Carpal-tunnel syndrome (CTS) is one of the most common workplace-related injuries among office workers. But is every case of CTS work-related?
The answer is important to employees, doctors, and employers alike. We won’t presume to tell doctors anything about CTS that they don’t already know, but CTS sufferers and their employers often overlook important factors when dealing with the issue. We’ll look at each of those groups in turn, but first a quick overview.
What Is Carpal Tunnel Syndrome (CTS)?
The carpal tunnel is a small space in the wrist designed to keep nerves and blood vessels properly aligned even when the wrist bends. The median nerve passes through the tunnel, guided by a ligament. Nerves are usually able to shift slightly to accommodate inflamed surrounding tissue. Because the carpal tunnel is rigid, it does not allow the median never travelling through it any room to move: if the ligament guiding the median nerve becomes inflamed, the nerve is pinched or compressed and soon begins to lose function. This pinching and loss of function define CTS.
Symptoms of CTS include weakness and a combination of pain, tingling, and numbness in the affected hand. This directly affects the quality of work done by many office workers and can make certain other tasks unsafe.
When CTS is diagnosed early, it can often be successfully treated with rest, wrist support, and/or anti-inflammatory medication. More serious cases after commonly treated with carpal tunnel release surgery, which relieves pressure on the never by severing the inflamed ligament.
CTS is often referred to as a repetitive-stress disorder, but its causes are more varied than that. Repeatedly performing the same activity can inflame the ligament often responsible for CTS, but so can injuries and certain medical conditions, including arthritis and diabetes. Patients should be aware of the full range of possibilities when discussing CTS-like symptoms with their doctors, as should employers when designing new work routines or handling medical claims dealing with CTS.
What Patients Should Know
CTS is a distressing and often painful condition. It may be tempting to seek quick answers for how it developed, and quick relief through surgery. But the quickest response isn’t always the wisest.
Patients sometimes well-meaningly give their doctors partial information. But jumping to conclusions about the cause of CTS can obscure the real culprit, with negative consequences for treatment and even for the sufferer’s long-term health.
CTS resulting from an accident might not be the only lingering effect of the original injury. For example, the hamate bone, located on the pinky side of the wrist, helps form both the carpal tunnel and the ulnar canal, which performs a similar function for the ulnar nerve. The hamate’s hook-like shape makes it vulnerable to minor fractures; if these heal poorly, they may lead to pressure on both the median nerve and the ulnar nerve. Too narrow a focus on CTS may keep doctors from treating the real problem.
More seriously, CTS resulting from an underlying health problem like diabetes could be the key to early diagnosis and treatment of a much more serious issue. In these cases, blaming CTS on repetitive stress could be a life-changing misstep.
Surgery to relieve CTS symptoms often comes with a price. It may take two or three months before patients are able to grip and lift even light objects. The wrist’s full strength may never return, and it may take a year before the wrist fully recovers whatever strength it can. As is the case with any surgery, picking the best surgeon for the job is of great importance. Determining which surgeon is the best can be hard, which is why we recommend reading our article on the best orthopaedic surgeons in Singapore.
What Employers Should Know
Because CTS can be caused by so many factors, and because the consequences of CTS surgery can be so limiting, employers and insurers should be careful when evaluating claims of CTS.
Most importantly, employers should be wary of claims that workplace-related repetitive stress alone has caused an instance of CTS.
For everyone’s sake, employers should insist on a full investigation of other possible causes of an employee’s CTS symptoms. These should include the employee’s injury history, at and away from work, and complete testing for more serious medical factors like diabetes and rheumatoid arthritis.
If no factors beyond repetitive stress seem to have caused an instance of CTS, employers should resist the conclusion that the repetitive stress was incurred solely at work. Other activities, running from knitting to playing the piano to certain sports, can contribute to CTS or even be its primary cause. Employers who ignore this possibility may find themselves accepting undue responsibility for an employee’s lost productivity, along with setting a costly precedent for future claimants. Just as importantly, they may be preventing their employees from properly treating their CTS, with dire consequences for everyone involved.
Employers should also ask whether a claimant had been diagnosed with CTS at a previous job. Therapies like splints or braces may provide long-term relief of CTS symptoms while not entirely correcting their underlying causes. In such cases, CTS may represent a pre-existing condition. If this is so, it may affect the way insurers handle claims, the way employers adapt work environments, and the way that employees seek further treatment.
What Everyone Should Know
Employees and employers alike can take steps to help diagnose CTS accurately and early, and to minimize the possibility of CTS arising in the first place.
Each side should resist the temptation to rely on common wisdom, and should work with doctors and insurers to properly document every possible cause of each reported case of CTS. Just as importantly, each side should take steps to prevent CTS when possible, and to address it quickly when need be.
Employers should take care to identify employees whose jobs involve extended repetitive motions: for example, line workers and employees who spend long hours writing on computers. When these roles have been identified, it may be wise to retain an ergonomic specialist to conduct a risk assessment and recommend any changes to equipment and work habits that might increase the possibility of CTS and related issues.
Employees should respond quickly if their fingers ever begin to tingle or feel numb on the job. Along with notifying their supervisors, employees should consider contacting Human Resources in those situations. CTS is the body’s response to sustained overwork, and the better a patient is able to concentrate on that recovery, the better for everyone involved.
For even more information on carpal tunnel, check out my other article/guide on this topic!