Volume 15, Number 2, May 1993, pp.39-40
Facts about Cumulative Trauma Disorders
by Chris Stavroudis
Here is more information on carpal tunnel syndrome (CTS) and
other repetitive stress injuries (RSI) or cumulative trauma
Some of the other forms of CTD are:
- Carpal tunnel syndrome; compression of the median nerve by
swollen tendons in the wrist.
- Tenosynovitis, pain and swelling of the tendon and its sheath,
especially in the hand or wrist.
- Tendonitis, pain and swelling of the tendons.
- Epicondylitis, pain and tenderness at the two bony points on
either side of the elbow (tennis elbow or golfer's elbow).
- Thoracic outlet syndrome; compression of the nerves and blood
vessels between the neck and shoulder.
Cumulative trauma disorders are much easier to treat in the early
stages, so see a qualified specialist at the merest hint of trouble.
The warning signs of CTS are:
- Numbness and tingling of the thumb and first three fingers. It
can feel like a mild electric shock in finger.
- A clumsy feeling in your hand.
- Weakness in your hand.
- Pain going up into your elbow or shoulder.
- Pain is worse at night.
To avoid CTD problems, the conservator should:
- Examine your own work habits. Watch arm, wrist, hand, and finger
positions. Avoid extension (bending the wrist up and back) and
flexion (bending the wrist towards the palm) while working. Keep the
forearm wrist and hand in a neutral (in-line) position. Be careful
of pinching and gripping actions.
- Redesign your work habits. Think about what you are asking you
body to do. Make the work as easy on your frame as possible.
- Take frequent breaks while performing rapid and repetitive or
physically stressful tasks.
- Repetitive tasks with cycle times of less than 30 seconds are
more stressful. Try modifying the task to decrease the repetition
- Working with the hands and arms elevated can cause thoracic
outlet syndrome. Even 4 minutes of light work can cause considerable
static effort that can contribute to the thickening of tendons and
compression of the nerves and blood vessels between the neck and
- Invest in good work chairs that match work table height. Chair
should support back. Feet should be flat on floor or on a solid foot
- Stretching exercises are very good. Stretching improves blood
circulation and lubricates the tendons.
- Never stretch to the point of pain or discomfort.
- If you are having a problem, don't begin stretching until
consulting with a qualified physician.
- It is best to correct poor work habits before manifesting
Reported problems for conservators:
- Scraping glue.
- Hand sewing.
- Fabricating book boxes.
When using hand tools:
- Choose working positions and tool configurations which are
comfortable. Keep hands and wrists in a relaxed neutral position.
Avoid flexion and extension of the joints.
- Consider using tools based on an ergonomic design. Many hand
tools are made with curved handles which allow normal usage of the
tool with the wrist in a neutral position.
- Build up handles of tools to allow a less closed grip,
diminishing stress from pinching finger postures. For example,
surround handles of pencils, pens, inpainting brushes and the like
with tubular polyethylene foam pipe insulation. The foam is
available from plumbing suppliers and is about 1/4 inch thick. The
foam tube will make the effective diameter of the tool 3/4 inches.
Build up the handle on scalpels with foam and tape.
- When using hand tools work with a relaxed grip.
- Use equipment that transmits minimum vibration to the hand.
When you work at a computer or typewriter:
- Configure your work space according to ergonomic guidelines.
Adjust monitor height, keyboard position, and chair height to
minimize stress on your musculoskeletal system.
- Keep wrists in neutral position, don't drop your wrists while
working. Wrist pads are available through computer suppliers to
support your wrists while you type. You can also wear a wrist brace.
- Use a good quality chair which supplies proper support.
When symptoms develop you must correct poor work habits. Begin
implementing the modifications of your work habits discussed above
If you develop symptoms, you must not only change your work
habits which contribute to the problem, you must examine all areas
of you life. Activities around the home also have to be
- If possible, have someone else do the housework until symptoms
- Use a dishwasher rather than stressing your joints by hand
- Build-up the handles on scrub brushes, knives, spoons for mixing
or stirring, and other utensils that are not exposed to heat.
- Use large sponges. To rinse a sponge, press it between the palms
of both hands rather than wringing it out.
- Build-up handles on vacuum, mop, or broom with foam pipe
insulation. Doubling the width of a broom handle is recommended.
- Use utility scrub brushes with handle (the type that look like
an iron). Slide hand underneath handle. Keep wrist neutral.
- Avoid zip-lock style bags. If used, use your entire hand to
open, and close them with another object.
- Use scissors to open sealed bags; e.g., potato chips.
- Use an electric can opener instead of manual. Us an electric jar
opener or have someone else open jars for you.
- Use care opening wine bottles. Use your open hand or other tools
as much as possible. Avoid screw-top capped wine. [That's got
nothing to do with Carpal Tunnel Syndrome.]
- Use two hands with milk containers, water bottles, etc. Put one
hand on the handle the other below supporting the weight.
- If bed is too close to wall, move it away. Making the bed with
flat sheets is easier on the hand and wrist than using fitted
- Use paper bags for groceries rather than bags with handles. Keep
bags light and use both hands to unpack.
- For problems with shoulder, store items in lower cabinets to
- Use lightweight iron if you must iron your clothes. Use two
hands or alternate iron between hands.
- Adopt a new look with an easy care hair cut. Use hood type hair
drier. Electric razors are less fatiguing than safety razors.
Build-up handles on toothbrush.
- Use self-wringing mop. Use dusting mitt and keep your hand open
Treatments for CTD include:
- Resting the affected area. This is often the first
recommendation. Moving the affected area is important, but avoid
stressing the joint. In conservation, this is often not practical
without taking time-off from work.
- For carpal tunnel, the wearing of a wrist-splint. The splint is
usually worn at night. It can also be worn during the day, but you
must be careful not to work against the splint as this can worsen
the condition. Splinting and analgesics can often alleviate
symptoms, but may take months to do so.
- Unconfirmed in the literature surveyed, but mentioned by a
number of people: Vitamin B6 therapy.
- Anti-inflammatory medications to reduce swelling and relieve
pressure on the median nerve. Ibuprofen is often recommended.
- Steroid injections into the wrist may be prescribed.
- Cold and hot baths (contrast baths) may be recommended by a
physical or occupational therapist. Heat alone is not recommended.
- Surgery may be required to open the carpal tunnel to relieve
pressure on the nerve. Often surgery is not effective or does not
effect a permanent cure.
- If work habits are not altered, CTS can recur after it has been
Hope for more accurate diagnosis of carpal tunnel and other CTDs
has appeared on the horizon. A research group has succeeded in
modifying a MRI (magnetic resonance imaging) to show nerves with
greater contrast. In the reported case, a body builder had lost
strength in one arm. The modified MRI showed that a nerve in the
shoulder was being pinched by a highly developed muscle. Surgeons
were able to relieve pressure on the nerve by excising a piece of
1. Anonymous. "RSI" (a bimonthly electronic newsletter for
people concerned about tendinitis, carpal tunnel syndrome, and other
repetitive strains), ZiffNet/Mac; RSI1-9.SEA (self-extracting
archive file). Issues 1-9. For more information, get in touch with
2. Apple Computer, Inc.: "Creating a Healthy Work Environment"
Apple Computer, Inc., 1991, 030-1922-A, 12 pages.
3. Kizer, Kenneth W.: "Your Hands & Wrists At Work. Carpal
Tunnel Syndrome: A Preventable Disease," California Occupational
Health Program; Berkeley; Sept. 1989, 8 pages.
4. Putz-Anderson, Vern, ed. "Cumulative Trauma Disorders: A
Manual for Musculosketal Diseases of the Upper Limbs," Taylor &
Francis, New York and London, 1988.
all CoOL documents]
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