What ever happened to carpal tunnel?

Trendy techno malady has eased, but we've already got a new ache

MSNBC.com—March 7, 2008 

Commentary by Dr. Edward V. Craig
Special to MSNBC.com

Remember when half your co-workers complained of “carpal tunnel” and wrist braces were the fashionable office accessory?

Cases of carpal tunnel syndrome, the white-collar epidemic of the '90s, have plummeted in recent years, according to labor statistics. What happened? Did all those ergonomic keyboards cure us of our aches and pains or is something else going on?

Something else is going on.

For one thing, the lumping of nearly every patient with an achy arm into the carpal tunnel category has diminished, and other trendy, multisyllabic diagnoses such as repetitive stress syndrome (RSS), cumulative trauma disorder (CTD) and musculoskeletal disease (MSD) are filling the gap. Secondly, measures taken in the workplace — job rotation, stretch breaks and attention to ergonomics have indeed had an effect — even if what had been labeled carpal tunnel was in reality plain old tendonitis, bursitis, spasm, or even muscular lack of conditioning.

Unquestionably, workers engaged in repetitive work many hours each day experience a variety of musculoskeletal pains. So do gardeners, waitresses and baseball players. That does not mean the work causes the problem. Association is different from causation. Just because chest pain often happens in cold weather does not mean winter causes heart disease.

Explosion of acronyms

There is little question that since use of computers has proliferated both in and out of the home, musculoskeletal problems have been common in the American workplace. But whether you call it carpal tunnel, RSS, CTD, MSD, or any other acronym, this vague, poorly defined, almost impossible-to-prove constellation of symptoms is responsible for lots of lost work time and hefty medical bills.

Doctors have never been entirely comfortable with these types of labels. That’s because such an eponym tries to assign a specific diagnosis to subjective complaints of pain rather than something the practitioner can observe or demonstrate. Putting a name to what is essentially an overuse problem leads the patient to believe there is serious injury, giving the condition a magnitude often undeserved, rather than recognizing it as one of the aches periodically experienced by each of us.

Dr. Edward V. Craig is Attending Surgeon at Hospital for Special Surgery in New York City and Professor of Clinical Orthopedic Surgery at Cornell Medical School.

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