Objectives To prospectively determine the association between occupational biomechanical exposures and the incidence of surgically treated carpal tunnel syndrome (CTS) in Swedish male construction workers.

Methods A cohort of 203 866 Swedish male construction workers who participated in a national occupational health surveillance programme between 1971 and 1993 were followed for CTS surgery between 2001 and 2019. Age, height, weight, smoking status and construction trade were obtained from programme records. CTS surgery cases were defined using the diagnostic code for CTS and surgical procedure code for peripheral median nerve decompression in the Swedish National Patient Register. Biomechanical exposure estimates were assigned by trade from a job-exposure matrix. The relative risk (RR) of CTS surgery for each biomechanical exposure was assessed with multivariable negative binomial regression modelling.

Results The study included 3851 cases and the total incidence rate of CTS surgery was 137.6 cases per 100 000 person-years. Associations were found for upper extremity load (RR 2.6; 95% CI 2.2 to 3.0), repetitive wrist flexion and extension (RR 2.6; 95% CI 2.2 to 3.0), full wrist extension (RR 2.3; 95% CI 1.9 to 2.6), power grip (RR 2.5; 95% CI 2.2 to 2.9), pinch grip (RR 2.0; 95% CI 1.7 to 2.4), handheld tool use (RR 2.3; 95% CI 2.0 to 2.7) and hand-arm vibration exposure (RR 2.3; 95% CI 1.9 to 2.7).

Conclusions Occupational upper extremity load and postural exposures were associated with increased risk for surgical treatment for CTS in this large construction worker cohort. Preventive actions and consideration of occupation on assessment are warranted.