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April 1994

Carpal Tunnel Syndrome and Hand-Arm Vibration Syndrome: A Diagnostic Enigma

Author Affiliations

From the Department of Occupational and Environmental Health, St Michael's Hospital, Toronto, Ontario (Dr Pelmear), and the Department of Occupational Medicine, University of Dundee (Scotland) (Dr Taylor).

Arch Neurol. 1994;51(4):416-420. doi:10.1001/archneur.1994.00540160118015

Objective:  This article serves to draw attention to the risk to workers from repetitive strain and hand-arm vibration in the workplace and to the diagnostic difficulty in distinguishing carpal tunnel syndrome from the sensorineural component of hand-arm vibration syndrome.

Data Sources:  Journal publications, textbooks on hand-arm vibration, guidelines of the International Standards Organisation, and European Economic Community directives.

Study Selection:  Recent reports and current standards.

Conclusion:  Carpal tunnel syndrome can be distinguished from hand-arm vibration syndrome if all factors—anatomical, associated physiological and medical conditions, work exposure history, and ulnar nerve involvement—are evaluated. In some circumstances, the conditions may be present together. A correct diagnosis is crucial because surgical intervention is not usually beneficial if hand-arm vibration exposure has been a contributing factor. The further reduction in grip strength may constitute a serious additional handicap for a worker.

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