On the Other "Hand"
Repetitive Overuse Injuries of the Hand & Wrist

Many repetitive overuse injuries take place in the workplace and are most commonly seen in the hand, wrist, shoulder, and spine. In fact, the U.S. Bureau of Labor estimates that the incidence of repetitive overuse injuries is dramatically increasing and now accounts for 50% of all work-related ailments. While it is true that certain occupations can contribute to musculoskeletal symptoms, the job itself is not always the main cause. Most people would agree that there are many factors that contribute to developing an overuse injury.

What are some of these factors?
Key factors usually attributed to repetitive overuse injuries are repetition or prolonged use, force directly applied to the soft tissues (nerves, tendons, ligaments, muscles), and awkward postures. Prolonged use combined with applied force can cause micro-trauma, resulting in inflammation and injury. Awkward postures, poor work station and equipment design, and improper work technique can lead to muscle imbalances. Additional hazards, such as vibration and exposure to the cold, must always be considered as well. Pre-existing conditions (such as diabetes, arthritis, and pregnancy) can also play a major role. Recreational activities and hobbies outside the workplace can also contribute to the development of an overuse injury.

Types of injuries
The most common form of repetitive overuse injury in the hand and wrist is tendinitis. This refers to an inflammation of the wrist tendons-fibrous bands of tissue that connect muscle to bone (see figure). The tendons may become very sensitive to touch, especially for those of you who do a lot of typing. Also, you may have limited motion and weakness in your wrist.

Another form of repetitive overuse injury commonly seen in the hand and wrist is carpal tunnel syndrome. Your wrist contains a firm, tunnel-like structure called the carpal tunnel, which contains nerves, bones, and ligaments. As a result of pressure placed on the wrist, the median nerve becomes pinched (see figure below), causing pain and numbness in your hand and wrist.

Treatment for both injuries can include ice, modifying or limiting your activity, wearing a splint, and taking nonsteroidal anti-inflammatory drugs (such as ibuprofen) to help reduce pain and swelling. Cortisone injections and surgery are reserved for severe, chronic (long-lasting) cases that do not improve with conservative treatment.

Stop it before it starts If a specific situation at work can be identified as the source of your prolonged use or awkward posture, then it should be corrected. Oftentimes, this is all that is needed to resolve the problem. Ergonomic interventions, such as redesigning work stations and modifying work methods, can help to prevent these problems. The most important aspect in preventing work-related problems is to identify the potentially hazardous situation before it affects you.

Since overuse injuries have increased so rapidly within the past 10 years, many aggressive and forward-thinking companies are having their work stations evaluated by experts in ergonomics to prevent their employees from experiencing these conditions. Also, you can perform various strengthening, stretching, and conditioning exercises before, during, and after work in a manner similar to an athlete participating in a sport. Because let's face it, even "industrial athletes" need to warm up.

David C. Rehak, M.D.
Columbus, Georgia