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
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Family history
Endocrine abnormalities
Diabetes
Post menopausal
Anatomic abnormalities
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
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