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undertaking. It is also crucial to consider whether there has been any material change to the
claimant’s working practice around the time that the symptoms developed. If not then many
experts will be unwilling to draw a causal link between the symptoms and the claimant’s work.
An improvement of symptoms away from work can point towards the condition having a cause
at work but it is also possible that work activities may be exacerbating a constitutional condition.
SPECIFIC CONDITIONS
Tennis Elbow – generally (but not always) a constitutional condition. Can be exacerbated
by work.
Golfer’s Elbow – similar to Tennis Elbow in that it is generally a constitutional condition but one
which can be caused by heavy work. Symptoms can be exacerbated by work however.
Tenosynovitis – commonly caused by repetitive forceful use of limbs at work or in sport.
De Quervain’s – generally a constitutional condition but one that can be exacerbated by work
including keyboard use.
Carpal Tunnel Syndrome – rarely caused by work but frequently exacerbated by repetitive
manual activities.
The carpal tunnel is a channel in the palm side of the wrist through which pass the tendons which
enable the fingers and wrists to bend. The tunnel also contains the median nerve, which controls
some of the muscles in the hand that in turn move the thumb.
Carpal tunnel syndrome is more common in women (11 per 100) than in men (3 per 100). The
symptoms include numbness, tingling and burning in the hand and fingers. Occasionally, it causes
pain in the forearm, which can radiate to the shoulder and even the neck. Usually, it is only the
thumb, index and middle fingers that are affected. Symptoms may be mild, intermittent or
continuous. In the severest and long lasting cases, the thumb muscles can waste away and the
median nerve may be permanently damaged. The condition tends to develop in people over the
age of 45. It is particularly prevalent in someone who is overweight and in people whose job
requires them to use their hands a lot. The incidence of carpal tunnel syndrome is increased in
people with thyroid problems, diabetes or who take oral contraceptives.
Where symptoms are severe, carpal tunnel release surgery may be effective. This entails severing
the carpal ligament to make more space for the nerves and tendons, which occupy the carpal
tunnel. Such surgery is usually ‘open’ surgery performed as a ‘day-case’ under local anaesthetic.
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