Sindrome De Tunel Carpiano

CLINICAL REVIEWS

Carpal Tunnel Syndrome As an Occupational Disease
Stephanie Y. Kao, MD, MPH
Background: Symptoms related to carpal tunnel syndrome (CTS) represent common patient complaints for many primary care physicians. However, there is a surprising lack of guidelines on diagnosing occupational CTS readily accessible to primary care physicians. This article aims to fill part of that voidby reviewing historical aspects of occupational CTS, leading up to more current epidemiologic studies of the association of CTS with occupational ergonomic risk factors. Methods: The English medical literature was reviewed on the relationship between CTS and occupational ergonomic risk factors. Recent legislative initiatives are discussed. Guidelines of diagnosing and managing occupational CTSare outlined. Results: Many studies are divided regarding whether CTS is associated with highly repetitive/forceful/ vibration work. However, a subset of patients presenting with symptoms related to CTS probably has occupational CTS. These patients can be objectively diagnosed and successfully treated and are able to return to work. Conclusions: By being armed with knowledge regarding the backgroundof CTS and by following simple diagnosis and treatment guidelines, the family practitioner should be able to manage many patients presenting with work-related CTS. (J Am Board Fam Pract 2003;16:533– 42.)

Carpal tunnel syndrome (CTS) is the most well known nerve entrapment syndrome. Involving the median nerve, it is often described as an occupational disease and claimed as a basis for worker’scompensation. To provide a perspective helpful in understanding the issues central to occupational CTS, this review will focus on the history of and aspects of epidemiologic research relating to occupational CTS. Armed with such knowledge, physicians will be better prepared to establish guidelines useful in determining whether CTS is directly and solely attributable to a patient’s occupation.

AHistorical Perspective
The need for occupational health as a field to prevent and treat occupational injuries and diseases has long been recognized, especially after the Workman’s Compensation Act was first established in 1911. This law was a landmark in establishing the

Submitted, revised, 5 March 2003. From the Department of Occupational/Environmental Medicine, Jeanes Hospital-TempleUniversity Health System, Philadelphia, Pennsylvania. Address correspondence to Stephanie Y. Kao, MD, MPH, Jeanes Physicians’ Office Building, Suite 201, 7500 Central Avenue, Philadelphia, PA 19111 (e-mail: omskao@yahoo.com).

need for safe working conditions and employment practices.1 It has its roots in abusive employment practices and the tragedy of workers injured on the job who suffered not onlyfrom the injury but also from the loss of livelihood and ability to pay for the required medical care and provide for their families. Before the passage of the law, to recover the cost of medical care and lost wages from the employers, workers generally bore the responsibility of proving not only that the disease/injury was work-related but also that the employer’s negligence directly caused theinjury. This burden of proof required workers to hire costly legal representation and seek the corroborating testimony of coworkers who were often unwilling or uncooperative because of intimidation and the fear of losing employment themselves. As the result of factors such as these, less than one third of employees who brought negligence suits against employer received redress. The Workman’sCompensation Act was therefore established as a compromise, “no-fault” solution: employers are required to pay for the medical care expenses of employees for work-related injuries or illnesses and reimburse part of each injured worker’s lost wages. In return, employees waive the right to payments for pain and suffering.

Carpal Tunnel Syndrome

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Any worker who suffers from occupational CTS...