Biomechanical overload of the arm:experience with risk prevention in the Fabrian metal-mechanical industy.

In the year 2000, the S.P.S.A.L. of Fabriano territorial zone, after a high number of reported cases of CTS in the Orthopedic Unit of the local hospital, started an informative and preventive study program on the risk of biomechanical overloading of the upper extremities. The study was divided in four main steps: 1. Epidemiological study I. A questionnaire assessing professional and pathological anamnesis, musculoskeletal disorders of the upper extremities as well as the professional and non professional risk factors was administered to 448 assembly line workers in seven metal mechanic factories (2000-2001). 2. Lecture for the proposed institution to communicate the results of study I (2001). 3. Evaluation of the trend on professional diseases reported by medical doctors and verified by INAL during the years 1999-2005. 4. Epidemiological study II. The same questionnaire from the first study has been administered to 448 assembly line workers in the same industries selected for the previous investigation (2005). The first study results, presented in the December 2001 lecture from the supervising institution, indicated the departments at risk and showed the necessity of collaboration between specific departments and specialized medical doctors to achieve a rapid diagnosis of work-related diseases. Following our data, the companies have adopted preventative measures, scientific methods of specific risk evaluation as well specific protocols of health survey. Both the reported and the verified diseases showed an increment starting from 2002. The comparison between the two studies demonstrated that the second group had a reduction in the CTS prevalence and in the other work-related upper extremities disorders; a reduction in the repetitive movements, in the use of vibrating instruments and work force; an increment in the number of working pauses and rotation exercises; an increment in the position switch following the appearance of the disorders. However, the results obtained show a fundamental discrepancy: a better trend has been observed in the big companies, but it is still not sufficient in the smaller companies.