When speaking of gradual-onset pain syndromes that seem to be related to work activity, we tend to use general descriptive terms such as cumulative trauma disorders, repetitive strain or stress injuries, or musculoskeletal disorders. What do these terms actually mean? Are we prone to throwing around terms such as these that do not have much meaning? Or are they helpful terms that let us address issues in the workplace that can lead to injury?
The American Society for Surgery of the Hand (ASSH)
“feels that the diagnoses of cumulative trauma disorder (CTD) and repetitive strain injury (RSI) are not appropriate and may actually lead the patient to believe that he or she has a condition that is something more than the ordinary aches and pains of life.” Having spent a large part of my career treating and educating those with repetitive strain injuries or at risk of developing them, having seen the correlation between the development of pain and inflammation related to highly repetitive movements, static positioning, awkward postures and forceful exertion, I needed to think carefully about the position that the ASSH takes in order to understand it.
The ASSH is, appropriately, looking at these injuries from a purely medical standpoint. It states that it “is concerned that patients with upper extremity pain are being assigned specific diagnoses on the basis of subjective complaints without objective physical findings. There is also a tendency to assign a causal relationship to work for this pain when there is a lack of epidemiological evidence. As part of our normal process of providing the best care for our patients, it is important that the diagnosis be accurate and the assignment of causation be correct.”
I have found clinically that the more specific the diagnosis a person has when they walk in the door, the better the treatment that can initially be provided. For example, if someone arrives in the hand therapy clinic with the diagnosis of a thumb tendinitis, I now have some information that will help me treat a localized injury. This specific diagnosis also provides me with information that can point me in the direction of what activity may have caused the injury. For instance, many people with a thumb tendinitis may be squeezing the mouse too tightly, hitch-hiking the thumb over the space bar, or texting frequently. As part of my treatment, I can now begin by asking about these work activities and analyzing work methods so that I can provide the appropriate education. This will help my client to reduce and prevent the injury when he or she is back in the work environment.
On the other hand, a more general diagnosis allows me to treat the entire upper arm, to provide ergonomic and injury prevention training, to address postural issues within the scope of the referring treatment prescription. This can be helpful for injuries that are vague, general in nature, and not localized to one particular area, perhaps the early stages that can lead to a more debilitating injury.
Both clinically and occupationally, I think most of us agree that repetition, awkward movements and forceful movements can lead to arm pain and fatigue, developing into more specific injuries, and even causing long term disability. It is convenient for us to lump a variety of diagnoses caused by overuse or overwork into general categories. If we had to describe the various nerve compressions and tendon inflammations that we are trying to prevent in every newsletter, article and employee training, we would become overwhelmed with the minutia and never get to the substance of our content. I believe that there is a need to address these occupational illnesses as a general category for educational and injury prevention purposes. These terms are becoming a part of our work culture and will be with us for awhile.Marji Hajic is an Occupational Therapist and a Certified Hand Therapist practicing at the Hand Therapy & Occupational Fitness Center in Santa Barbara, California. For more information on hand and upper extremity injuries, prevention and recovery, visit Hand Health Resources