CUMULATIVE TRAUMA DISORDERS OF THE UPPER EXTREMITY

Thomas G. Bergfield, M.D., M.S

• 1700’s Agrarian

• 1800’s Industrial RevolutionSafety not a concern

• 1900 Compensation Programs

• 1910 Compulsory Worker’s Comp in NY

• The workplace is still dangerous

• Obvious lacerations, fractures, amputations

• Not So Obvious Cumulative Trauma Disorder

Repetitive Motion Disorder Repetitive Strain Injury Repetitive Trauma Injury

CTD

Due to repetitive exertions and movements of the body which develop

over periods of weeks, months, or years

Any painful condition of the soft tissues of the upper extremity in a worker

engaged in repetitive activity

Presumption

repetitive movements and static postures

cause well-defined injury

analagous to stress fracture

• Pace of work

• Short recovery time

• Level of muscular effort

Result in tissue damage

Criticism

• Implies repetition as etiology• Injury implies damage• No information on frequency duration rate magnitude

OSHA

• Carpal Tunnel Syndrome

positioning

activity

flawed

• 1988 National Health Interview Survey

1.4% (1.87 million) cts

only 675,000 diagnosed by health care provider

Confusion in terms

Occupational Disease has direct cause

Work Related – medically when job and performance are 2 of several factors

Aggravated – legal term

Epidemiology

• Risk factors are associated with disease

• Cause and effect not clear

• Causal inference

probability

CTS

• Family history

• Endocrine abnormalities

• Diabetes

• Post menopausal

• Anatomic abnormalities

Work-Related Musculoskeletal Disorders

• 48% of work place illnesses

• 92,576 cases with lost work time

• CTS in37,804 (41%)

• Keyboard operators

• Assembly line

• Meat packers

• Material handlers

Report influenced by

Personal, psychological economic factors

Monotonous work, workload, time pressure, lack of control, lack of social support

Work Place Paradigm

It’s reported at work, it’s work-related

The search begins

CTS Incidence

The same whether or not people perform repetitive activities

Mirrors general population

What’s the deal?

• Do diagnosable soft tissue problems occur?

• Is a worker more at risk?

• Is repetitive motion the cause?

One piece of the puzzle

What can we do?

• Perdue experience – job rotation – many factors

• Pre-employment screening

• Honest physicians

• Collaboration