Our hands are one of our primary points of interaction with the world around us. We cook and clean with them, we write and eat with them, we say hello and hold onto our loved ones with them.
The frustrating irony is that this amazing tool we posses also is the part of our bodies most susceptible to injuries, and these injuries happen too frequently, particularly in the workplace. According to the most recent Bureau of Labor Statistics data, more than 274,000 hand, finger and wrist injuries occur in private industry annually.
Incurring hand and arm injuries can pose devastating consequences for workers for a variety of reasons. If the injury is severe enough that they lose function or worse yet, lose a limb, their future employment could be at risk. Not only that, but losing upper extremities means workers can't engage in the off-work activities they once found fulfilling and enjoyable.
Marji Hajic, an occupational therapist who works with hand injury patients at the Hand Health Resources clinic in Santa Barbara, Calif., cites the case of one patient who suffers from lateral epicondylitis or “tennis elbow.” The patient complains that her condition, which she incurred after 15 years as a hairdresser, does not allow her to do simple tasks for her granddaughter.
“This lady said to me, ‘I can deal with the pain at work, that's OK. But I was trying to take the foil off a pudding cup for my granddaughter the other day and it hurt so much that I couldn't do that,’” Hajic recalls.
With care, though, hand and arm injuries easily can be avoided. Following established safety guidelines and using protective guards, shields, gloves and other personal protective devices as needed not only can save a worker's hands from injury, but can save workers a lot of emotional frustration and their employers unnecessary disability claims.
Types of Hand and Arm Injuries
Aside from the head, hands and arms are the most exposed part of the body and can fall victim to a laundry list of injuries, such as:
Traumatic injuries: Hands, fingers and arms can get caught, pinched, crushed and amputated in chains, wheels, rollers, gears or other types of machinery. They can be punctured, torn or cut by spiked or jagged tools and edges that shear or chop.
Contact injuries: Hands and arms are injured through contact with solvents, acids, cleaning solutions, flammable liquids and other substances that can cause burns or injure tissue.
Repetitive motion or musculoskeletal injuries: Hands and arms become injured when tasks require repeated, rapid hand movements for long periods of time, resulting in strains and sprains of the upper extremities.
Several occupational and medical experts state that it's important to deduce why these injuries occur in the first place before mapping out a solution to reduce or eliminate them.
Dr. Michael Vender, a hand surgeon for the Arlington Heights, Ill.-based Hand Surgery Associates S.C., has seen his share of work-related hand injuries that fall under all three categories. However, when it comes to preventing acute or traumatic injuries, he claims only so much can be done.
“OSHA has been so rigorous in preventing workplace injuries that most companies have been pretty good about instituting safeguards to protect workers from cuts and amputations,” he says.
Vender claims that traumatic hand and arm injuries are still prevalent in the workplace - according to BLS, there were 99,460 cuts and lacerations and 7,990 amputations in private industry in 2005 - because workers have a tendency to take shortcuts so they can complete their tasks at a quicker pace. Protecting oneself from traumatic hand injuries like cuts and lacerations should be taken seriously, says Vender, because while they may not seem as severe as an amputation, they could turn deadly if the cut breaches an artery.
“I think workers understand the consequences of their actions, so lack of understanding and education is not the issue,” says Vender. “Some people may feel that they can go faster and be more productive if they bypass safety guards.”
Hajic, on the other hand, offers a more sympathetic view as to why workers take shortcuts or want to finish faster. “I think people feel pressured in their jobs and want to get things done quickly or they are looking for that break or they feel they have a tremendous caseload,” she explains, recommending that employers adopt the safety equipment necessary - such as machine guards or protective gloves or sleeves - to reduce the chance of hand and arm injuries.
Hajic also cautions that she wouldn't necessarily attribute these types of injuries to carelessness on the part of employees, but more so to fatigue. “Our attention wanders, especially when we are tired,” she points out.
Shortcuts Not Allowed
Taking shortcuts and bypassing safety guards, whether it's done to improve production time or because workers are fatigued or distracted and not paying attention, does not fly at the Fridley, Minn.-based metal manufacturing company E.J. Ajax & Sons, named one of America's Safest Companies by Occupational Hazards in 2007. Because the metalworking industry is at high risk for amputation hazards - according to company vice president Erick Ajax, there is one amputation a month in the state of Minnesota - the company is vigilant in making sure that its workers are following the company's detailed safety procedures.
Ajax says he covers all the bases to ensure the safety of his employees. First, he makes sure that the company's machinery - punch presses, press shears and other metal-working equipment - has the proper safeguards, which may include barrier guards such as two-hand tripping devices or sensing devices such as electric light curtains. The company also has a unique lockout/tagout procedure where they place a physical block that is disconnected from the punch press's control panel and placed in the amputation point of a machine for increased protection.
This, he says, is the best way to engineer out hazards to the hands, because with these types of machines, “there is no gray area,” no margin of error.
“If you have your hand and arm in the amputation point of the press and it cycles, it's black and white: It's amputated,” Ajax states. “We don't take any chances here. It's absolutely horrible to have to call a worker's spouse and explain their hand has been chopped off.”
He also ensures that his employees wear proper PPE, as their jobs require them to handle sharp pieces of raw metals like steel, which potentially can cause severe cuts and lacerations. Ajax notes that his choice of PPE for his employees are leather jersey gloves with a lightweight Kevlar liner inside for added protection, as well as a separate sleeve for the forearm made with the same material. (For more on PPE for hand and arm safety, see the sidebar).
E.J. Ajax's efforts in providing hand protection and promoting its use among employees has paid off: According to Eric Ajax, cuts, lacerations and amputations have been completely eliminated. But even though he has implemented all the important safeguards, he continues to remain vigilant to ensure employees don't become complacent and compromise their safety.
“If we observe employees not following our safety policies, we give them two verbal reminders on a 2-month period. If they need a third reminder, the employee will get a 1-day paid leave of absence to see if they wish to continue their career with us. After that, they are fired,” Ajax emphasizes.
Training Workers is Not Enough
Although repetitive hand injuries appear to be less severe (since they don't involve blood), they can be just, if not more, debilitating as traumatic injuries. According to Vender and Hajic, many patients who come to their clinics incurred strains and sprains while on the job.
Several factors can increase a person's risk of suffering strains, sprains or other cumulative injuries like carpal tunnel or tendonitis, but Vender explains that such injuries can happen to anyone.
“People who have a higher risk of musculoskeletal injuries are people who are out of shape or have a higher mass body index or have unhealthy smoking and drinking habits,” he says. “You see more risk with these people. Any well-tuned, healthy person can still get same conditions, [it is] just less likely.”
According to Vender, unhealthy habits “are generally bad for your body, not just your heart, but also bad for joints, bones, ligaments, tendons and nerves.”
Dr. David Rempel, M.D., professor of medicine at the University of California - San Francisco and fellow in the American College of Occupational and Environmental Medicine (ACOEM), currently is directing an ergonomics program that researches ways to redesign workplace job functions to prevent repetitive strain injuries.
One of the program's focuses is to determine whether musculoskeletal injuries are caused by repetitive hand and arm movements or by the grip or pinch force a person applies to an object.
Although the research still is ongoing, Rempel says his group believes that grip and pinch force is one of the factors driving the risk of strain and sprain injuries.
“So, if we could intervene by redesigning the tools or the task to reduce the amount of pinch or grip force the person applies in repetitive tasks, we can have a greater impact in reducing the number of musculoskeletal injuries that occur,” he says.
Rempel's group also found that simply providing proper training for job functions is not enough to reduce the risk of injury. According to Rempel, research from his team and other groups worldwide have found that training, while still worthwhile, has little or no effect in preventing musculoskeletal injuries if the work process or tools are not modified.
“This was a surprise to me and to researchers around the world since we all thought training was one of the most important factors,” says Rempel. “But by itself, it's not enough to reduce risk. You have to really go in and use different tools or design tasks differently so you can reduce those basic risk factors.”
Rempel's team already has been successful in redesigning some tools for construction workers. One job function, for example, requires workers to drill overhead into concrete, metal or cement ceilings to attach anchors for hanging pipes, duct work, cable tray and similar items. Rempel and his team designed an inverted drill press that workers can crank up to move the drill closer to the ceiling so they don't have to carry a heavy load on their shoulders or stand on ladders to do the job.
“The workers have reacted favorably to the redesigned drill,” says Rempel.
Positive Impact of Stretching and Hydration
At copper wire manufacturer Rea Magnet Wire (also a 2007 America's Safest Company), where 6.4 percent of workers experienced strains and sprains in 2002, it became obvious that certain changes needed to be made to decrease the number and severity of repetitive hand and arm injuries.
“There is not a corporation in this world that would think that number is acceptable,” says KenVandenberghe, Rea Magnet Wire's corporate EHS manager.
Alarmed by the high injury rate, Vandenberghe and the company's CEO adopted changes, such as implementing a stretching program. The organized program provides employees with a series of stretching exercises for their upper extremities, which allows the blood supply to reach working muscles and allow any acid buildup to be carried away.
“It's the buildup of acids that result in inflammation that we call cumulative trauma disorders,” Vandenberghe explains.
When compiling data for trend analysis, Vandenberghe also noticed the number of strains and sprains spiked during the summer months. As a former occupational health therapist, he theorized that when working in hot temperatures, a person's blood supply is taken away from normal working condition and instead is brought to the skin to help produce sweat, meaning muscles don't receive the blood supply they need to reduce acid buildup. In order to help workers' body temperature remain cool, Vandenberghe decided the company should make water and other liquids such as Gatorade accessible to employees.
These changes made a serious impact in the numbers of strains and sprains being reported by employees, says Vandenberghe.
“In 2007, we finished the year with a repetitive hand injury rate of 0.1, a dramatic drop,” he points out. “To help us continue to reduce the rate, we are also looking at performing ergonomic assessments to help us identify where else strains and sprains could potentially occur.”
These efforts to minimize the risks of hand and arm injuries have paid off in other ways, as well. Vandenberghe says that for the past 4 years, the company has had 80 percent savings in workers' compensation costs.
A few simple changes can reduce traumatic and repetitive hand and arm injuries, allowing employees to continue to work and enjoy their off-the-job activities while employers save on medical, rehabilitation and compensation costs. Whether you count the benefits on a calculator or by using your (10) fingers, the numbers speak for themselves.
The Lowdown on Hand and Arm PPE
Hand and arm protection has come a long way from the days when bulky, thick gloves were what workers once counted on. Today, the abundance of hand and arm protection choices actually can confuse employees and employers.
That's why Mike Myrick, product trainer and analyst for cut-resistant glove manufacturer MCR Safety, says it is important to understand what the gloves will be used for. If employees consistently work with knives, he advises workers or their employers to invest in Kevlar or Dyneema fiber gloves, which offer the highest level of protection.
Many workers, however, require dual protection from chemicals as well as sharp objects, so Myrick suggests gloves that have properties applicable to both scenarios and that also allow dexterity so that workers comfortably can move their hands. He says that many people choose not to go this route and double-glove instead, which can do more harm than good.
“Sometimes in double-gloving situations, people can't move their hands well, which makes you put too much pressure on the blades and move awkwardly,” Myrick says. “Anytime someone's hands are impeded, that causes more opportunity for danger.”
Myrick adds that mnay people mistakenly think gloves are cut-proof.
“All gloves, no matter how strong, are only cut-resistant,” he says. Myrick recalls one of his clients challenging him on this notion and Myrick jokingly told him: “Put the glove on and let me get a band saw and see if you would be happy with that!”
Gloves Aren't the Only Answer
Another common misconception, according to Tommy Lanwehr, sales manager for the safety blade company Martor USA, is that gloves are the only solution to protect hands from cuts and lacerations.
“People continue to buy gloves as a fix for the problem, when the real problem is that they are using the wrong knife in most instances,” he says. “Most people are not using a safety knife of any kind in their facility and they're buying expensive gloves to take care of the issue.”
According to Lanwehr, safety knives should be viewed as a necessary tool in any industrial settings. He says there are over 30 styles that can accommodate varied needs, and that that automatic spring-loaded retractable knives are one of the more popular styles. He adds that employers should train their workers how to properly to hold knives, change blades, etc.
Other gloves help prevent injuries that are ergonomically related, such as hand-arm vibration syndrome, which generally affects workers who use chain saws, jackhammers, drills and wood chippers. According to Tom Votel, president and CEO of Ergodyne, this syndrome affects about 8 percent of the working population. He recommends that workers who use vibration tools wear gloves that can dampen the vibration in the 40-percent, high-frequency range. For workers who do minor drilling operations, such as carpenters and mechanics, Votel says there are gloves that can dampen vibration in the 10-percent range and protect against other injuries such as bumps, scrapes and bruises.
Hand and arm vibration syndrome can cause symptoms include blanching of the fingers, tingling and numbness, and in more severe cases, workers can get gangrene on their hands.
“This is a disease you want to prevent because once you have it, it never goes away,” Votel warns.