Cumulative keyboard strokes: a possible risk factor for carpal tunnel syndrome

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Abstract

Background

Contradictory reports have been published regarding the association of Carpal Tunnel Syndrome (CTS) and the use of computer keyboard. Previous studies did not take into account the cumulative exposure to keyboard strokes among computer workers. The aim of the present study was to investigate the association between cumulative keyboard use (keyboard strokes) and CTS.

Methods

Employees (461) from a Governmental data entry & processing unit agreed to participate (response rate: 84.1 %) in a cross-sectional study. Α questionnaire was distributed to the participants to obtain information on socio-demographics and risk factors for CTS. The participants were examined for signs and symptoms related to CTS and were asked if they had previous history or surgery for CTS. The cumulative amount of the keyboard strokes per worker per year was calculated by the use of payroll’s registry. Two case definitions for CTS were used. The first included subjects with personal history/surgery for CTS while the second included subjects that belonged to the first case definition plus those participants were identified through clinical examination.

Results

Multivariate analysis used for both case definitions, indicated that those employees with high cumulative exposure to keyboard strokes were at increased risk of CTS (case definition A: OR = 2.23;95 % CI = 1.09-4.52 and case definition B: OR = 2.41; 95%CI = 1.36-4.25). A dose response pattern between cumulative exposure to keyboard strokes and CTS has been revealed (p < 0.001).

Conclusions

The present study indicated a possible association between cumulative exposure to keyboard strokes and development of CTS. Cumulative exposure to key-board strokes would be taken into account as an exposure indicator regarding exposure assessment of computer workers. Further research is needed in order to test the results of the current study and assess causality between cumulative keyboard strokes and development of CT.

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Most cited references 14

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Consensus criteria for the classification of carpal tunnel syndrome in epidemiologic studies.

B Evanoff, Mindy J. Katz, James M Hagberg … (1998)

Criteria for the classification of carpal tunnel syndrome for use in epidemiologic studies were developed by means of a consensus process. Twelve medical researchers with experience in conducting epidemiologic studies of carpal tunnel syndrome participated in the process. The group reached agreement on several conceptual issues. First, there is no perfect gold standard for carpal tunnel syndrome. The combination of electrodiagnostic study findings and symptom characteristics will provide the most accurate information for classification of carpal tunnel syndrome. Second, use of only electrodiagnostic study findings is not recommended. Finally, in the absence of electrodiagnostic studies, specific combinations of symptom characteristics and physical examination findings may be useful in some settings but are likely to result in greater misclassification of disease status.

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A prospective study of computer users: II. Postural risk factors for musculoskeletal symptoms and disorders.

Michele Marcus, Fredric Gerr, C D Ensor … (2002)

Despite widespread recommendations regarding posture during computer use, associations between specific postures and musculoskeletal health are not well characterized. Six hundred and thirty-two newly hired computer users were followed prospectively to evaluate associations between posture and neck or shoulder (N/S) and hand or arm (H/A) musculoskeletal symptoms and musculoskeletal disorders. Participants' postures were measured at entry and they reported symptoms on weekly diaries. Participants reporting symptoms were examined for specific disorders. Multivariate Cox regression models were used to estimate associations between postural variables and risk of symptoms and disorders, controlling for confounding variables. Keying with an inner elbow angle > 121 degrees, greater downward head tilt, and presence of armrests on the participants chair were associated with lower risk of N/S symptoms or N/S disorders. Keying with elbow height below the height of the "J" key and the presence of a telephone shoulder rest were associated with a greater risk of N/S symptoms or N/S disorders. Horizontal location of the "J" key > 12 cm from the edge of the desk was associated with a lower risk of H/A symptoms and H/A disorders. Use of a keyboard with the "J" key > 3.5 cm above the table surface, key activation force > 48 g, and radial wrist deviation of > 5 degrees while using a mouse was associated with a greater risk of H/A symptoms or H/A disorders. The number of hours keying/week was associated with H/A symptoms and disorders. The results suggest that the risk of musculoskeletal symptoms and musculoskeletal disorders may be reduced by encouraging specific seated postures. Copyright 2002 Wiley-Liss, Inc.

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Slopes of a receiver operating characteristic curve and likelihood ratios for a diagnostic test.

Y. Choi (1998)

This paper clarifies two important concepts in clinical epidemiology: the slope of a receiver operating characteristic (ROC) curve and the likelihood ratio. It points out that there are three types of slopes in an ROC curve--the tangent at a point on the curve, the slope between the origin and a point on the curve, and the slope between two points on the curve. It also points out that there are three types of likelihood ratios that can be defined for a diagnostic test that produces results on a continuous scale--the likelihood ratio for a particular single test value, the likelihood ratio for a positive test result, and the likelihood ratio for a test result in a particular level or category. It further illustrates mathematically and empirically the following three relations between these various definitions of slopes and likelihood ratios: 1) the tangent at a point on the ROC curve corresponds to the likelihood ratio for a single test value represented by that point; 2) the slope between the origin and a point on the curve corresponds to the positive likelihood ratio using the point as a criterion for positivity; and 3) the slope between two points on the curve corresponds to the likelihood ratio for a test result in a defined level bounded by the two points. The likelihood ratio for a single test value is considered an important parameter for evaluating diagnostic tests, but it is not easily estimable directly from laboratory data because of limited sample size. However, by using ROC analysis, the likelihood ratio for a single test value can be easily measured from the tangent. It is suggested that existing ROC analysis software be revised to provide estimates for tangents at various points on the ROC curve.

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Author and article information

Journal

Journal ID (nlm-ta): J Occup Med Toxicol

Journal ID (iso-abbrev): J Occup Med Toxicol

Title: Journal of Occupational Medicine and Toxicology (London, England)

Publisher: BioMed Central

ISSN (Electronic): 1745-6673

Publication date Collection: 2012

Publication date (Electronic): 2 August 2012

Volume: 7

Page: 16

Affiliations

[1 ]Department of Hygiene and Epidemiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 22, Papakyriazi str, Larissa, Thessaly, 41222, Greece

[2 ]Department of Orthopaedics and & Musculoskeletal Trauma Surgery, Faculty of Medicine, School of Health Sciences, University of Thessalia, Larissa, Greece

[3 ]Department of Public Health Technological Institute of Athens, Athens, Greece

Article

Publisher ID: 1745-6673-7-16

DOI: 10.1186/1745-6673-7-16

PMC ID: 3480831

PubMed ID: 22856674

SO-VID: 457f5f26-e030-428f-8587-0cffec3d9b63

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cumulative keyboard strokes: a possible risk factor for carpal tunnel syndrome

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Abstract

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Conclusions

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Tobacco Prevention & Cessation

Most cited references 14

Consensus criteria for the classification of carpal tunnel syndrome in epidemiologic studies.

A prospective study of computer users: II. Postural risk factors for musculoskeletal symptoms and disorders.

Slopes of a receiver operating characteristic curve and likelihood ratios for a diagnostic test.

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