Cumulative Trauma Disorder

Cumulative Trauma Disorder (CTD) refers to any injury due to repetitive motion of an involved joint. Carpal Tunnel Syndrome (CTS) is the most prevalent injury of this category.

In 1988, based on NIOSH statistics, 2 million cases of Cumulative Trauma Disorder were reported. This number rose to 3.2 million in 1989 and up to 5 million in 1995, and continues to escalate. Recent literature from the Journal of Hand Therapy reports that CTS affects over 8 Million Americans as of 1997.

It is important to note that the Bureau of :Labor and Statistics’ definition of CTDs does not take into account back pain due to cumulative trauma disorders.
U.S. employers currently spend more than 7.4 billion in workers’ compensation costs. In addition, the American Academy of Orthopedic Surgeons estimated the cost of CTDs to be $27 billion dollars annually in medical treatment and lost income.

Occupational Safety and Health Administration (OSHA) estimates that by the year 2000 CTDs will account for 50 cents of each $1.00 spent on medical care of which CTS is #1.

The Labor Department found that 3.2 million cases of repetitive motion injuries in 1989 were serious enough to take time away from jobs, adding up to 57 million lost workdays.

CTD-related costs are the fourth highest concern among U.S. executives responsible for protecting corporate assets. The repetitive motion injury category jumped from 16th in 1994 to 4th last year. The jump says risk managers see CTDs as a very serious and real problem.

Breaking these numbers down to individual CTD case statistics, each worker compensation claim for repetitive stress injuries can cost $30,000 – $100,000.

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is the number one Occupational Illness, termed the “Technological Disease of the 90′s” as it has reached epidemic proportions. In 1995 over 5 million Americans suffered from CTS up from 1.89 million in 1993.

Carpal Tunnel Syndrome if the #1 reported medical problem accounting for about 50% of all work-related injuries.

As of 1997, 25% of all computer operators had CTS with estimates that by the year 2000, 50% of the entire workforce may be affected.

Only about 23% of CTS patients were able to return to their previous profession following surgery.

Up to 36% of all CTS patients require unlimited medical treatment.

Some form of repetitive stress disorder – mostly carpal tunnel syndrome – is now showing up in fully 15% of the U.S. workforce and that number is growing. Anyone who does work involving highly repetitive manual acts and stressful wrist postures, where frequent rest is not possible, is susceptible. Over the past ten years automation and job specialization have fragmented workers’ tasks so that few manipulations are performed thousands of times per workday Carpal Tunnel Syndrome has become one of the most serious threats to employee health.

The exponential rise of computer usage in offices, homes and schools has thrown a brighter light on a problem that has been with us since the first days of the assembly line.

Studies have found high rates of the disorder among factory workers, food service workers, carpenters and typists/data entry personnel.

As of 1994 there were 75,000,000 computer users in the U.S. workforce, 50,000,000 of which are women.

A report by NIOSH revealed that more than 50% of all food cashiers (jobs predominantly held by women), suffered to some degree from Carpal Tunnel Syndrome and other forms of Repetitive Stress injuries as a result of the physical demands of scanning products at high speed.

Nearly 25% of 355,000 members of the Union of Needle and Industrial Employees suffer from Carpal Tunnel Syndrome and other forms of Repetitive Stress injuries. Women make up 75% of their membership.

In 1992, the Bureau of Labor and Statistics found that while women accounted for about 45% of all workers, they experienced nearly two-thirds of all work-related Carpal Tunnel Syndrome and other forms of Repetitive Stress injuries.

Women are twice as likely to develop CTS a opposed to their male counterpart. While women account for about 45% of all workers they experience nearly two thirds of all work-related repetitive stress injuries.

Carpal Tunnel Syndrome results in the highest median number of days of work lost (30 days) among all major work-related injury or illness categories. Almost half of CTS cases (47.5 percent) result in 31 days or more of work loss.

Along with increasing numbers of CTS, costs are escalating too, quadrupling since 1987. The average cost of a single case of Carpal Tunnel Syndrome, for example, rose to $30,000 in 1988 per the Bureau of National Affairs

In the United States, employers spend more than 7.4 Billion in Workers Compensation costs, and untold billions on medical treatment, litigation costs, and lost productivity. (U.S. Bureau of Labor Statistics)

Musculoskeletal disorders are the country’s most costly category of workplace injuries and illnesses, In addition to spending $20 billion annually on Workers Compensation costs due to Repetitive Stress Injuries (RTS’s), the U.S. spends another $100 billion on lost productivity, employee turnover and other indirect expenses. ( Agency for Health Care Policy and Research)

Ergonomic disorders are the fastest growing category of work-related illness. According to the U.S. Bureau of Labor Statistics, they account for 56% of illnesses reported to the Occupational Safety and Health Administration (OSHA). Repetitive Strain Injury has become the number one work related health problem.

CTS results in the highest median number of days of work lost (30) DAYS among all major work related injuries or illness categories. Almost half of the CTS cases (47.5%) result in 31 days or more of work lost.

Carpal Tunnel Surgery

In 1992 Carpal Tunnel Surgery, surgical division of the flexor retinaculum for CTS, became the most frequent compensable surgical procedure in North America.

In 1988 250,000 procedures were performed. That number jumped to between 400,000 – 500,000 procedures performed in 1995.
CTS Surgery costs in the U.S. are greater than $2 billion a year.

The surgical success rate for CTS is only 54-56 percent, and additional surgeries are required in about 10 percent of the cases. And according to some reports, at best, the procedure results in a minimum of a two to six month loss of use of the hand(s) involved.

Surgery to correct CTS cost about $2,000 – $4,000 plus the costs for rehabilitation and for lost wages which total $30,000 – $40,000.


“…the ADA is a federal statute enacted by congress in 1990 providing civil rights protection to individuals with disabilities, similar to those afforded to individuals based on race, color, sex, national origin, age and religion.”

Workers who sustain serious and permanent on-the-job injuries or develop Carpal Tunnel Syndrome or other forms of Repetitive Stress injury, qualify as a “disabled individual” under the ADA which prohibits employers from discharging or in any manner, discriminating against the injured worker.


“…Any worker who develops Carpal Tunnel Syndrome or other Repetitive Stress injuries as a result of performing the requirements of their job, is legally entitled to receive the comprehensive medical and cash benefits provided by the Illinois Workers Compensation Act.”

1986 – NIOSH Rubric

When job demands…repeatedly exceed the biomechanical capacity of the worker, the activities become trauma-inducing. Hence, traumatogens are workplace sources of biomechanical strain that contribute to the onset of injuries affecting the musculoskeletal system.

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