CUMULATIVE TRAUMA DISORDERS OF THE UPPER EXTREMITY Thomas G. Bergfield, M.D., M.S.
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Transcript of CUMULATIVE TRAUMA DISORDERS OF THE UPPER EXTREMITY Thomas G. Bergfield, M.D., M.S.
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CUMULATIVE TRAUMA DISORDERS OF THE UPPER EXTREMITY
Thomas G. Bergfield, M.D., M.S
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• 1700’s Agrarian
• 1800’s Industrial RevolutionSafety not a concern
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• 1900 Compensation Programs
• 1910 Compulsory Worker’s 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
It’s reported at work, it’s 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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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
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What can we do?
• Perdue experience – job rotation – many factors
• Pre-employment screening
• Honest physicians
• Collaboration