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It's All (Not) in the Wrist

Carpal tunnel syndrome not linked to computer use, says study

MONDAY, June 11 , 2001 (HealthDayNews) -- Computer users who suffer chronic and sometimes crippling arm and hand pain were dealt a double blow by a new study just published in the journal Neurology.

The first blow comes as a direct result of the study, which found that carpal tunnel syndrome -- the diagnosis often linked to computer use -- is not likely to be the cause of the pain. The finding could turn scores of work-related injuries into a new medical whodunnit.

The second blow might come in the workplace itself if employers use the study to deny that any changes need to be made in the office. Getting all businesses up to speed, ergonomically speaking, would cost between $4.5 billion and $100 billion, depending on whether you're talking to consumer advocates or businesses. And that's a major reason why President Bush shot down Occupational Safety and Health Administration-inspired regulations that would have required businesses to modify the workplace so fewer of these types of injuries would take place.

"There is no question from my vantage point of a clinician that computer workers develop musculoskeletal disorders of the upper extremities that can be severe. Regardless of what you call the specific diagnosis, these people are suffering," says Dr. Robin Herbert, co-director of the Mt. Sinai Center for Occupational and Environmental Medicine, at Mt. Sinai Medical Center in New York City. She was not involved in the study.

Carpal tunnel syndrome is a nerve-related condition that can result when certain repetitive hand motions, performed regularly over time, cause a swelling in a tunnel housing a nerve that runs from the fingers through the wrist and into the arm. That swelling compresses the nerve and can cause pain, tingling, numbness and weakness in the hands. Occasionally, the pain in the hand or arm is so intense that it can result in a temporary or permanent loss of use.

Although the symptoms closely match problems documented in computer workers, Dr. J. Clarke Stevens, the author of the new study, says there was little documented evidence to prove this was so -- a factor that prompted his new research.

"We thought the fault was in the literature -- that the studies were simply not finding out what we thought was true -- that carpal tunnel was linked to computer use," says Stevens, a neurologist at Mayo Clinic in Rochester, Minn.

"What we discovered, however, much to our surprise was that, on average, computer users are not at any greater risk for this disorder than the general population," says Stevens.

According to Dr. Michael Rubin, director of the Neuro-Muscular Service at New York Weill Cornell Medical Center in New York City, the findings are not a surprise -- and ring true.

"I've been saying this for years," says Rubin, who has testified as an expert witness in trials involving carpal tunnel syndrome. "And I believe that what the study found is definitely the truth."

Herbert, however, disagrees.

"There is something called the 'Healthy Worker Effect' -- meaning that often, when surveys of workers are taken in regard to injuries, the ones who have the worst problems are out of the work-force. So what you end up with in the study is only those workers who have not experienced significant problems, or problems, for a long period of time."

And that, in fact, may be one of the major flaws in the study, which was based, in part, on questionnaires sent to 314 computer workers from the Mayo Clinic. Questions involved the nature of their computer work, daily hours spent on the computer and any indication of hand- or arm-related pain.

Of those who received the questionnaire, 257 responded. And of those, about 30 percent (77 people) indicated varying degrees of hand, wrist and arm pain, including numbness and tingling in the fingers -- all of which can be signs of carpal tunnel syndrome.

Ultimately, only nine people were verified as actually having carpal tunnel syndrome, which translates to 3.5 percent of the original study group.

"That doesn't mean that computer users can't get this -- it's a very common condition. It just means that using a computer doesn't cause it," says Stevens.

So what is causing the pain? According to Herbert, a variety of medical diagnoses apply including, she insists, carpal tunnel syndrome.

"I've seen hundreds of people, journalists and others, whose work involved using computers for substantial periods of time, and they develop a range of work-related conditions, including carpal tunnel syndrome, as well as tendon-related disorders, other nerve entrapment disorders involving the elbow, and a range of upper back and neck problems," says Herbert.

To take this study as suggesting that there are no work-related injuries specific to computer use, or other work-station related issues, is just plain wrong, she insists. "Employers should not take this study to mean that ergonomic changes in the workplace are not necessary or helpful, as often symptoms improve when we do modify work situations."

Indeed, even Stevens agrees there is a long way to go before even the link between computer use and carpal tunnel syndrome can be ruled out.

"Our findings would have to be verified in a much larger study before we could say for certain this was true," he says.

What To Do

If you suffer from any hand, wrist, arm, neck, shoulder or even head pain that gets worse when you work at your computer, take your symptoms seriously and see your doctor.

While carpal tunnel syndrome may not be your problem, experts say there are other conditions, which, if left untreated, could worsen your pain and reduce your ability to work pain-free.

The subject is also politically hot, as evidenced by President Bush's rejection of the OSHA attempt to set ergonomics standards for the working public. Read all about it here.

For more information on carpal tunnel syndrome, here's a site that offers drawings and easy-to-understand explanations. And here's Harvard's InteliHealth view of the ailment.

Or, you may want to take a look at previous HealthDay stories on job injuries.

If you're interested in seeing what clinical trials are available, take a look at Veritas Medicine.

SOURCES: Interviews with J. Clarke Stevens, M.D., study author, neurologist at Mayo Clinic, Rochester, Minn.; Robin Herbert, M.D., co-director, Mt. Sinai Center for Occupational and Environmental Medicine, Mt. Sinai Medical Center, New York City; Michael Rubin, M.D., director, the Neuro-Muscular Service, New York Weill Cornell Medical Center, New York City; June 12, 2001, Neurology
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