138. Whatever Happened to the Carpal Tunnel Epidemic?

Once upon a time, office workers across America lived in fear of a dreaded infirmity. Was the computer keyboard really the villain -- and did carpal tunnel syndrome really go away?

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:01Stephen J. Dubner?

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• 2:36Stephen J. Dubner?

  Hey, podcast listeners. As you know, we like to take questions from just about anybody: readers, listeners, strangers in the street. Sometimes, we'll go out on a limb for a question. Literally, out on a limb. Like, the other day, I was just looking out my window,

• 2:54Stephen J. Dubner?

  and this pigeon, kind of looked familiar, but honestly, they all look alike to me. Anyway, this one guy, he just started yapping away at me.

• 3:05Stephen J. Dubner?

  What's that?

• 3:09Stephen J. Dubner?

  Huh, you know, I do remember that.

• 3:17Stephen J. Dubner?

  Yeah, that is a great question. Whatever did happen to the carpal tunnel syndrome epidemic?

• 3:34Speaker 01

  From WNYC, this is Freakonomics Radio, the podcast that explores the hidden side of everything. Here's your host, Stephen Dubner.

• 3:58Stephen J. Dubner?

  So Lev, I remember when we first met. I was at your office at the University of Chicago and your computer had one of those keyboards that sort of folded up in the middle. You type kind of like you're playing a concertina, those little push-button accordions. So what was that all about?

• 4:13Speaker 02

  Oh, man, carpal tunnel. So when I was a graduate student, I decided to type in the data from every congressional election that had ever occurred in the United States. And I got these big books and I had this horrible typing setup. Now, this is back in about 1990, 1991. Barely an internet. So here I was, I typed in this data and I got really good. I used my right hand and keypad and I got to be tremendously fast. And after about 10 hours straight of doing that, I get off the computer and, boy, man, my wrist would be tired. But I think, well, I was just tired. And I would do it day after day after day. It probably took me two weeks to type in all the data.

• 4:53Speaker 02

  By the end of the two weeks, my wrist ached and throbbed and was numb and I couldn't sleep at night. And I thought, well, this will go away. And I never heard of carpal tunnel, so I figured it was nothing. Seven years later, I was still sleeping with my arm dangling off the bed. I mean, you knew me when you first met me. I couldn't open a can of pickles to save my life. My right wrist was totally debilitated. And the irony of the whole thing is that as soon as I finished typing the data, I ran into a professor at Harvard who said, "Oh, you just typed in that data? I've already had all that key punched. I could just give it to you."

• 5:37Stephen J. Dubner?

  So there was a period, right around the time that you were, as a grad student, were doing all this data entry, I was starting out in journalism. And you'd walk into any newsroom at the time. You walk into the New York Times and it looked kind of like a Poli Award. All these people with braces and all these setups and they're sitting. And like, the ergonomics department was having a great period of activity because it was a-- it felt like an epidemic. Where'd it go?

• 6:03Speaker 02

  Yeah, great question.

• 6:07Speaker 02

  I think partly, once people knew about the damage, when it started to hurt, they stopped, they changed their setup. Partly, a lot of it was probably psychosomatic, right? Once everyone talks about how some problem is a great way to get out of work, right? To skip a few weeks of work by saying, "Now I can't type on the keyboard for a few weeks." I don't know, maybe people don't work as hard as they used to. Maybe they spend all their time clicking around on Facebook when they're supposed to be typing up their stories at the New York Times. That's another possibility.

• 6:40Stephen J. Dubner?

  All right. Plainly, Steve Levitt does not know the answer to this question, so let's try to find someone who does. Someone who can explain why, with so many more people typing and texting these days, the average office no longer looks like a polio ward.

• 6:57Speaker 03

  And actually, if you'll give me a license, I'll take the story back to 300 years before that.

• 7:03Stephen J. Dubner?

  That's Bradley Evanoff. He's an MD and professor at Washington University in St. Louis, and he specializes in occupational medicine.

• 7:14Speaker 03

  The first textbook of occupational medicine is written by an Italian physician, Bernardino Ramazzini, who was working in Padua in the late 1600s and early 1700s. So he writes this book called Diseases of Workers, and he describes in this wonderful 18th-century prose how work can be harmful to you. And I'll read the first line, just because we don't write medical texts like this anymore. But he says, "Various and manifold is the harvest of diseases reaped by certain workers from the crafts and trades that they pursue. All the profit that they get is a fatal injury to their health."

• 7:52Speaker 03

  So he describes two main causes of occupational injury, and one of his causes here, he says, "There are certain violent and irregular motions and unnatural postures of the body," and that these result in serious diseases that gradually develop.

• 8:17Stephen J. Dubner?

  So, one such disease is what eventually comes to be known as carpal tunnel syndrome. That is what happens when a nerve that runs through your carpal tunnel, which is at the base of your hand, gets pinched or squeezed. And it's easy to see how that might happen if you're shoeing a horse for 12 hours a day in 18th century Italy. Let's fast forward to the early 20th century. The same idea was advanced by a New York surgeon named Harry Finkelstein. Here's Evanoff again.

• 8:48Speaker 03

  And he's surrounded by a patient population that are working in the garment district and are probably just more aware of work, including housework and women's work. And he describes sort of wringing cloths and chopping wood and doing other hand-intensive tasks even that are occurring in the home. And so, Finkelstein, in talking about hand tendonitis, makes no bones about the fact that he thinks that chronic trauma from hand-intensive activities are a major cause. And at one point says, "The laboring classes are most frequently affected."

• 9:30Stephen J. Dubner?

  So, there's no dispute there. The cause of the problem is violent and irregular motions and unnatural postures among certain kinds of workers. But then, the story gets more complicated. There's another surgeon, George Phelan at Cleveland Clinic, who comes along and he helps to develop the operation that becomes standard for people who suffer from carpal tunnel syndrome. So, his opinion carries weight, which is a problem, because, as Bradley Evanoff tells it, Phelan's opinion is kind of off.

• 10:03Speaker 03

  So, he is ardently convinced that work is not a causal factor for carpal tunnel syndrome, and repeatedly refers to it as an idiopathic cause. And idiopathic is Latin for you. We don't know.

• 10:18Stephen J. Dubner?

  Now, why did Phelan think the cause was idiopathic? Perhaps because a lot of his patients were women.

• 10:26Speaker 03

  He basically says, "Women don't do heavy work with their hands." I didn't see very many men. Of the men I saw, only one had hand activity that he thought was abnormal or out of the range. And then, he says, "Look, most of it occurs in women, and women don't do heavy work with their hands. It's not work-related."

• 10:49Stephen J. Dubner?

  So, for many years, that was the prevailing view, that carpal tunnel syndrome was this murky, real, but not quite real affliction. But then, in the early 1970s, the Occupational and Safety Health Administration, or OSHA, was founded.

• 11:06Speaker 03

  And so, they, very early on, started reporting on the high rates of hand and wrist problems that were seen in some occupations and trades. And then, I think there were also economic forces in the 70s and 80s that probably did increase the actual rate of carpal tunnel syndrome. And these were in manufacturing and meatpacking, in a number of industries, it's reported that the line speeds had increased.

• 11:33Stephen J. Dubner?

  So, for the first time, work-related injuries, like hand and wrist pain, were not only reported and tracked, but were eligible for compensation.

• 11:43Speaker 03

  So, I think that prior to around 1985 or so, there's really very few cases of carpal tunnel syndrome that are paid for out of workers' compensation. Then you see this big growth between 1985 and about 1995, where many more cases are claimed as work-related. And this is the so-called epidemic of carpal tunnel syndrome that got people quite interested and focused on CTS in the late 80s, early 90s.

• 12:25Stephen J. Dubner?

  Coming up on Freakonomics Radio, how big was the carpal tunnel epidemic? And was the spike really due to the arrival of the computer keyboard?

• 12:35Speaker 03

  I think it is mostly a misconception.

• 12:58Stephen J. Dubner?

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• 14:01Stephen J. Dubner?

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• 15:25Stephen J. Dubner?

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• 15:55Speaker 01

  From WNYC, this is Freakonomics Radio. Here's your host, Stephen Dubner.

• 16:06Stephen J. Dubner?

  Today, we are trying to answer a question that a friend asked about carpal tunnel syndrome and how it seemed to become an epidemic when offices started using lots of computers. Now, I saw this firsthand in the mid-1990s, when I was working at The New York Times. Here's Bradley Evanoff. He's a professor of medicine at Washington University.

• 16:27Speaker 03

  So there were several newsrooms, actually, where there were a couple of cases of carpal tunnel syndrome. And I think this got a lot of attention in the journalistic world. And I think probably helped promote the keyboard as the main source of exposures that were relevant to carpal tunnel syndrome, when, in fact, it would be much better to work as a journalist than to work as a meat packer.

• 16:52Stephen J. Dubner?

  The notion that office workers are particularly prone to carpal tunnel syndrome is, according to Dr. Evanoff, largely false.

• 17:00Speaker 03

  I think it is mostly a misconception. There are some types of keyboard jobs that are at a higher risk for carpal tunnel syndrome, and this would be people who are like transcriptionists or data entry people where all they do for eight hours a day is pound a keyboard. Most people, though, working in office settings are not in a keying position where they're continuously keying for the entire day. In fact, in our studies, the office or clerical workers are actually the low-risk group with whom we're comparing these construction or manufacturing workers to-- we're comparing this high-risk group to the office people who are the group at lowest risk.

• 17:45Stephen J. Dubner?

  The number of carpal tunnel cases that qualify for workman's compensation peaked in the mid-1990s, Evanoff says.

• 17:52Speaker 03

  And then drops off really sharply after that.

• 17:55Stephen J. Dubner?

  But that hardly means that carpal tunnel syndrome has gone away. Overall, Evanoff says that between 1% and 2% of American workers today suffer from it, and the numbers are much higher in certain fields.

• 18:07Speaker 03

  Right, so if you look at construction workers, you may find that 5% to 8% have carpal tunnel syndrome. Some of the highest reported rates have been in manufacturing and food processing. And there are some food processing jobs where if you go in and examine all the workers, you may find that up to 20% have carpal tunnel syndrome. I think the slaughterhouses and meatpacking plants have some of the highest exposures. And, you know, they come in squawking at one end and go out wrapped in cellophane at the other end.

• 18:42Speaker 03

  You can imagine the amount of handwork that is involved in cutting up 2,000 chickens an hour, or cutting up, you know, a cow onto its constituent pieces. Other types of food processing are dairy, some vegetable picking and processing, anything that requires people to grab something, move it, twist it, cut it, pack it, stack it, pull it. And to do that thousands of times a day is a job that's at high risk for carpal tunnel syndrome, as well as for other disorders of the hand and wrists like tendonitis or epicondylitis.

• 19:35Stephen J. Dubner?

  So carpal tunnel syndrome is unfortunately alive and well among construction workers and food processing workers, among chefs and professional musicians, even among some journalists here and there, but it no longer captures the attention of journalists and therefore you no longer hear about it so much. Journalists, as you probably know, we love to write about ourselves. So if carpal tunnel syndrome isn't happening so much in the newsroom, well, if a tree falls in the forest and no one's around to hear it, does it make a sound?

• 20:09Speaker 04

  [makes a sound]

• 20:11Stephen J. Dubner?

  No, no, not your tree, little guy. You're fine. And hey, thanks for that question today. Maybe we'll go out on a limb again sometime.

• 20:19Speaker 04

  [makes a sound]

• 20:21Stephen J. Dubner?

  My pleasure.

• 20:33Stephen J. Dubner?

  Hey, podcast listeners. Next week, we revisit one of our favorite episodes, The Economist's Guide to Parenting. It's a data-driven look at what really matters when it comes to raising your kids.

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• 20:59Stephen J. Dubner?

  Kind of culture cramming in particular, right?

• 21:01Speaker 02

  Exactly. That none of that can be correlated at all with academic success.

• 21:06Stephen J. Dubner?

  Uh-oh. Should parents skip the museum trip in the ballet class? That's next time on Freakonomics Radio.

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