Occupational Disease Casebook

Tenosynovitis

Labour Department
Occupational Safety & Health Council
Occupational Safety and Health Branch
This booklet is published by the
Occupational Safety and Health Branch
Labour Department

This edition Feburary 2011

This booklet is issued free of charge and can be obtained from offices of the Occupational Safety
and Health Branch. Its contents can also be downloaded from the Labour Department website
at http://www.labour.gov.hk/eng/public/content 2_9.htm. For enquiries about addresses and
telephone numbers of the offices, please contact us at 2559 2297, or visit the Labour
Department website at http://www.labour.gov.hk/eng/tele/os.htm.

This booklet may be freely reproduced except for advertising, endorsement or commercial
purpose. Please acknowledge the source as “Occupational Disease Casebook - Tenosynovitis”
published by the Labour Department.
 Contents
Introduction 1

Case 1 : A Clerk suffering from “Tenosynovitis of the Wrist” 2

Case 2 : A Librarian suffering from “Tenosynovitis of the Thumb” 6

(De Quervain’s Disease)

Case 3 : A Cook suffering from “Tennis Elbow” 11

Case 4 : A Construction Site Worker suffering from 15

“Tennis Elbow” and “Golfer’s Elbow”

Conclusion 19

Enquiries and Complaints 20

 Introduction
Occupational Disease Casebook – Tenosynovitis

==Introduction

“Tenosynovitis” of hand or forearm is caused by excessive movements of the

muscles and tendons of the above parts, which result in traumatic inflammation
of the tendons or tendon sheaths. The better known “Tennis Elbow” and
“Golfer’s Elbow” also belong to this type of disease. The risk of developing this
disease increases if quick, repetitive and strenuous movements of hands or
forearms in awkward postures are required for prolonged periods at work.

There may be redness, swelling, heat, pain or decreased mobility in the affected
parts. If the conditions are severe, work and daily activities may also be affected.

The objective of this booklet is to explain to employers and employees how

certain working conditions give rise to tenosynovitis through some case studies.
It also recommends some specific preventive measures for reference.

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Case 1: A Clerk

Case 1 : A Clerk suffering from

“Tenosynovitis of the Wrist”

=Case Summary

Ken had been working as a clerk for more than three years. Every day, he
needed to use computer for typing and data input for a prolonged period
of time.

About half a year ago, he started to have pain in his right wrist after operating
a computer for a long time. The pain gradually increased afterwards. He felt
pain and weakness not only during computer operation but also when doing
some daily activities, such as wringing a towel or picking up a teapot. In
addition, he noticed signs like redness, swelling and hotness in the wrist.

Subsequently, he attended the Occupational Health Clinic of the Labour

Department, and the clinic doctor diagnosed his illness as “tenosynovitis of
the wrist”.

Causes of the Illness

According to the doctor’s analysis, Ken contracted “tenosynovitis of the wrist”

because of the following reasons:

1) Prolonged periods of repetitive and quick movements of the hands -

Ken often typed, entered data and operated a mouse rapidly and

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 Case 1: A Clerk
continuously for several hours in order to finish his work quickly. There
was no opportunity for resting his hands.

2) Awkward wrist posture – Ken placed the keyboard and the mouse on
his writing desk (See Figure 1). As the height of his seat was not adjustable
and fixed at a relatively low level, he had to use the keyboard and the
mouse with his wrists bended in an awkward posture (See Figure 2).

Figure1

3
Case 1: A Clerk

Figure 2

The above conditions resulted in strain injury and inflammation of the tendons
and tendon sheaths of the wrist.

Preventive Measures

The following measures can be adopted to prevent Ken’s and similar cases:

1) Avoid prolonged use of computer to reduce repetitive movements of

the hands

• Perform different types of work alternately. For example, after

using the computer for 1 to 2 hours, do some writing or document
processing work.

• Arrange periodic rest breaks.

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 Case 1: A Clerk
2) Pay attention to the workstation design and working posture

• Use a height-adjustable chair to match the height of the desk. The

elbows should be at the same level of the input devices and the wrist
should be kept straight when using the keyboard and the mouse.

Figure 3

• If the desk is too high, a pull-out tray can be installed underneath the
desk for the keyboard and the mouse (See Figure 3). Alternatively,
you may use a separate computer desk for computer operation.

• If frequent use of computer for data input is required, a wrist rest

may be used if the user finds its use more comfortable. A suitable
wrist rest not only provides comfortable padding but also keeps the
wrist straight when typing at the keyboard.

3) Do more relaxing and stretching exercises for the hands and wrists.

5
Case 2 : A Librarian

Case 2 : A Librarian suffering from

“Tenosynovitis of the Thumb”
(De Quervain’s Disease)

==Case Summary

Miss Chan had been working as a librarian for more than 8 years. She was
mainly responsible for carrying books and putting them back to the shelves.

A year ago, Miss Chan began to have pain at the base of her right thumb near
the lateral part of the right wrist when she grasped the books (See Figure 4).
Sometimes, she noticed swelling and stiffness at night. At first, she took some
pain-killers and applied
analgesic ointment on her
own. However, the
situation got worse. She
felt pain and weakness in
the affected area not only
when grasping books but
also when holding a pen.
Subsequently, she attended
the Occupational Health
Clinic of the Labour
Department and was
diagnosed to have tendons and
tendon sheaths
“tenosynovitis of the of the thumb
thumb” (de Quervain’s
disease).
Figure 4

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 Case 2 : A Librarian
==Causes of the Illness

The doctor assessed the work of Miss Chan and identified several causes for
her disease:

1) She frequently grasped the books firmly with her right thumb and fingers.

2) When the workload was heavy, she often held several books together
with her right hand and placed them on the shelves at one go. This
required a greater degree of stretching of her right thumb and extra-grip
strength. (See Figure 5)

Figure 5

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Case 2 : A Librarian

3) When she placed the books on the shelves, the lateral part of her right wrist
had to stretch and bear the weight of the books, particularly when she
placed the books on the higher shelves because she did not make use of
suitable footstep or ladder. As a result, the lateral part of the right wrist was
stretched even more. (See Figure 6)

Figure 6

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 Case 2 : A Librarian
= Preventive Measures

The following measures can be adopted to prevent developing similar illness as

Miss Chan’s:

1) Avoid over-exertion of the thumbs and wrists

• Do not hold many books with one hand at one go.

• Use both hands to hold heavy or thick books (See Figure 7).

Figure 7

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Case 2 : A Librarian

2) Avoid situations leading to awkward bending of the hands

• Avoid holding many books with one hand as far as possible because
tendons of the thumb can be injured by the excessive stretching.

• Footsteps or ladders should be used when placing books on the higher

shelves to avoid excessive stretching of the lateral part of the wrist.

3) Avoid prolonged and repetitive movements of hands and wrists

• Perform book handling duties alternately with other types of work

such as writing documents, updating book catalogues, etc.

• Arrange periodic rest breaks.

4) Do more relaxing and stretching exercises for the hands and wrists.

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 Case 3 : A Cook
Case 3 : A Cook suffering from
“Tennis Elbow”

==Case Summary

Mary had been working as a cook in an elderly home for over four years. She
needed to handle a lot of food every day. For example, she had to cut vegetables,
chop meat, blend food, open cans of food and then cook them. She was also
required to clean the stoves and the cooking utensils. About a year ago, Mary
started to feel soreness on the lateral part of her right elbow and forearm. Later
on, the symptoms worsened. She felt pain not only at work but also during
rest. She had to take sick leave frequently. The doctor told her that she was
suffering from “lateral epicondylitis”, which was commonly known as “tennis
elbow”.

==Causes of the Illness

According to the doctor’s analysis, Mary contracted “tennis elbow” because of

the following reasons:

1) She performed repetitive stretching and bending movements of her wrists

frequently in cutting, chopping, stir-frying and cooking of food.

2) Forceful exertion of the muscles of her wrists and forearms was frequently
required while spading a large amount of food (See Figure 8), carrying
cauldron filled with soup, lifting and moving large sacks of rice, as well as
cleaning big stoves and cooking utensils.

3) Heavy workload and tight schedule.

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Case 3 : A Cook

Figure 8

==Preventive Measures

The following measures can be used to prevent developing similar illness as Mary’s:

1) Avoid over-exertion of wrists and forearms

• Sharpen the knife regularly so as to minimize the efforts required for

cutting and chopping food.

• Use cooking utensils (i.e. cauldron, wok and ladle) of smaller size.
• If lifting or moving heavy loads of rice or food is required, ask another
colleague to help (See Figure 9) or use a trolley as an aid.

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 Case 3 : A Cook
Figure 9

2) Pay attention to the workplace design and working posture

• The working platform and stoves should be of appropriate height so that

the position of the hands would not be higher than the waist level when
doing work like cutting or stir-frying.

• If the working platform and stoves are too high or the cook is rather short,
a stable stage of appropriate height should be installed for her to stand on
to work.

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Case 3 : A Cook

Figure 10

3) Avoid prolonged and repetitive movements of wrist

• Use suitable mechanical aids, such as mincers (See Figure 10), blenders
and tin openers, etc.

• Arrange periodic rest breaks

4) Do more relaxing and stretching exercises for the upper limbs.

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 Case 4 : A Construction Site Worker
Case 4 : A Construction Site Worker
suffering from “Tennis Elbow”
and “Golfer’s Elbow”

==Case Summary

Derrick had been working as a labourer in construction sites for more than five
years. He had to perform manual handling of a large amount of construction
materials such as sand, gravel, concrete, bars and planks every day. Besides, he
often used a spade to dig the earth, a big hammer to break the concrete and a
crowbar to remove nails. A year ago, he began to have pain on both sides of his
right elbow. He even felt pain and weakness in moving tables and chairs or
taking a bath at home. The doctor diagnosed that he was suffering from “lateral
epicondylitis” and “medial epicondylitis”, which were commonly known as
“tennis elbow” and “golfer’s elbow” respectively (See Figure 11).

wrist extensor tendons

wrist flexor tendons

Figure 11
15
Case 4 : A Construction Site Worker

==Causes of the Illness

According to the doctor’s assessment, the causes for Derrick’s “tennis elbow”
and “golfer’s elbow” included the following:

1) Repetitive and forceful movements of his right wrist and forearm were
frequently required. (See Figure 12)

Figure 12

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 Case 4 : A Construction Site Worker
2) Proper manual lifting techniques were not adopted. He often lifted up
construction materials from the ground onto his shoulders very quickly,
and that overstrained his wrists and forearms.

3) He liked working fast and often handled heavy construction materials hastily
by himself without using suitable lifting aids or seeking assistance from his
fellow workers.

Preventive Measures

The following measures can be adopted to prevent developing similar illness as

Derrick’s:

1) Avoid over-exertion of the wrists and forearms

• Try all possible means to use mechanical aids to replace or assist the
manual work processes, such as using an excavator for digging.

• Use the correct method to handle construction materials and do not lift
them up quickly by hands.

• Seek help of his fellow workers or use a wheel barrow when handling
bulky or heavy materials (See Figure 13).

17
Case 4 : A Construction Site Worker

Figure 13

2) Suitable rest break arrangement can reduce the risks of cumulative trauma
to muscles and tendons.

3) Do more relaxing and stretching exercises for the upper limbs.

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 Conclusion
Conclusion
Although this booklet has only presented four cases of tenosynovitis from
different industries, the causes involved and the respective preventive measures
are also useful to employers and employees of other trades.

In fact, the prevention of “tenosynovitis” of the hand or forearm is based on

three principles:

1) Avoid quick and repetitive movements of the hands for a prolonged period
of time.
2) Reduce forceful exertion by the hands and forearms.
3) Work in correct and comfortable postures.

Employers and employees can take appropriate preventive measures in

accordance with the three principles to reduce the risks of developing
“tenosynovitis” of the hand or forearm.

“Tenosynovitis” of the hand or forearm arising from work is one of the

occupational diseases prescribed in the Employees’ Compensation Ordinance.
If you suspect that you have this disease or any other occupational diseases,
you are welcome to make an appointment for consultation at the Occupational
Health Clinic of the Labour Department.

Kwun Tong Occupational Health Clinic

2/F Kwun Tong Jockey Club Health Centre
457 Kwun Tong Road
Kwun Tong
Kowloon
Telephone : 2343 7133

Fanling Occupational Health Clinic

7/F Fanling Health Centre
2 Pik Fung Road
Fanling
New Territories
Telephone : 3543 5701

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Enquiries and Complaints

Enquiries

For enquiries on this booklet or advice on occupational health and hygiene

matters, please contact the Occupational Safety and Health Branch through:

Telephone : 2852 4041

Fax : 2581 2049
E-mail : enquiry@labour.gov.hk

Information on the services offered by the Labour Department and on

major labour legislation can also be found by visiting our website
http://www.labour.gov.hk.

Information on the services provided by the Occupational Safety and

Health Council can be obtained through its hotline 2739 9000 and
website http://www.oshc.org.hk.

Complaints

If you have any complaints about unsafe workplaces and practices, please
call the Labour Department’s Occupational Safety and Health complaint
hotline at 2542 2172. All complaints will be treated in the strictest
confidence.

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