CUMMULATIVE DISORDERS OF
UPPER EXTIMITY
DR HABIBOLLAHI
Definition
• Musculoskeletal disorder (MSD) is an injury or disorder of the
muscles, nerves, tendons, joints, cartilage,ligament and spinal
discs.
• It is not an acute injury, rather a chronic disease which
develops over time.
• MSD is related to manual tasks
• It has been recognized as a source of significant pain,
disability and disadvantage for the injured person and a
substantial burden on modern societies. Statistics suggest
that more than 30% of all occupational injuries are
musculoskeletal injuries associated with manual tasks)
ERGONOMICS
Nationally, almost 60% of all
work-related illnesses are
MSDs
Number of Claims
WMSDs
All
26%
other
claims
74%
Cost of Claims
All
WMSDs
other 40%
claims
60%
ERGONOMICS
WMSDs are sometimes referred to
using other unfamiliar terms such as :
1.
2.
3.
4.
5.
Cumulative Trauma Disorders – CTD
Repetitive Trauma Disorders – RTD
Repetitive Strain Injuries – RSI
Repeated Motion Disorders – RMD
Overuse Syndromes
ERGONOMICS
What is The Musculoskeletal System?
The Musculoskeletal System includes the following:
1.
2.
3.
4.
5.
6.
7.
Bones – The load-bearing structure of the body
Muscles- Tissue that contract to create movement
Tendons – Tissues that connect muscles to bones
Ligaments – Tissues that connect bones to bones
Cartilage – Tissue that provides cushioning and reduces friction
between bones
Nerves – Communication system that links muscles, tendons and other
tissue with the brain
Blood Vessels – Tubes that circulate nutrients throughout the body
ERGONOMICS
What Are Examples of WMSDs?
1.
2.
3.
4.
5.
Strain – Overstretching or overexertion of a muscle
or tendon
Sprain _Overstretching or overexertion of a ligament
that results in a tear or rupture of the ligament
Tendonitis – Inflammation of the tendon inside the
sheath
Tenosynovitis – Inflammation of the sheath around
the tendon
Carpal Tunnel Syndrome – Compression of the
median nerve as it passes through the carpal tunnel
in the heel of the hand
ERGONOMICS
What are Examples of WMSDs?
Tennis elbow or Golfer’s elbow – Medical term is
Epicondylitis – inflammation of the tendons at the elbow.
7. Trigger Finger – Common term for tendonitis or
tenosynovitis that causes painful locking of the finger(s)
while flexing
8. Pitcher’s Shoulder – Rotator cuff tendonitis –
inflammation of one or more tendons at the shoulder
9. White Finger – Medical term is Reynaud’s Phenomenon –
constriction of the blood vessels in the hands and fingers
10. Digital Neuritis – Compression of the nerves along the sides
of the fingers or thumbs
6.
Cumulative Trauma Disorder
Diagnoses

Nerves:

– Lateral Epicondylitis
Peripheral Entrapment
– Carpal Tunnel Syndrome
– Cubital Tunnel Syndrome
– Thoracic Outlet Syndrome

Tendons
(Tennis Elbow)
– Shoulder Impingement
(Rotator Cuff Disease)

Skin
– Blisters
– Calluses
Joint & Bone
– Arthritis
– Stress Fractures
– Ganglions
– Trigger Digits
– de Quervain’s Tendonitis

Muscles (Enthesopathy)

Vascular
– White Finger Syndrome
ERGONOMICS
Signs or Symptoms of WMSDs
 Painful joints
 Pain in wrists, shoulders, forearms, knees, etc.
 Pain, tingling or numbness in hands or feet
 Fingers or toes turning white
 Shooting or stabbing pains in arms or legs
 Back or neck pain
 Swelling or inflammation
 Stiffness
 Burning sensations
 Weakness or clumsiness in hands; dropping things
INCREASED RISK
FACTORS
Look for These Indicators:
Caution
Zone
Awkward Postures
High Hand Force
Highly Repetitive Motion
Repeated Impact
Heavy, Frequent or Awkward
Lifting
Moderate to High Hand-Arm
Vibration
Awkward Postures
Being in these work positions for
more than 2-4 hours total per day
–
–
–
–
–
–
Hands above head
Elbows above shoulder
Back bent forward more than 30 degrees
Neck bent more than 30 degrees
Squatting
Kneeling
Working with the Hands
Above Head
For more than 2 hours per day
Working with the Elbows
Above Shoulders
For more than 2 hours per day
Neck or Back Bent Forward
More than 30º
For more than 2 hours per day
Neck or Back Bent Forward
More than 30
For more than 2 hours per day
Neck or Back Bent Forward
More than 30
For more than 2 hours per day
Squatting
For more than 2 hours per day
Kneeling
For more than 2 hours per day
High Hand Force
More than 2 hours per day of:
Pinching 2 or
more pounds
weight or 4 or
more pounds
force
High Hand Force
More than 2 hours per day of:
Gripping 10 or
more pounds
weight or force
Highly Repetitive Motion
Workers repeat same motion every
few seconds for more than 2 hours
per day with:
– neck
– shoulders
– elbows
– wrists
– hands
Highly Repetitive Motion
Intensive keying
for more than 4 hours per day
Repeated Impact
Using hands or knees as a hammer
– more than 10 times per hour
– more than 2 hours per day
Repeated Impact
Using hands or knees as a hammer
– more than 10 times per hour
– more than 2 hours per day
Heavy, Frequent, or
Awkward Lifting
Lifting objects more than:
– 75 lbs. once/day
– 55 lbs. more than ten times/day
– 10 lbs. more than twice/minute
for more than 2 hours per day
– 25 lbs. above shoulders,
below knees, or at arms length
for more than 25 times/day
Heavy, Frequent, or
Awkward Lifting
Heavy, Frequent, or
Awkward Lifting
Moderate to High
Hand-Arm Vibration
Moderate Level
more than
2 hours/day
Moderate to High
Hand-Arm Vibration
High Level
More than
30 Min/day
Upper Extremity Disorders










Carpel tunnel syndrome
Cubital tunnel syndrome
Thoracic outlet syndrome
Raynaud’s syndrome (white finger)
Rotator cuff syndrome
DeQuervain’s disease
Tendinitis
Tenosynovitis
Trigger finger
Ganglion cyst
Neurovascular Disorders
• Carpal Tunnel Syndrome
– Impingement of the median nerve caused by irritation
and swelling of the tendons in the carpal tunnel
• Cubital Tunnel Syndrome
– Pressure on the ulnar nerve when the elbows are exposed
to hard surfaces
Neurovascular Disorders
• Thoracic Outlet Syndrome
– Compression of the blood vessels between the neck and
shoulder caused by reaching above shoulder level or
carrying heavy objects
• Raynaud’s Syndrome
– Also known as Vibration White Finger ; Blood vessels
of the hand are damaged (narrowed) from repeated
exposure to vibration for long periods of time
Tendon Disorders
• Rotator Cuff Syndrome
• DeQuervain’s Disease
– Combination of tendinitis and tenosynovitis
• Tendinitis
– Irritation of the tendon
• Tenosynovitis
– Irritation of the synovial sheath
• Ganglion Cyst
– Accumulation of fluid within the tendon sheaths
Tendinitis
Common Occupational CTDs
of the Upper Extremities
Carpal Tunnel Syndrome occurs from chronic
swelling of the flexor tendons in the wrist.
The median nerve, which feeds the first three fingers
and the thumb, can become impaired from pressure in
the carpal tunnel in the wrist.
Symptoms include:
 pain in the first three fingers and the thumb
 numbness in these areas
 tingling in these areas
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome
Common Occupational CTDs
of the Upper Extremities
Raynaud’s Syndrome is when blood vessels of the
hand are damaged (narrowed) from repeated exposure
to vibration for long periods of time
This is connected with use of vibrating tools, such as
hair clippers and jack hammers.
Raynaud’s Syndrome
Symptoms




Numbness and tingling in the fingers during vibration exposure;
may continue after exposure has been discontinued
Blanching (whitening) of one fingertip because of a temporary
constriction of blood flow
Other fingers also blanch
Intensity of pain & frequency of attacks increase in time
Common Occupational CTDs
of the Upper Extremities
Cubital Tunnel Syndrome is caused by resting
the elbows on hard surfaces such as unpadded
tables or armrests.
The ulnar nerve, which feeds the ring and little
fingers, can become impaired from pressure near the
elbows.
Symptoms include:
 pain in the ring and little fingers
 tingling in these areas
 numbness in these areas
Cubital Tunnel Syndrome
Common Occupational CTDs
of the Upper Extremities
Thoracic Outlet Syndrome is caused by frequent reaching
above shoulder level, by carrying heavy objects, or poor posture
involving a forward head tilt.
A Neurovascular bundle called the brachial plexus, which passes
between the collar bone and the top rib, can become impaired from
pressure associated with movements that causes these two bones to
be positioned close together.
Symptoms include:
 the arms “falling asleep”
 weakened pulse
 numbness in the fingers
Thoracic Outlet Syndrome
Common Occupational CTDs
of the Upper Extremities
Rotator cuff syndrome is a disorder involving swelling and pain
of tendons comprising the rotator cuff muscle group:
subscapularis, supraspinatus, infraspinatus, & teres minor
Symptoms include:
• Pain when you bend the arm and rotate it outwards against resistance
• Pain on the outside of the shoulder possibly radiating down into the arm
• Pain in the shoulder, which is worse at night
• Stiffness in the shoulder joint.
Prevention
• Avoidance of prolonged or repeated
overhead work may help lessen the
incidence of impingement type pain. In
addition, rotator cuff strengthening
exercises can sometimes improve the
symptoms associated with pathology in this
area.
Common Occupational CTDs
of the Upper Extremities
Tendinitis is a common CTD for the wrist, elbow, and
shoulder. It occurs when we continually stress the
tendon cables, causing them to become irritable and
sore.
Lateral Epicondylitis - “Tennis elbow”
Medial Epicondylitis - “Golfer’s elbow”
Symptoms include:
 point tenderness
 swelling
 tennis elbow, pain radiates down to back of hand
 golfer’s elbow, pain radiates down to back of hand
Tendinitis
Common Occupational CTDs
of the Upper Extremities
Tenosynovitis is swelling of the sheath that
covers the tendon from constant rubbing against
the tendon.
Symptoms include:
swelling
pain
loss of motion
loss of strength
Tenosynovitis
Common Occupational CTDs
of the Upper Extremities
Trigger Finger is a tendon
disorder that occurs when there is
a groove in the flexing tendon of
the finger
If the tendon becomes locked in
the sheath, attempts to move the
finger cause snapping or jerking
movements
Usually associated with using
tools that have handles with hard
or sharp edges.
Trigger Finger
Common Occupational CTDs
of the Upper Extremities
Ganglion Cyst is a bump under the skin caused
by an accumulation of fluid within the tendon
sheath. It is commonly found at the hand and wrist.
Ganglion Cyst
Common Occupational CTDs
of the Upper Extremities
De Quervain’s Disease is an inflammation of the
tendon sheath of the thumb attributed to excessive friction
between two thumb tendons and their common sheath.
It’s a combination of Tendonitis and Tenosynovitis.
May be caused by twisting and forceful gripping
Symptoms include:
•swelling
•pain at the base of the thumb.
De Quervain’s Disease
De Quervain’s Disease