Off-road machine controls: investigating the risk of carpal tunnel syndrome

Occupationally induced hand and wrist repetitive strain injuries (RSI) such as carpal tunnel syndrome (CTS) are a growing problem in North America. The purpose of this investigation was to apply a modification of the wrist flexion/ extension models of Armstrong and Chaffin (1978, 1979) to determine if joystick controller use in off-road machines could contribute to the development of CTS. A construction equipment cab in the laboratory was instrumented to allow force, displacement and angle measurements from 10 operators while they completed an approximately 30-min joystick motion protocol. The investigation revealed that both the external fingertip and predicted internal wrist forces resulting from the use of these joysticks were very low, indicating that the CTS risk associated with this factor was slight. However, the results also indicated that, particularly for the 'forward' and 'left' right side motions and for all left side motions, force was exerted by other portions of the fingers and hand, thereby under-predicting the tendon tension and internal wrist forces. Wrist angles observed were highest for motions that moved the joysticks to the sides rather than front to back. Thus, the 'right' and 'left' motions for both hands posed a higher risk for CTS development. When the right hand moved into the 'right' position and the left hand moved into the 'left' position, the wrist went into extension in both cases. Results indicate that neither learning nor fatigue affected the results.     

Off-road machine controls: investigating the risk of carpal tunnel syndrome

Occupationally induced hand and wrist repetitive strain injuries (RSI) such as carpal tunnel syndrome (CTS) are a growing problem in North America. The purpose of this investigation was to apply a modification of the wrist flexion/extension models of Armstrong and Chaffin (1978, 1979) to determine if joystick controller use in oV-road machines could contribute to the development of CTS. A construction equipment cab in the laboratory was instrumented to allow force, displacement and angle measurements from 10 operators while they completed an ? 30-min joystick motion protocol. The investigation revealed that both the external fingertip and predicted internal wrist forces resulting from the use of these joysticks were very low, indicating that the CTS risk associated with this factor was slight. However, the results also indicated that, particularly for the ‘forward’ and ‘left’ right side motions and for all left side motions, force was exerted by other portions of the fingers and hand, thereby under-predicting the tendon tension and internal wrist forces. Wrist angles observed were highest for motions that moved the joysticks to the sides rather than front to back. Thus, the ‘right’ and ‘left’ motions for both hands posed a higher risk for CTS development. When the right hand moved into the ‘right’ position and the left hand moved into the ‘left’ position, the wrist went into extension in both cases. Results indicate that neither learning nor fatigue aVected the results.     

Variance in direct exposure measures of typing force and wrist kinematics across hours and days among office computer workers

To determine the number of direct measurements needed to obtain a representative estimate of typing force and wrist kinematics, continuous measures of keyboard reaction force and wrist joint angle were collected at the workstation of 22 office workers while they completed their own work over three days, six hours per day. Typing force and wrist kinematics during keyboard, mouse and idle activities were calculated for each hour of measurement along with variance in measurements between subjects and between day and hour within subjects. Variance in measurements between subjects was significantly greater than variance in measurements between days and hours within subjects. Therefore, we concluded a single, one-hour period of continuous measures is sufficient to identify differences in typing force and wrist kinematics between subjects. Within subjects, day and hour of measurement had a significant effect on some measures and thus should be accounted for when comparing measures within a subject. PRACTITIONER SUMMARY: The dose response relationship between exposure to computer related biomechanical risk factors and musculoskeletal disorders is poorly understood due to the difficulty and cost of direct measures. This study demonstrates a single hour of direct continuous measures is sufficient to identify differences in wrist kinematics and typing force between individuals.     

A new method for estimating hand internal loads from external force measurements

This study examines using force vectors measured using a directional strain gauge grip dynamometer for estimating finger flexor tendon tension. Fifty-three right-handed participants (25 males and 28 females) grasped varying-sized instrumented cylinders (2.54, 3.81, 5.08, 6.35 and 7.62 cm diameter) using a maximal voluntary power grip. The grip force vector magnitude and direction, referenced to the third metacarpal, was resolved by taking two orthogonal grip force measurements. A simple biomechanical model incorporating the flexor tendons was used to estimate long finger tendon tension during power grip. The flexor digitorum superficialis and the flexor digitorum profundus were assumed to create a moment about the metacarpal phalange (MCP) joint that equals and counteracts a moment around the MCP joint measured externally by the dynamometer. The model revealed that tendon tension increased by 130% from the smallest size handle to the largest, even though grip force magnitude decreased 36% for the same handles. The study demonstrates that grip force vectors may be useful for estimating internal hand forces.     

A new method for estimating hand internal loads from external force measurements

This study examines using force vectors measured using a directional strain gauge grip dynamometer for estimating finger flexor tendon tension. Fifty-three right-handed participants (25 males and 28 females) grasped varying-sized instrumented cylinders (2.54, 3.81, 5.08, 6.35 and 7.62 cm diameter) using a maximal voluntary power grip. The grip force vector magnitude and direction, referenced to the third metacarpal, was resolved by taking two orthogonal grip force measurements. A simple biomechanical model incorporating the flexor tendons was used to estimate long finger tendon tension during power grip. The flexor digitorum superficialis and the flexor digitorum profundus were assumed to create a moment about the metacarpal phalange (MCP) joint that equals and counteracts a moment around the MCP joint measured externally by the dynamometer. The model revealed that tendon tension increased by 130% from the smallest size handle to the largest, even though grip force magnitude decreased 36% for the same handles. The study demonstrates that grip force vectors may be useful for estimating internal hand forces.     

Field measurement of hand forces of palm oil harvesters and evaluating the risk of work-related musculoskeletal disorders (WMSDs) through biomechanical analysis

Hand force data is critical in evaluating work-related musculoskeletal disorders (WMSDs). Nevertheless, earlier studies on oil palm workers relied on estimated or laboratory measurements, which may not accurately reflect the actual hand forces. This study is the first report on the field measurement of hand forces for palm oil harvesters using a chisel and sickle to harvest low and tall palm trees, respectively. The dynamic hand forces and ground reaction forces were measured using instrumented harvesting tools and force plates, while wearable motion (IMU) and electromyography (EMG) sensors were incorporated for quantifying postural angles and muscle activations, respectively. Additionally, the spinal loadings, continuous Rapid Entire Body Assessment (REBA) scores, and subjective pain scores were determined to evaluate the risk of WMSDs. A total of 10 harvesters were recruited to perform the palm pruning tasks using a chisel and sickle. Resultantly, the sickle and chisel recorded a maximum cutting force of 1601.23 ± 424.26 N and 420.80 ± 96.00 N, respectively. All pruning tasks were found to be highly risky to harvesters, with a peak REBA score of 12. Likewise, all investigated muscles were activated for over 40% MVC, thus inducing moderate pain in the muscles. The peak L5-S1 compression forces for all tasks exceeded the safety threshold (>3400 N), but the values were not significantly different. The shear force of the L5-S1 was extreme in pruning with a sickle (1446.10 ± 411.00 N) compared to using a chisel. In conclusion, palm harvesters were at a high risk of developing WMSDs following poor postures, high physical exertion and muscle activity, and excessive spinal loads.     

Prediction of forearm muscle activity during gripping

Occupational exposure is typically assessed by measuring forces and body postures to infer muscular loading. Better understanding of workplace muscle activity levels would aid in indicating which muscles may be at risk for overexertion and injury. However, electromyography collection in the workplace is often not practical. Therefore, a set of equations was developed and validated using data from two separate days to predict forearm muscle activity (involving six wrist and finger muscles) from grip force and posture of the wrist (flexed, neutral and extended) and forearm (pronated, neutral, supinated). The error in predicting activation levels of each forearm muscle across the range of grip forces, using the first day data (root mean square error; RMSEmodel), ranged from 8.9% maximal voluntary electrical activation (MVE) (flexor carpi radialis) to 11% MVE (extensor digitorum communis). Grip force was the main contributor to predicting muscle activity levels, explaining over 70% of the variance in flexor activation levels and up to 60% in extensor activation levels, respectively. Inclusion of gender as a variable in the model improved estimates of flexor but not extensor activity. While posture itself explained minimal variance in activation without grip force (< 10% MVE), wrist and forearm posture were required (with grip force) to explain over 70% of the variance of all six muscles. The validation process indicated good day-to-day reliability of each equation, with similar error for flexor muscle models but slightly higher error in the extensor models when predicting activity levels for the second day of data (RMSEvalid ranging from 8.9% to 12.7% MVE). Detailed error analysis during validation revealed that inclusion of posture in the model effectively decreased error at grip forces above 25% maximum, but was detrimental at very low grip forces. This study presents a potential new tool to estimate forearm muscle loading in the workplace using grip force and posture, as a surrogate to use of a complex biomechanical model.     

Method for determining musculotendon parameters in subject-specific musculoskeletal models of children developed from MRI data

Accurate knowledge of muscle-tendon parameters in biomechanical models is critical for accurate simulation and analyses of human movement. An excellent example of this is the creation of subject-specific models from magnetic resonance imaging (MRI). When Hill-type muscle models are used to calculate muscle forces, the determination of muscle attachment points, optimal fiber length, tendon slack length and maximum isometric force all have a significant influence on the joint moment-angle behavior of the model. In the present study a method was developed for customizing the values of muscle-tendon parameters in a generic model to create subject-specific biomechanical models from MRI. The method was applied by generating musculoskeletal models for the biomechanical simulation platform OpenSim, but the workflow is equally well applicable to other simulation platforms. New computational algorithms are described for identifying joint centers and for reconstructing the centroids of the muscle bellies from MRI. A?process is also described for the extraction of the muscle paths and for identifying the positions of ??via-points?? used to model muscles wrapping over bones. Finally, a new algorithm is described for adjusting the values of optimal fiber length, tendon slack length and maximum isometric force based on a comparison of the model results with experiment. We tested our computational algorithms by developing subject-specific biomechanical models of five typically developed children (age 9.5±1.7?years) from MRI. The joint moment-angle relationships calculated for the subject-specific models were similar to those determined for corresponding scaled generic models. The results indicate that the proposed methodology is suitable for developing subject-specific models of healthy children. Future studies should investigate how abnormalities of the musculoskeletal system, such as tibial torsion and muscle spasticity, can be integrated into the modeling process.     

Prediction of forearm muscle activity during gripping

Occupational exposure is typically assessed by measuring forces and body postures to infer muscular loading. Better understanding of workplace muscle activity levels would aid in indicating which muscles may be at risk for overexertion and injury. However, electromyography collection in the workplace is often not practical. Therefore, a set of equations was developed and validated using data from two separate days to predict forearm muscle activity (involving six wrist and finger muscles) from grip force and posture of the wrist (flexed, neutral and extended) and forearm (pronated, neutral, supinated). The error in predicting activation levels of each forearm muscle across the range of grip forces, using the first day data (root mean square error; RMSE_model), ranged from 8.9% maximal voluntary electrical activation (MVE) (flexor carpi radialis) to 11% MVE (extensor digitorum communis). Grip force was the main contributor to predicting muscle activity levels, explaining over 70% of the variance in flexor activation levels and up to 60% in extensor activation levels, respectively. Inclusion of gender as a variable in the model improved estimates of flexor but not extensor activity. While posture itself explained minimal variance in activation without grip force (<10% MVE), wrist and forearm posture were required (with grip force) to explain over 70% of the variance of all six muscles. The validation process indicated good day-to-day reliability of each equation, with similar error for flexor muscle models but slightly higher error in the extensor models when predicting activity levels for the second day of data (RMSE_valid ranging from 8.9% to 12.7% MVE). Detailed error analysis during validation revealed that inclusion of posture in the model effectively decreased error at grip forces above 25% maximum, but was detrimental at very low grip forces. This study presents a potential new tool to estimate forearm muscle loading in the workplace using grip force and posture, as a surrogate to use of a complex biomechanical model.     

Wrist posture affects hand and forearm muscle stress during tapping

Non-neutral wrist posture is a risk factor of the musculoskeletal disorders among computer users. This study aimed to assess internal loads on hand and forearm musculature while tapping in different wrist postures. Ten healthy subjects tapped on a key switch using their index finger in four wrist postures: straight, ulnar deviated, flexed and extended. Torque at the finger and wrist joints were calculated from measured joint postures and fingertip force. Muscle stresses of the six finger muscles and four wrist muscles that balanced the calculated joint torques were estimated using a musculoskeletal model and optimization algorithm minimizing the squared sum of muscle stress. Non-neutral wrist postures resulted in greater muscle stresses than the neutral (straight) wrist posture, and the stress in the extensor muscles were greater than the flexors in all conditions. Wrist extensors stress remained higher than 4.5 N/cm² and wrist flexor stress remained below 0.5 N/cm² during tapping. The sustained high motor unit recruitment of extensors suggests a greater risk than other muscles especially in flexed wrist posture. This study demonstrated from the perspective of internal tissue loading the importance of maintaining neutral wrist posture during keying activities.     

Vibration of portable orbital sanders and its impact on the development of work-related musculoskeletal disorders in the furniture industry

The wood furniture industry has a strong presence in Canada, where it employs over 100,000 workers. Because of the extensive number of manual tasks required in this industry, several studies have been undertaken to characterize the health and safety risk factors to which these workers are exposed, such as awkward postures, repetitive movements and the application of undue force. However, very little research has been done on workers’ exposure to vibration from portable orbital sanders, one of the most common tools used in this industry. Vibration is responsible for a specific occupational disease called vibration syndrome, but is also recognized as a risk factor that increases the prevalence of more common work-related musculoskeletal disorders (WMSDs). This study proposed to determine the level of vibration to which sanders of furniture parts are exposed, and to analyze its impact on the risk of WMSDs. The results show that the level of vibration to which the workers are exposed is well above acceptable levels defined by recognized standards and directives and that this vibration is combined with many other risk factors, thus representing a risk for the development of WMSDs.     

A stress-strength interference model for predicting CTD probabilities

A model for predicting the incidence rate of carpal tunnel syndrome (CTS) for a given job, was developed using known biomechanical data, mechanical properties of human tendons and reliability engineering techniques to simplify the problem. In addition, time-dependent stress-strength interference theory was used to quantify the stress on the tendons during a job cycle, based on wrist position and grip strength and to estimate the tendon failure rate (or CTS incidence) for a given job. Higher failure probabilities were predicted for greater wrist deviations, for higher grasp forces, for females as compared to males, for wrist extension as compared to wrist flexion, and for two-fingered pinches as compared to four-fingered grasps. The predictions closely matched previously reported CTS incidence rates for a poultry thigh boning task.     

Choice of optimization models for predicting spinal forces in a three-dimensional analysis of heavy work

Biomechanical models for predicting spinal compression forces are often used to assess industrial jobs with respect to the potential for low-back injury. However, there are a variety of optimization-based model formulations available for estimating internal forces from joint reaction moments in three-dimensional analyses. The question addressed in this study was, how much does the choice of model formulation affect spinal compression force estimates when analysing industrial tasks? Forty-one work postures in an aluminium reduction facility were selected for analysis. The postures were entered from videotape, and a static three-dimensional biomechanical model was used to compute the L2/L3 moments about the sagittal, frontal, and transverse planes. The shear and compression forces acting on the spine were computed from the L2/L3 moments using four optimization model formulations (minimize the sum of squared muscle stresses, sum of cubed muscle stresses, spinal compression, and a combination of maximum muscle stress and spinal compression). The anterior-posterior and compression forces predicted by the four models differed at the P<0·001 level of significance. The largest difference between model predictions for a single task was 3625 N     

The effect of typing posture on wrist extensor muscle loading

High static loading of the forearm extensor musculature has been observed during keying tasks. To reduce the level of loading, one must first understand the contributing factors. A simulation of the human finger was used to determine muscle force contributions during a static index finger key press at several wrist postures. The planar model included active and passive muscle forces of the intrinsic and extrinsic finger muscles. The model was expanded to include the passive forces from the other fingers as well as the weight of the hand to determine the exertion required of the wrist extensor muscles to maintain the given wrist and finger postures. Model results indicated that greater than 25% of maximal exertion is required of the wrist extensors when the wrist is extended to 30. The increased moment contribution from passive forces of the extrinsic finger flexor muscles was responsible for the majority of the increased wrist extensor contribution as the wrist was extended. These findings are in relative agreement with previous electromyographic studies and may indicate a mechanism for forearm extensor pain in office workers. Potential applications of this research include ergonomic modeling of the upper limb to determine internal loads that may lead to work-related disorders.     

Wrist and forearm posture from typing on split and vertically inclined computer keyboards

A study was conducted on 90 experienced office workers to determine how commercially available alternative computer keyboards affected wrist and forearm posture. The alternative keyboards tested had the QWERTY layout of keys and were of three designs: split fixed angle, split adjustable angle, and vertically inclined (tilted or tented). When set up correctly, commercially available split keyboards reduced mean ulnar deviation of the right and left wrists from 12 degrees to within 5 degrees of a neutral position compared with a conventional keyboard. The finding that split keyboards place the wrist closer to a neutral posture in the radial/ulnar plane substantially reduces one occupational risk factor of work-related musculoskeletal disorders (WMSDs): ulnar deviation of the wrist. Applications of this research include commercially available computer keyboard designs that typists can use and ergonomists can recommend to their clients in order to minimize wrist ulnar deviation from typing.     

Hand as hammer: A comprehensive review of biomechanical studies related to occupational hand strikes

A growing number of workers in modern automotive assembly plants are confronted with occupational tasks involving repeated high‐impact hand strikes. Such repetitive physical workloads account for diseases of soft tissues or musculoskeletal disorders in the hand, wrist, or entire upper body. The purpose of this review was to identify and discuss the most pertinent occupational and physiological investigations concerning such hand strikes with particular emphasis on the biomechanical parameters examined. Articles were drawn from four databases to identify publications about occupational hand strikes. First, studies were selected that evaluated hand impact loads measured with the help of force measurement devices. For a deeper understanding of biomechanical factors regarding hand impacts, the scope of the search was extended to include ancillary studies about impacts on wrists or elbows. Overall, 945 abstracts were screened, and five full‐text articles were included in the final review. In addition, 34 ancillary articles about impact stress on the hand–arm complex were discussed because of positive relations between high forces, repetition rates or acceleration, and progressing stress in the hand–arm complex identified in studies about critical biomechanical load limits, in the field of fall arrests and sports, i.e. tennis. Furthermore, studies about effective arm movements and body postures during hand strikes as used in martial arts were reviewed. Although certain biomechanical parameters are both known and well documented, studies available at present cannot sufficiently account for specific disorders in the wrist or arm that are triggered by occupational hand strikes.     

Effect of wrist position on grip force sense in healthy adults

To achieve a better understanding of the causes of higher rates of musculoskeletal disorders and to develop preventive strategies to decrease the risk of injury and optimally design hand tools, it is necessary to understand the effects of both wrist position and force level on grip force sense. In this study, the effects of both wrist position and force level on grip force sense in healthy males during an ipsilateral force reproduction task were investigated. Twenty healthy subjects were instructed to produce varying levels of target forces (i.e., 10%, 30%, and 50% of maximal voluntary isometric contraction [MVIC]) for five wrist positions (i.e., neutral position, full radial deviation, full ulnar deviation, full‐extension, and full flexion), and to reproduce these forces using the same hand. The results of our study revealed that the absolute error, constant error, and MVIC decreased as the wrist joint angle deviated from the neutral position. Subjects had a more accurate estimation of medium target force (30% MVIC), while low target force (10% MVIC) was overestimated and high target force (50% MVIC) was underestimated, in contrast to most previous studies.     

A real-time EMG-driven musculoskeletal model of the ankle

The real-time estimation of muscle forces could be a very valuable tool for rehabilitation. By seeing how much muscle force is being produced during rehabilitation, therapists know whether they are working within safe limits in their therapies and patients know if they are producing enough force to expect improvement. This is especially true for rehabilitation of Achilles tendon ruptures where, out of fear of overloading and causing a rerupture, minimal therapy is typically done for eight weeks post-surgery despite animal studies that show that low-level loading is beneficial. To address this need, we have developed a biomechanical model that allows for the real-time estimation of forces in the triceps surae muscle and Achilles tendon. Forces are estimated using a Hill-type muscle model. To account for differences in neuromuscular control of each subject, the model used EMGs as input. To make this clinically useful, joint angles were measured using electrogoniometers. A dynamometer was used to measure joint moments during the model calibration stage, but was not required during real-time studies. The model accounts for the force-length and force-velocity properties of muscles, and other parameters such as tendon slack length and optimal fiber length. Additional parameters, such as pennation angle and moment arm of each muscle in the model, vary as functions of joint angle. In this paper, the model is presented and it application is demonstrated in two subjects: one with a healthy Achilles tendon and a second 6 months post Achilles tendon rupture and repair.     

Assessing exposure to risk factors for work-related musculoskeletal disorders using Quick Exposure Check (QEC) in taxi drivers

Work-related musculoskeletal disorders (WMSDs) are a common health problem throughout the world. This study aimed to examine the risk factors that are involved in the development of WMSDs in taxi drivers. In total 382 taxi drivers were observed using Quick Exposure Check (QEC) observational tool, which allows practitioners and workers to assess four key areas of the body. Results of the QEC scores were found to be very high for the shoulder/arm, wrist/hand and neck, whereas the scores for the back were found to be high for static use and moderate for moving. The results also showed that the occupational risk factors for WMSDs were associated with restricted postures, repetitive movements, vibration, work related stress. Essential ergonomic interventions are needed to eliminate risk of exposures to WMSDs in taxi drivers.Relevance to industryThe study results have relevance for ergonomists, health and safety practitioners as well as the drivers themselves, and helpful for estimating the main physical risk factors for WMDSs before choosing a method prior to an ergonomic intervention in industry.     

Estimation of forces exerted by the fingers using standardised surface electromyography from the forearm

Determination and integration of human force capabilities and requirements is an essential component of ergonomic evaluation. With regard to hand-intensive tasks, direct force measurements can be cumbersome and intrusive. Here, the use of surface electromyography (EMG) was evaluated. EMG was obtained from three standardised electrode sites on the forearms of 30 individuals. Linear regression models were generated to estimate finger force levels from normalised electromyographic measures, while forces were generated in several finger couplings. The results suggest that standardised procedures for obtaining electromyographic data and simple linear models can be used to accurately estimate finger forces during a variety of finger exertions in fixed postures, although the level of accuracy depends on the type of model. Such models begin to overcome the limitations of direct finger strength measurements of individuals.