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An Approach to Work-Related Disorders of the Upper Extremity

Tufts University School of Medicine, Boston, and Chief of Occupational Medicine, New England Bone and Joint Institute, Boston.

Management of work-related musculoskeletal disorders has been frustrating for the orthopaedist. The so-called cumulative-trauma disorders have few objective findings, and patients often do not respond to well-established orthopaedic treatments, both nonsurgical and surgical. In some areas of the country the rate of reimbursement is low; that factor, combined with the excessive paperwork and the legal burden, discourages many orthopaedists from treating patients with these conditions. However, the incidence and cost of work-related disorders continue to increase, and the orthopaedic community is being called on to help understand their etiology and to attempt to control the "epidemic" that has significantly affected the survival of certain industries. The authors review the current orthopaedic and occupational medicine literature and suggest a management approach that has been found effective in reducing both costs and disability due to these disorders.