Carpal tunnel syndrome: what is attributable to work? The Montreal study.

Abstract

Objective-To estimate the fraction of carpal tunnel syndrome (CTS) that is attributable to work in the total adult population of the island of Montreal. Methods-The population consisted of 1.1 million people 20 to 64 years of age, with 73.2% of men and 60.6% of women employed. The rates of first surgery for CTS were compared between occupational groups and the total adult population with the standardised incidence ratio (SIR) method. Rates of surgery for the island of Montreal were obtained from the provincial data base of payments. The occupational history was obtained from telephone interviews of a sample of surgical cases. The attributable fractions in exposed people were calculated with odds ratios (ORs) obtained from logistic regressions with non-manual workers as the control group. Results-The surgical incidence of CTS was 0.9/1000 adults. SIRs for all manual workers were 1.9 (95% confidence interval (95% CI) 1.4-2.5) in men and 1.8 (95% CI 1.4-2.2) in women, and the fractions attributable to work were 76% (95% CI 47-88) and 55% (95% CI 33-69), respectively. Seven occupational groups were identified as having excess risk of surgical CTS, with fractions attributable to occupation ranging from 75% to 99%. Conclusion ranging from 50% to 90% from data published in 13 epidemiological studies that reported an association between CTS and occupation. Those studies, however, were carried out in specific workplaces and were not representative of the total population of workers. We are not aware of any study that estimated the proportion of cases of CTS attributable to work in a general population.

Carpal tunnel syndrome and manual work: the OCTOPUS cohort, results of a ten-year longitudinal study

“…Past investigations on CTS suggested that more that 50% of the cases might be attributable to occupational factors (28). However, in this highly informative study conducted among industrial and service workers we found that no more than one third of the cases could be attributed to exposure levels above the ACGIH AL.…”

Attributable risk of carpal tunnel syndrome in the general population: implications for intervention programs in the workplace

“…The RR estimates for blue-collar workers were in the same order of magnitude as those calculated in the only Roquelaure et al comparable study (the Montreal study) comparing the incidence of surgical release of the median nerve between manual and non-manual workers in 1994-1995 (13).…”

“…Consequently, the age-adjusted RR and the PAF of CTS in specific industries and occupational categories were underestimated because the comparison group included a substantial proportion of industrial and occupational groups at high risk of CTS (13). Since only limited information on medical history was available, analyses were controlled for age and gender, but not for other potential confounding factors related to occupational and non-occupational risk factors of CTS (1).…”

Electroacupuncture and splinting versus splinting alone to treat carpal tunnel syndrome: a randomized controlled trial

“…2 It is a major cause of disability in the upper extremity, 3 incurring considerable limitation on daily activities among patients. 4 As a workrelated disorder, carpal tunnel syndrome carries significant economic impact and often leads to compensation claims. 5 For patients with mild to moderate carpal tunnel syndrome without evidence of median nerve denervation, nocturnal wrist splinting or local steroid injection are 2 conservative treatments commonly recommended in primary care practice.…”