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S02-4 Personal, psychosocial, and biomechanical risk factors for work disability from carpal tunnel syndrome: a pooled prospective study
  1. Carisa Harris Adamson1,2,
  2. Ellen Eisen2,
  3. Kurt Hegmann3,
  4. Matthew Thiese3,
  5. Ann Marie Dale4,
  6. Bradley Evanoff4,
  7. Jay Kapellusch5,
  8. Arun Garg5,
  9. Stephen Bao6,
  10. Barbara Silverstein6,
  11. Fred Gerr7,
  12. David Rempel1
  1. 1University of California, San Francisco, San Francisco, USA
  2. 2University of California, Berkeley, USA
  3. 3University of Utah, Salt Lake City, USA
  4. 4Washington University School of Medicine, St Louis, USA
  5. 5University of Wisconsin, Milwaukee, USA
  6. 6National Institute for Occupational Safety and Health, Olympia, USA
  7. 7University of Iowa, Iowa City, USA


Introduction Carpal tunnel syndrome (CTS), the most common peripheral entrapment neuropathy, results from compression of the median nerve at the wrist that leads to more disability than most other upper extremity disorders (Foley 2007).

Method 4321 workers were followed up to 7 years with repeated symptom surveys and nerve conduction studies to identify prevalent and incident cases of CTS (N = 318). Work disability was derived from SF12 and quickDASH questionnaires, and defined as symptom driven: (1) change in work pace, (2) lost time, or (3) job change. Workplace psychosocial exposure was assessed using the Karasek Job Content Questionnaire. Job level biomechanical exposures were time weighted averages of peak hand force, HAL scale, total repetition rate, forceful repetition rate,% time all hand exertions, and% time in forceful hand exertions (≥1 kg-pinch or ≥4 kg-grip). Adjusted hazard ratios were estimated using Cox proportional hazards models.

Results Being female was associated with increased work disability(HR = 1.75; 95% CI: 1.23–2.5) as was having rheumatoid arthritis(HR = 1.85; 95% CI: 1.04–3.26). High job strain compared to low job strain more than doubled the rate of disability (HR = 2.38; 95% CI:1.03–5.51). The HAL Scale (HRmiddle = 3.91;95% CI: 1.82–8.38;HRupper = 3.20; 95% CI: 1.43–7.19), total repetition rate(HRmiddle = 2.30; 95% CI: 1.15–4.58; HRupper = 2.58; 95% CI: 1.23–5.38),% time in forceful exertions (HRupper = 2.03; 95% CI: 1.02–4.05) and% time in all exertions (HRupper = 2.53; 95% CI: 1.17–5.43) were associated with job change. Forceful repetition rate was associated with lost time (HRmiddle = 2.46;95% CI: 1.11–5.48; HRupper = 1.86; 95% CI: 0.91–3.83) and the HAL Scale (HRmiddle = 1.97; 95% CI: 1.24–3.12) and % time in all exertions (HRupper = 1.94; 95% CI: 1.17–3.24) was associated with pace change.

Discussion These results indicate that personal, workplace psychosocial and biomechanical factors are associated with an increased rate of work disability from CTS and should be taken into account for secondary prevention programs.

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