Depois de longas horas de trabalho ou exposição a fatores inadequados nos aspectos organizacionais e ergonômicos da atividade em si, pode surgir aquele desconforto nas mãos ou em outra parte do corpo, às vezes com formigamento e até fraqueza e incapacidade de segurar determinados objetos. Embora em um primeiro momento esses sintomas pareçam inofensivos, eles podem indicar síndromes clínicas, conhecidas como lesões por esforço repetitivo (LER) ou distúrbios osteomusculares relacionados ao trabalho (DORT).
Em busca de conscientizar sobre a LER/DORT, a Organização Mundial de Saúde (OMS) instituiu o dia internacional de combate a estas síndromes. Neste 28 de fevereiro, o Ministério da Saúde alerta sobre os sintomas, as causas e os tratamentos disponibilizados na rede pública.
O que são essas lesões?
A LER/DORT são estabelecidas pelo Guia de Vigilância em Saúde como síndromes clínicas que afetam o sistema musculoesquelético e nervoso do paciente. Elas podem ser causadas, mantidas ou agravadas pelo trabalho e atingem diversas categorias profissionais.
Quais são os fatores de risco à LER/DORT?
Diversas características podem tornar um ambiente propício ao desenvolvimento destas lesões, desde aspectos cognitivos, sensoriais, biomecânicos e afetivos. As síndromes podem estar associadas a movimentos repetitivos, sem pausas para recuperação; exposição a vibrações; posturas estáticas ou inadequadas no trabalho; mobiliários não ergonômicos; temperaturas extremas; ruídos elevados; carga e ritmo de trabalho acelerado; pressão por metas; horas extras excessivas; sobrecarga de peso; exigências cognitivas; ritmo de trabalho; ambiente social e técnico do trabalho, entre outros.
Os fatores de risco para a ocorrência de LER/DORT devem ser analisados de forma integrada, mas algumas ocupações estão mais propensas a sofrer estas lesões. No Brasil, de 2006 a 2022, o maior número de notificações da síndrome, de acordo com os dados do Sistema de Informação de Agravos de Notificação (Sinan), foi entre trabalhadores de serviço doméstico, seguido de alimentadores de linha de produção e operadores de máquinas a vapor e utilidades.
Confira algumas profissões mais comumente relacionadas às lesões:
Trabalhadores de teleatendimento;
Operadores de caixas;
Digitadores;
Escriturários;
Montadores de pequenas peças e componentes;
Trabalhadores de confecção de calçados;
Costureiros;
Telefonistas;
Passadeiras;
Cozinheiros e auxiliares de cozinha;
Trabalhadores de limpeza;
Auxiliares de odontologia;
Cortadores de cana;
Profissionais de controle de qualidade;
Operadores de máquinas e de terminais de computador;
Auxiliares e técnicos administrativos;
Auxiliares de contabilidade;
Pedreiros;
Secretários;
Copeiros;
Eletricistas;
Bancários;
Trabalhadores da indústria.
Como prevenir as lesões?
O melhor método é a avaliação e, quando necessário, a adequação nos ambientes e processos organizacionais de trabalho e atividades que podem desencadear a LER/DORT. Uma das formas utilizadas para avaliar esses ambientes é a Inspeção Sanitária em Saúde do Trabalhador, realizada pelas equipes de Vigilância em Saúde do Trabalhador.
Também é possível adotar programas de atividades físicas orientadas, como exercícios de alongamentos localizados e de grandes segmentos do corpo, fortalecimento muscular localizado e atividade aeróbica, por exemplo. As atividades também podem ser realizadas nos ambientes de trabalho, por meio da cinesioterapia laboral, com mecanismos de antecipação ou de compensação que se adaptem às atividades realizadas pelos colaboradores.
Orientações específicas também podem ser dadas por profissionais habilitados que conheçam as condições dos ambientes e do processo de trabalho que cada paciente está inserido.
Como identificar LER/DORT?
As principais queixas relacionadas são dor localizada, irradiada ou generalizada; desconforto; fadiga e sensação de peso, principalmente em membros superiores e coluna vertebral. Também podem ocorrer dor crônica; parestesia (formigamento); fadiga e enrijecimento muscular; edema; choque; inflamação articular; perda de força muscular, da firmeza das mãos e da sensibilidade; tenossinovites (processo inflamatório de tendões), sinovites (processo inflamatório de tecidos ou articulações) e compressões.
As complicações destas síndromes clínicas envolvem a incapacidade temporária parcial para o trabalho e a incapacidade permanente parcial ou total, podendo levar à perda precoce da capacidade para o trabalho e ao afastamento por período prolongado. Por isso, a principal orientação é buscar atendimento ao primeiro sinal de desconforto.
Como é feito o tratamento da LER/DORT?
O tratamento pode ser realizado por uma equipe interdisciplinar, envolvendo fisioterapeutas, terapeutas ocupacionais, enfermeiros, assistentes sociais, educadores físicos, médicos, psicólogos, além de profissionais de terapias complementares e terapeuta corporal, com domínio de técnicas diversificadas para se obter efetividade.
O atendimento clínico da Unidade de Saúde de Atenção Básica pode acompanhar os primeiros sintomas e os casos de baixa complexidade e, caso o médico da UBS tenha dúvidas relacionadas ao quadro clínico, ele encaminhará o paciente ao especialista, de acordo com a Rede de Atenção à Saúde disponível no município.
No entanto, com relativa frequência, os pacientes com LER/DORT procuram a Rede de Urgência/Emergência e Pronto-Atendimento em crises de dor, devido ao agravamento da síndrome clínica. O paciente com diferente grau de evolução pode apresentar dores que atingem um ou dois membros superiores, de forte intensidade. Após a assistência inicial no pronto-atendimento, o paciente deve ser encaminhado para a investigação e os procedimentos adequados na Rede de Atenção Básica.
Quais intervenções são feitas no SUS?
No Sistema Único de Saúde o profissional avaliará, de acordo com cada caso, o tratamento adequado. Uma das medidas eficazes a longo prazo são as atividades em grupo com os pacientes. Os encontros tem caráter terapêutico educativo, com proposta de reflexão do processo de adoecimento, discussão sobre dúvidas e compartilhamento das dificuldades enfrentadas no diagnóstico e no tratamento, além dos limites de cada paciente.
As vivências do grupo permitem ao trabalhador transformar as percepções individuais em noções coletivas e auxilia o estabelecimento de relações do seu próprio adoecimento com o processo de trabalho, de forma a auxiliar a consciência crítica e a adoção de posturas que transformam o ambiente de trabalho e a realidade social.
No SUS, também há a Rede Nacional de Atenção Integral à Saúde do Trabalhador (Renast), composta pela atenção primária à saúde, os serviços de média e alta complexidade, os Centros de Referência em Saúde do Trabalhador (Cerest) e a Vigilância em Saúde, dentre outros, que realizam ações de Vigilância em Saúde do Trabalhador, de acordo com suas especificidades e a partir do conhecimento do território de abrangência.
Atualmente, o sistema conta com 217 Cerest (190 regionais ou municipais e 27 estaduais ou distrital) que desempenham importante papel para prevenção e orientação nos casos de LER/DORT, com suporte técnico e especializado aos demais pontos da Rede de Atenção à Saúde do SUS para o desenvolvimento das ações de saúde do trabalhador.
As equipes realizam atividades de educação em saúde com trabalhadores diagnosticados, acompanham os pacientes na rede de atenção à saúde e notificam os casos no Sinan, além de emitirem a Comunicação do Acidente de Trabalho (CAT), caso o trabalhador seja segurado pelo Instituto Nacional do Seguro Social.
Fonte: Ministério da Saúde.
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