Carpal Tunnel Syndrome and Arthritis: Overworking the #1 Tool in a Farmer's Toolbox

Ned Stoller, Michigan AgrAbilityAmber Wolfe, National AgrAbility Project

Thursday, December 3, 2015

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AgrAbility: USDA-sponsored program that assists farmers, ranchers, and other agricultural workers with disabilities. Partners land grant universities with disability services

organizations. Currently 20 state projects National AgrAbility Project: Led by Purdue’s Breaking

New Ground Resource Center. Partners include: Goodwill of the Finger Lakes The Arthritis Foundation, Heartland Region University of Illinois at Urbana-Champaign Colorado State University

More information available at www.agrability.org

Overworking the #1 tool in a

farmer’s toolbox.

An overview of Carpal Tunnel

Syndrome (CTS) of the hand and

wrist.

Repetition, Repetition

Overview of Carpal Tunnel Syndrome

The median nerve, along with ligaments and tendons, pass

through a narrow space in your wrist called the carpal tunnel.

CTS Overview

Overview of Carpal Tunnel Syndrome (CTS)

Once the nerve is irritated in this narrow space, a person will begin to experience pain symptoms and eventually a reduction in strength of the hand.

Very closely associated as a form of arthritis, but it does not directly affect the carpal joint.

CTS Overview

Estimated 1 in 10 Americans (3%)

Female to Male ratio = 4:1

Most often 30-60 years old

Statistics

CTS Signs/Symptoms Hand weakness are common; may include stiffness,

clumsiness, and difficulty with gripping/holding things Pain, numbness, burning, loss of sensation in the wrist

area and palm of the hand (may radiate to the forearm, elbow, and shoulder)

To relieve the symptoms, patients often “flick” their wrist as if shaking down a thermometer

Nocturnal symptoms that wake the individual are more specific of CTS, especially if the patient relieves symptoms by shaking the hand/wrist

Limitations

Limitations

If pressure continues-

the muscles can weaken and atrophy

Atrophy

Tinel’s SignPhalen’s Test

Diagnosis

CTS Treatment Most cases of CTS can be adequately treated with

conservative (i.e. non-surgical) management Rest, therapy, exercises Neutral-position splints NSAIDs Steroid injections (short-term relief) Ergonomics Ultrasound therapy

Surgical management is generally reserved for severe sensory loss or atrophy, and is considered after the non-invasive options

have failed to provide relief.

Options

GENERAL MEASURES Avoid repetitive wrist and hand motions that

may exacerbate symptoms or make symptom relief difficult to achieve

Do not use vibrating hand tools or use excessive grip when driving vibrating machinery

Ergonomic measures to relieve symptoms depending on the motion that needs to be minimized

Use ergonomic assistive devices

Ergonomics

Wrist Splints or Braces Reduce inflammation and

irritation best when worn constantly and when started within 3 months

Durability Soft- working/flexibility Hard- nighttime, increased pain

Two categories Custom (made by OT/PT) OTC splints (pre-sized)

Wear Them!

ORAL MEDICATIONS

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Topical analgesics (creams)

Vitamin B6 Orally administered

corticosteroids

Pain Management

LOCAL INJECTION? SURGERY?

LOCAL INJECTION

Agricultural Tasks

‘til pain shuts you down…

AT Devices

Assistive Technology for Carpal Tunnel & Arthritis

AT Devices

1. Does the painful task have to be done?2. Could that task be done a different way?3. Can the task be traded with other

workers?4. Will a tool reduce pain caused by that

task?5. Would adapting a tool reduce your pain?6. Design a new tool to reduce the pain!

Assistive Technology for Carpal Tunnel & Arthritis

AT Devices

Transplanting from flats to pots Pruning & harvesting Hand Tools Vibration – steering wheels, power tools Tractors

Transplanting – 1000x

AT Devices

Transplanting – 1000x

AT Devices

Transplanting – 1000x

AT Devices

Pruning & Harvesting – 1000x

AT Devices

Pruning & Harvesting – 1000x

AT Devices

Pruning & Harvesting – 1000x

AT Devices

Pruning & Harvesting – 1000x

AT Devices

Hand Tools – 1000x

AT Devices

The “Easy-Grip Hand Tool”

AT Devices

AT Devices

Right Angle Long-handle Tools

AT Devices

Right Angle Long-handle Tool Grips

AT Devices

Tool Balancer

AT Devices

Vibration – Tractors & Power Tools

AT Devices

Tractors

AT Devices

Tractors

AT Devices

Tractors

AT Devices

Tractors

AgrAbility provides direct services to farmers with injuries, illnesses or conditions of aging.

No-cost farm assessment and recommendations for specific solutions based on your condition

Funding support via Easter Seals Michigan & Michigan Rehabilitation Services

Partnership of Easter Seals Michigan, Michigan State University Extension, Michigan Farm Bureau

Supported by The Andersons, Alpha Gamma Rho, Tri-Town 4-H, Michigan Sugar, and many donors

Summary

Conclusion Overview Carpal Tunnel Syndrome is a common, debilitating

condition for which there is an excellent prognosis, provided that the condition is recognized and the patients receive appropriate attention and treatment.

Pain and numbness in the wrist/forearm are the classic symptoms.

Home and work activities can be severely limited by CTS, debilitating the individual in many ways.

There is a simple progression of non-invasive treatments that can be applied before the option of surgery is considered.

Summary

Sourceso American Family Physicians Groupo Arthritis Foundationo Carpal Tunnel Assocationo DeRoyal “Carpal Tunnel Syndrome, Arthritis

and Wrist Fractures” (PDF file)o FamilyDoctor Website: Carpal Tunnel Syndromeo National Institute of Neurological Disorders and

Stroke: Carpal Tunnel Syndrome Fact Sheet

References