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Understanding Cumulative Trauma

Understanding Cumulative Trauma. TM 655 Carter J. Kerk SDSMT Summer 2010. Assignment. Read MacLeod, Chapter Three. What is cumulative trauma?. Wear and tear on joints and surrounding tissues over time because of overuse Cumulative vs. Acute Low Back Cervical Spine (neck)

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Understanding Cumulative Trauma

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  1. Understanding Cumulative Trauma TM 655 Carter J. Kerk SDSMT Summer 2010

  2. Assignment • Read MacLeod, Chapter Three

  3. What is cumulative trauma? • Wear and tear on joints and surrounding tissues over time because of overuse • Cumulative vs. Acute • Low Back • Cervical Spine (neck) • Upper Extremities • Shoulder, elbow, wrist, fingers

  4. Musculoskeletal & Neurovascular Disorders • Disorders of muscles, joints, tendons, ligaments, nerves, cartilage • usually a gradual buildup of stress to the musculoskeletal system and neurovascular system • diagnosis by a qualified medical expert • most common in upper extremities and spine

  5. Disorder Terminology • Cumulative Trauma Disorders (CTDs) • Repeated Motion Disorders (RMIs) • Repetitive Strain Injuries (RSIs) • Musculoskeletal Disorders (MSDs) • Involving muscles and connective tissue • Connective Tissue (bone, cartilage, tendon, ligament, fascia) • Neurovascular Disorders (NVDs) • Involving nerves and blood vessels

  6. MSD / NVD Symptoms • Vague, Slow to Develop • Soreness, pain, discomfort • Numbness, tingling sensations • Weakness, clumsiness • Burning sensations • Limited range of motion • Joint stiffness, popping/cracking in joints

  7. Diagnosis • Difficult to diagnose • Proper diagnosis should only be done by a qualified medical professional • Certified Occupational Physician (Occ Doc) • By training, experience, examination in occupational illness/disease • A few specialists • Not most doctors, no nurses, no ergonomists, no physical therapists, no occupational therapists, no engineers, and certainly no managers, etc.

  8. Treatment • Ice • Anti-inflammatory drugs • Rest • Possibly cortisone • After some time • Physical therapy (strengthening, stretching, work hardening, etc.) • Surgery (only as a last resort) • “Job Re-Design” – Always look at this

  9. Early Recognition • Early recognition is important in controlling MSDs / NVDs • Use early warning systems (e.g. body discomfort surveys) • Training of employees and managers • Working relationship with Occ Doc • Stress “conservative treatment” • Non-surgical

  10. The Risk Factor Model Lack of Rest Work/Rest Ratio Shift Length Environment Sustained Repetition Occupational Vibration Non-Occupational Temperature Posture Physical & Temporal Risk Factors Force Personal Psychosocial Compounding Risk Factors

  11. Wrist Disorder Rates by Exertion & Repetition (n=574, Silverstein, 1985)

  12. MSDs / NVDs Categorized by Body Part • Hand and Wrist • Elbow and Shoulder • Back, Neck, and Torso • Legs

  13. Wrist • Bones • Ligaments • Tendons • Nerves • Carpal Tunnel

  14. Elbow • Bones • Humerus (medial & lateral epicondyle); radius, ulna • Muscles • Forearm muscles attach at elbow • Nerves • Ulnar nerve

  15. THE SHOULDER Anatomy • Bones • Muscles • Ligaments • Bursa • Cartilage

  16. Hand and Wrist Disorders • Carpal Tunnel Syndrome (CTS), Tendonitis, De Quervain’s Disease, Digital Neuritis, Ganglion Cyst, Guyon Tunnel Syndrome, Synovitis, Trigger Finger

  17. Elbow and Shoulder Disorders • Bursitis, Epicondylitis, Radial Tunnel Syndrome, Rotator Cuff Tendonitis, Thoracic Outlet Syndrome

  18. Back, Neck, and Torso • Degenerative Disc Disease, Herniated Disc, Ligament Sprain, Mechanical Back Syndrome, Muscle Strain, Posture Strain, Tension Neck Syndrome, Hernia

  19. Legs • Patellar Synovitis, Phlebitis, Plantar Fascitis, Shin Splints, Sub-Patellar Bursitis, Trochanteric Bursitis

  20. Categories of Upper Extremity CTDs • Tendon disorders • Nerve disorders • Neurovascular disorders

  21. Tendon Disorders • Tendonitis • tenosynovitis • De Quervain’s disease • stenosing tenosynovitis crepitans (trigger finger) • ganglionic cyst • lateral epicondylitis (tennis elbow) • medial epicondylitis (golfer’s elbow) • rotator cuff tendonitis

  22. Nerve Disorders • Cubital tunnel syndrome • Carpal tunnel syndrome (CTS)

  23. Neurovascular Disorders • Thoracic outlet syndrome • Vibration syndrome • white finger or Raynaud’s phenomenon

  24. Swelling of tendons. Decreased blood supply to median nerve. Numbness/tingling in fingers. Prolonged irritation – scarring & nerve damage. Repetitive or strenuous activity. Carpal Tunnel Syndrome

  25. DeQuervain’s Tenosynovitis • Swelling of tendon sheath that surrounds thumb tendons as they travel through the wrist to the thumb. • Overuse. • Strain injury. • Inflammatory arthritis.

  26. Trigger Finger • Tendon thickens and bends finger • Arthritis, diabetes, lacerations, infections • Repeated “pistol gripping” of power tools • Long hours grasping steering wheel

  27. Lateral Epicondylitis • Tennis Elbow • Chronic tendinosis of the wrist and finger extensors at their insertion at the elbow. • Tendons of forearm become irritated or tear away from medial or lateral epicondyle causing irritation. • Overuse of forearm muscles used for rotation of the arm and extension of wrist.

  28. Medial Epicondylitis • aka. Golfer’s Elbow • Overuse of the flexor-pronator muscles whose origin is at anterior medial epicondyle of humerus • Sports related • Occupation related • Screwdriver, hammer use

  29. Ulnar nerve entrapment • Muscle, ligament, & bone make up cubital tunnel. • Ulnar nerve travels medially. • Frequent elbow bending – pulling levers, reaching, lifting. • Repeated injury or pressure. • Resting elbow on hard surface for long periods. • Direct blow or injury to ulnar nerve. • Anatomy- nerve shifts, snaps over bone  irritation.

  30. Rotator Cuff Injuries. • Single traumatic injury. • Collisions, fall on an outstretched hand • Multiple “micro-traumas” over time. • Repeated overhead activity. • Heavy lifting. • Normal degeneration in 3rd and 4th decades of life. • Most commonly the supraspinatus.

  31. Impingment: Rotator Cuff Tendonitis or Shoulder Bursitis • Tendons become red, sore, & inflamed usually from crowding by surrounding structures. • Trapped under acromium(impingement) • Inflammation of the bursa usually occurs too. Causes – Overuse (frequent overhead reaching); Rheumatoid arthritis.

  32. Low Back Pain (LBP) Categories • Muscular / Ligamentous • strain • Structural • overloading trauma, degenerative disease, facet dysfunction, osteoporosis, scoliosis • Discogenic • herniation, nerve irritation, tumor • Others • infections, congenital disorders

  33. ? Magnitude and Trend: Numbers and types of occupational illness cases between 1972 and 2001. (DHHS 2004, Fig 1-22)

  34. What are the reasons for the dramatic increase thru mid 90s? • Aren’t these the same jobs workers have been doing for decades? • Are workers getting weaker or wimpier? • Increased awareness and reporting? • Technological changes? • Aging workforce?

  35. Increase in Awareness & Reporting • MSDs have probably existed since the Stone Age • Only recently have we begun recording • Increased media exposure • Proactive training • Work expectations (we may no longer be willing to accept the pain) • Employees realize they can receive compensation (for suffering or faking)

  36. Increase in Awareness & Reporting (continued) • Diagnostic techniques have improved • Easier access to medical care and treatment • Companies are required by OSHA to record work-related disorders • When you start a new program, be prepared for a spike in reporting the first few years • Increased consciousness

  37. Changes in Technology • Increase Specialization of Tasks • Typewriters to keyboard • Drafting tables to CAD software • Chicken at the grocery store • Increases in Assembly Line Work • Traditionally started in the automotive industry, now common in many sectors • Gaps in Automation • Highly automated processes may be interspersed with repetitive human tasks

  38. Fads and Malingerers? • Fad? • “Australian Disease” (see course website) • Reporting phenomenon, increase attention in media • Ergonomics and CTDs are no fad! • Malingerers? • There is a problem – Workers’ Compensation • Malingerers are not the primary cause of increased claims

  39. ? Magnitude and Trend: Numbers and types of occupational illness cases between 1972 and 2001. (DHHS 2004, Fig 1-22)

  40. What are the reasons for the gentle decline since mid 90s? • Effects of ergonomics programs? • Effects of medical management? • Better overall understanding of the problem?

  41. Were MSDs invented in the 1980s? • MSDs are Age-Old (read cases p. 76-78) • MSDs in the 1700s • Dr. Bernardino Ramazzini (founder of Occ Med) wrote a book in 1713 (Diseases of Workers) • But amidst all these disorders are descriptions of “. . . The harvest of diseases reaped by certain workers . . . from irregular motions in unnatural postures of the body.” • MSDs in Literature • Herman Melville’s Moby Dick (1851) about life he experienced on whaling ships: • “they have swelled their wrists with all day rowing” • “a roll of flannel for the small of someone’s rheumatic back” {i.e., a lumbar cushion}

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