Program takes aim at carpal tunnel epidemic
Three-pronged approach is highly successful
HEALTHSOUTH Corporation has targeted a fast-growing industrial problem with a three-part program that identifies employees at risk for carpal tunnel syndrome (CTS) and other repetitive stress trauma and recommends an abatement program.
The goal of the program is to bring the best of conservative medicine and conservative ergonomics to deal with upper extremity cumulative trauma, says Eric Kennedy, MS, CPE, director of operations for HEALTHSOUTH’s occupational and preventative diagnostic division.
In one case study, HEALTHSOUTH researchers at a textile plant reported lost working days caused by carpal tunnel syndrome dropped from 240 the year before the program was begun to zero a year after the program was implemented. There were no new cases of CTS, compared to six in the preceding year, and no employees required carpal tunnel release surgery, compared with five the year preceding the HEALTHSOUTH program.
Scott Jaeger, MD, a Hadenfield, NJ, hand surgeon, developed the screen in the 1980s after he found that 70% of patients who had carpal tunnel release surgery had a recurrence of the disorder if they went back to the same job within two years.
"On a scale of 1 to 10, carpal tunnel syndrome doesn’t become symptomatic until you are an 8. If you wait that long, there is so much damage you can’t reverse it. I wanted to identify someone ahead of time and be proactive rather than reactive," says Jaeger who is national medical director for HEALTHSOUTH’s occupational and preventative diagnostic division.
The HEALTHSOUTH carpal tunnel syndrome screening program has three components:
• An ergonomics inventory assesses job risk factors such as repetitive actions, postures, and environmental exposures, such as cold, vibrations, or stress. The technician who performs the ergonomics inventory records the risk factors on a standardized form.
• An employee questionnaire looks at 45 personal risk factors for CTS such as diabetes, hormone status of women, thyroid conditions, hand dominance, hobbies that involve repetitive stress, numbness or tingling in hands, and pain in wrists, elbows, or shoulders. Employees answer simple questions on a form that can be scanned by a computer.
• A sensory nerve conduction test determines the current state of health of the median nerve. The test is conducted with the NeuroSentinel, a patented device developed by Jaeger.
The results of the three tests are analyzed by a computer program that assigns a numeric risk to each worker, based on individual factors, the mechanics of the job, and the nerve conduction test. Predictions are based on more than 20,000 screenings on more than 10,000 subjects during a seven-year period.
The computer algorithm evaluates all contributing factors and assigns an individual risk level for each worker. The program assesses the magnitude and the trend of the risk level and generates individual recommendations which may be medical, ergonomical, or a combination of both.
"Once the computer assigns the risks, we look at the individuals who have the higher risks and make abatement recommendations based on causal factors," Kennedy says.
If the screening program suggests a worker has a high risk for carpal tunnel syndrome, the HEALTHSOUTH consultants will suggest changes workers can make. Night splinting, hand exercises, changes in posture, or change in the way they do their jobs may be among the recommendations.
If statistics show a group of people doing one particular job are at greater risk, Kennedy and his staff will suggest an ergonomics assessment of the job, and train the workers to do their job in a safer manner.
The computer automatically assigns each employee who is at risk for CTS a re-screening date, depending on the level of risk.
The computer program also generates a summary report for management and an individual feedback letter to each employee.
The program can create 850 different feedback letters that detail the condition and what abatement measures are suggested. For instance, the letter may say the worker will benefit from hand exercises and that a therapist will come to the job site to teach them the exercises. If the person has been rescreened and is improving, the letter will state that the exercises can be discontinued.
Patients are also asked during rescreening if they have been following their instructions. If the answer is no, the letter they receive encourages them to do so.
HEALTHSOUTH bills for the services on a per-test basis or will negotiate a flat rate for an annual screening contract.
[For more information on HEALTHSOUTH’s carpal tunnel screening program, contact Debra Austin, field coordinator at (704) 332-8511.]
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