Volume 15, Number 2, May 1993, pp.39-40

Facts about Cumulative Trauma Disorders

Here is more information on carpal tunnel syndrome (CTS) and other repetitive stress injuries (RSI) or cumulative trauma disorders (CTD).

Some of the other forms of CTD are:

• Carpal tunnel syndrome; compression of the median nerve by swollen tendons in the wrist.
• Tenosynovitis, pain and swelling of the tendon and its sheath, especially in the hand or wrist.
• Tendonitis, pain and swelling of the tendons.
• Epicondylitis, pain and tenderness at the two bony points on either side of the elbow (tennis elbow or golfer's elbow).
• Thoracic outlet syndrome; compression of the nerves and blood vessels between the neck and shoulder.

Cumulative trauma disorders are much easier to treat in the early stages, so see a qualified specialist at the merest hint of trouble. The warning signs of CTS are:

• Numbness and tingling of the thumb and first three fingers. It can feel like a mild electric shock in finger.
• A clumsy feeling in your hand.
• Weakness in your hand.
• Pain going up into your elbow or shoulder.
• Pain is worse at night.

To avoid CTD problems, the conservator should:

• Examine your own work habits. Watch arm, wrist, hand, and finger positions. Avoid extension (bending the wrist up and back) and flexion (bending the wrist towards the palm) while working. Keep the forearm wrist and hand in a neutral (in-line) position. Be careful of pinching and gripping actions.
• Redesign your work habits. Think about what you are asking you body to do. Make the work as easy on your frame as possible.
• Take frequent breaks while performing rapid and repetitive or physically stressful tasks.
• Repetitive tasks with cycle times of less than 30 seconds are more stressful. Try modifying the task to decrease the repetition rate.
• Working with the hands and arms elevated can cause thoracic outlet syndrome. Even 4 minutes of light work can cause considerable static effort that can contribute to the thickening of tendons and compression of the nerves and blood vessels between the neck and shoulder.
• Invest in good work chairs that match work table height. Chair should support back. Feet should be flat on floor or on a solid foot rest.
• Stretching exercises are very good. Stretching improves blood circulation and lubricates the tendons.
• Never stretch to the point of pain or discomfort.
• If you are having a problem, don't begin stretching until consulting with a qualified physician.
• It is best to correct poor work habits before manifesting symptoms.

Reported problems for conservators:

• Inpainting.
• Scraping glue.
• Hand sewing.
• Fabricating book boxes.

When using hand tools:

• Choose working positions and tool configurations which are comfortable. Keep hands and wrists in a relaxed neutral position. Avoid flexion and extension of the joints.
• Consider using tools based on an ergonomic design. Many hand tools are made with curved handles which allow normal usage of the tool with the wrist in a neutral position.
• Build up handles of tools to allow a less closed grip, diminishing stress from pinching finger postures. For example, surround handles of pencils, pens, inpainting brushes and the like with tubular polyethylene foam pipe insulation. The foam is available from plumbing suppliers and is about 1/4 inch thick. The foam tube will make the effective diameter of the tool 3/4 inches. Build up the handle on scalpels with foam and tape.
• When using hand tools work with a relaxed grip.
• Use equipment that transmits minimum vibration to the hand.

When you work at a computer or typewriter:

• Configure your work space according to ergonomic guidelines. Adjust monitor height, keyboard position, and chair height to minimize stress on your musculoskeletal system.
• Keep wrists in neutral position, don't drop your wrists while working. Wrist pads are available through computer suppliers to support your wrists while you type. You can also wear a wrist brace.
• Use a good quality chair which supplies proper support.

When symptoms develop you must correct poor work habits. Begin implementing the modifications of your work habits discussed above immediately.

If you develop symptoms, you must not only change your work habits which contribute to the problem, you must examine all areas of you life. Activities around the home also have to be modified:

• If possible, have someone else do the housework until symptoms pass.
• Use a dishwasher rather than stressing your joints by hand washing.
• Build-up the handles on scrub brushes, knives, spoons for mixing or stirring, and other utensils that are not exposed to heat.
• Use large sponges. To rinse a sponge, press it between the palms of both hands rather than wringing it out.
• Build-up handles on vacuum, mop, or broom with foam pipe insulation. Doubling the width of a broom handle is recommended.
• Use utility scrub brushes with handle (the type that look like an iron). Slide hand underneath handle. Keep wrist neutral.
• Avoid zip-lock style bags. If used, use your entire hand to open, and close them with another object.
• Use scissors to open sealed bags; e.g., potato chips.
• Use an electric can opener instead of manual. Us an electric jar opener or have someone else open jars for you.
• Use care opening wine bottles. Use your open hand or other tools as much as possible. Avoid screw-top capped wine. [That's got nothing to do with Carpal Tunnel Syndrome.]
• Use two hands with milk containers, water bottles, etc. Put one hand on the handle the other below supporting the weight.
• If bed is too close to wall, move it away. Making the bed with flat sheets is easier on the hand and wrist than using fitted sheets.
• Use paper bags for groceries rather than bags with handles. Keep bags light and use both hands to unpack.
• For problems with shoulder, store items in lower cabinets to avoid reaching.
• Use lightweight iron if you must iron your clothes. Use two hands or alternate iron between hands.
• Adopt a new look with an easy care hair cut. Use hood type hair drier. Electric razors are less fatiguing than safety razors. Build-up handles on toothbrush.
• Use self-wringing mop. Use dusting mitt and keep your hand open while dusting.

Treatments for CTD include:

• Resting the affected area. This is often the first recommendation. Moving the affected area is important, but avoid stressing the joint. In conservation, this is often not practical without taking time-off from work.
• For carpal tunnel, the wearing of a wrist-splint. The splint is usually worn at night. It can also be worn during the day, but you must be careful not to work against the splint as this can worsen the condition. Splinting and analgesics can often alleviate symptoms, but may take months to do so.
• Unconfirmed in the literature surveyed, but mentioned by a number of people: Vitamin B6 therapy.
• Anti-inflammatory medications to reduce swelling and relieve pressure on the median nerve. Ibuprofen is often recommended.
• Steroid injections into the wrist may be prescribed.
• Cold and hot baths (contrast baths) may be recommended by a physical or occupational therapist. Heat alone is not recommended.
• Surgery may be required to open the carpal tunnel to relieve pressure on the nerve. Often surgery is not effective or does not effect a permanent cure.
• If work habits are not altered, CTS can recur after it has been cured.

Hope for more accurate diagnosis of carpal tunnel and other CTDs has appeared on the horizon. A research group has succeeded in modifying a MRI (magnetic resonance imaging) to show nerves with greater contrast. In the reported case, a body builder had lost strength in one arm. The modified MRI showed that a nerve in the shoulder was being pinched by a highly developed muscle. Surgeons were able to relieve pressure on the nerve by excising a piece of the muscle.

References

1. Anonymous. "RSI" (a bimonthly electronic newsletter for people concerned about tendinitis, carpal tunnel syndrome, and other repetitive strains), ZiffNet/Mac; RSI1-9.SEA (self-extracting archive file). Issues 1-9. For more information, get in touch with crose@applelink.apple.com.

2. Apple Computer, Inc.: "Creating a Healthy Work Environment" Apple Computer, Inc., 1991, 030-1922-A, 12 pages.

3. Kizer, Kenneth W.: "Your Hands & Wrists At Work. Carpal Tunnel Syndrome: A Preventable Disease," California Occupational Health Program; Berkeley; Sept. 1989, 8 pages.

4. Putz-Anderson, Vern, ed. "Cumulative Trauma Disorders: A Manual for Musculosketal Diseases of the Upper Limbs," Taylor & Francis, New York and London, 1988.