175251 Employment Screening for Carpal Tunnel Syndrome Using Nerve Conduction Studies is Not Supported by Current Evidence

Sunday, October 26, 2008

Theodore N. Armstrong, BS , Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO
Ann Marie Dale, OTR/L, PhD , Division of General Medical Sciences/ School of Public Health, Washington University School of Medicine in St. Louis/ Saint Louis University, St. Louis, MO
Alfred Franzblau, MD , Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI
Jaime Strickland, MA , Division of General Medical Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO
Bradley A. Evanoff, MD, MPH , Washington University School of Medicine, St. Louis, MO
Background: Post-Offer Pre-Placement screening with nerve conduction studies (NCS) is used by many employers to make job placement decisions, and is promoted as a strategy to reduce carpal tunnel syndrome (CTS) in jobs requiring intensive hand activity. Despite widespread use, few data support this practice. In a retrospective analysis of 2150 workers hired at a single company, Franzblau et al. found that abnormal NCS conferred increased risk of future CTS, but that most workers with abnormal NCS did not develop CTS, and most workers who developed CTS in the workplace had normal screening NCS.

Objective: Measure the predictive ability of NCS as a screening tool for CTS.

Methods: The PrediCTS study is an ongoing, prospective study of 1108 newly hired workers in a variety of industries. Subjects received NCS at time of hire; CTS outcomes are followed for 3 years.

Results: Preliminary analyses are based on the 726 subjects with 18 month follow-up to date. Of the 86 (12%) of subjects with abnormal baseline NCS, 21% reported new symptoms of CTS at 18 months, and 5 (6%) reported a new clinical diagnosis of CTS. Of subjects with normal baseline NCS, 4% had new symptoms and 5 (0.8%) a new diagnosis of CTS.

Conclusion: Abnormal baseline NCV predicts higher risk for the development of CTS symptoms or diagnosis. Since the majority of workers with abnormal NCV did not develop CTS or symptoms, our data do not support the practice of denying employment to those with abnormal NCV.

Learning Objectives:
As a result of this talk, the audience will: 1. Have greater understanding of issues involved in medical screening at time of hire 2. Apply evidence-based principles to workplace screening 3. Have increased knowledge of risk factors for carpal tunnel syndrome

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: This research was conducted as a part of the Doris Duke training, a clinical research training program for medical students, under the mentorship of Bradley Evanoff M.D.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.