Carpal Tunnel Syndrome as an Occupational Disease

Background: Carpal tunnel syndrome (CTS) has been listed since 2003 in the European Union's list of occupational diseases. In 2001, it took sixth place in frequency among all occupational diseases recognized in the European Union. It was not listed as an occupational disease in Germany until July 2009, when the medical expert advisory panel of the German Federal Ministry of Labour and Social Affairs issued an evaluative paper supporting its listing. Methods: We selectively reviewed the literature on the potential causation of CTS by occupational activities. Results: Repetitive manual work tasks involving flexion and extension at the wrist, forceful grip with the hand, and/or vibrations of the hand and arm, such as are induced (for example) by hand-held vibrating tools, can damage the median nerve and cause CTS. A combination of these exposures has been found to raise the risk of CTS with a more than additive effect. Harmful exposures arise in a wide variety of occupations; in judging whether a particular case of CTS is of occupational origin, the physician has to consider the actual manual tasks performed by the patient, rather than merely the job title. Working at a computer keyboard seems not to raise the risk of CTS. Conclusion: The causation of CTS by occupational activities, either alone or in combination with other factors, has been well documented by epidemiological data and is pathophysiologically plausible. In Germany, a physician who diagnoses carpal tunnel syndrome in an employee with a relevant, damaging occupational exposure is required to report the case to the German Social Accident Insurance.