Carpal Tunnel Syndrome

May 25, 2017 | Healthcare Risk, Quality, & Safety Guidance

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Carpal tunnel syndrome is the most prevalent peripheral neuropathy, affecting approximately 3% to 6% of the general adult population (LeBlanc and Cestia). According to a 2016 U.S. Bureau of Labor Statistics (BLS) report, the incidence rate for carpal tunnel syndrome severe enough to require days away from work is 0.5 per 100,000 workers. The median time away from work is 28 days (U.S. BLS). The BLS statistics do not analyze carpal tunnel syndrome in healthcare workers per se. However, laundry workers, food preparation workers, and housekeepers--all integral parts of the hospital support staff--had among the highest incidence of carpal tunnel syndrome in BLS's analysis of various musculoskeletal disorders (MSDs) by occupation, at 1.2, 1.1, and 1.0 per 10,000 workers, respectively. Additionally, medical and clinical laboratory technicians had the second-highest incidence of carpal tunnel syndrome as reported by BLS, at 1.4 per 10,000 workers. (U.S. BLS). The Occupational Safety and Health Administration (OSHA) includes carpal tunnel syndrome in the broader classification of MSDs, one of the leading causes of lost workday injuries and illnesses (OSHA "Healthcare"). For information on symptoms and medical management of carpal tunnel syndrome, see Carpal Tunnel Syndrome Clinical Overview.

As with all occupational health issues, carpal tunnel syndrome has the potential to negatively impact both individual employees and the larger organization. Individual employee consequences include pain, diminished quality of life, and limits to physical activity both work-related and not. This impact reaches far beyond individual harm. Given healthcare's around-the-clock staffing and frequent personnel shortages, decreased productivity or loss of one worker has a far-reaching impact. Constant shuffling of work schedules to adjust for frequent workplace injuries takes a physical and emotional toll on every worker (Lucian Leape Institute). And of course, pain or injury to clinicians can seriously compromise patient safety.

Carpal tunnel syndrome in the healthcare workforce is of concern to the risk manager from several perspectives:

Onset of symptoms is typically insidious, in contrast to a definitive "work injury" such as a needlestick. Causation is often confounding, as most cases of carpal tunnel syndrome cannot be definitively attributed to a single factor and a specific cause may not be identified (AAOS "Carpel"; LeBlanc and Cestia). There are also many significant nonoccupational risk factors that increase the likelihood of an individual developing carpal tunnel syndrome. Some of these may be at least somewhat within the individual's control, but many are not. Also, a number of these risk factors are of a sensitive nature (e.g., obesity) and must be addressed carefully in the context of occupational health and wellness.

The economic costs associated with carpal tunnel syndrome are significant for both employers and individuals. Carpal tunnel syndrome is among the greatest drivers of workers' compensation costs, lost time and productivity, and disability (Burt et al.). A diagnosis of carpal tunnel syndrome predicts a longer duration of disability; in one study, fewer than 50% of workers diagnosed with carpal tunnel syndrome returned to work within one month of their injury (Cheadle et al.). Given these factors, it is understandable that workers with carpal tunnel syndrome experience a...

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