TENDON DISORDERS

TENDON DISORDERS
Tendinitis
Tendinitis is a very common ailment. Pain and inflammation in the arms or elsewhere result from overuse and awkward posture. Tendons can eventually fray and tear. Remember, tendons are like chords that connect muscles and bones. Tendons twist and bend, but do not stretch or shrink.
Epicondylitis
This is also known as "tennis elbow." Pain begins in the elbow and then spreads to the forearm. The main conditions that cause this problem are repetition, rotating the forearm, or force.
Tenosynovitis
Unlike the tendons in the elbows, some are covered with a sheath. The tendons of the fingers, for example, are covered with a synovial sheath. The sheath is filled with a fluid that lubricates the tendon as it slides back and forth through the sheath. This fluid is called synovial fluid.
When workers perform highly repetitive motions too much fluid is produced in the sheath. The extra fluid builds up and the sheath becomes swollen and causes pain. Awkward posture, such as doing intensive keyboard work with the wrists bent backward, is also an important risk factor.
Stenosing tenosynovitis
Stenosing means constriction. The passageway through the sheath becomes smaller. This occurs when tendons become rough or irritated and the tendon sheaths are inflamed. The swollen sheaths then press on the tendons.
DeQuervain's disease
This is a specific example of a stenosing tenosynovitis. In DeQuervain's disease, the tendons at the side of the wrist and the base of the thumb are affected, causing pain and inflammation. These tendons are connected to the muscles on the back of the forearm. When these muscles tighten, the thumb is pulled back away from the hand.
DeQuervain's disease develops with too much friction of the tendons in the thumb and the sheath. The sheath gets thicker because of the friction, which in turn constricts the tendons. The risk factors for this disorder include tight gripping and a clothes-wringing motion. 

CARPAL TUNNEL SYNDROME

CARPAL TUNNEL SYNDROME
Carpal tunnel syndrome (also known as median neuritis) is a painful condition of the hands and wrists. It is caused by pressure on the median nerve, which runs from the shoulder, down the arm, to the hand. In advanced cases, carpal tunnel syndrome can make the simplest chore or activity impossible, such as holding a frying pan, folding laundry, or lifting an infant.
Symptoms: In addition to pain, the symptoms of carpal tunnel syndrome include numbness and tingling in the hands. These symptoms are usually felt in the first three fingers and the base of the thumb. Often the pain and other symptoms are worse at night or during sleep.
The figure on the left shows the parts of the hand and wrist that are involved. Tendons of the fingers, blood vessels, and the median nerve all pass through what is called the carpal tunnel. The carpal tunnel is formed by the carpal ligament in the wrist. Swelling and steady irritation of the tendons that pass through the carpal tunnel create pressure on the median nerve.
Risk factors: The major causes of carpal tunnel syndrome are:
working with bent wrists;
a high rate of repetition using the hands;
a lack of rest for the hands and wrists; and
forceful hand motions.
All of these risk factors are not necessary to get carpal tunnel syndrome. For example, VDT operators get carpal tunnel syndrome even though modern computers only require a very light force to press the keys. The awkward posture, intense keying, and lack of rest periods are more than enough to cause problems.
Carpal tunnel syndrome is a very serious injury. It can occur in one wrist, or both (bilateral carpal tunnel). Carpal tunnel syndrome affects workers in many industries such as meatpacking, grocery checkout, and assembly work. AFSCME members, especially among those who work with computers, are also victims of carpal tunnel syndrome. Early and proper treatment is important for this condition. Treatment should start out conservatively with rest and physical therapy. Surgery should not be the first choice. The person's job may have to be redesigned to remove or reduce risk factors at work. Otherwise, the symptoms are likely to get worse and require surgery to relieve the pain. 

CARPAL TUNNEL SYNDROME

CARPAL TUNNEL SYNDROME
Carpal tunnel syndrome (also known as median neuritis) is a painful condition of the hands and wrists. It is caused by pressure on the median nerve, which runs from the shoulder, down the arm, to the hand. In advanced cases, carpal tunnel syndrome can make the simplest chore or activity impossible, such as holding a frying pan, folding laundry, or lifting an infant.
Symptoms: In addition to pain, the symptoms of carpal tunnel syndrome include numbness and tingling in the hands. These symptoms are usually felt in the first three fingers and the base of the thumb. Often the pain and other symptoms are worse at night or during sleep.
The figure on the left shows the parts of the hand and wrist that are involved. Tendons of the fingers, blood vessels, and the median nerve all pass through what is called the carpal tunnel. The carpal tunnel is formed by the carpal ligament in the wrist. Swelling and steady irritation of the tendons that pass through the carpal tunnel create pressure on the median nerve.
Risk factors: The major causes of carpal tunnel syndrome are:
working with bent wrists;
a high rate of repetition using the hands;
a lack of rest for the hands and wrists; and
forceful hand motions.
All of these risk factors are not necessary to get carpal tunnel syndrome. For example, VDT operators get carpal tunnel syndrome even though modern computers only require a very light force to press the keys. The awkward posture, intense keying, and lack of rest periods are more than enough to cause problems.
Carpal tunnel syndrome is a very serious injury. It can occur in one wrist, or both (bilateral carpal tunnel). Carpal tunnel syndrome affects workers in many industries such as meatpacking, grocery checkout, and assembly work. AFSCME members, especially among those who work with computers, are also victims of carpal tunnel syndrome. Early and proper treatment is important for this condition. Treatment should start out conservatively with rest and physical therapy. Surgery should not be the first choice. The person's job may have to be redesigned to remove or reduce risk factors at work. Otherwise, the symptoms are likely to get worse and require surgery to relieve the pain. 

PART B -- VDT-RELATED INJURIES, ILLNESSES, AND DISCOMFORT

PART B -- VDT-RELATED INJURIES, ILLNESSES, AND DISCOMFORT
The muscles, tendons, ligaments, joints, bones, cartilage, and discs in the spine make up the musculoskeletal system. An injury or illness to these parts is called a musculoskeletal disorder (MSD). Some MSDs, such as carpal tunnel syndrome, can affect nerves as well.
To understand these injuries, it is necessary to understand the structure and function of various parts of the body.
Muscles are tissues made up of very small fibers. Muscles contract and relax to make movement.
Tendons connect muscles to bones. Tendons are also made up of fibers, but these fibers do not stretch or shrink. The tendons transfer the force from the muscle to move the bone. Some tendons, like those in the wrist and hand, are covered with a sheath that contains a lubricating fluid. These tendons pass back and forth through the sheath as the muscles tighten or relax.
Ligaments connect bones to form a joint. Joints are covered by ligaments that form a joint capsule which holds the ends of the bones together and allows movement. The joint also contains lubricating fluid. Some ligaments, such as those in the shoulder, elbow, and knee are shielded from friction by a bursa, a small sac filled with fluid.
Nerves carry messages throughout the body. The nerves send and receive information to and from the brain. Nerves allow us to see and hear, and also feel pain.
This chapter covers the most common injuries that VDT operators experience because of poor ergonomics at work. The symptoms and major risk factors are described for each disorder. Generally, the more time a worker is exposed to these risk factors, the greater the chance of developing one of these injuries. 

Just know

 

Know

 

POSTURE

POSTURE
Whether standing or sitting, there is a neutral position for the back, neck, arms, and hands. This is the position that puts the least amount of strain on a given part of the body. Postures that differ from the neutral position increase stress on the body. The illustrations below show positions that are good and bad for different parts of the body.
The wrists should be straight while keying. Operating the computer with the wrists bent backwards (extension) or forward (flexion) should be avoided.
The computer operator should be able to reach the keyboard or mouse while keeping the shoulders and upper arms relaxed and bending the elbows at a 90 degree angle.
The operator's back and neck should be straight while at the computer. The top of the monitor should be slightly below eye level. The worker should not have to tilt the head backward or turn to the side to see the screen. 

HEALTH PROBLEMS OF VDT WORK

HEALTH PROBLEMS OF VDT WORK
PART A -- RISK FACTORS
A risk factor is a working condition that increases the chance of injuries. Each of the risk factors described here can cause problems. Usually, however, workers are exposed to more than one risk factor at a time. The risk factors that cause most of the injuries and discomfort to VDT operators include:
Awkward posture: Includes keying with the wrists bent backward and reaching for the keyboard or mouse.
Repetition: Performing the same motion or motion pattern every few seconds or on a continuous basis for hours at a time or even the whole day.
Duration: Working for long periods with a VDT.
Lack of Recovery: Working with a computer without enough breaks from doing VDT work.
Force: the effort it takes to move or remain in a fixed position. Another type of force, known as contact stress, comes from pressure against a part of the body. For example, resting the wrists against a hard and/or sharp edge of a desk while working at a computer puts pressure on the wrists.
Uncomfortable Environment: Includes poor air quality, improper lighting, glare, noise and other conditions.
Organization of Work: Includes factors such as staffing levels, scheduling, workload and job pacing, electronic monitoring, performing monotonous tasks, and the amount of control workers have over how they perform their jobs. These are sometimes referred to as psychosocial factors. 

HEALTH PROBLEMS OF VDT WORK

HEALTH PROBLEMS OF VDT WORK
PART A -- RISK FACTORS
A risk factor is a working condition that increases the chance of injuries. Each of the risk factors described here can cause problems. Usually, however, workers are exposed to more than one risk factor at a time. The risk factors that cause most of the injuries and discomfort to VDT operators include:
Awkward posture: Includes keying with the wrists bent backward and reaching for the keyboard or mouse.
Repetition: Performing the same motion or motion pattern every few seconds or on a continuous basis for hours at a time or even the whole day.
Duration: Working for long periods with a VDT.
Lack of Recovery: Working with a computer without enough breaks from doing VDT work.
Force: the effort it takes to move or remain in a fixed position. Another type of force, known as contact stress, comes from pressure against a part of the body. For example, resting the wrists against a hard and/or sharp edge of a desk while working at a computer puts pressure on the wrists.
Uncomfortable Environment: Includes poor air quality, improper lighting, glare, noise and other conditions.
Organization of Work: Includes factors such as staffing levels, scheduling, workload and job pacing, electronic monitoring, performing monotonous tasks, and the amount of control workers have over how they perform their jobs. These are sometimes referred to as psychosocial factors. 

OMPUTER-RELATED HEALTH PROBLEMS

COMPUTER-RELATED HEALTH PROBLEMS
Introduction: I think that if many of us were asked what one thing has had the greatest impact on our lives in modern times, we would likely say the computer. Over the past twenty years or so, computers have gone from being monstrous curiosities taking up the entire space in large rooms, to relatively small boxes on almost every desk. Along with smaller size and lower prices has come an explosion in the number of PC’s, putting them within the reach of the vast majority of Americans. The speed and efficiency of the computers has made most businesses and institutions dependent on the technology. As a result, many people spend a large part of their time working with computers.The relatively recent advent of the widespread availability of the Internet has meant that even those individuals who don’t use computers at work likely use them at home to, ASurf the Net@. What this has meant is that many people are spending many hours on the computer at work and then again at home. As a result, there has been a significant increase in the reporting of health problems related to the use of computers. 

new problems related to the eyes.

Computers have become an integral part of everyone's life. They have made things so much fast and simple but have brought with them These problems affect all those who spend a significant time working on the computers everyday. However, these computer related eye problems are mostly due to our own wrong habits. I call this cluster of problems e-Pain (which may mean electronic / eye pain) which is also called Computer Vision Syndrome.
What are the problems?
Pain
Redness
Watering
Headache
Fatigue
Irritability
Poor Concentration
Pain and eye strain being so common among the computer users that it would be appropriate to call this cluster of computer related eye problems: e-Pain.
What causes these problems?
An understanding of what causes these symptoms can help us take appropriate preventive steps.
eyes@computer.pain
It is important to know that computer monitors do not emit any harmful rays or radiations (monochrome or color). The causes of the trouble are:
Constantly gazing at a near distance (at the monitor)
Decreased rate of blinking
Convergence Fatigue
When we look at a near object both our eyes move towards each other (converge) to fixate at the target. Prolonged viewing of the monitor at close distance leads to fatigue of convergence and its weakness / insufficiency. This consequently leads to eye strain, pain and headache.
Infrequent Blinking
Decreased rate of blinking while working on computers leads to instability of the tear film of the eyes. This leads to feeling of dryness, irritation, redness and a reflex watering from the eyes.
What is the solution?
There is no single magic remedy for this problem. Following set of measures can be undertaken together to get relief:
1. Proper Visual Hygiene
Monitor should be placed about 2-3 feet from the eyes (or at the farthest comfortable distance).
Do not gaze constantly at the monitor for long duration. Take your eyes off the screen every 5-10 minutes.
Every half an hour or so close your eyes for 1-2 minutes to give them rest.
Every hour or so take a 5 minutes break (go for a stroll or run some errand).
Make a conscious effort to blink more frequently. Avoid sitting in front of an air conditioner facing its air draft while working on computer.
2. Convergence Exercises
Regular eye exercise can help prevent the problems caused by working on comuters or even heavy reading or writing work. These exercises are advised for all copmuter professionals, students, office workers, etc.
Sit on a chair upright and look at a far off samll object.
Then hold out a pen at level with your eyes at an arm's lenght and look at its tip.
Gradually bring the pen close to your eyes to a point where you feel a mild strain on your eyes. The tip of the pen should remain clear and single in appearance. Hold the pen in this position for about half a minute and then again gradually take it back to an arms length. Hold it here again for about half a minute, and then again bring the pen close to your eyes.
Repeat above step 10 times and then again look the far off small object. Again repeat the whole sequence.
In the begining this exercise should be done for 5-10 minutes just once a day in the morning at a time when you are fresh and rested. After one week it should be increased to twice daily and after two weeks thrice a day. Avoid doing the exercise when you are tired or are having pain in eyes or headache. In the initial period when you begin exercising the pain in the eyes and headache may increase, but this should not discourage you. As you continue the exercise you will gradually feel relief from the sypmtoms over 2-3 weeks.
Continue the excercise for 2 months to build good eye muscle strength and reserves power.
3. Lubricant Eye Drops
Lubricant eye drops instilled 3-4 times a day help in soothing the eyes and relieving irritation and redness. Many preparations are available in the market e.g. Tears Plus, Hypotears Plus, Moss, Moisol, etc. Although allergy or reactions to these eye drops are uncommon yet one should be careful in using them, and if they cause any irritation, redness or swelling of the eyes they should be immediately discontinued. It is advisable to consult an ophthalmologist before using any eye medicines.
I hope that this article will help you reap the benefit of e-Commerce, and not suffer the misery of e-Pain.

Occupational Health Issues

Health problems that may be related to computer use and possible solutions
Low Back pain
Usually due to using the wrong type of chair, these have been four legged chairs found in any office for visitors, executive chairs where the back is not separate from the seat and therefore cannot be adjusted to offer any lumbar support.
If the user has not taken any time to adjust the chair.
Sitting on the edge of the chair and leaning forward can also cause problems and this often happens when there are arms on the chair which are not adjustable in height or when the user is short in stature, the arms on the chair will not move low enough to allow the user to get close enough to the desk.
Sitting with the legs crossed causes uneven weight on each buttock and strain on back muscles.
I have seen a lot of problems caused by arms on chairs that cannot be raised or lowered and recommend that all chairs are purchased without arms for this reason.
Poor desk configuration
If the screen is placed off to one side, the keyboard should still be positioned centrally to avoid twisting the torso, often if the screen is off to one side, the user will support one elbow on the desk putting strain in the muscles of the back.
If odd pieces of furniture are used to make up a workstation ensure that they are the same height. It is best to draw your proposed desk layout before moving furniture.
Having a set of drawers that prevent sideways movement
The L shaped desk layout allows more space and freedom of movement if writing and keyboard activity is required but when two desks are butted onto each other, one set of drawers can restrict movement. The set of drawers restricting movement can be removed with a screwdriver.
Ideally desks should be purchased without drawers and then modular drawer units can be placed in convenient locations.
Room temperature
If a room is too cold muscles can go into spasm and injury is more likely.
Dehydration
Many office workers drink too much tea and coffee, which has a diuretic action so water is the best choice. Remember that offices with several computers can make the air feel very dry.
Overstretching
Items used most frequently should be positioned within easy reach
If the hard drive/midi tower is housed under the desk, muscles can be pulled when bending over to switch the computer on.
Pain in the neck
Pain in the neck is often caused by too much up and down or side-to-side movement of the neck, a solution is to use a document holder at the same height as the screen or attached to the screen so that it is only necessary to transfer the gaze.
(These can be purchased from Gaynor in the computer shop for approx £4.00 and are much cheaper than in the Lyreco catalogue. You will need to complete a purchase order form for this product. (Approval for the use of purchase order forms has been sought from Mike Montgomery.)
Sitting with the telephone receiver in you neck.
Using bifocals because the neck is bent backwards to focus on the screen. These people should speak to their Optician about using a special pair of glasses for computer use or have their bifocal section on the glasses made wider.
If the screen is too high. The head should be in the neutral position with the gaze at a slightly downward angle when viewing the screen.
Not taking posture breaks
Posture breaks are important to prevent overuse of one group of muscles, break up periods of keying and mouse work regularly. (See information sheet on posture breaks and wrist exercises)
Pressure on the wrists from a sharp edge on a desk
Some desks have a sharp edge, which can cause pressure on the wrists. If users are trained typists, they usually do not rest their wrists whilst keying but most self taught keyboard users do, this causes pressure and increased risk of injury if the user is also working with their wrists bent. A gel wrist rest can be used to provide a soft cushion for resting the wrists in between periods of keying or mouse activity. Gel mouse mats are also available.
Painful wrists or fingers
Painful wrists or fingers often occur when the chair is not adjusted to the correct height to allow a perfect L shape between the shoulder, elbow and wrist, if the wrists are bent up or down then the fingers are not horizontal to the keys or the mouse, the clicking finger is not horizontal to the control mechanism and the wrist is left unsupported.
Striking the keys too hard or excessive mouse use can also cause painful fingers or by not keeping the mouse close enough to the body. Ideally a mouse should be used directly in front of the shoulder and as close to the body as possible.
Dirty mice are not efficient and require more clicking therefore increasing your risk of overuse syndrome.
Research has shown that intensive use of the mouse is more likely to cause symptoms of overuse syndrome than keyboard activity; you should consider keyboard shortcuts (These can be viewed on a separate page.)
For those using the Banner system at UWB there are specific short cuts (please see separate information sheet.) If you require further information about Banner keyboard shortcuts please contact Mike Wilson in the Academic Registry.)
Alternative mice
There are various alternative mice that relieve and prevent symptoms of overuse:
Optical mice are more efficient because they do not get dirty balls!
Cordless optical mice allow more freedom
Tracker balls offer an alternative movement but one could argue that you are just exchanging one repetitive movement for another and transferring the strain from the fingers to the thumb.
Joystick mice often have thumb controls.
Beware of mice that are advertised as being ergonomic because they may not be. Some mice totally fill the hand and can be uncomfortable for users with small hands.
Touch pads can be used in either hand and are ideal for people with one-handed symptoms because they can be used in either hand; the same amount of dexterity is not required for operation.
The whale mouse is ideal for mouse intensive work and can open out to fit any hand.
There are numerous options on the market but it is better to try before you buy.
You may want to contact other members of staff on the intranet at UWB to see if someone has a different type of mouse for you to try or you can contact the OHSU to see if there is a mouse for you to borrow for a short period so that you can evaluate it’s effects on your symptoms
Pain in the buttocks
Pain in the buttocks radiating down the thigh can be caused by a chair seat that is too long and causing pressure behind the knees or from inadequate lumbar support.
Pain in the shoulders
Pain in the shoulders can be caused by having arms on the chair that cannot be adjusted this causes the user to sit with the arms sticking out.
Sitting at the desk with one elbow supported on the desk and the other held lower or twisting the torso to look at the monitor will also cause pain.
Pain in the knees
Pain in the knees can be caused by the fact that when the chair has been adjusted to the correct height to allow the fingers to be horizontal to the keys, the feet are left unsupported, the solution is to purchase a footrest the small step type called (twin plus in the Lyreco catalogue are best because they do not take up much space under the desk, they can be adjusted according to the height of the person using them.)
If transcription is carried out it is better to have a large surface area on the footrest and the ability to keep this level to support the footswitch.
Pain in the knees can also be caused by a seat that is too long resulting in pressure behind the knees.
Eye strain
Eyestrain can be caused by glare from the monitor or from overhead lights. Ideally the desk should be placed between lights and not directly under them. If this is not possible you may be able to switch the overhead light off and use an angle poise lamp.
Glare from windows without blinds or with incorrectly fitted blinds.
Where there are casement window at the top and blinds cannot be used there is often glare from the sun on the screen. Some vertical blinds are not efficient and additional blackout roller blinds would improve efficiency and keep the room cool. If blinds cannot be fitted it may be possible to fit a tinted transparent film to the window.
Other solutions:
See the Optician about middle distance correction
Ask about a slight tinted coating to your glasses
Contact IT if there is any flicker on your screen
If your monitor is old and small (14inch CGA, VGA) it will have poor resolution and should be replaced with a 17inch SVGA or XGA.
Clean your screen
Adjust your contrast or brightness
Make sure that you are not too far away from the screen (correct viewing distance is 18-20 inches)
Remove the antiglare device. (These can cause problems focusing because you have to look thought it to see your screen.)
Introduce regular task rotation to break up periods of keying.
Choosing the right chair
Tudor Jones in the Estates department will order chairs for you and will be able to advise on models that are appropriate for computer use, by using this service you will also benefit from considerable cost savings.
If you use a computer you should order a chair that has a height adjustable back and preferably without arms as these often cause poor posture. If you really cannot live without arms on your chair they should be totally height adjustable (They do cost extra).
When you receive your new chair you should read the booklet that is usually attached so that you understand how all the mechanisms work. There is usually a handle or knob to raise and lower the height of the seat and another to enable a rocking action.It is important to use the rocking action, as this will reduce static loading.
There will be a mechanism for raising and lowering the height of the backrest to ensure adequate lumbar support. (Sometimes you need to release a tension knob at the back of the chair to allow for movement of the backrest.
If you are experiencing any pain or have a particular disability you should contact the Occupational Health Nursing Adviser for further information.