An apparent "outbreak" of cumulative trauma disorders (CTDs) was noted in a subset of white-collar workers employed in medical illustration and medical graphic arts. Among graphic artists (n = 7), there were three cases of carpal tunnel syndrome (CTS), based on patient reports of personal physician diagnoses; no such reports occurred among other workers in the department (n = 39, p = .0023, Fisher's exact test). Jobs were studied to identify possible risk factors for CTDs, and workers underwent a standardized medical screening protocol. Specific work elements were found to be performed more frequently by graphic artists and appeared to be related to increased reporting of distal upper extremity symptoms and electrodiagnostic changes at the wrist. Nevertheless, using a strict case definition of CTS that required electrophysiologic evidence of median mononeuropathy at the wrist and appropriate symptoms or signs, only two persons--one graphic artist and one comparison subject--had evidence of mild CTS. The approach employed in this study of an outbreak of CTDs is an example of a multidisciplinary investigation of CTDs in an office setting.