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Dear Tracy I attended an excellent lecture ona study day which covered this subject, froma Dr Ian Winspur a consultant Hand surgeon from the Wellington and Princess Grace Hospitals, who has a Hand clinic in London. He that the criteria for medical causation is: Strength of association with the activity e.g it goes away with holiday, weekends etc and comes back when resume work: the consistency of the symptoms with the activity - comes on every time the specificity -does not occur under any other circumstances and something called Biological gradient but I forget what that meant but I think it means the symptoms get worse the longer the activity is done and comes on more quickly. Tips were: it is best to keep doing something as unconditioned structures are more susceptible to tendonitis.- the GP's advice was initially correct but she should have gone back for further investigation of possible causes. Actions to return someone to work with hand pain is to do 20 mins of problematic activity 4 times a day and increase gradually to 60 minute slots but decrease if pain increases. Unsurprisingly he said a precise diagnosis is the most important thing which allows precise treatment and management. He suggests investing in a private opinion (really!!) rather than waiting for it to get worse on an NHS waiting list. Clinical evidence is that 30% of reported carpal tunnel are not carpal Tunnel, 30% are somewhat related and only 30% are true carpal tunnel and that these findings tend to be reflected in other common 'Industrial Arm Pain' conditions -he refused to acknowledge RSI and this man works with the world's top violinists etc so he knows what repetive movements means. Hopefully this helps to manage it in the short term and I suggest you write to the GP to prompt him into action to do a referral if you cannot convince the organisation that a private referral for an opinion is worth the money. regards Sue Susan Gorton Occupational Health Department Manager Occupational Health Department, Level 3 Ormond House, 26-27 Boswell Street, London WC1N 3JZ Mob: 07833294568 Tel: 020 7813 8554 Ext 0247 Fax : 020 7813 8355 Email: [log in to unmask] From Sept 2010 I am on study leave on Tuesdays throughout the academic year >>> Tracy Turner <[log in to unmask]> 15/06/2011 14:30 >>> Thank you once again for all your adivce. I work alone like many of us on the list and sometimes need a good sounding board and as ever Jiscmail and its memebers deliver. The lady is Polish and it has been difficult to translate her concerns.The discomfort only happens when she has worked on a particular part of the line - stringling meat. She has no other underlying medical condition nor does she partake in outside activites which may contribute. She is about 30years and very petite. Looking at records it appears she is not stringing meat joints for several weeks ( the men are doing it for her) and then she is asked to do three hours at a time when the men are not able to do it. Although as far as the manager was concerned all were rotating correctly at 1 - 2 hr intervals. I have arranged for her to reduce the time she is working in this part of the role initially and gradually increase the time ensuring that the task is undertaken regularly asking her to inform LM as soon as she feels discomfort. My hope is that she will gradually become acustomed to it and if not we will be able to identify at what point it causes discomfort. If expereinces discomfort I will ask for a physio assessment /GP referral. And you are right we are only advising - ******************************** Please remove this footer before replying. OCC-HEALTH ARCHIVES: http://www.jiscmail.ac.uk/lists/occ-health.html CONFERENCES AND STUDY DAYS: http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH ********************************************************************************************************* This message may contain confidential information. If you are not the intended recipient please inform the sender that you have received the message in error before deleting it. Please do not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents: to do so is strictly prohibited and may be unlawful. Thank you for your co-operation. ********************************************************************************************************* ******************************** Please remove this footer before replying. OCC-HEALTH ARCHIVES: http://www.jiscmail.ac.uk/lists/occ-health.html CONFERENCES AND STUDY DAYS: http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH