4) WMSDs 10jan10

Erna
Erna T
T
CTD RNI
WORK- RELATED
MUSCULO SKELETAL DISORDERS
(WMSDs)
Erna Tresnaningsih
23 Okt 09, IDKI Pratama

Pelatihan Dokter Kesja, Jogya 28 Juli 2009 Erna Tresnaningsih
Erna T
REFERENCES
LaDou, Joseph (1990) Occupational Medicine.
P A B Raffle, P H Adams, P J Baxter, & W R Lee (1994)
Hunters Diseases of Occupation 8th edition.
Zenz, Dickerson, Horvath (1994) Occupational Medicine
3rd edition.
U.S. Dept of Health and Human Services, NIOSH,
(March 1997) Elements of Ergonomics Programs.
U.S. Dept of Health and Human Services, NIOSH, (July
1997),Musculoskeletal Disorders and Workplace
Factors.
David M Rempel, Bradley A Evanoff (2005) Overall
approach to managing Musculoskeletal Disorders.

Erna T
WMSDs
I. WHAT ?
II. WHY?
III. WHO?
IV. WHEN?
V. WHERE
VI. HOW ?
Erna T
I. What are WMSDs ?

Erna T
WMSDs (NIOSH 1997)
Disorder of the musculoskeletal system:
muscles,tendons, tendon sheaths, ligaments, joints,
cartilage, nerves, or spinal discs.
Disorders diagnosed by a medical history, physical

exam.or other med.tests
can range in severity from mild and intermittent to

debilitating & chronic.
The work environment & the performance of work

contribute significantly or MSDs that are made worse
or longer lasting by work condition.


Erna T
WMSDs
= General categories not diagnoses.
Cumulative Trauma Disorder (CTD) --> USA
Repetitive Strain Injury (RSI) --> Australia & Canada
Occupational Cervicobrachial Disorder (OCD) --> Japan
Occupational Overuse Syndrome (OOS) --> Australia
WMSDs ---->more in use worldwide

History Erna
Erna T
T
Ramazinni described this injury concept over 200

years ago,
Various and manifold is the harvest of diseases reaped
by certain workers from the craft and trades that they
pursue. All the profit that they get is fatal injury to their
health, mostly from two causes.
- The first and most potent is the harmful character of the
materials they handle.
- The second, I ascribe to certain violent and irregular
motions and unnatural postures of the body, by reason of
which, the natural structure of the vital machine is so
impaired that serious diseases gradually develop there
from.
Erna T
Some Common WMSDs

(Types of)
A. Tendon/ Ligament / Bursa / Muscle

Disorders (Soft Tissue Injury)
B. Nerve Disorders
C. Neurovascular Disorders

Erna T
A. Muscle Injuries
Muscle composed of contractile fibers
Overuse leads to strain, irritation
Muscle fibers can tear
Severe blow may traumatize
Muscle become weaker if blood flow

or nerve supply interrupted

Erna T
Myositis
Myositis is inflammation of muscle.

The inflammation may be
- primary, as in polymyositis, or
- secondary to mechanical injury, as
when a muscle has been overstretched.

Erna T
a. Strain
A strained muscle, ligament, or tendon
insertion is one that has been pushed or
pulled to its extreme by forcing the joint
beyond its normal range of motion.
It commonly results from lifting a heavy
weight or bearing an external force
usually traction force.
By definition, the symptoms of strain
should resolve within a few days to a week

Erna T
b. Sprain
A sprain is an injury in which a ligament

has been stretched so far that a few fibers
within the substance of ligament or its
attachment may be torn.
A complete tear of the ligament is

sometimes called a third-degree sprain.

Erna T
c. Arthritis
Arthritis is a condition in which a joint is

inflamed or abnormal.
Examples include post traumatic arthritis,

osteoarthritis, and rheumatoid arthritis.

Erna T
B. Nerve Disorders
Caused when nerves are exposed to

pressure
Numbness and tingling
(funny bone)
If tendon sheaths become swollen in
carpal tunnel, median nerve pinched
Carpal Tunnel Syndrome (CTS)

Erna T
C. Neurovascular Disorders
Both nerves and blood vessels affected
E.g.: - Thoracic outlet syndrome
- Vibration syndrome (White Finger

or Raynauds Syndrome)

Erna T
II. Why are WMSDs

a Problem ?

Erna T
WMSDs are Problems
the most prevalent lost time injuries & illnesses in

almost every industry. (BLS 1995; NSC 1995)
LBP -- > the most costly occupational problem (NSC

1995)
span diverse workplaces & job operations
cause a great deal of pain & suffering
decrease productivity and the quality of products &

services

Erna T
III. Who is suffering with

WMSDs ?

Annual Incidence Of RSI inErna T
New South Wales

Erna T
10 industries w/
the highest rates
of WMSDs
LBP not included
3categories:
- Food
processing,
- metal work
- textiles
Repetitive hand &
arm work
Source:BLS,1993

Erna
Erna T
Epidemiologic studies: T
- Sewing machine operators (Andersen& Gaardboe, 1993) ->

prevalence of Chronic shoulder pain 25.2%, >< referent grp. = 8.5%
Elbow pain 4.5% >< referent grp. =2.6%
- Grocery checkers (Baron et al, 1991):
prevalence of Rotator cuff S. 15% Checkers, 34% checkers w/
scanners, 7% others grc w.
prev. of WCTS 11% >< 4% others grc w.
- Manufacturing workers (McCormack et al. 1990)
prev. lateral epicondylitis: sewing w. 2.1%, packaging / folding w. 2.2%
>< referent grp 1.9%
prev. CTS sewing w. 1.2%, packaging 0.5% >< non office w/ 1.3%
- Garment workers (Punnett et al. 1985):

prev. of elbow MDs 6.5% >< referent grp. 2.8% hospital w.
prev. of CTS 18% >< referent grp 6% hosp w.

Erna T
IV. When & V. Where

WMSDs RISK FACTORS

Erna T
WMSDs RISK FACTORS !!!
1. Awkward work posture

2. Repetitive motions
3. Heavy physical work/forcefulness
4. Fixed working posture

5. Psychological stress
6. Cold temp in work activities
7. Vibration
1. AWKWARD POSITION Erna T

AWKWARD POSTURES Erna T

Erna T
AWKWARD POSTURES
A
Erna T

Erna T

Erna
Erna T
T
Awkward work posture

Erna
Erna T
T
Awkward work posture

Erna
Erna T
T
> 1500 - 2000 / hour (Putz-Anderson,1988)
a cycle time < 30 seconds (Silverstein, 1985)

Erna T
Highly repetitive motions related to MSDs
Muscles contracting at high

velocities develop less tension
More muscle effort needed
More recovery time needed
High repetition tasks can cause trauma

even when minimal force required

Erna T
Effects of Repetition
CTS appears more influenced by reps
Than force
Machine-paced jobs have significantly

more tendenitis and tenosynovitis
Up to 2500 hand motions per workday
Researchers are only now addressing

acceptable limits of repetition

Erna T

Erna T
3. Heavy physical work /
Forcefulness
- hand forces 225 N max

- pinches 45 N max, or
30 N for repetitive work

Erna T
Force
Critical factor contributing to MSDs
Pressure on body tissues often hundreds of pounds
Increased muscle effort decreases circulation,

leading to fatigue
Recovery time can exceed actual work time when

force requirements are high
Insufficient recovery time leads to soft tissue injury

Erna T
Examples of High Force Tasks
Scissors can compress digital nerves
Forceful gripping of tools (trigger finger)
Pushing with dorsiflexed -
(Ulnar nerve entrapment)
Pounding with the hand
Gloves increase force requirements
Many variables determine tolerable force
(age, sex, body build, general health)

Erna T

Erna T

Erna
Erna T
T
5. Psychological Stress

Result Showing Employees Erna T
With Psychological Factors

Erna T
Repetitif, force, awkward work posture

Erna
Erna T
T
7. VIBRATION

Erna T
VIBRATION

Erna T
D. WMSDs
General categories:
1. Some Specific Clinical Conditions
- discrete pathological entities
- relatively well defined signs and symptoms
2. Some Less Specific Clinical Conditions

- less well defined myalgic conditions, involving
pain and dysfunction at multiple sites.
3. Some Occupational Variants

Erna T
WMSDs/CTD/RSI/OCD/OS continued
1. Specific Clinical Conditions

- Supraspinatus /Rotator cuff tendinitis
- Thoracic outlet syndrome
- Lateral epicondilitis (tennis elbow)
- Medial epicondilitis (golfers elbow)
- Tenosynovitis,Peritendinitis
- Carpal Tunnel Syndrome
- Trigger finger
- Ganglia

Erna T
WMSDs continued
2. Some Less Specific Clinical Conditions

- Cervical syndrome
- Tension neck, stiff neck, etc
- Frozen shoulder
- Occupational cramps
3. Some Occupational Variants

- data-processing disease
- telegraphists cramp,
- writers cramp - washer-womans thumb
- florists cramp - musicians cramp

F. How to prevent WMSDs ?Erna T
Comprehensive programs that integrate
ergonomic evaluations w/ med.treatment
the incidence & severity of WMSDs
includes:
Human Factors
& Medical management
Environment Factors
1. Recognition
2. Evaluation
3. Intervention
Erna T
PREVENTION
PREVENTION OF
OF WMSDs
WMSDs
Three basic Human factors:

1. People are different in shapes and sizes
2. People have physical and mental limitation
3. People have certain expectations and predictable
responses to given situations.
When we exceed the limit or ignore these factors,

the consequences are costly, both financially and
in terms of human discomfort and performance ->
mistakes, errors and incorrect decisions.

Erna T
Medical management
Good medical management of MSDs includes:
1. early reporting of symptoms,

2. timely access to healthcare providers &
appropriate medical treatment,
3. rapid evaluation and modification of job
risk factors,
4. the provision for limited or modified
work duties when necessary, and
5. close medical follow-up.
Erna T
1. Recognition:
Company records: OSHA Form 300 logs (jan1 2002),
workers compensation claim
Worker complaints:
- undue strain, discomfort,
- localize fatigue or pain and signs:
loss of function
limited movement, or
loss of muscle power
(aches & pains related to certain job)
Job tasks: repetitive & forceful exertions, frequent,
heavy or overhead lifts, awkward position

Erna T
2. Evaluation
- all job sites
- all tools / equipment
- all work methods & processes
- all MSDs identified in the med.rec

survey


Erna T
3. Intervention
a. Engineering controls
b. Administrative controls

1. Changes in job rules & procedures

Erna T
a. Engineering controls
Changing the way material, parts, and
products can be transported
Changing the process or product to reduce

worker exposures to risk factors
Modifying containers & parts presentation
Changing workstation layout
Changing tool designs

Erna T
b1. Administrative Controls
Changes in job rules & procedures/More
Comfortable working patterned:
- Scheduling more rest break
shorter exposure times
- Job sharing
- Rotating workers through jobs that are
physically tiring
training workers to recognize ergonomic risk

factors & to learn techniques for reducing the
stress & strain while performing their work tasks
(work practice).
Erna T
b2. Work practices
1. Keep everything in easy reach
2. Work at proper height
3. Work in good postures
4. Reduce excessive forces
5. Reduce excessive repetition
6. Minimize fatigue
7. Minimize contact stress
8. Provide mobility and change of posture
9. Provide clearance and access
10. Maintain a comfortable environment

Tichauers elbows (1978) Erna T

Erna T
c. Personal Protective Equipment
e.g.- wrist supports

- braces
- back belts (controversial)
- vibration attenuation gloves
Limitation
medical involvement

Erna
Erna T
T
TERIMA KASIH


4) WMSDs 10jan10

Diunggah oleh

Informasi Dokumen

Judul Asli

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

4) WMSDs 10jan10

Diunggah oleh

Hak Cipta:

Format Tersedia

Erna

23 Okt 09, IDKI Pratama

Pelatihan Dokter Kesja, Jogya 28 Juli 2009 Erna Tresnaningsih

I. What are WMSDs ?

Pelatihan Dokter Kesja, Jogya 28 Juli 2009 Erna Tresnaningsih

Disorders diagnosed by a medical history, physical

can range in severity from mild and intermittent to

The work environment & the performance of work

Pelatihan Dokter Kesja, Jogya 28 Juli 2009 Erna Tresnaningsih

Repetitive Strain Injury (RSI) --> Australia & Canada

Occupational Cervicobrachial Disorder (OCD) --> Japan

Occupational Overuse Syndrome (OOS) --> Australia

WMSDs ---->more in use worldwide

Pelatihan Dokter Kesja, Jogya 28 Juli 2009 Erna Tresnaningsih

Ramazinni described this injury concept over 200

Some Common WMSDs

A. Tendon/ Ligament / Bursa / Muscle

Pelatihan Dokter Kesja, Jogya 28 Juli 2009 Erna Tresnaningsih

Muscle composed of contractile fibers

Overuse leads to strain, irritation

Muscle fibers can tear

Severe blow may traumatize

Muscle become weaker if blood flow

Pelatihan Dokter Kesja, Jogya 28 Juli 2009 Erna Tresnaningsih

Myositis is inflammation of muscle.

Pelatihan Dokter Kesja, Jogya 28 Juli 2009 Erna Tresnaningsih

Pelatihan Dokter Kesja, Jogya 28 Juli 2009 Erna Tresnaningsih

A sprain is an injury in which a ligament

A complete tear of the ligament is

Pelatihan Dokter Kesja, Jogya 28 Juli 2009 Erna Tresnaningsih

Arthritis is a condition in which a joint is

Examples include post traumatic arthritis,

Pelatihan Dokter Kesja, Jogya 28 Juli 2009 Erna Tresnaningsih

Caused when nerves are exposed to

Pelatihan Dokter Kesja, Jogya 28 Juli 2009 Erna Tresnaningsih

Both nerves and blood vessels affected

E.g.: - Thoracic outlet syndrome

- Vibration syndrome (White Finger

Pelatihan Dokter Kesja, Jogya 28 Juli 2009 Erna Tresnaningsih

II. Why are WMSDs

Pelatihan Dokter Kesja, Jogya 28 Juli 2009 Erna Tresnaningsih

the most prevalent lost time injuries & illnesses in

LBP -- > the most costly occupational problem (NSC

span diverse workplaces & job operations

cause a great deal of pain & suffering

decrease productivity and the quality of products &

Pelatihan Dokter Kesja, Jogya 28 Juli 2009 Erna Tresnaningsih

III. Who is suffering with

Pelatihan Dokter Kesja, Jogya 28 Juli 2009 Erna Tresnaningsih

Pelatihan Dokter Kesja, Jogya 28 Juli 2009 Erna Tresnaningsih

Pelatihan Dokter Kesja, Jogya 28 Juli 2009 Erna Tresnaningsih

- Sewing machine operators (Andersen& Gaardboe, 1993) ->

- Garment workers (Punnett et al. 1985):

23 Okt 09, IDKI Pratama

IV. When & V. Where

Pelatihan Dokter Kesja, Jogya 28 Juli 2009 Erna Tresnaningsih

1. Awkward work posture

4. Fixed working posture

Pelatihan Dokter Kesja, Jogya 28 Juli 2009 Erna Tresnaningsih

Pelatihan Dokter Kesja, Jogya 28 Juli 2009 Erna Tresnaningsih

Pelatihan Dokter Kesja, Jogya 28 Juli 2009 Erna Tresnaningsih

Pelatihan Dokter Kesja, Jogya 28 Juli 2009 Erna Tresnaningsih

Awkward work posture