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Simply explained, Repetitive Motion Disorders (RMDs) are disorders of the musculoskeletal and nervous systems which may be caused or aggravated by:
RMDs usually develop gradually over a period of weeks or months and almost always are attributed to continuously repeated actions like twisting or bending of the hands, arms and wrists. It has also been noted that the severity of the injury is often proportional to the amount of force that is combined with the repetitive motion over time.
In the veterinary profession, the most likely workers at risk are groomers and housekeepers. Of course any staff member can suffer an ergonomic injury, but because of their limited range of activities and movements, these workers deserve special attention. The types of RMD injuries occurring in the veterinary practice are often different from ones occurring in the meatpacking industry or in supermarket checkouts. Although tendonitis is the most common form of RMD for assembly line workers, painters and others with limited, repeated movements of the hands, "trigger finger," "Raynaud’s syndrome" and back disorders are the most common RMDs for veterinary workers.
"Trigger finger" is a tendon disorder
where a groove in the flexing tendon of the finger develops from long-term use of tools or
instruments that have handles with hard or sharp edges - like grooming scissors. In this
condition, the tendon becomes "locked" in the sheath and attempts to move the
finger will cause snapping and jerking movements. Using tools or scissors with larger,
rounder handles will often prevent this condition in barbers and pet groomers.
"Raynaud’s syndrome" or white
finger, occurs when the blood vessels of the hand are damaged from repeated exposure to
vibration for long periods of time - as when using electric clippers for five or six hours
per day. The skin and muscles are unable to get the necessary oxygen and eventually die.
Common symptoms include intermittent numbness and tingling in the fingers; skin that turns
pale, ashen and cold; and eventual loss of sensation and control in the fingers and hand.
This condition seems to intensify when the hands are exposed to extremely cold
temperatures. There is no medical remedy for this condition except elimination or
reduction of the vibrations before permanent damage occurs.
Back disorders account for a significant loss of productivity as well as large compensation costs for the business. They are also the source of a great deal of discomfort for the staff member who is injured. Next to the common cold and flu, back disorder is the reason most often cited for absenteeism from work! Back disorders are categorized as RMDs because the majority of workplace back injuries are the result of chronic, long-term trauma to the back muscles, ligaments, tendons and disks rather than from one specific incident. When back muscles or ligaments are injured from repetitive pulling and straining, the weakening of all the back structures makes additional injuries more likely. Although any staff member can injure their back, housekeepers and stock workers are most at risk for these injuries because of the constant repetitive nature of their work. Things like mopping floors, lifting trash cans or handling large numbers of boxes or goods can all cause injury unless they are done properly.
Additionally, any worker who must sit or stand in a stationary position for long periods of time is more likely to suffer from a back injury, particularly if there is inadequate support in the lumbar area. Prolonged sitting stresses such as these can cause the lumbar region to bow outward; this abnormal curvature (called kyphosis) can lead to painful lower back problems that are a leading complaint among office workers.
There have been recent medical studies initiated to better understand the link between RMDs and seemingly non-related medical conditions. For instance, a study published in the Archives of Internal Medicine reported that carpal tunnel syndrome (one of the RMDs) may be caused more by an underlying disease than the tasks performed on the job. After examining 297 patients whose arm pain was thought to be caused by a job-related RMD, researchers found that nearly 37% were suffering from diabetes, arthritis or hypothyroidism. According to the study’s author, Dr. Steven Atcheson, MD, "These diseases cause arm pain or numbness in the hands, but for some reason the symptoms are always attributed to repetitive tasks in the workplace." Of course more investigation into this theory is warranted, but it certainly suggests that anyone suffering from what is believed to be a RMD should ask their physician for a complete and thorough physical examination to rule out underlying illness.
It is important to conduct a thorough analysis of the hazards of the workplace while the staff is actually performing the tasks. Remember, a thorough hazard analysis is also a requirement of the recently revised Personal Protection Equipment Standard (see the SEP/OCT 95 issue of The Digest for more information on the PPE Standard) so this step can not be overlooked. In addition, some situations may "accumulate" to make a normally safe procedure more hazardous. For example, the groomer may be at a moderate risk from RMD but not enough to make drastic changes in the procedures. On the other hand, if they are also constantly exposed to excessively high noise levels and potentially toxic chemicals, the combination may make any one of the three dangers more severe.
Begin by looking at the general conditions of where the work is performed. Is the lighting and ventilation adequate or is it dark and stuffy? Are there excessive chemical fumes or constantly barking dogs present? Can any of those conditions be changed easily - like moving barking dogs to another room or installing an exhaust fan over the bathing tub?
Next look at the relative position of the worker to the task. The majority of action should occur in the "comfort zone" - that’s the area above the waist and below the shoulders. Does the worker have the option of varying their posture, like alternating between standing and sitting on a stool or chair? How much lifting, bending or stooping is involved and how can it be minimized by the use of steps, ramps or platforms?
Examine the tools or instruments that are used. Are they in good working order and sharp enough to perform without excessive force. Are there hard straight edges on the gripping parts (like old-style hair clipping scissors) or are they more modern with curved, softened handles that "fit" the hand?
Based on the observations during this analysis, the leadership must decide what changes or protection are necessary. Of course, be sure to keep some written notes on what was evaluated, the observations and the conclusions, even if no changes were instituted.
Good design of the work areas and regular staff training are considered the primary ways of preventing problems. Personal protective devices are considered appropriate only when engineering or work practices controls are not effective in reducing the risk to acceptable levels.
Sometimes the most simple solutions pay the greatest benefits; things like adjusting the table height or changing the style of scissors will be all that is necessary to improve comfort, productivity and health.
Of course, no safety program or component would be complete without worker training. By reminding staff members that their health and safety are paramount to the mission of the hospital, training increases awareness of the expectation for doing the job right. When training for ergonomic awareness, be sure to stress the principles of proper lifting: keep the back straight and bend at the knees to lift more than a few pounds. Keep your wrists straight and elbows at a right angle when using tools or instruments like clippers or scissors. And above all, remind the staff that no specific program, device or procedure can protect them from injury better than they can protect themselves with attention to their posture and movements while working!
The information on these pages is excerpted from
The Complete Veterinary Practice Regulatory Compliance Manual (5th Edition) by Philip J. Seibert, Jr., CVT,
Copyright 2003 Philip J. Seibert, Jr., CVT All Rights Reserved
No part of this publication may be reproduced for distribution without prior permission
from the publisher.
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