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chronic development. They are disorders diagnosed by a medical history, physical examination,
or other medical tests that can range in severity from mild and intermittent to debilitating and
chronic, and with several distinct features as well as disorders defined primarily by the location
of the pain”. The definitions of others governmental agencies and organizations mirror the
definition proposed by NIOSH, however, with some changes. U.S. Occupational Safety and
Health Administration (OSHA) (2010), dissociates MSD from the motor vehicle accidents or other
similar accidents and cites also some examples. The European Agency for Safety and Health at
Work (EU-OSHA) adds to the affected tissues the vascular system (Schneider and Irastorza, 2010).
World Health Organization (WHO) mirrors the above definitions (Luttmann et al., 2003). The
NIOSH and OSHA, by excluding explicitly from their definitions the disorders caused by certain
instantaneous or acute events and by incorporating specific examples, have added substantial
clarity as to what disorders are not to be denoted as MSD.
Even though WRMSD were described systematically for the first time more than two centuries ago
by B. Ramazzini (Franco, 1999), it does not exist yet a single definition about them on the scientific
literature. This is because its definition largely depends upon the organizations, authoritative
agencies and national institutes from which it has been promulgated (WHO, 1985). Therefore,
different definitions have been used and proposed. According to the definition used by EU-OSHA,
WRMSD are MSD that are caused or aggravated primarily by the performance of work and by the
effects of the immediate environment where the work is carried out. Most of them are cumulative
disorders, resulting from repeated exposures to high – or low – intensity loads over a long period of
time. The symptoms may vary from discomfort and pain to decreased body function and disability
(Podniece et al., 2007, 2008). Definitions used by others authorities mirror that of EU-OSHA
(ANSI, 2007; NIOSH, 1997; Swedish Work Environment Authority, 1998).
Therefore, by definition, WRMSD are an heterogenous group of MSD, which are supposed to be
caused, accelerated, exacerbated or aggravated by exposure to ergonomic physical, physiological
and psychosocial risk factors, and their occupational exposure profile depends on which organ
or tissue level the underlying pathophysiological mechanism acts (Barbe and Barr, 2006; Forde,
Punnett, and Wegnar, 2002; Hagberg et al., 1995). In contrast to occupational diseases, where
there is a direct exposure-response relationship between hazard and disease (e.g., asbestos →
asbestosis), WRMSD do not involve always an objective pathologic condition (WHO, 1985). On one
hand, there are WRMSD for which a diagnosis can be deduced from specific symptoms and where
work related exposures are coherent with the development of the disorder (e.g., carpal tunnel
syndrome) and on the other hand, there are work related symptoms for which it is impossible to
identify reliably the pathology (e.g., iLBP) (Balagué et al., 2007; Boocock et al., 2009; Hagberg
et al., 1995; Op de Beek and Hermans, 2000; Van Dieën and Van der Beek, 2009; Visser and Van
Dieën, 2006).
Frequently, others synonymous terms have also been used internationally to describe WRMSD or a
group of them: work-related upper-limb disorders (WRULD), cumulative trauma disorders (mostly
in U.S.), repetitive motion injuries, occupational cervicobrachial diseases (mostly in Japan and
Sweden), repetitive strain injuries (mostly in Australia, U.K. and Canada), occupational overuse
syndromes (mostly in Australia), occupational overexertion syndromes, activity related soft tissue
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