When you think about workplace health and safety concerns, it may bring to mind anything from exposure to potential cancer-causing chemicals to injuries due to major mishaps at industrial worksites. But many employees file workers’ compensation claims for another reason: carpal tunnel syndrome.
The common condition afflicts upwards of around 1 in 20 adults, or between 3 and 6 percent of the U.S. population, based on prevalence research. It “occurs when the median nerve becomes compressed as it passes through the wrist within the carpal tunnel, resulting in pain, tingling, weakness, or numbness in the hand or the wrist,” as noted in recent research done by the California Department of Public Health and published by the Centers for Disease Control and Prevention. “Occupational risk factors for CTS include engaging in work activities that require forceful, repetitive tasks, prolonged use of the hands or wrists in an awkward posture, or vibration.” The state’s department of public health analyzed California workers’ compensation claims and found nearly 140,000 CTS cases were reported from 2007 to 2014.
In evaluating the rate of claims by industry during that period and by occupation in 2014, researchers found that female workers were much more likely — 3.3 times — to report carpal tunnel than men, reflecting previous research. Workers in three industries — textile, fabric finishing and coating mills; apparel accessories and other apparel manufacturing; and animal slaughtering and processing — reported the highest rates of carpal tunnel syndrome, at about six times the rate for all industries combined.
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CTS is a major cause of work-related injury as well as lost work time, according to Dr. Robert Harrison, a physician scientist with the CDPH’s Occupational Health Branch, who was the senior author on the research. “While the rates of CTS have been going down in the past decade, there are many jobs that have relatively high rates,” he says. These include jobs where workers have to use their hands for forceful and repetitive tasks, such as sewing clothing, butchering meat or repeatedly lifting heavy items, or where employees maintain an awkward posture on the job, like driving a motor vehicle, working on a production line or computer work, Harrison says.
To account for different patterns of work — including those working part time and others putting in overtime — researchers pegged CTS rates to full-time equivalent, or FTE, workers. An FTE is essentially the equivalent to one person who works 40-hour weeks for about a year (50 weeks, or 2000 hours total). They found that there was a little more than six (6.3) cases of CTS reported per 10,000 FTE. That rate climbed substantially to 39.8 per 10,000 FTE for animal slaughtering and processing; 43.1 for apparel accessories and other apparel manufacturing; and 44.9 for textile, fabric finishing and coating mills. “The Census Occupation Codes with the highest rate of CTS were telephone operators (90.3); cafeteria, food concession, and coffee shop counter attendants (66.0); and electrical, electronics, and electromechanical assemblers (46.2),” the researchers note.
Still, sorting out what may cause carpal syndrome isn’t such a simple job. Often a task that’s blamed — like typing — isn’t found to cause CTS after all, though it may exacerbate symptoms or make a person aware that they have the condition. “There is an association, but it’s not causal,” says Dr. Edward Reece, associate professor and chief of adult plastic surgery at Baylor College of Medicine in Houston.
What one does for a living can certainly have an impact on the CTS symptoms he or she experiences. “There is some evidence — even I would say some strong evidence — that it can be work-related,” says Dr. Daniel Osei, a hand and upper extremity surgeon at the Hospital for Special Surgery in New York City. Often a patient may already have the condition, however, and certain tasks may bring it to bear or seem to make it worse — but it didn’t actually start with work. “It may be because of a patient’s anatomy,” Osei points out. “If you have a little bit of a smaller wrist, there’s less room for the nerve that gets compressed, and this condition is caused by pressure on the nerves.” Other potential causes of carpal tunnel range from a wrist fracture to autoimmune disorders like rheumatoid arthritis.
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Still experts say the question about how occupation may be connected — and if CTS could impact a person’s ability to maintain a living — is relevant. And it behooves employers and employees to address the issue and work toward prevention or lessening symptoms. Improved ergonomics so that, for example, the position of a person’s wrist isn’t held at extreme angles, changes to machinery or how a job is done so that less force needs to be applied or less vibration is absorbed and taking regular breaks can all help alleviate the type of repetitive stress on hands and wrists linked with a higher incidence of carpal tunnel syndrome. “Many scientific studies have shown that repetitive, forceful and awkward work increases the risk of CTS,” Harrison says.
For employees, making such changes while keeping up with work demands can be easier said than done. But in addition to advocating for on-the-job approaches, some individuals who have CTS symptoms, like pain in the hand, wrist and forearm, may benefit from using wrist extension splints when off the job, like when a person sleeps. These can be purchased at a drugstore and usually have some sort of hardened material, whether that be metal or plastic, that keeps the wrist slightly extended, Reece says. “Extending the wrist slightly unloads the nerve and decreases the pressure on the nerve; and that decreases the worsening of carpal tunnel syndrome, and possibly can even treat it in some instances,” he explains.
Anti-inflammatory medications such as ibuprofen can help decrease strain and inflammation in the hands and wrists and might help modify some of the symptoms, Osei says. But experts say that it’s important to talk with a doctor about worsening symptoms to discuss treatment options before the effects of CTS potentially become irreversible — like permanent nerve damage — or the ability to treat the condition is severely limited.
Another treatment approach involves injecting a steroid into the carpal tunnel to decrease inflammation and pressure on the nerve. “Some people get permanent relief,” Reece says. “But it tends to be a temporary solution.” Steroid injection usually will provide patients relief from a few months to one or two years, he says.
Finally, for some people carpal tunnel release surgery is recommended. “Carpal tunnel release typically involves an incision on the palm, and that allows the surgeon to locate the tissue in the palm that presses directly on the nerve,” Osei explains. “By releasing or dividing that tissue that is draped across the nerve and puts too much pressure on it, it allows the surgeon to open up the carpal tunnel, and in doing so it decreases the pressure on the nerve. The pain symptoms that patients have because of the condition are relieved quite quickly. And any other symptoms that have occurred because of that typically get better over time.”
Risks of the surgery range from bleeding and infection to injury to the median nerve, or nerves that branch out from it, and recovery can take anywhere from several weeks to several months, according to Johns Hopkins Medicine.
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Although the surgery can be quite effective, clinicians emphasize that the longer a patient waits to address CTS the less likely — or less fully — it will respond to treatment. That makes it all the more important to be prevention-minded or to focus on alleviating symptoms when initially noticed, and not to wait to seek medical attention for CTS, especially as it worsens over time.
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