Journal of Occupational & Environmental Medicine:
Letters To The Editor
President; NeuMed; Lawrenceville, NJ
To the Editor: I have read with interest the article entitled"Screening for Carpal Tunnel Syndrome in the Workplace" by Glenn Pransky, MD, et al (J Occup Environ Med. 1997;39:727-733). While there are some very valid concepts expressed in this publication, I must state that the authors completely missed the point relative to employee screening. Employee screening is not a pure science. As the name states, it is a screen to identify those who require further evaluation. According to the Americans with Disabilities Act (ADA), none of these tests can be used for pre-employment testing, as suggested in the discussion. They can be used for post-offer examination to screen potential workers for proper work placement so as to not injure themselves or their fellow employees.
It remains the responsibility of the ordering physician to confirm the existence of the disorder in those subjects that have been identified by the screening test to be positive. It is a well-published issue that this should be done with a battery of subjective and objective clinical tests, including electrodiagnostic studies (EDS). This second tier of testing will eliminate the false positives detected in the screening test. The price of clinical EDS is an impractical cost for industry to absorb for screen testing of all employees. Screening, in effect, can save employers and the total health care system significant expenditures. I suggest that the authors research the insurance providers and companies for the potential savings. In a recent article that appeared in The New York Times, the author describes how a company reduced its carpal tunnel syndrome (CTS) claims over a three-year period from $325,000 to $18,000 per year by using screening tests. This was done without rejecting one employee detected with CTS. Those with the problem were positioned in less risky jobs. With proper understanding, screening can be done without risking denial of employment to qualified candidates.
Relative to the instrumentation used in the study, I believe it is incumbent upon the authors and the editors to properly identify the equipment used. This study identifies the Nicolet Biomedical instrument used in the study by brand name and model number. Since the FDA requires all medical devices to have a brand name and model number, I would think the authors and editors would require the same for accurate medical device association to test results. NERVEPACE®, which is used to identify an instrument used in this study, is a registered trademark of NeuMed, Lawrenceville, New Jersey. NeuMed manufactures three models of medical devices dedicated to the measurement of nerve conduction. Each bears the trademark NERVEPACE and represents an advancement in technology and testing capability. The readers of this publication have no way of knowing which of these three models was used in the study. As the manufacturer of the equipment, we can determine from our sales records that the instrument used was model S-100 manufactured in 1990. We assume, also from sales records, that the tests were performed in 1991. In all fairness to the manufacturer, your readership should have the benefit of knowing this since we now manufacture a battery-powered instrument that measures both motor and sensory response, displays waveform on an LCD oscilloscope, and is capable of ulnar-to-median comparison as well as palmar stimulation.
The study reports that "NP" (NERVEPACE) measures stimulus to peak response latency. This is an incorrect statement if NERVEPACE Model S-100 was used, since it measures stimulus to onset latency. NERVEPACE Model 200VS can measure stimulus to peak latency. The statement would be true only if NERVEPACE 200VS were used. The comparison of NP to EDS is inaccurate and reflects a lack of understanding of the equipment used.
While we respect the objective of the study we view the results as flawed and a misrepresentation.
Jack Guldalian, Jr, MS
President; NeuMed; Lawrenceville, NJ
Readers are invited to submit letters for publication in this department. Submit them to: The Editor, Journal of Occupational and Environmental Medicine, PO Box 370, Bryn Mawr, PA 19010. Letters should be typewritten and double spaced and should be designated”For Publication.”
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