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The problem with repetition.

The problem with repetition

Tendonitis. Thoracic outlet syndrome. Trigger finger. Raynaud's phenomenon. Tenosynovitis. Carpal tunnel syndrome. DeQuervain's disease. Tennis elbow.

These are some of the buzz words of occupational health for the nineties. In short, cumulative trauma disorders, also known as CTDs.

What is cumulative trauma disorder?

CTD is a work related problem that is caused by repetitive motion. Historically, it has been associated primarily with blue collar jobs involving assembly line work. However, more and more it is becoming recognized in the office.

These types of problems are becoming a much greater issue in occupational health. The effects are wide ranging. Problems are being recognized in office work, virtually all manufacturing and assembly production lines, municipal and public workers.

To put the magnitude of the problem in perspective, in 1982, the U.S. Department of Labor estimated that approximately 8% of all occupational injuries and illnesses were related to CTD. By 1987, that number had increased to 38% and in 1989, 48%.

The dramatic rise is accounted for by several factors:

* Increased use of automation involving repetitive motion.

* Increased recognition of the problem by management and government.

* Better informed workforce regarding problems of this nature. While the root cause of cumulative trauma disorders is automation and repetitive actions, the primary reasons for the tremendous rise in the incidence rates are the increased recognition of the problem and a better informed workforce.

OSHA is also taking a greater interest in the subject. Recently, one Fortune 100 corporation was fined $1.3 million for not recording reported instances of CTD.

Regardless of the OSHA issues, employers are also finding that, as with many other occupational safety and health issues, paying attention to ergonomic factors in the workplace is economically sound. By designing work stations and jobs with ergonomics in mind, employers find that worker efficiency is improved, time lost from work is reduced and workers compensation costs are lower.

How do I get help?

Webster defines ergonomics as "the study of the mental and physical capacities of persons in relation to the demands made upon them by various kinds of work." It is a specialty - one related to safety and medicine. And it is one that has relatively few experts available to turn to at this time. Even large corporations are still working at developing programs and personnel to address this area.

However, help is available. One company that is set up to specifically address the problems associated with cumulative trauma disorders is Health and Hygiene, Inc., of Greensboro, NC. Founded in 1982, the company is reported to be the most comprehensive private center in the United States devoted exclusively to occupational health.

Originally founded to provide regional occupational health services, the company has expanded today into an international provider of occupational health and safety expertise and advice. In addition to extensive capabilities in ergonomics, they also provide services in the following areas:

* Medical/occupational physicians to provide for medical case management and medical directorships.

* Industrial hygiene including laboratory services. Pulmonary, hearing and occupational toxicology, as well as standard occupational needs.

* Occupational training center.

* Work hardening center.

* Safety services to assist in accident prevention and meeting OSHA requirements. Services are provided at the company's 25,000 square foot facility in Greensboro, as well as in the client's plant, as needed.

One of the objectives of the company has been to integrate the many disciplines involved in occupational medicine in one location. Included in the Greensboro facility are doctors, nurses, industrial hygienists, audiologists, ergonomists, safety engineers and therapists. All can freely consult and work together to solve client problems.

While there are a number of companies available that provide industrial health services, Health and Hygiene is unique in providing extensive capability in cumulative trauma disorders.

As reported by the company, they provide an A to Z service in ergonomics. First, training is available for supervisory and safety personnel so that they will recognize the problem, potential problems, develop a preventative program and redesign the work environment to prevent injuries.

Second, they provide an on-site service to monitor and evaluate jobs for problems and potential problems. This involves on-site observation of the job and work station and videotaping of the job being performed followed by computerized motion analysis to detect areas of stress.

Third, job training. The company will analyze how workers are trained to perform a job and make recommendations on how that training can be modified to avoid CTD problems. In some cases, actual job training will be done by Health and Hygiene.

Fourth, if a problem has arisen, they can work with the affected employee using the latest non-surgical methods to try to correct the problem and get the employee back to work.

Facilities in North Carolina include diagnostic equipment where on-the-job motions can be evaluated and, in a combined effort with Baxter Health Care, a work hardening center where injured persons can be rehabilitated using simulated job motions. This worker conditioning can be very important for injured workers who have been off the job for some time, allowing them to come back to work fully effective and with minimized danger of re-injury.

How can a problem be recognized?

As mentioned earlier, problems with cumulative trauma disorder have just begun to get the recognition they need in the last few years. Still, there are many persons who are simply not aware that the problem exists.

First, the problem is often specific to an individual. For example, a given work station may be designed for a person between the height of 5'8" and 6'0". As long as workers are in this height range, no problems occur. However, if a worker who is only 5'6" tall goes to work on the job, problems may occur.

Similarly, given a production line where ten people are performing the same task with essentially identical equipment, a number of them may experience problems, albeit different problems. One may have trouble with his hands while another has problems with his shoulders or neck, etc. All may be related to the relative ergonomics in the job. Solutions will be as individual as the problems.

In many cases, workers may not even complain about the problem. They may fear management repercussions or may fear scorn from fellow employees who don't have a problem. In any case, their work efficiency will be affected. And, potentially, a serious workers compensation claim may be looming in the future.

Things to look for that indicate a potential ergonomics problem include:

* loss of grip

* odd motions used in performing a task

* numbness and tingling in the arm, hand, shoulder, etc.

* waking up with a pain in the arm, hand, shoulder, etc.

* swelling in the hand, arm shoulder, etc.

* ongoing ache in the hand, arm, shoulder, etc. Most problems occur in the hands, arms and shoulders. Less frequent are problems in the lower back and legs.

Supervisory and safety personnel should be aware of these symptoms and watch for characteristics actions by workers on the job that indicate there is a problem.


Avoiding problems with CTD involves understanding the causes and, where necessary, changing work routines and job positions to remove the stress of repetitive motion. As with many other occupational problems, one serious case of a cumulative trauma problem can easily exceed the cost of preventative measures that could be taken ahead of time.

It is a new area of concern for management in all industries. The effect on worker performance and job efficiency may well overshadow any costs involved. By and large, many modifications that do not require heavy capital spending can be made in job methodology that will relieve problems with CTD. Conversations I have had with URW representatives have indicated that it is a high priority item with the union in the coming years.

While a new field, capable help is available. Health and Hygiene, Inc., appears to be one very competent resource. It certainly behooves all managers and owners to become better informed and trained in how ergonomics affects work and job performance. Training and education, both management and workers, is one of the most important ways.

Future machines, work stations and equipment will undoubtedly be made adjustable, with ergonomics in mind. Work areas will be set up on a custom basis for specific workers to avoid these problems. Now is the time to learn what this science is about so that we can make intelligent decisions in the future and avoid the potential pitfalls.

Common cumulative trauma disorders

* Carpal Tunnel Syndrome - This is probably the most common CTD. It is caused by the entrapment of the median nerve in the wrist.

* Tendonitis - This is caused by inflammation of the tendon-muscle junctions. It is one of the more common job-related joint and shoulder diseases.

* Tenosynovitis - This is caused by irritation of the tendon sheaths in the arm. Swelling occurs that can lead to carpal tunnel syndrome.

* Trigger finger - This is a form of tenosynovitis. It occurs when any finger (not thumb) is repeatedly flexed against pressure.

* DeQuervain's disease - This affects the thumb. It is caused by the narrowing of the tendon sheath in the muscles. It is more common to women than men in tasks that involve repeated use of a firm grip.

* Tennis elbow - Not the same as tendonitis. Its real name is epicondylitis. It is generally associated with screwdriving.

* Thoracic outlet syndrome - This involves compression of the nerves and blood vessels between the neck and shoulder. It is similar in some respects to carpal tunnel syndrome.

* Raynaud's phenomenon - This problem is a vibration syndrome related to use of vibrating tools. Also known as "white finger."
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Title Annotation:cumulative trauma disorder
Author:Menough, Jon
Publication:Rubber World
Date:Oct 1, 1990
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