to Reduce Cumulative Trauma Disorders
Cumulative trauma disorders (CTD) account for nearly 60% of all recordable work related
illnesses, the costs are estimated at approximately $100 billion each year (Carson, 1994). Employers are
paying this price due to workers exposure to repetitive trauma and other ergonomic hazards, ranging from
Occupational Safety and Health Administration (OSHA) fines, higher workers compensation costs,
increased employee suffering, fatigue, and absenteeism (Randolph, 1992). Occupational health nurses are
in a key position to implement an effective ergonomic program in the workplace, which can significantly
reduce the incidence of CTD.Kemper Risk Management Services (1994) states CTD is a
medical condition of the musculoskeletal system that develops gradually due to repeated stress to the body.
Predisposing medical conditions such as arthritis, diabetes, old fractures, hypertension, thyroid disorders,
kidney disorders, gout, alcoholism, gynecological disorders, pregnancy, and other f!
emale hormonal changes can make a person more susceptible to CTD. Non-occupational related activities
such as racket sports, throwing motions, knitting, sewing, and playing musical instruments are additional
contributing factors to the development of CTD. The most common anatomical locations for CTD to
occur, are in the back, shoulder, elbow, forearm, wrist, and hand. The most common types of CTD, are
nerve disorders, such as carpal tunnel syndrome; tendinitis or tenosynovitis; muscle strains and sprains;
ganglionic cysts; and trigger finger. Signs and symptoms of a CTD include: pain or soreness, tenderness to
touch, stiffness, swelling, and unusual lumps or bumps which do not go away. Symptoms that resolve or
decrease over the weekend when the individual is off, then recur upon returning to work is also indicative
of a work related injury (Kemper, 1994).
Ergonomics is a science that involves fitting the surroundings of the environment, such as:
workstation, tools, and tasks or methods to the individual person. Factors such as the individuals size,
strength, and range of motion are all taken into consideration in order to make the appropriate
modifications (Sluchak, 1992). The goal of ergonomic improvements are to achieve maximum comfort of
the individual by reducing fatigue and stress of the musculoskeletal system. According to Kemper Risk
Management Services (1994), there are five basic ergonomic risk factors which need to be corrected:
1. Awkward position or postures from extreme range of motion; prolonged static positions; reaching above
shoulder height; elbows away from body; deviated wrist positions; and back and neck flexion or extension.
2. Repetitive motions from prolonged keying and assembly work.
3. Force from heaving lifting, pushing, pulling, gripping, and finger pinches.
4. Vibration from tools and equipment.
5. Environmental conditions such as extreme temperatures, high humidity, and poor air circulation.
Basic elements of an Ergonomic Program
OSHA has published, OSHA 3123, Ergonomics Program Management Guidelines for
Meatpacking Plants, (U.S. Department of Labor, 1990) which provides excellent information on steps any
employers can take. According to OSHA, the prerequisite to implementing an ergonomic program is to
obtain upper management support and employee involvement in the program. OSHA describes an effective
ergonomic program as stated in the following paragraphs.
A worksite analysis should be conducted, and initially performed by a qualified ergonomic expert.
This analysis should include medical and safety records review of all ergonomic related injuries; use of a
job specific ergonomic checklist and risk assessment; ergonomics task analysis to develop a plan for hazard
prevention and control (The Joyce Institute, 1990).
An ergonomic team should be assembled, preferably consisting of engineers and supervisors in
positions where ergonomic hazards are present. Ergonomic training of team members should consist of
identifying, analyzing, quantifying, and designing solutions to ergonomic problems in the workplace (The
Joyce Institute, 1990). There are many ergonomic short courses available in the United States.
All employee training should be conducted initially and on an annual basis. Training should
include how to identify the signs and symptoms of CTD and the importance of early reporting of symptoms
to medical personnel. Employees should also be counseled on the non-occupational activities which can
contribute to the development of CTDs. Carson (1994) states training should also include:
Changes to the work method such as proper tool use and breaks in repetition.
A different workstation set-up.
Modifications to existing equipment including proper adjustment of chair and height of work surface.
New or additional tools.
Exercises to affected areas of the body such as the hand or back.
A medical management program should be implemented. In an effort to reduce the occurrence and
severity of CTDs, training should include early identification, evaluation, and treatment of signs and
symptoms. This program as stated by OSHA, should be supervised by a physician or occupational health
nurse with training in the prevention and treatment of CTDs. Medical management of CTDs is a
developing field, and health care providers should continuously update themselves on the latest diagnostics
and treatments available.
According to The Joyce Institute (1990), leaders in ergonomic training, early and effective
ergonomic intervention have shown to decrease injuries by 20-30%; decrease errors in quality by 7-10%;
and increase productivity by 5-15%.
The occupational health nurse has day to day contact with the employees, is aware of the
occupational injury and illness trends, and is probably the only individual with any ergonomics awareness.
Therefore, the occupational health nurse is in the best position to develop and maintain an ergonomic
program in the workplace, thereby ultimately educing the number and severity of occupationally related
Carson, R. (1994). Reducing cumulative trauma disorders: Use of proper workplace design.
Journal of the American Association of Occupational Health Nurses, 42, 270-276.
The Joyce Institute. (1990). Principles and Applications of Ergonomics. Seattle, WA.
Kemper Risk Management Services/The NATLSCO Division. (1994). Five Minute Ergo Talks.
Long Grove, IL.
Randolph, S. (1992). Ergonomic strategies in the workplace. Journal of the American Association
of Occupational Health Nurses, 40, 103.
Sluchak, T. (1992). Ergonomics: Origin, focus, and implementation considerations. Journal of the
American Association of Occupational Health Nurses, 40, 105-111.
U.S. Department of Labor. (1990). Occupational Safety and Health Administration. Ergonomics
Program Management Guidelines for Meatpacking Plants. OSHA 3123. Washington, DC.