Carpal tunnel: Is it work-related?
If an employee reports carpal tunnel syndrome to his or her primary care physician, the provider may wrongly assume it's work-related and therefore, Occupational Safety and Health Administration (OSHA)-recordable.
"If the provider is only listening to the employee, and is not aware that there are other risk factors or other potential for the condition having happened off the job, we always bring this to the provider's attention," says Bruce E. Cunha, RN, MS, COHN-S, manager of employee health and safety at Marshfield (WI) Clinic.
"Keep in mind that most employees only are on the job about one third of the day, and not seven days a week," says Cunha. "The private life of the employee is as much, if not a greater, influence on conditions they develop as work is."
Research suggests carpal tunnel syndrome is less related to work, and more related to other risk factors such as weight, genetics, and other medical conditions, notes Cunha.1
A provider may examine an employee and assume the carpal tunnel is work-related, without identifying other significant risk factors. In other cases, the provider may not understand what the employee really does.
In this case, Cunha contacts the provider and asks that they show there are no other risk factors that could be the cause. "If we have the primary provider saying a condition is work-related, and we also have an Independent Medical Review saying it is not, we will typically go with the second opinion," he adds.
Since personal providers probably won't want to disagree with their patients, they're more likely to conclude an injury is work-related, especially if there is a financial incentive for the employee. An employee may say, for example, "Doctor, I think my back condition is related to my job. I don't have medical insurance and if workers' compensation does not cover this, I don't know how I will pay for the treatment."
The provider, especially if there is an established relationship with the patient, is more likely to say a condition is work-related, than to disagree and potentially have the employee drop them as their provider.
"This is where occupational health providers are at their best. They have a better understanding of the mechanisms of injury," says Cunha. "They can objectively review the issues, to determine if a condition is truly caused by or significantly aggravated by work."
1. Conolly WB, McKessar JH. Carpal tunnel syndrome: Can it be a work related condition? Aust Fam Phys 2009; 38(9):684-686.