WORK: A Journal of Prevention,Assessment & Rehabilitation

Evaluation of the patient with upper limb cumulative trauma disorder (CTD) requires use of both qualitative and quantitative measures. The clinical evaluations are reviewed, which include tests for range of motion, strength, limb size, sensation, and dexterity. Essential observations for identifying and describing the presentation of posture, symptoms, and painful events are illustrated for qualitative descriptions related to work activities and activities of daily living (ADL). Therapeutic intervention is described in two sequential stages: calming of symptoms and then control of symptoms.

Repetitive strain injuries (RSI) of the hand and upper extremity have been linked to video display terminals (VDT). The incidence of RSI has increased with the proliferation of computer use in the workplace and at home. A holistic approach to dealing with upper extremity RSI begins with the seated position. Simple adjustments made here can correct much of the poor positioning of the shoulders, arms, and hands. The rest of the workstation can then be designed around the correctly seated VDT user. In addition to being instructed in appropriate seating and posture, the VDT user must also learn proper keyboard technique, work pacing and rotation, and exercises to stretch shortened muscles and strengthen overstretched muscles. A checklist to review the basic components of a VDT ergonomic analysis has been developed.

Preliminary efforts to perform outcome evaluation at 20 outpatient rehabilitation facilities are presented, including utilization review and a patient satisfaction survey. Therapy services assessed in this initial phase ranged from acute care to work hardening and included patients with a wide variety of upper extremity diagnoses. Patients' perception of their general health status was assessed using the Short Form General Health Survey following discharge from therapy. Plans for improved outcome evaluation and development of critical pathways are included.

A sample of 42 subjects (84 hands) with complaints of pain, numbness and/or tingling were used to study the inter-rater agreement and accuracy of seven clinical tests which can be used to assist in the diagnosis of carpal tunnel syndrome (CTS). A ‘gold standard diagnosis’, defined as a clinical diagnosis of CTS rendered by one of two hand surgeons and supported by electrodiagnostic evidence of CTS, was used to classify the 84 hands as to the presence of CTS. Two therapists were blinded to patient history, electrophysiology, diagnosis and all evaluations performed by the other therapist, until clinical testing was completed. Tests performed included: wrist flexion, wrist extension, Tinel's, tethered median nerve (TMN), pinch, vibration and Semmes-Weinstein monofilament (SWMF) tests. Substantial inter-rater agreement was observed between the two therapists for five of the clinical tests (k > 0.71) with SWMF and TMN having lower agreement. The most accurate test was Phalen's wrist flexion test. Good accuracy was demonstrated by pinch and vibration tests. Tinel's test was characterized by lower sensitivity, but false positives were rare. Wrist extension and TMN tests had poor sensitivity. SWMF testing was very sensitive, but a high number of false positives occurred when ‘normal’ was classified as 2.83. Reliability and accuracy of these tests supports their use as components of a clinical diagnosis of CTS.

RSI is defined by the authors as a biopsychosocial disorder, under the umbrella of cumulative trauma disorder, involving a non-specific, potentially chronic pain syndrome of the upper extremity. Evaluation and treatment will focus on the client-centered practice. Patients are enrolled in an 8-week course of treatment, which focuses on patient involvement, education, relaxation, diaphragmatic breathing, exercise, postural modification, as well as assessing vocational and psychosocial issues.

This study examined the extent to which dental professionals have made changes within their practice environments to decrease the potential for developing a cumulative trauma disorder. A survey was disseminated to a sample of 95 dental professionals. The survey addressed the presence and location of pain, changes professionals made within their workplaces, and whether or not these changes were perceived as effective. Fifty two surveys were returned for a response rate of 55%. Results indicated that 96% noted pain during or after work; 88% had made changes in their work practices. Common strategies used to promote health were stretching, good posture, personal relaxation, and instrument maintenance. Use of ergonomic instruments, workstations, and new instrumentation strategies were seen as effective, but rated slightly lower than other categories.

This case report demonstrates the difficulty in treating women who are being abused within their environments. A frequent site of injury is the upper extremity. This issue may have significant effects on desired outcomes and should be properly assessed to improve intervention, return to work, and programs following discharge.

The purpose of this report is to describe the management of a patient with a Class I ring avulsion injury. There were no bony or skeletal injuries and both neurovascular bundles were intact, but soft tissue swelling and decreased range of motion contributed to complex management problems. Predictable patterns of range of motion limitations, secondary to adhesion formation, were addressed early in the rehabilitation program with tendon gliding exercises. Proximal interphalangeal extension splinting was initiated to combat a flexion contracture which is common when digital edema is present. Edema control techniques and scar management were also part of the hand therapy regimen. Careful assessment at each session and tissue response to exercise dictated changes in the hand therapy program. Emphasis on patient education and a comprehensive home program facilitated an early return to work.

This study examined the applicability of the 10% rule and the possible effect of years of work experience on the percent difference in grip strength for a sample of 124 factory workers in Indiana. The overall mean percent difference in grip strength, measured by the Jamar dynamometer, for both right- and left-handed participants was 6.3079%. A statistical difference was found (P = 0.029) in percent difference in grip strength among subjects with varying years of work experience. A significant difference (P = 0.007) also existed when comparing the right-handed scores to the left-handed scores of the Edinburgh Inventory. Results suggest that establishing grip strength norms for factory workers should not be determined by a percent difference rule, and the years of work experience need to be taken into consideration.

This paper presents an analysis of Tuberculosis (TB). Specifically addressed are the history of its development and treatment; its current resurgence; the global impact of this resurgence; the social issues responsible for the resurgence including poverty, homelessness, substance abuse, the HIV/AIDS epidemic, and increased immigration from TB endemic areas of the world; and the political, economic and ethical issues affecting its incidence today including inadequate funding, California's Proposition 187, pharmaceutical corporation profit motives, directly observed therapy and forced confinement of non-compliant patients.