Carpal tunnel syndrome (CTS) is the most commonly diagnosed nerve compression disorder in the working population in the United States and abroad — and the most expensive musculoskeletal disorder.  My team and I see attempts to relate CTS to all kinds of bodily injury claims…work-related or not.

However, as Shahriar Shahid notes in “The Economic Costs of Carpal Tunnel Syndrome in the Workplace,” the costs of CTS go beyond monetary losses.  Workers with the condition can no longer perform their duties and may have to change jobs and some “undergo painful procedures from which they never recover and may lose quality of life.”

The costs

No one doubts that carpal tunnel syndrome has a huge impact on U.S. businesses.  While the exact dollar cost of this injury is unknown, the expense to employers, workers, and insurance companies from carpal tunnel and other ergonomic workplace injuries can run into the billions. Shahid writes that between $2.7 billion and $4.8 billion per year is spent on the Medicare patient population alone.

Employers suffer indirect costs such as loss of productivity and time spent training new employees. Insurance companies and local governments bear a great deal of the economic burden as well.  Looking at data from 2011 to 1023, the National Council on Compensation Insurance and OSHA estimate that the direct cost of the injury would be $28,647.

The human hand has 27 bones, not including the sesamoid bone, the number of which varies between people, 14 of which are the phalanges (proximal, intermediate and distal) of the fingers and thumb. The metacarpal bones connect the fingers and the carpal bones of the wrist.

The indirect loss would be $31,511. The agencies project that a business would need total additional sales of $2,005,266 to pay for all these expenses.  While surgical costs vary regionally, these range between $2,445 to $5,354 depending on care from an ambulatory center or an acute care hospital.

Medical insights

The hand, wrist, arm and shoulder are used in almost every activity during work and at home. Constant use of the upper extremities increases the likelihood of injuries, strains and cumulative trauma, something we see virtually every day in claims and cases we review involving repetitive motion injuries.

A frequent type of work-related upper extremity disorder is entrapment neuropathy. The two most common neuropathies in the upper extremity are carpal tunnel and cubital tunnel.  If these conditions are treated early on, both may be resolved with conservative measures.  Surgical intervention may be necessary when conservative measures have failed or when the nerve is severely compressed.

  • Carpal tunnel involves the median nerve at the wrist level. Symptoms usually start with nocturnal tingling and sometimes pain, typically in the thumb, index, middle and one-half of the ring finger.  If severe enough, the person will experience motor impairment primarily seen in the muscle group at the base of the thumb.

     Risk factors in developing carpal tunnel are performing highly repetitive activities, prolonged forceful gripping and vibration, or poor or sustained postures.  Conservative treatment may include nonsteroidal anti-inflammatory drugs, injections, splinting and therapy interventions, such as ergonomics education for work and daily living, cardiovascular exercise, core/postural strengthening and neural glides.

  • Cubital tunnel involves the ulnar nerve at the elbow. The ulnar nerve is in a superficial location at the medial elbow, so it is vulnerable to external compression. Symptoms include pain, numbness in the ulnar side of the palm, small finger and half of ring finger and weakness with gripping, pinching, spreading fingers apart and holding them together.  Other common signs of cubital tunnel include Wartenburg’s sign (when the small finger cannot be held next to ring finger) and Froment’s sign (hyperflexion of thumb interphalangeal joint). Both of these signs are secondary to weakness of the musculature innervated by the ulnar nerve.

     Causes of cubital tunnel include repetitive/sustained elbow flexion (seen with prolonged holding of a phone) and pressure on the elbow (resting elbow on arm rest while driving long distances).  Conservative treatment includes elbow splinting, therapy (typically three-to-four weeks) with postural education, ergonomic positioning and range of motion, cardiovascular, core/postural strengthening and neural glides exercises.

Treatments and preventions

The clinician needs to understand the patient’s job demands and to consult with the employer. This ensures appropriate education on posture, workstation set-up and ergonomic tools available for use to provide the most favorable outcome.

Early intervention can help prevent an employee from suffering from carpal or cubital tunnel. Prevention of both diagnoses start with proper workstation ergonomics and decreasing risk factors.

Finally, remember the importance of having someone with the right medical training, experience and bottom-line attitude on your team.  For example, in non-workers comp claims in which CTS is alleged, we’ve found that the condition is extremely rare as being directly causally related, unless there is a significant, clearly documented trauma such as a fracture to the wrist.