CUMULATIVE TRAUMA DISORDERS OF THE UPPER EXTREMITY

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CUMULATIVE TRAUMA DISORDERS OF THE UPPER
EXTREMITY

• Thomas G. Bergfield, M.D., M.S

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• 1700s Agrarian
• 1800s Industrial RevolutionSafety not a concern

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• 1900 Compensation Programs
• 1910 Compulsory Workers Comp in NY
• The workplace is still dangerous

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• Obvious lacerations, fractures, amputations
• Not So Obvious Cumulative Trauma Disorder
• Repetitive Motion Disorder
• Repetitive Strain Injury
• Repetitive Trauma Injury

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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

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• Presumption
• repetitive movements and static
  postures
• cause well-defined injury
• analagous to stress fracture

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• Pace of work
• Short recovery time
• Level of muscular effort
• Result in tissue damage

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Criticism

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

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OSHA

• Carpal Tunnel Syndrome
• positioning
• activity
• flawed

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• 1988 National Health Interview Survey
• 1.4 (1.87 million) cts
• only 675,000 diagnosed by
  health care provider

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Confusion in terms

• Occupational Disease has direct cause
• Work Related medically when job and
  performance are 2 of several factors
• Aggravated legal term

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Epidemiology

• Risk factors are associated with disease
• Cause and effect not clear
• Causal inference
• probability

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CTS

• Family history
• Endocrine abnormalities
• Diabetes
• Post menopausal
• Anatomic abnormalities

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Work-Related Musculoskeletal Disorders
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• 48 of work place illnesses
• 92,576 cases with lost work time
• CTS in37,804 (41)
• Keyboard operators
• Assembly line
• Meat packers
• Material handlers

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Report influenced by

• Personal, psychological economic factors
• Monotonous work, workload, time pressure, lack
  of control, lack of social support

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• Work Place Paradigm
• Its reported at work, its work-related
• The search begins

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CTS Incidence

• The same whether or not people perform
  repetitive activities
• Mirrors general population

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Whats the deal?

• Do diagnosable soft tissue problems occur?
• Is a worker more at risk?
• Is repetitive motion the cause?
• One piece of the puzzle

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What can we do?

• Perdue experience job rotation many factors
• Pre-employment screening
• Honest physicians
• Collaboration