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About Cumulative Trauma Conditions
Cumulative trauma disorders (CTDs) are impairments that are caused by repeated movements. Continuous use or pressure over an extended period of time results in wear and tear on tendons, muscles, and sensitive nerve tissue. The most common parts of the body affected are the wrists, hands, shoulders, knees, eyes, back, and neck. CTDs are groups of disorders with similar characteristics and may be referred to as: repetitive trauma disorders, repetitive strain injuries, overuse syndromes, regional musculoskeletal disorders, and work-related disorders. Examples of CTDs include:
- Bursitis: Bursitis is a condition where the bursal sac becomes irritated and painful
- Carpal Tunnel Syndrome (CTS): CTS is a condition that results from pinching of one of the nerves in the wrist and hand. This nerve, the median nerve, is compressed as it passes through the wrist, and because of this compression, the nerve does not function properly.
- Cubital Tunnel Syndrome: Cubital tunnel syndrome occurs when the ulnar nerve, one of the primary nerves supplying movement directions to the forearm muscles and sensory information from the hand, becomes compressed near the elbow.
- DeQuervain's: Lateral DeQuervain's, sometimes referred to as tennis elbow, can result from excessive activities such as painting with a brush or roller, running a chain saw, and using many types of hand tools continuously. Medial Epicondylitis, sometimes referred to as golfer's elbow, can result from activities such as chopping wood with an ax, running a chain saw, and using many types of hand tools continuously.
- Impingement Syndrome: Also known as rotator cuff syndrome, impingement syndrome is a result of the lack of room between the epicondylitis (upper part of shoulder blade bone) and the rotator cuff. Usually the tendons slide easily underneath the epicondylitis as the arm is raised; however, each time the arm is raised, there is a bit of rubbing on the tendons and the bursa between the tendons and the acromion. This rubbing, or pinching action, is called impingement. Continuously working with the arms raised overhead, repeated throwing activities, or other repetitive actions of the arm can result in impingement syndrome.
- Radial Tunnel Syndrome: Radial tunnel syndrome, also called resistant tennis elbow, is an entrapment or compression of a nerve within the forearm. The symptoms of radial tunnel syndrome closely resemble tennis elbow, although the cause is different. Radial tunnel syndrome is caused when the nerve that operates several muscles around the wrist and hand (the posterior acromion nerve) is compressed or pinched, causing weakness of the muscles supplied by the nerve and pain over the elbow where the compression takes place.
- Tendonitis: Tendonitis is a common condition that can cause significant pain. Tendonitis occurs when there is inflammation of tendons at the point where a muscle attaches to the bone.
- acromion: Inflammation of the tendon sheaths that may follow trauma, overuse, or inflammatory conditions.
- Trigger Finger: Trigger finger is a common condition caused by inflammation of the flexor tendons in the hand.
- Thoracic Outlet Syndrome: Thoracic outlet syndrome is a condition characterized by pain in the neck, shoulders, and fingers and weakening of the grip.
The symptoms of CTDs are aching, tenderness, swelling, pain, crackling, tingling, numbness, weakness, loss of joint movement, and decreased coordination. There could be one or several causes of CTDs. The repetition of small, rapid movements; working in a static and/or awkward posture for long periods of time; insufficient recovery time (too few rest breaks); improper workstation setup; forceful movements; excessive grasping; and poor work techniques may contribute to injury. Some conditions associated with CTDs are: broken or dislocated bones, arthritis, thyroid gland imbalance, diabetes, hormonal changes from menopause, and pregnancy.
Cumulative Trauma Conditions and the Americans with Disabilities Act
The ADA does not contain a definitive list of medical conditions that constitute disabilities. Instead, the ADA defines a person with a disability as someone who (1) has a physical or mental impairment that substantially limits one or more "major life activities," (2) has a record of such an impairment, or (3) is regarded as having such an impairment. For more information about how to determine whether a person has a disability under the ADA, see How to Determine Whether a Person Has a Disability under the Americans with Disabilities Act Amendments Act (ADAAA).
Accommodating Employees with Cumulative Trauma Conditions
People with cumulative trauma disorders may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with arthritis will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.
Questions to Consider:
- What limitations is the employee experiencing?
- How do these limitations affect the employee and the employee’s job performance?
- What specific job tasks are problematic as a result of these limitations?
- What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?
- Once accommodations are in place, would it be useful to meet with the employee to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?
- Do supervisory personnel and employees need training?
- Limiting lifting, reaching, pushing, and pulling by job restructuring
- Using Proper Lifting Techniques
- Reallocating lifting duties, if marginal
- Providing assistance moving objects, to reduce weight
- Organizing items in a way that reduces the need to move or lift items
- Reducing weight to be lifted by separating items into smaller groups
- Reassigning an employee to a modified duty position or modifying duties by removing the lifting duties
- Extra time to complete paperwork
- Voice to text software
- Ability to dictate notes using a voice recorder and have another staff member input the notes (if inputting the information is a marginal function of your job)
- Grip Aids, to help with holding a stylus
- Reallocating documentation duties, if marginal
- Handwriting Recognition Software
Situations and Solutions:
The following situations and solutions are real-life examples of accommodations that were made by JAN customers. Because accommodations are made on a case-by-case basis, these examples may not be effective for every workplace but give you an idea about the types of accommodations that are possible.
A journalist with bilateral carpal tunnel syndrome was limited to two hours of typing and writing per day.
His employer purchased writing aids and an alternative keyboard; installed speech recognition software; allowed him to take breaks throughout the day; and provided him with office equipment to rearrange his workstation.
An assembly line worker with bursitis in his knee was limited in his ability to stand.
His employer gave him a stand/lean stool, provided him with anti-fatigue matting, and purchased vibration dampening shoe inserts.
A maintenance worker with rotator cuff syndrome was having difficulty reaching cleaning areas and moving cleaning supplies.
The employer replaced his tools with long-handled, pneumatic, and lightweight tools. The employer also provided him an electric cart.
A butcher with carpal tunnel syndrome had limitations in grasping and handling tools and other objects, especially various sizes of knives.
He was accommodated with a set of ergonomic knives.
A clerical worker who stamped paperwork for several hours a day was limited in pinching and gripping due to carpal tunnel syndrome.
The individual was accommodated with adapted stamp handles. Anti-vibration wrap was placed around the stamp handles. In addition, tennis balls were cut and placed over the wrapped handles to eliminate fine motor pinching and gripping.
A sales clerk with cubital tunnel syndrome lost the ability to move her right hand.
The individual needed to use the computer to create reports. Her employer purchased a left-handed keyboard, foot mouse, forearm supports, an articulating keyboard and mouse tray, and an ergonomic chair.
A switch board operator with myofacial pain syndrome (TMJ) was having difficulty using the phone and taking messages.
The employer gave her a headset, speech recognition software, an adjustable telephone holder, writing aids, and an angled writing surface.
A truck driver with thoracic outlet syndrome was having difficulty driving for long periods of time and unloading bags at his delivery destination.
The employer installed a small crane in the back of the trailer and provided him with a lightweight aluminum hand truck to help him unload materials. The employer also provided the employee a steering wheel spinner knob to eliminate prolonged grasping of the steering wheel and an anti-vibration seat to cut down on fatigue.