Cumulative Trauma Disorders of the Upper Extremities

To the Editor. —We read with interest the communication by Rempel et al.¹ We have been studying the cause of CTS in industrial workers for 8 years and have found no consistent objective evidence that occupation is a major contributing factor to conduction abnormalities of the median nerve.^2,3 Rather, we have found the major risk factors for abnormal nerve conduction to be individual characteristics (obesity, age, wrist dimensions, and lack of exercise). In turn, abnormal nerve conduction is by far the most important factor predicting clinical CTS after 5 years.³

We agree with Rempel et al¹ that it is desirable to reduce the incidence of clinical CTS in industrial workers. What we disagree with is how the reduced incidence is to be achieved. Most of the major risk factors for CTS are also major risk factors for other serious illnesses, such as cardiovascular disease, neuropsychiatric problems