Carpal Tunnel Injuries in Workers’ Compensation Cases

Employees who sustain carpal tunnel syndrome (CTS) injuries due to job-related activities are entitled to workers’ compensation benefits. These benefits may include

• medical care,
• temporary disability,
• permanent disability,
• compensation for lost wages, and
• job displacement benefits.

CTS is an injury to the median nerve in the wrist caused by engaging in repetitive motion such as writing or typing. It is a common occupational injury that causes numbness, weakness, and tingling in the fingers and palm. The actual cause of CTS is unknown.

The types of repetitive motion thought to cause CTS include:

• keyboard use
• the use of hand tools

CTS can be diagnosed through testing in a doctor’s office or through a nerve conduction study.

Filing a workers comp claim for a cumulative trauma injury to the hands or wrists will open a carpal tunnel claim.

The treatment for CTS is:

• medication
• splinting
• avoiding painful activities
• carpal tunnel release surgery

A carpal tunnel injury is rated using chapter 16 the American Medical Association Guides to the Evaluation of Permanent Impairment, Fifth Edition. The rating is based on a lack of sensation and the amount of strength in the median nerve.

In this article, our California personal injury attorneys will explain:

• 1. What is carpal tunnel syndrome?
• 2. What causes carpal tunnel syndrome?
• 3. How is carpal tunnel syndrome diagnosed?
• 4. What is the treatment for a carpal tunnel injury?
• 5. Filing a claim for a carpal tunnel injury
• 6. How a carpal tunnel injury is rated for disability level
• 7. Pursuing a carpal tunnel claim in California workers’ compensation

1. What is carpal tunnel syndrome?

Carpal tunnel syndrome (CTS) is likely the most frequently repetitive motion injury in California workers’ compensation.¹ It occurs when the median nerve, which runs from the forearm to the palm, is irritated at the wrist.²

It can result in numbness, weakness, and pain in the hand and wrist.³ Symptoms usually start gradually with frequent burning, tingling, itching, or numbness in the palm of the hand and the fingers, especially the thumb, index, and middle fingers.⁴

Example: Ken is a computer programmer. He uses a keyboard and mouse all day. He first develops tingling in the thumb and index finger of his right hand. He then begins to have numbness and pain in both hands.

The pain is less when Ken is not working for a few days and becomes more severe after working all day. He is also losing grip strength.

Although a medical evaluation is required, it is very likely that Ken has CTS in both wrists.

2. What causes carpal tunnel syndrome?

There is no clear cause of CTS. Repeated motion of the wrist can cause swelling of the median nerve. This can come from:

• hand positioning while using a keyboard or mouse
• vibration from power tools
• any other repeated movement of the wrists⁵

As CTS occurs over a period of time, a carpal tunnel injury will likely be a cumulative trauma.

Cumulative trauma is an injury that happens from repeated activities over more than one day.

Up to 20% of the population that do hand-intensive activities five days a week for at least five hours a day will develop CTS or similar condition.⁶

Women are three times as likely to develop CTS as men. This may be because women on average have a narrower carpal tunnel for the median nerve to travel through, therefore, making it is more likely to become compressed.⁷

Common occupations that may be more prone to CTS include:

• manufacturing
• assembly line work
• keyboarding occupations
• construction work⁸

In workers’ compensation, CTS has been diagnosed in many occupations. Those occupations include:

• truck driver⁹
• cashier¹⁰
• office assistant¹¹
• carpenter¹²
• grocery clerk¹³
• automotive line worker¹⁴
• ^{police officer15}
• ^{firefighter16}

Any worker in any occupation with extensive hand use can be susceptible to CTS and pursue a workers’ compensation claim.

Example: Dave is a carpenter in the film industry. He uses a hammer, electric drill, saw, and sander during the course of his job. He has been experiencing increasing numbness and tingling in his fingers. Some days he drops tools due to loss of grip strength.

Based on Dave’s job duties and symptoms, there is a strong possibility he has CTS.

Dave reports his injury to his employer. He is given a claim form and sent to a doctor.

3. How is carpal tunnel syndrome diagnosed?

CTS is diagnosed through:

• physical exam of the wrist and fingers for tenderness, swelling, sensation, or discoloration
• lab test to detect diabetes
• x-rays to detect arthritis
• manipulation of the wrist by the doctor to see if numbness or tingling occurs
• nerve conduction study that measures the electrical activity of the nerves and muscles
• ultrasound imaging that shows an abnormal size of the median nerve¹⁷

Example: Steve is having numbness and pain in his hands. He tells his doctor that he does soldering of computer components all day. He has pain and numbness in his fingers. His doctor does several tests in the office.

First, the doctor presses on the median nerve in Steve’s wrist. Steve has tingling in his fingers. The doctor then has Steve press the backs of his hands together. Steve again has numbness and tingling in his fingers.

Both tests are positive for CTS.

Steve’s doctor decides not to do any other testing because the testing is clear.

4. What is the treatment for a carpal tunnel injury?

The California workers’ compensation system follows the American College of Occupational and Environmental Medicine‘s Hand, Wrist, and Forearm Disorder Guideline for the treatment of CTS.

Treatment of CTS includes:

• splinting
• over the counter pain relievers
• prescription corticosteroids
• avoiding activities that may provoke symptoms
• alternative therapies such as yoga¹⁸

There are times when CTS will require surgery, a procedure called carpal tunnel release.

In the surgery, a ligament around the median nerve is severed to reduce pressure on the median nerve.¹⁹

After the surgery, an injured worker may need 3-8 physical therapy visits over 3-5 weeks. The total recovery time is three months.²⁰

An injured worker with CTS should be evaluated by an upper extremity specialist.²¹ This is an orthopedic doctor that specializes in hand and upper extremity injuries.

Example: Jennifer has attempted splinting her wrists and taking medication to treat her CTS. These treatments have not proven effective.

Even without working, Jennifer still has to use her hands in daily activities, and her condition has not improved.

She has carpal tunnel release surgery on an outpatient basis on her left wrist and seven weeks later, she has the same procedure on her right wrist. She has physical therapy and wears a brace after both surgeries. She is given pain medication. Jennifer has problems with grip strength that slowly improves.

5. Filing a claim for a carpal tunnel injury

To file a claim for workers’ compensation benefits for CTS requires filling out a claim form.²²

Subsequent filing a claim, an injured worker often has to be placed on modified or light duty, as he or she cannot continue to with regular work consisting of hand-intensive activities.

6. How a carpal tunnel injury is rated for disability level

The California workers’ compensation system uses the American Medical Association Guides to the Evaluation of Permanent Impairment, Fifth Edition (AMA Guides).²³

CTS is evaluated in chapter 16 of the AMA Guides. The evaluation measures the loss of sensation that goes through the median nerve to the hand and fingers and loss of hand movement and strength. Testing for this is determined using a nerve conduction study.

The AMA Guides do not recommend that grip strength be used to rate CTS.²⁴

Example: David has a medical evaluation for his CTS. The doctor sends David for a nerve conduction study. After the doctor receives the nerve conduction study results, she writes a report that finds David’s condition to be permanent and stationary, meaning it’s unlikely to improve, as of the date of the exam.

She gives him 5% impairment for both wrists based on the AMA Guides using the median nerve findings in the nerve conduction study.

7. Pursuing a carpal tunnel claim in California workers’ compensation

The exact cause of CTS is unknown. It is up to the injured worker to explain the work activities that he or she believes led to the wrist and hand complaints.

It is also up to the injured worker to select a specialist in upper extremity injuries so that the right treatment is provided.

If an injured worker does not completely recover from a carpal tunnel injury, an understanding of the AMA Guides is necessary to obtain full value for the permanent effects of his or her carpal tunnel injury.

For additional help…

For help with filing a workers’ compensation claim in California, completing workers comp forms or appealing a denial of benefits, contact us. Also see our article on the average settlement for a worker’s compensation carpal tunnel case. Our firm helps police officers, firefighters and other workers to get compensation for their job-related injuries in California. Also see our page on settlements for nerve injury to the hands.

Legal references: