This letter concerns the recent paper by Kjuus and his co-workers (1). In this paper, the exposed tunnel workers were compared with 50 other tunnel workers not using grout. The main finding was the surprising one that the nerve conduction abnormalities in the exposed tunnel workers were reduced sensory action potential of the conduction velocity and prolonged motor distal latency in the ulnar nerve. While the authors suggested that this finding represented neuropathy, I believe there is a more likely explanation. The nerve conduction findings are typical of ulnar neuropathy in the wrist (2, 3) most commonly from external compression such as the use of handtools, bicycle riding, video games, and the like. This possibility would fit nicely with the improvement over 12 months, the focal nature of the nerve conduction abnormalities, and the discordance of these findings from those of a generalized, distal, dying-back toxic neuro-pathy. I suggest that the authors reinterview the workers and find out what they did with their hands during the grout work and compare that activity with that of the nongrout tunnel workers.

Key terms grout worker; letter to the editor; neuropathy