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Ten
Things You Should Know About Hand and Wrist Pain
(also called Cumulative Trauma Disorders
(CTDs)
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| 1. |
There
are many kinds of CTD medical conditions that have ergonomic causes
among office workers, including carpal tunnel syndrome and various
kinds of tendon inflammation. Some other disorders, such as myofascial
pain syndrome, fibromyalgia, thoracic outlet syndrome, and reflexive
sympathetic dystrophy are believed to be the results of cumulative
trauma in some cases.
Because of the
complexity and subtle differences between disorders, physicians
don't always diagnose CTD's correctly or easily. The most knowledgeable
medical specialists for CTD's are generally considered to be physiatrists,
or physical medicine specialists.
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| 2. |
CTDs
can happen when there is very little repetitious work. Besides repetition,
other possible causes include:
- Holding one
position. Muscles that hold a body part in position for long periods
are more prone to fatigue than muscles that move a body part around.
- Non-neutral
postures. In this context, "posture" is the position
of an individual joint, not overall body posture. Any posture
significantly different from "neutral" is considered
to be at risk for musculoskeletal distress. "Neutral"
is considered to be the position about halfway through the available
range of motion for the joint.
- Localized
pressure. Direct pressure on nerves or tendons can cause damage
in the long run. The wrist is one location of concern. The elbow
(the funny-bone or crazy-bone nerve) is another.
- Use of force.
Even small exertions can cause stress if small muscles are involved.
Sudden, fast motions involving a jerk or snap.
- Cold temperatures.
- Vibration,
as with hand-held power tools or whole-body vibration as caused
by driving heavy equipment
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| 3. |
Keeping
these causes in mind, some of the rules of thumb for preventing CTD's
are:
- Break up
repetitious work.
- Relax. Don't
use your muscles to hold your hands or shoulders in a particular
position. Keep your limbs and shoulders limp as much as possible,
even during short pauses.
- Use moderate
postures for individual joints. Stay away from positions near
the extremes of your joints' range of motion --- the most neutral
joint position is about halfway.
- Minimize
contact with hard or sharp surfaces. This is especially important
at the wrists and elbows.
- Don't use
too much force. Notice any exertions you have to make and see
if they can be eliminated. "Exertions" don't have to
involve breaking into a sweat. They can be subtle, such as pulling
a hard-to-reach drawer or lifting a heavy file.
- Move with
an even motion. Avoid snapping the wrist or jerking against outside
forces.
- Keep your
hands and fingers warm. Consider gloves or even fingerless gloves.
- Break up
exposures to vibration
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| 4. |
"Fitting
the physical workspace to the worker" is often touted as the
best way to prevent CTD. This is an incomplete view. Although physical
workstation design, physical tool design, and adjustability are important,
there are many other work-related factors. Three less tangible but
extremely important factors are job design, stress control, and individual
workstyle.
Examples of
job design are infrequent or inflexible breaks, low activity variety,
and fast pace. Examples of stressors are deadlines, monitoring,
and bad management. Examples of harmful workstyles (in the context
of computer work, for instance) are how hard the individuals hits
keys, how the individual holds his/her wrists, and where the individual
places the mouse.
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| 5. |
Most
CTD's are preventable and curable if caught early. The key is to notice
trouble when it starts --- and do something about it. Early signs
may include persistent pain, tingling, numbness, burning, or aching.
The signs may be constant or may occur mostly after certain activities.
The drastic cures --- such as surgery --- are not reliable and should
be a last resort. Nevertheless, a health professional should be consulted
when you are concerned about possible early signs. |
| 6. |
Some
people get CTD's because their bodies are vulnerable to them. For
example, carpal tunnel syndrome seems to be related to diabetes, overweight,
thyroid conditions, hormone conditions such as those caused by hysterectomy
or removal of both ovaries, rheumatoid arthritis, previous injuries,
and other conditions. Smoking may also increase the risk. Anyone with
any of these conditions --- particularly obesity --- should be especially
careful about prevention. |
| 7. |
CTD's
can happen because of non-work activities. Hobbies, sports, driving,
and even sleeping positions can contribute to them. Any attempts at
treatment or prevention should include a look at off-the-job factors. |
| 8. |
One
of the most important preventive measures is 'variety.' In other words,
change posture and activities often. If possible, take breaks before
getting tired. Extremely short breaks can be very helpful of frequent
enough. A "break" doesn't have to be a rest break --- it
can simply involve doing something else for awhile. |
| 9. |
Don't
follow CTD prevention rules without looking for consequences. Every
fix has a drawback. Every ergonomic rule or gizmo has a downside which
can possibly make matters worse rather than better. The best way to
evaluate ergonomic fixes is by considering all the ergonomic risk
factors described above in #2. Example: a wrist rest may force a straighter
wrist (vertically) but may put too much pressure on the underside
of the wrist or make the individual bend the wrist sideways to reach
side keys. |
| 10. |
Total
CTD prevention involves ergonomics (changing the environment), ergonomics
education (changing work styles or habits), medical management (optimizing
treatments and return-to-work procedures), and management (monitoring
statistics to find the most hazardous jobs and working proactively).
CTD's usually cannot be adequately dealt with without all four approaches
happening together. Many obstacles to good ergonomics are not scientific,
medical, or engineering reasons ... they are political in nature. |
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