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At discharge, she does have considerations that were not in place previously. They are contained in a
new agreement with her supervisor and employer:
1. When faced with pushing
lifting that is beyond her specified job requirements, she will seek help.
This will prevent the sprain
/
strain she suffered previously.
2. If myofascial symptoms are high, she will be allowed short breaks for her stretching. She and her
supervisor will work out what is acceptable. This will prevent her suffering in silence and being
absent because of another physical problem.
3. The equipment she has to move has been ergonomically redesigned with larger and more movable
wheels. Force required for pushing and pulling has been reduced from 100# previously to 30# with
the new wheels. If other equipment or material creates high stresses, she is to report them for
analysing an ergonomic modification. To this point, the employer now has a relationship with
the rehabilitation ergonomist for more work to reduce stressors in the entire facility.
4. Interest in stretches, ergonomic education and fitness increased after there was interaction with
the rehabilitation ergonomist. Preventive programs were discussed and are being put into place
for all employees.
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22.6.4 Case Study III: Worksite Model
Makai Brown assembles furniture from parts shipped from a supplier. His employer sells the assembled
models, which are fitted with customized additions. Makai has begun to have right thumb and finger
numbness at night and discomfort in the lateral epicondyle area of his right arm during activity. His
physician has diagnosed early carpal tunnel syndrome and lateral epicondylitis on the right.
The company's occupational health department contracts for a rehabilitation ergonomist to work at the
company 2 days a week. The role is to work with the team in prevention ergonomics, to provide ergonomic
education to the workers and to work with those with early musculoskeletal symptoms, illness or injury.
The physician prescribes an anti-inflammatory medicine. The rehabilitation ergonomist institutes
therapeutic measures such as night splints, an epicondylitis band to support the elbow extensor
muscles and a stretching and flexibility exercise program for the neck and upper extremities. In addition,
modified functional testing is performed and matched with his job description. His current job requires
moderate to heavy repetitive upper extremity activity and use of an impact wrench. All gripping activities
increase his symptoms. He is able to do nonrepetitive work with his hands and arms and he has no
limitation in walking, standing or sitting.
It is desirable from his and the employer's point of view that he remains at work. He is temporarily
given the job tasks of quality inspection, inventory and tool maintenance. He is treated onsite with phys-
ical therapy for his epicondylitis. His functional statistics such as grip and pinch are taken for a baseline,
his carpal tunnel symptoms are documented and monitored, and he is given a home exercise and posi-
tioning program. He maintains his restrictions on gripping and repetitive work for home and rec-
reational activities. He also takes the ergonomic training course, which educates him on stressors and
modifications that he can do himself. He works for 2 weeks at the modified job.
At 2 weeks, his sensory symptoms in fingers and hands have been reduced, the lateral elbow pain is
gone, but the grip strength is only 75% of what his left hand shows. He states it feels weaker than
before his problems. He continues all treatments, as he gradually resumes some of his normal activities.
Four hours a day he resumes light furniture assembly. He is given a pneumatic impact wrench to replace
the mechanically driven one. The new one is half the weight and much easier to grip than the former tool.
The other 4 h continues to be the lighter duty tasks. He is aware of early symptoms and is to stop, stretch
and resume activity slowly if there is a problem.
At 4 weeks, both carpal tunnel and epicondylitis symptoms have subsided. His active treatment stops,
but self-exercise continues as needed. He resumes full duty with self-monitoring of symptoms and
regular re-evaluation by the rehabilitation ergonomist. Makai and the supervisor can call the ergonomist
with questions or problems and the ergonomist will consult to make adjustments as necessary.
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