Chronic “work-related” hand and upper-extremity disorders have stimulated contentious medicolegal debate. The role of the hand surgeon in this debate is to ensure that every effort is made to institute appropriate evaluation, diagnosis, and treatment of the patient. In doing so, it is important to recognize factors both in the workplace and out of it that may con- tribute to patients’ upper-extremity complaints. Apportioning weight to the multiple factors that influence the development of repetitive strain injury (RSI) or cumulative trauma disorder (CTD) is difficult and further complicated by the complexity of healthcare insurance plans. RSI and CTD comprise a multifactorial problem that is resistant to treatment unless all of the individual, psychosocial, and physical factors are addressed.
A number of terms, including RSI, have been used to describe mechanisms for injuries and disorders and are not themselves diagnostic entities. In fact, condensing all of these disorders under the term RSI or CTD has contributed to the confusion rather than assisted in clarification of this problem. Upper-extremity disorders can be caused by repetitive movements, occupational or otherwise, and abnormal postures or static positions, occupational or otherwise.
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