Carpal Tunnel Syndrome: Under-recognition of Occupational Risk Factors by Clinicians

Abstract

Carpal tunnel syndrome (CTS) is a common medical condition that is a part of the broader group of cumulative trauma disorders (CTD). It is associated with a marked symptomatology resulting from entrapment of the median nerve at the wrist, and can have serious occupational and economic implications. Works involving repetitive wrist and arm movements and jobs requiring strong grip, use of vibrating tools, and working in a cold environment are all known risk factors for CTS [1][2][3] . The burden of occupation-related CTS is substantial 4,5) , in particular among those employed in high-risk occupations such as the food industry, postal workers, and health care personnel. In the U.S., cumulative trauma injuries and repeated trauma, of which CTS makes up a substantial fraction, represent about 65% of occupational injuries 5) .Studies have repeatedly demonstrated that under-recognition and under-reporting of work-related CTS are quite common 2, 5-7) , despite extensive description of the syndrome in the occupational and general medical literature [7][8][9] . Not infrequently, non-occupational physicians do not address the possible role of occupational risk-factors in the etiology of the syndrome during the evaluation of a particular patient. This situation is quite unfortunate as after the relationship between specific occupational factors and the occurrence of CTS is established, appropriate preventive measures can be taken to alleviate suffering and prevent further damage to the afflicted individual, as well as preventing fellow workers from developing similar symptoms.The purpose of this study is to evaluate the level of awareness of non-occupational physicians to the possible role of occupational risk factors in the development of CTS in individual patients. The study was carried out in a large regional outpatient service that provides care for approximately 10% of the population of Israel and it was approved by the ethics committee of the regional hospital. The study group was consisted of 229 individuals aged 25-65, who were operated at the outpatient surgical units of the regional health care service during a threeyear period (1st January 1999 to 31st December 2001). All CTS cases were diagnosed based on clinical symptoms and nerve conduction velocity (NCV) studies. Only patients with first operation for CTS were included. Controls were subjects matched by gender and age (± 2

Carpal tunnel syndrome in manual tea harvesters

“…These electrophysiological and clinical findings suggest extensive fascicular involvement within the median nerve in contrast to idiopathic CTS. [1][2][3] There were statistically significant positive correlations between the clinical stages of the patients and the age, working duration and duration of symptoms in our study. A statistically significant positive correlation was also present between the neurophysiologic grades of the patients and the duration of symptoms in our study (Table II).…”

“…Carpal tunnel syndrome is shown to have a higher incidence rate in employed patients than in unemployed persons. [2,3,7,[16][17][18][19] It has been shown that occupational exposure to excess vibration, increased hand force and repetition increases the risk of developing CTS in a meta-analysis investigating the relationship between CTS and occupation. [20] Lengthy exposure to high repetitive hand and wrist movements, high range wrist action, constant extreme wrist position, using handheld vibrating tools, work involving frozen food and availability of protection have been shown to be the key occupational points to consider in determining work liability for CTS.…”

“…[1] It is also a part of the cumulative trauma disorders. [2] Although many clinical risk factors are associated with the syndrome, epidemiologic studies have identified that several combinations of work factors, individual factors, and psychosocial factors are also related to CTS. The incidence of CTS has been estimated at 1% in the general population and 5% among workers in certain industries requiring repetitive hand and wrist use.…”

Prevalence of carpal tunnel syndrome and its correlation with pain amongst female hairdressers

“…Abnormal is defined as 0.9 ms and has a sensitivity of 83% and specificity of 95% [17]. Even though its incidence is reported to be in a large interval such as 0.1-10%, CTS is observed more frequently for employed people than unemployed people in the general population [18][19][20][21].…”

Personal and occupational risk factors for carpal tunnel syndrome in meat processing industry workers in Northern Italy

“…In this regard, meat processing industry has been repetitively identified as a high risk environment for the CTS, as it typically requires significant exposure to repetitive hand movements to hang, kill, clean, eviscerate, cut, package and box meat at a rapid pace and at relatively low environmental temperature [6,[21][22][23]. Not coincidentally, the CTS prevalence in meat industry has been reported to be 15-24% [2,3,10,[18][19][20][23][24][25][26][27], and some reports suggest that even higher estimates may be found depending on the operative definition applied by researchers [20,21,28,29].…”