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Carpal tunnel syndrome and hand-arm vibration syndrome. A diagnostic enigma
1Department of Occupational and Environmental Health, St Michael's Hospital, Toronto, Ontario.
Objective:
This article serves to draw attention to the risk to workers from repetitive strain and hand-arm vibration in the workplace and to the diagnostic difficulty in distinguishing carpal tunnel syndrome from the sensorineural component of hand-arm vibration syndrome.
Data Sources:
Journal publications, textbooks on hand-arm vibration, guidelines of the International Standards Organisation, and European Economic Community directives.
Study Selection:
Recent reports and current standards.
Conclusion:
Carpal tunnel syndrome can be distinguished from hand-arm vibration syndrome if all factors--anatomical, associated physiological and medical conditions, work exposure history, and ulnar nerve involvement--are evaluated. In some circumstances, the conditions may be present together. A correct diagnosis is crucial because surgical intervention is not usually beneficial if hand-arm vibration exposure has been a contributing factor. The further reduction in grip strength may constitute a serious additional handicap for a worker.