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Abstract
Objective. To analyze retrospectively a group of patients presenting to an outpatient hand rehabilitation
clinic with complaints related to repetitive tasks of the upper extremity.
Design. Retrospective case study reviewing 24 consecutive cases for presenting symptoms and
response of patients to a multidisciplinary rehabilitation approach.
Setting. An outpatient hand rehabilitation clinic in a tertiary referral center offering simultaneous
medical, psychological, and occupational evaluations.
Patients. Twenty-four patients with upper extremity symptoms related to repetitive use, who
had all failed various prior therapeutic interventions. Fifty percent of the patients
were receiving medical disability compensation because of their symptoms. Sixty-two
percent had filed a worker's compensation claim.
Interventions. Treatment consisted of medical management with pharmacologic interventions, occupational
therapy with workplace simulation and job-site evaluations, and psychological treatment
with pain management and biofeedback training. Treatments were individualized to meet
each patient's needs.
Outcome measures. Reduction in symptom intensity or frequency, increase in work and performance of
activities of daily living, and termination of medical disability with return to work.
Results. Most cases (83%) were found to be related to occupational computer keyboard use.
Bilateral hand and forearm pain were the major symptoms. A unique physical finding
was diffuse tendon tenderness and tightness of the long flexor and extensor muscles
of the forearm. Carpal tunnel syndrome was found in only one patient. Twenty-five
percent of patients achieved resolution of most symptoms, although on a modified and
often reduced activity level; 54% had moderate improvement; and 13% had only minimal
or no improvement. Of the patients receiving medical disability compensation, 58%
returned to their previous jobs.
Conclusions. Patients with upper extremity symptoms related to repetitive use often have unique
physical findings, distinct from those of carpal tunnel syndrome. Resulting work disability
is high. Patients who have not responded to conventional interventions within a reasonable
time may benefit from a multidisciplinary treatment approach. Most patients improve
with this treatment but do not fully recover.
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© 1998 Hanley & Belfus, Inc. Published by Elsevier Inc. All rights reserved.
