CARPAL TUNNEL SYNDROME, CUMULATIVE TRAUMA

Among the most common problems currently seen in the workplace are those injuries due to cumulative trauma from repetitive motion. Repetitive activities are found in many occupational settings, including traditional manufacturing. Examples include work on an automobile assembly line or in food processing plants, such as a chicken processing facility. Repetitive activities are also found in the office environment, where repetitive trauma results from the prolonged use of keyboards. Repetitive trauma and carpal tunnel syndrome can also be seen in nonemployment situations due to underlying disease processes such as diabetes, or to repetitive activities such as knitting and sewing.

Cumulative trauma problems tend to effect joint surfaces or the neurological system. Joint surfaces may be worn to the point of causing pain. Carpal tunnel syndrome, a common problem, arises because the nerve, artery, and vein supplying the hand all travel through a narrow space in the wrist (the carpal tunnel), which can become irritated and swollen from regular and repetitive use. The most likely structure to be affected is the nerve, and pain is the most common presenting symptom. Other joints which may be affected from cumulative trauma are the elbow, shoulder, knee, and ankle. Repetitive activities or professional athletics are frequent causes.

There are several ways that cumulative trauma problems can be managed. Ideally, the repetitive activities causing the difficulty should be altered. This can be done in workplace settings, such as on an automobile assembly line, where workers can shift specific job activities every few hours and rest certain body parts while using others. For other settings or tasks that do not allow for such rotation, such as keyboarding, workers should be given regular rest breaks from these activities. When there is no possibility of altering the specific nature of the job there are supportive items that can be used. The use of splints, wrist rests, or other devices to optimize the positioning of the hand, and the adjustment of furniture height, may help in preventing and ameliorating carpal tunnel syndrome. Medication is sometimes used, as well, with variable results.

Should the problem persist, or worsen to the point where nerve damage can be documented by electrophysiological testing, then surgery may be necessary to open up the carpal tunnel space to relieve pressure on the nerve involved.

Congressional restrictions on collecting data about these difficulties has made it difficult to determine how widespread carpal tunnel syndrome and other cumulative trauma problems may be. There also has been a delay in the implementation of workplace regulations to help relieve these problems. After many years of planning and discussion, ergonomic regulations were put in place by the federal government, but quickly taken back, with additional plans made for further study of these issues.

Arthur L. Frank

(see also: Occupational Disease; Occupational Safety and Health )

Bibliography

Weebs, J. L.; Levy, B. S.; and Wagner, G. R. (1997). Preventing Occupational Disease and Injury. Washington, DC: American Public Health Association.