Arm pain in the workplace. A small area analysis.

In the mid-1980s, use-related arm pain was recognized as a major issue for worker health and workplace safety. National policy targeted these "cumulative trauma disorders," "overuse syndromes," and "motion illnesses" for a "special emphasis program" by the Occupational Safety and Health Administration, a federal regulatory agency. The program begins with case recognition to identify the responsible ergonomic hazards with the goal of mandating ergonomic remedies. This report is a small area analysis of the impact of this process on the US West Communications, Inc work force. US West employs some 55,000 workers in 14 states. Commencing in the mid-1980s, workers in four of these states complained of upper extremity pain and were diagnosed as suffering from conditions encompassed by the "cumulative trauma disorders" rubric. The incidence was tenfold higher in one task category, directory assistance operators. No ergonomic descriptor can account for the four endemics of arm pain in directory assistance operators. The response of the medical communities to the plight of these injured claimants varied considerably from community to community. Denver represents one extreme where the clinical judgments led to multiple surgical interventions, generated a total direct cost of some $1.5 million, and left many permanently disabled workers in their wake. This analysis raises many reservations about the validity of the "cumulative trauma disorder" hypothesis and provides an object lesson in the potential for untoward outcomes from the premature introduction of clinical hypotheses into the arena of health policy.