| Note : This article is done based on references | | | | efforts by the healthcare. However, if the patient |
| listed to share some basic points on Upper | | | | plays a passive role, if he expects recovery will |
| Extremity MSD/CTDs and encourage the | | | | be granted to him, if he is disinterested or |
| undertaking of preventive measures. There are | | | | uninformed, then surely all attempts to rehabilitate |
| extensive amounts of references on this for | | | | him will fail. |
| more details, however to obtain proper diagnosis, | | | | 2.0 Carpal Tunnel Syndrome (CTS) |
| prevention and recovery of MSD/CTDs, please | | | | & Thoracic Outlet Syndrome (TOC) |
| seek medical attention. | | | | Hands have a special significance in that their |
| Most of us suffer some form of CTD/MSD | | | | function is so complex & they are related to |
| (single or combination of disorders) as a result of | | | | earning a living. The proper function of hands are |
| some predisposing factors that we are unaware | | | | required to enable us to touch, feel, hug, caress, |
| of. It develops as we age and as we are | | | | lift, grip, hold things, eat, bath and carry out other |
| exposed to more and more risk factors. ASEANS | | | | dialy routine activities. Your ability to feel or touch |
| (including Malaysians) mostly experience long | | | | your family or loved ones, and to perform daily |
| working hours and practice inappropriate | | | | activities comfortably is affected when you have |
| ergonomics and this is why cases of CTD/MSD | | | | CTD/MSDs. In most CTD/MSDs, hand is the |
| are increasing. | | | | upper extremity affected most. |
| | | | | CTS affects the wrist and hands and is the most |
| 1. What is CTD / MSD | | | | common compression neuropathy in the upper |
| Definition : disorders of the nerves, muscles, | | | | extremity – caused by repetitive wrist flexion |
| tendons & bones that are caused, | | | | and extension with the fingers flexed. |
| precipitated or aggravated by repeated exertions | | | | - Sign & symptoms of CTS – strain |
| or movements of the body. These are | | | | stiffness, pain, numbness/loss of sensation, tingling |
| occupational-related and also caused/aggravated | | | | sensation, heaviness, temperature changes. |
| by living factors. Two main categories :i. | | | | - Predisposing factors for carpal tunnel syndrome |
| cervicobrachial disorders – myofascial pain | | | | (CTS) are inflammatory, trauma, neoplasias, |
| disorders, thoracic outlet syndrome (TOC), | | | | deposition of biosynthetic product, abnormal |
| cervical spondylosisii. nerve compression | | | | vasculature, and other system conditions. |
| syndromes – eg. carpal tunnel syndrome is | | | | - Women are at higher risk as the size of their |
| the most common compression neuropathy in the | | | | carpal are much smaller than men. |
| upper extremity– caused by repetitive wrist | | | | - Physical factors that heighten risk : force |
| flexion and extension with the fingers flexed, | | | | (pressing keyboard hard, or hard keyboards), |
| affecting the wrist & hand | | | | repetition (continuous typing and clicking), vibration |
| Single or a combination of disorders may exist in | | | | (car and other vibrating tools, or equipment with |
| patients and one CTD/MSDs may affect the | | | | insufficient vibration control), posture/ergonomics |
| other. Patients who understand the pathogenesis | | | | (improper seating/seat design, workstation & |
| of their condition, understand the rehabilitation and | | | | seat height in relative to each other etc, angle |
| prevention issues. | | | | postion of computer in relation to the |
| 1.1 Cause and Factors | | | | individual’s posture), cold temperature. Cold |
| Ergonomics (the study of work & workplace) | | | | temperature harms the dexterity of fingers/hand, |
| blends human characteristics with the living & | | | | can cause numbness |
| working environment, revealing that sedentary | | | | Risky postures that should be avoided :- |
| nature of work, inappropriate work station, | | | | - Long-term sitting, standing or repetitious |
| mechanical stress, nutritional inadequacies, | | | | shoulder & scapular motion |
| metabolic & endocrine dysfunctions, chronic | | | | - Improper posture of the back & neck / |
| infection, insufficient physical exercise causes or | | | | improper seating affect the position of the wrist |
| enhanced risk of CTD/MSD. | | | | and the hand, thus causing strain and repetitive |
| - This means how we perform work – work | | | | trauma injuries (RTI) to the wrist, hands, back, |
| posture at work station/computer, sleeping | | | | neck, shoulder. This can lead to nerve |
| posture, carrying things, using tools – heavy | | | | compression syndrome and TOC. |
| vibration, long-term sitting posture without break | | | | - The forward head, rounded shoulder posture is |
| & exercise, driving posture & car | | | | a predisposing factor in the development of |
| ergonomics. | | | | Thoracic Outlet Syndrome (TOC) which usually |
| - Job stress (anxiety & tension) & the | | | | co-exists with CTS in some individuals. |
| repetitive nature of many tasks in modern | | | | - Sitting with legs crossed under the other and |
| industry are leading to CTDs not to mention job | | | | leaning on one elbow while using computer, as this |
| frustration. | | | | eliminates ergonomic support & enhance the |
| - Physical factors mainly force, repetition, | | | | likehood of MSD/CTD. |
| vibration, posture/ergonomics, cold temperature | | | | - Hanging the hand on the top of a car steering |
| heightens risk for most disorders along with the | | | | wheel for a prolonged time. |
| predisposing factors that are likely to cause or | | | | 3.0 Measures for Prevention and |
| aggravate signs/symptoms. | | | | Rehabilitation of CTD / MSD |
| - Being overweight or obese is a serious risk | | | | Refer to DOSH guidelines on seating and using |
| factor that not only increases your risk for all | | | | VDU and other references at the end of this |
| health problems but also CTD / MSD. | | | | article mainly ‘carpal tunnel syndrome |
| - Women are at higher risk in most cases (mainly | | | | exercises’ and’ physical activity for |
| those with underlying factors) – congenital | | | | everyone’ for prevention of CTD/MSD |
| reasons, hormonal problems (including thyroid | | | | - Practice good posture and working habits. |
| problems), bone formation/shape, vasculature etc. | | | | - Rest in between work – exercise between |
| 1.2 Treatment and | | | | work eg after every 30 min of using the |
| Rehabilitation – based on specific injury | | | | computer take break for at least 20 min |
| disorder & whichever appropriate based on | | | | . Exercise regularly :Perform 3-5 hrs a week of |
| patient’s condition | | | | moderate-intensity aerobic exercise OR 2-3 hrs a |
| These are performed with medical advise upon | | | | week of vigorous-intensity aerobic exercise And |
| proper diagnosis of the condition. It’s | | | | muscle-strenghthening exercise – twice a |
| recommended by experts to seek second opinion | | | | week. |
| if necessary. Usually some or all of these are | | | | - Prevent from being overweight and obese. |
| required :- | | | | 4.0 Conclusion |
| | | | | As a conclusion, I intend to share my advice to |
| - Surgery in some situations and/or Injection / | | | | the community and the public/private sector |
| Anti-inflammatory Drugs | | | | employers. |
| - Physical therapy - stretching programme / | | | | - I pledge to the public and private sector as |
| therapeutic exercises (yoga, swimming, etc), heat | | | | well as every individual to take necessary |
| ice, ultrasound, electrical stimulation, massage | | | | measures to prevent and control MSD/CTD to be |
| - Occupational therapy – appropriate work | | | | able to fulfill our rising personal, family, social and |
| station and work posture (ergonomics) to reduce | | | | health needs. |
| of stress loads on the neck & shoulders, | | | | - Create posts for psychologist/occupational |
| posture strengthening, sufficient break and | | | | therapist at public/private workplace similar to |
| exercise, use of personal protective equipment | | | | those in the developed countries to provide |
| support tools (PPE) eg splints and back support | | | | advice/care on occupational health risks thus |
| brace etc. | | | | enabling healthy working habits, stress |
| 1.3 Motivation for | | | | management and healthy lifestyle. |
| Rehabilitation/Recovery | | | | The right knowledge, attitude and practice is the |
| Motivation is required for the recovery (i.e. | | | | key to prevention and control of health |
| rehabilitation) of function. Desire to get well often | | | | problems. So don’t wait, start now! |
| influences the ability to get well. Motivation for | | | | References : |
| recovery may not have direct effect on how the | | | | - DOSH Malaysia Guidelines for Seating At Work, |
| patient react to this disorder. It may effect his | | | | 2002 |
| attitude and lifestyle – And lifestyle is what | | | | |
| rehabilitation is all about.Most patients are | | | | - DOSH Malaysia Guidelines for Working with |
| motivated to get well and most of them wish to | | | | VDUs, 2003 |
| be rehabilitated once they understand what | | | | |
| rehabilitation means. They are many who | | | | - Occupational Hand & Upper Extremity |
| don’t want to go back to work or who are | | | | Injuries & Diseases, Edition by Mordon L |
| deterred by factors that impede the rehabilitation | | | | Kasdan, M.D., FACS. |