CARPAL TUNNEL SYNDROME
PRIVATE TRAINING GUIDE
National Health and Safety Representative
One of the good things about being a health and safety rep is that you are always on the side of right. After all, you are for health and good working conditions! And, who possibly could be for bad conditions and illness. Nevertheless, we find ourselves with more and more people afflicted with a wide variety of ailments resulting from use of computer terminals.
These illnesses or diseases have a variety of names. Normally, they are classified as Repetitive Strain Injuries or RSIs. Another overall term is Chronic Trauma Disorder or CTD. The most famous disease among these, although not the most common, is CARPAL TUNNEL SYNDROME.
Carpal Tunnel Syndrome gets its name from the carpal tunnel which is a 1 inch "channel" which is made by the carpal bones and ligament on the palm side of the wrist. Tendons, the median nerve and the fingers's blood vessels pass through the carpal tunnel onto the forearm where they connect with the muscles that control finger movement. So, if these tendons start swelling or become inflamed in any way, they can push against the result in compression of the median nerve. Continual pressure over time can result in damage or carpal tunnel syndrome. Other types of injuries include tendinitis.
Symptoms of these diseases include pain, numbness, tingling in the hand, the thumb, index finger, middle ring finger, or at the base of the palm. The pain can become so extensive that people are awakened at night by it.
WHAT CAUSES THIS AND OTHER DISEASES
1. Repetition. Work that we do no the FOSE terminals and the PCs in our offices causes us to use hand or finger movements over and over again. Unlike typewriters, which are rapidly becoming extinct, terminals do not require varied hand movements used to put paper in a typewriter, adjust the carriage, remove the paper, etc. Because we are typing continuously on a terminal, we are making the same hand, finger and wrist motions over and over again and we do this with ever increasing speed.
2. Awkward postures. To work on terminals in a good environment, our furniture must be adjustable, the work station must be adjustable, the computer must be adjustable, and the chair must be adjustable. This is not the case in most field offices. Terminals are often just placed on desks. Many people such as SSI CRs do not have their own terminals but must share others. They go from terminal to terminal and chair to chair and must adjust themselves to the terminal instead of vice versa. As a result, they can find themselves in many awkward postures.
3. Improper equipment. One of the cornerstones of a good work environment is furniture and equipment that meed the needs of the employee, not vice versa. A major problem with modular furniture and the installation of FOSE equipment is that it was simply placed in many cases on top of people's desks. Individuals found themselves as a result in difficult postures, since they had to make accommodations in order to be able to use the equipment such as by contorting their neck and shoulder muscles, etc.
In a perfect world or perfect work environment, employees would have furniture that is adjustable to their needs, that they can move up and down, the same way that they can (once they know how) do with an ergonomic chair.
The key principle here is ergonomics which is a science that sees to it that the job adapts to the person. It is a science that also recognizes that there are individual differences among employees, that there is no rule or regulation that employees be of a certain height, shape or size.
Carpal tunnel syndrome and other similar injuries are really not new, they have come to greater attention as a result of the growth of the computer in our society. In fact, one form of repetitive strain injury, an injury that many SRs and CRs have experienced is writer's cramp. Another form that developed over time was washerwoman's thumb which developed as a result of having to make the same motions or movements over and over again as these hard working people washed clothes by hand.
Other types of injuries that are growing are found among grocery store clerks who must make the same motion over and over again as they place the food products that we buy over a scanner that reads the bar codes with the prices that we must pay. The first group of workers who find themselves with an OSHA (Occupational Safety and Health Administration Standard) are those who work in the meatpacking industry. OSHA has adopted standards for those employees and it is possible that similar standards dealing with adjustable work stations and breaks may eventually be in place for all employees.
OSHA has established a Department of Ergonomics. But, unfortunately, this department for the entire country consists of one person who does not do ergonomic inspections.
AVOIDING THESE INJURIES
Besides having proper equipment, there are things that we can recommend to our co-workers that could help them to avoid these injuries:
1. People can be encouraged to keep their wrists straight whenever they type on the keyboard.
2. Some injuries have happened by doing things like lifting transmittals. All lifting should be done with our whole hand. CRs and SRs spend much of their day using their hands.
3. Workstations (more on redesign later for victims). But, we should have comfortable workstations. Our fingers should be lower than our wrists. The heel of our hands should not be rested on the keyboard.
4. We should use Article 38, Section 3-1 breaks. Continual use of the FOSE terminals is a contributing factor to problems. Intensive users are permitted VDT breaks twice each day for 10 minutes. These are in addition to our regular scheduled breaks and can be used to do other types of work. Non-intensive users are to receive a 15 minute break away from the terminal every 2 hours and once again this can be doing a different type of work assignment.
5. Soft touch. We should type with a soft touch, not pounding the keys, the level of force that we use on the keyboard may have some affect on the possibility of us coming down with a terminal illness.
6. Watch for pain. When it hurts to type, stop. Ask for accommodation from the pain.
WORK SITE INSPECTIONS--SSA-5510
One thing you can do is to look at terminals when you do your twice annual SSA-5510 inspection per Article 9, Section 7C. Under Part D of the 5510, question 25 deals directly with VDTs. "Are video display terminals maintained in a clean and proper manner?" This question applies to PCs as well as FOSE and should be looked at carefully.
What is a clean and proper manner? It is AFGE's belief that this question opens up the whole issue of safety.
In looking at this issue, we should ask the following questions:
1. Where are the terminals placed? Are they on desks? Are they on lazy susans? Is there any adjustability or do all the employees in an office use the same machines on the same furniture?
2. Are the chairs that go with the terminals ergonomic? Do employees know how to adjust them?
3. What about the screens? Does the office have filters or anti-glare screens? Do the terminals have a lot of flicker? Does light reflect on the screen from windows? If so, it may be possible to re-position terminals.
4. Do employees receive the breaks discussed above, per Article 38?
5. What about terminals in reception areas or front counters, are they positioned in such a way that employees are able to use them with the least possible strain on their hands and wrists? Are people in reception areas given adequate chairs or stools, or do they have to stand when they do inputs?
6. Do individuals who type for extensive periods have document holders?
7. Are there cleaning supplies to clean the terminals such as alcohol?
No responses and corrective action needed can be put on the SSA-5510 and you can use page 8 of this form for additional responses.
What you should do as well is to use the OSHA Log 200 to see how many associated computer injuries you have in your office. Management should as well be notifying you on workers compensation claims, per Article 34, Section 1B. So, you could use the information you have received in order to seek preventive measures.
HOW TO HELP INJURED WORKERS:
There are two methods of assisting injured workers:
1. WORKERS COMPENSATION. Afflicted employees must file for workers compensation. Since prolonged use of FOSE and/or PC terminals results over a period of time, the proper form to complete is normally the CA-2, which is the occupational disease/illness form.
Individuals approved for workers compensation will normally receive 2/3 of their salary if they have no dependents and 3/4 if they do. Workers compensation will also pay medical expenses. The employee will have to develop medical evidence and normally takes a CA-20 form to his/her doctor/HMO/clinic.
The employee should write as his/her injury "carpal tunnel/computer related repetitive strain injury." Remember, there are a variety of injuries. If someone has a particular diagnosis, such as tendinitis, list that.
Along with this, each afflicted employee should prepare a several page narrative. REMEMBER: It is important that you demonstrate a causal relationship between the job and the illness.
The following are some samples:
T2 CR. "I am a claims representative. My job is to take applications for retirement, survivor and disability benefits. I take these applications over a VDT computer screen. Out of an 8 hour day, I spent 7 hours at the terminal. I am constantly typing. When I do not use the terminal for applications, I use another personal computer for an hour or so to type letters to my claimants. My entire job is devoted to computer use. I have never had this kind of injury before. I do not have a computer at home. I am not engaged in any activity at home which involves the use of my hand or wrist such as golf, tennis, gardening, or arts and crafts. [If the person should, mention how they never had any ill affects until they started using the computer.]
Also describe the work station. "The computer terminal I have is just placed on my desk. It is not adjustable. I have to strain my body, my neck, my arms in order to use [have the person be descriptive]. Or, I share a terminal with another person and it is not adjustable to my height. Or, I have to use a terminal in the front which is not adjustable." [It helps to be descriptive.]
FOR T16 CRs. "I use the computer 5 hours a day. I need to use it to find out information about the cases I work, where a person lives, how much income he or she has, whether or not that individual has filed before, if the person is eligible, if the person has a valid Social Security Number, etc. I do not have a computer on my desk. As such, I have to go to different computers throughout the office. All are adjusted at different levels. When I interview, I go to the front of the office and interview there, the terminals there are not adjusted to my height. I find that I have to strain to use them. I do not have a computer at home or do anything with my hands or wrists. My illness is totally related to my job."
SRs. "I take quick interviews as a part of my job. I am on the computer 8 hours a day. Whenever I take a change of address or other change from a Social Security recipient, I immediately key that data into the computer system. Whenever I take an application for a Social Security card, I immediately key that data (and by keying I mean use the computer) into the computer system. I am continuously typing. Whenever I need to do some of my desk work, I use the computer. I use another computer, the personal computer, in order to write letters to people asking them to come into the office and see me or call me."
DC. "I use the computer 8 hours a day. I use it to do inquiries and find out where a check is going, what address, how much money a person is receiving, etc. I do not have a computer at my desk and so continually have to get up to use other people's machines.
"I do clerical work for other employees and when I do this, I must use a personal computer. The computer is not adjustable for me, but is on a table for everyone to use. I do not use a computer at home and do not do any activities involving my hands or wrists. I have not had such symptoms as numbness in my hands prior to my use of the computer."
A key in workers comp claims is to show a causal relationship between the job and the impairment. What we have is a 3 step process:
a. employee suffers injury or illness
b. injury or illness is causally related to the job
c. there is medical confirmation of this illness
When you have this, you have a successful claim. Often you must assist the employee in working with her/his doctor to see that the necessary factors are covered.
REMEMBER TO TELL YOUR EMPLOYEES THAT ONE OF THE MAJOR ADVANTAGES OF GETTING ON WORKERS COMP IS THAT MOST OF YOUR MEDICAL BILLS ARE PAID WHEN THE CLAIM IS APPROVED. (Tell your employees to give their doctors this message.)
2. REASONABLE ACCOMMODATION: Reasonable accommodation is an allowance that management makes that enables a qualified handicapped employee to be able to do his or her job. A worker with carpal tunnel syndrome or other repetitive strain injury can get this by having his or her doctor write the request on a piece of stationary. The employee should complete his/her request on an SSA-501 reasonable accommodation form. If management does not allow the request, the individual can file an informal EEO complaint.
What are such requests? Accommodations (which include limited duty) can include time away from the terminal, such as typing 4 hours a day instead of 8. They can include having management purchase a special chair, putting in keyboard modifications, having a wrist rest or other device being purchased. Purchases should be prescribed by doctors, don't forget. Other modifications could be glare screens, moving the terminal away from a window, having a special task light over the keyboard for the employee. Really, anything and everything that can help a person could be included.
Office changes resulting from FOSE have been beneficial. The downside, of course, has been the increasing number of injuries. However, all employees with the help of an experience and compassionate AFGE Health and Safety Rep can realize that truly with their union there is hope and with their union they can realize a better environment that either cope with these problems or prevent them. Health and safety is but another way in which AFGE spells RELIEF.