Web-OOS Network Support
For Occupational Overuse Syndrome Sufferers -
Support and Information

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OOS Medical Info and Diagrams

Not intended to be a professional medical website, this is our understanding (there are a lot of different theories out there!). Feel free to make your genuine contribution through our Web-OOS group but no selling is allowed in the group.

What's on this page:

•Common Stages of OOS
•Some Anatomy and Physiology
•Injuries and their Treatment Options
•Medical Professionals, who they are and what they do
•We need YOUR genuine feedback!

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...we only have one pair of hands....

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LINKS TO OTHER WEBSITES:
Ergonomics and human factors
E-medicine (tendonitis)

COMMON STAGES OF OOS INJURY

-Note that this is a guide only as the signs and symptoms of OOS can vary greatly.-
It is possible to have very minimal warning before Stage Three kicks in.
STAGE ONE STAGE TWO STAGE THREE
Mild, passing pain and/or weakness in arm, neck and/or hand. Pain and/or weakness progresses through the day but is usually gone by the next morning. However, there is sometimes pain in the night through lying on the affected arm. Pain is very severe, may be weakness as well. Pain does not go away at all. It is constant, 24 hours, and extremely debilitating.

What Is Happening?

Occupational overuse syndrome is basically the result of an over-stimulated muscle-nerve action. Repetitive arm/hand jobs, or other constant contraction or lifting of the arms, may easily lead to a serious and painful condition.

There are many different injuries that can occur as a result of repetitive motion and in New Zealand these are usually grouped under the label of a regional pain or chronic pain syndrome (by ACC assessors). Unfortunately, it is difficult to get a more accurate diagnosis.

If you have Diffuse OOS, as opposed to a simple local and TREATED tendon injury, you will probably always have to consciously instruct your muscles to relax. Diffuse OOS, causes "seizing up" of the arms and hands, because the muscles literally lock-up. It can lead to many lumps (myofascial trigger points) throughout the whole body. This can happen even over a comparatively short term (less than one year).

Once Diffuse OOS has spread, it is difficult to reverse. It takes a very experienced and interested practitioner to know how to treat it. We hope to compile a list of those who have helped people with OOS and a questionnaire to ask medical practitioners. Remember, it's YOUR life and YOUR health. Some practitioners today are, sadly, in it only for the money and do not have a vocational calling to help people.


ANATOMY AND PHYSIOLOGY:

The following is an introduction to the upper body's anatomy and physiology which may be damaged in a hand-arm OOS injury.

The diagram at left shows muscles of the arm. It is the right arm. Hand/finger muscles and tendons are moved by the forearm muscles. We know of sufferers whose tendons have bulged out from the palm of their hands as a result of OOS.
To the right is a photo of the right shoulder and upper arm, facing the front of the body. The median nerve can be seen running under the collar bone.
right arm muscles
shoulder and upper arm diagram
Copyright Univ of Newcastle Upon Tyne, UK

Further excellent anatomy and physiology links:

Muscle and Tendon Response to Overuse Biomechanical Mechanisms from Overuse
Vertebrae East Bay Chiropractic in US has info on the vertebrae and which areas of the body they affect.
Brachial Plexus A Brachial Plexus Tutorial from the University of Newcastle upon Tyne.

OOS INJURIES AND TREATMENTS:

Defining the Injuries:

Local/Regional Injuries:

Occupational Overuse Syndrome is a term used to cover various conditions usually caused by - yes, you guessed it! - overuse! This term covers many different injuries, some of which are in this table:

HAND and FOREARM
Intersection syndrome
DeQuervain's tenosynovitis
Carpal tunnel syndrome
Guyon's canal syndrome
Pronator teres syndrome
Trigger finger
Trigger thumb
Tenosynovitis/tendonitis
ELBOW
Tennis Elbow:
Epicondylitis (tennis elbow)
Radial tunnel syndrome
Cubital tunnel syndrome
SHOULDER
Bicipital tendonitis (pain over anterior shoulder)
Thoracic outlet syndrome
Impingement syndrome
Rotator cuff injury
UPPER SPINE
Cervical disc herniation
Chiari malformation syndrome
Supraspinatus tendonitis

Diffuse OOS:

This is a condition we have mentioned above which results from prolonged or excessive strain on the upper body, and thereby resulting in an ongoing condition which does not easily resolve nor heal by itself. There are various theories about Diffuse OOS. However, the stages above are the typical stages which can lead to Diffuse OOS (diffuse meaning it tends to travel - before you know it, it's up your arms and into your back and neck, and then you're lucky if it stops there!)
The term "Diffuse OOS" has been laid aside by a lot of practitioners and ACC, in favour of "chronic pain syndrome" or something similar. In our opinion this tends to diminish and cloud the nature of the condition so we continue to call it "Diffuse OOS".

-Please note that this is our own opinion and stance.-

Diagnosis (allopathic):

Many doctors find it difficult to make a diagnosis but there are some who know how to examine, not only for tendonitis and other simple local injuries, but also for trigger points. A good doctor should also know how and when to refer you for other tests, for example blood tests or a nerve conduction test. We would also like to see Drs referring us for venograms to measure venous bloodflow in our arms, and/or for high frequency ultrasound.

As well as medical examination, the type of work the person is involved in, the actions performed, pressure from supervisors to work harder and faster, hours per day at a high-risk task (not just keying), plus the ergonomic arrangements (or not) will all give clues as to which muscles etc are affected and why. You need to find a practitioner, whether it be a GP, osteopath or physio who properly understands OOS conditions and is interested in your health (not just their chequebook), or they can make your injury worse.

Treatments:

*Ask a health practitioner you trust before making treatment decisions*

Localised OOS:
Occupational overuse injuries must be treated individually. A couple of good websites which explain and illustrate a number of localised OOS injuries and remedies, are:
SPA. Anexcellent website which also has anatomy and treatment info worth reading. Medical Multimedia Group. This site explains local conditions like Carpal Tunnel Syndrome.

Diffuse OOS:
People with Diffuse OOS have found relief from a range of different treatments so it's not easy to make a list but many have found massage to be beneficial (but not curative) and relaxation therapy also helps to relax the muscles and aid maximum-possible function.

Specific Treatments
Physiotherapy can aid recovery if the physiotherapist understands that OOS can go through the body and if he/she is willing to work with you. We have had good reports from people receiving deep-needling (this is different to acupuncture), but this is something you should look into and decide whether it is appropriate for You. Deep needling may sometimes be done by physiotherapists or osteopaths or doctors.

Stretching? The stage of injury vs recovery is important when giving consideration to how you are treated. For example, never stretch if you have active, painful trigger points. In fact, never stretch to the point of pain. ("No pain, no gain" is incorrect in the treatment of OOS.) Here's an article on how to stretch - (when trigger points have been reduced and your condition is very stable. Get a good physio/osteopath).

Rest In the worst stages, rest and relaxation of the arms is absolutely critical and may be the only treatment which will really help. Some of us have found that, contrary to many physios' opinions, a splint/sling can be a good idea when the ache is very deep/sharp. Especially if even letting your arms "relax" at your sides is worsening the pain. Also, a cervical collar can rest the neck muscles if you're having difficulty holding up your head. Sounds daft but true! In our experience, rest is the most helpful treatment, together with warm/cold packs (ask your practitioner which to use) in the early stages. If rest is not given at that time, and if the injured person is not informed on how to rest the hand/s and arms, nor given adequate personal/home support, then a chronic condition is in the making.

Importantly, remember that you are the one who can best gauge what works best for you. When you do decide to try a new treatment, be wise and don't overdo it.

Biofeedback, an aid to relaxation therapy and measuring muscle response to activity. Website about biofeedback

Herbs, vitamins and pharmaceutical drugs have a mixed response. If you are in severe 24hour pain, sleep may not come easily. There are different medicines available from your doctor, or you can try one of the alternative medicines. However, the relief of pain is a necessity in order to be able to sleep. A good doctor will understand this. For medicinal treatment, please consult a naturopath and/or doctor as appropriate, so that you are taking correct dosages, and can be informed about contraindications and possible side-effects. The following is a list of some common ones which some people have found useful:

VITAMINS

Vitamin B complex, with choline
Vitamin C
Vitamin E
Vitamin A
HOMEOPATHIC/HERBAL

Magnesium tablets
Rhus Tox
, a homeopathic sprain remedy
Epsom salts, good in the bath
Anti-Flamme cream, (contains arnica)
ALLOPATHIC
(conventional medicine)

Gabapentin Info here.   Lumps pain and depression together. Depression is, of course, an understandable result of chronic pain.
Venlafaxine
Amitriptyline

We would like to hear from you if you have had particular relief from any one type of treatment. It could be massage, deep needling, relaxation therapy, acupuncture, spinal manipulation, homeopathy, naturopathy, physiotherapy, pharmaceuticals or a combination of treatments. Please tell us! If you do decide to email us, we need to know the area which has been affected and how long you've had OOS as well. Personal information is not and never will be divulged by us to ANYONE. That is an absolute promise.

Here is where to find info on:

Fibromyalgia, Myofascial Pain Syndrome and Reflex Sympathetic Dystrophy!

(This means you may be getting into severe and prolonged pain and disability, sorry people but that's the facts! If that happens, you need a support group of some kind.)
FIBROMYALGIA

(Note: It's possible for OOS to become a fibromyalgia condition. Fibromyalgia means "pain in the fibrous tissues and muscles".)

Devin Starlanyl: Do you have Fibromyalgia or Myofascial Pain Syndrome? Get some info at Devin Starlanyl's website.

A good newsgroup to join if you have fibromyalgia is
alt.med.fibromyalgia
It's excellent and international (although mainly American of course).

MYOFASCIAL PAIN

The Bones Doctor: This practitioner is in America. If you know of anyone who agrees with this treatment, please email us as we want to compile a list of treatment providers like Richard. This page has great info about the myofascia and trigger points!

Also see Devin Starlanyl's website at left.

RSD

Reflex Sympathetic Dystrophy is a much debated disorder. But when you have this, you are in deep pain.

RSD Hope, one of the best RSD websites.

Mensana Clinic: Tries to make some sense of it.

If you have chronic pain or disability and you want spiritual support,
this is the place for you to find it:

Rest Ministries, Inc. serving people who live with chronic illness or pain.

MEDICAL PROFESSIONALS and THERAPISTS - who they are and what they do-

a basic understanding only as many health professionals now mix alternative medicine
with allopathic (conventional) medicine.
General Practitioner Physiotherapist Osteopath
This is your local doctor. Choose carefully! Not all understand about OOS and its potentially devastating effects. Some don't believe there is anything wrong with people suffering from OOS. Physios can differ widely. Their typical work is stretching (great care needed with this!), heat application, exercises, ultrasound, and quite often (these days) manipulation. Some physios also use acupuncture or deep needling or massage. Osteopaths concentrate on massage and gentle tissue manipulation. They often use natural medications, too.
Medical Specialists Naturopaths Chiropractor
Orthopaedic surgeon (especially if you have something like carpal tunnel syndrome)
If you have Diffuse OOS, the main med Specialists in NZ who may help are rheumatologists. Again, some are better informed and more supportive than others.
Naturopaths vary widely. They usually concentrate on diet, vitamin and/or herbal supplements, homeopathy, aromatherapy, massage. Chiropractors manipulate the spine. Some use homeopathic treatments, too.
Kinesiologist Acupuncturist Self Therapy
Kinesiology is an interesting subject. Concentrates on muscle-loading, how muscles affect the lymph system, foods and is very individually based. Some have had great effect from this form of diagnosis and treatment. Most people know that acupuncturists use needles which they insert at various points in the body. But not all are the same. This treatment has varied response. Some say it's good, others have said that it did them harm. You can do a lot to help yourself. Gauging your own body is something you can best do yourself. Learn to interpret your body's signals.
Bowen Therapy
Very gentle and quite a few have found relief through it. A list of NZ practitioners can be found at Bowtech.

We need to hear from YOU:

1 - If you have had any of the following tests regarding your OOS:

•An MRI of the spine or arm/s
•A venogram or arteriogram
•High frequency ultrasound
•A nerve conduction test

Please send us the type of test/s you have had (you can of course remain anonymous), and the country you live in, to:Web-OOS Network Support. If you are happy to tell us the results of the test, then that also will be appreciated. No personal details AT ALL will be revealed EVER. It is simply to ascertain the numbers of OOS patients whose injuries are being fully medically investigated, and the numbers of these types of tests ordered.

2 - We would like you to help us compile a list of questions:

Questions which you wish you had asked your doctor (or any q's you think we should include on the list, or which you would like answered). Email us at Web-OOS Network Support.

3 - We would also like to hear of relief from treatment you've received.

Please tell us the treatment and what type of injury you have, if the OOS is local (hand/arm) or body-wide, for example. Email us at Web-OOS Network Support.

THANKS A LOT! We appreciate your genuine input!

Definitions of some terms used in text above:
•Ergonomics: a modern term for work safety arrangements like how high your work surface is, lighting etc. Ergonomists can come in and assess a workplace and give advice on how to prevent injuries there. OSH (the government dept of Occupational Safety and Health) can also send in officers to assess the workplace although OSH appears to have been under-resourced in recent years.

• Trigger point: a myofascial trigger point is a taut band of skeletal muscle located in the muscle tissue and/ or associated fascia.

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Disclaimer: this OOS website is intended to be for group support and discussion and NOT for medical assessment nor professional legal advice of any kind.
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Web-OOS Network Support