Our team is interested in studying screening for carpal tunnel syndrome (CTS). Specifically, in one project, we studied the effectiveness of physical examination as a screening tool for CTS. We discovered that physical examination maneuvers have a low yield in screening for CTS in workplace surveillance programs and in post-offer, pre-placement (POPP) programs.
In another study, we evaluated post-offer pre-placement (POPP) nerve conduction studies (NCS) for CTS, testing diagnostic yield and cost-effectiveness. After recruiting over a thousand newly hired workers and collecting measures of diagnostic yield and cost efficiency, we found that although abnormal NCS at hire increases risk of future CTS, the PPV is low, and POPP screening is not cost-effective to employers in most scenarios tested.
We have also evaluated the association between grip strength and upper extremity symptoms, work disability, and upper extremity musculoskeletal disorders (UE MSDs) in a group of workers newly
employed in both high and low hand intensive work. We collected physical examinations and repeated surveys over a three-year period. We then used our data to predict upper extremity symptoms, work disability, or UE MSD diagnosis. We found that physical hand strength testing was not useful for identifying workers at risk for developing UE MSDs, and may be an inappropriate measure for post-offer job screens.
In a different study, we evaluated the costs associated with pre-employment nerve conduction testing as a screening tool for CTS in the workplace. We conducted cost analyses and determined that a strategy of pre-employment screening for CTS should be carefully evaluated for yield and social consequences before being implemented. Our model suggests such screening is not appropriate for most employers.