Are you typing your way to Carpal Tunnel Syndrome?
Work-related musculoskeletal disorders (MSDs) are the primary cause of physical disability, today. Repetitive stressing of a body part to the point of injury takes time through the buildup of trauma 13. Office work and the fall out of long hours of uninterrupted keying, unsupported forearm posture, non-optimal location of the mouse, monitor height, and insufficient work surface and ergonomics incompatibility can result in different MSDs 13.
Most of us have heard the phrase carpal tunnel syndrome (CTS).
But most of us wait until it becomes an issue before trying to do something about it. This condition is characterized by pain, numbness, tingling or burning in the wrists. It often starts small, flies under the radar but can escalate pretty quickly and can often occur in one or both hands 1.
Statistics estimate that 3.8%- 4.9% of the general population are affected by CTS with more cases of the condition in women and peak prevalence occurring in the 5th decade of life 2.
The California Department of Public Health analysed worker’s compensation claims for CTS between 2007-2014 and found there was a total of 139,336 cases with incidence rates 3.3 times higher in women compared to men (8.2 cases vs 2.5 per 10,000) 3.
The impact of CTS on the workforce is enormous. In the United States, it is the most reported medical condition with around 900,000 cases and accounts for nearly half of all work- related injury claims.
“Workers affected by CTS miss an average of 31 days per incident compared to an average of 9 days for all other injuries. Staff compensation costs are also considerable for employers and range from $20,000 to $100,000” 4.
CTS Surgery & Treatment
Basically, for a condition that is mostly avoidable, a lot of issues are persisting and one could argue getting worse. CTS surgery is the 2nd most common after back surgery for musculoskeletal conditions with around 230,000 surgeries per year.
Over one third of people with CTS require continuous treatment for an indefinite period and it’s been reported that as many as 3 out of 4 workers who end up having surgery are unable to return to their previous jobs 4.
Who do you think are the most likely workers to be affected by this condition? Accounting for these large numbers may be attributed to the increase in desk workers, but maybe not.
Healthcare costs for CTS are estimated at 2 billion per year and the economic costs for business as a result of employee absenteeism, lost productivity and lost earnings are estimated to be much higher yet again 5.
The burden of CTS is so great, that it is now classified as an occupational disease - It is time to do something tangible and preventative about it.
The Risk Factors Involved With CTS.
Swelling or inflammation to some of the tissues within the joints of the hands does not occur by accident. Like most issues of this nature, it is largely preventative. CTS is also associated with chronic medical conditions such as diabetes, arthritis and thyroid diseases, again one may argue than these are all largely avoidable conditions as well. One patient group that is particularly at risk is pregnant workers due to increased swelling extremities and people with wrist fractures 6.
In relation to office workers, musculoskeletal disorders are more prevalent in staff who use computers in comparison to non- computer users 7 with high work strain and long duration use of the keyboard and mouse increasing the risk 8. Typing on a keyboard over an extended period is associated with CTS due to the repetitive finger motions and continuous muscle activation in the forearm 9. Intensive keyboard usage and strain from awkward postures has also been associated with CTS in office workers 10,11.
Treatment and Prevention
There is evidence for the use of a number of different conservative treatments in mild-to-moderate CTS. Splinting has been shown to be effective at improving function and reducing symptom severity in the short term 2. In cases of severe CTS, surgery may be required. CTS can have a devastating impact on the health of employees and organisations alike. Treatment costs are expensive and there is no guarantee that workers will be able to return to their previous duties (or even job) post-surgery.
Prevention is always better than the cure and reducing the risk of your employees developing CTS in the first place, should be a priority for every company. The California Department of Public Health recommended that “Industries with high rates of CTS should consider implementing intervention measures, including ergonomic evaluations and development of tools and instruments that require less repetition and force and that correct awkward postures” 3.
How Ergonomic Physiotherapists Can Help
Ergonomic Physiotherapists can help to identify and reduce the risks that compromise employees and leave them vulnerable to the development of CTS and other musculoskeletal disorders. Workstation assessments improve the positioning of employees at their desks and limit postural stress, and in this case, specifically related to the shoulders, forearm and wrists.
Ergonomic interventions targeting CTS, aim to place the wrist in a straight position so that the hand can be used without excessive flexion, extension or deviation of the wrist. This neutral position of the wrist places the least amount of pressure on the nerve as it creates more space in the carpal tunnel for the nerve to pass through unrestricted 1. Research has shown that ergonomic interventions can help to improve CTS symptoms after 12 weeks 12.
Desk Check list, Top 5 for CTS:
Elbows should be place at 90 degress to the desk
When elbows are in line with your ribcage, the keyboard should be under your hands
Forearms should be resting on the table, with the shoulders relaxed
Wrists should be in neutral while typing
Mouse should be placed right in beside the keyboard to avoid reaching
It is not a “One size fits all” approach and so care must be taken. Your work requirements of your daily tasks must be taken into account and then the proper adjustments made to decrease the forces on the body that result from poor working positions. When most people start to feel an issue in the wrist, they immediately go for the most obvious options like new equipment or medications.
May not need a new mouse (preferably ergonomic)
May not need a new keyboard
May not need a wrist support
Or even Injections
Looking at the bigger picture is only way to alleviate these issues long term and none of the above examples target the most common problem which is the shoulder! While sitting at a desk our shoulders are usually rounded (internally rotated) to some degree meaning that we lose the ability to turn them out the other way (external rotation). This has been shown to increase pressure on the wrists and lead to problems in the neck/shoulder blade, day‐ or night‐time numbness in the hands, tension neck, and carpal tunnel syndrome 14. A new mouse, keyboard or wrist support will not fix this issue.
It is important to fit the task to the worker rather than the worker to the task. Making sure someone takes an in-depth look at the workstation and applies the correct interventions to both the individual and their workspace is the key to success. This will help to safeguard the long-term musculoskeletal health of the employees and the financial health of the company.
Click/Tap For References ↓
O'Connor D, Page MJ, Marshall SC, Massy‐Westropp N. Ergonomic positioning or equipment for treating carpal tunnel syndrome. Cochrane Database of Systematic Reviews 2012, Issue 1. Art. No.: CD009600. DOI: 10.1002/14651858.CD009600.
S. Jiménez del Barrio, E. Bueno Gracia, C. Hidalgo García, E. Estébanez de Miguel, J.M. Tricás Moreno, S. Rodríguez Marco, L. Ceballos Laita. Conservative treatment in patients with mild to moderate carpal tunnel syndrome: A systematic review. Neurología, Volume 33, Issue 9, November–December 2018, Pages 590-601
Jackson, R., Beckman, J., Frederick, M., Musolin, K., & Harrison, R. (2018). Rates of Carpal Tunnel Syndrome in a State Workers’ Compensation Information System, by Industry and Occupation — California, 2007–2014. MMWR. Morbidity And Mortality Weekly Report, 67(39), 1094-1097. doi: 10.15585/mmwr.mm6739a4
Lewis RJ, Fogleman M, Deeb J, Crandall E, Agopsowicz D (2000) Effectiveness of a VDT ergonomic training program. Industrial Ergonomics 27: 119-131.
Mahmud N, Kenny DT, Zein RM, Hassan SN (2011) Ergonomic training reduces musculoskeletal disorders among office workers: Results from the 6-month follow-up. Malays J Med Sci 18: 16-26.
Norman R, Wells R (1998) Ergonomic interventions for reducing musculoskeletal disorders: an overview, related issues and future directions. Waterloo. Available from: http://www.qp.gov.bc.ca/rcwc/research/norman-wells-interventions.pdf
Kryger AI, Andersen JH, Lassen CF, Brandt LPA, Vilstrup I, et al. (2003) Does computer use pose an occupational hazard for forearm pain; from the NUDATA study. Occup Environ Med 60: 1-9.
Etuknwa AB, Humpheries S (2018) A Systematic Review on the Effectiveness of Ergonomic Training Intervention in Reducing the Risk of Musculoskeletal Disorder. J Nurs Health Stud Vol.3 No.2:3. doi:10.21767/2574-2825.1000032.
Rempel D, Tittiranonda P, Burastero S, Hudes M, So Y. Effect of keyboard keyswitch design on hand pain. Journal of Occupational and Environmental Medicine 1999;41(2):111‐9. [PUBMED: 10029956]
Kumar P N (2018). Musculoskeletal Disorders: Office Menace. Office Buildings:105-126
Toomingas A, Hagberg M, Jorulf L, Nilsson T, Burström L, Kihlberg S (1991). Outcome of the abduction external rotation test among manual and office workers. American Journal of Industrial Medicine. 19:(2)