title: Presentation and response of patients with upper extremity repetitive use syndrome to a multidisciplinary rehabilitation program: a retrospective review of 24 cases.
abstract: OBJECTIVE
  To analyze retrospectively a group of patients presenting to an outpatient hand rehabilitation clinic with complaints related to repetitive tasks of the upper extremity.
  
  
  METHODS
  Retrospective case study reviewing 24 consecutive cases for presenting symptoms and response of patients to a multidisciplinary rehabilitation approach.
  
  
  METHODS
  An outpatient hand rehabilitation clinic in a tertiary referral center offering simultaneous medical, psychological, and occupational evaluations.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, California, USA. hrbarthel@earthlink.net
authors.forename: H R
authors.initials: HR
authors.lastname: Barthel
authors.forename: L S
authors.initials: LS
authors.lastname: Miller
authors.forename: W W
authors.initials: WW
authors.lastname: Deardorff
authors.forename: R
authors.initials: R
authors.lastname: Portenier
mesh_terms: D000328:Adult; D001132:Arm; D001676:Biofeedback, Psychology; D003201:Computers; D012090:Cumulative Trauma Disorders / Q000534:rehabilitation*; D006804:Ergonomics; D005260:Female; D006801:Humans; D008297:Male; D009784:Occupational Diseases / Q000534:rehabilitation*; D009788:Occupational Therapy; D010348:Patient Care Team; D026741:Physical Therapy Modalities; D012189:Retrospective Studies; D014481:United States; D014942:Workers' Compensation