Evaluating Causation for the Opposite Upper Limb
J. Mark Melhorn
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James B. Talmage
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Charles N. Brooks
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Christopher R. Brigham
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Abstract

Workers’ compensation and personal injury claims often become embroiled in debates about the cause of the clinical presentation. When the primary claim involves an extremity, affected individuals sometimes report subsequent symptoms in the contralateral, previously “normal” limb and often attribute its onset to overuse while favoring the initially involved extremity; such an overuse hypothesis seems plausible, and perhaps intuitively obvious, to some. The concept that favoring one upper limb can result in injury to or illness in the other is not based on scientific evidence and instead is an unsupportable myth. Determining relationships between risk factors or exposures and medical conditions is a complex process that is outlined in the Guides to the Evaluation of Disease and Injury Causation (Causation). A search on PubMed and MEDLARS using the key phrases “opposite uninjured arm” and “uninjured arm” returned only six relevant articles, and the authors report that claims of serious or persisting painful syndromes in the arm or hand opposite the injured one are seldom adequately supported by clinical evidence. Similarly, the literature does not support “favoring” as a reasonable cause for development of symptoms in the contralateral shoulder or elbow. Epidemiological studies can provide general information regarding risk; this information must be filtered by specific steps to assess causal association for a disorder and determine if the injury is work related. Findings then can be applied to the specific individual.

  • 1.

    Melhorn JM, Martin D, Brooks CN, Seaman S. Upper limb. In: Melhorn JM, Ackerman WE, eds. Guides to the Evaluation of Disease and Injury Causation. Chicago, IL: AMA Press; 2008:141202.

    • Search Google Scholar
    • Export Citation
  • 2.

    Ring D. Carpal tunnel syndrome causation. In: 74th Annual Meeting of the American Academy of Orthopaedic Surgeons at San Diego, CA Feb. 16, 2007. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2007:12.

    • Search Google Scholar
    • Export Citation
  • 3.

    Fisher B, Gorsche R. Diagnosis, Causation and Treatment of Carpal Tunnel Syndrome: An Evidence-Based Assessment. Alberta, Canada: Workers' Compensation Board; 2004:1153.

    • Search Google Scholar
    • Export Citation
  • 4.

    Lo SL, Raskin K, Lester H, Lester B. Carpal tunnel syndrome: a historical perspective. Hand Clin. 2002;18:211217.

  • 5.

    Egilman D, Punnett L, Hjelm EW, Welch L. Evidence for work-related musculoskeletal disorders. J Occup Environ Med. 1996;38:10791080.

  • 6.

    Brenner LH, Bal BS, Brenner JA. Beyond medical negligence—judgement immunity. Ortho Med Leg Advisor. 2007;1:14.

  • 7.

    Nordstrom DL, Vierkant RA, DeStefano F, Layde PM. Risk factors for carpal tunnel syndrome in a general population. Occup Environ Med. 1997;54:734740.

    • Search Google Scholar
    • Export Citation
  • 8.

    Andersen JH, Thomsen JF, Overgaard E, et al. Computer use and carpal tunnel syndrome: A 1-year follow-up study. JAMA. 2003;289:29632969.

    • Search Google Scholar
    • Export Citation
  • 9.

    Nathan PA, Meadows KD, Istvan JA. Predictors of carpal tunnel syndrome: an 11-year study of industrial workers. J Hand Surg. 2002;27A:644651.

    • Search Google Scholar
    • Export Citation
  • 10.

    Clarke Stevens J, Witt JC, Smith BE, Weaver AL. The frequency of carpal tunnel syndrome in computer users at a medical facility. Neurology. 2001;56:15681570.

    • Search Google Scholar
    • Export Citation
  • 11.

    Hadler NM. Occupational Musculoskeletal Disorders. Philadelphia, PA: Lippincott Williams & Wilkins; 1999:1300.

  • 12.

    Garland FC, Garland CF, Doyle EJ, et al. Carpal tunnel syndrome and occupation in U.S. Navy enlisted personnel. Arch Environ Health. 1996;51:395407.

    • Search Google Scholar
    • Export Citation
  • 13.

    Garg A, Kapellusch J, Hegmann K, et al. The Strain Index (SI) and Threshold Limit Value (TLV) for Hand Activity Level (HAL): risk of carpal tunnel syndrome (CTS) in a prospective cohort. Ergonomics. 2012;55:396414.

    • Search Google Scholar
    • Export Citation
  • 14.

    Hegmann KT, Oostema SJ. Causal associations and determination of work-relatedness. In: Melhorn JM, Ackerman WE, eds. Guides to the Evaluation of Disease and Injury Causation. Chicago, IL, AMA Press; 2008:3346.

    • Search Google Scholar
    • Export Citation
  • 15.

    Melhorn JM, Hegmann KT. Methodology. In: Melhorn JM, Ackerman WE, eds. Guides to the Evaluation of Disease and Injury Causation. Chicago, IL, AMA Press; 2008:4760.

    • Search Google Scholar
    • Export Citation
  • 16.

    Barth RJ. Determining injury-relatedness, work-relatedness, and claim-relatedness. Guides Newsletter. May/June 2012;95:1.

  • 17.

    Barth RJ. Examinee-reported history is not a credible basis for clinical or administrative decision making. Guides Newsletter. September/October 2009;79:1.

    • Search Google Scholar
    • Export Citation
  • 18.

    Harris WR, Harrington IJ. Symptoms in the Opposite or Uninjured Arm. Ontario, Canada: The Workplace Safety and Insurance Appeals Tribunal; 1999:110. Copyright Queen's Printer for Ontario, 1999. Reproduced with Permission.

    • Search Google Scholar
    • Export Citation
  • 19.

    Padua L, Padua R, Nazzaro M, Tonali P. Incidence of Bilateral Symptoms in Carpal Tunnel Syndrome. J Hand Surgery Br. 1998;23b(5):603606.

    • Search Google Scholar
    • Export Citation
  • 20.

    Yamaguchi K, Tetro AM, Blam O, et al. Natural history of asymptomatic rotator cuff tears: a longitudinal analysis of asymptomatic tears detected sonographically. J Shoulder Elbow Surg. 2001;10:199203.

    • Search Google Scholar
    • Export Citation
  • 21.

    Siivola SM, Levoska S, Latvala K, et al. Predictive factors for neck and shoulder pain: a longitudinal study in young adults. Spine. (Phila Pa 1976) 2004;29:16621669.

    • Search Google Scholar
    • Export Citation
  • 22.

    Werner RA, Franzblau A, Gell N, Ulin SS, Armstrong TJ. A longitudinal study of industrial and clerical workers: predictors of upper extremity tendonitis. J Occup Rehabil. 2005;15:3746.

    • Search Google Scholar
    • Export Citation
  • 23.

    Mall NA, Kim HM, Keener JD, et al. Symptomatic progression of asymptomatic rotator cuff tears: a prospective study of clinical and sonographic variables. J Bone Joint Surg Am. 2010;92:26232633.

    • Search Google Scholar
    • Export Citation
  • 24.

    Carnide F, Veloso A, Gamboa H, Caldeira S, Fragoso I. Interaction of biomechanical and morphological factors on shoulder workload in industrial paint work. Clin Biomech 2006;21 Suppl 1:S33S38.

    • Search Google Scholar
    • Export Citation
  • 25.

    Escobedo EM, Hunter JC, Hollister MC, Patten RM, Goldstein B. MR imaging of rotator cuff tears in individuals with paraplegia. Am J Roentgenol. 1997;168:919923.

    • Search Google Scholar
    • Export Citation
  • 26.

    Ludewig PM, Borstad JD. Effects of a home exercise programme on shoulder pain and functional status in construction workers. Occup Environ Med. 2003;60:841849.

    • Search Google Scholar
    • Export Citation
  • 27.

    Worland RL, Lee D, Orozco CG, SozaRex F, Keenan J. Correlation of age, acromial morphology, and rotator cuff tear pathology diagnosed by ultrasound in asymptomatic patients. J South Orthop Assoc. 2003;12:2326.

    • Search Google Scholar
    • Export Citation
  • 28.

    Safran O, Schroeder J, Bloom R, Weil Y, Milgrom C. Natural history of nonoperatively treated symptomatic rotator cuff tears in patients 60 years old or younger. Am J Sports Med. 2011;39:710714.

    • Search Google Scholar
    • Export Citation
  • 29.

    Yamaguchi K, Ditsios K, Middleton WD, et al. The demographic and morphological features of rotator cuff disease. A comparison of asymptomatic and symptomatic shoulders. J Bone Joint Surg Am. 2006;88:16991704.

    • Search Google Scholar
    • Export Citation
  • 30.

    Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB. Abnormal findings on magnetic resonance images of asymptomic shoulders. J Bone Joint Surg Am 1995;77A:1015.

    • Search Google Scholar
    • Export Citation
  • 31.

    Milgrom C, Schaffler M, Gilbert S, van HM. Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender. J Bone Joint Surg Br. 1995;77:296298.

    • Search Google Scholar
    • Export Citation
  • 32.

    Palmer KT, Harris EC, Coggon D. Compensating occupationally related tenosynovitis and epicondylitis: a literature review. Occup Med. 2007;57:6774.

    • Search Google Scholar
    • Export Citation
  • 33.

    Padua L, Padua R, Nazarro M, Tonali P. Incidence of bilateral symptoms in carpal tunnel syndrome. J Hand Surg Br. 1998;23B:603606.

  • 34.

    Werner RA, Gell N, Franzblau A, Armstrong TJ. Prolonged median sensory latency as a predictor of future carpal tunnel syndrome. Muscle and Nerve. 2001;24:14621467.

    • Search Google Scholar
    • Export Citation
  • 35.

    Stetson DS, Silverstein BA, Keyserling WM, Wolfe RA, Albers JW. Median sensory distal amplitude and latency: comparisons between nonexposed managerial/professional employees and industrial workers. Am J Ind Med. 1993;24:175189.

    • Search Google Scholar
    • Export Citation
  • 36.

    Bagatur AE, Zorer G. The carpal tunnel syndrome is a bilateral disorder. J Bone Joint Surg Br. 2001;83B:655658.

  • 37.

    Melhorn JM, Wilkinson LK, O'Malley MD. Successful management of musculoskeletal disorders. J Hum Ecolog Risk Assess. 2001;7:18011810.

    • Search Google Scholar
    • Export Citation
  • 38.

    Melhorn JM, Wilkinson LK, Riggs JD. Management of musculoskeletal pain in the workplace. J Occup Environ Med. 2001;43:8393.

  • 39.

    Lozano Calderon SA, Anthony S, Ring D. The quality and strength of evidence for etiology: example of carpal tunnel syndrome. J Hand Surg Am. 2008;33:525538.

    • Search Google Scholar
    • Export Citation
  • 40.

    Uejo C. Carpal tunnel syndrome—occupationally related or not? Guides Newsletter, May/June 2009;77:1.

  • 41.

    Melhorn JM, Ackerman WE, Glass LS, Deitz DC. Understanding work-relatedness. In: Melhorn JM, Ackerman WE, eds. Guides to the Evaluation of Disease and Injury Causation. Chicago, IL, AMA Press; 2008:1332.

    • Search Google Scholar
    • Export Citation
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