Reducing Cumulative Trauma Disorders: Easy, Fast and Cost Effective

Published: 18th August 2009
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Cumulative Trauma Disorders (CTDs) are defined as disorders or diseases of the neuromusculoskeletal system due to chronic, or accumulative micro trauma. The neuromusculokeletal system is designed to tolerate work and physical stress. However, when the physical stress exceeds the body's tolerance level, trauma and injury results. Trauma or injury to the neuromusculoskeletal system can be a result of direct physical stress or force or it can be from the internal stresses formed within the neuromusculoskeletal tissues. Macro-trauma, is an immediate injury that occurs from a single, direct force of a high intensity, the damage or injury is obvious and immediate, resulting in pain and loss of function. An example of macro-trauma is a fracture sustained due to a fall or a knee ligament sprain during a football tackle. Micro-trauma is tiny, microscopic, damage that is painless and not always immediately detected. Micro trauma occurs daily, and usually heals overnight.





How do CTDs develop?

The neuromusculoskeletal tissues work as a system to perform certain functions, including: activities of daily living, recreational activities and work activities. The muscle fibers generate an internal force or contraction, resulting in internal pressures inside the muscle. The force is then transmitted along to the tendons and the skeletal system to move the bones and perform voluntary movement. When bones move, they rotate about an axis, or joint, when this occurs, the joint experiences compressive forces.



When the neuromusculoskeletal system experiences stresses and internal forces that overload the tissues, local tissue fatigue can occur. This local tissue fatigue can lead to micro tearing of the tissues, this is also called micro trauma. Micro trauma or wear and tear damage does occur on a daily basis. When micro-trauma continues over a period of time at a rate that exceeds the rate of the body's ability to repair itself, the damage or trauma accumulates. The accumulation of trauma, over time, results in pain and loss of function. Further damage and trauma can lead to the formation of scar tissue, changes in body or tissue chemistry and even degenerative changes that may also affect motion, strength and function.



What are the Clinical Signs and Symptoms?

When a worker over stresses his or her tissues, and the body is unable to repair itself, the worker begins to experience pain and loss of function as a result of injury to those tissues. Daily activities and even work tasks become difficult and tedious. The worker will complain of and demonstrates the clinical signs and symptoms of CTDs.



A clinical sign of an injury or disease is the objective clinical evidence of a disease or injury. Some signs of injury include: swelling, loss of motion or strength, loss of reflexes and numbness or tingling in nerve distributions. A clinical symptom is the subjective evidence of an injury or disease observed by the person. Symptoms can include: pain, numbness or tingling and a burning sensation. Common clinical signs and symptoms of CTDs include:



• Pain

• Swelling.

• Numbness and tingling

• Burning sensation.

• Weakness

• Nocturnal pain (pain at night)



These symptoms are the body's warning signals that there is too much damage followed by too little repair time.



Common CTDs in the Workplace

Due to the nature of work and the relationship between inadequate recovery time and the development of CTD, some injuries or CTDs are observed more frequently in the workplace than others. The most common CTDs are defined and described below in terms of the area of the body that is most likely affected, the mechanism of the injury, which describes how the injury is initiated, and common causes that can lead to the development of these injuries.



1. Carpal Tunnel Syndrome (CTS)

Mechanism of Injury

According to the National Institute of Occupational Safety and Health, carpal tunnel syndrome is the most commonly reported musculoskeletal disorder in the workplace. Carpal Tunnel Syndrome (CTS) results from the compression and inflammation of the medial nerve as it passes through the carpal tunnel of the wrist. The carpal tunnel is an anatomical space formed by the eight wrist bones and the transverse carpal ligament. The nine finger flexion tendons, median artery and nerve all pass through the carpal tunnel. When the structures with in the carpal tunnel become compressed, they swell, become inflamed, causing pain and numbness and tingling in the ulnar nerve distribution of the hand.







Common Causes

Common causal or risk factors for the development of CTS include:

• Highly repetitive hand or wrist motions.

• Direct pressure on the wrist.

• Frequent or prolonged exposure to vibration.

• Frequent or prolonged exposure to cold temperatures.

• Prolonged, extreme or forced positions of the wrist.



2. Tendonitis

Mechanism of Injury

Tendonitis is defined as the inflammation of the tendon. Tendons attach muscles to bones to direct forces and allow voluntary movement. The tendon becomes irritated or inflamed when forces overstress the tendon.



Common Causes

Common causal or risk factors that can result in an overstressed tendon include:

• Overstressing tendons

• Friction forces that are developed as the tendons rub against bones or ligaments.

• Repetitive motions.

• Awkward positions.

• Forceful movements.



3. Tenosynovitis

Mechanism of Injury

Tenosynovitis is defined as the local inflammation of the tendon sheath. The synovial sheath covers the tendon. This sheath acts to protect and allow the tendon movement, and sliding, thus minimizing frictional forces. When excessive forces are placed on the tendon, the sheath becomes inflamed and swollen. DeQuervain's is an example of a common tenosynovitis that occurs at the thumb.



Common Causes

Common causal or risk factors that can result in an inflamed tendon sheath include:

• Overstressing tendons.

• Friction forces that are developed as the tendons rub against bones or ligaments.

• Repetitive motions.

• Awkward positions.

• Forceful movements.

• Direct pressure or contact stress.

• Contusions.



4. Epicondylitis

Mechanism of Injury

Lateral epicondylitis, also known as "tennis elbow" is the inflammation of the tendons of the forearm extensor group at the origin point on the elbow. Medial epicondylitis, also known as "golfer's elbow", is the inflammation of the tendons of the forearm flexor group at the origin point on the elbow.



Common Causes

Common causal or risk factors that can result in an inflamed tendon include:

• Overstressing tendons.

• Friction forces that are developed as the tendons rub against bones or ligaments.

• Repetitive motions.

• Awkward positions.

• Forceful movements.

• Direct pressure or contact stress.

• Caused by rotation against resistance of the forearm.

• Rapid extension of the wrist when the forearm is pronated (palm down.)





5. Bursitis

Mechanism of Injury

A bursa is a fluid filled sac between a tendon and a bone, it acts to reduce contact friction. Bursitis is the inflammation of a bursa sac.

Common Causes

Common causal or risk factors that can result in an inflamed bursa include:

• Friction forces that are developed as the tendons rub against bones or ligaments.

• Repetitive motions.

• Awkward positions.

• Forceful movements.



6. Muscle Strain

Mechanism of Injury

A muscular strain is an injury due to the overstretching of muscle fibers, beyond their limit, as a result of forceful tension, effort or overuse. Actual deformation or tearing of the fibers can result. There are three types of strains:

TYPES OF STRAINS

Degree:

Signs:

Mild (GRADE I) Slightly pulled muscle without tearing of muscle or tendon fibers. There is no loss of strength.

Moderate (GRADE II) Tearing of fibers in a muscle, tendon or at the attachment to bone. Strength is diminished.

Severe (GRADE III) Complete rupture of the muscle-tendon-bone attachment with separation of fibers.





























Common Causes

Common causal or risk factors that can result in a muscle strain include:

• Overstressing tendons and muscle fibers.

• Repetitive motions.

• Awkward positions.

• Forceful movements.

• Direct pressure or contact stress.

• Excessive muscular contractions.

• Twisting forces.

• Overuse.



7. Ligamentous Sprain

Mechanism of Injury

A ligamentous sprain is an injury due to the overstretching or tearing of ligaments, beyond their limit, as a result of forceful tension, effort or overuse. Actual deformation or tearing of the fibers can result. There are 3 types of sprains:



TYPES OF SPRAINS

Degree:

Signs:

Mild (GRADE I) Tearing of minimal ligament fiber, there is no loss of function.

Moderate (GRADE II) Tearing of a portion of the ligament. Strength and function is diminished.

Severe (GRADE III) Complete rupture of the ligament or complete separation of the ligament from the bone.







Common Causes

Common causal or risk factors that can result in a ligamentous sprain include:

• Overstressing ligamentous fibers.

• Repetitive motions.

• Awkward positions.

• Forceful movements.

• Direct pressure or contact stress.

• Twisting forces.

• Overuse.



Summary:

To keep you patients active and working, teach them ways to protect their joints, avoid ergonomic risk factors, and allow sufficient rest on off hours and take notice if they experience an increase in any of the CTD signs and symptoms!


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