Where Has Carpal Tunnel Syndrome Gone?

By: Donald R. DeCarlo

Carpal Tunnel Syndrome (“CTS”) is a gradual injury that was described as the next crisis in workers compensation claims in the 1990s, and that has fortunately evolved into routine claims with no expected surge.

“At its height of diagnosis, anybody showing up at a doctor’s office with wrist pain or hand pain was being diagnosed with carpal tunnel,” said Carol Harnett, vice president of insurer Hartford Financial Services Group Inc.’s group benefits division. People have learned to adapt and have adjusted their behaviors to compensate for potential problems. For example, occasional shoulder pangs caused by using a mouse pushed far rightward by a typically bulking modern keyboard. Switching to a laptop keyboard and allowing the hand to come back to the center fixed the problem.

The correct clinical name is Median Nerve Compression Neuropathy. According to the AMA Physicians Guide to Return to Work, “CTS is actually a condition with known pathology and not a syndrome, but the name carpal tunnel syndrome has become so well known that CTS is used rather than median nerve compression neuropathy.”

Although the popular belief is that keyboard use causes CTS, the science shows otherwise. Nine studies have reviewed this relationship, including The Mayo Clinic, Harvard Medical School, and a Swedish study reported in Orthopedics Today, demonstrate that “there is no causal relationship between CTS and computer keyboarding.” The scientific research shows that keyboards are safe to use and do not cause CTS. Furthermore, keyboard design has no effect on the incidence of CTS. Symptoms may increase with many activities, including the use of keyboards, but keyboards do not cause CTS.

What complicates the diagnosis and treatment of CTS is that there are multiple causes for CTS which include diabetes, pregnancy, various vitamin deficiencies, insufficient water consumption, exposure to cold temperatures, smoking, playing musical instruments, recreational sporting activities and other non-work-related activities.

Medical studies have shown that up to 85 percent of patients who are told they have CTS are misdiagnosed. Yet in the workers compensation industry the overwhelming number of cases are determined to be work-related, and it has been reported that up to 70 percent go on to receive CTS surgery.

Carpal tunnel syndrome is a frequently cited example of gradual injury. There has been a significant amount of litigation over the compensability of carpal tunnel claims. In the majority of instances, the claims have been found compensable.

A number of states have specifically amended their statutes to address claims for carpal tunnel syndrome or repetitive trauma. In certain cases, such claims are included within the definition of injury. Alabama defines injury to include physical injury caused either by carpal tunnel syndrome disorder or by other cumulative trauma disorder if either disorder arises out of and in the course of the employment. In Arkansas, carpal tunnel syndrome is specifically categorized as a compensable injury. Connecticut’s definition includes a personal injury to an employee that is causally connected with his employment and is the direct result of repetitive trauma or repetitive acts incident to such employment.

And a final example is found in Kentucky where the term injury means “any work-related traumatic event or series of traumatic events, including cumulative trauma arising out of and in the course of employment which is the proximate cause producing a harmful change in the human organism evidenced by objective medical findings.”

A number of states include reference to repetitive injury or cumulative trauma syndrome under the definition of occupational disease. In Louisiana, an occupational disease includes injuries due to work-related carpal tunnel syndrome. Missouri also recognizes repetitive motion injuries, and in Texas, the term occupational disease is defined to mean a disease arising out of and in the course of employment that causes damage or harm to the physical structure of the body, including a repetitive trauma injury. “Repetitive trauma injury” means damage or harm to the physical structure of the body occurring as the result of repetitious, physically traumatic activities that occur over time and arise out of and in the course and scope of employment.

California uses a different approach to cumulative injury. Under its law, a covered injury may be “specific” or “cumulative.” A cumulative injury is defined as one occurring as repetitive mentally or physically traumatic activities extending over a period of time, the combined effect of which causes any disability or need for medical treatment. For purposes of clarity, California defines the date of injury for occupational disease or cumulative injuries as “that date upon which the employee first suffered disability therefrom and either knew, or in the exercise of reasonable diligence should have known, that such disability was caused by his present or prior employment.”

Conclusion:

Whether cumulative injuries are compensable depends on the state in which the claim is filed. When a state draws any distinction between a cumulative injury and an event-specific injury for purposes of determining compensation under workers compensation, how the injury is characterized makes all the difference in whether there will be compensation. The new vintage workers compensation claim of the 1990s – CTS and mental stress claims and a myriad of other claims – have been dealt with in an effective manner within the 100-year-old workers compensation system. For those advocating abolishing workers compensation, consider how CTS and mental stress claims would be compensated without workers compensation.

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Donald T. DeCarlo, Esq., WCP

Donald T. DeCarlo, Esq. is the principal of an independent law firm in Lake Success, NY, which focuses on mediation/arbitration and regulatory and insurance counseling.  Before establishing the firm in 2005, Mr. DeCarlo was a Partner at Lord Bissell & Brook LLP and headed its New York office. Formerly, he was Senior Vice President and General Counsel of The Travelers Insurance Companies, Deputy General Counsel for its parent corporation Travelers Group, Inc. and Executive Vice President and General Counsel for Gulf Insurance Group.

Mr. DeCarlo is a Certified ARIAS-US Arbitrator and Umpire, a Master Arbitrator for the NYS Insurance Department, and an Arbitrator for the American Arbitration Association and Center for Dispute Resolution. Mr. DeCarlo is also the Founder, Chairman and President of The American Society of Workers Comp Professionals, Inc. (AMCOMP). In addition, Mr. DeCarlo is a Director of 17 companies in the insurance industry.

Mr. DeCarlo has authored numerous scholarly articles in legal and trade journals and is a co-author of two books on workers compensation insurance, Workers Compensation Insurance & Law Practice – The Next Generation and Stress in the American Workplace – Alternatives for the Working Wounded.

Mr. DeCarlo Chairs an Advisory Committee of the World Trade Center Captive Insurance Company, and formerly served as Chairman and Commissioner of the New York State Insurance Fund (NYSIF) for 10 years. He also served as an Inspector for the NYS Athletic Commission.