Multiple Risk Factors Influence Development of Carpal Tunnel Syndrome

Reducing awkward postures and improving other workplace factors can only go so far in reducing the risks of carpal tunnel syndrome, according to a recent study.

Researchers from the American Association of Neuromuscular and Electrodiagnostic Medicine revealed the findings of a report at the organization's annual conference in San Diego. According to the study, certain risk factors play a role in influencing an individual's likelihood of developing CTS, which is caused by the compression of the median nerve through the carpal tunnel in the wrist area. When constricted, blood cannot flow freely through the hand to the fingers causing individuals to experience numbness and pain.

Between July 2007 and August 2008, a cross-sectional study was performed on 1,000 patients with arm pain. The prevalence of CTS was 25 percent in the study group. According to researchers, the mean body mass index was higher in CTS patients in both genders and the wrist dimension ratio was also found to be higher in the CTS group. In addition, steroid use was reported in 2 percent of the control group and in 8 percent of the CTS group. Diabetes mellitus was found in 4 percent of the control group and in 11.2 percent of the CTS group. Of the control group, 8.8 percent had reached menopause, as compared to 25.2 percent in the CTS group. The female to male ratio of individuals with CTS was 7 to 1.

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Weight loss and CTS. Safety professionals are well-aware that obesity impacts a variety of health issues and can increase an employee's risk of developing a musculoskeletal disorder, such as CTS. However, according to two recent studies, employees who lose weight can actually improve the painful symptoms of CTS.

In a second report by the AANEM, researchers evaluated the effects of bariatric surgery in patients with a presurgical diagnosis of CTS. Sixteen patients who were classified as obese to morbidly obese took part in the research. Each had a body mass index ranging from 36 to 44, and a previous diagnosis of CTS confirmed by nerve conduction studies. The patients were evaluated by clinical and neurophysiological tests over a 12- to 23-week period after bariatric surgical procedures.

In 14 patients, a significant and progressive improvement was observed after the procedure. Researchers said this improvement directly correlated with a reduction of BMI to a range of 29 to 34, with an adjustment of the associated conditions. In two patients, no neurological function improvement was noted. However, the study noted that there was improvement in numbness and pain sensation.

An additional study by the American Society of Plastic Surgeons provided more support to the weight-loss argument. The findings suggested that massive weight loss alone may provide a cure for CTS. For the study, plastic surgeons analyzed the carpal tunnel histories and before and after weight-loss health conditions of 43 massive weight-loss patients. More than half of the patients (24) originally reported to have CTS while four patients reported to have symptoms of the disorder. After losing 50 pounds or more, however, all but three patients reported a resolution of symptoms.

Implement solutions. Cindy Roth, president and CEO of Ergonomic Technologies Corp. in Syosset, N.Y., said CTS remains a huge issue in the U.S. and worldwide.

"The problem is that it is very difficult to diagnose, and as this study shows, a lot of carpal tunnel cases can be attributed to personal risk factors," she said. "However, you also have a lot of people who have been working for many years in environments that place them in awkward postures and include forceful and repetitious tasks."

Despite these personal risk factors, such as smoking and obesity, Roth said employers can be held responsible if the CTS is reported at work. Treatments such as carpal tunnel release surgery and the long-lasting effects that can hinder an employee's work performance can add up to a costly workers' compensation claim. Therefore, she said, it is not an injury to be taken lightly.

"CTS should be taken seriously," Roth said. "It is not hard to get an understanding of what jobs are creating CTS risk factors, and it is not expensive to make solutions. It can save an employee from unnecessary surgical intervention."

Roth said employers should:

Start with good ergonomics training. "Employees must have an understanding of awkward postures, force and repetition, and how they influence the development of CTS," she said.
The Occupational Safety and Health Administration, Roth said, provides a variety of free resources on preventing awkward postures and improving the work environment.
Offer a wellness program. Make an effort to target employee obesity.
Target aging workers. Roth said older employees may be at an increased risk of CTS. Provide accommodations and work closely with this employee population to reduce risks as much as possible.

Read more at the WORKERSCOMP Forum^TM homepage.

November 30, 2009

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