Musculoskeletal Disorders

Public health importance of work-related musculoskeletal disorders

The magnitude, cost and burden of work-related musculoskeletal disorders (WMSDs) are enormous. From 1992 - 2000, there were 380,485 Washington State accepted workers' compensation state fund claims for non-traumatic soft tissue musculoskeletal disorders of the neck, back and upper extremity. These claims resulted in $2.9 billion in direct costs, and 26.9% of all state fund workers' compensation claims. Of WMSD claims during this time period, 32.4% were compensable with an average of 123 lost time days per compensable claim.

Work related musculoskeletal disorders occur when there is a mismatch between the physical requirements of the job and the physical capacity of the human body. More than 100 different work-related musculoskeletal disorders may stem from repetitive motions that produce wear and tear on the body. Specific risk factors associated with WMSDs include repetitive motion, heavy lifting, forceful exertion, contact stress, vibration and awkward posture among others.

Purpose and operation

Purpose

The purpose of this system is the identification of patterns and trends that can be used to reduce, through prevention, the occupational risks associated with nontraumatic soft tissue musculoskeletal disorders of the neck, back, and upper extremity.

Objectives

  • Describe the incidence and prevalence of neck, back and upper extremity WMSDs.
  • Identify high risk occupations and industries.
  • Identify useful prevention strategies.
  • Generate hypotheses about causative agents and factors.

Planned uses

  • Identifying outbreaks of WMSDs.
  • Analyzing risks by occupation and industry.
  • Tracking trends in incidence, prevalence and cost of WMSDs.
  • Sharing information with the public, legislature, health care providers, public health professionals, and labor and industry stakeholders.
  • Evaluating efforts to reduce WMSDs as an occupational risk.
  • Measuring progress toward meeting Healthy People 2010 objective 20-3, reducing the risk of injury and illness involving days away from work due to overexertion or repetitive motion.

Case definition

An accepted claim is a case of nontraumatic soft tissue (NTST) WMSD of the neck, back or upper extremities if either one of two conditions is met.

  1. The first report of injury contains references to a body part in Table 1, to an affected soft tissue identified as a nature of injury in Table 2, and to a type of injury associated musculoskeletal disorders as shown in Table 3, OR
  2. The medical bills associated with the claim includes one or more of the diagnosis/procedure codes shown in Table 4, and the type of injury is listed in Table 3 for that body part *.

An example of the first case definition, an injury described as a shoulder sprain resulting from breaking concrete with a jack hammer, would be a case because 450 (the code for shoulder) is in Table 1, 310 (the code for strain or sprain) is in Table 2, and 083 (the code for abraded by vibrating object) is contained in Table 3. It would also be counted as a case under upper extremity because this body group contains shoulder as a subgroup.

* The workers' compensation costs associated with this case definition are included only if the body part also matches those listed in Table 1. This is done to avoid inflating the costs by including cases with multiple injuries of which MSD is not the major reason for the lost work time.

Table 1 - Composition of body groups
Body group Group composition
Hand/Wrist 320(hand), 330(wrist), 340(fingers), 350(hand and fingers)
Elbow 313(elbow), 315(forearm)
Shoulder 311(upper arm), 450(shoulder)
Back 420(back)
Neck 200(neck)
Multiple 498(trunk-multiple), 600(back and neck),  700(multiple)
Upper Extremity 300(upper extremity), 310(arm unspecified), 318(arm multiple), 398 (upper extremity, nec), and Body Groups (SHOULDER, ELBOW, and HAND/WRIST)

Table 2 - Nature of injury codes and type of musculoskeletal disorder
Code Description NTST neck NTST back NTST upper extremity
190 dislocation/herniation of discs X X  
260 inflammation or irritation of joints, tendons or muscles X X X
310 strains and sprains X X X
400 multiple injuries     X
560 injuries to the nervous system X X X
562 diseases of the nerves and peripheral ganglia X X X
580 ill defined symptoms and conditions X X X
999 not classified X X X

Table 3 - Types of Injury and Associated Body Groups
Code Description Neck Back Upper Extremity
81 abraded by kneeling/sitting   X  
82 abraded by object handling   X X
83 abraded by vibrating object   X X
85 abraded by foreign object   X X
86 abraded by motion   X X
100 bodily reaction X X X
120 overexertion unspecified X X X
121 overexertion lifting X X X
122 overexertion pushing/pulling X X X
123 overexertion wielding/ throwing X X X
124 overexertion carrying X X X
129 overexertion NEC X X X
899 type NEC X X X
999 not classified X X X

Table 4 - ICD 9 Diagnosis and Procedure Codes Used in Defining Cases of WMSD
Body Part Diagnosis Description
Neck 722.00 Neuritis or radiculitis due to displacement of cervical disc
722.71 Invertebral disc disorder with myelopathy
723.00 Other disorders of cervical region
723.10 Cervicalgia (pain in the neck)
723.30 Cervicabrachial syndrome
723.40 Cervical radiculitis, radicular syndrome
723.50 Torticollis
847.00 Sprain and strain of neck
Back 722.10 Lumbago or sciatica due to displacement of intervertebral disc
722.73 Intervertebral disc disorder with myelopathy
724.00 Other disorders of back
724.20 Lumbago, lumbalgia, low back pain
724.30 Sciatica
724.50 Backache, unspecified
Upper Extremity
Body Part Diagnosis Description
Shoulder-Rotator Cuff Syndrome 726.1 Rotator cuff syndrome
726.10 Rotator cuff, supraspinatus syndrome
727.61 Complete rupture of rotator cuff
840.40 Sprains and strains of rotator cuff capsule
Procedure Description
23410 Repair ruptured rotator cuff - acute
23412 Repair ruptured rotator cuff - chronic
23415 Coracoacromial ligament release  - chronic ruptured rotator cuff
23420 Repair of complete rotator cuff avulsion, chronic
Upper Extremity
Body Part Diagnosis Description
Elbow-Epicondylitis 726.31 Medial epicondylitis
726.32 Lateral epicondylitis
Procedure Description
24350 Lateral or medial fasciotomy
Upper Extremity
Body Part Diagnosis Description
Hand/wrist-Carpal tunnel syndrome 354.00 Carpal tunnel syndrome
Procedure Description
64721 Median nerve decompression at carpal tunnel
Upper Extremity
Body Part Diagnosis Description
Tenosynovitis/
tendinitis
727.03 Trigger finger
727.04 DeQuervain's disease
727.05 Other tenosynovitis of hand and wrist
727.4 Ganglion & cyst of synovium, bursa, tendon
727.42 Ganglion of the tendon sheath

Legal authority

No specific legal authority was needed to create this surveillance system.

Organizational location

The surveillance system is located within the Safety and Health Assessment and Research for Prevention (SHARP) Program of the Washington State Department of Labor & Industries.

System components

Population under surveillance

The population under surveillance is the workers employed in the state of Washington who have workers compensation insurance under state law.

Time period of data collection

January 1, 1991 through December 31, 1999

Collection and reporting sources

Workers' compensation claims data are available from the data warehouse. It contains information from the Labor & Industries Industrial Insurance System (LINIIS), the computer system for processing workers' compensation claims and the Medical Insurance Payment System (MIPS) that is used by providers of health services to submit bills for payment of services rendered under workers' compensation.

Data management

A query is used to create an analysis database in SAS from the data warehouse. A SAS record containing data from LINIIS and MIPS is created if at least one of the MSD case definitions is met. The record indicates which of the other case definitions used in the query are also met.

Data analysis and dissemination

A variety of tables are created using standard procedures in SAS. A technical report is produced and disseminated annually.

Patient privacy, data confidentiality, and system security

All records containing or accompanied by patient identifying information are confidential. These records are used solely for surveillance and prevention purposes. Physical access to the building and access to individual computers are controlled as part of the security systems of the Department of Labor & Industries.

Work-related musculoskeletal disorder (WMSD) resources developed by the SHARP program

Publications

WMSD reports are available from SHARP's Publications page.

Links to other WMSD information

External hyperlinks are provided as a public service by the SHARP Program. Neither L&I nor SHARP are responsible for the reliability or accuracy of the information found on other Web sites. (Disclaimer)

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