. "Case Study 48: Work-Related Disorders of the Neck and Upper Extremity." Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press, 1995.
The following HTML text is provided to enhance online
readability. Many aspects of typography translate only awkwardly to HTML.
Please use the page image
as the authoritative form to ensure accuracy.
Environmental Medicine: Integrating a Missing Element into Medical Education
of the carpal tunnel.
One year after the problem was first noted, he had surgery, first on the left hand and then on the right hand. Following surgery, the company placed him in a transitional work center for a 3-month period where he worked at his own pace and had no symptoms. He then returned to the assembly line with the restriction that he not use welding guns or air-powered hand tools. When he worked on the line, he occasionally had symptoms, but they were substantially less intense and less frequent than before.
He later transferred to a warehouse, because he felt that he would have a better chance of avoiding long layoffs there. He was placed on a job that required use of a stapling gun to seal packages. Three weeks after being placed in this job, his symptoms began to return with their former intensity. Through ordinary channels he immediately sought and was given a transfer to a position driving a fork lift truck. This change reduced, but did not eliminate, his symptoms. Currently he has numbness, tingling, and pain in the singers of both hands about twice a month. Playing volleyball usually triggers a severe attack. With the use of nighttime splints, he can sleep through most nights without awakening. While he feels that his hands are weaker than before he developed his symptoms, he is still able to perform his job. He has decided that as long as his symptoms remain at this level, he will continue working.
This case illustrates the intermittent and progressive nature of most work-related disorders of the upper extremity, and particularly of CTS, the best known of the common work-related disorders of the upper extremity. Other examples of these disorders that may be related to work include Quervain’s disease, epicondylitis, rotator (or rotor) cuff tendinitis (mainly supraspinatus), and tension neck syndrome. This family of disorders may involve muscles (tension neck syndrome), tendons (supraspinatus tendinitis disease), joints (degenerative joint disease), skin (calluses), nerves (CTS), or blood vessels (hand-arm vibration syndrome, or Raynaud’s phenomenon of occupational origin).