Editing Carpal tunnel syndrome (section)

=== CTS and activity ===
Work-related factors that increase risk of CTS include vibration (5.4 [[odds ratio]]), hand force (4.2), and repetition (2.3).<ref name=":1">{{cite journal | vauthors = Newington L, Harris EC, Walker-Bone K | title = Carpal tunnel syndrome and work | journal = Best Practice & Research. Clinical Rheumatology | volume = 29 | issue = 3 | pages = 440–453 | date = June 2015 | pmid = 26612240 | pmc = 4759938 | doi = 10.1016/j.berh.2015.04.026 }}</ref> Exposure to wrist extension or flexion at work increases the risk of CTS by 2.0 times.<ref name=":1" /> {{As of|2023}}, a systematic review of studies looking at the relationship between CTS and computer use has found current studies to be inconclusive and contradictory, due to poor study methods and confounding variables not being accounted for.<ref>{{Cite journal |last=Lisica Mandek |first=Denis |last2=Brborović |first2=Hana |date=2023-07-03 |title=Computer use at work and carpal tunnel syndrome: overview of systematic reviews |url=https://hrcak.srce.hr/305261 |journal=Sigurnost: časopis za sigurnost u radnoj i životnoj okolini |language=en |volume=65 |issue=2 |pages=163–177 |doi=10.31306/s.65.2.3 |issn=0350-6886|doi-access=free }}</ref>

The international debate regarding the relationship between CTS and [[Repetitive stress injury|repetitive hand use]] (at work in particular) is ongoing. The [[Occupational Safety and Health Administration]] (OSHA) has adopted rules and regulations regarding so-called "cumulative trauma disorders" based concerns regarding potential harm from exposure to [[Ergonomic hazard|repetitive tasks, force, posture, and vibration]].<ref name=Derebery_2006>{{cite journal | vauthors = Derebery J | title = Work-related carpal tunnel syndrome: the facts and the myths | journal = Clinics in Occupational and Environmental Medicine | volume = 5 | issue = 2 | pages = 353–67, viii | year = 2006 | pmid = 16647653 | doi = 10.1016/j.coem.2005.11.014 | doi-broken-date = 1 November 2024 }}</ref><ref name=NINDS_2009>{{Cite web |author=Office of Communications and Public Liaison |title=National Institute of Neurological Disorders and Stroke |date=December 18, 2009 |url=http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm |url-status=live |archive-url=https://web.archive.org/web/20160303181005/http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm |archive-date=March 3, 2016 }}</ref>

A review of available scientific data by the [[National Institute for Occupational Safety and Health]] (NIOSH) indicated that job tasks that involve highly repetitive manual acts or specific wrist postures were associated with symptoms of CTS, but there was not a clear distinction of paresthesia (appropriate) from pain (inappropriate) and causation was not established. The distinction from work-related arm pains that are not carpal tunnel syndrome was unclear. It is proposed that repetitive use of the arm can affect the [[biomechanics]] of the upper limb or cause damage to tissues. It is proposed that postural and spinal assessment along with ergonomic assessments should be considered, based on observation that addressing these factors has been found to improve comfort in some studies although experimental data are lacking and the perceived benefits may not be specific to those interventions.<ref name=Cole_2006>{{cite journal | vauthors = Cole DC, Hogg-Johnson S, Manno M, Ibrahim S, Wells RP, Ferrier SE | title = Reducing musculoskeletal burden through ergonomic program implementation in a large newspaper | journal = International Archives of Occupational and Environmental Health | volume = 80 | issue = 2 | pages = 98–108 | date = November 2006 | pmid = 16736193 | doi = 10.1007/s00420-006-0107-6 | bibcode = 2006IAOEH..80...98C | s2cid = 21845851 | collaboration = Worksite Upper Extremity Research Group }}</ref><ref>{{cite journal | vauthors = O'Connor D, Page MJ, Marshall SC, Massy-Westropp N | title = Ergonomic positioning or equipment for treating carpal tunnel syndrome | journal = The Cochrane Database of Systematic Reviews | volume = 1 | issue = 1 | pages = CD009600 | date = January 2012 | pmid = 22259003 | pmc = 6486220 | doi = 10.1002/14651858.CD009600 }}</ref> A 2010 survey by NIOSH showed that two-thirds of the 5{{nbsp}}million carpal tunnel diagnosed in the US that year were related to work.<ref>{{Cite web |url = http://blogs.cdc.gov/niosh-science-blog/2013/06/24/nhis/ |title = How Does Work Affect the Health of the U.S. Population? Free Data from the 2010 NHIS-OHS Provides the Answers |date = 24 June 2013 | vauthors = Luckhaupt SE, Burris DL |publisher = National Institute for Occupational Safety and Health |access-date = 18 January 2015 |url-status = live |archive-url = https://web.archive.org/web/20150118192906/http://blogs.cdc.gov/niosh-science-blog/2013/06/24/nhis/ |archive-date = 18 January 2015 }}</ref> Women are more likely to be diagnosed with work-related carpal tunnel syndrome than men.<ref>{{Cite web |url = http://blogs.cdc.gov/niosh-science-blog/2013/05/13/womens-health-at-work/ |title = Women's Health at Work |publisher = National Institute for Occupational Safety and Health |access-date = 21 January 2015 |date = 13 May 2013 | vauthors = Swanson N, Tisdale-Pardi J, MacDonald L, Tiesman HM |url-status = live |archive-url = https://web.archive.org/web/20150118223513/http://blogs.cdc.gov/niosh-science-blog/2013/05/13/womens-health-at-work/ |archive-date = 18 January 2015 }}</ref> Many if not most patients described in published series of carpal tunnel release are older and often not working.<ref>{{cite journal | vauthors = Gelfman R, Melton LJ, Yawn BP, Wollan PC, Amadio PC, Stevens JC | title = Long-term trends in carpal tunnel syndrome | journal = Neurology | volume = 72 | issue = 1 | pages = 33–41 | date = January 2009 | pmid = 19122028 | pmc = 2633642 | doi = 10.1212/01.wnl.0000338533.88960.b9 }}</ref>

Normal pressure of the carpal tunnel has been defined as a range of {{cvt|2–10|mm}}.<ref name="Carpal Tunnel Syndrome: Symptoms, C">{{cite journal | vauthors = Zamborsky R, Kokavec M, Simko L, Bohac M | title = Carpal Tunnel Syndrome: Symptoms, Causes and Treatment Options. Literature Reviev | journal = Ortopedia, Traumatologia, Rehabilitacja | volume = 19 | issue = 1 | pages = 1–8 | date = January 2017 | pmid = 28436376 | doi = 10.5604/15093492.1232629 | doi-broken-date = 1 November 2024 }}</ref> Wrist flexion increases the pressure eight-fold and extension increases it ten-fold.<ref>{{cite journal | vauthors = Ibrahim I, Khan WS, Goddard N, Smitham P | title = Carpal tunnel syndrome: a review of the recent literature | journal = The Open Orthopaedics Journal | volume = 6 | issue = 1 | pages = 69–76 | date = 2012-02-23 | pmid = 22470412 | pmc = 3314870 | doi =  10.2174/1874325001206010069  |doi-access=free}}</ref> There is speculation that repetitive flexion and extension in the wrist can cause thickening of the synovial tissue that lines the tendons within the carpal tunnel.<ref>{{cite journal | vauthors = Lluch AL | title = Thickening of the synovium of the digital flexor tendons: cause or consequence of the carpal tunnel syndrome? | journal = Journal of Hand Surgery | volume = 17 | issue = 2 | pages = 209–212 | date = April 1992 | pmid = 1588206 | doi = 10.1016/0266-7681(92)90091-F | s2cid = 39895571 }}</ref>