Arm and Wrist Injuries Teach Scientists to Accept Limits

Courtesy of VistaLab TechnologiesMatthew Springer learned to take breaks and rest his hands after suffering two repetitive-motion injuries. "I ended up with two basically useless arms." In constant pain, he says, he could not type for more than a few seconds or do simple tasks like grasp a steering wheel.The injury sent him to physical therapy and he followed a prescribed regimen for a full year. He also practiced yoga, and learned to manage stress. With help from colleagues, who took over his m

Mignon Fogarty
Mar 1, 2004
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Courtesy of VistaLab Technologies

Matthew Springer learned to take breaks and rest his hands after suffering two repetitive-motion injuries. "I ended up with two basically useless arms." In constant pain, he says, he could not type for more than a few seconds or do simple tasks like grasp a steering wheel.

The injury sent him to physical therapy and he followed a prescribed regimen for a full year. He also practiced yoga, and learned to manage stress. With help from colleagues, who took over his manual lab work for him, and voice-recognition software, he presented a body of work that helped land him an assistant professor's appointment at the University of Califor-nia, San Francisco. He still takes anti-inflammatories. He still can't hold onto a phone.

Springer took action in time to save his wrists and arms. But many researchers do not. Studies provide only sketchy details about the rate and...

RSI AND THE LAW

State-based workers' compensation usually requires insurance or self-insurance to pay for treatment so that workers can continue on the job, generous short-term disability pay for the time that work is not possible, and less generous long term payments.

No state or US Occupational Safety and Health Administration rules address repetitive stress injuries specifically, says Kevin Costello of Dupont Safety Resources in Newark, Delaware. "If OSHA decides to issue a citation for an ergonom-ics violation, they will cite the general duty clause that says employers must keep their workplace free of recognized and serious hazards," Costello adds.

Many state-based occupational safety offices also evaluate workplaces for safety, including ergonomics. Dean Fryer, a spokesman for California OSHA, says that requesting a consultation will not flag an employer for additional regulatory scrutiny. "We have a consultation side and an enforcement side," he says, "and we work very hard to maintain a barrier between the two."

President Clinton enacted ergonomics rules that the AFL-CIO lauded as long overdue but opponents derided as vague and too costly for small businesses. In his first act as president, George W. Bush suspended the rules and repealed them a year later. The Bush administration also told companies they do not have to track ergonomics-related injuries. Bush's goal is now to draft new sets of industry-specific rules.

RSI PAIN DESTROYS PROMISING CAREER

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Courtesy of Cameo Decosta

Cameo Decosta aspired to be the best on her team; repetitive stress injury stopped her

An after hours hush permeated the Medarex building in Milpitas, Calif., and Cameo Decosta stared at the three-inch stack of quality-control reports that she had to fill out by hand, by the next day. Tendonitis and nerve damage had forced her to stop working in the hybridoma lab that she so enjoyed and take a desk job. So Decosta knew she shouldn't overdo it.

As the deadline approached, she glanced up at the brightly colored hula posters decorating her cubicle that reminded her of her hometown, Mililani, Hawaii. The posters also prompted memories of her promising future as a successful University of Hawaii, Manoa, student (she got her Bachelor's of Arts in pre-medicine) – she was even named Miss Hawaii Teen USA in 1992.

CAREER PROMISE

With a eye on her future, Decosta pushed herself hard in the lab, multitasking while doing cell culture work to compete with colleagues who had master's degrees. She would limit her lunches to 15-minutes, or refuse to stop at all, to increase her production. "I would have four things going at once," she relates. "I didn't do one assay, sit around, and let it do its thing.... I was very efficient."

The efficiency paid off: In two years, Decosta had received a $10,000 raise and climbed three rungs on the career ladder, moving from research assistant to research associate II. She was the only one she knew among her acquaintances who had moved up that fast; the others had moved just one rung. But her hands and arms resisted the work, and the pain had sent her to this desk job. Now the desk job had caused its own stress.

With a felt tip pen, she wouldn't have to press too hard, she told herself as she picked up another report. "Here we are again, the last ones here," Decosta recalls a friend saying who had walked into the second-floor office. The friend, a former Medarex researcher, confirmed the facts of Decosta's case, but did not want to be named in the story. A spokeswoman at the company's Princeton headquarters confirmed Decosta's employment, but declined any further comment.

When Decosta reported feeling some pain, she says, the friend urged her to quit working for the day. Decosta finally stopped. The two chums chatted as Decosta tidied her desk. Suddenly, her right hand swelled like a water balloon. "Oh my god," she recalls saying. She couldn't even make a fist. Decosta grabbed one of the ice packs she kept at work and drove herself home through Silicon Valley traffic using only her left hand.

Going over her situation as she drove, Decosta grew more frustrated. She was only 28, and, after just two years in her favorite job, her arm pain had forced her to see the workers' compensation physicians several times. The company had supplied her ergonomic pipettes, special pens, and an ergonomic desk approved by specialists. Nevertheless, her right hand had given out so many times that she knew the drill: The workers' compensation doctors would tell her to ice it, wear the brace, and go back to work. Despite pain, she followed orders.

At work, the boss was sympathetic and apologetic, but could do nothing to help her. Under California law, physicians who contract to treat work-related injury – often paid by a workers' comp insurance company – mandate whether and when an employee restarts work during the first 30 days following an injury. It is not unusual for the insurance companies to encourage an early return, says Richard Stevenson, a spokesman for the California state division of workers' compensation. "That's often a good thing for both sides, the injured worker and the employer," he adds. "That's what [the injured workers] want to do and, for the employer it's better to have someone at work being productive."

Decosta's own human resources department had discouraged her from taking sick leave, and if the workers' comp physicians wouldn't approve time off, her boss couldn't send her home. "Just don't over do it," the boss cautioned. But Decosta's pride and work ethic made the job torture as she did little more than fill out reports and run quality-control experiments with her left hand. "We're kind of competitive; that's how scientists are," Decosta observes. "You have to prove that you can do it, and so ... you push yourself to get as much [done] as you can."

A week later, her left hand gave out too. This new injury left Decosta no choice. She knew she had to rest, but when her workers' comp physician advised her to take pain pills and return to work, Decosta prepared to follow orders. That's when her mother, visiting from Hawaii, took a stand. "I said, 'You have to get a second opinion,"' Angel Decosta relates. "'Only you know what's in your body, and you have to take responsibility."'

Diana Johns, medical director of the US HealthWorks clinic where Decosta visited the workers' comp doctor, declined to comment, citing confidentiality rules. When Decosta finally did see a second doctor, he was adamant. "You shouldn't be working in this condition," he said after a 20-minute exam. He pulled her out of work and drew up a tailored physical therapy program.

During the weeks and months that followed, Decosta would feel better and then something as simple as pulling on a stuck door handle would cause a major relapse. Not only were her tendons ultra-sensitive, but her wrists were so constricted they caused circulation problems in her arms. She'd try something as simple as pulling on a pair of jeans, and her fingers would swell up like little sausages and turn purple.

LAST RESORT

<p>POSTURES OF PAIN</p>

Courtesy of VistaLab Technologies

1. An elevated arm can cause shoulder strain and rotator-cuff tendonitis. 2. Having the wrist ulnar turned can lead to swelling in thumb lining, trigger thumb, and carpal tunnel syndrome. 3. The elevated arm, forearm supination, wrist extension, and radial deviation can lead to shoulder-arm injuries, elbow problems, swelling tendon linings, and possible lateral epicondylitis. 4. Forearm supination and wrist flexion ulnar turn can lead to straining in the area of the elbow, swelling within tendons, and medial epicondylitis. 5. A tight hand grip, wrist ulnar deviation and thumb strain can lead to strain in medial area of elbow and base of thumb, swelling within tendon linings, and DeQuervain's tendonitis.

After Decosta's six months on temporary disability, the insurance company pressured her doctor to send her back to work. The physician gave her a long list of restrictions, but they both knew that was a joke. How could she work when she couldn't type or lift more than five pounds? Her boss wracked his brain for some way that Decosta could contribute, asking if she could think of anything she might be able to do. Eventually, they both came to an agreement and Decosta was legally terminated.

Out of options, Decosta returned to Hawaii with her parents. Six months later, she relishes small victories like chopping an onion. She focuses on managing her slow recovery and getting her life back. "It's amazing how her positive spirit has come through," Angel Decosta relates.

Long-term, Decosta hopes to work in real estate in Hawaii, where her family has connections and the work is easy on the hands and arms. But for now, she looks forward to a day when she can hold a phone without pain and have the strength to lift her new 10-pound nephew. "I tell people, 'The moment your muscles feel fatigued, and they are aching, you just have to stop,"' Decosta says. "I don't care what you have to do tomorrow, stop, it's not worth it.' I felt that pain and I pushed myself, and now I can't go back."

Mignon Fogarty mignon@welltopia.com is a freelance writer in Santa Cruz, Calif.

WORK SAFE

Kevin Costello has confronted a lot of laboratory hand and neck problems, and a lot of denial. "People think they don't have an ergonomics problem because they don't do anything repetitive," says Costello, ergonomics practice manager for Dupont Safety Resources in Newark, Delaware. "But repetition is using the same muscles and tendons throughout the day, and you don't have to be doing the same task to use the same muscles and tendons."

Force and technique are key. In pipetting, for example, Costello says, "Tipping and detipping create some of the most force."

Bad posture is almost as harmful. "When you have to reach up or out, that is when your risk starts to increase," says Costello. Laying an arm on the hood edge can restrict blood flow and compress nerves. "You have to lay out the work so everything is within fairly comfortable reach," he says. Gel pads or even bubble wrap are also good fixes for hard edges.