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Cumulative Trauma Disorders of the Upper Extremities FREE

Tom Bohr, MD
[+] Author Affiliations

Edited by Drummond Rennie, MD, Deputy Editor (West), and Bruce B. Dan, MD, Senior Editor.


JAMA. 1992;268(6):787-787. doi:10.1001/jama.1992.03490060123037
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To the Editor.  —The article by Rempel et al1 is a welcome addition to the growing literature on the subject of workrelated arm problems. However, there are some questionable neurological concepts that have recently come under more scrutiny by others.The authors equate the term "cubital tunnel syndrome" with the more common and accurate diagnosis of "ulnar neuropathy at the elbow." There is some evidence that only a minority of lesions actually occur within the cubital tunnel, and the conflation of these two terms adds to current confusion on the subject.2,3Earlier reports of the so-called pronator syndrome have been called into question recently, and the criteria for this syndrome are ill-defined and controversial. For many physicians, it seems to constitute a convenient "wastebasket" for lower arm pain, analogous to the way "thoracic outlet syndrome" has been used for other vague arm pains.3,4Some popular but questionable

REFERENCES

Rempel DM, Harrison RJ, Barnhart S.  Work-related cumulative trauma disorders of the upper extremity. JAMA . 1992;;267:838-842.
Wilbourn AJ.  Ulnar neuropathy at the elbow: electrodiagnostic approaches.  In: Focal Peripheral Neuropathies: Selected Topics, 14th Annual Continuing Education Course . Rochester, Minn: American Association of Electrodiagnostic Medicine; 1991;:13-17.
Stewart JD. Focal Peripheral Neuropathies . New York, NY: Elsevier Science Publishing Co Inc; 1987;.
Wilbourn AJ.  The pronator syndrome.  In: Focal Peripheral Neuropathies: Selected Topics, 14th Annual Continuing Education Course . Rochester, Minn: American Association of Electrodiagnostic Medicine; 1991;:29-32.
Seror P.  Phalen's test in the diagnosis of carpal tunnel syndrome. J Hand Surg . 1988;;13B:383-385.
Phalen GS.  Reflections on 21 years' experience with the carpal-tunnel syndrome. JAMA . 1970;;212:1365-1367.
Stewart JD, Eisen A.  Tinel's sign and the carpal tunnel syndrome. BMJ . 1978;;2: 1125-1126.
Katz JN, Larson MG, Sabra A, et al.  The carpal tunnel syndrome: diagnostic utility of the history and physical examination findings. Ann Intern Med . 1990;;112:321-327.
Viikari-Juntura E, Porras M, Laasonen EM.  Validity of clinical tests in the diagnosis of root compression in cervical disc disease. Spine . 1989;;14:253-257.
Kimura J.  The carpal tunnel syndrome: localization of conduction abnormalities within the distal segment of the median nerve. Brain . 1979;;102:619-635.
Stevens JS.  The electrodiagnosis of carpal tunnel syndrome. Muscle Nerve . 1987;;10:99-113.

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Rempel DM, Harrison RJ, Barnhart S.  Work-related cumulative trauma disorders of the upper extremity. JAMA . 1992;;267:838-842.
Wilbourn AJ.  Ulnar neuropathy at the elbow: electrodiagnostic approaches.  In: Focal Peripheral Neuropathies: Selected Topics, 14th Annual Continuing Education Course . Rochester, Minn: American Association of Electrodiagnostic Medicine; 1991;:13-17.
Stewart JD. Focal Peripheral Neuropathies . New York, NY: Elsevier Science Publishing Co Inc; 1987;.
Wilbourn AJ.  The pronator syndrome.  In: Focal Peripheral Neuropathies: Selected Topics, 14th Annual Continuing Education Course . Rochester, Minn: American Association of Electrodiagnostic Medicine; 1991;:29-32.
Seror P.  Phalen's test in the diagnosis of carpal tunnel syndrome. J Hand Surg . 1988;;13B:383-385.
Phalen GS.  Reflections on 21 years' experience with the carpal-tunnel syndrome. JAMA . 1970;;212:1365-1367.
Stewart JD, Eisen A.  Tinel's sign and the carpal tunnel syndrome. BMJ . 1978;;2: 1125-1126.
Katz JN, Larson MG, Sabra A, et al.  The carpal tunnel syndrome: diagnostic utility of the history and physical examination findings. Ann Intern Med . 1990;;112:321-327.
Viikari-Juntura E, Porras M, Laasonen EM.  Validity of clinical tests in the diagnosis of root compression in cervical disc disease. Spine . 1989;;14:253-257.
Kimura J.  The carpal tunnel syndrome: localization of conduction abnormalities within the distal segment of the median nerve. Brain . 1979;;102:619-635.
Stevens JS.  The electrodiagnosis of carpal tunnel syndrome. Muscle Nerve . 1987;;10:99-113.
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