July 2011
A 48 year old obese lady with a history of hypothyroidism and three childbirths was diagnosed with bilateral carpal tunnel syndrome. She works as a medical secretary. The claim was allowed for bilateral carpal tunnel syndrome. She underwent bilateral carpal tunnel release surgeries. She reported persistent complaints of pain and numbness in her hands six months after her time of surgery at the time of her independent medical evaluation. The persistent symptoms were not explained by her orthopedic surgeon.
At the time of her IME, objective electrophysiologic testing in the form of peripheral motor and sensory nerve conduction studies was performed. There was no evidence of residual carpal tunnel syndrome in either hand. The medical conclusions included that she was properly diagnosed, properly treated and had made a full recovery from her bilateral carpal tunnel syndrome without any residual physical impairment. Therefore, there were no physical restrictions for her to resume her chosen activities of daily living.
Teaching points:
- She displayed multiple known risk factors for carpal tunnel syndrome that included in order: obesity, being a woman, “middle age,” history of multiple childbirths and hypothyroidism. Given the set of significant risk factors, her carpal tunnel syndrome would not be considered work-related from a medical standpoint but administratively the claim was already allowed and therefore this was not discussed in the medical conclusion section of the report.
- There is proof in the medical literature that carpal tunnel syndrome is not related to typing. Typing is not a cause or a contributing factor to carpal tunnel syndrome. Carpal is Latin for hand and therefore it means hand tunnel syndrome. The confined space of the carpal tunnel is further confined in women who have smaller hands than men and therefore they are four times more likely to develop it. The #1 risk factor for carpal tunnel syndrome is obesity. The additional adipose and soft tissues within the closed space of the carpal tunnel caused compression of the median (carpal tunnel) nerve.
- Electrodiagnostic studies, namely nerve conduction studies, serve as the gold standard for the diagnosis of carpal tunnel syndrome. In this case, this proved imperative in an effort to objectively support the patient’s ongoing subjective symptoms. It is well known that if pain and other complaints are reported as work-related, patients report such complaints on a much more consistent basis after successful surgery in comparison to those who do not blame the workplace. The electrodiagnostic data should be collected and interpreted by the same clinical evaluating physician, such as a medical expert in physiatry.
