Symptoms of Cumulative Trauma in Hand Therapy Professionals, A Descriptive Study

Abstract

Sharon R. Flinn, Kimberly Couch, Amy Darragh, Division of Occupational Therapy, Ohio State University, Columbus, OH, USA; Hand Center Occupational Therapy Services, The Ohio State University, Columbus, OH, USA Purpose: Describe the physical and functional changes found in working hand therapists. Background: Several authors have identified hand therapists at risk for cumulative trauma symptoms. Harmon et al. (1997) found 73% of hand therapists had previously experienced CTD symptoms. Caragianis (2002) found 66% of hand therapists with pain were occupational injuries with the most common site of pain at MP/CMC joints of the thumb. CTS symptoms have been reported in 38-46% of hand therapists and 67-75% had engaged in protective/corrective measures (Bash & Farber, 1999; Sefcovic et al. 2000). Methods: This study was part of a larger study to document exposure to risk factors for work-related musculoskeletal symptoms among hand therapists. Quantitative measures were collected in this study on symptoms of cumulative trauma and limitations found in non-work activities. Physical functioning instruments included pain (VAS, diagrams), sensibility (SWM), motor function (composite ROM, tendon gliding), hand volume, grip, pinch strength. FDS findings of # 2cm and intrinsic tightness # .5 cm were considered normal. Average grip and pinch over three trials were calculated. Nonwork activity limitations were assessed using the Flinn Performance Screening Tool to identify valued life activities. Over 300 photographs were used to screen ADL/IADL. Results: Demographics. Twenty therapists from three hand therapy clinics were evaluated. The mean age was 47 years (SD 7.09). Total therapy experience was 23 years (SD 8.85) with hand therapy experience of 17 years (SD 7.83). All participants reported being right hand dominant. Pain. When rating least and worst pain levels, 55% reported no pain for least levels but 100% reported worst levels averaging 4.99/10. Of those reporting worst pain, 63% reported pain occurred at work, 26% at home, and 10% at work and home. The most common area of pain was dominant thumb (75%), upper back/posterior head (55%), the nondominant thumb (50%), and dominant anterior forearm (45%). A majority had pain/pulling with the Finkelstein’s maneuver on right (60%) and left (70%) thumbs. A small subgroup had positive grind test on the right (20%) and left (15%) thumbs. Sensibility. 35% reported hand paresthesias. The upper limb test was positive most often for the median nerve on right (60%) and left (40%) extremities. Over 50% had abnormal findings for the median nerve using 2.83 monofilament. 25% had decreased sensibility in radial nerve distribution and 20% in all peripheral nerves. Motor. Composite ROM was not problematic for extrinsic and intrinsic extensibility, FDS gliding, or thumb flexion-abduction. Large restrictions were found in Apply-Scratch Test on right (-6 cm) and left (-8 cm). Average strength dominant and non-dominant hands were 54/48#; lateral pinch 16/15#, and tip pinch 10/10#. Hand Volume. Hand volumes were not problematic with averages of 12ml difference between dominant/non-dominant and 1ml difference between pre-posttests. ADL Function. An average of 11 ADL limitations was reported with a range of 0-48 items. A majority of items required upper body strength or pinch. Conclusion: A majority of participants experienced specific cumulative trauma symptoms and non-work ADLs. Recommendations will be provided for improved surveillance.