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Guide to Cumulative Trauma Disorders (CTDs)

by Cindy Schmidler


Guide to Cumulative Trauma Disorders (CTDs)

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Cumulative trauma disorders (CTDs) are injuries of the musculoskeletal system—including the joints, muscles, tendons, ligaments, nerves, and blood vessels that are often grouped together as CTDs, Repetitive Stress Injury (RSI), overuse syndrome, and repetitive motion disorders. CTDs are the largest work-related health problem in the U.S. CTD symptoms develop from the accumulation of repeated small injuries or stresses to our musculoskeletal system. CTD is not disease but a response to excessive or repeated demands on our body without enough time to recover before adding more stress. This article explains some of the concepts of CTD, what can cause CTD and how CTD causes symptoms. There are links to articles on our site many common CTDs as well as links to anatomy and function articles for the subject injuries.

Causes of Cumulative Trauma Disorders

CTDs are usually caused by a combination of risk factors:


CTDs which usually affect the arm and hands:

Common symptoms of CTDs include pain and swelling of the affected body part. Although back injuries are not considered CTDs, they often result from similar risk factors as CTDs. Some work and play activities have more risk factors than others. However, it’s possible to reduce your risks and prevent CTDs. We’ve said overuse can cause problems, but what’s really happening? Muscle Tension + Repetitive Motion + Over Use + Incorrect or Static Posture = CTD

Muscle Tension

To work properly, the body and its parts need a steady blood supply, rich in oxygen and nutrients. Cutting off or reducing the blood supply injures body tissues. When muscles are tense, they squeeze off the blood supply which is their source of energy and fuel. Muscles can get energy without oxygen however, the process produces lactic acid, a potent pain causing chemical. As the pain gets worse, the muscles keep tightening to protect the injured area—slowing down the blood supply even further. When nerves don’t have enough blood plus the area is being squeezed by tense muscles, the nerves begin to tingle (that pins and needles feeling) or even go numb.

Repetitive Motion

Repetitive motion injuries cause tissue damage from repeated trauma—like writing, painting or typing. Almost any activity that produces repeated small trauma to an area of soft tissue—tendons, nerves, muscles—can lead to CTD. Trauma happens when muscles and joints perform the same movement over-and-over.

Over Use

Using muscles and joints after they’re tired increases the chances of injury. When muscles or tendons are overloaded or overworked they don’t get enough rest  and don’t have a chance to fully recover.


Incorrect or Static Posture

Incorrect standing and sitting postures put abnormal stress on the body causing pain and stiffness. Our joints are made to move—even correct posture held for too long is considered overuse.

Types of Cumulative Trauma Disorders

CTDs are basically disorders of tendons—which are part of the muscles—or nerves.

Tendon Disorders

Tendons are fibrous tissue that connect muscles to bones. Tendon disorders and their protective coverings, called synovial sheaths, are the most common CTDs. CTD symptoms include:

Common tendon CTDs:


Nerve Disorders

Pressure on the nerves pressing against hard edges or of work surfaces, tools, or nearby bones during repeated activities can result in cumulative trauma disorders of the nerve. The most common type of nerve CTDs:


Treatment of Cumulative Trauma Disorders

If you’re diagnosed with a CTD, there are many conservative, non-surgical treatments to relieve discomfort from overuse. Splints may be recommended as an early treatment to protect and rest sore areas. Anti-inflammatory medicines are often used along with physical therapy like ice packs, ultrasound, or electrical stimulation. Special exercises help tissues move safely while they heal. Assess both your work and recreational activities to figure out if they are adding to your problem. Keep in mind that tension restricts the flow of blood causing muscles and nerves not to get enough oxygen and nutrients, aggravating the symptoms of CTD. Resting the injured area during work and play can relieve tension and allow recovery.

Hand being fitted for carpal tunnel syndrome splint

Correct Posture and the Neutral Spine Position

Posture has a big role in CTDs. Slouching the spine or leading with your head puts your body off balance causing your arms and legs to be stretched or bent in awkward positions. The neutral spine position maintains the three natural curves of the spine:

Too much curvature or straightening in either the neck or lower back takes the spine out of its neutral position and increases the risk of injury. To prevent injury:

Basic Guide for Sitting Posture

Sitting with a neutral alignment of the spine is also important. Sit in a comfortable chair designed to encourage correct sitting posture. Don’t slouch; sit back in your seat against the back of the chair. Bending your head down strains your neck and affects nerves and arteries that go down into your arms. Relax your shoulders with your elbows, hips and knees bent at a right angle. Avoid pressure to the back of your knees. Keep your feet flat on the floor or support them on a foot rest. Don’t sit still for long periods. Staying in one position causes muscle fatigue and tension. Take breaks often; get up and stretch.

Cumulative Trauma Disorders by Body Area

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