Reference values of the distal sensory median and ulnar nerves among newly hired workers
Date
2021
Authors
Hischke, Molly, author
Rosecrance, John, advisor
Neophytou, Andreas, committee member
Anderson, Brooke, committee member
Gerr, Fredric, committee member
Reiser, Raoul F., II, committee member
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Abstract
Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in the upper extremity and more common among workers in industrial occupations than in the general population (Atroshi et al., 1999; Mattioli et al., 2009; Palmer, Harris, & Coggon, 2007). Because of the high prevalence of CTS in certain industries, some employers have implemented post-offer pre-placement screening programs using nerve conduction studies (NCS) to identify those at higher risk of developing CTS. NCS are commonly used to identify the median neuropathy characteristic of CTS by assessing the nerve conduction speed of the median nerve. There have been a number of retrospective and prospective cohort studies that have examined the relationship between NCS indicating median neuropathy among workers and the subsequent development of CTS (Werner et al., 2001; Franzblau et al., 2004; Gell et al., 2005; Silverstein et al., 2010; Dale et al., 2014). These studies have indicated that workers with NCS indicating median neuropathy across the carpal tunnel who were initially asymptomatic for CTS, eventually developed CTS at a statistically significant greater rate than workers with normal nerve studies. Some employers have used NCS to identify workers at higher risk of developing CTS and placing them into low hand-intensive work tasks to reduce the high prevalence of work-related CTS. To identify workers at higher risk, their NCS results are often compared to population-based reference values. However, many of these published reference values are limited by their small samples sizes and unsuitable statistical methodologies (Dillingham et al., 2016). Further, some researchers have questioned whether population-based reference values are representative of working populations, especially those in industries with a high prevalence of abnormal NCS (Dale, Gardner, Buckner-petty, Strickland, & Evanoff, 2016; Salerno et al., 1998). The purpose of this dissertation research was to (1) establish reference values for NCS outcomes of the distal upper extremity from a large sample (N=17,630) of newly hired manufacturing workers using novel statistical methods more appropriate for nerve conduction data, (2) investigate comorbid conditions associated with nerve conduction outcomes, and (3) determine the sensitivity and specificity of CTS symptoms for identifying workers with median mononeuropathy.
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Subject
carpal tunnel syndrome
entrapment neuropathy
upper extremity
industrial occupations
nerve conduction studies