Editor's Correspondence |

Work-Related Carpal Tunnel Syndrome: Fix the Jobs; Don't Blame the Workers

Steven G. Atcheson, MD
Arch Intern Med. 1999;159(12):1371-1373. doi:.
Text Size: A A A
Published online


In reply

I thank Burt and Hales for their thoughtful comments. It is unfortunate that they assumed that our study1 was flawed by detection bias, even before seeing the data related to their assertion.

They believe that I did not search for concurrent medical diseases in a uniform fashion, without respect to CTS diagnosis. Here is the relevant information: Excluding those patients with an acute traumatic injury, 100% of the 123 patients that I diagnosed as having CTS underwent either radiography (92.7%) of symptomatic areas or laboratory studies (95.9%). Of those not diagnosed as having CTS, 98.7% underwent either x-ray (89.3%) or laboratory tests (87.3%). Only 2 patients did not undergo any studies; in both, their symptoms had nearly resolved by the time of my examination. The evaluation process was the same in all patients: x-ray films were reviewed at the time of the examination, and laboratory tests were then ordered as necessary. The same basic laboratory tests were obtained regardless of CTS diagnosis because conditions, such as arthritis, diabetes mellitus, and hypothyroidism, commonly cause rheumatic complaints in people with no symptoms suggestive of CTS. There is further evidence against significant detection bias in the 43 concurrent diseases that we found in the 170 patients that I did not think had CTS; in virtually all these cases, laboratory or x-ray testing was necessary to confirm a diagnosis.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview





Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles
[Endoscopic treatment of carpal tunnel syndrome]. Acta Ortop Mex 2012 Nov-Dec;26(6):398-401.

The Rational Clinical Examination
Make the Diagnosis: Carpal Tunnel Syndrome

The Rational Clinical Examination
Original Article: Does This Patient Have Carpal Tunnel Syndrome?