LTD / ERISA Disability Lawyers: Riverside, Orange & San Bernardino Counties
Carpal Tunnel Syndrome
The National Institutes of Health (NIH) has described carpal tunnel syndrome as follows. {See:Reference below.]
What is carpal tunnel syndrome?
“Carpal tunnel syndrome” (CTS) is a nerve compression disorder, which occurs when the median nerve, which runs down the wrist from the forearm into the palm of the hand, becomes compressed at the wrist by the carpal bones and ligaments as it crosses the wrist. The name comes from the “carpal tunnel,” which is a narrow, canal-like anatomical structure, about an inch wide, through which the median nerve passes as it crosses the wrist. The median nerve innervates the thumb, index, middle and the inside of the ring fingers, on their palm-side, and it also controls the movement of intrinsic muscles at the base of the thumb.
What are the symptoms of carpal tunnel syndrome?
Symptoms vary from patient to patient, but most patients with carpal tunnel syndrome experience localized pain, burning, tingling, and numbness in the palm of the hand and fingers, especially the thumb and the index and middle fingers. One or both hands may be involved. Symptoms may worsen at night, and a patient may feel the need to "shake out" the hand or wrist. As symptoms progress, there may be decreased grip strength that makes it difficult to form a fist, grasp small objects, or perform other manual tasks. In chronic cases, muscle atrophy and wasting may occur, particularly in the muscles at the base of the thumb.
What are the causes of carpal tunnel syndrome?
Carpal tunnel syndrome may occur in patients who use their hands a lot, such as assembly-line workers, typists, musicians, or persons who work in manufacturing, sewing, finishing, cleaning, and meat, poultry, or fish packing. Persons who perform repetitive activities with their hands are prone to develop this condition. However, carpal tunnel syndrome may be seen in certain medical conditions, such as in pregnancy or hypothyroidism. Diabetics are prone to developing carpal tunnel syndrome. Patients with rheumatoid arthritis, scleroderma, lupus, or other arthritic, rheumatic, or connective tissue disorders may develop carpal tunnel syndrome. There are other causes, and sometimes no single cause can be identified.
How is carpal tunnel syndrome diagnosed?
The diagnosis of carpal tunnel syndrome is based on its characteristic clinical symptoms, with pain, tingling, and numbness affecting the thumb, index, middle, and the inside of the ring fingers (but not the little finger).
Phalen's test is a test that patients can do at home by holding their arms out in front of them and then flexing the wrists and letting the hands hang down for about 60 seconds. The test is “positive” if it induces pain, numbness, or tingling in the fingers.
Tinel's sign, in which a doctor lightly taps the ventral aspect of the wrist with a percussion hammer, is considered positive when it reproduces the symptoms of pain, numbness, or tingling in the fingers.
An electromyogram (EMG) and nerve conduction test (NCT), performed by a neurologist, are objective and definitive tests for this condition.
Early diagnosis and treatment are important to avoid permanent damage to the median nerve and chronic symptoms that may be difficult to treat or correct.
How is carpal tunnel syndrome treated?
The treatment of carpal tunnel syndrome depends on its symptoms and severity. In mild cases, perhaps the only treatment required may be the use of a wrist splint (especially at night). Avoiding activities that cause or aggravate carpal tunnel syndrome is important. Non-steroidal anti-inflammatory drugs (NSAIDs) may be useful. Local injections of cortisone may improve symptoms.
Surgery
Surgery may be required when symptoms are progressive and fail to respond to conservative measures. Carpal tunnel surgery involves cutting a ligament around the median nerve at the wrist to relieve the pressure on the nerve. That can be done by open release surgery, or by less invasive endoscopic surgery. Following surgery, the ligaments usually grow back together and allow more space than before. Although some symptoms may be relieved immediately after surgery, further recovery from carpal tunnel surgery can take months.
Recurrence of carpal tunnel symptoms following surgery is typically uncommon, but full recovery of grip strength and function is also less common than we would like, with fewer than half of individuals reporting that their hand(s) feel completely normal following surgery. Some residual numbness or weakness is common.
Studies published in peer-reviewed medical journals show that the frequency of residual symptoms, after carpal tunnel surgery, ranges from 3.7 to 57 percent. [Ref: Dexter, L, et al. “Long-term outcomes of carpal tunnel release: a critical review of the literature.” Hand(N Y). 2012 Sep; 7(3): 242–246.]
How can carpal tunnel syndrome be minimized or prevented?
At the workplace, workers can do on-the-job conditioning, perform stretching exercises, take frequent rest breaks, and ensure correct posture and wrist position. Wearing fingerless gloves can help keep hands warm and flexible. Workstations, tools and tool handles, and tasks can be redesigned to enable the worker's wrist to maintain a natural position during work. Jobs can be rotated among workers. Employers can develop programs in ergonomics, the process of adapting workplace conditions and job demands to the capabilities of workers. However, research has not conclusively shown that these workplace changes prevent the occurrence of carpal tunnel syndrome.
Disability Benefits for Carpal Tunnel Syndrome
Long-term disability (LTD) benefits, whether through Social Security (SSDI) and/or under an employer-provided disability plan (ERISA), may be available for applicants with a diagnosis of carpal tunnel syndrome, depending on the severity of symptoms.
Applicants who have difficulty with fine motor skills and are unable to do repetitive tasks, such as typing, using a telephone, or manipulating hand-held tools, may qualify for LTD if they have a combination of sensory and motor deficits related to their carpal tunnel syndrome that are severe enough to impair light or sedentary work.
A doctor's report that an applicant is unable to do even sedentary work when it includes any type of repetitive use of the hands, may help in getting benefits.
