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Suh, Cheon, Kim, Kim, Park, Yang, Park, Na, Yoon, and Lee: Prevalence and Risk Factors of Upper Extremity Musculoskeletal Diseases among Farmers in Gyeongnam
Original Article

J Rheum Dis 2015;22(6):366-373.

Published online: 31 October 2015

DOI: https://doi.org/10.4078/jrd.2015.22.6.366

Prevalence and Risk Factors of Upper Extremity Musculoskeletal Diseases among Farmers in Gyeongnam

Young Sun Suh1, Yun-Hong Cheon1, Hyun-Ok Kim1, Rock-Bum Kim2, Ki Soo Park2, Hyun-Su Yang2, Hyung Bin Park3, Jae-Bum Na4, Chul Ho Yoon5, Sang-Il Lee1

1Division of Rheumatology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea

2Department of Preventive Medicine, Gyeongsang National University School of Medicine, Jinju, Korea

3Department of Orthopedic Surgery, Gyeongsang National University School of Medicine, Jinju, Korea

4Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Korea

5Department of Rehabilitation Medicine, Gyeongsang National University School of Medicine, Jinju, Korea

Corresponding to: Sang-Il Lee, Division of Rheumatology, Department of Internal Medicine, Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju 52727, Korea. E-mail: goldgu@gnu.ac.kr

Received 6 November 2015       Revised 17 November 2015       Accepted 18 November 2015

Copyright © 2015 The Korean College of Rheumatology

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

To evaluate the prevalence and risk factors of upper extremity musculoskeletal diseases (MSDs) among Korean farmers.

Methods

The study was carried out from June 2013 to August 2015 on 850 farmers and 203 non-farmers (controls) in Gyeongnam Province. Physical examinations were performed by rheumatologists, orthopedists, and rehabilitation specialists. Plain radiography, a nerve conduction examination, and magnetic resonance imaging were performed, and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire was used to assess upper extremity function.

Results

Thirty-four different types of upper extremity MSDs were detected in the 1,053 study subjects. The prevalence of any MSD in farmers was 8.96-fold higher than in control (p＜0.001). The most obvious difference in prevalence between farmers and non-farmers was hand osteoarthritis (48.2% vs. 4.9%). Mean total DASH score was higher for farmers than non-farmers (14.29±13.66 vs. 10.03±10.85, p＜0.001). Among farmers, myofascial pain syndrome, rotator cuff tear, and epicondylitis were more prevalent among overhead workers (growing persimmons, pears, and grapes) than in non-overhead workers (growing rice and upland crops). The following factors were associated with a rotator cuff tear; older age, overhead work, high waist circumference, and lower level of education. Hand osteoarthritis was found to be associated with older age, a female gender, high waist circumference, and longer total work time.

Conclusion

The prevalence of upper extremity MSDs is much higher in farmers than non-farmers and greater still for farmers doing overhead work. Various factors contribute to the occurrence of upper extremity MSDs, and thus, the authors suggest an efficient preventive strategy, which involves consideration of type of work and risk factors, be established for farmers to reduce upper extremity MSDs.

Keywords: Musculoskeletal diseases, Upper extremity, Prevalence, Risk factors

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Table 1.
Baseline characteristics of participants
Characteristic Farmer (n=850) Non-farmer (n=203) p-value
Age (yr) 59.68±8.06 58.46±8.72 0.068
Gender     0.138
 Female 440 (51.8) 93 (45.8)  
 Male 410 (48.2) 110 (54.2)  
Level of education     ＜0.001
 ≤ Elementary school 328 (38.6) 7 (3.4)  
 Middle school 218 (25.6) 11 (5.4)  
 ≥ High school 294 (34.6) 185 (91.1)  
Marriage (yes) 760 (89.4) 183 (90.1) 0.898
Smoking (yes) 124 (14.6) 19 (9.4) 0.053
Hypertension (yes) 256 (30.2) 48 (23.6) 0.070
Diabetes (yes) 93 (10.9) 20 (9.9) 0.706
Subjective health status     0.044
 Well-being 147 (17.3) 48 (23.6)  
 Impaired 702 (82.6) 154 (75.9)  
BMI (kg/m2) 24.52±3.04 24.08±2.87 0.060
Waist circumference (cm) 85.09±8.42 83.78±8.81 0.049
Total working period (yr) 30.39±14.25 28.43±10.68 0.079
Major crops      
 Fruit tree (persimmon, pear, grape) 502 (59.0)    
 Strawberry 187 (22.0)    
 Rice 140 (16.5)    
 Upland crops 21 (2.5)    
Depression (PHQ-2 ≥3) 106 (12.5) 11 (5.4) 0.004
DASH score 14.29±13.66 10.03±10.85 ＜0.001

Values are presented as mean±standard deviation or number (%). BMI: body mass index, DASH score: the Disabilities of the Arm, Shoulder, and Hand score, PHQ-2: the Patient Health Questionnaire-2.

Table 2.
Prevalence of upper extremity musculoskeletal diseases
Disease Farmer (n=850) Non-farmer (n=203) p-value
Myofascial pain syndrome 644 (75.8) 105 (51.7) ＜0.001
Rotator cuff tear 496 (58.4) 73 (36.0) ＜0.001
Hand osteoarthritis 409 (48.1) 10 (4.9) ＜0.001
Carpal tunnel syndrome 370 (43.5) 29 (14.3) ＜0.001
Lateral epicondylitis 281 (33.1) 33 (16.3) ＜0.001
Biceps tendon pathology 179 (21.1) 11 (5.4) ＜0.001
Medial epicondylitis 151 (17.8) 26 (12.8) 0.090
Slap lesion 99 (11.6) 12 (5.9) 0.017
Acromioclavicular joint abnormality 68 (8.0) 0 (0.0) ＜0.001
Rotator cuff tendinosis 49 (5.8) 14 (6.9) 0.541
Peripheral neuropathy 36 (4.2) 3 (1.5) 0.062
Cervical neuropathy 32 (3.8) 13 (6.4) 0.095
Trigger finger 29 (3.4) 4 (2.0) 0.290
Frozen shoulder 26 (3.1) 11 (5.4) 0.101
Cubital tunnel syndrome 23 (2.7) 7 (3.4) 0.707
Calcific tendinitis of shoulder 16 (1.9) 6 (3.0) 0.337
Elbow osteoarthritis 14 (1.6) 2 (1.0) 0.489
Others 47 (5.5) 7 (3.4) 0.288

Values are presented as number (%).

Table 3.
The prevalence of upper extremity musculoskeletal diseases in Korean farmers according to work posture
Disease Work posture p-value
Overhead work Non-overhead work
Myofascial pain syndrome 443/550 (80.5) 201/300 (67.0) ＜0.001
Rotator cuff tear 337/544 (61.9) 159/294 (54.1) 0.033
Hand osteoarthritis 266/550 (48.4) 143/299 (47.8) 0.886
Carpal tunnel syndrome 237/524 (45.2) 133/300 (44.3) 0.827
Lateral epicondylitis 217/550 (39.5) 64/300 (21.3) ＜0.001
Biceps tendon pathology 111/550 (20.2) 68/300 (22.7) 0.428
Medial epicondylitis 118/550 (21.5) 33/300 (11.0) ＜0.001

Values are presented as number (%).

Table 4.
Comparison of demographic characteristics among farmers, stratified by the number of major upper extremity musculoskeletal diseases*
  UE-MSD ≤1(n=216) UE-MSD 2(n=291) UE-MSD ≥3(n=343) p-value
Age (yr) 54.85±9.01 58.89±8.07 63.40±7.30 ＜0.001
Gender       0.056
 Female 101 (46.8) 145 (49.8) 194 (56.6)  
 Male 115 (53.2) 146 (50.2) 149 (43.4)  
Level of education       ＜0.001
 ≤ Elementary school 46 (21.3) 105 (36.1) 181 (52.8)  
 Middle school 45 (20.8) 82 (28.2) 95 (27.7)  
 ≥ High school 125 (57.9) 104 (35.7) 67 (19.5)  
Marriage (yes) 197 (91.2) 262 (90.0) 301 (87.8) 0.397
Smoking (yes) 42 (19.4) 43 (14.7) 39 (11.4) 0.029
Hypertension (yes) 51 (23.6) 90 (30.9) 115 (33.5) 0.044
Diabetes (yes) 21 (9.7) 32 (11.0) 41 (12.0) 0.632
Subjective health status       0.345
 Well-being 44 (20.4) 49 (16.8) 54 (15.7)  
 Impaired 172 (79.6) 242 (83.2) 289 (84.3)  
BMI (kg/m2) 24.19±2.96 24.34±3.08 24.88±3.01 0.015
Waist circumference (cm) 83.09±8.78 84.92±8.31 86.49±8.02 ＜0.001
Total working period (yr) 24.28±13.19 28.99±13.66 35.33±13.66 ＜0.001
Depression (PHQ-2 ≥3) 27 (12.5) 32 (11.0) 47 (13.7) 0.606
DASH score 11.67±11.91 13.94±13.68 16.23±14.38 0.001

Values are presented as mean±standard deviation or number (%). BMI: body mass index, DASH score: the Disabilities of the Arm, Shoulder, and Hand score, PHQ-2: the Patient Health Questionnaire-2, UE-MSD: upper extremity musculoskeletal disease.

* Myofascial pain syndrome, hand osteoarthritis, rotator cuff tear, and carpal tunnel syndrome.

Table 5.
The risk factors of major upper extremity musculoskeletal diseases among Korean farmers
Variable Myofascial pain syndrome
 Rotator cuff tear
 Hand osteoarthritis
 Carpal tunnel syndrome
OR 95% CI p-value OR 95% CI p-value OR 95% CI p-value OR 95% CI p-value
Age 0.974 0.949∼0.999 0.044 1.046 1.021∼1.071 <0.001 1.144 1.111∼1.177 <0.001 1.029 1.006∼1.054 0.014
Female 1.831 1.128∼2.753 0.004 0.741 0.512∼1.072 0.111 2.025 1.363∼3.009 <0.001 1.749 1.217∼2.515 0.003
Overhead work 2.347 1.654∼3.329 <0.001 1.43 1.038∼1.97 0.029 0.963 0.681∼1.363 0.831 0.978 0.715∼1.337 0.887
Waist circumference 0.994 0.974∼1.015 0.58 1.031 1.012∼1.051 0.002 1.037 1.016∼1.059 <0.001 1.033 1.014∼1.053 0.001
Education level* (≤Elementary school)                        
 Middle school 0.663 0.417∼1.053 0.082 0.859 0.573∼1.289 0.463 1.156 0.765∼1.746 0.49 1.036 0.703∼1.526 0.858
 ≥High school 0.448 0.268∼0.747 0.002 0.623 0.397∼0.978 0.04 1.125 0.707∼1.791 0.618 0.867 0.559∼1.345 0.525
Marriage 0.929 0.531∼1.626 0.797 0.692 0.413∼1.16 0.163 1.449 0.824∼2.547 0.198 1.029 0.625∼1.696 0.909
Smoking 1.107 0.682∼1.797 0.68 0.79 0.499∼1.251 0.315 0.783 0.475∼1.29 0.337 0.837 0.53∼1.322 0.445
Hypertension 0.985 0.676∼1.435 0.936 0.998 0.71∼1.404 0.992 0.728 0.509∼1.041 0.082 0.924 0.665∼1.283 0.636
Diabetes 1.129 0.664∼1.922 0.654 0.611 0.381∼0.981 0.042 0.652 0.396∼1.071 0.091 1.172 0.73∼1.883 0.512
Depression 1.485 0.859∼2.567 0.157 0.978 0.627∼1.526 0.923 1.045 0.647∼1.689 0.856 0.765 0.492∼1.188 0.233
Total working period 0.997 0.982∼1.011 0.647 1.003 0.99∼1.017 0.634 1.015 1.001∼1.03 0.038 1.008 0.995∼1.021 0.214

CI: confidence interval, OR: odds ratio.

* The reference group of education level is ≤ Elementary school in the multiple logistic regression analysis (see above).

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