Carpal Tunnel Syndrome and Arthritis Overworking the 1

Carpal Tunnel Syndrome and Arthritis: Overworking the #1 Tool in a Farmer's Toolbox Ned Stoller, Michigan Agr. Ability Amber Wolfe, National Agr. Ability Project Thursday, December 3, 2015

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Agr. Ability: 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 Agr. Ability 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

Coping with Carpal Tunnel Syndrome & Arthritis Overworking the #1 tool in a farmer’s toolbox. An overview of Carpal Tunnel Syndrome (CTS) of the hand wrist.

Repetition, Repetition

CTS 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 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.

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

Limitations 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

Atrophy Limitations If pressure continuesthe muscles can weaken and atrophy

Diagnosis Tinel’s Sign Phalen’s Test

Options 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.

Ergonomics 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

Wear Them! 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)

Pain Management ORAL MEDICATIONS Nonsteroidal antiinflammatory drugs (NSAIDs) Topical analgesics (creams) Vitamin B 6 Orally administered corticosteroids LOCAL INJECTION? SURGERY?

LOCAL INJECTION

Agricultural Tasks

AT Devices ‘til pain shuts you down…

AT Devices Assistive Technology for Carpal Tunnel & Arthritis 1. 2. 3. 4. 5. 6. Does the painful task have to be done? Could that task be done a different way? Can the task be traded with other workers? Will a tool reduce pain caused by that task? Would adapting a tool reduce your pain? Design a new tool to reduce the pain!

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

AT Devices Transplanting – 1000 x

AT Devices Transplanting – 1000 x

AT Devices Transplanting – 1000 x

AT Devices Pruning & Harvesting – 1000 x

AT Devices Pruning & Harvesting – 1000 x

AT Devices Pruning & Harvesting – 1000 x

AT Devices Pruning & Harvesting – 1000 x

AT Devices Hand Tools – 1000 x

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

Summary Agr. Ability 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.

References Sources o o o American Family Physicians Group Arthritis Foundation Carpal Tunnel Assocation De. Royal “Carpal Tunnel Syndrome, Arthritis and Wrist Fractures” (PDF file) Family. Doctor Website: Carpal Tunnel Syndrome National Institute of Neurological Disorders and Stroke: Carpal Tunnel Syndrome Fact Sheet