CUMULATIVE TRAUMA DISORDERS Current Issues and Ergonomic Solutions: A Systems Approach Kathryn G. Parker Harold R. lmbus LEWIS PUBLISHERS Boca Raton Ann Arbor London Tokyo Library of Congress Cataloging-in-Publication Data Parker, Kathryn G. Cumulative trauma disorders : current issues and ergonomic solutions: a systems approach I Kathryn G. Parker, Harold R. Imbus. p. em. Includes bibliographical references and index. ISBN 0-87371-322-2 1. Overuse injuries. 2. Overuse injuries-Prevention. I. Imbus, Harold R. [DNLM: 1. Human Engineering-methods. 2. Occupational Dis- eases-etiology. 3. Occupational Diseases-prevention & control. 4. Stress-etiology. 5. Stress-prevention & control. WA 440 P241c] RD97.5.P37 1992 616.98'03-dc20 DNLM/DLC for Library of Congress 92-20620 CIP COPYRIGHT © 1992 by LEWIS PUBLISHERS ALL RIGHTS RESERVED This book represents information obtained from authentic and highly regarded sources. Reprinted material is quoted with permission, and sources are indicated. A wide variety of references are listed. Every reasonable effort has been made to give reliable data and information, but the author and the publisher cannot assume responsibility for the validity of all materials or for the consequences of their use. Neither this book nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy- ing, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher. Direct all inquiries to CRC Press, Inc., 2000 Corporate Blvd., N.W., Boca Raton, Florida 33431. PRINTED IN THE UNITED STATES OF AMERICA 2 3 4 5 6 7 8 9 0 Printed on acid-free paper PRINCIPLE AUTHORS: Kathryn G. Parker, MS Consultant in Ergonomics Harold R. lmbus, MD President, Health & Hygiene, Inc. CONTRIBUTING AUTHORS: R. Keith Butterfield, MS Peter G. Johnson, MD A. Ritchie Lewis, MD Sheila H. Mullins Anthony P. Wright PREFACE A number of books have been written on ergonomic assessment and prevention of cumulative trauma disorders. There have also been many articles in the medical literature pertaining to these disorders. How- ever, seldom is the subject treated in a comprehensive and integrated fashion. We attempt to do so in this book. Ergonomics is the mainstay in preventing cumulative trauma disor- ders. Early detection is important for the treatment of cases, and ergo- nomic programs will fail to achieve their full potential without ad- equate early detection. However, further ergonomic follow up is vital in controlling the factors that cause the case in the first place. Cumulative trauma cases often start as simple muscle pain and fatigue. Frequently they are complicated by overzealous treatment, including unnecessary surgical care. Therefore, to control cumulative trauma disorders, there must be a continuous interaction between er- gonomists, medical providers within the plant setting, and medical specialists outside the plant setting. This book, while presenting the subjects in a traditional, categorical approach to identifying ergonomics and medicine, tries to integrate these approaches to assist management, ergonomists, and medical care providers in acheiving optimum results. Although technical, this book is written in a manner that we hope will be readily accessable to most of those normally responsible for dealing with these problems. EDITORS Kathy Parker is an independent consultant in ergonomics, specializ- ing in soft tissue fatigue and cumulative trauma, and is based in Chapel Hill, North Carolina. She has a dual background. She is a licensed physical therapist with a Bachelor of Science degree from the Univer- sity of North Carolina at Chapel Hill in 1984. In 1986, she earned a Master of Science degree in Industrial Engineering from North Carolina State University with a study emphasis in occupational biomechanics. Her experience includes ergonomics consulting, training, and man- aging ergonomics programs for a variety of manufacturing and service companies. She has a special interest in the textile and apparel industry, for which she has provided a variety of programs. Ms. Parker was previously employed as the Director of Ergonomics for Health and Hygiene, Inc. in Greensboro, North Carolina, where she initiated and developed their ergonomics consulting services. Dr. Harold R. Imbus is the chairman of Health & Hygiene, Inc. He received his M.D. and Sc.D. from the University of Cincinnati. Dr. Imbus has practiced occupational medicine for three decades and is an international expert on medical surveillance, respiratory testing, and worker compensation issues of byssinosis (cotton dust lung disease). He has published numerous scientific articles on toxic substances and human health, including studies on toxic metals (boron, cadmium, chromium, nickel), formaldehyde, hydrocarbon solvents, and cotton dust. His publications include a chapter on clinical occupational medi- cine published in Zenz's classic text, Occupational Medicine. Dr. Imbus served 12 years as Medical Director for Burlington Industries and Deputy Medical Director for Kennedy Space Center. Dr. Imbus has over 30 years experience dealing with cumulative trauma disorders as an occupational physician. He has seen a rapid increase of these disorders in the last decade and has been extensively involved with them in recent years. Dr. Imbus has consulted with many large companies pertaining to medical and ergonomic prevention and management of these disorders. TABLE OF CONTENTS Introduction ................................................................................................... 1 Workplace Trends ................................................................................. 2 Absenteeism ....................................................................................... 2 Specialization ..................................................................................... 2 Consumerism ..................................................................................... 2 Office Automation ............................................................................ 3 Workforce Trends .................................................................................. 4 Women in the Workforce ................................................................ 4 Demographics .................................................................................... 5 Age ...................................................................................................... 5 Physical Ability ................................................................................. 5 Social Trends .......................................................................................... 6 Medical Community ........................................................................ 6 Workers' Compensation and OSHA ............................................. 7 Legal Systems ......................................................................................... 8 Purpose of Book ..................................................................................... 8 Primary Prevention .......................................................................... 9 Secondary Prevention ...................................................................... 9 References ............................................................................................. 10 Part I CAUSATION OF CUMULATIVE TRAUMA DISORDERS ................ 11 Chapter 1 Body Tissues and Fatigue ......................................................................... 13 Basic Anatomy of the Upper Quarter .............................................. 13 Musculoskeletal System ................................................................. 14 Nervous System of the Upper Extremity ................................... 22 Circulation of the Upper Extremity ............................................. 25 Physiology of Fatigue on Body Tissues ........................................... 25 The Conditioning Process ............................................................. 25 Rate of Increase in the Activity ............................................... 27 Physical Conditon of the Individual ...................................... 27 State of Health ............................................................................ 27