The Board denies claimant’s DCD petition, based primarily on literature cited by employer’s medical expert that typing and keyboard work do not increase the likelihood of developing carpal tunnel syndrome.
This case involved a DCD petition in which the claimant alleged that he suffered bilateral carpal tunnel syndrome from his cumulative repetitive duties as a teacher for the State of Delaware. The employer denied the petition based on causation grounds.
The claimant’s testimony showed that he is a 54-year-old high school science teacher who has been doing this work for 12 years. He estimated that, as part of his teaching duties, he spends between three to four hours per day consistently keyboarding. The claimant began developing symptoms of numbness and tingling in his hands in 2018. Following an EMG study, he was diagnosed with severe bilateral carpal tunnel syndrome in both wrists. He had right wrist carpal tunnel surgery on February 12, 2019, and a similar procedure on his left wrist on April 2, 2019. Thereafter, he made an excellent recovery and returned to work with only some residual complaints.
Dr. Shin, the claimant’s expert, focuses solely on pathology involving the upper extremities and is Board Certified in orthopedic surgery with an added qualification in hand surgery. He testified that the claimant had tenosynovitis that led to the development of carpal tunnel syndrome. In his opinion, both conditions were causally related to the claimant’s work activities involving significant amounts of typing and keyboarding as well as use of a computer mouse.
Dr. Spellman testified as the employer’s expert and agreed that the claimant clearly had bilateral carpal tunnel syndrome. Dr. Spellman’s practice includes treating patients from beef packing plants, which is tough, demanding work that involves vigorous activities. Dr. Spellman testified that based on his experience, as well as the medical literature, there is a correlation between vigorous work activities and tool use and carpal tunnel syndrome, but not keyboarding work. He further indicated that the peer reviewed medical literature for carpal tunnel syndrome shows that the most common cause is idiopathic. His key opinion was that a careful analysis shows that people doing keyboarding work do not have a higher incidence of carpal tunnel syndrome compared to the general population.
The Board analyzed the evidence and concluded that the claimant failed to meet the burden of proving that his bilateral carpal tunnel syndrome was causally related to his work activities as a teacher. In so doing, the Board accepted the testimony of Dr. Spellman as convincing, which showed that a careful analysis has been done on typing and keyboarding work and does not establish an increased incidence or association with carpal tunnel syndrome. Dr. Spellman testified credibly that carpal tunnel syndrome is more pervasive in persons who perform jobs that are physically demanding on the wrist, specifically with repetitive activity involving force, which is why he has seen an increased incidence of carpal tunnel syndrome in the workers at the meat packing plants and those who use vibrating tools. Dr. Spellman noted that forcible use of the wrist against resistance is not characteristic of keyboard work. The Board concluded, based on the credible medical evidence, including the peer reviewed medical literature, that there is no higher instance of carpal tunnel syndrome from keyboarding work than in the general population. Therefore, the petition was denied as the claimant failed to meet his burden of proof.
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