Lecture 5 Cumulative Trauma Disorders (CTD)

Copyright 2002 by Dr. Govind Bharwani, Wright State University

What is CTD?
Cumulative = Repeated stress to specific part of the body. Mechanical stress causing intermittent aches & pains. Continuous pain affecting efficiency of body function

Trauma

Disorders

Copyright 2002 by Dr. Govind Bharwani, Wright State University

Physiological effect of CTDs

CTDs are disorders due to repeated stress to soft tissue of the body. They range from joint inflammation (pain) to muscle soreness. CTDs are usually caused in tendons, nerves & blood vessels of upper extremity. Major areas of CTDs are joints in the upper extremity such as fingers, wrists, elbows & shoulders. Other areas of CTDs are lower back & neck.
Copyright 2002 by Dr. Govind Bharwani, Wright State University

Other names to describe CTDs

Repetitive Strain Injury (RSI) Repetitive Motion Disorders Overuse Syndrome Cumulative Effect Disorders Degenerative Joint Diseases Wear & Tear Disorders Work-Related Musculoskeletal Disorders(WMSDs) Overuse Injuries
Copyright 2002 by Dr. Govind Bharwani, Wright State University

Upper extremity - the working arm

Muscles, tendons, ligaments & nerves are affected by CTDs. Muscles can result in fatigue, pain, cramps and spasms due to stress. Tendons can result in inflammation & severe pain due to repeated stress. Ligaments can be strained if the joint is twisted repeatedly beyond its normal range. Nerves can cause pain, numbness & tingling due to repeated pressure.
Copyright 2002 by Dr. Govind Bharwani, Wright State University

CTD risk factors

Awkward postures Force Repetition Direct pressure Cold Vibration
Copyright 2002 by Dr. Govind Bharwani, Wright State University

Anatomy of the hand & wrist

Tendons in the hand connect arm muscles to the bones in the fingers. They go through a tunnel in the wrist called carpal tunnel . Tendons are surrounded by tubing called synovial sheath which contains a fluid called synovial fluid. This protects the tendon as well as provides lubrication for efficient movement. When efficiency of synovial fluid diminishes in the wrist, it can lead to tendon inflammation and wrist pain called tendonitis.
Copyright 2002 by Dr. Govind Bharwani, Wright State University

Awkward wrist postures

Awkward wrist postures reduce blood flow through the wrist thereby reducing the efficiency of synovial fluid and muscles in the wrist & hand. This can increase the risk of CTDs.

Copyright 2002 by Dr. Govind Bharwani, Wright State University

Twisting the wrist & Pinch grip

Twisting the wrist along with bending can reduce blood flow and increase the risk of CTD. Pinch grip requires force which also reduces blood flow when coupled with bent wrist posture.

Copyright 2002 by Dr. Govind Bharwani, Wright State University

Leg pain
Injuries of the legs 1) Bursitis of the knee 2) Strain in the ankle 3) Varicose veins Causes of leg pain Repetitive kneeling or bending the knee Improper height of the chair Standing with limited movement Knee and less than 60o during sitting.
Copyright 2002 by Dr. Govind Bharwani, Wright State University

Medical names of CTDs

Carpal Tunnel Syndrome Cubital tunnel syndrome DeQuervain s disease Epicondylitis Ganglionic cyst. Rotator cuff tendonitis Wrist tendonitis or tendonitis Tenosynovitis Thoracic outlet syndrome Trigger finger Ulnar nerve compression
Copyright 2002 by Dr. Govind Bharwani, Wright State University

Non-medical popular names of CTDs

Tennis elbow Telegraphist s wrist Bible bump Pizza palsy Golfer s elbow Clothes wringing disease Slot-machine tendonitis Sewing machinists injury Seamstresses disease
Copyright 2002 by Dr. Govind Bharwani, Wright State University

Examples of CTDs in manufacturing

Manual buffing/grinding Punch press operation Manual spray paint opn. Assembly line operations Sub-assembly operations Final Pack operations Molding & core making Stockroom & shipping Material handling Microscope operations Raynaud s syndrome Rotator cuff tendonitis Thoracic outlet syndrome Carpal tunnel syndrome wrist tendonitis DeQuervain s disease Wrist tendonitis Back and shoulder pain Back pain Neck pain & eye strain

Copyright 2002 by Dr. Govind Bharwani, Wright State University

Cumulative trauma disorders (CTDs) can be classified as

1) Tendon disorders 2) Nerve disorders 3) Neurovascular disorders

Copyright 2002 by Dr. Govind Bharwani, Wright State University

What are Tendon disorders?

Tendon disorders occur at or near the joints where tendons rub against ligaments & bones. Symptoms of tendon disorders : - dull aching sensation at the joint - discomfort with movement - tenderness with touch Type of tendon disorders - Tendonitis - Rotator cuff tendonitis - Epicondylitis - DeQuervian s disease - Ganglionic cyst - Trigger finger
Copyright 2002 by Dr. Govind Bharwani, Wright State University

What are symptoms of DeQuervains disease?

Pain around the thumb (page 54)

Copyright 2002 by Dr. Govind Bharwani, Wright State University

Symptoms of Tendon disorders

Type of disorder Wrist tendonitis Rotator cuff tendonitis Epicondylitis DeQuervain s disease Ganglionic cyst Trigger finger Employee complaints Wrist pain Shoulder pain Elbow pain Thumb pain Bump under the skin Uneven & jerky motion of the fingers Excessive pain while moving the shoulder

Bursitis

Copyright 2002 by Dr. Govind Bharwani, Wright State University

What are nerve disorders?

Nerve disorder occurs due to pressure on the median & ulnar nerve. Symptoms of nerve disorders - Pain, numbness & tingling sensation in fingers - Awakened at night with pain Type of nerve disorders 1) Ulnar nerve compression: pain, numbness & tingling feeling in the little and part of ring finger. 2) Carpal tunnel syndrome: pain, numbness & tingling feeling in the thumb and next 3 fingers.
Copyright 2002 by Dr. Govind Bharwani, Wright State University

What are Neurovascular disorders?

Neurovascular disorders results from the compression of the blood vessels Type of Neurovascular disorders 1) Thoracic outlet syndrome 2) Raynaud s syndrome

Copyright 2002 by Dr. Govind Bharwani, Wright State University

What is Thoracic outlet syndrome?

Thoracic outlet syndrome involves compression of the nerves and blood vessels between the neck and shoulder. Symptoms of Thoracic outlet syndrome 1) Numbness and tingling in the fingers. 2) Arms get tired with weakening pulse. Root causes 1) Working above shoulder level with bent neck. 2) Moving the shoulder forward or backward. Note: It is regularly misdiagnosed as Carpal Tunnel Syndrome with unnecessary surgeries.
Copyright 2002 by Dr. Govind Bharwani, Wright State University

What is Raynaud s syndrome?

Raynaud s syndrome is also called White finger disease . It causes loss of oxygen to the muscles leading to shut-down of blood vessels in the fingers. Symptoms of Raynaud s syndrome - Fingertips become pale and white. - Blanching of the skin with hands turning blue. - Unusual sensitivity to cold Root causes of Raynaud s syndrome 1) Use of vibration tools: grinders, jack hammers 2) Repetitive exposure to extreme cold temperature
Copyright 2002 by Dr. Govind Bharwani, Wright State University

Copyright 2002 by Dr. Govind Bharwani, Wright State University

Root causes of CTDs

Type of CTD Root causes

Copyright 2002 by Dr. Govind Bharwani, Wright State University

Awkward (static) postures which can cause CTDs

Copyright 2002 by Dr. Govind Bharwani, Wright State University