Cumulative trauma disorder (CTD) or repetitive stress injury (RSI) refers to a large group of disorders that can affect bones, muscles, tendons, ligaments, bursae, and nerves.
Other interchangeable terms include:
1- repetitive stress disorder,
2- repetitive strain disorder,
3- repetitive strain injury,
4- repetitive motion disorder,
5- repetitive motion injury,
6- repetitive injury, and
7- overuse syndrome.
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It is believed to be caused by micro traumas that occur from repeated overuse or misappropriate use of a body part or repeated external force applied to a body part. It is also thought to result from a combination of major trauma and micro traumas – a major trauma may weaken the body part so that micro traumas do more damage, or micro traumas may weaken the body part to a point where a larger trauma does more damage than it would have on a healthy body part.
Cumulative trauma disorders include disorders such as:
carpal tunnel syndrome and other entrapment neuropathies, tendinitis, tenosynovitis, epicondylitis, and bursitis. Often, however, there are patients who develop characteristic symptoms temporally related to repeated activity at work but who have no active medical condition that can be demonstrated on diagnostic testing or physical examination.
Cumulative trauma disorders occur most commonly in the hands, wrists, and elbows, but can also occur in the shoulders, neck, back, hips, knees, legs, feet, and ankles. The disorders often cause pain, swelling, redness, decreased motion, muscle fatigue, decreased strength, and dyesthesias.
Because these conditions are much easier to treat in early stages, it is important to initiate treatment quickly to minimize pain, improve treatment outcomes and facilitate early return to work in those who have been out of work. In addition, many patients with these disorders, particularly those without objective evidence of an active medical condition, are at high risk of developing a chronic pain syndrome, which further underscores the importance of an early return to work philosophy.
It is usually necessary to reduce or stop the motions that seem to cause symptoms; options might include taking breaks to give the affected area rest and to perform stretching and relaxation exercises. In general the sooner treatment is sought, the better the outcome. Supervisors should be aware of the symptoms so they notice them. Applying ice and using pain relievers, anti-inflammatory medications, and cortisone may be beneficial. Splints to relieve pressure and physical therapy to relieve soreness and pain can be tried. Rarely, surgery may be necessary. In difficult cases, the physician should utilize occupational therapists, vocational rehabilitation specialists, and ergonomic specialists to evaluate the workplace and assist the employee in an early return to the workplace.
Contributed by: Peter D Morris, MD, MPH. Dr. Morris works as a consultant in North Carolina. He is involved mostly in issues dealing with occupational health, public health, workers’ compensation, and disability determination. Thank you Dr. Morris for your insightful contribution. Much appreciated by the many companies who visit www.ReduceYourWorkersComp.com
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