Carpal Tunnel

Carpal Tunnel: Work or Not Work-Related? What’s Really Important…

I’ve read recent Linked In Work Comp Analysis Group comments regarding  Daniel Miller’s posting, “Carpal Tunnel Syndrome Often Misdiagnosed; Not Work-Related” with interest.  Obviously there is conflicting data and many opinions.

As an ergonomist-job analysis specialist and a 30-yr work-injury treating physical therapist with reasonable knowledge of the science and physiology as well as experience regarding mechanism of injuries typically called “carpal tunnel”, there is no question that repetitive motion to the extent called for in many job “causes” increased soft tissue friction, fatigue, inflammation, swelling and associated “mechanical-overcrowding” of structures, pain of whatever tissue or area involved.  In addition, surrounding body areas will experience supporting muscle fatigue, reactive postures compounding the problem.

These multiple variables cause diagnostic problems that most treaters attempt to oversimplify.  For example the common assumption of “carpal tunnel” with typical ineffective rehab treatment, surgery, and questionable outcomes, while ignoring other potential causes such as the other areas of the “triple-crush” chain (elbow, thoracic-outlet, cervical) for fear of “expanding the injury” an losing credibility or favor with referrers or payers.  An alternative would be to courageously address and educate on the underlying poor cervical posture will often eliminate the complaints of finger numbness and tingling and encourage better habits that will minimize future problems.

There is no doubt that “life-style” is a significant risk factor including not just additional personal time on the computer, smartphone, or tablet, but other common health risks such as diabetes, obesity, hypertension, lack of exercise, diet, etc…  These are also specific risk factors for musculoskeletal injury and conditions.

What is so sad is that despite the monstrous costs, incredible confusion and frustration including the mentioned scientific evidence that “carpal tunnel” is NOT work-related (although I obviously disagree in that generalization); despite all this:  Employers and their representatives continue to ignore the simple and common sense approaches to PREVENTING this conundrum.   Here are two that come to mind:

1. Legally and appropriately SCREEN-OUT new hire candidates with signs and symptoms of existing (pre-existing) repetitive motion conditions.  Yes, it is entirely legal and defensible when performed according to ADAAA/EEOC and state guidelines and RECOMMENDATIONS.  Studies have shown that:

  • 1/3 of CT cases occur in the first year of employment
  • 15% occur in the first 3 months of employment
  • Resulting in the new employer  paying for the previous employer’s problem (or the employee’s personal pre-existing non- work-related condition)

2. Implement early discomfort detection and treatment programs in line with OSHA guidelines and RECOMMENDATIONS. Treat employees as well as their ergonomic concerns and opportunities to interact and intervene BEFORE the inevitable “claim” and resulting antagonistic and costly sequelae.

Notice I didn’t say, “Go out and buy expensive ergonomic workstations for everybody in the company.”  Obviously very costly and it doesn’t help.  But don’t continue to hide your head in the sand or wring your hands and complain about these problems when there are simple and effective solutions.


  1. Don’t hire your next claim. Legally SCREEN-OUT those with pre-existing conditions that make them at risk or impending and significant harm to themselves or others.  Don’t buy trouble.
  2. Get expert advice on reasonably mitigating common injury mechanisms including such simple alternatives as: lifting with 2 people instead of one, job rotation-(switch to the other side of the assembly line 4 times per day, schedule switches between different machines, tasks, etc…), pre-shirt and in-shirt stretching and general fitness-type exercise to get the blood and lymph moving from problem areas
  3. Implement early detection and OSHA “first-aid” treatment programs.


Hundreds of the most well-known companies are using these simple methods with positive and documentable results.  With the high costs of each injury, preventing or mitigating just one will easily pay for all the above-mentioned programs with plenty left over.  Feel free to contact me for documentation or further information.


Terry Lawson, PT, CAE