Barbara A. Silverstein

Hand wrist cumulative trauma disorders in industry.

A total of 574 active workers from six different industrial sites were categorised into four force repetitive exposure groups. Workers in low force-low repetitive jobs served as an internal comparison population for the three other groups. Videotapes and surface electromyography were used to estimate hand force and repetitiveness. The presence of cumulative trauma disorders (CTD) was determined by structured interview and standardised non-invasive physical examination. Only workers who had been working on the study jobs for at least one year at the time of evaluation were eligible for selection. Categorisation of jobs and identification of CTDs were carried out independently by investigators who were appropriately blinded to exposure and outcome. The analysis of associations between CTDs and exposure categories were performed using Mantel-Haenszel plant adjusted odds ratios and unconditional multiple logistic regression. Significant positive associations were observed between hand wrist CTDs and high force-high repetitive jobs. These associations were independent of age, sex, years on the specific job, and plant.

Ergonomics considerations in hand and wrist tendinitis

The objectives of this article are to present (1) a historical perspective on hand and wrist tendinitis in workers, (2) new data that demonstrate a relationship between the repetitiveness and forcefulness of manual work and the prevalence of tendinitis, (3) possible biomechanical factors in tendinitis, and (4) possible job modifications for the prevention of tendinitis. Numerous studies during the last 100 years show that tendinitis is a major cause of worker suffering and workers compensation in intensive hand work. Epidemiologic data show that the risk of hand and wrist tendinitis in persons who perform highly repetitive and forceful jobs is 29 times greater than in persons who perform jobs that are low in repetitiveness and force. A possible factor in this relationship is viscous deformation of the tendons and adjacent tissues. Although these data suggest that the risk of tendinitis among workers can be reduced by reduction of the repetitiveness and the forcefulness of the work, this hypothesis has not yet been fully tested.

Can in-plant exercise control musculoskeletal symptoms?

After 1 year of an on-job exercise program to control musculoskeletal symptoms in the neck and upper limb, there were no statistically significant differences in localized postural discomfort scores or in the proportion of those whose discomfort decreased based on exercise participation. Although no clear reduction in discomfort was achieved by the exercise program alone, at least 67% of respondents who participated in the exercise program reported that the program made them feel better.

Hand-wrist disorders among investment casting plant workers

A survey of the prevalence of chronic soft tissue disorders of the hand and wrist was conducted 3 years after an initial survey of workers in a midwestern investment casting plant. The second survey of 136 (90%) of the original participants disclosed that (1) approximately 25% had different jobs in 1986, (2) 35% of those who had different jobs in 1986 reported transfers because of disorders, and (3) of those workers with the same job during both surveys, 11% reported temporary job changes due to disorders in the preceding 3 years. Workers with hand-wrist disorders in high-force and high-repetitive jobs tended to transfer out of these jobs more frequently than those in low-force-low-repetitive jobs. We failed to detect a relationship between ergonomic changes and change in prevalence of chronic hand-wrist disorders. This may be because the changes did not substantially alter the force and repetitiveness characteristics of the jobs.

Detection of cumulative trauma disorders of upper extremities in the workplace.

Surveillance for musculoskeletal disorders of the upper extremity in industry is in its infancy. Research efforts to elucidate the causal factors of these disorders often rely on either the analysis of existing medical records, worker compensation records (passive surveillance), or the surveying of workers with questionnaire and physical examination (active surveillance). The use of either type of data for routine surveillance presents several difficulties illustrated with the results presented in this paper. The analysis of existing records is generally less costly but the reliability of the data is difficult to assess. Standardized questionnaire and physical examinations can be as sensitive as the use of unusually thorough existing occupational medical records; however, it is unclear whether the additional cost of an active surveillance system will deter the routine use of such systems.

The Proposed OSHA Standard Related to Ergonomics

This roundtable discussion will be devoted to the proposed OSHA Standard related to Ergonomics which is scheduled to be published the first week in October. The discussion will be timely and important. This is a very controversial topic. The participants have been selected from different backgrounds and opinions. Barbara Silverstein is the head of the standard writing team and is on leave at OSHA in Washington, D.C. from her regular employment with the State of Washington Department of Labor and Industries. Deborah Berkowitz is the Director of Safety and Health of a national labor union (United Food and Commercial Workers) and has been actively pushing for better ergonomic accommodation for workers. Gregory Worrell is the Corporate Ergonomics Director of a major meatpacking company (Monfort Inc.) and has extensive experience in establishing and conducting Ergonomics programs. Thomas Albin is a corporate level Ergonomist for 3M and is responsible for a considerable part of that companys Ergonomics effort and has extensive experience in establishing and conducting Ergonomics programs. Todd Brown is a Senior Research Engineer with the Association of American Railroads who has considerable experience in funding and conducting ergonomic research for application in the railroad environment. William Marras is a leading researcher and practitioner in the field of Ergonomics, Biomechanics, and Cumulative Trauma Disorders. Thomas Armstrong is a pioneer in the research and practice in the fields of Ergonomics and Biomechanics as they relate to Cumulative Trauma Disorders. These are talented, well respected people in their areas of expertise and will bring the latest thinking to this roundtable. This roundtable will not be a rehash of old stale ideas. The proposed standard is new and very important to the field of Ergonomics and to industry.