Employees with Cumulative 

Trauma Disorders

Accommodation and Compliance Series
Practical Solutions • Workplace Success

2

Preface

The Job Accommodation Network (JAN) is a service of the Office of Disability 

Employment Policy of the U.S. Department of Labor. JAN makes documents available 

with the understanding that the information be used solely for educational purposes. 

The information is not intended to be legal or medical advice. If legal or medical advice 

is needed, appropriate legal or medical services should be contacted. 

JAN does not endorse or recommend any products or services mentioned in this 

publication. Although every effort is made to update resources, JAN encourages 

contacting product manufacturers/vendors and service providers directly to ensure that 

they meet the intended purposes. This guarantees that the most up-to-date information 

is obtained. 

The following document is not copyrighted and reproduction is encouraged. Section 

105 of the Copyright Law provides that no copyright protection is available for works 

created by the U.S. Government. Therefore, all works created by JAN fall under this 

provision. While individuals may use such work with impunity, individuals may not 

claim copyright in the original government work, only in the original material added. 

Individuals may access the full text of the law from the U.S. Copyright Office 

http://www.loc.gov/copyright. Please note that specific information cited by JAN may be 

copyrighted from other sources. Citing secondary sources from a JAN publication may 

violate another organization's or individual's copyright. Permission must be obtained 

from these sources on a case-by-case basis. When using JAN materials, JAN asks that 

the materials not be reproduced for profit, that the tone and substance of the information 

are not altered, and that proper credit is given to JAN as the source of the information. 

For further information regarding this or any other document provided by JAN, please 

contact JAN.

Authored by Beth Loy, Ph.D. Updated 03/22/10.
Practical Solutions • Workplace Success

3

JAN’S ACCOMMODATION AND COMPLIANCE SERIES

Introduction

JAN’s Accommodation and Compliance Series is designed to help employers determine 

effective accommodations and comply with Title I of the Americans with Disabilities Act 

(ADA). Each publication in the series addresses a specific medical condition and 

provides information about the condition, ADA information, accommodation ideas, and 

resources for additional information.

The Accommodation and Compliance Series is a starting point in the accommodation 

process and may not address every situation. Accommodations should be made on a 

case by case basis, considering each employee’s individual limitations and 

accommodation needs. Employers are encouraged to contact JAN to discuss specific 

situations in more detail. 

For information on assistive technology and other accommodation ideas, visit JAN's 

Searchable Online Accommodation Resource (SOAR) at http://askjan.org/soar.

Information about Cumulative Trauma Disorders (CTDs)

How prevalent are CTDs?

CTDs account for more than 50 percent of all occupational illnesses in the United States 

(Bureau of Labor Statistics, 2003). Among major disabling injuries and illnesses, carpal 

tunnel syndrome, a type of CTD, accounted for the greatest number of days away from 

work, surpassing fractures and amputations (Bureau of Labor Statistics, 2003). In 

addition, injuries caused by repetitive motion, such as grasping tools, scanning 

groceries, and typing, resulted in the longest absences from work (Bureau of Labor 

Statistics, 2004).

What are CTDs?

CTDs are disorders that are caused, precipitated, or aggravated by repeated exertions 

or movements of the body (National Institute for Occupational Safety and Health, 

1997b). Continuous use or pressure over an extended period of time results in wear and 

tear on tendons, muscles, and sensitive nerve tissue. The most common parts of the 

body affected are the wrists, hands, shoulders, knees, eyes, back, and neck. CTDs are 

groups of disorders with similar characteristics and may be referred to as: repetitive 

trauma disorders, repetitive strain injuries, overuse syndromes, regional 

musculoskeletal disorders, and work-related disorders (National Institute for 

Occupational Safety and Health, 1997b). Examples (from About.com, 2005) of CTDs 

include: 
Practical Solutions • Workplace Success

4

Bursitis: Bursitis is a condition where the bursal sac becomes irritated and painful.

Carpal Tunnel Syndrome (CTS): CTS is a condition that results from pinching of one of 

the nerves in the wrist and hand. This nerve, the median nerve, is compressed as it 

passes through the wrist, and because of this compression, the nerve does not function 

properly.

Cubital Tunnel Syndrome: Cubital tunnel syndrome occurs when the ulnar nerve, one of 

the primary nerves supplying movement directions to the forearm muscles and sensory 

information from the hand, becomes compressed near the elbow.

DeQuervain’s Disease: With DeQuervain’s Disease, pain comes from the tendons 

becoming inflamed on the side of the wrist and forearm just above the thumb.

Epicondylitis: Lateral epicondylitis, sometimes referred to as tennis elbow, can result 

from excessive activities such as painting with a brush or roller, running a chain saw, 

and using many types of hand tools continuously. Medial epicondylitis, sometimes 

referred to as golfer's elbow, can result from activities such as chopping wood with an 

ax, running a chain saw, and using many types of hand tools continuously. 

Guyon’s Canal Syndrome: Guyon's canal syndrome occurs when there is compression 

of the ulnar nerve as it passes across the palm of the hand. Also called handlebar palsy, 

Guyons canal syndrome is similar to carpal tunnel syndrome in that it is caused by a 

pinched nerve.

Impingement Syndrome: Also known as rotator cuff syndrome, impingement syndrome 

is a result of the lack of room between the acromion (upper part of shoulder blade bone) 

and the rotator cuff. Usually the tendons slide easily underneath the acromion as the 

arm is raised; however, each time the arm is raised, there is a bit of rubbing on the 

tendons and the bursa between the tendons and the acromion. This rubbing, or 

pinching action, is called impingement. Continuously working with the arms raised 

overhead, repeated throwing activities, or other repetitive actions of the arm can result 

in impingement syndrome.

Radial Tunnel Syndrome: Radial tunnel syndrome, also called resistant tennis elbow, is 

an entrapment or compression of a nerve within the forearm. The symptoms of radial 

tunnel syndrome closely resemble tennis elbow, although the cause is different. Radial 

tunnel syndrome is caused when the nerve that operates several muscles around the 

wrist and hand (the posterior interosseous nerve) is compressed or pinched, causing 

weakness of the muscles supplied by the nerve and pain over the elbow where the 

compression takes place. 

Tendonitis: Tendonitis is a common condition that can cause significant pain. Tendonitis 

occurs when there is inflammation of tendons at the point where a muscle attaches to 

the bone.
Practical Solutions • Workplace Success

5

Tenosynovitis: Inflammation of the tendon sheaths that may follow trauma, overuse, or 

inflammatory conditions.

Trigger Finger: Trigger finger is a common condition caused by inflammation of the 

flexor tendons in the hand.

Thoracic Outlet Syndrome: Thoracic outlet syndrome is a condition characterized by 

pain in the neck, shoulders, and fingers and weakening of the grip.

What are the symptoms of CTDs?

The symptoms of CTDs are aching, tenderness, swelling, pain, crackling, tingling, 

numbness, weakness, loss of joint movement, and decreased coordination in the 

affected area (National Institute for Occupational Safety and Health, 1997a). The most 

common body parts affected by CTDs are the fingers, hands, wrists, elbows, arms, 

shoulders, back, and neck; however, other areas can be affected. Symptoms may 

appear in any order and at any stage in the development of an injury. A serious injury 

can develop only weeks after symptoms appear or it may take years. 

What causes CTDs? 

There could be one or several causes of CTDs. The repetition of small, rapid 

movements; working in a static and/or awkward posture for long periods of time; 

insufficient recovery time (too few rest breaks); improper workstation setup; forceful 

movements; excessive grasping; and poor work techniques may contribute to injury. 

Some conditions associated with CTDs are: broken or dislocated bones, arthritis, 

thyroid gland imbalance, diabetes, hormonal changes from menopause, and pregnancy 

(National Institute for Occupational Safety and Health, 1997b). 

How are CTDs treated? 

Treatments for CTDs vary; exercising alleviates some individuals’ symptoms, while 

other individuals need surgery. The first recommendation is usually to rest the affected 

area. Vitamin B6 therapy, anti-inflammatory medication, ibuprofen, steroid injections, 

contrast baths (hot and cold), surgery, and work habit alteration are also treatment 

options (Carpal tunnel . . . , 1998). 
Practical Solutions • Workplace Success

6

CTDs and the Americans with Disabilities Act

Is a CTD a disability under the ADA?

The ADA does not contain a list of medical conditions that constitute disabilities. 

Instead, the ADA has a general definition of disability that each person must meet 

(EEOC, 1992). Therefore, some people with CTDs will have a disability under the ADA 

and some will not. 

A person has a disability if he/she has a physical or mental impairment that substantially 

limits one or more major life activities, a record of such an impairment, or is regarded as 

having such an impairment (EEOC, 1992). For more information about how to 

determine whether a person has a disability under the ADA, visit 

http://askjan.org/corner/vol02iss04.htm.

When requesting an accommodation, do employees with CTDs have to tell their 

employers that they have a CTD?

Under the ADA, when an employee requests an accommodation, an employer can 

require sufficient medical documentation to determine whether the employee has a 

disability and needs the requested accommodation. According to the Equal Employment 

Opportunity Commission (EEOC), sufficient medical documentation can include the 

name of the medical condition. The employee may want to begin by giving a more 

general description of the condition, such as saying “I have a cumulative trauma 

disorder,” and see if that suffices. However, such a limited description does not tell the 

employer that the individual has an impairment that substantially limits a major life 

activity because it is vague.

To increase the chance that the employer will settle for the use of a vague term, the 

employee may want to provide a letter from his/her doctor that confirms the existence of 

a "cumulative trauma disorder,” but then goes on to give concrete information about

how the condition substantially limits a major life activity. The inclusion of concrete 

information may satisfy the employer. However, if the employer insists on knowing the 

diagnosis and the individual refuses to divulge it, the employer probably has a valid

reason to refuse to provide the requested accommodation.
Practical Solutions • Workplace Success

7

Accommodating Employees with CTDs

(Note: People with CTDs may develop some of the limitations discussed below, but 

seldom develop all of them. Also, the degree of limitation will vary among individuals. Be 

aware that not all people with CTDs will need accommodations to perform their jobs and 

many others may only need a few accommodations. The following is only a sample of 

the possibilities available. Numerous other accommodation solutions may exist.)

Questions to Consider:

1. What limitations is the employee with the CTD experiencing?

2. How do these limitations affect the employee and the employee’s job performance?

3. What specific job tasks are problematic as a result of these limitations?

4. What accommodations are available to reduce or eliminate these problems? Are all 

possible resources being used to determine possible accommodations?

5. Has the employee with the CTD been consulted regarding possible 

accommodations?

6. Once accommodations are in place, would it be useful to meet with the employee 

with the CTD to evaluate the effectiveness of the accommodations and to determine 

whether additional accommodations are needed?

7. Do supervisory personnel and employees need training regarding CTDs?

Accommodation Ideas:

Fatigue/Weakness:

• Reduce or eliminate physical exertion and workplace stress

• Schedule periodic rest breaks away from the workstation

• Allow a flexible work schedule and flexible use of leave time

• Allow work from home

Fine Motor Impairment: 

• Implement ergonomic workstation design 

• Provide alternative computer and telephone access 

• Provide arm supports 

• Provide writing and grip aids 

• Provide a page turner and a book holder 

• Provide a note taker

• Provide ergonomic tools and other adaptations
Practical Solutions • Workplace Success

8

Gross Motor Impairment: 

• Modify the work-site to make it accessible 

• Provide parking close to the work-site 

• Provide an accessible entrance 

• Install automatic door openers 

• Modify the workstation to make it accessible 

• Make sure materials and equipment are within reach range 

• Move workstation close to other work areas, office equipment, and break rooms

• Provide carts and lifting devices

Temperature Sensitivity:

• Modify work-site temperature

• Modify dress code 

• Use fan/air-conditioner or heater at the workstation

• Allow flexible scheduling and flexible use of leave time

• Allow work from home during extremely hot or cold weather 

• Maintain the ventilation system 

• Redirect air conditioning and heating vents 

• Provide an office with separate temperature control

Administrative Considerations:

• Provide training on ergonomic principles, including proper lifting techniques, 

adequate maintenance, awkward postures, and correct use of equipment.

Situations and Solutions:

A journalist with bilateral carpal tunnel syndrome was limited to two hours of typing and 

writing per day. His employer purchased a digital tape recorder, writing aids, and an 

alternative keyboard; installed speech recognition software; allowed him to take breaks 

throughout the day; and provided him with office equipment to rearrange his 

workstation. 

An assembly line worker with bursitis in his knee was limited in his ability to stand. His 

employer gave him a stand/lean stool, provided him with anti-fatigue matting, and 

purchased vibration dampening shoe inserts.

A sales clerk with cubital tunnel syndrome lost the ability to move her right hand. The 

individual needed to use the computer to create reports. Her employer purchased a 

left-handed keyboard, foot mouse, forearm supports, an articulating keyboard and 

mouse tray, and an ergonomic chair. 
Practical Solutions • Workplace Success

9

A construction worker with DeQuervain’s disease had severe inflammation of the wrist 

and forearm after prolonged use of handtools. The employer provided him with 

lightweight and pneumatic tools; anti-vibration tool wraps and gloves; and tool 

balancers/positioners for stationary work. 

A switch board operator with myofacial pain syndrome (TMJ) was having difficulty using 

the phone and taking messages. The employer gave her a headset, speech recognition 

software, an adjustable telephone holder, writing aids, and an angled writing surface.

A truck driver with thoracic outlet syndrome was having difficulty driving for long periods 

of time and unloading bags at his delivery destination. The employer installed a small 

crane in the back of the trailer and provided him with a lightweight aluminum hand truck 

to help him unload materials. The employer also provided the employee a steering 

wheel spinner knob to eliminate prolonged grasping of the steering wheel and an antivibration seat to cut down on fatigue. 

A clerical worker who stamped paperwork for several hours a day was limited in 

pinching and gripping due to carpal tunnel syndrome. The individual was 

accommodated with adapted stamp handles. Anti-vibration wrap was placed around 

the stamp handles. In addition, tennis balls were cut and placed over the wrapped 

handles to eliminate fine motor pinching and gripping. 

A maintenance worker with rotator cuff syndrome was having difficulty reaching 

cleaning areas and moving cleaning supplies. The employer replaced his tools with 

long-handled, pneumatic, and lightweight tools. The employer also provided him an 

electric cart. 

Products:

There are numerous products that can be used to accommodate people with limitations. 

JAN's Searchable Online Accommodation Resource (SOAR) at http://askjan.org/soar is 

designed to let users explore various accommodation options. Many product vendor 

lists are accessible through this system; however, upon request JAN provides these 

lists and many more that are not available on the Web site. Contact JAN directly if you 

have specific accommodation situations, are looking for products, need vendor 

information, or are seeking a referral.
Practical Solutions • Workplace Success

10

Resources

Job Accommodation Network

West Virginia University

PO Box 6080 

Morgantown, WV 26506-6080

Toll Free: (800)526-7234

TTY: (877)781-9403

Fax: (304)293-5407

jan@askjan.org

http://askjan.org

The Job Accommodation Network (JAN) is a free consulting service that provides 

information about job accommodations, the Americans with Disabilities Act (ADA), and 

the employability of people with disabilities. 

Office of Disability Employment Policy

200 Constitution Avenue, NW, Room S-1303

Washington, DC 20210

Toll Free: (866)633-7365

TTY: (877)889-5627

Fax: (202)693-7888

http://www.dol.gov/odep/

The Office of Disability Employment Policy (ODEP) is an agency within the U.S. 

Department of Labor. ODEP provides national leadership to increase employment 

opportunities for adults and youth with disabilities while striving to eliminate barriers to 

employment. 

American Industrial Hygiene Association

2700 Prosperity Ave., Suite 250

Fairfax, VA 22031

Direct: (703)849-8888

Fax: (703)207-3561

infonet@aiha.org

http://www.aiha.org

AIHA promotes, protects, and enhances industrial hygienists and other occupational 

health, safety, and environmental professionals in their efforts to improve the health and 

well- being of workers, the community, and the environment. 
Practical Solutions • Workplace Success

11

American National Standards Institute 

1819 L Street, NW, 6th Fl.

Washington, DC 20036

Direct: (202)293-8020

Fax: (202)293-9287

info@ansi.org

http://web.ansi.org/

American National Standards Institute (ANSI) is a private, non-profit organization 

(501(c)3) that administers and coordinates the U.S. voluntary standardization and 

conformity assessment system.

American Society of Safety Engineers

1800 E Oakton St.

Des Plaines, IL 60018

Direct: (847)699-2929

Fax: (847)768-3434

customerservice@asse.org

http://www.asse.org

Founded in 1911, ASSE is the oldest and largest professional safety organization. Its 

more than 30,000 members manage, supervise, and consult on safety, health, and 

environmental issues in industry, insurance, government, and education. ASSE is 

guided by a 16-member Board of Directors, which consists of 8 regional vice presidents, 

three council vice presidents, Society president, president-elect, senior vice president, 

vice president of finance, and executive director. ASSE has 12 practice specialties, 150 

chapters, 56 sections, and 64 student sections. 

Association for Repetitive Motion Syndromes, The

P.O. Box 471973

Aurora, CO 80047-1973

Direct: (303)369-0803

http://www.certifiedpst.com/arms 

The Association for Repetitive Motion Syndromes (ARMS) is a nonprofit organization 

committed to assisting workers at-risk or injured by repetitive motion syndromes. ARMS 

also provides assistance to employers, workers compensation specialists, and health 

care professionals.

National Institute for Occupational Safety and Health

395 E Street SW

Suite 9200

Patriots Plaza

Washington, DC 20201

Toll Free: (800)CDC-INFO

Direct: (513)533-8328
Practical Solutions • Workplace Success

12

TTY: (888)232-6348

Fax: (513)533-8347

http://www.cdc.gov/niosh/

The National Institute for Occupational Safety and Health (NIOSH) is the Federal 

agency responsible for conducting research and making recommendations for the 

prevention of work-related disease and injury. The Institute is part of the Centers for 

Disease Control and Prevention (CDC). 

National Institute of Arthritis and Musculoskeletal and Skin Diseases

National Institutes of Health

1 AMS Circle

Bethesda, MD 20892-3675

Toll Free: (877)22N-IAMS

Direct: (301)495-4484

TTY: (301)565-2966

Fax: (301)718-6366

niamsinfo@mail.nih.gov 

http://www.niams.nih.gov

The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases 

is to support research into the causes, treatment, and prevention of arthritis and 

musculoskeletal and skin diseases, the training of basic and clinical scientists to carry 

out this research, and the dissemination of information on research progress in these 

diseases. 

Occupational Safety & Health Administration

200 Constitution Avenue, NW

Washington, DC 20210

Toll Free: (800)321-OSHA

TTY: (877)889-5627

http://www.osha.gov

The mission of the Occupational Safety and Health Administration (OSHA) is to save 

lives, prevent injuries, and protect the health of America's workers. To accomplish this, 

federal and state governments must work in partnership with the more than 100 million 

working men and women and their six and a half million employers who are covered by 

the Occupational Safety and Health Act of 1970.
Practical Solutions • Workplace Success

13

References

About.com. (2005). Dictionary for common terms [Electronic database]. Retrieved 

September 3, 2008, from http://about.com

Bureau of Labor Statistics. (2003). Lost-worktime injuries and illnesses: characteristics 

and resulting time away from work. Retrieved April 30, 2005, from 

http://www.bls.gov/news.release/osh2.nr0.htm

Bureau of Labor Statistics. (2004). Repetitive motion results in longest work absences. 

Retrieved April 30, 2005, from 

http://www.bls.gov/opub/ted/2004/mar/wk5/art02.htm

Carpal tunnel syndrome. (1998). Typing injury FAQ and the RSI network newsletter. 

Retrieved April 30, 2005, from http://www.tifaq.com/

Equal Employment Opportunity Commission. (1992). A technical assistance manual on 

the employment provisions (title I) of the Americans with Disabilities Act. 

Retrieved September 3, 2008, from http://askjan.org/links/ADAtam1.html 

National Institute for Occupational Safety and Health. (1997a). Musculoskeletal 

disorders (MSDs) and workplace factors. Retrieved September 3, 2008, from 

http://www.cdc.gov/niosh/docs/97-141/

National Institute for Occupational Safety and Health. (1997b). Work-related 

musculoskeletal disorders. Retrieved September 3, 2008, from 

http://www.cdc.gov/niosh/topics/ergonomics/
Practical Solutions • Workplace Success

14

This document was developed by the Job Accommodation Network, funded by a 

contract agreement from the U.S. Department of Labor, Office of Disability Employment

Policy (DOL079RP20426). The opinions expressed herein do not necessarily reflect the 

position or policy of the U.S. Department of Labor. Nor does mention of trade names, 

commercial products, or organizations imply endorsement by the U.S. Department of 

Labor.