1. Atcheson, S.G., “Carpal tunnel syndrome: Is it work related?” AOHP Journal, 1999; 27-31.
Does not believe work causes CTS. He thinks health factors are paramount.
2. Atcheson, S.G., Ward, J.R., Lowe, W. “Concurrent medical disease in work-related carpal tunnel syndrome.” Arch Intern Med, 1998; 158:1506-1512.
Concludes CTS tends to occur in people with lost of other physical problems. Therefore, whether work related or decline in general health becomes the unanswered question.
3. Danta, G. “Familial carpal tunnel syndrome with onset in childhood.” J Neurol, Neurosurg, and Pysch, 1975; 38:350-355.
Suggests a specific pattern of CTS presentation in a large family tree with multiple members diagnosed with CTS.
4. Editorial, “Occupational disorders-The disease of the 1990s: A challenge or a bane for hand surgeons.” JHS, 1992; 193-194.
5. Feldman, R.G., Travers, Hyland, P., Chirico- Post, J., Keyserling, W.M. “Risk assessment in electronic assembly workers: Carpal tunnel syndrome.” JHS, 1987; 12: 849-855.
This without a doubt one of the most poorly performed, flawed studies that has ever been reported on attempting to tie workers and their tasks into development of CTS. Not only did the authors have a very low inclusion rate in evaluating workers at a given plant, i.e. just over 500 in a plant with over 700 workers, they then tested only a very small segment of them using an incomplete form of a test for entrapment neuropathy. Subsequent follow exam a year thereafter, they had further sampling error, testing 25% less of the already meager tested worker population. The workers were not matched for age, sex, handedness, or hours at work or duration of employment. The authors then attempted to ascribe problems with their job and the development/progression of signs and symptoms of carpal tunnel syndrome to their tasks. In the discussion section of their article, the authors then went on not only to make conclusions that were not validated by their study format, but they went on to make many grossly erroneous treatments regarding Raynaud’s syndrome and CTS, etc. This article has really no value for the educated reader, other than to demonstrate the severity of flaws that occur in typical study suggesting an occupational causation of CTS and/or the potential benefits of ergonomic modifications. One must be ever vigilant to not accept information from this type of poor quality source.
6. Frontlines. “Study to probe workplace injuries.” AAOS Bulletin, 1999; 18.
7. Hadler, N.M. “Arm pain in the workplace.” JOM, 1992; 113-119.
Dr. Hadler relates awareness of “cumulative trauma disorders” to be related to OSHA and the NIOSH contends that tasks relatedness to regional upper extremity discomfort is unproved. Image is illusive and empirical remedies remain empirical. He contends that the term cumulative trauma disorder has no home in the clinical lexicon. Data presented regarding the incidence of carpal tunnel syndrome is grossly erroneous based upon hesitation of other incorrect information in the medical literature. He goes on to quote the literature as overwhelmingly affirming that when regional arm pain is felt to be intolerable. The psychosocial variables in the work environment are far more likely to be responsible than the physical demands of the tasks.
8. Hadler, N.M. “Repetitive upper-extremity motions in the workplace are not hazardous.” JHS, 1997; 22A: 1.
9. Hadler, N.M. “Work-related disorders of the upper extremity Part I: Cumulative Trauma Disorders-A critical review.” Occup Prob Med Pract Med Public Inc., 1989; 4:2.
10. Hadler, N.M. “Work-related disorders of the upper extremity Part II: Can shoulder periarthritis, thoracic outlet syndrome, or carpal tunnel syndrome be ascribed to repetitive usage?” Occup Prob Med Pract Med Public Inc, 1989.
Dr. Hadler relates awareness of “cumulative trauma disorders” to be related to OSHA and the NIOSH contends that tasks relatedness to regional upper extremity discomfort is unproved. Image is illusive and empirical remedies remain empirical. He contends that the term cumulative trauma disorder has no home in the clinical lexicon. Data presented regarding the incidence of carpal tunnel syndrome is grossly erroneous based upon hesitation of other incorrect information in the medical literature. He goes on to quote the literature as overwhelmingly affirming that when regional arm pain is felt to be intolerable the psychosocial variables in the work environment are far more likely to be responsible than the physical demands of the tasks.
11. Hadler, N.M., “The roles of work and working in disorders of the upper extremity.” Bailliere Clinical Rheumatology, 1989; 3: 1: 121-141.
The essence of Dr. Hadler’s article is that we are witnessing a phenomenon wherein a segment of society (the workers) is being asked to maintain vigilance for regional musculoskeletal illness of the upper arm and hand. The employers and the worker’s compensation administrators are hearing the shrill cry of injury while surgeons and physicians are being caught unaware by “injured workers” and responding as if they were treating patients in their customary role, rather than often angry “injured” workers. He presented data upon which the work relatedness is alleged and he espouses his assent with that concept. He concludes that he is not convinced that workers with regional musculoskeletal illness of the upper extremity are injured, but he also convinced that some form of usage could exacerbate the symptoms of some of the regional illness. He felt that ergonomic modification might have some utility in palliating some symptoms. However, he points out that job flexibility, increased wages, job rotations, and enlightened management are other options and the choice is negotiable.
12. Kirschbert, G.J., Fillingim, R., Davis, V.P., Hogg, F. “Carpal tunnel syndrome: Classic clinical symptoms and electrodiagnostic studies in poultry workers with hand, wrist, and forearm pain.” Southern Med J, 1994; 87:3: 328-330.
Unfortunately, there is a lack of careful clinical examination documentation for evaluation for the ulnar nerve at the cubital tunnel, etc. is not included nor is there any mention of EMG results, if they were actually even performed in addition to the NCS. This typifies the disparity in clinical experience in treating versus simply processing people with symptoms and limitations of a one-time visit to evaluate.
13. Millender, L.H., “Occupational disorders-The disease of the 1990s: A challenge or a bane for hand surgeon’s.” Editorial, JHS, 1992; 17A: 2:193-194.
Dr. Millender concluded that today we face a new challenge one that combines the mind and the body. The editorial relates to the concept of work relatedness of musculoskeletal and the fact that patients who typically fail to respond to treatments have underlying psychosocial confluence more than anything else. In quoted, psychiatrists explain chronic pain is equivalence of fear, anger, frustration and depression. He also concluded that as soon as one realizes that many of the patients have psychosocial factors that impede their recovery, one may begin to solve the problem. He went on to state that there is no area in medicine in which sympathetic listening followed by compassionate questioning is more important. The references listed probably are well worth looking into for the clinician doing a lot of work comp. A Must Read.
14. Nathan, P.A., Keniston, R.C., Myers, L.D., and Meadows, K.D. “Longitudinal study of median nerve sensory conduction in industry: Relationship to age, gender, hand dominance, occupational hand use, and clinical diagnosis.” JHS, 1992; 17A: 850-857.
15. Nathan, P.A., Keniston, R.C., Meadows, K.D., “Keyboarding as a risk factor for carpal tunnel syndrome: Comparing clerical workers to managers in eight industries.” Unpublished-available by writing to them.
In their unpublished study in Oregon, they compared the prevalence of slowing, probable CTS, and definite CTS in 319 managers and 213 clerical workers utilizing electrodiagnostic studies in all those evaluated. They found no significant difference in prevalence of slowing, probable CTS, or definite CTS between the managers and the clerical workers in 8 combined industries. There was also no trend for increase in the prevalence of slowing, probable, or definite CTS with increase of number of hours of keyboard use per day. In fact, those keyboarding less than 1 hour per day actually had the highest prevalence of all 3 factors. In this series there was also no gender difference in the prevalence of slowing despite more keyboarding by the female workers. They concluded that there was no difference between managers and clerical workers in the risk for nerve conduction abnormalities for symptoms that confirm carpal tunnel syndrome. They also found no trend for risk increase with more time spent keyboarding. A Must Read.
16. Nathan, P.A., Meadows, P.A., Doyle, L.S., “Occupation as a risk factor for impaired sensory conduction of the median nerve at the carpal tunnel.” JHS, 1988; 13B: 2: 167-170.
Looking at 471 industrial workers from 27 occupations in 4 industries, slowing of the median sensory conduction was found in 39% of the subjects (26% of the hands). There was no consistent association between the type and level of occupational hand activity in the prevalence or severity of slowing. In addition, they noted the prevalence of bilateral slowing of conduction of the median nerve was not associated by manual occupational hand activities. The length of employment of the subjects in this industry did not influence the occurrence of impaired sensory conduction.
17. Nathan, P.A., et al, “Natural history of median nerve sensory conduction and industry relationship to symptoms of carpal tunnel syndrome in 558 hands over 11 years.” JHS, 1988; 13B: 2: 167-170.
This is a follow up study of “Occupation as a risk factor for impaired sensory conduction of the median nerve at the carpal tunnel.” There was a trend for mean sensory latency slowing to increase and among individual hands, nerve conduction abnormalities tended to persist (82% 11 year persistence), while symptoms are said to fluctuate widely. They found that most of those with slowing of the median conduction did not develop symptoms or CTS. They concluded that changes in conduction status of the median nerve occur naturally with increasing age, but did not necessarily lead to symptoms or CTS.
18. Vender, M.I., Heights, A., Kasdan, M.L., and Truppa, K.L. “Upper extremity disorders: A literature review to determine work-relatedness.” JHS, 1995; 20A: 534-541.
Not worth reading except to show how poor the literature has been with regard to suggesting work relatedness.
19. Weiland, A.J., “Repetitive strain injuries and cumulative trauma disorders.” Editorial, American Journal of Hand Surgery, May 1996; 21A: 3: 337
Dr. Weiland, the then president of the American Society for Surgery of the Hand (ASSH) points out that correct diagnosis needs to be utilized in dealing with people complaining of problems occurring on their job. In cases where a correct diagnosis cannot be made with certainty, physicians are better to not ascribe an arbitrary “tendonitis” or tenosynovitis diagnosis rather than counseling the person to have pain or fatigue that may or may not be related to the occupation without definite diagnosis.
20. Werner, R.A., Franzblau, A., Albers, J.W., Armstrong, T.J., “Median mononeuropathy among active workers: Are there differences between symptomatic and asymptomatic workers?” Am J Industrial Med, 1998; 33:374-378.
Another worthless article.