The American Academy of Orthopedic Surgeons approved new guidelines for the diagnosis and treatment of carpal tunnel syndrome, a condition that causes extreme pain for millions of workers. Contractors in Iraq, especially women, are highly at-risk for developing CTS.
Previously, many doctors primarily relied on MRI images to diagnose CTS. Others used thenar atrophy, which is reduced muscle mass around the thumb, as a diagnostic red flag. According to the AAOS Board of Directors, new evidence supports a more comprehensive approach to diagnosis and testing. Moreover, MRI images do not necessarily indicate CTS damage, and while thenar atrophy is associated with CTS, the two do not necessarily go hand-in-hand. To assist doctors, the panel developed a list of CTS risk factors, including psychosocial factors, peri-menopausal status, distal upper extremity tendinopathies, an unfavorable wrist ratio/index, vibration, tendonitis, assembly line work, computer work, and workplace forceful grip/exertion.
In terms of treatment, the Board of Directors suggests a combination of splints to stabilize and support the wrists, oral or injected steroids to increase muscle mass, liberal use of anti-inflammatory ketoprofen phonophoresis gels, and magnetic therapy to realign tissues. The AAOS also heartily endorsed surgical release of the transverse carpal ligament – the tissue overlaying the carpal wrist structure – based on “strong evidence” that the procedure is successful.
Carpal Tunnel Syndrome
Every year, CTS affects upwards of three million workers in the United States alone. It is the compression of the median nerve, which runs from the palms to the fingers. The carpal tunnel – the network of ligaments and bones that houses the median nerve – is very narrow, and almost any irritation causes compression.
Symptoms begin with a mild burning or itching sensation radiating from the palms to the middle fingers. Some victims report that their fingers feel uncomfortably swollen and bloated, although little or no swelling is present. Symptoms typically begin at night, as victims wake up and feel compelled to “shake out” their wrists.
As the condition progresses, symptoms appear during the day. Eventually, victims are unable to grasp objects or even form fists. Ultimately, the muscles at the base of the thumb completely deteriorate and victims permanently lose much of the sensation in their fingers, most notably the ability to distinguish between hot and cold.
In addition to genetic predisposition, there are a number of environmental factors that cause CTS, including:
- A wrist fracture or sprain,
- Work-related physical stress from frequent typing or a similar task, and
- Continual or recurring use of certain types of hand tools.
Women are three times more likely to develop CTS than men, primarily because doctors believe that the carpal tunnel is smaller in women.
CTS and Contractors
With the increasing military and non-military contractor activity in Iraq, more and more of these individuals will come home with some form of CTS.
Wrist sprains and fractures are very common in both slip-and-falls and vehicle collisions. Motorcycle riders may be familiar with “biker’s arm,” a serious nerve condition. During a fall or similar event, it is a natural reaction to use the arms to brace for impact. But the wrists cannot handle the sudden force; as a result, the bones break and the nerves are compressed.
CTS is more commonly associated with repetitive stress injuries, such as frequent paperwork and typing. In Iraq, many contractors are pressed into office work because of a lack of clerical support. Such labor often occurs at makeshift workstations that are not conducive to healthy wrist alignment.
These repetitive injuries do not just occur inside offices. Construction workers often develop CTS because they grip small hand tools almost all day with very little rest. Vibrating tools, like nail guns, put even more stress on wrists, fingers, hands and other areas.
According to the Defense Base Act, contractors working overseas must have access to workers’ compensation insurance that compensates for medical care and for economic losses due to repetitive stress injuries, like CTS, back pain from loading and unloading boxes, respiratory distress due to burn pit exposure, and even psychiatric injuries sustained as a result of exposure to harsh and dangerous working conditions.
Injured contractors do not have to prove liability to obtain cash benefits for lost wages. In most cases, the amount is calculated by taking two-thirds of the worker’s average weekly wage (AWW). Calculations can vary widely, and an attorney who routinely assists injured Iraq contractors can help obtain maximum benefits.
Contact Aggressive Attorneys
CTS and other occupational diseases mean large medical bills and extensive lost work. For a free consultation with attorneys who help you get the benefits you deserve, contact Barnett, Lerner, Karsen & Frankel. We do not charge upfront legal fees in DBA matters.