pathology: cumulative trauma disorder (CTD)

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Definition

Collective term for disorders caused by unusually frequent repeated stress. The German literature lacks a conceptual analogue, meaningful translations would be cumulative trauma disorder or cumulative traumatic disease. CTD has a large overlap with Repetitive Strain Injury Syndrome RSI. As early as 1813, Ramazzini pointed out that clerks and writers tend to suffer from hand disorders in particular. However, it was only after the middle of the last century that interest in this topic increased, as it had growing economic implications.
The disorders mostly relate to the upper extremity and there usually to the forearm-hand system, whereby they can be divided into mainly muscular and nervous disorders. Factors that often play a role in the development of the disorder include

  1. Workplace conditions/ergonomics
  2. higher and highly repetitive movements
  3. low variation range of physical movements/movement spectrum
  4. Lack of regeneration time/rest between workloads
  5. Endogenous and exogenous work expectations

The main causes of CTD are

  1. Frequently repeated movements
  2. Physical exertion that goes beyond the usual and appropriate level of training (especially pulling, pushing/pushing, lifting, gripping)
  3. Mechanical compression of tissues
  4. long paused postures
  5. postures that deviate strongly from the zero positions of the joints
  6. Very fast movements
  7. Exposure to vibrations, especially in cold environments

As a result, these disorders are often found in the following fields of activity:

  1. Office work
  2. Packaging activities
  3. Assembly work, especially on the assembly line
  4. sewing
  5. Polishing and grinding
  6. Walls
  7. Maintaining activities

The most common muscular CTDs that occur in practice are

The most common nerve disorders are

  1. Carpal tunnel syndrome
  2. Other nerve compression syndromes such as cubital tunnel syndrome, pronator teres syndrome, radial tunnel syndrome, supinator ligament syndrome
  3. Thoracic outlet syndrome
  4. Raynaud’s syndrome

Disorders of other soft tissues or joints also occur as a secondary problem. The disorders can be structurally demonstrable or functional, i.e. without a demonstrable anatomical correlate.

Silverstein defined repetitive movement patterns that last less than 30 seconds or in which an identical movement is performed half of the time as a criterion for dispositional triggering activities. According to Silverstein, cofactors are manually applied forces of 45 N or more, as it is known that the increased tissue pressure in muscles deteriorates the arterial supply during contractions from about 20% of their maximum force in terms of the 1RM. Sustained isometric contractions are also considered to be favourable for the same reason, just as unfavourable positions of the relevant joints, such as pronounced dorsiflexions of the wrist are considered to be predisposing. According to Chatterjee, the pincer grip, frequently repeated pronations and supinations of the forearm with continued flexion of the elbow joint as well as significant ulnar abductions or radial abductions of the wrist joint are also risk factors.

Prevention and recurrence prophylaxis play a major role in all of these disorders. If recognised and intervened in early, the severity and duration of the disorder can be limited.

Symptoms

The most common symptoms include

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