New Information - Newport Workers' Compensation
CUMULATIVE TRAUMA DISORDERS
EDWARD AKELMAN, M.D.
PROFESSOR ORTHOPAEDIC SURGERY
BROWN UNIVERSITY SCHOOL OF MEDICINE
What are cumulative trauma disorders?
Cumulative trauma disorders are muscle, tendon, vascular and nerve injuries that result from repeated or sustained actions or exertions of different body parts 5,12,15,16 . These injuries result from an accumulation of small traumatic events to each tissue over periods of time, ranging from weeks, months, and years. Other terms that have been used to describe these disorders include repetitive trauma disorder, repetitive strain injury, overuse syndrome, work-related disorder and regional musculoskeletal disorders. The risk factors that have been implicated in cumulative trauma disorder include exertion, frequency, duration, force, postures, low temperatures and vibration.
The common medical conditions that have been related to cumulative trauma disorder include carpal tunnel syndrome, stenosing tenosynovitis or trigger finger, deQuervains disease, lateral epicondylitis and thoracic outlet syndrome. 4,11,12,12,16,19,21
Who is affected by cumulative trauma disorders?
The incidence of cumulative trauma disorders include a wide range of diagnoses, without a consistent set of universally accepted medical conditions. Supplemental Data System (SDS), a federal-state cooperative program administered by the Bureau of Labor Statistics which compiles data on occupational injuries and illnesses from records of Workers Compensation patients in 24 states, has indicated that 115,400 cases of cumulative trauma disorders occurred in 1988, an incidence of 15.4 cases per 10,000 full-time workers 16 ; 90% of these occurred in manufacturing. These disorders have been reported with increasing frequency. In 1983, these injuries accounted for 25% of reported occupational injuries. In 1988, they accounted for 48% of reported occupational illnesses 15 .
It has been reported that 6485 claims were filed for cumulative trauma disorders in Ohio according to the Bureau of Workers Compensation Data Base. Claims from cumulative trauma disorders increased 84.6% between 1985 and 1989, an increase in 16.6% per year 16. Increases over the period of 1985-1989 were noted for carpal tunnel syndrome (127.7%) and tendon disorders, such as stenosing tenosynovitis and deQuervains disorder (40.6%). Carpal tunnel syndrome accounted for 49.1% of reported cumulative trauma disorders in Ohio in 1989.
Other reported data comes from the Washington State Workers Compensation Commission 16. An overall incidence of occupational carpal tunnel syndrome was noted to be 1.74 claims per 1000 full-time equivalent employees over the 1984-1988 period. The annual incidence rates were 1.96 per 1000 FTs for women and 1.58 per 1000 for men, a female to male incidence ratio of approximately 1.2:1. These data reflect all workers covered by Workers Compensation in the state of Washington, including 1.3 million full time workers in 1988.
The incidence in the State of Washington increased from 1.78/1000 full time equivalents in 1984 to 2.00/1000 in 1988. The rates for women increased significantly over this period while male incidence rates were stable.
Physician reporting at the Centers for Disease Control has allowed estimates of 47% of carpal tunnel syndrome cases being work related 16. Applying this percentage to national estimates indicated that each year more than 103,000 carpal tunnel release operations result from occupational disease.
What does cumulative trauma disorder mean in terms of health care costs?
Data on the indirect and direct costs of cumulative trauma disorder is not available. In 1988, carpal tunnel release was the tenth most frequently 16 performed procedure in terms of dollars in the United States under Medicare Part B. The total cost in this older population was estimated at over 15.5 million dollars. This figure does not include younger patients who are more likely to have cumulative trauma disorder-related carpal tunnel syndrome.
It has been estimated that a worker with carpal tunnel syndrome who was treated conservatively and is allowed to go back to work without surgery costs approximately $3,500.00. If the same injured worker requires surgery, the cost has been felt to average approximately $20,000.00 if the individual returns to work. If the individual is unable to return to work, the cost for one carpal tunnel claim could be as high as $100,000.00 13.
It has been estimated that cumulative trauma disorders cost U.S. industries as much as $27 billion dollars annually 12.
What has been accomplished regarding the treatment of cumulative trauma disorders?
Prevention continues to be the best treatment with these injuries, with ergonomic design and evaluation of the work place becoming an accepted standard of treatment 1,7,8,10,18. Changes of design of a work station or tools may reduce the stimuli for cumulative trauma disorder. Therapeutic modalities have been extremely helpful as treatment. They include splinting using custom and prefabricated splints and providing protection in the workplace from re-injury, and also decreased inflammation by blocking motion during repetitive activities. Exercise protocols have been designed for reach specific cumulative trauma disorder disease. Strengthening using isometric, isotonic and isokinetic exercises have been shown to improve patient return to work data. The use of nonsteroidal anti-inflammatory medications and cortisone has been a useful adjunct for treatment 9. Surgical treatment, including carpal tunnel release as popularized by Phalen in 1959 15, has shown excellent result using both open and endoscopic release means 6.
What remains to be accomplished?
Future research in cumulative trauma disorders would continue to diminish these illnesses. Increased funding for research would allow physicians and scientists to: