Hand–arm vibration syndrome

Personal risk factors for carpal tunnel syndrome in female visual display unit workers

“…Carpal tunnel syndrome (CTS) is a symptomatic compression neuropathy of the median nerve at the level of the wrist, physiologically characterized by increased pressure within the carpal tunnel and a decreased function of the nerve at that level [1,2]. With the prevalence estimated between 7% and 18% of the adult population [3], CTS is the most common entrapment neuropathy of the cases is over-reported.…”

“…As CTS is a very frequent condition in adult females [3][4][5], for both anatomical and physiological reasons [1][2][3][4][5], with a very large array of well-established occupational and non-occupational risk factors [6][7][8][9][10][11][12][13][14][15], it should be interpreted as a "work related musculoskeletal disorder," i.e., an impairment of body structures associated with, rather than simply caused by, cumulative exposure to work and working environment over a long period of time [25]. In other words, not only occupational but also personal history influence in probabilistic terms natural history of CTS, both inducing and anticipating its clinical presentation [1,2,16]. As CTS has become one of the most frequent causes of work compensation, both in Europe and in the United States, and due to the large and still increasing number of people working with computers, also a feeble excess of risk means that a high number of workers may then experience upper extremities [4,5].…”

“…Third, symptoms that are usually associated with CTS, such as numbness, tingling, burning or pain at the first digit and at wrist, are very common in the general population [1][2][3][4][5]. Also physical tests (such as Phalen's, reverse Phalen's, Tinel's and carpal compression test), even when combined, do not guarantee a reliable diagnosis without ultrasound and/or nervous conduction studies [1][2][3]21]: a large number of epidemiological studies on CTS in VDU workers are based on self-referred symptoms and the risk of CTS cumulative use) and hormone replacement therapy (HRT); the latter variables were considered together for the purposes of the present analysis. Regular physical activity was defined following the World Health Organization (WHO) recommendation for 18-64 year-olds [28].…”

“…Second, until recently the definition of the exposure to VDU was difficult and erratic, as the use of computers and computer devices (i.e., mouse and keyboard) may be very heterogeneous and even a cut-off, based on the time spent at the VDU, has been irregularly applied [16][17][18][19][20]. Third, symptoms that are usually associated with CTS, such as numbness, tingling, burning or pain at the first digit and at wrist, are very common in the general population [1][2][3][4][5]. Also physical tests (such as Phalen's, reverse Phalen's, Tinel's and carpal compression test), even when combined, do not guarantee a reliable diagnosis without ultrasound and/or nervous conduction studies [1][2][3]21]: a large number of epidemiological studies on CTS in VDU workers are based on self-referred symptoms and the risk of CTS cumulative use) and hormone replacement therapy (HRT); the latter variables were considered together for the purposes of the present analysis.…”

“…Discomfort in the neck with or without radiation into the upper limb for at least 1 day during the preceding 12 months and/ or the presence of pain elicited by palpation of paravertebral muscles/spinal apophyses, and/or pain at active/passive mobilization of the neck identified the patients as positive at cervical spine clinical evaluation [29,30]. The patients reporting symptoms such as numbness, tingling, burning or pain in at least 1 of the 1st, 2nd or 3rd digit, palm or wrist pain and having a positive Phalen's test and/or positive reverse Phalen's test, and/or a positive Tinel's test, and/or positive carpal compression test, were considered clinically as potential cases of CTS and further evaluations with ultrasonography and/or nerve conduction study were performed [1,2]. Only patients where ultrasonography and/or nerve conduction defined a diagnosis of CTS were included in the study as cases.…”