Proper medical management can reduce cumulative trauma disorder incidence.
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The impact of occupational injury on injured worker and family: outcomes of upper extremity cumulative trauma disorders in Maryland workers.
BACKGROUND: Surveys have identified a dramatically rising incidence of work-related upper extremity cumulative trauma disorders (UECTDs). Outcome studies have addressed time lost from work and cost of compensation; omitting other significant consequences. We assess health, functional and family outcomes. METHODS: We identified 537 Workers' Compensation UECTD claimants. A computer-assisted telephone questionnaire was used to elicit symptom prevalence, functional impairment, depressive symptoms (CES-D scale), employment status. RESULTS: One to 4 years post-claim, respondents reported persistent symptoms severe enough to interfere with work (53%), home/recreation activities (64%) and sleep (44%). Only 64% of responses to the activities of daily living scale items indicated "normal" function. Job loss was reported by 38% of respondents, and depressive symptoms by 31%. CONCLUSIONS: Work-related UECTDs result in persisting symptoms and difficulty in performing simple activities of daily living, impacting home life even more than work. Job loss, symptoms of depression, and family disruption were common.
Activities of Daily Living↗
An investigation of symptom-specific muscle hyperreactivity in upper extremity cumulative trauma disorder.
OBJECTIVE: The study examined symptom-specific muscle hyperreactivity in patients with chronic pain with upper limb cumulative trauma disorder (CTD). DESIGN: Four tasks were presented in counterbalanced order and included neutral, general stressor, personal stressor, and pain stressor tasks. Ratings of stressfulness and recordings of skin conductance level confirmed the effectiveness of the experimental manipulations in inducing stress experiences for all subject groups. SETTING: The study was conducted in a university research center. PATIENTS: Thirty patients with CTD were matched as closely as possible for age and gender to control groups of chronic low back pain, arthritis, and pain-free subjects. OUTCOME MEASURES: Surface electromyograph recordings were taken from the frontalis, forearm flexors, trapezius, and lower back during baseline and tasks. RESULTS: The study found no evidence of greater muscle tension increases or extended duration of return to baseline for the CTD or low back pain patients at any of the muscle sites for any of the tasks in comparison to control groups. CONCLUSIONS: The results indicate that symptom-specific psychophysiological responses may be limited to certain subgroups rather than being characteristic of chronic musculoskeletal pain patients in general.
Adult↗
Recent trends in work-related cumulative trauma disorders of the upper extremities in the United States: an evaluation of possible reasons.
The increasing trends of cumulative trauma disorders of the upper extremities (CTDUEs) in US industry is well established; however, systematic examination of potential reasons for these trends has been lacking. Data from the United States Bureau of Labor Statistics and from Liberty Mutual Group workers' compensation claims were used to count CTDUEs. The proportions of all Bureau of Labor Statistics' cases and Liberty Mutual Group workers' compensation claims that resulted from CTDUEs were estimated for the years 1986 to 1993. The proportions by occupation (job classification code), gender, potential video display unit use, and in the meat-packing industry are described. Both data systems show a steady increase in cases and claims from less than 1% in 1986 to about 4% in 1993. Women and specific occupational categories are over-represented with respect to CTDUEs. A shift to service industry work and video display unit use do not appear to be strongly related to the increased reporting of CTDUEs, whereas increased productivity, an increased number of women in the work force and general awareness of CTDUEs in the media and health care system may be related. Coding and definition problems still limit these conclusions, however.
Arm Injuries↗
Experience of cumulative trauma disorders on life roles of worker and family member: a case study of a married couple.
The prevalence of diagnosed cumulative trauma disorders (CTD) within the workforce comes at a high price for employers burdened with financial losses from missed work and worker's compensation costs. Research has focused primarily on the impact of CTD on the worker role within the workplace, overlooking the impact on roles across multiple environments [24,35,54]. Furthermore, the influence of CTD on life roles of a spouse has not been examined. This single case study illustrated the experience of CTD within a marital relationship through the use of grounded theory. Results indicated that adaptations to CTD symptoms were least altering to the established routines and roles of the couple. With progression of symptoms, the spouse without symptoms was relied on more heavily for adaptations to manage pain. The results of this study indicate that occupational therapists must examine the client's valued roles and incorporate the family into intervention strategies.
Activities of Daily Living↗
Identifying cumulative trauma disorders of the upper extremity in workers' compensation databases.
BACKGROUND: Impeding the use of workers' compensation databases for surveillance of cumulative trauma disorder of the upper extremity (CTDUE) is the lack of valid and reliable extraction strategies. METHODS: Using the Z795-96 Coding of Work Injury or Disease Information standard, an algorithm was developed to classify claims as definite, possible, or non-CTDUE. Reliability was assessed with standardized claim reviews. RESULTS: Moderate to substantial agreement (Kappa = 0.48, 95% CI 0.42-0.54, n = 328; weighted Kappa = 0.75, 95% CI 0.70-0.80, n = 328) was demonstrated. The algorithm produced relatively homogeneous groups of definite and non-CTDUE claims but 29.1% of the possible CTDUE claims were categorized as definite CTDUE by claim review. Part of body agreement was almost perfect (Kappa = 0.81-1.00) when determining whether the upper extremity or specific parts of the upper extremity were involved. CONCLUSIONS: The algorithm can be used to estimate the number of CTDUE and extract homogeneous groups of definite and non-CTDUE claims. Furthermore, certain upper extremity part of body codes can be used to target anatomically defined claims.
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Educational techniques used in occupational therapy treatment of cumulative trauma disorders of the elbow, wrist, and hand.
OBJECTIVE: This study examined patient education techniques used by occupational therapists when treating cumulative trauma disorders (CTDs) of the elbow, wrist, and hand. METHOD: A self-administered survey was sent to 232 registered occupational therapists whose primary area of practice was hand therapy. The questionnaire sought information about specific content areas and methods (i.e., media, format) used to educate patients about preventing the recurrence of CTDs in the elbow, wrist, and hand. RESULTS: One hundred twenty-eight therapists responded to the survey. A majority of respondents (n = 116) reported that patient education content area consisted of anatomy of the joint, the CTD disease process, and job modification. Verbal instruction, illustrations, and pamphlets and handouts were the most frequently used forms of educational media. A majority of respondents (n = 111) also reported that individual interaction was the most common format of patient education. CONCLUSION: The findings indicate that a majority of therapists use the same patient education techniques with regard to content areas, media, and format, regardless of the area being treated (i.e., elbow, wrist, hand). Furthermore, it appears that therapists with specialty training in CTDs more frequently include anatomy of the elbow, job modification, and proper body mechanics in the content of their patient education about the elbow.
Adult↗
Use of workers' compensation claims data for surveillance of cumulative trauma disorders.
Workers' compensation claims in Ohio were evaluated as a source of surveillance data for identifying workplaces at high risk of cumulative trauma disorders (CTDs) and analyzed for their demographic and industrial characteristics. During a 5-year period (1980 to 1984), 6,849 workers' compensation claims met the case criteria for CTDs. Tenosynovitis due to continuous motion was the most frequently reported condition (58%), and the wrist was the body part most frequently affected (48%). The highest case rate was observed for female workers in the 36 to 45 age group. Incidence rates for individual companies were determined and those with the highest rates for CTDs were identified. The employer-specific rates for CTDs based on workers' compensation claims data can be used as an effective surveillance tool in locating high-risk operations where ergonomic interventions can be implemented to reduce CTD hazards.
Adolescent↗
A checklist for evaluating ergonomic risk factors associated with upper extremity cumulative trauma disorders.
A two-page checklist for determining the presence of ergonomic risk factors associated with the development of upper extremity cumulative trauma disorders (e.g., repetitiveness, local mechanical contact stresses, forceful manual exertions, awkward postures, and hand tool usage) was developed and evaluated as part of a joint labour-management ergonomics intervention programme. This checklist was used by plant personnel at four work sites to assess the presence of upper extremity risk factors in 335 manufacturing and warehouse jobs. In addition, results generated by the checklist were compared to the results of ergonomic analyses performed by persons with advanced training (Masters degree) in occupational ergonomics for a subset of 51 jobs. Most of the jobs included in the survey were found to have significant exposures to upper extremity risk factors. Awkward work postures were common, with 90% of the jobs requiring wrist deviations outside the neutral range-of-motion. The jobs were also highly repetitive and frequently required workers to exert high hand forces. Results generated by the checklist were generally in agreement with results generated by the ergonomic analysts; however, the checklist was found to be more sensitive in identifying the presence of risk factors. The checklist was found to be an effective rapid-screening instrument for identifying jobs that expose workers to potentially harmful ergonomic stresses. However, the checklist methodology did not include sufficient documentation of work methods to identify specific job attributes associated with these exposures.
Arm Injuries↗
Perceived psychological stress and upper extremity cumulative trauma disorders.
This report presents data exploring the relationship between perceived psychological stress and several variables implicated in the etiology of upper extremity cumulative trauma disorders (UECTDs). The sample was 354 workers from three different manufacturing companies. The primary job exposure for the subjects was that they were engaged in jobs that involved repetitious movements of the upper extremities, primarily of the hands and arms. Data collection included a detailed health history, a comprehensive physical examination of the upper extremities, limited electrodiagnostic testing, Cohen's Perceived Stress Scale, Karasek's Job Content Questionnaire, demographic information, and a measurement of repetition. Descriptive analyses, analysis of variance, correlational analyses, and multiple linear regression were used to examine the data. Perceived stress, as measured in this study, was only weakly associated with repetition, job dissatisfaction, and subjective complaints related to UECTDs. In addition, factors generally accepted as related to UECTDs (e.g., repetition, female gender, hormonal influences, and existing medical conditions) were not robust predictors of perceived stress. The major limitation is related to the measurement of perceived psychological stress. Like most psychosocial phenomena, perceived stress is a complex construct, one that is difficult to measure and correlate with health outcomes. Further research is necessary to examine what role, if any, perceived stress may have in the etiology of UECTDs.
Adult↗
Cumulative trauma disorder: a primary care provider's guide to upper extremity diagnosis and treatment.
This article gives an overview of the nonmedical aspects of cumulative trauma disorder (CTD) such as workers' compensation and hazard evaluation. The pathophysiology and presenting symptoms of CTDs are addressed, including entrapment neuropathies of the median, ulnar, and radial nerves; thoracic outlet syndrome; and tendinitis of the elbow, shoulder, wrist, and thumb. History and specific examination techniques are discussed. There is a focus on primary care treatment options, which includes ergonomic interventions.
Adult↗
Are deficiencies in manual tracking associated with upper extremity cumulative trauma disorders?
OBJECTIVES: To examine the reliability of manual tracking performance and its association with impairment and disability in individuals symptomatic of an upper extremity cumulative trauma disorder (CTD). METHODS: Volunteer and physician referred subjects (100 control, 140 CTD) tracked a target cursor moving quasi-randomly using a hand-held stylus interfaced with a digitizing tablet. Impairment was physician-rated and the Disability of the Arm, Shoulder and Hand questionnaire measured disability. Subsamples of 25 subjects per group were tested on three occasions. RESULTS: Reliability of tracking performance was excellent (ICC > or = 0.88) and sensitivity was 81%. Performance was superior in controls (p < 0.001) and deteriorated as a function of impairment level (p < 0.001). Tracking and impairment rating explained 65% of the disability score. CONCLUSIONS: Tracking performance may be an important outcome for monitoring change over time and the impact of a CTD on function in everyday activities.
Adolescent↗
Effect of EMG biofeedback compared to applied relaxation training with chronic, upper extremity cumulative trauma disorders.
This study examined the relative effectiveness of EMG biofeedback, applied relaxation training and a combined procedure in the management of chronic, upper extremity cumulative trauma disorder. Forty-eight patients with a history of about 5-6 years of upper extremity pain were randomly assigned to 1 of 4 treatment conditions, namely applied relaxation training, EMG biofeedback, a combined approach or a wait-list control. Treatments were conducted on an individual basis, twice per week for 4 weeks. Patients in all 3 treatment conditions showed significant short-term reductions in pain and psychopathology in comparison to the wait-list group who showed minimal change. Six-month follow-up data were obtained for patients in the treatment conditions, but not the wait-list group. There was some evidence of relapse on measures of depression, anxiety and pain beliefs for treated patients during the 6-month follow-up period, although measures remained significantly below pre-treatment levels for most outcome indices. Self-monitored pain continued to decrease for the treatment groups through follow-up. Contrary to predictions, however, the strongest short-term treatment benefits were shown by patients receiving applied relaxation training on measures of pain, distress, interference in daily living, depression and anxiety. By 6-month follow-up, differences between treatment groups were no longer evident.
Adult↗
"Neurologic manifestations of cumulative trauma disorder".
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Age Distribution↗
Isokinetic peak torque in women with unilateral cumulative trauma disorders and healthy control subjects.
OBJECTIVES: To compare isokinetic peak torque in the symptomatic and asymptomatic limbs of women with lateral epicondyle or forearm pain due to cumulative trauma disorders (CTDs), and to compare peak torque in women with CTDs to peak torque in healthy women. DESIGN: Case control comparison. SETTING: Private occupational rehabilitation clinic and a sports science tertiary education center. SUBJECTS: Women with CTDs involving one arm (n=17) and a convenience sample of healthy women (n=7) INTERVENTION: Subjects performed isokinetic strength testing for wrist extension and flexion, wrist supination and pronation, and knee extension and flexion. MAIN OUTCOME MEASURES: Peak torque at 120 degrees/sec on a Biodex isokinetic dynamometer. RESULTS: Control subjects had significantly higher peak torque in wrist extension, flexion, supination, and pronation than CTD subjects on the symptomatic side. Control subjects also had significantly higher peak torque of wrist flexion, pronation, and supination than CTD subjects on the asymptomatic side; wrist extension was greater, but this did not reach significance. In addition, control subjects had significantly higher peak torque in knee extension and flexion than CTD subjects. CTD subjects had significantly greater left-right asymmetry in wrist extension torque than did control subjects. CONCLUSIONS: Isokinetic peak torque is diffusely reduced in women with unilateral CTDs compared with healthy control subjects, these differences occurring in symptomatic and asymptomatic limbs.
Adolescent↗
[Epidemics of musculotendinous pathologies of the upper limbs (cumulative trauma disorders) in a group of assembly line workers].
The study was prompted by a report concerning a group of assembly line workers in a factory producing prams who had developed various muscular and tendinous disorders of the upper limbs that can be classified under the larger category of Cumulative Trauma Disorders (CTD). The study first concentrated on the working conditions with analysis of the main factors responsible for overloading of the upper limbs during work. This analysis revealed high frequency and repetitiveness of upper limb movements together with a marked inadequacy of the length and distribution of pauses. In a significant part of the operations the workers also performed movements in positions that over loaded the wrist and hand. A parallel clinical and instrumental study carried out in collaboration with specialists in orthopedics, brain surgery and neurophysiology on all 40 workers in the shop showed that 90% of the subjects suffered from a form of CTD of the upper limbs: in particular, 40% were affected with carpal tunnel syndrome (12.5% bilateral), and there were high prevalence of tenosynovitis (32% Trigger Finger, 17% De Quervain's syndrome) and epicondylitis (20% medial or lateral). The results of the study once again emphasize the need for greater attention of occupational health practitioners in Italy for muscular and tendinous disorders of the upper limbs due to repeated strain, which Italian law defines, albeit controversially, as occupational.
Adult↗
Ergonomic risk exposure and upper-extremity cumulative trauma disorders in a maquiladora medical devices manufacturing plant.
Workers at a Nogales, Mexico, maquiladora plant that assembles medical devices were studied to determine the prevalence of upper-extremity cumulative trauma disorders (CTD). Subjects included production workers employed 6 months or longer; of the 148 eligible workers, 145 (98%) participated. Subjects had a mean age of 24.6 years (SD = 5.2; range, 17 to 45) and the mean length of employment was 3.5 years (SD = 2.5; range, 0.5 to 14). Job tasks were videotaped and analyzed for ergonomic risk factors, using pre-defined criteria. All jobs performed by study subjects were found to involve one or more ergonomic risk factors associated with the development of CTD. A CTD questionnaire and screening physical examination format, similar to that used by the National Institute of Occupational Safety and Health (NIOSH) in a chicken processing plant study, were administered. Period prevalence of CTD within the previous year, as reported on the questionnaire, was 28%. Prevalence of CTD was 17%, using data from the screening physical examination. Point prevalence (current pain data from the questionnaire plus positive symptoms on the screening physical examination) was 15%. CTD was reported more frequently in women than men (46% and 25%, respectively; P < 0.05) and in subjects who had worked at the plant less than one year (50%; P < 0.05). Workforce turnover (3% monthly) may have resulted in those affected by CTD leaving employment, reducing the apparent CTD rate in experienced workers.
Adolescent↗
The inter-rater reliability and validity of self-report of risk factors for cumulative trauma disorders within the hand therapist population - a pilot study.
OBJECTIVES: This study examined the validity of hand therapists' self-report of cumulative trauma disorder (CTD) risk factors by comparing the self-report to observations performed by the raters. Inter-rater reliability was also analyzed between the raters who observed the hand therapists. STUDY DESIGN: Two raters simultaneously observed each hand therapist during a splinting task at a therapy facility. Following this task, the raters and the hand therapist independently completed an identical assessment tool. Thirteen therapists were observed and a total of six raters observed the therapists. Responses from two categories of the self-assessment, "posture" and "mechanical stress", were compared. Percentage of agreement was calculated by dividing the number of like responses by the total number of possible responses for each category. RESULTS: Overall inter-rater reliability was 72%, significantly above the accepted minimum standard of 60-70%, and validity was 39%, significantly below the accepted minimum. CONCLUSION: The high percentage of inter-rater reliability established consistency and accuracy among the raters in their observations. However, the low percentage of validity should prompt hand therapists to investigate the accuracy of a patient's self-report before relying on it for treatment.
Journal Article↗