Case Study: Occupational Overuse Syndrome

Patient profile

The subject of the case has skin in the game. His injuries sustained over years of ab(-use). These injuries have motivated a reassessment of his work practices.

The n=1 is question here is me!

The back story: excerpt of a letter to my GP

I have conservatively managed and rehabilitated all minor bingles as well as periodic occupational overuse syndrome (OOS) effecting the forearms and thumb tendons.In 2015 I injured my L wrist splitting wood.

Managed conservatively: stabilisation (wrist widget), mobilisation and strength. Established medical trail at Cobargo Doctors. Shortly after recommencing osteopathic practice in July 2016 I developed focal L common flexor tendon pain.

Naomi White (hand physiotherapist in Bega) concurred with my suspicions that wrist instability might be driving the issue. She detected instability in association with suspected TFC (triangular fibre cartilage) injury as well as ECU dislocation (mobile, popping).

She prescribed rotational and minimi-training (flexion, abduction). She fashioned a heat-form splint. With ‘work-hardening’ CFT issue resolved but wrist instability remains but is distinct from the more general OOS presentation described below.

Current symptoms picture has substantially worsened in July- August 2017.

– dysthesia and periodic twangs overlaying the CT
– twangs effecting thumb extensor/abductor
– overall sense of fullness, lymphatic congestion of both hands, tingling dysthesia
– some mild tendinopathy of both common extensor and flexor origins
– dull, tingly and burning mild joint pain PIP, DIP, MCP + MC-trapezium (pollicus)
– thickening of all flexor sheaths and some focal densification (pearl ganglion?) of R 2,3 MC flexors


2 months ago I invested in my capacity to continue working as an osteopath as well as offer a rigorously validated therapeutic modality alongside hands-on and movement therapies. I acquired an integrated Thor laser and LED system and immediately set to work treating my hands and forearms.


After 3 sessions I noted a significant change in oedema, sensation and tactile acuity of both hands. My rings fit! Inflammation, thickening and sensitivity of flexor tendons have largely resolved. Over the course of 10 treatment my hands returned to normal volume and have remained so with short weekly treatments that are adequate to counteract the effects of hand-on osteopathic treatment.

2/50 Princes Highway Cobargo NSW 2550