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Occupational Medicine Advance Access published online on November 2, 2006
Occupational Medicine, 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

Article

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

Keith T. Palmer 1 *, E. Clare Harris 1, and David Coggon 1

1 MRC Epidemiology Resource Centre, University of Southampton, UK

* To whom correspondence should be addressed.
Keith T. Palmer, E-mail: ktp{at}mrc.soton.ac.uk


  Abstract

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.
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