The cumulative trauma disorder clinical intervention trial is designed to prospectively compare two clinical regimens for the treatment of upper extremity problems associated with office work and keyboarding. The two regimens are 1) primary medical management and 2) physical medicine with secondary medical management. In addition, the effectiveness of keyboard technique retraining on longer term outcome will be assessed by sub-dividing each treatment arm into a retrained and non-retrained group, with intensive individual retraining following completion of the two therapeutic regimens. The long-term evaluation of technique retraining represents an assessment of the effectiveness of the """"""""intrinsic ergonomics"""""""" approach which emphasizes the contributory role of work patterns and styles to upper extremity injury. Worksite remediation will be conducted on all participants, consistent with current medical and ergonomic practice for this patient cohort. Efficacy of treatment will be assessed in two principal ways, by anamnestic assessment of symptoms and function and by clinical assessment, which will include evaluations of muscle strength, range of motion and flexibility, and provocation of pain. Efficacy of retraining will be assessed by direct clinical evaluation, subjective report of pain and function, and evidence of chronicity or recurrence. Efficacy of treatment will be evaluated at the conclusion of the principal therapeutic intervention (8-10 weeks) and at six months after the conclusion of treatment.
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