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Journal of Occupational & Environmental Medicine:
ORIGINAL ARTICLES: CME Article #2

Assessment of the Scientific Basis for Genetic Testing of Railroad Workers with Carpal Tunnel Syndrome

Schulte, Paul A. PhD; Lomax, Geoffrey Dr PH

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Abstract

Learning Objectives:

* Evaluate the rationale used by those who would recommend genetic testing of railroad workers engaged in track management who have carpal tunnel syndrome (CTS).

* Describe the probable respective contributions of physical/environmental and genetic factors in railroad track workers with CTS.

* Discuss the medical, social, and ethical issues raised by testing railroad track workers for genetic mutations and deletions.

In 2000, approximately 20 railroad track workers who filed injury reports or compensation claims for carpal tunnel syndrome were tested by their employer for two genetic traits to determine the work relatedness of the condition. The testing involved deletions, variants, or mutations in the genetic coding for peripheral myelin protein (PMP22) and transthyretin (TTR). This article is an assessment of whether there is a scientific basis for such testing. A review of the scientific literature indicated that neither the scientific basis nor the population validity of the PMP22 or TTR tests for carpal tunnel syndrome were adequately established before use on railroad track workers in 2000. Although ethical and legal issues may predominate in this case, the absence of a compelling scientific basis undermines the decision to conduct the tests.

©2003The American College of Occupational and Environmental Medicine

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