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Rydberg M, Perez R, Merlo J, Dahlin LB. Carpal Tunnel Syndrome and Trigger Finger May Be an Early Symptom of Preclinic Type 2 Diabetes. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5907. [PMID: 38881965 PMCID: PMC11177834 DOI: 10.1097/gox.0000000000005907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/30/2024] [Indexed: 06/18/2024]
Abstract
Background Type 2 diabetes (T2D) is a major risk factor for carpal tunnel syndrome (CTS) and trigger finger (TF), but less is known regarding the risk of developing T2D after being diagnosed with CTS or TF. CTS and TF could be early signs of preclinical T2D, and early detection of T2D is crucial to prevent complications and morbidity. Therefore, we investigate the association between CTS/TF and T2D in an adult population without previous T2D using big data registers in Sweden. Methods Data were collected by crosslinking five nationwide Swedish registers. Individuals aged 40-85 years on December 31, 2010, without prior overt diabetes, were included (n = 3,948,517) and followed up from baseline (ie, a diagnosis of CTS or TF) or January 1, 2011, for controls, until a diagnosis of T2D, prescription of oral antidiabetics or insulin, or end of follow-up four years after baseline. Multivariate Cox regression models were created to calculate hazard ratios for T2D. Results In total, 37,346 (0.95%) patients were diagnosed with CTS, whereof 1329 (3.46%) developed T2D. There were 17,432 (0.44%) patients who developed TF, whereof 639 (3.67%) developed T2D. Among the controls, 2.73% developed T2D. Compared with controls, there was an increased risk of developing T2D after being diagnosed with either CTS (HR 1.35; 95% confidence interval 1.28-1.43) or TF (HR 1.21; 95% confidence interval 1.12-1.31). Conclusion Compared with controls, a diagnosis of CTS or TF was associated with 35% and 21% higher risk for later T2D, respectively, which might indicate the existence of undetected T2D in this population.
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Affiliation(s)
- Mattias Rydberg
- From the Department of Hand Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
- Department of Translational Medicine-Hand Surgery, Lund University, Malmö, Sweden
| | - Raquel Perez
- Unit for Social Epidemiology, Department of Clinical Sciences (Malmö), Faculty of Medicine, Lund University, Malmö, Sweden
| | - Juan Merlo
- Unit for Social Epidemiology, Department of Clinical Sciences (Malmö), Faculty of Medicine, Lund University, Malmö, Sweden
- Center for Primary Health Research, Region Skåne, Malmö, Sweden
| | - Lars B Dahlin
- From the Department of Hand Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
- Department of Translational Medicine-Hand Surgery, Lund University, Malmö, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Dahlin LB, Zimmerman M, Calcagni M, Hundepool CA, van Alfen N, Chung KC. Carpal tunnel syndrome. Nat Rev Dis Primers 2024; 10:37. [PMID: 38782929 DOI: 10.1038/s41572-024-00521-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/25/2024]
Abstract
Carpal tunnel syndrome (CTS) is the most common nerve entrapment disorder worldwide. The epidemiology and risk factors, including family burden, for developing CTS are multi-factorial. Despite much research, its intricate pathophysiological mechanism(s) are not fully understood. An underlying subclinical neuropathy may indicate an increased susceptibility to developing CTS. Although surgery is often performed for CTS, clear international guidelines to indicate when to perform non-surgical or surgical treatment, based on stage and severity of CTS, remain to be elucidated. Neurophysiological examination, using electrophysiology or ultrasonography, performed in certain circumstances, should correlate with the history and findings in clinical examination of the person with CTS. History and clinical examination are particularly relevant globally owing to lack of other equipment. Various instruments are used to assess CTS and treatment outcomes as well as the effect of the disorder on quality of life. The surgical treatment options of CTS - open or endoscopic - offer an effective solution to mitigate functional impairments and pain. However, there are risks of post-operative persistent or recurrent symptoms, requiring meticulous diagnostic re-evaluation before any additional surgery. Health-care professionals should have increased awareness about CTS and all its implications. Future considerations of CTS include use of linked national registries to understand risk factors, explore possible screening methods, and evaluate diagnosis and treatment with a broader perspective beyond surgery, including psychological well-being.
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Affiliation(s)
- Lars B Dahlin
- Department of Translational Medicine - Hand Surgery, Lund University, Malmö, Sweden.
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden.
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Malin Zimmerman
- Department of Translational Medicine - Hand Surgery, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Orthopedics, Helsingborg Hospital, Helsingborg, Sweden
| | - Maurizio Calcagni
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Caroline A Hundepool
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Clinical Neuromuscular Imaging Group, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kevin C Chung
- Professor of Surgery, Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
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Svensson AK, Dahlin LB, Rydberg M, Perez R, Zimmerman M. Surgery for carpal tunnel syndrome in patients with and without diabetes-Is there a difference in the frequency of surgical procedures? PLoS One 2024; 19:e0302219. [PMID: 38718087 PMCID: PMC11078357 DOI: 10.1371/journal.pone.0302219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/28/2024] [Indexed: 05/12/2024] Open
Abstract
Carpal tunnel syndrome (CTS) occurs more often among individuals with diabetes. The aim of this retrospective observational registry study was to examine whether individuals with diabetes and CTS are treated surgically to the same extent as individuals with CTS but without diabetes. Data on CTS diagnosis and surgery were collected from the Skåne Healthcare Register (SHR). A total of 35,105 individuals (age ≥ 18 years) diagnosed with CTS from 2004-2019 were included. Data were matched to the Swedish National Diabetes Register (NDR. Cox regression models were used to calculate the risk of the use of surgical treatment. Of the 35,105 included individuals with a CTS diagnosis, 17,662 (50%) were treated surgically, and 4,966 (14%) had diabetes. A higher number of individuals with diabetes were treated surgically (2,935/4,966, 59%) than individuals without diabetes (14,727/30,139, 49%). In the Cox regression model, diabetes remained a significant risk factor for surgical treatment (PR 1.14 (95% CI 1.11-1.17)). Individuals with type 1 diabetes were more frequently treated surgically (490/757, 65%) than individuals with type 2 diabetes (2,445/4,209, 58%). There was no difference between the sexes and their treatment. The duration of diabetes was also a risk factor for surgical treatment in diabetes type 2, but high HbA1c levels were not. Individuals with diabetes are more likely to be treated surgically for CTS than individuals without diabetes. Individuals with type 1 diabetes are more likely to be treated surgically for CTS than individuals with type 2 diabetes.
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Affiliation(s)
- Anna-Karin Svensson
- Department of Hand Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
- Department of Translational Medicine–Hand Surgery, Lund University, Malmö, Sweden
- Department of Orthopedics, Helsingborg Hospital, Helsingborg, Sweden
| | - Lars B. Dahlin
- Department of Hand Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
- Department of Translational Medicine–Hand Surgery, Lund University, Malmö, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Mattias Rydberg
- Department of Hand Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
- Department of Translational Medicine–Hand Surgery, Lund University, Malmö, Sweden
| | - Raquel Perez
- Department of Hand Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
- Department of Social Epidemiology, Lund University, Malmö, Sweden
| | - Malin Zimmerman
- Department of Hand Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
- Department of Translational Medicine–Hand Surgery, Lund University, Malmö, Sweden
- Department of Orthopedics, Helsingborg Hospital, Helsingborg, Sweden
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Kraut A, Rydz E, Walld R, Demers PA, Peters CE. Carpal tunnel syndrome among Manitoba workers: Results from the Manitoba Occupational Disease Surveillance System. Am J Ind Med 2024; 67:243-260. [PMID: 38265110 DOI: 10.1002/ajim.23566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is associated with occupational high-force repetitive tasks and vibration. This project examines the relationship between CTS and work to: (1) identify jobs and industries with increased CTS risk; (2) explore whether there is a sex difference in the risk of CTS after controlling for occupation; and (3) determine whether any observed relationships persist after excluding Workers Compensation Board (WCB) accepted time-loss CTS claims. METHODS We linked 95.5% of time-loss WCB claims from 2006 to 2019 to provincial administrative health data. The cohort included 143,001 unique person-occupation combinations. CTS cases were defined as at least two medical claims for (ICD-9 354) within a 12-month period or a surgical claim for CTS from 2 years before the WCB claim to 3 years after. WCB accepted CTS time-loss claims not identified by the medical claims were also included. RESULTS A total of 4302 individuals (3.0%) met the CTS definition. Analysis revealed that the hazard ratios (HRs) of CTS vary considerably with occupation. Sex-based differences in CTS risks were observed, both in low- and high-risk occupations. In many occupations with increased HR, the HR remained elevated after excluding accepted time-loss WCB cases. CONCLUSIONS The risk of developing CTS varied with occupation. Job titles with ergonomic risk factors had higher risks than those with lower exposures. This finding remained after eliminating time-loss compensated WCB cases, suggesting that all cases of CTS in high risk jobs are not identified in WCB statistics. Female workers in some job titles had excess CTS cases compared to male workers within the same job title.
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Affiliation(s)
- Allen Kraut
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth Rydz
- CAREX Canada, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Randy Walld
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Cheryl E Peters
- CAREX Canada, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- BC Cancer, Vancouver, British Columbia, Canada
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Tassara R, Inolopú J, Cruz-Ausejo L, Mayma KJ, Soncco-Llulluy F, Rosales-Rimache J. High frequency of carpal tunnel syndrome and associated factors: A cross-sectional study in Peruvian workers from agro-export industry. Medicine (Baltimore) 2023; 102:e35927. [PMID: 37932974 PMCID: PMC10627667 DOI: 10.1097/md.0000000000035927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/12/2023] [Indexed: 11/08/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is a peripheral mononeuropathy caused by compression of the median nerve at the wrist and has been reported in workers who perform repetitive movements that involve actions of sustained grasping of vibrating objects. We carried out a cross-sectional analytical study in March 2018 to identify the factors associated with the CTS among workers of agro-export companies in Ica-Peru. CTS confirmation in our study was based on having at least 1 positive screening test (Tinel or Phalen) and a presumptive result of CTS by the Kamath and Stothard Questionnaire. We carried out 4 Poisson regression models to evaluate the factors associated with CTS based on epidemiological and statistical criteria. We enrolled 112 agro-export workers in production (42.0%), packing (35.7%), and administration (22.3%) working areas. The CTS frequency in Peruvian agro-export workers in production, packing, and administrative working area were 78.7%, 45.0%, and 28.0%, respectively. The bivariate analysis found a relationship between the CTS with age, female sex, sports practice, job seniority in the working area (year), and repetitive wrist movements (hours per day). In the multivariate analysis, only job seniority in the working area (year) and repetitive wrist movements maintained their association with CTS. Occupational factors are significantly associated with a high frequency of CTS, such as job seniority in the working area (year) and repetitive wrist movements in agro-export workers. Surveillance programs should be held to prevent, reduce, and monitor workers' health status.
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Affiliation(s)
| | - Jorge Inolopú
- Centro Nacional de Salud Ocupacional y Protección del Ambiente para la Salud, Instituto Nacional de Salud, Lima, Peru
| | | | - Kevin Jesús Mayma
- Centro Nacional de Salud Ocupacional y Protección del Ambiente para la Salud, Instituto Nacional de Salud, Lima, Peru
| | | | - Jaime Rosales-Rimache
- Vicerectorado de Investigación, Universidad Privada Norbert Wiener, Lima, Peru
- Escuela Profesional de Tecnología Médica, Universidad Continental, Lima, Peru
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Shields LBE, Iyer VG, Daniels MW, Zhang YP, Shields CB. Impact of Occupations and Hobbies on the Severity of Carpal Tunnel Syndrome: An Electrodiagnostic Perspective. J Occup Environ Med 2023; 65:655-662. [PMID: 37171095 DOI: 10.1097/jom.0000000000002866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE This study describes the clinical and electrodiagnostic (EDX) findings as well as occupations and hobbies in 613 patients diagnosed with carpal tunnel syndrome (CTS). METHODS Patients with moderate, moderately severe, or severe CTS based on EDX criteria were included. RESULTS The most common occupations included workers in offices, construction/maintenance, and assembly lines. The occupation severity scores were greatest in garment workers, musicians, and landscapers. Regardless of occupation, patient age and occupation duration were significantly correlated ( P < 0.001). Gardeners had the highest average severity score of the hobbies, followed by painters, those who sew, and individuals who perform house chores. CONCLUSIONS Physicians should be aware of particular occupations and hobbies associated with a greater risk of severe CTS and offer modifications to their patients' work duties and hobbies to minimize the likelihood of developing severe CTS.
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Affiliation(s)
- Lisa B E Shields
- From the Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky (L.B.E.S., Y.P.Z., C.B.S.); Neurodiagnostic Center of Louisville, Louisville, Kentucky (V.G.I.); Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, Kentucky (M.W.D.); and Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky (C.B.S.)
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Is Smoking Associated with Carpal Tunnel Syndrome? A Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10101988. [PMID: 36292435 PMCID: PMC9601480 DOI: 10.3390/healthcare10101988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 11/04/2022] Open
Abstract
To date, the role of smoking in carpal tunnel syndrome (CTS) is unclear. The aim of this systematic review and meta-analysis was to assess the association between smoking and CTS. The literature searches were conducted in PubMed, Embase, and Scopus, from inception until October 2021. Three reviewers screened the titles, abstracts, and full-text articles and evaluated the methodological quality of the included studies. A random-effects meta-analysis was used, and heterogeneity across studies was examined using I2 statistic. A total of 31 (13 cross-sectional, 10 case-control, and 8 cohort) studies were qualified for meta-analysis. In a meta-analysis of cohort studies, the risk of CTS did not differ between current and never smokers (pooled hazard ratio (HR) 1.09, 95% CI 0.84–1.43), current and past/never smokers (HR 1.07, 95% CI 0.94–1.23), and past and never smokers (HR 1.12, 95% CI 0.83–1.49). Furthermore, a meta-analysis of case control studies found no difference in the risk of CTS between current and never smokers (pooled odds ratio (OR) 0.92, 95% CI 0.56–1.53), current and past/never smokers (OR 1.10, 95% CI 0.51–2.36), and past and never smokers (OR 0.91, 95% CI 0.59–1.39). However, a meta-analysis of cross-sectional studies showed the associations of ever (OR 1.36, 95% CI 1.08–1.72) and current smoking (OR 1.52, 95% CI 1.11–2.09) with CTS. However, the association between ever smoking and CTS disappeared after limiting the meta-analysis to higher quality studies or after adjusting for publication bias. The association between current smoking and CTS also attenuated after limiting the meta-analysis to studies that confirmed CTS by a nerve conduction study or studies with low attrition bias. This meta-analysis does not support an association between smoking and CTS. The association between smoking and CTS observed in cross-sectional studies could be due to biases and/or confounding factors.
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Dahlin LB, Perez R, Nyman E, Zimmerman M, Merlo J. Carpal Tunnel Syndrome and Ulnar Nerve Entrapment Are Associated with Impaired Psychological Health in Adults as Appraised by Their Increased Use of Psychotropic Medication. J Clin Med 2022; 11:jcm11133871. [PMID: 35807165 PMCID: PMC9267822 DOI: 10.3390/jcm11133871] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/16/2022] [Accepted: 06/28/2022] [Indexed: 02/05/2023] Open
Abstract
We aimed to study psychological health, as approximated by the use of psychotropic drugs, in a population diagnosed and surgically treated for carpal tunnel syndrome (CTS) or ulnar nerve entrapment (UNE), or both, also considering the demographic and socioeconomic factors of the individuals. Linking data from five large national registers, use of psychotropics (at least one dispensation during the first year after the surgery or the baseline date) was examined in around 5.8 million people 25–80 years old residing in Sweden 2010. Among these individuals, 9728 (0.17%), 890 (0.02%) and 149 (0.00%) were identified as diagnosed and surgically treated for CTS, UNE, or both, respectively. As much as 28%, 34% and 36% in each group, respectively, used psychotropic drugs, compared with 19% in the general population. Regression analyses showed a general higher risk for use of psychotropics related to these nerve compression disorders, to higher age, being a woman, and having low income or low occupational qualification level. Individuals born outside of Sweden had a lower risk. We conclude that surgically treated individuals with a nerve compression disorder have an increased risk of impaired psychological health. Caregivers should be aware of the risk and provide necessary attention.
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Affiliation(s)
- Lars B. Dahlin
- Department of Translational Medicine—Hand Surgery, Lund University, 20502 Malmö, Sweden;
- Department of Hand Surgery, Skåne University Hospital, 20502 Malmö, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, 58183 Linköping, Sweden;
- Correspondence:
| | - Raquel Perez
- Unit for Social Epidemiology, Department of Clinical Sciences (Malmö), Faculty of Medicine, Lund University, 20502 Malmö, Sweden; (R.P.); (J.M.)
| | - Erika Nyman
- Department of Biomedical and Clinical Sciences, Linköping University, 58183 Linköping, Sweden;
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University Hospital, 58183 Linköping, Sweden
| | - Malin Zimmerman
- Department of Translational Medicine—Hand Surgery, Lund University, 20502 Malmö, Sweden;
- Department of Hand Surgery, Skåne University Hospital, 20502 Malmö, Sweden
| | - Juan Merlo
- Unit for Social Epidemiology, Department of Clinical Sciences (Malmö), Faculty of Medicine, Lund University, 20502 Malmö, Sweden; (R.P.); (J.M.)
- Center for Primary Health Research, Region Skåne, 20502 Malmö, Sweden
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