- The Washington Times - Tuesday, January 7, 2003

Repetitive stress or strain injuries, such as carpal tunnel syndrome, can strike not just typists, but anyone in any job that requires the same movements over long periods of time construction workers, tailors, carpet layers, musicians.
The Occupational Safety & Health Administration (OSHA) says the number of such workplace injuries is on the decline. In 2001, private industries reported 5.2 million injuries at the workplace, an 8 percent decrease in such cases from 2000.
Still, too many companies are losing valuable employee time because of aches suffered while at work.
Repetitive stress injuries (RSIs), also known as cumulative trauma disorders or muscular-skeletal disorders, result when tasks are performed repeatedly over years without sufficient time to heal. Such actions strain tendons, ligaments, muscles and nerves. The mistreated tissue can become inflamed, causing pain, stiffness and limited mobility if left untreated.
Complicating matters is the mercurial nature of these injuries.
Two employees can work side by side for years, but only one may develop an injury from the work effort, says Dr. Mustafa Haque, chief of hand surgery at Georgetown Medical Center.
"Is it the work, or are there underlying anatomic factors?" Dr. Haque asks.
Obesity, smoking and poor overall health may put workers at greater risk of developing such injuries, he says. Beyond that, doctors lack definitive answers.
One of the more common RSIs is carpal tunnel syndrome. The condition gets its name from the eight hand bones and the flexor tendons that lie under the tunnellike hollow they create.
Repetitive movements, such as extended periods of typing or wrist activity, cause the tendons to swell and place pressure on the median nerve running through them. Symptoms include pain and tingling in one or both hands and a feeling that the fingers are swollen even though they are not.
Advanced carpal tunnel syndrome also results in numbness to heat or cold and diminished hand strength.
Another RSI, a strain on the thumb side of the wrist known as deQuervain's tendinitis, can be found in the workplace or even in new mothers continually raising and lowering their child.
Other repetitive stress injuries include tennis elbow, which features damage to the forearm muscles and tendons; golfer's elbow, a compression of the nerve at the elbow; and cubital tunnel syndrome. The latter involves the ulnar nerve near the elbow, causing a sensation akin to being hit in the "funny bone." It is caused by repeated bending of the elbow, as in pulling levers or performing frequent lifting motions. Symptoms include numbness on the inside of the hand and pain.
Dr. Haque says treatments for these conditions range from anti-inflammatory medications and temporary braces to surgery, the latter only if several months of conventional treatment fail.
Surgery can mean cutting ligaments to allow more room for the nerves that are being cramped by the swollen tissue.
Doctors generally believe that putting the body through repetitive motions creates microtraumas in the associated tissue. Bodybuilders use this principle to break down muscle tissue during heavy workouts. They wisely allow 24 to 48 hours of time to pass before working those particular muscles again, letting the body heal itself.
Workers committed to a set array of on-the-job movements don't always have that luxury.
OSHA Administrator John Henshaw credits increased awareness of RSIs and the availability of preventive tips and devices (see sidebar) for the decreasing number of injuries.
"Part of any safety and health program will have an ergonomic component," Mr. Henshaw says.
"I think managers are coming on board, once they recognized there are feasible, cost-effective solutions and [that they] truly reduce the pain and suffering of the injuries," he says.
Researchers at Union Memorial Hospital's Curtis National Hand Center in Baltimore conducted a small-scale study about five years ago measuring the pressure felt in the hand during typing exercises.
Pressure monitors were used to measure the tension in secretaries' hands after a full day of typing. After the day was over, the monitors measured a lower level of tension than at the start of the day, says Dr. Raymond Wittstadt, an attending hand surgeon at the Baltimore center.
"It doesn't imply what may happen in 20 years of typing," Dr. Wittstadt says of the surprising findings, but it did point up the murky quality of this field.
"Despite a fair amount of research, the bottom line is, we still don't know," he says.
What is known, he says, is that some jobs, such as anything involving vibrating equipment such as jackhammers, make workers more susceptible to RSIs.
Age also can play a factor in RSIs, but again, the evidence is cloudy. Carpal tunnel syndrome and most tendinitis problems seem to crop up with people in their 30s and 40s, Dr. Wittstadt says.
The advent of computers in the workplace may be partly responsible for RSIs, he says. Years ago, manual typewriters could type just so fast before the keys would jam up. Modern keyboards allow typists to type as fast as their fingers will allow, putting extra pressure on their hands and wrists.
A small percentage of RSI sufferers won't bounce back from their injuries, but most will heal completely after treatment, Dr. Wittstadt says.
"There's a high success rate with the appropriate treatment," he says, estimating that about 90 percent of RSI patients can resume their previous work functions when healed.
Computers, often to blame in RSI cases, also can play a role in avoiding them.
Companies offer software packages including RSIGuard, WorkPace and ErgoEnterprise to help workers avoid stress injuries.
Frank Deardorff, vice president of channel distribution with New Jersey-based Magnitude, the maker of ErgoEnterprise, says early ergonomic software packages were little more than computerized egg timers. They simply told the computer user to take a break after a set period of time, regardless how much, or little, computer work had been done.
Newer products measure actual computer activity.
If the software is set to measure 20 continuous moments of keystrokes and mouse moving, "it takes into account natural microbreaks. It resets itself," Mr. Deardorff says.
A tiny green light turns to red once that level has been reached, followed by an animated sequence illustrating several stretches the computer user can do to prevent soreness. Such breaks last just up to a minute, but often that can be enough to prevent weary hands.
Such "anti-injury" software is catching on, Mr. Deardorff says, much as anti-virus programs did a few years ago.
His software packages also allow company workers to swap messages regarding potential injuries, dubbed "comfort messages" to act as a proactive measure against RSIs.
Experts have plenty of advice on ways to stave off these nagging injuries, particularly for those who type for a living.
Their wisdom ranges from the simple, assuming a comfortable posture at your workstation and taking tiny breaks, to more specific: keeping your computer's keyboard and mouse below elbow level to reduce physical stress. Workers also shouldn't hit the keys too hard or tense their elbows and shoulders while typing.
Stretching can help prevent RSIs and soothe the hands and wrists of those with existing injuries. The prayer stretch involves placing hands in a basic prayer position, palms together, then pressing first the right hand toward the left, then the opposite. The prayer position also can be rotated toward and away from you to stretch your wrists.
Dr. Haque says recommendations such as using a soft cushion below where the palms of your hands fall, called a keyboard rest, are helpful, if inexact.
"Nobody can say using a keyboard rest changes anything, really, or using ergonomic keyboards," he says. "It's a very difficult area for proving or disproving things."

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