The Risk Authority

Manuel Solis

A recently released meta-analysis in the Journal of Occupational and Environmental Medicine, revisits the controversy of the link between carpal tunnel syndrome and keyboard usage. The conclusion of the meta-analysis is there is no definitive correlation between keyboard use and carpal tunnel syndrome.


Prior individual studies have drawn the same conclusion, however, in the workers’ compensation arena it is very difficult to find a workers’ compensation Judge or Referee that will support that conclusion.


Many of the studies point to congenital predisposition, gender, weight, arthritis, prior trauma, fluid retention during pregnancy or menopause among other items as the leading causation factors. However, there is minimal support for those theories in the workers’ compensation arena.


In this vein, I found this article informative and pertinent to the discussion. The author makes some very good points; of specific interest is the fact that there are over 250,000 carpal tunnel syndrome surgeries a year. Whether those are treated as occupational or non-occupational, the disability and medical cost as a result of those surgeries are astronomical and need to be addressed.


What are the next steps to reducing carpel tunnel syndrome?

While we may see changes in the future, for the here and now we need to work within the current system and mitigate costs as much as possible.  I suggest consideration of the following steps as a good starting point:


  • Continue or start an ergonomic program, in some States it is the law, and appropriate body mechanics can assist with carpal tunnel syndrome (mentally if not physically) and numerous other repetitive stress injuries. Among the many parts of the program all new employees should have a work station assessment within the first week. If that cannot be done in person, consider an online option; also make safety/ergonomics part of the orientation program.
  • Ensure that the claim team and medical provider obtain a complete history, medical and employment and detail any off duty activity.
  • Establish a protocol with your claim team that when appropriate you want all cases referred to specific hand specialists and therapy groups.
  • If the diagnosis of carpal tunnel syndrome is provided, ask your claim administrator to insure that the diagnosis is correct, has the proper test been administered?
  • Post injury ergonomic evaluation; make sure you are not putting the employee back into the same situation.
  • Employee education, report a claim at onset of symptoms, early intervention. Employee should be aware of they have access to the ergonomic program without having to file a claim.
  • Post offer, pre-employment physicals.


These are just some of the steps one can take to control cost, a program needs to be flexible and always evolving.


By: Manuel Solis, ARM, CPDM

Manuel has been involved in the claims arena since 1981, as a claim adjuster, supervisor and consultant. He currently serves as Assistant Vice President of Worker’s Compensation Claims Administration at The Risk Authority at Stanford, and as Worker’s Compensation Claims Administrator at the Stanford University Medical Center.  His emphasis is to ensure the timely and appropriate delivery of benefits to our employees and reduction of claims management costs.