Carpal Tunnel Syndrome

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What is carpal tunnel syndrome?

Carpal Tunnel Syndrome (CTS) is a type of repetitive strain illness that involves the swelling of tendons and compression of the median nerve which runs through the carpal tunnel in the wrist.  The median nerve controls both feeling and movement in the hand by sending messages from the brain to the hand.

The symptoms of CTS may first appear as pain, numbness, and tingling in one or both hands.  Shaking the hand(s) may provide a feeling of temporary relief.   Pain radiating into the forearm may also be a symptom of CTS.  These symptoms often appear during the night, and are frequently painful enough to disturb sleep.  There is also a feeling of uselessness in the fingers, which are sometimes described as feeling swollen, even though little or no swelling is apparent.  In addition to hand pain, discomfort may be felt in the area above the wrist.  A decreased ability and power to squeeze objects may follow.  In advanced cases, one of the muscles at the base of the thumb wastes away, and strength is lost.  If left untreated, nerve damage may result in loss of hand feeling and movement.

Many patients with CTS are unable to differentiate hot from cold by touch, and experience an apparent loss of strength in their fingers.  They may appear clumsy because they may have trouble in performing simple tasks such as tying their shoes or picking up small objects.

What causes it?

The following factors, together or separately, can lead to CTS:

◆   Repetitive motion;

◆   Awkward wrist positions;

◆   Force; and

◆   No rest.

Stressful conditions which may contribute to CTS include:

◆   Working with the wrist in a bent or awkward position;

◆   Forceful finger, hand, and arm movements;

◆   Excessive use of the index finger;

◆   Circular twisting of the wrist;

◆   Overly tight grip on tools;

◆   Using vibrating tools; and

◆   Working in cold temperatures, especially when cold air blows on the wrist.

How can you prevent CTS?

The best way to prevent Carpal Tunnel Syndrome is to make changes in the job environment, including the equipment you work with and the way the job is performed.

◆   Approach your shop steward and employer if you suspect that your work conditions may be causing your symptoms.  Ask them to examine the job environment in order to identify where excess force, repetition, or awkward postures may be prevented by making changes in tools, workstations, and in the pace of your job.

◆   Maintain your wrists in a neutral (straight, no flexing) position in all activities.

◆   Reduce repetitive movements by reducing the work rate.

◆   Reduce the amount of force that must be applied with the wrists in a bent or awkward position.

◆   Minimize exposure to vibration.

◆   Avoid poorly fitting gloves, which may increase the force necessary to perform a task.

◆   Avoid working in low temperatures with unprotected hands.

◆   Establish a more frequent break schedule or use worker rotation to decrease exposure to excessive force, repetition, and awkward postures.

How can you treat CTS?

Diagnosing and treating Carpal Tunnel Syndrome (CTS) at the earliest stage is the best guarantee for successful treatment.  A doctor, preferably a neurologist (because CTS is a disease of the nerve), should be seen and told about conditions at work that may cause these symptoms. 

Treatment of CTS may initially involve rest, cold applications to the inflamed area, use of a wrist splint, and use of anti-inflammatory drugs.  More advanced cases of CTS are usually treated with surgery in order to relieve the pressure on the median nerve – a treatment that may not be successful and should be used as a last resort.  Permanent disability can result even with surgery, and the condition often recurs if the worker returns to the same job.  The outcome of any treatment also depends on other factors, such as the degree of nerve damage and the type of work the patient performs.

CTS is sometimes misdiagnosed as arthritis.  One way to distinguish between the two is to recognize that arthritis affects the entire hand whereas CTS affects only the first four fingers of the hand, not including the pinky.  Although medical conditions such as diabetes and rheumatoid arthritis may also cause the swelling associated with CTS, the condition is most frequently caused by repetitive wrist movements.

Carpal Tunnel Syndrome:  a “women’s problem”?

It is true that Carpal Tunnel Syndrome shows up more frequently in women than in men.  One of the reasons that women have a higher incidence of CTS may be that they are more frequently employed in jobs with higher exposures to the CTS risk factors.  Therefore, reducing exposures to physical risk factors through job modification will have a greater and more beneficial effect than gender-based job screening.

Government Regulations

There are no specific Federal OSHA standards to protect employees against Carpal Tunnel Syndrome.  OSHA, however, has cited employers based on the General Duty Clause, which states that each employer should provide a workplace “free from recognized hazards that are causing death or serious physical harm to his employees”.

OSHA requires employers to record occupational illnesses, such as Carpal Tunnel Syndrome, on the Log of Occupational Injuries and Illnesses (OSHA Form No. 200).  The injury and illness log identifies employees who were hurt on the job, along with his/her occupation, where the injury or illness occurred, a description of the injury or illness, the number of lost workdays, and the type of illness.  On the log, CTS cases should be listed under ‘disorders associated with repeated trauma’.  The worker and his/her union representative have the right, under OSHA, to see and copy this log. 

OSHA also allows employees and their representatives (with the employee’s written consent) to examine and copy their company-maintained exposure and medical records.  These records can help identify patterns of workplace injuries and illnesses. 

Most states recognize Carpal Tunnel Syndrome as a compensable disease.  Some have, however, begun to refuse compensation for repetitive trauma cases.  To verify if you are entitled to compensation, contact the Workers’ Compensation Department in your state.

What can the local union do?

You should contact your union representative and your local union safety and health committee so that they can study the problem and find solutions.  Several measures can be taken to identify the problem:

  1. Take a look at the employer’s Log of Occupational Injuries and Illnesses (OSHA No. 200 form or equivalent) and Employee Medical Records to recognize cases of CTS that may or may not have been recorded as workplace illnesses by the employer.
  2. Conduct a workplace walkthrough to identify jobs which place excessive stress on the wrists and forearms.  See the “How can you prevent CTS?” section for risk factors that contribute to CTS.
  3. Keep records of individuals who have the disease and where they work.
  4. Distribute a questionnaire about Carpal Tunnel Syndrome to the membership to gather information.  Call the International Brotherhood of Teamsters (IBT) Safety and Health Department to discuss the information that should be included in a survey for your workplace.