According to a recent Danish study, worse support from managers, more physical and mental abuse and a higher physical workload leads to more stress for nighttime workers.
That is partly what the staff at evening and night shifts in eldercare experience compared to their counterparts on day shift.
Researcher Kirsten Nabe-Nielsen performed the analysis, with the aim of the doctoral study being to investigate work-related health problems among shift workers in the Danish elderly. The studies were supported by the rate adjustment pool funds.
Questionnaire data collected from a cohort consisting of 2,870 newly-trained social and healthcare helpers and assistants showed that:
1. Upcoming shift workers lived more unhealthy than the next day work, even before they came into work
2. Smoking increased the probability of having evening, night work or work in 2/3-holdsskift night work a year later.
Cross-sectional data from questionnaires collected from 4,590 nursing staff in elder care showed:
1. Evening and night workers experienced lower quantitative requirements (i.e. the requirement to work quickly and cope with large workloads), lower job control, lower support from their leaders, more physical and mental violence, and a higher physical workload in relation to their colleagues on a day shift;
2. Apparently coincidences of adverse health factors among shift workers, which may contribute to why shift workers, are becoming more ill.
Data from an intervention study among 321 employees in elderly care and a follow-up measurement with 297 participants, who completed questionnaires, had blood tests and were interviewed showed:
1. Self-selected working hours increased the proportion of employees who were involved in planning their own working hours, from 19 percent to 97 percent;
2. Study could not demonstrate that self-selected working hours resulting in improved health and wellbeing.
To view the study, visit: http://www.arbejdsmiljoforskning.dk/da/nyheder/arkiv/2011/~/media/Boeger-og-rapporter/KNN-phd.pdf
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact:RShafer@ReduceYourWorkersComp.com or 860-553-6604.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
A Professional Employer Organization (PEO) offer employers the opportunity to outsource a variety of services including workers compensation insurance, other types of insurance administration, payroll administration, management of human resources, employee benefits and taxes. The PEO takes over the administration of these employer functions, allowing the employers to focus on their core business. This allows the employer/client to reduce their administrative cost and to provide access to lower cost benefits.
1- PEOs are utilized by many types of small businesses, but are especially prevalent in industries where there is high risk of workplace injuries, like the construction industry. PEOs are often used by temporary staffing agencies due to the staffing agencys ever changing workforce. PEOs frequently take over the hiring and recruiting of employees for employers. By hiring the employees, the PEO becomes the employer of record for workers compensation purposes and tax purposes. This is often referred to as co-employment as the employee is performing his work functions for the PEOs client, but is an employee of the PEO for insurance and tax purposes. (WCxKit)
2- A promotional point PEOs use to obtain clients is their ability to obtain workers compensation insurance cheaper than the employer can obtain on their own. The PEO obtains workers compensation coverage for both the PEO itself and and for it employer clients. This is allowed because the PEO is the co-employer of the employees of the client companies. The PEO uses economies of scale to purchase the workers compensation insurance at a lower cost than a small employer would pay for the coverage. However, the various different types of employee classifications in a PEO can make underwriting of the PEO difficult for the workers compensation insurance company.
3- PEOs also promote they can improve the clients cash flow by reducing or eliminating the down payments associated with the purchase of workers compensation insurance. Depending on the size of the client employer and the amount of other insurance, employee benefits, taxes, etc that are taken over by the PEO, the client employer may not incur any finance charges for their work comp insurance premiums. In some cases, PEOs will utilize a pay-as-you-go work comp program (monthly work comp premium payments with coverage extended month by month).
4- As PEOs are in the business of managing the benefits, taxes and insurance for employers, they have the expertise to effectively manage and control workers compensation claims for their clients. PEOs will normally require their client employers to have a return to work program that puts employees back to work on modified duty as soon as the treating physician will allow the employee to do so.
5- Another PEO benefit that impacts workers compensation is the PEO will provide and verify the safety programs of their clients. While the client company will be responsible for administering the safety program, the PEO will retain the right to perform safety inspections to verify the client employer is complying with the safety program and is providing a safe environment for work. This benefits all employers within the PEO by lowering the number of work comp claims for the PEO.
6- Some PEOs will turn down potential new clients if they have a poor claims experience history or if the client has a substandard safety program and is unwilling to accept the safety inspections and safety requirements of the PEO. If the PEO is not protective of their loss experience history, the work comp insurance rates will increase, negatively impacting the PEOs ability to attract new clients.
7- Employers who are considering the utilization of a PEO to manage their administrative programs, taxes, benefits and workers' compensation insurance, should evaluate the PEO on its:
1. experience in their industry
2. its safety program and risk management assistance
3. its return to work program required of all clients
4. its financial stability
5. its workers compensation insurance program cost
6. its workers compensation insurer (A or higher rating with A.M. Best)
7. its workers compensation third party administrator (if the claims are not handled by the insurer)
8. the cost of all of its other administrative functions (WCxKit)
8- PEOs can reduce the cost of workers compensation and other administrative requirements of the employer. The client employer does give up some control over administrative functions (which can be a good thing). PEOs charge a service fee for handling the workers compensation and other administrative functions which most PEOs will claim is more than offset by the savings they provide on the cost of workers compensation and other employee benefits.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
An administrative law judge with the Occupational Safety and Health Review Commission has upheld fines placed on an Ohio company. According to an inspection, several employees had symptoms of a potentially fatal respiratory disease after sweeping up pigeon droppings.
Safetynewsalert.com reports that OSHA began an investigation against ALL Erection & Crane Rental Corp. in June 2009 after a worker was struck in the head by debris during the cleanup of a 600,000-square-foot factory building in Cleveland that was owned by the company. (WCxKit)
ALL Erection brought in subcontractor Labor Ready to remove debris, including pigeon waste, from the building.
The inspection revealed several workers had symptoms of histoplasmosis due to inhaling dust created by sweeping and shoveling the bird waste.
ALL Erection contested the citations claiming that the workers were employed by Labor Ready. The judge rejected the argument due to the fact workers were being supervised by ALL Erection and the company was in charge of the manner of the work being accomplished.
The judge upheld five serious citations against the company for failure to provide:
1. Guarding for a fifth floor elevator shaft
2. Personal protective equipment
3. Compliant respirators
4. Medical personnel for advice and consultation, and
5. Training for employees on hazardous chemicals in the workplace.
The judge also upheld a less-than-serious citation for failing to determine the presence, quantity and location of asbestos-containing material. A serious citation for failing to provide an assessment for lead was tossed out. (WCxKit)
In all, ALL Erection was fined $10,850.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact:Info@ReduceYourWorkersComp.com or 860-553-6604.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
New Zealands Accident Compensation Corporation (ACC) has welcomed the conviction of Daryl Adair Ramsay, who was sentenced to nine months home detention in the Waitakere District Court recently.
Ramsay, of Waitakere City, faced 18 charges of dishonestly using a document under the Crimes Act, for a period of offending which spanned more than four years. (WCxKit)
On July 3, 2003, Ramsay, who at the time was national service manager for a commercial cleaning company, injured his neck and shoulder. He supplied ACC with a medical certificate stating that he was unable to work because of his injury, and ACC began paying him weekly compensation for lost earnings from July 17, 2003.
For approximately four years Ramsay supplied further medical certificates to ACC, advising that he was fully unfit for work, and ACC kept paying weekly compensation. Throughout this period Ramsay constantly misrepresented his employment status and submitted a significant number of false declarations to ACC.
In May 2007, ACC launched an investigation which revealed Ramsay had begun operating a business, ‘D’Z Contracting’, within five months of his injury. He had both worked physically for and received income from this business during the period when he was receiving weekly compensation. (WCxKit)
In total, Ramsay received $133,525 from ACC to which he was not entitled. As well as the sentence of home detention, Ramsay was also ordered to repay a portion of the money fraudulently obtained.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact:Info@ReduceYourWorkersComp.com or 860-553-6604.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
The 9th Circuit recently revived a lawsuit (Francisca Palomino Gutierrez, et al. v. Advanced Medical Optics, Inc., No. 09-55860, 9th Cir.) brought by several elderly Mexicans who allege they lost their eyes or were blinded by a California companys tainted surgical materials.
According to Courthouse News Service, while determining that a federal judge in Santa Ana, Calif., had properly dismissed the complaint and sent it to Mexico, the subsequent refusal of the Mexican courts to accept the case would "leave their horrific injuries wholly underdressed," the federal appeals panel in San Francisco ruled. (WCxKit)
Eight elderly residents of Monterrey, Nuevo Leon, Mexico claim they lost one of their eyes or were blinded in one eye after obtaining cataract surgery from a well-qualified Mexican surgeon. They allege that they contracted bacterial endophthalmitis from a defective product manufactured by defendant Advanced Medical Optics.
The suit claims surgeons use of Healon Viscoelastic product caused the plaintiffs eyes to run with puss and led them to fevers, nausea and vomiting. Three of the plaintiffs had to have an infected eye removed, while five others became blind in the infected eye.
"After the plaintiffs surgical complications occurred, unopened batches of defendants Healon product were tested and found to be infected with a virulent strain of bacteria that causes endophthalmitis," the ruling stated.
The plaintiffs sued Advanced Medical Optics in California, where the business is based. The company successfully petitioned to have the case thrown out after arguing that the Mexican courts were a more convenient forum.
While appealing the District Courts dismissal, the plaintiffs also filed their complaint in Mexico. The Mexican courts refused to take on jurisdiction.
In ruling on the plaintiffs appeal of the dismissal recently, the three-judge appeals panel stated that the District Court had every right to move the case to Mexico. The panel refused to leave the case there, however, stating that doing so would leave the plaintiffs without a court to make their plea. (WCxKit)
The panel claimed it was "persuaded by the reasoning of [its] sister circuits, and join[ed] them in holding that when intervening developments in a foreign jurisdiction, subsequent to a District Courts initial [forum] ruling, could leave plaintiffs without an available forum in which to bring their claims, it is appropriate to remand the matter back to the District Court so it can reconsider its decision based upon updated information," the ruling notes.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact:Info@ReduceYourWorkersComp.com or 860-553-6604.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
If you have ever reviewed a workers compensation medical bill and saw what is referred to as an ICD-9 code or a CPT code and wonder what the codes mean, you are not alone. Both the CPT codes and the ICD-9 codes are numerical ways used to communicate within the medical community.
The ICD-9 codes are used to describe the medical diagnosis.
The CPT codes are used to describe what medical procedures were provided to the patient.
1- The International Statistical Classification of Diseases and Related Health Problems (abbreviated to ICD) is used for the diagnosis of medical conditions. The ICD codes are published by the World Health Organization (WHO) and are used world-wide for morbidity and mortality statistics. (WCxKit)
2- The ICD-9 abbreviation stands for the International Classification of Diseases, the ninth edition. Per the WHO, the system is used to “classify diseases, signs and symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease”. The ICD-9 codes start at 001 and go through 999. The most common ICD-9 codes seen in work comp are the codes 800 to 999 which are used for “injury and poisoning”. In addition to the numbers 001 to 999, there are codes E000 to E999 which are for the Supplementary Classification of External Causes of Injury and Poisoning, and codes V01 thru V91 for Supplementary Classification of Factors Influencing Health Status.
3- The American Medical Association (AMA) publishes the copyrighted Current Procedural Terminology (CPT) codes. Per the AMA, the CPT codes are intended as a way for medical providers to have a consistent description for the medical, diagnostic and surgical services.
4- The CPT codes are five digits numbers from 00100 to 99499. CPT code 00100 is used for an anesthesia service. CPT code 99499 is a miscellaneous code used for “unlisted evaluation and management services”. This code is normally used by nurse practitioners, physician assistants and other non-physicians to bill for a lesser level of service.
5- All the numbers between 00100 and 99499 are not used. Only about 7,800 codes are used to depict the medical, radiological, anesthesiology, laboratory, surgical and evaluation/management services of doctors,
hospitals, physical therapist and other medical providers.
6- On occasion the 7,800 CPT codes are not enough. If there is an unusual situation, a two digit modifier, either numerical or alpha are used to explain the unusual situation. The numbers from 22 through 99 may be used to explain additional medical services provided. Not all numbers between 22 and 99 are used, only about 30 two digit numbers are used. In addition to numbers there about 25 alpha codes from AA to US that can be used as a modifier.
7- If you are beginning to think this system of ICD-9 codes for diagnosis and CPT codes for medical procedures is a bit complicated, you are right. The AMA recommends that only medical personnel with the proper credentials and training assign the ICD-9 codes and CPT codes.
8- By having a systematic classification of diagnosis and procedure codes, medical personnel can review the coding and quickly understand both the diagnosis and medical treatment provided to the injured employee by other medical providers. In addition to the communication between medical providers, the ICD-9 and CPT codes allow for uniformity in billing by all medical providers.
9- The ICD-9 codes and CPT codes are incorporated into the medical fee schedules for workers compensation used in most states. They are also utilized by health insurance companies and CMS (Centers for Medicare and Medicaid Services) for the pricing of medical billing. (WCxKit)
10- In future, we will have ICD-10, the tenth revision. It has more than 14,400 diagnosis codes. It was originally slated to be put in use in the United States on October 1, 2011. The implementation of ICD-10 has been pushed back to October 1, 2013 due to issues CMS has had with the implementation.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
For the first time, a New York City official is reporting a rise in cancer for firefighters who served at Ground Zero, according to The New York Post.
Dr. David Prezant, the Fire Departments chief medical officer, discovered that firefighters who dug for victims at the World Trade Center are getting cancer at a larger rate than firefighters prior to 9/11 — and some forms of cancer are "bizarrely off the charts," claim sources briefed on the seven-year, federally funded study. (WCxKit)
Prezant discussed the findings with members of a WTC medical-monitoring committee last month, according to several attendees.
He has not yet unveiled the data, but sources claim he has cited unusual increases in three blood cancers — leukemia, non-Hodgkins lymphoma and multiple myeloma — as well as esophageal, prostate and thyroid cancers.
The report, slated for publication around the 10th anniversary of 9/11, would be the first to document a cancer-rate increase among rescue and recovery workers.
The city recently came to settlement on lawsuits by 10,000 WTC workers, more than 600 with cancer.
But officials have so far stood by the fact that there is no scientific proof that Ground Zero smoke and dust caused cancer.
Prezant noted researchers have compiled medical records for three years and had access to state cancer registries, though New York's is three years behind. "Those things keep adding cases," he informed the group.
In 2007, doctors at Mt. Sinai Medical Center, which monitors WTC responders other than FDNY, reported seeing blood cancers like multiple myeloma, which normally strikes in the 60s or 70s, among relatively young cops. (WCxKit)
The state Health Department has confirmed that 345 Ground Zero workers have passed away due to various cancers as of last June.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact:Info@ReduceYourWorkersComp.com or 860-553-6604.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
California workplace safety officials have fined Larry Flynts Hustler Video and another porn producer for not using condoms on set to protect sex performers from exposure to disease.
Associated Press reports that Hustler is looking at $14,175 in fines for three violations, including failure to provide condoms or other protective equipment, according to a Division of Occupational Safety and Health citation. (WCxKit)
Hustler "failed to ensure the use of appropriate personal protective equipment, such as condoms" to protect its employees from semen, vaginal excretions and blood in the course of producing adult videos, according to the citation.
The present penalties are based on the same section of state law that also requires
hospitals to provide nurses with protective gear to spare them exposure to blood-borne and fluid-borne illnesses.
Flynt has commented previously that audiences dont want to watch porn in which actors use condoms.
Hustler was also fined for failing to maintain a written injury and illness policies and for failing to provide workers with vaccines for hepatitis C.
Hustlers citation stems from a Sept. 14 inspection of a job site in response to a complaint from the AIDS Healthcare Foundation, a Los Angeles-based nonprofit that advocates for safe sex in pornography.
Forsaken Pictures faces $12,150 in fines for similar violations. The fines were issued March 9.
Cal/OSHA Senior Safety Engineer Deborah Gold commented that the state continually investigates the porn industry, though job sites can be difficult to find, and has cited a handful of producers for violations in recent years. (WCxKit)
In 2010, a porn actor tested positive for HIV at a California clinic, causing panic among actors. Some San Fernando Valley pornographers in the multibillion-dollar adult entertainment industry shuttered productions as a precaution
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact:Info@ReduceYourWorkersComp.com or 860-553-6604.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
Employers can be held liable for discriminatory conduct even if the individual responsible for the decision was not discriminatory but relied to a degree on those who were, the U.S. Supreme Court ruled recently, according to
www.BusinessInsurance.com
The courts unanimous ruling in
Vincent E. Staub vs. Proctor Hospital backs what is known as the “cats paw” theory of liability. (WCxKit)
According to the opinion, Mr. Staub, an angiography technician at Proctor Hospital in Peoria, Ill., was part of the U.S. Army Reserve, which mandated he attend drills one weekend a month and train on a full-time basis two to three weeks yearly.
Business Insurance reported a pair of supervisors was allegedly hostile to Staubs military obligations, and one allegedly made a false complaint to the hospitals VP of human resources, who partially relied on that information to fire Staub in 2004.
Staub sued the hospital through the Uniformed Services Employment and Re-Employment Rights Act of 1994, alleging his firing was motivated by hostile intent toward his military obligations. A jury deemed that military status was a motivating factor in Staubs discharge and awarded him $57,640 in damages.
In a turn of events, the 7th U.S. Circuit Court of Appeals in Chicago threw out the case, claiming that a cats paw case “could not succeed unless the no decision-maker exercised such ‘singular influence' over the decision-maker that the decision to terminate was the product of ‘blind reliance,' which was not the case involving this matter.
“Because the undisputed evidence established that (the HR VP) was not wholly depending on the advice of (the supervisor), the court held that Proctor was entitled to judgment,” the 7th Circuit ruled.
However, the Supreme Court overturned the appeals court. Proctor “contends that the employer is not liable unless the de facto decision-maker…is motivated by discriminatory animus,” the high court stated.
“If a supervisor performs an act motivated by anti-military animus that is intended by the supervisor to cause an adverse employment action, and if that act is a proximate cause of the ultimate employment action, then the employer is liable under USERRA,” the Supreme Court ruled.
The court ruled 8-0 in favor of overturning the 7th Circuit opinion, with Justices Samuel Alito Jr. and Clarence Thomas backing a concurring opinion, and Justice Elena Kagan not taking part in the decision. (WCxKit)
The high court remanded the case to the 7th Circuit with instructions to determine whether to reinstate the jury verdict or to seek another trial.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact:Info@ReduceYourWorkersComp.com or 860-553-6604.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
We are very fortunate to be associated with some very fine, knowledgeable persons who provide excellent insight into the various topics we constantly highlight in bringing our readers and clients cost effective ways of reducing workers compensation costs.
On such person is Alice M Martinson, M.D., a board-certified orthopaedic surgeon and former Naval Medical Officer. I recently interviewed “Dr. Alice” on the topic of chronic soft tissue and its effects on workers compensation.
What is Chronic Soft Tissue Overload Syndrome?
This is a cluster of conditions that can develop in upper extremities which are used for rapidly-repetitive and/or forceful gripping activities.
Is there an abbreviation for Chronic Tissue Overload? Are there other names for this injury?
If you want to abbreviate it, it's most accurate to call it “chronic soft tissue overload syndrome" (CSTOS). Some people term it "repetitive stress syndrome,” but that seems a little vague to me. Repetitive stress of what? (WCxKit)
CSTOS is characterized by a group of separately-identifiable conditions, all of which have names and all of which are related to each other by the presence of tenosynovial irritation from rapid fingering activities. The commonest of the conditions are:
1. Carpal Tunnel Syndrome
2. De Quervain's "disease”
3. Trigger Fingers
4. Extensor Tenosynovitis on the dorsum of the wrist and forearm.
Conditions in the more proximal parts of the arms can appear in some employees as well. They are not related to tenosynovitis, but rather represent the consequences of prolonged periods of unrelieved fixed posture. The most common of these are:
1. Lateral Epicondylitis
2. Cubital Tunnel Syndrome (ulnar nerve compression at the elbow)
3. Postural Upper Backaches are the commonest examples of proximal problems.
In elbow problems, prolonged elbow flexion allows the extensor muscles to tighten and makes them more susceptible to strain ("lateral epicondylitis"). Prolonged elbow flexion keeps the ulnar nerve on stretch as it passes around the flexed elbow within the confines of the cubital tunnel. Sitting for a long time with shoulders hunched places the upper back muscles on stretch so that when there is concentration or tension, burning pain develops adjacent to the shoulder blades. Think accountants in the couple of months before tax time.
What industries does it typically occur in? Do federal agencies and private industry get this injury?
For many years it was the forceful-grip industries experiencing the condition the most – meat/ poultry processing and automobile or airplane assembly. When the objects gripped were vibrating tools, the problems arose faster than in other pure grip activities. Now that computer keyboarding and mouse use are so widespread, most of the problems seem to be arising in those jobs requiring constant activities of that sort in both Federal employment and private industry.
In Federal service I've seen it most in IRS customer service representatives, who spend their entire workday on the computer. Certain kinds of postal work can be highly repetitive as well. Customer service representatives in
telecommunications and other similar private industries seem to be quite commonly affected. The common denominator is rapidly-repetitive use of the hands for extended periods, and/or in fixed postures. That means the condition is also very common in professional musicians as well – particularly violinists and woodwind players.
Chronic illnesses also can have a major impact on these conditions. Diabetes, thyroid disease, gout, and rheumatoid arthritis are good examples. The fluid accumulation during pregnancy is well-known to precipitate carpal tunnel syndrome, even in non-repetitive situations. These non-work related conditions do NOT cause CSTOS, but they do influence the progression and severity or the conditions once they develop.
In your years in the Navy were there some departments in which it was most common?
My active duty career ended just as computers were starting to become ubiquitous. My recollection is that the heavy-duty specialties such as machinists' mate, boiler tender, and other similar ratings were the ones most commonly affected most commonly. Now, in the computer era, I would expect any of the ratings using computers extensively will see it. Fortunately the individuals in highly-stressful jobs such as radar, sonar, and fire-control technicians typically serve for only several hours at a time. That protects the soft tissues as well as ensuring fatigue doesn't degrade critical performance.
What type of specialist treats this type of injury? What type of treatment do they receive? Is it permanently disabling or can an employee recover 100%?
Orthopaedic surgeons primarily treat these conditions, although plastic surgeons specializing in hand surgery treat them as well. Ideally early appreciation and insightful intervention will allow these conditions to be treated non-surgically. Carpal or cubital tunnel problems, triggering fingers, and tenosynovitis of the thumb abductors can sometimes be settled down with corticosteroid injections, but if they cannot, there are simple and safe surgical procedures available to treat these conditions.
What should employers know about prevention?
Repetitive hand use jobs can't really be changed that much. Employers can, however, ensure that their employees have proper ergonomic environments. In the meat packing industries, this means keeping knives and scissors very sharp so that the force of grip can be diminished.
In keyboarding jobs, it means keyboards and screens are at proper height to allow proper employee posture. Taking frequent "mini-breaks" is a strategy used by musicians with great success, and one that can be used successfully by keyboarders as well. Those breaks are built into most compositions but musicians get into trouble during intense unrelieved periods of hard practice.
Frequent stretching of the tendons of the forearm and hand is very useful, as is the practice of postural stretching exercises for the shoulder girdles. It doesn't have to be for long periods; typical minibreaks will be useful if they are no longer than about 30 seconds and are repeated every 15 minutes or so.
Carpal tunnel syndrome seems very common. What treatment do you recommend for CTS?
Splinting for carpal tunnel syndrome – particularly at night is very useful. It's next to impossible to work in a splint, however, if you ever need to try, go to the bowling alley, and get a bowler's brace. It's cut differently since it must be used to hold the ball hold, the beer, and the pencil for scoring. What splints do is keep the wrist out of prolonged flexion. That's the position that pulls the maximum volume of tissue into the carpal canal, and it's the position we all tend to assume during sleep. That's why waking up at night with burning paresthesias in the fingers is a very common – almost diagnostic – part of the patient's history in carpal tunnel syndrome.
Once an employee has CSTOS, will they be able to return to work?
Every individual's soft tissues have different tolerance for highly repetitious activities. This appears to be an inborn biologic characteristic. Some employees will tolerate rapidly repetitive jobs for a number of years, while others will develop progressive symptoms is as short a time as two weeks. Once one of the soft tissue overload conditions appears, it can be successfully treated; but if the individual returns to the same job with the same poor ergonomics, another of the constellation of conditions will develop – and in less time than it took for the first one to appear. The employer can make the necessary ergonomic and scheduling modifications, but motivation plays a major role in individuals’ ability to resume their repetitive jobs successfully.
What is the typical length of time an employee is out of work with CSTOS?
That's a hard question to answer, since it varies depending on the syndrome being treated and its severity. The diagnosis itself is NOT a good reason to take an individual off work. Minimizing time off keeps employees engaged with their employment and doesn't allow the secondary gain of "illness" to take root.
When surgery is involved, most employees should be able to return to some sort of modified work within three to four weeks of the procedure. Frankly, the lost time from work has a great deal to do with an employer's response to the employee's complaints. In highly repetitive and unskilled jobs, employers are much less motivated to make the necessary adjustments or modifications, since the position can be filled by a new hire without sacrificing any investment in employee training. (WCxKit)
Doctor, do you have any final thoughts for employers (federal or private) about CSTOS?
Much as employers would like not to believe it, the condition is real. It can be managed, but ignoring it will not make it go away. There is a lot of partial or misinformation circulating among employees in industry where the conditions are frequently seen.
The three most important things for prevention and control of the decreased productivity resulting from these conditions are: (1) A proactive program of employee and supervisor education; (2) attention to the ergonomics of the workspace; and (3) fostering a corporate environment where employees do not feel threatened when reporting a condition.
Author: Alice M Martinson, MD has practiced for 40 years as a board-certified orthopaedic surgeon, 25 of which were as a Naval Medical Officer. Relying on her extensive military experience with injury evaluation, she performs IMEs and consults on loss control issues. Contact: 870-480-7475 or
docalice@aol.com. To read more about "Doc Alice,” go to:
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
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