Authors' objectives:

This systematic review of published evidence assesses four common musculoskeletal disorders affecting workers - carpal tunnel syndrome (CTS), cubital tunnel syndrome, epicondylitis, and de Quervain's disease. This report is a 'Best Evidence' synthesis in which address the best available evidence, not the best possible evidence is addressed. 13 key questions were assessed regarding their diagnosis, treatment, and costs.

Authors' results and conclusions: The literature describing these disorders is often of poor quality, with few studies addressing any given issue. The evidence currently available suggests the following tendencies: - Two diagnostic tests for CTS, distal motor latency and palmar sensory latency, appear to have high specificity and low-to-moderate sensitivity. - Patients who have undergone surgery for CTS are predominantly middle aged and female. It is not possible to determine the characteristics of those undergoing surgery for the other three conditions. - Studies comparing open and endoscopic carpal tunnel release show a small but statistically significant advantage for endoscopic release, despite a higher rate of complications and reoperation compared to open release. - CTS patients benefit, but may not recover fully or permanently after steroid injection into the carpal tunnel. - Published data do not support the use of neurolysis, ligament reconstruction, or ultrasound for most CTS patients. - Laser therapy does not appear to be an effective treatment for epicondylitis. - Patients with epicondylitis who were treated with acupuncture had better global outcomes and greater pain relief than patients given sham acupuncture.

Authors' recommendations: Published literature describing the diagnosis, treatment and impact of worker-related upper-extremity disorders is diffuse and generally of low quality, making it difficult to come to firm evidence-based conclusions. There are trends in available data, but it is often difficult to quantify them.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/tp/muscltp.htm

Year Published: 2002

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)