published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Introduction: Garment work is repetitive and detailed and requires constant use of the hands. It is no surprise that garment workers are at high risk for developing repetitive strain injuries (RSI’s) (MFL Occupational Health Centre, 1999). Work-related upper limb disorders, popularly known as RSI’s, affect over 370,000 people in Great Britain with 86,000 new cases recorded in 2010. This costs employers almost £300 million in lost working time, sick pay and administration (The Chartered Society of Physiotherapy, 2007). There is however no statistics documented on RSI’s among garment workers found for South Africa. Aim: To determine the prevalence of signs and symptoms of carpal tunnel syndrome and de Quervains tenosynovitis. Method: A study using quantitative data was used. A validated questionnaire consisting of open-ended and closed questions was utilized. Data was collected from two hundred subjects of varying age, gender and ethnic group. Information on signs and symptoms and possible risk factors of RSI’s were obtained. The visual analogue scale was used to assess pain, a goniometer to measure active range of movement, the Phalens test, Reverse Phalens test and Finkelsteins test was used to assess the signs and symptoms of the two occupational repetitive strain disorders. Data analysis: All data was captured and analysed using the Statistical Package for Social Sciences (SPSS version 15). Descriptive statistics such as mean, standard deviation, proportions, median, mode and interquartile range was used to summarize the data. Pearson’s Chi Square tests and Fishers Exact tests were used to test for association between two categorical variables. Independent Samples t-tests were used for the difference in age distribution between participants that presented with carpal tunnel syndrome and de Quervains tenosynovitis and of those who did not present with them. The level of significance was set at 0.05. Bar graphs, tables and pie charts were used to depict the results. Results/Discussion: The results of this study indicated that 59% of participants presented with signs and symptoms of de Quervains tenosynovitis and 63% of participants presented with signs and symptoms of carpal tunnel syndrome. The prevalence of carpal tunnel syndrome and de Quervains tenosynovitis was 42% and 43% respectively among garment workers in the eThekwini district. In addition, 100% of participants stated that they work under the following conditions, applying weight through the arms, repeated movement, work with their arms in unsupported positions, fast hand movements and holding or grasping for more than 2 hours continuously per day. Seventy two and a half percent of participants stated that their work entailed using vibratory tools for prolonged hours. Pearson’s Chi Square tests showed no association of use of vibratory tools to de Quervains tenosynovitis (P=0.666) or to carpal tunnel syndrome. This is inconsistent with the findings of the study completed by Leclerc et al. (1998) who stated that different dimensions of exposure to physical workload are widely recognised as risk factors. These risk factors include rapid hand motions, repetitive bending and twisting of the hands and the wrist, fast work pace, repetitive grasping with the fingers, mechanical stress at the base of the palm and the palm and the use of vibratory tools (Leclerc et al. 1998). Conclusion: This study has identified the prevalence of signs and symptoms of carpal tunnel syndrome and de Quervains tenosynovitis among garment workers. It has also shown that a significant percentage of garment workers presented with symptoms of burning, tingling, itching and numbness in their hands as well as feelings of swollen and ‘useless’ hands. A significant number presented with functional limitations to certain activities of daily living suggestive of the presence of carpal tunnel syndrome. De Quervains tenosynovitis was indicated when a significant number of participants presented with pain, tenderness or swelling over the radial aspect of the wrist as well as functional limitations to certain activities of daily living. / Thesis (M.Sc.)-University of KwaZulu-Natal, Westville, 2012.

The hand is one of the most complex of all of the anatomical structures in the human body. It has been found that hand injuries are among the most frequent injuries that occur to the body, predominantly during industrial activities. It has therefore been concluded that more research is needed into protective factors, such as glove use. The design features of a glove emphasise either protection or performance. There is often a trade-off between increased safety and performance capability when donning gloves. It has been determined that gloves which are fitted and comfortable for the worker may provide the best compromise between protective functions and decreased performance. This investigation aimed to assess the influence of glove fit on the performance attributes of industrial tasks, as well as on the responses of the human operator. Glove fit was analysed as 35 male participants donned three different glove sizes during each test, including a best-fitting glove, a glove one size smaller than best-fitting, and a glove one size larger than best-fitting. For each glove size, gloves of two differing materials were tested, namely nitrile and neoprene. A barehanded condition was also tested, totalling seven gloved/barehanded conditions for each test. The seven conditions were assessed in a laboratory setting in a battery of tests. This consisted of components of task performance, including maximum pulling and pushing force, maximum torque, precision of force, tactility, speed and accuracy and dexterity. The performance responses were recorded, as well as participants’ perceptual responses using the Rating of Perceived Exertion scale, and muscle activity. Six muscles were selected: Flexor Digitorum Superficialis, Flexor Pollicus Longus, Extensor Carpi Ulnaris, Extensor Carpi Radialis, Flexor Carpi Ulnaris and Flexor Carpi Radialis. The results revealed that glove fit does affect certain spects of performance, and influences human operator responses for selected task components. Furthermore, discrepancies were distinguished between orking barehanded and working with an optimally fitted glove. There was also a glove material effect established. Overall, it was found that muscle activity when exerting maximum force in a pushing and pulling direction was optimal with the nitrile glove material. Maximum torque performance was enhanced with the use of a best-fitting glove, as compared with an ill-fitting glove or barehanded work. Force precision was preferable when barehanded, as opposed to the tactility task which rendered optimal results with a best-fitting glove. The same was found for speed and accuracy results, as glove fit appeared to have no effect on performance, but performance was improved when participants were barehanded. Dexterity performance was the most conclusively influenced by the conditions, resulting in barehanded performance being optimal. However, should a glove be necessary for a given task, an optimally-fitted glove which is of a thinner material would be recommended. It is necessary to distinguish the performance components of a task within industry and select the most appropriate glove for optimal performance and the least risk of overexertion.