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In recent years, reports of repetitive motion injuries have
risen dramatically in workplaces across the country. These
problems, frequently termed "Cumulative Trauma Disorders" are
being reported at alarming rates in all types of workplaces
- from meatpacking plants to newspaper pressrooms. According
to the Bureau of Labor Statistics, “disorders associated
with repeated trauma” account for about 60% of all
occupational illnesses. Of all these disorders, carpal tunnel
syndrome is the condition most frequently reported.
What is Carpal Tunnel Syndrome (CTS)?
The carpal tunnel receives its name from the 8 bones in
the wrist, called carpals, that form a tunnellike structure.
The tunnel is filled with flexor tendons which control finger
movement. It also provides a pathway for the median nerve
to reach sensory cells in the hand. Repetitive flexing and
extension of the wrist may cause a thickening of the protective
sheaths which surround each of the tendons. The swollen tendon
sheaths, or tenosynovitis, apply increased pressure on the
median nerve and produce Carpal Tunnel Syndrome (CTS).
What are the Symptoms of CTS?
The symptoms of CTS often first appear as painful tingling
in one or both hands during the night, frequently painful
enough to disturb sleep. Accompanying this is a feeling of
uselessness in the fingers, which are sometimes described
as feeling swollen, even though little or no swelling is
apparent. As symptoms increase, tingling may develop during
the day, commonly in the thumb, index, and ring fingers.
A decreased ability and power to squeeze things may follow.
In advanced cases, the thenar muscle at the base of the thumb
atrophies, and strength is lost.
Many patients with CTS are unable to differentiate hot from
cold by touch, and experience an apparent loss of strength
in their fingers. They appear clumsy in that they have trouble
performing simple tasks such as tying their shoes or picking
up small objects.
What Causes CTS?
As stated earlier, swelling of the tendons that line the
carpal tunnel causes CTS. Although there are many reasons
for developing this swelling of the tendon, it can result
from repetitive and forceful movements of the wrist during
work and leisure activities. Research conducted by the National
Institute for Occupational Safety and Health (NIOSH) indicates
that job tasks involving highly repetitive manual acts, or
necessitating wrist bending or other stressful wrist postures,
are connected with incidents of CTS or related problems.
The use of vibrating tools also may contribute to CTS. Moreover,
it is apparent that this hazard is not confined to a single
industry or job but occurs in many occupations especially
those in the manufacturing sector. Indeed, jobs involving
cutting, small parts assembly, finishing, sewing, and cleaning
seem predominantly associated with the syndrome. The factor
common in these jobs is the repetitive use of small hand
tools.
How Large a Problem is CTS?
In the past ten years, more and more cases of workers afflicted
with CTS have been reported in medical literature. One reason
for this increase may be that automation and job specialization
have fragmented workers' tasks to the point where a given
job may involve only a few manipulations performed thousands
of times per workday. Increased awareness of work-related
risk factors in the onset of CTSis reflected in the growing
number of requests for health hazard evaluations (HHEs) received
by NIOSH to investigate such suspected problems. NIOSH received
about three times as many HHE requests related to hand and
wrist pain in 1992 as compared to 1982.
Prevention
NIOSH recommendations for controlling carpal tunnel syndrome
have focused on ways to relieve awkward wrist positions and
repetitive hand movements, and to reduce vibration from hand
tools. NIOSH recommends redesigning tools or tool handles
to enable the user's wrist to maintain a more natural position
during work. Other recommendations have involved modified
layouts of work stations. Still other approaches include
altering the existing method for performing the job task,
providing more frequent rest breaks, and rotating workers
across jobs. As a means of prevention, tool and process redesign
are preferable to administrative means such as job rotation.
The frequency and severity of CTS can be minimized through
training programs that increase worker awareness of symptoms
and prevention methods, and through proper medical management
of injured workers.
Treatment
Treatment of CTS may involve surgery to release the compression
on the median nerve and/or use of antiinflammatory drugs
and hand splinting to reduce tendon swelling in the carpal
tunnel. Such medical interventions have met with mixed success,
especially when an affected person must return to the same
working conditions.
To read the rest of this article from the National Institute
for Occupational Safety and Health (NIOSH), please click
here: http://www.cdc.gov/niosh/ctsfs.html
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