The thumb, index, middle, and half of the ring finger on her right-hand tingles. She awakens at 2 AM, but her hand is asleep, and she has to wriggle and rotate it until it’s as awake as she is (what we call the “wake and shake” phenomenon). Out of an eight-hour workday, she’s sitting in front of a computer screen about 75 percent of the time, sending and responding to emails, creating documents and slide decks, and participating in web-based meetings. She’s never had trauma to her wrists or hands and doesn’t have any arthritis, but she takes medicine for an underactive thyroid and is also a borderline diabetic.

Sounds like typical carpal tunnel syndrome, with many of the usual medical and occupational risk factors. So it probably needs the usual approach, with splinting, getting an ergonomist to look at the workstation, some adjustment of job duties, and possibly even a nerve conduction study and evaluation by a hand surgeon. However, there is one wrinkle I forgot to mention — she works from home.

So what? So what is that her “desk” is her dining room table, her computer is her personal laptop, and she sits on one of the dining room chairs that works great for the couple of hours of Thanksgiving dinner but not so great for the six hours of her workday.

Statistics abound about the frequency of remote work before, during, and since the bump COVID-19 instigated. But even with more businesses now demanding that employees return to the workplace for at least part of the workweek, and even if the remote work rate eventually returns to pre-COVID levels (possible but unlikely), some percentage of the workforce will continue to work from home or somewhere other than the company address and be subject to the same types of physical (and/or psychological/emotional) episodic or cumulative trauma.

In this context, one of the questions that arises is whether or not an employer can or should accept their employees’ stories at face value without being able to monitor or supervise the actual work occurring at home. The most liberal view is that someone may work in a less-than-ideal ergonomic environment that might need modification, perhaps with a formal in-home evaluation. The fix might be elevating the laptop on a couple of old college textbooks after wiping off the dust from cellar storage; maybe splinting, a wrist pad, a new chair with adjustable arms rests; and maybe a footstool to get the knees up to the same level as the hips and overall optimize her body’s alignment at the table. And if those don’t work, it could mean testing and a surgical visit.

But I have known employers to occupy both ends of the acceptance-denial spectrum, so some might argue that since the employee only has one set of hands, it’s impossible to remove the work hands and use only the home hands when succumbing to the temptations of being home. Maybe that’s taking a break to chop vegetables for dinner, doing some Instagram phone scrolling, enjoying a little diversion at the gaming console while the kids are at school, taking the puppy or baby for a quick walk, etc. It’s therefore, similarly impossible to exclude the contribution of non-work-related activities to the problem. 

So how much can you trust that all the stress on the hands and wrists is “received by an employee in the course of employment”, to quote the Workers Comp Act? Well, you either trust or don’t; it’s the honor system. Carpal tunnel syndrome from work duties is indistinguishable from carpal tunnel syndrome that occurs because of home hand use or the mix of home and work activities, but in Pennsylvania, the bar for calling something a compensable work-related injury/illness is pretty low—work activities only have to contribute to it, not be the sole cause.  

From our standpoint as Occupational Medicine providers, we will see anybody you send us. Still, it’s up to you to accept the story (and the claim) or deny it when deciding whether to direct them to your workers’ comp provider panel or their personal physicians.

So sharpen up those policy-writing pencils; remote work may decrease, but it’s not going away.. 

If you would like to learn more about workers’ compensation and other services offered, please contact The Occupational Health Center at Chester County Hospital.

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