Prevalence and risk factors of carpal tunnel syndrome and ulnar neuropathy at the elbow in floor cleaners. A tuscany multicentre study

Objective: To determine the prevalence of carpal tunnel syndrome (CTS) and ulnar neuropathy at the elbow (UNE) in a cohort of floor cleaners and to check differences between workers with and without CTS. Methods: All female floor cleaners of three hospitals in Tuscany were contacted. Clinical and electrophysiological severity of CTS and UNE were evaluated with standardised scales and symptoms were assessed with the self-administered Boston Questionnaire (BQ); demographic and non-occupational factors and durations of current and previous occupations were recorded. Univariate analysis of risk factors between workers with and without CTS was performed. Logistic regression was used to evaluate the capacity of independent variables to predict CTS. Results: Out of a total of 179 cleaners, 145 (81%), mean age 39.6 years (20-64 years), were enrolled in the study; 70 (48%) had CTS (diagnosis based on clinical and electrophysiological findings), 17 (12%) had asymptomatic neurographic anomalies of the median nerve and 12 (8%) had symptoms without delay of median nerve conduction. BQ symptom and hand function scores were anomalous in 108 (74%) and 84 (58%) subjects, respectively. UNE was detected in 7/103 women, asymptomatic delay of the ulnar nerve across the elbow in nine and symptoms of UNE without neurographic anomalies in two. Univariate analysis showed that cleaners with CTS were older, had greater BMI and longer exposure to cleaning with previous employers than those without CTS. In the logistic regression, the only predictor of CTS was duration of cleaning with previous employers (O.R. 3.0, 95% CI 1.6-5.7). Conclusions: These results indicate a high occurrence of CTS in floor cleaners, UNE is less frequent than CTS, presumably due to repetitive movements that stress wrists more than elbows. The only predictive factor of CTS was the duration of cleaning as an occupation with previous employers. Cleaning per se may not be a risk factor for CTS, but how it is performed.