Occupational musculoskeletal disorders: occurrence, prevention, and therapy. Fehr K, Krueger H, eds. Basel: EULAR Publishers, 1992 Jan; :83-89
Cumulative trauma disorders (CTDs) were reviewed, emphasizing repetitiveness of work as the major risk factor. In 1989, more than 53% of all occupational illnesses in the US were due to CTDs, an eight fold increase in 5 years. Based on their frequency, severity, and preventability, NIOSH included musculoskeletal disorders among its ten leading work related diseases and set a priority for surveillance and prevention. The current definition of CTD requires that symptoms of pain, aching, stiffness, burning, numbness, or tingling occurred in the past year, lasted more than 1 week, or more than once a month in the past year. Health Hazard Evaluations (HHE) were conducted for slaughterhouse workers, supermarket checkers, and video display terminal users at a large metropolitan newspaper in order to illustrate different facets of these disorders. At the slaughterhouse, 140 of 200 workers had CTDs, and job tasks were the strongest predictor. HHE recommendations included reduction of extreme postures, force, repetitive movements, and vibration; education of employees on early signs of CTD; early physical evaluation; appropriate time off work; medical reevaluation; reconditioning; and alternative work. Supermarket cashiers had higher CTDs than other supermarket workers, with repetitive hand motions the main factor. Reduction of movements thought to add to risk of CTD was recommended, including multiple scanning of items, over reaching, and excessive and improper lifting. For video display workers, psychosocial factors predicted CTD. Recommendations suggested included considering psychosocial and work organization factors to prevent CTDs rather than programs restricted to the physical environment. The Sentinel Events Notification for Occupational Risk Program at NIOSH was established for physicians to report and follow up newly diagnosed CTD. The author concludes that NIOSH continues to research the interactive nature of ergonomics of CTD and remains vigilant in prevention methods.