Carpal tunnel syndrome (CTS) is estimated to be the most common peripheral neuropathy. When occurring as a result of occupational exposures, the term “work-related carpal tunnel syndrome” (WRCTS) may be applied. WRCTS is part of a group of disorders known as work-related musculoskeletal disorders (WMSDs). WMSDs represent a large public health burden that continues to grow. Workers from various economic sectors are affected, including clerical work, construction, food preparation, health care, product fabrication, etc. In 2009 alone, 30,236 WMSDs were reported in Ontario workplaces, representing nearly half of all occupational illness cases reported to the Workplace Safety and Insurance Board of Ontario (WSIB)1.

Among WMSDs, WRCTS is one of the most disabling and costly, representing a major cause of lost time and productivity. According to the U.S. Bureau of Labor Statistics, across all economic sectors, CTS results in a median 21 days away from work2. Compare that to 30 days for fractures, and 20 days for amputations2. Consequently, medical management of WRCTS should emphasize disability prevention, early case identification and intervention, as well as control of occupational exposures.

Also, it is important to recognize that any presenting complaint has the potential to be work-related so medical students should practice taking an occupational history during every medical encounter.

Case Study:
Image Source: Victoria Squissato

A 45 year old right-handed woman who works in an office presents with pain and tingling paresthesias in the right hand, which she's had for several months. The pain radiates from the wrist mostly to the first three fingers, but often to the whole hand and sometimes to the elbow. 

Things to consider:

What is your approach?
How would you take an occupational history?
What typical findings on physical examination would help you reach a specific diagnosis?

1Supplemental Statistics to the 2009 Annual Report. Workplace Safety and Insurance Board.
2U.S. Bureau of Labor Statistics. Economic News Release: Occupational Injuries and Illnesses by Selected Characteristics for State and Local Government News Release. Accessed on July 27, 2011.