Relationship between repetitive work and the prevalence of carpal tunnel syndrome in part-time and full-time female supermarket cashiers: a quasi-experimental study

  • Roberta BonfiglioliEmail author
  • Stefano Mattioli
  • Cristiana Fiorentini
  • Francesca Graziosi
  • Stefania Curti
  • Francesco S. Violante
Short Communication



To investigate the prevalence of Carpal Tunnel Syndrome (CTS) in full-time and part-time supermarket cashiers exposed to a different weekly duration of biomechanical load.


All the 269 cashiers and 127 office workers were asked to participate. The protocol included ergonomic risk assessment, collection of personal and clinical data and bilateral electrodiagnostic study of the median nerve. CTS symptoms were defined as past and/or current nocturnal and/or diurnal numbness, tingling, burning or pain involving at least one of the first three fingers. Results were evaluated according to two case definitions based on current symptoms and on the combination of current symptoms and slowing of sensory conduction velocity from wrist to palm, respectively. Difference in proportions of CTS symptoms and cases was evaluated by the Pearson’s chi-square (χ2) test, univariate and multivariate logistic regression analyses were performed to determine the impact of weekly exposure.


The final female study population included 71 full-time cashiers, 155 part-time cashiers and 98 office workers. Ergonomic risk level was rated 5 for hand activity level and 4 for peak of force according to ACGIH. The intersection of the two values fell on the threshold limit value line, confirming the possible exposure to biomechanical risk factors for CTS. The prevalence of current CTS symptoms was higher among full-time (31.0%) than in part-time cashiers (19.3%) or controls (16.3%) (p = 0.055). A similar pattern was found for CTS past symptoms and cases. Univariate analysis showed that full-time cashiers had a 2.3 fold increased risk for CTS specific current symptoms than control subjects. A similar trend also emerged for CTS cases but was not significant (Odds ratios 1.23). Multivariate logistic regression analysis confirmed the increased risk for CTS current symptoms in full-time cashiers.


Intensive manual work associated with inadequate recovery time might have generated an impairment of the median nerve at the wrist level proportionally increasing with duration of hand use. Our study can provide useful information both for ergonomic risk assessment and work organization.


Carpal tunnel syndrome Supermarket cashiers Upper limb repetitive movements 



We are grateful to Chiara Scardoni for scientific editing.


  1. ACGIH Worldwide (2002) Threshold limit value for chemical substances and physical agents and biological exposure indices. ACGIH, Cincnnati, OH, pp 112–114Google Scholar
  2. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I (1999) Prevalence of carpal tunnel syndrome in a general population. JAMA 282(2):153–158PubMedCrossRefGoogle Scholar
  3. Bernard BP (1997) Musculoskeletal disorders and workplace factors. a critical review of epidemiologic evidence for work-related musculoskeletal disorders of the neck, upper extremity, and low back. US Department of Health and Human Services (DHHS) (NIOSH National Institute for Occupational Safety and Health), Cincnnati, OH (Publication No. 97–141: Chapter 5 (a, b))Google Scholar
  4. Bland JD (2005) The relationship of obesity, age, and carpal tunnel syndrome: more complex than was thought? Muscle Nerve 32(4):527–532PubMedCrossRefGoogle Scholar
  5. Denys EH (1995) AAEM minimonograph no. 14: the influence of temperature in clinical-neurophysiology. Muscle Nerve 14(9):795–811CrossRefGoogle Scholar
  6. Fallentin N (2003) Regulatory actions to prevent work-related musculoskeletal disorders—the use of research-based exposure limits. Scand J Work Environ Health 29(4):247–250PubMedGoogle Scholar
  7. Fallentin N, Viikari-Juntura E, Waersted M, Kilbom A (2001) Evaluation of physical workload standards and guidelines from a nordic perspective. Scand J Work Environ Health 27(Suppl. 2):1–52PubMedGoogle Scholar
  8. Giersiepen K, Eberle A, Pohlabeln H (2000) Gender differences in carpal tunnel syndrome? Occupational and non-occupational risk factors in a population-based case-control study. Ann Epidemiol 10(7):481PubMedCrossRefGoogle Scholar
  9. Hagberg M, Silverstein B, Wells R, Smith MJ, Hendrick HW, Carayon P, Pérusse M (1995) In: Kuorinka I, Forcier L (eds) Work related musculoskeletal disorders (WMSDs): a reference book of prevention. Taylor & Francis, London, pp 17–138Google Scholar
  10. Hakim AJ, Cherkas L, El Zayat S, MacGregor AJ, Spector TD (2002) The genetic contribution to carpal tunnel syndrome in women: a twin study. Arthritis Rheum 47(3):275–279PubMedCrossRefGoogle Scholar
  11. Jablecki CK, Andary MT, Floeter MK, Miller RG, Quartly CA, Vennix MJ, Wilson JR (2002a) Second literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome. Muscle Nerve Published online 1 June 2002 in Wiley InterScience ( DOI 10.1002/ mus.10215
  12. Jablecki CK, Andary MT, Floeter MK, Miller RG, Quartly CA, Vennix MJ, Wilson JR (2002b) Practice parameter: electrodiagnostic studies in carpal tunnel syndrome. Report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation. Neurology 58:1589–1592Google Scholar
  13. Katz JN, Stirrat CR (1990) A self-administered hand symptom diagram for the diagnosis of carpal tunnel syndrome. J Hand Surg [Am] 15(2):360–363Google Scholar
  14. Katz JN, Stirrat CR, Larson MG, Fossel AH, Eaton HM, Liang MH (1990) A self-administered hand symptom diagram for the diagnosis and epidemiologic study of carpal tunnel syndrome. J Rheumatol 17(11):1495–1498PubMedGoogle Scholar
  15. Kimura J (1978) A method for determining median nerve conduction velocity across the carpal tunnel. J Neurol Sci 38(1):1–10PubMedCrossRefGoogle Scholar
  16. Kimura J (1979) The carpal tunnel syndrome. Localization of conduction abnormalities within the distal segment of the median nerve. Brain 102(3):619–635PubMedCrossRefGoogle Scholar
  17. Kouyoumdjian JA, Zanetta DM, Morita MP (2002) Evaluation of age, body mass index, and wrist index as risk factors for carpal tunnel syndrome severity. Muscle Nerve 25(1):93–97PubMedCrossRefGoogle Scholar
  18. de Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F (1992) Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol 45(4):373–376PubMedCrossRefGoogle Scholar
  19. Margolis W, Kraus JF (1987) The prevalence of carpal tunnel syndrome symptoms in female supermarket checkers. J Occup Med 29(12):953–956PubMedGoogle Scholar
  20. Nathan PA, Meadows KD, Istvan JA (2002) Predictors of carpal tunnel syndrome: an 11-year study of industrial workers. J Hand Surg [Am] 27(4):644–651CrossRefGoogle Scholar
  21. National Research Council, the Institute of Medicine (2001) Musculoskeletal disorders and the workplace: low back and upper extremities. Panel on musculoskeletal disorders and the workplace. Commission on behavioral and social sciences and education. National Academy Press, Washington, DC, pp 85–183Google Scholar
  22. Nordstrom DL, Vierkant RA, DeStefano F, Layde PM (1997) Risk factors for carpal tunnel syndrome in a general population. Occup Environ Med 54(10):734–740PubMedGoogle Scholar
  23. Osorio AM, Ames RG, Jones J, Castorina J, Rempel D, Estrin W, Thompson D (1994) Carpal tunnel syndrome among grocery store workers. Am J Ind Med 25(2):229–245PubMedGoogle Scholar
  24. Putz-Anderson V (1988) Cumulative trauma disorders. A manual for musculoskeletal diseases of the upper limbs. Taylor & Francis, New York, pp 21–25Google Scholar
  25. Rempel D, Evanoff B, Amadio P, De Krom M, Franklin G, Franzblau A, Gray R, Gerr F, Hagberg M, Hales T, Katz J, Pransky G (1998) Consensus criteria for the classification of carpal tunnel syndrome in epidemiologic studies. Am J Pub Health 88(10):1447–1451PubMedCrossRefGoogle Scholar
  26. Rosenbaum RB, Ochoa JL (1993) Carpal tunnel syndrome and other disorders of the median nerve. Butterworth-Heinemann, Stoneham MA, pp 197–231Google Scholar
  27. Tanaka S, Wild DK, Cameron LL, Freund E (1997) Association of occupational and non-occupational risk factors with the prevalence of self-reported carpal tunnel syndrome in a national survey of the working population. Am J Ind Med 32(5):550–556PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Roberta Bonfiglioli
    • 1
    Email author
  • Stefano Mattioli
    • 1
  • Cristiana Fiorentini
    • 1
  • Francesca Graziosi
    • 1
  • Stefania Curti
    • 1
  • Francesco S. Violante
    • 1
  1. 1.Occupational Health Unit, Policlinico Sant’Orsola-MalpighiAlma Mater Studiorum, University of BolognaBolognaItaly

Personalised recommendations