Clinical evaluation and management of work-related carpal tunnel syndrome

Abstract

Carpal tunnel syndrome (CTS) is a clinical entity characterized by pain, paresthesias, and numbness in the distribution of the median nerve with weakness and atrophy of the thenar muscles in advanced cases. It is universally accepted that CTS is the clinical concomitant of compression of the median nerve as it passes through the carpal canal. It is reported to be the most common of the entrapment neuropathies. Increasing evidence suggests that occupational factors, including forceful use of the hands, repetitive use of the hands, and hand‐arm vibration, are etiologic for CTS. When occurring as a result of occupational exposures, the term “work‐related carpal tunnel syndrome” is applied. Clinical approaches to the diagnosis and treatment of work‐related CTS are described in this paper. Particular attention is paid to the clinical features and pathophysiology of CTS, the epidemiology of work‐related CTS, ascertainment of work‐relatedness in the clinical setting, treatment including both work and non‐work interventions, and control of occupational ergonomic risk factors that may contribute to the illness. Am. J. Ind. Med. 37:62–74, 2000. © 2000 Wiley‐Liss, Inc.

Changes in the Thickness of Median Nerves Due to Excessive Use of Smartphones

“…CTS is a disease that shows the highest frequency among accumulated injuries and representative neuropathy among musculoskeletal diseases in the wrist area 14) . Local causes include tendon sheath swelling, fractures in the distal part of the radius, rheumatic arthritis, lunate forward dislocation, and ganglions; systemic causes include diabetes mellitus, hypothyroidism, acromegaly, pregnancy, and amyloidosis [15][16][17] .…”

Analysis of reporting return to work in studies comparing open with endoscopic carpal tunnel release: A review of randomized controlled trials

“…In this way, the employer may incur lower compensation or sick benefit costs. The ergonomic characteristics of work -hand and wrist forces, paces, postures and durations -may have played a role in the causation of the patient's carpal tunnel syndrome and are likely to affect recovery (41,42). The nature of the workplace was unclear in nine of the studies that were reviewed (8,9,(15)(16)(17)(18)(19)(20)22), and it was unclear if the patient was returning to the same or different duties in all of the studies reviewed.…”

Epidemic occupational pseudo-illness: The plague of acronyms

“…Almost all refer to the amazing growth of work-caused repetitive trauma, not just in the number of cases, but their longer duration and greater cost [28][29][30][31][32][33]. In the United States, hand pain surpassed back pain toward the end of the 20th century [30] with the United Kingdom not far behind [32].…”

“…Years later h e c o n c e d e d t h a t " pr ol on g e d f or c e f ul g r a s p i n g movements" may be a cause, but "an exceedingly rare cause" [44]. A review among reviews at the end of the millennium admits obliquely in one sentence only that no sound evidence exists to relate the condition to employment, before taking the entirely opposite line to treat work as the undoubted cause [29]. In fact, the hypothesis has been tested systematically to produce the decisive invalidation; "the conclusion that carpal tunnel syndrome is not a work-related disorder is incontrovertible" [45].…”

“…The authors of an invited review did not have tongue in cheek when they cautioned that insistence on the gold standard "will result in detection of less than 10% of all cases of CTS" [29]. Neither did Melhorn [34] when he pointed out that the success of surgery depends on the relief of complaint and "does not depend on improvement in objective measurements or neurologic function, strength, or dexterity."…”