Contact Information:
Josh Reilly
Safety Officer
County of Santa Cruz
831-454-4820

Why are we doing this?
What are we doing?
How to obtain recommended equipment
Scope of Problem
Body components at risk - soft tissues
Types of Diagnoses
Risk factors
Work station evaluation
Corrective measures
Interesting Ergonomics links

Why are we doing this?

Calif. Code of Regulations title 8, Section 5110 – Repetitive Motion Injuries. Requires employers to take action after at least one case that is work related, diagnosed by a licensed MD (the County has a few more than one). Action required includes worksite evaluations, control of exposures and training.

County Personnel Administrative Manual (PAM) Section 2011 – Injury and Illness Prevention Program – Office Ergonomic Guidelines. Requires ergonomic guidelines when selecting, purchasing equipment, training and information.

Worker’s Compensation covers repetitive stress injuries and costs are high.

Employee comfort, safety and productivity. These injuries become harder to treat, more disabling and often more painful as they progress. We would like to prevent them, manage those we cannot prevent and keep those we manage from progressing to a level where comfort, safety and productivity are adversely affected.

What are we doing?

If a Worker’s Compensation claim is filed

Upon receipt of Repetitive Stress-related claim, Risk Mgmt contacts our consultants, WPC. WPC contacts the employee who filed the claim and the supervisor and schedules an assessment to be completed within about three weeks.
WPC does the assessment and may make some adjustments onsite. They then send the report to the Risk Mgmt. We review it and send it to the employee, supervisor and departmental personnel analyst or safety liaison, with additional comments as needed (procedure varies with department).
If the report recommends it, the department purchases new equipment or assists employee in re-configuring existing equipment as needed.
The treating physician may also impose work restrictions, which the department must evaluate and accommodate if possible (if accommodation is not possible, the department may opt to send the employee home until his/her next medical evaluation or until the restrictions are lifted or altered.

If there is no Worker’s Compensation claim

Upon contact by employee supervisor or other interested party, the Safety Officer will schedule an assessment with the employee.
The safety officer will make adjustments onsite and write a report (workstation ergonomics assessment) containing items adjusted, items discussed and items recommended.
The report goes to the supervisor with cc’s to the employee, personnel analyst and sometimes, other department manager(s).
The department is then responsible for buying recommended equipment or making recommended changes.

How to obtain recommended equipment

Send requisition to Purchasing with copy of work station assessment report or cover letter indicating that this purchase is required by a workstation ergonomics assessment. Use the Ergonomic Equipment list Corporate Express catalog and order via the normal procedure for furniture or office equipment.
Chairs – arrange to try out demo model by contacting Safety Officer (x4820). After trying chairs, discuss with Safety Officer and select. Order chairs through Purchasing.
Use another vendor as department policy allows (credit card purchase, etc.)
If needed, the safety officer will assist with selecting, purchasing and sometimes, delivering and installing equipment.

Scope of Problem

Injury data – Carpal tunnel syndrome diagnosis: median 27 lost days/case (BLS). Average cost per claim in Calif. = $32,000.00. Cumulative trauma was the fastest growing category of injury on Dept. of Labor/Bureau of Labor Statistics injury numbers in 1999 and for the 9 years previous.

County data – Cumulative trauma injuries have been the in the top five most frequently reported injuries in County WC statistics for since 1999. They have been either the second or third most expensive types of injuries during the same years. Injuries happen in office and field work jobs.

Body components at risk – soft tissues

Muscles and tendons – A “strain” occurs when muscles and/or tendons are stretched and inflamed, torn or scarred. Collagen fibers in tendons do not stretch very far and may scar in response to stress. The scar tissue may cause chronic irritation or may pre-dispose the joint to re-injury.

A “sprain” occurs when a joint is displaced beyond its normal range. Repetitive motion may cause stretching or tearing of ligaments. Pre-existing sprains may raise the risk of repetitive motion injuries.

A “bursa” is a small, flat sac lines with synovial fluid, which normally prevents rubbing between muscle and tendon or bone. Repetitive motion may cause inflammation of the bursa or “bursitis” and reduce range of motion in the joint.

Nerves – Any nerves subject to sustained pressure from inflamed joints, tendons, bones, muscles or compression by tools, equipment, hard surfaces or body position may be affected. Motor, sensory or autonomic nerves may be affected.

Blood vessels – Pressure on veins may reduce blood flow and oxygen supply to muscles, weakening them and impairing recovery after exertion. This contributes to increased inflammation.

Types of Diagnoses

Carpal tunnel syndrome (CTS) – results from compression of the median nerve in the carpal tunnel in the wrist, by the tendon sheath surrounding the finger flexor tendons. Swelling of the sheath and/or flexion or extension of the wrist can cause or contribute to CTS.

Cubital tunnel syndrome – compression of the ulnar nerve below the notch of the elbow.

Epicondylitis – irritation, inflammation of the tendons connecting to the humerus bone, between shoulder and elbow.

Ganglion – (“Bible bump”) – bump on the radial or dorsal side of the wrist filled with synovial fluid, may also be a cystic tumor on a tendon sheath or joint membrane. Used to be treated by smashing with a large book, hence the colorful colloquialism.

Shoulder tendonitis (rotator cuff syndrome) – inflammation of the rotator cuff: 4 tendons that fuse over the shoulder and help move the arm. The 4 tendons pass through a small opening between the shoulder and the arm.

Tendonitis – Inflammation of any tendon. Tendon may stretch, tear, harden or thicken in response to repetitive stress or pressure.

Tenosynovitis – Inflammation of tendons inside a sheath, resulting in reduced movement or tendon and pain. A special case is “trigger finger”, wherein the flexors are so badly trapped in the sheath that movement of the index finger or thumb is by a snapping, jerking motion.

White Finger (Raynaud’s syndrome) – Blanching of skin due to insufficient blood supply to fingers.

DeQuervain’s Syndrome – Tendonitis of the thumb extensor and/or abductor muscles.

Risk factors

Repetition – general guideline - repetitious motions have a cycle time of less than 30 seconds or more than 50% of the cycle performing the same functional motion. Accuracy requirement in each repetition may also be a risk factor.

Static exertion - if the muscles remain contracted at greater than 15 to 20% of their maximal capability circulation is impaired, oxygen flow is reduced and physiological strain may occur.

Posture, position – Isometric contractions needed to maintain extreme or near-extreme work positions will cause or contribute to strain. A static posture in a “normal” position may also contribute.

Pressure, compression from tools – gripping tightly for long periods, applying “pinch” grips, especially if the handle forces that hand out of a neutral position.

Vibration – can reduce blood flow, cause numbness and swelling in tendons.

Exposure to cold – contributes to repetitive stress.

High levels of force – large loads impacting small joints

Work station evaluation

Sitting posture, shoulder and thoracic outlet position
Foot position
Keyboard
Mouse
Neck alignment, monitor position, copy position
Lighting
Hours of work, nature of tasks
Lifting, limb extension

Corrective measures

Work style/position of equipment
1.	Neutral positions for hands, wrists, arms, back, legs – just over 90 degrees in the knees, hips and elbows in a comfortable, upright working position. 180 degrees through the wrists. Avoid wrist flexion and extension (up and down) and inside/outside wrist deviation.
2.	Keep input devices (keyboard, mouse) close to torso. Keep shoulders apart, thoracic outlet open.
3.	Reduce force used in keystroking, mouse clicking, etc.
4.	Rest breaks, exercise – every 45 to 55 minutes for 5 to 10 minutes at a time. Do tasks that do not involve computer. Stand up, walk, stretch, use other muscles, etc.
5.	Work style – use formal typing style; keep wrists elevated over keyboard, drop fingers to hit keys, don’t extend right or left. Improve your touch-typing if needed. Touch-typing is easier on wrists, than hunting and pecking.
Equipment
6.	Task lighting – shaded light, direct on work, not in eyes or on monitor screen.
7.	Foot rest – reduces contact stress on underside of legs, allows chair to be positioned higher for neutral arm and neck positions.
8.	Ambient lighting - Keep monitor at or near right angles to the window; best position to reduce glare and backlighting.
9.	Pullout keyboard and mouse trays – adjust for height and apply negative tilt, to maintain neutral arm and wrist position.
10.	Wrist support – current research shows wrist supports may not improve outcomes; use intermittently. Are more accurately called “palm supports”. When using, place the bottom of the palm on the support device, NOT the wrist.
11.	Telephone headsets – allow hands to stay free. Eliminate source of neck strain. Should be used by any worker using phones greater than 30 minutes per hour or taking more than 5 calls per hour (approx.), while using the computer or writing notes.
12.	Ergonomic design – Designed to fit the user’s dimensions and comfortable reach, lift and work distances. In general, use equipment with adjustable features to accommodate a range of human ergonomic factors and workstyles. Track ball mouse, inline document holder, adjustable mouse platform or mouse bridge may be used to improve user comfort at some work stations depending on job demands.
13.	Sit-stand equipment – adjusts from sitting to standing position or supported standing position. This type of work station is sometimes prescribed or recommended for chronic moderate to severe lower back injuries and some leg injuries.
14.	Software – example, MS Outlook’s Global address book finds the address after you type in a few characters (saving keystrokes). Learn keyboard shortcuts as alternatives to mouse use. Learn and use the shortest task pathways, with the fewest keystrokes to reduce repetition. Adjust trackball mouse sensitivity controls to make it easier to control the cursor (reducing repetitious fine motor skill demand).
Work demands
15.	Pace of work – breaking up repetitive or high risk tasks over time or among workers;
16.	Requirements of work - reduce or eliminate redundant forms or data entry requirements.
Medical component - Treatment must be coordinated with workplace response. The providers must understand the job and work environment. Proper diagnosis and referral to knowledgeable specialists are required. Rapid intervention and continuity of care will result in faster return to work.
Prevention - Education of workers and medical providers. Conditioning is important; work poses a set of known physical demands; the “Industrial Athlete” is better equipped to meet the demands, also has faster recovery time, if injured.

Interesting Ergonomics links:

Here are some links of interest to employees with questions about ergonomics issues. No endorsements implied or intended. We will be posting more in the future.

CUErgo - all-purpose office ergonomics information developed by Cornell University; search the site for “cuergotips”, “managing office ergonomics issues” or “chair selection”.

CCOHS - website of the Canadian Centre for Occupational Health and Safety (CCOHS) – Huge amount of health and safety info – for a stretching routine for computer users, go to “http://www.ccohs.ca/oshanswers/ergonomics/office/stretching.html”.

Office Ergonomics Training - vendor website - go to “A checklist” for information on how to evaluate a workstation. Also has a good “conventional wisdom vs. reality” section

College of Letters & Science - posted by the UC Berkeley College of Letters and Sciences; go to "http://ls.berkeley.edu/lscr/support/faq/ergo/ergodef.html" for FAQ’s on ergonomics.

Medical MultiMEDIA Group - vendor website - Information on health effects and injuries with good text and excellent graphics; used for health education by medical service providers, search site for “carpal tunnel syndrome”.

Washington State department of Labor and Industries - Excellent wide-ranging site posted by the State of Washington Dept. of Labor and Industries - go to the “Ergonomic Ideas Bank” for ideas from other users.