Meta-analysis of Published Studies of Workrelated Carpal Tunnel Syndrome

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Rudolph Jennings
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1 Meta-analysis of Published Studies of Workrelated Carpal Tunnel Syndrome MOUSTAFA A. F. ABBAS, MD, ABDELMONEM A. AFIFI, PHD, Z. W. ZHANG, PHD, JESS F. KRAUS, PHD The published information about work-related carpal tunnel syndrome (CTS) was surveyed to identify risk estimates and possible biases influencing the risk estimates. Seventeen studies from the Endish-laneuaee literature were identified and 0 " study characteristics were coded for tlnivariate and regression analysis. Country of publication, study population, force, and repetitive motion were significant predictors or risk, with R2 = 0.57, adjusted R2 = 0.43, Cp = 5.79, and AIC = 19.6 using the best-subset method of variable selection. Using the fonvardvariable selection method, country, study population, study type, and repetitive motion were significant predictors, with R2 = 0.57, Cp = 6.24, p = Excess risks of work-related CTS were consistent in the studies reviewed. Studiespublished in the United States reported higher risk estimates than did those published elsewhere. Some industrial populations were found to have higher risk estimates than others. Cross-sectional designs were the most common epidemiologic ap proach, but are not without methodologic concerns. Key words: carpal tunnel spdrome: meta-analysis risk estimates; work-related risk. INT J OCCUP ENVIRON HEALTH 1998;4: C arpal tunnel syndrome (CTS) is one of the group afflictions known as cumulative-trauma musculoskeletal disorders. Numerous research papers about CTS have been published since the 1980~,~"~ emphasizing the importance of CTS in the workforce. The U.S. National Institute for Occupational Safety and Health (NIOSH), in its National Occupational Research Agenda59 placed musculoskeletal disorders of the upper extremities among its priority research areas. Although the incidence of CTS is not well established, the number of reported work-related musculoskeletal disorders of the upper extremity has steadily increased, accounting for more than 60% of all Received from the Occupational Medicine Department, Faculty of Medicine, Suer Canal University, Ismailia, Egypt (MAFA); and the Department of Biostatistics (AAA, ZhZ) and the Department of Epidemiology (JFK), School of Public Health, UCLA, Los Angeles, California. This study was done at the UCLA School of Public Health. Supported in part by the Southern California Injury Prevention Research Center (CDC grant # R49 / CCR )and the Center for Occupational and Environmental Health, UCLA, School of Public Health. Address correrpondence and reprint requesu to: Jess Kraus, PhD, UCLA School of Public Health, Department of Epidemiology, Le Conte Avenue, Los Angeles, GZ , U.S.A. occupational illnesses in Carpal tunnel syndrome encompasses all anatomic alterations of the wrist that produce compression of the median nerve within the carpal tunnel. The signs and symptoms of CTS are consistent with sensory and motor changes in the median nerve distribution of the hand.51 Untreated, it may result in chronic pain, weakness, and significant impairment in functioning of the affected hand.50 Lack of a uniform case definition of CTS has limited the value of epidemiologic studies, and clouded the interpretation of studies regarding treatment options. In 1989, NIOSH developed a surveillance-case definition to facilitate standardized data collection regarding the incidence of work-related CTS.'jl The case definition for work-related CTS is: 1. One or more of symptoms suggestive of CTS, e.g., paresthesia, pain, or numbness. 2. Positive Tinel's sign, Phalen's sign, or nerve-conduction velocity (NW) test 3. Evidence of work relatedness. or a historv before development of symptoms of a job involving one or mord activities such as repetitive motion, use of force, awkward postures, use ofvibrating hand tools, and prolonged pressure on the hand. Nonoperative treatment of CTS is reserved for mild intermittent cases. Non-steroidal anti-inflammatory drugs and nighttime splints are commonly prescribed. Surgical decompression appears to be indicated for patients who fail conservative therapy. Postoperative problems are seen in 2-15% of surgical cases and include failure to relieve symptoms, incomplete release, recurrence, and injury of the median nerve.'jl METHODS Meta-analysis is a synthetic statistical technique that aims to derive an aggregate risk estimate from different published research studies. In this report we describe the pattern of risk in the published studies and examine the reasons for the differences found in the risk estimates reported. For purposes of this study, we searched the literature to identify reported estimates of risk, risk factors, and study designs. We focused our search on studies published in the English language, and excluded very early

Current Developments in the Prevention and Treatment of Repetitive Motion Injuries of the Upper Extremity

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