All Hands on Deck with Al Brown

<p><a href="https://www.bls.gov/iif/oshwc/osh/case/cd_r13_2018.htm">In 2018, BLS data shows</a> hand, wrist, and finger injuries comprise more than 43% of all upper extremity injuries that caused days away from work.  On this episode of the MEMIC Safety Experts Podcast, Al Brown, MEMIC's Director of Ergonomics takes a look hand injuries causes and some strategies for prevention including MEMIC's E-Ergo™️️ tool, use of gloves, and tool and workplace design.</p> <p> </p> <p><strong>Peter Koch:</strong> [00:00:04] Hello listeners, and welcome to the MEMIC Safety Experts podcast, I'm your host, Peter Koch. Besides our voices, our hands allow us to express creativity and emotion through gestures and complex movements. The hand and wrist, believe it or not, have more than 27 different bones and 30 muscles, in addition to tendons and ligaments that allow for a staggering number of movements in positions. We use our hands every day to point, grasp, move, support, throw, catch, you name it. Our hands are usually involved with what we're doing, even gesturing right now. As I'm talking, I'm using my hands. You can't see them, but I am using my hands. Without them or even without one of them will struggle to live up to our potential. Think about it for a minute. Consider your day. So far, whenever you're listening to this podcast, what have you done that didn't require one or both of your hands? How did you put on your glasses or put in your contacts or on your sunglasses? How did you tie your shoes or brush your teeth, drive your car, [00:01:00] grab that cup of coffee? Using our hands to do things is so commonplace that we typically take them for granted until we hurt one of them. So a story, I had to take my dad to the E.R. the other day after a fall and we were checking in. And as we were checking in, a chef who, you know, you could tell he was a chef because he had the apron and the chef's coat that had his name on it. Chef Andy, he walked in holding his left index finger covered in a bloody rag, and he was treated in the next space over from my dad and I. And once the bleeding was stopped and I was listening, he was whisked away to see the orthopedic surgeon because they couldn't treat him there. I expect he's going to have a good outcome, but I imagine, at least for the next few weeks, he'll struggle with everyday activities, not to mention his work duties. So cuts and lacerations, crushing injuries, struck by injuries are all pretty common. There's good data out there to show that PPE can help reduce the severity of the injury that was caused by the event. However, there are a raft of other injuries [00:02:00] that are even more difficult to prevent because they're not always caused by a specific event like a splinter or a laceration. Injuries caused by prolonged static or awkward postures can be just as crippling as a traumatic event, and the healing process can be way more prolonged and dependent upon the injured person's changing their behavior or the workplace changing configuration or tools. So on the podcast with me today is Al Brown PT and director of Ergonomics, for Maine Employers Mutual Insurance Company, or MEMIC. Al has been on the podcast a number of times before and always brings a great perspective as to how the body interacts with the stressors in the workplace and what to do about them. Today Al is going to help me get a better grasp. Pardon the pun, of the causes of hand and wrist injuries and how to prevent them. Al welcome back to the podcast.</p> <p><strong>Al Brown:</strong> [00:02:51] Thanks, Peter. Appreciate that. I have to hand it to you. That was a great intro.</p> <p><strong>Peter Koch:</strong> [00:02:55] Oh, I'd Shake your hand Al for that for being on so many times and hopefully we'll stop being [00:03:00] quite so punny as we get moving</p> <p><strong>Al Brown:</strong> [00:03:03] Jazz hands. I'm so excited about this.</p> <p><strong>Peter Koch:</strong> [00:03:07] So this is awesome to have you back on. And I know we've talked about this subject a lot because hand injuries, regardless of what it is, are very common and one of the more common types of workplace injuries that we're going to see. So let's talk about some of the stats that are out there like we know it's a problem, but how big a problem are hand and wrist injuries out there in the workplace?</p> <p><strong>Al Brown:</strong> [00:03:28] Looking back through some of the data and when you look back through some of the Bureau of Labor reporting and OSHA, they probably account for about a third of work related injuries. And that's when you sort of include, you know, the hand, the wrist and a little bit of the, you know, the forearm. But they account for about a third and their second, probably only to back injuries when you look at that data. So significant. Significant. [00:04:00] And then, you know, there's you know, when you look at costs, for example, loss of a thumb, you were talking about the gentleman that walked into the E.R. with the bloodied finger had he chopped off his thumb and could not put it back on. That's a thirty five thousand dollar for permanent disability kind of thing. That that's a chunk of change. When you think about it, you know, when you look at tendon repairs, they can cost up to 70,000 dollars. So it because of the intricacy of the hand, the fine motor activity, the abilities, there's a lot of things that can go wrong. You know, we often think about hand injuries to in the world of manual material handling, lifting, moving, carpentry, things like that, the chef. But we do see a lot of hand injuries just in the office environment, too. As matter of fact, a good portion when we look at banking and looking at law firms and accounting for in places like that,  [00:05:00]probably the leading injury. Second, I should back up and say slip trips and fall seems to be number one, but when we look at strains, sprains and injuries along those lines, their leading body part injury is the hand. Wrist and hand or upper extremity. So it is very common that we see these across all industries.</p> <p><strong>Peter Koch:</strong> [00:05:21] Yeah, and I think people tend to think about the severity of the hand or wrist injury with those traumatic type injuries. And I imagine you have stories like this, too. I have a friend way back when I was actually building houses, he was a phenomenal carpenter, an amazing guitar player, fingerpicking guitar player, could play just about any style, could hear it, and within a few minutes figure out the melody without any music in front of them. And just amazing guy. And he was ripping some plywood on a table saw without a guard, and he got a little kickback and put his hand down [00:06:00] on top of the spinning blade and pretty much cut his hand from his index finger across the meat of his thumb down to his wrist. And it took enough of the muscle out of there where it took him almost five years to get the dexterity back, to be able to finger pick again. And just, you know, you think about those severity things. People think about machinery, like you said before, with the severity of the injury. But we've also seen some pretty significant injuries that have come from those awkward postures or repetitive type injuries that might happen in an office. They just happen over a longer period of time. It's not that instantaneous. I touch something and it caught me or it crushed me and I have a permanent injury. So those same things can happen regardless. And I think it's important to know not just what can injure you in around the machinery, but what can injure you within in the other parts of the workplace. Those maybe not quite [00:07:00] so dangerous sounding jobs that are out there.</p> <p><strong>Al Brown:</strong> [00:07:03] My common thread, if you ever listen to the podcast that we've talked about, I always talk about gravity. I talk about neutral. And the reason, you know, we are a structure walking around in this world of gravity. So balance is real key. Our body likes that balance the wrist and hand. There's an orchestration between brain and hand. And it's funny, we're you know, we're right. People who are either right handed or left handed. There is a core of the population that is ambidextrous. But you're either right handed or left handed, right handed people, believe it or not, your right hand is controlled by the left side of your brain and your left hand is controlled by the right side of your brain. So about 80 percent of the population is right handed. So there's about 10 to 15 percent of the population that's left handed. You talk about guitar, you're going to buy a guitar. You know, just and you said my son was left handed. He said, I went into the store, music store and I said, hey, we'd like to get a left handed guitar. They totally [00:08:00] discouraged us from doing that because they said wherever he goes, if he walks in somewhere and that happens to be a guitar laying there and someone says, hey, you play the guitar, why don't you strike a tune for us? And he picks it up and it's a right handed guitar and he's learned on a left handed guitar, he will have a very hard time playing it unless you're Jimi Hendrix.</p> <p><strong>Peter Koch:</strong> [00:08:19] I was just thinking about that, too, right,</p> <p><strong>Al Brown:</strong> [00:08:22] Who flipped a right handed guitar upside down and learned to play it left handed. So there's, you know, looking at fine motor again, that's that relationship between brain and hand and the fact that it's such a complex structure and much of what we do is unconscious in nature. When you start to create those muscle patterns going between hand and you look at the complexity of it and it's repeated patterns over and over and over again, they say that the hand will go through twenty five million bends and stretches over a lifetime. That's one hand.</p> <p><strong>Peter Koch:</strong> [00:08:58] Wow.</p> <p><strong>Al Brown:</strong> [00:08:58] So, I mean, that's [00:09:00] just incredible. And if you are someone like a guitar player or a piano player or a carpenter, that hand is just put through those repeated motions over and over again. We do a lot of unconscious repeated behavior.</p> <p><strong>Peter Koch:</strong> [00:09:14] We definitely do. And there's that. We were talking about this before the podcast as well. There's that relationship between power and dexterity that the hand has. That's pretty amazing. You talk about a carpenter, right? So I need to have the dexterity in my hand to be able to pick up a nail and hold it in place. But I also have to have the power in my other hand to be able to mash that nail into whatever wood that I'm going to be driving it into. And so that's tough, too. Now, you are doing a little bit of research on some of those fun facts around, like what the hand can actually do. And I think it's pretty fascinating. So, like, if you think about power, like how strong are people's hands compared to how dexterous people's hands are because it lives in the same body, you can do the same thing. Dexterous things and pretty strong [00:10:00] things.</p> <p><strong>Al Brown:</strong> [00:10:01] Yeah. I looked up some of those things, but, hey, back to that hammer thing. Yeah. And the ability to hold on to that nail and come down and strike that thing with something very hard, hoping you don't hit the wrong nail.</p> <p><strong>Peter Koch:</strong> [00:10:17] Very true. Very true.</p> <p><strong>Al Brown:</strong> [00:10:19]  There's a relationship there. A rookie, the new employee is going to hit more fingernails than maybe the person that is more seasoned. So, you know, there is that. But when we look at the extremes, it was a fun little search I did on the internet and I said, OK, what's one of the most powerful things the hand could do? And I said, well, grip. And I said, what's the most? So I looked up, what's the biggest deadlift of the world record for the deadlift? And I guess it was set back in May of 2020 by a person named Hawthorn Björnsson, nicknamed Thor, [00:11:00] very apropos from Iceland, and he lifted over eleven hundred pounds of force in the deadlift. So that's, you know, granted he does have an assist with the grip, with some straps. But other than that it is, you know, each hand is handling, you know, five hundred and fifty pounds of force that he has to hang on to in order to stand upright, that the large muscle body, large muscles in his body is his buttock, his back extensors, his quads have to lift, but he has to hang on to the weight with his hands. I'm going to go to the other extreme. You go to the other extreme. And I said, what's the most difficult piano piece to play? And there was a number of top choices. But the one I picked was it was Beethoven's number twenty nine B flat major Opus 106, which if you look at that online, it has got to be one of the fastest hand movements and so intricate that it's very difficult [00:12:00] to even the most seasoned piano players to play. So you look at that extreme from those fine manipulating motor activities that have to move each individual finger to lifting 1,100 pounds, you know, that that just fascinates me in the extreme abilities of the hand.</p> <p><strong>Peter Koch:</strong> [00:12:20] It is amazing what the hand can do. And that's just fascinating to be able to lift 1,100 pounds with the weak link being the coupling of your hands. Right. To be able to lift that whole thing. And then I'm pretty sure Thor's not a piano player. But, you know, if he is, he's probably not playing Beethoven. But you never know</p> <p><strong>Al Brown:</strong> [00:12:37] Could be could be.</p> <p><strong>Peter Koch:</strong> [00:12:41] Even to be dexterous enough to take a pencil and write your name, all of the fine motions that have to happen to be able to hold the pencil at the particular angle and then produce the motions and the movement with your hand, your wrist and your fingers to make the script occur on the page is all fascinating [00:13:00] and how your hand can do that and the connection between your brain. And we've all probably maybe some of our younger listeners might not have had this as much. But I bet you remember going back to school and getting a cramp in your hand, taking notes in class at some point in time, like you're just you're furiously writing notes to keep up with the professor who's up in front of you. And, you know, you're shaking your hand out because it hurts, because you're gripping it so hard that I'm not at neutral anymore. I'm causing some discomfort and from not so much overuse, but probably not the best posture or trying to produce those different fine motor functions in a way that's not allowing me not long enough circulation to move through. So really amazing what the hand can do. And fascinating, there's lots of different parts of the body that have that like we talked about the spine before, that have that's a lot of power and in functionality and movement [00:14:00] within that as well. But the hand really lots of cool things that can happen that it can do for sure.</p> <p><strong>Al Brown:</strong> [00:14:05] Well, it's been a big paradigm shift. I mean, you go back to me and you start with chalk on a chalkboard, go to a pencil, you know, and you know. So chalk is a different kind of prehensile grip to actually right on the chalk. Prehensile grips or the different things like pinch grips, like, you know, your thumb, your pulp grip. And, you know, there's three point chuck grip. The chalk was like a three point chuck grip. Then you went to a pencil, which was more like a prehensile grip or fine motor activity to now where we hover over a keyboard. So if we hearken back to the days, it's a matter of fact, the handwriting has gotten progressively worse simply because most folks are hanging out on the keyboard now, typing away. So the ability to write and take notes is really sort of it's just a different format. </p> <p><strong>Peter Koch:</strong> [00:14:51] I Finally feel normal because my handwriting has been messy all my life and now I fit in with everything else.</p> <p><strong>Al Brown:</strong> [00:14:56] You fit in with the rest of the crowd.</p> <p><strong>Peter Koch:</strong> [00:14:57] Lowering the bar [00:15:00] every day. Right. There we go. Just kidding.</p> <p><strong>Al Brown:</strong> [00:15:03] I'm still trying to figure out the keyboard. So, you know,</p> <p><strong>Peter Koch:</strong> [00:15:06] It is an interesting shift. And that shift from writing on the chalkboard to taking notes with a pen or pencil to the manual typewriter, to the automatic typewriter and now to the computer keyboard has really changed how writing or written communication affects our physical the physical demands. Right. So the written word hasn't changed. You could we could have a whole other podcast on how that is altered. But you think about written communication. I have to send something or write something that someone can read going from the student or the professor to the student, the student to the paper. And now, you know, all the way to the computer keyboard has really changed the demands of what the body needs to do in order to get the word onto whatever medium you're doing. And there's different exposures there. Right. So that exposure [00:16:00] of writing is very different than the exposure for typing, and it creates different challenges for us.</p> <p><strong>Al Brown:</strong> [00:16:06] Then throw in the mouse, you know, if we go back to that office environment and then, you know, a lot of things are sort of driven by the mouse and the mouse was a later invention from the keyboard. And then we all sort of kind of placed it out to the side. So then the fine activity of the hand, there's different shape mice out there nowadays because I can't tell you how many folks I deal with that have you know, they've got tingling in this hand. They've got discomfort like on the corner right below the bottom of your little finger, like way back by your wrist. There's a bone right there. And it's called your pisiform. And a lot of people that have limited space by their keyboard will be pivoting on that. And they create what's called a contact stressor. So you'll see it'll be red and angry and they'll go, it hurts right there. And it's yeah, I don't know why. And it's, you know, just hanging out [00:17:00] on that mouse and pivoting on that part of your wrist, just moving the mouse back and forth. So it's or you take people to ask about vertical mice, mice that are vertical. Well, if it's too vertical, your fingers want to drop down to earth. Welcome back to Gravity. So even though that's a small muscle group, you tend to hang on to that vertical mouse a little bit harder than you would maybe a semi vertical or a flat mouse. So all of a sudden you're noticing discomfort in the back side of the thumb or in the forearm, the different names from De Quervain's tendonitis. And it's because you're trying to hang on to this mouse just because of its positioning. So those subtleties in life have become more frequent simply because the way we compose words nowadays are kind of hovering over these things in front of us.</p> <p><strong>Peter Koch:</strong> [00:17:52] So let's just break that out a little bit, because, you know, we've talked about some of the most frequent injuries being cuts, lacerations, abrasions, and we're going [00:18:00] to touch on those and prevention of those. But let's break apart the process of typing, because most people are going to do it. You know, even if you are, you don't have an office job, you don't have a job that demands you be in front of the computer all the time, the majority of us are going to be on something, whether it's an iPad or a phone or some electronic device that's going to have some sort of static posture that's you're going to be generating words with in some form or another. So why do we see so many repetitive stress or awkward posture type injuries or claims coming from keyboard and mouse use? He talked about the pisiform bone and the pivoting on that piece and mouse. But there's other stuff that happens to, you know, people do you know, how does that happen? What happens and what do we do to prevent it?</p> <p><strong>Al Brown:</strong> [00:18:49] Sure. Yeah, no, that's just one little tiny piece. But yeah, we could do a whole lot.</p> <p><strong>Peter Koch:</strong> [00:18:53] Yes, we could.</p> <p><strong>Al Brown:</strong> [00:18:54] Let me give you the highlights. I mean, some simple basic problems. We run into standard desks [00:19:00] that were those writing desks that we used to have in the past, that we still have are twenty nine and a half inches high and most chairs that we sit on probably go up to about 20 inches. The seat pan. There's quite a difference between twenty nine and a half and twenties, about nine and a half, almost ten inch difference between seat pan height. So if the desk, which often is the case, is too high, we have to manipulate that keyboard and put it in certain positions which as if we can't reach parallel if our forearm and wrists, are recess to be in line with our forearm and hovering over our keyboard. If we can't get to that posture on our current situation because the desk is too high, the chair's too low, we tend to either push the keyboard back or we put the keyboard might be too low or too high. We change that angle between wrist and forearm. And as that changes, the further it gets away from neutral, where the hand is parallel with the forearm, the more [00:20:00] you close down a place that delivers the nerve and blood supply to the wrist and the hands. And the more you start to fatigue the shoulders, too, and the more you start weight bearing on those and creating these awkward postures so you can get tingling in the fingers. If you're seated too low, your arm might wing out to the side and you might rested on the arm of your chair. It might be resting on the return on your desk and all of a sudden you expose and compress the little nerve that goes right around your elbow called your funny bone or your ulnar nerve. And you're noticing that your fourth and fifth finger kind of go and tingly. So again, just the height of the desk and this little discussion we're having will impact what happens to your hands if the reach to the mouse is too far. And again, remember standard keyboards, Pete, you've got the qwerty, which are the letters which are typically like a typewriter, but then, I don't know, someone mandated we got to have a number [00:21:00] pad. So they hung that out on to the right side of the keyboard. And then if you look at 80 percent of the population is right handed. Where do they all tend to put the mouse? To the right hand side of the keyboard? So now that arm has moved way out of neutral to go get it and people tend to hang on. That's when they start pivoting on the wrist or loading up the wrist in hand. And that's when we start to see the forearm elbow tendinitis, because folks are parked in a very long distance away from the body. So we're trying to bring everything back in closer. You were talking about the connection between brain and hand. One of the suggestions we often give for the keyboard with the number pad to the right, with the mouse to the right with a with a standard bilateral mouse, one that you can use in either side is what you put the mouse on the left hand side of the keyboard. What do you think the response is when we say that?</p> <p><strong>Peter Koch:</strong> [00:21:52] I can't do that.</p> <p><strong>Al Brown:</strong> [00:21:53] I can't do that.</p> <p><strong>Peter Koch:</strong> [00:21:54] I can't do that.</p> <p><strong>Al Brown:</strong> [00:21:56] And it's a simple motor pattern, just moving something around and clicking it. But it [00:22:00] brings it's a quick, easy solution to bring things more into neutral and reduce the forces on the wrist and hand and shoulder and neck. And it takes a couple, three days. It's just a motor pattern, but that's a plan. But again, that's that right left brain. This is my dominant hand. Don't try me. Tell me. And again, you go back to injury. Many folks listening to the podcast today that may have been that are right handed, that might have fallen and sprained their wrist, the right wrist or fractured it. And we're casted very quickly discover how dependent they are on that right hand, but realize after a couple of days that the left hand is a good second choice and it steps up to the steps up to the plate and does a pretty good job after a couple, three days.</p> <p><strong>Peter Koch:</strong> [00:22:49] It is amazing how you can train your body to do a different act or an activity in a different way when you're forced to do it. But that's an interesting [00:23:00] part, too. And I think we'll talk about this as we go through that prevent the prevention piece. It's one of the challenging pieces of repetitive motion or awkward postures, because they're cumulative, because they take time to do that and it takes time for you to learn the other way to do it. You should be kind of doing this all along, switching from side to side so you don't have the repetition or the constant awkward posture of the constant pressure on that one side happening. But it just takes time. It's weird. I know one of my friends, they broke their right forearm and they were casted. So they really couldn't do a whole lot with that. And I remember them. The hardest thing for them to change was brushing their teeth. And they came to me one day. We got coffee together and a blistering hot cup of coffee and they took a sip of the coffee. And it burned. Right. But I took a sip of the coffee and it was hot, a little burning. But they were like incredible pain, like, [00:24:00] Dan, what's going on? It's like, well, I was brushing my teeth today with my left hand because I can't do it my right hand and I stab myself in the back of the throat with a toothbrush because they just didn't have the fine motor control of that. But, you know, a week later, they were like at no big deal. It works just fine. So it just takes a little while to figure it out, to learn it. Yeah. Yeah. That retraining of that.</p> <p><strong>Al Brown:</strong> [00:24:21] Yeah. Discomfort breeds change. But I mean, that's the only thing that kind of, you know, and that's the problem is that's why people won't learn, you know, kind of flip flop back and forth unless there's some discomfort or problem or, you know, something that restricts you. You typically don't change simply because it's just more efficient to just keep moving forward and using that your right hand or your, you know, whichever handed you are. Yeah. And why change, you know, until you have to.</p> <p><strong>Peter Koch:</strong> [00:24:46] Right. Right. Now, let's talk a little bit about anatomy and physiology of the hand and wrist, like we talked about that it is a really it's a very dexterous body part for us. We can do lots of things that can be powerful. It can be really it [00:25:00] can do a lot of fine motor stuff. But what allows it to do all those things? What's the anatomy that makes it all up? And then how does some of those postures affect the anatomy that cause some of those challenges in repetitive or awkward posture injuries?</p> <p><strong>Al Brown:</strong> [00:25:17] Sure. Yeah. Well, you had mentioned earlier there's about and again, it varies. Some people have some extra little bones in the hand, but somewhere between 27 and 29, bones that make up the wrist and hand and it's about it, believe it or not, that's about a quarter of all the bones in the body are little spot. Yeah, right there, you know, about thirty muscles, about 129 ligaments, about 17,000 touch receptors in the palm, you know. So when you look at all those things that come together. Now, here's the thing. Most of the muscles that run the fingers, there's only tendons up in the finger, the belly of itself, the muscle itself. So if you think of a bicep, because everybody's kind of familiar with the bicep, the biceps [00:26:00] has this big meaty part in the middle of your upper arm. And then it what it does is it pars down to like a tendonous structures that connects below the elbow and then another two tendonous structures that go up into the shoulder. Very much like the hand, the meaty part of that muscle for the fingers is in the palm of your hand and it's just the long tendon structures that go up into your fingers and those things run your fingers. You can kind of wave your fingers around. You can make it sort of, you know, like bring your knuckles down and straighten your fingers out that your lumbar curls. But then the thing that moves your wrists, those muscles, the long tendons go up your forearm and those meaty part of it is your forearm itself and then attach to the elbow one of the problems we run into when you make a fist. OK, if you if you hold your hand up in front of you so that your thumb is kind of facing you and you make a fist, OK, you're going to look at the upper fingertips. They're all curling down. [00:27:00] But as they curl down, you'll notice the knuckles, you know, sort of at the base of your finger where the hand comes up and then the base of the finger. If you look at the back of that, hand back your hand, which way is the back of your hand moving? It's actually moving backwards away from that curl. Well, that's an orchestration between the flexors and the extensors of the wrist. The flexors are curling your hand down, but the extensors at the same time are pulling your wrist back because it makes it a more efficient grip. And that's why your hand tends to drop back in. Those muscles, the flexors attached to the inside of your elbow, kind of the part of your forearm that doesn't have much hair sort of that. And you get a little bump on the inside of your elbow. The extensors go up, that sort of the hairy side of your forearm and attach on the outside of your elbow called the if people have injured that before, it's called tennis elbow. And the reason for that is it tends [00:28:00] to be an injury that tennis players got. And when they would hit backhand, the ball would hit the racket and do a quick jerk and they'd get sort of a torque on that tendon. Making a fist, that balance between those muscles is so important. And, you know, we will do if you took the hand and you had someone just grip and we can do this with a grip dinamometer where you can measure the grip strength. And say you could generate 100 pounds of force with that. And you did it in neutral, which means that hand is balanced and right there in front of you. But then if we put the hand in an awkward position, kind of reach out, you might have to flex the wrist a bit. People will lose when we have them do that same amount of effort and force. They'll lose anywhere between 20 and 40 percent of their ability to generate grip strength. So think about that in the world of work in that if I have to work in an awkward position with my wrist in hand, I think of a company that I was working with that were putting trailer lights on. They [00:29:00] had to hold the light, what they were holding the light with the left hand and then there reaching up around and back to put the knot on. So that hand was on a very awkward position for an extended period of time, very inefficient, lost most of their ability to generate force. So it took more energy to do that all day long. Fatigue came quicker. What do you think the quality of the work was by the end of the day?</p> <p><strong>Peter Koch:</strong> [00:29:25] Oh, I'm sure a lot more mistakes could happen there, too, right?</p> <p><strong>Al Brown:</strong> [00:29:27] Oh, dropping the nut, you know, not, you know, not fully tightening the nut. Even you start to lose your ability to palpate and feel and touch and your sensory your muscle strength goes. So now here is a worker hurting themselves, the product going out of the door, out the door. You know, you're driving down the road is the consumer. But yourself a nice new trailer and you're looking at the trailer lights banging along the road because they fell off, you know, and again and you bring the trailer back and go this trailer's horrible, I'm going to give it a one star. And so, again, [00:30:00] looking at design, how are workers working? How are their hands neutral? Understand that neutral position, set that workforce up so that they're more in a balanced position, better quality work, happier worker, happier customer.</p> <p><strong>Peter Koch:</strong> [00:30:13] Yeah, and you can't change you can't change anatomy. So you've got to change something else about the work. So either the tool that they're using or the ergonomics of it. We talked a little bit about how to set that, you know, an ergonomic workstation up to be more in neutral. And that's the key. You've talked about that before. You said it's been a theme throughout many of the podcasts. And it is because any time you interact with something you want to look at, if I can start the job in neutral, how far out of neutral do I go to complete the job and how often am I there and how long am I there so neutral posture is a fairly important thing to remember, regardless of what the task is, and especially for something that you're doing with your hands, arms or shoulders for sure.</p> <p><strong>Al Brown:</strong> [00:30:55] Pete I mean, think of tooling, you know, we were talking about pencils and computers [00:31:00] and you threw in typewriters. I forgot about those. I sort of skipped that era. But think about the morphing or the or the number of iterations. Of the screwdriver.</p> <p><strong>Peter Koch:</strong> [00:31:14] Right, right,</p> <p><strong>Al Brown:</strong> [00:31:15] You know, think about what a screwdriver looks like nowadays, it's you know, it's a pistol grip, you know, if that's what we're using and it's power driven. And, you know, think about, I remember having to put together a friend of mine said, hey, I got this shed and it was one of those aluminum sheds. And they said, I got it for free. And they handed me a bag of screws. I mean, we're talking a giant bag of screws like we're talking a small kitchen trash bag full of screws and said, could you put that together? And I had, there was no such thing as a power screwdriver. And, you know, two days later, I couldn't even, like, wash my hair after it was all over. I just couldn't move my hands [00:32:00] because of the number of rotations to put that together. But had I had a power screwdriver, life would have been glorious</p> <p><strong>Peter Koch:</strong> [00:32:08] Sure faster, quicker, less repetitions. But I think that that breeds even a better question because take the power screwdriver out of it. Take the screw gun out of it for a moment. You can buy a screwdriver in many different sizes and configurations, not just the, you know, a Philips versus a star versus a flat bit, but the handle can be configured very different. Some are bulbous, some are long. Some are short. Some are textured. Some are smooth. And really, if you're thinking about it, there's multiple reasons for some of the different configurations. But when we talk about ergonomics, if I can't have the power screwdriver with the pistol grip and I have to use a manual driver to do that, because sometimes you have to what's the best way? Like what's the best type of grip for that hand tool [00:33:00] that you aren't going to be able to pistol grip it with?</p> <p><strong>Al Brown:</strong> [00:33:04] We were just looking at some ergo film the other day, some film a company had sent to us in what's called our E Ergo process. It's where a company can submit video footage of a job and have us analyze it. They were manufacturing small products and in that particular case, and it's on a workbench and they're sitting and if they had a pistol screw gun, the problem is they actually have to, we call it deviate the wrist, which would be instead of flexing and extending. So instead of flexing your hand forward and extending it backwards, they actually have to deviate, which would be sort of tipping your hand toward your little finger side. And there's two deviations. There's ulnar and radial deviation where you can tip your hand towards your thumb side. But in this particular case, they'd have to go towards our little finger side with a pistol grip to actually do the work. In that particular case, a shaft electric screwdriver where they could literally [00:34:00] grab and come straight down with a power grip was much better for them. And with this particular tool, some of them are air driven, even we have them on a tool balancer. So when they release this thing, instead of laying it back down on the workbench, it actually hovers back up over the workbench so they can just reach up, pull down and do the screws. So in that particular case, a pistol grip would not have been effective, would have created probably more problems in some cases when there's really fine motor like small screws, even just a standard Old-World screwdriver works a whole bunch better. So, you know, you really have to look at the specific job and the tasks to determine what's the best tool. You know, you don't go out just by a bunch of pistol grip tool, you know, screwdriver to go there all fixed. You may be creating some of the problems along the way. So, again, go back to how do I keep that person's hand in good, neutral, working posture balanced? [00:35:00] You know, I wanted balance when I see really awkward extremes of the wrist. I know there's potential problems ahead.</p> <p><strong>Peter Koch:</strong> [00:35:07] Right, so that deviation on their side radial side or flexed forward or flexed backwards are things to consider with the position of the work that you're doing and then thinking about where neutral is and then determining what type of tool is going to keep you in that neutral position. Best give you the best grip. That's good advice.</p> <p><strong>Peter Koch:</strong> [00:35:31] Let's take a quick break so I can tell you about our E Ergo resource that can be used to help solve ergonomic challenges at your workplace, sometimes contacting, contracting with and scheduling an ergonomist or occupational health nurse for an onsite evaluation doesn't really fit with our Just-In-Time workflow. In a competitive economy fixing the problem right now is essential. And improving worker comfort and efficiency are key components to ongoing success. So [00:36:00] free to our policyholders. MEMIC's E Ergo tool can help you overcome ergonomic challenges. With just five quick photos or a short 30 second video and a brief description of what's being shown, you can send us the critical demands and essential functions within the work tasks once received are ergonomics team can identify risks and exposures and provide reasonable suggestions for ergonomic improvement within just a few short days. Start that E Ergo process now by logging into the MEMIC safety director at www.MEMIC.com/Workplace Safety. Now let's get back to today's episode.</p> <p><strong>Al Brown:</strong> [00:36:42] One thing I didn't mention is when you look at if you were looking at a tool like a hammer or very much like a tennis racket or something like that, people want to get the right size grip, too, because of the tool is too small. I see this in dental offices, too. Like if you look at the pics and the different fine motor things that they're doing on your teeth, [00:37:00] you may notice that some of your dentist, your hygienists have like fat handled tools now. Well, they discovered that those really small stainless steel, tiny tools, they were actually over gripping because it was too small. So they had to work harder. You can also go in the other direction if it's too fat over gripping. So if you're going to go out and buy a tennis racket or a racquetball racket or a nice hammer, it's always good to go down. There's like a couple of creases in your hand, but the one that kind of goes right across the middle of your hand, if you measure from that crease up to the tip of your middle finger, that's a good sort of rough way to measure what the circumference should be of that thing that you purchase. It's you know, it's a good way to kind of determine what's a good efficient grip for you.</p> <p><strong>Peter Koch:</strong> [00:37:47] Would a tool that measured, similar to this, the distance between that crease in your hand or the tip of your you said middle finger, index finger,</p> <p><strong>Al Brown:</strong> [00:37:57] Middle finger, middle finger</p> <p><strong>Peter Koch:</strong> [00:37:58] For that. So [00:38:00] if the circumference measure is pretty close to that, well, that feel pretty comfortable in your hand, like, is it does it pass sort of the straight face test of it feels good or will it feel fairly awkward in your hand if you're not if you're not used to it?</p> <p><strong>Al Brown:</strong> [00:38:14] It should for the most part, you know, call it rule of thumb.</p> <p><strong>Peter Koch:</strong> [00:38:18] I applaud you Al for bringing that in.</p> <p><strong>Al Brown:</strong> [00:38:22] That it will you know, and this is we're talking about a power grip, too. We're not talking about a dental tool that should be that creates. But we're talking more of a power type tool, a racket, something like that. Yes. Most likely that'll feel pretty comfortable because that's probably one of the more efficient grips that will keep the muscles that are holding it. Remember those muscles on the back side of your forearm, on the front side of the forearm, make that power grip, you know, coupled with the thumb. You know, the one thing we didn't talk about is that thumb opposes, which makes us very different from a simian hands. I mean, the hand of the ones that you see in the monkey, but the [00:39:00] human hand can oppose the thumb. There's nine muscles that run that thing. So that's what helps us determine that most efficient grip.</p> <p><strong>Peter Koch:</strong> [00:39:08] Is that one of the reasons we see, like if you think about landscaping or yard work, you're seeing a trend over the last I don't know how many years now you've seen it where you've gone from a very small wooden handle on your rake and your shovel to maybe a thicker fiberglass handle or a cushion, the thicker cushioned handle on that rake or the shovel or whatever hand tool that you're going to be using to give you a larger grip. Because I do remember like doing work when I was growing up or for my parents or my grandparents where, you know, you had the really thin broom handled rake to rake the yard with. And now if you grab one of those, I can tell you my forearms, my elbows, my wrists start to fatigue a lot more quickly. And, you know, old tendinitis kind of comes back, it feels like. But some of the larger grips, they feel a little bit more comfortable. So [00:40:00] is that the reason why they're doing that for those tools as well?</p> <p><strong>Al Brown:</strong> [00:40:04] Yeah, that's a perfect example, Pete. I mean, that's a that's a prime example of how there's been a transformation of tools. And part of that, too, is if you remember the old rakes and old shovels and things, a lot of them, they were wooden handles and sometimes they were then varnish. So they became very smooth. So it's even that texture to that. You now look at modern day tools. If you go down to the hardware store, there are a little bit more rubberized. There's a little bit higher friction surface maybe at the end in the middle, the rakes, because that ability to grip on you don't need as much force if there's a better texture between your hand. Same thing with gloves. You're seeing gloves. Now, remember the old leather gloves, the old sort of cowhide leather glove with the big gauntlet cuff on it. And, you know, people just hand them out and, you know, you just really couldn't grip very well with them. And in fact, ill-fitting [00:41:00] gloves can really reduce your ability to grip. You can lose 20 to 30 percent of your grip strength simply because the glove is ill-fitting. I remember working at a large industry here in Maine and all they handed out were those gloves in large. And they have hands of every size there. So the person that fit them well, you know, fit their hand well would probably do well again, fitting the work to the worker. But then you give someone that, you know, might be a small person or very large person, probably more small where the hand goes in there and he got all this extra material and then folks. Well, you can't how come you can't grip on to that? And it's not because they have any less skill or ability. It's just they're trying to overcome all this extra material. So, you know, it's amazing how tools and gloves and things like that have really changed. And it's important to look at the right tool, the right glove, the right, you know, the texture [00:42:00] when you're when you're looking at ergonomics.</p> <p><strong>Peter Koch:</strong> [00:42:02] So it enhances the grip. It provides better dexterity to give you the ability to use the hand and the arm in the way it was designed in the most powerful way so that you can do the work. Otherwise it gets in the way. I know I've been I've had that same thing where the only glove I have is one that doesn't fit well and all of a sudden it's I just can't do that. So what do you do? You take your glove off and then you go do the work and it might be better for you from a dexterity standpoint. It might be better for you from an economic standpoint, but it exposes you to all the other hazards which really haven't got into yet. And I think it's a good time to jump in to that particular exposure because we you know, we started this conversation with the chef coming into the E.R. with the bloody rag and cut his finger and having to go see the orthopedic surgeon. But there's a lot more ways that you can hurt your hands and probably for lack of a better term, more popular ways to hurt your hands [00:43:00] than a repetitive motion injury. So talk a little bit about that. What are the other ways beyond a poor ergonomics or a poor workstation set up where you can find hand and finger injuries?</p> <p><strong>Al Brown:</strong> [00:43:12] Sure, sure. I mean, if you look at some of the common causes, it's, you know, fatigue, distraction and attentiveness. I'm guessing the chef someone yelled to him, "hey, hey", he turned and was still chopping as he was still doing that unconscious behavior. And just that inattentiveness changed things. And, you know, there goes the finger. So he has a new restaurant called Nine Fingers. It's a great place that no. So probably serves finger sandwiches. But there you go. One of the one of the things I always try to encourage, particularly in the manufacturing or the construction industry, is very simple thing. Jewelry and one in particular rings are really they contribute big time [00:44:00] to hand injuries that simply I encourage employees or employers to just say take your ring off and just put it on a chain on your neck, if you want to make sure that it's still with you and all that kind of good thing, or they have these breakaway rings now that now exists, which I'm actually seeing more and more in the industry because a simple ring Pete, to give you an example, coming down a ladder, if you're walking, you coming down a ladder and your hand over your feet and you're in good contact if you're lowering your body in that left hand with that ring, gets hooked on the ladder rung and you lower yourself, you don't react quick enough to go back up to protect your finger. And oftentimes we've seen fingers that are literally amputated or degloved where the skin is kind of pulled up and off. So just taking that ring off, having a glove on would have probably helped a bit. But still, the other [00:45:00] exposure that has to is in the automotive industry and ring on it. And you are working with something that's electric, like the battery, and you happen to ground out with that hand. That ring will conduct the electricity and cook the base your finger pretty quickly. So again. So those are two just jewelry. You know, as I say, if you want to keep your finger, don't put a ring on it.</p> <p><strong>Peter Koch:</strong> [00:45:26] Oh, Beyonce.</p> <p><strong>Al Brown:</strong> [00:45:28] Oh, sorry Beyonce. But that is true, you know, so we really tried. I worked with the lumber company and really, you know, I actually put together a sort of a fact sheet on that the degloving and that kind of thing to convince workers that you really, it was funny because I had one worker got stood up there and there was his ring finger gone and he goes, oh, yeah, that happened to me. I said, so there you go.</p> <p><strong>Peter Koch:</strong> [00:45:53] Don't lose that story. Right. Gosh.</p> <p><strong>Al Brown:</strong> [00:45:56] So and then, you know, other things like an industry. And it's funny because I'm [00:46:00] an ergonomist. So I walk in the industry and I look at more kind of physiology things that can happen to tendinitis is the muscle strains. But in manufacturing, you know, there's a lot of I learned the term at MEMIC pinch points where there are open wheels and belts where a finger can fit in and that, you know, you can create a amputation, you can create a crush injury, you know, so guarding and things like that or something, just like your friend took the guard off the saw and decided, you know, something went. And again, it's usually a tool that sort of changes its behavior, maybe either misuse or inappropriate use of the tool or, you know, he didn't have the guard on. Quickly it occurs. You know, you're thinking that wasn't good.</p> <p><strong>Peter Koch:</strong> [00:46:50] No. And it just it really just takes an instant. I was reflecting, as you were talking about the ladder in the ring. And I imagine just about anyone [00:47:00] who's climbed a ladder. Often has had that experience where they're coming down and their ring catches for just a moment and it might not be enough to injure, but it's enough to remind you that, oh, that was close. And I got away with it. But, gosh, maybe the next time I'm not going to get away with it, maybe the next time I'm going to get caught and I'm going to actually start to load my entire body weight on that. And I'm going to what's going to happen. And there's plenty of evidence in the world to show that that's not a good thing. And again, like amputations, machinery, amputations, where someone either an improperly guarded tool or the employee purposely defeats the guard or the guard is not functional. And they get their body part, their finger, typically the tip of one of their fingers is going to get too close to those rotating parts. And there it's gone. And even, you know, we don't we take for granted a lot the weight of things that we work around.  [00:48:00]Again, it's funny, there's always a story for something. But again, I worked with a guy. They were loading jersey barriers onto a back of a truck after they had finished a construction project. And as he was loading the second to last one, he was guiding it with his hand. Right. So had it on the inside of that. And it didn't touch really hard against the Jersey barrier. That was that it was sitting down against what had touched enough. So it crushed the tip of his middle finger inside his glove. But, you know, pretty much lost the tip of his finger from his nail bed up to the top because it was crushed with the weight of it. And it just took an instant. And he talked to him later on. He said, oh, I knew how heavy it was, but I only think about the quote unquote, impact of what would happen if it just tapped against another immovable object. So just we take things for granted. A lot of things for granted.</p> <p><strong>Al Brown:</strong> [00:48:53] Yeah. Speaking of granite, in the world of stone masonry and building stone [00:49:00] walls and landscaping, that same incident occurs when someone is moving a large rock and placing it on another. And it's actually referred to as the granite kiss. And that's where two rocks and your finger become. And so that's something you can't take for granted when you're placing rocks.</p> <p><strong>Peter Koch:</strong> [00:49:23] You sure can. And I would imagine you start to look at that type of industry and this goes to landscaping or even carpentry or any time you're going to be working with your hands in an environment where there's a lot of abrasive materials, just a glove. And again, the right fitting glove is going to go a long way to prevent many of those minor injuries. And in a minor injury like a cut or laceration, even someone's using a box knife to cut sheetrock or they're cutting up cardboard to put in the recycling piece. A fairly [00:50:00] minor injury is going to take that person out of the work for a little while to go get treated. And they might not even go to the doctor, but they got to go get a bandage and clean it out properly, because if they don't, chances are it's going to get infected and then it's going to be worse later on, where a simple 5, 10, 15 dollar pair of gloves, depending on how dexterous you really need your hands, would have fixed that or prevented the injury. The event would have still happened, like the slip with the knife or the granite kiss would have still happened. But the glove would have reduced the severity of that event. That's something we don't always think about. But it's a recommendation that happens almost all the time when we go down onto a job site where they're doing something manual with their hands and they're not using gloves, why not use gloves?</p> <p><strong>Al Brown:</strong> [00:50:47] Yeah, just think like passing lumber. You know, I worked at a lumber mill or just slide boards off what they call the green chain and sliding, you know, and if barehanded, how [00:51:00] many times have you slid a board through your hands and just taken a sliver somewhere? And just that tiny piece of wood is painful and we're not even talking about something that might be, you know PT, which has got the chemicals in it, which now you would you know, you've introduced a sliver with chemicals into your hand. So just a glove allows you to let that slip through and avoid or at least mitigate that risk a lot just by having that extra protection.</p> <p><strong>Peter Koch:</strong> [00:51:29] Sure.</p> <p><strong>Al Brown:</strong> [00:51:30] So, you know, I never sort of do anything without my gloves on. You know, as I've gotten older and I'm less physical, my hands are less resistant. I don't have the buildup. So even more important. And that's when you look at some of the data from OSHA, NIOSH, it's a lot of times it's the new employees, the sort of the new workforce less experienced that, you know, these things occur. So even more to protect and guard them. Folks [00:52:00] in the middle tend to be a little bit more seasons have been around, they kind of get the value of that, and then the next exposed group is more the older worker, 55 and older experienced understand. But their recovery time takes a lot longer. So you really do want to make sure they're protected doing what they're doing.</p> <p><strong>Peter Koch:</strong> [00:52:19] Recovery's a lot longer, and I think reaction time is a lot slower as well. So you just think about what a glove would do, even that simple passing lumber from point A to point B or even if you're a finished carpenter and you're moving sheet goods from point A to point B and it slips a little bit in your hand, your reaction time isn't good enough to keep it from moving enough to maybe drive a splinter in your finger so the glove would help. It would help prevent that potential for injury there. And there's so many different types of gloves to.</p> <p><strong>Al Brown:</strong> [00:52:54] Yeah, and Pete think of this, we're talking manual material handling, you know, grip protection. [00:53:00] But think about your world of ski resorts. Sure. You know, and thermal protection, you know, and that you got to have, you know, if you're protecting the hands. Because I tried to find the naval study that I wanted to look mid-shipment. They actually looked at mid-shipment and they said they wanted to see how temperature affected the hand dexterity. So they said, I want you to tie a knot. It was very simple knot I don't know what the knot is, but they said just tie as many of these you can in a minute. And they had their hands at 70 degrees. You know, it was just room temperature, 70 degrees. And that was the ambient temperature. And they could tie I think it was 42 knots in a minute. I mean, it was a symbol, bup bup bup bup bup bup. So they could go pretty quickly. Then they lowered the ambient temperature down to like fifty degrees and just really reduced. You know their hands were cold. And you know what happens when your hands get cold. They went down to six knots a minute. They couldn't they didn't have the dexterity to [00:54:00] complete that task. So when you look at oil delivery folks, when you look at the ski industry, when you look at anybody who's out in a cold environment, that might have to do fine motor activity know that, look at power workers up in bucket trucks up trying to do nuts and bolts during this, you know, winter storm, you know, and then they've got on double gloves for insulation. You know, their ability to generate force and be dexterous drops off considerably. So you have to keep that in mind when you're looking at the worker and what it is they're doing and how is that going to impact them?</p> <p><strong>Peter Koch:</strong> [00:54:40] I can tell you from personal experience, both myself having to tie knots in cold weather as a ski patroller and then as the patrol director going back in and, you know, looking at those really bone chillingly cold days where as a patroller, you're out doing something and then you're having to repair a fence or do something that requires [00:55:00] you to be dexterous with your fingers and your hands. And you look at the result and many times the knot won't be the same knot. It'll be something that's much easier to tie rather than trying to tie a more complex knot that would be the correct, not for that particular situation. Easier to untie later on when we have to, but it was the only knot that they could tie because their fingers just weren't functioning well enough. And that doesn't even need to be a hypothermic issue where you've got some brain function challenge. It's truly the dexterity of your fingers and the gelling of everything, just not making it work the way you want it to. And that goes it doesn't need to be an outside person. Many times in the wintertime, you might have a mechanic working in a shop, right. That the door's open and closed, open and close, open and close. And it might be warm in the office or the parts room, but you get out onto the floor where the guy is doing work and it's pretty chilly out there. And it might be in the, you know, low 60s, which could be comfortable for you. [00:56:00] But when you're there all day on a concrete floor, your hands could get pretty chilly and work production is going to go down and the potential for mistakes and injuries go up from there for sure.</p> <p><strong>Al Brown:</strong> [00:56:10] Well, that's you know, what happens in a situation like that is core temperature drops off your body, core temperature drops off. And what it will do is it'll pull the blood in from your extremities to kind of it's a survival mode and your core will try to stay warm. So what happens is your ability to do fine motor activity drops off exponentially. So I dealt with this once in the manufacturing environment where they had a cold mist blowing on, you know, to help them with the work. I'm not sure what the reason for the cold mist, but it really impacted. And they were putting together plugs, electric plugs. They just couldn't understand. And I said, you know, with the cold mist, it's very difficult. You'll change the temperature, the core temperature of the hand and their ability to manipulate goes down tremendously. [00:57:00] And that the example there's a sort of local example of how can we improve that and then the general example of you of opening the door to the whole bay and you're chilling the person, reduces their ability to produce fine motor activity. So you've got to keep those things in mind when you're when you're thinking about was my production down?</p> <p><strong>Peter Koch:</strong> [00:57:23] Yeah. There's so many different things that could go into that. That's a whole body challenge. Right. When we started thinking about core temperature drop and one of the first effects you're going to see are going to be your fingers getting chillier because blood is trying to come back into the core something. But, you know, knowing that there's different ways to prevent it, you could prevent it locally with gloves. But that's not going to change the overall core temperature of the person you might need to look at different opportunities to do it. Yeah, so lots of different ways to lots of different reasons that people might put their hands in the wrong spot. It could be because the dexterity [00:58:00] isn't there. It could be because they're moving a lot of physical things around, whether it be stone, rock or other product. And whenever you're doing it with your hands, you're putting your hands at risk. And they are. They are I mean, they are the things that really get us to interact with our world. You think about what you can't do if you don't have use of your hands like we started at the beginning of the podcast. It's phenomenal how many times you interact with the world, with your hands and even if you lose another sense. So you talk about someone who might have vision issues or hearing issues like that tactile sense that you have with your hand to be able to identify something in front of you or around you by touching it is just makes your world that much bigger. And without that, because of an injury, whether it be repetitive injury or because of a traumatic injury, you lose a whole part of your world. We talk about it like when we do when [00:59:00] I do hearing conservation training, we talk about your hearing and how it really broadens your world and that inability once you start to lose your hearing, to have great conversations with people or talk to them in a loud environment or when it gets really bad hear, the beauty of the world around you. And when you start to get hand injuries, those same things you're going to miss out on, it might not be something you hear, but to be able to shake someone's hand or to be able to pet your dog or something that you really enjoy, you're not going to be able to do that if you don't take care of your hands. And it's just a big part of it. We just take them for granted. Truly take them for granted.</p> <p><strong>Al Brown:</strong> [00:59:39] You know, a thought Pete just think about us as aging to, you know, we're an aging population, so, you know, we didn't touch on the thing about arthritis and those kinds of changes that occur on the hand or comorbidities. But as we age, what do we tend to do? But, you know, what's the leading cause of injury in the work environment that's slips, trips and falls? And what's the thing that we stick out [01:00:00] to kind of, you know, cushion that fall is usually the hand. And even in the ski world, you know, you're talking about skiing before. And when you fall down, you tend to put that hand out. And what's the thing that usually takes the hit is that, you know, there was a fracture or usually it's a broken wrist. And the function, all that, that had been taken for granted before, as you just mentioned, really comes you know, you realize, oh, my goodness, I really lost the function of my hand. And as a physical therapist, it takes months of rehab to regain just the majority of that range of motion and strength. But you'll never come back 100 percent. So, you know, it's one of those things to think about again as an employer or just around your everyday life. Think about, you know, yeah, I want to get the right tool and all this, but look at slip trip and fall hazards all around. You know, that that could lead to a broken wrist.</p> <p><strong>Peter Koch:</strong> [01:00:59] Sure. You [01:01:00] could do everything that you can to get, like you said, the right tool. I've set everything up ergonomically, but the box that I didn't pick up behind my workstation that I just tripped over and now I've done the same thing to my hand that I that I might have done if I didn't get the right tools. So it's a big picture of peace preventing injuries. No matter what it is. It's truly a big picture view that you've got to take, because even if you take care of one particular hazard, if you haven't identified and manage the others, you can still put yourself at significant risk there. So what else, did we miss anything about hand injuries, whether it be a traumatic injury from a hand to wrist, or an injury from awkward postures or prolonged postures? Is there something else that we want to touch on here before we kind of get towards the end of our podcast?</p> <p><strong>Al Brown:</strong> [01:01:45] Right. Yeah, I guess just the final thing, because I think we've handled this really well. I think we've covered most topics and, you know, think of contact stresses in the hand. You know, we [01:02:00] never talked about, you know, there's different things. De Quervain's tenosynovitis pain on the back side of the thumb, you know, that's created by we'll see with scissors, manual scissors, where you're constantly opening the scissors back up to create the cut, that lifting the thumb is not really made well to pull open, you know, abductor's pull the thumb back to open the scissors up and they make scissors now that have a spring-loaded that will self open. So you have to do is grip and close to your power grip. So that's where your most efficient ganglion cysts, where you get some pressure on a tendon or a trigger finger. To a certain extent, you know, you have sleeves those remember those long tendons. I talked about the go to the tip of your finger. They actually pass under sleeves, so they stay. So these tendons don't bow out away from your finger. It looks like your skin's blown away. These little sheets hold the tendon close to the finger. Well, if you inflame one of those tendons and now it's bigger and it's on one side of these this little loop, [01:03:00] and then when you close your finger, you kind of force it through, it'll click and then you notice that your finger is stuck down and you have to kind of grab it and pull it back up to move that thick intended. It's a lot of times you're getting a contact stressor or one of the tools in your hand by putting a lot of pressure on that tendon, which creates the enlarged, you know, the large tendons. So now it's bulbous and can't go through that sheet. So again, you look at padding proper grip size, shifting hands to kind of avoid some of those things, you know, cortisone injections, dental surgery, you know, those kinds of things you want to avoid if you can. But again, that's proper tooling. You know, looking at contact stressors, neutral posture, you know, efficiency of what you're doing reduces those risks.</p> <p><strong>Peter Koch:</strong> [01:03:48] I think you put your finger right on that last piece. Absolutely. No I think that's awesome. And I think a great thing to leave [01:04:00] us with is, you know, you don't want to get to the point where surgery is necessary. Like they talk about oh well I'm going to have carpal tunnel surgery I'm going to be fine. Well, you might have carpal tunnel surgery, but the rest of that sentence is false. You're not going to be fine, because if you haven't changed, what put you in that condition in the first place, you're going to go right back to it before. So, you know, looking at all those parts of the workplace that so what is neutral for me. Right. So when I work at this place, what is neutral? How do I keep how do I hold my body? And then how does the job put me outside of neutral? How much do I have to lift? How often do I have. To do that and then work backwards towards how do I reduce the stress on my body and there's multiple ways to do that, we talked about using gloves, utilizing the correct tool, supporting those tools properly in a way where I don't have to hold onto them all the time. I don't have to pick them up all the time. But there's other ways to manage that, too. If [01:05:00] the workplace can't be adjusted, maybe that's work rotation. So I'm not going to do the same job over and over and over and over and over and over and over again throughout the entire day. I can change the amount of times that I go through the cycle in the day and increase the amount of rest so that I can move more oxygenated blood and pulse, some of those byproducts of work away from the muscles and the tendons and I can stay more healthy.</p> <p><strong>Al Brown:</strong> [01:05:27] You know, you're talking about root cause to a certain extent, your sort of covering root cause or if you go back and try to figure out the root cause, that's probably the most important. You know, some of the most success we've had is to, you know, as a physical therapist, I can start treating a wrist, you know, with whatever my tools are. But if I never go back and address the root cause, I'll never change the problem, because once the person feels better, they're going to go back doing the job that probably created it. I think of a welder that I was dealing with once back many years ago, and they had to weld [01:06:00] around a corner and it was very hard for them to see. And actually our senior vice president in lost control. I worked with him in a different work environment, and he was able to create an offset welding device so the person didn't have to do that. And then we actually went back to a different department and they could weld this thing before. So the worker no longer had to put their hand in that awkward position. So there's an example of addressing the root cause. I also deal with office workers sometimes that we can look at all the ergonomics, correct them, and they're still having problems with tingling in their fingers. And I will always ask the question, when you go to bed at night, you know, where are your hands and do you curl them up and they'll go, Yeah, I do. And I go, you can't do that. Because when you when you make a fist and you curl it up like it's a fetal position, you actually are compressing the median nerve and you won't necessarily feel it until you move your hands. And then you go, oh, my hands are asleep. So, you know, there's an unconscious behavior that's not [01:07:00] even part of the work environment, but still contributing to the problem and ongoing cause. So until you address those root causes, the hand symptoms don't go away.</p> <p><strong>Peter Koch:</strong> [01:07:09] So let's talk about resources here. And you had mentioned it early on, but that we have a tool called E Ergo that employers can access. And so why don't you talk a little bit about how E Ergo works and how employers can use that tool to help search for a root cause and maybe look for solutions?</p> <p><strong>Al Brown:</strong> [01:07:27] Mm hmm. Sure. Pete E Ergo is a is a virtual tool. It is. It can be used in a variety of ways as our consultants get back out on the road post covid and on sites. They can either the employer or our consultant can take some video of a job where they see some awkward wrist hand postures or might be a go back to your loss runs where you know, where your losses are and go play with a lot of hand injuries in this area and you gather some photo or [01:08:00] video of that. Typically, video works the best of a job cycle and you try to get three or four job cycles so we can see what the unconscious behavior is. It's funny when you first have a camera and you set up, people are very understanding and neutral and you give them time five to ten minutes, then eventually that camera kind of disappears and they go back to their normal work behavior. But we get to see that and we can analyze it. You can send that in to us. We can analyze it and get you back some insight as to what might be causing some of the problems. And we look at it from a physiological standpoint, you know, human behavior standpoint, tooling and offer up suggestions or recommendations that have worked maybe in other locations, in other industries and kind of share those with you. And that's in the manufacturing environment. It's typically video in the office environment. It's more static. It can be photos. As a matter of fact, it's been a very valuable tool during this work from home time where [01:09:00] we can't go into a person's home to analyze the ergonomics. But we get folks that can take these five photos on us and then we can even have a virtual meeting like this. And, you know, we can look at their workstation in sort of a virtual way and make and oftentimes solve the problem. So this E Ergo tool has been great. If you if you have a safety consultant with us and you can certainly ask them about it, they can guide you through it. But it's a great way for us to try to help you solve some of your ergonomic issues.</p> <p><strong>Peter Koch:</strong> [01:09:38] Yeah, it has been a good tool. I know some of my policyholder's that I work with have used it before and they've used it in two ways. One, they've used it from a post pain standpoint, like an injury has occurred or someone is expressing discomfort and they're taking pictures or video. And then in other cases we're doing it from [01:10:00] a like a almost a new process set up, like we're setting up a new process. Here's the area. Here's where things are. We're going to do a move. So let's talk about what's not so good and good in these in these areas. So they'll send some of those photos that I know in the past years, your team has provided some recommendations that have been excellent in injury prevention on the forefront, not so much the not on the back end like the injury has prevented injury from. Happening in the first place, so it's another way, I think, to think about that E Ergo tool, not just from a post injury prevention, but a from a pre work injury prevention standpoint.</p> <p><strong>Al Brown:</strong> [01:10:37] We just we just did that. We actually looked at some video where a company is in Maine and they're going to be locating to another state, you know, keeping the company in Maine, but expanding to another state. And they said we want to not repeat the mistakes we may have made here or we'd like to improve operations, probably to improve upon the ergonomics. What do you see that we might incorporate in this location? And we went [01:11:00] through that process with them. So, yeah, that was that was a nice use of the tool because, again, it's trying to, you know, fit the work to the worker, eliminate those risks and exposures on the front side.</p> <p><strong>Peter Koch:</strong> [01:11:14] Yeah, that's great. Good. awesome. So anything else that we need to cover as we talk about hands and wrist injuries? I think we have we've grasped most of it today, I believe.</p> <p><strong>Al Brown:</strong> [01:11:26] And there it is again.</p> <p><strong>Peter Koch:</strong> [01:11:29] Had to.</p> <p><strong>Al Brown:</strong> [01:11:30] You put you put your finger on it buddy.</p> <p><strong>Peter Koch:</strong> [01:11:32] Right on. Well Al, I really appreciate you being here today and talking to us about hand and wrist injuries. So thanks for really sharing your expertise with us. Again, I appreciate that very much.</p> <p><strong>Al Brown:</strong> [01:11:42] Thanks. It's always a pleasure.</p> <p><strong>Peter Koch:</strong> [01:11:45] So thanks again for joining us. And to all of our listeners out there, thank you very much for joining us today. Today on the MEMIC Safety Experts podcast, we've been speaking about ergonomics and hand and wrist injuries with Al Brown PT and director of ergonomics at [01:12:00] MEMIC. If you have any questions or I'd like to hear more about our particular topic on our podcast, email me at podcast@MEMIC.com. Also, check out our show notes that MEMIC.com/podcast where you can find additional resources, links to other podcasts with Al, as well as our entire podcast archive. And while you're there, sign up for our Safety Net blog so you never miss any of our articles or safety news updates. And if you haven't done so already, I'd appreciate it if you took a few minutes to review us on Stitcher, iTunes or whatever podcast service that you found us on. And if you've already done that, thanks, because it really helps us spread the word. Please consider sharing this show with a business associate friend or family member that you think will get something out of it. And as always, thank you for the continued support. And until next time, this is Peter Kotch reminding you that listening to the MEMIC Safety Experts podcast is good, but using what you learned here is even better.</p>