1. 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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6.  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.orgwww.agrability.org

7. Overworking the #1 tool in a farmer’s toolbox. An overview of Carpal Tunnel Syndrome (CTS) of the hand and wrist.

8. Repetition, Repetition

9. 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

11. 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

13.  Estimated 1 in 10 Americans (3%)  Female to Male ratio = 4:1  Most often 30-60 years old Statistics

14. 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

15. If pressure continues- the muscles can weaken and atrophy Atrophy

16. Tinel’s Sign Phalen’s Test Diagnosis

17. 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

18. 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

19. 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!

20. ORAL MEDICATIONS  Nonsteroidal anti- inflammatory drugs (NSAIDs)  Topical analgesics (creams)  Vitamin B6  Orally administered corticosteroids Pain Management LOCAL INJECTION? SURGERY?

21. LOCAL INJECTION

23. Agricultural Tasks

24. ‘til pain shuts you down… AT Devices

25. 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!

26. Assistive Technology for Carpal Tunnel & Arthritis AT Devices  Transplanting from flats to pots  Pruning & harvesting  Hand Tools  Vibration – steering wheels, power tools  Tractors

27. Transplanting – 1000x AT Devices

28. Transplanting – 1000x AT Devices

29. Transplanting – 1000x AT Devices

30. Pruning & Harvesting – 1000x AT Devices

31. Pruning & Harvesting – 1000x AT Devices

32. Pruning & Harvesting – 1000x AT Devices

33. Pruning & Harvesting – 1000x AT Devices

34. Hand Tools – 1000x AT Devices

35. The “Easy-Grip Hand Tool” AT Devices

36. Right Angle Long-handle Tools

37. AT Devices Right Angle Long-handle Tool Grips

38. AT Devices Tool Balancer

39. AT Devices Vibration – Tractors & Power Tools

40. AT Devices Tractors

41. AT Devices Tractors

42. AT Devices Tractors

43. AT Devices Tractors

44.  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

45. 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

46. 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