Carpal tunnel syndrome: causes, symptoms, and treatment

Carpal Tunnel

Program description

The current program will be utilized to determine if the handrests in use are helping to deter the number of occurrences of carpal tunnel. It is the researcher's belief that the current handrests at said company are not helping to decrease the occurrences of carpal tunnel, and therefore further testing and evaluation is necessary. Further examination will help to determine whether current methods i.e. handrests are helping to ease the symptoms often associated with carpal tunnel or decrease the number of occurrences of employees reporting about carpal tunnel like symptoms. The current program for carpal tunnel prevention has not been properly assessed and is therefore in need of further support to confirm whether current methods are in fact improving the current circumstances.

Goals of program

The goals of the current program are to decrease the number of instances that employees report cases of carpal tunnel or carpal tunnel like symptoms. Another goal of the program is to determine methods that will decrease the number of carpal tunnel events that occur all together among the 300 employees currently with the company. Lastly, another goal of the program is to exam whether the handrests are effective or simply increasing symptoms and occurrences of carpal tunnel.

Purpose of the evaluation

The purpose of the current evaluation is to support whether the handrests (specifically) in use are helping to decrease the number of carpal tunnel or carpal tunnel like symptoms from occurring in the 300 employees issued a handrest. In addition, there is also a need to create a basis for comprehension on how to test whether or not a method is effective within the company concerning issues related to carpal tunnel.

Description of stakeholders

In the current evaluation, the stakeholders are the employees (300 with handrests) in the company. These are the main individuals that will benefit from a program that is designed to protect and help decrease the likelihood of injuries amongst staff in the workplace. Another stakeholder includes the company itself. A decrease in injuries amongst employees will save the company from time away from work due to injuries, as well as increase productivity, decrease in workman's compensation insurance etc. These are the two stakeholders being considered in the current evaluation.

Description of any political issues, other limitations, or threats to the reliability and validity of the evaluation.

Limitations of the study include the inclusion of only 300 employees within the company being evaluated. It is possible that with other companies or staff that there may be varying result with use of the handrest. Another limitation of the evaluation is the exclusion of the effects that the keyboard and mouse have on the symptoms of carpal tunnel. Research that has been conducted regarding keyboards and mouse usage has been included in this evaluation report. To further affirm the need for clarity regarding the effectiveness of the handrest being used and if there are efficient ways to determine how effective the current program is in decreasing occurrences of carpal tunnel, or aiding in decreasing the symptoms associated with carpal tunnel. Validity depends on the honesty of the employees answering the questionnaire (see appendices a) and the accuracy of the evaluator as far as marking the personal interviews and the system used to rate the interviews. Location of the evaluator may also be a consideration in the validity. Proper use of the handrests is not being considered in the current evaluation. The evaluator does not believe that the exclusion is a threat to the validity of the program since the handsets are very simple devices, and the level of intelligence required to do any of the jobs evaluated would strongly suggest that the subject could figure out how to use the handrests properly. The evaluator does not expect any political issues concerning the current evaluation.

Design & methodology of evaluation & reason for using these methods.

Two methods will be utilized in the evaluation. First, a survey (see Appendices a) will be given to all employees. The survey asks questions about current problems that resemble symptoms of carpal tunnel syndrome (CTS), past problems that may have complicated any current problems, and frequency of activity that may put the employee at risk for CTS (a tech in the factory has little risk compared to a quality auditor who writes reports on a near constant basis). The evaluator will also consider how long, if any time is only able question participants.

The second method consists of personal interviews with a small number of employees. This would be further complicated because of a threat to the validity of the evaluation in that the evaluator is located in a remote office far away from most of the subjects. Therefore, the evaluator will only have a limited pool of subjects to interview, all of whom participate in some type of data entry on a regular basis.

The evaluation will be broken down using a numbered system, giving point values to certain pre-existing conditions, current status and job, and period of use of handrests. The evaluator will give more points to people who had suffered CTS in the past or had exhibited symptoms of CTS. Subjects that have had no events of CTS will only be awarded a 1 for this (maximum points available = 5). Subjects that do increased amounts of data entry would get higher points as well. An employee in the shipping department who did minimal keyboard work may receive a 2. While an order-processing clerk could get a 4 or a 5, depending on the level and type of orders being processed and how much of that person's time was devoted to that one task (some clerks have additional duties that do not require the use of a keyboard). Finally, points are awarded based on whether the employees were using the handrests or not. The evaluator will not evaluate if the handrests were being used properly. This is in an attempt to save time and money. There will be no interim reports, as the evaluation will not be dictated by the company and would be voluntary on the part of the employees. For this evaluation, there will not be anyone to submit an interim report to once questionnaires have been completed.

This evaluation will determine if the program of providing handrests is effective in helping to prevent CTS and minimize its effects on those already suffering from it. However, the evaluator also expects to determine that areas for improvement are in the education part of the process. The current program fails to address teaching the employees the benefits of the handrests. It only provides the employees with limited information stating that it is a good idea to use the handrest. Therefore not considering that there are employees that may not think it is important to use the handrest, nor understand the appropriate ways to utilize the handrest or the risks of using it if there are any involved in the utilization of the handrest.

Schedule or Time Line for implementation, analysis, and reporting of the evaluation.

The time line for the current evaluation is estimated at 90 days. This will allow sufficient time for all employees to submit the questionnaires. Dispersing questions should take no more than a week to all employees. 30+ days is allotted for the employees to return the questionnaire to the evaluator. If the evaluator is, the sole individual to compile all the data 30+ days will be required in order to access which employees will be considered in the evaluation, when they will be interviewed and the assessments that are conducted on the interviews and questionnaires. 30 days shall also be allotted for compilation of all results and time to submit the data to the proper point of contacts. If additional support is available for distribution of questionnaires and evaluation on inclusion and exclusion in the evaluation the timeline may be re-evaluated and properly deducted for all additions.

Supporting Research

CTS results from compression of the median nerve at the wrist, resulting in burning, tingling, and eventually pain and weakening. Women are three times more likely to suffer from this syndrome than men. (Messing, Lippel, Demers & Mergler, 2000, p. 29) Increased levels of corticosteroids, particularly cortisol, can lead to increased fluid retention in body tissues. This could be an important risk factor for carpal tunnel syndrome (CTS). (Carayon, Smith & Haims, 1999, p. 644) Musculoskeletal disorders make up the largest portion of reported job-related injuries and illnesses in the United States. (Emanoil, 2000) the National Institutes of Occupational Safety and Health (NIOSH) performed a health hazard evaluation of workers in supermarkets in the early 1990's and found an increased risk of developing carpal tunnel syndrome (CTS) if the checker had worked at the job for 10 or more years or had worked more than 25 hours per week. (Marras, Marklin, Greenspan & Lehman, 1995)

Shivers, Mirka & Kaber (2002), discuss that repetitive, awkward, high-force pinch grip exertions have been related to fatigue, discomfort, and injury to the hand/wrist complex in industrial populations. In a study of sewing machine operators, showed that operators with a history of carpal tunnel syndrome used pinch grips more frequently and that the force used during these pinch grip exertions was greater than that employed by the control group (women performing the same jobs at the time that the case group members reported their symptoms). The effects of pinch grip exertions on the intrinsic muscles of the hand were considered in a study of employees in a garment shop. They found a positive correlation between pinch grip duration and hand pain in this population.

Emanoil (2000), discusses research that found that subjects using the vertical split keyboard kept their wrist angles and forearm movements in the lowest risk zone for carpal tunnel syndrome 71% and 78% of the time, respectively. When typing on traditional keyboards, subjects were in the lowest risk zone only 44 and 25% of the time. Wrists were in the highest risk zone only 2% of the time when using the vertical split keyboard compared with 12% with the traditional keyboard. (p. 13) Increased extensor activity, combined with wrist extension, may also increase carpal tunnel pressures. This may be intensified given the flexor tendon loading to depress the keys and increasing the carpal tunnel pressure as well. (Keir & Wells, 2002) research suggest that the specific interaction between a worker's body and tool use may be important, since pressure on the carpal tunnel from work tools is affected by this interaction " (Messing, Lippel, Demers & Mergler, 2000, p. 31)

Another study that Emanoil discussed compared an oversized, flat, and adjustable computer mouse with a built-in palm support with a smaller, contoured mouse device. Researchers measured the wrist extensions and hand movements of 24 men and women while they used the different mouse devices to move the cursor position and to scroll on the computer. Subjects also rated the smaller and larger mouse devices for comfort. The researchers found that the larger mouse reduced wrist extension by an average of more than eight degrees. At high levels, wrist extension can lead to carpal tunnel syndrome. The adjustability of the larger mouse also kept subjects from making small hand movements, such as flicking their wrists, which could increase their risk of injury. (Emanoil, 2000, p. 13)

The aim of this study was to perform a comprehensive investigation to document wrist and forearm postures of users of conventional computer keyboards. Researchers instrumented 90 healthy, experienced clerical workers with electromechanical goniometers to measure wrist and forearm position and range of motion for both upper extremities while typing. For an alphabetic typing task, the left wrist showed significantly greater (p [less than].01) mean ulnar deviation (15.0[degrees] [plus or minus] 7.7[degrees]) and extension (21.2[degrees] [plus or minus] 8.8[degrees]) than the right wrist (10.1[degrees] [plus or minus] 7.2[degrees] and 17.0[degrees] [plus or minus] 7.4[degrees] for ulnar deviation and extension, respectively). On the other hand, the right forearm had greater mean pronation (65.6[degrees] [plus or minus] 8.3[degrees]) than the left forearm (62.2[degrees] [plus or minus] 10.6[degrees]). Researchers further noted minimal functional differences in the postures of the wrists and forearms between alphabetic and alphanumeric typing tasks. Ergonomists should consider the statistically significant and probable practical difference in wrist and forearm posture between the left and right hand in ergonomic interventions in the office and in the design of computer keyboards. Actual or potential applications of this research include guiding the design of new computer keyboards. (Simoneau, Marklin & Monroe, 1999, p. 413)