What clusters exist among the health care personnel screened for upper extremity musculoskeletal conditions?

BACKGROUND: Self-limiting or degenerative upper extremity musculoskeletal conditions (UEMSCs) are common and often managed without medical intervention. This study aims to identify latent subgroups of these conditions in individuals who do not seek care, by examining a range of biopsychosocial factors. Understanding these patterns, can provide insights to inform personalized and comprehensive care strategies for individuals who do seek medical attention for musculoskeletal illnesses. METHODS: A total of 4,635 healthcare staff who provided consent were included in a within cohort-cross-sectional study. We conducted interviews and physical examinations to screen participants for common UEMSCs. Two latent class analyses (LCA) identified statistical groupings of the following upper extremity conditions diagnosed based on symptoms and signs: carpal tunnel syndrome (CTS), lateral epicondylitis (LE), trapeziometacarpal osteoarthritis (TMC OA), DeQuervain tendinopathy (DEQ), trigger digit (TD), ganglion cyst (GAN), and rotator cuff tendinopathy (RCT). One LCA among the 4635 people screened and the other LCA among the 713 people with at least one UEMSC. We then analyzed the association of several biopsychosocial factors with the specific classes identified. RESULTS: Among the 4635 workers, 3 latent classes were identified: (1) All UEMSCs except GAN, high distress, lower socioeconomic status, and limited strength (0.4%; 18 workers), (2) Varied UEMSCs, high distress, lower socioeconomic status, and average strength (3.6%, 168 workers), and (3) Limited prevalence of UEMSCs, average distress, average socioeconomic status, and average strength (96%, 4449 workers). Among the 713 people with at least one UE diagnosis 4 latent classes were identified: (1) Isolated RCT (30%, 223 people), (2) Isolated CTS (16%, 127 people) (3) Isolated GAN (7%, 47 people), and (4) varied other specific UEMSCs (47%, 316 people). The people in the GAN class were younger and both mentally and physically healthier. CONCLUSION: The finding that upper extremity musculoskeletal symptoms and signs are classified with psychological distress and lower socio-economic status among people not seeking care (population cohort), particularly when there is more than one focus of musculoskeletal symptoms, suggests that mental and social health may be key aspects of musculoskeletal illness. TYPE OF STUDY/LOE: Differential Diagnosis / Symptom Prevalence Study. LEVEL OF EVIDENCE: Level II.