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Introduction

Ergonomics in the Ergonomics is defined as the design of the


workplace workplace, equipment, machine, tool, prod-
uct, environment, and system, taking into
consideration the human’s physical, physio-
logical, biomechanical, and psychological
capabilities, and optimizing the effectiveness
and productivity of work systems while assur-
Jeffrey E. Fernandez
ing the safety, health, and wellbeing of the
workers. In general, the aim in ergonomics is
to fit the task to the individual, not the indi-
vidual to the task.
An ergonomist evaluates the demands of a
specific task with reference to the capacity of
workers to perform the task over a certain
time period. In the first phase of job design,
The author the demands of the task would ideally be held
Jeffrey E. Fernandez is Associate Professor and Boeing within the capacity of a fixed percentage of the
Fellow in the Industrial and Manufacturing Engineering population (so that 75 per cent to 95 per cent
Department, Wichita State University, Wichita, Kansas, of the population is accommodated). When
USA. the task demands of an existing job are such
that it is beyond the capacity of this fixed
Abstract percentage of the population, then the work,
Defines ergonomics and discusses various issues such as procedures, and/or work tools should be
anthropometry, seat design, workplace principles, manual redesigned in order to accommodate the fixed
materials handling, and cumulative trauma disorders. percentage of the working population. If the
These important issues need to be appreciated if the accommodated percentage is (below 75 per
objective of the facilities manager is to reduce work- cent) unacceptable and redesign is not possi-
related injuries, improve productivity, and improve the ble, then the final alternative is the placement
quality of life of the workers. of the workers so that only those whose capac-
ity exceeds the task demands are allowed to
perform the task.
The application of ergonomic principles in
the workplace can result in the following:
• increased productivity;
• improved health and safety of workers;
• lower workers’ compensation claims;
• compliance with government regulations
(e.g. OSHA standards);
• job satisfaction;
• increased work quality;
• lower worker turnover;
• lower lost time at work;
• improved morale of workers;
• decrease in absenteeism rate.
Since ergonomics is the study of people, it is
often convenient to think of ergonomic-
related problems by the type of body system
which is affected. The musculoskeletal system
is one example. The physical demands of

Facilities This article is based on a paper delivered at the


Volume 13 · Number 4 · April 1995 · pp. 20–27 IFMA 94 conference, St Louis, Missouri, USA,
© MCB University Press · ISSN 0263-2772 6-9 November 1994.
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Jeffrey E. Fernandez Volume 13 · Number 4 · April 1995 · 20–27

many jobs make the musculoskeletal system This text has compiled a comprehensive
highly vulnerable to a variety of occupational anthropometric database. In different parts of
injuries and illnesses. There are two main the world the workforce is different and diver-
types of musculoskeletal injury: injury associ- sified; therefore, it is important to design the
ated with manual materials handling (MMH) workplace based on the anthropometry of the
and cumulative trauma disorders (CTD). users.
This article, therefore, discusses key issues Tables I and II are anthropometric mea-
such as anthropometry, seat design, work- sures adapted from Pheasant[2] of US and
place principles, manual materials handling, Japanese adults. The 5th percentile male is
and cumulative trauma disorders. These known as the small male, the 50th percentile
important issues need to be understood and male is known as the average male, and the
applied if the objective of the facilities manag- 95th percentile male is known as the large
er is to reduce work-related injuries, improve male. Similarly, the 5th percentile female is
productivity, and improve the quality of life of known as the small female, the 50th percentile
the workers. female is known as the average female, and
the 95th percentile female is known as the
large female. The smallest value of a measure-
Anthropometry
ment is usually associated with the 5th per-
Anthropometry may be defined as the mea- centile female, and the largest value of a mea-
surement of human beings. Factors which surement is usually associated with the 95th
affect anthropometric measurements include percentile male.
gender differences, ethnic differences, growth As an example, the anthropometric mea-
and development, secular trend, ageing, social sures of two populations are presented to
class and occupation, and clothing and per- show the differences in some anthropometric
sonal equipment. measurements. The designer needs to know
Anthropometric surveys have been con- the worker population and then use the
ducted and published on various populations. appropriate anthropometric table in the
These days the most referred source book is design process. If the workers were from both
an international text for the International the US and Japanese populations then it
Labour Office by Jurgens et al.[1] in 1990. would be appropriate to use both these Tables

Table II Anthropometric measures (in mm) for Japanese


Table I Anthropometric measures (in mm) for US adults adults

Male Female Male Female


Percentile Percentile
Dimension 5th 50th 95th 5th 50th 95th Dimension 5th 50th 95th 5th 50th 95th
Stature 1640 1755 1870 1520 1625 1730 Stature 1560 1655 1750 1450 1530 1610
Eye height 1595 1710 1825 1420 1525 1630 Eye height 1445 1540 1635 1350 1425 1500
Shoulder height 1330 1440 1550 1225 1325 1425 Shoulder height 1250 1340 1430 1075 1145 1215
Elbow height 1020 1105 1190 945 1020 1095 Elbow height 965 1035 1105 895 955 1015
Hip height 835 915 995 760 835 910 Hip height 765 830 895 700 755 810
Sitting height 855 915 975 800 860 920 Sitting height 850 900 950 800 845 890
Sitting eye height 740 800 860 690 750 810 Sitting eye height 735 785 835 690 735 780
Sitting elbow height 195 245 295 185 235 285 Sitting elbow height 220 260 300 215 250 285
Thigh thickness 135 160 185 125 155 185 Thigh thickness 110 135 160 105 130 155
Buttock-knee length 550 600 650 525 575 625 Buttock-knee length 500 550 600 485 530 575
Buttock-popliteal 445 500 555 440 490 540 Buttock-popliteal 410 470 510 405 450 495
Knee height 495 550 605 460 505 550 Knee height 450 490 530 420 450 480
Popliteal height 395 445 495 360 405 450 Popliteal height 360 400 440 325 360 395
Shoulder breadth 425 470 515 360 400 440 Shoulder breadth 405 440 475 365 395 425
Hip breadth 310 360 410 310 375 440 Hip breadth 280 305 330 270 305 340
Elbow span 875 955 1035 790 860 930 Elbow span 790 870 950 715 780 845
Vertical reach (stand) 1950 2080 2210 1805 1925 2045 Vertical reach (stand) 1805 1940 2075 1680 1795 1910
Vertical reach (sit) 1155 1255 1355 1070 1160 1250 Vertical reach (sit) 1105 1185 1265 1030 1095 1160
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in the proper ergonomic design of the work- (3) Economic factors:


place instead of using just one Table. • initial cost of the chair;
In ergonomic design, one can use anthro- • maintenance of the chair;
pometric data in three different ways. The • life of the chair.
first is designing for a range (designing for the (4) Safety factors:
smallest to the largest, usually from the 5th • tipping;
percentile to the 95th percentile), an example • gliding;
being the design of adjustable height chairs • other.
based on popliteal height. The second is (5) Other factors:
designing for the extremes (designing for the • swivel mechanism to reduce/eliminate
smallest or the largest, usually for the 5th awkward postures of the body;
percentile or the 95th percentile), an example • armrest (adjustable height and width);
being the design of the doorpost height for the • castors;
largest person’s stature (plus ample clearance) • weight.
and designing a shelf for the smallest person’s
functional reach. The third and last method is
Ergonomic principles in workplace
designing for an average. This method is only
design
acceptable when one is using the workplace
for a very short duration. This method is Some ergonomics principles that should be
usually avoided by an ergonomist as it does applied to the workplace, whether it be an
not accommodate a large segment of the user industrial or an office environment, include
population. An example is designing worksur- the following:
face heights in a bank for customers’ elbow • Aim at dynamic work, avoid static work
height. (work where there is no movement). Static
work or static loading of the muscles is
inefficient and accelerates fatigue. Static
Seating
work can occur when the workplace is too
The main two objectives of ergonomic seating high or too low, when holding a weight in
in the workplace are: one’s arms for an extended period, or
(1) increase individual efficiency and reduce constant bending of the back to perform
fatigue; some task.
(2) facilitate proper posture. • Work surface heights should depend on the
size(anthropometry) of the worker and the
The advantages of sitting over standing
type of task performed (precision, light
include the following:
assembly, or heavy manual).
• Sitting requires less muscular activity,
• In general, work within 30 per cent of one’s
delaying fatigue. An individual can sit for
maximum voluntary contraction
approximately one hour but stand for
(strength). Avoid overloading of the mus-
approximately only half an hour before
cular system.
fatigue sets in.
• Primary controls, devices, and workpieces
• Sitting has more stability, which is needed
should beplaced within the normal working
for precision or fine tasks.
area. Secondary controls should be placed
• A worker can operate a foot control more
within the maximum working area so as to
easily while maintaining a good posture.
reduce extended reaches and fatigue.
The factors most often emphasized when • Strive for best mechanical advantage of the
purchasing or selecting chairs are cost and skeletal system.
appearance. The factors that should be con- • Work with both hands. Do not use one
sidered in the design and selection of chairs hand (non-preferred hand) as a biological
include: holding device.
(1) Ergonomic factors: • Hands should move in symmetrical and
• anthropometry of the users; opposite directions.
• comfort of the users (not the buyer). • Use the feet as well as the hands.
(2) Adjustability factors: • Design knowing the capacity of the fingers.
• range of adjustability of the user; Do not overload the fingers.
• ease of adjustability (e.g. labelled, • Use gravity, do not oppose it to dispose of
colour-coded controls). unbreakable products.
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• Avoid unnatural posture. Bend the handle lines proposed by Mital et al.[9] and Snook
of the tool not the wrist. and Ciriello[10] are industry norms and
• Permit change of posture. should also be used to reduce the risk of
• Maintain a proper sitting posture. MMH injuries.
• Counter-balance tools when possible to
reduce the weight and forces.
Cumulative trauma disorders
• Accommodate the large individual and give
him or her sufficient room. Cumulative trauma disorders (CTDs) are
• Use bins with lips for storage and manual defined as physical injuries which develop
retrieval of small parts instead of boxes. over a period of time as a result of repeated
Incline containers so as to reduce awkward biomechanical or physiological stresses on a
postures of the body. specific body part. CTD is a collective term
• Train the individual to use the workplace for syndromes characterized by discomfort,
facility and equipment properly. impairment, disability, or persistent pain in
joints, muscles, tendons and other soft tis-
sues[11]. Other terms which are also used to
Manual materials handling
describe these disorders include repetitive
Low back injuries, often due to improper trauma injuries (RTI), repetitive strain
manual handling of materials, form the largest injuries (RSI), musculoskeletal disorders
subset of musculoskeletal injuries. The seri- (MSD), and occupational overuse syndrome.
ousness of the lower back injury problem is Since these injuries develop over relatively
reflected in the large number of claims under long periods of time (months or years), it is
the US Worker’s Compensation Act of 1970. difficult to determine how often CTDs occur.
According to Leamon[3], low back pain costs CTDs are generally considered to be work-
Liberty Mutual Insurance Group about US$1 related. In other words, these disorders tend
billion per year, at an average cost of to be more prevalent among working people
US$8,321 per incident. The National Safety than among the general population.
Council[4] reported that in the USA 400,000 There has been a significant increase in the
workers face disabling back injuries every number of CTD cases reported in the
year. Statistics[5] also show that back injuries USA[12] from 1981 to 1991, as shown in
resulting from manual materials handling Figure 1. Some of the reasons for this increase
(MMH) activities are a major source of lost could include a change in technology, an
time and compensation claims. Morris[6] ageing workforce, decreased physical capaci-
estimated that 28 per cent of the US industrial
population will experience disabling lower
back pain at some time in their lives, with 8
Figure 1 Number of CTDs reported in the USA from 1981
per cent of the total working population being
to 1991
disabled during each year. Lahey[7] stated
that back injuries alone cost industry an
estimated US$14 billion a year. In 1981 the 250
National Institute for Occupational Safety
and Health (NIOSH) published the Work
Practices Guide for Manual Lifting[5]. This 200
Number of cumulative trauma

technical report contains guidelines which


disorders (in thousands)

were designed to aid in the identification of


150
hazardous MMH situations and to help evalu-
ate these jobs as well as possible solutions
when problems are encountered. In 1991, 100
NIOSH revised its lifting equation[8], which
is now being used in industry.
The risk factors for low back injuries 50
include force and amount of weight lifted,
frequency of lifting, location and size of load,
0
starting and ending point of lift, stability of 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
the load, handles, twisting, geometry of the
workplace and environmental factors. Guide-
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ties of new workers, lower worker turnover, muscle/tendon unit. Since tendons have
increased awareness, and change in reporting virtually no blood supply, they are incapable
methods. An increase in the number of CTD of self repair and damage becomes incremen-
cases means the associated cost has also tal[16]. The accumulation of minor damage
increased significantly. results in a roughened, nubby tendon which
Putz-Anderson[13] summarizes the rele- may produce friction and irritation of its
vant research in the area of CTDs, where it is sheath. Ultimately, the tendon may become so
emphasized that there are basically four occu- weakened that it ruptures. Without rest or
pational risk factors associated with the devel- sufficient time for tissue to heal, the tendon
opment of CTDs. These are awkward pos- may be permanently damaged[17].
tures, excessive manual force, high rates of
Tendinitis is most likely to occur in areas
manual repetition, and task duration (or
where the tendon is restricted anatomically,
inadequate rest). Static loading has also been
such as in bony channels and tunnels[16].
observed to increase the risk of CTDs[14].
Examples would be the thumb tendons in the
Static loading occurs when muscles are
radial groove at the wrist or in tendons which
required to generate tension without move-
support a joint, such as the rotator cuff of the
ment. Static work is not very efficient and
causes the muscles to fatigue rapidly. Vibra- shoulder.
tion is another variable which has been impli- Tenosynovitis
cated in the development of CTDs. Vibration Tenosynovitis is fairly common in finger and
causes constriction of blood vessels in the wrist tendons or in other areas where the
fingers as well as numbness and swelling of tendon excursion from the synovial sheath is
the hand tissues. This leads to a reduction in long (usually two or more inches). In such
grip strength. Any job which involves one or situations, repetitive motion (gliding) of the
more of these risk factors will have a high
tendon within the sheath may overwhelm the
probability of causing CTDs depending on
lubricating ability of the sheath. This will
the severity of each factor.
ultimately result in an inflammatory reaction
The potential for CTDs’ development
within the tendon sheath[16].
increases when leisure time activities such as
sewing, gardening, and woodworking contin- Bursitis
ue to strain the ligaments and muscles. In Bursae are anti-friction devices found
addition, as the mean age of the working throughout the body where bony
population increases, strength and flexibility prominences are close to the skin surface and
decrements are visible. These are also impor- friction from outside the body or where ten-
tant factors which can contribute to the devel- dons and ligaments may rub against the
opment of CTDs[15]. prominences[16]. In the presence of high
Putz-Anderson[13] outlined several of the degrees of friction, the bursae will oversecrete
common forms of upper extremity CTDs.
lubricating fluids and bursal sacs will become
These can be classified into three major cate-
enlarged and distended. If friction persists,
gories: tendon disorders, neurovascular disor-
the walls of the sac will thicken and become
ders, and nerve disorders.
inflamed.
Tendon disorders Ganglionic cyst
The tendon is a specialized type of connective Caused by the swelling of a tendon sheath
tissue which serves to attach muscle to bone. with synovial fluid, a ganglionic cyst is com-
Tendons are surrounded by sheaths of fibrous mon and is generally related to wrist
tissue in order to protect the tissue from usage[18]. Though rarely causing symptoms
friction in certain areas. The sheath contains a of nerve compression, such a cyst can often be
synovial membrane which facilitates gliding of painful and is usually treated by aspiration or
the tendon during mechanical actions. Minor by surgical removal if the ganglion recurs[18].
disorders of tendons and their sheaths are
very common[13]. Neurovascular disorders
Tendinitis Neurovascular disorders are those CTDs
Tendinitis is inflammation of the tendon which involve both the nerve and adjacent
occurring from repeated action of the blood vessels.
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Thoracic outlet syndrome hard work surfaces and sharp edges on hand
Probably the most common form of neurovas- tools.
cular disorder is the thoracic outlet Although the innervation pattern varies
syndrome[13]. Thoracic outlet syndrome is a slightly, the primary areas affected by the
general term for compression of the nerves median nerve include most of the palmar side
and blood vessels as they pass through the of the hand, the thumb, and all of the fingers
neurovascular bundle between the neck and except the ulnar side of the ring and small
shoulder. fingers. Under normal conditions, there is
Also known as cervicobrachial disorder, smooth movement of the nerve and tendons
thoracic outlet syndrome is generally thought accompanying movements of the wrist. How-
to result from heavy workloads combined with ever, compression of the nerve will result from
repetitive straining or unnatural static posi- flexion and extension movements when the
tioning of the arms[19]. Typical symptoms of boundaries of the tunnel are compromised or
thoracic outlet syndrome include numbness when structures of the tunnel become
and tingling in the fingers and hand, as well as enlarged.
a sensation of the arm “going to sleep”. The Initial complaints of CTS include sensa-
blood pulse at the wrist may also become tions of pain, numbness, and tingling in one
weakened. or both of the hands at night. The symptoms
of CTS may progress until attacks of pain
Vibration syndrome and/or tingling are experienced during the
Sometimes referred to as vibration-induced day. At this point, individuals may complain
white finger, Raynaud’s syndrome, or trau- of a general clumsiness or an inability to grasp
matic vasospastic disease, vibration syndrome and hold objects. A significant reduction in
is characterized by episodes of blanching work-related measures, particularly grip
(whiteness or paleness) of the fingers due to strength, range of motion, and performance
closure of the digital arteries[13]. Due to the time has been demonstrated.
blockage of circulation in the fingers, coldness The exact incidence rate of CTS in indus-
and pain are often associated with vibration try is unknown; however, many industries
syndrome[20]. This condition is caused by now claim that CTS is among their most
the transmission or vibration (varying in disabling and costly medical problems[21].
acceleration, or power, and frequency) from a The average cost of a CTS case has been
tool to the hand. It is believed to be in part a reported to be approximately US$3,500,
vascular disturbance due to changes in the while for the more severe cases, compensation
blood vessel walls and in part a nervous dis- and disability claims may range from
turbance caused by reflex contraction of the US$30,000 to US$60,000[22]. Fernandez et
smooth muscles of the blood vessels. al.[23] stated that the average cost for CTS
cases in a mid-western manufacturing facility
Nerve entrapment disorders ranged from US$15,000 to US$18,000.
Nerve entrapment disorders occur when There are a number of risk factors which
repeated or sustained work activities expose have been associated with the development of
the nerves to pressure from hard, sharp edges CTS. These risk factors can be divided into
of the work surface, tools or nearby structures three broad categories:
such as bones, ligaments, and tendons. (1) systemic conditions;
(2) non-occupational risk factors;
Carpal tunnel syndrome
(3) occupational risk factors as described by
Carpal tunnel syndrome (CTS) is one of the
Turner and Buckle[24].
major forms of cumulative trauma disorders.
Other terminology used to describe CTS The occupational risk factors most frequently
includes occupational neuritis, partial thenar associated with CTS include force, repetitive-
atrophy, and median neuritis. CTS is general- ness, and posture[13]. When a job requires
ly attributed to insult, usually compression, of high levels of force and repetition, more mus-
the median nerve within the wrist. Compres- cle effort is required. This increases the need
sion of the median nerve is, in turn, associated for increased rest periods or recovery time.
with repeated or sustained activities of the Without sufficient recovery time, cumulative
fingers and hands, often combined with the injuries are likely to occur. The amount of
application of force, as well as pressure from time required to perform a task is also thought
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Jeffrey E. Fernandez Volume 13 · Number 4 · April 1995 · 20–27

to be an important variable in the develop- • Pyogenic infections – episodes of CTS sec-


ment of CTS[14,25]. ondary to pyogenic (pus-producing) infec-
Systemic conditions may account for about tions of the forearm and hand have been
20-30 per cent of the total number of CTS reported.
sufferers, some of these conditions include the • Gender – female CTS sufferers tend to
following: outnumber male sufferers by two to ten.
• Acromegaly – this is an endocrine disorder • Acute trauma – approximately 5-6 per cent
where ongoing pituitary over-activity of several groups of CTS sufferers had
appears to be related to the appearance of previously fractured their affected wrist.
CTS. • Vitamin B6 deficiency – this may be associ-
• Amyloidosis – deposits of amyloid have been ated with development of CTS.
found in the carpal tunnel of patients with
this disorder.
Concluding remarks
• Diabetes mellitus – it has been reported that
approximately 5-16 per cent of certain The four elements in an ergonomics pro-
groups of CTS patients appear to be dia- gramme are worksite analysis, hazard preven-
betics. tion and control, medical management, and
• Hyperparathyroidism – primary and sec- training and education[26]. The new
ondary (resulting from renal dysfunction) Ergonomics Protection Standard is scheduled
hyperparathyroidism have been associated to be published by OSHA in 1995. It is antici-
with the development of CTS. pated that this standard will emphasize proac-
• Hypothyroidism and myoedema – this is an tive ergonomics as opposed to reactive
endocrine disorder which has been associ- ergonomics, and require employee involve-
ated with CTS. ment and management commitment. It will
• Renal failure – altered hemodynamics also be consistent with international quality
resulting from dialysis procedures may be assurance activities (ISO 9000).
related to CTS development. Ergonomics is no longer just a buzzword; it
• Rheumatoid arthritis – it has been reported is going to be around for a long time because
that approximately 7-11 per cent of CTS it makes good business sense. Companies are
patients suffer from this disorder. realizing that making ergonomic changes
before major work-related injuries occur
Some of the non-occupational risk factors (proactive ergonomics) is cost effective when
which appear to be associated with the devel- compared with making ergonomic changes
opment of CTS are: after major work-related injuries occur (reac-
• Family history – one type of bilateral CTS tive ergonomics). In short, either we pay now
has been reported to be an inheritable or we pay a lot later in ergonomic changes and
disorder transmitted by an autosomal possibly sacrifice the quality of life of our
dominant gene. workers.
• Gynaecological surgery – a hysterectomy
with bilateral ophorectomy and the use of
vibratory hand-held tools has been associ- References
ated with CTS. 1 Jurgens, H.W., Aune, I.A. and Pieper, U., International
• Medication – some drug preparations (e.g. Data on Anthropometry, Occupational Safety and
oral contraceptives) appear to precipitate Health Studies, International Labour Office, Geneva,
episodes of CTS. 1990.
• Menopause – women of menopausal age are 2 Pheasant, S., Bodyspace: Anthropometry, Ergonomics
at an increased risk for developing CTS. and Design, Taylor and Francis, London, 1986.
• Pregnancy – as mentioned earlier in this 3 Leamon, T.B., “L5/S1: so who is counting?”, Interna-
tional Journal of Industrial Ergonomics, Vol. 13 No. 3,
report, some pregnant women report
1994, pp. 259-65.
experiencing symptoms consistent with
4 National Safety Council, Accident Facts, NSC, Chicago,
those for CTS.
IL, 1978.
• Premenstrual syndrome (PMS) – women
5 National Institute for Occupational Safety and Health,
with PMS who experience water retention, A Work Practices Guide for Manual Lifting, DHHS
weight gain, and/or bloatedness also report (NIOSH) Publication No. 81-122, NIOSH, Cincinnati,
symptoms of CTS. OH, 1981.
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6 Morris, A., “Programme compliance key to preventing 17 Curwin, S. and Stanish, W.D., Tendinitis: Its Etiology
low back injuries”, Occupational Health and Safety, and Treatment, Collamore Press, Lexington, MA,
March 1984, pp. 44-7. 1984.
7 Lahey, J.W., “Bearing down on musculoskeletal 18 Birnbaum, J.S., The Musculoskeletal Manual, 2nd ed.,
disorders”, National Safety News, Vol. 129 No. 3, W.B. Saunders, Philadelphia, PA, 1986.
1984, pp. 37-9.
19 Sallstrom, J. and Schmidt, H., “Cervicobrachial
8 National Institute for Occupational Safety and Health, disorders in certain occupations, with special refer-
Revisions in NIOSH Guide to Manual Lifting, paper ence to compression in the thoracic outlet”, American
presented by V. Anderson and T. Waters in Ann Arbor, Journal of Industrial Medicine, Vol. 6, 1985, pp. 45-52.
MI, 1991.
20 Taylor, W., “The vibration syndrome: introduction”, in
9 Mital, A., Nicholson, A. and Ayoub, M.M., A Guide to Taylor, W. (Ed.), The Vibration Syndrome, Academic
Manual Materials Handling, Taylor and Francis,
Press, London, 1974.
London, 1993.
21 Bleeker, M.L., “Carpal tunnel syndrome: a case study.
10 Snook, S.H. and Ciriello, V., “The design of manual
Preventing illness and injury in the workplace”,
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11 Kroemer, K.H.E., “Cumulative trauma disorders: their 22 Hiltz, R., “Fighting work-related injuries”, National
recognition and ergonomic measures to avoid them”, Underwriter, Vol. 89 No. 13, 1985, p. 15.
Applied Ergonomics, Vol. 20 No. 4, 1989, pp. 274-80. 23 Fernandez, J.E., Marley, R.J. and Young, K.R., “Results
12 US Labor Department, Occupational Injuries and of an ongoing monitoring program for carpal tunnel
Illnesses in the United States by Industry, BLS syndrome”, in Das, B. (Ed.), Advances in Industrial
No. 2424, Washington, DC, 1993. Ergonomics and Safety II, Taylor and Francis, London,
1990, pp. 265-71.
13 Putz-Anderson, V., Cumulative Trauma Disorders: A
Manual for Musculoskeletal Diseases of the Upper 24 Turner, J.P. and Buckle, P.W., “Carpal tunnel syndrome
Limbs, Taylor and Francis, London, 1988. and related risk factors – a review”, in Buckle, P.W.
14 Fernandez, J.E. and Marley, R.J., “Monitoring and (Ed.), Musculoskeletal Disorders at Work, Taylor and
screening tests for carpal tunnel syndrome”, in Francis, London, 1987, pp. 124-32.
Lovesey, E.J. (Ed.), Contemporary Ergonomics 1990, 25 Silverstein, B.A., Fine, L.J. and Armstrong, T.J., “Hand
Taylor and Francis, London, 1990, pp. 63-8. wrist cumulative trauma disorders in industry”, British
15 Chaffin, D.B. and Anderson, G.B.J., Occupational Journal of Industrial Medicine, Vol. 43, 1986, pp. 779-
Biomechanics (2nd ed.), Wiley-Interscience, New York, 84.
NY, 1991. 26 OSHA, Ergonomics Program Management Guidelines
16 Rowe, M.L., Orthopaedic Problems at Work, Perinton for Meatpacking Plants, US Department of Labor,
Press, Fairport, New York, NY, 1985. OSHA 3123, 1990.

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