To The Editor:
I am writing with regard to the Current Concepts Review entitled "Repetitive Stress Injury: Diagnosis or Self-Fulfilling Prophecy?" (82-A: 1314-1322, Sept. 2000), by Szabo and King. The authors of the article review a specific legal case of keyboard use as a cause of repetitive stress injury (RSI) and also discuss the topic of overuse injuries in the workplace in general. It is undoubtedly true that the evidence associating keyboard use with specific injuries is weak, that the benefit of ergonomically motivated changes in keyboard design is unknown, and that the use of the term RSI as a specific diagnosis is ill-advised. However, in generalizing from a specific case of keyboard use as a cause of a specific entity called RSI to the larger issues of repetitive activity as a cause of injury in the workplace and the role of ergonomics in understanding and reducing such injuries, Szabo and King move from firm to far shakier ground.
First, they greatly overstate the magnitude and locus of the problem, possibly because they use outdated data. The data that they cite are from 1992 and were obtained from Bureau of Labor Statistics (BLS) reports. These annual reports track all work-related musculoskeletal disorders (WRMSDs), from fractures and lacerations to the dreaded RSI. The most recent data are from 1998. According to these reports, both the rate and the absolute number of WRMSDs peaked in 1993 and have been diminishing, in all categories, ever since1. The number of cases of carpal tunnel syndrome (CTS) resulting in lost work days, for example, has dropped by more than 30%, to roughly 26,000 in 1998, for a rate of three per 10,000 workers1. The rate of such cases in which repetitive motion was implicated has likewise decreased, to 7.4 per 10,000 workers (less than 5% …
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