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  1. #1
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    Feb 2007
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    Question How Long To Develop Carpal Tunnel Syndrome

    How long do I have to work at a job to develop carpal tunnel? I've been working hard at an assembly type job for the past two months and think I have carpal tunnel in both wrists now. The company HR says I got it at my last job, or from off work activity (I'm on line often, like now). I've been hoping to get on disability so I can start my own website company, but this job pays benefits and I want to keep it for awhile. Should I wait longer to claim I have carpal tunnel - say 6 months, or is 2 months long enough to get carpal tunnel? Thanks

  2. #2
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    Default Re: How long to develop carpal tunnel?

    Genetic and lifestyle factors are causitive of CTS while there is very little in the way of clinical scientific evidence to support work factors in CTS. There is specifically no link between keyboard, keying, typing , and development of CTS.

  3. #3
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    Charlotte, NC
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    Default Re: How long to develop carpal tunnel?

    POR must be an insurance adjuster.

    You can ask 10 hand surgeons what causes carpal tunnel and you will probably get 8 or 10 different answers. You have to distinguish between a single trauma, multiple trauma, and repetitive or micro trauma.

    Hand specialists who are whores for industry and insurance carriers will tell you what POR just said, and that you cannot get it from work.

    Hand specialists who have managed to maintain their independence and integrity may give you an opinion that repetitive motion microtrauma at work can also cause it.

    Whether or not you got it from your work seems to depend on the doctor you ask as much as any other factor.

    Heck, they may all be right. No one really seems to know for sure. In NC, where I practice, CTS cases based on "occupational disease" (repetitive trauma rather than a one-time trauma) are among the most difficult cases to win. But the standard of proof necessary to win is not "for sure." The standard of proof required is "more likely than not." As in, is it more likely than not that your repetitive work caused your CTS? In NC, there are additional requirements to the proof set that must also be met.
    The North Carolina Court of Appeals has held that "In contested Workers' Compensation cases today, access to competent legal counsel is a virtual necessity." Church v. Baxter Travenol Labs, Inc., and American Motorists Insurance Company, 104 N.C. App. 411, 416 (1991).

    Bob Bollinger, Attorney at Law

  4. #4
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    Default Re: How long to develop carpal tunnel?

    Bob;

    sorry to burst your bubble but I am only referencing the medical literature - you've heard of that ? the one where the facts are published, not some lawyerly work around text.....Surgeons would be about the least qualified professional to ask an opinion on CTS about, they are not epidemiologists or public health trained, but maybe the names Norman Hadler MD or Richard Deyo MD rings a bell.

    The fact that the law sees it differently in matters of entitlement does not negate the facts and if you would like references I would be more than happy to flood the board with them.

  5. #5
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    Default Re: How long to develop carpal tunnel?

    Well, I am aware of the debate in the literature. But a surgeon's opinion is all that is required to carry the burden of proof in a comp case.

    On a purely theoretical level, POR, you may well be correct, but from a practical point of view an injured worker can win a CTS case without that level of scientific evidence.

    Most work comp acts, like NC's, are supposed to be "construed liberally" in favor of the worker. That was part of the original compromise between labor and industry that lead to the creation of work comp acts. Maybe that "liberal construction" explains the difference. And most state systems only require the doctor's expert opinion, not original research from an epidemiologist.
    The North Carolina Court of Appeals has held that "In contested Workers' Compensation cases today, access to competent legal counsel is a virtual necessity." Church v. Baxter Travenol Labs, Inc., and American Motorists Insurance Company, 104 N.C. App. 411, 416 (1991).

    Bob Bollinger, Attorney at Law

  6. #6
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    Default Re: How long to develop carpal tunnel?

    You are correct and medical science should never stand in the way of the law as far as entitlements and the medicalization of normal events is concerned eh ?

  7. #7
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    Default Re: How long to develop carpal tunnel?

    It is apparently too complex for you to grasp.
    The North Carolina Court of Appeals has held that "In contested Workers' Compensation cases today, access to competent legal counsel is a virtual necessity." Church v. Baxter Travenol Labs, Inc., and American Motorists Insurance Company, 104 N.C. App. 411, 416 (1991).

    Bob Bollinger, Attorney at Law

  8. #8
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    Feb 2007
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    775

    Default Re: How long to develop carpal tunnel?

    With all due respect Bob; your snide comments are way out of line and add nothing. I understand you are a lawyer who represents injured workers and I understand that there are many working people who develop CTS. I am an Occupational Medicine/ Rehab physician who does not work for industry. I treat IWs and so have many patients who have both a job that uses their hands and who have CTS. Therefore I have no axe to grind with you or anyone else. All I presented were the medical facts as we currently understand them.

    There really is no "debate" in the peer reviewed, international epedimiologic literature on the topic of risk factors for development of carpal tunnel syndrome. The only "debate " occurs in the legal circles. To say that;"...But a surgeon's opinion is all that is required to carry the burden of proof in a comp case. " reflects the legal problems inherent in out WC systems and says nothing about the science. I believe this is properly called Appeal to Authority Fallacy.

    Surgeons are about the least qualified professionals to opine on epidemiology but non-medical professionals tend to hold surgeons in very high esteem and will accept just about anything a surgeon might say as fact.

    As medicine slowly moves towards more evidence based, the current buzzword, underpinnings we are finding that many accepted and long held notions do not hold up to close scrutiny.

    As I said before, the development carpal tunnel syndrome has been found to be associated with some very specific job activites. What has already emerged in the literature is that there are not as many of these type activites as was once thought, that genetics and other non-occupational factors play the larger role. This bit of science has not yet filtered down to the workers comp system in any meaningful way and may never. That's fine with me.

    You also have to take into account that the current understanding may well change again in the future as it is based on meta-analyis of all existing studies. We may well design better studies in the future that lead to a different analysis.

    The more interesting debate is the one I alluded to earlier though, the medicalization of normal life experiences. This occurs when outside interests have something to gain by engaging otherwise well normal people in the medical experience. Lawyers play their part in this as well.

  9. #9
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    Default Re: How long to develop carpal tunnel?

    You are correct about the snide comments. My apologies.

    Thanks for identifying your profession. It certainly gives you a lot more credibility in this discussion. You really did sound like an insurance adjuster earlier.

    The work comp cases generally require "expert medical opinion" testimony to provide the link of causation between the work activity and the diagnosed condition. A family doctor who mostly treats the flu, diabetes, and gives rectal exams can therefore testify as to causation of CTS, and if his is the only medical opinion provided, it will carry the day.

    Workers' comp laws are supposed to be "liberally construed" to provide benefits to injured workers, rather than strictly construed to deny benefits. This is due to a public policy that favors "industry taking care of its wreckage." So, the work comp judges may not scrutinize the scientific background of the medical opinions as closely as a scientist might. The vast majority of them do not have a scientific background anyway.

    In the CTS cases that I have handled, the hand surgeon that performed the CTS release will typically testify that the worker's repetitive job activities either did or did not significantly contribute to the development of the CTS. These docs may be using something along the lines of "medical intuition" to some degree. They have no way to check the genetic profile of the patient. But I don't think a doc has to rely simply on studies to support his opinion. The doctor's clinical experience counts too, and the opinion is still legally "competent" evidence if based on his experience.

    For example, I recently had a Lyme disease case for a young woman who worked in a vet clinic, and the doc testified that in his clinical experience, he had seen a high percentage of Lyme patients who worked closely with animals or in forests, therefore the risk of getting Lyme was greater if you worked in a vet clinic or were a forest ranger or logger.

    We are on appeal at the NCIC now, so we will see if that testimony was enough for the IC. Under the case law, it should be. In that case, the clinical experience is the main basis of the opinion.
    The North Carolina Court of Appeals has held that "In contested Workers' Compensation cases today, access to competent legal counsel is a virtual necessity." Church v. Baxter Travenol Labs, Inc., and American Motorists Insurance Company, 104 N.C. App. 411, 416 (1991).

    Bob Bollinger, Attorney at Law

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