2013WEB004 - Preventing Repetitive Motion Injuries Repetitive Motion Injuries
2013WEB004 - Preventing
Repetitive Motion InjuriesRepetitive Motion Injuries
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Webinar Presenter
Ergonomics in Action
Teresa Boynton, MS, OTR,
CSPHP
Greek
�ergo = WORK
�nomos = RULES, NATURAL LAW
Purpose:
�promote a safe, healthy and productive work environment for
employees, and
� prevent injuries and workers’ compensation claims.
�Ergonomics = science of fitting jobs to people
�Ergonomics encompasses the body of knowledge
about physical abilities and limitations as well as
other human characteristics that are relevant to
job design. Ergonomic design is the application of job design. Ergonomic design is the application of
this body of knowledge to the design of the
workplace (i.e., work tasks, equipment, and
environment) for safe and efficient use by
workers. (Proposed U.S. Ergonomic Standard,
2002)
The science of work
Ergonomics removes barriers to:
�quality,
�productivity, and
�safe human performance
by fitting:
� products,
�tasks and
�environments to PEOPLE.
�Ergonomics:
�Takes into account people’s abilities and limitations and other
human traits pertinent to job design.
�Ergonomic Design:�Ergonomic Design:
� Focuses on designing workstations, tools, and job tasks for
safety and efficiency.
�Effective ergonomic design coupled with good posture and
positioning can reduce employee injuries, and increase job
satisfaction and productivity.
A systematic process for:
� anticipating,
�identifying, �identifying,
�analyzing and
�controlling
Ergonomic Risk Factors.
�Injuries –strains
�Increased frequency and severity of workers’ compensation claims
�Lower production output
�Increased lost time
Higher medical and material costs�Higher medical and material costs
�Increased absenteeism
�Low-quality work
�Increased probability of accidents and errors
�Increased labor turnover
�Less spare capacity to deal with emergencies
Risk factors include:
� forceful exertion,
�awkward postures,
� sustained postures,� sustained postures,
� repetitive exertion,
� vibration and
�environmental factors such as temperature.
�Injuries or disorders of the muscles, nerves,
tendons, ligaments, joints, cartilage, and/or spinal
discs.
�Also known as:�Also known as:
Repetitive strain injury
Repetitive motion injury
Upper extremity cumulative trauma disorder
Work related upper limb disorder
Work related musculoskeletal disorders
�Pain
�Numbness and tingling
� Stiffness or cramping
� Inability to hold objects or loss of grip strength
� Symptoms that go away overnight are usually a sign of fatigue. � Symptoms that go away overnight are usually a sign of fatigue. Symptoms that are continuous and don't go away overnight may indicate a more serious problem. Those experiencing such symptoms should seek medical attention.
�Repetitive motion injuries are easier to treat in their early
stages. Ignoring symptoms could lead to chronic or serious
injury.
�Over 10 years, 3 million MSDs prevented, (avg. of 300,000 interventions per year)
�$22,500 savings in direct costs for each MSD prevented
�Work-related MSDs account for 1/3 of all occupational injuries/illnessesinjuries/illnesses
�Employer cost of MSDs: $15-$20 billion annually
�Ergonomic Programs could reduce MSDs by 4.6 million injuries in the next 10 years (saving $9.1 billion)
Bureau of Labor Statistics 2009
Injury Data Analysis
Assessments:
�RULA
�REBA�REBA
�NIOSH Revised Lifting Equation
�Liberty Mutual Tables
�Observations and Audits
�Use the findings from assessment tools, develop and implement action plans
�Participatory Ergonomics = Involve Employees�Participatory Ergonomics = Involve Employees
�Look at
�Engineering Controls
�Work Practice Controls
�Administrative Controls
�A good method to determine how many
employees are working with discomfort or
pain
�A good method for finding out which job tasks
are the most difficult
�A good method for getting feedback from
employees on how to make their jobs easier to
perform
� Figure out what items or issues can be addressed right away and which require long term planning
� Address items with the greatest risk of injury or history of injury as soon as possible
� Determine which tasks require in-depth ergonomic evaluations
� Determine who is responsible for following-up and completing � Determine who is responsible for following-up and completing action items
� Set clear expectations and deadlines
An effective sustainable solution often requires Follow-Up and PERSISTENCE
�Establish procedures for employees to report
symptoms of musculoskeletal disorders and respond
quickly to their complaints
�Inform employees of workplace hazards that may
cause musculoskeletal disorders and repeat
ergonomic training once every three years, or more
often if additional injuries occur
�Analyze jobs and consult employees in those jobs to
identify factors that may cause or aggravate
musculoskeletal disorders and either eliminate or
significantly reduce themsignificantly reduce them
�Train employees on how to avoid injuries that may
cause musculoskeletal disorders
�Keep written records of actions taken and injury rates
RULE 17, EXHIBIT 5
Cumulative Trauma Conditions Cumulative Trauma Conditions
Medical Treatment GuidelinesRevised: September 16, 2010
Effective: October 30, 2010
http://www.colorado.gov/cs/Satellite/CDLE-
WorkComp/CDLE/1248095315991
�The terms “cumulative trauma disorder,” “repetitive
strain injury,” “myofascial pain” and other similar
nomenclatures are umbrella terms that are not
acceptable, specific diagnoses. The health care acceptable, specific diagnoses. The health care
provider must provide specific diagnoses in order to
appropriately educate, evaluate and treat the patient.
(e.g., de Quervain’s, cubital tunnel syndrome, lateral
epicondylagia).
�Furthermore, there must be a causal relationship
between work activities and the diagnosis.
�Assess the individual’s ability to perform job duties: this may include a jobsite evaluation as well as the patient’s description of the job duties.
�Job title alone is not sufficient information. The clinician is responsible for documenting specific information responsible for documenting specific information regarding repetition, force, other risk factors and duration of employment.
� Information must be obtained regarding other employment, sports, recreational, and avocational activities that might contribute to, or be impacted by CTC development.
�Step 1 – Diagnosis established using Section D1f
Tables
�Step 2 – Job duties clearly described. Job evaluation
may be necessarymay be necessary
�Step 3 – Job duties meet the following on risk factor
definitions from the table
�Step 4 – Consult Diagnosis-Based Risk Factor tables
Example: Force and Repetition/Duration
�Category: Force and Repetition/Duration
�As a Primary Risk Factor
� 6 hrs. of: >50% of individual max force with task cycles 30 seconds or less
of force is used for at least 50% of a task cycle-max force for most
individuals is 3-5 kg of force.
� 6 hrs. of lifting 10 lbs. >60xper hour. � 6 hrs. of lifting 10 lbs. >60xper hour.
� 6 hrs. of: use of hand held tools weighing 2 lbs. or greater.
�As a Secondary Risk Factor
� 4 hrs. of: >50% of individual max force with task cycles 30 seconds or less
force is used for at least 50% if a task cycle-max force for most individuals
is 3-5 kg of force.
� 4 hrs. of: lifting 10 lbs >60x per hour
� 4 hrs. of: use of hand held tools weighing 2 lbs or greater
Example: Carpal Tunnel Syndrome
� Diagnosis:: CTS
� Evidence FOR Specific Risk Factors
� Strong: Multiple high quality studies: None
� Good: One high quality study or multitude adequate studies: combination of force, repetition, and vibration
� Evidence AGAINST Specific Risk Factors
� Good evidence – Keyboarding less than or equal to 7 hrs. in good ergonomic � Good evidence – Keyboarding less than or equal to 7 hrs. in good ergonomic position is NOT RELATED.
� Non-Evidence-Based: Additional Risk Factors to Consider. These factors must be present for at least 4 hours of the work day, and may not overlap evidence risk factors.
• Non-Evidence-Based: Additional Risk Factors to Consider. These factors must be present for at least 4 hours of the work day, and may not overlap evidence risk factors.
� High repetition defined as task cycle times of less than 30 seconds or performing the same task for more than 50% of total cycle time.
�…if the injured employee is diagnosed with carpal
tunnel syndrome, this diagnosis would be considered
an ordinary disease of life unrelated to the
compensable event. Based on a podium presentation compensable event. Based on a podium presentation
at the American Academy of Orthopedic Surgeons
Annual Meeting, carpal tunnel syndrome was not felt
to be causally related to occupational exposures.
�The belief that carpal tunnel syndrome is caused by
occupational exposures is based upon limited data of
variable quality with relatively low scores on a
quantitative measure of causal association. Given the quantitative measure of causal association. Given the
remarkable impact of such beliefs on society, it would
be irresponsible of us to support an association
between occupation and CTS without convincing
evidence according to very strict criteria.
�Such evidence is currently lacking and CTS is most
accurately and most optimally considered an
idiopathic condition with a substantial genetic idiopathic condition with a substantial genetic
association.
�Additionally, in 1995, the Industrial Injury Committee
of the American Society for Surgery of the Hand,
following the literature review of thousands of articles
concluded that there is no causal relationship
between work activities and any distinct medical
entity, including carpal tunnel syndrome. entity, including carpal tunnel syndrome.
�None of the reviewed studies have established a
causal relationship between carpal tunnel syndrome
and work activities.
Definition of Insanity
Doing the same thing over and over
again and expecting different results.
Albert Einstein
Teresa Boynton, MS, OTR, CSPHP
Injury Prevention and Workers'
Compensation Consultant
Ergonomics Specialist
Certified Safe Patient Handling Professional Certified Safe Patient Handling Professional
Risk Management
Banner Health, Western Region