Carpal Tunnel Syndrome: A Challenge for Rehabilitation

The present article is an exploration of the impact of the increasing number of workers with carpal tunnel syndrome on the field of rehabilitation. The causes, incidence, and intervention strategies are summarized. Implications for the field of vocational rehabilitation are posited. Carpal Tunnel Syndrome (CTS) has been known for sometime, but with changing technology CTS will play a significantly greater role in the general rehabilitation counselor's caseload than in the past. Carpal Tunnel Syndrome is one specific type of injury included in a broader category known as "motion injuries. " Motion injuries, also termed, "cumulative trauma disorders" may comprise 50% of workmen's compensation cases in the year 2000 (Mallory and Bradford, 1989). CTS also has been classified as a compression or entrapment neuropathy (Goodgold, 1981). The present article contains a discussion of what constitutes CTS, the prevalence of the syndrome, current diagnostic and intervention methods, and the implications these factors have for rehabilitation counseling professionals. What is CTS? Green (1988) and Goodgold (1981) state that Carpal Tunnel Syndrome (CTS) is the most common form of compression neuropathy. A compression neuropathy is a condition involving pressure usually affecting a superficial nerve in and around bony prominences (Berkow, 1987). CTS has been classified as an "entrapment neuropathy" (Stearin, 1988). Stearin defines an entrapment neuropathy as ". A region of traumatic neuritis in which the nerve is maintained in an irritated state by external pressure created from a nearby anatomical configuration. " (p. 948). Schenectady (1989) describes CTS as an ". An increase in the volume of the contents of the carpal canal or decrease in the space of the canal" (p. 226). Schenectady explains that the carpal canal is a conduit-like space on the palm side of the wrist. The median nerve along with nine flexor tendons pass through this canal. Rapid and traumatic flexing and extension of the wrist (example, hammering), a strong gripping action (example, stapling gun), or a vibrating force (example, pneumatic hammer) may cause enlargement of the flexor tendons and, indirectly, chronic irritation of the median nerve. Pregnancy also has been shown to result in and/or exacerbate CTS (Berkeley, 1982). Although CTS has received considerable attention recently, it was first described in medical literature by Sir James Paget in 1863 (Green, 1988). Modus coined the term for CTS in 1938 and Wright and Wilkes described the first recorded surgical treatment for CTS in 1947 (Green, 1988). Thus, prior work has resulted in the identification of a variety of symptoms associated with CTS which includes weakness and/or clumsiness of the hand, faulty sensation in the area innervated by the median nerve, and aggravation of symptoms with increased use of the hand, especially grasping. Manifestations of CTS are varied, but usually include pain, numbness and weakness of the hand. If left untreated, CTS can result in partial or complete disability of the hand (Center for Disease Control [CDC], 1989). Prevalence of CTS Schenck (1989) estimates that 26,000 CTS operations are performed each year. The popular press, i.e., newspapers and magazines, has given considerable attention to the impact of CTS on certain segments of the work force. One such article indicates reports of CTS related injuries have risen from 20,000 in 1983 to almost 74,000 in 1987 (Business Week, January 1989). This same source estimates that rapid motion injuries will comprise 50% of workers' compensation claims by the year 2000. Carpal Tunnel Syndrome seems to be common to many occupations including butchers, garment workers, grocery checkers, electronic assembly workers, typists, computer terminal operators, musicians, carpenters and packers. One case of a surgeon with CTS has been reported (Belsole & Greeley, 1988). …