CUMULATIVE TRAUMA DISORDERS OF THE UPPER EXTREMITY Thomas G. Bergfield, M.D., M.S

1700’s Agrarian 1800’s Industrial Revolution Safety 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