Occupational Carpal Tunnel Syndrome Research Articles

Occupational Carpal Tunnel Syndrome: a scoping review of causes, mechanisms, diagnosis, and intervention strategies.

Carpal Tunnel Syndrome (CTS) has traditionally been viewed as a specialized medical condition. However, its escalating prevalence among professionals across a multitude of industries has sparked substantial interest in recent years. This review aims to delve into CTS as an occupational disease, focusing on its epidemiological patterns, risk factors, symptoms, and management options, particularly emphasizing its relevance in professional environments. The complex interaction of anatomical, biomechanical, and pathophysiological factors that contribute to the development of CTS in different work settings underlines the critical role of ergonomic measures, prompt clinical identification, and tailored treatment plans in reducing its effects. Nevertheless, the challenges presented by existing research, including diverse methodologies and definitions, highlight the need for more unified protocols to thoroughly understand and tackle this issue. There's a pressing demand for more in-depth research into the epidemiology of CTS, its injury mechanisms, and the potential role of targeted medicine. Moreover, recognizing CTS's wider ramifications beyond personal health is essential. The economic burden associated with CTS-related healthcare costs, productivity losses, and compensation claims can significantly impact both businesses and the broader society. Therefore, initiatives aimed at preventing CTS through workplace interventions, education, and early intervention programs not only benefit the affected individuals but also contribute to the overall well-being of the workforce and economic productivity. By fostering a collaborative approach among healthcare professionals, employers, policymakers, and other stakeholders, we can strive towards creating safer and healthier work environments while effectively managing the challenges posed by CTS in occupational settings.

The Professional Future in Operated Carpal Tunnel Syndrome: A Cross-Sectional Study of Recognized Occupational Cases.

Carpal tunnel syndrome (CTS) is frequently present among workers. This syndrome's professional and economic impact makes it a priority in occupational health. We aimed to describe the professional future of workers suffering from occupational CTS after surgery and the factors that could influence their retention at the job. -Methods:A retrospective descriptive study of workers operated on occupational CTS was conducted from 2014 to 2019. The data was collected using pre-established and phone questionnaires to determine their professional future after surgery. We included 99 workers with operated CTS. They had a mean age of 45±6.5 years, were predominantly female (97%), and had two dependent children in 72.7% of cases. They worked as a seamstress in 44.4% of patients with a mean professional seniority of 18±7.2 years. The professional future was a return to work with a job transfer at 44.4% and job maintenance with ergonomic adjustments at 39.4%. A job loss was noticed in 12.2% of cases. Early retirement was noticed in 8.2%, dismissal in 3%, and resignation in 1% of cases. The factors influencing the professional future were age 50 to 59 years (p=0.01) and dependent children (p=0.02). In our survey, most operated-CTS workers benefited from a job transfer and kept their job with ergonomic adjustments to their work conditions. Therefore, interventions aiming to improve the professional future of workers operated on CTS by ensuring sufficient staff and adjusting workplaces are needed.

The bilaterality of idiopathic carpal tunnel syndrome among manual workers.

To evaluate: a) the prevalence of bilateral idiopathic carpal tunnel syndrome (CTS) in manual workers; b) a correlation between the duration of unilateral and bilateral CTS symptoms; c) a correlation between the onset of CTS symptoms in the unilateral dominant/non-dominant hand and the time of developing bilateral CTS; and d) findings of the nerve conduction study (NCS) in symptomatic and asymptomatic hands of patients with unilateral CTS. Clinical and neurophysiological examinations were conducted along with a detailed analysis of job exposure of 332 manual workers admitted to the Occupational Medicine Department, the Nofer Institute of Occupational Medicine, with suspected occupational CTS. Eventually, 258 patients were excluded from the study: 34 with associated neuropathies and 206 with other conditions potentially associated with CTS. Cases with work-related CTS (18) were also excluded. A total of 74 patients were diagnosed as idiopathic CTS. In idiopathic CTS, the right hand was affected in 15 (20.3%) patients, the left hand in 4 (5.4%) patients, and both hands in 55 (74.3%) patients. Symptoms duration was longer in the patients with bilateral CTS (4.01 years) than in those with a unilateral right (1.7 years, p = 0.002) or left hand condition (2.8 years, p = 0.313). Median nerve impairment at the wrist was revealed by NCS in 6 left and 2 right asymptomatic hands. The findings of the study indicate the need for "alerting" patients with unilateral CTS about the risk of the disease developing in the contralateral hand. Therefore, NCS should be routinely performed in the asymptomatic hands of patients with unilateral CTS, which is essential for the prevention of neuropathies, especially among manual workers performing repetitive manual tasks. Int J Occup Med Environ Health. 2020;33(2):151-61.

Effects of Exercise and Enzyme Therapy in Early Occupational Carpal Tunnel Syndrome: A Preliminary Study.

Objectives Occupational carpal tunnel syndrome (CTS) due to upper extremity overuse has in recent years been the most commonly recognized occupational disease in the Czech Republic and its prevalence has steadily increased. This pilot observation aimed to assess the effects of exercise techniques and oral enzyme therapy in automotive plant workers with early CTS. Patients and Methods The observation comprised automotive plant assembly line workers in whom nerve conduction study revealed incipient CTS. The subjects were divided into three groups: a group practicing exercise techniques (exercising; N=15), a group receiving oral enzyme therapy (N=16), and a group of controls (N=14). Subjects in the control group were only observed without any specific intervention, which is a common procedure in incipient CTS. Throughout 9-week observation, the workers did their jobs. Prior to and after that period, the workers' CTS-related symptoms were ascertained through structured interviews with a physician and the following median nerve parameters were measured: sensory conduction velocity (SCV) and distal motor latency (DML). Results In both the exercise and enzyme therapy groups, statistically significant decreases in the total score for symptoms were achieved (p<0.0001), unlike controls. On final examination, both treated groups demonstrated significantly increased SCV as compared with the initial values (p=0.00013 and p<0.0001, respectively); in controls, the mean SCV did not significantly change. Similarly, a statistically significant shortening of DML was noted in the enzyme therapy group (p=0.008). Conclusion The results showed the efficiency of both exercise and oral enzyme therapy in incipient CTS. These methods may be recommended for preventing more severe forms of CTS.

Development of an Ergonomic Tool to Predict Carpal Tunnel Syndrome Risk Based on Estimated Carpal Tunnel Pressure

OCCUPATIONAL APPLICATIONS An ergonomic tool that predicts Carpal Tunnel Syndrome (CTS) risk based on predicted carpal tunnel pressure (CTP) was developed and a preliminary evaluation was made in a large manufacturing environment. Elevated CTP has been associated with CTS. However, CTP is invasive to measure in vivo, and is thus not practical in an applied setting. This project represents the development of an ergonomic tool based on predicted CTP that could be an asset to ergonomists both in job evaluation and (re)design to reduce occupational CTS risk in workers with otherwise normal wrists.TECHNICAL ABSTRACT Background: CTS remains an important issue in the workplace. Increased carpal tunnel pressure (CTP) may lead to the aggravation or development of CTS. A CTP of 30 mmHg has been used as a threshold limit value for CTS risk. Deviation from a neutral wrist, neutral forearm, and relaxed fingers results in an increase in CTP. Fingertip loading has also been shown to increase CTP independently of posture. Purpose: To develop an ergonomic tool to predict carpal tunnel syndrome (CTS) risk based on the predicted carpal tunnel pressure (CTP) in healthy wrists. Method: A tool was developed to predict CTS-risk based on CTP determined from the literature. The tool was evaluated by comparing the output of the tool (CTS risk) to the incidence of CTS in a large manufacturing environment. Results: The model predicted a mean (S), time-weighted CTP of 21.3 (0.4) mmHg (range 18.5–27.8 mmHg). Evaluative results were promising, as CTS risk was slightly higher in jobs with a historical incidence of CTS. Conclusion: While the tool predicted CTS risk based on CTP, too few CTS claims existed to develop a strong correlation. Further refinement and investigation are needed to include combined postures and mechanical compression, and to further validate the tool.

Work-related carpal tunnel syndrome treatment: a cross-sectional study among 106 patients.

The objective is to assess the influence of sociodemographic, professional and clinical variables on the choice of treatment of work-related carpal tunnel syndrome (CTS). An exhaustive and trans-sectional study was conducted over a period of eight years, from 1st January 2006 to 31 December 2013 in the Department of Occupational Medicine at University Hospital of Mahdia, Tunisia. The study population was represented by patients with work-related carpal tunnel syndrome. Data collection was based on a questionnaire sheet, describing social, occupational and medical characteristics of patients. The study population was characterized by a large female dominance, representing 95.3% with an average age of 42±7.8 years. Patients medically treated represented 38.7% and 61.3% had had surgical treatment. After binary logistic regression, surgical indication of CTS was significantly correlated to diabetes (p=0.017), other musculoskeletal disorders (p=0.02), functional signs of CTS (acrocyanosis p=0.05; muscle weakness p=0.015; radiating pain p=0.01; painful discomfort of the hand, the forearm or arm p=0.027) and to the atrophy of thenar muscles (p=0.018). According to this study, the choice of therapy for occupational CTS depends only on clinical data. More detailed studies will be needed to refine these results.

Is ulnar nerve entrapment at wrist frequent among patients with carpal tunnel syndrome occupationally exposed to monotype wrist movements?

Association between carpal tunnel syndrome (CTS) and ulnar nerve entrapment at wrist remains controversial. The aim of the study has been to investigate the prevalence of Guyon's canal syndrome amongst patients diagnosed with the CTS, occupationally exposed to repetitive wrist movements. The retrospective analysis of 310 patients (268 females, 42 males) representing the mean age of 52±7 years old hospitalized for the suspected occupational CTS was performed. In the analyzed cohort, 4 patients had undergone decompression of the Guyon's canal in the right limbs. Nerve conduction studies (NCS) in the ulnar nerves performed during the hospitalization of those patients did not show any abnormalities. Nerve conduction studies revealed signs of the ulnar neuropathy (UN) at the wrist affecting exclusively sensory fibers for 6 patients. Only those 4 patients who had undergone the operation suffered from clinical symptoms of the UN before the surgery. In the case of the remaining patients, despite the NCS changes, signs suggestive of the UN at the wrist were not detected. In the case of the patients with the occupational CTS, no signs of the ulnar nerve dysfunction were recorded. The frequency of ulnar nerve entrapment at the wrist among patients with the CTS is lower than that already reported. The low prevalence of ulnar involvement (3.2%) for the CTS patients in our study may be related to the relatively small number of the CTS hands with the severe changes in the NCS and/or other personal factor including anatomical variation of the Guyon's canal borders and its contents. Int J Occup Med Environ Health 2017;30(6):861-874.

Medical and professional consequences of occupational carpal tunnel syndrome

Describe the medical and professional consequences in victims of carpal tunnel syndrome. Exhaustive and descriptive study on 233 cases of carpal tunnel syndrome identified in two occupational medicine departments of the center of Tunisia from 2005 to 2010. The Boston questionnaire was used to assess the functional disability. To study the medical and professional becoming, we contacted 128 employees (54.9% of response rate). During the study period, 81 salaried (63.3%) kept the same job; seven employees (5.5%) had a workstation arrangement. An outplacement was noted in 16 employees (12.5%). Of the 24 who lost their jobs, four employees were dismissed, 15 employees left their companies at the end of their contract, three employees resigned and two employees were put on early retirement. The Boston questionnaire was evaluated in 96 patients. Six patients had severe symptoms and functional status was considered severe in four patients. The analytical study of the professional future showed that the prevention policy was correlated with the employee's age, employment status, job tenure and the company's size. Vocational rehabilitation was correlated with the declaration of the occupational disease and the sector. The carpal tunnel syndrome which is a “socio-economic phenomenon” with significant adverse effects on employees’ health requires an adequate preventive measures and a multidisciplinary approach.

CZYNNIKI ETIOLOGICZNE ZESPOŁU CIEŚNI NADGARSTKA U OSÓB ZAWODOWO WYKONUJĄCYCH MONOTYPOWE RUCHY W NADGARSTKU

Carpal tunnel syndrome (CTS) is the most common neuropathy of upper limbs and a leading cause of upper extremity musculoskeletal disorders, in terms of work exposure, repetitive and forceful exertions of the hand and use of vibrating hand tools. The aim of the study was to evaluate etiological factors of carpal tunnel syndrome in subjects occupationally exposed to monotype movements in wrist. We conducted the retrospective analysis of 300 patients (261 women, 39 men), mean age 52 years (standard deviation: +/-6.93) hospitalized with the suspicion of occupational CTS. The study revealed high percentage (68.7%) of diseases and systemic factors involved in the pathogenesis of CTS in the analyzed population, especially obesity (32%), thyroid diseases (28.7%), hormone replacement therapy and/or oophorectomy (16.3%) and diabetes mellitus (12%). In 111 patients the coexistence of at least a couple of potential etiological factors of the neuropathy was recognized. Clinical analysis and occupational exposure allowed to diagnose occupational carpal tunnel syndrome in 18 (6%) patients only. The undeniable long-term (20(.2+/-9.3 years) occupational exposure to repetitive, forceful movements in the wrist was observed in this group. The results of our study indicated that non-occupational etiological factors of CTS predominated and in 37% of patients at least several factors were found. The analysis showed the high prevalence of CTS in workers employed in various sectors of industry, including so called "blue collar" workers. Our study confirmed the multifactorial etiology of carpal tunnel syndrome, however, occupational agents contributed to only 6% of cases.

ANALIZA CZYNNIKÓW ETIOLOGICZNYCH ZESPOŁU CIEŚNI NADGARSTKA W POPULACJI OSÓB PRACUJĄCYCH ZAWODOWO Z UŻYCIEM KOMPUTERA

Carpal tunnel syndrome (CTS) is the most frequent mononeuropathy of upper extremities. From the early 1990's it has been suggested that intensive work with computers can result in CTS development, however, this relationship has not as yet been proved. The aim of the study was to evaluate occupational and non-occupational risk factors for developing CTS in the population of computer-users. The study group comprised 60 patients (58 women and 2 men; mean age: 53.8 +/- 6.35 years) working with computers and suspected of occupational CTS. A survey as well as both median and ulnar nerve conduction examination (NCS) were performed in all the subjects. The patients worked with use of computer for 6.43 +/- 1.71 h per day. The mean latency between the beginning of employment and the occurrence of first CTS symptoms was 12.09 +/- 5.94 years. All patients met the clinical and electrophysiological diagnostic criteria of CTS. In the majority of patients etiological factors for developing CTS were non-occupational: obesity, hypothyroidism, oophorectomy, past hysterectomy, hormonal replacement therapy or oral contraceptives, recent menopause, diabetes, tendovaginitis. In 7 computer-users etiological factors were not identified. The results of our study show that CTS is usually generated by different causes not related with using computers at work.

Nível de evidência e grau de recomendação dos artigos sobre a acurácia diagnóstica da ultrassonografia na síndrome do túnel do carpo

OBJETIVO: Este trabalho teve como objetivo avaliar a qualidade dos artigos relacionados com a acurácia diagnóstica da ultrassonografia na síndrome do túnel do carpo idiopática e relacionada com o trabalho. MATERIAIS E MÉTODOS: Realizou-se busca em bases de dados eletrônicas, selecionando-se relatórios de revisões sistemáticas, ensaios clínicos randomizados e estudos observacionais. Após quatro etapas de análise, desde a triagem inicial até a avaliação pelo instrumento elaborado pelo Critical Appraisal Skills Programme, os artigos foram classificados em níveis de evidência, com seus respectivos graus de recomendação. RESULTADOS: Dos 68 artigos inicialmente encontrados, apenas 4 preencheram os critérios de qualidade propostos neste estudo. A mensuração da área transversal do nervo mediano foi o critério mais importante para o diagnóstico de síndrome do túnel do carpo (ponto de corte entre 9 e 10 mm²: sensibilidade = 82-86,3%; especificidade = 48-87%). Os quatro artigos obtiveram nível de evidência "1b" e grau de recomendação "A". CONCLUSÃO: A avaliação ultrassonográfica em pacientes com suspeita clínica de síndrome do túnel do carpo pode ser realizada como teste de primeira linha, com boa relação custo-benefício, reduzindo a necessidade de exames eletrodiagnósticos.

FP60-FR-01 Occupational carpal tunnel syndrome: diagnostic value of clinical tests

FP60-FR-01 Occupational carpal tunnel syndrome: diagnostic value of clinical tests

Carpal tunnel syndrome and manual milking: nerve conduction studies in 43 cases

From 1989 to 2004, 3125 consecutive patients had electrodiagnosis of carpal tunnel syndrome (CTS); from these 43 cases (1.38%) were associated to manual milking; mean age was 44.9 years and 88.4% were male. The mean time in the milking profession was 247 months; the mean daily milking time was 146 minutes; symptoms referred at electrodiagnostic consultation had lasted on average 34 months, 83% were bilateral. The median sensory nerve conduction study was abnormal in 75.6% to the right and 66.7% to the left hand. The median nerve motor distal latency (MDL) was abnormal in 92.1% to the right and in 80.0% to the left hand. There were no differences between right and left for all electrophysiological parameters. In CTS related to manual milking most cases were men, with the MDL more affected than the sensory distal latencies and the electrophysiological abnormalities were found to be symmetric. Manual milking could be a natural model for occupational CTS. In contrast to idiopathic CTS, there was a greater involvement of motor fascicles; this finding is remarkable for CTS.

Carpal tunnel syndrome as an occupational disease.

Symptoms related to carpal tunnel syndrome (CTS) represent common patient complaints for many primary care physicians. However, there is a surprising lack of guidelines on diagnosing occupational CTS readily accessible to primary care physicians. This article aims to fill part of that void by reviewing historical aspects of occupational CTS, leading up to more current epidemiologic studies of the association of CTS with occupational ergonomic risk factors. The English medical literature was reviewed on the relationship between CTS and occupational ergonomic risk factors. Recent legislative initiatives are discussed. Guidelines of diagnosing and managing occupational CTS are outlined. Many studies are divided regarding whether CTS is associated with highly repetitive/forceful/vibration work. However, a subset of patients presenting with symptoms related to CTS probably has occupational CTS. These patients can be objectively diagnosed and successfully treated and are able to return to work. By being armed with knowledge regarding the background of CTS and by following simple diagnosis and treatment guidelines, the family practitioner should be able to manage many patients presenting with work-related CTS.

Revisiting the work-relatedness of carpal tunnel syndrome.

The incidence of occupational carpal tunnel syndrome may be a synergy between genetics, physiology, and lifestyle factors in addition to biomechanics. It seems prudent to avoid general rules of thumb applied to all occupations and all workers to link occupational hand-use to carpal tunnel syndrome. The lines of evidence are not consistent or continuous from the cellular, tissue, and organism levels.

WORK-RELATED CARPAL TUNNEL SYNDROME: CURRENT CONCEPTS

Carpal Tunnel Syndrome (CTS) has been the subject of a growing number of studies, most of them leading to contradictory outcomes. The dual aim of this paper is to provide the foundation for a thorough understanding of CTS history, and to emphasize the strong relationship between upper extremity activities and occupational CTS. Evidence of work relatedness, as well as contradictory opinions regarding the role of job-related risk factors on CTS development are addressed. It is proposed that a thorough understanding of the factors that intervene in the task-CTS causal relationship, as well as the assessment of workers' adaptation capacity will lead to ergonomic interventions that will ensure a reduction in the number of work-related CTS cases.

Endoscopic Carpal Tunnel Release in Selected Rheumatoid Patients

Fifty-six endoscopic carpal tunnel releases were performed in 42 patients with quiescent seropositive rheumatoid arthritis using the Menon technique. Endoscopic carpal tunnel release was not considered for patients who had florid synovitis with crepitus, loss of active finger flexion, evidence of flexor tendon rupture or previous operation in the carpal area. Access to the tunnel was not so tight comparing to idiopathic or occupational carpal tunnel syndrome and visualization of the flexor retinaculum was satisfactory in all cases. There were no immediate complications. Endoscopic carpal tunnel release can be safely performed in selected patients with rheumatoid arthritis. The absence of a palmar scar can be a great advantage to rheumatoid disabled patients.

Different case definitions to describe the prevalence of occupational carpal tunnel syndrome in meat industry workers.

The aim of this study was to assess the prevalence of carpal tunnel syndrome (CTS) in a group of meat industry workers, using typical symptoms, median nerve conduction studies (NCSs) and their combinations. In the case definition including the NCSs, we tested the electrodiagnostic reference values derived from the general healthy population and from the asymptomatic study population. One-hundred fourteen workers were examined by clinical interviews and median NCSs. The prevalence of CTS varied from 11% to 53%, with a progressive reduction passing from symptoms to NCSs to the their combinations. The prevalence was identical and the highest at the same time (53%) considering the case definitions based only on the symptoms and only on the NCSs with Kimura's reference values. Using the asymptomatic workers' electrodiagnostic reference values, alone or in combination with symptoms, the prevalence of CTS was the lowest (respectively, 15% and 11%). In the epidemiological studies, median NCSs should be considered desirable, if not essential, for confirming a clinical diagnosis, most of all in the longitudinal studies. In the future of CTS diagnosis, attention should be paid to the electrodiagnostic reference values that are discriminating to confirm the presence or not of the disease.

Job performance failure and occupational carpal tunnel claims.

Using a sample of one job type from one firm (to hold job tasks and sick leave/disability policy constant), we estimate the effect of demographic variables, job performance warnings, and workers' compensation benefits on the propensity to file a carpal tunnel syndrome (CTS) loss work-time claim. We find that disciplinary notices increase the employees' propensity to file a CTS claim. State maximum workers' compensation benefits are also positively related to CTS claim frequency, however, the relationship is not statistically significant. CTS claimants respond differently than other sprain/strain claimants to benefits and to gender. In particularly, women have relatively more CTS claims, while men have relatively more other sprain/strain claims in our sample. The estimates here underscore the importance of psychosocial factors in the filing of occupational CTS and sprain injuries claims.

Prevalence and Work‐Relatedness of Self‐Reported Carpal Tunnel Syndrome Among U.S. Workers: Analysis of the Occupational Health Supplement Data of 1988 National Health Interview Survey

To estimate the prevalence and work-relatedness of self-reported carpal tunnel syndrome (CTS) among U.S. workers, data from the Occupational Health Supplement of 1988 National Health Interview Survey (NHIS) were analyzed. Among 127 million "recent" workers" who worked during the 12 months prior to the survey, 1.47% (95% CI: 1.30; 1.65), or 1.87 million self-reported CTS, and 0.53% (95% CI: 0.42; 0.65), or 675,000, stated that their prolonged hand discomfort was called CTS by a medical person. Occupations with the highest prevalence of self-reported CTS were mail service, health care, construction, and assembly and fabrication. Industries with the highest prevalence were food products, repair services, transportation, and construction. The risk factor most strongly associated with medically called CTS was exposure to repetitive bending/twisting of the hands/wrists at work (OR = 5.2), followed by race (OR = 4.2; whites higher than nonwhites), gender (OR = 2.2; females higher than males), use of vibrating hand tools (OR = 1.8), and age (OR = 1.03; risk increasing per year). This result is consistent with previous reports in that repeated bending/twisting of the hands and wrists during manual work is etiologically related to occupational carpal tunnel syndrome.