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Is Carpal Tunnel Syndrome a work-related disease?

Carpal Tunnel Syndrome is a frequent pathology affecting individuals over 35 years of age and mostly women. It is often thought to be caused by manual labour and computer work. Currently, the aetiology of this condition remains controversial and it is unclear to what extent anatomical and predisposing factors or professional activities lead to the disease.
 
Different from an acute injury, a Carpal Tunnel Syndrome is the result of a slow degenerative process either linked to metabolic changes and fibrotic growth of the synovium or arising from prolonged, excessive/repetitive wrist flexion-extension and grip movement typical of some professions. 

A review article published in 2016 in the journal Best Practice & Research: Clinical Rheumatologyanalysing the literature around the relationship of Carpal Tunnel Syndrome with occupational activities, highlights the lack of evidence for the association between the disease and computer-mouse work and reinforces the link with wrist flexion/extension movement and forceful gripping, especially when both activities are combined. 
 

Assessing compensation claims for Carpal Tunnel Syndrome: The examiner dilemma

 
The compensation cost for Carpal Tunnel Syndrome is substantial. In the US, the National Council on Compensation Insurance (NCCI) states that compensation for Carpal Tunnel Syndrome is second only to compensation for disc pathology of the lumbar spine in terms of lost-time claims. In fact, $1 out of $3 given for worker compensation was due to Carpal Tunnel Syndrome. 

The lack of clarity on the causation of Carpal Tunnel Syndrome poses a challenge for a medical examiner who attempts to distinguish between work and constitutional factors, especially when work compensation is at stake. Furthermore, the examiner may be required to state whether the occupational practice may have exacerbated an existing condition.
 
The New South Wales Workers Compensation Act provides a set of useful criteria to determine whether occupational factors contribute to an injury, which help differentiate an injury from a degenerative disease. 

They include:
  • Time & place of injury
  • Work nature & tasks performed
  • Employment duration
  • Probability of the injury to occur in worker’s life independent of profession
  • Worker’s health prior to disease
  • Worker’s life-style/activities outside workplace.
The Act also requires the examiner to express judgement as to whether specific occupational practices pose a higher risk to cause the disease, and thus demonstrate that the employment has indeed contributed to its development. However, there is never an absolute certainty on the causality and each client case needs to be examined individually.

Does worker compensation affect disease outcome?

 
A British study on 166 individuals who underwent carpal tunnel release surgery within 8 years, divided into worker and non-worker compensation groups, showed that over 80% of the workers receiving compensation had persisting problems, whereas only 40% of non-compensated workers did. 

Also, the compensated work group required three months to return to work as compared to the non-compensated workers who were back to work after three weeks. It is interesting to note that post surgery, 50% of the compensated workers changed jobs mostly due to the Carpal Tunnel Syndrome as opposed to only 25% of the non-worker compensation group. Does this data suggest that work compensation may influence disease outcomes? The outcomes may depend on the worker’s expectations for a rapid recovery compared to their persisting discomfort, which is typical of this condition. It cannot be excluded that the worker may hope for a larger compensation with prolonged symptoms and delayed recovery. 

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a common condition caused by the entrapment of the median nerve in the carpal tunnel resulting in numbness and significant pain in the hand, fingers and wrist.

Although the causality of manual work and the carpal tunnel syndrome remains unclear, a number of measures including occupational health and safety rules at workplace should be implemented to reduce the risk to develop a carpal tunnel syndrome. These recommendations include:

  • Ergonometric education for correct posture during manual activities (avoid to keep the wrist bent)
  • Wear gloves or splints 
  • Use workstations designed for optimal posture of hand and wrist
  • Regular stretching exercises while working
  • Frequent rests when involved in heavy industrial manual work
  • Job rotation amongst employees
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