Effects of exercise on carpal tunnel syndrome symptoms

This is a study of whether participation in an exercise programme for increasing upper extremity flexibility, strength, and circulation has any effects on symptoms of carpal tunnel syndrome (CTS). Two groups (exercise and control) of seven participants each who did repetitive hand motion tasks were studied. The exercise group participated in daily arm, hand, and other upper-extremity exercises for 8 weeks. The control group did not participate in the exercise programme. Dependent (response) variables monitored were motor nerve conduction latency through the carpal tunnel, grip strength, and subjective comfort in the dominant hands of participants. Test results indicated no statistically significant differences in nerve conduction latency or subjective comfort between the two groups. Significant differences did develop in grip strengths over time, suggesting that the exercise group may have benefited physiologically from the exercise programme.     

An ergonomic comparison of pneumatic and electrical pistol grip hand tools

The purpose of this study was to compare the ergonomic demands associated with air and DC pistol grip hand tool use. Seven channels of EMG data were collected from 15 male and 15 female subjects to estimate the muscular demands on the forearms, biceps, shoulders and neck. An accelerometer was also used to estimate the torque reaction transmitted to the hand. Subjects performed drilling with five pistol grip tools obtained from two tool suppliers. This resulted in two air tools, one non-transducerized electric (DC_NT) and two transducerized electric (DC_T) tools. Three types of joints were simulated: (1) , (2) and (3) . Subjects were asked to drill five joints to completion within a period, and to repeat this five times for each condition (25 joints per condition). Results of a three factor repeated measures ANOVA indicated that, in comparison to air tools, pistol grip DC tools do not pose an additional risk of musculoskeletal injury to the upper limbs. In fact, the data suggest that the use of pistol grip DC tools will reduce the demands on the forearms during horizontal drilling.

Relevance to industry

Powered hand tools can potentially cause upper limb injuries due to the postures, repetitions, and forces associated with their use. However, while DC tools have engineering advantages (loop monitoring of the tool, and increased quality control) the ability to implement ergonomic strategies also appears to reduce the muscle demands associated with tool use.     

Assessment of grip force and subjective hand force exertion under handedness and postural conditions

The Borg CR-10 scale has been used to quantify the perception of physical exertion. An experiment was conducted to test the grip force of males on four levels of the CR-10 scale under experimental conditions. It was found that the subjects applied higher grip forces than they perceived at levels 2, 5, and 7 on the scale. The grip forces between dominant and non-dominant hands at low CR-10 levels were negligible. The grip forces were significantly different between the two hands at level 10. Similar results were found for the postural conditions. A follow-up experiment was conducted to estimate the subjective rating when applying a pre-determined grip force under the same conditions. Regression models were established to link the relationship between the subjective rating and hand force. The estimated ratings were lower than those actual values under all the tested conditions, even though the models have high R² values.     

Effect of grip span on maximal grip force and fatigue of flexor digitorum superficialis.

The aim of this study was to investigate the effect of grip span on isometric grip force and fatigue of the flexor digitorum superficialis (FDS) muscle during sustained voluntary contractions at 60-65% of the maximal voluntary contraction (MVC). Eighteen subjects performed isometric, submaximal gripping contractions using a grip dynamometer at four different grip span settings while the pronated forearm rested on a horizontal surface. Maximal absolute grip force and median power frequency of FDS surface electromyography (EMG) during the submaximal trials were analyzed. Fatigue of FDS, as inferred from EMG frequency shifts, did not change as a function of grip size. However, middle grip sizes allowed for greater absolute forces than the small or large size. When contractions are at 60-65% MVC and the muscle is allowed to fatigue, however, grip size may be less influential than when maximal absolute force is required.     

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.     

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.     

Effect of object width on precision grip force and finger posture

This study aimed to define the effect of object width on spontaneous grasp. Participants held objects of various masses (0.75 to 2.25 kg) and widths (3.5 to 9.5 cm) between thumb and index finger. Grip force, maximal grip force and corresponding finger postures were recorded using an embedded force sensor and an optoelectronic system, respectively. Results showed that index finger joints varied to accommodate the object width, whereas thumb posture remained constant across conditions. For a given object mass, grip force increased as a function of object width, although this result is not dictated by the laws of mechanics. Because maximal grip force also increased with object width, we hypothesise that participants maintain a constant ratio between grip force and their maximal grip force at each given width. Altogether we conclude that when the task consists in manipulating objects/tools, the optimal width is different than when maximal force exertions are required.     

Effect of object width on precision grip force and finger posture

This study aimed to define the effect of object width on spontaneous grasp. Participants held objects of various masses (0.75 to 2.25 kg) and widths (3.5 to 9.5 cm) between thumb and index finger. Grip force, maximal grip force and corresponding finger postures were recorded using an embedded force sensor and an optoelectronic system, respectively. Results showed that index finger joints varied to accommodate the object width, whereas thumb posture remained constant across conditions. For a given object mass, grip force increased as a function of object width, although this result is not dictated by the laws of mechanics. Because maximal grip force also increased with object width, we hypothesise that participants maintain a constant ratio between grip force and their maximal grip force at each given width. Altogether we conclude that when the task consists in manipulating objects/tools, the optimal width is different than when maximal force exertions are required.     

Strength and range of motion of females with carpal tunnel syndrome

An experimental study was conducted to evaluate the grip and fingertip pinch strength, and range of motion of females with carpal tunnel syndrome (CTS). The range of motion of the wrist was measured in the sagittal, frontal, and transverse planes. Strength and range of motion measurements were also conducted on a control group. Results indicate that some strength and range of motion measures of the females with CTS were significantly different from that of the control group. Also, measurements in different planes caused significant differences in some range of motions of the wrist for both the CTS and the control groups.     

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.     

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.     

Power hand tool vibration effects on grip exertions

Operation of vibrating power hand tools can result in excessive grip force, which may increase the risk of cumulative trauma disorders in the upper extremities. An experiment was performed to study grip force exerted by 14 subjects operating a simulated hand tool vibrating at 9.8 m/s² and 49 m/s² acceleration magnitudes, at 40 Hz and 160 Hz frequencies, with vibration delivered in three orthogonal directions, and with 1.5kg and 3.0kg load weights. Average grip force increased from 25.3 N without vibration to 32.1 N (27%) for vibration at 40 Hz, and to 27.1N (7%) for vibration at 160 Hz. Average grip force also increased from 27.4 N at 9.8 m/s² acceleration to 31.8 N (16%) at 49m/s². Significant interactions between acceleration x frequency, and frequency x direction were also found. The largest average grip force increase was from 25.3N without vibration to 35.8N (42%) for 40 Hz and 49 m/s² vibration. The magnitude of this increase was of the same order as for a two-fold increase in load weight, where average grip force increased from 22.5N to 35.0N (56%). A second experiment studied hand flexor and extensor muscle responses using electromyography for five subjects holding a handle vibrating at 8 m/s² using ISO weighted acceleration, with frequencies of 20 Hz, 40 Hz, 80 Hz and 160 Hz, and grip forces of 5%, 10% and 15% of maximum voluntary contraction. Muscle responses were greatest at frequencies where grip force was affected, indicating that the tonic vibration reflex was the likely cause of increased grip exertions.     

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.     

Effect of grip span on lateral pinch grip strength

Repetitive, high-force pinch grip exertions are common in many occupational activities. The goal of the current study was to quantify the relationship between lateral pinch grip span (distance between thumb and index finger) and lateral pinch grip strength. An experiment was conducted in which 40 participants performed maximal lateral pinch grip exertions at 11 levels of grip span distances (0, 10%, ... 100% of maximum functional lateral pinch grip span distance). The results show a significant effect of lateral pinch grip span, with strength at the maximum functional lateral pinch grip span 40% higher than that found at the smallest lateral pinch grip span considered. Between these two endpoints, strength increased monotonically with increasing pinch grip span. The application of these results in pinch grip design criteria for both high-force and long-duration exertions is discussed. Potential applications of this research include the design of hand tools and controls for which significant force is applied by the user.     

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.     

Choice of handle characteristics for pistol grip power tools

The optimal surface material and cross-section of power tool handles are not sufficiently described in ergonomic literature. The objective of the present study was to increase knowledge in these matters. The handle of four similar drilling machines were covered with rubber with different hardness. The preferences and forearm muscle electric activity (12 male and 12 female subjects) as well as the vibration level (6 male subjects) when using these drilling machines were assessed. The results showed that foam rubber on the handle is a more preferable covering material compared to harder rubber and it does not increase the muscular activity. Foam rubber on the handle may also to some extent attenuate vibrations.

Furthermore preferred width and thickness of handles for drilling machines were evaluated by letting 12 male and 12 female subjects perform three tasks: (a) choosing handle width (free choice) and ranking handle thickness (3 alternatives), (b) ranking handle width (3 alternatives), (c) making a handle out of hand putty (free choice). The subjects hand size (hand length, functional grip diameter and hand volume) were also measured and compared to their preferences. The results showed that the most commonly used handle cross-section size (50×35 mm) is an acceptable compromise in terms of preferences. The measured hand size measures had low correlation with preferred handle width/circumference.

Relevance to industry

Information concerning the design of handles for power tools is essential for tool designers.     

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.     

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 > or = 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.     

Effect of body posture and common hand tools on peak torque exertion capabilities

An experimental investigation was conducted to investigate the effects of body posture and of different types of common non-powered hand tools on maximum volitional torque exertion capabilities of males and females. Thirty-six males and 14 females applied peak torque in 21 different body postures while using nine different hand tools. The data analysis indicated that, for both males and females, the magnitude of volitional torque is strongly influenced by the type of tool used and the posture assumed. Between the two, however, the effect of hand tool is more profound. The correlation between the tool type and volitional torque was of the order of 0.71. No other variable was as strongly correlated with volitional torque. Maximum volitional torque profiles, as a function of posture and tool type, are provided for males and females.