Correspondence

Blueberry Rakers' Tendinitis

N Engl J Med 1994; 331:552August 25, 1994

Article

To the Editor:

Annually, from late July through early September, thousands of seasonal workers harvest wild blueberries in Maine and the eastern provinces of Canada. Maine's crop in 1993 was approximately 30 million kg1. The harvesting is done mostly by manual raking through the low-lying bushes (height, <25 cm). In response to reports of tendinitis among blueberry rakers, we conducted a survey in August 1993, consisting of a questionnaire about symptoms, physical examinations of the hands and wrists, and an ergonomic assessment of raking.

The participants in the study were 134 rakers who volunteered on site; 73 percent were male, as compared with 74 percent of the total of 1300 rakers hired by the company. The median age of our subjects was 30 years, as compared with 28 years for all the rakers. Children (age, 12 to 18 years) accounted for 10 percent of the study participants and 16 percent of all the rakers.

Participants reported moderate-to-severe pain in the back (13.5 percent), in the hand or wrist (12.0 percent), and in the elbow (7.5 percent). On screening physical examinations, 9.8 percent had some hand or wrist pain, with a positive Phalen's or Tinel's test (suggesting the carpal tunnel syndrome2) or a positive Finkelstein's test (suggesting de Quervain's disease -- tenosynovitis of the abductor pollicis longus and the extensor pollicis brevis3).

Ergonomic analysis of raking revealed that the rakers worked mostly in a stooped posture and frequently carried loaded buckets (up to 13 kg each). The metal rakes, shaped like deep dustpans with the handles attached inward, varied in width (35 to 60 cm) and weight (1.2 to 2.1 kg). The typical raking motion involved a constant firm grip on the handle, with ulnar deviation of the wrist initially to insert the tines into the bush, followed by radial deviation and lifting of the rake to separate the berries. The mean (±SD) force of this lifting motion was estimated to be 87 ±17.5 N, and the motion was repeated 32 ±13 times per minute.

These forceful and repetitive motions would cause friction on the tenosynovium and explain a high incidence of tendinitis4. Many seasonal workers depend on income from this work. Ergonomic recommendations, such as keeping the wrist in a neutral position (to avoid deviations)5 and raking slowly during the initial period of work (work hardening) may reduce the incidence of tendinitis. Efforts are also under way to improve the design of the rake.

Shiro Tanaka, M.D.
Cheryl Fairfield Estill, M.S.
National Institute for Occupational Safety and Health, Cincinnati, OH 45226

Stephen C. Shannon, D.O., M.P.H.
Maine Department of Human Services, Augusta, ME 04333

5 References

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2. 2

   Katz JN, Larson MG, Sabra A, et al. The carpal tunnel syndrome: diagnostic utility of the history and physical examination findings. Ann Intern Med 1990;112:321-327
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   Loomis LK. Variations of stenosing tenosynovitis at the radial styloid process. J Bone Joint Surg Am 1951;33:340-346
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   Lapidus PW, Fenton R. Stenosing tenovaginitis at the wrist and fingers. Arch Surg 1952;64:475-487
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   Armstrong TJ. Ergonomics and cumulative trauma disorders. Hand Clin 1986;2:553-565
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Citing Articles (5)

Citing Articles

1. 1

   John May, Lynae Hawkes, Amanda Jones, Patrick Burdick, Barbara Ginley, Blanca Santiago, Michael Rowland. (2008) Evaluation of a community-based effort to reduce blueberry harvesting injury. American Journal of Industrial Medicine 51:4, 307-315
   CrossRef

2. 2

   Lynae Hawkes, John May, Giulia Earle-Richardson, Kris Paap, Blanca Santiago, Barbara Ginley. (2007) Identifying the Occupational Health Needs of Migrant Workers. Journal of Community Practice 15:3, 57-76
   CrossRef

3. 3

   Dawn N. Castillo, Nelson Adekoya, John R. Myers. (2000) Fatal Work-Related Injuries in the Agricultural Production and Services Sectors Among Youth in the United States, 1992-96. Journal of Agromedicine 6:3, 27-41
   CrossRef

4. 4

   P S Millard, S C Shannon, B Carvette, S Tanaka, W E Halperin. (1996) Maine students' musculoskeletal injuries attributed to harvesting blueberries.. American Journal of Public Health 86:12, 1821-1822
   CrossRef

5. 5

   E J Rankow. (1996) Sexual identity vs sexual behavior.. American Journal of Public Health 86:12, 1822-1823
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