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Friday, September 11 • 2:25pm - 3:10pm
Physical & Psychosocial Workplace Factors Associated With Carpal Tunnel Syndrome: A Pooled Prospective Study

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Topic Overview: INTRODUCTION: Between 2001 and 2010, five research groups conducted coordinated prospective studies of carpal tunnel syndrome (CTS) incidence among U.S. workers from various industries. This analysis examined the associations between workplace physical, psychosocial factors and incidence of dominant-hand CTS, adjusting for personal risk factors.

METHODS: 2,474 participants were followed up to 6.5 years (5102 person-years.) Individual workplace exposure measures of the dominant hand were collected for each task and included force, repetition, duty cycle and posture. Task exposures were combined across the workweek using time-weighted-averaging (TWA) to estimate job level exposures. CTS case-criteria was based on symptoms and results of electrophysiological testing. Information on occupational psychosocial factors was collected with scales from the Job Content Questionnaire (JCQ.) 

RESULTS: After adjustment for covariates, analyst (HR=2.17; 95% CI: 1.38-3.43) and worker (HR=2.08; 95% CI: 1.31-3.39) estimated peak hand force, forceful repetition rate (HR=1.84; 95% CI: 1.19-2.86) and percent time spent (e.g., duty cycle) in forceful hand exertions (HR=2.05; 95% CI: 1.34-3.15) were associated with increased risk of incident CTS. Associations were not observed between total hand repetition rate, percent duration all hand exertions, or wrist posture and incident CTS. Psychological demand (HR=1.31; 95%CI: 0.88-1.96) was not confounded by biomechanical exposures, yet decision latitude was confounded by the HAL Scale (HR=0.84; 95%CI: 0.54-1.31). There was evidence of effect modification of the association between decision latitude and CTS by forceful repetition rate among the lower half (HR=0.64; 95%CI=0.34-1.20) and upper half (HR=1.78; 95%CI=0.83-3.81) and various physical exposure measures. 

DISCUSSION:  In this prospective multi-center study of production and service workers, measures of exposure to forceful hand exertion were associated with incident CTS after controlling for important covariates. When work psychosocial factors were assessed for effect modification by biomechanical exposure, a trend supported a protective association between high decision latitude and incidence of CTS only among those with low biomechanical exposure.


  1. Discuss the hypothesized relationship among physical, psychosocial factors & CTS using a directed acyclic graph.
  2. Describe how different measures of force are associated with incident CTS.
  3. Recognize how psychosocial factors are independently related to CTS.
  4. Identify how physical risk factors modify the relationship between psychosocial risk factors and CTS.

avatar for Dr. Carisa Harris Adamson

Dr. Carisa Harris Adamson

Dr. Carisa Harris started her career as a Physical Therapist with a master's degree from the University of California at San Francisco. She developed a keen interest in occupational health through her work in various occupational medicine clinics and eventually spent 10 years developing... Read More →

Friday September 11, 2015 2:25pm - 3:10pm PDT
Pacific Concourse H&I