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 [email protected] 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

27 Health ad Safety Educate ad iform your workforce Have you educated ad iformed your workforce to help prevetio? Have you ivolved safety represetatives i commuicatig iformatio about ULD risk factors? What steps have you take to esure that traiig reiforces safe workig practices ad cotrol measures? 98 Educatio ad traiig are complemetary to all other aspects of your programme for the prevetio of ULDs ad ideed are critical to its success. Iformig staff about sigs ad symptoms of ULDs, risk factors, cotrol measures ad the eed for early reportig ad actio will improve the overall effectiveess of your programme ad will ecourage employees to become actively ivolved i idetifyig ad cotrollig ULD risks. Traiig as a cotrol measure 99 Traiig should ot be relied o as the primary meas of cotrollig the risk of ULDs. Ifluecig the way workers perform tasks through traiig is a essetial part of risk cotrol, but relyig o this aloe has bee show to have limited success i prevetio. Traiig should ideally complemet other higher order cotrols that have already bee implemeted (ie redesig of the work task, substitutio or replacemet of tools or compoets, isolatig the risk at the source etc). It ca be very beeficial to ivolve employees i the developmet ad presetatio of traiig. Who should receive educatio? 100 All workers, supervisors ad maagers should receive educatio o ULDs to eable them to idetify the early warig sigs of potetial ULD risk factors. Educatio should also exted to purchasig staff, egieers, maiteace ad support staff, particularly where they are ivolved i specifyig, desigig or modifyig work equipmet i order to icrease their awareess of ergoomic issues ad ULD risk factors. What should traiig cover? 101 Traiig ca be desiged both to raise geeral awareess of ULD issues ad to address the specific eeds of a particular job or task. Geeral traiig should aim to: icrease awareess ad kowledge of ULD issues/problems i the workplace; reduce the likelihood of ULD problems by providig adequate iformatio: recogitio of symptoms of ULDs (see Appedix 3); risk factors preset i the workplace; safe workig methods; correct operatio of cotrol measures; the importace of procedures for the early reportig of ULD symptoms. Upper limb disorders i the workplace Page 27 of 89

28 Health ad Safety 102 Task-specific traiig should cosider ULD risk factors associated with the job i greater detail. Such traiig should iclude a review of risk factors related to tasks ad safe workig methods for that particular task. Ay specific cotrol measures associated with the job, icludig persoal protective equipmet should also be covered. Makig traiig more effective 103 Traiig that ivolves o more tha sittig with a experieced employee who does ot have appropriate uderstadig of ULDs is ulikely to be satisfactory sice bad habits ad practices ca easily be passed o to the ew employee. Whe attemptig to alter worker behaviour, programmes will eed to cosider: adverse traditioal methods ad igraied habits; productio pressures; ay perceptio that ew methods are difficult or time cosumig; ay lack of uderstadig of risk factors for ULDs; situatios where improvemets i job methods may be costraied by poor workplace layout, materials, equipmet ad/or job desig; employee ivolvemet. This is fudametal to the success of ay traiig programme. Employers should promote participatio by ecouragig discussio, askig employees for suggestios ad commets o traiig issues ad, where appropriate, ivolvig employees i the presetatio of traiig material; the role of safety represetatives i promotig safe workig practices ad reiforcig traiig messages; the eed to provide opportuities for immediate practice ad feedback so as to correct performace ad to esure that skill levels ca be maitaied followig traiig. Priciples covered i traiig sessios should be reiforced by supervisors, safety represetatives ad peers o a regular basis; the eed for periodic refresher traiig for all employees. Evaluatio ad follow up 104 Periodic evaluatio of your traiig programmes should be udertake as part of a geeral review of your ULD prevetio programme. Employees should be ivolved i this process, particularly safety represetatives ad supervisors, who ca assess the impact ad effectiveess of the traiig offered. Traiig should also be reviewed whe there are chages i: workplace layouts, task desig or work orgaisatio or the itroductio of ew work equipmet; work practices or cotrol measures; reported ijury levels i other workplaces i the idustry, or i workplaces with similar jobs. Upper limb disorders i the workplace Page 28 of 89

29 Health ad Safety Maage ay episodes of ULDs Have you implemeted ad supported a system for early reportig of 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? 105 Adequate cotrol of risk factors will go a log way to prevet the occurrece of ULDs. Due to idividual differeces i the body s respose to stresses it is ot possible to esure that every possible episode of ULDs will always be preveted. It is ecessary, therefore, to have a system i place to maage ay reports or cases of ULDs that arise i the workforce. The approach to maagig these complaits is broadly similar whether they are thought to have bee caused by work activity, bee made worse by the work or are largely urelated to particular work tasks. Reportig ad recordig 106 Idividuals will vary i their willigess to report early symptoms of ULDs. It is importat to maitai a climate i which early reportig of symptoms is regarded positively ad this will be ecouraged if maagers ad safety represetatives both emphasise the beefits of such early detectio of possible harm. Educatio o possible symptoms ad sigs, who to see i the compay ad what help to expect should be provided to all employees where there is a residual risk of ULDs. Employees should be advised to have ay relevat symptoms recorded i the compay accidet book. Ay first aid provided should also be documeted. 107 If symptoms are such that cotiuig to work does ot make them worse, the it may be eough to provide the worker with reassurace, advice o risk factors, ad to review the idividual s work tasks with them. 108 If cotiuig to work at the same job causes symptoms to get worse or become prologed, or if the perso was cocered about the ature of the symptoms the it would be appropriate to obtai further advice by meas of a referral to a health professioal. A diagostic support aid for ULDs has bee developed ad is likely to be of beefit to Geeral Practitioers (GPs) ad other health professioals. 35 If symptoms are aggravated by a perso s curret job it is advisable to look for alterative work that they ca do, eve if this is quite differet from their ormal duties. This ca prevet the eed for sickess absece ad allow for recovery time before retur to their ormal duties. Referral 109 Oe way to obtai health advice is by referral to a occupatioal health service, either o or off site. Appedix 3 cotais more iformatio o the scope of occupatioal health provisio ad how to access this. Access to a occupatioal health service will usually allow both the worker ad their maager to be give appropriate advice with miimal delay. The idividual will be advised o the ature of their complait ad ay appropriate treatmet Upper limb disorders i the workplace Page 29 of 89

30 Health ad Safety ad the maager ca be advised whether the complaits are likely to have bee related to work ad the short term implicatios for cotiuig employmet. 110 If a employee is off sick with what is believed to be a ULD the it is useful to make early cotact with the perso, for example a telephoe call, to see what you ca do to help their retur to work. Appedix 3 lists a umber of specific medical diagoses to look out for if you are cocered about complaits of ULDs. 111 If you do ot have access to a occupatioal health service the, with your employee s agreemet ad writte coset, you ca write to their GP askig for a report which may help you i maagig the absece. However, ay such commuicatio has to comply with the priciples detailed i the Access to Medical Reports Act, ,37 The followig poits could be raised: the ature of the illess; whether the doctor thiks it is related to work; if treatmet will be ecessary ad time required to access treatmet; whe a retur to work may be expected; whether activity will eed to be limited for a period after returig to work; if ay log term effects are to be expected from the illess. 112 Appedix 3 provides further iformatio o a rage of possible treatmets for ULDs. Diagosis ad retur to work 113 Receipt of a writte diagosis of a upper limb disorder may trigger a requiremet to make a report to the relevat eforcig authority uder The Reportig of Ijuries, Diseases ad Dagerous Occurreces Regulatios (RIDDOR). 38,39,40 This requiremet applies oly to a small umber of ULDs which arise i the course of specified work activities. Appedix 4 provides further details. 114 A umber of ULDs are also prescribed uder the Social Security (Idustrial Ijuries) (Prescribed Diseases) Regulatios At the time of writig, the list of ULDs which are Prescribed Diseases is the same as those which are reportable uder RIDDOR. Idividuals diagosed with such disorders should be advised that they might be etitled to beefit uder the Idustrial Ijuries Scheme. 115 Cofirmatio of a case of a ULD should be take as a prompt to cosider whether existig risk assessmets ad cotrols are adequate. This is especially importat if there are other previously reported cases. 116 The exact timig of a idividual s retur to work will deped o the medical advice which they receive which i tur will deped o the ature of the uderlyig disorder. It is ofte possible to retur to work before symptoms have resolved, ad, i some cases this may be advatageous. 117 You may also eed to review your arragemets for occupatioal health advice to assist with the maagemet of ay further cases which may occur. This is particularly importat i work where there is already existig evidece of upper limb complaits. Upper limb disorders i the workplace Page 30 of 89

31 Health ad Safety Surveillace 118 Health surveillace ca be udertake o either a volutary or a statutory basis. The Approved Code of Practice for the Maagemet of Health ad Safety at Work Regulatios 20 recommeds that health surveillace is udertake where certai criteria are met. Oe of these is access to a valid meas of detectig the disease or coditio of cocer. At preset it is ot cosidered that valid techiques exist for the detectio of chages which reliably idicate the early oset of specific upper limb disorders. 119 Valuable iformatio ca however be obtaied from less precise measures such as reports of symptoms. It is good practice to put i place systems which allow idividuals to make early reports of upper limb complaits. Where appropriate these ca be supplemeted by regular surveys of symptoms. Further iformatio ca be foud i Health surveillace at work. 42 Upper limb disorders i the workplace Page 31 of 89

32 Health ad Safety 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 ULD maagemet programme? Are you aware of ew developmets/iformatio? Do you aim for cotiuous improvemet? Why moitor or review? 120 I ay maagemet system it is importat to check the effectiveess of your actios, ad this is o less so i the prevetio of ULDs. These checks ca be cosidered at two levels: moitorig: which is the ogoig ad regular appraisal of the procedures ad systems which you have i place to cotrol risk; ad reviewig: which is a less frequet but more strategic activity which cosiders how well the overall cotrols are workig ad whether ay chages might be beeficial ad reasoably practicable. Moitorig 121 Moitorig is a itegral part of maagemet ad requires commitmet, cosultatio ad participatio at all levels i the orgaisatio i order to be fully effective. Moitorig geerally ivolves recordig treds i ULD symptoms ad risk factors over time i order to assess the performace of existig cotrol measures ad to pla ad implemet ew itervetios. 122 Factors to cosider i plaig moitorig ad reviewig systems iclude: method; frequecy; whe to moitor; costs ad beefits. 123 The method ad frequecy of moitorig should be cosidered whe iitially plaig ad implemetig cotrol measures. The scale ad extet of moitorig required will deped o the degree of risk ad the relative costs ad beefits of available methods. It is importat that there is cosultatio with employees so that they are fully aware of the moitorig procedures which are i place. Approaches to moitorig 124 There are two broad approaches to moitorig systems passive ad active moitorig. Table 1 compares the geeral features of each approach. Upper limb disorders i the workplace Page 32 of 89

33 Health ad Safety Table 1 Geeral features of passive ad active moitorig Passive Uses existig iformatio sources ad methods Usually iexpesive Usually udertake first Data codig ad aalysis is usually simple No-cliical Readily established as iformatio sources usually desiged for other admiistrative purposes. Active Active seekig of iformatio about sigs, symptoms, risk factors Geerally ivolves additioal costs Usually udertake as a follow-up to passive moitorig but may be the first lie approach where there is a sigificat ULD risk. I depth data codig ad aalysis require specialist assistace. No-cliical ad cliical idicators icluded Recommeded whe faced with a outbreak of ULDs 125 Some iitial value ca be gaied from passive moitorig but active moitorig builds o this iformatio ad eables a i-depth look at risk factors, sigs ad symptoms i a specific workplace. Cosultatio with employees is particularly importat sice there are ethical cosideratios relatig to the hadlig of persoal health iformatio. Examples of passive ad active moitorig Some examples of passive ad active moitorig methods are give i Table 2. Table 2 Passive ad active moitorig methods Passive Accidet book/first aid record Compesatio data Statutory reportig systems (RIDDOR) 38 Medical retiremet reports Symptoms reported Sickess absece records Active Workplace walkthroughs Body mappig Task aalysis Cofidetial questioaires Health iterviews Health examiatios Productio productivity ad quality measures Exposure checklist 27 Staff turover Health ad safety meetigs Morale ad employee satisfactio Moitorig outcomes 126 I iterpretig iformatio obtaied from moitorig it is useful to look for cosistet patters i: commets from employees; symptoms reported; existig risk factors; results of surveys. Upper limb disorders i the workplace Page 33 of 89

34 Health ad Safety 127 Comparisos betwee groups of employees i differet locatios withi the orgaisatio may be helpful particularly where similar work is beig udertake. Where practicable, comparig your experieces with other compaies i your sector may also assist i evaluatig the performace of 42, 43 your cotrol measures. 128 Where problems are idetified, actio should be take to revise the measures i your maagemet policy to improve cotrol of the risk. Employees should be advised of the situatio ad ay appropriate medical maagemet made available. Further moitorig will determie if these revised measures have bee effective. Reviewig 129 Reviewig provides a opportuity to look at the overall performace of your systems for maagig ULD risks ad should be cosidered as a itegral part of the maagemet process. It should be udertake whe moitorig suggests that the curret policy/programme is ot adequately cotrollig the risks or whe techical developmets or orgaisatioal chages are plaed which may alter the levels of risk. 130 Reviewig relies largely o the use of existig maagemet iformatio ad may ofte be icorporated i a periodic review of busiess effectiveess, eg, as part of a quality programme. 131 Reviewig: eeds to be systematic i approach; makes full use of existig maagemet resources; is a opportuity to lear from experieces gaied i maagig ULD risk factors, sigs ad symptoms; determies whether itervetios cotiue to be effective; establishes whether risks have bee cotrolled where reasoably practicable; provides a opportuity to assess whether improved cotrol measures should be itroduced. 132 A system should be i place to esure that the outcomes from the review are acted upo, feedig back ito the maagemet system as show i Figure 1. Upper limb disorders i the workplace Page 34 of 89

35 Health ad Safety Appedices Appedix 1: Case studies These case studies have bee divided ito the stages preseted i the maagemet model show i Figure 1. This has bee doe retrospectively so all stages of the model are ot always fully represeted. Case study A: Easter egg ad chocolate box packig Backgroud 1 A large factory idetified a umber of tasks that created a risk of ULDs: Task 1: Easter egg packig For packig Easter eggs, eight separate compoets were assembled by had. Most of these compoets arrived as flat-packs which the had to be folded ad bet ito the correct shape. The operators o this task were paid piecework rates depedet upo the umber of eggs they assembled i a workday. Task 2: Chocolate box packig Durig the productio of boxes of chocolates, two layers of chocolates i a plastic moulded tray, a pad of corrugated cardboard, ad the uit key (ie to idetify the fillig i the chocolate) were eeded to be packed ito differet-size boxes. The boxes were preseted to the operator o a movig coveyor, ad, as they wet past, differet operators had to put differet compoets (the chocolates, the mouldigs i which they sit, the cardboard pad, ad iformatio leaflets) ito the boxes i a flow assembly operatio. Uderstad the issues ad commit to actio 2 The compay physiotherapist ad other medical departmet staff were seeig people from the egg ad chocolate packagig departmet with ULDs. With the permissio of the employees cocered, maagemet had become aware of ULD referrals ad had directed actio o the issue. Create the right orgaisatioal eviromet 3 The compay doctor, the operatios maager ad the idustrial egieer for the site worked with employees throughout the process of assessmet. Trials of solutios to reduce the risks were also doe i a participative maer. Assess the risk of ULDs i your workplace 4 A risk assessmet of task, eviromet ad idividual factors for ULDs idetified the followig risk factors: Upper limb disorders i the workplace Page 35 of 89

36 Health ad Safety Task 1: Easter egg packig Task-related factors Repetitio: Workig posture: Force: Duratio of exposure: Eviromet-related factors: Psychological factors: This task was highly repetitive with workers performig the same figer, wrist, arm ad shoulder movemets may times per miute. The task required may movemets of the had ad wrist, eg sideways bedig ad bedig the wrists up ad dow while foldig the cardboard ad sappig a plastic cover over the eggs. The elbow was ofte held ad moved i positios away from the body. Sappig of the plastic cover over the eggs required force with pich grip. Workers coducted this task for prologed periods each day. Workers were paid o a piecework basis which may have ecouraged them to push themselves beyod the poit at which they experieced discomfort. This may also have iflueced the workers willigess to report upper limb discomfort for fear of reduced workig hours/ speed etc Task 2: Chocolate box packig Task-related factors Repetitio: Workig posture: Duratio of exposure: This task was highly repetitive with workers performig the same upper limb movemets may times per miute. The operator s work rate was determied by the coveyor speed. The box desig made it difficult to place the compoets accurately i the boxes whe the coveyor was movig quickly. This meat that workers assumed awkward postures of the shoulder ad wrist. Workers udertook this task for prologed periods each day. 5 If workers were rotatig betwee the two tasks, they may have bee at a icreased risk of ULDs. Both tasks preset very similar risk factors for ULDs (repetitio of similar upper limb postures for log periods) ad i combiatio, further icrease the risk of ULDs. This example highlights the importace of lookig at the risk assessmets of tasks i combiatio where workers are performig multiple tasks durig the shift. Reduce the risk of ULDs 6 After the assessmet was completed it was determied that certai elemets eeded to be redesiged: the packig operatio was redesiged to remove the risk elemet of cardboard bedig ad the sappig shut of the plastic mould. This reduced the umber of ucomfortable wrist ad had movemets; the pay structure was chaged from piecework to salaried work; for chocolate box assembly, egieers developed a mock-up workstatio to trial with operators i which the rate of completio of the task was determied by the operator, ot by the coveyor; Upper limb disorders i the workplace Page 36 of 89

37 Health ad Safety a sigle operator udertook the whole assembly task rather tha puttig oe compoet i the box (ie job elargemet); egieers worked out the best agle for viewig the compoets, for takig them off the coveyor, ad for assemblig them without twistig ad turig; after testig out this desig with the participatio of the operators the ew lie was built ad istalled. Maage ay episodes of ULDs 7 The compay employs a physiotherapist ad other medical departmet staff i order to maage ay episodes of ULDs ad facilitate rehabilitatio ad retur to work where possible. Carry out regular checks o programme effectiveess 8 For Easter egg packig: fewer cases of wrist ad had problems are ow reported to medical staff; overall efficiecy of the productio lie has improved; the umber of uits damaged has decreased, ad the visual quality of the fiished product has improved; the amout of material (chocolate, plastic, cardboard) wasted has decreased; staff morale has improved; the egg productio workflow is easier to maage ad regulate; ad there eeds to be less staff rotatio because the ature of the job has improved. 9 For the chocolate box packig: operator comfort has icreased, as the adjustability i each workstatio ca be used to meet each operator s eeds; assembly quality has improved, as the operators are o loger tryig to put the compoets ito a movig box. 10 Packig operatios are performed maually i a rage of differet idustries. As this case study illustrates, the operator is ofte required to use positios of the had ad wrist, which ca lead to upper limb disorders, especially whe combied with high force ad/or repetitio. The compay has beefited i both productio efficiecy ad staff well beig ad health by recogisig risks withi the task, ad ivestig i ergoomic chages to the tasks ad packagig materials. Case study B: Computer use i ews media orgaisatio The work covered by this case study was subject to the Display Scree Equipmet Regulatios. This case study shows how the structured approach i the guidace ca help comply with the Regulatios i a uusual situatio with complex challeges. Backgroud 11 For may years a large ews media orgaisatio had used a computer-based system to store ad trasfer ews stories. This was gradually becomig outdated ad required upgradig due to developmets i the electroic trasfer of stories ad the eed for a faster more efficiet system. Upper limb disorders i the workplace Page 37 of 89

38 Health ad Safety 12 A ew off-the-shelf package based o a existig ad widely used system was chose. Some adaptatios were made for the curret orgaisatio ad it was istalled i the ewsroom ad elsewhere. Accompayig the rollout was a programme of chage maagemet that icluded advice o implemetatio, istallatio ad traiig for users icludig workstatio adjustmet ad posture. Uderstad the issues ad commit to actio 13 The use of the ew system led to uaticipated cosequeces because it was beig used for a task for which it was ot desiged the preparatio of sometimes legthy, i-depth ews stories rather tha short bulleti-style pieces. 14 Prior to the itroductio of the ew system, comparatively few cases of ULDs had arise eve though computerised techology had bee i use for may years. There the followed a rapid surge i ew cases i the order of a three to four fold icrease over the previous years. Create the right orgaisatioal eviromet 15 Right from the begiig a ope-mided policy was adopted so that all staff could be kept fully iformed of the extet of the problem ad its progress. Assess the risk of ULDs i your workplace 16 Assessmet of task, eviromet ad idividual factors for ULDs revealed that the software did ot cope with page breaks, spell checkig, cut-ad-paste editig facilities ad the eed for the ews orgaisatio to cope with o- Eglish material. The task of text iput ad editig agaist costat deadlies was ow much more oerous tha with a stadard word processig style package. Ufortuately the implemetatio of this ew system coicided with the outbreak of a major iteratioal ews evet ecessitatig a eormous icrease i workload. I additio, orgaisatioal chages were beig made to the busiess ifrastructure i commo with those beig made elsewhere at the time. This ievitably led to ucertaity about the future, isecurity o the part of the workforce, ad to higher levels of stress. 17 Idetified risk factors for ULDs icluded: Task-related factors Repetitio: Workig posture: Duratio of exposure: Eviromet-related factors Psychosocial factors: Staff were performig multiple mouse clicks as well as highly repetitive keyig. Positio of the keyboard, mouse ad moitor meat that static cotractio of the shoulder ad eck muscles was occurrig whe workers were usig the iput devices ad/or lookig at the scree. Wrist postures were also problematic for some workers. Text iput ad editig tasks were performed for prologed periods each day. The outbreak of the major ogoig ews evet meat that may workers were workig loger hours. Orgaisatioal chages, strict deadlies ad workload associated with the major ews evet were all idetified as psychosocial risk factors. Upper limb disorders i the workplace Page 38 of 89

39 Health ad Safety Reduce the risk of ULDs 18 Cotrols to reduce the risk of ULDs were implemeted as follows: computer related equipmet which icluded hardware, software ad furiture was reviewed by the safety maager; chages to workstatio layout were made to improve workig postures, particularly i relatio to the upper limb ad mouse ad keyboard use. This focused o the risk factor of workig posture; chages were made to the software to reduce repetitio; the maager altered the work orgaisatio icludig work patters ad shifts. This rectified ay adverse work practices ad icluded cotrol over work quality ad deadlies. These cotrols focused o the risk factors of duratio ad psychosocial factors. Maage ay episodes of ULDs 19 Early reportig of idividual cases to the occupatioal health departmet was ecouraged so that steps could be take by maagers to miimise the impact of symptoms. Three mai routes of maagemet were draw up: a self-help route icludig a rage of physical therapies ad relaxatio exercises; a therapeutic route to ivestigate symptoms ad sigs, carry out diagostic ad other ivestigatios ad refer, as appropriate, for treatmet optios doe by the occupatioal health departmet. Treatmet could iclude medicatio, oward referral to GP or specialist, physiotherapy or cousellig; from iitial oset or reportig of symptoms, a cycle of four weeks was allowed for the above to be accomplished, after which a case coferece/ review meetig would take place to determie if the idividual was ow fit ad could retur to work, was improvig ad could retur to modified work or where the programme had failed ad a job chage was required. Carry out regular checks o programme effectiveess 20 After several years from the iitial outbreak the umber of origial cases had halved, of which more tha 60% were deemed to be cured or dormat. 21 This study shows that the outlook for the majority of cases should be good so log as a programme is adopted which ecourages early reportig ad maagemet of cases without fear of prejudice, i a eviromet of mutual co-operatio betwee employees, maagers, uios, safety officers, IT specialists ad occupatioal health professioals. Case Study C: Healthcare product packig Backgroud 22 A large maufacturig compay with several factory sites produces ad packs a wide rage of cosmetic ad ski care products. These ofte have short packig ru times, ad some product lies are difficult to automate. The compay recogised that the highly maual packagig tasks preseted a risk of ULDs ad took measures to tackle these. Uderstadig the issues ad commit to actio 23 The compay idetified the eed to take actio to reduce the risk of ULDs ad for a proactive system to maage ULD referrals/cases across the differet factory sites. This was met through the developmet of a compay ULD policy. A compay ergoomist was also recruited to develop ad facilitate a ergoomics programme. Upper limb disorders i the workplace Page 39 of 89

40 Health ad Safety Create the right orgaisatioal eviromet 24 Maagers ad operators had bee aware of reported symptoms of ULDs ad were supportive of measures to reduce these. From the start the ergoomist worked closely with occupatioal health staff ad maagemet. 25 Packig team leaders ad seior team members with resposibility for the health ad safety of their particular area were traied i safety risk assessmet ad the idetificatio of possible risk reductio measures. Assess the risk of ULDs i the workplace 26 A three-stage risk assessmet process was set up: detailed risk assessmets of the packagig tasks were udertake usig the rapid upper limb assessmet (RULA) method 28 ad a body part discomfort ad psychosocial survey. These formed the basis for prioritisig risk reductio recommedatios; seior team members regularly assess the risk of ULDs durig routie risk assessmets of their packig lies. They are ecouraged to idetify ad implemet risk reductio measures ad ca seek advice from the compay ergoomist; whe a ew product is to be itroduced to a lie, a chage cotrol assessmet is udertake to idetify ay specific problems which may relate to the packig of that product, ad possible solutios. A example of a task idetified durig a packig trial risk assessmet as posig a ULD risk was sealig a two-piece glass jar usig a wire metal clasp. The task required repetitive activity ad the applicatio of force to close the clasp. There was also the risk of pressure poits o the palm from the wire. The risk of ULDs associated with the task was reduced by ecouragig operators to stad rather tha sit to make it easier to apply force; providig a leather palm protector; esurig two people udertook the task to reduce duratio of exposure ad icrease recovery time; ad providig guidace o task procedure. After implemetatio, o ULD symptoms were reported from this packig operatio. Reduce the risk of ULDs 27 The followig measures apply to all packig lies: all packig employees rotate to a differet task every 30 miutes. Where possible, rotated tasks are sigificatly differet i terms of upper limb movemets required; icreased automatio, stadardisatio of packagig, ad ways of reducig repetitive movemets are sought at the desig stage (eg reducig the umber of turs required to faste a lid); developmet of procedures that ecourage operators to adopt good postures ad movemets o packig tasks; the developmet ad availability of risk reducig aids (eg tools ad equipmet); icreased awareess of ULD issues amog the workforce, ad ecouragemet of all employees to participate i idetifyig risk reductio measures ad solutios. Educate ad iform your workforce 28 A leaflet o ULDs, coverig causes of ULDs, how to idetify sigs ad symptoms, ad what to do if these are experieced, was issued to all staff with a follow-up issue after 18 moths. Upper limb disorders i the workplace Page 40 of 89

41 Health ad Safety 29 Where appropriate, awareess traiig is provided by the compay ergoomist to promote suitable workig techiques that ca be used to reduce ULD risk. Maage ay episodes of ULDs 30 The compay policy requires employees to report ay ULD symptoms to their team leader who refers them to the occupatioal health service. Their workstatio ad tasks are assessed i light of the problems experieced ad appropriate recommedatios give. The team leader reviews the situatio weekly, ad occupatioal health staff regularly moitor the employee s symptoms. Carry out regular checks o programme effectiveess 31 Regular health ad safety group meetigs (ivolvig seior maagemet, occupatioal health staff, the compay ergoomist, factory egieers ad safety represetatives) review risk maagemet issues ad the impact of risk reductio measures take. They also provide effective routes of commuicatio betwee staff ivolved. 32 Followig the iitial awareess raisig campaig (which icluded issue of the ULD leaflet) there was a expected icrease i referrals to the occupatioal health service. This was followed by a steady reductio i referral rate over the followig two years. Whe the leaflet was re-issued the aticipated icrease i referrals was ot experieced. 33 There are ogoig reviews of occupatioal health data, ad a follow-up body part discomfort survey is plaed to evaluate the impact of the risk reductio programme. Case Study D: New couter desig for cashiers Backgroud 34 A leadig bookmaker s group with over staff ad shops plaed to roll-out a radically ew desig of electroic poit-of-sales (EPOS) system ad associated couter. Prevetio of ULD risks was a major cosideratio i the selectio of equipmet, desig of the couter, furiture ad software. The ew desig ad maagemet programme had to accommodate a rage of shop eviromets, staff regularly movig betwee premises ad differet cashier workstatios. 35 The cashier s task for which the ew desig was specified maily ivolves sittig at the workstatio ad dealig with trasactios (hadlig bettig slips ad moey). The EPOS system ivolves some computer work (keyboard ad mouse use) to hadle ad process bets. Uderstad the issues ad commit to actio 36 Maagemet recogised that ULD risk factors were preset i the cashier s task eg repetitively reachig to the couter top ad awkward stretches to reach equipmet. Seior maagemet was supportive of the pla to itroduce ew couter desig guidelies ad recogised the potetial impact o occupatioal health. Create the right orgaisatioal eviromet 37 It was agreed that the ew couter desig ad layout should be based o ergoomics criteria. Maagemet also recogised that providig iformatio to employees ad havig a meas of idetifyig ay health problems was essetial i maagig occupatioal health. A project team was assembled Upper limb disorders i the workplace Page 41 of 89

42 Health ad Safety with represetatives from facilities maagemet, health ad safety, IT ad IT developmet, lie maagemet, ad the geeral workforce to specify ad develop the ew couter layout ad associated equipmet. Assess the risk of ULDs i the workplace 38 A risk assessmet idetified that certai movemets ad tasks would be required (reachig to couter top, cash drawer, hadlig moey etc) which cotaied the ULD risk factors of repetitio, reachig ad awkward posture. This eabled ergoomics criteria to be specified for the couter desig. Reduce the risk of ULDs 39 To reduce the risks of ULDs: ergoomics advice was sought for body dimesio criteria o which to base the couter desig; mock-ups of couters were trialled by cashiers; computer related equipmet icludig scaer, priter ad scree, ad their layout were reviewed ad trialled to reduce the risk of ULDs ad esure their ease of use, (eg scaig rather tha keyboard use was selected for data etry ad equipmet was placed withi the zoe of comfortable reach); the software desig reduced the pressure o cashiers by helpig with maagemet of deadlies, for example, takig bets i relatio to whe races started; maagemet also esured that there were sufficiet staff i each shop to allow rest ad recovery durig the shift, ad to cover particularly busy periods. Educate ad iform your workforce 40 Iformatio o settig up the workstatio ad chair adjustmet was provided o the compay itraet to which all cashiers have access. I additio, o a ogoig basis employees are prompted to complete a o-lie assessmet of their workstatio after a certai umber of log-os. This also directs staff to relevat guidace documetatio. Maage ay episodes of ULDs 41 Most health problems are idetified i the o-lie assessmet or through the absece maagemet system. Ay problems idetified are reported to the employee s lie maager, ad to the safety maager, ad it is the lie maager s resposibility to actio chage (eg replace faulty equipmet). Where a problem has bee idetified the employee completes a o-lie assessmet 21 days after the iitial report. If the problem has ot bee resolved it is reported to a higher level of maager, ad a re-assessmet is completed after a further 21 days. Cotiuig problems are reported to a director of the compay. This provides a icetive for reported problems to be dealt with rapidly ad esures that awareess is raised amog all staff. 42 Expert medical ad ergoomics support is available for ay employee with a ogoig health problem, so that idividual workstatios ca be assessed ad appropriate adjustmets made. Upper limb disorders i the workplace Page 42 of 89

43 Health ad Safety Carry out regular checks o programme effectiveess 43 A expert ergoomic evaluatio of the ew couters idetified that they did ot pose a sigificat risk of ULDs. Ogoig moitorig of occupatioal health data cotiues. Further ivestigatio is takig place ito the desig of bettig slips to allow more electroic recogitio of optios (ie usig tick boxes) so that the amout of mouse use by cashiers dealig with trasactios ca be reduced. Case Study E: Addressig ULDs i poultry processig Backgroud 44 A large poultry processig compay with a umber of differet sites wated to systematically tackle their ULD problems. Uderstad the issues ad commit to actio 45 The compay had received guidace from their idustry federatio ad was aware of the extet of ULD problems i the sector. There had also bee a sigificat umber of referrals to their occupatioal health departmet ad claims for ULDs, which acted as a motivator to tackle these issues. Although maagers had bee aware of the issues, attitudes chaged sigificatly whe the cost of placig people with ULDs oto lighter duties was calculated, ad foud to be cosiderable. Create the right orgaisatioal eviromet 46 Followig a review of their health ad safety maagemet systems, the compay established a programme for the prevetio of ULDs. Policies were writte, arragemets ad procedures put i place, ad roles ad resposibilities clarified. 47 Multidiscipliary ergoomics teams were created, ivolvig all levels of the busiess ad led by lie maagers. Teams were give a ergoomics traiig programme to raise awareess of the issues ad idetify ways of reducig the risks. I additio, the compay s occupatioal health urses were give a more proactive role i maagig ULDs ad worked closely with first lie maagers. Assess the risk of ULDs i the workplace 48 The ULD risk assessmets were itegrated ito the safety maagemet of the busiess. Geeral risk assessmets are doe by traied risk assessors uder the guidace of the lie maager of the departmet. The assessmet cosiders a rage of risks ad uses specific checklists for ULDs, maual hadlig ad ergoomics issues. If these idetify a potetial ULD risk, a perso traied i ergoomics or a occupatioal health urse udertakes a more detailed assessmet. Reduce the risk of ULDs 49 Because staff o the shop floor have had ergoomics traiig they have bee able to geerate may workplace improvemets themselves. It is primarily through the empowermet ad commitmet of the first lie maagers that the process has bee successful. Upper limb disorders i the workplace Page 43 of 89

44 Health ad Safety Chicke hag o Oe of the poultry processig activities ivolves hagig chilled whole birds oto movig shackle lies so that they ca be cut ito chicke portios by a machie. The task requires idividual birds to be picked from a hopper situated i frot of the operator ad the legs of the bird placed i the shackle o a suspeded coveyor. The operators carryig out this task work i teams of three, at a rate of 70 birds per miute. A decisio was take to replace the cut up machies ad, as a part of that project, to redesig the hag-o workstatio to reduce the ULD risk ad the wasteful hadlig ivolved i the existig process. A detailed assessmet revealed the followig: Task related risk factors Repetitio: Workig postures: Force: Duratio of exposure: The task was highly repetitive with up to 25 cycles per miute. The task was also machie paced. Workers had to reach forward ad dow to pick up the birds, the up to place them i the shackle. Positioig the bird to alig with the shackle also required awkward postures. Some force was required to place birds i the shackle; Birds weigh up to 2 kgs. Workers coducted this task for prologed periods each day. Eviromet related risk factors Workig eviromet: Psychosocial factors: Low workroom temperature (12 ºC) ad low temperature of product (3 ºC) The work was machie paced. A two-phase re-desig was implemeted to reduce, ad ultimately elimiate, the risk. Phase 1 Redesiged workstatio reduced height of shackle o coveyor; repositioed bird delivery hopper so the reach distaces required were reduced; redesiged shackle to make attachmet easier. Employees were cosulted ad ivolved i the desig of the revised workplace. Phase 2 Direct feed of birds from aother shackle lie, to the shackle lie o the automatic cut up machie, thus elimiatig the eed to maually hag birds. Outcomes iclude: Sigificat reductio i ergoomic risk; reductio of reported ULDs from the activity; reductio i umber of employees o lighter duties from this operatio; a marked improvemet i productivity. Educate ad iform your workforce 50 All staff receive iductio traiig which covers the risk of ULDs, cotrol measures ad reportig procedures. Further iformatio ad traiig are give o the job. The profile of ULDs has bee raised withi the compay ad there is ope commuicatio about the issue. Upper limb disorders i the workplace Page 44 of 89

45 Health ad Safety Maage ay episodes of ULDs 51 If a employee experieces ULD symptoms they are referred through their lie maager to the occupatioal health departmet who will assess their coditio ad work, ad make recommedatios cocerig appropriate actio (workplace or task modificatios, rest, lighter duties). Occupatioal health staff udertake o-goig surveillace of those with problems. A physiotherapist is available o site to treat ad advise those with ULDs. Carry out regular checks o programme effectiveess 52 The compay udertakes a six mothly audit of the ULD programme to review the maagemet system ad procedures, their effectiveess ad the impact they have had, ad to idetify ay further improvemets. 53 Recet examiatio of the cost of placig people o light duties (largely due to ULDs) idetified that i a sample week i 1998 of 2300 processig staff, 60 (2.6%) were o light duties. Followig the ergoomics programme, i the same sample week i 2001 oly 16 staff (0.7%) were o light duties. I direct labour costs aloe the compay estimate that this reductio equates to a savig of I oe factory, the umber of people placed o light duties has falle by almost 80% i this period. Upper limb disorders i the workplace Page 45 of 89

46 Health ad Safety Appedix 2: Risk Filter ad Risk Assessmet Worksheets The aim of the Risk Filter is to set out a approximate threshold below which the risk of ULDs is likely to be low. The guidelies i the Risk Filter ad Worksheets are provided as a aid to risk assessmet. They have bee developed from the scietific literature ad from expert opiio. As such, they are ot precise exposure limits, but are iteded to help you to idetify the potetial risks ad possible measures to reduce them. Other methods of assessmet are available ad may be equally appropriate i assessig the level of risk of ULDs. 27,28,29,30 Overview 1 Together the Risk Filter ad Risk Assessmet Worksheets provide a twostage assessmet process, which may be photocopied for use: Stage oe: Use the Risk Filter to help idetify situatios where a more detailed assessmet is ecessary. (Please ote that certai risk factors have bee purposely omitted i the filter i order to provide a useable, first stage, screeig tool.) Stage two: Use the Risk Assessmet Worksheets to coduct a more detailed risk assessmet for those tasks idetified by the Risk Filter 2 Before udertakig your assessmet, you should read Assess the risk of ULDs i your workplace (which provides guidace o risk assessmet ad risk factors) (see paragraphs 43-86). I order for your assessmet to be effective you should: ivolve your workforce i the assessmet ad cotrol process to take advatage of their itimate kowledge of the work; explai to the worker(s) what you are doig prior to assessig a task. You should always emphasise that the assessmet is of the task ad ot the worker s performace; walk through the area ad idetify ay tasks that relate to display scree equipmet or ivolve maual hadlig because you also eed to refer to specific guidace o the relevat regulatios to assess these; make sure that you have spet some time observig the job ad what you are seeig is represetative of ormal workig procedures; observe all the workers for a short period of time where several people do the same job, to esure that you have some isight ito the demads of the job from all workers perspectives; complete the assessmet i the workplace (where possible, ad if it is safe to do so); focus o the upper limb at each step esurig you cosider the figers, hads, arms, elbows, shoulders ad eck; where the Risk Filter idicates further actio move o to stage two of the assessmet usig the Risk Assessmet Worksheets. 3 Equipmet that may be useful icludes: stopwatch or timer to measure cycle times; video camera to allow for more detailed aalysis of movemet cycles, ad for the assessmet to be fialised away from the workplace if ecessary; scales/force guage (sprig balace ad strig) to measure the weight/ forces related to upper limb activities. Upper limb disorders i the workplace Page 46 of 89

47 Health ad Safety Read the followig guidace i cojuctio with the risk filter. Duratio: A cosideratio of duratio, or exposure time, as a risk factor for ULDs would iclude both the legth of time that a task is performed i a typical workig day as well as how ofte it is repeated (eg daily, weekly or less ofte). Buildig such a complex factor ito a simple risk filter ad worksheet is difficult. 2 cosecutive hours or more tha 2 hours total per workday have bee used as basic buildig blocks of exposure time throughout the guidelies i the risk filter ad risk assessmet worksheets. Cosecutive i this cotext meas the task or similar groups of tasks are repeated successively throughout the 2 hour period. It must be emphasised that the 2 hour period is ot a limit ad should be applied pragmatically. For example, if a task was performed for 1 hour ad 40 miutes, followed by a 10 miute break, the for aother 1 hour ad 40 miutes, followed by aother break, ad so o, throughout a 8 hour workday, the worker has ot strictly worked more tha 2 cosecutive hours. The duratio of exposure for this task, however, is certaily high ad would be of cocer if the other risk factors for ULD were also preset. Coversely, if the task requiremets are exceptioally demadig, a duratio of less tha 2 cosecutive hours may preset a uacceptable risk. STAGE 1: Risk Filter procedure Esure you have read Assess the risk of ULDs i your workplace ad the geeral guidace at the begiig of this Appedix prior to udertakig your assessmet. 4 Completig the Filter ivolves: recordig the basic details of the task such as the date, ame of the task, the assessor ad task descriptio; probably usig a separate Filter sheet for each task; goig through each step i tur ad placig a tick i each box where you observe examples of these risks; plaig a more detailed risk assessmet if ay of the risk factors are ticked; idetifyig those tasks with the most risk factors (the more there are the greater the risk) to help i prioritisig tasks for the secod stage risk assessmet. 5 Step 1: Sigs ad symptoms: Look for: actual cases of ULDs i work: review sickess absece records ad medical certificates received; ask your occupatioal health service for aoymous iformatio about cases of ULDs; complaits of aches or pais: check the accidet book ad or treatmet book for metio of sprais ad strais ad ay other types of aches ad pais; talk to maagers, supervisors ad workers; Upper limb disorders i the workplace Page 47 of 89

48 Health ad Safety improvised chages to work equipmet, furiture or tools: walk through the workplace to idetify improvised chages; check with maagers, supervisors ad workers for difficult jobs or those which have become more difficult recetly. 6 Step 2: Repetitio: Check for frequet movemets for prologed periods. Examples may iclude repeated had press operatios, repeated triggerig operatios, repeated cuttig actios, repeated hadlig etc. A Cycle refers to a sequece of actios of relatively short duratio that is repeated over ad over, ad is almost always the same. They are ot ecessarily associated with oe sigle joit movemet, (such as the elbow), but with movemets of oe or more parts of the limb (such as reachig, maipulatig ad placig a object). Cycles are ot always clear-cut, ad i such cases observers should look for similar actios that are repeated. A simple task may cosist of a sequece of movemets which would be repeated ad therefore form the cycle. A more complex task may cosist of elemets (as described i paragraph 53) some or all of which may be distict cycles. 7 Step 3: Workig postures: Check for postures that are awkward ad/or held for prologed periods i a static or fixed positio. Check figers, wrists, hads, arms, shoulders ad ecks. Remember: The more the joits deviate from their eutral positio, the greater the risk. 8 Step 4: Force: Check for sustaied or repeated applicatio of force. 9 Step 5: Vibratio: Make a ote of the type of vibratig tools or equipmet such as griders, polishers etc. that are used for the stage 2 assessmet. You should also be aware that psychosocial ad workig eviromet factors (such as high job demads ad lack of cotrol, cold ad lightig) could further icrease the risk of ULDs. These factors are expaded i the full risk assessmet. Upper limb disorders i the workplace Page 48 of 89

49 Health ad Safety RISK FILTER Task: Assessor: Date: Locatio/work area: IF YOU ANSWER YES TO ANY OF THE STEPS, YOU SHOULD THEN MAKE A FULL RISK ASSESSMENT OF THE TASK. REMEMBER TO CONSIDER ALL OF THE BODY PARTS OF THE UPPER LIMBS (FINGERS, HANDS, WRISTS, ARMS, SHOULDERS AND NECK). ANSWER ALL QUESTIONS Step 1: Sigs ad symptoms Are there ay: Medically diagosed cases of ULDs i this work? Complaits of aches ad pais? Improvised chages to work equipmet, furiture or tools? Are ay of these preset? YES NO Move o to Step 2 Step 2: Repetitio Are there repetitive elemets such as: Repeatig the same motios every few secods? A sequece of movemets repeated more tha twice per miute? More tha 50% of the cycle time ivolved i performig the same sequece of motios? For more tha 2 hours total per shift? YES NO Move o to Step 3 Step 3: Workig postures Are there ay workig postures such as: Large rage of joit movemet such as side to side or up ad dow? Awkward or extreme joit positios? Joits held i fixed positios? Stretchig to reach items or cotrols? Twistig or rotatig items or cotrols? Workig overhead? For more tha 2 hours total per shift? YES NO Move o to Step 4 Step 4: Force Are there ay forces applied such as: Pushig, pullig, movig thigs (icludig with the figers or thumb? Graspig/grippig? Pich grips ie holdig or graspig objects betwee thumb ad figer? Steadyig or supportig items or work pieces? Shock ad/or impact beig trasmitted to the body from tools or equipmet? Objects creatig localised pressure o ay part of the upper limb? Sustaied or repeated applicatio of force for more tha 2 hours total per shift? YES NO Move o to Step 5 Step 5: Vibratio Do workers use ay powered had-held or had-guided tools or equipmet or do they had-feed work pieces to vibratig equipmet? Regularly (ie at some poit durig most shifts)? YES NO If you aswer yes to ay of the steps, you should make a full risk assessmet of the task. Upper limb disorders i the workplace Page 49 of 89

50 Health ad Safety STAGE 2: Risk Assessmet Worksheets procedure Read the followig guidace i cojuctio with the Risk Assessmet Sheets overleaf. Esure you have read Assess the risks of ULDs i your workplace (see paragraphs 43-86) ad the geeral guidace at the begiig of this Appedix prior to udertakig your assessmet..b. The risk factor of duratio is addressed withi the guidace values for other risk factors ad therefore does ot have a headig i its ow right. 10 Completig the Risk Assessmet Worksheets ivolves: usig a set of Worksheets for each task; recordig basic task details o the Worksheets, such as how log the task is carried out, a task descriptio etc. (A example task descriptio is: a worker reaches for screws, places them i positio at head height, the uses couterbalaced drill to fix screws. The fiished product is the pushed across the body to the ext statio); goig through each risk factor i tur, observig the task(s) i relatio to the appropriate guidelies to see if a risk of ULDs is preset; recordig which aspects of the task(s) preset the risk; otig dow possible cotrol optios; idetifyig those tasks with the most risk factors to help i prioritisig tasks for a programme of cotrol (the more yes ticks the greater the risk). Completig each risk factor 11 The followig procedures should be observed whe completig each risk factor: place a tick i the Yes box where you observe examples of these risk factors ad a tick i the No box whe you do ot; write dow what the perso is doig i relatio to that risk factor i the ext colum, icludig: body part affected; how log the task is beig doe, for example umber of times per miute, umber of hours per day. (eg five times per miute, five shifts of 7.5 hours); what aspects of the task are presetig the risk; type of work equipmet; whether ay referece umerical values are exceeded (possibly idicatig a elevated level of risk for ULDs) write dow ay possible cotrol measures that ca be take to miimise the risk of ijury i the secod last colum. Some cotrol optios are listed i the fial colum, these are explaied i further detail i Appedix 2: Suggestios for reducig the risk. The cotrols listed represet some optios oly ad are ot a exhaustive list. Upper limb disorders i the workplace Page 50 of 89

51 Health ad Safety Completig the actio pla 12 The followig procedures should be observed whe completig the actio pla: summarise ad prioritise the cotrol optios; examie the completed risk assessmet ad the idetified cotrol optios to prioritise actio. Idetify tasks with the highest umber of Yes ticks. Tasks with a higher umber of Yes ticks may require more immediate actio; where you have established that there are diagosed cases of ULDs or complaits of discomfort etc. as well as risk factors, view this combiatio as a high priority for implemetig cotrol measures develop a short, medium ad log term strategy to implemet cotrols, ad place dates agaist these; eter a date for re-evaluatio i the actio pla table to esure that implemetatio dates are moitored. Upper limb disorders i the workplace Page 51 of 89

52 Health ad Safety RISK ASSESSMENT WORKSHEETS Worksheet Referece Number Date: Name of assessor: Task: No. of employees that coduct this task How log is the task typically udertake for: a) without a break b) i a typical shift (excludig breaks) How frequetly is the task udertake (eg. daily, weekly): Other tasks udertake by worker that may pose risk of ULDs (iclude worksheet referece umbers): What had tools are used i the task: Task descriptio: 1 Repetitio For 2 cosecutive hours per work day: 1.1 Does the task ivolve repeatig the same movemets every few secods? 1.2 Is there a cycle or sequece of movemets that is repeated twice per miute or more OR More tha 50% of the task ivolves performig a repetitive sequece of motios? 1.3 Are the wrists/hads/ figers used itesively? 1.4 Is there repetitive shoulder/arm movemet (ie regular arm movemet with some pauses or almost cotiuous arm movemet?) 1.5 Are tools used that require repetitive figer or thumb actio? A Cycle is a sequece of actios of relatively short duratio that is repeated over ad over, ad is almost always the same. A cycle is ot ecessarily associated with oe sigle joit movemet, but also with complex movemets of oe or more parts of the body. Yes No Describe ay problem(s) ad probable cause(s): Describe what the perso is doig eg. had operatio of drill 10 times per miute. Performed 3 hours per day, five days per week. Describe ay risk cotrol optios you have idetified Cotrol optios (ot exhaustive list) Reduce repetitio: Mechaise or automate repetitive fuctios Use power ratchet tools Remove machie or other pacig Restructure task (Job desig) Remove or moitor piecework schemes Reduce duratio: Implemet job elargemet Esure adequate breaks Implemet job rotatio Limit/cotrol overtime Upper limb disorders i the workplace Page 52 of 89

53 Health ad Safety 2 Workig posture Figers, hads ad wrist 2.1 Is the wrist bet repetitively up ad/or dow? 2.2 Is the wrist held i a positio that is bet upwards or dowwards? 2.3 Are the figers grippig or used while the wrists are bet? 2.4 Is the wrist bet repetitively to either side? 2.5 Is the wrist held bet to either side? 2.6 Are the hads repetitively tured or twisted so that the palm is facig up or dowwards? 2.7 Are the hads held with the palms facig up or dow? 2.8 is a wide figer ad/ or had spa eeded to grip, hold or maipulate items? 2.9 Do static postures of the figers, had or wrist occur, for more tha two cosecutive hours per workig day? 2.10 Are there tools, equipmet ad/or work pieces that are poorly shaped ad/or do ot fit the had comfortably? 2.11 Are there ay tools, had held equipmet or work pieces that are too large or small to be gripped easily? 2.12 Are tools desiged for right haded use oly? Remember: the greater the deviatio from a eutral positio, the greater the risk. Yes No Describe ay problem(s) ad probable cause(s): Note problem postures ad idetify parts of the upper limb ivolved. eg. Static grippig posture used for up to 2 hours at a time, wrists repetitively bet sideways whe drillig objects. Describe ay risk cotrol optios you have idetified Cotrol optios (ot exhaustive list) Optimise workig posture: Modify operatio or productio method Relocate equipmet or items Preset work items differetly Reduce amout of maipulatio required Esure equipmet accouts for differeces i worker size, shape ad stregth Esure workig heights are appropriate Esure items are withi reach distaces Provide suitable (ad adjustable) seatig Use fixtures/jigs After tools or cotrols Esure tools are suitable for task Esure tools do ot require awkward postures Upper limb disorders i the workplace Page 53 of 89

54 Health ad Safety 3 Workig posture Arms ad shoulders 3.1 Is work performed above the head or with the elbows above the shoulders for more tha 2 hours total i a workig day? 3.2 Does the task ivolve repetitively movig the upper arms out to the side of the body? 3.3 Does the task ivolve holdig the upper arms out to the side of the body without support? 3.4 Do static postures of the shoulder or elbow occur, for more tha two cosecutive hours per work day? 3.5 Does the work ivolve ay other postures such as: Awkward forward or sideways reachig? Awkward reachig behid the body? Awkward reachig across the body? Remember: the greater the deviatio from a eutral positio, the greater the risk. Workstatio layout ad workig height ca be a major ifluece o workig postures Yes No Describe ay problem(s) ad probable cause(s): Note problem postures ad idetify parts of the upper limb ivolved. eg. Shoulder held i fixed positio with elbow out to the side for up to 2 hours at a time. This is due to the work height. Describe ay risk cotrol optios you have idetified Cotrol optios (ot exhaustive list) Optimise workig posture: Automate or mechaise Modify operatio or productio method Relocate equipmet or items Preset work items differetly Reduce amout of maipulatio required Esure workplaces ad equipmet accout for differeces i worker size, shape ad stregth Esure workig heights are appropriate Esure items are withi reach distaces Provide suitable (ad adjustable) seatig Use fixtures/jigs Alter tools or cotrols Esure tools are suitable for task Esure tools do ot require awkward postures Provide arm support for precisio work Upper limb disorders i the workplace Page 54 of 89

55 Health ad Safety 4 Workig posture Describe ay problem(s) ad probable cause(s): Note problem postures ad idetify parts of the upper limb ivolved. eg. eck held i fixed bedig positio to see screw holes. Describe ay risk cotrol optios you have idetified Cotrol optios (ot exhaustive list) Head ad eck 4.1 Does the task ivolve repetitively bedig or twistig the eck? 4.2 Does the task ivolve holdig the eck bet ad/or twisted for more tha 2 hours total per workig day? 4.3 Do the visual demads of the task require the worker to view fie details ad adopt awkward positios? 4.4 Do aspects of lightig such as dim light, shadow, flickerig light, glare ad/or reflectios cause the worker to adopt awkward postures? Remember: the greater the deviatio from a eutral positio, the greater the risk. Yes No Optimise workig posture: Esure visual requiremets are ot too demadig Provide visual aids Esure lightig is suitable Repositio items that workers are required to look at Upper limb disorders i the workplace Page 55 of 89

56 Health ad Safety 5 Force Describe ay problem(s) ad probable cause(s): eg. Drill hadle is too small resultig i icreased grippig force for up to 4 hours per day. Also high force applied to screws 5.1 Does the task require repetitive or static applicatio of force? 5.2 Is it a pich grip beig used repetitively or statically for more tha two hours total per work day? 5.3 Does the worker use the grip of the figer, thumb or had as a pressig tool? 5.4 Do tools require the applicatio of pressure o a trigger or butto? 5.5 Does the had apply force by twistig objects/ tools or squeezig items? For the had/ wrist, high-force tasks are those with estimated average idividual had force requiremets of 4 kg or above. For example, pichig a usupported object weighig 0.9 kg (2 lbs) or more per had, or usig a similar pichig force (eg holdig a small bider clip ope). Yes No Describe ay risk cotrol optios you have idetified Cotrol optios (ot exhaustive list) Optimise workig posture: Reduce forces ecessary Use power tools Ca the fuctio be achieved differetly? Use jigs to hold items Reduce weight of items Preset items differetly Icrease mechaical advatage After task to use stroger muscles Use foot pedals If gloves used check that they are appropriate Maitai tools Esure tools are suitable for task Improve hadles Use light weight tools Use tool couterbalaces Esure tool hadles fit workers comfortably 5.6 Is the had or wrist used as a hammer? 5.7 Is force beig applied whe the wrists are bet ad/or with the arms raised? 5.8 Does the task require the wearig of gloves which affect grippig? 5.9 Do ay objects, work pieces, tools or parts of the workstatio impige or create localised pressure o ay part of the body? Upper limb disorders i the workplace Page 56 of 89

57 Health ad Safety 6 Workig eviromet Describe ay problem(s) ad probable cause(s): eg. Workers exposed to had vibratio from drill up to 4 hours per day. Workers 6.1 Are vibratio exposures likely to regularly exceed HSE s recommeded actio level of 2.8 m/s 2 A(8)? Yes No have cold air blowig o hads from exhaust. Describe ay risk cotrol optios you have idetified Cotrol optios (ot exhaustive list) Improve the workig eviromet: - impulsive tools (chippig hammmers, eedle gus, hammer drills, etc) may exceed HSE s recommeded actio level after oly a few secods use per day ad are highly likely to exceed the actio level after 30 miutes use per day - Rotary tools (griders, saders, etc may exceed HSE s recommeded actio level after oly a few miutes use per day ad are highly likely to exceed the actio level after 2 hours use per day 6.2 Do tools create or trasmit jerky actios, shock or torque (twistig)? 6.3 Does the task ivolve workig i cold or i draughts, particularly with cold air blowig over the hads? 6.4 Does the task ivolve holdig cold tool hadles, work items or other cold objects? Use alterative process(es) Select alterative lower vibratio equipmet Use balacers/ tesioers Maitai equipmet Reduce exposure time to vibratio Provide iformatio ad traiig Coduct health surveillace Avoid workig i cold Avoid hadlig or isulate cold items or tools Redirect blowig air Use warm clothig Upper limb disorders i the workplace Page 57 of 89

58 Health ad Safety 7 Psychosocial factors (These factors are best dealt with through discussio with workers. Sesitivity may be required) 7.1 Is the work placed? ie machie or team sets the pace, or the work rate is otherwise ot uder the worker s cotrol? 7.2 Is there a system of work, or piecework, which ecourages workers to skip breaks or to fiish early? 7.3 Do workers fid it difficult to keep up with their work? 7.4 Do workers feel that there is a lack of support from supervisors or co-workers? 7.5 Is there overtime/shiftwork that is uplaed, umoitored ad/or ot orgaised to miimise risk of ULDs? 7.6 Do the tasks require high levels of attetio ad cocetratio? 7.7 Do the workers have little or o cotrol over the way they do their work? 7.8 Are there frequet tight deadlies to meet? 7.9 Are there sudde chages i workload, or seasoal chages i volume without ay mechaisms for dealig with the chage 7.10 Do workers feel that they have bee give sufficiet traiig ad iformatio i order to carry out their job successfully? Yes No Describe ay problem(s) ad probable cause(s): eg. Workers are o piecework system. Support from supervisio ad co-workers is low. Describe ay risk cotrol optios you have idetified Cotrol optios (ot exhaustive list) Reduce force: Reduce mootoy Esure reasoable workload ad deadlies Esure good commuicatio ad reportig of problems Ecourage teamwork Moitor ad cotrol overtime ad shiftwork Reduce or moitor productivity relatedess of pay systems Provide appropriate traiig 8 Idividual differeces Describe ay problem(s) ad probable cause(s): eg. No system for gradual retur to work 8.1 Are ay workers potetially at icreased risk of ULS due to: beig ew employees or returig to work after a log break; differeces i competece ad skills; beig part of vulerable groups such as older, youger workers, ew or expectat mothers; disability ad health status. Yes No Describe ay risk cotrol optios you have idetified Cotrol optios (ot exhaustive list) Improve the workig eviromet: Allow for a gradual build up to full productio speed Provide suitable traiig to develop the skills required Seek advice o special requiremets Upper limb disorders i the workplace Page 58 of 89

59 Health ad Safety REMEMBER TO CONSIDER HOW THE RISK FACTORS INTERACT WITH EACH OTHER (eg are forces repetitively i awkward posture etc) ACTION PLAN Worksheet referece Cotrols to be implemeted Priority Who is resposible for implemetig cotrols? Target implemetatio date Date of re-evaluatio Upper limb disorders i the workplace Page 59 of 89

60 Health ad Safety Suggestios for reducig the risk *This is ot a exhaustive list. Iovative ideas for cotrollig risks are ofte devised by workers or those familiar with the task. Reducig repetitio Geerally Automatio ad mechaisatio Tools Job desig Job elargemet Rest breaks Job rotatio Overtime Reduce the umber of repetitive movemets ad the rate at which they are made, especially where these are combied with applyig force ad/or i awkward postures. Limit the duratio of cotiuous work or restructure work methods to provide greater variety. Ca machiery do the highly repetitive fuctios more varied jobs for the workers (Take care to avoid creatig repetitive, borig ad mootoous tasks to feed the machiery with work). Avoid pacig of the work. Automated machiery ad team workig ca all act to icrease the work rate. Aim to allow people to cotrol their ow pace of work. Use power tools i place of maual tools. Use maual tools with ratchet devices to reduce the umber of movemets required, eg screwdrivers or spaers (see also Tools ). Break up log periods of frequet repetitios ad static iactivity or spread repetitios across both hads. Share repetitive work through teamwork or job rotatio. Distribute the workload over differet muscle groups ad joits. Cosider addig extra activities to the job to provide variety i posture ad speed of work. Breaks, before the oset of fatigue, are importat. Cosultatio with workers may help to set a adequate work rest ratio or alteratively allocate times whe workers should rotate from a specific task. Icrease the frequecy of breaks. Frequet short breaks are preferable to a few log oes. Rotate the worker to perform other tasks, which varies body part actio ad speed. Remember that rotatig to a task that utilises the same parts of the body ad presets the same risk factors for ijury as the origial task will ot provide rest periods for the parts of the body that are at risk of ULDs (see also Job rotatio i Reducig duratio ). Place a limit o or moitor overtime ad provide sufficiet rest breaks to accout for prologed exposure. Upper limb disorders i the workplace Page 60 of 89

61 Health ad Safety Optimisig work postures Poor workstatio ad equipmet desig is usually resposible for postural problems leadig to ULDs. There are a umber of methods for reducig postural problems. Geerally Workstatio ad tool desig Work orgaisatio ad job desig Presetatio/ orietatio of work items Seatig Reach distaces Eable work to be doe with the joits at about the mid poits of their rage of motio. Reduce the time spet holdig ad/or repeatig awkward postures. Avoid usig static postures for prologed periods. Cosider the locatio, agles ad height of equipmet, cotrols or work pieces i relatio to the operator. Modify to improve posture. Esure workplaces ad work equipmet are desiged or selected to accout for differece i size, shape ad stregth of workers. Alter tool desig to improve wrist posture. Ca chages be made upstream of the job? ie does the task really have to be like this, or ca alteratios i the process elsewhere mea that items do ot have to be assembled/preseted i this way? Ca the sequece be chaged to make the task less awkward? Cosider positio of the work, ad the use of fixtures ad jigs to agle ad hold work i more accessible positios. Cosider how the body will iterface with the equipmet. Are there objects or attachmets that act as obstacles ad lead to poor posture? Esure seats are adjustable. Esure that there is sufficiet space to eable workers to make effective use of the adjustable features of their chairs. Do workers kow how to adjust their chairs? Esure that there is sufficiet leg space for the worker to stretch ad make chages i leg ad foot posture. Cofied leg space ca costrai overall body posture. Place equipmet ad materials withi primary reach zoes keepig repetitive reachig as close as possible to the body ad always withi 450 mm of the frot of the operator. Figure 12 illustrates how the most frequetly used items have bee positioed withi ease of reach areas of the worker. Upper limb disorders i the workplace Page 61 of 89

62 Health ad Safety Figure 12 For further iformatio o reach distaces, workig zoes ad seatig refer to Seatig at work. 44 Workig height Ca the height, agle ad positio at which the work is beig coducted be chaged to improve visibility of the task? Seated workstatio tables should accommodate the largest users. Platforms, adjustable chairs ad footrests ca be used by smaller users to achieve optimal workig height. Stadig workstatios should be used for jobs that require a lot of body movemet ad greater force. Figure 13 The most suitable workig height depeds upo the ature of the task beig performed (See Figure 13) Maipulative tasks (ivolvig a moderate degree of both force ad precisio): table height should be mm below elbow height. Precisio tasks (icludig writig): table height should be from mm above elbow height. Heavier tasks (particularly if they ivolve dowward pressure to be applied o the work piece): table height should be from mm below elbow height. The dimesios above are merely geeral guidelies ad ca be applied to both seated ad stadig work tasks. Give that idividuals differ sigificatly i their build, elbow height, as a referece poit will vary Upper limb disorders i the workplace Page 62 of 89

63 Health ad Safety cosiderably from perso to perso. I additio, differet types of tasks may require sigificatly differet workig height. It is therefore recommeded that adjustable height surfaces be provided wherever possible. (It is ot always the work surface height that has to be altered; platforms ca be used to alter the effective height). Sit/stad workstatios eable workers to vary their workig posture. For sit/stad workstatios provide appropriate ad adjustable chairs, adjustable tables or stadig platforms. (See Figure 14). Figure 14 Arm support Visio ad lightig Reducig force Geeral Work orgaisatio ad job desig Provide support to the arms whe they are raised if possible, ad whe precisio work is beig performed. Provide purpose built supports where eeded to improve comfort ad workig posture. Cosider providig visio aids, if applicable, such as magifyig glasses. Esure that lightig is suitable ad adequate for the work udertake. Reduce forces required, especially whe applied i combiatio with poor postures, eg use weaker sprigs i triggers, ad use other power sources rather tha muscle power. Reduce frequecy with which force eeds to be applied (see also Reducig repetitio ). Reduce time spet applyig force. This especially relates to static forces beig applied ad sustaied for steadyig or supportig items or grippig tools. Exertig excessive force ofte results from iappropriate workig height for the task. For appropriate workig heights refer to Optimisig workig postures. Cosider why high forces are ecessary. Is it because of ill-fittig compoets, lack of maiteace or heavy items? Ca this be addressed upstream of this job? Through better maiteace? By reducig the weight of items, Upper limb disorders i the workplace Page 63 of 89

64 Health ad Safety eve those that are ot lifted, but simply moved or accelerated maually. Presetatio/ orietatio of work items Distribute force ad eable stroger muscle groups to be used Mechaical advatage Gloves Tools Cotact force or localised pressure Reducig duratio Geerally Job rotatio Cosider alterig the positio or pieces or tools so that ay force ca be applied more easily ad efficietly ie improve the posture of the workers whe applyig forces (See Awkward posture ). Ca foot pedals be used to provide force? Distribute force requiremets over several figers rather tha oe. Allow operators to use alterate hads to operate cotrols. Provide some meas of icreasig mechaical advatage, such as loger levers, or other meas of mechaical assistace. Select appropriate gloves. Poor glove desig or iappropriate choice of gloves or glove sizig ca lead to poor sese of touch ad icreased effort i grippig. Use light weight tools or provide supports, jigs or couterbalace devices. Had tools should ot require excessive force or have hadles that are too large or small. They should ot exert pressure or dig ito the had. (For more iformatio see Tools ). Keep cuttig edges sharp ad movig parts appropriately lubricated. If there are sharp or hard cotact poits betwee equipmet ad workers cosider removig, flatteig or levellig. Allow for short breaks i work. Develop a work/rest regime which provides sufficiet time for recovery. Moitor ad maage overtime workig. Cosider job elargemet, job rotatio. Job rotatio has the potetial to reduce duratio of exposure. Remember that rotatig to a task that utilises the same parts of the body, ad presets the same risk factors for ijury, as the origial task will ot provide rest periods for parts of the body that are at risk of ULDs. Whe job rotatio is itroduced be aware of the followig: traiig may be required to give the workers the ecessary skills; skills used o oe task may iterfere with those o subsequet tasks ad therefore, time for readjustmet betwee tasks may be ecessary; Upper limb disorders i the workplace Page 64 of 89

65 Health ad Safety time may be eeded to allow workers to get used to each job i the rotatio sequece; rotatio may have oly a superficial impact upo risk exposure. I practice, the same level of physical demad may remai eve though it appears to be quite differet. Eviromet Vibratio Visio ad lightig Temperature ad vetilatio Psychosocial Job cotet Use low vibratio equipmet. Esure that tools are well maitaied so as to reduce excess vibratio. Purchase tools with vibratio dampig or add vibratio dampig to existig tools. 45 Miimise the amout of time that workers are usig vibratig tools. Ati-vibratio gloves ca be appropriate i some situatios, however their impact o grip stregth ad type must be cosidered. Esure workers are traied i the risks associated with vibratio. Esure task illumiatio is at a level that allows the worker to comfortably view the work piece without squitig or alterig their posture. Shadows or reflectios, flickerig lights ad glare should also be cotrolled as they ofte cause people to adopt awkward postures. All light sources should be regularly maitaied. Thermal coditios i the workplace should be such that all workers are reasoably comfortable regardless of seasoal variace. Avoid positioig workstatios i the viciity of air vets as draughts may cause musculoskeletal discomfort. Where possible esure that tools ad products hadled by workers are ot uduly cold. Reduce mootoous aspects, rotate workers betwee tasks. Esure reasoable workloads assess speed of productio. Ivolve employees i determiig workload. Esure a good climate of commuicatio. Esure task clarity clear performace requiremets, feedback o performace ad lies of reportig. Ecourage teamwork. Moitor ad maage overtime workig. Overtime icreases duratio of exposure ad decreases the time for recovery. There should be a break before startig overtime. Upper limb disorders i the workplace Page 65 of 89

66 Health ad Safety Work pressures Tools Selectio Size Hadle desig Esure pay does ot relate directly to productio. Bous systems ad job-ad-fiish ca icrease the risks because they ecourage people to work beyod their atural capacity. If there is a bous system, try to reduce the extet of productivity relatedess, aim for a balace betwee bous systems ad workload. Esure a good climate of commuicatio. Develop a appropriate work rest schedule. Allow for short breaks or micro pauses i work schedules. Allow a gradual build up to full productio speed, for example, whe ew workers start ad whe people retur from absece. Allow time for maiteace of tools, sharpeig etc. I selectig tools, a trial period with several workers is recommeded. The purchaser should also have some kowledge of the task for which the tool will be used prior to selectio. It should be possible to use the tool i either had or provide a specific tool for left haded workers. Cosider differeces i male ad female had sizes, ad the effect of wearig gloves. Tools like pliers should ot require a wide had spa, aroud 60 mm is good. Tool hadles should eable a straight wrist posture (hadshake) ad avoid awkward had ad wrist postures. Esure hadles are log eough to fit the whole had i a power grip. Avoid rigid hard surfaced hadles, sharp edges or arrow hadles that place localised pressure o the had. Figure 15 Force Where ot used as a safety device (ie dead ma s hadle ) triggers ad switches should ot require cotiuous applicatio of force. Provide trigger locks where operatio is sustaied (for more tha about 30 secods). The operatig force should be as low as possible. Triggers should eable operatio by more tha oe figer. Retur sprigs i cuttig tools ad pliers ca help, but esure the sprig resistace is ot too great. Upper limb disorders i the workplace Page 66 of 89

67 Health ad Safety Weight Should be miimised, especially for precisio work. Aim for aroud 1.5 kg ad o more tha 2.3 kg for power tools. Susped the tool or use couterbalaces. Figure 16 Vibratio Purchase low vibratio equipmet. Esure that tools are well maitaied. Ask tool suppliers for vibratio data related to how you will use the tool ad for advice o safe use, eg daily maximum useage time. Keep tools well maitaied to retai lowest vibratio performace ad keep sharp. Blut tools are less effective ad mea loger exposure time for the operator. 45 Figure 17 Illustrates vibratio ad optimal wrist posture Upper limb disorders i the workplace Page 67 of 89

68 Health ad Safety Appedix 3: Medical aspects of upper limb disorders (ULDs) 1 This sectio provides outlie details for a rage of disorders that medical practitioers commoly diagose. It is ot iteded to be a defiitive medical referece for such disorders or a method of self-diagosis. It also gives guidace o the health maagemet of ULDs, coverig issues such as treatmet ad rehabilitatio ad occupatioal health support. Health maagemet is a importat aspect of the overall maagemet of ULDs i your workplace. Itroductio 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. The limb ca be thought of as a mechaical system made up of rigid liks, (the boes), movig at joits, which are held together by ligamets ad surroudig tissues (capsules). Muscles are attached to these boes by tedos, which trasmit the force produced durig muscle cotractio across a joit, resultig i movemet of the boe ad the limb segmet, to which the muscle is attached. 3 Muscular activity ca be either static or dyamic. Static effort is used to support or positio the limb ad hold it i space. Dyamic effort results i movemet. For example, whe cuttig a piece of wood oe arm is moved to cut the wood ad hold the saw, while the other works statically i holdig ad steadyig the wood. Movemets deped o a complex patter of muscle activatio. The eergy eeded for muscle actio comes through the blood supply, which also removes waste metabolic products. Tedos are smooth ad slippery ad i places are covered by syovial tissue. This produces a fluid to lubricate movemet ad is particularly foud i may of the tedos of the wrist ad had. 4 Various theories exist to explai how upper limb disorders arise withi the tissues ad oe recogised model details the iteractio of exposure, dose, respose ad capacity The pathophysiological processes ivolved may iclude disruptio ad deformatio of tissue structures as a result of physical loadig or compressio, chages i the metabolism of muscle ad other tissues, or the effect of factors such as ifectio, iflammatio, degeeratio ad the immue respose. Persoal factors such as age, sex, pregacy, geetics, body shape, medical history, utritioal status, persoality ad behaviour also have a ifluece o presetatio, progress ad recovery. ULD complaits 6 Symptoms ad sigs associated with ULDs iclude the followig: pai; ache or discomfort; tederess; swellig. Upper limb disorders i the workplace Page 68 of 89

69 Health ad Safety 7 Abormal sesatios that may occur are: umbess; tiglig; pis ad eedles; burig sesatio; feelig of warmth; cramp. 8 Other observatios may iclude: stiffess; impairmet of movemet; weakess; reduced grip; muscle spasms. 9 Sigs of ULDs ca be miimal or abset at examiatio but this may deped o the experiece of the health professioal i examiig the musculoskeletal system. Guidace is available to assist doctors i the assessmet of symptoms ad sigs Sigs that ca be detected might iclude: a appearace of swellig or deformity; chages i ski colour; tederess o touchig the affected part; a sesatio of cracklig (called crepitus) whe tedos are moved; touchig particular area of ski may precipitate symptoms. If these are elicited the areas may be referred to as trigger poits; joit movemet may be restricted ad paiful; loss of muscle power may be see i fuctios such as graspig ad grippig; the respose to stimulatig the ski may be reduced or lost (loss of sesatio to touch). 11 Upper limb disorders fall ito oe of two broad categories, those coditios that are recogised as discrete diseases with characteristic features, ad ospecific pai sydromes where it is ot possible to defie a specific uderlyig cause for the pai, which is the pricipal characteristic feature of the disorder. Recogised medical diseases 12 These ca be grouped by the mai aatomical structures ivolved as the followig examples show: tedo-related disorders: teosyovitis, DeQuervai s disease of wrist, tediitis, trigger figer, epicodylitis; erve-related disorders: Peripheral erve etrapmet (media, radial, ular erves); muscle-related disorders: writer s cramp; eurovascular disorders: The sesorieural ad vascular compoets of the had-arm vibratio sydrome; joit related disorders: osteoarthritis, shoulder capsulitis, gaglio; soft tissue disorders: beat had, beat elbow, Dupuytre s cotracture. Upper limb disorders i the workplace Page 69 of 89

70 Health ad Safety 13 These coditios are usually diagosed by the ature of oset ad progressio over time, of certai symptoms ad the presece of cliical sigs o examiatio. The essetial defiig features of a rage of commo ULDs have bee detailed ad the criteria for idetificatio agreed at a cosesus medical coferece I the process of a cliical assessmet, some special tests may be required to check for geeral medical coditios or to cofirm the diagosis, eg blood tests for evidece of rheumatic disease or edocrie disturbace, or a urie test for diabetes. Occasioally specialist cofirmatory tests are required, eg electrical tests of erve coductio or muscle fuctio, or imagig tests such as X-rays, boe sca, or Magetic Resoace Imagig (MRI). No-specific pai sydromes 15 I may idividuals a specific disease might ot be idetifiable ad the the appropriate descriptor to use is the mai symptom complait ie pai ad its aatomical locatio. No-specific arm pai ca be compared with ospecific low back pai (LBP), where it is also ot possible to precisely defie a specific uderlyig cause for the pai. Such o-specific pai sydromes are o less real tha the discrete coditios ad the impact o fuctio may be equally severe. Medical equiry should cosider such features as: site ad time of oset of pai; character, itesity, frequecy, duratio ad radiatio of pai; precipitatig factors; provokig, relievig factors; ifluece of rest ad activity (work, home, leisure); associated symptoms; psychosocial factors. 16 Most of us will experiece arm pai at some time ad for the majority it will be a brief self-limitig episode ad ot idicative of serious harm. However i situatios where pai does ot improve with rest, if it is disturbig sleep, recurrig or persistig i ature the medical advice should be sought. 17 I a miority it ca be said that pai itself becomes the disease rather tha beig solely a symptom of disease. This is thought to arise because the stimulus of pai has the potetial to make the ervous system more resposive to further stimulatio, a process kow as eural sesitisatio. This mechaism uderlies the developmet of prologed ad progressive symptoms i some people, where arm pai becomes severe ad chroic, with impaired use of the limb ad the developmet of a permaet disability. This may be difficult to treat ad is likely to require a trial of a combiatio of itervetios icludig behavioural therapy. The ratioale of early assessmet, advice, appropriate treatmet where idicated, ad adjustmets to work, should assist i prevetig, or at least reducig the impact of such cases ad reduce the burde of ill health. Upper limb disorders i the workplace Page 70 of 89

71 Health ad Safety A A-Z of upper limb disorders Disorder Descriptio Associatio with occupatioal activity* BURSITIS/CELLULITIS (beat elbow, beat had) CARPAL TUNNEL SYNDROME CRAMP OF THE HAND CUBITAL TUNNEL SYNDROME DE QUERVAIN S DISEASE A distesio of the fluid sac (bursa) ad/or ifectio of the subcutaeous tissues. The bursa ad the overlyig ski may also become ifected. Beat had is a ifectio i the palm of the had. Redess, heat, swellig ad pai at relevat aatomical site. A peripheral erve disorder resultig from compressio of the media erve as it eters the palm of the had. Tiglig, umbess, tederess ca occur several hours after activity ad appear i the parts of the had iervated by the media erve, (maily i the thumb, idex, middle ad side of rig figer). Characteristic itesificatio at ight ad relief gaied by hagig the arm over the side of bed. Weakess of grippig ad clumsiess. A focal dystoia, which affects the cotrol ad co-ordiatio of muscle activity. Spasm of the muscles i the had or forearm is observed. This ofte occurs whe iitiatig specific movemets ad the effect may impair the use of the etire limb. It geerally prevets the iteded actio from beig performed. Durig a episode there may be stiffess or tightess i the had. A peripheral erve disorder resultig from compressio of the ular erve at the elbow. It causes medial elbow pai ad tederess ad umbess ad tiglig i the rig ad little figer. There may be weakess of movemet of these figers, impaired grip ad clumsiess. A localised swellig ivolvig two tedos that move the thumb ad which pass through a fibrous tuel i the wrist. Activity related discomfort is experieced over the radial aspect of the wrist ad forearm. Use of the had ad thumb for graspig becomes icreasigly paiful. Associated with repeated (beat elbow, beat had) local trauma from prologed leaig, or pressure, frictio over elbow. Use of had tools eg hammers ad shovels, together with abrasio from dirt/dust. Associated with; - highly repetitive work; - forceful work; - had arm vibratio. Strog associatio with a combiatio of risk factors eg force, repetitio ad posture. Associated with prologed periods of repetitive movemets of the figers, had or arm. Associated with direct pressure or trauma. Associated with; - repetitio; - force; - posture. Strog associatio with a combiatio of these risk factors. Ca be associated with direct trauma of the radial aspects of the wrist. * These associatios are derived from the NIOSH review of the epidemiological literature of relevat authors. 7 Upper limb disorders i the workplace Page 71 of 89

72 Health ad Safety DUPUYTREN S CONTRACTURE EPICONDYLITIS (Teis/ Golfer s elbow) GANGLION OSTEOARTHRITIS A thickeig of the tissue below the ski i the palm of the had which results i a progressive cotracture appearig, especially of the rig ad little figer of oe or both hads. It is a pailess thickeig, possibly with a palpable odule i the palmar crease. Oe or more figers ca curl up ad caot be straighteed. A degeeratio or iflammatio of the short tedoous. attachmets from the forearm muscles to the boe at the elbow. O the iside of the arm these attach at the medial epicodyle ad o the outside at the lateral epicodyle. Local tederess is felt at the attachmet of the tedo ad is commoly kow as teis elbow (lateral epicodylitis) or golfers elbow (medial epicodylitis). Pai ca radiate ito the forearm ad is activity depedat. There may be weakess of grip. A cyst filled with syovial fluid arisig from a joit or tedo sheath ad usually foud o the back of the had or wrist. The swellig ca vary i size ad be tese ad firm or soft ad squeezable ad is usually pailess. A disturbace i the smooth articular cartilage surfaces which lie joits, with associated chages i the surroudig boe, icludig boy overgrowth. This ca affect ay articulatig joit, which i the upper limb icludes those i the eck, shoulder, elbow, wrist, thumb ad figers. Symptoms iclude stiffess ad achig pai o movemet of the affected joit. Pai may radiate from eck ito the arm (kow as referred pai). There may be limitatio i the full rage of joit movemet ad boy swelligs. Sometimes there is a gratig oise o movemet (crepitus). No geerally accepted associatios Associatios with forceful work activities. Strog associatio with combiatios of risk factors; force, repetitio, posture. No geerally accepted associatios Occupatioal exposures may modify this disease process. Upper limb disorders i the workplace Page 72 of 89

73 Health ad Safety ROTATOR CUFF TENDINITIS BICIPITAL TENDINITIS SHOULDER CAPSULITIS (Froze shoulder) STENOSING TENOSYNOVITIS (Trigger figer/thumb) TENOSYNOVITIS VIBRATION WHITE FINGER A iflammatio or degeeratio of the tedos i the regio of the shoulder joit. Symptoms are achig ad pai i the shoulder which may be provoked by lyig o the affected side at ight. There is limitatio of certai shoulder movemets depedet o what tedo is affected. I bicipital tedoitis pai is experieced i the frot of the shoulder ad o raisig the arm i frot. A iflammatio or degeeratio of shoulder joit tissue. There is a gradual oset of stiffess ad pai i the shoulder which is more severe at ight ad with icreasig restrictio i all shoulder movemets. A tedo sheath swellig i oe of the tedos that cross the palm of the had ad ru dow the palmar surface of the figer/thumb. This restricts tedo movemet through a fibrous rig termed a pulley. Triggerig, clickig or catchig felt o straighteig the figers or thumb ad is ofte worse i the morig. A teder odule is felt i the palm just beyod the base of the figer. A iflammatio of tedo sheaths at the wrist. Achig ad pai is felt i the affected tedo which is worse o movemet. Usually there is local tederess ad swellig. The overlyig ski may appear red ad warm with a gratig feelig felt over the tedo (crepitus) durig movemet. Graspig ad pichig may be weak depedig upo the tedo affected. This is a disorder arisig from impairmet of blood circulatio i the figers ad occurs i periodic attacks usually provoked by cold. The figer/s tur white (blach) with associated umbess ad tiglig. Restoratio of blood flow results i paiful red throbbig figers. I severe cases there is blachig of most figers, co-ordiatio ad dexterity is impaired. Associated with highly repetitive work ad shoulder postures greater tha 60 degrees flexio, abductio. No geerally accepted associatios Possible associatio with overuse. Associated with; - repetitio; - force; - posture. Strog associatio with a combiatio of these risk factors Associated with exposure to vibratio trasmitted to the had ad arm from work processes Upper limb disorders i the workplace Page 73 of 89

74 Health ad Safety Treatmets ad rehabilitatio 18 Acute ULDs are geerally curable if recogised early ad accurately diagosed. Eve where symptoms have become chroic ad severe, occupatioal rehabilitatio ca be successful. The approach to most pai from acute ULDs is to rest the limb ad reduce soft-tissue iflammatio. Additioal actios may be cocered with icreasig muscle stregth, rage of joit movemet ad fuctioal capacity. 19 Oe of the most effective meas of restig the affected part is to reduce or elimiate exposure to the tasks which may have cotributed to the oset of the coditio, whether these arise i occupatioal or o-occupatioal activity, or i both settigs. A short period of complete rest may be helpful particularly if iflammatio is preset. Protracted rest should be avoided uless uder medical supervisio as this ca lead to decoditioig ad weakeig of the muscles ad associated structures. 20 Ati-iflammatory drugs ad aalgesic medicatios, pai killers, ca be take durig this time. I the short term, the use of paikillers may allow cotiuatio of work. This rus the risk, however, of exacerbatig or prologig the episode of ill health if work activity is a cotributory or aggravatig factor to a idividual s symptoms. Local areas of tedo iflammatio ca be treated with steroid ad local aaesthetic ijectios durig the period of rest. Their effectiveess is compromised if risk factors i work activities are ot also reduced or elimiated. 21 Immobilisatio by appropriate splitig or support of the symptomatic area ca be used, but this eeds to be carefully supervised as there is a risk of weakeig the limb. The regular use of supportive badagig i a workplace to assist idividuals sufferig arm pai should however be discouraged. This is ulikely to be effective treatmet o its ow, ad it idicates that there is a uderlyig problem which should be tackled. 22 Physiotherapy ad occupatioal therapy practitioers ca provide a rage of treatmets to assist with the restoratio of fuctio ad rehabilitatio. This might iclude specific exercises ad/or stretchig of muscles ad erves, joit mobilisatio, electrotherapy, ultrasoud, cold ad heat applicatios. Some experts cosider that more specialised eurodyamic techiques ca be of beefit where pai is the mai problem, although this approach remais cotroversial. Practitioers of maipulative therapies such as osteopaths ad chiropractors ca also provide treatmets ad advice o rehabilitatio ad prevetio. 23 Specialist opiio should ideally be obtaied from practitioers who have experiece i the recogitio, treatmet ad maagemet of ULDs. This could iclude physicias specialisig i rheumatology, musculoskeletal medicie, eurology, psychology, ad pai cotrol. Specialists i occupatioal medicie ca advise o workplace issues. Specialist opiio might ivolve referral to specialists i had, orthopaedic or plastic surgery or, eurosurgery. 24 Surgical optios are usually cosidered after less ivasive treatmet approaches have bee tried. How quickly after surgery a employee is able to retur to work will deped o the success of the surgery ad the postoperative recovery. The extet to which ergoomic hazards i the workplace have bee modified, ad the results of a occupatioal health assessmet are also relevat to recovery. Upper limb disorders i the workplace Page 74 of 89

75 Health ad Safety 25 Treatmet for chroic o-specific arm pai usually requires a detailed approach to be take to the idividual sufferer. A umber of itervetios are likely to be eeded to stop the progressio of symptoms, give the idividual a sese of cotrol over their pai ad avoid deterioratio i metal health. Therapeutic measures are based o a reductio of stress, by attetio to physical or psychological stresses, cousellig ad relaxatio therapies ad pai relief (tricyclic medicatio, trigger poit therapy, electrical stimulatio, ijectios aroud erves ad acupucture are possible approaches). 26 Complemetary treatmets are offered by a variety of therapists ad iclude acupucture, homeopathy, ad yoga, as examples. There is little research o which to base the selectio, or assess the effectiveess, of such therapies for maagig ULDs. Occupatioal health provisio 27 Occupatioal health broadly embraces the issues cocerig prevetio of illess from work, maagig the effects of illess at work ad promotig health. I the cotext of ULDs, occupatioal health services could assist with: idetificatio of health hazards, assessmet of risk, ad advice o cotrol methods; advice o work placemet of employees ad medical fitess for particular work duties; provisio of appropriate o-site first aid ad treatmet facilities; idetifyig causes of ill health withi the workforce ad liaiso with other health care professioals, takig accout of medical cofidetiality, ad the eed to obtai a idividual s coset; advisig o suitable health surveys, the aalysis ad iterpretatio of health data ad udertakig health related iterviews or examiatios; developig protocols for the maagemet of ULDs i the workplace icludig rehabilitatio, exercise programmes ad retur to work arragemets; advice o adjustmets to work, or workig arragemets, to support ad maitai employmet. Where to get help 28 There are various ways i which occupatioal health support might be arraged, icludig provisio of a i-house service or use of exteral providers. The larger occupatioal health services will be led by a doctor or urse ad may be part of a multidiscipliary health ad safety team. These may be private providers, public providers such as a NHS trust, co-operative groups, or group occupatioal health services. Other services come from idepedet occupatioal health physicias ad urses or from geeral practitioers ad practice urses workig i occupatioal health. Professioal bodies ca provide lists of practitioers (see Further iformatio). 29 HSE s Employmet Medical Advisory Service (EMAS) ca advise o occupatioal health services available i your local area ad ca give geeral advice o the maagemet of the health effects of ULDs i the workplace. 30 Where a idividual has a ogoig disability, assistace with workplace assessmet ad adjustmet ca be accessed through the local Disability Service Team at the Departmet for Work ad Pesios (DWP). Upper limb disorders i the workplace Page 75 of 89

76 Health ad Safety Appedix 4: Legal requiremets Geeral 1 Employers have legal resposibilities to esure the health ad safety at work of their employees, ad this icludes the prevetio of accidets ad work related ill health such as ULDs. The Health ad Safety at Work etc Act places geeral duties o employers ad others. There are also a umber of Regulatios which impose specific requiremets, ad those most relevat to the prevetio of ULDs iclude: Maagemet of Health ad Safety at Work Regulatios; 20 Workplace (Health, Safety ad Welfare) Regulatios; 47 Health ad Safety (Display Scree Equipmet) Regulatios; 5 Provisio ad Use of Work Equipmet Regulatios; 48 Persoal Protective Equipmet at Work Regulatio; 49 Maual Hadlig Operatios Regulatios; 50 Reportig of Ijuries, Diseases ad Dagerous Occuraces Regulatios 38, 39, (RIDDOR). 2 The followig paragraphs summarise those parts of the law that are particularly relevat to prevetio of ULDs. They provide pertiet iformatio o the regulatios ad associated guidace ad approved code of practice (where relevat), but does ot attempt to give a comprehesive geeral summary of each piece of legislatio. Health ad Safety at Work etc Act The Act imposes duties o everyoe cocered with work activities, icludig employers, self-employed, employees, maufacturers ad desigers. The duties are imposed both o idividual people ad o corporatios, compaies, parterships, local authorities etc. The duties are expressed i geeral terms so that they apply to all types of work activity ad situatios. 4 Sectio 2 of the Act puts a duty o all employers to esure, so far as is reasoably practicable, the health, safety ad welfare at work of all their employees. The most importat areas relate to: the provisio ad maiteace of plat (eg machiery ad equipmet), ad systems of work such that they are safe ad without risks to health; the use, hadlig, storage ad trasport of articles ad substaces at work; the provisio of iformatio, istructio, traiig ad supervisio, as ecessary; the provisio ad maiteace of a workig eviromet that is safe ad free of risks to health. 5 I additio, a duty is placed o employers, uless exempted by the Act, to prepare ad revise, as appropriate, a writte statemet of their geeral policy with respect to the health ad safety at work of employees, the arragemets for carryig out the policy, ad to brig it to the attetio of employees. This applies to udertakigs with five or more employees. Such policy statemets should, where appropriate iclude referece to arragemets i place for the prevetio of ULDs. Upper limb disorders i the workplace Page 76 of 89

77 Health ad Safety 6 Sectio 3 of the Act places duties o employers to prevet other people, who are ot their employees, beig exposed to risks to their health ad safety. 7 Sectio 7 of the Act places duties o employees to take reasoable care for the health ad safety of themselves ad of other persos who may be affected by what they do, or fail to do, at work. Maagemet of Health ad Safety at Work Regulatios These Regulatios set out broad geeral duties which apply to almost all kids of work. They place a umber of requiremets o employers to: assess the risk to the health ad safety of their employees ad to ayoe else who may be affected by their activity, so that the ecessary prevetive ad protective measures ca be idetified; the assessmet should take ito accout risks relatig to ew or expectat mothers (this is relevat because pregacy ca affect ULD risks due to hormoal chages which affect ligamets, posture, blood pressure ad cause fatigue); make arragemets for puttig ito practice the health ad safety measures that follow from the risk assessmet. This covers plaig, orgaisatio, cotrol, moitorig ad review, ie the maagemet of health ad safety; provide such health surveillace as is appropriate havig regard to the health ad safety risks which are idetified by the assessmet; appoit competet people to help devise ad apply the measures eeded to comply with employers duties uder health ad safety law (see paragraphs 39-40); give employees iformatio about health ad safety matters; co-operate with ay other employers who share a work site; provide iformatio to people workig i their udertakig who are ot their employees; make sure that employees have adequate health ad safety traiig ad are capable eough at their jobs to avoid risk; ad give some particular health ad safety iformatio to temporary workers, to meet their special eeds. 9 The Regulatios also: place duties o employees to follow health ad safety istructios ad report dager; require employers to cosult employees safety represetatives ad provide facilities for them. Cosultatio must take place o such matters as the itroductio of measures that may substatially affect health ad safety; the arragemets for appoitig competet persos; health ad safety iformatio ad traiig required by law; ad health ad safety aspects of ew techology beig itroduced to the workplace. Workplace (Health, Safety ad Welfare) Regulatios The aim of the regulatios is to esure that workplaces meet the health, safety ad welfare eeds of each member of the workforce. As well as factories, shops ad offices the regulatios cover schools, hospitals, hotels, places of etertaimet, roads ad paths o idustrial estates, ad temporary work sites (but ot costructio sites as they are covered by separate legislatio - Costructio (Health, Safety ad Welfare) Regulatios ad The Costructio (Desig ad Maagemet) Regulatios Upper limb disorders i the workplace Page 77 of 89

78 Health ad Safety 11 The Regulatios expad o employer s duties i sectio 2 of the Health ad Safety at Work etc. Act 1974, ad are iteded to protect the health ad safety of everyoe i the workplace, ad to esure that adequate welfare facilities are provided for those at work. 12 Various aspects of the workplace are covered icludig: workstatios ad seatig: workstatios should be arraged so that each task ca be carried out safely ad comfortably i terms of height of the work surface ad accessibility to ecessary items, with freedom of movemet maiteace of the workplace, ad of equipmet, devices ad systems. Equipmet should be maitaied i efficiet workig order temperature i idoor workplaces: durig workig hours the temperature i workplaces iside buildigs should provide reasoable comfort without eed for special clothig (special circumstaces apply, eg for food hadlig) lightig: this should be sufficiet to eable people to work ad use facilities. Where ecessary, local lightig should be provided at idividual workstatios. Health ad Safety (Display Scree Equipmet Regulatios) The Regulatios apply where workers habitually use display scree equipmet, such as computers, as a sigificat part of their ormal work. I terms of prevetig ULDs they require employers to: assess ad reduce risks: the mai health problems iclude upper limb pais ad discomfort; temporary visual fatigue (possibly leadig to the adoptio of awkward postures which ca cause further discomfort i the upper limbs); fatigue due to poor workstatio, tasks or eviromet desig, ad stress; esure workstatios meet miimum requiremets. I most cases the display scree should swivel ad tilt, be free of reflectios ad glare ad have a clear, stable image. The keyboard should tilt ad be separate from the scree, with legible keys. The workstatio should be sufficietly large to allow flexibility ad comfort. The work chair should be stable, comfortable, adjustable i height ad the back should adjust i height ad tilt. A footrest should be made available, if eeded. The eviromet such as space, lightig, heat ad humidity should be adequate, ad software should be suitable ad easy to use; pla breaks or chages of activity. Timig ad duratio of these are ot stipulated i the Regulatios as it depeds o the ature of the work. However breaks should be icluded i the workig time, preferably short frequet breaks away from the scree ad take before the oset of fatigue; provide health ad safety iformatio ad traiig; provide eye tests o request, ad special spectacles if required for DSE work. Upper limb disorders i the workplace Page 78 of 89

79 Health ad Safety Provisio ad Use of Work Equipmet Regulatios The Regulatios place geeral duties o employers ad list miimum requiremets for work equipmet to deal with hazards i all types of idustry. The Regulatios require employers i all idustries to esure that work equipmet is suitable for the purpose ad safe to use. Work equipmet covers everythig from a had tool, through machies of all kids, to a coected series of machies such as a productio lie. The term use icludes startig, stoppig, programmig, settig, trasportig, repairig, modifyig, maitaiig, servicig ad cleaig. The Regulatios require that work equipmet is suitable ad safe for the work carried out ad does ot pose ay health or safety risk. 15 The geeral duties require employers to: take ito accout the workig coditios ad risks i the workplace whe selectig equipmet; make sure that equipmet is suitable for the iteded use ad that it is used with suitable safety measures; esure that it is properly maitaied ad ispected as ecessary; take accout of ergoomic risks whe selectig work equipmet, (ie esure that equipmet ad operatig positios, workig heights, reach distaces etc. are compatible with the iteded operator); give adequate iformatio, istructio ad traiig o use of the equipmet before use. Persoal Protective Equipmet at Work Regulatios The Regulatios place a duty o employers to esure that suitable persoal protective equipmet (PPE) is provided to employees who may be exposed to a risk to their health ad safety while at work, i circumstaces where such risks caot be adequately cotrolled by other meas. PPE should take ito accout ergoomic requiremets of the perso who wears it ad be capable of fittig the wearer correctly. 17 A example of PPE is had ad arm protectio which is used to provide protectio agaist a rage of idustrial hazards, but which may also reduce the ability to grip ad cotribute to ULDs. Maual Hadlig Operatios Regulatios These regulatios apply to all maual hadlig tasks, ie tasks which ivolve trasportig, such as liftig, pushig, pullig or supportig a load. I work places, there are a wide rage of hadlig ad trasportig processes takig place, ragig from assembly lie work, liftig boxes, bags ad compoets, to helpig people with limited mobility with their day to day activities. The Regulatios apply to operatios which ca cause ijury ot oly to the back but may also affect all parts of the body icludig the upper limbs. 19 The regulatios place duties o the employer to: avoid the eed for udertakig ay maual hadlig operatios at work which ivolve a risk of beig ijured, so far as is reasoably practicable; where it is ot reasoably practicable to avoid risk of ijury, carry out a assessmet of the risks to take ito accout the task, load, workig eviromet ad the worker s idividual capability to carry out the task. Upper limb disorders i the workplace Page 79 of 89

80 Health ad Safety HSE guidace o the regulatios provides guidelies for liftig loads; the maximum weight depeds o factors such as height of the lift, the distace that the object is exteded from the body, whether the employee is male or female, ad whether sittig or stadig; where it is ot reasoably practicable to avoid risk of ijury, to take appropriate steps to reduce the risk of ijury from hazardous maual hadlig to the lowest level reasoably practicable. Reportig of Ijuries, Diseases ad Dagerous Occurreces Regulatios 1995 (RIDDOR) RIDDOR places a duty o employers, o the self-employed ad o those i cotrol of work premises to report certai work-related accidets, diseases, ad dagerous occurreces to the eforcig authorities (HSE or local authorities). If a doctor diagoses ad reports to a employer that a employee is sufferig from a reportable work-related disease, ad the perso cocered is curretly employed i a associated work activity, the the employer must sed, either by post or electroically via the HSE website, a completed disease report form to the relevat eforcig authority. 21 I terms of ULDs, the diseases which i specified circumstaces are reportable are cramp of the had or forearm, subcutaeous cellulitis of the had, bursitis or subcutaeous cellulitis arisig at or about the elbow, traumatic iflammatio of the tedos of the had or forearm, carpal tuel sydrome ad had-arm vibratio sydrome (although the latter is outside the scope of this guidace). Upper limb disorders i the workplace Page 80 of 89

81 Health ad Safety Refereces Refereces Cited i Text 1 Securig health together: A log term occupatioal health strategy for Eglad, Scotlad ad Wales Misc 225 HSE Books Revitalisig Health ad Safety: Strategy Statemet Jue 2000 The Statioery Office Further copies are available from Departmet of the Eviromet, Trasport ad the Regios, Free Literature Service, PO Box 236, Wetherby, West Yorkshire LS23 7NB. Tel: Fax: Website: 3 Had-arm vibratio HSG88 HSE Books 1994 ISBN Mechaical Vibratio: Guidelies for the measuremet ad assessmet of huma exposure to had-trasmitted vibratio. Part 2: Practical guidace for measuremet at the workplace First Editio ISO Display scree equipmet work. Health ad Safety (Display Scree Equipmet) Regulatios Guidace o Regulatios L26 HSE Books 1992 ISBN Workig with VDU s Leaflet INDG36(rev1) HSE Books 1998 (sigle copy free or priced packs of 10 ISBN ) 7 Berard B P ad Putz-Aderso V (editors) Musculoskeletal disorders ad workplace factors. A critical review of epidemiological evidece for workrelated musculoskeletal disorders of the eck, upper extremity ad lower back Natioal Istitute for Occupatioal Safety ad Health DHHS (NIOSH) Publicatio No Huter D The Diseases of Occupatios (Nith editio) Arold Lodo 2000 ISBN Cherry N et al Surveillace of work-related diseases by occupatioal physicias i the UK: OPRA Occupatioal Medicie (7) Cherry N et al The reported icidece of work-related musculoskeletal disease i the UK: MOSS Occupatioal Medicie (7) Mackay C et al Musculoskeletal disorders i supermarket cashiers HSE Books 1998 ISBN X 12 Work-Related Upper Limb Disorders: A Review of the Evidece Natioal Research Coucil Washigto DC Natioal Academy Press 1998 ISBN Joes J R ad Hodgso J T Self reported work related Illess i 1995: Results from a household survey HSE Books 1998 ISBN X ad Joes JR, Hodgso JT ad Osma J Self reported workig coditios i 1995 HSE Books 1997 ISBN Upper limb disorders i the workplace Page 81 of 89

82 Health ad Safety 14 Iformatio sheet 2/99/EMSU Ecoomic Impact: Revised data from Selfreported Work-related Illess survey i 1995 (SWI95) Available from HSE s Epidemiology ad Medical Statistics Uit ad HSE s website 15 Chaffi D ad Adersso G (editors) Occupatioal biomechaics (Third editio) Wiley 1999 ISBN Whitig W ad Zericke R (editors) Biomechaics of musculoskeletal ijury Leeds Huma Kietics 1998 ISBN Armstog T, Buckle P, Fie L et al. A coceptual model for work-related eck ad upper-limb musculoskeletal disorders. Scadiavia Joural of Work Eviromet & Health Buckle P ad Devereux J Work related eck ad upper limb musculoskeletal disorders Europea Agecy for Safety ad Health at Work Luxembourg 1999 ISBN Health & Safety at Work etc Act 1974 Ch 3 The Statioery Office 1974 ISBN Maagemet of health ad safety at work. Maagemet of Health ad Safety at Work Regulatios Approved Code of Practice ad guidace L21 (Secod editio) HSE Books 2000 ISBN Work related upper limb disorders; the developmet of a iteractive database HSE Cotract research report. (To be published). For further iformatio see other websites. 22 A guide to the Health ad Safety (Cosultatio with Employees) Regulatios Guidace o Regulatios L95 HSE Books 1996 ISBN Safety represetatives ad safety committees L87 (Third editio) HSE Books 1996 ISBN A guide to the Offshore Istallatios (Safety Represetatives ad Safety Committees) Regulatios Guidace o Regulatios L110 (Secod editio) HSE Books 1998 ISBN Haies HM ad Wilso JR Developmet of a framework for participatory ergoomics CCR174 HSE Books 1998 ISBN Hadle with care. Assessig musculoskeletal risks i the chemical idustry HSE Books 2000 ISBN X 27 Li G ad Buckle P Evaluatig chage i exposure to risk for musculoskeletal disorders: A practical tool CRR251 HSE Books 1999 ISBN X 28 McAtamey L et al Reducig the risks of work related upper limb disorders Istitute of Occupatioal Ergoomics Nottigham Uiversity Buckle P TUC Guide to assessig WRULD risks Trade Uio Cogress, College Hill Press Lodo 1994 ISBN Li G ad Buckle P (editors) Curret techiques for assessig physical exposure to work-related musculoskeletal risks, with emphasis o posture based methods Ergoomics (5) Upper limb disorders i the workplace Page 82 of 89

83 Health ad Safety 31 Lightig at work HSG38 (Secod editio) HSE Books 1997 ISBN New ad expectat mothers at work: A guide for employers HSG122 HSE Books 1994 ISBN A pai i your workplace? Ergoomic problems ad solutios HSG121 HSE Books 1994 ISBN Woods V ad Buckle P Research ito practice the value of case studies i reducig musculoskeletal problems i the cleaig idustry. Proceedigs Premus 2001, Fourth Iteratioal Scietific Coferece o Prevetio of Work-Related Musculoskeletal Disorders 35 Graves RJ, Siclair DT et al Developmet ad evaluatio of diagostic support aids for upper limb disorders CRR280 HSE Books 2000 ISBN Access to Medical Reports Act 1988 (c.28) The Statioary Office ISBN Cox R A et al Fitess for Work: The Medical Aspects (Third editio) Oxford Uiversity Press 2000 ISBN A guide to the Reportig of Ijuries, Diseases ad Dagerous Occurreces Regulatios 1995 L73 (Secod editio) HSE Books 1999 ISBN RIDDOR Reportig: Iformatio about the ew icidet cetre MISC310 HSE Books RIDDOR Explaied HSE 31(rev1) HSE Books Social Security (Idustrial Ijuries)(Prescribed Diseases) Regulatios 1985 The Statioery Office ISBN Health surveillace at work HSG61 (Secod editio) HSE Books 1999 ISBN X 43 Health ad safety bechmarkig Improvig together: Guidace for those iterested i applyig bechmarkig to health ad safety Leaflet INDG301 HSE Books 1999 (sigle copy free or priced packs of 10 ISBN ) 44 Seatig at work HSG57 (Secod editio) HSE Books 1997 ISBN Vibratio solutios: Practical ways to reduce the risk of had-arm vibratio ijury HSG170 HSE Books 1997 ISBN Harrigto JM et al Surveillace case defiitios for work related upper limb pai sydromes Occupatioal ad Evirometal Medicie (4) Workplace health, safety ad welfare. Workplace (Health, Safety ad Welfare) Regulatios Approved Code of Practice L24 HSE Books 1992 ISBN Upper limb disorders i the workplace Page 83 of 89

84 Health ad Safety 48 Safe use of work equipmet. Provisio ad use of work equipmet regulatios Approved code of practice ad guidace (Secod editio) HSE Books 2001 ISBN Persoal protective equipmet at work. Persoal Protective Equipmet at Work Regulatios Guidace o Regulatios L25 HSE Books 1992 ISBN Maual hadlig. Maual Hadlig Operatios Regulatios Guidace o Regulatios L23 (Secod editio) HSE Books 1998 ISBN A guide to the Costructio (Health, Safety ad Welfare) Regulatios 1996 Leaflet INDG220 HSE Books 1996 (sigle copy free or priced packs of 10 ISBN ) 52 Maagig costructio for health ad safety. Costructio (desig ad maagemet) regulatios Approved code of practice HSE Books 1995 ISBN While every effort has bee made to esure the accuracy of the refereces listed i this publicatio, their future availability caot be guareteed. Upper limb disorders i the workplace Page 84 of 89

85 Health ad Safety HSE publicatios Jackso P R ad Parker S K (editors) Chage i maufacturig: How to maage stress-related risks HSE Books 2001 ISBN Eforcemet policy statemet MISC030 HSE Books 2001 Siclair DT, Graves RJ et al Feasibility of developig a prototype decisio aid for iitial medical assessmet of work-related upper limb disorders CRR279 HSE Books 2000 ISBN Geeral vetilatio i the workplace: Guidace for employers HSG202 HSE Books 2000 ISBN Health risks from had-arm vibratio: Advice for employers Leaflet INDG175(rev1) HSE Books 1998 (sigle copy free or priced packs of 10 ISBN ) Cox T, Griffiths A, Barlow C et al Orgaisatioal itervetios for work stress: A risk maagemet approach HSE Books 2000 ISBN Power tools: How to reduce vibratio health risks - Guide for employers Leaflet INDG338 HSE Books 2001 (sigle copy free or priced packs of 15 ISBN ) Statig your busiess: Guidace o preparig a health ad safety policy documet for small firms Leaflet INDG324 HSE Books 2000 (sigle copy free or priced packs of 5 ISBN ) Successful health ad safety maagemet HSG65 (Secod editio) HSE Books 1997 ISBN McCaig R ad Harrigto M (editors) The chagig ature of occupatioal health HSE Books 1998 ISBN Thermal comfort i the workplace: Guidace for employers HSG194 HSE Books 1999 ISBN Upper limb disorders: Assessig the risks Leaflet INDG171 HSE Books 1994 (sigle copy free or priced packs of 10 ISBN ) Upper limb disorders i the workplace Page 85 of 89

86 Health ad Safety Geeral Texts Helader M A Guide to the Ergoomics of Maufacturig Taylor & Fracis 1997 ISBN Moo S D ad Sauter S L (editors) Beyod Biomechaics: Psychosocial aspects of musculoskeletal disorders at work Taylor ad Fracis 1996 ISBN Pheasat S Bodyspace: Athropometry, Ergoomics ad the Desig of Work (Secod editio) Taylor & Fracis 1996 ISBN Sluiter JK, Rest KM, Frigs-Drese MHW Criteria documet for the evaluatio of the work-relatedess of upper extremity musculoskeletal disorders Coroel Istitute for Occupatioal ad Evirometal Health, Uiversity of Amsterdam, Netherlads 2000 Putz-Aderso V Cumulative trauma disorders: A maual for musculoskeletal diseases of the upper limbs Taylor & Fracis 1998 ISBN Dul J ad Weerdmeester B (editors) Ergoomics for begiers A quick referece guide (Third editio) Taylor & Fracis 2000 ISBN Pheasat S Ergoomics, Work ad Health McMilla Press 1991 ISBN O Neil R Europe Uder Strai: A report o Trade Uio iitiative to combat workplace musculoskeletal disorders TUTB Brussels 1999 ISBN Wilso J R ad Corlett E N (editors) Evaluatio of Huma Work: A practical ergoomics methodology Taylor & Fracis 1995 ISBN Kroemer K H E ad Gradjea E (editors) Fittig the Task to the Huma (Fifth editio) Taylor & Fracis 1997 ISBN Parker S K ad Wall T D Job ad work desig: orgaisig work to promote wellbeig ad effectiveess Sage Lodo 1998 ISBN Musculoskeletal disorders ad the workplace: Low back ad upper extremities Natioal Research Coucil Natioal Academy Press 2001 ISBN Kasda M L Occupatioal had ijuries Occupatioal Medicie: State of the Art Reviews (3) Hadler N M Occupatioal Musculoskeletal Disorders (Secod editio) Lippicott Williams ad Wilkis 1999 ISBN Clark T S ad Corlett E N (editors) The ergoomics of workspaces ad machies: A desig maual (Secod editio) Taylor & Fracis 1995 ISBN Di Martio V ad Corlett N (editors) Work orgaisatio ad ergoomics Iteratioal Labour Office Geeva 1998 ISBN Kuorika I ad Forcier L (editors) Work related musculoskeletal disorders (WMSDs): A referece book for prevetio Taylor & Fracis 1995 ISBN Hutso M A Work-related upper limb disorders: Recogitio ad maagemet Butterworth-Heima 1999 ISBN Upper limb disorders i the workplace Page 86 of 89

87 Health ad Safety Govermet bodies Health ad Safety : HSE Employmet Medical Advisory Service look for details of your local HSE office i the telephoe directory or HSE web site. Departmet of Health: Departmet for Work & Pesios/Disability service team: Local Authority Evirometal Health Officers : cotact the Evirometal Health Office of your Local Authority Professioal ad Other Associatios British Chiropractic Associatio Blagrave House, 17 Blagrave Street Readig, Berkshire. RG1 1QB Tel: Web: British Istitute of Musculoskeletal Medicie 34 The Aveue Watford, Herts. WD1 3NS Tel: Web: Chartered Society of Physiotherapy 14 Bedford Row Lodo WC1R 4ED Tel: Scottish Office Tel: , Welsh Office Tel: Web: College of Occupatioal Therapists Borough High St Southwark Lodo SE1 1LB Tel: Faculty of Occupatioal Medicie of the Royal College of Physicias 6 St Adrew s Place Reget s Park, Lodo NW1 4LB Tel: Web: Geeral Osteopathic Coucil 176 Tower Bridge Road Lodo SE1 3LU Tel: Web: Istitute of Occupatioal Safety ad Health The Grage, Highfield Drive Wigsto, Leicestershire LE18 1NN Tel: Web: Upper limb disorders i the workplace Page 87 of 89

88 Health ad Safety Occupatioal Therapy i Work Practice ad Productivity c/o Specialist Sectios Officer College of Occupatioal Therapists Borough High Street Southwark Lodo SE1 1LB Royal College of Nursig 20 Cavedish Square Lodo W1M 0AB. Tel: Web: Society of Occupatioal Medicie 6 St Adrew s Place Reget s Park, Lodo, NW1 4LB Tel: Web: The Associatio of Chartered Physiotherapists i Occupatioal Health ad Ergoomics (ACPOHE) PO Box 121 Lodo E17 Tel: The Ergoomics Society Devoshire House, Devoshire Square Loughborough, Leicestershire LE11 3DW Tel: Web: The RSI Associatio Harrow Road Lodo W9 2HU Tel: Web: Other Websites Europea Agecy for Safety ad Health at Work Gra Via 33 E Bilbao Spai Tel: [email protected] Web: ad msd/ Natioal Health Service Natioal Istitute for Occupatioal Health ad Safety (NIOSH)(USA): cdc.gov/iosh/homepage.html Work related upper limb disorders: a database of court judgemets Upper limb disorders i the workplace Page 88 of 89

89 Health ad Safety Further iformatio For iformatio about health ad safety rig HSE s Ifolie Tel: Fax: Textphoe: [email protected] or write to HSE Iformatio Services, Caerphilly Busiess Park, Caerphilly CF83 3GG. HSE priced ad free publicatios ca be viewed olie or ordered from or cotact HSE Books, PO Box 1999, Sudbury, Suffolk CO10 2WA Tel: Fax: HSE priced publicatios are also available from bookshops. British Stadards ca be obtaied i PDF or hard copy formats from the BSI olie shop: or by cotactig BSI Customer Services for hard copies oly Tel: [email protected]. The Statioery Office publicatios are available from The Statioery Office, PO Box 29, Norwich NR3 1GN Tel: Fax: [email protected] Website: (They are also available from bookshops.) Statutory Istrumets ca be viewed free of charge at Published by HSE 02/10 Page 89 of 89