Carpal tunnel syndrome: Targeting biomechanical exposure may be the key

Personal, biomechanical, psychosocial, and organizational risk factors for carpal tunnel syndrome: A structural equation modeling approach
Roquelaure, Y., Garlantezec, R., Evanoff, B., Descatha, A., Fassier, J., & Bodin, J.

Level of Evidence: 2b

Follow recommendation: 👍 👍 👍

Type of study: Aetiologic

Topic: Carpal tunnel syndrome - Demographic, biomechanical, psychological, and work pace factors

This prospective study assessed the effect of age, gender, BMI, work-related biomechanical exposure, work-related psychological distress, and machine- vs customer-paced jobs on carpal tunnel syndrome (CTS) development. The study included a large sample (n = 1367) of participants involved in several different occupations. Work-related biomechanical exposure was defined as repetitive or sustained wrist movements for prolonged periods of time, exposure to vibration hand tools, activities involving pinching, and work requiring physical exertion. Work-related psychological distress factors included the inability to make autonomous decisions. Working pace was either set by machine production (machine-paced) or dependent on customer demands (customer-paced). All of the participants were healthy at baseline. At follow up (average 5 years), 3.7% of sample (n =51) participants presented with symptomatic CTS (pain/paraesthesia in the 2nd and 3rd digit) and of these, 2.3% of sample (n = 32) presented with signs of CTS (positive on either wrist flexion and compression, carpal compression, Phalen, or Tinel test). The results showed that older age and female gender were risk factors for CTS in this cohort. Biomechanical exposure was the main risk factor leading to CTS. Work-related psychological distress (inability to make autonomous decisions) indirectly increased the risk of CTS by increasing biomechanical exposure. Both biomechanical exposure and psychological distress (inability to make autonomous decisions) were increased when involved in machine-paced jobs. Customer-paced jobs appeared to reduce biomechanical exposure and reduce psychological distress, which reduced the risk of CTS. No direct link was found between psychological distress and CTS development. BMI was not associated with an increased risk of developing CTS. Clinical Take Home Message: Biomechanical exposure appears to be a key risk factor in the development of CTS. Hand therapists might liaise with the workplace supervisor to find strategies to limit extreme wrist position, repetitive motions, use of vibration hand tools, pinching activities, and physical exertion in patients presenting with CTS, or to prevent the development of this condition. Increasing the number of breaks or reducing the work load may be effective strategies. Hand therapists should be aware that workers in a machine-paced job are at higher risk of developing CTS.