Functional psychomotor deficits associated with carpal tunnel syndrome

A reliable task was developed for investigating functional deficits associated with carpal tunnel syndrome (CTS). A rapid pinch and release psychomotor task utilizing muscles of the hand innervated by the median nerve was administered using a strain gauge dynamometer and providing limited force feedback. The motor performance characteristics studied were speed and force control. An experiment was conducted for studying the effects of force level, hand dominance, test-retest reliability, learning, and inter-subject variability using 13 subjects free from any hand disabilities or symptoms. A companion study was also conducted using 17 normal subjects and ten subjects diagnosed having CTS to investigate differences between CTS and control subjects. Dominant hands performed 4% to 8% better than the non-dominant hands by having a greater pinch rate, a smaller overshoot force, and less time above the upper force level and below the lower force level. Control subjects performed 25% to 82% better than CTS subjects. Age contributed 6% of the total variance for pinch rate and 7% of the total variance for the time below the lower force level. The results suggest that people suffering from CTS may experience similar functional psychomotor deficits in daily living and manual work activities.     

A gap detection tactility test for sensory deficits associated with carpal tunnel syndrome

An automated gap detection tactility test was investigated for quantifying sensory deficits associated with carpal tunnel syndrome (CTS). The test, which involved sensing a tiny gap in an otherwise smooth surface by probing with the finger, had functional resemblance to many work-related tactile activities such as detecting scratches or surface defects. Gap detection thresholds were measured using the converging staircase method of limits paradigm. Sixteen normal subjects between 21 and 66 years of age were tested for studying important factors affecting gap detection thresholds. Actively probing with the index finger had a threshold almost an order of magnitude more sensitive (mean = 0·19mm, SD = 0·llmm) than passive touch (mean =1·63mm. SD = 0·62mm), which was similar to two-point discrimination. Average thresholds decreased by 24% as contact force increased from 25 to 75?g. Performance in this tactility test quickly stabilized and showed little learning effects over the period of the test, as evidenced by the lack of significant differences between six replicates. The results were highly repeatable. No significant threshold differences were observed between test and retest trials on different days, or between dominant and non-dominant hands. A contact force of 50?g was recommended as optimal for this test since it required moderate force but resulted in a smaller threshold compared with 25 or 75?g. A companion study was conducted using eight normal subjects and ten subjects diagnosed as having CTS. Average gap detection threshold, when finger probing was allowed, was 0·20?mm (SD = 0·11?min) for the normal subjects and increased two-fold to 0·40?mm (SD = 0·19?mm) for the CTS subjects. Average gap detection threshold, when the finger probing was not allowed, was 1·71?mm (SD = 0·53mm) for the normal subjects and increased by 48% to 2·53?mm (SD = 0·87?mm) for the CTS subjects. The results suggest that people suffering from CTS may experience similar functional deficits in daily living and work activities. The small inter-subject variability makes this test a candidate for having utility as a monitoring test for loss of cutaneous tactile sensitivity.     

The development of risk assessment models for carpal tunnel syndrome: a case-referent study

The present study developed risk assessment models for carpal tunnel syndrome (CTS) which can provide information of the likelihood of developing CTS for an individual having certain personal characteristics and occupational risks. A case-referent study was conducted consisting of two case groups and one referent group: (1) 22 work-related CTS patients (W-CTS), (2) 25 non-work related CTS patients (NW-CTS), and (3) 50 healthy workers (HEALTHY) having had no CTS history. The classification of CTS patients into one of the case groups was determined according to the type of insurance covering their medical costs. Personal characteristics, psychosocial stresses at work, and physical work conditions were surveyed by using a questionnaire tailor-designed to CTS (reliability of each scale ? 0.7). By contrasting the risk information of each case group to that of the referent group, three logistic regression models were developed: W-CTS/HEALTHY, NW-CTS/HEALTHY, and C-CTS/HEALTHY (C-CTS, the combined group of W-CTS and NW-CTS). ROC analysis indicated that the models have satisfactory discriminability (d′ = ;1.91 to 2.51) and high classification accuracy (overall accuracy = 83 – 89%). Both W-CTS/HEALTHY and C-CTS/HEALTHY include personal and physical factors, while NW-CTS/HEALTHY involves only personal factors. This suggests that the injury causation of NW-CTS patients should be attributable mainly to their ‘high’ personal susceptibility to the disorder rather than exposure to adverse work conditions, while that of W-CTS patients be attributable to improper work conditions and CTS-prone personal characteristics in combination.     

Wrist movements among females in a repetitive,non-forceful work

Wrist positions and movements were measured and a physical examination was conducted in 12 female operators in an industrial quality-control work. The handled products are of very low weight, thus, the work can be considered as non-forceful. The work was highly repetitive; 0.54Hz for the right wrist/hand and 0.41Hz for the left. The angular velocities were also high; for the right wrist/hand median value was 30 degrees /s and peak value 108 degrees /s, for the left wrist/hand 24 degrees /s and 88 degrees /s, respectively. The frequency of musculoskeletal disorders was high, especially for the right wrist/hand. Although the work was non-forceful and there were minor extreme positions in the wrists, the results are consistent with reported exposure-response relations in other high-risk jobs. Thus, the repetitiveness and the high velocities are the likely causes for the high prevalence of disorders in the wrists/hands among the operators.     

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.     

Obesity effect on male active joint range of motion

Despite the prevalence of obesity, how obesity affects human physical capabilities is not well documented. As an effort toward addressing this, the current study investigated the obesity effect on joint range of motion (RoM) based on data collected from 20 obese and 20 non-obese males. In total, 30 inter-segmental motions occurring at the shoulder, elbow, knee and ankle joints and lumbar and cervical spine areas were examined. The obesity effect was found to be non-uniform across the joint motions. Obesity significantly reduced RoM for nine of the 30 motions: shoulder extensions and adductions, lumbar spine extension and lateral flexions and knee flexions. The largest significant RoM reduction was 38.9% for the left shoulder adduction. The smallest was 11.1% for the right knee flexion. The obesity-associated RoM reductions appear to be mainly due to the mechanical interposition and obstruction of inter-segmental motions caused by excess fat in the obese body.

Statement of Relevance: Currently, obesity is prevalent worldwide and its prevalence is expected to increase continually in the near future. This study empirically characterised the obesity effects on joint RoM to provide better understanding of the physical capabilities of the obese. The study findings will facilitate designing man–artefact systems that accommodate obese individuals.     

Effects of computer mouse design and task on carpal tunnel pressure

Computer mouse use has become an integral part of office work in the past decade. Intensive mouse use has been associated with increased risk of upper extremity musculoskeletal disorders, including carpal tunnel syndrome. Sustained, elevated fluid pressure in the carpal tunnel may play a role in the pathophysiology of carpal tunnel syndrome. Carpal tunnel pressure was measured in 14 healthy individuals while they performed tasks using three different computer mice. Participants performed a multidirectional dragging (‘drag and drop’) task starting with the hand resting (static posture) on the mouse. With one mouse, an additional pointing (‘point-and-click’) task was performed. All mice were associated with similar wrist extension postures (p= 0.41) and carpal tunnel pressures (p= 0.48). Pressures were significantly greater during dragging and pointing tasks than when resting the hand (static posture) on the mouse (p= 0.003). The mean pressures during the dragging tasks were 28.8- 33.1 mmHg, ～ 12 mmHg greater than the static postures. Pressures during the dragging task were higher than the pointing task (33.1 versus 28.0 mmHg), although the difference was borderline non-significant (p= 0.06). In many participants the carpal tunnel pressures measured during mouse use were greater than pressures known to alter nerve function and structure, indicating that jobs with long periods of intensive mouse use may be at an increased risk of median mononeuropathy. A recommendation is made to minimize wrist extension, minimize prolonged dragging tasks and frequently perform other tasks with the mousing hand.     

Wrist postures while keyboarding: effects of a negative slope keyboard system and full motion forearm supports

Abstract

Video-motion analysis was used to analyse hand/wrist posture for subjects typing at a 101-key QWERTY keyboard on a 68 cm high worksurface. Three conditions were tested: subjects typed at the keyboard without arm support, subjects typed with adjustable full motion forearm supports, and subjects typed with an adjustable negative slope keyboard support system. The average declination of the negative slope keyboard support chosen by subjects was 12° below horizontal, which flattened the angle of the key tops. Ulnar deviation was comparable in all conditions and averaged 13° for the right hand and 15° for the left hand. Full motion forearm supports did not significantly affect any postural measures. Dorsal wrist extension averaged 13° when typing with or without the full motion forearm supports, but this was reduced to an average — 1° with the use of the negative slope keyboard support system. Subjects chose to sit at a distance of 79 cm from the computer screen when using the negative slope keyboard system compared with 69 cm without this.     

Experimental investigation of the effect of thermal comfort parameters on cervical range of motion

The most well-known ailment affecting the neck muscles is neck stiffness, caused by sharp changes in temperature, chilling of the muscles by air conditioning or drafts, and consequent painful muscle contractions. A stiff neck is typically characterized by soreness and difficulty in moving the neck – especially when trying to turn the head to the side. A stiff neck may also be accompanied by a headache, neck pain, shoulder pain and/or arm pain. Reduced cervical range of motion (ROM) is a common finding in people with neck pain. Musculoskeletal disorders continue to represent a major source of pain and discomfort as well as a significant source of workday loss and workers' compensation costs.In this study, the effects of parameters in air conditioning such as temperature, humidity and air velocity on cervical ROM have been investigated experimentally. In this investigation, each of the three parameters was used as a variable while the others were kept constant in a controlled laboratory room, and the effects of the parameter variations were investigated. Based on the observation that individuals often enter the air conditioned room perspiring in summer conditions, both dry and sweaty conditions were examined. Finally, experimental data were assessed with ANOVA analyses, and cervical rotation was found to be influenced by temperature and air velocity, but not humidity. It was also determined that parameters (temperature, air velocity and humidity) are not effective factors on cervical motion limitation provided that indoor air conditions remain within comfort limits which are prescribed in current standards of ASHRAE Standard 55 – 2004 and ISO 7730.     

Effects of restrictive clothing on lumbar range of motion and trunk muscle activity in young adult worker manual material handling

The objective of this study was to examine the effect of wearing restrictive trousers on lumbar spine movement, trunk muscle activity and low back discomfort (LBD) in simulations of manual material handling (MMH) tasks. Twenty-eight young adults participated in the study performing box lifting, liquid container handling while squatting, and forward reaching while sitting on a task chair when wearing tight pants (sizes too small for the wearer) vs. fit pants (correct size according to anthropometry). Each task was repeated three times and video recordings were used as a basis for measuring lumbar range of motion (LRoM). The response was normalized in terms on baseline hip mobility. Trunk muscle activity of rectus abdominis (RA) and erector spinae (ES) muscles were also measured in each trial and normalized. At the close of each trial, participants rated LBD using a visual analog scale. Results revealed significant effects of both pants and task types on the normalized LRoM, trunk muscle activity and subjective ratings of LBD. The LRoM was higher and trunk muscle (ES) activity was lower for participants when wearing tight pants, as compared to fit pants. Discomfort ratings were significantly higher for tight pants than fit. These results provide guidance for recommendations on work clothing fit in specific types of MMH activities in order to reduce the potential of low-back pain among younger workers in industrial companies.     

Invariant surface and motion estimation from sparse range data

In this paper, we present a system for the estimation of the surface structure and the motion parameters of a free-flying object in a tele-robotics experiment. The system consists of two main components: (i) a vision-based invariant-surface and motion estimator and (ii) a Kalman filter state estimator. We present a new algorithm for motion estimation from sparse multi-sensor range data. The motion estimates from the vision-based estimator are input to a Kalman filter state estimator for continuously tracking a free-flying object in space under zero-gravity conditions. The predicted position and orientation parameters are then fed back to the vision module of the system and serve as an initial guess in the search for optimal motion parameters. The task of the vision module is two-fold: (i) estimating a piecewise-smooth surface from a single frame of multi-sensor data and (ii) determining the most likely (in the Bayesian sense) object motion that makes data in subsequent time frames to have been sampled from the same piecewise-smooth surface. With each incoming data frame, the piecewise-smooth surface is incrementally refined. The problem is formulated as an energy minimization and solved numerically resulting in a surface estimate invariant to 3D rigid motion and the vector of motion parameters. Performance of the system is depicted on simulated and real range data.     

Effects of seated lumbar extension postures on spinal height and lumbar range of motion during prolonged sitting

Prolonged sitting during sedentary work has been reported as a potential risk factor for low back pain. Furthermore, prolonged sitting can result in both reduced spinal height (SH) and lumbar range of motion (LROM). This study compared the effects of no intervention (control) with two recovery postures on SH and LROM (flexion and extension) during prolonged sitting. Twenty-four participants were randomly assigned to three interventions for three consecutive days. The interventions comprised two seated lumbar extension recovery postures (unsupported sustained and supported dynamic lumbar extension postures) and a control. Both interventions facilitated a relatively short recovery period for both SH and LROM. Supported dynamic lumbar extension conditions significantly helped SH recovery, as compared with control condition, after the first recovery posture intervention, and both postures have potential to maintain LROM. However, both postures failed to induce SH recovery over an extended time.     

Muscle activity and range of motion during active trunk rotation in a sitting posture

Twisted trunk postures during tractor driving are associated with low-back pain. The purposes of this study were to quantify the muscle activity as a function of twisting angle, to quantify the range of motion (ROM) during active trunk rotation and to determine whether there were any differences between tractor drivers and office workers and between twisting direction for these variables. The subjects performed exertions in a seated position, twisting from the neutral position to the end of the ROM. The results showed that external oblique and erector spinae had significantly different activation patterns depending on twisting direction. For the contralateral external oblique and the ipsilateral erector spinae, the muscle effort required to twist the trunk was low up to about 20° twisting angle, then the muscle effort needed to twist the trunk increased progressively. No significant differences due to occupation or twisting direction were found. The result implies that work in twisted trunk postures might be a risk factor for low-back pain.     

Vibrometry of industrial workers: A case study

Vibrometry was performed on 165 factory workers and supervisors in 18 different job classifications. A low vibrometry score indicates insensitivity to vibrations and thus potential compression neuropathy. Males had significantly higher scores than females. Subjective estimates of the job's repetitiveness, force requirement and wrist angle movement did not correlate significantly with the vibrometry score but pace did (self-paced jobs had higher scores). Questions relating to pain in the hands and numbness in the hands were significant predictors of the score. The conventional vibrometry score is the total from seven frequencies. Analysis shows only the top frequencies (125, 250, 500 Hz) are needed and possibly just 250 and 500 Hz.     

The Strain Index (SI) and Threshold Limit Value (TLV) for Hand Activity Level (HAL): risk of carpal tunnel syndrome (CTS) in a prospective cohort

A cohort of 536 workers was enrolled from 10 diverse manufacturing facilities and was followed monthly for six years. Job physical exposures were individually measured. Worker demographics, medical history, psychosocial factors, current musculoskeletal disorders (MSDs) and nerve conduction studies (NCS) were obtained. Point and lifetime prevalence of carpal tunnel syndrome (CTS) at baseline (symptoms + abnormal NCS) were 10.3% and 19.8%. During follow-up, there were 35 new CTS cases (left, right or both hands). Factors predicting development of CTS included: job physical exposure (American conference of governmental industrial hygienists Threshold Limit Value (ACGIH TLV) for Hand Activity Level (HAL) and the Strain Index (SI)), age, BMI, other MSDs, inflammatory arthritis, gardening outside of work and feelings of depression. In the adjusted models, the TLV for HAL and the SI were both significant per unit increase in exposure with hazard ratios (HR) increasing up to a maximum of 5.4 (p = 0.05) and 5.3 (p = 0.03), respectively; however, similar to other reports, both suggested lower risk at higher exposures. Data suggest that the TLV for HAL and the SI are useful metrics for estimating exposure to biomechanical stressors. PRACTITIONER SUMMARY: This study was conducted to determine how well the TLV for HAL and the SI predict risk of CTS using a prospective cohort design with survival analysis. Both the TLV for HAL and the SI were found to predict risk of CTS when adjusted for relevant covariates.     

Effects of age and gender on maximum voluntary range of motion of the upper body joints

The maximum voluntary range of motion (ROM) of the major joints of the upper body was studied in a seated position and compared between young and elderly subjects. A total of 41 subjects (22 young male and female subjects aged 25 to 35 years, 19 elderly male and female subjects aged 65 to 80 years) took part in the experiment. In total, 13 maximum voluntary joint motions were performed by each subject. Age was found to have a non-uniform effect on the ROM of the joints investigated in this study. Its effect on ROM was joint specific and motion specific. The highest loss in ROM was observed in the neck and trunk, especially for neck extension, lateral flexion and axial rotation as well as for trunk lateral flexion and axial rotation. No significant age differences were observed in the elbow and wrist joint ROMs. The effect of gender on joint ROM was much weaker than that of age. Only four among the 26 joint ROMs investigated in this study were significantly different between the two gender groups.     

Measuring the effects of structural turnout suits on firefighter range of motion and comfort

Abstract

Range of motion (ROM) can be restricted by wearing stiff and bulky clothing. This is particularly true of firefighter suits that are constructed using fabric layers to provide thermal protection from fire. This study developed an evaluation technique to quantify the loss of mobility associated with wearing firefighters’ protective suits that were deliberately selected to represent similar ergonomic design features. The ROM of 10 firefighters was measured using electro-goniometers attached to their bodies while they wore uniforms and a reference outfit, and performed specific movements. The most restrictive uniform is the Bulky suit that contained additional layers of materials in sleeves and on the knees. The Traditional Suit was more ROM restrictive than Ergonomic. The subjective evaluation of suits supported the objective assessments provided by the electro-goniometers. A 3-D body scanning technique was employed to establish a correlation between the bulkiness of firefighter outfits and subject ROM.

Practitioner Summary: This study presents a methodology for measurements of range of motion (ROM) in firefighters wearing personal protective equipment (PPE). Even small differences in designs of PPE may impact firefighters’ ROM, which can be detected by electro-goniometers providing measurements if they are attached along the joint to measure limb angular movement.     

多轴联动的风洞变角度机构同步协调控制

为解决风洞尾撑变角度机构运动过程中多轴之间的同步协调控制问题,本文提出了一种结合并行控制和交叉耦合控制的同步控制方法.首先,将并行控制应用于多轴联动控制中,根据前后侧滑轴定位时间一致以及速度变化时间一致的原则,开展了提高多轴同步性能的研究.然后,采用了基于同步误差传递函数的交叉耦合控制方法,对并行控制给定的运动参数进行修正补偿.最后,通过机构运动进行了实验验证,实验结果表明该控制方法可有效减小横向同步误差,提高同步性能,满足风洞试验控制要求.该方法也为类似机构的同步控制提供了参考.     

The influence of occupation on lumbar sagittal motion and posture

The aim of this study was to determine whether sheep shearers have clinically hypothesized adaptive postural and sagittal mobility parameters of the lumbar spine and pelvis. Sixty-four shearers and 64 non-shearers, matched by age and anthropometry and surveyed for present and previous low back pain, participated in a study to determine the effects of occupation on sagittal spinal motion and posture. Lumbar and hip mobility measurements were made with a geometric CAD analysis of lateral photographs using surface reflective markers. Sagittal range of motion demonstrated similar ranges of lumbar flexion between the two groups; however, there was a marked gain in hip flexion in the shearers as well as a marked loss of lumbar extension. The shearers also demonstrated a more lordotic lower lumbar curvature compensated by a flatter (less kyphotic) mid to lower thoracic region. Shearers appear to lose lumbar extension, gain hip flexion and develop an adaptive normal stance. This adaptation appears to be independent of previous or current back pain. Conversely, lumbar extension loss in non-shearers correlates with previous back injury. A stepwise linear regression of all participants indicated that the occupation is the predominant influence on motion and posture followed by age. The implications are one of structural adaptation in this occupational group that does not appear to be correlated with back pain.     

Prevalence of carpal tunnel syndrome among employees at a poultry processing plant

Objective

To determine prevalence of carpal tunnel syndrome (CTS) among poultry processing employees while taking into account non-occupational factors and assess any association between CTS prevalence and exposure groups.

Methods

Performed a cross-sectional survey to assess CTS (n = 318). A CTS case was defined as an employee with self-reported CTS symptoms, an abnormal hand symptom diagram, and an abnormal nerve conduction study (NCS). Log-binomial regression was used to estimate prevalence ratios.

Results

Three hundred and one participants had sufficient symptom information or NCS data to be classified. 126 (42%) of 301 participants had evidence of CTS. In the adjusted analysis, the highest exposure group had CTS prevalence that was significantly higher than that for the lower exposure group [PR: 1.61; 95% CI = (1.20, 2.17)].

Conclusions

Increasing levels of hand activity and force were associated with increased CTS prevalence among participants. Recommendations were provided to reduce exposure to these risk factors.