Cumulative trauma disorders

The relationship between work activities and the diagnostic entities discussed in this article is poorly understood, but their development is probably multifactorial. The enormous cost to industry and society is driving many investigators to study the causes and pathologic manifestations of CTDs, and this research should lead to improved strategies for treating and preventing work-related injuries. Prevention, however, will work only if both management and labor participate in preventive efforts. When a task force approach can be implemented and senior management gives it the power to make effective changes, CTDs often can be reduced dramatically, as has been shown in numerous studies illustrating the success of this approach. It is unfortunate that many in senior management are reluctant to permit such task forces due to fear of increased injury claims. Our worry is that, in the end, the solution to problems believed to be associated with repetitive trauma at work may be shaped more by regulatory bodies and attorneys rather than scientists. Hand surgeons, who see patients with complaints that are perceived to be work related, often find themselves in the middle of this complicated problem, being asked to determine whether a patient's symptoms are caused by the performance of job tasks. To treat our patients with hand and wrist symptoms, we must stay abreast of the current understanding of CTDs and be familiar with the diagnosis and management of recognized disease entities such as those reviewed in this article. In most cases, a diagnosis of a specific clinical condition can be established that is based on strict criteria. If this is not possible and the picture is unclear, it is important not to guess at a diagnosis. Labeling a patient with a diagnosis such as thoracic outlet syndrome or nonspecific tendonitis without clear-cut and objective clinical signs can have lasting economic and employment consequences. For this reason, diagnosis of a specific clinical entity should be made only when the findings of the history, physical examination, and ancillary tests firmly support it.