Monday, March 31, 2008

Experts debate reasons for fall in carpal tunnel cases

Still discussing why reports of RSI are in decline ...

"Can a workplace epidemic be cured?

With the personal computing boom of the 1990s came thousands of “repetitive stress injuries” or “repetitive strain injuries.” RSI became the hip medical acronym of the keyboard era, with subset carpal tunnel syndrome the diagnosis of the day.

“At its height of diagnosis, anybody showing up at a doctor’s office with wrist pain or hand pain was being diagnosed with carpal tunnel,” said Carol Harnett, vice president of insurer Hartford Financial Services Group’s group benefits division.

Since then, carpal tunnel cases have plummeted, declining 21 percent in 2006 alone, according to the Bureau of Labor Statistics. Among workers in professional and business services, the number of carpal tunnel syndrome cases fell by half between 2005 and 2006.

What changed?

First, it may not have been the white-collar epidemic it appeared to be.

A 2001 study by the Mayo Clinic found heavy computer users (up to seven hours a day) had the same rate of carpal tunnel as the general population. Harvard University headlined a 2005 news release: Computer use deleted as carpal tunnel syndrome cause.

“Clearly, if keyboarding activities were a significant risk for carpal tunnel, we should have seen, over the last 10 to 15 years, an explosion of cases,” said Dr. Kurt Hegmann, director, the Rocky Mountain Center for Occupational & Environmental Health. “If keyboarding were a risk, it cannot be a strong factor."

Blue-collar workers, especially those doing assembly line work such as sewing, cleaning and meat or poultry packing, have a far greater incidence of carpal tunnel than white-collar workers, according to Bureau of Labor Statistics data.

RSI label dropped
That doesn't mean white-collar workers don't get carpal tunnel and related disorders. But it may mean such disorders were overdiagnosed when they were most in the news, resulting in an artificially high number of cases by the late 1990s. Most doctors have dropped the term RSI, calling them "musculoskeletal disorders" while government agencies like "cumulative trauma disorders."

Now, some experts think some of those patients had "referred pain" from trouble elsewhere, such as the neck. Other theories claim attention to ergonomics has prevented injuries, or that they have become underreported because they lack the immediacy of a broken bone.

People who've had a cumulative trauma disorder say it can be debilitating. Clay Scott, now an assistant professor of electrical engineering and computer science at the University of Michigan, developed severe wrist pain during college at Harvard University. By the end of his senior year, he said he was incapable of doing daily tasks, such as cutting food and opening doors.

His recovery started with physical therapy a few times a week and a home exercise program to stretch and strengthen his back and neck muscles. It took three or four years for him to recover, he said.

Stopping it before it starts
Some businesses have been focusing on prevention, part of a growing effort by employers to keep their workers healthy.

Outdoor clothing company L.L. Bean shuts down its manufacturing line three times a day for mandatory five-minute stretches. Retailer Replacements Ltd. also runs on-the-clock group stretches as well as a fitness-walking program.

Blue Cross Blue Shield of Kansas started a program in 1991, when costs of the injuries to its employees passed $500,000. It bought ergonomic chairs and desks, introduced ergonomic assessments for new employees during their first two weeks of work and hired two full-time registered nurses to work with employees.

Since the program started, the company's workers' compensation costs have fallen by 62 percent, said Terri Janda, a nurse who leads the Blue Cross program."    (Continued via Houston Chronicle)    [Ergonomics Resources]

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