Repetitive Strain vs. Cumulative Trauma and Carpal Tunnel Syndrome

I am often asked “What type of injury do I have? Is it Repetitive Stain or Cumulative Trauma?” “Both” is the closest I can come to an answer.

Repetitive Strain is just what is sounds like – strains that occur repeatedly, over and over again. Trauma means injury. Cumulative Trauma means trauma that accumulates over time. So, Repetitive Strain produces Cumulative Trauma. A repetitive strain injury is a Cumulative Trauma.

In common use, Repetitive Strain Injury refers specifically to Musculoskeletal Injuries – injuries to muscles, tendons, and bones, frequently from repetitious motion (thus Repetitive Motion Injury). Cumulative Trauma may refer to this but may also be used to describe any type of injury that occurs over time – such as multiple heart attacks or strokes: e.g. “The cumulative trauma from previous strokes has produced the current condition.”

How confusing! None of these three terms mean exactly the same thing, but they are frequently used to mean the same thing – and an injury can easily be all three. It’s best not to be too picky.

Carpal Tunnel Syndrome is considered to be a Repetitive Motion Injury (RMI) however, it can occur after only a few very stressful occurrences. Other times, it can take months or years to develop. No particular action or job will predictably cause Carpal Tunnel Syndrome. It seems to take a combination of factors to produce.

The use of the word ‘Syndrome’ is also interesting. A Syndrome is a collection of symptoms, not a particular physiological condition. If you have Carpal Tunnel Syndrome, there are specific things that you are experiencing –

• Tingling or itching numbness in the palm, especially the thumb, index and middle finger. This is usually variable through the day, sometimes better, sometimes worse.

• Fingers may feel swollen, although they don’t look swollen

• Decreased grip strength, sometimes to the point that forming a fist is difficult, as is handling small objects (I thought it was because my fingers were swollen).

• Thumb muscles may loose bulk.

• There may be a deadening of hot and cold sensations.

The problem is pressure on the median nerve that occurs within the carpal tunnel (a bony structure in the wrist that the nerve passes through on the way to the fingers).

The National Institute of Health (NIH) conjectures that some people have smaller carpal tunnels and that make them more likely to develop carpal tunnel syndrome. Other factors that might make you more likely to develop carpal tunnel include injury to the wrist (swelling that increases pressure on the nerve), glandular conditions that cause swelling, arthritis, and fluid retention related to pregnancy or menopause (we lucky women).

The good thing about having carpal tunnel syndrome that’s related to fluid retention is that when the fluid retention gets better, so does the carpal tunnel!

Other contributing factors include prolonged or frequent use of hand tools that vibrate, work stress, problems in the wrist itself, or something in the carpal tunnel that decreases its size, such as a tumor or cyst. In some cases no cause can be identified.

NIH has found “little clinical data to prove whether repetitive and forceful movements of the hand and wrist during work or leisure activities can cause carpal tunnel syndrome.”

Despite common opinion, carpal tunnel syndrome may not be a result of repetitive strain, may not be a repetitive motion injury, and may not be a cumulative trauma (but probably is). Each of these may vary depending on the particular case. Hmmmmmmmmmm.

Be aware that if your wrist, hand and fingers hurt, even if you don't have carpal tunnel syndrome, there are other conditions that you may have. It’s good to see a doctor who is familiar with all the possibilities. Healthy hands should not go numb, constantly hurt, or feel swollen.

Sending you good thoughts…