The social recognition of repetition strain injuries: an Australian/American comparison

Carpal Tunnel Pressure during Typing: Effects of Wrist Posture and Typing Speed

With increasing frequency, reports appear in the popular press linking hand and wrist musculoskeletal disorders (MSDs) with keyboard work. Excessive ulnar deviation and self-perceived fast typing speed are two of the many risk factors identified through various epidemiological studies of upper extremity MSD symptoms among those working with keyboards. Yet no study has offered quantitative, biomechanical evidence to explain how these factors might contribute to MSD development. A study was designed to examine carpal tunnel pressure (CTP) during typing, and the effect of radial-ulnar wrist posture and typing speed on CTP. Female subjects typed on a commercially-available keyboard which was oriented in standard and in split configurations. In the split arrangement ulnar deviation was eased in all but one wrist. In the split arrangement, all subjects demonstrated a decrease in CTP concomitant with a decrease in ulnar wrist deviation. However, only one subject exhibited CTP which significantly exceeded pressure thresholds identified in the literature. CTP appeared to be subject-specific in nature. Typing speed was found to affect peak CTP in half of the subjects.

Effects of computer keyboarding on ultrasonographic measures of the median nerve

BACKGROUND

Keyboarding is a highly repetitive daily task and has been linked to musculoskeletal disorders of the upper extremity. However, the effect of keyboarding on median nerve injuries is not well understood. The purpose of this study was to use ultrasonographic measurements to determine whether continuous keyboarding can cause acute changes in the median nerve.

METHODS

Ultrasound images of the median nerve from 21 volunteers were captured at the levels of the pisiform and distal radius prior to and following a prolonged keyboarding task (i.e., 1 hr of continuous keyboarding). Images were analyzed by a blinded investigator to quantify the median nerve characteristics. Changes in the median nerve ultrasonographic measures as a result of continuous keyboarding task were evaluated.

RESULTS

Cross-sectional areas at the pisiform level were significantly larger in both dominant (P = 0.004) and non-dominant (P = 0.001) hands following the keyboarding task. Swelling ratio was significantly greater in the dominant hand (P = 0.020) after 60 min of keyboarding when compared to the baseline measures. Flattening ratios were not significantly different in either hand as a result of keyboarding.

CONCLUSION

We were able to detect an acute increase in the area of the median nerve following 1 hr of keyboarding with a computer keyboard. This suggests that keyboarding has an impact on the median nerve. Further studies are required to understand this relationship, which would provide insight into the pathophysiology of median neuropathies such as carpal tunnel syndrome.

Cultural models and somatic syndromes

OBJECTIVES

To review the relevance of cultural models in the generation and amplification of somatic symptoms and syndromes.

METHODS

Based on a selective review of literature, we examine evidence that cultural and personal explanatory models can contribute to the pathogenesis, symptomatology, and chronicity of medically unexplained symptoms and functional somatic syndromes.

RESULTS

In the contemporary world, culture involves flows of information, roles, and institutions that offer individuals multiple models for understanding illness. Cultural models include 1) explanatory models, which make causal attributions and impute specific mechanisms or processes of pathophysiology; 2) prototypes, which are salient images or exemplars drawn from personal experience, family, friends, mass media, and popular culture that are used to reason analogically about one's own condition; and 3) implicit models and procedural knowledge that may be difficult to articulate because they are embedded in body practices and ways of experiencing distress. Symptom attributions and explanations can participate in vicious circles of symptom amplification that give rise to culture-specific varieties of panic disorder, hypochondriacal worry, and medically unexplained symptoms.

CONCLUSIONS

Clinical research using the methods of experimental cognitive and social psychology as well as community-based ethnographic and ecological research are needed to advance our understanding of the impact of personal and cultural models on somatic distress. Nevertheless, the current state of knowledge on social and cultural dimensions of somatic syndromes suggests a typology of forms of psychosomatic and sociosomatic looping that has implications for the nosology of somatoform disorders.

The demise of repetitive strain injury in sceptical governing rationalities of workplace managers

In the mid-1990s, RSI (repetitive strain injury) loomed as an occupational health epidemic in industrialised countries. A decade later, the problem appears to have faded away, but there has been little explanation for how this problem might have diminished. This paper offers an explanation for the decline of RSI in the social relations of workplaces, in the pragmatic, day-to-day governance of occupational health by workplace managers. Using the conceptual lens of governmentality theory, this study examined how workplace managers conceptualised, rationalised and responded to RSI in their work organisations. Open-ended interviews were conducted with 35 managers at four Ontario newspaper workplaces. This paper describes managers as guided by a discourse of scepticism about the legitimacy of RSI complaints. This discourse was 'practised' in different ways at each newspaper in varied RSI-management strategies, but each strategy privileged ideas about RSI being problematic in certain types of workers rather than in types of physical work environments. This conceptualisation of RSI splintered, subordinated and collapsed the problem within a broad human resources framework. This paper suggests that the 'taming' of RSI might have occurred in the context of micro-political, workplace-level shifts in the conceptualisation and management of RSI as an occupational health problem.

Disputed diagnoses: the cases of RSI and childhood cancer

Recently, greater emphasis has been accorded lay views and involvement in debates on health care provision. At the macro level, policy makers are urged to take heed of the opinions of the general public when formulating new policies for health care or making changes to existing ones. Furthermore, it is suggested that this accommodation should be repeated at the level of the individual, namely in encounters between doctors and patients. However, imbalances in the doctor-patient power relationship, compounded by structural barriers, can create problems which prevent this sort of collaborative interaction from taking place. Against this background, the paper draws on evidence from studies of two quite different conditions, repetitive strain injury (RSI) and childhood cancer, to explore lay perspectives and empowerment in relation to obtaining a diagnosis. The findings of the studies are scrutinised in respect of four related areas of concern: how much lay views count, exercising choice, referral pathways and the withdrawal of trust from medical practitioners. The evidence suggests that a substantial number of patients with RSI and parents of children with cancer felt their experiences and knowledge were disregarded by doctors in the diagnostic process. Denying the validity of an individual's perceptions had implications for obtaining an accurate diagnosis, which could in turn make access to appropriate health care and treatment problematic. Their experiences led some people with RSI to show a general distrust of medicine; this was less the case for parents of children with cancer. A key issue to emerge from the analysis is the need for additional training in two areas of the medical curriculum: communication skills and occupational health problems. The underlying problems of attitudes, especially giving weight to the informed views of lay people, is another matter which needs to be addressed.

Gender trends in sick-listing with musculoskeletal symptoms in a Swedish county during a period of rapid increase in sickness absence

Sickness absence and disability pension due to musculoskeletal diagnoses has increased in Sweden.

STUDY OBJECTIVE

To study gender trends in sickness absence with musculoskeletal diagnoses and its changes in 1985-87.

DESIGN

A prospective population-based study of all new sick-leave spells exceeding seven days in 1985-87. Sickness absence with "all diagnoses" was compared to "all musculoskeletal diagnoses", the latter group was also divided into three sub-groups.

SETTING

The county of Ostergötland, Sweden.

PARTICIPANTS

All sick-leave insured aged 16-65; 107,000 women and 100,000 men.

RESULTS

More women than men were sick-listed in "all diagnoses" in 1985. There were corresponding gender differences in sickness absence with musculoskeletal diagnoses except with the diagnosis "low back pain". Sick-listing with musculoskeletal diagnoses increased for both women and men from 1985 to 1987, but the increase was consistently much higher for women, especially for younger women.

Recent trends in work-related cumulative trauma disorders of the upper extremities in the United States: an evaluation of possible reasons

The increasing trends of cumulative trauma disorders of the upper extremities (CTDUEs) in US industry is well established; however, systematic examination of potential reasons for these trends has been lacking. Data from the United States Bureau of Labor Statistics and from Liberty Mutual Group workers' compensation claims were used to count CTDUEs. The proportions of all Bureau of Labor Statistics' cases and Liberty Mutual Group workers' compensation claims that resulted from CTDUEs were estimated for the years 1986 to 1993. The proportions by occupation (job classification code), gender, potential video display unit use, and in the meat-packing industry are described. Both data systems show a steady increase in cases and claims from less than 1% in 1986 to about 4% in 1993. Women and specific occupational categories are over-represented with respect to CTDUEs. A shift to service industry work and video display unit use do not appear to be strongly related to the increased reporting of CTDUEs, whereas increased productivity, an increased number of women in the work force and general awareness of CTDUEs in the media and health care system may be related. Coding and definition problems still limit these conclusions, however.

A quantitative description of typing biomechanics

One approach to combating work- related upper extremity musculoskeletal disorders (UEMSDs) is to improve understanding of MSD risk factors through quantitative biomechanical characterization of manual tasks, including joint postures, joint dynamics, and force exertion. This paper describes a methodology employed to quantitatively assess professional typing in a workplace setting, and the results of that assessment. Results are compared between different kinds of typing tasks, and between typing and hand- intensive industrial tasks, based on nontask- specific biomechanical terms. Quantitative, biomechanical characterizations of manual tasks will lead to identification of appropriate ranges for joint kinematics and force exertion, which will, in turn, facilitate proper design of manual tasks. Additionally, the methodology could be used to assess manual performance of skilled tasks for proper (healthy) technique, or be used to evaluate progress through a course of rehabilitation (when do an impaired worker's motions begin to resemble motions of healthy workers?).

On the origin of mass casualty incidents in Kosovo, Yugoslavia, in 1990

In March 1990, a mysterious outbreak of illness spread suddenly among thousands of ethnic Albanian high school students in Kosovo (Yugoslavia). It was an unprecedented event on the worldwide scale both in terms of the number of cases and in terms of controversies concerning the aetiology. A retrospective analysis indicated that the epidemic consisted mainly of cases who felt ill in the absence of exposure to any physical agent. It is suggested that in an atmosphere of severe tension between the two ethnic groups living in Kosovo an increased frequency of respiratory infections may have triggered mass sociogenic illness.

The Australian RSI debate: stereotyping and medicine

The vehement scientific debate which took place in Australia in the 1980s over the epidemic of the chronic cervicobrachial pain syndrome known as repetition strain injury (RSI) was remarkable for the accompanying social commentary offered by many of the medical participants. This commentary was to have a profound effect on relationships between individual doctors and their patients with RSI. It reflected and reinforced the prevailing stereotypes within Australian society, not only of working women, but also of recipients of workers' compensation payments. On the other hand, some of the medical responses to the epidemic were severely criticized by social scientists who analysed the epidemic. In the process of such criticism, a number of stereotypes of doctors were also reinforced.

Tarantism, dancing mania and demonopathy: the anthro-political aspects of 'mass psychogenic illness'

This study questions the widely held assumption that the phenomenon known as mass psychogenic illness (MPI) exists per se in nature as a psychiatric disorder. Most MPI studies are problematical, being descriptive, retrospective investigations of specific incidents which conform to a set of pre-existing symptom criteria that are used to determine the presence of collective psychosomatic illness. Diagnoses are based upon subjective, ambiguous categories that reflect stereotypes of female normality which assume the presence of a transcultural disease or disorder entity, underemphasizing or ignoring the significance of episodes as culturally conditioned roles of social action. Examples of this bias include the mislabelling of dancing manias, tarantism and demonopathy in Europe since the Middle Ages as culture-specific variants of MPI. While 'victims' are typified as mentally disturbed females possessing abnormal personality characteristics who are exhibiting cathartic reactions to stress, it is argued that episodes may involve normal, rational people who possess unfamiliar conduct codes, world-views and political agendas that differ significantly from those of Western-trained investigators who often judge these illness behaviours independent of their local context and meanings.

Disability in occupations in a national sample

OBJECTIVES

We sought to develop lists of jobs whose members reported high and low levels of functional disability.

METHODS

Samples of women (n = 6096) and men (n = 3653) were drawn from the National Health and Nutrition Examination Survey I Epidemiological Follow-up. Disability was measured with a modified Stanford Health Assessment Questionnaire. We analyzed women and men separately, and we calculated average disability indices within longest-held occupations while adjusting for age, age-squared, married spouse present, and education. We minimized attrition bias with an econometric technique.

RESULTS

From highest to lowest association with disability, the female broad occupations ranking was as follows: farming, no occupation, laborers, service, technicians, operatives, crafts workers, transportation operators, professionals, sales workers, administrative support, and managers. The male broad occupations ranking was as follows: no occupation, farming, operatives, crafts workers, service, technicians, manager, administrative support, sales, and professionals. The highest levels of disability for women and men occurred among nonconstruction laborers, farm workers, twisting machine operators, servants, machinery maintenance workers, mining machine operators, and bus drivers.

CONCLUSIONS

Our results suggest that, in understanding levels of functional disability, occupational safety and health play a larger role than is generally assumed.

Chronic pain, compensation and clinical knowledge

The nosological status of the putative clinical entity of compensation neurosis and the relationship of chronic pain complaints to compensation are explored. It is concluded that, using the traditional criteria of diagnostic validity, there is no support for the view that a specific type of psychiatric disorder related to compensation or litigation can be demonstrated. Although it has been generally considered that chronic pain complaints reflect an underlying disease state, recent evidence has shown that in the medico-legal setting the nature of the compensation system and the level of available benefits have a marked influence on both the rate of chronic pain complaints and the duration of pain related work incapacity.