OPEN ACCESS Jacobs Journal of Physical Rehabilitation Medicine Carpal Tunnel Syndrome in the Digital Era - Are Electronic Health Records and Wrist Pedometers Potentially Synergistic Risk Factors? David I. Feldman BS *1 , Seth S. Martin MD MHS 1 , Roger S. Blumenthal MD 1 , and E. Gene Deune MD 2 1 The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, USA; 2 The Department of Orthopedic Surgery, Division of Hand Surgery, The Johns Hopkins University, Baltimore, Maryland, USA *Corresponding author: Mr. David I. Feldman, The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, 600 North Wolfe Street: Blalock 501, Baltimore, MD, 21287 USA, Tel: 305-469-3028 ; Fax: 410-614-9190 ;Email: Difeldman4@gmail.com Received: 07-23-2015 Accepted: 09-01-2015 Published: 10-01-2015 Copyright: © 2015 David Case Report Cite this article: Feldman D I. Carpal Tunnel Syndrome in the Digital Era - Are Electronic Health Records and Wrist Pedometers Potentially Synergistic Risk Factors?. J J Physical Rehab Med. 2015, 1(2): 010. Abstract A 53-year-old right-handed healthy male health care professional presented with 2.5 months of numbness and tingling in the left median nerve distribution, consistent with carpal tunnel syndrome. Six weeks before symptom onset, his hand use for keyboarding had increased because of the implementation of an electronic health record system and he began wearing a cir- cumferential left-wrist electronic pedometer. The increased repetitive finger flexor motion, altered wrist flexion/extension angle while typing, and mild circumferential compression of the flexor tendons and median nerve likely led to his symptoms. He had no upper extremity clubbing, cyanosis, or edema but had mild bilateral thumb carpometacarpal joint arthritis with minimal osteophytes and slight subluxation. Although his symptoms improved after eliminating the wrist pedometer and using a wrist splint for proper ergonomics, it is premature to state that wearing an electronic wrist pedometer will cause carpal tunnel syndrome. However, during the one-year follow-up visit, the patient reports no further issues since removing the electronic wrist pedometer and maintaining regular daily activities. As a result, we recommend several precautions for wrist pedometer use. Introduction Multiple potential causes are implicated in the development of carpal tunnel syndrome (CTS) [1-2]. Risks factors include obesity, female sex, diabetes, rheumatoid arthritis, and a family history of CTS [3]. To our knowledge, no conclusive research is available to support repetitive motion as the sole cause [3]. We present the successful treatment of symptoms and one-year follow-up consistent with CTS in an otherwise healthy male health care professional. Case report A right-handed 53-year-old male presented with 2.5 months of tingling and numbness in the left index and middle fin- gers and stiffness in finger and wrist flexion and extension. Six weeks before symptom onset, his computer keyboarding had increased because of the implementation of an electron- ic health record at his institution, and he had concurrently started to wear a circumferential left-wrist electronic pe- dometer (Figure 1) that was adjusted to fit comfortably (Fig- ure 2). Initially the numbness, left-wrist swelling, and dis- comfort with flexion and extension would occur only after keyboarding. Later, the symptoms persisted for more than 30 minutes even after cessation of typing and removing the wrist pedometer. He also developed wrist and hand discom- fort with pronation and supination. He had also noticed the pedometer dented the palmar wrist soft tissue when typing