2013web004 preventing repetitive motion injuries · injuries or disorders of the muscles, nerves,...

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

teresa.boynton@bannerhealth.com