musearm (LH Indholdsside)

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      <HtmlField Name="PageContent"><![CDATA[<h2>Basisoplysninger</h2>
<h3>Definition </h3>
<ul>
    <li>Begrebet musearmer et folkeligt udtryk, for de gener der kan opst&aring; i forbindelse med&nbsp;gentagen overbelastning af muskler, ledb&aring;nd, sener og nerver, for eksempel ved computerarbejde.</li>
    <li>Musearmsbegrebet omfatter symptomer, typisk smerter&nbsp;i skulder, arm, h&aring;ndled og h&aring;nd.&nbsp; B&aring;de symptombilledet og diagnosen vil s&aring;ledes variere, alt efter hvilke anatomiske strukturer, der er overbelastet.&nbsp;Der er meget sj&aelig;ldent tale om en&nbsp;egentlig sygdomsdiagnose</li>
    <li>F&aelig;llesn&aelig;vneren er, at generne optr&aelig;der ved arbejde ved computertastatur eller -mus </li>
</ul>
<h3>Forekomst</h3>
<ul>
    <li>En hyppigt forekommende tilstand, formentlig associeret til &oslash;get brug af computer &nbsp;&nbsp;</li>
    <li>Evidensen for sammenh&aelig;ngen er dog ikke klar<a title="Waersted M, Hanvold TN, Veiersted KB., 2: Waersted M, Hanvold TN, Veiersted KB. Computer work and musculoskeletal disorders of the neck and upper extremity: a systematic review.. BMC Musculoskelet Disord. 2010;29: 79" href=" " data-url="reference-link" data-value="Waersted M, Hanvold TN, Veiersted KB., 2: Waersted M, Hanvold TN, Veiersted KB. Computer work and musculoskeletal disorders of the neck and upper extremity: a systematic review.. BMC Musculoskelet Disord. 2010;29: 79" data-type="journal-reference" data-value-piped="Waersted M, Hanvold TN, Veiersted KB.|2: Waersted M, Hanvold TN, Veiersted KB. Computer work and musculoskeletal disorders of the neck and upper extremity: a systematic review.|BMC Musculoskelet Disord.|2010|29|79">1</a></li>
</ul>
<h3>&nbsp;&AElig;tiologi og patogenese</h3>
<ul>
    <li>Musearmssygdommen er ikke et strengt medicinsk defineret syndrom, som rummer alle belastningsrelaterede klager, der kan opst&aring; i overekstremiteterne i form af
    <ul>
        <li>ledinflammation </li>
        <li>(patologiske forandringer i muskel- og senetilh&aelig;ftninger (<a href="~/link.aspx?_id=EDF2594D620A400A9A17FFEFA6CDA173&amp;_z=z">epikondylitis</a>))</li>
        <li>(nerveafklemning (f.eks. <a href="~/link.aspx?_id=24AB216C45314628ACAA9B347B9B46B7&amp;_z=z">karpaltunnelsyndrom</a>))</li>
        <li>smerter, men ikke en egentlig sygdom (som epikondylitis, karpaltunnelsyndrom mm.)</li>
    </ul>
    </li>
</ul>
<h4>Patogenese</h4>
<ul>
    <li>Langvarige, gentagne anstrengelser med monotont arbejde ved computer </li>
    <li>Brug af computermus - pr&aelig;cisionsarbejde med mus medf&oslash;rer tidsm&aelig;ssigt l&aelig;ngere perioder, hvor h&aring;ndleddet holdes i en stilling, som afviger fra normalstillingen&nbsp; </li>
</ul>
<div>Arbejdsstilling og arbejdsergonomi spiller formodentlig en rolle, men evidensen er uklar, der savnes klare anbefalinger<a title="Dick FD, Graveling RA, Munro W, Walker-Bone K, Workplace management of upper limb disorders: a systematic review. . Occup Med (Lond). 2011;61: 19-25" href=" " data-url="reference-link" data-value="Dick FD, Graveling RA, Munro W, Walker-Bone K, Workplace management of upper limb disorders: a systematic review. . Occup Med (Lond). 2011;61: 19-25" data-type="journal-reference" data-value-piped="Dick FD, Graveling RA, Munro W, Walker-Bone K|Workplace management of upper limb disorders: a systematic review. |Occup Med (Lond).|2011|61|19-25">2</a><sup>,</sup><a title="Gerr F, Monteilh CP, Marcus M., Keyboard use and musculoskeletal outcomes among computer users.. J Occup Rehabil. 2006;16: 265-77" href=" " data-url="reference-link" data-value="Gerr F, Monteilh CP, Marcus M., Keyboard use and musculoskeletal outcomes among computer users.. J Occup Rehabil. 2006;16: 265-77" data-type="journal-reference" data-value-piped="Gerr F, Monteilh CP, Marcus M.|Keyboard use and musculoskeletal outcomes among computer users.|J Occup Rehabil.|2006|16|265-77">3</a>&nbsp;</div>
<div>I en stor dansk unders&oslash;gelse viste unders&oslash;gelserne, at det der virkede bedst ved den ergonomiske indretning, var muligheden for at indrette arbejdspladsen efter eget &oslash;nske og med mulighed for at &aelig;ndre stilling l&oslash;bende igennem dagen (NUDATA)<a href=" " data-type="journal-reference" data-value="Andersen JH, Fallentin N, Thomsen JF, Mikkelsen S, Risk factors for neck and upper extremity disorders among computers users and the effect of interventions: an overview of systematic reviews. PLoS One 2011;6: e19691" data-value-piped="Andersen JH, Fallentin N, Thomsen JF, Mikkelsen S|Risk factors for neck and upper extremity disorders among computers users and the effect of interventions: an overview of systematic reviews.|PLoS One|2011|6|e19691|21589875" data-url="reference-link" data-pubmedid="21589875" title="Andersen JH, Fallentin N, Thomsen JF, Mikkelsen S, Risk factors for neck and upper extremity disorders among computers users and the effect of interventions: an overview of systematic reviews. PLoS One 2011;6: e19691">#</a><strong><em>&nbsp;</em></strong></div>
<h3>Disponerende faktorer</h3>
<ul>
    <li>Langvarigt arbejde ved computer -&nbsp;specielt statisk arbejde med musen&nbsp;</li>
</ul>
<ul>
</ul>
<h3>ICPC-2</h3>
<p>[ICPC] </p>
<h3>ICD-10/SKS-koder</h3>
<p>[ICD10] </p>
<h2>Diagnose</h2>
<h3>Diagnostiske kriterier</h3>
<ul>
    <li>Smerter i overekstremitet og nakke som f&oslash;lge af langvarig og/eller intenst arbejde ved computer</li>
</ul>
<h3>Differentialdiagnoser </h3>
<ul>
    <li>Specifikke tilstande som
    <ul>
        <li><a href="~/link.aspx?_id=24AB216C45314628ACAA9B347B9B46B7&amp;_z=z">Karpaltunnelsyndrom</a> </li>
        <li><a href="~/link.aspx?_id=30BD27F23AC0455095DD580B034DDDEB&amp;_z=z">H&aring;ndledstendinitis</a> </li>
        <li><a href="~/link.aspx?_id=EDF2594D620A400A9A17FFEFA6CDA173&amp;_z=z">Epikondylitis</a> </li>
        <li><a href="~/link.aspx?_id=3CE2B6DFACB8459C88C2E6E093D94C79&amp;_z=z">Nakkemyoser</a></li>
    </ul>
    </li>
</ul>
<h3>Sygehistorie</h3>
<ul>
    <li>Symptomatologien kan variere alt afh&aelig;ngig af, hvilke strukturer som er afficerede </li>
    <li>Typiske klager er smerter i underarme, h&aring;ndled, h&aring;ndflader og skuldre</li>
    <li>Smerterne &oslash;ges i reglen efter l&aelig;ngerevarende arbejdsopgaver ved computeren. Typisk ses en &oslash;get genehyppighed ved computerarbejde over 25 timer pr. uge</li>
</ul>
<h3>Kliniske fund</h3>
<ul>
    <li>Ved meget tastaturarbejde
    <ul>
        <li>&Oslash;mhed er her som regel lokaliseret bilateralt svarende til trapeziusmuskulatur, nakke og overarme</li>
    </ul>
    </li>
    <li>Ved meget musearbejde
    <ul>
        <li>S&aelig;dvanligvis ensidige klager fra underarme, h&aring;ndled og albue</li>
    </ul>
    </li>
</ul>
<h3>Hvorn&aring;r skal patienten henvises?</h3>
<ul>
    <li>Diagnosen er prim&aelig;rt en udelukkelsesdiagnose baseret p&aring; arbejdsanamnesen, og patienten b&oslash;r udredes yderligere ved vedvarende smerter uden oplagt forklaring. Yderligere udredning kan eventuelt foreg&aring; p&aring; en arbejdsmedicinsk klinik.</li>
</ul>
<h2>Link til vejledninger</h2>
<ul>
    <li>Forl&oslash;bsbeskrivelser og pakkeforl&oslash;b [ICPC]&nbsp;</li>
    <li><a href="http://www.arbejdsmedicin.rm.dk/">Arbejdsmedicin, &Aring;rhus</a></li>
</ul>
<h2>Behandling</h2>
<h3>Behandlingsm&aring;l</h3>
<ul>
    <li>Forebygge belastningsgener </li>
    <li>Genvinde normal arbejdsfunktion</li>
</ul>
<h3>Generelt om behandlingen</h3>
<ul>
    <li>Jf. beskrivelsen af de specifikke belastningstilstande i L&aelig;geh&aring;ndbogen, f.eks.
    <ul>
        <li><a href="~/link.aspx?_id=24AB216C45314628ACAA9B347B9B46B7&amp;_z=z">Karpaltunnelsyndrom</a> </li>
        <li><a href="~/link.aspx?_id=30BD27F23AC0455095DD580B034DDDEB&amp;_z=z">H&aring;ndledstendinitis</a> </li>
        <li><a href="~/link.aspx?_id=EDF2594D620A400A9A17FFEFA6CDA173&amp;_z=z">Epikondylitis</a> </li>
        <li><a href="~/link.aspx?_id=3CE2B6DFACB8459C88C2E6E093D94C79&amp;_z=z">Nakkemyoser</a></li>
    </ul>
    </li>
    <li>S&aelig;dvanlige behandlingsprincipper omfatter aflastning, evt. sygemelding, evt. <a href="http://pro.medicin.dk/Laegemiddelgrupper/grupper/213010">NSAID</a>, evt. <a href="http://pro.medicin.dk/Laegemiddelgrupper/grupper/171050">kortisoninjektioner</a>, evt. fysioterapi, evt. operation </li>
</ul>
<h3>Ergonomiske tiltag</h3>
<ul>
    <li>Unders&oslash;gelser tyder p&aring;, at det vigtigste ergonomiske tiltag er, at man kan indrette sin computerarbejdsplads efter eget &oslash;nske og variere den i l&oslash;bet af dagen</li>
    <li>Nedenst&aring;ende anbefalinger kan herudover bruges<em>:&nbsp;</em>
    <ul>
        <li>Kontorstolen b&oslash;r v&aelig;re justerbar</li>
        <li>S&oslash;rg for at tastaturbordet har den rigtige h&oslash;jde i forhold til, hvordan brugeren sidder</li>
        <li>St&oslash;tte under h&aring;ndleddene/h&aring;ndens bagkant kan v&aelig;re nyttig for nogle</li>
        <li>Anvendelse af musem&aring;tte betyder, at man arbejder mindre intenst ved bev&aelig;gelse af musen</li>
        <li>Forskellige udformninger af musen giver forskellige belastningsgener. Det anbefales derfor at variere arbejdet frem for at anvende "specialmus"</li>
        <li>Nogle arbejder bedst i st&aring;ende stilling</li>
        <li>Arbejdsstillingen b&oslash;r l&oslash;bende varieres, og computerbrugeren b&oslash;r indimellem rejse sig og g&aring; lidt omkring</li>
    </ul>
    </li>
</ul>
<h3>Forebyggende behandling</h3>
<ul>
    <li>Jf. ergonomiske tiltag </li>
</ul>
<h4>R&aring;d vedr. forebyggelse af musearmssygdommen</h4>
<ul>
    <li>Individuelt udformet og ergonomisk tilpasset arbejdsplads</li>
    <li>omfanget af computerarbejde b&oslash;r ikke overstige 25 timer pr. uge og med indlagte pauser i l&oslash;bet af dagen</li>
    <li>Vari&eacute;r arbejdsstillingen </li>
    <li>Variation i anvendelsen af enhver form for pegeinstrument - mus, "trackball", pegepind </li>
    <li>Variation af hvilken h&aring;nd, der anvendes til at styre musen </li>
    <li>Brug af tastaturkommandoer i stedet for at bruge mus </li>
    <li>Begr&aelig;ns omfanget af dobbeltklik </li>
    <li>Tag korte pauser i arbejdet </li>
    <li>Undg&aring;, s&aring;fremt det er muligt, muse- og tastaturarbejde under stress</li>
    <li>Indl&aelig;g pauser i l&oslash;bet af dagen og udf&oslash;r ansp&aelig;ndende &oslash;velser</li>
</ul>
<h2>Forl&oslash;b, komplikationer og prognose</h2>
<h3>Forl&oslash;b </h3>
<ul>
    <li>Generne kan opst&aring; akut efter kortvarigt intenst arbejde ved computer, men hyppigere er tiltagende gener p&aring; grund af langvarigt arbejde ved computer</li>
</ul>
<h3>Komplikationer</h3>
<ul>
    <li>Inflammation i sener, senetilh&aelig;ftninger, nerveafklemningssyndrom </li>
</ul>
<h3>Prognose</h3>
<ul>
    <li>Tidlig intervention med ergonomiske tiltag betyder en god prognose </li>
</ul>
<h2>Patientinformation</h2>
<ul>
    <li>
    <a href="~/link.aspx?_id=A9E87189FEDD46BB8648FA2ABFB36411&amp;_z=z">Musearm</a> </li>
</ul>
<h3>Animation</h3>
<ul>
    <li>
    <a href="~/link.aspx?_id=B21D3FD046CB41B1987298229FF82639&amp;_z=z">Nakkesmerter</a></li>
</ul>
<h3>Tr&aelig;ningsfilm for albue og underarm</h3>
<ul>
    <li><a href="~/link.aspx?_id=73767A48745041A09432DB6606696284&amp;_z=z">&Oslash;velsesprogram, 3 &oslash;velser</a><br>
    <br>
    <a href="~/link.aspx?_id=F72A8EE6731841AE839261CF3566367D&amp;_z=z"><img alt="" height="84" width="135" src="75B6E3B12E8C4C0AACCA429AA76D364A-135-84" style="height: 84px; width: 135px;"></a></li>
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]]></Media>
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