Cumulative Trauma Injuries

Cumulative Trauma Injuries

A cumulative trauma injury essentially refers to injuries that affect the musculoskeletal system and occur due to repetitive minute injuries which develop due to the over use of a body part, or due to the wrong use of that particular body part. At times repeated minute injuries due to the application of an external force can also lead to cumulative trauma injuries. At times, a micro trauma may weaken that particular part of the body to the extent that a macro trauma experienced causes more damage than it would in a perfectly healthy body and vice versa. In most cases the trauma occurs due to repetitive stress on the particular body part, causing constant trauma and as a result the injury builds up. Examples of cumulative trauma injuries include carpal tunnel syndrome, epicondylitis, trigger finger, knee bursitis and hand-arm vibration syndrome among others.
Carpal Tunnel Syndrome
The Carpal Tunnel Syndrome is usually characterized by irritation and swelling of the tendons and nerves running into the wrist, due to the application of added pressure onto the nerve. The median nerve and tendons run through a tunnel (carpal tunnel) created by carpal ligaments at the top and the wrist bones at the bottom. Irritation and swelling of the tendons and the sheath compress the median nerve and lead to loss of feeling in the hand as well as in the fingers. This irritation or swelling is usually caused by overextension or overflexion of the hand, repetitive motions, trauma and injuries as well as genetic predisposition. Flexing a hand or a finger usually causes irritation which if allowed time, normally heals, repetitive motions do not allow such time and as such lead to cumulative trauma and as a result carpal tunnel syndrome.

Symptoms
CTS leads to loss of hand strength, reduced muscle development, difficulty in holding or pinching as well as weakness of the thumb. Sensory symptoms usually include stiffness, tingling, numbness as well as pain, more so at night.
Treatment/Management
a) Preventive measures usually include: Modifying workstations or adjusting the length of time one spends on activities that can aggravate the wrist.
b) A resting splint may be applied in order to relieve symptoms more so at night.
c) Physiotherapy can be utilized in the initial stages of carpal tunnel syndrome
d) Surgery may at times be required for the advanced stages of carpal tunnel syndrome.
It is well accepted that carpal tunnel syndrome is a work related disorder and currently insurers companies are catering for medical expenses of workers. It is therefore currently accepted as a compensable work related injury, with the average figure of compensation being about $33,000 per case. The syndrome contributed to 3.7% of compensable claims from the state fund.
Epicondylitis
Simply refers to elbow pain resulting from inflammation at the epicondyle, due what can be referred to as over use of the forearm or arm. There usually is injury to the attachment point of the muscles and tendons, and can occur laterally or medially, commonly called tennis and golfer’s elbows respectively. This condition is most commonly seen in manual laborers or sports participants, more so painters, carpenters, gardeners, plumbers, racquet game players, golfers and fencers, due to the repetitive use of the arms and forearms in these fields.
Symptoms
i) Pain radiating to the forearm
ii) Pain that worsens when lifting objects
iii) Pain worsens with wrist movement
iv) Pain on the outside of the elbow, in most cases affecting the dominant arm, or the one used the most.
v) Swelling around the elbow
Management
i) In order to avoid worsening the pain, counter force braces such as elastic bands may be wrapped around the forearm
ii) Avoiding overuse of the wrist through tight gripping or such activities.
Treatment
i) Resting of the affected arm
ii) Application of ice to the inflamed area
iii) Application of cortisone either topically or through injection directly to the site
iv) Use of non steroidal anti inflammatory drugs such as ibuprofen
v) In serious cases surgery may be used
Epicondylitis is accepted as an occupational health problem and is compensable, with total compensations for the disorder accounting for 0.4% of compensable claims due to work related musculoskeletal disorders in 2002.
Trigger Finger
This condition refers to the locking, catching or snapping of a finger tendon resulting in pain or dysfunction of the involved finger. This therefore results in difficulty extending or flexing the finger which is accompanied by a popping sound when the finger unlocks similar to the sound achieved when the trigger of a gun is released. The locking usually occurs due to the development of nodules and thickening of the flexor tendon, due to repeated irritation making it harder for the tendon to slide smoothly through its tunnel (the tendon sheath. The locking is therefore as a result of the tendon momentarily getting stuck at the mouth of its sheath, with passage and sudden straightening being accompanied by the customary pop. The condition commonly occurs due to activities that strain the hand and in individuals with conditions such as rheumatoid arthritis or diabetes, although its particular cause is still unknown.
Symptoms
The symptoms usually are of sudden onset and no accompanying injury, although a period of heavy hand use may precede the symptoms.
i) Swelling
ii) The appearance of a tender lump in the palm
iii) A Catching, locking or popping sensation in the thumb or finger joints
iv) Pain resulting from straightening or bending of the fingers.
v) The catching or locking worsens with inactivity
Treatment
i) Resting of the affected finger using splints
ii) Use of non steroidal anti-inflammatory drugs
iii) Use of injectable corticosteroids
iv) Surgery aimed at widening the tendon sheath.
Trigger finger is on the list of compensable work related injuries, with a solicitor in the United Kingdom setting the sum of compensation per case at about 1200 to 15000 pounds, depending on the severity of the condition and whether or not surgery is required.

Hand Arm Vibration Syndrome
HAV is a condition in which circulation and the motor and sensory nerves of the hand and fingers are affected and at times even damaged due to exposure to vibration. The condition is commonly caused by tools which produce high levels of vibration, ranging from chain saws, grinders, chipping hammers to road drills. This commonly leads to a vasospastic disorder with accompanying discoloration of the fingers and narrowing of blood vessels, usually referred to as secondary Raynaud’s phenomenon.
Symptoms
i) Whitening of the fingertips with accompanying numbness and prickly sensations due to spasms in the blood vessels during episodes.
ii) Pain and ulceration of the finger tips with gangrene in some severe cases.
iii) Reduced grip strength
Prevention
i) Use of impact absorbing and antivibration gloves
ii) Use of wrist supports
Treatment
i) Use of vasodilators such as calcium channel blockers
ii) Surgery to correct the narrowed blood vessels.
Compensation usually depends on the determination of whether the Raynaud’s is primary or secondary, with secondary Raynaud’s phenomenon usually a compensable work related disorder.

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