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Abstract
Carpal tunnel syndrome (CTS), the most common peripheral entrapment neuropathy, is caused by compression of the median nerve at the wrist, and annual costs of CTS treatment in the United States total $2 billion. Although CTS often is attributed to repetitive motions at work, recent reports have questioned the relationship of CTS and occupational activities. This article reviews recent publications and provides insights into the causation of this common problem. Despite ergonomic workplace modifications aimed at reducing perceived risk factors, rates of imputedly work-related musculoskeletal disorders such as CTS have not decreased during the past ten years. One study found a prevalence of electrodiagnostically confirmed CTS of 3.5% in frequent computer users, but the authors also note that affected and unaffected employees had similar occupations, years using a computer, and usage rates. Another group concluded that computer use does not pose a severe occupational hazard for developing symptoms of CTS. Recent publications have suggested other risk factors such as age, obesity, hand dominance, reduced physical fitness, lifetime alcohol intake, and smoking; others have correlated weight and body mass index with prolonged median nerve latency. A relatively small number of jobs may be associated with CTS, primarily those that involve high force and repetition. The etiology of CTS usually is multifactorial, and risk factors include genetics, age, female sex, and obesity; its relationship with occupational injury is questioned.
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Falkiner S, Myers S. When exactly can carpal tunnel syndrome be considered work-related? ANZ J Surg. 2002; 204-209.
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Melhorn M. Understanding causation: an example using carpal tunnel syndrome. Guides Newsletter. Nov-Dec 2007, 5.
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Abba MA, et al.. Meta-analysis of published studies of work-related carpal tunnel syndrome. Int J Occup Environ Health. 1998; 4:160-67.
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Forst P, et al.. Occurrence of carpal tunnel syndrome in relation to sustained high velocity and high force manual work. Scan J Work Environ Health. 1998: 24;285-92.
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Mackinnon SE. Double and multiple ‘crush’ syndromes. Hand Clin. 1992; 8: 369-90.
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Stevens JC, Witt JC, Smith BE, Weaver AL. The frequency of carpal tunnel syndrome in computer users at a medical facility. Neurology. 56:1568-1570, June 2001.
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Anderson JH, et al., Computer use and carpal tunnel syndrome: a 1-year follow-up study. JAMA. 2003; 22:289.
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Thomsen JF, Hansson GA, Mikkelsen S, Lauritzen M. Carpal tunnel syndrome in repetitive work: a follow-up study. Am J Ind Med. 42:344-53, 2002.
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Atroshi I, Gummesson C, Ornstein E, et al.. Carpal tunnel syndrome and keyboard use at work: a population-based study. Arthritis Rheum. 56:3620-25, 2007.
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Nathan PA et al.. Occupation as a risk factor for impaired sensory conduction of the median nerve at the carpal tunnel. J Hand Surg (Br).1988; 13B; 167-70.
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Nathan PA et al.. Longitudinal study of median nerve sensory conduction in industry: relationship to age, gender, hand dominance, occupational hand use, clinical diagnosis. J Hand Surg (Am). 1992; 17A:850–57
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Nathan PA, Keniston RC. Carpal tunnel syndrome and its relation to general physical conditions. Hand Clin. 1993; 9: 253-61.
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Stallings SP et al.. A case-control study of obesity as a risk factor for carpal tunnel syndrome in a population of 600 patients presenting for independent medical examination.
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Becker J, et al.. An evaluation of gender, obesity, age and diabetes mellitus as risk factors for carpal tunnel syndrome. Clin Neurophys.113 (2002) 1429-34.
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Hakim AJ, et al.. The genetic contribution to carpal tunnel syndrome in women: a twin study. Arthr and Rheum. June 2002;15:47 (3) 275-79.
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Werner RA, et al.. The relationship between body mass index and the diagnosis of carpal tunnel syndrome. Muscle Nerve. 1994; 17:632-36.
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Jugnet PM, et al.. Carpal tunnel syndrome in patients on hemodialysis. Acta Orthop (Belg). 1995; 61:183-89.
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Wilson JR, Summer AJ. Immediate surgery is the treatment choice for carpal tunnel syndrome. Muscle Nerve. 1995;18:660-2.
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Wand JS. Carpal tunnel syndrome in pregnancy and lactation. J Hand Surg (Br).1996;15B: 93-95.
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Abbas MA, Afifi AA, Zhang ZW, Kraus JF. Meta-analysis of published studies of work-related carpal tunnel syndrome. Int J Occup Environ Health. 4:160-67, 1998.
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Frost P, Andersen JH, Nielsen VK. Occurrence of carpal tunnel syndrome in relation to sustained high velocity and high force manual work. Scan J Work Environ Health. 24:285-92, 1998.
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