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A Publication of WTVP

It appears to have afflicted the American workforce. Some of IWIRC's clients swear it even becomes contagious at times. The problem: carpal tunnel syndrome. Carpal tunnel syndrome (CTS) is a painful problem caused when pressure increases in the carpal tunnel of the wrist-the place where nerves and tendons pass from the forearm to the hand. The median nerve supplies sensation to the thumb, index, and middle fingers and part of the ring finger. This build up of pressure on the median nerve might cause the hand to develop numbness, lose strength, and, in some cases, even muscle control.

With so much controversy surrounding the diagnosis of CTS, one would think more would be known regarding the best way to diagnose and treat the malady. The truth is, no consensus exists on how to diagnose CTS, say Drs. Franzblau and Werner of the University of Michigan. "Symptoms of pain, numbness, and tingling in the hands are common in the general population," but the prevalence of actual CTS is about 3 percent in the general population. In spite of its rather infrequent incidence, U.S. doctors perform about 200,000 surgeries at a cost of more than $1 billion annually.

While workers like to attribute the causes of CTS to the workplace, many believe it's more of a lifestyle injury. George Piligian, occupational medicine physician in New York, says while work-related forceful, repetitive motion contributes to CTS, so can pregnancy, arthritis, and diabetes. Hobbies such as quilting or needlepoint, playing the guitar or piano, golfing, and working in the yard can also play a role in the ailment's 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 typing and keyboarding were the major culprits. However, recent research concludes there's little evidence to support such a conclusion.

Treatment includes both non-surgical and surgical interventions. In simplest terms, the faster one reports symptoms and the faster early conservative interventions are implemented, the more likely a quick recovery and less likely the need for surgery. From personal experience, what was initially diagnosed as CTS becomes issues related to neck and shoulder problems instead. When surgical interventions are used, the successful outcomes are about 90 percent, according to one surgeon. Willard Schuler, a Colorado orthopedic surgeon, says, "If the procedure isn't successful, then the problem probably wasn't CTS in the first place."

Susan Mackinnon, professor of surgery at Washington University in St. Louis, says most of the time, conservative interventions-non-surgical-take care of the problem, making a lot of surgeries unwarranted.

The question a lot of employers have is what to do. The Illinois Industrial Commission rulings aren't necessarily in line with the research. The first step-as hard as it might be to do-is encourage early symptom reporting. Second, do your homework. When the injury is reported-before is even better-know the physical demands of the job. When it's reported, inquire about the worker's hobbies and interests. 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

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