UMY

Ergonomic
#1 Cumulative Trauma Disorder

Gunawan Setia prihandana, PhD Eng.

Universitas
Muhammadiyah
Yogyakarta
www.umy.ac.id

1995

CUMULATIVE TRAUMA DISORDERS (CTD)

The cost of work-related musculoskeletal disorders such as
cumulative trauma disorders (CTDs) is quite high.
15-20% of workers in meatpacking, poultry processing, auto
assembly, and garment manufacturing are at potential risk for
CTD.
61 %t of all occupational illnesses are associated with
repetitive motions.
The worst industry is manufacturing, while the worst
occupational title is butchering, with 222 CTD claims per
100,000 workers
1995

CUMULATIVE TRAUMA DISORDERS (CTD)

Injuries to the musculoskeletal system that develop
gradually as a result of repeated micro trauma due to poor
design and the excessive use of hand tools and other
equipment.
These problems are a collection of a variety of problems,
including repetitive motion disorders and carpal tunnel
syndrome.

1995

CUMULATIVE TRAUMA DISORDERS (CTD)

Four major work-related factors lead CTD:
excessive force,
awkward or extreme joint motions,
high repetition, and
duration of work.
The most common symptoms associated with CTD include:
pain, joint movement restriction, and soft tissue swelling.
In the early stages, there may be few visible signs; however, if
the nerves are affected, sensory responses and motor control
may be impaired. If left untreated, CTD can result in
permanent disability.
1995

CUMULATIVE TRAUMA DISORDERS (CTD)

Tenosynovitis is the inflammation of the tendon sheaths
due to overuse or unaccustomed use of improperly
designed tools.
Carpal tunnel syndrome is a disorder of the hand caused
by injury of the median nerve inside the wrist. Repetitive
flexion and extension of the wrist under stress may cause
inflammation of the tendon sheaths.

1995

CUMULATIVE TRAUMA DISORDERS (CTD)

White finger results from excessive vibration from power
tools, inducing the constriction of arterioles within the digits.
The resulting lack of blood flow appears as a blanching of
the skin, with a corresponding loss of motor control
Short-term fatigue and discomfort have also been shown to
result from poor handle and work orientation in hammering,
and improper tool shape and work height in work with
screwdrivers.
Typically, a poor tool grip design leads to the exertion of
higher grip forces and to extreme wrist deviations, resulting
in more fatigue)
1995

Position of the hand and arm

(From: Putz-Anderson, 1988)

1995

CTD RISK FACTORS

CTD risk factors can be divided into two main classes: physical factors and nonphysical
factors.
Physical factors commonly involve external factors imposed on the individual (job
requirements, job layout, equipment/tools used, etc.).

1995

CTD RISK FACTORS

Nonphysical factors tend to be more focused on the
personal attributes, behaviors, and capacities of the
individual.

1995

SURVEILLANCE METHODS
- To identify the existence of or potential for CTD risk factors.
Surveillance consists of the periodic collection and analysis of data
to determine if health and safety problems exist or if risk factors
are present.
Surveillance can be performed for an entire company (multiple
plants), a given plant, certain jobs, or classes of jobs within a plant.

Surveillance classified into passive and active surveillance.

- Passive surveillance includes activities that use existing data.
- Active surveillance involves collecting data at the workplace
such as exposure data for various risk factors, checklists, worker
interview data, and medical examinations.
1995

PASSIVE SURVEILLANCE
Passive surveillance is typically less expensive and less time consuming
than active surveillance because the data already exists.
The sources of information:
OSHA 200 Log and Summary of Occupational Injuries and Illnesses,
OSHA 100 Supplementary Record of Occupational Injuries and
Illnesses, etc
- Availability of the different types of data will vary from plant to plant Minimum information include:
. The total number of CTD cases reported;
. The date each case was reported;
. The department or job of each injured worker; and
. The number of workers on the same job or in the same department.
A factor that can be useful for calculating incidence rates is the
number of hours worked by all employees in the previous year, or
several years if workers are doing the same job for that long.
1995

ACTIVE SURVEILLANCE
Active surveillance are more extensive than passive surveillance.
Active surveillance consist of worker health and workplace surveillance.
The simplest form of worker health surveillance is questionnaires which is
colleting information concerning pain, discomfort, swelling, etc., for each
body part.
The health surveillance involves activities like medical screenings, physical
exams, and worker interviews.
Another surveillance is workplace risk factor assessment by using checklists
and job analysis.
Checklists should be filled out by a person knowledgeable about the risk
factors and ergonomics.
Job analysis requires measurement of specific levels of various risk
factors.
The primary risk factors for CTDs are force, posture, and repetition, cold and
vibration.
Other factors: task invariability, cognitive demands, organizational and
1995
psychosocial factors, and static muscle loading.

PREVENTION AND CONTROL OF CTDS

IN INDUSTRY
Control and prevention of CTDs in industry can be accomplished
through two major categories of controls:
Administrative
Administrative controls are worker-focused changes where management
or medical staff makes an effort to reduce the effects of both physical
and nonphysical risk factors.
Administrative controls usually focus on modifying the functions of
workers through training, job rotation, and job assignment
Engineering.
Engineering controls are job-focused changes where an attempt is
made at redesigning the job, equipment used, or workplace layout to
control CTD physical risk factors
1995

Practice tips to avoid injury

Always warm up your body as an athlete would before a practice or event.
Muscles need a good warm up in order to function at their best.
Begin with gentle stretches and playing passages of music slowly.
Do not practice or perform when you are physically or mentally tired.
Almost all CTDs are caused when fatigued tissue receives inadequate
recovery and is forced to perform in spite of fatigue.
Make sure that your technique and training is top notch.
As a musician grows and the technical difficulty of the music increases, good
technique and training are the foundation for continued ability to perform
without injury.
Approach a concert as a performance athlete.
Determine the physical requirements of the repertoire.
Approach it as a marathon runner who systematically increases the number
of miles he can run over a period of months in order to be fully prepared for
the 26 miles the day of the race.

1995

Practice tips to avoid injury

Allow your body to move freely to the music while you are playing.

Static posture, and the requirements of some instruments to be held

against gravity can cause fatigue in selected muscle groups and
decreased time to recovery.
While learning a new technique, be mindful of the fact that the muscles
are being asked to learn a new skill and will fatigue faster.
Therefore, avoid excessive repetition. Learn new passages slowly and
gradually increase the tempo as the muscles become conditioned to
requirements.
Instrument transport.
If you play an instrument that requires transporting it from site to site,
this needs to be a part of your whole body physical training as well.

1995

VIBRATION-INDUCED CTDs
THE NATURE OF VIBRATION
Vibration is an integral part of our everyday lives.
As we drive our cars and motorcycles we feel vibration.
At work, machinery vibrates, lift trucks vibrate, pneumatic- and electricallypowered tools all vibrate.
Little is thought about vibration since it is so common; until something
happens to make us take notice.
Vibration refers to the directional motion of an object.
There are actually up to six directions at anyone point front-to-back, side-toside, up or down, and three corresponding rotations: pitch, yaw, and roll.
What we see with our eyes as an object moves is called displacement; what we
don't see is the object's speed, or velocity, the time rate of change of a moving
object..

1995

WHOLE-BODY VIBRATION
Whole-body vibration (WBV) or head-to-toe vibration is usually experienced by
operators of trucks, buses, locomotives, lift trucks, heavy equipment operation, farm
vehicle operation, overhead cranes, and found near vibrating machinery such as punch
presses or mold shakeout areas in foundries.
Studies of diseases in large worker populations have indicated that WBV exposure is
associated with various musculoskeletal diseases including, but not limited to, low-back
pain, degenerative intervertebral disc diseases, and herniated and slipped discs.
In addition, some studies show that females exposed to WBV have additional
gynecological risks, especially during pregnancy.
Some medical consequences of WBV exposure appear as CTDs, where WBV
exposure is experienced by the worker with no apparent difficulties for an extended
period of time.
Then, problems such as a slipped disc might occur for no apparent reason or from an
innocuous event like leaning over to pick up a light object
WBV exposure can cause both safety and health problems.
These problems are more likely at human resonance frequencies where humans are
especially vulnerable. At that point, a small amount of impinging vibration can produce a
large effect because of the internal involuntary amplification of this vibration by the
human body.
1995

HAND-ARM VIBRATION
Hand-arm vibration (HAV) exposure usually arises when workers use vibrating
pneumatic-, electrical-, or gasoline-powered hand tools such as chain saws,
grinders, chippers, drills, nut tighteners, jack hammers, demolition tools, etc.
Cases:
Some of the medical effects of HAV exposure were discovered in the early 1900s
when stone cutters who used pneumatic cutting hammers were experiencing
tingling and numbness in their fingers.
Due to increased vibrating tool exposure, and triggered by cold temperatures,
these workers next experienced a far worse stage of the disease, episodic
attacks of finger blanching or whitening, resulting from a loss of finger blood
supply.
If this condition is left untreated and the worker is not removed from the HAV
exposure, in the extreme case it can eventually result in possible digit amputation.

1995

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CONTROLLING VIBRATION IN THE

WORKPLACE

Controlling vibration is usually includes vibration reduction and ergonomics

Check and maintain vehicle suspension systems, tires, and tire pressure.
After long periods of driving/riding in vehicles, do not lift or bend immediately.
Rather, first walk around and stretch for a few minutes. Use minimum twisting
when exiting a vehicle
In fixed plant situations, mechanically isolate vibrating equipment, machinery from
floors and workers' bodies.
Where possible, keep workers away from vibrating equipment by using remote
controls, switches, closed circuit TV.
As appropriate, use WBV standards and guides.
If signs and symptoms of back pain and back disorders occur, consult a physician.
If possible, use antivibration (A/V) tools.
Try not to use vibration-damping materials externally wrapped around
conventional vibrating tool handles.
1995

Risk Factors for Musculoskeletal Disorders

Excessive force
Awkward and/or prolonged
postures

Repetition

Direct Pressure

Temperature Extremes

Vibration

Work organization
1995

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Risk Factors for Musculoskeletal Disorders

Excessive Forces
Lifting and carrying
Pushing and pulling
Reaching to pick up
loads
Prolonged holding
Pinching or squeezing

Awkward Postures
Working overhead
Kneeling all day
Reaching to pick up
loads
Twisting while lifting
Bending over to
floor/ground
Working with wrist bent
1995