POLICY NUMBER: 1. 2. 4R

Effective Date: February 7, 1997
Date Issued: February 7, 1997
Date Approved by Board of Directors: February 7, 1997
Topic: Carpal Tunnel Syndrome
Section: Entitlement
Subsection: Occupational Diseases

Definition

Carpal Tunnel Syndrome is a compression of the median nerve as it passes through an area in the wrist known as the Carpal Tunnel.

Policy Statement

1.Claims for traumatic Carpal Tunnel Syndrome will be considered for acceptance if the condition arrises out of and in the course of employment. For example:

1.1 the client's work involves repetitive flexion and extension of the wrist on fairly full time basis;

or

1.2 the client's work involves the use of vibratory tools;

or

1.3 the client's work involves the use of tools which place the wrist/hand in an awkward position;

or

1.4 the client's work involves sustained or repeated stress over the base of the palm;

or

1.5 there is direct, blunt trauma to the integrity of the carpal tunnel structures (ie. crush injury, wrist fracture, etc.).

Frequency, intensity and duration of force on the median nerve should all be considered in each claim.

2. The length of time doing a particular occupation should be considered. Short term work with appropriate factors present (as listed above) would favour a traumatic etiology. Long term work with a recent change, ie. overtime, would also favour a traumatic etiology.

3. Physical signs of trauma are often absent, but with appropriate history claims can still be considered for acceptance.

4. Where there is evidence that non-occupational factors have contributed to development of the condition, section 10(5) of the Act will apply.

5. There should be objective evidence of median nerve conduction delay at the wrist as compared to the ipsilateral ulnar nerve for carpal tunnel surgery. In cases when the electrodiagnostic studies are normal, and the diagnosis of carpal tunnel is being made and surgery contemplated, the Board requires a second opinion from a physician of its choice. If the first and second opinion are not in agreement, a third opinion by a physician mutually acceptable to the worker's physician and the Board will be sought. Regardless of the number of opinions received, all medical evidence must be weighed before a final decision on the surgery is made.

6. Before bilateral carpal tunnel is accepted, the criteria listed above must be met for each wrist independently.

Application

This Policy applies to all decisions made on or after February 7, 1997.

References

Workers' Compensation Act (Chapter 10, Acts of 1994 - 95), Section 10, 102.