We refer back to a recent question posed by “Blossom” regarding carpal tunnel syndrome and workcover. Unfortunately it appears that it is not straight forward to blame Carpal Tunnel Syndrome on work-related activities.
Carpal tunnel syndrome and workcover
In Victoria. I am 61 years, a Home Care Worker, 15 hours per week with top up from Newstart, Centrelink. My work involves mostly house cleaning for the Aged and Disabled ie. vacuuming, moping, bathroom/s toilet/s etc. I have developed carpal tunnel to the point where the doctor has given me “light duties”. The doctor reluctantly filled out Work Cover form and said I have no chance, will probably be knocked back and will find it very stressful. Am I wasting my time with Work Cover??? [See original question here]
Carpal Tunnel Syndrome and workcover
Over the past several years, countless media reports have highlighted Australian research into carpal tunnel syndrome (CTS) that suggests that this affliction may have causes that are unrelated to work – at least in part. Even though it has been consistently argued that repetitive work is often the cause and continuing such work exacerbates the injury.
The major complaints of patients with Carpal Tunnel are burning pain, numbness, and tingling, usually in the thumb and palmar surface of the index and middle fingers. These symptoms are especially worse at night and on awakening in the morning.
If it was established that the syndrome is largely unrelated to work then the implications are considerable for workers’ compensation and common law claims that are based on a ‘work-related’ argument as the cause of Carpal Tunnel Syndrome.
A review in the ANZ Journal of Surgery states that the risk factors are obesity or lack of fitness, diabetes, reaching menopausal age, smoking and a lifetime alcohol intake.
One such major research was undertaken by (VIC) Orthopaedic surgeon, Dr Stuart Myers. As stated on a news leaflet from St Vincent’s hospital, Dr Myers believes that “There are a lot of factors which play a role (in the development of Carpal Tunnel). The most critical treatable factor is weight or Body Mass Index. Some other factors include age, being female, a family history, pregnancy, fluid retention.” Also, his research (2002) suggested that only in cold temperature work, often with load and repetition, such as butchery, has a true connection with carpal tunnel syndrome been established…
Unfortunately there are many independent medical examiners (IMEs), especially the elderly and conservative generation, who do believe the same, and who will find the cause of Carpal Tunnel Syndrome to be anything but work related.
A couple of legal cases regarding Carpal Tunnel and workcover
Comcare tried to blame fishing, not keyboard work for worker wrist injury (2012)
In this legal case, Comcare et al. tried to blame the worker’s wrist tenosynovitis on the worker’s love of deep sea fishing, and an IME (Dr Richard Gibberd) didn’t even believe the symptoms were organic in nature despite the obvious MRI imaging (Read article>> Jump to full text of legal case>>)
Carpal tunnel syndrome ruled not work-related (2008)
‘… I am unable to conclude that Mrs K’s employment has had any part to play in the causation of her right carpal tunnel syndrome. Nor am I able to discern that there is sufficient evidence on which I could base a finding, made on the balance of probabilities, that Mrs K suffered an aggravation of her right carpal tunnel syndrome that was contributed to in a material degree by her employment.… I further note the opinions of Dr Hicks (work is no longer a significant aggravating factor) and Dr Bornstein (carpal tunnel syndrome is of constitutional origin and deterioration is consistent with the clinical progress of the condition) …’
Telstra worker’s carpal tunnel syndrome was not caused by her repetitive keyboard work (2007)
The Federal Court has ruled a former Telstra worker’s carpal tunnel syndrome was not caused by her repetitive keyboard work, because the symptoms persisted after she was made redundant.(WTF!)
Employed as an administrative officer with Telstra whose duties involved data entry and answering telephones, the worker was made redundant in September 2003 and a few days after receiving notice she submitted a compensation claim for alleged ‘nerve entrapment at elbow and nerve entrapment at wrist’ of her left arm.
Telstra denied the claim and the AAT confirmed its decision. It concluded that the timing of the worker’s claim relative to her redundancy, the length of time that passed between the onset of her symptoms and her making anyone at work aware of the symptoms (over a year) ‘all affected the weight to be given to her evidence’.
In Court, the injured worker argued she first noticed pins and needles in her left fingers and palm in September 2002 and that in February 2003 she began to experience pain and weakness in her forearm at night or when she tried to lift an object.
She conceded that she saw her GP on more than five occasions between October 2002 and July 2003 without mentioning her arm symptoms to him.
She again consulted her GP in late July claiming the pain in her arm was so bad that she ‘couldn’t stand it’ and she was taking strong painkillers everyday. However, she agreed that earlier that month she had asked to be given an increased amount of keying work.
She said that she had told her manager about her condition in early August 2003 but did not make a claim.
Telstra submitted that her carpal tunnel syndrome was not work-related as she was not required to do a huge amount of keyboard work (approximately half a day) and that her timing of the claim (days after being made redundant) was significant.
It also relied on medical reports from an orthopaedic surgeon which stated her pain was not due to her work:
‘I don’t consider the entrapment of the ulnar nerve at the elbow can be related to keyboard work. I don’t consider that carpel[sic] tunnel syndrome is caused by repetitive keyboard work either, but if a person has a propensity to carpel tunnel syndrome and does a lot of keyboard work, this can aggravate the situation and make the symptoms worse,’ the surgeon said.
‘The fact that her symptoms persisted after she stopped work and the decompression wasn’t done until April 2004, is a strong indication that there is little relationship of her carpel [sic] tunnel syndrome to her employment. I believe that if the employment were an aggravating factor, one would anticipate that the symptoms would subside when the employment was ceased.’
He also attached to his reports medical articles from peer-reviewed medical journals and commentaries indicating that there is no causal relationship between clerical and keyboard duties and the onset of carpal tunnel syndrome.
The Judge agreed with the surgeon’s evidence – carpal tunnel syndrome was unlikely to have been aggravated by her keyboard work because the symptoms persisted after she stopped work.
And so, the injured worker’s challenge was dismissed.
Read the full text of the legal case here: Butler v Telstra Corporation  FCA 1504 (27 September 2007)
Carpal tunnel syndrome not related to work (2008)
‘For the following reasons, I do not accept that Ms Manoharan’s carpal tunnel syndrome resulted from her employment with American Express:
… the only support for a connection between the carpal tunnel syndrome and Ms Manoharan’s employment with American Express is from Dr Nash.
I do not accept his opinion on causation.
… and most important of all, in support of his opinion that Ms Manoharan’s condition is related to her typing duties with American Express, Dr Nash referred to the Institute of Neurological Disorders in the USA as reporting that carpal tunnel syndrome was common in those performing assembly line work, manufacturing, sewing, finishing, cleaning, meat poultry and fish packing, “where it was found that it was 3 times [more] common than amongst data entry personnel”.
This seems to suggest that data entry (which is not an accurate description of Ms Manoharan’s occupation with American Express in any event) is not an occupation where the incidence of carpal tunnel syndrome is common. Similarly, the studies of 269 cashiers and 127 office workers by Bonfiglioi et al suggested, “Intensive manual work associated with inadequate recovery time might have generated an impairment in the median nerve at the wrist level proportionally increasing with the duration of hand use” … Ms Manoharan’s duties with American Express did not fit the description of “intensive manual work” …’
However, here’s a winner:
Change in work duties proved injury aggravation (Carpal Tunnel) (2010)
In a case in 2010, the AAT granted compensation to a psychologist for carpal tunnel syndrome, after finding a change in job role significantly increased her keyboard duties.
A psychologist employed with the Department of Health and Aged Care claimed compensation for aggravation of underlying carpal tunnel syndrome, tennis elbow and back pain.
In January 2008, the worker had volunteered to work full-time on a hotline involved with the investigation of complaints in the aged care section.
The work involved telephone answering and taking complaints from 9 am to 5 pm, four days per week, while seated at a desk and entering data into a computer.
In her previous role, she had used a keyboard for up to two hours only per working day.
The injured worker claimed she experienced a gradual onset of ‘pins and needles’ in right hand and forearm, approximately two months after beginning her new role.
This became numbness and a feeling of ‘weakness’ and ‘heaviness’ in her right hand. She noticed the symptoms would improve overnight and on weekends.
Comcare accepted liability for the tennis elbow, but rejected the claim for the other injuries. The worker appealed to the AAT.
AAT member Anne Shanahan noted that all of the worker’s symptoms have now resolved following surgery and a change in her work duties.
‘Both Mrs Cichello’s (worker) cervical spondylitic pain and her left hand symptoms were temporary but incapacitating until they resolved with prolonged rest. Should she resume the exact same employment activities she performed between January and June 2008 it would be likely that she would suffer recurrence of her neck and left hand symptoms,’ Shanahan said.
‘She remains asymptomatic since resuming work in the finance section of the Department performing different activities.’
‘The symptoms of the right CTS resolved completely after right carpal tunnel release surgery.’
Shanahan found her condition was asymptomatic until her employment change triggered the symptoms.
She ruled Comcare was liable for compensation and remitted it back to the authority for determination.
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