Barthel H R, Miller L S, Deardorff W W, Portenier R
Cedars-Sinai Medical Center, Los Angeles, California, USA.
J Hand Ther. 1998 Jul-Sep;11(3):191-9. doi: 10.1016/s0894-1130(98)80037-9.
To analyze retrospectively a group of patients presenting to an outpatient hand rehabilitation clinic with complaints related to repetitive tasks of the upper extremity.
Retrospective case study reviewing 24 consecutive cases for presenting symptoms and response of patients to a multidisciplinary rehabilitation approach.
An outpatient hand rehabilitation clinic in a tertiary referral center offering simultaneous medical, psychological, and occupational evaluations.
Twenty-four patients with upper extremity symptoms related to repetitive use, who had all failed various prior therapeutic interventions. Fifty percent of the patients were receiving medical disability compensation because of their symptoms. Sixty-two percent had filed a worker's compensation claim.
Treatment consisted of medical management with pharmacologic interventions, occupational therapy with workplace simulation and job-site evaluations, and psychological treatment with pain management and biofeedback training. Treatments were individualized to meet each patient's needs.
Reduction in symptom intensity or frequency, increase in work and performance of activities of daily living, and termination of medical disability with return to work.
Most cases (83%) were found to be related to occupational computer keyboard use. Bilateral hand and forearm pain were the major symptoms. A unique physical finding was diffuse tendon tenderness and tightness of the long flexor and extensor muscles of the forearm. Carpal tunnel syndrome was found in only one patient. Twenty-five percent of patients achieved resolution of most symptoms, although on a modified and often reduced activity level; 54% had moderate improvement; and 13% had only minimal or no improvement. Of the patients receiving medical disability compensation, 58% returned to their previous jobs.
Patients with upper extremity symptoms related to repetitive use often have unique physical findings, distinct from those of carpal tunnel syndrome. Resulting work disability is high. Patients who have not responded to conventional interventions within a reasonable time may benefit from a multidisciplinary treatment approach. Most patients improve with this treatment but do not fully recover.
回顾性分析一组因上肢重复性任务相关主诉前来门诊手部康复诊所就诊的患者。
回顾性病例研究，对连续24例患者的症状表现及患者对多学科康复方法的反应进行评估。
一家三级转诊中心的门诊手部康复诊所，提供同步的医学、心理和职业评估。
24例因重复性使用导致上肢症状的患者，此前所有的各种治疗干预均告失败。50%的患者因症状领取医疗残疾补偿。62%的患者已提出工伤赔偿申请。
治疗包括药物干预的医学管理、工作场所模拟和工作现场评估的职业治疗，以及疼痛管理和生物反馈训练的心理治疗。治疗方案根据每位患者的需求进行个性化定制。
症状强度或频率降低、日常生活工作及活动能力提高，以及停止医疗残疾并恢复工作。
多数病例（83%）被发现与职业性计算机键盘使用有关。双侧手部和前臂疼痛是主要症状。一个独特的体格检查发现是前臂长屈肌和伸肌弥漫性肌腱压痛和紧张。仅1例患者发现患有腕管综合征。25%的患者大部分症状得到缓解，尽管活动水平有所改变且往往降低；54%的患者有中度改善；13%的患者仅有轻微改善或无改善。在领取医疗残疾补偿的患者中，58%恢复了原工作。
因重复性使用导致上肢症状的患者常有独特的体格检查发现，与腕管综合征不同。由此导致的工作残疾率很高。在合理时间内对常规干预无反应的患者可能从多学科治疗方法中获益。多数患者经此治疗有所改善但未完全康复。
