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CARPAL TUNNEL SYNDROME

PRIVATE TRAINING GUIDE

by

Howard Egerman
National Health and Safety Representative

April, 1991

One of the good things about being a health and safety
rep is that you are always on the side of right. After
all, you are for health and good working conditions!
And, who possibly could be for bad conditions and
illness. Nevertheless, we find ourselves with more and
more people afflicted with a wide variety of ailments
resulting from use of computer terminals.

These illnesses or diseases have a variety of names.
Normally, they are classified as Repetitive Strain
Injuries or RSIs. Another overall term is Chronic
Trauma Disorder or CTD. The most famous disease among
these, although not the most common, is CARPAL TUNNEL
SYNDROME.

Carpal Tunnel Syndrome gets its name from the carpal
tunnel which is a 1 inch "channel" which is made by the
carpal bones and ligament on the palm side of the
wrist. Tendons, the median nerve and the fingers's
blood vessels pass through the carpal tunnel onto the
forearm where they connect with the muscles that

So. the work station must be adjustable. remove the paper. numbness. we are making the same hand. finger and wrist motions over and over again and we do this with ever increasing speed. adjust the carriage.control finger movement. our furniture must be adjustable. the computer must . Because we are typing continuously on a terminal. etc. Symptoms of these diseases include pain. the thumb. To work on terminals in a good environment. terminals do not require varied hand movements used to put paper in a typewriter. The pain can become so extensive that people are awakened at night by it. which are rapidly becoming extinct. Awkward postures. Unlike typewriters. middle ring finger. Repetition. or at the base of the palm. 2. tingling in the hand. Other types of injuries include tendinitis. Work that we do no the FOSE terminals and the PCs in our offices causes us to use hand or finger movements over and over again. they can push against the result in compression of the median nerve. WHAT CAUSES THIS AND OTHER DISEASES 1. index finger. Continual pressure over time can result in damage or carpal tunnel syndrome. if these tendons start swelling or become inflamed in any way.

In a perfect world or perfect work environment. Improper equipment. not vice versa. A major problem with modular furniture and the installation of FOSE equipment is that it was simply placed in many cases on top of people's desks. One of the cornerstones of a good work environment is furniture and equipment that meed the needs of the employee. Individuals found themselves as a result in difficult postures. . and the chair must be adjustable. be adjustable. employees would have furniture that is adjustable to their needs. Many people such as SSI CRs do not have their own terminals but must share others. the same way that they can (once they know how) do with an ergonomic chair. 3. Terminals are often just placed on desks. since they had to make accommodations in order to be able to use the equipment such as by contorting their neck and shoulder muscles. This is not the case in most field offices. that they can move up and down. they can find themselves in many awkward postures. etc. As a result. They go from terminal to terminal and chair to chair and must adjust themselves to the terminal instead of vice versa.

Another form that developed over time was washerwoman's thumb which developed as a result of having to make the same motions or movements over and over again as these hard working people washed clothes by hand. an injury that many SRs and CRs have experienced is writer's cramp. The key principle here is ergonomics which is a science that sees to it that the job adapts to the person. that there is no rule or regulation that employees be of a certain height. It is a science that also recognizes that there are individual differences among employees. they have come to greater attention as a result of the growth of the computer in our society. SOME HISTORY Carpal tunnel syndrome and other similar injuries are really not new. . In fact. Other types of injuries that are growing are found among grocery store clerks who must make the same motion over and over again as they place the food products that we buy over a scanner that reads the bar codes with the prices that we must pay. The first group of workers who find themselves with an OSHA (Occupational Safety and Health Administration Standard) are those who work in the meatpacking industry. OSHA has adopted standards for those employees and it is possible that similar standards dealing with adjustable work stations and breaks may eventually be in place for all employees. shape or size. one form of repetitive strain injury.

CRs and SRs spend much of their day using their hands.OSHA has established a Department of Ergonomics. Intensive users are permitted VDT breaks twice each day for 10 minutes. But. These are in addition to our regular scheduled breaks and can be used to do other types of work. there are things that we can recommend to our co-workers that could help them to avoid these injuries: 1. 3. AVOIDING THESE INJURIES Besides having proper equipment. Continual use of the FOSE terminals is a contributing factor to problems. The heel of our hands should not be rested on the keyboard. We should use Article 38. we should have comfortable workstations. this department for the entire country consists of one person who does not do ergonomic inspections. 2. People can be encouraged to keep their wrists straight whenever they type on the keyboard. unfortunately. But. All lifting should be done with our whole hand. . Our fingers should be lower than our wrists. 4. Some injuries have happened by doing things like lifting transmittals. Workstations (more on redesign later for victims). Non-intensive users are to receive a 15 minute break away from the terminal every 2 hours and once again this can be doing a different type of work assignment. Section 3-1 breaks.

Soft touch. we should ask the following questions: 1. What is a clean and proper manner? It is AFGE's belief that this question opens up the whole issue of safety. the level of force that we use on the keyboard may have some affect on the possibility of us coming down with a terminal illness. In looking at this issue. Watch for pain. stop. question 25 deals directly with VDTs. When it hurts to type. WORK SITE INSPECTIONS--SSA-5510 One thing you can do is to look at terminals when you do your twice annual SSA-5510 inspection per Article 9. "Are video display terminals maintained in a clean and proper manner?" This question applies to PCs as well as FOSE and should be looked at carefully. Where are the terminals placed? Are they on desks? Are they on lazy susans? Is there any adjustability or do all the employees in an office use the same machines on the same furniture? 2. We should type with a soft touch. Section 7C. not pounding the keys. Are the chairs that go with the terminals ergonomic? Do employees know how to adjust them? 3. Ask for accommodation from the pain. Under Part D of the 5510. What about the screens? Does the office have filters or anti-glare screens? Do the terminals have a lot of flicker? Does light reflect .5. 6.

are they positioned in such a way that employees are able to use them with the least possible strain on their hands and wrists? Are people in reception areas given adequate chairs or stools. per Article 34. Section 1B. per Article 38? 5. Do employees receive the breaks discussed above. What about terminals in reception areas or front counters. Are there cleaning supplies to clean the terminals such as alcohol? No responses and corrective action needed can be put on the SSA-5510 and you can use page 8 of this form for additional responses. 4. you could use the information you have received in order to seek preventive measures. or do they have to stand when they do inputs? 6. Management should as well be notifying you on workers compensation claims. So. on the screen from windows? If so. it may be possible to re-position terminals. What you should do as well is to use the OSHA Log 200 to see how many associated computer injuries you have in your office. Do individuals who type for extensive periods have document holders? 7. HOW TO HELP INJURED WORKERS: There are two methods of assisting injured workers: .

I use another personal computer for . WORKERS COMPENSATION. The following are some samples: T2 CR. the proper form to complete is normally the CA-2. The employee will have to develop medical evidence and normally takes a CA-20 form to his/her doctor/HMO/clinic." Remember. If someone has a particular diagnosis. REMEMBER: It is important that you demonstrate a causal relationship between the job and the illness. Individuals approved for workers compensation will normally receive 2/3 of their salary if they have no dependents and 3/4 if they do. Along with this. The employee should write as his/her injury "carpal tunnel/computer related repetitive strain injury.1. I am constantly typing. When I do not use the terminal for applications. My job is to take applications for retirement. Afflicted employees must file for workers compensation. survivor and disability benefits. I spent 7 hours at the terminal. such as tendinitis. "I am a claims representative. which is the occupational disease/illness form. Since prolonged use of FOSE and/or PC terminals results over a period of time. there are a variety of injuries. Workers compensation will also pay medical expenses. each afflicted employee should prepare a several page narrative. Out of an 8 hour day. list that. I take these applications over a VDT computer screen.

Or. I have to go to different computers throughout the office. I do not have a computer on my desk. I need to use it to find out information about the cases I work. All are adjusted at different levels. gardening." [It helps to be descriptive. I go to the front of the office . I share a terminal with another person and it is not adjustable to my height. My entire job is devoted to computer use. tennis. if the person has a valid Social Security Number. It is not adjustable. how much income he or she has. [If the person should.] FOR T16 CRs. mention how they never had any ill affects until they started using the computer. etc. When I interview. I am not engaged in any activity at home which involves the use of my hand or wrist such as golf. I have to use a terminal in the front which is not adjustable. I have never had this kind of injury before. I have to strain my body.] Also describe the work station. I do not have a computer at home. or arts and crafts. if the person is eligible.an hour or so to type letters to my claimants. my arms in order to use [have the person be descriptive]. As such. "The computer terminal I have is just placed on my desk. "I use the computer 5 hours a day. Or. my neck. whether or not that individual has filed before. where a person lives.

I am on the computer 8 hours a day. I immediately key that data into the computer system. I am continuously typing. My illness is totally related to my job. I must use a personal computer. what address. the personal computer. Whenever I take an application for a Social Security card.and interview there. I immediately key that data (and by keying I mean use the computer) into the computer system. I use the computer. I find that I have to strain to use them. Whenever I need to do some of my desk work. the terminals there are not adjusted to my height. in order to write letters to people asking them to come into the office and see me or call me. I use another computer. I use it to do inquiries and find out where a check is going. "I use the computer 8 hours a day. I do not have a computer at home or do anything with my hands or wrists." DC. The . "I take quick interviews as a part of my job. "I do clerical work for other employees and when I do this. how much money a person is receiving." SRs. etc. Whenever I take a change of address or other change from a Social Security recipient. I do not have a computer at my desk and so continually have to get up to use other people's machines.

injury or illness is causally related to the job c.) 2. REASONABLE ACCOMMODATION: Reasonable accommodation is an allowance that management makes that enables a qualified handicapped employee to be able to do his or her job. there is medical confirmation of this illness When you have this. (Tell your employees to give their doctors this message. Often you must assist the employee in working with her/his doctor to see that the necessary factors are covered." A key in workers comp claims is to show a causal relationship between the job and the impairment. computer is not adjustable for me. The employee should complete his/her request on an SSA-501 reasonable . REMEMBER TO TELL YOUR EMPLOYEES THAT ONE OF THE MAJOR ADVANTAGES OF GETTING ON WORKERS COMP IS THAT MOST OF YOUR MEDICAL BILLS ARE PAID WHEN THE CLAIM IS APPROVED. What we have is a 3 step process: a. you have a successful claim. I have not had such symptoms as numbness in my hands prior to my use of the computer. employee suffers injury or illness b. A worker with carpal tunnel syndrome or other repetitive strain injury can get this by having his or her doctor write the request on a piece of stationary. I do not use a computer at home and do not do any activities involving my hands or wrists. but is on a table for everyone to use.

having a special task light over the keyboard for the employee. . Health and safety is but another way in which AFGE spells RELIEF. moving the terminal away from a window. The downside. Office changes resulting from FOSE have been beneficial. Purchases should be prescribed by doctors. Other modifications could be glare screens. don't forget. has been the increasing number of injuries. What are such requests? Accommodations (which include limited duty) can include time away from the terminal. of course. accommodation form. all employees with the help of an experience and compassionate AFGE Health and Safety Rep can realize that truly with their union there is hope and with their union they can realize a better environment that either cope with these problems or prevent them. However. having a wrist rest or other device being purchased. putting in keyboard modifications. If management does not allow the request. They can include having management purchase a special chair. anything and everything that can help a person could be included. such as typing 4 hours a day instead of 8. Really. the individual can file an informal EEO complaint.

salah satu kemungkinan adalah CTS. kelemahan dan masalah lainnya di tangan Anda. atau Sindroma Terowongan Karpal. Biang Keladi Ujung Jari Tangan Kesemutan & Baal Mengapa ujung-ujung jari tangan saya sering kesemutan Dok? Penyebab jari tangan kesemutan dan baal bisa bermacam-macam. padalah penyakit yang sebenarnya bukan di jari Anda. aliran listrik saraf terganggu dan sinyal saraf akan ‘error’. saraf medianus memanjang dari lengan ke tangan melewati sebuah terowongan yang disebut dengan terowongan carpal (carpal tunnel). dokter harus melakukan pemeriksaan terlebih dahulu. . saraf yang berfungsi mengatur pergerakan dan sensasi (rasa) pada ibu jari hingga jari manis adalah saraf medianus. pada CTS. kesemutan.CTS. Apa itu CTS? CTS adalah suatu kondisi yang cukup sering yang menyebabkan munculnya rasa baal (mati rasa). Untuk memastikan diagnosis. Jika terjepit. saraf medianus terjepit di terowongan tersebut. CTS singkatan dari Carpal Tunnel Syndrome. yang akan dirasakan sebagai jari kesemutan.

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Gejala sering terasa lebih berat setelah bekerja dengan tangan (misalnya mencuci piring. otot-otot tangan dapat menjadi lemah. Apa yang harus saya lakukan jika menderita CTS? Anda harus diperiksa oleh dokter yang mengerti benar soal CTS. pemusik. jari tengah dan setengah jari manis. Kadang dengan menggoyangkan tangan dapat membuat gejala berkurang. memasak) dan terasa sebagai nyeri di jari tangan yang membuat terbangun dari tidur pada malam hari. tumor.Apa yang saya rasakan bila menderita CTS? Anda akan mengalami jari tangan kesemutan seperti ada listrik disertai baal. telunjuk. Anda harus menjaga pergelangan tangan tetap lurus saat mengetik atau menggunakan mouse komputer. montir atau ibu rumah tangga yang memasak dan mencuci baju dengan tangan. Jari tangan kesemutan ini dapat terasa hilang timbul atau terus menerus. Jika benar. Pertama dokter akan memeriksa apa benar itu CTS. dan lain sebagainya. Mengapa bisa terjadi CTS? Jepitan saraf medianus di terowongan karpal dapat terjadi karena berbagai sebab. Misalnya jadi sulit menggenggam benda-benda kecil. Apa yang saya dapat lakukan sehari-hari? Tangan yang terkena CTS harus diistirahatkan selama beberapa minggu. Jika lebih berat lagi. penyakit saraf tertentu. Bisa juga karena penyebab lain yang lebih serius seperti pembengkakan tendo otot. dokter akan mencari penyebab CTS dan mengatasinya. penebalan tulang. CTS adalah salah satu penyakit yang sehari-hari ditangani dokter di Klinik Flex-free. Hindari gerakan menekuk pergelangan tangan berulang-ulang ketika memasak dan mencuci dengan tangan. tebal dan nyeri di terutama di ibu jari. Bisa karena gerakan menekuk pergelangan tangan yang berulang-ulang seperti pada penjahit. .

Apakah saya harus mengkonsumsi obat? Ya. Obat anti radang/nyeri harus diberikan atas petunjuk dokter karena jika dikonsumsi jangka lama memiliki efek samping. Apakah berguna? Ya. Biasanya anda akan diberikan obat-obat anti radang/nyeri dan vitamin saraf. Dokter akan menentukan dosis yang tepat dengan menimbang risiko dan kegunaannya. karton keras atau penggaris plastik yang dipakai hanya saat tidur. Anda dapat menggunakan bidai tangan yang terbuat dari kertas kardus. Sarung tangan khusus itu membatasi gerak menekuk pergelangan tangan. Dapat Anda gunakan saat beraktifitas sehari-hari (memasak. karena:  CTS bukan asam urat atau rematik dan bukan penyakit yang sembuh hanya dengan minum obat dokter atau jamu atau obat herbal. mengetik) dan saat tidur (menjaga pergelangan tangan tetap lurus saat tidur untuk mencegah nyeri di malam hari). hanya terasa sebagai kesemutan dan kadang nyeri di malam hari saja. .Saya pernah melihat orang memakai sarung tangan khusus. Apakah boleh saya meminum jamu asam urat dan rematik atau obat herbal untuk nyeri? Tidak boleh. Jika gejala CTS anda masih ringan.

Apa saya perlu disuntik? Ada dua macam suntikan yang dapat dilakukan untuk CTS. tetapi campuran obat anti radang dan steroid. Bisa diulang hingga 3 kali dengan jeda waktu tergantung obat apa yang disuntikkan. Waspadai jamu yang sudah berbentuk pil atau sacchet. daya tahan tubuh menurun. Terapi dengan ultrasound itu juga dapat menambah aliran darah ke saraf medianus yang terjepit. Tujuannya mengurangi radang dan bengkak. keropos tulang. Disuntik ke dalam terowongan karpal. Misalnya. Laser energi rendah dapat mengurangi nyeri. dan masih banyak lagi. Ini adalah cara memasukkan krim kortikosteroid ke dalam tubuh menggunakan gelombang suara (ultrasound). Ini adalah suntikan khusus. Sebagian besar jamu asam urat dan rematik isinya bukan jamu. Apa CTS saya perlu dioperasi? Tergantung pada penyebab CTS dan seberapa berat CTS sudah terjadi. Penjelasan ada di bagian selanjutnya. Jika penyebab CTS anda adalah penyebab ‘biasa’.  Phonophoresis. jamur kulit. dari awal tentu pengobatan seharusnya adalah operasi pengangkatan tumor. Apa lagi yang bisa dilakukan untuk CTS saya? Ada beberapa metode rehabilitasi medik yang bisa dilakukan:  Terapi laser. jika penyebab CTS adalah tumor yang menjepit saraf medianus.  Suntikan steroid. Dilakukan dengan gerakan lengan atas tertentu. maka operasi dilakukan jika tingkat jepitan sudah berat atau tidak dapat diatasi dengan obat. Artinya saraf medianus yang terjepit dan bengkak digerakkan untuk mencegah perlengketan dengan jaringan sekitarnya yang dapat membuat jepitan semakin parah. bisa dengan bantuan USG atau tanpa USG.  Mobilisasi saraf medianus. Salah satu tanda jika jamu yang anda konsumsi mengandung obat nyeri kuat adalah jika langsung memberikan efek hilang nyeri dalam waktu ½-1 jam setelah diminum. seperti luka lambung. Jika dikonsumsi jangka panjang dapat menyebabkan banyak efek samping. gerakan pergelangan tangan dan beberapa pijatan di sekitar pergelangan tangan. peradangan dan sering dapat lebih efektif daripada injeksi steroid. rehabilitasi medis .  Hydrodissection of median nerve.

jika Anda tidak mau dioperasi. Hydrodissection bisa menjadi pilihan alternatif lain dari operasi pada kasus CTS yang ‘biasa’. Dokter di Klinik Flex-free dapat melakukan hydrodissection dengan bantuan visualisasi USG.800 1267157747765 . anti radang dan bisa juga zat yang merangsang perbaikan jaringan saraf (proloterapi atau PRP).dan injeksi. 294. Apa itu hydrodissection? Hydrodissection adalah pelepasan saraf dari perlekatan dengan jaringan sekitar menggunakan cairan yang disuntikkan dengan bantuan visualisasi USG. Cairan yang disuntikkan bisa cairan garam fisiologis. Operasi ini melepaskan saraf medianus dari perlekatan dengan jaringan sekitar dan mengurangi tekanan oleh ligamen karpal yang menebal. obat baal.