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Carpal tunnel may have been overstated

Nurse Terri Janda leads a program meant to prevent repetitive stress injuries at BlueCross BlueShield of Kansas. Some say programs such as these are the reason for a reduction in RSI cases.

Associated Press

Nurse Terri Janda leads a program meant to prevent repetitive stress injuries at BlueCross BlueShield of Kansas. Some say programs such as these are the reason for a reduction in RSI cases.

NEW YORK

Can a workplace epidemic be cured?

With the personal computing boom of the 1990s came thousands of "repetitive stress injuries" or "repetitive strain injuries." RSI became the hip medical acronym of the keyboard era, with subset "carpal tunnel syndrome'' the diagnosis of the day.

"At its height of diagnosis, anybody showing up at a doctor's office with wrist pain or hand pain was being diagnosed with carpal tunnel," said Carol Harnett, vice president of insurer Hartford Financial Services Group Inc.'s group benefits division.

Since then, carpal tunnel cases have plummeted, declining 21 percent in 2006 alone, according to the Bureau of Labor Statistics.

What changed?

First, it may not have been the epidemic it appeared to be.

A 2001 study by the Mayo Clinic found people who used computers up to seven hours a day had the same rate of carpal tunnel as the general population.

"Clearly, if keyboarding activities were a significant risk for carpal tunnel, we should have seen, over the last 10 to 15 years, an explosion of cases," said Dr. Kurt Hegmann, director of the Rocky Mountain Center for Occupational & Environmental Health.

Blue-collar workers, especially those doing assembly-line work such as sewing, cleaning and meat or poultry packing, have a far greater incidence of carpal tunnel than white-collar workers, according to Bureau of Labor Statistics data.

That may mean such disorders were overdiagnosed when they were most in the news, resulting in an artificially high number of cases by the late 1990s. During 1998, for instance, an estimated three of every 10,000 workers lost time from work because of carpal tunnel syndrome, according to the National Institutes of Health.

Many doctors have since dropped the term RSI, calling them "musculoskeletal disorders." Government agencies term them "cumulative trauma disorders."

Now, some experts think some of those patients had "referred pain" from trouble elsewhere, such as the neck. Other theories claim attention to ergonomics has prevented injuries or that they have become underreported because they lack the immediacy of a broken bone.

People who have had a cumulative trauma disorder say it can be debilitating. Clay Scott, now an assistant professor at the University of Michigan, developed severe wrist pain while enrolled at Harvard University. By the end of his senior year, he says, he was incapable of cutting food and opening doors.

His recovery started with physical therapy a few times a week and a home exercise program to stretch and strengthen his back and neck muscles. It took three or four years for him to recover, he said.

A growing number of businesses have focused on prevention.

Outdoor clothing company L.L. Bean Inc. halts its manufacturing line three times a day for mandatory five-minute stretches. BlueCross BlueShield of Kansas started a program in 1991, when costs of the injuries to its employees passed $500,000. It bought ergonomic chairs and desks, introduced ergonomic assessments for new employees during their first two weeks of work and hired two registered nurses to work with employees.

Since the program started, the company's workers' comp costs have fallen by 62 percent, said Terri Janda, a nurse who leads the BlueCross program.

The Federal Occupational Safety and Health Administration introduced ergonomic standards in 2000, which were assailed by businesses, claiming the standards would cost them somewhere between $20-billion and $100-billion to implement. The standard was overturned by Congress in 2001.

Carpal tunnel may have been overstated 03/24/08 [Last modified: Tuesday, March 25, 2008 5:20pm]
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