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46

Work-related upper limb disorders (RSI)

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BASIC FACTS ABOUT WORK-RELATED UPPER LIMB DISORDERS

According to the HSE at www.hse.gov.uk/msd/msdprogramme.htm#uld the term upper limb disorders (ULDs) is used as an umbrella term for a range of disorders of the hand, wrist, arm, shoulder and neck. It covers those conditions, with specific medical diagnoses (e.g. frozen shoulder, carpal tunnel syndrome), and other conditions (often called repetitive strain injury or RSI) where there is pain without specific symptoms. Symptoms may include pain, swelling and difficulty in moving. The worst cases can result in permanent disablement if no action is taken. ULD cases can also mean production losses and compensation claims for employers.

The HSE uses the term ULDs instead of RSI because they say that RSI does not cover all ULDs. The TUC prefers to use the term RSI. However, the terms ULDs and RSI will be used interchangeably throughout this chapter. HSE statistics on upper limb disorders, based upon results from the latest surveys of self-reported work-related illness showing that:

  • In 2007/08, an estimated 213,000 people in Great Britain who had worked in the last year believed they were suffering from a musculoskeletal disorder mainly affecting the upper limbs or neck that was caused or made worse by their current or past work, according to the LFS. This equates to 700 per 100,000 people (0.7 per cent) in Great Britain who worked in the last 12 months.
  • Of these, over a third, 81,000 people, first became aware of their work-related musculoskeletal disorder mainly affecting the upper limbs or neck in the previous 12 months. This equates to an estimated 270 per 100,000 people (0.27 per cent) with a new work-related musculoskeletal disorder mainly affecting the upper limbs or neck in this period.
  • This incidence rate is statistically significantly lower than in 2006/07, but of a similar order to other years over the period 2001/02 to 2005/06.
  • The LFS shows that an estimated 2.8 million working days (full-day equivalent) were lost in 2007/08 through musculoskeletal disorders mainly affecting the upper limbs or neck caused or made worse by work. On average, each person suffering took an estimated 13.3 days off in that 12 month period.
  • The number of days lost per worker in 2007/08 was of a similar order to the two previous years, but statistically significantly lower than in each of 2001/02, 2003/04 and 2005/06.

Although detailed analysis from the 2007/08 Labour Force Survey is not yet available, the following figures from the 2006/07 survey show that:

  • The prevalence of self-reported work-related upper limb or neck disorders for both men and women was of a similar order. For both genders, the age group carrying the highest rate was the oldest working age group (55–64 years for men and 55–59 years for women).
  • There were no statistically significant differences between countries in the prevalence rates, but there were some regional differences, with the South West having a statistically significantly higher prevalence rate than England and the South East having a statistically significantly lower prevalence rate.
  • Construction, health and manufacturing industries carried statistically significantly higher prevalence rates compared with the average for all industries. Certain occupational groups within these industries such as process, plant and machine operatives, skilled construction and building trades and health and social welfare workers have the highest rates.
  • Small workplaces had a statistically significantly lower prevalence rate than medium and large.

According to the HSE, musculoskeletal disorders (MSDs) are the most common cause of occupational ill health in Great Britain, currently affecting 1 million people a year and costing society £5.7 billion (www.hse.gov.uk/msd/mac/index.htm). MSDs affect the muscles, joints, tendons and other parts of the musculoskeletal system. For full details see the HSE web page on MSDs at www.hse.gov.uk/msd.

In February 2007, HSE figures analysed by the Labour Research Department for the Chartered Society of Physiotherapy (CSP) showed that the jobs where workers are most likely to get RSI are:

  • metal, plastics, textile and other plant and machine workers (1.1 per 100 workers)
  • bricklayers, plumbers, carpenters and others in skilled trades (0.91 per 100 workers)
  • nurses, journalists and IT technicians, in associated professional and technical occupations (0.76 per 100 workers)

Full details

In the 2008 TUC safety representatives survey, safety representatives identified MSDs as a major problem. Back strains were identified by 31 per cent of all safety representatives, repetitive strain injuries (RSI) by 40 per cent, while 13 per cent identified handling heavy loads. Back strains caused particular problems in the health service (47 per cent), distribution, hotels and restaurants (67 per cent) and leisure services (31 per cent). An earlier TUC survey relating to the experience of women at work found out what workplace health and safety problems women suffer from and what were their priorities. In all, 53 per cent said that RSI was a problem for women.

Physical hazards causing ULDs are responsible for a heavy toll of suffering, much of it endured in silence and never fully reported. Thousands of workers have to leave their jobs each year and thousands more stay on only to suffer further. If a job feels uncomfortable then it is probably doing harm. The aim is to fit the job to the worker, not the other way around.

RSI

The TUC uses RSI as the collective name to describe a range of muscle and tendon conditions of the neck, shoulders, elbows, wrists, hands and fingers caused by:

  • continuous, repetitive or pressurised finger, hand or arm movements
  • twisting movements
  • squeezing
  • hammering or pounding
  • pushing, pulling, lifting or reaching movements
  • awkward postures

Other names used to describe these conditions include WRULDs (see above), Occupational Overuse Syndrome and Cumulative Trauma Disorders. Symptoms include:

  • pain in the fingers, wrists, arms or shoulders
  • tenderness
  • feeling of heaviness in the arms/wrists swelling
  • tingling sensation at the fingertips
  • numbness
  • joint restriction

There are two main types of RSI – localised conditions and diffuse conditions. Localised conditions are where the symptoms are normally confined to a particular part of the body and are easier to diagnose. Examples of localised RSIs are explained in the London Hazards Centre table below. Diffuse conditions are characterised by general muscle discomfort, pain, burning and tingling. It is often difficult to determine the exact site of the injury.

According to the RSI Hazards Handbook from the London Hazards Centre (see www.lhc.org.uk/members/pubs/books/rsi/rsi_toc.htm), RSI is a progressive condition which can be divided into three broad stages:

  • Stage 1 (mild): with pain, aching and tiredness of wrists, arms, shoulders, necks or legs during work, which improves overnight. This stage may last weeks or months, but is reversible
  • Stage 2 (moderate): with recurrent pain, aching and tiredness occurring earlier in the working day, persisting at night and possibly disturbing sleep. Physical signs may be visible, such as swelling of the tendon areas. This stage may last for several months
  • Stage 3 (severe): with pain, aching, weakness and fatigue experienced even when the sufferer is resting completely. Sleep is often disturbed and the sufferer may be unable to carry out even light tasks at home or work. This stage may last for months or years. Sometimes it is irreversible and the person never gets back full use of the affected part of their body

RSI is difficult to treat but it is important that treatment begin as early as possible. If the condition reaches the chronic stage, recovery may take years and it may be too late for a full recovery. The trade union priority is to prevent the injury occurring in the first place.

The London Hazards Centre has produced a table of examples of localised RSIs and which is reproduced below.

EXAMPLES OF LOCALISED RSIs (London Hazards Centre)

Injury - Bursitis Inflamation of the soft pad of tissue between skin and bone or bone and tendon. Can occur at the knee, elbow, shoulder. Called ‘beat knee’, ‘beat elbow’ or ‘frozen shoulder’ at these locations.
Symptoms Pain and swelling at the site of the injury.
Typical causes Kneeling, pressure at the elbow, repetitive shoulder movements.

Injury - Carpal tunnel syndrome pressure on the nerves which pass up the wrist.
Symptoms Tingling, pain and numbness in the thumb and fingers, especially at night.
Typical causes Repetitive work with a bent wrist, use of vibrating tools.

Injury - Cellulitis infection of the palm of the hand following repeated bruising. Called ‘beat hand’.
Symptoms Pain and swelling of the palm.
Typical causes Use of hand tools, like hammers and shovels, coupled with abrasion from dust and dirt.

Injury - Epicondylitis inflammation of the area where bone and tendon are joined. Called ‘tennis or golfer’s elbow’ when it occurs at the elbow.
Symptoms Pain and swelling.
Typical causes Repetitive work often from strenuous jobs like joinery, plastering, bricklaying. Common in meat packers.

Injury - Ganglion a cyst at a joint or in a tendon sheath, usually on the back of the hand or wrist.
Symptoms Hard, small, round swelling usually painless.
Typical causes Repetitive hand movement.

Injury Osteoarthritis: damage to the joint resulting in scarring at the joint and the growth of excess bone.
Symptoms Stiffness and aching in the spine and neck, and other joints.
Typical causes Long-term overloading of the spine and joints.

Injury - Tendonitis inflammation of the area where muscle and tendon are joined.
Symptoms Pain, swelling, tenderness and redness of hand, wrist, and/or forearm. Difficulty in using the hand.
Typical causes Repetitive movements.

Injury - Tenosynovitis inflammation of the tendons and/or tendon sheaths.
Symptoms Aching, tenderness, swelling, extreme pain, difficulty in using the hand.
Typical causes Repetitive movements, often non-strenuous. Can be brought on by sudden increase in workload or by introduction of new processes.

Injury Tension neck or shoulder: inflammation of the tendons.
Symptoms Localised pain in the neck or shoulders.
Typical causes Having to maintain a rigid posture.

Injury - Trigger finger inflammation of tendons and/or tendon sheaths of the fingers
Symptoms Inability to move fingers smoothly, with or without pain.
Typical causes Repetitive movements, having to grip too long, too tightly or too frequently

 

LEGAL AND OTHER STANDARDS FOR PREVENTION AND CONTROL

A considerable number of laws and regulations of general application apply to work-related upper limb disorders. Duties can be found in the following chapters of this book:

  • SRSC Regulations 1977 – Chapter 3, with reference to safety representatives’ rights and consultation
  • Health and Safety at Work etc. Act 1974 – Chapter 12, dealing with the general duties of employers and employees under Sections 2–9. Generally, the employer has a duty to ensure the health, safety and welfare of employees
  • Management of Health and Safety at Work Regulations 1999 – Chapter 13, with the obligations placed upon employers to make suitable and sufficient assessments of risks to their employees.

They must also make arrangements for the health and safety of employees by effective planning, organisation, control, monitoring and review (see below)

  • Health and Safety (Display Screen Equipment) Regulations 1992 – Chapter 25, where the
    Regulations seek to reduce the health and safety risks from using visual display units in the workplace. Employers should: assess and reduce risks; provide breaks and changes of activity; provide training and information; provide eye tests where these are appropriate; and ensure workstations meet minimum ergonomic requirements
  • Manual Handling Operations Regulations 1992 – Chapter 32, where the Regulations seek to reduce the health and safety risks to employees from handling and lifting loads. They give advice on how to handle and move loads to prevent poor posture or injury, including handling while seated. This may be useful to help assess jobs that are causing back pain and might involve the use of repetitive work
  • Provision and Use of Work Equipment Regulations 1998 (as amended) – Chapter 43
  • Workplace (Health, Safety and Welfare) Regulations 1992 – Chapter 45
  • Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 – Chapter 49, where employers must notify their enforcing authority in the event of certain types of defined ULDs

Useful guidance can also be found in the HSE publication Upper Limb Disorders in the Workplace, which outlines what ULDs are, what causes them and preventive measures. The guidance stresses the need for risk assessment, and for applying ergonomic principles
so that the job fits the worker rather than the other way round. The guidance also makes it clear that employers should look at the principal risk factors:

  • task-related – repetition, working postures, force and duration of exposure
  • worker-related – individual differences
  • environment-related – working environment and psychosocial factors

The HSE has produced online versions of its Upper Limb Disorders Risk Filter [pdf] and Risk Assessment Worksheets [pdf]

WHAT CAN SAFETY REPRESENTATIVES DO?

There are a number of positive steps that safety representatives can take to raise awareness and
tackle problems to do with ULDs.

Identifying problems

Safety representatives can help to identify sources of risk, mobilise members and press employers to make improvements. Safety representatives can:

  • carry out regular inspections
  • look critically at all work operations
  • make a list of all such tasks
  • circulate a short questionnaire to members
  • try out body mapping with members. Ask them to stick small labels on large outlines of the body that you can draw on a chart. Ask them to stick the labels where their own job is making them sick or hurt
  • look at the accident book and sickness records. Is there absence associated with ULDs?
  • do a special inspection using the inspection checklist below
  • rank the problems identified in terms of priority and work out which to tackle first

Having assessed the size of the problem, safety representatives should make a written report and discuss this with fellow members. Decide on priorities for risk assessments to be carried out. Safety representatives should report their concerns and those of their members to management in writing. Use Chapter 7 above for ideas on how you can make sure that management gets things done.

Upper limb disorder risk assessments

Safety representatives and workers should be involved in the risk assessment process, and use some of the following points:

  • check that all tasks/operations have been covered, including work done away from the employer’s premises
  • where a range of problems has been found, try to agree priorities for action, with an agreed timetable for improvements
  • assessment is not an end in itself. The value of an assessment is to identify areas which need improvement to make work safer
  • be prepared to show that ULDs are likely and will cause pain and disablement if preventive measures are not taken. When cost is an issue, point out that ULDs cost employers money in lost working time, payments for sick leave and job cover; loss of trained and experienced staff; and successful compensation claims
  • tackling problems with ULDs is rarely a one-off exercise. It requires a sustained campaign with short-, medium- and long-term objectives
  • safety representatives have a right to information about new processes, including proposed workplace layouts. Involvement at the design stage gives the chance to eliminate problems before a new machine process or work system is installed
  • whenever ability among men or women appears to be a limiting factor, make sure they are not banned from such work but that the work is modified to suit their abilities
  • when changes occur in a worker’s health, either permanently or temporarily, work should be suitably adapted or they should be allocated alternative work without loss of pay
  • the effect of ULDs on women’s health is often underestimated or ignored because men appear to be handling heavier loads. The injurious effects of repeated handling on muscles, joints and ligaments tend to be gradual and cumulative

Safety policies

Safety representatives can also monitor the employer’s safety policy and systems of work
regarding ULDs, and check that:

  • there are competent personnel dealing with ULDs, and that they obtain expert advice when necessary from the HSE or reputable consultants
  • there is consultation ‘in good time’ about work with risks of ULDs about arrangements for the appointment of competent people and for training and information
  • where there is any potential risk, their employer has given all their workforce appropriate training and information

THE MANAGEMENT OF HEALTH AND SAFETY AT WORK REGULATIONS 1999

Employers have a duty to conduct risk assessments and implement protective and preventive measures taking account of ergonomic principles. Provisions in the 1999 Regulations that are important for upper limb disorders are reproduced below.

  • Making a suitable and sufficient assessment of risks
  • Identifying measures needed to comply with legal requirements
  • Reviewing the risk assessment
  • Recording the assessment where there are five or more employees
  • Implementing preventive and protective measures using ergonomic principles, as described below.

Regulation 4 (and Schedule 1): Implementing preventive and protective measures

On the basis of:

  • avoiding risks
  • evaluating the risks which cannot be avoided
  • combating the risks at source
  • adapting the work to the individual, especially as regards the design of workplaces, the choice of work equipment and the choice of working and production methods, with a view, in particular, to alleviating monotonous work and work at a predetermined work-rate and to reducing their effect on health
  • adapting to technical progress
  • replacing the dangerous by the non-dangerous or the less dangerous
  • developing a coherent overall prevention policy which covers technology, organisation of work, working conditions, social relationships and the influence of factors relating to the working environment
  • giving collective protective measures priority over individual protective measures
  • giving appropriate instruction to employees

 

Checklist

Download the RSI Checklist (PDF)

FURTHER INFORMATION (in alphabetical order)

Equality & Human Rights Commission

News and information http://www.equalityhumanrights.com/

Ergonomics Society

News, resources and registered consultancies

Hazards magazine factsheets (see Section 6.2 for contact details)

  • No. 83: Drop Dead: Overwork
  • No. 68: Europe Under Strain
  • No. 61: Body Mapping
  • No. 56: Ergonomics: Making the Job Fit
  • No. 46: Pregnancy and Work
  • No. 45: Visual Display Units
  • No. 44: Risk Assessment: No Hazard – No Risk
  • No. 38: Strain Injuries and Work

£1.50 each for union subscribers. £6 for nonsubscribers

Hazards magazine website

HSE priced and free publications on upper limb disorders

  • For all the latest documents containing general standards and guidance on ULDs, go to the HSE web page
  • Alternatively, obtain a free copy of the latest HSE Books catalogue, CAT 34, by telephoning 01787 881 165

HSE upper limb disorders risk assessment worksheet [pdf]

HSE upper limb disorders risk filter [pdf]

HSE upper limb disorders website

The HSE has a specific web page which draws together HSE information on upper limb disorders
in one place

Labour Research Department (see Section 6.2 for contact details)

  • Pain at Work: an LRD Guide to Musculoskeletal Disorders £4.50
  • Women’s Health and Safety £4.75
  • Rehabilitation: a Trade Unionist’s Guide £3.15

London Hazards Centre (see Section 6.2 for contact details)

RSI Hazards Handbook

TUC (see Section 6.1 for contact details)

Trade union information

This page http://www.tuc.org.uk/workplace/work_related_upper_limb_disorders.cfm
printed 7 February 2012 at 04:46 hrs by 38.107.179.230