Association between work-related biomechanical risk factors and the occurrence of carpal tunnel syndrome: an overview of systematic reviews and a meta-analysis of current research

Carpal tunnel syndrome and exposure to work-related biomechanical stressors and chemicals: Findings from the Constances cohort

Objective

To investigate the effects of co-exposure to biomechanical wrist stressors and chemicals on the risk of CTS in a large cohort of French workers.

Methods

Prospective study using the data collected at baseline and at the first 12 month-follow-up for the 18,018 participants included in the population-based Constances cohort between 2012 and 2015. CTS at follow-up and exposure to biomechanical wrist stressors and chemicals at baseline were assessed using a self-administered questionnaire. Associations between CTS and co-exposure to biomechanical wrist stressors and chemicals were studied using multivariate logistic regression models, adjusted for personal/medical factors.

Results

184 men (2.1%, 95%CI 1.8–2.4) and 331 women (3.6%, 3.2–3.9) free from chronic hand symptoms at baseline declared suffering from unilateral/bilateral CTS at follow-up. A potentiating effect of co-exposure to biomechanical wrist stressors and chemicals on the risk of CTS was found for both genders, with higher OR in the co-exposure group (OR = 3.38 [2.29–5.01] in men and OR = 4.12 [2.73–6.21] in women) than in the biomechanical exposure group (OR = 2.14 [1.51–3.03] in men and OR = 2.19 [1.72–2.78] in women) compared to no exposure group.

Conclusions

The study showed an association between CTS and co-exposure to biomechanical wrist stressors and chemicals, after adjustment for the main personal and medical factors. This finding should be confirmed using more objective case definition of CTS and assessment of the chemical exposure before drawing conclusions on the possible synergistic effects of mechanical stressors and chemical on the median nerve.

Comparing open conventional carpal tunnel release with mini-incision technique in the treatment of carpal tunnel syndrome: A non-randomized clinical trial

Background

Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy which is the result of the compression of the median nerve in the wrist. Currently, there is no consensus about the best treatment option. The purpose of this clinical trial was to compare the clinical outcomes of patients undergoing open CT release with mini-incision CT release.

Patients and methods

This clinical trial included 75 patients with CTS who were divided into two groups of 45 and 30 patients to undergo open-CT release or mini incision CT release respectively. Patients were evaluated pre-operatively, days after the surgery and then five months after the operation to record outcomes. At follow-up, the visual analogue scale (VAS) scores for pain, patients' satisfaction, return to work, length of scar, paresthesia, grip and opposition strength were measured.

Results

A total of 75 patients (mean age: 52.13 years, 73.3% female) underwent CTS surgery. Forty-five patients (60%) had open-CT release and 30 patients (40%) had mini-incision CT release. Postoperative pain and scar length were significantly lower in the mini incision group compared to open group (p < 0.001). The mini-incision CT group returned to work earlier than open group with higher satisfaction (p < 0.001). No significant differences were observed between two groups in respect to the improvement of the opposition, grip and paresthesia (p > 0.05).

Conclusion

Our study demonstrated that mini-incision CT release improves pain more effectively and has better quality of life because of smaller length of scar, immediate return to work and higher overall satisfaction. Neurosensory and motor improvements were also seen in both techniques with the same clinical impact.

Proportion of upper extremity musculoskeletal disorders attributable to personal and occupational factors: results from the French Pays de la Loire study

BACKGROUND

Upper extremity musculoskeletal disorders (UEMSD) are one of the most common and costly occupational health problems. We aimed to assess the population-attributable fraction (PAF) of personal and occupational risk factors associated with incident UEMSD in a working population.

METHODS

From 2002 to 2005, a random sample of 3710 workers from the Pays de la Loire region in France, aged 20-59 were included by occupational physicians (OPs). Between 2007 and 2010, 1611 workers were re-examined by their OPs. Subjects free from UEMSD at baseline were included in this study (1275 workers, mean age: 38.2 years). Cox regression models with equal follow-up time and robust variance estimates were used to estimate age-adjusted and multivariable-adjusted relative risks (RRs) and their 95% confidence intervals (CIs). Based on multivariable models, PAF associated with each factor included in the models was estimated.

RESULTS

During the follow-up period, 143 (11%) cases of UEMSD were diagnosed. PAFs for factors associated with the incident UEMSD risk were 30% (7 to 51) for high physical exertion (RPE Borg scale ≥12), 12% (- 0.2 to 24) for low social support, 7% (- 3 to 17) for working with arms above shoulder level (≥2 h/day), 20% (12 to 28) for age group ≥45, 13% (3 to 22) for the age group 35-44, and 12% (0.3 to 24) for female gender.

CONCLUSIONS

Our study suggests that an important fraction of UEMSD can be attributed to occupational exposures after the contributions of personal and other work-related factors are considered. In terms of public health, our findings are in agreement with the ergonomic literature postulating that a high proportion of UEMSD are preventable through modifying workplace risk factors. Such information is useful to help public health practitioners and policy makers implement programs of prevention of UEMSD in the working population.

Carpal Tunnel Syndrome Among Male French Farmers and Agricultural Workers: Is It Only Associated With Physical Exposure?

Background

Exploratory study to investigate whether co-exposure to physical wrist stressors and chemicals is associated with carpal tunnel syndrome (CTS) in French male farmers and agricultural workers.

Methods

Cross-sectional study of 711 men aged 30–65 years and working as either farmers or agricultural workers in 2009–2010 within a cohort covered by the French Agricultural Workers' and Farmers' Mutual Benefit Fund. CTS and exposure to physical wrist stressors and chemicals were assessed using a self-administered questionnaire. Associations between CTS and personal/medical factors, exposure to physical wrist stressors, exposure to chemicals, and co-exposure to physical wrist stressors and chemicals were studied using multivariate logistic regression models.

Results

Forty-four men {5.6% [95% confidence interval (CI) 4.0–7.7]} reported that they had suffered from unilateral/bilateral CTS during the last 12 months. CTS was associated with age, current smoking [odds ratio (OR) = 2.1 (1.0–4.5)], and exposure to physical wrist stressors [OR = 2.6 (1.1–5.9)]. An association was found between CTS and co-exposure to physical wrist stressors and chemicals [OR = 3.3 (0.8–14.3), p = 0.044] in comparison with the no-exposure group.

Conclusions

This exploratory study shows an association of CTS with exposure to biomechanical wrist stressors in male farmers and agricultural workers and suggests an association of CTS with co-exposure to physical wrist stressors and chemicals. Owing to the limitations of the study, this result must be confirmed by a prospective study with objective assessments of the outcome and exposure before drawing conclusions on the possible synergistic effects of mechanical stressors and chemicals on the impairment of the median nerve.

Carpal Tunnel Syndrome as Sentinel for Harmful Hand Activities at Work: A Nationwide Danish Cohort Study

OBJECTIVE

Evaluate incidence rates (IRs) of carpal tunnel syndrome (CTS) as sentinels to identify job groups with high hand-wrist exposures.

METHODS

A nationwide register-based cohort study of all born in Denmark. During follow-up 2010 to 2013, we identified first-time CTS diagnoses. We established job groups, calculated sex-specific age-standardized IRs (SIRs) per job group. We linked occupational codes with a job exposure matrix, calculated mean hand load estimate per job group, and plotted hand load against the SIRs.

RESULTS

We followed 1,171,580 men and 1,137,854 women for 4,046,851 and 3,994,987 person-years; identified 4405 cases among men, 7858 among women; obtained crude IRs of 10.9 and 19.7 per 10,000 person-years. For both sexes, there was a positive association between SIRs and hand load.

CONCLUSIONS

Higher SIRs pointed to job groups with higher hand load. Elevated SIRs of CTS may serve as sentinels of harmful hand activities.

Impact of technical variations on the ring-finger test for carpal tunnel syndrome

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The median and ulnar nerves can be recorded consecutively or simultaneously to diagnose carpal tunnel syndrome.

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Simultaneous and consecutive recording of the median and ulnar nerves sensory latency have a poor agreement.

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Technical variations can have diagnostic consequences.

Objective

To assess if recording the sensory latencies of the median and ulnar nerves one-by-one (consecutive) or at the same time (simultaneous) in the ring-finger test for carpal tunnel syndrome (CTS) will show equivalent results or if it will lead to a different clinical classification of patients.

Methods

We assessed the limits of agreement between the simultaneous and the consecutive method based on the median- ulnar sensory latency difference derived by both methods in 80 subjects and compared the number of minimal CTS cases identified by the two methods.

Results

Limits of agreement ranged from −0.23 to 0.29 ms. A significantly higher proportion of subjects with minimal CTS (only detectable by using the comparison test) was found using the simultaneous method (n = 8 and 2, respectively; p = 0.03).

Conclusion

The two methods have a poor to moderate agreement as indicated by the range of the limits of agreement (0.5 ms).

Significance

Even small methodological changes to the ring-finger test can lead to results with different clinical meaning in the same individual and one should be aware of which method was used when interpreting results.

Occupational co-exposure to biomechanical factors and neurotoxic chemicals in a representative sample of French employees

Objectives

Musculoskeletal disorders, mainly carpal tunnel syndrome, represent a leading cause of compensation claims of workers worldwide. Despite this, and the fact that occupational exposures to biomechanical factors and neurotoxic chemicals have been individually associated with peripheral nerve damage, the prevalence of occupational co‐exposure to biomechanical factors and neurotoxic chemicals has rarely been explored. Therefore, our aim was to assess the prevalence of occupational co‐exposure to biomechanical factors and neurotoxic chemicals in a national representative sample of the French working population.

Methods

The study was based on the French representative cross‐sectional survey SUMER 2010. A total of 47 983 employees who had worked in their current job for at least one year were included. Occupational exposure to biomechanical factors and neurotoxic chemicals within the previous week of work were assessed using a questionnaire during face‐to‐face interviews with occupational physicians.

Results

Approximately 5% of male employees and 1% of female employees were co‐exposed to biomechanical factors and neurotoxic chemicals. This prevalence was up to 10% among male blue‐collar workers and 13%, 8%, and 6%, respectively, among male employees in the construction, agriculture, and industry sectors. Male employees under 30 years old, in apprenticeships, and working in small companies were more co‐exposed to biomechanical factors and neurotoxic chemicals than their counterparts.

Conclusions

Occupational co‐exposure to biomechanical factors and neurotoxic chemicals was observed in a significant proportion of French male employees, suggesting that further studies are required to investigate its potential adverse effects on peripheral neuropathies.

Upper limb neurodynamic test 1 in patients with clinical diagnosis of carpal tunnel syndrome: A diagnostic accuracy study

STUDY DESIGN

Diagnostic accuracy.

INTRODUCTION

Upper limb neurodynamic test 1 (ULNT1) is used to evaluate the mechanical sensitivity especially in the peripheral nerves of the upper limbs. The reproduction of typical symptoms in the affected hand improves the estimation of the probability of carpal tunnel syndrome (CTS). However the test has not been evaluated sufficiently to determine its real usefulness. In the present study the diagnostic accuracy of ULNT1 as a clinical test for CTS was determined.

METHODS

We used the ULNT1 as the index test and nerve conduction as the reference standard. 120 subjects, (240 hands), with a medical diagnosis of CTS were evaluated. The study population was a consecutive series of participants. Sensitivity, specificity, positive and negative predictive values, accuracy, and positive likelihood ratio were calculated.

RESULTS

ULNT1 was found to have a sensitivity of 93 % and a specificity of 6.67 %. The positive likelihood ratio was 1.04 and the negative likelihood ratio was 1.00. The positive predictive value was 86.9 % and the negative predictive value was 12.5%.

DISCUSSION

Acute or relatively mild CTS cases may not be accurately identified through nerve conduction tests. The findings of this study coincide with other studies in the finding that ULNT1 has a significant diagnostic and clinical screening value for CTS in people at-risk, or with upper limb symptoms.

CONCLUSION(S)

This research suggests the use of ULNT1 as a screening test for CTS, followed by tests that are more specific.

LEVEL OF EVIDENCE

III-2.

Musculoskeletal health, work-related risk factors and preventive measures in hairdressing: a scoping review

Background

Hairdressers are exposed to various work-related biomechanical and organizational risk factors. To date, there has been no overview of the evidence for this occupational group. The purpose of this scoping review is to gain insight into the current state of research on work-related musculoskeletal disorders (MSD) in hairdressing.

Methods

Studies published up to November 2018 were identified by a systematic search using electronic databases (MEDLINE, PUBMED, CINAHL, Web of Science, LIVIVO), Google Scholar and reference lists of articles. Studies were screened by two researchers and synthesized in a descriptive manner.

Results

Overall 44 studies with different study designs, scopes and approaches were included. Nineteen studies provided data on MSD prevalence in at least one body site. The prevalence values between the studies varied considerably. On average, the highest 12-month prevalence was reported for the lower back (range 13-76%), neck (range 9-58%), shoulder (range 28-60%) and hand/wrist (range 11-53%). In comparison to other occupational groups, hairdressers reported more frequent MSD in all body regions or exhibited a greater risk of leaving the profession for health reasons. Common risk factors include working with arms above shoulder level, repetitive movements, forceful exertion of upper extremities, awkward back postures and movements, high mechanical workload and standing. In addition to physical stress, lack of adequate breaks, overtime, and general distress may deteriorate health and performance of hairdressers. Three rehabilitative and three preventive interventional studies were found. Only the rehabilitative studies showed positive effects on the management of physical and mental strain and resulted in significant pain reduction, increased physical capacity and knowledge of potential risk factors for MSD.

Conclusion

This data provides some evidence for work-related risk factors for MSD in hairdressers and indicate that there should be an intense focus on preventive measures. High quality and long-term interventional studies are needed to clarify the effectiveness of complex preventive concepts in hairdressing.

Etiopathogenic Value of the Associated Pathology in Carpal Tunnel Syndrome

The present study focused on highlighting the pathology associated with carpal tunnel syndrome. Carpal tunnel syndrome is a susceptible neuropathy of the upper limb, its appearance being favored by the coexistence of other chronic pathologies.

The study group consisted of 163 patients treated in the Plastic Surgery Clinic of the Emergency County Hospital in Constanţa, men and women of adulthood. The only exclusion criteria was non-compliant patients.

The results were consistent with other studies published in the literature, with an over three times higher incidence of female sex.

The decades of age most prone to the disease were the fourth, fifth, and sixth.

Approximately one third of patients experienced bilateral carpal tunnel syndrome.

A particularly important presence of the triad was found: hygh blood pressure, obesity and diabetes mellitus, at least one of which was present in over 70% of patients.

The etiopathogenicity of the carpal tunnel syndrome is becoming clearer, the “Golden Trio” dominating the clinical picture in most patients.

Observed Differences between Males and Females in Surgically Treated Carpal Tunnel Syndrome Among Non-manual Workers: A Sensitivity Analysis of Findings from a Large Population Study

Objectives

We aimed at assessing whether differences among males and females in carpal tunnel syndrome (CTS) epidemiology might be attributable to segregation with respect to occupational biomechanical exposures or differential access to care by sex.

Methods

We analysed surgically treated cases of CTS occurring among non-manual workers in Tuscany between 1997 and 2000. We conducted a Monte Carlo simulation to estimate the difference in occupational biomechanical exposures between males and females necessary to explain the observed incidence rate ratios. We also accounted for the sex-specific probability of receiving surgery after the diagnosis of CTS, as women were reported to be more likely to undergo surgery in a subset of our study population. We quantified the hypothetical biomechanical overload through the hand activity level (HAL) metric proposed by the American Conference of Governmental Industrial Hygienists. To quantify the effect of HAL on CTS risk, we assumed a prior distribution based on findings from two large cohort studies of industrial workers.

Results

After adjustment for the probability of receiving surgery, women showed a 4-fold incidence of CTS as compared with men. To explain this association among non-manual workers, women should have an average value of HAL at least 5 points higher.

Conclusions

Our analysis does not support the hypothesis that the difference in CTS incidence between males and females is entirely attributable to occupational risk factors or to differential access to surgery. The causal pathway between sex and CTS might include more determinants such as hormonal factors, anthropometric characteristics, and non-occupational exposure to biomechanical overload (e.g. household tasks).

Work-related neck and upper limb disorders - quantitative exposure-response relationships adjusted for personal characteristics and psychosocial conditions

BACKGROUND

We have previously reported quantitative exposure-response relationships between physical exposures recorded by technical methods, and complaints and diagnoses in the neck/shoulders, and the elbows/hands, based on group data. In the present study the number of workers was doubled, and information on individual factors, and psychosocial working conditions was used. Relationships between various kinds of exposure and response have been analysed in this larger and more detailed sample.

METHODS

The prevalence of complaints (Nordic Questionnaire) and diagnoses (clinical examination) were recorded in a number of occupational groups within which the participants had similar work tasks, 34 groups of female employees (N = 4733 women) and 17 groups of male employees (N = 1107 men). Age and other individual characteristics were recorded, as well as psychosocial work environment factors (job-content questionnaire) for most participants. Postures and velocities (inclinometry) of the head (N = 505) and right upper arm (N = 510), right wrist postures and velocities (electrogoniometry; N = 685), and muscular activity (electromyography; EMG) in the right trapezius muscle (N = 647) and forearm extensors (N = 396) were recorded in representative sub-groups. Exposure-response relationships between physical exposure and musculoskeletal disorders, adjusted for individual factors with Poisson regression were then calculated. The effect of introducing psychosocial conditions into the models was also assessed.

RESULTS

Associations were found between head velocity, trapezius activity, upper arm velocity, forearm extensor activity and wrist posture and velocity, and most neck/shoulder and elbow/hand complaints and diagnoses. Adjustment for age, other individual characteristics and psychosocial work conditions had only a limited effect on these associations. For example, the attributable fraction for tension neck syndrome among female workers with the highest quintile of trapezius activity was 58%, for carpal tunnel syndrome versus wrist velocity it was 92% in men in the highest exposure quintile.

CONCLUSIONS

Based on the findings, we propose threshold limit values for upper arm and wrist velocity.

Work-Related Upper Limb Symptoms in Hand-Intensive Health Care Occupations: A Cross-Sectional Study With a Health and Safety Perspective

BACKGROUND

Research with physical therapists reveals high rates of work-related musculoskeletal injuries, especially low back pain, with early career onset. Less focus has been given to upper limb disorders (ULDs) in these professionals, who frequently perform repetitive arm/hand and precision finger motions during work.

OBJECTIVE

The objective was to estimate prevalence of body-site-specific upper limb (UL) symptoms and diagnosed ULDs in Irish chartered physical therapists, physiotherapists, and athletic therapists, with adjustment for leisure time injury, and document first onset of specific UL symptoms.

DESIGN

The design was a cross-sectional survey (N = 347) using random sampling (physiotherapists in private practice), proportionate cluster sampling (hospital-based physiotherapists), and all-population sampling (physical therapists and athletic therapists).

METHODS

The methods used were a postal questionnaire with annual, current, and incapacitating UL symptoms (neck, shoulders, elbows, wrists, fingers, thumbs) (Nordic Questionnaire); symptom onset; diagnosed UL disorders; and sociodemographics; prevalence with 95% CIs, and adjusted prevalence (general linear modeling).

RESULTS

Adjusted annual prevalence of UL symptoms in at least 1 body site was 78.1% (95% CI = 71.4-82.2), and of incapacitating symptoms was 21.0% (95% CI = 16.4-27.0). Shoulder (53.2%, 95% CI = 47.9-58.7), neck (49.4%, 95% CI = 44.2-55.0), and thumbs (46.1%, 95% CI = 40.7-51.5) were mostly affected. Hospital-based therapists had a significantly higher prevalence of incapacitating symptoms compared with others (35.7% vs 23.3%). Respondents totaling 28.2% had at least 1 lifetime diagnosis of ULD, most commonly shoulder tendonitis (12.5%, 95% CI = 8.4-15.3) and overuse syndrome (11.8%, 95% CI = 8.4-15.3). First onset was mostly after 5 years working as a therapist; however, this differed by anatomical site.

LIMITATIONS

A cross-sectional study design limited interpretation of symptoms as work-related causes.

CONCLUSIONS

The high prevalence of ULD and symptoms warrants attention from occupational health and safety personnel. Training in injury prevention and risk assessment should be provided during education and as part of continuing education.

Psychosocial Risk Factors and the Association With Carpal Tunnel Syndrome: A Systematic Review

BACKGROUND

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper limb. Research has shown that associative factors for CTS include occupational and biomechanical elements, sex, and age. To date, no systematic review has been undertaken to determine specifically whether there are any psychosocial risk factors in developing CTS. The objective is to determine whether psychosocial factors are associated with and/or predict the development of CTS.

METHODS

A systematic review was conducted including searches of PubMed (MEDLINE), EMBASE, and CINAHL from inception to May 30, 2017. Quantitative studies must have investigated a minimum of 1 or more psychosocial factors-cognitive, affective, behavioral, vocational, or interpersonal processes (eg, social support)-and include a point or risk estimate. One reviewer conducted the search and 2 reviewers independently assessed eligibility and completed methodological quality assessment using a modified Downs and Black checklist. Data were analyzed narratively.

RESULTS

Six moderate- to high-quality studies were included in the final review. Five studies reported a positive association between psychosocial factors and CTS, where psychosocial factors were more in those who reported CTS. One study reported no positive or negative association with CTS development. Four studies reported a negative association between psychosocial factors and CTS, where psychosocial factors were less in those who reported CTS.

CONCLUSIONS

There is limited evidence for a positive association between psychosocial factors and CTS. However, this was not a consistent finding across all included studies. Further research is indicated in standardizing CTS diagnostic criteria and investigating other working environments.

Carpal Tunnel Syndrome: Making Evidence-Based Treatment Decisions

Carpal tunnel syndrome (CTS) is one of the most common musculoskeletal disorders of the upper extremity. Comorbidities associated with the development of CTS include diabetes and obesity. Although a high rate of repetitive hand/wrist motions is a risk factor, there is insufficient evidence to implicate computer use in the development of CTS. Initial treatment generally is nonoperative, with the strongest evidence supporting bracing/splinting. Strong evidence supports operative treatment, regardless of technique, as superior to nonoperative treatment. Complications are infrequent and most are minor and transient.

Optimizing implementation of interventions in agriculture for occupational upper extremity musculoskeletal disorders: Results of an expert panel

BACKGROUND

Upper extremity musculoskeletal disorders (UEMSD) is reported worldwide as the second-largest occupational musculoskeletal disorder in agriculture.

OBJECTIVE

The objective of the study is to identify facilitators and barriers for employers and workers for implementing interventions to reduce work-related risk factors associated with occupational UEMSD in the agricultural sector, according to health and safety consultants.

METHODS

An expert panel was used comprising nine health and safety consultants from the Dutch agricultural sector.

RESULTS

Facilitators and barriers for employers and workers were categorized in the following themes: knowledge, skills, attitude, culture, costs, loss of income, facilitation and employability. There were no differences in facilitators and barriers between UEMSD.

CONCLUSIONS

Facilitators and barriers for implementing preventive interventions in agriculture were on organizational level, like diversity in choice of preventive devices, and personal level such as willingness if there is no work disability.

The biomechanics of subsynovial connective tissue in health and its role in carpal tunnel syndrome

Carpal Tunnel Syndrome (CTS) is the most common surgically treated problem in the hand. Aside from the neuropathy itself, the most common findings are fibrosis of the subsynovial connective tissue (SSCT) and increased intra carpal tunnel pressure. Normally, the SSCT is a multilayer tissue interspersed among the carpal tendons and nerve. As the tendons move, successive SSCT layers are recruited, forming a gliding unit and providing a limit to differential movement. Exceeding this limit, damages the SSCT as has been shown in both cadavers and animal models. This damage leads to a non-inflammatory response with progressive fibrosis and nerve ischemia leaving the SSCT more susceptible to injury. Although the direct consequences for patients are not fully understood, ultrasound research shows that this fibrosis restricts median nerve displacement during tendon loading. This article aims to provide insights into the mechanical properties of SSCT described so far and place it in the context of CTS pathophysiology. A theoretical damage model concerning the SSCT is proposed showing a chain of events and vicious cycles that could lead to the nerve compression as it is found in CTS. Although not complete, this model could explain the pathophysiological pathway of idiopathic CTS.

Carpal tunnel syndrome among laboratory technicians in relation to personal and ergonomic factors at work

OBJECTIVES

Work-related carpal tunnel syndrome (CTS) has been reported in different occupations, including laboratory technicians, so this study was carried out to determine the prevalence and the associated personal and ergonomic factors for CTS among laboratory technicians.

METHODS

A cross-sectional study was conducted among 279 laboratory technicians at King Fahd Hospital, Saudi Arabia, who filled in a self-administered questionnaire, including questions regarding their demographic criteria, occupational history, job tasks, workplace tools, ergonomic factors at work, and symptoms suggestive of CTS. Physical examinations and electrodiagnostic studies were carried out for those who had symptoms suggestive of CTS to confirm the diagnosis. Univariate and multivariate analysis were performed for both personal and physical factors in association with confirmed CTS among laboratory technicians.

RESULTS

The prevalence of CTS among the laboratory technicians was 9.7% (27/279). The following were the statistically significant risk factors for CTS among them: gender (all cases of CTS were female, P=0.00), arm/hand exertion (OR: 7.96; 95% CI: 1.84-34.33), pipetting (OR: 7.27; 95% CI: 3.15-16.78), repetitive tasks (OR: 4.60; 95% CI: 1.39-15.70), using unadjustable chairs or desks (OR: 3.35; 95% CI: 1.23-9.15), and working with a biosafety cabinet (OR: 2.49; 95% CI: 1.11-5.59). CTS cases had significant longer work duration (17.9 ± 5.6 years) than CTS non-case (11.5 ± 7.4 yeas) with low OR (1.108).

CONCLUSION

This study demonstrates some personal and ergonomic factors associated with CTS among the laboratory technicians, including female gender, arm/hand exertion, pipetting, repetitive tasks, working with a biosafety cabinet, and an unadjusted workstation.

Prevalence of Obesity in Carpal Tunnel Syndrome Patients: A Cross-Sectional Survey

Carpal tunnel syndrome (CTS) is the most common compressive entrapment neuropathy caused by the compression of the median nerve at the wrist space known as the carpal tunnel. The epidemiologic factors related to CTS include genetic, medical, social, vocational, and demographic factors. The common symptoms experienced include pain, paresthesia, and numbness in the median nerve distribution. If left untreated, it can lead to irreversible median nerve damage, causing a loss of hand function. Body mass index (BMI) has been attributed as a risk factor for the development of CTS.

We planned to determine the frequency of obesity among CTS patients in the neurophysiology department of a tertiary care center in Islamabad, Pakistan. The survey was designed as a cross-sectional descriptive study from March 2016 to August 2016 using a consecutive nonprobability sampling technique. A total of 112 patients with a mean age of 54 ± 5 years were included in the study. In the study population, 39 patients (35 percent) were males and 73 were females (65 percent). Based on BMI, 74 patients (66 percent) had a normal weight and 38 (34 percent) were obese. The frequency of obesity in our study was 34 percent, excluding the other comorbid conditions, which is quite high. Targeted therapy in those with CTS should also include weight reduction measures because obesity poses a cause-and-effect relationship for both the severity and the pathogenesis of CTS.

Distal pain and carpal tunnel syndrome diagnosis among cashiers: a longitudinal study

OBJECTIVE

To estimate in a longitudinal study the yearly incidence of carpal tunnel syndrome (CTS) in a cohort of women working as cashiers.

METHOD

A total of 198 cashiers, belonging to a cohort investigated in 2011-2012 for arm pain, were screened for re-assessment in 2015 (at least 40 months from the first examination), and 156 women had complete demographic, personal and working data allowing to be included in this study. On the basis of self- and clinician-administered questionnaires investigating the presence of CTS, all symptomatic patients underwent clinical and neurophysiological [nerve conduction studies (NCS) of median and ulnar nerves] assessments.

RESULTS

NCS confirmed the presence of CTS in 17 out of 149 workers; however, seven of them already received the diagnosis of CTS at the previous assessment in 2011-2012, leading to an overall incidence of new cases equal to 7.0%. Cumulative working time at the cashier of the women with CTS in the period 2012-2015 was highly variable (1744-4479 h) without an evident association with the severity of CTS. No differences in general demographic data were found in the women with vs. without CTS. Comorbidities potentially associated with increased risk of CTS were present in 21 women in the entire cohort (14.0% of the population, 40.0% in the subgroup of women with newly assessed CTS). Overweight/obesity and hypothyroidism were the most frequent comorbidities.

CONCLUSION

The results of this prospective study showed that the annualized incidence of CTS in our population of cashier was 2.0%; 40% of the new CTS cases had comorbidities.

Median and common peroneal neuropathy in coir workers of Alappuzha district, Kerala

Introduction:

Coir work, in a large number of people involves mechanically rolling the coconut fibers into coir which is later subjected to various processes. The primary work is done as a cottage industry specially by women in the sitting posture for several hours. This study reports evidence of median and common peroneal neuropathy electrophysiologically in people who had been engaged in this job for several years. This study was initiated to establish the possible relationship between coir work and symptomatic neuropathies which was seen in that region with all investigations “for other causes not” contributing to the etiological diagnosis.

Subjects and Methods:

One hundred and forty-two upper limbs and 142 lower limbs in patients engaged in long years of coir work but having no symptoms were evaluated electrophysiologically with informed consent and financial compensation, appropriate inclusion and exclusion criteria were followed as described in the text.

Results:

There is electrophysiological evidence for median and common peroneal neuropathy in persons engaged in long years of coir work.

Conclusions:

Coir workers neuropathy appears to be a new occupational neuropathy which can be prevented by following simple preventive measures.

[Not Available]

Objectif

Permettre aux médecins de famille de comprendre l’épidémiologie, la pathogenèse, les symptômes, le diagnostic et la prise en charge de la maladie des vibrations, une maladie professionnelle importante et courante au Canada.

Sources d’information

Une recherche a été effectuée sur MEDLINE afin de relever les recherches et comptes rendus portant sur la maladie des vibrations. Une recherche a été effectuée sur Google dans le but d’obtenir la littérature grise qui convient au contexte canadien. D’autres références ont été tirées des articles relevés.

Message principal

La maladie des vibrations est une maladie professionnelle répandue touchant les travailleurs de diverses industries qui utilisent des outils vibrants. La maladie est cependant sous-diagnostiquée au Canada. Elle compte 3 éléments : vasculaire, sous la forme d’un phénomène de Raynaud secondaire; neurosensoriel; et musculosquelettique. Aux stades les plus avancés, la maladie des vibrations entraîne une invalidité importante et une piètre qualité de vie. Son diagnostic exige une anamnèse minutieuse, en particulier des antécédents professionnels, un examen physique, des analyses de laboratoire afin d’éliminer les autres diagnostics, et la recommandation en médecine du travail aux fins d’investigations plus poussées. La prise en charge consiste à réduire l’exposition aux vibrations, éviter les températures froides, abandonner le tabac et administrer des médicaments.

Conclusion

Pour assurer un diagnostic rapide de la maladie des vibrations et améliorer le pronostic et la qualité de vie, les médecins de famille devraient connaître cette maladie professionnelle courante, et pouvoir obtenir les détails pertinents durant l’anamnèse, recommander les patients aux cliniques de médecine du travail et débuter les demandes d’indemnisation de manière appropriée.

Hand-arm vibration syndrome: What family physicians should know

OBJECTIVE

To provide family physicians with an understanding of the epidemiology, pathogenesis, symptoms, diagnosis, and management of hand-arm vibration syndrome (HAVS), an important and common occupational disease in Canada.

SOURCES OF INFORMATION

A MEDLINE search was conducted for research and review articles on HAVS. A Google search was conducted to obtain gray literature relevant to the Canadian context. Additional references were obtained from the articles identified.

MAIN MESSAGE

Hand-arm vibration syndrome is a prevalent occupational disease affecting workers in multiple industries in which vibrating tools are used. However, it is underdiagnosed in Canada. It has 3 components-vascular, in the form of secondary Raynaud phenomenon; sensorineural; and musculoskeletal. Hand-arm vibration syndrome in its more advanced stages contributes to substantial disability and poor quality of life. Its diagnosis requires careful history taking, in particular occupational history, physical examination, laboratory tests to rule out alternative diagnoses, and referral to an occupational medicine specialist for additional investigations. Management involves reduction of vibration exposure, avoidance of cold conditions, smoking cessation, and medication.

CONCLUSION

To ensure timely diagnosis of HAVS and improve prognosis and quality of life, family physicians should be aware of this common occupational disease and be able to elicit the relevant occupational history, refer patients to occupational medicine clinics, and appropriately initiate compensation claims.