American Society for Surgery of the Hand
Position Statement on Cumulative Trauma Disorder and Repetitive Strain
Injury
The American Society for Surgery of the Hand is concerned that
patients with upper extremity pain are being assigned specific diagnoses
on the basis of subjective complaints without objective physical
findings. There is also a tendency to assign a causal relationship
to work for this pain when there is a lack of epidemiological
evidence. As part of our normal process of providing the best care
for our patients, it is important that the diagnosis be accurate and the
assignment of causation be correct.
The American Society for Surgery of the Hand feels that the diagnoses
of "cumulative trauma disorder" (CTD) and "repetitive strain injury"
(RSI) are not appropriate and may actually lead the patient to believe
that he or she has a condition that is something more than the ordinary
aches and pains of life.
Tendinitis is a term that clearly indicates inflammation of tendons
or tendon-muscle attachments, while tenosynovitis indicates inflammation
of a tendon sheath. These terms are examples of clearly definable
and diagnosable entities with a known histologic appearance. In
the absence of edema, erythema, or crepitation, it is inappropriate to
assign the provisional diagnosis of conditions such as tendinitis or
tenosynovitis to patients with upper extremity pain. If patients
are told they have one of these conditions, the oppressive power of
these words may lead them to believe they are severely injured. A
treating physician would do better to explain to their patients that
they have pain or fatigue that may or may not be related to their
occupation, but there is no definable diagnosis.
© 2005 American Society for Surgery of the Hand
Approved by ASSH Council January 1995
Reviewed and reaffirmed by ASSH Council May 2005
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