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Carpal tunnel syndrome affects sensation in the hand, making tasks difficult.
Work-related musculoskeletal disorders in the upper extremity are a leading cause of work disability in industrial countries, according to a November 2006 article in "Occupational and Environmental Medicine." Carpal tunnel syndrome is caused by compression of the median nerve in the wrist. Workers affected by CTS sometimes require a functional capacity evaluation to determine whether they can safely perform their job duties.
Carpal Tunnel Syndrome
CTS is the most common nerve compression disease in the upper extremities, and a study published in the March 2011 issue of "Journal of Occupational Rehabilitation" determined that 3 out of every 10,000 workers were affected by this condition. The carpal tunnel is at the base of your palm, just above your wrist. Nine tendons that move the muscles that bend your wrist, fingers and thumb travel through this tunnel, along with the median nerve. This nerve supplies sensation to your thumb, index, middle and thumb-side of the ring finger, and powers the muscles that bend your wrist and allow your fingers to grip. Compression of the median nerve causes pain, tingling, numbness and weakness.
Workers who perform manual labor are at high risk for CTS, according to the article in "Occupational and Environmental Medicine." Job activities, such as repetitive bending of the wrist, gripping, using hand tools, sustained awkward postures and using vibrating tools, significantly increase the risk for developing CTS. If the problem is diagnosed early, the worker can change work habits to reduce future risks. Severe CTS can lead to lost time from work, increased costs to the employer and disability for the employee.
Functional Capacity Evaluation
FCEs determine a worker's ability to perform work-related tasks. Currently there is no "gold standard" for FCEs, but several different testing instruments provide structure for these assessments. FCEs are typically ordered by a physician and performed by a physical therapist. In some cases, other health care professionals, such as a psychologist, also participate in the testing process. FCEs are most often used to determine whether an injured worker can safely perform his job duties after injury.
FCE for CTS
Workers with CTS sometimes undergo FCE to assess physical capabilities to provide the treating physician with information to help decide whether the worker is able to return to work, and what capacity he is able to work in. FCEs for CTS typically assess grip and pinch strength, lifting and carrying abilities, tool manipulation and other tasks specific to the injured worker's job description. Tests may also be used to assess the worker's consistency of effort to evaluate whether the worker's limitations are valid. The physician then uses the information from the FCE to determine the extent of the worker's disability.
What to Expect
Depending on the practitioner and number of items to be assessed, an FCE can last from 4 hours to 2 days. The evaluation often begins with a pain and functional abilities questionnaire. A physical therapist does a clinical examination, assessing range of motion and strength. A variety of standardized tests are performed to assess functional abilities based on the injured worker's job duties. For CTS, this may include tests to measure object manipulation speed and use of specific hand tools. A lifting assessment measures maximum lifting capability and determines appropriate limitations for return to work.