Student Injuries On Rise

Genevieve Roach '94 can't type or play piano for more than an hour a time. Any longer than that, and the pain in her wrists brings her to a halt.

A doctor recently told Harvard-Radcliffe Orchestra bassoonist Glenn M. Davis '95 he couldn't play his instrument for four or five months. He can only hope that he won't have to wait a year, like other musicians bothered by pain similar to his, before his doctor lifts the restriction.

Last semester, Ishir Bhan '96 began noticing a pain in his wrists which developed after he had been typing at his computer keyboard for a few hours or more, forcing him to stop frequently to rest.

This semester, thanks to the purchase of a new keyboard equipped with a wrist rest and specially designed to allow for more natural wrist movements, Bhan's pain hardly ever recurs. And Bhan, who is co-president of Digitas, a students group focusing on emerging technologies spends about five hours per day on his computer, between logging onto the student network and working on papers.

Roach hasn't been so lucky. Her wrist pain still plagues her when she stays at the keyboard too long. This spring, she was forced to ask her boyfriend to type her senior thesis in linguistics for her.

Davis, who was looking forward to performing with a summer stock theater company, is over the depres- sion he felt when he was told he had to stopplaying. But, he says, "it's hard when you spendso much time doing something then you're forced tostop."

Bhan's symptoms were never diagnosed by aphysician. Davis and Roach were both diagnosedwith tendonitis. The three share symptoms ofdisorders which physicians say are on the rise incomputer users, including students, and others whoperform repetitive tasks involving the wrists andhands.

Comulative trauma disorders (CTDs),characterized by pain, numbness or swelling in thehands, among other symptoms, were once industriessuch as meat and poultry processing, electronicassembly and garment production.

With the increased dependence on computers,however, the prevalence of CTDs and relateddisorders such as tendonitis among those whoperform other repetitive tasks--such as electronicscanning at supermarkets and typing--hasincreased.

Today, firmly ensconced in the world of themicrochip, students should at least begin thinkingabout some dangers that accompany with theincreased capabilities of computers, says Dr.Jeffrey N. Katz, an assistant professor ofmedicine at the Medical School who specializes ininjuries of the hand and wrist.

Workers and their employers in many sectorsseem to be taking notice of CTDs and a relateddisorder known as carpal tunnel syndrome, thoughtto be caused by the same types of motions andcharacterized by many of the same symptoms.

Carpal tunnel a painful disorder which can leadto permanent impairment of the hand and which cancost as much as $30,000 per case to treat,according to the Federal Centers for DiseaseControl's National Institutes for OccupationalSafety and Health (NIOSH). The disorder is causedby increased pressure on the median nerve, whichserves the hands, as it runs within the "tunnel"formed by the carpal bones in the wrist.

In a 1988 study, NIOSH projected the prevalenceof "medically-diagnosed" carpal tunnel syndrome at700,000 cases among the 72 percent of U.S.residents who had worked in the percent 12 months.More recently, officials reported that NIOSHreceived three times many requests for HealthHazard Evaluations of hand and wrist injuries in1992 as they did in 1982.

While the relationship between CTDs andrepetitive wrist movements is still a topic ofcontroversy, doctor say that job tasks involvinghand motions which are repetitious, forceful andperformed continuously without, rest can lead toCTDs and tendonitis, especially when performedwith a bent wrist.

Nancy Curtin, an industrial hygienist with theUniversity's Office of Environmental Health andSafety (EHS), says that with the computer boom,wrist injuries are showing up in situations neveranticipated by experts.

No statistics are kept on student cases of suchinjuries, she says. Although injuries are morecommon among full-time computer users such asdata-entry operators, recent studies have foundthat even those who workless than full days at thecomputer are falling victim to such disorders.

But should the senior thesis writer whospent most of spring semester banging away at acomputer keyboard be worried about contractingcarpal tunnel syndrome, CTDs or tendonitis?According to Katz, the answer is a qualified, no.

"If all one were concerned about were carpaltunnel syndrome, probably more of a fuss has beenmade about it than is merited," says Katz, who isauthor of a number of medical journal articles onsuch disorders. "Students are at a lower riskthan, say, poultry processors. But it is not atrivial of risk."

Dr. Hillel D. Skoff, director of the hand andupper extremity service at the Brigham and Women'sHospital in Boston, agrees.

"Students are not in the right age group [forcarpal tunnel syndrome]," says Skoff, who is aninstructor in orthopedic surgery at the MedicalSchool. "It starts more when people are in theirthirties, and the incidence grows by a percentageevery year,"

Typing itself, if done properly, does not seemto increase the risk of wrist injury. However,ever, extreme flexion or extension of the wrist,such as might be the result of keyboard work inawkward positions, could lead to injury. Theoverwhelming majority of such incidents instudents are not of the majority of such incidentsin students are not of the same serious nature ascarpal tunnel syndrome, but can cause discomfortwhen performing many tasks.

After five weeks of feeling pain in histhumb after rehearsals, Davis, who, in addition tothe HRO, has performed with numerous pitorchestras and in chamber music classes, wasdiagnosed with tendonitis by an orthopedist atBoston Children's Hospital.

Roach's wrist pain started nearly two yearsago, during a summer job in date entry when shewas spending 20 hours per week at the computerkeyboard. She says that she and a co-worker, whowas diagnosed with carpal tunnel syndrome, weren'tinstructed on the proper way to type in order toavoid wrist pain.

And such information may fail to beincorporated into the planning of many workenvironments. For example, the desks with whichHarvard furnishes dormitory rooms are designed forwriting, not typing. Typing surfaces should belower. Bhan says he noticed that after working atthe keyboards in the Science Center basement,which are placed too high, his wrist pain occurredmore often.

Roach complains of the same problem. Becausecomputer keyboards in the Science Center and theMather House computer room are shackled to thedesks, Roach often sits on her knees to type in amore comfortable position.

Curtin suggests that students who findthemselves experiencing discomfort in any typingposition, including at the Science at the ScienceCenter, contact the EHS office. "Students seem tobe the least informed about the services availableand how to get to them," she says. "We very rarelyget calls from students."

Curtin has noticed a definite rise in requestsfor work site evaluations, both for individualsand for offices. This year, she has alreadyperformed 173 such evaluations of individuals'work sites, indicating an increased awareness ofrisks for wrist injury.

Skoff has had many student patients, most ofwhom are musicians. In running fingers up and downpiano keys, or the neck of stringed instrument,for example, musicians perform repetitiousmovements. Davis says he knows students in the HROwho have had or continue the have cases of handand wrist injury.

But medical School Associate Clinical Professorof Orthopedic Surgery Dr. Barry P. Simmons, whotreats, such cases at University Health Service(UHS), says that the majority of the patients hehas seen have been graduate students andUniversity employees such as library workers--notundergraduates.

Katz' patients have included pottery artists,housecleaners and checkers. He also recalls oneparalegal who suffered from painful symptoms inthe upper extremities.

The most important step in preventinginjury, doctors agree, is to take a good look atthe ergonomic, or work, environment. Katzrecommends that students keep keyboards near laplevel rather than higher, to avoid typing with abent wrist. And using keyboard wrist rests, whichare popping up all over campus, makes good sense,says Katz.

"Pressures in the canal at the base of the palmincrease dramatically by moving your wrists to theextreme," says Simmons, who is the author of theleading book on work-related injuries in the upperextremities. "You want your wrist neutral orstraight ahead."

Bhan's self-prescribed remedy of a new keyboardincluding a wrist rest, which matches doctors'recommendations, seems to have worked.

"It's made a tremendous difference," Bhan says."The pain is much reduced now. If I'm on thecomputer a lot, say writing a paper after workingon the computer all day. I might start noticing.But it's nowhere near as bad as it used to be."

Many cheap measures are just as effective asthe more elaborate and expensive ones, saysCurtin. Telephone books, for example, can adjustthe height of one's feet for comfort just as wellas commercial foot rests, which can cost as muchas $50.

Injuries sustained during improper keyboard useare not limited to the wrist and hands. Simmonsstresses the importance of not keeping the elbowsflexed much more than 70 degrees in order to avoidundue pressure on nerves in the elbow. This canprevent discomfort from extending up the arm tothe neck and shoulder.

Dr. David S. Rosenthal '95, director of UHS,suggests that students should avoid keeping theirhands in unusual or even the same positions fortoo long. When typing or even reading, studentstend to find a comfortable position, remain it infor an hour or more, and then get up to findthemselves suffering discomfort.

"For typing and reading, good advice is thatevery half hour or 45 minutes, people should getup and change their position," Rosenthal says. "Nomatter what position one is in, one should movesas often as possible."

"The incidence of tendonitis and carpal tunnelsyndrome goes up exponentially for those who workmore than an hour or an hour and a half non-stop."says Skoff. "The most important behaviormodification [for prevention] is to take a breakevery hour of so."

Simmons agrees, recommending the use of"auto-save" features available on many programs tosignal "stop and rest."

Whatever measures students take, flexibility isa key issue. for example, Curtin recommends thatcomputer keyboards and monitors each be placed onindependently adjustable surfaces.

The University is also taking a closer look atthe incidence and prevention of injuries in theworkplace. Formed this January, the UniversityErgonomics Committee is charged with studyingpossible solutions to the problem of suchinjuries, according to Curtin. The committee isco-chaired by Robert E. Wheaton, EHS manager ofgraduate schools and technical services, andSheila M. Sheridan director of facilities andadministrative services at the Kennedy School ofGovernment.

If pain or discomfort does occur,suggests Katz, students shouldtake a break, and take some over-the-counter painmedicine. But Simmons warns that chronicdiscomfort should not be ignored. Repeatedproblems may call for using wrist splints whentyping.

"If you have a long weekend, does your pain goaway?" Simmons tells sufferers to ask themselves."Does it get worse at the week goes on?"

If either of these is the case, the disorder isstill in its early stages, and might be helped byaltering the work environment or by visitingtherapist. "You want to be very wary of ansurgical procedure," Simmons warns.

Therapists may instruct patients or improvedwork environments or utilize ice and heattreatments to reduce the pain. Roach was referredto Brigham and Women's Hospital, which runs aspecial therapy program for musicians who comedown with the disorders. Davis, who wears a bracefor his thumb began physical therapy andultrasound treatment yesterday.

Katz says therapists try to think of theirpatients' upper extremities in the same way thatrunners might think of their lower bodies: "Youwouldn't walk around with a serious ankle painfor a while ."

"When everyone started running, we saw lots ofknee and shin injuries," he says. "That doesn'tmean that running is a dangerous sport. Having areal awareness is the issue."CrimsonAlex B. LivingstonPreventing work-related injury

Bhan's symptoms were never diagnosed by aphysician. Davis and Roach were both diagnosedwith tendonitis. The three share symptoms ofdisorders which physicians say are on the rise incomputer users, including students, and others whoperform repetitive tasks involving the wrists andhands.

Comulative trauma disorders (CTDs),characterized by pain, numbness or swelling in thehands, among other symptoms, were once industriessuch as meat and poultry processing, electronicassembly and garment production.

With the increased dependence on computers,however, the prevalence of CTDs and relateddisorders such as tendonitis among those whoperform other repetitive tasks--such as electronicscanning at supermarkets and typing--hasincreased.

Today, firmly ensconced in the world of themicrochip, students should at least begin thinkingabout some dangers that accompany with theincreased capabilities of computers, says Dr.Jeffrey N. Katz, an assistant professor ofmedicine at the Medical School who specializes ininjuries of the hand and wrist.

Workers and their employers in many sectorsseem to be taking notice of CTDs and a relateddisorder known as carpal tunnel syndrome, thoughtto be caused by the same types of motions andcharacterized by many of the same symptoms.

Carpal tunnel a painful disorder which can leadto permanent impairment of the hand and which cancost as much as $30,000 per case to treat,according to the Federal Centers for DiseaseControl's National Institutes for OccupationalSafety and Health (NIOSH). The disorder is causedby increased pressure on the median nerve, whichserves the hands, as it runs within the "tunnel"formed by the carpal bones in the wrist.

In a 1988 study, NIOSH projected the prevalenceof "medically-diagnosed" carpal tunnel syndrome at700,000 cases among the 72 percent of U.S.residents who had worked in the percent 12 months.More recently, officials reported that NIOSHreceived three times many requests for HealthHazard Evaluations of hand and wrist injuries in1992 as they did in 1982.

While the relationship between CTDs andrepetitive wrist movements is still a topic ofcontroversy, doctor say that job tasks involvinghand motions which are repetitious, forceful andperformed continuously without, rest can lead toCTDs and tendonitis, especially when performedwith a bent wrist.

Nancy Curtin, an industrial hygienist with theUniversity's Office of Environmental Health andSafety (EHS), says that with the computer boom,wrist injuries are showing up in situations neveranticipated by experts.

No statistics are kept on student cases of suchinjuries, she says. Although injuries are morecommon among full-time computer users such asdata-entry operators, recent studies have foundthat even those who workless than full days at thecomputer are falling victim to such disorders.

But should the senior thesis writer whospent most of spring semester banging away at acomputer keyboard be worried about contractingcarpal tunnel syndrome, CTDs or tendonitis?According to Katz, the answer is a qualified, no.

"If all one were concerned about were carpaltunnel syndrome, probably more of a fuss has beenmade about it than is merited," says Katz, who isauthor of a number of medical journal articles onsuch disorders. "Students are at a lower riskthan, say, poultry processors. But it is not atrivial of risk."

Dr. Hillel D. Skoff, director of the hand andupper extremity service at the Brigham and Women'sHospital in Boston, agrees.

"Students are not in the right age group [forcarpal tunnel syndrome]," says Skoff, who is aninstructor in orthopedic surgery at the MedicalSchool. "It starts more when people are in theirthirties, and the incidence grows by a percentageevery year,"

Typing itself, if done properly, does not seemto increase the risk of wrist injury. However,ever, extreme flexion or extension of the wrist,such as might be the result of keyboard work inawkward positions, could lead to injury. Theoverwhelming majority of such incidents instudents are not of the majority of such incidentsin students are not of the same serious nature ascarpal tunnel syndrome, but can cause discomfortwhen performing many tasks.

After five weeks of feeling pain in histhumb after rehearsals, Davis, who, in addition tothe HRO, has performed with numerous pitorchestras and in chamber music classes, wasdiagnosed with tendonitis by an orthopedist atBoston Children's Hospital.

Roach's wrist pain started nearly two yearsago, during a summer job in date entry when shewas spending 20 hours per week at the computerkeyboard. She says that she and a co-worker, whowas diagnosed with carpal tunnel syndrome, weren'tinstructed on the proper way to type in order toavoid wrist pain.

And such information may fail to beincorporated into the planning of many workenvironments. For example, the desks with whichHarvard furnishes dormitory rooms are designed forwriting, not typing. Typing surfaces should belower. Bhan says he noticed that after working atthe keyboards in the Science Center basement,which are placed too high, his wrist pain occurredmore often.

Roach complains of the same problem. Becausecomputer keyboards in the Science Center and theMather House computer room are shackled to thedesks, Roach often sits on her knees to type in amore comfortable position.

Curtin suggests that students who findthemselves experiencing discomfort in any typingposition, including at the Science at the ScienceCenter, contact the EHS office. "Students seem tobe the least informed about the services availableand how to get to them," she says. "We very rarelyget calls from students."

Curtin has noticed a definite rise in requestsfor work site evaluations, both for individualsand for offices. This year, she has alreadyperformed 173 such evaluations of individuals'work sites, indicating an increased awareness ofrisks for wrist injury.

Skoff has had many student patients, most ofwhom are musicians. In running fingers up and downpiano keys, or the neck of stringed instrument,for example, musicians perform repetitiousmovements. Davis says he knows students in the HROwho have had or continue the have cases of handand wrist injury.

But medical School Associate Clinical Professorof Orthopedic Surgery Dr. Barry P. Simmons, whotreats, such cases at University Health Service(UHS), says that the majority of the patients hehas seen have been graduate students andUniversity employees such as library workers--notundergraduates.

Katz' patients have included pottery artists,housecleaners and checkers. He also recalls oneparalegal who suffered from painful symptoms inthe upper extremities.

The most important step in preventinginjury, doctors agree, is to take a good look atthe ergonomic, or work, environment. Katzrecommends that students keep keyboards near laplevel rather than higher, to avoid typing with abent wrist. And using keyboard wrist rests, whichare popping up all over campus, makes good sense,says Katz.

"Pressures in the canal at the base of the palmincrease dramatically by moving your wrists to theextreme," says Simmons, who is the author of theleading book on work-related injuries in the upperextremities. "You want your wrist neutral orstraight ahead."

Bhan's self-prescribed remedy of a new keyboardincluding a wrist rest, which matches doctors'recommendations, seems to have worked.

"It's made a tremendous difference," Bhan says."The pain is much reduced now. If I'm on thecomputer a lot, say writing a paper after workingon the computer all day. I might start noticing.But it's nowhere near as bad as it used to be."

Many cheap measures are just as effective asthe more elaborate and expensive ones, saysCurtin. Telephone books, for example, can adjustthe height of one's feet for comfort just as wellas commercial foot rests, which can cost as muchas $50.

Injuries sustained during improper keyboard useare not limited to the wrist and hands. Simmonsstresses the importance of not keeping the elbowsflexed much more than 70 degrees in order to avoidundue pressure on nerves in the elbow. This canprevent discomfort from extending up the arm tothe neck and shoulder.

Dr. David S. Rosenthal '95, director of UHS,suggests that students should avoid keeping theirhands in unusual or even the same positions fortoo long. When typing or even reading, studentstend to find a comfortable position, remain it infor an hour or more, and then get up to findthemselves suffering discomfort.

"For typing and reading, good advice is thatevery half hour or 45 minutes, people should getup and change their position," Rosenthal says. "Nomatter what position one is in, one should movesas often as possible."

"The incidence of tendonitis and carpal tunnelsyndrome goes up exponentially for those who workmore than an hour or an hour and a half non-stop."says Skoff. "The most important behaviormodification [for prevention] is to take a breakevery hour of so."

Simmons agrees, recommending the use of"auto-save" features available on many programs tosignal "stop and rest."

Whatever measures students take, flexibility isa key issue. for example, Curtin recommends thatcomputer keyboards and monitors each be placed onindependently adjustable surfaces.

The University is also taking a closer look atthe incidence and prevention of injuries in theworkplace. Formed this January, the UniversityErgonomics Committee is charged with studyingpossible solutions to the problem of suchinjuries, according to Curtin. The committee isco-chaired by Robert E. Wheaton, EHS manager ofgraduate schools and technical services, andSheila M. Sheridan director of facilities andadministrative services at the Kennedy School ofGovernment.

If pain or discomfort does occur,suggests Katz, students shouldtake a break, and take some over-the-counter painmedicine. But Simmons warns that chronicdiscomfort should not be ignored. Repeatedproblems may call for using wrist splints whentyping.

"If you have a long weekend, does your pain goaway?" Simmons tells sufferers to ask themselves."Does it get worse at the week goes on?"

If either of these is the case, the disorder isstill in its early stages, and might be helped byaltering the work environment or by visitingtherapist. "You want to be very wary of ansurgical procedure," Simmons warns.

Therapists may instruct patients or improvedwork environments or utilize ice and heattreatments to reduce the pain. Roach was referredto Brigham and Women's Hospital, which runs aspecial therapy program for musicians who comedown with the disorders. Davis, who wears a bracefor his thumb began physical therapy andultrasound treatment yesterday.

Katz says therapists try to think of theirpatients' upper extremities in the same way thatrunners might think of their lower bodies: "Youwouldn't walk around with a serious ankle painfor a while ."

"When everyone started running, we saw lots ofknee and shin injuries," he says. "That doesn'tmean that running is a dangerous sport. Having areal awareness is the issue."CrimsonAlex B. LivingstonPreventing work-related injury