Cumulative trauma disorders in the workplace : bibliography

164 Pages·1996·10.621 MB·English

by  coll.

Cumulative trauma disorders:
A manual for musculoskeletal diseases
of the upper limbs

Cumulative trauma
disorders:
A manual for
musculoskeletal
diseases of the upper
limbs
Edited by
Vern Putz-Anderson
National Institute for Occupational Safety and Health,
Cincinnati, Ohio, USA
informa
healthcare
New York London
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Contents
Abstract viii
Preface ix
Acknowledgements x
List of Contributors xi
PART I: RECOGNIZING CUMULATIVE TRAUMA DISORDERS
1. Defining Cumulative Trauma Disorders 3
The Nature and Source of Cumulative Trauma Disorders 3
The Increase in Cumulative Trauma Disorders 6
2. Upper Extremity Structures and Overexertion Injury 9
The Working Arm 9
Muscle and Tendon Injuries 11
Ligament and Bursa Injuries 12
3. Description of Common Cumulative Trauma Disorders 15
Tendon Disorders 16
Nerve Disorders 18
Neurovascular Disorders 19
4. Jobs and Cumulative Trauma Disorders 21
Types of Jobs Implicated 21
Problems with Posture, Force and Repetition 21
Non-occupational Factors Associated with CTDs 24
References-Part I 25
PART II: SEARCHING FOR CUMULATIVE TRAUMA INDICATORS 31
5. Reviewing Available Records 33
OSHA Form 200 Logs 33
Plant Medical Records 35
Worker Compensation Records 36
Safety and Accident Reports 37
Payroll Records 37
Minimum Information Required for Evaluating Records 37
Conclusions 39
6. Surveying the Workers 41
Surveys and Questionnaires 42
Medical Screening Exams 44
v
7. Analyzing Jobs 4 7
Work-Methods Analysis 48
Examples of Job Analysis 49
Risk Factor Analysis 49
Checklist Items for Worksites 51
Evaluating Stressful Postures 52
Evaluating Forces and Muscle Strengths 57
Evaluating Frequency of Movements 59
Evaluating Physical Fatigue 60
Evaluating Work Stations and Worker Posture 61
Static Work 61
Work Space and Reaching Distances 63
Height of the Work Surface 64
Sitting versus Standing 64
Evaluating Tools, Handles and Controls 65
Indicators of Faulty Tool Selection or Usage 65
Tool-Induced Postures 66
Tool-Related Repetitive Action 67
Tool-Transmitted Forces 68
Human Variation 69
Clothing and Personal Equipment 69
Conciu~on 70
References-Part II 70
PART Ill: PREVENTING CUMULATIVE TRAUMA DISORDERS 75
Administrative and Engineering Controls 75
Getting Approval and Support 75
8. Instituting Personnel-Focused Work Practices 79
Selecting Workers to Fit Specific Jobs 79
Training Workers 81
Training Principles 81
Training Conclusions 82
Worker Rotation 83
9. Redesigning Tools, Work Stations and Jobs 85
Changing the Job, Not the Worker 85
Coping with Obstacles in Redesigning Jobs 86
Design Principles Based on Ergonomics 87
Reduction of Extreme Joint Movement 87
Reduction of Excessive Force 87
Reduction of Highly Repetitive Movements 88
Design of Work Stations 88
Guidelines 89
Design of Work Methods 98
Guidelines 99
Design of Tools and Handles 103
Guidelines 104
References-Part Ill 111
Summary 113
vi
Appendix A: Terminology for Position and Movement 115
Glossary 115
Appendix B: Medical Diagnosis and Treatment 119
How and Why Diagnoses are Made 119
History-The Patient's Experience 120
The Physical Examination 121
Laboratory Tests 121
The Assessment 122
Medical Treatment 123
Treatment Strategies 123
Restricting Motion 124
Heat and Cold 125
Medication 125
Stretching and Exercise 125
Conclusions About Treatments 126
Suggested Reading 127
Appendix C: CTD Statistics: Prevalence, Incidence, and Severity 129
Advantages and Limitations of Statistical Measures 130
Response Measures for Evaluating CTDs 131
Counting Systems Based on Identification of Symptpms 132
Counting Systems Based on the Severity of the Disorder 132
Counting Systems Based on Employee Surveys 133
Counting Systems Based on Occupational Injury Statistics 133
Case Studies of CTD Costs and Frequency 135
Case 1: Electronic Parts Manufacturer 135
Case 2: Metal Fabrication 136
Case 3: Poultry Processing Plant 136
Case 4: Clothing Makers 138
Identification of Problem Areas 139
Generating Job-Specific Rates of CTD 139
Statistical Method for Identifying Problem Areas 140
Postscript
International Perspective: Some CTD Prevention Strategies 143
References-Appendices 145
Suggested Reading 14 7
Index 151
vii
Abstract
This manual was developed to define cumulative trauma
disorders (CTDs) in the workplace, to enable non-medical
personnel to recognize them, and to present strategies for
preventing their occurrence. Emphasis is placed on CTDs of the
upper extremities.
Part I of this manual defines the cumulative trauma category of
musculoskeletal disorders. Information is provided on the
structures of the hand and arm to help identify the symptoms
and location of the disorders. Descriptions of some of the
common types of CTDs are also provided along with examples of
jobs in which CTDs may occur.
Part II presents methods for determining how many workers at
a worksite have CTDs or have some early symptoms of CTDs.
Extensive information on conducting an ergonomic job analysis
is also provided. Information from such a job analysis is useful
for identifying work conditions and tools that may cause or
contribute to CTDs.
Part Ill focuses on two strategies used to control or prevent the
occurrence of CTDs: Instituting Personnel-Focused Practices
and Redesigning Tools, Work Stations and Jobs. The merits of
each strategy are discussed. Combinations of elements of each
strategy are frequently used in workplaces where prevention
programs for CTDs have been implemented. Guidelines for
ergonomic redesign are also provided along with a list of
references for further information on ergonomics.
The Appendices include specialized material designed to
supplement information contained in the body of the manual.
Appendix A includes a glossary of terms and a series of
illustrations to define the positions and movements of the body.
Appendix 8 provides an introduction to the diagnostic process
used by the medical profession to identify CTDs and a summary
of medical procedures used to treat them. Appendix C defines
some common epidemiological terms and describes statistical
procedures for evaluating the prevalence, incidence, and
severity of CTDs. In addition, a series of case histories are
provided to illustrate the frequency and costs associated with
CTDs among specific work populations.
viii
Preface
This manual evolved out of a project in the Division of
Biomedical and Behavioral Science, Applied Psychology and
Ergonomics Branch, entitled Methods For Detecting Cumulative
Trauma Injury.
A literature review indicated that there were several methods
for detecting cumulative trauma disorders (CTDs). What was
missing was a general reference source or a manual that
explained, with a minimum of technical language, the concept of
CTDs, the parts of the body affected and the potential causes.
Once the reader understands the seriousness and
characteristics of CTDs, a description of the most current
methods for use in detecting, evaluating and controlling CTDs at
the worksite can follow and take on new meaning.
The present manual was prepared with this aim.
The manual consists of three distinctive parts and an
appendix. To the extent possible, each of the three parts of the
manual is complete with respect to its general purpose. Parts I
and II were designed primarily to instruct, whereas Part Ill and
the Appendices were designed as a reference tool for the more
advanced users.
Part I provides an overview of CTDs for those individuals
unfamiliar with the problem. Part II builds on this introductory
base and is directed at those individuals responsible for
maintaining the health and productivity of the workforce, as well
as those responsible for making preliminary determinations
about jobs with a potential for CTDs. The emphasis in Part II is on
specifying a set of procedures for identifying and analyzing
records and jobs for indicators of cumulative trauma. Part Ill
outlines strategies for controlling CTDs and provides a series of
ergonomic-based guidelines for redesigning high risk jobs. Part
Ill should be of particular interest to those practitioners who are
responsible for improving and maintaining the safety and health
of workers. This may include nurses, physicians, safety
engineers, union representatives, industrial hygienists,
supervisors, insurance carriers, and even individual workers
who are concerned about the problem. Finally, the materials
presented in the appendix provide an expanded treatment of a
variety of issues related to posture, medical treatment, and
surveillance techniques that had been previously presented in a
more abbreviated form in the body of the manual.
Most of the information contained in the manual was derived
from original source materials provided by noted experts in their
fields. A list of the contributors is given on page xi.
Vern Putz-Anderson
ix