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      Meta-Analysis: Association Between Wrist Posture and Carpal Tunnel Syndrome Among Workers


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          Carpal tunnel syndrome (CTS) is a common work-related peripheral neuropathy. In addition to grip force and repetitive hand exertions, wrist posture (hyperextension and hyperflexion) may be a risk factor for CTS among workers. However, findings of studies evaluating the relationship between wrist posture and CTS are inconsistent. The purpose of this paper was to conduct a meta-analysis of existing studies to evaluate the evidence of the relationship between wrist posture at work and risk of CTS.


          PubMed and Google Scholar were searched to identify relevant studies published between 1980 and 2012. The following search terms were used: “work related”, “carpal tunnel syndrome”, “wrist posture”, and “epidemiology”. The studies defined wrist posture as the deviation of the wrist in extension or flexion from a neutral wrist posture. Relative risk (RR) of individual studies for postural risk was pooled to evaluate the overall risk of wrist posture on CTS.


          Nine studies met the inclusion criteria. All were cross-sectional or case–control designs and relied on self-report or observer's estimates for wrist posture assessment. The pooled RR of work-related CTS increased with increasing hours of exposure to wrist deviation or extension/flexion [RR = 2.01; 95% confidence interval (CI): 1.646–2.43; p < 0.01: Shore-adjusted 95% CI: 1.32–2.97].


          We found evidence that prolonged exposure to non-neutral wrist postures is associated with a twofold increased risk for CTS compared with low hours of exposure to non-neutral wrist postures. Workplace interventions to prevent CTS should incorporate training and engineering interventions that reduce sustained non-neutral wrist postures.

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          Most cited references25

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          Recall bias in epidemiologic studies.

          S Coughlin (1990)
          The factors which contribute to bias due to differential recall between cases and controls in retrospective studies have been little studied. A review of the literature on recall accuracy suggests that the extent of inaccurate recall is related to characteristics of the exposure of interest and of the respondents, though a distinction must be drawn between recall which is biased and that which is simply inaccurate. Interviewing technique and the study protocol, including the design of questionnaires and the motivation of respondents, play a central role and are under the control of the investigator. The results of validation studies carried out to date suggest that the likelihood of recall bias may be greater when recall is poor in general.
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            Consensus criteria for the classification of carpal tunnel syndrome in epidemiologic studies.

            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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              Carpal tunnel syndrome and its relation to occupation: a systematic literature review.

              To assess occupational risk factors for carpal tunnel syndrome (CTS), we conducted a systematic literature review. We identified relevant primary research from two major reviews in the 1990s and supplemented this material by a systematic search of the MEDLINE and EMBASE biomedical databases from the start of the electronic record to 1 January 2005. Reports were obtained and their bibliographies checked for other relevant publications. From each paper, we abstracted a standardized set of information on study populations, exposure contrasts and estimates of effect. Altogether, we summarized 38 primary reports, with analyses based either on a comparison of job titles (22) or of physical activities in the job (13) or both (3). We found reasonable evidence that regular and prolonged use of hand-held vibratory tools increases the risk of CTS >2-fold and found substantial evidence for similar or even higher risks from prolonged and highly repetitious flexion and extension of the wrist, especially when allied with a forceful grip. The balance of evidence on keyboard and computer work did not indicate an important association with CTS. Discussion Although the papers that we considered had limitations, a substantial and coherent body of evidence supports preventive policies aimed at avoiding highly repetitive wrist-hand work. There is a case for extending social security compensation for CTS in the United Kingdom to cover work of this kind.

                Author and article information

                Saf Health Work
                Safety and Health at Work
                31 January 2014
                31 January 2014
                March 2014
                : 5
                : 1
                : 27-31
                [1 ]Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
                [2 ]Division of Occupational and Environmental Medicine, University of California, San Francisco, CA, USA
                Author notes
                []Corresponding author. Ergonomics Laboratory, 1301 South 46th Street, Building 163, Richmond Field Station, Richmond, CA 94804, USA. doohee.y@ 123456berkeley.edu
                © 2014 Published by Elsevier B.V. on behalf of Occupational Safety and Health Research Institute.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 16 July 2013
                : 15 January 2014
                : 15 January 2014
                Original Article

                Occupational & Environmental medicine
                carpal tunnel syndrome,meta-analysis,systematic review


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