What ever happened to carpal tunnel? 3-11-08

Remember when half your co-workers complained of “carpal tunnel” and wrist braces were the fashionable office accessory?

Cases of carpal tunnel syndrome, the white-collar epidemic of the '90s, have plummeted in recent years, according to labor statistics. What happened? Did all those ergonomic keyboards cure us of our aches and pains or is something else going on?

Something else is going on.

For one thing, the lumping of nearly every patient with an achy arm into the carpal tunnel category has diminished, and other trendy, multisyllabic diagnoses such as repetitive stress syndrome (RSS), cumulative trauma disorder (CTD) and musculoskeletal disease (MSD) are filling the gap. Secondly, measures taken in the workplace — job rotation, stretch breaks and attention to ergonomics have indeed had an effect — even if what had been labeled carpal tunnel was in reality plain old tendonitis, bursitis, spasm, or even muscular lack of conditioning.

Unquestionably, workers engaged in repetitive work many hours each day experience a variety of musculoskeletal pains. So do gardeners, waitresses and baseball players. That does not mean the work causes the problem. Association is different from causation. Just because chest pain often happens in cold weather does not mean winter causes heart disease.

Explosion of acronyms
There is little question that since use of computers has proliferated both in and out of the home, musculoskeletal problems have been common in the American workplace. But whether you call it carpal tunnel, RSS, CTD, MSD, or any other acronym, this vague, poorly defined, almost impossible to prove constellations of symptoms is responsible for lots of lost work time and hefty medical bills.

Doctors have never been entirely comfortable with these types of labels. That’s because such an eponym tries to assign a specific diagnosis to subjective complaints of pain rather than something the practitioner can observe or demonstrate. Putting a name to what is essentially an overuse problem leads the patient to believe there is serious injury, giving the condition a magnitude often undeserved, rather than recognizing it as one of the aches periodically experienced by each of us.

Not surprisingly, it has been a short leap to the belief that office work somehow “caused” the problem and that it should be compensable. Right or wrong, the upside is that it brought attention to ergonomics issues at the office, and these improvements have reduced our aches and pains no matter what they’re called.

Thumb’s up?
So now that carpal tunnel is no longer the plague of cubicle workers everywhere, what’s our next pain point likely to be? The thumb. Yes, “Blackberry thumb” — the trendy malady of the text-messaging set.

There is no question that thumb problems are on the rise, particularly in the basal joint, the joint at the thumb closest to the wrist. This joint has long been vulnerable to wear and tear as we age. But while doctors used to just see this in a patient’s dominant hand, we’re now seeing it at an earlier age, and in both dominant and non-dominant hands. But how will you know when “Blackberry thumb” has become the next white-collar epidemic? Probably when you start spotting thumb braces around the office.