cumulative trauma disorders ( ctds ) are defined as muscle , nerve , tendon , joint , cartilage , 
 and spinal disc damages or disorders due to exposure to risk factors in the work 
 environment1 . the common characteristics 
 of ctds are that they arise or increase due to working and that they may lead to limitations 
 on activities in the business environment or nonbusiness activities2 . these disorders , which do not include injuries due to 
 accidents , generally develop in the musculoskeletal system over a long term1 . ctds are basically classified into two 
 groups as upper extremity disorders ( ue - ctd ) and waist disorders . these disorders create 
 negative effects in business life on productivity , costs , and the quality of the lives of 
 employees . the frequency of ue - ctd is getting higher , and because the losses of labor it 
 causes , economic losses , and decreases in quality of life of employees , it has become a 
 serious public health problem3 . a doner kebab chef or doner chef is a person with the skills needed to marinate the meats 
 to be used in a doner kebab , place a doner in a cooker , cook it , cut it in leaf form , and 
 serve it in the desired portions . the job of doner chef is specific to turkey , and their 
 upper extremities are used in performance of this business . especially when cutting a doner , 
 they frequently repeatedly perform upper shoulder flexion and extension and wrist flexion 
 and extension movements . the doner knife , which is longer and heavier than a normal life , 
 makes this work harder , and this leads to problems in the elbows and wrists . in this study , 
 we examined the frequency of ue - ctd in doner chefs , and whether it increases in comparison 
 with individuals who do not need to perform repetitive , forceful upper extremity movements 
 in their jobs . volunteers who did not need to perform repetitive , forceful upper extremity movements in 
 their jobs and doner chefs were selected for this study . those having systemic diseases 
 ( diabetes , rheumatic diseases , muscle diseases , neuropathy , etc . ) leading to upper extremity 
 problem or congenital or acquired upper extremity damages ( deformity , torticollis , 
 scoliosis , loss of sense , nerve damage , etc . ) all of the 
 participants were informed about the study , and written consent was obtained from them . face - to - face interviews were performed by visiting the cases in their workplaces . a survey 
 form containing questions about demographic information , age , occupational experience 
 ( years ) , daily working duration , height , weight , any second job , and diseases was provided . all of the 
 participants were also asked about any musculoskeletal system complaints ( lasted for at 
 least 1 week ) in last 6 months , and both of their upper extremity musculoskeletal systems 
 were physically examined . in the physical examination , the subjects were examined for 
 deformity , color change , panicula , atrophy , and hypertrophy through inspection of the neck 
 and upper extremity . temperature increase and painful points were investigated through 
 palpation of bones , joints , and soft tissues . measuring the active - passive movement gap of 
 all of the joints , the subjects were examined for any limitation , crepitation , or 
 mobility - induced pain . the manual muscle test and a neurologic examination for the upper 
 extremity were carried out . then a definitive diagnosis was made via special tests specific 
 to upper extremity problems . the special tests performed were the spurling test , neer test 
 ( subacromial impingement test ) , speed test , cozen test ( tennis elbow test ) , golfer s elbow 
 test , finkelstein test , tinel test , and phalen test4,5,6,7,8 . statistical assessments were carried out by using the statistical package for social 
 sciences ( spss , inc . , chicago , il , usa ) 16.0 software . besides the definitive statistical 
 methods ( average , standard deviation ) during assessment , intergroup comparisons of age , 
 experience ( years ) , and daily work duration were carried out via the independent t test , 
 while comparisons of complaint and disorder rates were carried out via the  
 test . results were accepted as 
 statistically significant if the p value was lower than 0.05 . eighty - two individuals working as doner chefs and 82 individuals not working as doner chefs 
 participated into the study voluntarily . all of the participants were male , and there was no 
 difference among groups in terms of age , experience ( years ) , daily work hours , and body mass 
 index ( table 1table 1.comparison of age , bmi and duration of work between the two groupsstudy group(n=82)control group(n=82)age34.466.75328.86bmi26.052.9426.084.78work experience ( years)13.055.4610.408.71duration of work ( hours / day)9.891.7610.481.75 ) . upper extremity musculoskeletal system complaints were detected in 44.8% of the study group 
 and 34.7% of the control group , while upper extremity musculoskeletal system disorders have 
 been detected in 20.6% of the study group and 15.6% of the control group . there was no 
 statistical difference among the two groups in terms of rates of upper extremity 
 musculoskeletal system complaints and disorders ( p>0.05 ) . the doner chefs having lateral epicondylitis had 17.668.01  years of work experience , while 
 doner chefs not having lateral epicondylitis had 10.408.71  years of work experience 
 ( p=0.005 ) . comparisons of groups in terms of the upper extremity complaints and in terms of 
 the diagnosis of the upper limbs are presented in tables 2 and 3table 2.comparison of upper extremity complaints between groupsstudy group(n=82)control group(n=82)hand pain10 ( % 12)1 ( 1.2%)hand numbness1 ( % 1.2)1 ( 1.2%)elbow pain13 ( % 15.8)4 ( 4.8%)shoulder pain7 ( % 8.5)7 ( 8.5%)neck pain6 ( % 7.3)11 ( % 13)table 3.comparison of diagnosis of the upper limbs between groupsstudy group(n=82)control group(n=82)carpal tunnel syndrome1 ( 1.2%)1 ( 1.2%)de quervain s disease1 ( 1.2%)3 ( 3.6%)lateral epicondylitis12 ( 14.6%)2 ( 2.4%)medial epicondylitis1 ( 1.2%)2 ( 2.4%)biceps tendinitis1 ( 1.2%)0 ( 0%)rotator cuff tear1 ( 1.2%)0 ( 0% ) . one of the most important complaints of working people is work - related upper extremity 
 disorders ( ueds)9 . the main complaint in 
 ue - ctd is pain in the upper extremities , neck , shoulder , elbows , wrists , and waist . exclusive usage of extensor muscles leads to lateral epicondylitis , and two of its results 
 are inflammation and irritation of the tendon insertion10 . one of the most important results of our study is that lateral epicondylitis occurs less 
 frequently in doner chefs than in other members of society . also , the working durations of 
 doner chefs with lateral epicondylitis were longer than in those not having lateral 
 epicondylitis . lateral epicondylitis is seen frequently in people working in meat factories 
 ( 6.4% ) , sausage makers ( 11.3% ) , packers ( 7% ) , nursery school cooks ( 10.5% ) , and people 
 working in manufacturing ( 5.8% ) , fish processing ( 14.3% ) , and textile production . the 
 frequency of lateral epicondylitis increases as the exposure duration increases11,12,13,14 . the rate of lateral epicondylitis was 14.6% in doner chefs in our study , while the rate of 
 hand pain was 12% . the frequency of lateral epicondylitis or tennis elbow varies between 1% 
 and 3% among the general population15 , 
 while it varies between 2% and 23% among the working population16 . it has been revealed in earlier epidemiologic articles 
 that lateral epicondylitis occurs due to forceful movements of the elbow17,18,19 . on the other hand , the results reported 
 on the relationship between lateral epicondylitis and arm movement are inconsistent20 . epicondylitis risk was defined by job title in a review by palmer et al21 . on the other hand , in a more recent 
 article , the 
 studies that reported only results concerning epicondylitis were excluded from that article . palmer et al . found that the risk of epicondylitis significantly increases in working people 
 exposed to vibration , such as workers , foresters , pipe fitters and water / gas suppliers , meat 
 cutters , packers , and japanese nursery school cooks . in parallel with these findings , the 
 findings of the present study indicate an increased lateral epicondylitis risk in male meat 
 cutters . the present study improves the existing knowledge by providing quantitative 
 information for exposure - response relationships between work - related factors and the 
 occurrence of four specific elbow disorders . but many different exposure studies and 
 different diagnoses for specific elbow complaints have been reported , and so study pooling 
 is not suitable in this field . when the employees are exposed to combined risk factors , such as force and repetition , or 
 either force or repetition and extreme non - neutral arm postures , the relationship between 
 workload factors and epicondylitis reaches its maximum point11 , 22 . we have revealed that 
 lateral epicondylitis is significantly related to work tasks requiring a combination of 
 repetitive and forceful activities and also with a longer exposure durations . the exposure to physical loads during work is generally evaluated and investigated by 
 self - report in epidemiologic articles . this method has the advantage of affording the 
 possibility to study cumulative exposure over time , but its reliability or validity may be 
 questionable23 . the most difficult 
 parts are the assessments of the weights of handled loads and the exerted forces . the revealed relationships were found to be stronger among physical factors rather than 
 psychosocial ones . low social support , one of the psychosocial factors , remains significant 
 only for men , even after adjustment , and other factors became nonsignificant for both 
 genders , but some other authors have revealed significant associations between psychosocial 
 factors and elbow disorders24 , 25 . for assessing the links between psychosocial factors and 
 physical ones , further research is required26 , 27 . the monthly income level and their 
 educational statuses are low . the frequency of upper extremity tendinitis has been found to be higher in obese 
 subjects28 . in our study , the bmis of 
 doner chefs classified them as obese . it has been shown in a cross - sectional study that the effect of aging can not be 
 separated from the cumulative effect of current and earlier deleterious exposure . on the 
 other hand , in parallel with the theory about the aging affect associated with tissue 
 degeneration29 , in the present study , 
 the effect of age remained significant among employees working in the same job for more than 
 10  years . as stated in the previous articles about elbow disorder30 , 31 , elbow pain and 
 epicondylitis are associated with other musculoskeletal disorders . this reveals the 
 complexity of movements and consequently the pain in different body parts . because the mean 
 age of our study group was 34.466.75  years , our 12 subjects with lateral epicondylitis 
 cases were advanced - aged patients . in conclusion , our study shows that lateral epicondylitis in the elbow is a common 
 work - related upper limb disorders among doner chefs . low socioeconomic level , age , obesity , 
 and complex hand - wrist movements increase this risk . in occupational groups such as doner chefs , employees should not perform the same tasks 
 repetitively , the durations of breaks should be modified , and wearing splints should be 
 ensured if possible to decrease the risk of lateral epicondylitis .