The Truth About Carpal Tunnel Syndrome

by Michael Davis, IWIRC Corp.

It appears to have afflicted the American workforce—and even seems contagious at times. Carpal tunnel syndrome (CTS) is a painful problem caused by increased pressure in the carpal tunnel of the wrist, the place where nerves and tendons pass from the forearm to the hand. Increased pressure on the median nerve—which supplies sensation to the thumb, index and middle fingers, and part of the ring finger—may cause the hand to develop numbness, lose strength, and in some cases, even lose muscle control.

A University of Michigan study says carpal tunnel syndrome is prevalent in about three percent of the general population. In spite of this relative infrequency, U.S. doctors perform about 200,000 surgeries annually, at a cost of more than $1 billion.

While workers often attribute the causes of CTS to the workplace, many believe it is more often a lifestyle injury. CTS can be induced by pregnancy, arthritis and diabetes. Quilting, needlepoint, playing the guitar or piano, golfing, and working in the yard can also play a role in its development. Taking this a step further, hand surgeon Peter Nathan believes “non-work factors such as age, exercise and body weight play the largest part in triggering CTS… The older you are, the fatter you are and the less you exercise, the more prone you are to CTS. Work factors play only peripheral roles.” Once it was thought that typing and keyboarding were major culprits, yet recent research demonstrates little evidence to support such a conclusion.

Treatment for CTS includes both non-surgical and surgical interventions. The trick to this scenario seems to be early reporting and detection of symptoms. In simplest terms, the faster that early conservative interventions are implemented, the more likely a quick recovery, and less likely the need for surgery.

When surgical interventions are used, the successful outcomes are about 90 percent, according to one surgeon. "If the procedure is not successful,” states Willard Schuler, a Colorado orthopedic surgeon, “then the problem probably wasn't CTS in the first place." Susan Mackinnon, Professor of Surgery at St. Louis’ Washington University, adds that conservative interventions (non-surgical) usually take care of the problem, making many surgeries unwarranted. “Based on our [study] results, surgery often is neither necessary nor recommended.”

The question many employers want to know is what to do. The first step is to encourage early symptom reporting. Remember, the earlier the symptoms are treated, the less likely the need for surgery. Second, do your homework. When the injury is reported, know the physical demands of the job, inquire about the worker’s hobbies and interests, and be vigilant in your documentation. The more documentation you have regarding the work and the worker’s outside activities, the more likely the best outcome can be attained.

In terms of prevention, encourage stretching for the arm and neck throughout the workday. Identify trouble spots for “hand-intensive” work, and be proactive to reduce the worker’s exposure. iBi