Carpal Tunnel Syndrome and Arthritis: Overworking the #1 Tool in a Farmer's Toolbox Ned Stoller, Michigan AgrAbility Amber 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
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 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
If pressure continues- the muscles can weaken and atrophy Atrophy
Tinel’s Sign Phalen’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
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
Sources o American Family Physicians Group o Arthritis Foundation o Carpal Tunnel Assocation o DeRoyal “Carpal Tunnel Syndrome, Arthritis and Wrist Fractures” (PDF file) o FamilyDoctor Website: Carpal Tunnel Syndrome o National Institute of Neurological Disorders and Stroke: Carpal Tunnel Syndrome Fact Sheet References