Initially, Shirley Thrasher dismissed the dull, achy pain that sometimes settled in her thumbs.
Then it got worse, sending stabbing sensations through her thumbs and into her elbows, which swelled up with fluid. As the throbbing increased, so did its regularity.
Unable to ignore the pain any longer, Thrasher consulted a doctor. She was diagnosed with carpal tunnel syndrome - a painful condition caused by compression of a nerve that runs from the forearm to the wrist - and inflamed tendons on the outside of the elbow, otherwise known as tennis elbow.
The culprit? Her job.
For 32 years, Thrasher has performed data entry for a car leasing company. On most days, she types up to eight hours a day. This, combined with Thrasher's awkward positioning in relation to her computer and desk, led to her repetitive stress injuries.
In offices across the nation, Thrasher's predicament is a familiar one. In 2001, more than 355,000 employees nationwide reported suffering injuries to their upper extremities, including fingers, hands, and wrists. About two-third of these injuries were sustained, as were Thrasher's, because of worker motion and positioning, reports the U.S. Bureau of Labor Statistics. And costs to employers continue to rise.
But many employers have found that conditions like carpal tunnel syndrome are curable and avoidable. Their remedy of choice is ergonomics, a discipline that finds ways to adapt work environments to fit employees, rather than the other way around. Many workers also have been better trained during the past few years to improve their workplace posture and to take more breaks to avoid repetitive strain injuries.
Not dealing with it can cost thousands of dollars. The average worker's compensation claim associated with an upper extremity musculoskeletal disorder (MSD) - the blanket term for soft-tissue disorders affecting the upper limbs - costs about $8,000, reports the Occupational Safety and Health Administration. Annually, the injuries cost the U.S. work force $54 billion. The latest labor statistics show that, in 2001, more than 26,000 employees missed work because of carpal tunnel syndrome; another 14,000 because of tendonitis.
Seemingly contemporary, the concept of ergonomics dates back centuries. In 1700, Italian physician Bernardino Ramazinni first wrote about work-related injuries and illnesses in the publication De Morbis Artificum, or Diseases of Workers. His colleagues ostracized him for visiting his patients' workplaces to uncover their ailments.
Ramazinni would have been much more popular today. Although employers aren't required to implement ergonomic programs - a 2001 bill to require an ergonomics standard in the workplace was defeated in Congress - many are launching them voluntarily.
"Large, enlightened employers are recognizing and implementing [ergonomics] programs that, if nothing else, improve productivity," says Dr. Edward Bernacki, head of occupational medicine at Johns Hopkins Medical Institutions.
He counts Hopkins among them. The institutions' approach to ergonomics includes a task force to study the office. An industrial hygienist evaluates "stressors" in the work area and finds ways to ameliorate them. On-site occupational medicine physicians such as Bernacki diagnose and treat employees who complain of aches and pains. And, thanks to software developed at Hopkins, the institutions' safety professionals receive alerts to investigate workplace accidents soon after they occur. Also at hand is a nurse case manager who works closely with injured employees.
The results speak for themselves.
Established in 1992, Hopkins' ergonomics program focused on identifying and treating upper extremity MSDs. Within seven years, the program had virtually eliminated the need to surgically repair carpal tunnel syndrome arising from upper extremity MSDs. Now, 14 years later and with a population double its original size, the program averages one surgery for carpal tunnel repair every other year.
It has also reaped savings. During the past five years, Hopkins has reduced the number of days it pays for injured employees from 5.5 per $100,000 of its payroll to one per $100,000.
When ergonomic problems in the workplace are detected before resulting in significant injury, the fixes generally are not expensive.
"Ninety percent of corrections are no-cost," says John Schaefer, associate director for Health, Safety and the Environment at Hopkins. "It's often a matter of realigning the person with the workstation so the individual, the computer, the keyboard and the monitor are all in a straight line."
Few companies have the internal resources to develop an in-house ergonomics program and many hire consultants to handle those duties.
"Each year our business grows at least two to three times over the past year," says Lori Eig, a physical therapist who runs Ergo Concepts LLC, a Bethesda-based ergonomic consulting business. "In the long run, we help companies that are trying to be proactive and see a greater return on their investment. Keeping employees safe and comfortable helps with retention and attraction."
The principles of ergonomics weigh heavily on the mind of Carol Currotto, interior designer for Baltimore architectural firm Kann and Associates.
"It's my job to make sure a work space works for the person who uses it," she says.
That includes choosing furnishings carefully. But it also includes training.
"We have excellent furniture, but we had to train people on how to use it," says Catherine Quinn, occupational health nurse with CareFirst BlueCross BlueShield.
To combat repetitive stress pain, Thrasher has had to wear splints she calls restrictive and uncomfortable. She also has received multiple cortisone shots administered directly into the bone of her elbow, and undergone physical therapy twice a week.
Thrasher's physical therapist offered tips on how to improve her posture while sitting for hours at her desk. She also advised Thrasher to swap her chair for one that offered better support, and to replace her keyboard with a "split keyboard" for greater hand and wrist comfort.
Those suggestions and the physical therapy helped Thrasher avoid surgery for carpal tunnel syndrome. She also said she managed not to miss any time from work.
"I've thought about quitting [my job]. But I can't," says the 55-year-old Thrasher. "My physical therapist told me that the way I was sitting at the computer had a lot to do with my problems."