Repetitive stress injury

According to the passage, why do I la mil I c employees have a high rate of repetitive stress injury ... 

The Texas City explosion is but one of many examples of dramatic workplace accidents that engulfed the country during the later stages of the Laissez Faire Revival, a few of which are described in Box 8.1. In addition to the dramatic loss of life and limb that attended catastrophic accidents, the workplace extracted a less dramatic daily toll on workers who were maimed by repetitive stress injuries and poisoned by toxic dusts and chemicals as related in Box 8.2. 

Job-induced repetitive stress injuries is the fastest-growing category of workplace injuries. Specific stress factors include repetitive motion, awkward posture, heavy lifting, or a combination of these factors. According to the Bureau of Labor Statistics (BLS) lost- time injuries and illnesses reported in 1993 included the following ... 

In another part of the BLS report, organizations that insure for workers compensation estimated 2.73 million workers compensation claims for repetitive stress injuries in 1993. These injuries cost employers more than 20 billion. 

There are many individuals in the health care, insurance protection coverage, and safety professions who think that repetitive stress injuries are rising faster than any other workplace health concern. This problem is not confined to the warehouse environment. It is not unusual for a manufacturer of computer keyboards to lose a court case for injuries suffered from the use of their product. A major keyboard manufacturer lost a court case in 1996 in which a worker in New York was awarded 5.3 million. The settlement amount may be unusual, but equipment manufacturers have been the targets of numerous product liability lawsuits. 

The musculoskeletal system consists of the muscles, bones, joints, tendons, and ligaments. Disorders related to the musculoskeletal system often are classified by etiology. Acute soft-tissue injuries include strains and sprains of muscles and ligaments. Repeated movements in sports, exercise, work, or activities of daily living may lead to repetitive strain injury, where cumulative damage occurs to the muscles, ligaments, or tendons.1-3 While tendonitis and bursitis can arise from acute injury, more commonly these conditions occur as a result of chronic stress.3,4 Other forms of chronic musculoskeletal pain, such as pain from rheumatoid arthritis (see Chap. 54) or osteoarthritis (see Chap. 55), are discussed elsewhere in this text. 

Stress lifestyle modifications for rehabilitation and prevention. Recommend strength training, range-of-motion exercises, and a warm-up period before exercise. In repetitive-motion injury, recommend methods to correct biomechanical abnormalities and vary work tasks as applicable. Refer to a physical therapist or sports trainer as needed. 

Examples of health concerns, developed in the civil tort of negligence and which are receiving increasing attention in the courts and by the HSE, are workplace stress repetitive strain injury (RSI) and (WRULD) and vibration white finger (VWF). ... 

Slaughterhouses. On the cutting floor of a slaughterhouse, workers slice cattle carcasses on mechanical assembly lines that move at a rate of up to 400 carcasses per hour. In addition to causing deep cuts and dismemberment, the repetitive motions can cause carpal tunnel syndrome and other repetitive stress diseases. The animal slaughtering and processing industry reported almost 27,000 lost workday injuries in 2008. ... 

Expression of matrix metalloproteinases (MMPs) and their inhibitors is an important function of the RPE, particularly with respect to the maintenance of appropriate permeability of the Bruch s membrane (Ahir et al., 2002). This function can be tested in vitro (Marin-Castano et al., 2006). For example, it has been shown that the expression of MMP-2, TIPM-2s (tissue inhibitor of MMP-2), and type IV collagen by cultured ARPE-19 cells is affected by repetitive exposures to nonlethal oxidant injury with hydroquinone (Marin-Castano et al., 2006). Oxidative stress decreases MMP-2 activity and increases collagen type IV accumulation. 

The selective serotonin reuptake inhibitors (SSRI) have been used in adults for a wide variety of disorders, including major depression, social anxiety (social phobia), generalized anxiety disorder (GAD), eating disorders, premenstrual dysphoric disorder (PMDD), post-traumatic stress disorder (PTSD), panic, obsessive-compulsive disorder (OCD), trichotillomania, and migraine headaches. Some of the specific SSRI agents have an approved indication in adults for some of these disorders, as reviewed later in this chapter. The SSRIs have also been tried in children and in adults for symptomatic treatment of pain syndromes, aggressive or irritable ( short fuse ) behavior, and for self-injurious and repetitive behaviors. This chapter will review general aspects of the SSRIs and discuss their approved indications in children and adolescents. 

Neuropathic changes to the autonomic nervous system as a consequence of diabetes may affect the motor nerve supply of small intrinsic muscles of the foot, resulting in muscular imbalance, abnormal stresses on tissues and bone, and repetitive injuries. Diminished sensory perception causes an absence of pain and unawareness of minor injuries and ulceration. Also, the sympathetic nerve supply may be damaged and can result in an absence of sweating this leads to dry cracked skin, which can become secondarily infected. ... 

A risk factor is defined as an attribute or exposure that increases the probability of a disease or disorder (Putz-Anderson, 1988). Biomechanical risk factors for musculoskeletal disorders include repetitive and sustained exertions, awkward postures, and application of high mechanical forces. Vibration and cold environments may also accelerate the development of musculoskeletal disorders. Typical tools that can be used to identify the potential for development of musculoskeletal disorders include conducting work-methods analyses and checklists designed to itemize undesirable work site conditions or worker activities that contribute to injury. Since most of manual work requires the active use of the arms and hands, the structures of the upper extremities are particularly vulnerable to soft tissue injury. WUEDs are typically associated with repetitive manual tasks with forceful exertions, such as those performed at assembly lines, or when using hand tools, computer keyboards and other devices, or operating machinery. These tasks impose repeated stresses to the upper body, that is, the muscles, tendons, ligaments, nerve tissues, and neurovascular structures. There are three basic types of WRDs to the upper extremity tendon disorder (such as tendonitis), nerve disorder (such as carpal tunnel syndrome), and neurovascular disorder (such as thoracic outlet syndrome or vibration-Raynaud s syndrome). The main biomechanical risk factors of musculoskeletal disorders are presented in Table 22. 

Human factors are also important in rehabilitation, where various aids for the disabled must be sized correctly, be versatile enough to accommodate special needs, be acceptable to the human user, and be socially acceptable to others. Without proper incorporation of human factors, health problems such as eyestrain, mental stress, and physical injury can result. Cumulative trauma disorder (work-related musculoskeletal disorder) comes about when working repetitively with tools under awkward conditions. Carpel tunnel syndrome is one form of this. 

On the construction worksite, ergonomic principles are being used to help adapt the job to fit the person, rather than force the person to fit the job. Redesigning the job to fit the worker can reduce stress and eliminate many potential injuries and disorders associated with the overuse of muscles, bad posture, and repetitive motions. Also referred to as biotechnology or human engineering, it is intended to maximize productivity by reducing worker fatigue and discomfort. 

In 2006,1 made two similar studies, both for companies whose OSHA incident rates were well below average for their industries. Incident investigation reports on serious injuries only were sent to me for review. In one instance, 63% of serious injuries occurred to nonproduction personnel in the other study, 67%. Although the percentages fall within a narrow range, other research shows that such ratios are not found when the work requires intensive manual labor and when the work is highly repetitive and physically stressful. 

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