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Occupational Medicine Advance Access originally published online on November 2, 2006
Occupational Medicine 2007 57(1):57-66; doi:10.1093/occmed/kql125
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© The Author 2006. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Carpal tunnel syndrome and its relation to occupation: a systematic literature review

Keith T. Palmer, E. Clare Harris and David Coggon

MRC Epidemiology Resource Centre, University of Southampton, UK

Objectives To assess occupational risk factors for carpal tunnel syndrome (CTS), we conducted a systematic literature review.

Methods We identified relevant primary research from two major reviews in the 1990s and supplemented this material by a systematic search of the MEDLINE and EMBASE biomedical databases from the start of the electronic record to 1 January 2005. Reports were obtained and their bibliographies checked for other relevant publications. From each paper, we abstracted a standardized set of information on study populations, exposure contrasts and estimates of effect.

Results Altogether, we summarized 38 primary reports, with analyses based either on a comparison of job titles (22) or of physical activities in the job (13) or both (3). We found reasonable evidence that regular and prolonged use of hand-held vibratory tools increases the risk of CTS >2-fold and found substantial evidence for similar or even higher risks from prolonged and highly repetitious flexion and extension of the wrist, especially when allied with a forceful grip. The balance of evidence on keyboard and computer work did not indicate an important association with CTS.

Discussion Although the papers that we considered had limitations, a substantial and coherent body of evidence supports preventive policies aimed at avoiding highly repetitive wrist–hand work. There is a case for extending social security compensation for CTS in the United Kingdom to cover work of this kind.

Keywords      Carpal tunnel; classification; neuropathy; occupational risk factors

Correspondence to: Keith T. Palmer, MRC Epidemiology Resource Centre, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK. Tel: +44 23 8077 7624; fax: +44 23 8070 4021; e-mail: ktp{at}mrc.soton.ac.uk


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