Cumulative Trauma Disorders

By Steve Burt
MSALC Director of Education

Cumulative Trauma Disorders Defined

Cumulative trauma disorders are a family of gradual onset injuries that are becoming increasingly common in the workplace. The two most frequently seen CTDs in letter carriers appear to be carpal tunnel syndrome and lateral epicondylitis, although there are a number of other injuries involving an accumulation of minor injuries and strains which gradually produce serious injury.

A sad fact about CTDs is that they very often effect the best and hardest workers, those who persist in continuing to try to work, even over pain, while their injuries become steadily worse.

Cumulative trauma disorders have become well known because they are established as important occupational illnesses afflicting computer users.(1) OSHA has even published instructions for the recording of CTDs under Standard Number 1904.(2)

Carpal Tunnel Syndrome

Carpal tunnel syndrome involves compression of the median nerve as it passes beneath the transverse carpal ligament, due to the swelling of the tendons which share this small passageway from the wrist to the hand. Symptoms include pain, weakness, and numbness of the thumb, index, middle, and inside half of the ring finger. A frequent symptom will be great pain and numbness in the hand and arm while sleeping.

Medical evidence for carpal tunnel syndrome involves submission of a narrative medical report including the findings of Phalen’s and Tinel’s Signs and results of nerve conduction studies and electromyographic testing. Requirements for evidence in carpal tunnel syndrome claims are summarized on Form CA-35H, which is found in Appendix C of Publication CA-810.(3) If you need a copy, you may request one from my work or E-Mail address. For an excellent, in-depth discussion on compensation claims for this condition, see Bert Doyle’s Postal Record column on carpal tunnel.(4)

Tennis Elbow

Lateral epicondylitis, or tennis elbow, is produced by small tearing injuries to the tendons in the outside bump (epicondyle) of the elbow. If tendon injuries in the elbow accumulate faster than they can heal, an abnormal, inflamed tissue may form along with possible spurring of the bone. Symptoms involve pain in the elbow which is worsened by reaching with the arm, flexing the wrist, or gripping. Activities resembling a backhand tennis stroke will likely be painful and aggravating to persons with tennis elbow.

Other Cumulative Trauma Disorders

Other CTDs that may occur in our work include, but are not limited to, trigger finger syndrome, a condition where tendon injuries to the index finger prevent straightening, and impingement syndrome of the shoulder, where accumulated strain binds (impinges) the motion of the rotator cuff in the shoulder. CTDs seen less frequently involve other nerves and tendons in the wrist (intersection syndrome, Guyon’s canal syndrome, and DeQuervain’s syndrome); elbow (medial epicondylitis, radial tunnel syndrome, and cubital tunnel syndrome); and the outlet from the neck to the chest (thoracic outlet syndrome).(5)

Claims for Cumulative Trauma Disorders with Form CA-2

Federal employees report cumulative trauma disorders as occupational illnesses under Form CA-2, due to the gradual development of these conditions over a period greater than one workday or shift.(6) To effectively complete Form CA-2 in such claims, an appreciation of how CTDs develop is vital in the development of a full and accurate employee’s statement (Instruction 1) and would be of critical value in the physician’s medical report (Instruction 2). A successful explanation of the accumulated trauma arising directly from work performance factors would furnish highly probative evidence of causal relationship. Strong, well-reasoned explanations of causal relationship are essential to winning claims of occupational illness.

Claims for cumulative trauma disorders can usually be successful, because our work is producing an appalling number of these injuries, the disability is obvious, and it is easy to furnish medical reasoning to explain how unique work features caused these uniquely specific disorders.

Although the classic CTDs are wrist, arm, shoulder, and neck conditions, the cumulative trauma process may well explain many of the bursitis and arthritis claims we see involving knees, some unrecovered sprained ankles, and calcareous spur conditions involving the heels. Where these explanations make sense, claimants and their physicians would improve upon the medical rationale presented in occupational illness narrative reports by making active reference to the cumulative trauma which gradually produced or continued to aggravate the claimed disabling conditions.

CTD Prevention and Management

Factors associated with the prevention of CTDs include: taking regular breaks, resting acutely tired muscles, maintaining good posture and a neutral spine position, avoiding caffeine and tobacco, and avoiding recreational activities that worsen work-related problems. Above all, do not continue doing something that is making you hurt, even a little!

Letter carrier office and street duties, with an ever-present emphasis on speed, hard physical work with weight bearing, and constant repetition, create ideal conditions for the development of cumulative trauma disorders. Worse, after an employee becomes injured and files Form CA-2, benefits will not be forthcoming until the claim is successful.

Our DPS automation changes will lessen mail actually cased, but will involve more mail delivered and will require more complex grasping while in the field for long durations. More stress and strain of the hands over even longer time periods is an open invitation to CTD type injuries. The last thing we need is more CTDs. On the subject of DPS and various safety issues, the jury is still out; but the evidence thus far is grounds for real concern.

There is lively debate on what is the optimum management philosophy toward injured workers in order to successfully effect their recovery and their prompt return to work. Much of the expert advice involves minimizing the stresses and maximizing initial rest to employees while they begin recovery. Emphasis is also placed on job redesign in ways that factor out the repetitive and physically stressful work processes that caused the cumulative trauma injury in the first place.

USPS management has a markedly unhealthy approach to the rehabilitation of injured workers. Employees delay in filing to avoid the hassles and due to the fact that their incomes will often be interrupted until the claim is approved. The USPS policy of offering light duty work emphasizing casing duties--without a guarantee of eight hours--is a completely harmful policy. This forces injured workers to delay filing claims and forces recovering workers to throw mail for long hours--the most repetitive part of our jobs--or go without wages.