Do Not Be So Quick To Diagnose Carpal Tunnel


Disclaimer—This is not a medical article.  This is not meant to diagnose or treat a condition. This is merely a guide to use as potential reference to occupational cases.  Always consult your physician for advice on what your diagnosis may or may not be.
If I went to a doctor’s office and said my hands are numb, and he automatically diagnosed me with carpal tunnel and sent me for an EMG, I would be looking for another opinion right away.
Why? I know that just because I have numbness in my hands, the automatic diagnosis of carpal tunnel is premature.  Numbness can be caused by a multitude of issues, both possibly occupational in nature, and, more importantly, not occupational in nature.  The background of getting to the root cause of a condition can take a long time, and just cannot be made in one or two visits to the doctor, whether this is a hand specialist or just a general occupational physician.
Below we discuss a little about the warning signs of carpal tunnel, and some other conditions that could be the cause:
1.    Where is the Numbness?
Generally speaking, if a person says their entire hands are numb, chances are that just carpal tunnel is not the entire cause.  Median nerve compression, an indicator of carpal tunnel, will isolate itself to a combination of the thumb, pointer finger, middle finger, and maybe part of the ring finger.  If your whole hand is numb, you can have a combination of carpal tunnel and cubital tunnel, or many other issues genetic in nature all combined.  To make a diagnosis of just carpal tunnel is incorrect, and not a detailed enough analysis to fly for any adjuster out there.
Cubital tunnel, or ulnar nerve entrapment, will tend to be the ringer finger and little finger, and the entrapment will occur at the elbow area.  Cervical radiculopathy will remain in the neck/shoulder region, with numbness maybe going down the back of the arm and wrapping around the arm to the forearm and possible referring symptoms into the hand. 
2.    Is Carpal Tunnel Work Related?
This is a debate that has gone back and forth for years.  Many physicians state that the primary cause of carpal tunnel is genetic predisposition.  Other contributing factors are diabetes, pregnancy, smoking, obesity, and others.  Waking up at night is a huge indicator, since we all at some point tuck our wrists into the fetal position.  Once this occurs, the symptoms of numbness and pain reproduce, waking up from sleep. 
If a person says they have carpal tunnel but they are also sleeping though the night with no waking, chances are the nerve impingement is not at the wrist. Even if you sleep on your back and you know for a fact that you will never once sleep in this fetal position, I would beg to differ.  But again most doctors either agree or disagree with this theory. 
3.    You Have to Look at the Medical/Occupational History of the Claimant
This includes both work related and non-work related jobs and movements.  All kinds of things can contribute to carpal tunnel, including medications, past/current illnesses, family history of illness, pregnancy, timing and location of the numbness, and any contributing hobbies.  I heard of a case where a guy claimed to have carpal tunnel from his desk job, but then the adjuster discovered the claimant had a second job as a violinist in a community orchestra.  Certainly the postures and movements of a violin player can contribute to the progression of carpal tunnel symptoms, or even cubital tunnel.
Another large contributory player in the realm of hobbies is carpentry work.  Use of vibratory or torqued tools that vibrate can start symptoms that are then aggravated by work duties that could be repetitive in nature.  Even minor movements that are repetitive in nature can be a culprit.  So take the time to do a careful medical and non-medical investigation since all movements or hobbies with gripping or movements could be included as a risk factor.
4.    So is it Cubital Tunnel and Not Carpal Tunnel?
That will depend on the location of the numbness.  The elbow is the most common site for compression of the ulnar nerve.  This syndrome is stereotypically known to affect men more than women, but again this depends on the study you review. 
Symptoms will include pain and tenderness around the inside of the elbow radiating into the forearm and the ring/little finger with associated tingling, numbness, and burning.  These symptoms again may occur more frequently at night than during the day.
Cubital tunnel causes can be frequent bending of the elbow from pulling items or levers on machinery, constant direct pressure on the elbow over time from leaning on the elbow, sleeping with bent elbows, or from direct trauma to the elbow area such as a fracture.
5.    So Can Cubital Tunnel be Work Related or is it Genetic in Nature?
Depending on your study and your physician, it is hard to say whether this is more of a work related diagnosis or one that is more genetic in nature.  You must take the time to delve into the case, and take a careful history of all employments, job tasks, and also all tasks or hobbies that your claimant does outside of the workplace.
Any type of injury that has associated numbness cannot lead itself to a blanket diagnosis of just carpal tunnel alone, but more times than not in the work comp world we see it more and more.  All physicians and adjusters have to take the time to do a full workup of the case, involving every job task both inside and out of the workplace. 
Many hobbies or activities outside of work can be the culprit of the cause of these issues, including the way you sleep, the way you drive your car, any hobbies the person partakes in, and so on.  Don’t be quick to accept the diagnosis and rush a person in for surgery.  Explain to your claimant the risk factors both in and out of the workplace, and that you just want to make sure you target the actual problem so it can be corrected and the person can move on with their lives, hopefully in a pain-free fashion.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%.
Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. Contact:
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.  

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional about workers comp issues.

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