The BLS estimate of $225,000 included all costs of having one worker off work for several weeks due to a work-related injury. This figure not only figures medical costs (including surgery), but it also includes the cost of losing an experienced employee. There are the added costs of documentation, including initial injury and medical reports, filing worker compensation claims, verification of injury and medical intervention, worker compensation benefits claims, as well as the cost of a temporary employee, or the cost to the company when another employee(s) has to pick up the injured employee's work load. Additional costs may include long-term disability benefits, social security supplemental benefits for total disability, or retraining costs where possible. And these are just some of the costs that go into that 1990 figure!

Do Ergonomics Help?

Since 1990, an estimated one trillion dollars have been spent by industry on ergonomics. In 1997, the incidence of reported carpal tunnel syndrome had risen to 67% of work-related reported injuries. More claims were surfacing as health-related claims, as opposed to work-related injuries. In 1998, the incidence reported by BLS dropped to 66% with the commentary that the decrease in reporting the injury as a work-related claim accounts for the decrease, not an actual decrease in incidence.

So, what about the people who have the carpal tunnel symptoms of numbness, tingling of the forearms and hands, loss of strength, loss of grasp and loss of function? Do they have CTS? If so, what, if anything, can be done?

What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome is an isolated diagnosis in which the median nerve is trapped, compressed or crushed by the connective tissue bands, bony structures, or swelling in the carpal tunnel at the wrist. It affects the thumb, index and portion of the middle finger, and can cause swelling, extreme pain, numbness, tingling, burning, decreased strength and loss of function. Sound familiar? The cause can be bone fractures, a compression or crush injury, repetitive stress, or structural anomaly. The treatment has typically been nighttime resting splints, anti-inflammatory medications, time off work and surgical release of the entrapped nerve. The reports of success are mixed at best.

The problem with this scenario is that the problem, or cause, is not at the wrist. This is by definition a problem of connective tissue. Connective tissue (fascia) is the largest structure of the human body. A connective tissue cell connects every other cell muscle, bone, organ, etc., to itself and other structures. Fascia cells consist of elastin and collagen and are exactly the same wherever they are located in the body. These cells exert 2000 pounds of tensile strength per square inch. They hold the memory cells, are very strong, yet very forgiving. When pressure is exerted or applied at one point of the system, it is translated (and increases) to the opposite point of the system. This means that the wrist bone is connected to the elbow bone and the elbow bone is connected to the shoulder bones, which are connected to the neck bones. It also means that the pain experienced when a toe is stubbed can translate through the system and cause a headache. This is because the fascia system is a closed system. Thus, a force exerted at the neck or between the shoulder blades is transferred through all the muscles, bones and supportive tissues to the wrist and hand.

The memory portion of the fascia cells records all happenings. When the memory cells fill up and the cumulative stress or pressure goes beyond the flexibility of the system, the sum total of the stress applied is felt at the farthest point of attachment -- in this case, the wrist and hand.

The force and stress can be muscular, structural (bone), vascular and nerve in nature, all translating to the opposite end of the system. The cause can be physical force, strain, mechanical restrictions (scars), or physiological caused by an internal safety mechanism called FIGHT OR FLIGHT. When the human system perceives it is threatened or compromised, it shifts blood supply to the legs for FLIGHT or the trunk structures for FIGHT. When the body is not allowed to run away or physically stand and fight, all the excess energy that would have been expelled in either one of these activities is stored in the cellular tissues. This is called freeze frame in the animal kingdom. When an animal is about to die, it often freezes in place. If it survives, it shakes itself or trembles, thus dispelling the excess energy. The mechanism is the same in the humans except that humans don't generally have a healthy mechanism for dispelling unused energy, or the stressor. This means that the fascia, which has thickened when stressed, retains the memory and stores it. Over time, this causes shortening of the elastin fibers in the fascia cell, exerting a pull against the farthest most structures.

What Can Be Done?

So, what does all this mean? Basically, it means that when a person sits in the same posture for a long time (more than 30 minutes) and there is stress present, the fascia becomes compromised. It tightens down, or shortens, and the muscle and fascia in the back, shoulders blades, neck, shoulders and upper arms all pull on the attachment at the wrist.

In addition, the programs must address the neck and back structures and posture first to gain any resolution in the wrist. This fact is supported by a statistic printed in the Yearbook of Hand Surgery. Associated with carpal tunnel syndrome are other diagnoses, such as deQuervain's Syndrome, thumb pain and dysfunction, radial nerve compression, elbow pain and dysfunction syndromes, other hand involvement, and neck pain with many more surgeries associated with these as the intervention travels backward from the wrist to the neck. Other complaints, not usually involving surgery, include migraines, other types of headaches, digestive troubles, constipation, weight gain, disturbed sleep, and anxiety.

The rate of a second surgery is expected within five years of the first surgery if the individual returns to the same job, even with adaptation. After the second and third surgery, the rate of total disability escalates -- another contributing factor in the high cost of this problem.

It is estimated that only two percent of all carpal tunnel syndrome diagnoses are actually CTS. The rest are cumulative trauma dysfunction, which is the more accurate phraseology.

If you believe you have CTS, what can you do? You have a choice to follow these few easy steps along with a habit adjustment in postural shifts, or to continue with the disabling, painful, anxiety producing, costly syndrome masquerading as carpal tunnel syndrome.

Caryl A WashburnThompson, MA, OTR/L can be reached at 907-344-8891.