Carpal tunnel syndrome: classic clinical symptoms and electrodiagnostic studies in poultry workers with hand, wrist, and forearm pain

Carpal tunnel syndrome (CTS) has been linked to repetitive motion only in the past 15 years or so. Often the studies supporting this proposed link have not used strict clinical criteria and have rarely had electrodiagnostic confirmation of the diagnosis. In order to better assess the actual incidence of CTS in patients in a repetitive-motion job who had pain, numbness, tingling, or all three in the hand, wrist, or forearm, we examined 112 consecutive charts of such patients referred to a consulting neurologist for a possible diagnosis of carpal tunnel syndrome. Thirty-five percent of those patients had either classic clinical symptoms or positive electrodiagnostic results, but only half of these (17% of the total) actually had both. It is thus suggested that the incidence of CTS in patients doing repetitive motion may have been overestimated in the literature, and very strict clinical and electrodiagnostic criteria should be used before a diagnosis of carpal tunnel syndrome is made or surgery is contemplated in these patients.

Assessment of aerobic power in chronic pain patients before and after a multi-disciplinary treatment program

Physical exercise is widely used in the treatment of chronic pain patients, and direct measurement of physical capabilities is needed to objectively document change. In this study, 46 residential chronic pain patients undergoing treatment at a multidisciplinary rehabilitation center were administered a cycle ergometer graded exercise test, using a Medical Graphics CAD/NET exercise system, to measure aerobic fitness and other physiological parameters before and after the four-week treatment program. Patients evinced highly statistically significant changes in all major indices of cardiopulmonary functioning, including MAXVO2 and METS, and a measure of lower body power (WATTS). Possible mechanisms underlying such dramatic changes in this short time period include improved physical fitness, learning or desensitization to symptoms associated with exertion, and improved effort. Documenting treatment-related changes is important, and metabolic exercise testing provides an objective method for assessing changes in functional capacities. Such changes may have important practical implications for these individuals. The importance of assessing and improving aerobic fitness in chronic pain populations is discussed.

Median nerve latencies in poultry processing workers: an approach to resolving the role of industrial "cumulative trauma" in the development of carpal tunnel syndrome

Much attention has been paid recently to a claimed connection between stressful repetitive motion at the work site and the development of carpal tunnel syndrome. Little of this has made its way into the widely appreciated medical literature. To try to discover a reasonable basis for the presence or absence of such an association we measured median nerve motor and sensory latencies in a random sample of employees in a medium industry of the kind thought to be associated with the emergence of carpal tunnel syndrome. A control group made up of applicants for positions of this sort was used. No association between employment experience and the development of slowing of the median motor latency was encountered in any group. No association was discovered for sensory latencies for men or for the left hands of women. A small association was discovered for the sensory latency in right hands of long-term female employees. This was similar in magnitude to the increased risk of prolongation associated with aging. Our data provide very little evidence for the concept of cumulative trauma as a prominent cause of carpal tunnel syndrome in American industry. These results are discussed in light of the recent Australian false epidemic of repetition strain injury.