Medical check-ups for hand-intensive work

In accordance with a regulation from the Swedish Work Environment Authority, all employees who carry out hand-intensive work must be offered a medical check-up by 1 November. The regulation has increased awareness of this type of work, which will hopefully result in more potential injuries being detected in time. On ships, examples of occupations concerned include cleaners, cooks and repairers.

Many different industries and a large number of occupational groups have hand-intensive work. In November 2019, the Swedish Work Environment Authority issued a regulation stating that employers are obliged to offer medical check-ups to employees who perform hand-intensive work. Employers were given a period of two years to review their operations and carry out risk assessments. By 1 November at the latest, those workers who carry out hand-intensive work with a risk of injury or discomfort must be offered medical check-ups. 

”There are many large organizations and companies that ask us for advice on how they should proceed with the work,” says Peter Palm, ergonomist and researcher at Occupational and Environmental Medicine at the University Hospital in Uppsala. “We have also heard that several organizations have already taken measures that will hopefully result in better work environments in the long term, but I think that many smaller companies are behind with their planning and some probably don’t even know about the new regulations.” 

The definition of hand-intensive work used by the Swedish Work Environment Authority is sustained rapid wrist movements towards the outer position of the joint, in combination with force. Cleaners who wipe down walls and tables, shop workers who move goods at the checkout and repairers who tighten and loosen bolts or screws by hand are typical examples. However, determining exactly what is hand-intensive work is seldom easy and there are many factors involved in a risk assessment, such as how much you work, the proportion of hand work and the total load during a working day. The weight on the hand is also a factor, as well as how hard you grip tools and objects. But even when the load is less, such as a precision grip between the index finger and thumb, it may involve a large amount of force which can lead to strain injuries in the long term. In deciding whether work is hand-intensive or not, the support of an ergonomist is often required,  who knows the loads on the body during different movements and what kind of load can lead to injuries. Teresia Nyman is an ergonomist, researcher and operations manager at Occupational and Environmental Medicine at the University Hospital in Uppsala. 

“As an employer, you should contact the occupational health service for help with a risk assessment,” she says. “There are different methods for the risk assessment of hand-intensive work and the choice depends on the type of work and workplace. In general, though, few risk assessments are made and you can probably say that the best type of risk assessment is the one that is carried out.” 

According to the Swedish Work Environment Authority, people who work four hours or more a day with hand-intensive work must be offered medical checks, if there is any risk of injury. Even those who spend less time doing hand-intensive work may suffer from pain and thus be entitled to a medical check-up. Shole Alinagi is a physiotherapist at the occupational health centre Feelgood in Stockholm. She points out that there are wide variations in how people manage a certain type of work, and that this must be taken into account when risk assessments are carried out. 

“Every person is unique and it is not possible to state a general period of time after which a task becomes harmful. How much we can take is very individual, so the workplace also needs to be flexible and adaptable,” she says. 

Hand-intensive work strains tendons, nerves and muscles, among other things, and can result in different problems and injuries to the arms, shoulders, shoulder blades and neck. Examples include tennis elbow, carpal tunnel syndrome and overused hand syndrome, the first signs of the latter being a feeling of fatigue and exhaustion in the hand. The next step is pain, and if no action is taken the symptoms can develop into numbness and swelling and the hand (and sometimes even the whole arm) no longer functions properly. This type of strain problem is relatively common, but it can be serious and in some cases require surgery and long-term sick leave. 

“The earlier you notice injuries, the better the outcome because it is more likely that the employee can return to work,” says Shole Alinagi. “But we prefer to work preventively to avoid injuries from the start by using technical aids and looking over the structure of the workplace.” You may also need to think about how work is organized in terms of conditions and performance requirements, and whether they are reasonable. Do people have time to think about ergonomics when they work?

There are different measures that can be put in place to avoid hand-intensive work, from mechanical aids that reduce the load on the body to work rotation schemes. “Not all hand-intensive work can be avoided,” says Teresia Nyman, “and medical check-ups are then important to detect and prevent injuries. But if you are 30 years old and have problems doing hand-intensive work, and it is not possible to prevent this by changes to the work environment, you should perhaps not continue doing the same work for another 35 years,” she says.

Regulations and guidance   

  • Systematic work environment management requires cooperation between employers, employees and if possible your occupational health organisation. Try to involve everyone and encourage participation. 
  • Organize introductory training for new employees. 
  • Offer training in ergonomics that is adapted to your activities and requirements. An ergonomist from your occupational health service can help you choose the right training. 
  • Be aware of early signals that may indicate poor health and safety routines. 
  • Encourage employees to write deviation reports and incident reports. 
  • Compile information from sick leave statistics, safety rounds and risk assessments, employee surveys and so on, and carry out an overall survey of the work environment, produce action plans and follow up measures carried out.

More information about hand-intensive work can be found in the Swedish Work Environment Authority regulations: AFS 2019:3 and AFS 2012:2 (1, 2). https://www.av.se/arbetsmiljoarbete-och-inspektioner/publikationer/foreskrifter/belastningsergonomi-afs-20122-foreskrifter/

You can also download the occupational health guide on hand-intensive work free of charge at: https://www.foretagshalsor.se/sites/default/files/2020-04/Vibrationsguide%202020-1.pdf and https://www.foretagshalsor.se/sites/default/files/2020-09/Guide%20Handintensivt%20arbete_2.pdf 

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