Cumulative trauma disorders (CTDs) are a broad diagnostic category characterized by musculoskeletal injuries that develop gradually due to microtraumas that cannot fully heal because of repeated stress, force, or awkward postures over time. Since many occupations and hobbies involve repetitive motions, CTDs commonly affect the arms and hands. Examples include:

• Carpal tunnel syndrome results from compression of the median nerve as it passes through the wrist, leading to symptoms in the thumb, index, middle finger, and thumb-side of the ring finger. When the median nerve is hindered higher up in the forearm near the pronator teres muscle, the condition is referred to as pronator teres syndrome.
• Cubital tunnel syndrome stems from compression of the ulnar nerve at the elbow and causes symptoms in the pinkie finger and pinkie-side of the ring finger, as well as along the inner forearm. The ulnar nerve can also be compressed at the wrist (this is called Guyon’s canal syndrome) and results in a similar pattern of symptoms in the hand.
• De Quervain’s tenosynovitis is the inflammation of the thumb tendons (abductor pollicis longus and extensor pollicis brevis), producing pain and tenderness on the thumb side of the wrist and thumb.
• Trigger finger (stenosing tenosynovitis) is the locking or catching of one or more fingers due to tendon sheath inflammation, with pain often located at the base of the affected finger or thumb.
• Lateral epicondylitis (tennis elbow) is caused by inflammation of the extensor tendons at the lateral elbow that causes pain with gripping and wrist extension in the outer elbow and top of the forearm.
• Medial epicondylitis (golfer’s elbow) is due to inflammation of the flexor tendons at the inner elbow leading to pain along the inner elbow and forearm during wrist flexion and gripping.
• Rotator cuff tendinopathy is associated with inflammation or degeneration of the shoulder tendons and is felt as aching in the shoulder and upper arm, particularly with overhead motions.
• Bicipital tendinopathy is inflammation of the biceps tendon at the shoulder that produces pain when lifting and reaching.
• Thoracic outlet syndrome describes compression of the brachial plexus and/or subclavian vessels at the thoracic outlet, leading to diffuse symptoms including pain, numbness, or tingling from the neck down into the hand.

When a patient presents with upper-extremity pain or dysfunction, it’s important to conduct a thorough examination from the neck to the hand to identify all potential contributors. Cumulative trauma disorders often overlap or co-occur, so a comprehensive evaluation is critical. Only then can a chiropractor tailor appropriate, conservative treatments to achieve the best possible outcome for the patient.