Clinical determination of work-relatedness in carpal tunnel syndrome

The purpose of this study was to determine the diagnosis and work-relatedness of carpal tunnel syndrome (CTS) using standardized criteria in a series of cases that were referred for an independent medical examination with a prior diagnosis of work-related CTS. using a liberal case definition, only 65% of cases had CTS. Using Wisconsin's worker's compensation criteria for work-relatedness, only 55% of the cases had any work-related disorder, while only 37% of the cases had work-related CTS. Duration of exposure was not significantly associated with work-related vs. non-work-related CTS. It was noted that the development of non-work-related CTS cases occurred uniformly across the various durations of exposure, as if unrelated to exposure. The symmetry of the disorder was unrelated to work-relatedness, provided that the symmetry of the disease matched the symmetry of the exposure. Personal characteristics, such as obesity and diabetes, revealed no statistically significant associations with work-relatedness or CTS. The present findings illustrate application of a standard procedure for determining the work-relatedness of CTS in a series of cases referred for independent medical examination. The results indicate that CTS is often, overdiagnosed and inaccurately linked to work. While the results may be limited by the method of determining work-relatedness, the findings indicate the importance of careful consideration of criteria for CTS and work-relatedness. When such an approach is taken, more targeted clinical management of the patient and appropriate intervention in the workplace should result.