Carpal Tunnel Syndrome in the Workplace

Anywhere from 4 to 10 million Americans suffer from carpal tunnel syndrome every year, affecting their ability to work efficiently and even complete daily tasks. This painful progressive condition is caused by compression of a key nerve in the wrist. Virginia Jones, M.D., OrthoAtlanta orthopaedic surgeon fellowship trained in hand and upper extremity surgery, cites it as among the top conditions she treats each year. It is a common Workers’ Comp claim.

Anatomy
There is a narrow channel on the palm side of the wrist. This “tunnel” is the protective passage for the median nerve and all nine tendons that bend the fingers and thumb. The median nerve relays sensations from the thumb, index, middle and ring fingers. This nerve also controls several small muscles in the hand, especially muscles that move the thumb.

Carpal tunnel syndrome, or CTS, is a caused by compression of the median nerve as it passes through the carpal tunnel on its way to the palm of the hand.  Compression of the median nerve cuts off its blood flow, decreasing its ability to function. Over time, this can lead to permanent nerve and muscle damage if left untreated.

CTS is most often related to work activities that involve repetitive motions. We are most familiar with CTS resulting from computer use, however, the repetitive motions of assembly line workers, cashiers, meat cutters, hairstylists and those using vibrating mechanical tools find themselves at risk for this painful condition. CTS is three times more common among assemblers than among data-entry personnel.

Symptoms

Knowing the early signs of carpal tunnel syndrome can help catch the condition in its most treatable stage. Symptoms include:

• Numbness or tingling in the thumb, index, middle or ring finger. Initially, numbness may come and go.
• Pain that wakes a person up in the night
• The sensation that your hand is going to sleep while driving, using a phone or even while blow drying hair

As the condition worsens, symptoms may include:

• Grip weakness
• Dropping objects
• Pain described as a persistent ache, particularly in the thumb, later spreading up the shoulder, neck or both.

Diagnosis

The physician will determine if there is decreased feeling in the thumb, or index, middle or ring finger. In severe cases, it may be determined the muscle has atrophied.  Tests to determine the amount of nerve damage may include a nerve conduction study or electromyography.

Causes

To prevent or minimize carpal tunnel syndrome in the workplace, employers can educate employees about the importance of:

• Taking frequent breaks
• Repositioning of hands regularly while working
• Utilizing office equipment or workstations that allows the worker to change the pattern of hand use, such as setting a smartphone on a table when typing rather than holding it, or use of telephone headsets
• Stretching exercises may be helpful

Treatment

Seeking treatment early is key to successful non-operative outcomes. The physician may recommend a wrist brace for mild cases, oral anti-inflammatory medication and avoiding activities that cause irritation. A steroid injection to reduce inflammation may be helpful, although relief may be temporary. In more severe circumstances, surgery may be necessary to correct the issue.

The physician will also want to rule out other conditions such as arthritis, tendonitis and other nerve problems, as well as diabetes and hypothyroidism.

“The key to a quick recovery from carpal tunnel syndrome is treatment upon the onset of symptoms,” says Dr. Jones. “The longer an employee puts off seeing a doctor, the more potential for nerve damage, which leads to a longer recovery and a higher probability of needing surgery.”

This article was written by Virginia Jones, M.D., OrthoAtlanta orthopedic surgeon fellowship trained in hand and upper extremity surgery. Carpal Tunnel Syndrome is one of the top conditions she treats each year, and is a common Workers’ Compensation claim. 

See Work Related Injuries and Evaluations to learn more about the OrthoAtlanta Workers’ Compensation Healthy Returns program and the Workers’ Compensation Benefits Liaison in your area.