SEPTEMBER 1987 VOLUME 12A, NUMBER 5, PART 2 Official journal AMERICAN SOCIETY FOR SURGERY OF THE HAND THE JOURNAL OF HAND SURGERY AMERICAN VOLUME Editorial comment: Prevention of upper extremity occupational disorders Sidney J. Blair, M.D., F.A.C.S.*, and Jane Bear-Lehman, M.S., O.T.R., O.T.(C),** Maywood. Ill .• and Toronto . Ont .• Canada In the United States and in other parts of the world, particularly Australia and Sweden, there has been an increasing prevalence of upper extremity disorders in workers that have come to be known as cumulative trauma disorders or overuse syndromes. Many different health care disciplines have been working on the prob- lem, and it is the purpose of this supplement to bring their research and ideas to the surgeons and other health professionals who are treating patients with this dis- order. Cumulative trauma disorders may develop in the soft tissues, most frequently in the tendons, muscles, and nerves, or possibly the vascular system in response to repeated overexertions and excessive movements of the human body. Synonyms for these disorders include the following: (1) repetitive motion disease, (2) repetition strain injuries, (3) upper limb syndrome, (4) shoulder- arm syndrome, and (5) overuse syndrome. The various nerve compression syndromes, tenosynovitis, tendon- itis, and muscle strains may be considered in this clas- sification if their cause can be traced to a mechanical origin. The increase of these problems has been con- Reprint requests: Sidney J. Blair, M.D ., F.A.C.S., Department of Orthopaedics and Rehabilitation, Loyola University Medical Cen- ter, 2160 S. First Ave ., Maywood, IL 60153. *Chainnan, Department of Orthopaedics and Rehabilitation, Loyola University Medical Center; Chainnan. Industrial Injuries and Pre- vention Subcommittee. American Society for Surgery of the Hand. ** Assistant Professor, Division of Occupational Therapy. University of Toronto; Chainnan. Safety and Prevention Committee. Amer- ican Society of Hand Therapists. firmed by the United States Bureau of Labor Statistics. They listed new occupational illnesses associated with repeated trauma as follows: 1980, 23,300; 1983, 26,000; 1984, 34,700. Historically, these disorders have been described since the Middle Ages. Bernardino Ramazzini, the fa- ther of occupational medicine, was the first to identify these types of disorders as we know them today in his eighteenth century book entitled De Morbis Artificum Diatriba or the English translation, Diseases of Work- ers. In this work, he not only identified the disorders, but traced them to an occupational cause, as shown in such statements as: "Various and manifold is the harvest of diseases reaped by certain workers from the crafts and trades that they pursue; all the profit that they get is fatal injury to their health. That crop germinates mostly, I think. from two causes. The first and most potent is the harmful character of the materials that they handle, for these emit noxious vapors and very fine particles inimical to human beings and induce particular diseases; the second cause I ascribe to cer- tain violent and irregular motions and unnatural pos- tures of the body, by reason of which the natural struc- ture of the vital machine is so impaired that serious diseases gradually develop therefrom." (Ramazzinni, p. 15) With the advent of the Industrial Revolution. these disorders became more prevalent. In addition, the num- ber of acute industrial accidents also increased. For example, there was a 29% increase in the accident rate between 1961 and 1970. In response to this, in 1970 the U. S. Congress passed the Occupational Safety and THE JOURNAL OF HAND SURGERY 821 SEPTEMBER 1987 VOLUME 12A, NUMBER 5, PART 2 Official journal AMERICAN SOCIETY FOR SURGERY OF THE HAND THE JOURNAL OF HAND SURGERY AMERICAN VOLUME Editorial comment: Prevention of upper extremity occupational disorders Sidney J. Blair, M.D., F.A.C.S.*, and Jane Bear-Lehman, M.S., O.T.R., O.T.(C),** Maywood. Ill .• and Toronto . Ont .• Canada In the United States and in other parts of the world, particularly Australia and Sweden, there has been an increasing prevalence of upper extremity disorders in workers that have come to be known as cumulative trauma disorders or overuse syndromes. Many different health care disciplines have been working on the prob- lem, and it is the purpose of this supplement to bring their research and ideas to the surgeons and other health professionals who are treating patients with this dis- order. Cumulative trauma disorders may develop in the soft tissues, most frequently in the tendons, muscles, and nerves, or possibly the vascular system in response to repeated overexertions and excessive movements of the human body. Synonyms for these disorders include the following: (1) repetitive motion disease, (2) repetition strain injuries, (3) upper limb syndrome, (4) shoulder- arm syndrome, and (5) overuse syndrome. The various nerve compression syndromes, tenosynovitis, tendon- itis, and muscle strains may be considered in this clas- sification if their cause can be traced to a mechanical origin. The increase of these problems has been con- Reprint requests: Sidney J. Blair, M.D ., F.A.C.S., Department of Orthopaedics and Rehabilitation, Loyola University Medical Cen- ter, 2160 S. First Ave ., Maywood, IL 60153. *Chainnan, Department of Orthopaedics and Rehabilitation, Loyola University Medical Center; Chainnan. Industrial Injuries and Pre- vention Subcommittee. American Society for Surgery of the Hand. ** Assistant Professor, Division of Occupational Therapy. University of Toronto; Chainnan. Safety and Prevention Committee. Amer- ican Society of Hand Therapists. firmed by the United States Bureau of Labor Statistics. They listed new occupational illnesses associated with repeated trauma as follows: 1980, 23,300; 1983, 26,000; 1984, 34,700. Historically, these disorders have been described since the Middle Ages. Bernardino Ramazzini, the fa- ther of occupational medicine, was the first to identify these types of disorders as we know them today in his eighteenth century book entitled De Morbis Artificum Diatriba or the English translation, Diseases of Work- ers. In this work, he not only identified the disorders, but traced them to an occupational cause, as shown in such statements as: "Various and manifold is the harvest of diseases reaped by certain workers from the crafts and trades that they pursue; all the profit that they get is fatal injury to their health. That crop germinates mostly, I think. from two causes. The first and most potent is the harmful character of the materials that they handle, for these emit noxious vapors and very fine particles inimical to human beings and induce particular diseases; the second cause I ascribe to cer- tain violent and irregular motions and unnatural pos- tures of the body, by reason of which the natural struc- ture of the vital machine is so impaired that serious diseases gradually develop therefrom." (Ramazzinni, p. 15) With the advent of the Industrial Revolution. these disorders became more prevalent. In addition, the num- ber of acute industrial accidents also increased. For example, there was a 29% increase in the accident rate between 1961 and 1970. In response to this, in 1970 the U. S. Congress passed the Occupational Safety and THE JOURNAL OF HAND SURGERY 821