shoulder height, later supraspinatus tendonitis appears and ulceration and partial tear that can evolve to total rupture of the cuff, parallel to this there is osteophytic degeneration of the acromion with more entrapment of the subacromial space. There may also be a rupture of the biceps head.

Acute or gradual pain in the anterior shoulder that appears when performing new activities of repetitive movements. Sometimes pain on the lateral side of the arm that sometimes radiates to the distal part, elbow and hand of variable intensity.

It consists of pain in the arm during abduction from 30° to 40° elevation, above 90° in forward flexion position, in 90° elbow flexion, external rotation does not cause discomfort, internal rotation is painful.

It is diagnosed by simple AP shoulder X-ray taken in internal and external, axillary and outlet rotation. sclerotic and degenerative changes of the joint. in those older than 70 years, most have cuff tears.

Differential diagnosis: angina due to AMI, acute shoulder infection, symptomatic degenerative arthritis, osteoarthritis of the glenohumeral joint is not common.

The treatment aims to resolve pain and muscle stability. Start with conservative measures such as passive exercise and avoidance of overhead shoulder work, or it is possible to inject corticosteroids with local anesthetic with a 25 needle into the greater tuberosity 2.5 cm below the anterior lateral quadrant of the acromion. The diagnosis is made if the pain immediately improves. Open surgery or arthroscopy to decompress the space, bursectomy, and cuff debridement and repair may also be considered in more complicated cases if necessary.

Thoracic Outlet Syndrome

It is a compression of the neurovascular bundles coming from the neck and thorax below the clavicle towards the armpit. It is rare and has various causes such as supernumerary ribs, scalene syndrome, costiform process, pectoralis minor syndrome, nonthrombotic occlusion of the subclavian vein, or simple inflammation. It generally occurs in trades in which it is necessary to adopt uncomfortable positions with the arm over the head for long periods of time and is correlated with people with long necks and sloping shoulders.

It is very common to have paresthesias and pain that radiate to the arm, there are problems with overhead activities, the hand feels heavy, and there are symptoms in the muscles innervated by the ulnaris as well as symptoms of venous compression.

It is necessary to differentiate it from other pathologies such as cervical disc disease or compression of the ulnar nerve in the cubital tunnel, for which a simple x-ray of the cervical spine can be performed looking for cervical ribs, transverse processes or hypoplasia of the first rib or tumors of the pancoast.

Elbow, wrist or hand injuries

Carpal Tunnel Syndrome

Wrist support for carpal tunnel syndrome. Often, carpal tunnel syndrome is the justification for an occupational disease claim. It is usually due to a combination of factors that increase pressure on the nerve and tendons in the wrist. It may be a congenital predisposition in some individuals, having the carpal tunnel is simply smaller in some people than others. Other factors that contribute to the diagnosis include trauma or injury to the wrist that causes swelling, such as a sprain or fracture; as well as hormonal and autoimmune actions and work stress (repeated use of vibrating hand tools, for example), among others.

There is little clinical data to prove whether forceful repetitive hand and wrist movements in work or leisure activities can cause carpal tunnel syndrome. Repetitive motions that occur in the normal course of work or other daily activities can lead to repetitive motion disorders such as bursitis (inflammation of a small insulating bursa in the joint) and tendonitis (inflammation of the tendons). Writer's cramp—a condition caused by a lack of motor coordination, pain, and pressure in the fingers, wrist, or forearm from repetitive activity—is not a symptom of carpal tunnel syndrome.

Lateral Humeral Epicondylitis

Also called tennis elbow, since it is presented by repetitive dorsiflexion or repetitive forced extension of the wrist, collagenous necrosis occurs at the insertion on the epicondyle of the extensor carpi radialis brevis muscle and at the origin of the extensor carpi radialis longus.

Pain that radiates to the back of the forearm can occur at night while resting, but more commonly it is related to activity (gripping, dorsiflexing the wrist). On physical examination, the symptoms can be reproduced by asking the patient to do forced dorsiflexion or pain is found in the lateral epicondyle on palpation.

It is prevented with general strengthening of the elbow and forearm musculature and proper use of hand tools.

It is treated by suppressing the causative activity, applying NSAIDs and triamcinolone acetonide (40 mg), injected into the painful area. However, adverse reactions such as fat necrosis, local skin atrophy or depigmentation may occur. Surgery is rarely necessary and is for the release of the common extensor.

De Quervain's Tenosynovitis

Affects the first dorsal extensor compartment of the wrist, due to overuse of the thumb and repetitive gripping.

The patient has a history of repetitive grip maneuvers, pain and/or swelling on the radial side of the base of the thumb, severe pain when the patient is asked to perform ulnar deviation of the hand (hammering), known as finkelstein manoeuvre.

It is appropriate to decrease the triggering activities, lidocaine (1 mL) injected with a 25-gauge needle followed by triamcinolone acetonide into the sheath of the first common dorsi extensor; NSAIDs; immobilization; in severe cases: common extensor sheath surgery.

Media Epicondylitis

Also called epitrochleitis, golfer's elbow, or pronator-flexor syndrome, it is caused by overuse of the flexors of the fingers and flexors and pronators of the wrist. It affects golfers, baseball pitchers, manual workers.

Shows local hyperesthesia, pain during exercise or flexion of the wrist against resistance.

Treated with rest, proximal forearm band, injected steroids.

Ulnar Nerve Compression

Produced by entrapment, irritation or subluxation of the ulnar nerve as it passes through the cubital tunnel. It is related to previous elbow injuries, growing osteophytes, ulna valgus, subluxated nerve coming out of the groove, prolonged pressure on the nerve that causes inflammation or injury to nearby body structures. It occurs in professions in which prolonged support is maintained on the elbows.

Patients present acute pain on the medial side of the elbow, paresthesias in the distribution of the nerve, the symptoms are aggravated by flexion or support of the elbow on a table. Tinel's sign over the cubital tunnel, weakness of the interosseous and adductor pollicis muscles.

The diagnosis is clinical, it must be differentiated from nerve compression at the level of Guyon's canal, here there are no sensory alterations in the little finger and half of the ring finger.

With conservative treatment, avoid pressure on the flexed elbow, if there is atrophy of the interosseous bones, perform surgical decompression with medial epicondylectomy or transposition of the nerve to a submuscular position.

Workplace cancer

Most adult cancers are thought to be caused by a combination of lifestyle factors and environmental exposures. While only 20% correspond to cancers caused by endogenous factors (specific to each individual), the remaining 80% correspond to exposures to exogenous or environmental factors, such as asbestos, tobacco or exposure to occupational environmental factors.

Two worrisome agents are exposure to solar radiation and exposure to tanning lamps, both emitting ultraviolet rays, which produce malignant cells in the skin.

Phases

The process of carcinogenesis consists of three phases:

• Initiation phase: A DNA mutation occurs due to interaction with a carcinogenic agent.
• Promotional phase: Tumor development due to the stimulation of the development of the altered cell, due to exposure to environmental factors
• Progression phase: Development of the malignant tumor, spread by metastasis. Also known as a period of latency, it extends from the first exposure to the first manifestation of the tumor.

Examples

• Asbestos lung cancer: construction workers, demolition, textiles, naval, painters, mines... and people who used asbestos in individual production teams.
  See also: Asbestos
• Lung cancer per pot, coke, etc.: coke oven workers, desholliners, etc.
• Arsenic lung cancer: skin tanning workers, pesticides, copper melting, etc.

Legislation

In Spain, Royal Decree 1299/2006, of November 10, which approves the list of occupational diseases in the Social Security system and establishes criteria for their notification and registration. BOE no. 302 of December 19. In Argentina, in 1995, the Occupational Risk Law No. 24,557 was sanctioned and promulgated. In Mexico, worker protection is present in article 123 of the Constitution and in the Federal Labor Law. The treatment of occupational diseases depends on the social security institution to which the workplace is registered, be it ISSSTE or IMSS.

In Colombia, everything related to safety and health at work is regulated by Law 1072 of 2015 of the Ministry of Labor.