Work-related Hand Injuries Research Articles

Epidemiology of work-related hand and wrist injuries in a referral center: A descriptive study.

Occupational hand and wrist injuries (OHWIs) account for 25% of work-related accidents in low- and middle-income countries. In Colombia, more than 500000 occupational accidents occurred in 2021, and although the rate declined to less than 5% in 2020 and 2021, at least one in four accidents involved a hand or wrist injury. To describe the OHWIs in workers seen at the emergency room at a second-level hospital in Colombia. An observational study was performed using data from workers who experienced OHWIs and attended a second-level hospital, between June, 2020 and May, 2021. The overall frequency of OHWIs, as well as their distribution by sociodemographic, clinical, and occupational variables, are described. Furthermore, association patterns between sex, anatomical area (fingers, hand, wrist), and type of job were analyzed by correspondence analysis (CA). There were 2.101 workers treated for occupational accidents, 423 (20.3%) were cases of OHWIs, which mainly affected men (93.9%) with a median age of 31 years and who worked mainly in mining (75.9%). OHWIs were more common in the right upper extremity (55.3%) and comprised different types of injuries, such as contusion (42.1%), laceration (27.9%), fracture (18.7%), and crush injury (15.6%). They primarily affected the phalanges (95.2%), especially those of the first finger (25.7%). The CAs showed associations between the injured anatomical area and the worker's job that differed in men and women (explained variance > 90%). One out of five workers who suffered occupational accidents in Cundinamarca, Columbia had an OHWI, affecting mainly males employed in mining. This occupational profile is likely to lead to prolonged rehabilitation, and permanent functional limitations. Our results might be useful for adjusting preventive measures in cluster risk groups.

Shedding light on work-related and non-work-related hand injuries from the social work perspective.

Upper extremity injuries may cause not only physical but also serious social and psychological problems in workers. The aim of this study was to compare demographic and work-related features of persons with hand injuries who sustained a work-related or a non-work-related injury to gain insights into possible predisposing factors for work-related injuries as well as psychosocial consequences of hand injuries from the social work perspective. This case-control study was conducted on 30 work-related and 30 non-work-related hand injury patients. The patients were evaluated using a questionnaire designed by the authors based on the principles of social work involving demographics, work-related features, thought-emotion-behaviour features, family and friend relationships, need for family support and professional psychosocial support. Survey data from both groups were statistically analysed using descriptive statistics, Chi-square and Fisher Exact test. When compared with the non-work-related hand injury group, the majority of the subjects of the work-related hand injury group were blue-collar workers (p = 0.003), had a lower level of education (p < 0.001), worked off-the-clock (p = 0.015), held the employer responsible for the accident (p < 0.001), needed more time to return to work (p = 0.014), were worried about the future (p = 0.045), and expressed loss of joy (p = 0.004). Hand injuries, regardless of their relation to work, lead to important psychosocial problems which need to be evaluated widely and carefully focusing on the patient and patient's environment, work environment in this case.

Occupational Hand-Related Injuries at a Major Tertiary Care Burn and Reconstructive Center in Pakistan

IntroductionWork-related hand injuries are usually a consequence of mechanical force on hand. This study retrospectively investigated the occurrence of work-related hand injuries in patients belonging to different age groups, gender, educational status, occupation, etc. MethodologyThis cross-sectional study was conducted from October 2018 to December 2019 at the Department of Burn and Plastic Surgery, Holy Family Hospital, Rawalpindi, Pakistan. Demographic and clinical characteristics were gathered through a structured questionnaire based on relevant literature. Patients were assessed using the purposive sampling technique and written informed consent was taken from each participant. A p-value of <0.05 was considered statistically significant. Statistical tests were performed using the Statistical Package for the Social Sciences (SPSS).ResultsOne hundred and twenty participants were interviewed, and 87.5% of patients did not have a vascular injury, and 62.5% of patients had an associated fracture. Over half of them (57.5%) had injuries of their dominant hands. Most of the injuries (67.5%) involved fingers while the rest of the injuries were found either in the palm or the dorsum of the hand. Among the causes of accidents, the majority didn't wear or wore unfitted gloves (76.6%) and the main causes of the hand injuries were related to defects in the workplace (53.3%). Lack of concentration (11.7%), wearing loose or unfitted clothes or jewelry (19.2%), lack of machine maintenance (29.2%), and a patient’s chronic disease (1.66%) were among the less frequent causes. ConclusionIt is important to understand the relationship between occupational and hand injuries. It provides an insight into the lack of protection and guidance of workers.

Predictors of return to work in patients with occupational hand injury

Work-related hand injuries are the primary cause of disability and prolonged time away from work. This prospective cohort study was conducted to determine the predictors of return to work (RTW) after traumatic work-related hand injuries. Our study included 280 patients who were referred to the Plastic and Reconstructive Center for treatment of their occupational hand injuries from July 2017 to February 2018. Several functional questionnaires were completed, and they were followed up at 1, 3 and 8 weeks. Telephone interviews were done 3 months later. Approximately half the subjects had returned to work during the first 3 months after a median time away of 57 days. No relationship was found between age, gender, marital status, hand dominance and RTW time. Nevertheless, there was correlation between RTW time with cigarette smoking, injury severity and disability. Our study findings suggest that injury severity and higher work disability scores are prognostic factors for RTW. Also, smoking was associated with later RTW, which could be the result of poor circulation and delayed healing. Employers should implement injury prevention programs with appropriate rehabilitation that takes into consideration the severity of the hand injury, and health strategies to improve unhealthy lifestyle factors such as smoking.

Decisional trust and regret mediate the HRQL in work-related hand injury patients

BackgroundDespite mounting evidence that non-injury-related factors have an important role in recovery from injury; specific variables associated with surgery outcomes are poorly understood. This lack of knowledge complicates efforts to improve the care of work-related hand injury (WRHI) patients. However, substantial research and investigation have still not clarified these underlying relationships, which merit further attention.ObjectiveThe purpose of this study was to evaluate the Health-Related Quality of Life (HRQL) outcome for WRHI patients after the impact of event and to investigate the moderated mediation analysis associated with their decision trust and regret.MethodsA cross sectional study design was used to investigate the impact of event and the associated HRQL in 53 WRHI patients following severe and major hand injury. All consenting patients completed the Impact of Event Scale Revised, the Symptom Checklist-90-Revised, Decisional Trust scale, Decisional Regret scale and Short Form-36.Anticipated achievementIn the result of mediation analysis, patients affected HRQL via decisional trust and decisional regret, respectively. In addition, our data suggest that certain decisional trust and decisional regret (partial) characteristics significantly moderate this association. These findings may aid in the development of clinical interventions to enhance HRQL for WRHI patients. Overall, it is important for clinicians to consider the notion that more decisional trust or less decisional regret may sometimes, but not always, be better.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Entry into vocational rehabilitation program following work-related hand injury: Potential candidates.

This case-control study aimed to investigate the predictors of return to work (RTW) following work-related major forearm, wrist or hand injury at the preparation stage of return to work. A total of 80 clients were recruited and divided into 2 groups depending on their readiness of RTW. The groups were compared with each other with regard to their demographics, compensation status, hand injury severity, health perception, and time off work (TOW) using correlation coefficient. Predictors of RTW were measured by logistic regression analysis. There were no significant differences in demographics and the severity of hand injury between 2 groups. Self-perceived physical functioning (p = 0.04), vitality (p = 0.01), mental health (p = 0.03) and TOW (p = 0.001) were significantly different between Action group and Preparation group. With binary logistic regression analysis, self-perceived vitality (odds ratio (OR) = 1.041) and TOW (OR = 0.996) were shown to be strongly predictive of RTW at the preparation stage of return to work. This study has shown that shorter TOW and better self-perceived vitality could predict early readiness for RTW after major work-related forearm, wrist or hand injury.

The impact of shift starting time on sleep duration, sleep quality, and alertness prior to injury in the People’s Republic of China

Early shift start time and night shifts are associated with reduced sleep duration and poor sleep quality that often lead to increased fatigue levels, performance decrements and adverse safety and health outcomes. This study investigates the impact of shift starting time on sleep patterns, including the duration and quality of sleep and alertness/sleepiness at the time of injury, in a large epidemiological field study of hospitalized adults with severe work-related hand injury in the People’s Republic of China (PRC) from multiple industries with severe work-related traumatic hand injury were recruited from 11 hospitals in three industrially-developed cities in the PRC: Ningbo, Liuzhou and Wuxi. Analysis of covariance (ANCOVA) was used to compare sleep duration, sleep quality and alertness/sleepiness across 3 h increments of shift start time, while adjusting for age, gender, work hours, shift duration, day of injury and several transient work-related factors. Effect modification by gender was also evaluated. Seven-hundred and three hospitalized adults (96.4%) completed a face-to-face interview within 4 days of injury; 527 (75.0%) were male, with a mean (±SEM) age of 31.8 ± 0.4 years. Overall, these adults worked relatively long weekly (55.7 ± 0.6 h) and daily hours (8.6 ± 0.07 h). Average sleep duration prior to injury was 8.5 h (±0.07), and showed significant variations (p value <0.05) across shift starting time increments. Overall mean prior sleep duration was shortest for individuals starting shifts from “21:00–23:59” (5.6±0.8 h) followed by midnight “00:00–02:59” (6.1 ± 0.6 h). However, a statistically significant interaction (p < 0.05) was observed between gender and shift starting time on mean sleep duration. For males the shortest sleep duration was 5.6 h (“21:00–23:59”) and for females the shortest was 4.3 h (“24:00–02:59” and “15:00–17:59”). Sleep quality (generally quite well) and alertness/sleepiness based on the KSS (generally alert) did not vary significantly across shift starting time. Results suggest that sleep duration is shortest among injured PRC adults starting shifts late night and early morning. However, with more than 8.5 h of sleep on average work days, Chinese slept much longer than typical US day workers (Sleep in America Poll, 2012, 6:44 on workdays, 7:35 on free days), and this may help to explain higher than expected alertness/sleepiness scores at the time of injury.

Work-related hand injuries treated at a tertiary care hospital.

The hands are known to be the most commonly injured body parts in traumatic occupational injuries. They can be disabling, leading to major adverse social and economic consequences for the worker and for his or her family. The aim of the study was to describe work-related hand injuries and their potential risk factors and also investigate lines of management in relation to the type of injury. Patients who presented to the emergency room of a tertiary hospital over a 6-month period with occupational hand injuries were interviewed using a predesigned questionnaire. It included questions pertaining to the sociodemographic, occupational, and medical aspects related to the injury. A total of 163 patients were interviewed. More than 50% had injuries from cuts. Almost 60% of work-related hand injuries occurred in the absence of machines. The most common causes of hand injuries mentioned by workers were lack of concentration (68.7%), wearing no or ill-fitting gloves (63.2%), and a defect in the work place (51.5%). On examination, fingers were the most affected site (66.7%). About half of the cases were managed in the emergency room, 28.8% were managed with minor procedures, and 21.9% were managed with major procedures. Work-related hand injuries have multifactorial causes; lack of concentration was the most common in this study. Injuries from cuts were the most common and fingers were the most affected part. Modifications of the possible risk factors may reduce the incidence of acute hand injury at work.

Rest breaks – a countermeasure for work-related injuries?

Rest breaks – a countermeasure for work-related injuries?

The effects of rest breaks, work shift start time, and sleep on the onset of severe injury among workers in the People’s Republic of China

The aim of the present study was to investigate the effects of the duration and timing of rest breaks on traumatic injury risk across a shift in a relatively large sample of hospitalized workers with severe work-related hand injury in the People's Republic of China (PRC). Hospitalized workers from multiple industries with severe work-related traumatic hand injury were recruited from 11 hospitals in three industrially-developed cities in the PRC: Ningbo, Liuzhou, and Wuxi. Cox regression was used to compare time into the work shift of injury across categories of rest breaks, while evaluating several potential covariates including age, gender, work hours, work start time and duration, injury day and time, duration and quality of last sleep, alertness/sleepiness, job control, and several transient work-related factors. Effect modification by work shift start time was also evaluated. With four days of injury, 703 hospitalized workers completed a face-to-face interview. After adjusting for significant covariates, workers with rest breaks of 1-30, 31-60, and >60 minutes were able to work significantly (P<0.001) longer into their work shift without an injury (>5 hours) then those with no rest break. A significant interaction was also observed between rest break status and start time of the work shift. The results of this study suggest that rest breaks of any duration have a significant effect on delaying the onset of a work-related injury, which is modified by the time of day in which a shift begins.

A systematic review of prognostic factors for return to work following work-related traumatic hand injury

Study designSystematic review. IntroductionTraumatic hand injuries are frequent cause of work related injuries and can result in prolonged durations of time loss from work. PurposeTo systematically review available evidence to determine which prognostic factors predict return-to-work (RTW) following work-related traumatic hand injuries. MethodsWe searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL and PsycINFO from 1980 to September 2013 and reference lists of articles. Studies investigating any prognostic factors of RTW after traumatic hand injury were included. Two reviewers performed study selection, assessment of methodological quality and data extraction independently of each other. Identified factors were grouped into conceptual prognostic factor categories. ResultsWe assessed 8 studies, which addressed 11 potential prognostic factors (i.e., sociodemographic factors, occupation, work compensation status, treatment related factors, impairment severity, location of injury, etc.). The quality of the studies was low to moderate. Across all included studies, RTW (original or modified work) occurred in over 60% of individuals by 6 months. There was consistent low-moderate quality evidence that individuals with more severe impairments and lower pre-injury income were less likely to RTW, and low-moderate quality evidence that age, gender and level of education had no impact on RTW. Evidence on other commonly cited prognostic factors were limited in the literature. ConclusionImpairment severity and lower pre-injury income showed a consistent association with RTW following occupational hand injury, while other factors demonstrated no or variable effects across studies. Additional high-quality studies are warranted toward improving our understanding of the complex factors that mediate RTW following a traumatic work-related hand injury. Level of evidence2a.

The psychotic mummified hand: An unusual hand injury complication

The authors report the case of a patient with psychotic symptoms secondary to a posttraumatic stress disorder following a work-related hand injury. The somatic presentation was a “mummified” hand neglected for several years in a splint without any care. The psychiatric analysis concluded that this was part of a delusion of persecution expressing a conflict against the patient's employer and insurance company. Surgical treatment was limited to a hand cleaning with hardware removal. Despite 3years of antipsychotic medication the patient was still suffering from delusion and the hand remained neglected at the last follow-up.

Predictors of return to work and duration of absence following work-related hand injury

The aims of the study were to explore the situation and the potential determinants of return-to-work (RTW) and the absence duration following work-related hand injury, and to provide evidence for the future intervention strategy of improving RTW. A prospective cohort of workers with work-related hand injury from three selected hospitals in East China was followed up on the outcomes of RTW up to 8 months after discharge. Demographic and clinical data were collected during admission; economic factors, psychological factors and RTW outcomes were, respectively, investigated using a structured questionnaire via phone call after discharge from the hospitals in 0.5 month, 2 months, 4 months and 8 months. Univariate analysis and Cox regression model were used to examine the associations between potential determinants and outcomes of the RTW. Out of the 246 cases, 192 (78.1%) eventually returned to work with the median duration of the absence of 44.0 days during the 8-month follow-up. Factors from demographic, clinical, economic and psychological domains affected RTW in the univariate analyses. Receiving timely treatment at outpatient clinics, less serious injury, no tendon trauma and no skin loss were found to be significantly beneficial to RTW, while workers with the decreased monthly salary during absence and lower pre-injury salary were likely to take longer sick leave. Most of the workers successfully achieved RTW after work-related hand injury. Proper clinical treatment and rehabilitation, as well as economic and social support seem to have played vital roles in prompting RTW that should be prioritised for the intervention strategy.

Occupational Hand Injuries Treated at a Tertiary Care Facility in Western Turkey

The study was designed to investigate characteristics of work-related hand injuries (WRHI) referred to a University hospital emergency department (ED) in an industrialized region as well as to supply data for preventive strategies. All patients with WRHI referred to the University-based ED in the two-year period were investigated. Sociodemographic and injury-related clinical information were analyzed. Out of 746 patients who were admitted to the ED due to occupational injuries within the two-year study period, 244 (32.7%) with isolated wrist, hand and finger injuries were included in the study. Male patients constituted the majority 87.2% (n=213) and 57.0% (n=139) of the patients were between 25 and 34 yr of age. WRHI recorded in industries involving metal and machinery constituted 41.4% (n=101) of all injuries. The sites of injuries were not significantly affected by differences in age, social security status and sectors. The most common types of injury were lacerations, punctures, and abrasions (40.2%, n=98). There was a statistically insignificant rise in amputation injuries with increasing age. Incidences, etiologies and characteristics of WRHI should be highlighted and preventive strategies based on these facts be implemented due to higher level of suffering and more serious consequences attributed to this specific injury.

Acidentes de trabalho envolvendo mãos: casos atendidos em um serviço de reabilitação

O objetivo do estudo foi caracterizar os casos de lesões na mão relacionadas ao trabalho atendidos no Setor de Terapia da Mão do Hospital Maria Amélia Lins, em Belo Horizonte, MG. Foram analisados 711 protocolos de avaliação dos pacientes atendidos de janeiro 2004 a dezembro 2005, dos quais 238 corresponderam a acidentes do trabalho, com 87% de homens e média de idade 34 anos. Em 45% dos casos, a lesão foi no lado direito, sendo o não-dominante mais acometido (52%). Manutenção e/ou reparação (35%) e serviços e/ou comércio (33%) foram as categorias ocupacionais com maior índice de acidentes e as máquinas o principal agente causador (57%). Tendão (29%) e osso (23%) foram as estruturas mais lesadas, sendo atingidos principalmente os dedos (73%) e as mãos (18%). A grande maioria dos pacientes (80%) levaram de 2 a 60 dias após o acidente para iniciar a reabilitação e a mediana do tempo de tratamento foi 55 dias. As associações da ocupação do paciente com o agente causador e com a estrutura lesada foram significativas (p&lt;0,05), bem como as associações entre agente causador e estrutura lesada e dessa com o tempo decorrido entre a lesão e início da reabilitação. Tipo de lesão e agente causador estavam associados ao tempo em reabilitação, explicando porém apenas 6,7% de sua variabilidade. Essas características das lesões ocupacionais das mãos devem ser consideradas no planejamento das ações de prevenção e de melhoria dos serviços de saúde.

Work-related hand injuries: Case analyses in a Brazilian rehabilitation service

Purpose. Professionals who work with rehabilitation of the hand usually assess performance components as their main outcome measures. Intervention is aimed at normalization of deficits of these components, with the expectation that the integrity of the structures and functions of the body will revert to improvements in the client's functional performance. The objectives of this study were to describe changes in patients who received rehabilitation in a Brazilian public hospital after having suffered hand injuries due to workplace accidents, and to examine the relations between performance components and levels of functioning.Methods. Observational cross-sectional study was used. A convenience sample was selected, including 42 patients assessed at service admission and at discharge. Assessed characteristics included grip strength, wrist and finger range of movement (ROM), sensitivity, and self-perceptions of functional performance (COPM). Statistical procedures included correlations between performance components and COPM scores and differences on selected variables at admission and discharge.Results. Significant improvements in all assessed functional components. COPM values increased more than 100% after intervention (effect size d = 1.996 for performance and d = 1.553 for satisfaction) demonstrating improvements in both domains. Low correlations between grip strength and COPM scores were found only at admission (r = 0.314; p = 0.045). When the relationship between gains in strength and COPM scores at discharge were examined, significant correlations were found with the performance (r = 0.324; p = 0.039) and satisfaction (r = 0.0326; p = 0.038) subscales.Conclusions. Results of this study provide evidence for functional gains in clients treated in a rehabilitation service and supply information about the relation between specific components and functional performance.

Return to work outcomes after work-related hand trauma: the role of causal attributions

Purpose: This study examined the relationship between workers’ judgments of responsibility for their accidents (causal attributions) and work-site avoidance after work-related injuries. Methods: Ninety-two hand-injured workers referred for psychologic treatment of posttraumatic stress and depressive symptoms were assessed for their beliefs about the cause(s) of their accidents. Causal attributions were obtained before and after psychologic intervention. Results: Workers who blamed coworkers or equipment for their injuries were more likely to resist returning to former work activities than workers who judged themselves responsible for their accidents. In addition those with relatively minor injuries were as much at risk for work-site avoidance as those with more severe injuries. Age, gender, and length of employment with current employer were unrelated to avoidance. Conclusions: These results suggest the importance of causal attributions as potential predictors of work-site avoidance after traumatic work-related hand injuries, and support the risk for psychologic symptom development after less-severe injuries.

Work-related hand and lower-arm injuries in New Zealand, 1979 to 1988.

The aim of this study was to describe the epidemiology of work-related hand and lower-arm injuries in New Zealand. Nonfatal hand and lower-arm injuries were identified from New Zealand's national database of hospital admissions for the period 1979 to 1988. Thirty-seven per cent (9714) of all such injuries (26,228) were work-related. Piercing and cutting instruments (38.5 per cent) and machinery (37.2 per cent) were the two most common agents of work-related hand and lower-arm injury. Specific occupations in which the number of cases was high included meat workers (n = 1020, 3.3 per 1000 employees), carpenters (n = 548, 2.2 per 1000), machine operators (n = 450, 11.9 per 1000) and sawmill workers (n = 498, 7.7 per 1000). The injury rate for meat workers, carpenter-joiners, machine operators and sawmillers increased significantly over the 10-year study period.

Symptoms of posttraumatic stress disorder in worker's compensation patients attending a work rehabilitation program

Posttraumatic stress disorder (PTSD) is a psychological consequence of traumatic work-related hand injury. In the current study, we investigated this relationship by examining the prevalence, of PTSD symptoms in 121 Worker's Compensation patients enrolled in a work rehabilitation program following a wide array of work-related injuries. Eighty-eight men and 33 women, ranging in age from 16 to 78 (M=40.9,SD=10.2), completed the Injury Adjustment Survey, a measure of PTSD symptoms, psychological/behavioral changes following injury, and desire for psychological treatment. We found that the majority of patients reported difficulties sleeping, a diminished sense of future, loss of interest, and increased anger. Twenty percent of patients endorsed symptoms from criteria B (reexperiencing the trauma), C (persistent avoidance or numbing), and D (inreased arousal) for PTSD according to the DSM-IV. PTSD symptoms did not significantly, relate to age, gender, locations of injury, type of injury, seeing the injury occur, or length of time since injury. PTSD symptoms did significantly relate to psychological/behavioral changes or difficulties and the desire to seek psychological treatment. Discussion of the results proceeds from within a psychotraumatological framework. In general, our research confirmed that PTSD symptoms appear to be a clinically significant problem for patients suffering from a variety of work-related injuries.

Psychological adjustment following work-related hand injury: 18-month follow-up.

Severe, work-related hand injuries are often accompanied by a significant number of psychological symptoms that are frequently associated with posttraumatic stress disorders. These symptoms occur in the following four domains of psychological functioning: cognitive, affective, physiological, and behavioral. This study examined the incidence of a variety of symptoms occurring with work-injured patients. Interviews were conducted at 1 week, 3 months, 6 months, 12 months, and 18 months after injury. Symptom frequencies were recorded. The results indicate that many of these symptoms were persistent 18 months later and continued to be significantly debilitating. The results support the need for psychological intervention after severe, work-related hand injuries.