Carpal tunnel syndrome is a type of repetitive stress injury characterized by pain, paralysis, or weakness in the wrist area. This condition is caused by nerve compression that passes through the carpal tunnel in the wrist. Carpal tunnel syndrome, or CTS, is the single most reported medical condition, accounting for nearly half of all work-related injury claims.
The following are some CTS statistics compiled from the Bureau of Labor Statistics and the Occupational Safety & Health Administration:
- Around 900,000 cases of carpal tunnel syndrome occur each year.
- Carpal tunnel syndrome causes workers to miss an average of 31 days per incident; the average for all other repetitive stress injuries is 23 days, while the average for all other injuries is only nine days.
- Workers’ compensation claims for carpal tunnel syndrome can cost anywhere from $20,000 to $100,000 (some cases involve more).
- Only 23% of people who have had surgery for carpal tunnel syndrome are able to return to work.
- Approximately 36% of patients with carpal tunnel syndrome require ongoing treatment that lasts for an indefinite amount of time (called “unlimited medical treatment”).
- “Carpal tunnel release” procedures help to free the compressed nerve in patients with carpal tunnel syndrome. However, they have a high failure rate of about 57%.
- Each year, there are around 230,000 CTS surgeries. Of all musculoskeletal disorder surgeries, only back surgeries have higher numbers.
- As a result of the long recovery time and persistent symptoms, CTS is usually referred to as an “illness” rather than an accident.
Occupations with High Risks of Carpal Tunnel Syndrome (Greatest Risk to Lowest):
- Cafeteria workers and cooks
- Electrical power line installers and repairers
- Personnel involved in construction and maintenance (including painters)
- Painting, construction, and maintenance
- Highway workers
- The worker who cuts metal, solders, brazes, and welds
- Diesel engine mechanics and specialists (buses and trucks)
- Housekeepers and maids
- Industrial machine mechanics
- Freight laborers and stockers
- Auto mechanics and service technicians
- Public bus drivers
- General maintenance/ repair workers
- Installers/repairers of telecommunications equipment (cable, internet, etc.)
- Janitors
- Food prep workers
- Truck and heavy tractor-trailer drivers
- HVAC specialists (Heaving, ventilation, and air-conditioning/refrigeration)
- Correctional officers
- Carpenters
With a prevalence of between 2.7 and 5.8 percent in the general adult population, carpal tunnel syndrome is the most common entrapment neuropathy.
Symptoms
Typically, pain and paresthesias associated with carpal tunnel syndrome are located along the distribution of the median nerve (i.e., thumb, index finger, and middle finger). Occasionally, they can occur in all fingers but not on the dorsum or palm of the hand.
Median Nerve Palmar Distribution
It is possible for pain and paresthesia to radiate proximally into the forearm and even into the arm and shoulder. Patients may complain that their fingers are swollen and useless but do not have swelling. Patients may also report a loss of strength when gripping or performing certain tasks. Flick signs refer to a patient waking up with nighttime pain and shaking their hands or flicking their wrists in an attempt to alleviate the discomfort. The flick sign correctly predicts electrodiagnostic abnormalities in 93 percent of cases and has a false-positive rate of less than 5 percent.
The physician can ask the patient to trace their hand on paper or use a hand symptom diagram to identify patterns of symptoms that indicate carpal tunnel syndrome. There is a 64 percent sensitivity for carpal tunnel syndrome in the classic and probable patterns on a hand symptom diagram. Roughly 9 percent of patients with an unlikely pattern have the condition.
In guiding the family physician to a proper diagnosis, a hand symptom diagram can be helpful. Below are examples of classic, probable, and unlikely patterns. At least two of the digits 1, 2, or 3 are affected in the classic pattern. The condition permits symptoms on the fourth and fifth fingers, wrist pain, and radiating pain proximal to the wrist, but not on the palm or dorsum of the hand.
The probable pattern has the same symptom pattern as the classic pattern, except palmar symptoms are not allowed unless the symptoms are restricted solely to the ulnar aspect. One of the digits 1, 2, or 3 is involved in the possible pattern. In the unlikely pattern, none of the symptoms are present in digits 1, 2, or 3.
Physical Examination
Acute injury to the tissue, including the median nerve, may be the cause of ecchymosis or abrasion on the wrists and hands. Bony abnormalities, such as boutonniere deformity, swan neck deformity, and ulnar deviation of the wrist indicate rheumatoid arthritis, whereas carpal or distal phalanx bossing indicates osteoarthritis. There is usually only thenar atrophy with severe, chronic carpal tunnel syndrome, and it is more commonly associated with other neuropathy syndromes and carpometacarpal arthritis.
There may be hypalgesia (a reduced ability to perceive painful stimuli) along the palmar aspect of the index finger in comparison to the ipsilateral little finger in the affected hand. With a caliper, you can perform a two-point discrimination test, in which the inability to distinguish points less than 6 mm apart is considered abnormal.
On strength tests, the abductor pollicis brevis may show notable weakness. The physician can observe this weakness by asking the patient to raise their thumb perpendicular to the palm as they apply downward pressure on the distal phalanx, resisting thumb abduction.
Can I Collect Workers Compensation for Work-Related CTS?
Most likely, yes. The United States Department of Labor has recognized CTS as the “chief occupational hazard of the ’90s – disabling workers in epidemic proportions.” Still, as with any other work-related injury, you should:
- Report your injury to your employer as soon as possible. Some states require notice within 2-30 days after the injury. As soon as you realize an injury or illness resulted from your job, you must report it.
- Make sure you get medical treatment and follow your doctor’s instructions.
- You should file a claim with your employer’s insurance provider. Your employer must provide an insurance claim form.
- Save all copies of paperwork throughout the entire process.
Treatment
Carpal tunnel syndrome should be managed according to its severity. Patients with mild to moderate carpal tunnel syndrome have normal to mildly abnormal nerve conduction studies and electromyograms. Severe disease symptoms are marked by worsening clinical symptoms and clearly abnormal electrodiagnostic studies. In patients with mild disease, six weeks to three months of conservative treatment is reasonable.
A cock-up and neutral wrist splint, oral corticosteroids, and local corticosteroid injections are considered first-line treatments. Patients with moderate to severe disease or persistent symptoms despite conservative treatment may be referred for surgical evaluation.
Do I Need a Lawyer for Help With a Carpal Tunnel Syndrome Claim?
The most common type of work-related injury is carpal tunnel syndrome. It can affect a person’s ability to work for several weeks or months. You may wish to hire a personal injury lawyer if you need help filing an insurance or workers’ compensation claim. Your lawyer can guide you through the filing process.
They can represent you in court if you wish to file a lawsuit to recover legal damages. If you need compensation for your carpal tunnel syndrome claim, use LegalMatch today to find the right personal injury lawyer for your needs.
