Upper limb disorders in the workplace

Transcription

1 Health ad Safety Upper limb disorders i the workplace This is a free-to-dowload, web-friedly versio of HSG60 (Secod editio, published 2002). This versio has bee adapted for olie use from HSE s curret prited versio. You ca buy the book at ad most good bookshops. ISBN Price 9.50 Wherever you work there is a chace that upper limb disorders could affect you. They ca cause pai ad eve permaet ijury to the eck, shoulders, arms, wrists or hads. I most cases they are prevetable ad this book shows you how to assess ad miimise the risks through positive actio. It should help you to comply with the law ad make your workplace safer. HSE Books Page 1 of 89

2 Health ad Safety Crow copyright 2002 First published 1990 ISBN All rights reserved. No part of this publicatio may be reproduced, stored i a retrieval system, or trasmitted i ay form or by ay meas (electroic, mechaical, photocopyig, recordig or otherwise) without the prior writte permissio of the copyright ower. Applicatios for reproductio should be made i writig to: The Office of Public Sector Iformatio, Iformatio Policy Team, Kew, Richmod, Surrey TW9 4DU or licesig@opsi.gov.uk This guidace is issued by the Health ad Safety. Followig the guidace is ot compulsory ad you are free to take other actio. But if you do follow the guidace you will ormally be doig eough to comply with the law. Health ad safety ispectors seek to secure compliace with the law ad may refer to this guidace as illustratig good practice. Page 2 of 89

3 Health ad Safety Cotets Preface 5 Itroductio 6 Upper limb disorders: Uderstad the issues ad commit to actio 8 Uderstad the issues 8 Commit to actio 11 Create the right orgaisatioal eviromet 13 Participatio ad ivolvemet 13 Commuicatio 14 Competece 14 Allocatio of resposibilities 14 Assess the risk of ULDs i your workplace 15 What is a ergoomics approach? 15 Idetifyig problem tasks 15 Risk assessmet 16 ULD risk factors 17 Reduce the risk of ULDs 24 Lookig for higher order solutios 24 Usig a ergoomics approach 24 Basic priciples i implemetig solutios 25 Idividual differeces 25 Suggestios for reducig the risk 25 Other guidace o solutios 25 After implemetatio 26 Educate ad iform your workforce 27 Traiig as a cotrol measure 27 Who should receive educatio? 27 What should traiig cover? 27 Makig traiig more effective 28 Evaluatio ad follow up 28 Maage ay episodes of ULDs 29 Reportig ad recordig 29 Referral 29 Diagosis ad retur to work 30 Surveillace 31 Carry out regular checks o programme effectiveess 32 Why moitor or review? 32 Moitorig 32 Approaches to moitorig 32 Examples of passive ad active moitorig 33 Moitorig outcomes 33 Reviewig 34 Appedices 35 Appedix 1: Case studies 35 Appedix 2: Risk Filter, Risk Assessmet Worksheets, suggestios for reducig the risk 46 Appedix 3: Medical aspects of upper limb disorders 68 Upper limb disorders i the workplace Page 3 of 89

4 Health ad Safety Appedix 4: Legal requiremets 76 Refereces 81 Further iformatio 89 Upper limb disorders i the workplace Page 4 of 89

5 Health ad Safety Preface The Health ad Safety Commissio (HSC) has a strategy for tacklig musculoskeletal disorders (MSDs)* icludig upper limb disorders. The strategy adopts the priciples of Securig Health Together: A log-term occupatioal health strategy for Eglad, Scotlad ad Wales. 1 This forms a itegral part of Revitalisig Health ad Safety. 2 Govermet departmets i co-operatio with employers, employees, trade uios, employer s orgaisatios, health professioals ad volutary groups have set several challegig targets as part of Securig Health Together. These have bee used i establishig a HSC priority programme for musculoskeletal disorders with the followig targets, to be achieved by 2010: 20% reductio i icidece of work-related ill health caused by MSDs; 30% reductio i the umber of workig days lost due to MSDs. The priority programme aims to improve compliace with the law, to promote cotiuous improvemet, ad to develop the ecessary kowledge, skills ad support systems to achieve the MSD targets. This guidace forms oe strad of the support to be provided for employers, employees ad those who advise them. It aims to esure that they have the right iformatio ad advice to prevet ad maage upper limb disorders i the workplace. * The term musculoskeletal disorders (MSDs) refers to problems affectig the muscles, tedos, ligamets, erves or other soft tissues ad joits. Upper limb disorders are a subcategory of MSDs. Upper limb disorders i the workplace Page 5 of 89

6 Health ad Safety Itroductio Uderstad the issues ad commit to actio Is the risk of ULDs recogised i your workplace? Is maagemet committed to prevetig or miimisig the risk of ULDs? Are there adequate maagemet systems ad policies to support this commitmet? Create the right orgaisatioal eviromet Is worker participatio actively sought ad valued? Are safety represetatives ivolved? Are all departmets aware of the cotributio they ca make? Is competece esured? Have you allocated resposibilities? Assess the risk of ULDs i your workplace Are ay ULDs hazards idetified through simple checks? Are risk factors for ULDs preset? Repetitio Workig eviromet Workig posture Psychosocial factors Force Idividual differeces Duratio of exposure Reduce the risk of ULDs Have you prioritised your actios to cotrol the risks of ULDs? Have you looked for higher order solutios? Have you utilized a ergoomics approach? Have you implemeted solutios? Educate ad iform your workforce Have you educated ad iformed your workforce to help prevetio? Have you ivolved safety represetatives i commuicatig iformatio about ULDs risk factors ad cotrol measures? What steps have you take to esure that traiig reiforces safe work practices ad cotrol measures? Maage ay episodes of ULDs Have you implemeted ad supported a system for early reportig of systems for ULDs? Do you actively look for symptoms of ULDs? Have you arraged for occupatioal health provisio? Do you have systems i place for employees returig to work after a ULD? Carry out regular checks o programme effectiveess Do you have systems i place to moitor ad review your cotrols for ULDs? Do you have systems i place to moitor ad review your ULDs maagemet programme? Are you aware of ew developmets/iformatio? Do you aim for cotiuous improvemet? Figure 1 Framework for the maagemet of ULD risks Upper limb disorders i the workplace Page 6 of 89

7 Health ad Safety 1 This documet describes how maagers, together with their employees, ca cooperate to miimise the risks of upper limb disorders (ULDs) through a positive maagemet approach. It gives geeral guidace o the processes ivolved ad icludes a risk assessmet filter ad worksheets as well as iformatio o the medical aspects of ULDs ad the legal requiremets. 2 ULDs are coditios which affect the muscles, tedos, ligamets, erves or other soft tissues ad joits. The upper limb icludes the eck, shoulders, arms, wrists, hads ad figers. ULDs ca occur i almost ay workplace ad they ca usually be preveted. Whe prevetio has ot worked, systems are eeded to make sure they are promptly reported, properly diagosed ad treated. Employers legal resposibility to prevet work-related accidets ad ill health also applies to ULDs. 3 This guidace replaces Work-related upper limb disorders: A guide to prevetio ad reflects the chages i our uderstadig of risk factors ad cotrol strategies which have emerged from research over the last decade. This has show the importace of psychosocial risk factors actig i cojuctio with physical risk factors. It has demostrated the eed for a itegrated approach to the maagemet of ULD risks which addresses both orgaisatioal ad physical aspects of the idividual s task ad work eviromet. 4 This guidace presets a approach which is based o seve stages i a maagemet cycle. The stages are: uderstad the issues ad commit to actio; create the right orgaisatioal eviromet; assess the risk of ULDs i your workplace; reduce the risks of ULDs; educate ad iform your workforce; maage ay episodes of ULDs; carry out regular checks o programme effectiveess. 5 Each stage is cosidered i a separate sectio of the guidace. A overview of the approach is show i Figure 1. (see also paragraph 30) 6 Appedices 1-4 iclude the followig: Appedix 1: illustrates real life examples where the risks of ULDs have bee maaged. Appedix 2: provides practical help with risk assessmet ad cotais a Risk Assessmet Filter ad Worksheets ad suggestios for reducig the risk. Appedix 3: gives backgroud iformatio o medical aspects of ULDs. Appedix 4: sets out the rage of legal duties which apply to the prevetio of ULDs. 7 Vibratio is icluded i this documet where it cotributes to the developmet of ULDs, but the guidace does ot cover all aspects of the prevetio of vibratio-iduced illesses, such as vibratio white figer. 3,4 I additio, the risks of upper limb disorders due to Display Scree Equipmet (DSE) use are covered by the DSE regulatios, ad separate HSE guidace is specifically available o this topic. 5,6 Duty holders must comply with the DSE regulatios; however this ULD guidace may be used to provide supplemetary iformatio. Upper limb disorders i the workplace Page 7 of 89

8 Health ad Safety Upper limb disorders: Uderstad the issues ad commit to actio Is the risk of ULDs recogised i your workplace? Is maagemet committed to prevetig or miimisig the risk of ULDs? Are there adequate maagemet systems ad policies to support the commitmet? Uderstad the issues What are upper limb disorders? 8 The phrase upper limb disorders is a geeral label which is used to refer to a rage of medical coditios which ca be caused or made worse by work. There are a umber of commo terms which are also i use to describe the same coditios, of which the most well kow is repetitive strai ijury. Other lesser kow terms are cumulative trauma disorder, or occupatioal overuse sydrome. These commo terms ca be misleadig with regard to the may factors which ca cotribute to the oset of the coditios, ad for this reaso the more geeral descriptio of upper limb disorders is used i this guidace. 9 The term upper limb refers to: the part of the body: the arm ad had, coverig a regio extedig from the tips of the figers to the shoulder ad extedig ito the eck; the tissues: the soft-tissues, muscles ad coective tissues (tedos ad ligamets) ad the boy structures, as well as the ski, alog with the circulatory ad erve supply to the limb. 10 The term disorder refers to the cliical effects produced by uderlyig chages i the tissues. These comprise symptoms such as pai, experieced by the perso, ad sigs which are abormalities, eg i the appearace of the limb, which may be apparet to the perso or may oly be foud o examiatio by a doctor. These cliical effects are accompaied by fuctioal chages, eg a reductio i the ability to use the affected part of the limb ad are ofte associated with a restrictio i the rage or speed of movemet. Stregth ad sesatio may also be affected. Although the cliical ad fuctioal effects are cofied to the limb itself, their presece will ofte lead to a reductio i a idividuals assessmet of their geeral health ad to a reductio i their quality of life. Figure 2 Upper limb disorders i the workplace Page 8 of 89

9 Health ad Safety 11 Upper limb disorders ca be described by the part of the body affected, or by the presumed pathological mechaism. There are commo terms for may of the idividual coditios, such as teis elbow ad froze shoulder. A simple guide to the more commo upper limb disorders is cotaied i Appedix Pai is a commo symptom of ULDs but the experiece of pai i the upper limb is also commo amogst the geeral populatio. Therefore, feelig pai i the upper limb is ot i itself a idicatio of the presece of a ULD, ad such symptoms may be difficult to attribute to work with ay certaity. 13 Pai ca also be experieced i the form of stiffess or soreess of the muscles accompaied by temporary fatigue. These symptoms are comparable to those followig uaccustomed exertio where o permaet pathological coditio results. Full recovery usually occurs after appropriate rest. 14 At ay oe time it is possible to experiece symptoms i the upper limb which result from a umber of differet causes. This guidace is primarily cocered with ULDs for which there is evidece to believe that the coditios ca be caused by, or made worse by work activity. Are all upper limb disorders work-related? 15 The simple aswer is o, but experiece has show that ULDs are ofte directly liked to workplace activities or if due to a o-work cause, made worse by work. 16 It is importat to recogise that the musculoskeletal system is well suited to producig repeated motios at low force levels. Udesirable forces may, however, be imposed o muscles, tedos ad joits by some job demads ad workig practices. Such stresses are usually withi the physical capability or stregth of the tissues, provided the forces are of short duratio ad rest periods are adequate. Prologed tissue loadig caused by static posture or performace of very frequet exertios ca, however, be harmful. 17 There are established associatios betwee may types of ULDs ad work tasks, or specific risk factors withi these tasks. 7 Evidece comes from: aecdotal reports which have historically liked specific occupatios ad particular coditios; 8 cliical case studies ad reportig schemes for occupatioal diseases; 9,10 workplace surveys of symptoms; 11 epidemiological reviews 7,12 ad populatio surveys; 13,14 laboratory studies of the physiological impact of experimetally imposed physical stresses. 15,16,17 18 The reviews of the epidemiological literature 7,18 provide good evidece of the associatios betwee workplace risk factors ad ULDs, particularly where workers are highly exposed to these risk factors. 19 No-work activities, such as domestic activity ad hobbies, may cotai similar types of risk as are foud i work activities. These tasks are geerally ot as repetitive, forceful, or prologed as are work tasks. Also, the idividual has a high degree of cotrol as to whe the activity ca be temporarily stopped or abadoed altogether. Upper limb disorders i the workplace Page 9 of 89

10 Health ad Safety How big is the problem? 20 Musculoskeletal disorders are the most commo work related ailmet afflictig the geeral populatio i Great Britai. They accout for more tha half of all self-reported occupatioal ill health (more tha 1 millio cases). 13 These problems are ot cofied to particular jobs or sectors ad are foud throughout most maufacturig ad service idustries. 21 Based o a household survey doe i 1995, a estimated people were sufferig from a musculoskeletal disorder which affected the upper limbs or eck. 22 A estimated miimum 4.2 millio workig days were lost i Britai due to musculoskeletal disorders affectig the upper limbs or eck i 1995, with each affected employee takig, o average, 13 days off work. 14 Costs to employers of musculoskeletal disorders of the upper limbs or eck were estimated to be at least 200 millio. What types of job carry particular risks? 23 Evidece gathered over recet years shows that ULDs are ot cofied to ay oe particular group of workers or idustrial activity, but are widespread i the workforce. The followig list of groups which have reported high levels of arm pai illustrates this poit. A commo feature of the jobs is that their tasks have recogised risk factors: assembly lie workers; cleaig ad domestic staff; costructio workers; garmet machiists; hairdressers; meat ad poultry processors; mushroom pickers; pottery workers; secretaries/temps; textile workers. 24 This list is ot exhaustive, ad there are may other jobs that carry a risk of ULDs. Similarly, the presece of jobs o this list does ot imply that the risk of ijury to these workers caot be adequately cotrolled. Why should I be cocered? 25 If work which carries the risk of ULDs is ot maaged properly the the cosequeces are see i: the huma cost of pai ad sufferig experieced by employees ad their families through ill health; loss of earigs; loss of the ability to work; problems i quality cotrol ad productivity; decrease i efficiecy; sickess absece; costs of staff replacemet ad traiig; the risk of litigatio; the risk of bad publicity; a rise i isurace premiums ad costs of compesatio to ijured workers. 26 Ay warig sigs may be the tip of the iceberg. Oe perso with symptoms may mea there are umerous other workers also exposed to risk factors, ad who are i the process of developig a disorder. What are my legal resposibilities? 27 There are geeral duties o all employers uder the Health ad Safety at Work etc Act ad the Maagemet of Health ad Safety at Work Upper limb disorders i the workplace Page 10 of 89

11 Health ad Safety Regulatios which require the risks of ULDs to be addressed. These, ad other legal resposibilities are outlied i Appedix ULDs have also bee the subject of much civil litigatio over the past twety years. 21 Although the legal process has sometimes appeared icosistet there is o doubt that the employer s duty of care towards their employees with respect to ULDs is ow well established i the civil courts. This civil law duty rus parallel to the employer s statutory resposibility uder health ad safety legislatio. Commit to actio 29 Realisig that ULDs may be a risk withi, ad to, your busiess is ot eough. It is essetial to tur that awareess ad uderstadig ito a commitmet to take actio to maage the risks. The framework i Figure 1 outlies seve stages which form a soud basis for developig a effective programme for the maagemet of ULD risks. 30 The stages are as follows: Uderstad the issues ad commit to actio: Maagemet ad workers should have a uderstadig of ULDs ad be committed to actio o prevetio. This commitmet may be expressed through positive leadership o the topic, by geeratig a effective health ad safety policy o ULDs ad by havig appropriate systems i place. These actios will help to promote a positive health ad safety culture i the workplace. Create the right orgaisatioal eviromet: The orgaisatioal eviromet should foster active worker participatio ad ivolvemet, have clear ad ope lies of commuicatio ad ecourage partership workig i the ext five steps. This will ivolve developig the competecies of workers, supervisors ad maagers for their differig roles. Assess the risks of ULDs i your workplace: A core feature of the maagemet programme is to assess the risk of ULDs. It eeds to be doe i a systematic way by maagers ad workers so that the mai risks i the workplace ca be idetified ad prioritised for actio. As risks are potetially widespread, simple checks, icludig a filter questioaire ca be used to idetify jobs which require a more detailed assessmet. Reduce the risks of ULDs: Oce risks have bee assessed ad prioritised a coheret process of risk reductio should be udertake usig a ergoomics approach. Possible risks should be reduced or elimiated at source. Implemetatio should iclude workforce participatio as this is kow to lead to better solutios ad more effective, sustaied chages. Educate ad iform your workforce: To eable participatio ad ivolvemet of the workforce ad for idividuals to assume their proper resposibilities, provisio of educatio ad iformatio is vital. Traiig will support all aspects of the maagemet programme, ad should be cosidered as a o goig activity ad ot as a oe-off task. Maage ay episodes of ULDs: It is importat to have a system to maage ay episodes of ULDs. Employees should be ecouraged to Upper limb disorders i the workplace Page 11 of 89

12 Health ad Safety idetify ay symptoms ad to report them before they become persistet. Maagers eed to respod quickly by reviewig risks ad itroducig more effective cotrols, if ecessary. They also eed to reassure employees that reportig of symptoms will ot prejudice their job or positio. Early medical maagemet ca stop established cases from deterioratig ad also help the process of retur to work. Carry out regular checks o programme effectiveess: To esure that this programme cotiues to work properly over time regular checks of effectiveess should be carried out. This will help to esure that cotrols o ULD risks remai effective ad will allow you to progressively improve their effectiveess. Maagemet commitmet 31 If this programme of cotrol is to work effectively the it is importat to demostrate maagemet commitmet to the whole process. Effective maagemet of occupatioal health risks is characterised by: visible seior maagemet ivolvemet; ope maagemet style; good commuicatios which egeder owership of problems (ie persoal resposibility ad participatio); a appropriate balace betwee health ad safety ad productio goals. Supportig policies ad systems 32 A clear policy for the maagemet of ULDs sets the directio for the orgaisatio ad meas that people throughout the orgaisatio, however large or small it is, will kow that the prevetio of ULDs is a issue which has to be addressed i all stages of busiess plaig, both for day-to-day operatios ad i the loger term. 33 The framework i Figure 1 ad the guidace i the followig sectios are a meas to tur your itetios ito reality ad to keep these itetios uder scrutiy. Upper limb disorders i the workplace Page 12 of 89

13 Health ad Safety Create the right orgaisatioal eviromet Is worker participatio actively sought ad valued? Are safety represetatives ivolved? Are all departmets aware of the cotributio they ca make? Is competece esured? Have you allocated resposibilities? 34 The effective maagemet of ULDs requires seior maagemet commitmet. I additio, it eeds the presece i the orgaisatio of shared ad iterliked beliefs, attitudes ad behaviours that allow the maagemet of risks to proceed effectively. These elemets make up what has bee referred to as the health ad safety climate or culture. Key features crucial to developig a positive eviromet for dealig with ULD problems iclude: participatio ad ivolvemet; commuicatio; competece; allocatio of resposibilities. Participatio ad ivolvemet 35 Ivolvig staff i the plaig ad orgaisatioal processes ca be a importat way of icreasig the likelihood of success of your risk cotrol strategy. Workers have first-had kowledge ad a almost uique uderstadig about particular aspects of the tasks they perform. It may however be importat to provide educatio ad traiig o ULDs before expectig employees to cotribute fully to the process of assessmet ad cotrol. Key idividuals are Safety Represetatives as they provide a effective chael for commuicatio with the workforce they represet ad they ca use their fuctios to provide a reality check to esure that the proposed cotrol measures might actually work. The Health ad Safety (Cosultatio with Employees) Regulatios 1996, 22 Safety Represetatives ad Safety Committees Regulatios 1996, 23 ad the Offshore Istallatios (Safety Represetatives ad Safety Committees) Regulatios require you to cosult with your employees o their health ad safety at work. This would exted to actios you ited to take to tackle ULDs. Further iformatio about employee participatio ca be foud i Developmet of a framework for participatory ergoomics 25 ad also Hadle with care - assessig musculoskeletal risks i the chemical idustry A supportive compay culture ad opeess will be importat factors i esurig that the adverse effects of ULDs are ot hidde from maagemet. Ecouragig early reportig of work related aches ad pais to supervisors or lie maagers, ad i tur to the occupatioal health service (if you have oe available) ca provide sigificat beefits for both the employee ad the compay. Oe of the mai difficulties with reportig is the fear of the outcome, eg possibly beig declared ufit for work. This is where a ope, positive culture becomes importat. Employees ought to feel safe to report aches ad pais early i their oset. Upper limb disorders i the workplace Page 13 of 89

14 Health ad Safety Commuicatio 37 Good commuicatio will esure that staff members i every departmet of your busiess are aware of the risks of ULDs ad what they ca do to help reduce them. Product desig staff will ifluece the details of the maufacturig process ad the decisios of marketig staff will determie the ature of the packagig required. Purchasig departmets will cotrol the sourcig of the equipmet used ad geeral maagemet will determie terms ad coditios icludig workig schedules. I some cases, factors which ifluece these risks may be cotrolled at a distace i a paret orgaisatio. A rage of methods should be used to esure that everyoe is kept iformed of how their roles ca impact o other workers ad also the compay s programme o the prevetio of ULDs. These are likely to iclude semiars, meetigs, posters ad articles i the house joural or ewsletter. The iteret also provides some useful websites, some of which are icluded i the Further Iformatio sectio. 38 A ope system of commuicatio should provide opportuities to distribute iformatio to employees ad also opportuities for feedback. This ca be iformal (eg to supervisors) or more structured, for example through regular surveys. If complaits occur they should be ivestigated. Competece 39 It is importat that people are competet to prevet ULDs withi their techical areas of resposibility. Health ad safety traiig is importat, payig particular attetio to the risk factors for ULDs ad how these may be avoided. Some groups of staff may require specialised traiig, eg i the applicatio of ergoomic priciples, evaluatio of workplace chages or the recogitio of upper limb health complaits. 40 The eed for competece also exteds to areas such as the operatio of recruitmet ad placemet procedures ad systems to idetify traiig eeds whe work practices ad techologies chage. Staff developmet systems ca be used to esure that idividuals have access to the traiig they require, ad their operatio ca form part of the regular checks o programme effectiveess. Allocatio of resposibilities 41 As may people will have a role i your programme to prevet ULDs, it is importat to be clear about who is resposible for what fuctios. For example, supervisors who uderstad the risks ca take a active role i helpig to cotrol them, ad i ecouragig staff to report ay problems. You may eed to set up systems to deal with ay problems which may occur, to esure a early respose to them. 42 Settig objectives for your orgaisatio, with clear roles ad accoutabilities will help keep you o target. You may be able to use bechmarkig as a way of checkig progress, eg betwee departmets or with eighbourig busiesses. Upper limb disorders i the workplace Page 14 of 89

15 Health ad Safety Assess the risk of ULDs i your workplace Are ay ULD hazards idetified through simple checks? Are risk factors for ULDs preset? Repetitio, workig posture, force, duratio of exposure, workig eviromet, psychosocial factors, idividual differeces, 43 Assessig the risk associated with ULDs ivolves two major steps amely: idetifyig problem tasks; ad risk assessmet. 44 A example of a method for tacklig the above two steps ca be foud i Appedix I order to be able to get the most beefit from the process, you ad your workforce eed to be able to work together to idetify, assess ad cotrol the risk of ULDs. This process should ivolve a ergoomics approach ad should iclude the participatio of workers. What is a ergoomics approach? 46 Ergoomics (or huma factors), is cocered with esurig work is desiged to take accout of people, their capabilities ad limitatios. Its objective is to optimise health, safety ad productivity. A ergoomics approach is the most effective way of dealig with ULD problems. This is because it ecourages you to take accout of all the relevat parts of the work system ad requires worker participatio. Idetifyig problem tasks 47 There are two mai approaches you ca use to idetify if you have a problem i your workplace. Firstly maagers ad workers ca look for ay sigs of problems or symptoms amogst the workforce. Secodly, you ca observe work tasks themselves to see if risk factors for ULDs are preset. This ca be doe usig a simple iitial assessmet of risks such as the risk filter approach foud i Appedix 2. Sources of iformatio that may help iclude expert advice, idustry stadards ad legislative stadards. Warig sigs 48 Warig sigs ca idicate the presece of hazards relatig to ULDs. Sigs of existig ULD problems ca iclude: ijury ad illess records; jobs which workers are reluctat to do; jobs where workers complai of discomfort; workers havig made adaptatios to workstatios, tools or chairs; workers requestig to be re-deployed or take off a job; splits or badages beig wor, ad/or; use of paikillers. Upper limb disorders i the workplace Page 15 of 89

16 Health ad Safety Figure 3 49 Paragraphs outlie other ways of moitorig the umber of workers who are experiecig upper limb pai or discomfort. Risk Filter 50 A detailed assessmet of every job could be a major udertakig ad might be a uecessary effort. To help idetify situatios where a detailed assessmet is ecessary, a Filter for a iitial screeig of tasks has bee devised. Where the Filter idetifies several risk factors i combiatio, the risk of ULDs is likely to be greater. A copy of the Risk Filter ad istructios for use ca be foud i Appedix 2. Risk assessmet 51 Oce you have idetified that certai tasks may be creatig a risk of ULDs (by lookig for sigs ad symptoms ad usig the risk filter), a more detailed risk assessmet should be coducted, ivolvig maagers ad workers, i order to ascertai the likelihood ad severity of risk. ULD assessmet worksheets that ca assist i recogisig ad recordig risk factors, ca be foud i Appedix 2. The risk assessmet process 52 A job ofte cosists of series of tasks. Performig your risk assessmet ca be simplified by thikig i terms of these tasks ad their subsidiary elemets. To illustrate this poit, Figure 4 describes the job of a process worker that cosists of three differet tasks o a assembly lie: statio 1: attachig a hadle; statio 2: gridig, ad; statio 3: packig. 53 As ca be see i this example, these tasks ca also be further broke dow ito elemets, which are distict sequeces of movemet withi the task. 54 Lookig at task elemets ca help both i idetifyig the causes of risks ad i devisig potetial solutios. For example, i the case of the process worker the risk filter might idetify the task of attachig a hadle (statio 1) as posig a possible risk. The more detailed assessmet usig the worksheet would idetify repeated use of a pich grip whe pickig up ad positioig the screws (elemets 1 ad 2), ad awkward arm posture out to the side of the body whe drillig (elemet 3). Whe cosiderig the task i this way it is easier to lik the risks to particular actios or operatios, which the helps whe cosiderig risk reductio measures. 55 I this case better positioig of the assembly lie i relatio to the worker, ad re-orietatig the objects will reduce the risk to the right arm ad shoulder. Reducig the duratio spet o the task ad itroducig more frequet breaks will reduce the risk associated with usig the pich grip. Upper limb disorders i the workplace Page 16 of 89

17 Health ad Safety Figure 4 The tasks ad elemets of a process worker s role 56 Remember to cosider whether workers perform a umber of potetially risky tasks (ie that have bee highlighted by the risk filter), i a give shift. If this is the case, it is essetial that your risk assessmet cosiders the overall impact of performig the combiatio of tasks i your risk assessmet. I practice, this would usually mea that a separate filter ad risk assessmet worksheet would be filled out for each task, ad that the completed worksheets would be cosidered i combiatio whe decidig o the overall level of risk for those workers. Detailed istructios for the risk filter ad risk assessmet worksheets ca be foud i Appedix Other risk assessmet tools are available. 27,28,29,30 These rage from stadardised or quatitative tools that are usually required to be udertake by a competet perso, to simple checklists. Egagig a competet perso may be appropriate for more complex risk assessmets. ULD risk factors 58 Risk factors ca be thought of as task, eviromet, or worker-related withi a ergoomic approach. The pricipal ULD risk factors are: Upper limb disorders i the workplace Page 17 of 89

18 Health ad Safety Task related factors Eviromet-related factors Worker-related factors repetitio; workig postures; force; duratio of exposure. workig eviromet; psychosocial factors. idividual differeces. 59 Each of these risk factors, icludig their defiitios ad why they create the risk of ULDs, will be discussed i more detail i the followig paragraphs. 60 Risk factors commoly iteract with each other i creatig the overall risk of ULDs. For example, the task of grippig a heavy power tool with a large hadle for six hours would result i a awkward, forceful grippig posture ad exposure to vibratio over a prologed period. Therefore workig postures, duratio, force ad workig eviromet are all risk factors for ijury i this task. 61 I cotrast, if this task was oly doe for a short period i each shift, the risk of ijury may ot be high. This is despite the fact that the risk factors of workig postures; force ad vibratio are still preset. 62 Geerally, there is a icreased risk of ijury whe there are a umber of risk factors actig i combiatio. However, oe risk factor actig aloe ca create a uacceptable risk of ijury if it is sufficietly great i magitude, frequecy or duratio. Repetitio 63 Work is repetitive whe it requires the same muscle groups to be used over ad over agai durig the workig day or whe it requires frequet movemets to be performed for prologed periods. 64 Rapid or prologed repetitio may ot allow sufficiet time for recovery ad ca cause muscle fatigue due to depletio of eergy ad a build up of metabolic waste materials. Repeated loadig of soft tissues is also associated with iflammatio, degeeratio ad microscopic chages. Fast movemets ad acceleratio require high muscle forces. Figure 5 Upper limb disorders i the workplace Page 18 of 89

19 Health ad Safety Workig posture 65 Workig postures ca icrease the risk of ijury whe they are awkward ad/ or held for prologed periods i a static or fixed positio. Figure 6 Awkward postures 66 A awkward posture is where a part of the body (eg a limb joit) is used well beyod its eutral positio. A eutral positio is where the truk ad head are upright, the arms are by the side of the body, forearms are hagig straight or at a right agle to the upper arm, ad the had is i the hadshake positio. For example, whe a perso s arm is hagig straight dow with the elbow by the side of the body, the shoulder is i a eutral positio. However, whe employees are performig overhead work (eg repairig equipmet or accessig objects from a high shelf) their shoulders are far from the eutral positio. 67 Whe awkward postures are adopted, additioal muscular effort is eeded to maitai body positios, as muscles are less efficiet at the extremes of the joit rage. Resultig frictio ad compressio of soft tissue structures ca also lead to ijury. Static postures 68 Static postures occur whe a part of the body is held i a particular positio for exteded periods of time without the soft tissues beig allowed to relax. Whe holdig a box, for example, it is likely that the hads ad arms are i a static posture. 69 Static loadigs restrict blood flow to the muscles ad tedos resultig i less opportuity for recovery ad metabolic waste removal. Muscles held i static postures fatigue very quickly. 70 I both the above types of posture (awkward ad static), the risk of ULDs will be related to the umber of times the posture is repeated, the amout of force required, ad/or the legth of time it is held. As with all the risk factors for ULDs, the impact of the workig posture eeds to be uderstood i relatio to other risk factors. Force 71 Force ca be applied to the muscles, tedos, erves ad joits of the upper limb by: hadlig heavy objects whe performig tasks, ie a exteral load; fast movemet or excessive force geerated by the muscles of the body ofte to be trasmitted to a exteral load, eg tryig to udo a stiff bolt; local force ad stress from items comig ito cotact with parts of the upper limb, such as the hadle of a pair of pliers diggig ito the palm of the had. Upper limb disorders i the workplace Page 19 of 89

20 Health ad Safety Figure 7 72 The level of force that is geerated by the muscles is affected by a umber of factors icludig: workig posture: the level of muscular effort required icreases whe a part of the body is i a awkward posture; the size ad weight of objects beig hadled; the speed of movemet: as extra force is eeded at the begiig ad ed of fast movemets such as hammerig; ad vibratig tools or equipmet: as operators eed to use icreased grip force i workig with vibratig equipmet. 73 Use of excessive force ca lead to fatigue ad if sustaied, to ijury, either through a sigle-evet strai ijury or through the cumulative effect of the repeated use of such force. Local force ad stress ca also cause direct pressure o the erves ad/or blood vessels ad icrease the risk of discomfort ad ijury. Force i grippig 74 The eed to grip raw materials, product or tools is a potetial risk factor if excessive force is used. The amout of force required to grip ca be iflueced by the type of grip used, the posture of the wrist, exposure to cold ad vibratio ad the effects of wearig gloves. 75 The force required to grip objects is also depedet upo the material or item beig gripped. For example, a screwdriver hadle with a flexible grip requires less force whe beig used tha oe with a harder hadle. The size of the object beig gripped ca also affect the force required. For example, pliers with too wide or too arrow a spa will be more difficult to grip. 76 Muscle force is greatest whe a power grip (eg grippig a hadle i the palm with figers ad thumb) is used as, this allows a large surface area of the had to be utilised. The strogest grip stregth occurs whe the wrist is close to the hadshake positio ad is slightly bet upwards. Duratio of exposure 77 Duratio refers to the legth of time for which a task is performed. It icludes the legth of time that the task is udertake i each shift, plus the umber of workig days the task is performed (eg four hours per day, five days per week). Duratio is a importat cocept i assessig the risk of musculoskeletal disorders. 78 It is geerally accepted that may types of upper limb disorders are cumulative i ature. Therefore, whe duratio time is icreased the risk of ijury is icreased. This is because whe parts of the body udertake work for periods without rest, there may be isufficiet time for recovery. Cosequetly, time for the idividual s body to recover from a specific task or tasks is importat. Upper limb disorders i the workplace Page 20 of 89

21 Health ad Safety 79 Short exposures are ulikely to create sigificat risk of ijury, except where the task is exceptioally demadig ad/or the worker has ot bee allowed to build up to its demads over a period of time. This ca occur after retur to work from holidays or with a icrease i work pace. Figure 8 Workig eviromet 80 Workig eviromet refers to aspects of the physical work eviromet that ca icrease the risk of ULDs. This icludes factors such as vibratio, cold ad lightig. Vibratio 81 Exposure to had-arm vibratio results from the use of had-held/guided power tools ad equipmet or fixed machiery such as bech griders where the workpiece is held by the worker. Vibratio ca icrease the risk of ULDs ad is kow to cause vibratio white figer ad carpal tuel sydrome, loss of sese of touch or temperature, paiful joits ad loss of grip stregth. Iformatio about the dose (ie vibratio magitude ad exposure time) of vibratio is eeded i order to accurately assess the risk. Further iformatio o vibratio ca be foud i Had-arm vibratio 3, ISO ad Appedix 3. Figure 9 Cold 82 Workig i cold temperatures, hadlig cold products or havig cold air blowig o parts of the body ca place additioal demads o the body as well as possibly requirig the use of persoal protective equipmet (which ca compoud the risk by requirig additioal force to grip). Exposure to cold ca result i decreased blood flow to the hads ad upper limbs, decreased sesatio ad dexterity, decreased maximum grip stregth ad icreased muscle activity (which is part of the body s atural respose to beig cold). Upper limb disorders i the workplace Page 21 of 89

22 Health ad Safety Figure 10 Lightig 83 The visual demads of the task are a importat cosideratio, sice a worker s posture ca be largely dictated by what they eed to see. Dim light, shadow, glare or flickerig light ca ecourage workers to adopt a bet eck ad poor shoulder postures i order to see their work, thereby exacerbatig the effects of other risk factors. Further iformatio o lightig ca be foud i Lightig at work. 31 Figure 11 Psychosocial factors 84 Physical risk factors exert their harmful ifluece through physiological ad biomechaical loadig of the upper limb. Of equal importace is the large body of work showig that a worker s psychological respose to work ad workplace coditios has a importat ifluece o health i geeral ad musculoskeletal health i particular; that is, work as experieced by workers. These are referred to as psychosocial risk factors. They iclude the desig, orgaisatio ad maagemet of work ad the overall social eviromet i geeral (the cotext of work) ad also the specific impact of job factors (the cotet of work). It is very likely that physical ad psychosocial risk factors combie ad that the greatest beefit will be achieved whe both are idetified ad cotrolled. May of the effects of these psychosocial factors occur via stress-related processes which iclude direct biochemical ad physiological chages. Also icluded are istaces where idividuals try to cope with stressful demads with behaviours that, i the log term, may be detrimetal to health. A example would be where a idividual, because of high workload or deadlies, foregoes the rest breaks to which they are etitled. 85 Psychosocial risk factors are commo i sectors where upper limb disorders occur 13. Importat aspects of work desig iclude the amout of cotrol people have i their jobs, the level of work demads, the variety of tasks that they have to carry out ad the support they receive from supervisors ad Upper limb disorders i the workplace Page 22 of 89

23 Health ad Safety co-workers. May jobs are ot well desiged ad iclude some or all of the followig udesirable features where: workers have little cotrol over their work ad work methods (icludig shift patters); tasks require high levels of attetio ad cocetratio especially i coditios where the worker has little cotrol over the allocatio of effort to the task; workers are uable to make full use of their skills; they are ot, as a rule, ivolved i makig decisios that affect them; they are expected to carry out repetitive, mootoous tasks exclusively; work is machie or system paced (ad may be moitored iappropriately); work demads are perceived as excessive; paymet systems ecourage workig too quickly or without breaks; work systems limit opportuities for social iteractio; high levels of effort are ot balaced by sufficiet reward (resources, remueratio, self-esteem, status); As with physical risk factors, psychosocial issues are best addressed with full cosultatio ad ivolvemet of the workforce. Idividual differeces 86 All idividuals are differet ad for biological reasos there may be some people who are more or less likely to develop a ULD. Idividual differeces may also have implicatios for employees reportig ULD type coditios. Where a ergoomic approach is followed, this should esure that tasks are withi the capabilities of the etire workforce. Some factors may icrease the risk of developig symptoms ad should be cosidered i the maagemet programme. These iclude: ew employees may eed time to acquire the ecessary work skills ad/ or rate of work; differece i competece ad skills; workers of varyig body sizes, ie height, reach etc. This ca lead to adoptig poor postures whe workig at shared workstatios; vulerable groups, eg older, youger workers ad ew or expectat mothers; 32 health status ad disability; idividual attitudes or characteristics that may affect compliace with safe workig practices or reportig of symptoms. Upper limb disorders i the workplace Page 23 of 89

24 Health ad Safety Reduce the risk of ULDs Have you prioritised your actios to cotrol the risks of ULDs? Have you looked for higher order solutios? Have you utilised a ergoomics approach? Have you implemeted solutios? 87 Havig assessed the work to determie the likelihood ad scale of the risks associated with each of the relevat tasks (ad the tasks i combiatio where applicable), you must implemet cotrols i order to reduce these risks as far as is reasoably practicable. 88 Prioritise actios so that, for example, serious risks affectig a umber of employees are tackled before a isolated complait of mior discomfort. Look for higher order solutios 89 A hierarchical approach to risk reductio ad cotrol should be followed where priority is give to elimiatio of risk at source. Firstly, cosider if it is reasoably practicable to elimiate the hazard, eg by redesig of the work task, by substitutio or replacemet of tools or compoets, or through automatio of the task. I some cases it may be possible to isolate the risks at source by egieerig cotrols or protective measures, eg by shieldig the worker from draughts or by prevetig exposure to vibratio. Where these are ot viable, the lowest order i the hierarchy of cotrols is to miimise risk by desigig suitable systems of work, usig PPE if appropriate ad to provide traiig. Usig a ergoomics approach 90 As i risk assessmet, a ergoomics approach is importat i developig your itervetios to reduce risk. A participative approach to solutio fidig is cosidered to be the most effective method for itervetio developmet. 18 Itervetios may ivolve chages to the task, the workig eviromet, or the idividual (or work group) or to all of these. Research has show that itervetios that take accout of all these aspects are more effective i reducig risk: Chages to the work task(s) may iclude redesig of the workstatio ad work equipmet. It may iclude the provisio of appropriate furiture, equipmet or tools that have bee matched to the eeds of the workers ad the task. Job rotatio or automatio may be beeficial i reducig ULD risks. Chages to the eviromet could iclude modificatios to the thermal coditios, vibratio exposure or lightig levels. Chages to ifluece psychosocial factors may be required. A review of the work orgaisatio ad structure such as reductio of work hours or chages to schedulig of breaks, or modifyig pacig or icetive schemes may also be helpful. Traiig ad provisio of iformatio to idividuals or work groups may also be eeded to support other chages. Upper limb disorders i the workplace Page 24 of 89

25 Health ad Safety Basic priciples i implemetig solutios 91 Risks ca be removed or reduced through systematic attetio to some or all of the factors metioed previously. Some helpful priciples are: great beefit ofte results from simple ad low cost itervetios (eg chages i workig height) which are geerally more practical ad easier to implemet; cosider a umber of possible solutios, preferably tryig them out o a small scale before decidig o oe to implemet; employees ca be especially good at devisig effective ad practical improvemet measures; check that ay chages do ot create ew health ad safety risks elsewhere; successful implemetatio ofte requires the ivolvemet of all employees from the top level dowwards. Eve soud ergoomic solutios may ot be successful if they are imposed. Ivolvig workers i problem solvig ad the implemetatio processes, gives a ehaced sese of owership of the solutios ad may create a greater commitmet to their effective implemetatio; i large, geographically spread orgaisatios, icorporate short-term local iitiatives ito the compay s overall health ad safety strategy; refer to case studies from other sources, eg from trade associatios or the Iteret, for ideas cocerig best practice solutios. Idividual differeces 92 All tasks should be desiged so they ca be udertake without creatig a risk of ULDs. There is o scietifically valid screeig test which ca predict the future developmet of ULDs i a idividual. Placemet procedures should take accout of the risk assessmet, job requiremets ad the idividual differeces outlied i the previous sectio. 93 New employees, particularly youg workers, ad those returig to work from a holiday, sickess or ijury, may eed to be itroduced to a slower rate of productio tha the existig workforce, followed by a gradual icrease i pace. This works best, for example, by oly workig for a limited time per day at productio speed, icreasig as appropriate. Itroducig ewcomers at a slower pace eables them to develop good work practices before havig to cocetrate o workig fast ad helps them to assimilate traiig more effectively: ideally, early traiig should be doe off-lie. Regulatio 12 i the Maagemet of Health ad Safety at Work Regulatios details requiremets cocerig ew employees. Suggestios for reducig the risk 94 Some examples of approaches that may be useful for reducig the risk of ULDs are listed i Appedix 2. Other guidace o solutios 95 HSE has produced a umber of publicatios that provide guidace o reducig workplace musculoskeletal disorders. This icludes guidace based o case studies 33, 34 as well as some that is idustry-specific. Iformatio ca also be foud o the HSE, ad some other websites. See further iformatio for sources. Upper limb disorders i the workplace Page 25 of 89

26 Health ad Safety 96 If you are usure of how to approach implemetig chages withi the workplace, you may wish to cosider seekig specialist advice from a ergoomist or other workplace health ad safety cosultat. After implemetatio 97 Fially, it is importat to moitor the situatio to make sure solutios are still effective at a later date (particularly where their success depeds o some form of learig or behaviour chage). Keep abreast of ew developmets (eg whe ew machiery or staff are itroduced ito the workplace or whe other alterative risk cotrol measures are developed). Moitorig ad reviewig are explaied i paragraphs Upper limb disorders i the workplace Page 26 of 89