Pain on the job: musculoskeletal disorders put a cramp in worker's compensation.

University of Utah student Wendy Weber is in constant pain and she's beginning to fear her future. Since losing all feeling in her left thumb this past spring, her life has changed dramatically while she waits for a diagnosis. "Suddenly one day, my thumb went totally numb and the tips of the other fingers are numb too," says Weber. "The neurologist my physician referred me to said that it was nerve damage, a symptom of advanced carpal tunnel syndrome. At night, the whole hand just goes numb."

According to the most recent data from the U.S. Department of Labor Statistics, Weber is among nearly 300 Utah private industry employees who've reported suffering a repetitive motion occupational injury or illness. And 37 percent of those injuries were related to a musculoskeletal system and connective tissue disorder (WMD). In fact, experts say WMD's count as one of the top 10 causes of the most disabling workplace injuries (those that cause an employee to lose six or more workdays), and one of the most expensive to employers and industries.

Where It Hurts

Musculoskeletal disorders (MSD's) include conditions that involve the nerves, tendons, muscles and supporting structures (such as interverebral discs). Examples include carpal tunnel syndrome, wrist tendonitis, golfer's elbow, tennis elbow and even "gamer's thumb" (a swelling of the thumb caused by excessive video game playing).

"Musculoskeletal system disorders by cost and frequency are the number one biggest problem," says Dan Hair, Utah's Workers Compensation Fund chief underwriting and safety officer. "Upper extremity problems and back injuries, people pulling muscles and tendons, drive the largest costs to industry and the funds paid in [workers compensation] claims."

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Liberty Mutual's Research Institute for Safety reports that more than half of the estimated $48.3 billion of the real (inflation-adjusted) cost of the most disabling workplace injuries are attributed to overexertion, in which Hair says includes repetitive motion injuries due to repeated stress or strain.

While billions are spent on annual workers compensation costs due to WMD's, according to the National Institute for Occupational Safety and Health (NIOSH), more is spent on lost productivity, employee turnover and other expenses.

"It's estimated that for every dollar spent in direct injury costs, such as medical and indemnity costs, $4 are spent in indirect costs such as lost productivity, retraining costs, and property damages," says Hair. "Everyone understands there are hidden costs to injuries."

Hair says those costs can be attributed to the fact that MSD's are extremely ambiguous, making them hard to diagnose and resulting in hidden costs. "The diagnosis for these [disorders] just isn't as clear. There are disagreements in the appropriate treatment methods, and there are many differences between the people with the injuries. A lot of times, [the injuries] just produce a lot of pain," which Hair says sometimes involve longterm disabilities.

Weber says this is her second round at trying to heal her injury. "[Symptoms] actually started two years ago," she says. "Then I just went to my primary care physician and a chiropractor, but after I was talking about how my work affected the pain so much they suggested I file a worker's compensation claim."

Weber says, though, that filing the claim didn't solve the problem. The doctor she was referred to after filing the claim diagnosed her with tendonitis, gave her a hand brace and five to 10 weeks of physical therapy, then prescribed exercises and stretches and a prescription to manage the pain. But as soon as she was back on the job, the symptoms reappeared. "After the therapy I felt pretty good, but then I went back to typing, typing, typing," says Weber. "I think those treatments were just a temporary solution."

Doctor Mark Bromberg, a neuromuscular neurologist at the University of Utah, says proper diagnosis is critical to successful healing. He uses an electrodiagnostic procedure with his patients because he finds it reveals more about nerve damage, versus going only by a patient's description of his or her symptoms. "The question is always 'what is the gold standard in diagnosis?"' he says.

A Closer Look

University of Utah Professor Kurt Hegmann was awarded $2 million--the largest grant ever awarded by NIOSH--to discover more about MSD's. Working with researchers at the University of Wisconsin, Hegmann is a co-principal investigator in an extensive study on the risk factors of Carpal Tunnel Syndrome and Tennis Elbow. The researchers were also given another $1.5 million last year to extend the project to discover interactions between risk factors.

Hegmann believes these projects will reveal much about how to treat the costly disorders. "We expect to find both personal as well as occupational risk factors, the magnitude of them and what other physical conditions such as obesity and diabetes, contribute to the development of these disorders," says Hegmann. "These are major considerations for the designs of jobs, to determine safe work limits, to reduce injuries, and lower workers' compensation costs."

Researchers have also added shoulder tendonitis disorders to the study, but carpal tunnel is still the big focus since Hegmann says they're the highest costing MSD. Although he says they haven't confirmed it yet, the evidence so far doesn't point to keyboarding as the carpal tunnel culprit. "Rather, evidence is strong for high force, hand intensive weight lifting such as what you find in processing (meat and fish) industry jobs."

Serious Impact

The U.S. Department of Labor Statistics reports that most of the nonfatal occupational injuries and illnesses involving missed workdays (of all natures) in Utah's private sector were in the service providing and goods producing industries, and almost 2 percent of those injuries, in each industry, were related to MSD's. In Utah's information industry, though, about 7 percent of reported injuries in the same categories were related to MSD's.

The highest amount of reported nonfatal injuries (all natures, involving missed workdays, in Utah's private sector) were in transportation and material moving, construction and extractive occupations, in which about 2 percent of the reported injuries were related to MSD's. In private sector office and administrative support occupations, however, about 10 percent of the reported injuries are related to MSD's. Most of the reported private sector WMD's related injuries (all categories) involved the upper body extremities; about 14 percent in the wrist and 83 percent of all reported upper extremity injuries in the finger, hand or wrist. Almost 34 percent of all reported work-related nonfatal injuries in the private sector involved contact with an object or equipment.

Weber, who is now being treated by Hegmann, strongly believes working 10 years in the information technology field is responsible for her second worker's compensation claim, more doctor visits, tests, therapy and the pain. "If I didn't do anything over the weekend, it would feel better by Monday," she says. "But by Friday, I would be in a lot of pain." She's now in constant pain regardless of rest periods, and her condition seems to be rapidly worsening. "It's really affecting my life at this point," she says. "I can't do anything with my left hand now and I'm kind of nervous because I don't want to lose my job."

A Different Approach

Doctor Alan Colledge, medical director of the Utah State Labor Commission, says there are other issues, such as social and psychological factors, that impact an injured worker's ability to heal and return to work. "Risk mangers may consider using the athletic model," explains Colledge. "It's a method that entails employing a team approach to help athletes recover from their injuries, and it can also be very effective in returning injured workers to their jobs."

The athletic model involves three factors: motivation of the injured worker (the athlete), appropriate medical care and the desire of the employer (the team) to have the injured worker return to work; the latter component is manifested by the employer's willingness to support and accommodate the worker throughout the healing process. Colledge says if any one of these components is missing, the injured worker is less likely to heal or return to work.

To optimize recovery outcomes, Colledge says the risk manager should ensure that the team coordinates its goals with the treatment methods used by the medical provider. Also, the team and the medical provider can work in conjunction to devise ways to control compensation costs, which might include increasing employee/employer communication, reducing lost time and associated indirect costs, utilizing disability management, finding alternatives to litigation and decreasing unnecessary medical expenses.

Hair says Pixar Animations Studios is a good example of a company who "gets it" when it comes to understanding the return on workplace safety and health investments. "Steve Jobs [Pixar's chairman of the board] recognized that with Pixar's production deadlines they needed everybody at work," says Hair. "And they understood the productivity costs of work-related musculoskeletal disorders because they employ hundreds of animators who work via a personal computer."

Pixar's safety program consisted of a significant investment in state-of-the-art, completely adjustable workstations, making it so the animator could work from a seated or standing position. The company also arranged for an occupational physician and physical therapist to visit the facility twice a week to help with any discomfort the staff was experiencing. "To Jobs, this was all worth the cost to keep the highly skilled and valuable employees healthy and productive," says Hair.

RELATED ARTICLE: WMD Information Resources

Many resources are available for employers and employees regarding occupational injuries. Hair says WCF policyholders can call for assistance as well as attend more than 70 free safety seminars offered statewide throughout the year. The seminars include instruction regarding an Analyze-Plan-Act-Check model of measures designed to create a positive safety culture within the company. "I just met with several of our customers in Vernal and many of them have reduced their workers compensation costs by 10 to 30 percent by consistently applying these measures," says Hair.

The Utah Safety Council also provides training, videos, educational material and other safety and health resources to businesses, industries and the community; many of the resources are bilingual. Videos addressing topics such as "Working Ergonomically in the Office," "Back Injury Prevention Employee Training," "Carpal Tunnel Syndrome" and "Repetitive Motion Injuries in the Office," last from five to 24 minutes. Anyone can access them, but fees vary for Utah Safety Council members and non-members.

There are also many publications regarding occupational health and safety, such as Occupational Health and Safety magazine (www.ohsonline.com), providing news about occupational health, safety, ergonomics and industrial hygiene. Compliance magazine (www.compliancemag.com) informs professionals responsible for workplace safety, health and environment about existing regulations, significant new laws and recent product developments and Cumulative Trauma Disorder News (www.ctdnews.com) is a monthly newsletter on information regarding cumulative trauma disorders (a sub-category of MSD's), workplace health and ergonomics.