National & International Statistics for Carpal Tunnel Syndrome and Repetitive Strain Injuries of the Upper Extremity

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  • Repetitive Motion Results in Longest Work Absences
    Repetitive motion, such as grasping tools, scanning groceries, and typing, resulted in the longest absences from work among the leading events and exposures in 2002—a median of 23 days. (Source: Bureau of Labor Statistics)


  • Conclusions Regarding Repetition
    There is evidence of a positive association between highly repetitive work alone and CTS. There is strong evidence of a positive association between highly repetitive work in combination with other job factors and CTS, based on currently available epidemiologic data. (Source: Bureau of Labor Statistics)
  • Workplace Illness Cases, Private industry 1981-2000 (BLS)
    It is interesting to note in this older document / graph published by BLS, that as the statistic for "Disorders associated with repeated trauma" went down, the statistic for "All other illnesses" went up. The is due to the "reclassification" of certain repetitive motion disorders as "illnesses", just as Carpal Tunnel Syndrome is classified as an "illness" by the government, not an injury. Reclassification of these disorders is very misleading to the public, and is utilized to reduce the outlook by the public that these disorders have reached epidemic levels.

  1. Carpal tunnel syndrome is the most common nerve compression disorder of the upper extremity. This process affects 1 percent of the general population and 5 percent of the working population who must undergo repetitive use of their hands and wrists in daily living. 1 Surgical treatment for carpal tunnel syndrome is the most frequent surgery of the hand and wrist, with 463,637 carpal tunnel releases annually in the United States, 2 accounting for $1 billion in direct costs. 3 (Source - Plastic and Reconstructive Surgery:Volume 105(5)April 2000pp 1662-1665 The Incidence of Recurrence after Endoscopic Carpal Tunnel Release. Concannon, Matthew J. M.D.; Brownfield, Mona L. M.D.; Puckett, Charles L. M.D )
  2. Carpal tunnel syndrome results in the highest number of days lost among all work related injuries. Almost half of the carpal tunnel cases result in 31 days or more of work loss.- National Center for Health Statistics.

  3. According to the U.S. Department of Labor, Occupational Safety and Health Administration (OSHA), repetitive strain injuries are the nation's most common and costly occupational health problem, affecting hundreds of thousands of American workers, and costing more than $20 billion a year in workers compensation.

  4. According to the U.S. Bureau of Labor Statistics, nearly two-thirds of all occupational illnesses reported, were caused by exposure to repeated trauma to workers upper body ( the wrist, elbow or shoulder ). One common example of such an injury is carpal tunnel syndrome.

  5. The only national routine source of information on occupational injuries and illnesses experienced by U.S. workers is the Annual Survey of Occupational Injuries and Illnesses conducted by the Bureau of Labor Statistics (BLS). The survey is a random sample of about 250,000 private sector establishments, but excludes the self-employed, farms with fewer than 11 employees, private households, and ALL GOVERNMENT AGENCIES. (Source - Statement of Lina Rosenstck, M.D., M.P.H. Director of National Institute For Occupational Safety And Health before the Subcommittee on Workforce Protections Committee on Education and the Workforce-U.S. House of Representatives 5/21/97.)

  6. Musculoskeletal disorders, including carpal tunnel syndrome, are among the most prevalent medical conditions in the U.S., affecting 7% of the population. They account for 14% of physician visits and 19% of hospital stays. 62% of the persons with musculoskeletal disorders report some degree of limitation on activity, compared with 14% of the population at large, according to the National Institute for Occupational Safety and Health.

  7. 849,000 new cases of carpal tunnel syndrome occurred in 1994.-National Center for Health Statistics.

  8. Approximately 260,000 carpal tunnel release operations are performed each year, with 47% of the cases considered to be work related.-National Center for Health Statistics.

  9. A report by NIOSH revealed that more than 50% of all food cashiers, (jobs predominantly held by women), suffered some degree of carpal tunnel syndrome and other forms of repetitive strain injuries as a result of the physical demands of scanning products at high speed.

    The following sources are compiled from the Bureau of Labor and Statistics and the National Institute for Occupational Safety and Health-NIOSH.**

  10. The U.S. Department of Labor has concluded that Carpal Tunnel Syndrome is the "chief occupational hazard of the 90's"-disabling workers in epidemic proportions.

  11. Currently, Carpal Tunnel Syndrome affects over 8-million Americans.

  12. Carpal Tunnel Syndrome is the #1 reported medical problem, accounting for about 50% of all work-related injuries

  13. Presently, 25% of all computer operators have Carpal Tunnel Syndrome, with estimates that by the year 2000, 50% of the entire workforce may be affected.


  14. Only 23% of all Carpal Tunnel Syndrome patients were able to return to their previous professions following surgery.


  15. Up to 36% of all Carpal Tunnel Syndrome patients require unlimited medical trearment.


  16. Women are twice as likely to develop Carpal Tunnel Syndrome as opposed to their male counterparts.


  17. While women account for about 45% of all workers, they experience nearly 2/3's of all work-related Repetitive Strain Injuries.


  18. Surgery for Carpal Tunnel Syndrome is the second most common type of surgery, with well over 230,000 procedures performed annually.


  19. The National Institute of Occupational Safety and Health (NIOSHA) reports that by the year 2000 one half of all office workers may suffer symptoms of CTDs. If the incidences should rise as NIOSHA predicts- 50% of all office workers will be averaging a CTD cost of $2,000 each.


  20. Injuries resulting from repeated motion (repetitive / cumulative trauma disorders -- CTDs) are growing. According to recent annual statistics from the U.S. Survey of Occupational Injuries and Illnesses , over 302,000 CTDs account for nearly two-thirds all of workplace-related illnesses


  21. Ergonomic disorders are the fastest growing category of work-related illness. According to the most recent statistics from the U.S. Bureau of Labor Statistics , they account for 56 percent of illnesses reported to the Occupational Safety and Health Administration.


  22. United States, employers spend more than $7.4 billion in workers compensation costs, and untold billions on medical treatment, litigation costs, hidden costs and lost productivity. U.S. Bureau of Labor and Statistics.


  23. More than eight million people are affected by carpal tunnel syndrome each year. Surgery for carpal tunnel syndrome is the second most common type of musculoskeletal surgery, (back surgery is #1) with well over 230,000 procedures performed annually.


  24. ONLY 23% of all carpal tunnel syndrome patients returned to their previous professions following surgery, according to the Bureau of Labor & Statistics and the National Institute for Occupational Safety & Health (1997-2000 Statistics).


  25. Carpal tunnel surgery has about a 57% failure rate following patients from 1-day to 6-years. At least one of the following symptoms re-occurred during this time: Pain, Numbness, Tingling sensations. Source: Nancollas, et al, 1995. J. Hand Surgery.


  26. Musculoskeletal disorders are the country's most costly category of workplace injuries and illnesses. In addition to spending $20 billion annually on workers' compensation costs due to RSIs, the U.S. spends another $100 billion on lost productivity, employee turnover, and other indirect expenses; The Agency for Health Care Policy and Research.

  27. According to a recent survey conducted by CTD News (reported June '98 issue, page 7), a common office cumulative trauma disorder -carpal tunnel syndrome or CTS- averaged $1,918 per case in 1997. (This does not include surgery or rehabilitation because the national average is more than $12,000 per hand.)

  28. The U.S. Department of Labor has concluded that Carpal Tunnel Syndrome is the "chief occupational hazard of the 90's"-disabling workers in epidemic proportions.

  29. Each year thousands of people are diagnosed with some kind of an illness directly related to poorly designed work stations. In the U.S., Repetitive Strain Injury (RSI, for short) has become the number one work-related health problem, according to OSHA statistics.

  30. Other industries, however, have higher total numbers of CTS-related events that cause lost-work days. The following is a list of occupations published by the Bureau of Labor Statistics in 2002 that rates workers with highest to lowest numbers of such events: SOURCE: Bureau of Labor Statistics, U.S. Department of Labor, April 2002 •  Assemblers •  Cashiers •  Secretaries •  General office clerks •  Laborers, non-construction •  Bookkeeping, accounting, and auditing clerks •  Welders and cutters •  Data-entry employees •  Textile sewing machine operators •  Order clerks •  Supervisors and proprietors, sales occupations •  Machine operators (unspecified) •  Truck drivers •  Investigators and adjusters, (not insurance) •  Insurance adjusters, examiners, and investigators •  Electrical and electronic equipment assemblers •  Packaging and filling machine operators •  Janitors and cleaners •  Bank tellers •  Production inspectors, checkers, and examiners

  31. In the industrialized world, the incidence of musculoskeletal injury (MSI) has reached epidemic proportions. In the United States, these disorders affect one out of every four people (American Academy of Orthopedic Surgeons, 2000).

  32. According to the National Institute for Occupational Safety and Health (NIOSH), MSIs account for one-third of all job-related injuries.

  33. A national health survey completed by Statistics Canada in 1998 found one out of fifteen Canadians living with a potentially disabling MSI. In Ontario, approximately one half of workers compensation claims are for muscular strains and strains (Workplace Safety and Insurance Board, Statistical Supplement to the Annual Report, 2000).

  34. MUSCULOSKELTAL INJURIES (MSI's): Work related musculo-skeletal injuries (MSIs) affecting the upper body and limbs are now recognized as one of the leading causes of worker pain and disability. A work-related musculoskeletal disorder is an injury to the muscles, tendons and/or nerves of the upper body either caused or aggravated by work. Other names used to describe work-related musculoskeletal disorders include repetitive motion injuries, repetitive strain injuries, cumulative trauma disorders, soft tissue disorders and overuse syndromes.

  35. One out of every 10 Canadian adults had a repetitive strain injury (RSI) serious enough to limit their normal activities in 2000/01, according to a new study published today in Health reports , which shows that RSIs are affecting a growing number of adults.

  36. An estimated 2.3 million people aged 20 or older reported having had an RSI at some point in the 12 months prior to their participation in the Canadian Community Health Survey, for which data collection began in September 2000.

  37. This marked an increase in the prevalence of RSIs during the late 1990s. In 1996/97, 8% of adults reported the problem, according to the National Population Health Survey. The proportion hit 10% in 2000/01. Work-related activities were most often the cause.

  38. Repetitive strain injury is an umbrella term for a group of disorders usually caused by repetitive movements that affect the muscles, tendons and nerves. Unlike other injuries, which occur at a single point in time, RSIs develop over an extended period.

  39. In 2000/01, men and women were almost equally likely to report an RSI, although since 1996/97, the percentage of women sustaining such injuries rose faster than the percentage of men. For women, the increase was from 7.9% to 10.3%, compared with an increase from 8.2% to 9.9% for men.

    STATISTICS & STUDIES: SURGERY

  40. Carpal tunnel surgery outcomes in workers: Effect of workers' compensation status.
    One hundred thirteen workers' compensation and 53 non-workers' compensation patients who had undergone open carpal tunnel release were queried, about job status and the presence or absence of residual symptoms of numbness, pain, or nocturnal awakening an average of 42 months postoperatively. ... Residual symptoms were significantly morecommon in workers' compensation compared to non-workers' compensation subjects, with 92 of the former and 26 of the latter subjects reporting some residual symptoms. ( Source - The Journal of Hand Surgery. Volume 20, Issue 3, May 1995, Pages 354-360

  41. Revision Surgery after Carpal Tunnel Release – Analysis of the pathology in 200 cases during a 2 year period - Carpal tunnel release (CTR) is regarded as a common and successful operative procedure in hand surgery. However, an increasing number of patients with complications have been referred to our hospital. This retrospective investigation was undertaken to clarify the reasons for persisting or recurrent symptoms in 200 patients who underwent secondary exploration during a 26 month period at a single institution. In 108 cases, the flexor retinaculum was found to have been released incompletely. In 12 patients, a nerve laceration had occurred during the primary intervention. In 46 patients, symptoms were due to the nerve being tethered in scar tissue. The re-exploration revealed circumferential fibrosis around and within the median nerve in 17 patients and a tumour in the carpal tunnel in four patients. In 13 patients, no specific reason was found for recurrence of symptoms. (Source - The Journal of Hand Surgery: British & European Volume Volume 31, Issue 1, February 2006, Pages 68-71)

  42. (Carpal tunnel patients)...30% reported poor to fair strength and long-term scar discomfort, and 57% noted a return of some pre-operative symptoms, most commonly pain, beginning an average of 2 years after surgery. Source - The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand. Volume 20, Issue 4, August 1995, Pages 470-474 Long-term results of carpal tunnel release

  43. There seems to be a statistically higher incidence of recurrence of carpal tunnel syndrome after endoscopic release compared with the traditional open release in our cases. Although the pathogenesis of this increased rate of recurrence is not clear, this should be considered when planning surgical release of the volar carpal ligament for carpal tunnel syndrome. (Plast. Reconstr. Surg. 105: 1662, 2000.)

  44. The fail rate for carpal tunnel surgery is over 50%. Many times I meet women who have undergone multiple surgeries, still unable to work and struggling with chronic pain. (Sportstouch.com / Kate Montgomery)

  45. School of Medicine researchers surveyed 166 people who had undergone the surgery during an eight-year period. Eighty-one percent of those who had received workers' compensation reported residual symptoms, compared with 49 percent of those who had not. The former returned to work 12 weeks after their surgeries, whereas the latter took only three weeks to get back on the job.

    "So our study suggests that the workers' compensation system in some way affects outcomes of carpal tunnel surgery," said Philip E. Higgs, M.D., assistant professor of surgery and of occupational therapy. Higgs was lead author of the study, which was described in a recent issue of the Journal of Hand Surgery.

  46. National Center for Health Statistics found that 32,000 carpal tunnel patients were discharged from non-federal hospitals in 1992. So Higgs and his colleagues wanted to determine whether the availability of workers' compensation influenced discharged patients' recovery. "In surgical circles, there has been a suspicion that people covered under workers' compensation have a different post-operative course than those who are covered by conventional insurance or are self-paying," he explained.

    Researchers surveyed 166 people by phone, inquiring about job status and duties, pain, numbness and nocturnal symptoms. They chose the subjects at random from 1,700 patients who had undergone carpal tunnel surgery at the Washington University Medical Center between 1984 and 1992. The average time since surgery was 42 months. One-hundred-thirteen of the subjects had received workers' compensation, whereas 53 had not. The survey excluded people who were retired, unemployed, homemakers, had non-related medical problems or had undergone their surgeries within the previous 18 months.

    The two groups differed in job stability as well as in time off work and presence of residual symptoms, the survey found. Half of the workers' compensation patients had changed jobs since the surgery, and 65 percent of these attributed the change to carpal tunnel syndrome. Only one-quarter of the other patients had changed jobs, and only 14 percent of these blamed the switch on residual symptoms.

    "So our data support what has only been implied in the past -- that our workers' compensation system has some adverse effect on the outcome of this particular surgical procedure," Higgs said.

  47. Carpal tunnel surgery has about a 57% failure rate following patients from 1-day to 6-years. At least one of the following symptoms re-occurred during this time: Pain, Numbness, Tingling sensations. Source: Nancollas, et al, 1995. J. Hand Surgery

  48. Oftentimes, the surgery fails to produce any lasting help. A published study by Dr. Strasberg, at the Washington University School of Medicine, reported some startling results. This study, involving patients requiring a second surgery for CTS, revealed that only 53% of the patients showed significant improvement in their symptoms .

  49. Another study produced by the Washington School of Public Health and Community Medicine showed that relief from pain was complete or modest in 86% of the patients. Of the patients studied, only 67% were able to return to their old jobs whereas, 15% had to change jobs and the remainder did not return to work.

  50. MUST READ THIS BY ONE OF THE MOST RENOUND MEDICAL JOURNALS- JAMA!!! http://www.mit.edu/people/wchuang/unix/CTS/CTS_Surgery.txt

    School of Medicine researchers surveyed 166 people who had undergone the surgery during an eight-year period. Eighty-one percent of those who had received workers' compensation reported residual symptoms , compared with 49 percent of those who had not. The former returned to work 12 weeks after their surgeries, whereas the latter took only three weeks to get back on the job.

    "So our study suggests that the workers' compensation system in some way affects outcomes of carpal tunnel surgery," said Philip E. Higgs, M.D., assistant professor of surgery and of occupational therapy. Higgs was lead author of the study, which was described in a recent issue of the Journal of Hand Surgery. The two groups differed in job stability as well as in time off work and presence of residual symptoms, the survey found. Half of the workers' compensation patients had changed jobs since the surgery , and 65 percent of these attributed the change to carpal tunnel syndrome. Only one-quarter of the other patients had changed jobs, and only 14 percent of these blamed the switch on residual symptoms.

  51. The author of the book, Occupation and Disease: How Social Factors Affect the Conception of Work Related Disorders, says that a very large number of the 240,000 carpal tunnel operations performed in the U.S. each year are useless or worse. While doctors claim an 85-95 percent success rate for their surgeries, another expert in the field says that among the patients she has spoken to the rate of satisfaction was closer to one percent. Stephanie Barnes, director of the Association for Repetitive Motion Syndromes in Santa Rosa.

  52. Many patients are undergoing multiple surgeries, which can cause complications ranging from excessive scar tissue overgrowth (re- compressing the nerve tunnel) to surgical injuries that leave the fingers totally devoid of sensation. United Press, August 8, 1996.

  53. Other researchers are warning that misdiagnoses are more often the rule than the exception. "By the time we've completely mutilated the person, maybe then we'll decide it's not carpal tunnel syndrome after all," says one epidemiologist. Barbara Silverstein, research director at the Washington State Department of Labor and Industries, Olympia, Washington.

  54. STATISTICS: TYPING

  55. If you type 40 words a minute : you press 12,000 keys per hour or 96,000 keys per 8-hour day.

  56. Approximately 8 ounces of force is necessary to depress one key. •  Almost 16 tons of force will be exercised by your fingers.

    Note for computer users and typists: Repetitive typing and key entry is highly associated with missing work due to CTS. The risk for CTS in this group, however, is still much lower than with occupations involving heavy labor. One small 2001 study reported that nerve conduction tests on frequent computer users showed the same rate of CTS (3.5%) as in the general population. However, 10% of the computer users complained of CTS symptoms and 30% reported tingling and burning in the hand. The typing speed may affect risk. For example, the fingers of typists whose speed is 60 words per minute exert up to 25 tons of pressure each day . And in one, study typists with CTS struck the keys with greater force than those without the disorder did.