The incidence of cumulative trauma disorders of the hand and wrist among workers in automotive factories was studied. Data on the incidence of carpal tunnel syndrome, Dequervain's disease, Raynauds's phenomenon, ganglion of the wrist, and ulnar nerve entrapment were obtained. Sources included assembly, trim, foundry, axle, and stamping automotive factories from OSHA Form 200 injury and illness logs from 1984 to 1987 and from medical insurance claims filed over the same period. Cases of cumulative trauma disorders were identified in 59 workers using OSHA logs and in 150 workers using insurance data from all factories combined. The rates of hand and wrist disorders were higher in the assembly and foundry factories compared with the other factories using OSHA records, and highest in axle and foundry factories using insurance data. The largest number of cases were identified in the assembly factory, and within this factory, paint related and trim/chassis areas had the highest rate of cumulative trauma disorders. The authors conclude that medical insurance records identify more cases of cumulative trauma disorders than does the OSHA 200 log.