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WORKING PERIOD OF WOMEN LABOUR IN CIGARETTE FACTORY AND INCIDENCE OF CARPAL TUNNEL SYNDROME : A DESCRIPTIVE STUDY
Y Waluyo 1,2, I Subadi1,2, M Andriana1,2 1. Physical and Rehabilitation Medicine Dr.Soetomo General Hospital, Surabaya, Indonesia 2. School of Medicine Airlangga University, Surabaya, Indonesia Contact details : 1. Yose Waluyo (+6281342689277, email : yose_waluyo@yahoo.com) 2. Imam Subadi (+628123250655, email : isubadi_roesdam@yahoo.co.id ) 3. Meisy Andriana (+628155030667, email : meisy1913@yahoo.com )

Background Carpal tunnel syndrome(CTS) is the most common entrapment neuropathy in human. It is also a part of cumulative trauma disorders.1,2,3 Although many clinical risk factor are associated with the syndrome, epidemiology has identified that several combination of work factor, individual factors are also related to CTS. Many physical factors such repetition, force, posture, vibration and pressure have been considered as possible risk factor for work-related CTS.1,4-9 CTS resulted from the compression of median nerve as it crosses the wrist and is characterized by numbness, tingling, pain and weakness in the hand. They may have farreaching effects on a persons job, hobbies, and activities daily living.1,2,3 Kretek cigarette that manually made by human processed in four Phases (grinding, cutting, packaging, and labeling) that require repetitive and powerful use of wrist extensor muscles and considered to be specific risk factor for work related CTS especially grinding and cutting phase. For the first stage namely grinding, each labour has 3000 cigarettes as target to be done in 8 hours. In the next stage, cutting phase, each labour has 9000 cigarettes as target to be done. Several recent studies has concluded that occupational factors play big role as CTS etiology, however kretek cigarette worker has not yet been investegated. The aim of this study was to present the occurence of CTS in the Kretek cigarette labours and the length of employment when first visit to our installation PATIENTS AND METHODS We collected data of CTS patients from medical records in PM&R installation Dr. Soetomo General Hospital during the period of january 1st, 2012 to December 31st which were consulted from cigarette factory clinic. The age and length of employment in the kretek cigarette factory until they visit our installation was recorded.

The diagnosis of carpal tunnel syndrome is based on clinical criteria such as history taking and physical examination. From the history taking we got the sensory symptoms predominantly, included pain and tingling sensation in the area innervated by median nerve and atrophy of thenar muscle also have been found in several cases. Previous physical examination such as tinels test, phalens test, and prayer test are done to produce CTS symtoms. RESULT Twenty two CTS patients was registered. All of the labours were women with mean age was 42+ 5,84, the range of the age was 30 to 54 years. From 22 patients 9 patients were from cuting phase labour and 13 from grinding phase. We found that the average length of employment of the patients was 18 years and 8 month. DISCUSSION Carpal tunnel syndrome is shown to have higher incidence rate in employed patients than in unemployed persons. it has shown that occupational exposure to excess vibration, increasing hand force and repetition increases the risk of developing CTS had been suggested in meta-analysis investigation the relationship between CTS and ocupation.4-9 The mean age of CTS patients in our study was 42 + 5,84 and this findings was relevant/irrelevant with this might be explained because the impact of work force was riskful to create entrapment of carpal tunnel. Length of employment of kretek cigarette workers was 18 year and 8 month, our finding was less than what found from study from the tea harvester by Ciftdemir et al (2013) with working duration 33.5 + 9,8 until the worker got CTS.5 The incidence of carpal tunnel syndrome and the working period of the patients in kretek cigarette factory is presented in this study. Unfortunately this study has some limitation. First, we only record the first visit of the pasient to the hospital and it was not the

first onset. Second, we didnt record the hand dexterity of the pasient and what side of the wrist is efected by CTS. In conclusion, Kretek cigarette labour is an occupational risk factor for development occupation related CTS. The working target each day and years of working should be decreased in order to reduce the risk of CTS development among workers. The factory should design a program to promote and prevent the worker from CTS such as doing strengthening and steching exercise before and during working time, and regular icing after work hour at home and wrist splint if needed.

References 1. Bengston K, Brault JS. Hand disorders. In : DeLisa JA, Gans BM, Walsh NE, Editors. Physical Medicine and Rehabilitation Principle and Practice. New Jersey : Lippincott Williams and Wilkins. 2009.p843-44 2. Cuccurullo S, editor: Physcal Medicine and Rehabilitation Board Review. New Jersey: Demos. 2009. p355-357 3. Tan J, Horn SE, editors: Practical Manual of Physical Medicine and Rehabilitation. New York:Mosby. p398-400 4. Smith LS. Nerve Response to injury and repair. In : Skirven TM, Osterman AL, Fedorczyk, Amadio PC, editors. Rehabilitation of the hand and upper extremity 6th Edition. Philadelphia : Elsevier Mosby. 2010. p601-60 5. Ciftdemir M, Copuroglu M. Carpal tunnel Syndrome in manual tea harvesters. Joint disease and related Surgery 2013;24(1);p12-17 6. Barcenilla A, March LM, Chen JS, Sambrook PN. Carpal tunnel syndrome and its relationship to occupation: a meta-analysis. Rheumatology (Oxford).2012;51;250-61. 7. Conolly WB, McKessar JH. Carpal tunnel syndrome-can it be a work related condition? Aust Fam Physician 2009;38;684-6 8. Wang LY, Pong YP, Wang HC, et al. Cumulative trauma disorders in betel pepper leaf cullers visiting a rehabilitation clinic: experisnce in Taitung. Chang Gung Med J 2005;28;237-46. 9. Eleftheriou A et al. Cumulative keyboard strokes: a possible risk factor for carpal tunnel syndrome. Journal of Occupational Medicine and Toxicology 2012, 7:16 10. Raman SR, Al-Halabi B, Hamdan E, Landry MD. Prevalence and risk factors associated with self-reported carpal tunnel syndrome (CTS) among office workers in Kuwait. BMC Research Notes 2012, 5:289