Screening potential hires for carpal tunnel not cost effective

ANN ARBOR—Employers who try to save money by screening out new hires who are most likely to develop carpal tunnel syndrome ultimately end up spending more, a University of Michigan researcher says.

Alfred Franzblau, professor of environmental health sciences, examined the practice of using a post-offer preplacement median nerve test as a means to find employees most susceptible to carpal tunnel syndrome. His results are in the July issue of the Journal of Occupational Environmental Medicine.

Franzblau said companies have been using the carpal tunnel screening practice for more than 15 years, but without data to show whether it actually saves them money if they don’t hire employees who might make expensive workers’ compensation claims.

"In most circumstances, it’s not cost effective," Franzblau said. "What we’ve shown is that it just doesn’t work."

In addition to his appointment at the U-M School of Public Health, Franzblau is also an associate professor of emergency medicine and an associate research scientist at U-M’s Center for Ergonomics.

Franzblau and his coauthors, Robert Werner and Joanne Yihan, examined a company that hired 2,150 workers between new hires through May 2003. The company conducted preplacement nerve tests on all new hires but did not use results to reject employees.

Franzblau found that 35 cases of work-related carpal tunnel syndrome occurred in the new hires. Using the nerve test results could have prevented only about nine of them. Significantly, most cases of CTS occurred among workers whose nerve tests were normal when hired, which illustrates the inefficiency of preplacement nerve testing and is a main reason why the practice is not cost effective.

Avoidable workers’ compensation costs, including both direct and indirect costs, totaled $178,985. Direct costs included medical expenses and wage replacement costs, while indirect costs included such things as reassigning employees to light duty jobs while they recovered.

However, if the company had rejected all employees whose nerve tests were abnormal, and had instead recruited and screened additional workers to fill those positions, the company would have spent $536,338.

The net loss would have been $357,353.

The "failure rate" of the nerve test was 15.21 percent, which would have led the company to reject 327 otherwise qualified recruits. To fill those positions, it would have had to screen an additional 386 job applicants.

Carpal tunnel syndrome can be associated with repetitive motion, sometimes on the job, irritating the median nerve where it passes through the wrist into the hand in the carpal tunnel.

The median nerve runs down the arm to the hand and usually provides the sense of touch in the thumb and all of the fingers except the little finger. The carpal tunnel is a narrow canal of ligament and bones at the base of the hand, through which the median nerve and several tendons run. If irritated tendons thicken or other swelling narrows the tunnel, the median nerve can get compressed, leading to pain, weakness or numbness in the hand and wrist, radiating up the arm.

Franzblau said he understands employers’ motivation to prevent carpal tunnel syndrome on the job–but his research shows pre-employment nerve testing is not the way to do it.

"Instead of spending resources on post-offer preplacement nerve tests and discriminating against large numbers of workers who ‘fail’ the nerve test, companies might be better off investing in alternative strategies to reduce costs related to workers’ compensation carpal tunnel syndrome (and other upper extremity musculoskeletal disorders), such as reducing ergonomic work hazards," he wrote in the paper’s conclusion and recommendations.

For more on Franzblau: http://www.sph.umich.edu/faculty/afranz.html

Journal of Occupational and Environmental Medicine

National Institute of Neurological Disorders and Stroke’s carpal tunnel syndrome fact sheet: http://www.ninds.nih.gov/health_and_medical/pubs/carpal_tunnel.htm

New York Times story—"Handsand Wrists are Thrust into the Hiring Process"

E-mail:cnewvine@umich.edu