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PubMed1992

Cumulative trauma disorders of the hand and wrist in the auto industry.

Surveillance for cumulative trauma disorders (CTDs) of the hand and wrist was carried out in five US automotive plants from 1985 to 1986, using Occupational Safety and Health Administration (OSHA) Form 200 injury and illness logs and medical insurance claims. Results using both record sources indicated that hand and wrist disorders may be more common in foundries than in other types of automotive plants. Similarly, in assembly plants, employees in certain departments appeared to be at higher risk for CTDs. Although our results are based on small numbers of cases, they suggest plants and departments that might be targeted for more detailed investigation.

Automobiles↗
PubMed1989

Relationship of cumulative trauma disorders of the upper extremity to degree of hand preference.

The degree of hand preference, ie, the extent to which the use of one upper extremity is obligate, has not been studied previously as a possible risk factor for the development of upper extremity cumulative trauma disorders (UECTDs). This case-control study was designed to test the hypothesis that strong hand preference, whether left or right, would be associated with UECTDs in a working population. Case subjects were drawn from workers who presented to one of two acute care clinics for treatment of work-related cumulative trauma disorders of the upper extremity. Control subjects were drawn from job applicants presenting for preplacement examinations at the same two clinics. The degree of hand preference was determined by the Edinburgh Handedness Inventory of Oldfield. The 48 case subjects evidenced a higher absolute value of the mean handedness score (indicative of a stronger degree of hand preference) than the 134 control subjects (P = .01). As a dichotomized variable, being "strong"-handed versus "weak"-handed was a significant risk factor for UECTD (P = .01, odds ratio = 2.48). Among the 48 case subjects, 83% had a UECTD ipsilateral to the side of hand preference. This study found that workers who develop cumulative trauma disorders of the upper extremity are more likely to exhibit a strong hand preference than a group of applicants entering the work force. These findings suggest that the endogenously determined obligate use of one extremity may be a significant risk factor for the development of upper extremity cumulative trauma disorders.

Adult↗
PubMed1992

Biomechanical factors affecting upper extremity cumulative trauma disorders in sign language interpreters.

Symptoms associated with upper extremity cumulative trauma disorders (UECTDs) recently have been reported in professional sign language interpreters. The present investigation is a case control study of potential biomechanical factors that may exacerbate or maintain UECTD-related symptoms in this occupational group. Based on the results of a medical screening, interpreters were classified into two groups: working with pain (n = 16) and working without pain (n = 13). There were no significant differences between the groups on age, gender, years signing, years interpreting, and wrist and forearm endurance and flexibility as measured during an isokinetic strength test of the upper extremities. Subjects were exposed to a standard interpreting task. Groups were compared on measures of repetitiveness of hand/wrist motion, work/rest cycle, postural stress, and smoothness of movement. Heart rate, pain, fatigue, and perceived reduction in extremity flexibility also were measured. The group working with pain demonstrated a distinct pattern of potential biomechanical risk factors previously associated with UECTDs in other occupations. By comparison with the control group, those working with pain exhibited fewer rest breaks, more frequent hand/wrist deviations from neutral, more frequent lateral excursions from an optimal work envelope, and more rapid finger/hand movements while interpreting. Significant group differences on self-report measures of pain, fatigue, and perceived limitation in range of motion also were observed. An analysis of heart-rate response to the interpreting task revealed that both groups demonstrated a modest increase in heart rate to the interpreting task, although interpreters working with pain displayed lower heart rates across all phases of the experimental task.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Reinjury prevention follow-through for clients with cumulative trauma disorders.

OBJECTIVES: Fifteen subjects with upper extremity work-related cumulative trauma disorders were involved in a quality improvement study to determine their self-reported degree of follow-through with reinjury prevention regimens. The effect of cuing was also studied. METHOD: During occupational therapy, subjects were involved in an educational session that focused on recommendations in ergonomic equipment, therapeutic maintenance techniques, body mechanics, and work simplification techniques. Follow-through with reinjury prevention education was evaluated and rated via telephone interviews approximately 2 weeks (T1) and 4 weeks (T2) after the educational session. Subjects did not know the questions they would be asked at T1, but were cued that their progress would be checked again at T2. Dependent t tests were conducted to compare the mean number of recommendations for which complete follow-through was expected with the mean number of recommendations at T1 and T2 that were implemented completely. RESULTS: A significantly lower degree was found of absolute completion of recommendations at T1 and T2 than had been anticipated (p < .002). No significant difference between T1 and T2 was found, indicating that cuing at T1 had little effect on subjects' actual follow-through rate. CONCLUSION: The implications of these findings for occupational therapists support the need for further research in reinjury prevention and employer education.

Adult↗
PubMed1996

Cumulative trauma disorders among apparel manufacturing employees in the southeastern United States.

Factors associated with cumulative trauma disorders (CTDs) of the upper extremities were studied retrospectively, using data from three apparel manufacturing plants in the southeastern United States. Reported CTDs among the employees at risk during fiscal years 1991 and 1992 were analyzed focusing on individual and plant variables. Results showed that CTD rates increased from 1991 to 1992 and fluctuated in a cyclical pattern each year, peaking during January, March, and August. Employee age and duration of employment were associated with CTD rates. Employees aged 45 to 49 had higher CTD rates than those in any other age groups. Employees with 1 to 3 years' experience had higher CTD rates than employees with more years of service.

Adolescent↗
PubMed1994

Industrial wrist motions and incidence of hand/wrist cumulative trauma disorders.

One of the major research voids in the study of occupational hand/wrist cumulative trauma disorders (CTDs) is the lack of quantification of the relationship between the known kinematic risk factors, such as wrist angle and repetition, and CTD risk. A previously published article in this journal (Marras and Schoenmarklin 1993) reported the descriptive results from a quantitative surveillance study performed in industry in which worker's wrist motions were monitored on the factory floor. The wrist motion components that were monitored on each subject were position, velocity, and acceleration measures in each plane of movement (radial/ulnar, flexion/extension, and pronation/supination). The objective of this article was to form a metric that associates the degree of incidence of hand/wrist CTDs with those types of wrist motions that were significant in the earlier paper. Of all the kinematic parameters measured, multivariate analysis of the motion data revealed that acceleration in the flexion/extension plane discriminated the best between groups of low and high incidence rates of CTDs. The epidemiological association between flexion/extension acceleration and CTD incidence rate is compatible with results from empirical studies and theoretical models in the physiologic and biomechanical literature. The flexion/extension acceleration values from this study can serve as preliminary motion benchmarks that establish relative risk levels of CTDs for hand-intensive, highly repetitive jobs that do not require hand tools. Industrial practitioners can use this methodology, along with other accepted tools, to enhance ergonomic assessments of jobs.

Adult↗
PubMedDate not supplied

Interrater reliability of pinch and grip strength measurements in patients with cumulative trauma disorders.

The purposes of this study were to examine the interrater reliabilities of grip, lateral pinch, and tripod pinch measurements in patients with cumulative trauma disorders. Thirty-eight patients with unilateral (n = 28) or bilateral (n = 10) cumulative trauma disorders were tested independently by two hand therapists, during a one-hour period. The tests were completed in a normal hand clinic environment using the standard protocol recommended by the American Society of Hand Therapists. Interrater reliability coefficients for the scores obtained using either a single repetition or the mean of three repetitions were very high (intraclass correlation coefficient [ICC] > 0.87) for all strength measurements. As a result, strength determination in this patient group, when performed by different hand therapists, may be considered reliable.

Evaluation Studies as Topic↗
PubMed1987

Work pace, stress, and cumulative trauma disorders.

This paper discusses the potential roles of work pace and work pressure as risk factors in the development of cumulative trauma disorders. Specifically, electromyographic (EMG) data were collected from the forearm flexor muscles of workers performing a highly repetitive task. This task had previously been identified as one that involved a high incidence of cumulative trauma disorders. Workers were asked to increase and decrease their work pace for short periods of time. The EMG data indicated that faster work paces were accompanied by higher forces. However, it was also noted that unsuccessful attempts to speedup or slowdown produced similar increases and decreases in EMG activity, indicating that speed of movement was not the only factor contributing to the changes in muscular activity. The results are discussed in relation to the stress and tension associated with work pressure caused by machine pacing, production standards, and incentive systems.

Accidents, Occupational↗
PubMed1996

Cumulative trauma disorders of the upper limbs in workers on an agricultural farm.

The work associated with repetitive efforts and inadequate resting periods, strong physical exertion, awkward postures or static positioning exposes workers to the risk of cumulative trauma disorders of the upper limbs. These risk factors are present in many agricultural activities. A study was carried out among workers on an agricultural farm. The workers' histories were taken and they were given periodical medical check-ups. The presence of upper limb disorders was shown in a group of workers. A sample of 42 people was selected for the study by means of specific tests: electromyography, ultrasonography and laser-doppler flowmetry. The tests showed a high incidence of carpal tunnel syndrome and microcirculation disorders. The study confirmed that electromyography, ultrasonography and/or laser-doppler flowmetry are highly useful tools for identifying cumulative trauma disorders.

Adult↗
PubMed1996

A prospective study for upper-extremity cumulative trauma disorders of workers in aircraft manufacturing.

Occupational diseases affect 15 to 20% of all Americans. Cumulative trauma disorders (CTDs) account for 56% of all occupational injuries. The recognition and control of occupational injuries has become a major concern of employees, employers, medicine, and the federal government because of health risk and related costs. Upper-extremity CTDs are identified by the National Institute for Occupational Safety and Health as one of the ten most significant occupational health problems in the United States. It is estimated by the year 2000 that 50 cents on the dollar will be spent on CTDs. Although enlightened aircraft employers have developed primary prevention strategies, primary prevention can never be expected to eliminate 100% of the cases. To evaluate several preventive activities, a CTD risk-assessment program was developed and implemented in cooperation with a major aircraft manufacturer employing over 8000 workers. This program was focused on objectively identifying the relationship of work and other activities to an individual worker experiencing CTDs. Early identification has been linked, when applicable, to intervention algorithms for medical care, job task modification, workplace accommodation, and training. A prospective study group of 212 workers who used rivet guns was placed into a four-way experimental design for ergonomic posture training, exercise training, and rivet-gun type (primary factors). A statistical model was developed for the level of CTD risk and evaluated using the SAS software program (SAS Institute, Inc, Carry, NC). Statistical analysis of the primary factors without regard to associated variables (covariates) demonstrated that only posture training had a beneficial risk reduction for the individual. The impact (beneficial or detrimental) for exercise training and for vibration-dampening rivet guns was probably obscured because of the large variability of the responses regarding the associated variables (covariates). When the covariates were analyzed in conjunction with the four experimental groups, a positive benefit from ergonomic posture training and exercise training was demonstrated for the following groups: the dominant han, time spend in an awkward position, number of standard rivets bucked, number of parts routed, number of parts ground, number of vibration-dampening rivets bucked, and newly hired individuals. A negative effect (increase in individual risk level) for current employees using a vibration-dampening rivet gun was demonstrated. This prospective study helps to identify the possible benefit of education and training for controlling CTDs and demonstrates the usefulness of being able to evaluate materials, methods, machines, and environments as they relate to the individual's risk level for the development of upper-extremity CTDs.

Adult↗
PubMed1997

Cumulative trauma disorders: an ergonomic approach for prevention.

Clinical practice can place the dental hygienist at risk of acquiring cumulative trauma disorders (CTD). This article describes causative factors of CTD and suggests implementation of ergonomic intervention--by way of clinical and environmental factors--as a method of preventing and/or reducing CTD in the workplace. Included is a chronology of the rehabilitation process of a dental hygienist who has been disabled by CTD. Observing this clinician's re-training process, which included utilizing an ergonomically designed operator chair, arm and wrist supports, and modification of operator positioning, prompted an investigation into strategies to prevent CTD. Ergonomic design and protective operator techniques in dental hygiene practice may be key to preventing and/or reducing CTD occurrence.

Cumulative Trauma Disorders↗