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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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- Occupational factors and carpal tunnel syndrome.Am J Ind Med. 1987; 11: 343-358
- Workplace ergonomic factors and the development of musculoskeletal disorders of the neck and upper limbs: a meta-analysis.Am J Ind Med. 1991; 19: 87-107
- Cumulative trauma disorders: an overview.AAOHN J. 1992; 40: 113-116
- Hand-wrist cumulative trauma disorders in industry.Br J Ind Med. 1986; 43: 779-784
- A conceptual model for work-related neck and upper limb musculoskeletal disorders.Scand J Work Environ Health. 1993; 19: 73-84
- Prevalence and work-relatedness of self-reported carpal tunnel syndrome among U.S: workers: analysis of the Occupational Health Supplement data of 1988 National Health Interview Survey.Am J Ind Med. 1995; 27: 451-470
- Repetitive strain injuries.Lancet. 1997; 349: 943-947
- Musculoskeletal problems of performing artists.Curr Opin Rheumatol. 1995; 7: 147-150
- Upper extremity disorders: a literature review to determine work-relatedness.J Hand Surg. 1995; 20A(4): 534-541
- Occupational injury: fact, fantasy, or fraud?.Neurol Clin. 1995; 13: 431-446
- What do doctors mean by tenosynovitis and repetitive strain injury?.Occup Med (Oxf). 1995; 45: 97-104
- Repetitive upper-extremity motions in the workplace are not hazardous.J Hand Surg. 1997; 22A(1): 19-29
- Repetitive strain injury (RSI) or cumulative trauma disorder (CTD) as legal and clinical entities: the need for a total reappraisal of this concept as being occupationally caused and therefore compensatable.Med Sci Law. 1995; 35: 279-286
- Medical screening of office workers for upper extremity cumulative trauma disorders.Arch Environ Health. 1993; 48: 164-170
- Soft-tissue injuries related to the use of the computer keyboard: a clinical study of 53 severely injured persons.J Occup Med. 1993; 35: 522-532
- University of Michigan School of Public Health, Ann Arbor, Mich.1984 Evaluation of Upper Extremity and Low Back Cumulative Trauma Disorders: A Screening Manual.
- Tendinitis, overuse syndromes, and tendon injuries.Hand Clin. 1990; 6: 467-476
- Evaluation and treatment of hand and wrist disorders in musicians.Hand Clin. 1990; 6: 405-416
- Writer's cramp, a focal dystonia: etiology, diagnosis and treatment.J Hand Surg. 1993; 18A: 542-544
- Isolated painless manual incoordination in 57 musicians.J Neurol Neurosurg Psychiatry. 1987; 50: 291-295
- Clinical diagnosis of peripheral nerve compression in the upper extremity.Orthop Clin North Am. 1996; 27: 227-236
- Myofascial pain.Baillieres Clin Rheumatol. 1994; 8: 857-880
- Myofascial pain syndrome and trigger-point management.Reg Anesth. 1997; 22: 89-101
- Ergonomic hazards in the workplace: assessment and prevention.AAOHN J. 1994; 42: 171-176
- University of Minnesota Press, Minneapolis, Minn.1960 A MMPI Handbook.
- Toward an empirically derived taxonomy of chronic pain patients: integration of psychological assessment.J Clin Consult Psychol. 1988; 56: 233-238
- Development of the multidimensional health locus of control (MHLC) scales.Health Educ Monog. 1978; 6: 160-170
- A self-rating depression scale.Arch Gen Psychiatry. 1965; 32: 63-70
- Effect of EMG biofeedback compared to applied relaxation training with chronic, upper extremity cumulative trauma disorders.Pain. 1995; 63: 199-206
- University of Pittsburgh, Pittsburgh, Pa.1989 Multiaxial Assessment of Pain: Multidimensional Pain Inventory [user's manual]. Version 2.
- Upper limb musculoskeletal disorders in highly repetitive industries: precise anatomical physical findings.Ergonomics. 1995; 38: 1408-1423
- Comprehensive multidisciplinary treatment of chronic pain: a follow-up study of treated and untreated groups.Pain. 1991; 45: 35-43
- Efficiency of multidisciplinary pain treatment centers: a meta-analysis review.Pain. 1992; 49: 221-230
- Randomized controlled trials in industrial low back pain, part 3: subacute/chronic pain interventions.Arch Phys Med Rehabil. 1997; 78: 414-423
- Repetitive strain injury: musicians helped by team approach [letter].BMJ. 1994; 308: 270
- Multidisciplinary rehabilitation of chronic work-related upper extremity disorders: long-term effects.J Occup Med. 1993; 35: 396-403
- Effects of active and completed litigation on treatment results: workers' compensation patients compared with other litigation patients.J Occup Med. 1989; 31: 265-269
- Work-related upper-extremity disorders and work disability: clinical and psychosocial presentation.J Occup Environ Med. 1995; 37: 1278-1286
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