Annals of Occupational and Environmental Medicine

The Korean Society of Occupational & Environmental Medicine (대한직업환경의학회)
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Comparing the Characteristics of CTS by the Frequency of Exposure to Wrist-burdening Work: CTS Surveillance System, 2001-2004

손목부담 작업 노출빈도에 따른 수근관증후군의 특성 비교: 수근관증후군 감시체계, 2001-2004

  • Jung, Suk-Chul (Department of Occupational and Environmental Medicine, College of Medicine, Dankook University) ;
  • Chae, Yoo-Mi (Department of Occupational and Environmental Medicine, College of Medicine, Dankook University) ;
  • Roh, Sang-Chul (Department of Occupational and Environmental Medicine, College of Medicine, Dankook University)
  • 정석철 (단국대학교 의과대학 산업의학교실) ;
  • 채유미 (단국대학교 의과대학 산업의학교실) ;
  • 노상철 (단국대학교 의과대학 산업의학교실)
  • Received : 2010.01.13
  • Accepted : 2010.04.02
  • Published : 2010.06.30
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Abstract

Objective: We investigated the differences among the patients who were diagnosed with carpal tunnel syndrome according to the frequency of exposure to wrist-burdening work by using carpal tunnel syndrome surveillance system. Methods: The study subjects were a total of 855 patients from 1,017 patients who were diagnosed with carpal tunnel syndrome in 9 university hospitals from May, 2001 to October, 2004, and we excluded 161 patients who had no clear information for their occupational status. The subjects were classified into three groups according to four types of wrist-burdening work: 1) repetitive use of wrists, 2) inappropriate posture of the hand, 3) use of vibrating tools, and 4) overpressure work on the hand or palm, - as defined in the operational definition by the National Institute for Occupational Safety and Health (NIOSH). The subjects with two or more types of wrist-burdening work were classified as 'high risk group', the subjects with one type of wrist-burdening work were classified as 'intermediate risk group', and the subjects with none of the types of wrist-burdening work were classified as 'low risk group'. We used chi-square test, Fisher's exact test and ANOVA for comparing the characteristics according to the 3 subgroup. Results: The mean age in the high risk group was the lowest(53 years), and there was a significant difference among the groups for the mean age(p<0.05). The high risk group included the most males with 39(22.0%). The subjects in the high risk group had significantly more jobs in agriculture forestry fisheries, factory work, and simple labor and less comorbidities, including diabetes and rheumatoid arthritis(p<0.05). The subjects in the intermediate risk group had a higher proportion of service workers. There were significant differences for the symptoms of carpal tunnel syndrome according to the frequency of exposure to wrist-burdening work. The subjects in the high risk group showed the highest proportion of work-related aggravation of symptoms with 88(76.5%) and the highest mean number of days absent from work(6 days) as related to carpal tunnel syndrome. Conclusion: Worker in agriculture forestry fisheries, factory work, and simple labor showed significantly more frequent carpal tunnel syndrome, and so management strategies are needed to prevent them from developing carpal tunnel syndrome.

목적: 수근관증후군 감시체계를 통해 수근관증후군으로 진단된 환자들을 손목부담 작업 노출빈도에 따라 3군으로 분류하여 각 군의 특징을 비교하였다. 방법: 본 연구는 2001년 5월부터 2004년 10월까지 8개 지역의 9개 대학병원 재활의학과에서 CTS로 진단된 1017명 중 직업력이 불분명한 161명을 제외한 855명을 연구대상으로 하였다. 이들을 NIOSH 실행적 정의에 언급된 4가지 손목부담 작업-'손목의 반복적 사용', '불편한 손자세', '진동공구의 사용', '손 손바닥에 지속적으로 압력이 주어지는 일'-의 노출빈도에 따라 2가지 이상에 해당하는 대상자를 고위험군, 1가지 작업에만 해당하는 대상자를 중등도위험군, 어느 작업에도 해당하지 않는 대상자를 저위험군으로 분류하였다. 각 군에 따른 일반적 특성, 임상 양상, 업무관련 특성 등을 비교하기 위해 범주형 변수는 chi-square test와 Fisher's exact test를, 연속형 변수에 대해서는 ANOVA를 시행하였다. 결과: 고위험군에서 남성비율이 39명(22.0%)으로 가장 높았고, 평균 연령은 52.5세로 가장 낮았다. 또한 농업 임업 및 어업숙련 종사자, 단순노무 종사자, 기능원 및 관련 기능 종사자, 장치 기계 조작 및 조립 종사자 등의 직업군이 고위험군에서 상대적으로 높은 비율을 보였으며, 당뇨, 류마티스 관절염 등의 유병률은 다른 군에 비해 상대적으로 낮았다. 중등도위험군은 성비, 연령비, CTS 관련 질환 유병률 등이 고위험군과 저위험군의 중간 정도의 비율을 보였으며, 직업군에서 서비스종사자의 비율이 높았다. 징후, 전기진단검사 등의 임상 특성에서는 각 군에 따른 유의한 차이를 보이지 않았으나, 임상증상은 손목부담 작업 노출빈도가 높은 군일수록 증상 호소율이 높았다. 업무로 인해 증상이 악화된 대상자도 고위험군이 88명(76.5%)으로 가장 많았고, CTS로 인한 결근일의 중앙값도 고위험군이 6일로 가장 길었다. 결론: 기존 연구의 작업관련성 CTS의 특성을 보이는 고위험군에는 농업 임업 및 어업숙련 종사자, 단순노무 종사자, 기능원 및 관련 기능 종사자, 장치 기계 조작 및 조립 종사자들의 비율이 가장 높았으며, 이들 고위험 직업군에 대해 업무량 및 강도 조절 등을 통한 효과적인 중재 프로그램이 수행될 경우 전체 인구의 CTS 발생을 줄일 수 있을 것으로 생각한다. 추후 본 연구에 제시된 3군에 따라 노출빈도와 강도를 보완하여 전향적 연구가 진행된다면, CTS발생과 업무적 요인의 인과 관계 입증에 도움이 될 것으로 생각한다.

Keywords

References

  1. Kieran O, Kalva S. Carpal tunnel syndrome. In: Rom WN. Environmental and Occupational Medicine 4th Ed. Lippincott-Raven Pub, Philadelphia. 2007. pp 937-40.
  2. US Bureau of Labor Statistics. Nonfatal Occupational Injuries and illnesses Requiring Days Away From Work 2007. Available: http://www.bls.gov/iif/home.htm. [cited 1 May 2009].
  3. Lincoln AE, Vernick JS, Ogaitis S, Smith GS, Mitchell CS, Agnew J. Interventions for the primary prevention of work-related carpal tunnel syndrome. Am J Prev Med 2000;18(4):37-50. https://doi.org/10.1016/S0749-3797(00)00140-9
  4. Daniell WE, Fulton-Kehoe D, Franklin GM. Work-related carpal tunnel syndrome in Washington State workers'compensation: utilization of surgery and the duration of lost work. Am J Ind Med 2009;52(12):931-42. https://doi.org/10.1002/ajim.20765
  5. Tanaka S, Wild DK, Seligman PJ, Halperin WE, Behrens VJ, Putz-Anderson V. Prevalence and workrelatedness of self-reported carpal tunnel syndrome among U.S. workers: analysis of the Occupational Health supplement data of 1988 National Health Interview Survey. Am J Ind Med 1995;27(4):451-70. https://doi.org/10.1002/ajim.4700270402
  6. Roquelaure Y, Ha C, Pelier-Cady MC, Nicolas G, Descatha A, Leclerc A, Raimbeau G, Goldberg M, Imbernon E. Work increases the incidence of carpal tunnel syndrome in the general population. Muscle Nerve 2008;37(4):477-82. https://doi.org/10.1002/mus.20952
  7. Roquelaure Y, Ha C, Nicolas G, Pelier-Cady MC, Mariot C, Descatha A, Leclerc A, Raimbeau G, Goldberg M, Imbernon E. Attributable risk of carpal tunnel syndrome according to industry and occupation in a general population. Arthritis Rheum 2008;59(9):1341-8. https://doi.org/10.1002/art.24002
  8. Bongers FJ, Schellevis FG, van den Bosch WJ, van der Zee J. Carpal tunnel syndrome in general practice (1987 and 2001): incidence and the role of occupational and non-occupational factors. Br J Gen Pract 2007;57(536):36-9.
  9. Davis L, Wellman H, Punnett L. Surveillance of work-related carpal tunnel syndrome in Massachusetts, 1992-1997: a report from the Massachusetts Sentinel Event Notification System for Occupational Risks (SENSOR). Am J Ind Med 2001;39(1):58-71. https://doi.org/10.1002/1097-0274(200101)39:1<58::AID-AJIM6>3.0.CO;2-3
  10. Osorio AM, Ames RG, Jones J, Castorina J, Rempel D, Estrin W, Thompson D. Carpal tunnel syndrome among grocery store workers. Am J Ind Med 1994;25(2):229-45. https://doi.org/10.1002/ajim.4700250209
  11. Rosecrance JC, Cook TM, Anton DC, Merlino LA. Carpal tunnel syndrome among apprentice construction workers. Am J Ind Med 2002;42(2):107-16. https://doi.org/10.1002/ajim.10093
  12. Hagberg M, Morgenstern H, Kelsh M. Impact of occupations and job tasks on the prevalence of carpal tunnel syndrome. Scand J Work Environ Health 1992;18(6):337-45.
  13. Nordstrom DL, Vierkant RA, DeStefano F, Layde PM. Risk factors for carpal tunnel syndrome in a general population. Occup Environ Med 1997;54(10):734-40. https://doi.org/10.1136/oem.54.10.734
  14. Wieslander G, Norback D, Gothe CJ, Juhlin L. Carpal tunnel syndrome (CTS) and exposure to vibration, repetitive wrist movements, and heavy manual work: a case-referent study. Br J Ind Med 1989;46(1):43-7.
  15. Maghsoudipour M, Moghimi S, Dehghaan F, Rahimpanah A. Association of occupational and non-occupational risk factors with the prevalence of work related carpal tunnel syndrome. J Occup Rehabil 2008;18(2):152-6. https://doi.org/10.1007/s10926-008-9125-4
  16. Falkiner S, Myers S. When exactly can carpal tunnel syndrome be considered work-related? ANZ J Surg 2002;72(3):204-9. https://doi.org/10.1046/j.1445-2197.2002.02347.x
  17. Lee WJ, Lee EI, Cha CW. Carpal tunnel syndrome among packing workers in a rayon manufacturing factory. Korean J Prev Med 1992;25(1):26-33. (Korean)
  18. Kang JK, Paek DM, Ma HI, Song MA, Lee HK, Choi JK. Carpal tunnel syndrome among workers in a condom industry. Korean J Prev Med 1996;29(3):507-20. (Korean)
  19. Lee JM, Kim SK, Kim JM. Carpal tunnel syndrome in meat-processing workers. Korean J Occup Environ Med 1999;11(3):407-14. (Korean)
  20. Son JE, Jang TW, Kim YK, Hong YS, Jung KY, Kim DI, Lee KJ, Ha NJ, Kim SB, Kim JY. Survey on the prevalence of carpal tunnel syndrome in simple repetitive workers who use upper extremities. Korean J Occup Environ Med 2001;13(3):209-19. (Korean)
  21. Kim SA, Kim JS, Jeon HR, Jung SJ, Kim SW, Lee CY, Ham JO, Yoo JY, Choi TS, Goo HB, Cho MH, Woo KH. Surveillance of work-related diseases in Kumi. Korean J Occup Environ Med 2003;15(1):95-110. (Korean)
  22. Jeong WC, Kwon HJ, Ha M, Roh SC, Kwon BS, Hyun JG, Lee SJ, Lee JM, Kwon JY, Kim JS, Baek NJ, Lee H, Lee KW, Lee SK. Surveillance of work-related carpal tunnel syndrome in Korea. Korean J Occup Environ Med 2004;16(1):37-47. (Korean)
  23. Ahn YS, Kang YJ. Analysis of work-related carpal tunnel syndrome compensated with the industrial accident compensation insurance from 2000 to 2002. J Korean Acad Rehabil Med 2005;29(5):469-78. (Korean)
  24. Matte TD, Baker EL, Honchar PA. The selection and definition of target work-related condition for surveillance under SENSOR. Am J Public Health 1989;79:21-5.
  25. Katz JN, Larson MG, Fossel AH, Liang MH. Validation of a surveillance case definition of carpal tunnel syndrome. Am J Public Health 1991;81(2):189-93. https://doi.org/10.2105/AJPH.81.2.189
  26. National Institute for Occupaitonal Safety and Health. Musculoskeletal disorders and workplace factors. Available: http://www.cdc.gov/niosh/docs/97-141/ergotxt5a.html. [cited 1 Sep 2009].
  27. Yagev Y, Carel RS, Yagev R. Assessment of work-related risks factors for carpal tunnel syndrome. Isr Med Assoc J 2001;3(8):569-71
  28. Silverstein BA, Fine LJ, Armstrong TJ. Occupational factors and carpal tunnel syndrome. Am J Ind Med 1987;11(3):343-58. https://doi.org/10.1002/ajim.4700110310
  29. Blanc PD, Faucett J, Kennedy JJ, Cisternas M, Yelin E. Self-reported carpal tunnel syndrome: predictors of work disability from the National Health Interview Survey Occupational Health Supplement. Am J Ind Med 1996;30(3):362-8. https://doi.org/10.1002/(SICI)1097-0274(199609)30:3<362::AID-AJIM16>3.0.CO;2-U
  30. Nordstrom DL, Vierkant RA, DeStefano F, Layde PM. Risk factors for carpal tunnel syndrome in a general population. Occup Environ Med 1997;54(10):734-40. https://doi.org/10.1136/oem.54.10.734
  31. Mondelli M, Giannini F, Giacchi M. Carpal tunnel syndrome incidence in a general population. Neurology 2002;58(2):289-94.
  32. Oh KW, Chang MJ, Lee JM, Lee YK, Kim YT. Epidemiologic report of diabetes in Korea. Clinical Diabetes 2007;8(4):361-5. (Korean)
  33. Dillon C, Petersen M, Tanaka S. Self-reported hand and wrist arthritis and occupation: data from the U.S. National Health Interview Survey-Occupational Health Supplement. Am J Ind Med 2002;42(4):318-27. https://doi.org/10.1002/ajim.10117
  34. Mattioli S, Baldasseroni A, Curti S, Cooke RM, Mandes A, Zanardi F, Farioli A, Buiatti E, Campo G, Violante FS. Incidence rates of surgically treated idiopathic carpal tunnel syndrome in blue- and white-collar workers and housewives in Tuscany, Italy. Occup Environ Med 2009;66(5):299-304. https://doi.org/10.1136/oem.2008.040212
  35. Werner RA, Andary M. Carpal tunnel syndrome: pathophysiology and clinical neurophysiology. Clin Neurophysiol 2002;113(9):1373-81 https://doi.org/10.1016/S1388-2457(02)00169-4
  36. Chan L, Turner JA, Comstock BA, Levenson LM, Hollingworth W, Heagerty PJ, Kliot M, Jarvik JG. The relationship between electrodiagnostic findings and patient symptoms and function in carpal tunnel syndrome. Arch Phys Med Rehabil 2007;88(1):19-24. https://doi.org/10.1016/j.apmr.2006.10.013
  37. Priganc VW, Henry SM. The relationship among five common carpal tunnel syndrome tests and the severity of carpal tunnel syndrome. J Hand Ther 2003;16(3):225-36. https://doi.org/10.1016/S0894-1130(03)00038-3
  38. Schottland JR, Kirschberg GJ, Fillingim R, Davis VP, Hogg F. Median nerve latencies in poultry processing workers: an approach to resolving the role of industrial "cumulative trauma"in the development of carpal tunnel syndrome. J Occup Med 1991;33(5):627-31.
  39. Kearns J, Gresch EE, Weichel CY, Eby P, Pallapothu SR. Pre- and post-employment median nerve latency in pork processing employees. J Occup Environ Med 2000;42(1):96-100. https://doi.org/10.1097/00043764-200001000-00022
  40. Rempel D, Evanoff B, Amadio PC, de Krom M, Franklin G, Franzblau A, Gray R, Gerr F, Hagberg M, Hales T, Katz JN, Pransky G. Consensus criteria for the classification of carpal tunnel syndrome in epidemiologic studies. Am J Public Health 1998;88(10):1447-51. https://doi.org/10.2105/AJPH.88.10.1447
  41. Roquelaure Y, Ha C, Fouquet N, Descatha A, Leclerc A, Goldberg M, Imbernon E. Attributable risk of carpal tunnel syndrome in the general population: implications for intervention programs in the workplace. Scand J Work Environ Health 2009;35(5):342-8.