title: Multilevel nerve compression and muscle imbalance in work-related neuromuscular disorders.
abstract: BACKGROUND
  Work-related upper limb disorders have come under increasing scrutiny and become a frustrating problem.
  
  
  METHODS
  A unifying hypothesis to explain the multiplicity of symptoms with work related neuromuscular disorders is outlined. This multifactorial problem includes physical, individual, and psychosocial factors. Abnormal postures and positions may compress nerves or may alter muscle length resulting in secondary compressive forces on nerves or in muscle imbalances. Evaluation should identify all nerve compression levels and muscle imbalance in the arm and cervicoscapular region. Management must include patient education, postural correction, and an exercise program to address the multiple nerve compression levels and muscle imbalance.
  
  
  CONCLUSIONS
  The etiology of work related neuromusculoskeletal disorders is multifactorial and successful management must address all contributing factors. Appropriate conservative management will relieve symptoms in most patients. Surgery should be reserved for those few patients with evidence of a specific diagnosis who have failed conservative management.
authors.affiliation: Division of Plastic & Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
authors.forename: Christine B
authors.initials: CB
authors.lastname: Novak
authors.forename: Susan E
authors.initials: SE
authors.lastname: Mackinnon
mesh_terms: D001132:Arm / Q000294:innervation*; D006801:Humans; D018482:Muscle, Skeletal / Q000294:innervation; D009334:Neck Muscles / Q000294:innervation; D009408:Nerve Compression Syndromes / Q000175:diagnosis* / Q000503:physiopathology; D009468:Neuromuscular Diseases / Q000175:diagnosis* / Q000503:physiopathology; D009784:Occupational Diseases / Q000175:diagnosis* / Q000503:physiopathology; D010525:Peripheral Nerves / Q000503:physiopathology; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications