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Tabatabaeifar S, Dalbøge A. Carpal tunnel syndrome and occupational hand exposures: a Danish nationwide cohort study. Occup Environ Med 2024:oemed-2024-109568. [PMID: 39160073 DOI: 10.1136/oemed-2024-109568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 08/06/2024] [Indexed: 08/21/2024]
Abstract
OBJECTIVES The aim was to examine exposure-response relations between occupational hand exposures and carpal tunnel syndrome (CTS) and to compare the relation between surgery-treated and non-surgery-treated CTS. The secondary aim was to study sex-specific differences in exposure-response relations. METHODS We conducted a nationwide register-based cohort study of all persons born in Denmark (1945-1994). During follow-up (2010-2013), we identified first-time events of CTS. Occupational hand exposure estimates the year before each follow-up year were obtained by linking individual occupational codes with a job exposure matrix. We used multivariable logistic regression equivalent to discrete survival analysis based on sex and surgery. The excess fraction of cases was calculated. RESULTS For both sexes, exposure-response relations were found for all occupational hand exposures. Among men, we found ORadj of 3.6 (95% CI 3.2 to 3.8) for hand-related force, 2.9 (95% CI 2.5 to 3.2) for repetitive hand movements, 3.8 (95% CI 2.7 to 5.2) for non-neutral hand posture and 2.5 (95% CI 2.2 to 2.7) for hand-arm vibration in the highest exposure groups. For combined exposure (hand load), ORadj was 3.5 (95% CI 3.1 to 4.0). Slightly higher ORsadj were generally found for surgery-treated CTS compared with non-surgery-treated CTS for both sexes. When comparing sex, somewhat higher ORsadj were found among men. The excess fraction was 42%. CONCLUSIONS Occupational hand exposures carried a 3-5-fold increased risk of CTS with slightly higher risks for surgery-treated compared with non-surgery-treated CTS. Even though CTS occurs more frequently among women, somewhat higher exposure-response relations were found for men compared with women. In the general working population, a substantial fraction of first-time CTS could be related to occupational hand exposures.
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Affiliation(s)
- Sorosh Tabatabaeifar
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
- Centre for Integrated Register-Based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Annett Dalbøge
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Peters S, Undem K, Solovieva S, Selander J, Schlünssen V, Oude Hengel KM, Albin M, Ge CB, Kjellberg K, McElvenny DM, Gustavsson P, Kolstad HA, Würtz AML, Brinchmann BC, Broberg K, Fossum S, Bugge M, Christensen MW, Ghosh M, Christiansen DH, Merkus SL, Lunde LK, Viikari-Juntura E, Dalbøge A, Falkstedt D, Willert MV, Huss A, Würtz ET, Dumas O, Iversen IB, Leite M, Cramer C, Kirkeleit J, Svanes C, Tinnerberg H, Garcia-Aymerich J, Vested A, Wiebert P, Nordby KC, Godderis L, Vermeulen R, Pronk A, Mehlum IS. Narrative review of occupational exposures and noncommunicable diseases. Ann Work Expo Health 2024; 68:562-580. [PMID: 38815981 PMCID: PMC11229329 DOI: 10.1093/annweh/wxae045] [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: 12/22/2023] [Accepted: 05/09/2024] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVE Within the scope of the Exposome Project for Health and Occupational Research on applying the exposome concept to working life health, we aimed to provide a broad overview of the status of knowledge on occupational exposures and associated health effects across multiple noncommunicable diseases (NCDs) to help inform research priorities. METHODS We conducted a narrative review of occupational risk factors that can be considered to have "consistent evidence for an association," or where there is "limited/inadequate evidence for an association" for 6 NCD groups: nonmalignant respiratory diseases; neurodegenerative diseases; cardiovascular/metabolic diseases; mental disorders; musculoskeletal diseases; and cancer. The assessment was done in expert sessions, primarily based on systematic reviews, supplemented with narrative reviews, reports, and original studies. Subsequently, knowledge gaps were identified, e.g. based on missing information on exposure-response relationships, gender differences, critical time-windows, interactions, and inadequate study quality. RESULTS We identified over 200 occupational exposures with consistent or limited/inadequate evidence for associations with one or more of 60+ NCDs. Various exposures were identified as possible risk factors for multiple outcomes. Examples are diesel engine exhaust and cadmium, with consistent evidence for lung cancer, but limited/inadequate evidence for other cancer sites, respiratory, neurodegenerative, and cardiovascular diseases. Other examples are physically heavy work, shift work, and decision latitude/job control. For associations with limited/inadequate evidence, new studies are needed to confirm the association. For risk factors with consistent evidence, improvements in study design, exposure assessment, and case definition could lead to a better understanding of the association and help inform health-based threshold levels. CONCLUSIONS By providing an overview of knowledge gaps in the associations between occupational exposures and their health effects, our narrative review will help setting priorities in occupational health research. Future epidemiological studies should prioritize to include large sample sizes, assess exposures prior to disease onset, and quantify exposures. Potential sources of biases and confounding need to be identified and accounted for in both original studies and systematic reviews.
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Affiliation(s)
- Susan Peters
- Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 2, 3584 CM Utrecht, the Netherlands
| | - Karina Undem
- National Institute of Occupational Health (STAMI), Gydas vei 8, 0363 Oslo, Norway
| | - Svetlana Solovieva
- Finnish Institute of Occupational Health, P.O. Box 40 FI-00032 TYÖTERVEYSLAITOS, Finland
| | - Jenny Selander
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden
| | - Vivi Schlünssen
- Department of Public Health, Research Unit for Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Bartholins Allé 2 DK-8000 Aarhus, Denmark
| | - Karen M Oude Hengel
- Netherlands Organisation for Applied Scientific Research TNO, Princetonlaan 6 3584 CB Utrecht, the Netherlands
| | - Maria Albin
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden
| | - Calvin B Ge
- Netherlands Organisation for Applied Scientific Research TNO, Princetonlaan 6 3584 CB Utrecht, the Netherlands
| | - Katarina Kjellberg
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Torsplan, Solnavägen 4, 113 65 Stockholm, Sweden
| | - Damien M McElvenny
- Institute of Occupational Medicine, Research Ave N, Currie EH14 4AP, Edinburgh, United Kingdom
- Centre for Occupational and Environmental Health, University of Manchester, Oxford Rd, Manchester M13 9PL, United Kingdom
| | - Per Gustavsson
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden
| | - Henrik A Kolstad
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99. DK-8200 Aarhus, Denmark
| | - Anne Mette L Würtz
- Department of Public Health, Research Unit for Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Bartholins Allé 2 DK-8000 Aarhus, Denmark
| | - Bendik C Brinchmann
- National Institute of Occupational Health (STAMI), Gydas vei 8, 0363 Oslo, Norway
| | - Karin Broberg
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden
| | - Stine Fossum
- National Institute of Occupational Health (STAMI), Gydas vei 8, 0363 Oslo, Norway
| | - Merete Bugge
- National Institute of Occupational Health (STAMI), Gydas vei 8, 0363 Oslo, Norway
| | - Mette Wulf Christensen
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99. DK-8200 Aarhus, Denmark
| | - Manosij Ghosh
- Department of Public Health and Primary Care, Centre for Environment & Health, KU Leuven, Kapucijnenvoer 7, box 7001 3000 Leuven, Belgium
| | - David Høyrup Christiansen
- Centre of Elective surgery, Region Hospital Silkeborg, Department of Clinical Medicine, Aarhus University, Falkevej 3. 8600 Silkeborg, Denmark
| | - Suzanne L Merkus
- National Institute of Occupational Health (STAMI), Gydas vei 8, 0363 Oslo, Norway
| | - Lars-Kristian Lunde
- National Institute of Occupational Health (STAMI), Gydas vei 8, 0363 Oslo, Norway
| | - Eira Viikari-Juntura
- Finnish Institute of Occupational Health, P.O. Box 40 FI-00032 TYÖTERVEYSLAITOS, Finland
| | - Annett Dalbøge
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99. DK-8200 Aarhus, Denmark
| | - Daniel Falkstedt
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden
| | - Morten Vejs Willert
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99. DK-8200 Aarhus, Denmark
| | - Anke Huss
- Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 2, 3584 CM Utrecht, the Netherlands
| | - Else Toft Würtz
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99. DK-8200 Aarhus, Denmark
| | - Orianne Dumas
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d’Épidémiologie respiratoire intégrative, CESP, 94807, Villejuif, France
| | - Inge Brosbøl Iversen
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99. DK-8200 Aarhus, Denmark
| | - Mimmi Leite
- National Institute of Occupational Health (STAMI), Gydas vei 8, 0363 Oslo, Norway
| | - Christine Cramer
- Department of Public Health, Research Unit for Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Bartholins Allé 2 DK-8000 Aarhus, Denmark
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99. DK-8200 Aarhus, Denmark
| | - Jorunn Kirkeleit
- National Institute of Occupational Health (STAMI), Gydas vei 8, 0363 Oslo, Norway
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17 Block D 5009 Bergen, Norway
| | - Cecilie Svanes
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17 Block D 5009 Bergen, Norway
- Department of Occupational Medicine, Haukeland University Hospital, P.O box 1400 5021 Bergen, Norway
| | - Håkan Tinnerberg
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden
- School of Public Health and Community Medicine, Gothenburg University, Huvudbyggnad Vasaparken, Universitetsplatsen 1, 405 30, Gothenburg, Sweden
| | - Judith Garcia-Aymerich
- Barcelona Institute for Global Health (ISGlobal), C/ Doctor Aiguader 88, 08003 Barcelona, Spain
- Universitat Pompeu Fabra (UPF), carrer de la Mercè 12, 08002 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos 3-5, 28029 Madrid, Spain
| | - Anne Vested
- Department of Public Health, Research Unit for Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Bartholins Allé 2 DK-8000 Aarhus, Denmark
| | - Pernilla Wiebert
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Torsplan, Solnavägen 4, 113 65 Stockholm, Sweden
| | | | - Lode Godderis
- Department of Public Health and Primary Care, Centre for Environment & Health, KU Leuven, Kapucijnenvoer 7, box 7001 3000 Leuven, Belgium
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 2, 3584 CM Utrecht, the Netherlands
| | - Anjoeka Pronk
- Netherlands Organisation for Applied Scientific Research TNO, Princetonlaan 6 3584 CB Utrecht, the Netherlands
| | - Ingrid Sivesind Mehlum
- National Institute of Occupational Health (STAMI), Gydas vei 8, 0363 Oslo, Norway
- Institute of Health and Society, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospitals, Copenhagen, Bispebjerg Bakke 23, DK-Copenhagen 2400 NV, Denmark
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5 1353 Copenhagen, Denmark
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Luo YT, Huang YT, Chiu V, Chang YW, Horng YS. Diagnostic meta-analysis of the efficacy of ultrasonography for diagnosing carpal tunnel syndrome: A comparison between Asian and non-Asian populations. J Formos Med Assoc 2024:S0929-6646(24)00302-4. [PMID: 38965008 DOI: 10.1016/j.jfma.2024.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/13/2024] [Accepted: 06/30/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Ultrasonography is used to diagnose carpal tunnel syndrome (CTS) according to various criteria. This diagnostic meta-analysis aimed to evaluate the efficacy of ultrasonography for diagnosing CTS, focusing on the cross-sectional area (CSA) of the median nerve (MN) at the inlet of the carpal tunnel and regional variations in diagnostic thresholds between Asian and non-Asian populations. METHODS A comprehensive literature search was conducted using PubMed, Embase, and the Cochrane Library. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Patient demographic data, diagnostic "gold standards", CSA cutoff values, and diagnostic results were extracted. Meta-analysis was performed to determine the sensitivity, specificity, and optimal CSA cutoff values. RESULTS For the 25 included studies, a combined sensitivity of 88% and specificity of 84% for CSA measurements at the carpal tunnel inlet were obtained. The Asian group had a sensitivity of 84% and specificity of 86%, while the non-Asian group had a sensitivity of 91% and specificity of 82%. The mean CSA in the Asian group was significantly lower than that in the non-Asian group (12.93 mm2 and 14.77 mm2, respectively; p = 0.042). For the Asian group, the summary receiver operating characteristic curve had an area under the curve (AUC) of 0.92 with an optimal cutoff of 10.5 mm2; for the non-Asian group, an AUC of 0.94 was obtained with a cutoff of 11.5 mm2. CONCLUSION Ultrasonography is a reliable diagnostic method for CTS, with distinct optimal cutoff values observed between Asian and non-Asian populations. Therefore, population-specific diagnostic criteria for CTS are recommended.
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Affiliation(s)
- Yan-Ting Luo
- Department of Physical Medicine and Rehabilitation, Taipei Tzuchi Hospital, Buddhist Tzuchi Medical Foundation, New Taipei City, Taiwan
| | - Yu-Ting Huang
- Department of Physical Medicine and Rehabilitation, Taipei Tzuchi Hospital, Buddhist Tzuchi Medical Foundation, New Taipei City, Taiwan
| | - Valeria Chiu
- Department of Physical Medicine and Rehabilitation, Taipei Tzuchi Hospital, Buddhist Tzuchi Medical Foundation, New Taipei City, Taiwan; Department of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yi-Wei Chang
- Department of Physical Medicine and Rehabilitation, Taipei Tzuchi Hospital, Buddhist Tzuchi Medical Foundation, New Taipei City, Taiwan; Department of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yi-Shiung Horng
- Department of Physical Medicine and Rehabilitation, Taipei Tzuchi Hospital, Buddhist Tzuchi Medical Foundation, New Taipei City, Taiwan; Department of Medicine, Tzu Chi University, Hualien, Taiwan.
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Aldehailan KS, Alhubail FM, Almukhaimar SK, Wutayd HF, Alshehri RA, Almukhaimar NK, Almuslim NI. Symptoms and Risk Factors of Carpal Tunnel Syndrome among Schoolteachers in Al-Ahsa, Saudi Arabia: A Cross-sectional Study. Ann Afr Med 2024; 23:429-436. [PMID: 39034569 DOI: 10.4103/aam.aam_152_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 10/05/2023] [Indexed: 07/23/2024] Open
Abstract
CONTEXT Carpal tunnel syndrome (CTS) is caused by compression of the median nerve as it travels through the carpal tunnel into the wrist. It is the most common peripheral mononeuropathy and accounts for a large proportion of occupational upper extremity disorders. Teaching is an occupation associated with musculoskeletal disorders. AIMS This study aimed to investigate the prevalence of CTS symptoms and related risk factors among schoolteachers in Al-Ahsa. SETTINGS AND DESIGN A cross-sectional study was conducted on schoolteachers in Al-Ahsa, Saudi Arabia, during 2023. SUBJECTS AND METHODS We distributed the Boston Carpal Tunnel Questionnaire to the teachers' groups through social media in the form of an online questionnaire, and we visited schools to encourage participation. STATISTICAL ANALYSIS USED Data were analyzed using the Statistical Package for the Social Sciences. P < 0.05 was considered statistically significant. RESULTS Our study included 619 schoolteachers. The syndrome symptoms were present in 71.1% of individuals, and functional disruption was present in 52.7%. The likelihood of exhibiting the symptoms is increased by being female, not participating in sports, having a chronic illness, writing for more than 4 h, and having symptoms in both hands. CONCLUSIONS We found a comparatively high percentage (71.1%) of the syndrome symptoms among schoolteachers working in Al-Ahsa, Saudi Arabia, which suggests that any signs of CTS in schoolteachers should be evaluated to ensure proper diagnosis and treatment.
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Affiliation(s)
| | | | | | - Haya Fayez Wutayd
- Medical Student, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Razan Ali Alshehri
- Medical Student, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | | | - Nora Isa Almuslim
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Bicha N, Gashaw M, Chanie ST, Mekie M, Yalew ES. Burden of carpal tunnel syndrome and its associated factors among construction industry workers in Gondar town, Ethiopia. Front Public Health 2024; 12:1365124. [PMID: 38957208 PMCID: PMC11218597 DOI: 10.3389/fpubh.2024.1365124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/21/2024] [Indexed: 07/04/2024] Open
Abstract
Background Carpal tunnel syndrome is characterized by symptoms such as pain, numbness, or tingling on the anterior surface of the index, middle, or radial half of the ring finger, which is frequently associated with weakness of hand grip, and nocturnal pain and/or numbness resulting from compression of the median nerve at the carpal tunnel between the carpal bones and the transverse ligament. The construction industry involves many activities aside from the building process, such as landscaping, painting, electrical supply, plastering, paving, and telecommunications. Performing such tasks involves repetition of wrist flexion and extension, forceful grip with the hand, and/or vibrations of the hand and arm. This study aimed to assess the prevalence of carpal tunnel syndrome and its associated risk factors among construction workers. Method An institutional-based cross-sectional study design was conducted among six construction sectors in Gondar from April to July 2021. An interviewer-administered questionnaire was prepared from the literature with a Katz hand diagram, and a physical examination and a special test (carpal compression test, Phalen's, and Tinel's test) were carried out for those participants who reported pain during the interview. Binary logistic regression was conducted with SPSS 25 to identify the associated risk factors for carpal tunnel syndrome. The strength of the association was detected by the adjusted odds ratio. Result A total of 333 study participants aged 18-70 years were included in this study. Among the participants, 11.7% (AOR: 95%CI: 8.1-15.3) had carpal tunnel syndrome. Age, cigarette smoking, work experience, and working with finger-pressing tools were risk factors significantly associated with carpal tunnel syndrome among construction workers with a p-value of <0.05. Conclusion The magnitude of carpal tunnel syndrome was 11.7% among construction workers. Being of older age, having more experience, cigarette smoking, and working with finger-pressing tools were risk factors significantly associated with carpal tunnel syndrome among construction workers. Employers should implement work safety education programs that raise awareness about the risks of cigarette smoking and encourage employers and supervisors to seek early medical intervention and treatment for carpal tunnel syndrome before it becomes a chronic problem.
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Affiliation(s)
- Nigus Bicha
- Physiotherapy Unit, Boru Meda Hospital, Amhara Health Bureau, Dessie, Ethiopia
| | - Moges Gashaw
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Samuel Teferi Chanie
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melisew Mekie
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ermias Solomon Yalew
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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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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Harinesan N, Silsby M, Simon NG. Carpal tunnel syndrome. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:61-88. [PMID: 38697747 DOI: 10.1016/b978-0-323-90108-6.00005-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Median neuropathy at the wrist, commonly referred to as carpal tunnel syndrome (CTS), is the most common entrapment neuropathy. It is caused by chronic compression of the median nerve at the wrist within the space-limited carpal tunnel. Risk factors that contribute to the etiology of compression include female gender, obesity, work-related factors, and underlying medical conditions, such as hypothyroidism, pregnancy, and amyloidosis. The diagnosis is made on clinical grounds, although these can be confounded by anatomical variations. Electrodiagnostic studies, which are specific and sensitive in diagnosing CTS, support the diagnosis; however, a subgroup may present with normal results. The advent of imaging techniques, including ultrasound and MRI, further assists the diagnostic process. The management of CTS is divided into the nonsurgical approaches that include hand therapy, splinting and corticosteroid injection, and surgical decompression of the carpal tunnel. Although several surgical techniques have been developed, no one method is more effective than the other. Each of these management approaches are effective at providing symptom relief and are utilized at different severities of the condition. There is, however, a lack of consensus on standardized diagnostic criteria, as well as when and to whom to refer patients for surgery.
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Affiliation(s)
- Nimalan Harinesan
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Matthew Silsby
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Neil G Simon
- Northern Beaches Clinical School, Macquarie University, Sydney, NSW, Australia.
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Stjernbrandt A, Johnsen M, Liljelind I, Aminoff A, Wahlström J, Höper AC, Pettersson H, Nilsson T. Neurosensory and vascular symptoms and clinical findings in the hands of Arctic open-pit miners in Sweden and Norway - a descriptive study. Int J Circumpolar Health 2023; 82:2254916. [PMID: 37669310 PMCID: PMC10481761 DOI: 10.1080/22423982.2023.2254916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/25/2023] [Accepted: 08/30/2023] [Indexed: 09/07/2023] Open
Abstract
This cross-sectional study aimed to describe exposure to cold climate and hand-arm vibration (HAV) as well as neurosensory and vascular symptoms and clinical findings among open-pit Arctic miners. It was based on data from questionnaires and physical examinations, including 177 men and 75 women from two open-pit mines in Sweden and Norway (response rate 54%). Working outdoors or in an unheated building or machine for at least two hours per day was reported by 44% and HAV exposure of the same duration by 10%. Neurosensory symptoms (e.g. reduced perception of touch) in the hands were reported by 47% and Raynaud's phenomenon by 14%. In brief conclusion, the study showed that Arctic miners were commonly exposed to both cold temperatures and HAV. They also reported a broad range of neurosensory and vascular symptoms in their hands and had abnormal clinical findings related to the symptoms. The results emphasise the need for additional preventive measures in this occupational setting.
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Affiliation(s)
- Albin Stjernbrandt
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Magnar Johnsen
- Department of Occupational and Environmental Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Ingrid Liljelind
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Anna Aminoff
- Department of Occupational and Environmental Medicine, University Hospital of North Norway, Tromsø, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Jens Wahlström
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Anje Christina Höper
- Department of Occupational and Environmental Medicine, University Hospital of North Norway, Tromsø, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Hans Pettersson
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Tohr Nilsson
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Panggabean AS, Setyopranoto I, Wicaksono AR, Rismawan A, Dwianingsih EK, Tama WN, Gofir A, Setyaningrum CTS, Sutarni S, Asmedi A, Rhamadianti AF, Bawono RG, Malueka RG. Neuropathy caused by pesticide exposure on farmers in Ngablak District, Magelang, Central Java, Indonesia: An electroneuromyography study. Toxicol Rep 2023; 11:330-338. [PMID: 37840896 PMCID: PMC10570540 DOI: 10.1016/j.toxrep.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/17/2023] Open
Abstract
Uncontrolled and unsafe use of pesticides can lead to acute and chronic toxicity in farmers, with neuropathy being one of the most common symptoms of chronic toxicity. However, the effects of this toxicity on farmers' electroneuromyography (ENMG) are still unclear. To address this, we conducted a cross-sectional study from July to October 2017 in Ngablak District, Magelang, Central Java, Indonesia. Eligible farmers who were exposed to pesticides underwent electrophysiology examinations, as well as additional tests such as physical examination and laboratory testing. We collected general information such as age and work history by interview. In total, 64 farmers were included in this study. Out of these, 44 farmers were found to have polyneuropathy, with 41 of them having motor polyneuropathy and 19 of them having sensory polyneuropathy. Our findings showed that low blood cholinesterase was associated with distal latency prolongation (p-value: 0.014). The group exposed to organophosphate/carbamate pesticides was also significantly associated with prolonged distal latency (p-value: 0.012). However, motor polyneuropathy was significantly associated with chronic exposure to organophosphate/carbamate pesticides (p-value: 0.009) and not with low blood cholinesterase levels (p-value: 0.454). The study concludes that chronic exposure to organophosphate or carbamate pesticides could result in polyneuropathy disease, particularly in the motor system.
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Affiliation(s)
- Andre Stefanus Panggabean
- Neurology Department, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Ismail Setyopranoto
- Neurology Department, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Arjanto Ramadian Wicaksono
- Neurology Department, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Alfian Rismawan
- Neurology Department, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Ery Kus Dwianingsih
- Department of Anatomical Pathology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Whisnu Nalendra Tama
- Neurology Department, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Abdul Gofir
- Neurology Department, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Cempaka Thursina Srie Setyaningrum
- Neurology Department, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Sri Sutarni
- Neurology Department, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Ahmad Asmedi
- Neurology Department, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Aulia Fitri Rhamadianti
- Department of Anatomical Pathology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Rheza Gandi Bawono
- Department of Anatomical Pathology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Rusdy Ghazali Malueka
- Neurology Department, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
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Demissie B, Yenew C, Alemu A, Bantie B, Sume BW, Deml YA, Tegegne E. Carpal tunnel syndrome and its associated factors among computer user bankers in South Gondar Zone, Northwest Ethiopia, 2021: a cross sectional study. BMC Musculoskelet Disord 2023; 24:828. [PMID: 37858114 PMCID: PMC10585807 DOI: 10.1186/s12891-023-06918-5] [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: 04/02/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION The use of information devices like computers is skyrocketed in recent years, leading injuries. Carpal Tunnel Syndrome is a leading cause of upper extremity MSDs specially to banking workers. Hence, this paper was intended to highlight its magnitude associated factors in the study area. METHODS AND MATERIALS Institutional based cross-sectional study was conducted from September 13, 2021 to October 09, 2021. A total of 422 private and government owned computer user bankers were participated. Simple random sampling technique was used to select the study participants. Data were collected using Durkan's compression test, flexion and compression test, Phalen's test, and Tinel's test. Multivariable logistic regression model was used to investigate the relationship between predictors and Carpal Tunnel Syndrome. P-value less than 0.05 was considered to declare as a significant and Adjusted Odds Ration for strength association between risk factors and Carpal Tunnel Syndrome. RESULT Among 422 participants, the annual prevalence of CTS was 11.7%. Being smoker [AOR: 4.2; 95% CI: 1.76-10.26], having > 5-year work experience [AOR: 7.98; 95% CI: 3.7-17.33], movement repetition [AOR: 3.9; 95% CI: 1.66-9.4] and lack of ergonomics training [AOR: 5.2; 95% CI: 2.8-9.5] were independently associated risk factors to Carpal Tunnel Syndrome. CONCLUSION Carpal Tunnel Syndrome was high (11.7%) among bankers in this study area. Carpal Tunnel Syndrome was predicted by smoking, length of employment, movement repetition, and not received ergonomics training. Therefore, fore the banking industry, it would be better to maintain strict follow-up and provision of ergonomics training.
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Affiliation(s)
- Biruk Demissie
- Department of Environmental Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Chalachew Yenew
- Department of Environmental Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Alelign Alemu
- Department of Environmental Health and Hygiene, Bonn University Hospital, Bonn, Germany
| | - Berihun Bantie
- Department of Comprehensive Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Bickes Wube Sume
- Department of Biomedical Sciences, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Yikeber Argachew Deml
- Department of Biomedical Sciences, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Eniyew Tegegne
- Department of Environmental Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
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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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12
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Dahlgren G, Liv P, Öhberg F, Slunga Järvholm L, Forsman M, Rehn B. Correlations between Ratings and Technical Measurements in Hand-Intensive Work. Bioengineering (Basel) 2023; 10:867. [PMID: 37508893 PMCID: PMC10376394 DOI: 10.3390/bioengineering10070867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/11/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
An accurate rating of hand activity and force is essential in risk assessment and for the effective prevention of work-related musculoskeletal disorders. However, it is unclear whether the subjective ratings of workers and observers correlate to corresponding objective technical measures of exposure. Fifty-nine workers were video recorded while performing a hand-intensive work task at their workplace. Self-ratings of hand activity level (HAL) and force (Borg CR10) using the Hand Activity Threshold Limit Value® were assessed. Four ergonomist observers, in two pairs, also rated the hand activity and force level for each worker from video recordings. Wrist angular velocity was measured using inertial movement units. Muscle activity in the forearm muscles flexor carpi radialis (FCR) and extensor carpi radialis (ECR) was measured with electromyography root mean square values (RMS) and normalized to maximal voluntary electrical activation (MVE). Kendall's tau-b correlations were statistically significant between self-rated hand activity and wrist angular velocity at the 10th, 50th, and 90th percentiles (0.26, 0.31, and 0.23) and for the ratings of observers (0.32, 0.41, and 0.34). Significant correlations for force measures were found only for observer-ratings in five of eight measures (FCR 50th percentile 0.29, time > 10%MVE 0.43, time > 30%MVE 0.44, time < 5% -0.47) and ECR (time > 30%MVE 0.26). The higher magnitude of correlation for observer-ratings suggests that they may be preferred to the self-ratings of workers. When possible, objective technical measures of wrist angular velocity and muscle activity should be preferred to subjective ratings when assessing risks of work-related musculoskeletal disorders.
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Affiliation(s)
- Gunilla Dahlgren
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, S-901 87 Umeå, Sweden
| | - Per Liv
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, S-901 87 Umeå, Sweden
| | - Fredrik Öhberg
- Radiation Physics, Department of Radiation Sciences, Umeå University, S-901 87 Umeå, Sweden
| | - Lisbeth Slunga Järvholm
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, S-901 87 Umeå, Sweden
| | - Mikael Forsman
- IMM Institute of Environmental Medicine, Karolinska Institutet, S-171 77 Stockholm, Sweden
- Division of Ergonomics, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Hälsovägen 11C, S-141 57 Huddinge, Sweden
| | - Börje Rehn
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, S-901 87 Umeå, Sweden
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13
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Omole AE, Awosika A, Khan A, Adabanya U, Anand N, Patel T, Edmondson CK, Fakoya AO, Millis RM. An Integrated Review of Carpal Tunnel Syndrome: New Insights to an Old Problem. Cureus 2023; 15:e40145. [PMID: 37304388 PMCID: PMC10250024 DOI: 10.7759/cureus.40145] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 06/13/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is a common entrapment neuropathy characterized by pain, numbness, and impaired function of the hand due to compression of the median nerve at the level of the wrist. Although CTS can develop from repetitive strain, injury, or medical conditions, there are also congenital and genetic risk factors that can predispose individuals to the condition. With respect to anatomical factors, some individuals are born with a smaller carpal tunnel, which increases their susceptibility to median nerve compression. Variations in specific genes, such as those encoding proteins involved in extracellular matrix remodeling, inflammation, and nerve function, have also been linked to an increased risk for CTS. CTS is associated with a high cost of health care maintenance and loss of work productivity. Therefore, it is vital that primary care physicians fully understand the anatomy, epidemiology, pathophysiology, etiology, and risk factors of CTS, so they can be proactive in prevention, diagnosing, and guiding proper treatment. This integrated review also provides insights into how biological, genetic, environmental, and occupational factors interact with structural elements to determine who is most likely to acquire and suffer from CTS. Keeping health practitioners abreast of all the factors that could impact CTS should go a long way in decreasing the health care and socioeconomic burden of CTS.
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Affiliation(s)
- Adekunle E Omole
- Anatomical Sciences, American University of Antigua, Saint John, ATG
| | - Ayoola Awosika
- College of Medicine, University of Illinois, Chicago, USA
| | - Anosh Khan
- Emergency Medicine, Spartan Health Sciences University, Vieux Fort, LCA
| | | | - Nikhilesh Anand
- Pharmacology, American University of Antigua, Saint John, ATG
| | - Tirath Patel
- Surgery, American University of Antigua, Saint John, ATG
| | | | - Adegbenro O Fakoya
- Cellular Biology and Anatomy, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Richard M Millis
- Pathophysiology, American University of Antigua, Saint John, ATG
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14
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Ahmad S, House R, Holness DL, Nisenbaum R, Thompson AMS. Evaluation of neurological testing for hand-arm vibration syndrome. Occup Med (Lond) 2023; 73:36-41. [PMID: 36516395 DOI: 10.1093/occmed/kqac137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The neurological component of hand-arm vibration syndrome (HAVS) uses the Stockholm Workshop Scale sensorineural (SWS SN) stages for classification. Proximal compressive neuropathies are common in HAVS and the symptoms are similar to SN HAVS. The SWS may not be a valid staging tool if a patient has comorbid proximal compression neuropathy. AIMS To evaluate the prevalence of proximal compression neuropathy in patients presenting for HAVS assessment and examine the association between compressive neuropathies and SWS SN. METHODS A standardized assessment protocol was used to assess 431 patients for HAVS at St. Michael's Hospital, Toronto, Ontario. The prevalence of median and ulnar compressive neuropathies was determined. The association between proximal compression neuropathies and SWS SN stage (0/1 versus 2/3) was evaluated using Chi-square and Fisher's exact tests as well as multivariable logistic regression. RESULTS Most patients (79%) reported numbness and 20% had reduced sensory perception (SWS SN Stage 2/3). Almost half (45%) had median neuropathy at the wrist and 7% had ulnar neuropathy. There was no association between the SWS SN stage and median or ulnar neuropathy. CONCLUSIONS Two neurological lesions should be investigated in patients presenting for HAVS assessment: compressive neuropathy and digital neuropathy. The prevalence of compressive neuropathies is high in patients being assessed for HAVS and therefore nerve conduction studies (NCS) should be included in HAVS assessment protocols. Comorbid proximal neuropathy does not affect the SWS SN stage; therefore, NCS and SWS SN seem to be measuring different neurological outcomes in HAVS patients.
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Affiliation(s)
- S Ahmad
- Royal College of Surgeons in Ireland - Medical University of Bahrain, Manama 15503, Bahrain
| | - R House
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Division of Occupational and Environmental Medicine, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - D L Holness
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Division of Occupational and Environmental Medicine, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON M5B 1T8, Canada
| | - R Nisenbaum
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON M5B 1T8, Canada
| | - A M S Thompson
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Division of Occupational and Environmental Medicine, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
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15
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Schulze DG, Nilsen KB, Clemm T, Grotle M, Zwart JA, Ulvestad B, Nordby KC. Influence of ergonomic factors on peripheral neuropathy under HAV exposure. Occup Med (Lond) 2023; 73:13-18. [PMID: 36480225 DOI: 10.1093/occmed/kqac118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hand-arm vibration (HAV) is a risk factor for carpal tunnel syndrome (CTS) and ulnar neuropathy at the elbow (UNE). It is unclear how ergonomic factors influence the relationship between HAV exposure and CTS and UNE. AIMS We aimed to assess the relationship between cumulative HAV exposure and CTS and UNE in workers exposed to HAV from two tools with different ergonomic profiles. METHODS We performed nerve conduction studies (NCSs) of the sensory and motor median and ulnar nerves and recorded symptoms indicating CTS and UNE in workers exposed to HAV from impact wrenches or from rock drills. Exposure was measured as cumulative lifetime exposure. We used linear regression adjusted for age and body mass index to assess linear relationships. RESULTS Sixty-five workers participated (33 rock drill and 32 impact wrench operators). We found inverse linear associations between cumulative HAV exposure and median nerve sensory conduction velocity in impact wrench operators and ulnar nerve motor conduction velocity in rock drill operators (beta of 0.63 and 0.75). Based on NCS findings and symptoms, seven impact wrench operators had CTS and one UNE, and four rock drill operators had CTS and six UNE. CONCLUSIONS Our findings indicate that ergonomic factors influence the development of CTS and UNE under HAV exposure. The ergonomic profile seems to influence which type of neuropathy workers exposed to HAV will develop. Design of occupational exposure guidelines and future studies should be based on ergonomic profile and exposure characteristics for different tools and not merely HAV.
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Affiliation(s)
- D G Schulze
- Department of Neurology, Oslo University Hospital and University of Oslo, 0424 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, 0424 Oslo, Norway
| | - K B Nilsen
- Department of Neurology, Oslo University Hospital and University of Oslo, 0424 Oslo, Norway
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, 0424 Oslo, Norway
| | - T Clemm
- National Institute of Occupational Health, 0304 Oslo, Norway
| | - M Grotle
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, 0424 Oslo, Norway
- Oslo Metropolitan University, 0130 Oslo, Norway
| | - J A Zwart
- Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, 0424 Oslo, Norway
| | - B Ulvestad
- National Institute of Occupational Health, 0304 Oslo, Norway
| | - K C Nordby
- National Institute of Occupational Health, 0304 Oslo, Norway
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Cousins DJE, Schaefer BH, Holmes MWR, Beaudette SM. The effects of COVID-19 related shutdowns on perceived lifestyle and prevalence of musculoskeletal discomfort. Work 2023; 76:11-20. [PMID: 36872831 DOI: 10.3233/wor-220388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND COVID-19 caused a transition to work-from-home conditions, closures of recreation facilities and cancelation of social events. OBJECTIVE This study sought to characterize and quantify the impact COVID-19 related shutdowns had on perceptions of health and wellbeing, musculoskeletal discomfort, and physical characteristics of workstation set-up in full time workers who transitioned to working from home. METHODS 297 participants from 8 countries completed a retrospective pre/post survey design that assessed outcomes prior to COVID-19 shutdowns and when each participant was experiencing peak pandemic-related restrictions. There were 3 categories including, health and wellbeing, musculoskeletal discomfort, and workplace ergonomics. RESULTS General discomfort on a scale from 1 to 100 increased from 31.4 pre to 39.9 during COVID-19. Notable areas increasing in severity of discomfort from pre to during included the neck (41.8 to 47.7), upper back (36.3 to 41.3) and right wrist (38.7 to 43.5). The percentage of the population experiencing discomfort increased from pre to during in the low back (41.5% to 55.2%), upper back (28.7% to 40.9%), neck (45.5% to 60.9%) and right wrist (16.1% to 23.7%). CONCLUSION There were three distinct groups for physical activity one group including, one maintaining and one that decreased, which did not have an impact on perceived general discomfort. There was a significant decrease in usage of a desk and adjustable chair and an increase in laptop use. Working from home in some capacity will likely be a more common occurrence which will require further ergonomic assessments and considerations to keep a healthy workforce.
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Affiliation(s)
- Daniel J E Cousins
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Bailey H Schaefer
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Michael W R Holmes
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Shawn M Beaudette
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
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Hassan A, Beumer A, Kuijer PPFM, van der Molen HF. Work-relatedness of carpal tunnel syndrome: Systematic review including meta-analysis and GRADE. Health Sci Rep 2022; 5:e888. [PMID: 36340637 PMCID: PMC9629628 DOI: 10.1002/hsr2.888] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 11/11/2022] Open
Abstract
Background and Aims Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome with a high prevalence among workers. Insights on the physical work-related risk factors is necessary to develop appropriate preventative methods. The objective of this systematic review, including meta-analyses, is to assess which physical work-related risk factors are associated with carpal tunnel syndrome. Methods Systematic literature searches were carried out using PubMed and Embase until September 6, 2021. Studies were included if: (1) CTS was clinically assessed, (2) the studies were prospective cohort studies, and (3) the exposure was reported using terms of exposed/less or nonexposed. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Results In total, 9270 patients with CTS from a population of 1,051,707 workers were included from 17 studies. Meta-analyses revealed high-quality evidence for associations between CTS and high exposures to repetition (hazard ratio [HR] 1.87, 95% CI 1.42-2.46), force intensity (HR 1.84, 95%CI 1.22-2.79), exposures above hand activity level of ACGIH (HR 1.75, 95%CI 1.40-2.17), and the Strain Index >10 (HR 1.58, 95% CI 1.09-2.30). No significant associations were found for pinch gripping, hand-arm vibration or force duration. High computer-use exposure was significantly associated with a decreased rate of work-related CTS (HR 0.28, 95% CI 0.12-0.64). Conclusion This systematic review of prospective cohort studies found high certainty for an increased rate of CTS due to a high Strain Index, exposures exceeding the Activity Level of ACGIH, and high force intensity and high repetition. Workers performing tasks requiring both high force and high repetition even have a higher rate of developing CTS.
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Affiliation(s)
| | - Annechien Beumer
- Department of Public and Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, Amsterdam Movement Sciences, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands,Department of Orthopaedic SurgeryAmphia HospitalBredaThe Netherlands
| | - P. Paul F. M. Kuijer
- Department of Public and Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, Amsterdam Movement Sciences, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Henk F. van der Molen
- Department of Public and Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, Amsterdam Movement Sciences, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
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18
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Li T, Yan J, Hu J, Liu X, Wang F. Efficacy and safety of electroacupuncture for carpal tunnel syndrome (CTS): A systematic review and meta-analysis of randomized controlled trials. Front Surg 2022; 9:952361. [PMID: 36211261 PMCID: PMC9539120 DOI: 10.3389/fsurg.2022.952361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
AimWe carried out a systematic review and meta-analysis to evaluate the safety and efficacy of electroacupuncture for patients with carpal tunnel syndrome.MethodsWe searched PubMed, Embase, Cochrane Library, Scopus, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Chongqing VIP Database (VIP), and Wan Fang Database up to May 2022 for relevant studies. Relevant studies were identified by using specific eligibility criteria and data were extracted.ResultsA total of 26 randomized controlled trials (RCTs) with 1,698 patients were included. Compared with routine treatment, electroacupuncture treatment had lower visual analog scale (VAS) score [mean difference = −0.79, 95% confidence interval (CI): −1.11 to −0.47, P < 0.00001], and the symptom severity scale and function status scale in electroacupuncture group were significantly lower than the control group (P = 0.0001 and P = 0.006). Moreover, the electrophysiological parameters in the electroacupuncture group were better than the control group. The electroacupuncture group had higher total effective rate than the control group (odds ratio = 4.94, 95% CI: 3.44–7.08, P < 0.00001).ConclusionOur meta-analysis indicated that electroacupuncture had lower VAS score, higher total effective rate, a lower the scores of symptoms and function and electroacupuncture had better electrophysiological parameters. However, these findings needed to be verified further by multicenter, double-blind, and large-sample RCTs.
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Affiliation(s)
- Ting Li
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, China
- Department of Postgraduate, Chengdu Medical College, Chengdu, China
| | - Jingxin Yan
- Department of Interventional Therapy, Affiliated Hospital of Qinghai University, Xining, China
- Department of Postgraduate, Qinghai University, Xining, China
| | - Jiang Hu
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, China
| | - Xilin Liu
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, China
- Correspondence: Fei Wang Xilin Liu
| | - Fei Wang
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, China
- Correspondence: Fei Wang Xilin Liu
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Stjernbrandt A, Vihlborg P, Wahlström V, Wahlström J, Lewis C. Occupational cold exposure and symptoms of carpal tunnel syndrome - a population-based study. BMC Musculoskelet Disord 2022; 23:596. [PMID: 35725430 PMCID: PMC9210706 DOI: 10.1186/s12891-022-05555-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cold exposure is an underrecognized occupational hazard that may increase the risk of peripheral nerve entrapment. The aim of this study was to determine if self-reported occupational exposure to contact and ambient cooling was associated with symptoms of carpal tunnel syndrome (CTS). METHODS In this mainly cross-sectional study, surveys were conducted on a population-based sample of men and women between 18 and 70 years of age, living in northern Sweden. Cold exposure and presence of symptoms suggestive of CTS were subjectively reported. Associations between exposure and outcome were evaluated using logistic regression. RESULTS The study included 2,703 women and 2,314 men, with a median age of 60 years (interquartile range 19). Symptoms of CTS were reported by 453 (9.2%). Being highly occupationally exposed (almost always) to contact cooling of the hands was associated with reporting CTS (OR 3.20; 95% CI 1.62-6.33), as was ambient cooling (OR 2.00; 95% CI 1.03-3.88) and severe ambient cooling (OR 4.02 95% CI 2.09-7.71), after adjusting for age, gender, body mass index, current daily smoking, diabetes mellitus, joint disease, and hand-arm vibration exposure. The point estimates increased with longer daily exposure duration. For workers exposed to severe ambient cooling for more than half of their working hours, in addition to performing heavy manual handling every day, the OR for reporting CTS was 7.25 (95% CI 3.88-13.53), with a positive additive interaction effect (expressed as relative excess risk due to interaction) of 4.67. CONCLUSIONS Self-reported occupational exposure to contact and ambient cooling was associated with symptoms suggestive of CTS. There were statistically significant positive exposure-response patterns for time spent exposed to contact and ambient cooling at work in relation to reporting symptoms of CTS. Positive additive interaction effects between cold exposure and heavy manual handling were also found. Since there was important potential uncontrolled confounding regarding repetitive wrist movements and forceful gripping, the results need to be confirmed by other studies, preferably with longitudinal design and more detailed exposure assessment.
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Affiliation(s)
- Albin Stjernbrandt
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, 901 87, Umeå, Sweden.
| | - Per Vihlborg
- Department of Geriatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Viktoria Wahlström
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, 901 87, Umeå, Sweden
| | - Jens Wahlström
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, 901 87, Umeå, Sweden
| | - Charlotte Lewis
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, 901 87, Umeå, Sweden
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Linde F, Rydberg M, Zimmerman M. Surgically Treated Carpal Tunnel Syndrome and Ulnar Nerve Entrapment at the Elbow in Different Occupations and their Effect on Surgical Outcome. J Occup Environ Med 2022; 64:e369-e373. [PMID: 35543630 PMCID: PMC9275840 DOI: 10.1097/jom.0000000000002539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
OBJECTIVE We investigated whether certain occupations were over-represented among surgically treated carpal tunnel syndrome and ulnar entrapment at the elbow, and if manual occupation affected surgical outcome. METHODS We included 9030 patients operated for CTS and 1269 for UNE registered in the Swedish National Quality Register for Hand Surgery (HAKIR) 2010-2016. Occupational data was retrieved from Statistics Sweden. Outcome was assessed using the QuickDASH questionnaire. RESULTS In patients operated for CTS, there were more assistant nurses, attendants/care providers/personal assistants, nannies/student assistants, carpenters/bricklayers/construction workers, cleaners, nurses, and vehicle mechanics than in the general population. In the UNE population, assistant nurses and attendants/care providers/personal assistants were over-represented. Manual workers with CTS scored the preoperative QuickDASH higher than non-manual workers. CONCLUSIONS Manual workers are overrepresented among surgically treated CTS and UNE. Manual workers with CTS have more symptoms preoperatively than non-manual workers.
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Anderson DA, Agur AM, Oliver ML, Gordon KD. Effects of slight flexion-extension and radial-ulnar deviation postures on carpal tunnel volume. Clin Biomech (Bristol, Avon) 2022; 92:105575. [PMID: 35051839 DOI: 10.1016/j.clinbiomech.2022.105575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 01/05/2022] [Accepted: 01/09/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Non-neutral wrist postures are a commonly reported risk factor for carpal tunnel syndrome. It is unclear how slight flexion-extension and radial-ulnar deviation postures affect the carpal tunnel. The objective was to determine the effects of slight non-neutral postures by quantifying carpal tunnel volume. METHODS Computed tomography images were collected on ten cadaveric specimens in target postures of -20°, -10°, -5°, 0°, 5°, 10°, and 20° of flexion and - 10°, -5°, 0°, 5°, and 10° of radial-ulnar deviation. Surface meshes of the carpal tunnel, carpal bones, radius, and third metacarpal were generated with manual segmentation. Carpal tunnel volume was calculated as the volume between proximal and distal boundaries defined with anatomical landmarks and the orientation of the tunnel. The precise wrist posture of each scan was determined with inertial-based coordinate systems of the radius and third metacarpal. FINDINGS Through multiple linear regression it was determined that, over the observed range of postures, flexion-extension angle does not have a significant effect (p = 0.99) while radial-ulnar deviation angle has a significant effect of -5.9 mm3/degree (p = 0.003). The findings were consistent with previous studies of postural effects on carpal tunnel pressure. INTERPRETATION For the treatment and prevention of carpal tunnel syndrome, results suggest that attention should be given to slight radial-ulnar deviation postures (<10°), while slight flexion-extension postures (<20°) are of lesser consequence to carpal tunnel volume.
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Affiliation(s)
| | - Anne M Agur
- Division of Anatomy, Department of Surgery, University of Toronto, Canada
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Jiménez-del-Barrio S, Cadellans-Arróniz A, Ceballos-Laita L, Estébanez-de-Miguel E, López-de-Celis C, Bueno-Gracia E, Pérez-Bellmunt A. The effectiveness of manual therapy on pain, physical function, and nerve conduction studies in carpal tunnel syndrome patients: a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2022; 46:301-312. [PMID: 34862562 PMCID: PMC8782801 DOI: 10.1007/s00264-021-05272-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/19/2021] [Indexed: 11/03/2022]
Abstract
AIM OF THE STUDY Systematic review and meta-analysis to assess the effectiveness of manual therapy in improving carpal tunnel syndrome (CTS) symptoms, physical function, and nerve conduction studies. METHOD MEDLINE, Web of Science, SCOPUS, Cochrane Library, TRIP database, and PEDro databases were searched from the inception to September 2021. PICO search strategy was used to identify randomized controlled trials applying manual therapy on patients with CTS. Eligible studies and data extraction were conducted independently by two reviewers. Methodology quality and risk of bias were assessed by PEDro scale. Outcomes assessed were pain intensity, physical function, and nerve conduction studies. RESULTS Eighty-one potential studies were identified and six studies involving 401 patients were finally included. Pain intensity immediately after treatment showed a pooled standard mean difference (SMD) of - 2.13 with 95% confidence interval (CI) (- 2.39, - 1.86). Physical function with Boston Carpal Tunnel Syndrome Questionnaire (BCTS-Q) showed a pooled SMD of - 1.67 with 95% CI (- 1.92, - 1.43) on symptoms severity, and a SMD of - 0.89 with 95% CI (- 1.08, - 0.70) on functional status. Nerve conduction studies showed a SMD of - 0.19 with 95% CI (- 0.40, - 0.02) on motor conduction and a SMD of - 1.15 with 95% CI (- 1.36, - 0.93) on sensory conduction. CONCLUSIONS This study highlights the effectiveness of manual therapy techniques based on soft tissue and neurodynamic mobilizations, in isolation, on pain, physical function, and nerve conduction studies in patients with CTS.
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Affiliation(s)
- Sandra Jiménez-del-Barrio
- Clinical Research in Health Sciences Group. Department of Surgery, Ophthalmology, Otorhinolaryngology, and Physiotherapy, Faculty of Health Sciences, University of Valladolid, Calle Universidad S/N, 42002 Soria, Spain
| | - Aida Cadellans-Arróniz
- Physiotherapy Department, Faculty of Medicine and Health Sciences, International University of Catalunya, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Barcelona Spain
| | - Luis Ceballos-Laita
- Clinical Research in Health Sciences Group. Department of Surgery, Ophthalmology, Otorhinolaryngology, and Physiotherapy, Faculty of Health Sciences, University of Valladolid, Calle Universidad S/N, 42002 Soria, Spain
| | - Elena Estébanez-de-Miguel
- Department of Physiatrist and Nursery, Faculty of Health Sciences, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain
| | - Carles López-de-Celis
- Physiotherapy Department, Faculty of Medicine and Health Sciences, International University of Catalunya, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Barcelona Spain
- Jordi Gol I Gurina University Institute for Research in Primary Health Care Foundation, Barcelona, Spain
| | - Elena Bueno-Gracia
- Physiotherapy Department, Faculty of Medicine and Health Sciences, International University of Catalunya, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Barcelona Spain
- Department of Physiatrist and Nursery, Faculty of Health Sciences, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain
| | - Albert Pérez-Bellmunt
- Physiotherapy Department, Faculty of Medicine and Health Sciences, International University of Catalunya, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Barcelona Spain
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Tang HC, Cheng YY, Guo HR. Association between hormone replacement therapy and carpal tunnel syndrome: a nationwide population-based study. BMJ Open 2022; 12:e055139. [PMID: 34983770 PMCID: PMC8728457 DOI: 10.1136/bmjopen-2021-055139] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Carpal tunnel syndrome (CTS) is the most common compressive focal mononeuropathy, and the increased incidence in postmenopausal and pregnant women suggests its association with oestrogen. The objective of this study is to evaluate the relationship between hormone replacement therapy (HRT) and the occurrence of CTS. DESIGN Population-based case-control study. SETTING Nationwide health insurance programme operated by the government with a near 100% coverage rate. PARTICIPANTS We identified women ≥45 years old in the Health Insurance Research Database of Taiwan, which contains data on a representative sample of one million enrollees. After exclusion of those who were diagnosed with CTS before the prescription of HRT, a total of 118 309 participants were included and followed up for 15 years starting from 1 January 1996. Both HRT and occurrence of CTS were identified using the insurance claims. MAIN OUTCOME MEASURES We identified incident patients of CTS and evaluated the association between HRT and CTS by calculating the OR. RESULTS Of the 4535 participants who developed CTS during the study period, 2334 (51.5%) were HRT recipients. In participants without CTS, the proportion of HRT recipients was 28.1%, yielding an OR of 2.72 with a 95% CI of 2.56 to 2.88. After adjustment for age, diabetes, rheumatoid arthritis, hypothyroidism, gout and obesity, the OR of CTS associated with HRT was 2.04 (95% CI 1.91 to 2.17). While HRT, diabetes, rheumatoid arthritis and gout had similar effects on CTS across all age groups, hypothyroidism and obesity had different effects on different groups. CONCLUSION This study observed a positive association between HRT and CTS, independent of age, diabetes, rheumatoid arthritis, hypothyroidism, gout and obesity. While the ORs of CTS associated with HRT were similar across age groups, those associated with hypothyroidism and obesity were not, indicating effect modifications by age.
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Affiliation(s)
- Hsien-Chin Tang
- Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ya-Yun Cheng
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Occupational Safety, Health and Medicine Research Center, National Cheng Kung University, Tainan, Taiwan
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Al Shahrani E, Al Shahrani A, Al-Maflehi N. Personal factors associated with carpal tunnel syndrome (CTS): a case-control study. BMC Musculoskelet Disord 2021; 22:1050. [PMID: 34930200 PMCID: PMC8690538 DOI: 10.1186/s12891-021-04941-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 11/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is one of the most common nerve entrapments in the upper limb. In Saudi Arabia, few studies have investigated CTS in the general population. This study aimed to determine the association between personal factors and CTS. METHODS A case-control study involved adults aged 18 and above. Cases were recruited from electrophysiology lab records as consecutive case series, while controls were individuals who were free of CTS symptoms according to the Boston Carpal Tunnel Questionnaire (BCTQ). The electronic medical records of participants were reviewed to obtain age, height, weight, medical conditions, and mobile numbers. Cases and controls were contacted via phone to complete a questionnaire that was designed based on previous literature. We used multivariate binary logistic regression to identify the personal factors significantly associated with CTS. RESULTS A total of 95 cases and 190 controls were included. Most of the participants were female (84.2%) and Saudi (93%). Most of cases were above 45 years of age (73.7%), while 84.7% were 45 year - old or younger among the control group. Stratified logistic regression showed that performance of household chores was significantly associated with CTS. While physical exercise associated with decreased odds of CTS. CONCLUSIONS This study adds to the body of evidence on personal factors associated with CTS. However, the degree of differences in the age structure of the cases compared with the controls suggest that there is a considerable potential for residual confounding affecting the results. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Eman Al Shahrani
- Department of Family & Community Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abeer Al Shahrani
- Department of Clinical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.
| | - Nassr Al-Maflehi
- Department of Periodontics & Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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Association of clinically relevant carpal tunnel syndrome with type of work and level of education: a general-population study. Sci Rep 2021; 11:19850. [PMID: 34615920 PMCID: PMC8494938 DOI: 10.1038/s41598-021-99242-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 09/22/2021] [Indexed: 01/12/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is a common cause of work disability. The association with occupational load and education level has not been established in general-population studies. The purpose of this study was to investigate the association of clinically relevant CTS with work and education. From the Healthcare Register of Skane region (population 1.2 million) in southern Sweden we identified all individuals, aged 17–57 years, with first-time physician-made CTS diagnosis during 2004–2008. For each case we randomly sampled 4 referents, without a CTS diagnosis, from the general population matched by sex, age, and residence. We retrieved data about work and education from the national database. The study comprised 5456 individuals (73% women) with CTS and 21,667 referents. We found a significant association between physician-diagnosed CTS and type of work and level of education in both women and men. Compared with white-collar workers, the odds ratio (OR) for CTS among blue-collar workers was 1.67 (95% CI 1.54–1.81) and compared with light work, OR in light-moderate work was 1.37 (1.26–1.50), moderate work 1.70 (1.51–1.91), and heavy manual labor 1.96 (1.75–2.20). Compared with low-level education, OR for CTS in intermediate level was 0.82 (0.76–0.89) and high-level 0.48 (0.44–0.53). In women and men there is significant association with a dose–response pattern between clinically relevant CTS and increasing manual work load and lower education level. These findings could be important in design and implementation of preventive measures.
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Landsbergis P, Johanning E, Stillo M, Jain R, Davis M. Upper extremity musculoskeletal disorders and work exposures among railroad maintenance-of-way workers. Am J Ind Med 2021; 64:744-757. [PMID: 34128253 DOI: 10.1002/ajim.23259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/16/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Our objective was to examine occupational risk factors for musculoskeletal disorders of the shoulders, elbows, wrists, and hands among railroad maintenance-of-way (MOW) workers. Little systematic research on musculoskeletal disorders has been conducted in this occupational group. METHODS In total, 3995 active members of the Brotherhood of Maintenance of Way Employes Division (BMWED) completed a standardized survey focusing on disorders caused by hand-transmitted vibration. We computed adjusted prevalence ratios (aPRs) using Poisson regression for shoulder, elbow, carpal tunnel syndrome, and vibration white finger musculoskeletal symptoms by work exposures, adjusted for age, region, race/ethnicity, smoking, potential second job, and spare time vehicle vibration exposure, and other work exposures. RESULTS Among active male BMWED members, we found associations between >5.2 years (vs. 0.0-0.7 years) duration of full-time equivalent power tool use and shoulder pain (aPR = 2.01; 95% confidence interval [CI], 1.43-2.85), elbow pain (aPR = 2.88; 95% CI, 1.86-4.46), vibration white finger symptoms (aPR = 2.49; 95% CI, 1.06-5.85), hand/wrist pain (aPR = 2.40; 95% CI, 1.74-3.32), finger numbness or tingling (aPR = 1.86; 95% CI, 1.38-2.50) and self-reported carpal tunnel syndrome diagnosis (aPR = 2.16; 95% CI, 1.24-3.77). Associations were not consistent across outcomes for the duration of non-powered hand tool use and "repeated lifting, pushing, pulling, or bending." Positive gradients were observed for most outcomes. CONCLUSIONS Hand-arm vibration and some other biomechanical exposures were associated with shoulder, elbow, wrist, hand, and finger symptoms. Prevention programs should address occupational risk factors for upper extremity musculoskeletal disorders among MOW workers.
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Affiliation(s)
- Paul Landsbergis
- Downstate School of Public Health State University of New York (SUNY) Brooklyn New York USA
| | - Eckardt Johanning
- Department of Medicine, Center for Family and Community Medicine Columbia University New York New York USA
| | - Marco Stillo
- Downstate School of Public Health State University of New York (SUNY) Brooklyn New York USA
| | - Rahul Jain
- Downstate School of Public Health State University of New York (SUNY) Brooklyn New York USA
| | - Michelle Davis
- Downstate School of Public Health State University of New York (SUNY) Brooklyn New York USA
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Trillos-Chacón MC, Castillo-M JA, Tolosa-Guzman I, Sánchez Medina AF, Ballesteros SM. Strategies for the prevention of carpal tunnel syndrome in the workplace: A systematic review. APPLIED ERGONOMICS 2021; 93:103353. [PMID: 33453588 DOI: 10.1016/j.apergo.2020.103353] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/21/2020] [Accepted: 12/28/2020] [Indexed: 05/27/2023]
Abstract
Carpal Tunnel Syndrome (CTS) is one of the most frequently occurring musculoskeletal disorders of the upper limbs. Strategies for preventing CTS in the workplace include interventions such as ergonomics, education, exercise, physical therapy, and occupational health. The purpose of this study was to provide a general overview based on the review of scientific literature regarding strategies used for preventing CTS in working populations. From September to October 2018, the MEDLINE, PUBMED, EMBASE and SCOPUS (1990 to December 2017) databases were searched for evidence. The risk of bias assessment in the selected papers was evaluated using the criteria recommended by The Cochrane Handbook and the methodological quality of the included studies was evaluated using Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. A total of 11 studies were included in the present review. A total of 1,061 subjects participated in the studies. The quality of the included studies was limited in three studies, appropriate in three studies, good in three studies, and strong in two studies. The overall results suggest a mixed level of evidence of the effect of applying strategies for preventing CTS in the workplace. The bias assessment was primarily due to incomplete result data, selective reporting of results, and blinding. In this review, interventions focused on the modification or change of accessories (keyboard, mouse, wrist rest, and the overall workstation), education in ergonomics, exercise, and physical therapies, among others, were analyzed. The findings of this review show different possibilities when choosing an intervention strategy for the workplace. However, it was challenging to analyze each of the papers owing to the heterogeneity of the studies included.
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Affiliation(s)
- María-Constanza Trillos-Chacón
- Research Group in Health Cognition and Work (GiSCYT). School of Medicine and Health Sciences, Universidad Del Rosario, Bogotá, Cra 24#63c- 69, Colombia.
| | - Juan A Castillo-M
- Research Group in Health Cognition and Work (GiSCYT). School of Medicine and Health Sciences, Universidad Del Rosario, Bogotá, Cra 24#63c- 69, Colombia
| | - Ingrid Tolosa-Guzman
- Research Group in Health Cognition and Work (GiSCYT). School of Medicine and Health Sciences, Universidad Del Rosario, Bogotá, Cra 24#63c- 69, Colombia
| | - Andrés Felipe Sánchez Medina
- Research Group in Health Cognition and Work (GiSCYT). School of Medicine and Health Sciences, Universidad Del Rosario, Bogotá, Cra 24#63c- 69, Colombia
| | - Silvia Marcela Ballesteros
- Research Group in Health Cognition and Work (GiSCYT). School of Medicine and Health Sciences, Universidad Del Rosario, Bogotá, Cra 24#63c- 69, Colombia; Clinical Studies and Clinical Epidemiology Division, Fundación Santa Fe de Bogotá, Bogotá, Colombia
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Tekavec E, Löfqvist L, Larsson A, Fisk K, Riddar J, Nilsson T, Nordander C. Adverse health manifestations in the hands of vibration exposed carpenters - a cross sectional study. J Occup Med Toxicol 2021; 16:16. [PMID: 33926509 PMCID: PMC8082821 DOI: 10.1186/s12995-021-00305-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite EU regulatory standards, many workers suffer injury as a result of working with hand-held vibrating tools. Our aim of this study was to confirm whether carpenters, a highly exposed group, suffer more injuries to their hands than painters, a group assumed to be less exposed to vibration. METHODS 193 carpenters (participation rate 100%) and 72 painters (participation rate 67%), all men, answered a questionnaire and underwent a clinical examination to identify manifestations of neural and vascular origin in the hands. Neurosensory affection was defined as having at least one symptom in the fingers/hands (impaired perception of touch, warmth, or cold, impaired dexterity, increased sensation of cold, numbness or tingling, or pain in the fingers/hands when cold) and at least one clinical finding (impaired perception of touch, warmth, cold, vibration, or two-point discrimination). Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI). RESULTS Neurosensory affection was fulfilled for 31% of the carpenters and 17% of the painters, age-adjusted OR 3.3 (CI 1.6-7.0). Among carpenters with neurosensory affection 18% reported interference with daily life activities, the most common symptoms being increased sensation of cold, numbness and pain in the fingers/hands when cold, the most common clinical findings were impaired perception of touch and vibration. Neurosensory affection was found in 12% of young carpenters (≤ 30 years old). No difference was found in the prevalence of white fingers between carpenters and painters. CONCLUSIONS Carpenters showed more symptoms and clinical findings of neurosensory affection than painters, probably due to vibration exposure. Also young carpenters showed signs of neurosensory affection, which indicates that under current conditions workers at these companies are not protected against injury. This underlines the importance of reducing exposure to vibration and conducting regular medical check-ups to detect early signs of neural and vascular manifestations indicating hand-arm vibration injuries. Special attention should be given to symptoms of increased sensation of cold, pain in the fingers when cold, and numbness, as these were the most common initiating ones, and should be addressed as early as possible in the preventive sentinel process. It is also important to test clinically for small- and large-fibre neuropathy, as the individual may be unaware of any pathology.
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Affiliation(s)
- Eva Tekavec
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
| | - Lotta Löfqvist
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Anna Larsson
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Karin Fisk
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Jakob Riddar
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Tohr Nilsson
- Division of Sustainable Health and Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Catarina Nordander
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
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Personal, biomechanical, psychosocial, and organizational risk factors for carpal tunnel syndrome: a structural equation modeling approach. Pain 2021; 161:749-757. [PMID: 31815912 DOI: 10.1097/j.pain.0000000000001766] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This longitudinal study aimed at exploring the direct and indirect relationships between organizational, psychosocial, biomechanical, and personal factors and carpal tunnel syndrome (CTS) in French workers. Between 2002 and 2005, 3710 workers were included in the Cosali cohort. Between 2007 and 2010, 1611 workers were re-examined using the same standardized clinical protocol. Subjects free from CTS at baseline were studied (804 men and 563 women). We used structural equation models to examine the relationships between incident CTS cases and organizational (machine-paced work or work pace dependent on customers' demand), psychosocial (job strain model), biomechanical (Borg's rating perceived exertion, wrist bending, pinching, and hand-transmitted vibrations), and personal factors at baseline. Symptomatic CTS risk was directly increased by biomechanical factors (standardized coefficient = 0.19, P = 0.011), female gender (0.25, P < 0.001), and age (0.15, P = 0.042). No psychosocial factors had a direct impact on CTS, but decision authority and skill discretion had an indirect impact by influencing biomechanical exposure. Exposure to machine-paced work had an indirect impact on increasing CTS, either by raising biomechanical exposure (0.19, P < 0.001) or by lowering decision authority (-0.18, P < 0.001) and skill discretion (-0.20, P < 0.001), which in turn increased biomechanical exposure. Similar complex relationships were observed between risk factors and CTS defined by a more strict case definition. Biomechanical exposure had a direct impact on CTS, while organizational factors and psychosocial factors had an indirect impact on CTS. The findings support conceptual models linking work organization to CTS.
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Farias Zuniga A, Ghavanini AA, Israelian G, Keir PJ. Ultrasound examination predicts 6-month progression in carpal tunnel syndrome patients. J Orthop Res 2021; 39:609-618. [PMID: 33098574 DOI: 10.1002/jor.24893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/03/2020] [Accepted: 10/21/2020] [Indexed: 02/04/2023]
Abstract
Carpal tunnel syndrome (CTS) is a peripheral neuropathy resulting from chronic median nerve compression. Chronic compression leads to neurological changes that are quantified through nerve conduction studies (NCS). Although NCS represents the gold standard in CTS assessment, they provide limited prognostic value. Several studies have identified ultrasound as a tool in diagnosing and potentially predicting the progression of CTS in patients. The purpose of this study was to evaluate the predictive value of ultrasound examination in CTS patients. Twenty patients recruited at their first visit with the neurologist completed two NCS and ultrasound examinations approximately 6 months apart. Ultrasound examination consisted of B-mode, pulse-wave Doppler and colour Doppler ultrasound videos and images to quantify median nerve cross-sectional area, intraneural blood flow velocity in three wrist postures (15° flexion, neutral, and 30° extension), and displacement of the flexor digitorum superficialis (FDS) tendon and the adjacent subsynovial connective tissue (SSCT) of the middle finger during repetitive finger flexion-extension cycles. A questionnaire was administered to assess the work-relatedness of CTS. Linear regression analyses revealed that intraneural blood flow velocity (R2 = 0.36, p = .03), assessed in wrist flexion, and relative FDS-SSCT displacement (R2 = 0.27, p = .04) and shear strain index (R2 = 0.28, p = .04) were significant predictors of nerve sensory and motor changes at 6 months. Results suggest the possibility of using a battery of ultrasound measures as viable markers to predict median nerve functional changes within 6 months.
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Affiliation(s)
| | - Amer A Ghavanini
- Canadian Neurologic Center, Mississauga, Ontario, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Division of Neurology, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Gaspar Israelian
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Division of Neurology, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Peter J Keir
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
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Paiva Filho HR, Elias BAB, Salomão Junior MSB, Paiva VGN, Oliveira EF, Rocha MA. Is there an association between electroneuromyography and ultrasound in the diagnosis of carpal tunnel syndrome? Rev Bras Ortop 2021; 56:69-73. [PMID: 33627902 PMCID: PMC7895613 DOI: 10.1055/s-0040-1713390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 03/17/2020] [Indexed: 11/22/2022] Open
Abstract
Objective
To verify whether there is an association between the results of the severity in electroneuromyography and the positivity in ultrasound in the diagnosis of carpal tunnel syndrome.
Methods
Sixty-eight patients were included in the study, 61 women and 7 men, with a mean age of 54.4 years. The ultrasound results (positive or negative) were crossed with the results of electroneuromyography (mild, moderate or severe), and the existence of association was verified.
Results
One hundred and thirty-six hands with suspicion or symptoms of carpal tunnel syndrome were evaluated. Positive ultrasound diagnosis was observed in 72 hands and negative in 64; 123 hands presented positive electroneuromyography for carpal tunnel syndrome, and there were 13 negative results. The severe degree in electroneuromyography was prevalent.
Conclusion
There was a statistically significant association between electroneuromyography and ultrasonography (
p
< 0.05), and ultrasound positivity was higher for more severe levels of carpal tunnel syndrome given by electroneuromyography.
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Affiliation(s)
- Henver Ribeiro Paiva Filho
- Serviço de Cirurgia da Mão, Hospital de Clínicas, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil
| | - Bruno Adriano Borges Elias
- Serviço de Cirurgia da Mão, Hospital de Clínicas, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil
| | | | | | - Elias Felix Oliveira
- Serviço de Cirurgia da Mão, Hospital de Clínicas, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil
| | - Murilo Antônio Rocha
- Serviço de Cirurgia da Mão, Hospital de Clínicas, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil
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Glenday JD, Steinhilber B, Jung F, Haeufle DFB. Development of a musculoskeletal model of the wrist to predict frictional work dissipated due to tendon gliding resistance in the carpal tunnel. Comput Methods Biomech Biomed Engin 2020; 24:973-984. [PMID: 33356567 DOI: 10.1080/10255842.2020.1862094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Carpal tunnel syndrome is an entrapment neuropathy that has been associated with the aggravation of tendon gliding resistance due to forceful, high velocity, awkwardly angled, and repetitive wrist motions. Cadaveric and epidemiological studies have shown that combinations of these risk factors have a more than additive effect. The aim of the current study was to develop a musculoskeletal model of the wrist that could evaluate these risk factors by simulating frictional work dissipated due to the gliding resistance of the third flexor digitorum superficialis tendon. Three flexion angle zones, three extension angle zones, five levels of task repetitiveness, and five levels of task effort were derived from ergonomic standards. Of the simulations performed by systematically combining these parameters, the extreme wrist flexion zone, at peak task repetitiveness and effort, dissipated the most frictional work. This zone dissipated approximately double the amount of frictional work compared to its equivalent zone in extension. For all motions, a multiplicative effect of the combination of task repetitiveness and effort on frictional work was identified by the musculoskeletal model, corroborating previous epidemiological and experimental studies. Overall, these results suggest that the ergonomic standards for wrist flexion-extension may need to be adjusted to reflect equivalent biomechanical impact and that workplace tasks should be designed to minimise exposure to combinations of highly repetitive and highly forceful work, especially when the wrist is highly flexed.
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Affiliation(s)
- J D Glenday
- Multi-level Modeling in Motor Control and Rehabilitation Robotics, Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tübingen, Germany
| | - B Steinhilber
- Institute of Occupational and Social Medicine and Health Services Research, Eberhard-Karls University, Tübingen, Germany
| | - F Jung
- Multi-level Modeling in Motor Control and Rehabilitation Robotics, Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tübingen, Germany.,Institute of Occupational and Social Medicine and Health Services Research, Eberhard-Karls University, Tübingen, Germany
| | - D F B Haeufle
- Multi-level Modeling in Motor Control and Rehabilitation Robotics, Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tübingen, Germany
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Abstract
Importance Carpal tunnel syndrome and meralgia paresthetica are 2 common neuropathies complicating pregnancy. Each of these causes significant discomfort but can be diagnosed and treated safely during pregnancy. Objective This article outlines the existing literature diagnosis, treatment, and prognosis of carpal tunnel syndrome and meralgia paresthetica, specifically looking at the implications during pregnancy. The aim is to provide a reference for physicians diagnosing and treating neuropathies in pregnant patients. Evidence Acquisition Existing literature on neuropathies during pregnancy, clinical presentation, and treatment options for both carpal tunnel syndrome and meralgia paresthetica was reviewed through a MEDLINE and PubMed search. Referenced articles were reviewed and used as primary source materials as appropriate. Results Carpal tunnel syndrome affects individuals of all ages and sexes but is more prevalent in women, particularly during pregnancy. Meralgia paresthetica can occur in various circumstances but is most commonly associated with prolonged second stage in lithotomy position. Multiple clinical signs and neurologic tests are useful to establish the diagnosis of either neuropathy. Effective treatment for carpal tunnel syndrome includes wrist splints, steroid and lidocaine injections, and release surgery. Optimal treatment of meralgia paresthetica remains controversial but includes nerve block injections and active release techniques. Conclusions and Relevance Neuropathies are common in pregnancy and can result in significant impairment. Accurate diagnosis is possible during pregnancy and can usually be accomplished with bedside neurologic tests. Treatment options can be safely considered during pregnancy and can result in symptomatic improvement and reduction in chronic symptoms.
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Stirling PHC, Jenkins PJ, Clement ND, Duckworth AD, McEachan JE. The Influence of Self-Reported Hand-Arm Vibration Exposure on Functional Outcomes Following Carpal Tunnel Release. J Hand Surg Am 2020; 45:1029-1036. [PMID: 33153530 DOI: 10.1016/j.jhsa.2020.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 07/01/2020] [Accepted: 08/25/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE This study describes the impact of self-reported hand-arm vibration (HAV) exposure on patient-reported outcomes, health-related quality of life, and satisfaction after carpal tunnel release. METHODS We prospectively collected data from Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH), patient satisfaction, and 5-level EuroQol-5D questionnaires before and after surgery. Patient-reported outcomes were available for 475 patients (78% follow-up at a mean of 14 months). Fifteen patients were excluded, giving a final cohort of 460 patients. RESULTS A total of 119 patients reported HAV exposure (26%). Median postoperative QuickDASH and QuickDASH improvement were significantly worse in the HAV-exposed group, although both groups improved after surgery. Multivariable linear regression revealed a significantly worse postoperative score and change in QuickDASH in HAV-exposed patients. There was no difference in satisfaction, but after surgery, the 5-level EuroQol-5D score was significantly worse in HAV-exposed patients. CONCLUSIONS Carpal tunnel release in HAV-exposed patients results in a significantly lower improvement in self-reported disability compared with patients without HAV exposure. This study provides important prognostic information for patients with previous HAV exposure undergoing carpal tunnel release. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic III.
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Affiliation(s)
- Paul H C Stirling
- Department of Hand Surgery, Queen Margaret Hospital, Dunfermline, United Kingdom.
| | - Paul J Jenkins
- Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Nicholas D Clement
- Departmental of Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Andrew D Duckworth
- Departmental of Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Jane E McEachan
- Department of Hand Surgery, Queen Margaret Hospital, Dunfermline, United Kingdom
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Ghasemi F, Gholamizadeh K, Rahmani R, Doosti-Irani A. Prevalence and severity of carpal tunnel syndrome symptoms among Iranian butchers and their association with occupational risk factors: Implications for ergonomic interventions. Work 2020; 66:817-825. [PMID: 32925141 DOI: 10.3233/wor-203227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is a common disorder among occupations where upper extremities are actively involved in. Many occupational and non-occupational risk factors may contribute to this disorder. Knowledge regarding occupational risk factors can guide us to implement interventional programs. OBJECTIVE The aim of the present study was to assess the prevalence and severity of CTS symptoms among butchers and their association with several occupational and non-occupational risk factors. METHODS In this study, 152 butchers in Hamadan, Iran, were examined. The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was used to investigate the severity of CTS symptoms among the individuals. Several risk factors such as body mass index (BMI), wrist ratio, active working hours per day, working experience, and the ergonomic quality of hand tools used by butchers were also investigated. Statistical tests such as the crude and robust regression were used to analyze the data. RESULTS The prevalence of moderate and mild symptoms of CTS were 7% and 54%, respectively. Moreover, 39% of the butchers were free of CTS symptoms. Crude regression analyses showed that the severity of CTS symptoms had a significant relationship with age, work experience, active working hours per day, working hours per week, and ergonomic quality of the hand tools (p value <0.05). There was no significant relationship between the severity of CTS symptoms and wrist ratio and BMI. Results of the robust regression analysis showed a significant relationship between the severity of CTS symptoms with experience, active working hours, and quality of the hand tools. CONCLUSION Occupational risk factors such as working experience, active working hours per day, and the ergonomic quality of hand tools are significant risk factors of CTS symptoms among butchers. Slippery handle is the main non-ergonomic feature of knives and cleavers used by butchers. There was no association between BMI and wrist ratio with CTS symptoms.
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Affiliation(s)
- Fakhradin Ghasemi
- Department of Ergonomics, Occupational Health and Safety Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Kamran Gholamizadeh
- Department of Occupational Health Engineering, Student Research Committee, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ramin Rahmani
- Department of Occupational Health Engineering, Student Research Committee, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Amin Doosti-Irani
- Department of Epidemiology, Research Center for Health Sciences, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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Roquelaure Y, Garlantézec R, Rousseau V, Descatha A, Evanoff B, Mattioli S, Goldberg M, Zins M, Bodin J. Carpal tunnel syndrome and exposure to work-related biomechanical stressors and chemicals: Findings from the Constances cohort. PLoS One 2020; 15:e0235051. [PMID: 32584856 PMCID: PMC7316232 DOI: 10.1371/journal.pone.0235051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 06/02/2020] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Yves Roquelaure
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Angers, France
| | - Ronan Garlantézec
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Vincent Rousseau
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Angers, France
| | - Alexis Descatha
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Angers, France
- INSERM UMS 011, Population Based Epidemiological cohorts Unit and Paris Descartes University, Paris, France
| | - Bradley Evanoff
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Stefano Mattioli
- Department of Medical and Surgical Sciences, Occupational Medicine, University of Bologna, Bologna, Italy
| | - Marcel Goldberg
- INSERM UMS 011, Population Based Epidemiological cohorts Unit and Paris Descartes University, Paris, France
| | - Marie Zins
- INSERM UMS 011, Population Based Epidemiological cohorts Unit and Paris Descartes University, Paris, France
| | - Julie Bodin
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Angers, France
- * E-mail:
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Roquelaure Y, Jégo S, Geoffroy-Perez B, Chazelle E, Descatha A, Evanoff B, Garlantézec R, Bodin J. Carpal Tunnel Syndrome Among Male French Farmers and Agricultural Workers: Is It Only Associated With Physical Exposure? Saf Health Work 2020; 11:33-40. [PMID: 32206372 PMCID: PMC7078553 DOI: 10.1016/j.shaw.2019.12.003] [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: 07/18/2018] [Revised: 12/02/2019] [Accepted: 12/10/2019] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Yves Roquelaure
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-49000, Angers, France
| | - Sylvaine Jégo
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-49000, Angers, France
| | - Béatrice Geoffroy-Perez
- Santé Publique France, French National Public Health Agency, Direction of Occupational Health, F-94415, Saint-Maurice, France
| | - Emilie Chazelle
- Santé Publique France, French National Public Health Agency, Direction of Occupational Health, F-94415, Saint-Maurice, France
| | - Alexis Descatha
- INSERM UMS 011, Population Based Epidemiological Cohorts Unit and University Versailles St-Quentin, F-78035, Versailles, France
| | - Bradley Evanoff
- Washington University School of Medicine, Division of General Medical Sciences, St. Louis, MO, 63310, USA
| | - Ronan Garlantézec
- Univ Rennes, CHU Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-35000, Rennes, France
| | - Julie Bodin
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-49000, Angers, France
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Carpal Tunnel Syndrome as Sentinel for Harmful Hand Activities at Work: A Nationwide Danish Cohort Study. J Occup Environ Med 2020; 62:375-382. [PMID: 32167999 DOI: 10.1097/jom.0000000000001852] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
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.
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40
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Choi B. Opioid use disorder, job strain, and high physical job demands in US workers. Int Arch Occup Environ Health 2020; 93:577-588. [PMID: 31919662 DOI: 10.1007/s00420-019-01514-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/27/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE Little is known about the work environmental risk factors for opioid use disorder (OUD) in working populations. The purpose of this study is to examine whether adverse physical and psychosocial working conditions are associated with OUD in a working population of the United States (US). METHODS Among the participants of the National Survey of Midlife Development in the United States (MIDUS) II Study (2004-2006), 2134 workers (1059 men and 1075 women; mean age, 51 years) were chosen for this study. OUD was measured with self-administered questions in line with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSD-5). Physical demands (physical efforts, heavy lifting, and crouching/stooping/kneeling) and psychosocial work stressors (skill discretion, decision authority, job control, psychological job demands, supervisor and coworker support at work, job insecurity, and work hours) were measured with a standard questionnaire. RESULTS The prevalence of OUD was 3.8%. In multivariate analyses, low skill discretion, high psychological job demands, job strain (a combination of low control and high demands), and high physical job demands were significantly associated with OUD. The multivariate prevalence ratios for OUD by job strain and frequent heavy lifting were 1.98 (1.27-3.10) and 2.23 (1.22-4.10), respectively. Job strain was more strongly associated with OUD in men, while high physical job demands were more strongly associated with OUD in women. CONCLUSION This study implies that adverse physical and psychosocial working conditions may be important risk factors for OUD in US working populations. Future longitudinal and mechanistic studies are urgently warranted.
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Affiliation(s)
- BongKyoo Choi
- Department of Medicine and Program in Public Health, University of California Irvine, 100 Theory, Suite 100, Irvine, CA, 92617, USA.
- Center for Work and Health Research, Irvine, CA, USA.
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Schulze DG, Nordby KC, Cvancarova Småstuen M, Clemm T, Grotle M, Zwart JA, Nilsen KB. Impact of technical variations on the ring-finger test for carpal tunnel syndrome. Clin Neurophysiol Pract 2019; 5:23-29. [PMID: 31909307 PMCID: PMC6940656 DOI: 10.1016/j.cnp.2019.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 11/19/2019] [Accepted: 11/23/2019] [Indexed: 11/15/2022] Open
Abstract
The median and ulnar nerves can be recorded consecutively or simultaneously to diagnose carpal tunnel syndrome. Simultaneous and consecutive recording of the median and ulnar nerves sensory latency have a poor agreement. 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.
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Affiliation(s)
- Daniel Gregor Schulze
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Research and Communication Unit for Musculoskeletal Health, Oslo University Hospital, Norway
| | | | - Milada Cvancarova Småstuen
- Oslo and Akershus University College, Oslo, Norway.,Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Thomas Clemm
- National Institute of Occupational Health, Oslo, Norway
| | - Margreth Grotle
- Oslo and Akershus University College, Oslo, Norway.,Research and Communication Unit for Musculoskeletal Health, Oslo University Hospital, Norway
| | - John Anker Zwart
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Research and Communication Unit for Musculoskeletal Health, Oslo University Hospital, Norway
| | - Kristian Bernhard Nilsen
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Research and Communication Unit for Musculoskeletal Health, Oslo University Hospital, Norway
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Trillos MC, Soto F, Briceno-Ayala L. Upper limb neurodynamic test 1 in patients with clinical diagnosis of carpal tunnel syndrome: A diagnostic accuracy study. J Hand Ther 2019. [PMID: 28623065 DOI: 10.1016/j.jht.2017.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
| | - Felipe Soto
- Instituto de Diagnostico Medico, Idime, Bogota, Colombia
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43
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Baker NA, Feller H, Freburger J. Does Insurance Coverage Affect Use of Tests and Treatments for Working Age Individuals With Carpal Tunnel Syndrome in the United States? Analysis of the National Ambulatory Medical Care Survey (2005-2014). Arch Phys Med Rehabil 2019; 100:1592-1598. [DOI: 10.1016/j.apmr.2019.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/19/2019] [Accepted: 03/12/2019] [Indexed: 12/13/2022]
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Lund CB, Mikkelsen S, Thygesen LC, Hansson GÅ, Thomsen JF. Movements of the wrist and the risk of carpal tunnel syndrome: a nationwide cohort study using objective exposure measurements. Occup Environ Med 2019; 76:519-526. [PMID: 31189693 PMCID: PMC6703125 DOI: 10.1136/oemed-2018-105619] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 05/17/2019] [Accepted: 05/28/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVES We conducted a large cohort study to investigate the association between work-related wrist movements and carpal tunnel syndrome (CTS). METHODS Electro-goniometric measurements of wrist movements were performed for 30 jobs (eg, office work, child care, laundry work and slaughterhouse work). We measured wrist angular velocity, mean power frequency (MPF) and range of motion (ROM). We established a cohort of Danish citizens born 1940-1979 who held one of these jobs from age 18-80 years, using Danish national registers with annual employment information from 1992 to 2014. We updated the cohort by calendar year with job-specific and sex-specific means of measured exposures. Dates of a first diagnosis or operation because of CTS were retrieved from the Danish National Patient Register. The risk of CTS by quintiles of preceding exposure levels was assessed by adjusted incidence rate ratios (IRRadj) using Poisson regression models. RESULTS We found a clear exposure-response association between wrist angular velocity and CTS with an IRRadj of 2.31 (95% CI 2.09 to 2.56) when exposed to the highest level compared with the lowest. MPF also showed an exposure-response pattern, although less clear, with an IRRadj of 1.83 (1.68 to 1.98) for the highest compared with the lowest exposure level. ROM showed no clear pattern. Exposure-response patterns were different for men and women. CONCLUSIONS High levels of wrist movement were associated with an increased risk of CTS. Preventive strategies should be aimed at jobs with high levels of wrist movements such as cleaning, laundry work and slaughterhouse work.
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Affiliation(s)
- Christina Bach Lund
- Department of Occupational and Environmental Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Sigurd Mikkelsen
- Department of Occupational and Environmental Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Gert-Åke Hansson
- Occupational and Environmental Medicine, University and Regional Laboratories Region Scania, Lund, Sweden.,Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Jane Frølund Thomsen
- Department of Occupational and Environmental Medicine, Bispebjerg Hospital, Copenhagen, Denmark
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45
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Abstract
The Academy of Orthopaedic Physical Therapy and the Academy of Hand and Upper Extremity Physical Therapy have an ongoing effort to create evidence-based clinical practice guidelines (CPGs) for orthopaedic and sports physical therapy management and prevention of musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability and Health (ICF). This particular guideline focuses on hand pain and sensory deficits in carpal tunnel syndrome. J Orthop Sports Phys Ther 2019;49(5):CPG1-CPG85. doi:10.2519/jospt.2019.0301.
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46
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Pramchoo W, Geater AF, Tangtrakulwanich B. Physical ergonomic risk factors of carpal tunnel syndrome among rubber tappers. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2018; 75:1-9. [PMID: 30372372 DOI: 10.1080/19338244.2018.1507991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/01/2018] [Accepted: 07/30/2018] [Indexed: 06/08/2023]
Abstract
This study evaluated physical ergonomic risk factors associated with carpal tunnel syndrome (CTS) among rubber tappers in Thailand. The Boston Carpal Tunnel Syndrome Questionnaire and Phalen's test and Tinel's sign were used to identify 133 cases with CTS and 401 non-CTS controls. Video recordings and Rapid Upper Limb Assessment used to evaluate the level of ergonomic risk in right and left hand postures. Significant physical ergonomic risk factors of CTS were higher number of trees tapped at or below knee level and collecting latex. Among right-handed tappers, tapping at higher than chest level involved significantly higher proportion of right wrist flexion and/or extension, and left wrist radial and/or ulnar deviation and twist than tapping at a lower level.
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Affiliation(s)
- Walaiporn Pramchoo
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Alan F Geater
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Boonsin Tangtrakulwanich
- Department of Orthopedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Salman Roghani R, Hashemi SE, Holisaz MT, Gohari F, Delbari A, Lokk J. The diagnostic accuracy of median nerve ultrasonography in elderly patients with carpal tunnel syndrome: sensitivity and specificity assessment. Clin Interv Aging 2018; 13:1953-1962. [PMID: 30349214 PMCID: PMC6187921 DOI: 10.2147/cia.s177307] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Accurate diagnosis of carpal tunnel syndrome (CTS), the most common entrapment neuropathy, and its differentiation from other diseases are essential, especially in older individuals with advanced symptoms and modified electrophysiological abnormalities. The current study was conducted to evaluate the diagnostic accuracy of ultrasonography (US), regarding sensitivity and specificity in the diagnosis of CTS in elderly patients. Methods Individuals with upper limb complaints and reference subjects were recruited from the Rofaydeh Hospital, Tehran, Iran, from June 2013 to October 2014 – (15 months). We evaluate case and control subjects for health status, demographics, clinical characteristics of CTS, median nerve physiology by electrodiagnostic tests, and anatomy by US. Median nerve cross-sectional area (CSA) at precanal, tunnel inlet, midcanal, tunnel outlet, and antecubital levels was measured applying US examination. Results Of the 723 complaining patients, we assessed 380 patients with CTS symptoms. Electrodiagnostic studies (EDX) confirmed the CTS diagnosis in 203 of these clinically diseased patients. A total of 103 patients (of the 113 reference subjects) had normal EDX in the reference group. Comparisons of wrists between the afflicted and reference subjects demonstrated the CSA at precanal, tunnel inlet, midcanal, and tunnel outlet levels being significantly more abundant in the diseased hands than in the nondiseased hands. CSA at the tunnel inlet and the inlet-to-antecubital CSA ratio with a threshold of 8.5 mm2 and 0.65 gave the best diagnostic accuracy with a sensitivity and specificity of 96.9 and 93.6% for the inlet CSA and 99 and 28% for the CSA ratio, respectively. Conclusion The US as a noninvasive diagnostic method may serve for the investigation of CTS in elderly patients with excellent sensitivity and specificity.
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Affiliation(s)
- Reza Salman Roghani
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden, .,Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Ebrahim Hashemi
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Taghi Holisaz
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faeze Gohari
- Student Research Committee, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Delbari
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation, Tehran, Iran
| | - Johan Lokk
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden,
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48
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Setayesh M, Zargaran A, Sadeghifar AR, Salehi M, Rezaeizadeh H. New candidates for treatment and management of carpal tunnel syndrome based on the Persian Canon of Medicine. Integr Med Res 2018; 7:126-135. [PMID: 29984174 PMCID: PMC6026351 DOI: 10.1016/j.imr.2018.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 02/06/2018] [Accepted: 02/13/2018] [Indexed: 12/30/2022] Open
Abstract
Carpal tunnel syndrome (CTS) is defined as a compressing median mononeuropathy. CTS is one of the major costly debilitating diseases of the hand. Although CTS is a relatively recent concept in current medicine, some evidences show that medieval physicians in Persian medicine (PM) such as Avicenna were familiar with it. The PM textbook written by Avicenna, the Canon of Medicine, defines the anatomy of carpal tunnel and median nerve, as well as mononeuropathy; it also offers suggestions for the prevention and treatment of carpal tunnel syndrome (called as Vaja al-asab and Khadar) in the chapter of nerve diseases. The book describes not only symptoms including pain, paresthesia, hypoesthesia, tingling, and numbness, but also its etiology such as nerve compression (entrapment neuropathy); nonphysical reasons such as disturbed balance among the four body humors; alteration in the nerve's temperament (Mizaj) that prevents the transmission of nerve impulses; and the others such as nutrition, mental condition, sleep, weather condition, body movements, and proper disposal of body waste. Furthermore, the book suggests a lifestyle modification method based on six factors and 10 prescriptions composed with 85 natural products that are not actively used for CTS treatment in modern times. The medicinal suggestions for CTS in the Canon of Medicine will be good candidates for discovering new treatments besides providing historical significance to the various insights considered 1000 years ago.
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Affiliation(s)
- Mohammad Setayesh
- Department of Persian Medicine, School of Persian Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Arman Zargaran
- Department of Traditional Pharmacy, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Department of History of Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Reza Sadeghifar
- Department of Orthopedic Surgery, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehdi Salehi
- Traditional and Complementary Medicine Research Center (TCMRC), Department of Traditional Medicine, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Hossein Rezaeizadeh
- Department of Persian Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
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49
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Musolin KM, Ramsey JG. Carpal tunnel syndrome prevalence: an evaluation of workers at a raw poultry processing plant. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2018; 23:282-290. [PMID: 29873286 DOI: 10.1080/10773525.2018.1474420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Evaluate the prevalence of carpal tunnel syndrome (CTS) among workers at a raw poultry processing plant and categorize jobs on the basis of hand activity and force. METHODS A cross-sectional survey among 191 workers assessed CTS defined by self-reported CTS symptoms, a hand symptom diagram, and measurements of nerve conduction parameters. We categorized jobs based on American Conference of Governmental Industrial Hygienists' (ACGIH®) limits for hand activity and force, and examined the relationships with CTS occurrence. RESULTS A total of 64 workers (34%) had CTS after adjusting for non-occupational factors. Overall, 81% of jobs were above the ACGIH action limit; 59% were above the ACGIH threshold limit value®. CTS prevalence did not differ significantly between exposure groups (PR = 0.82, p = 0.35). CONCLUSIONS These findings suggest that poultry processing jobs continue to be hazardous with workers at risk for CTS. Recommendations for the study population were provided to reduce exposure and CTS risk among workers.
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Affiliation(s)
- Kristin M Musolin
- a National Institute for Occupational Safety and Health , Cincinnati , OH , USA
| | - Jessica G Ramsey
- a National Institute for Occupational Safety and Health , Cincinnati , OH , USA
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50
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Roquelaure Y, Fouquet N, Chazelle E, Descatha A, Evanoff B, Bodin J, Petit A. Theoretical impact of simulated workplace-based primary prevention of carpal tunnel syndrome in a French region. BMC Public Health 2018; 18:426. [PMID: 29606118 PMCID: PMC5879836 DOI: 10.1186/s12889-018-5328-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy in the working-age population. The reduction of CTS incidence in the workforce is a priority for policy makers due to the human, social and economic costs. To assess the theoretical impact of workplace-based primary interventions designed to reduce exposure to personal and/or work-related risk factors for CTS. METHODS Surgical CTS were assessed using regional hospital discharge records for persons aged 20-59 in 2009. Using work-related attributable fractions (AFEs), we estimated the number of work-related CTS (WR-CTS) in high-risk jobs. We simulated three theoretical scenarios of workplace-based primary prevention for jobs at risk: a mono-component work-centered intervention reducing the incidence of WR-CTS arbitrarily by 10% (10%-WI), and multicomponent global interventions reducing the incidence of all surgical CTS by 5% and 10% by targeting personal and work risk factors. RESULTS A limited proportion of CTS were work-related in the region's population. WR-CTS were concentrated in nine jobs at high risk of CTS, amounting to 1603 [1137-2212] CTS, of which 906 [450-1522] were WR-CTS. The 10%-WI, 5%-GI and 10%-GI hypothetically prevented 90 [46-153], 81 [58-111] and 159 [114-223] CTS, respectively. The 10%-GI had the greatest impact regardless of the job. The impact of the 10%-WI interventions was high only in jobs at highest risk and AFEs (e.g. food industry jobs). The 10%-WI and 5%-GI had a similar impact for moderate-risk jobs (e.g. healthcare jobs). CONCLUSION The impact of simulated workplace-based interventions suggests that prevention efforts to reduce exposure to work-related risk factors should focus on high-risk jobs. Reducing CTS rates will also require integrated strategies to reduce personal risk factors, particularly in jobs with low levels of work-related risk of CTS.
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Affiliation(s)
- Yves Roquelaure
- Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, University of Angers, CHU Angers, University of Rennes, Inserm, Ehesp, F-49000, Angers, France.
| | - Natacha Fouquet
- Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, University of Angers, CHU Angers, University of Rennes, Inserm, Ehesp, F-49000, Angers, France.,Santé publique France, Equipe associée en Epidémiologie et Prévention des TMS (EpiPrevTMS), F-94415, Saint-Maurice, France
| | - Emilie Chazelle
- Santé publique France, Equipe associée en Epidémiologie et Prévention des TMS (EpiPrevTMS), F-94415, Saint-Maurice, France
| | - Alexis Descatha
- INSERM UMS 011, Population Based Epidemiological Cohorts Unit and University Versailles St-Quentin, F-78035, Versailles, France
| | - Bradley Evanoff
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO, 63310, USA
| | - Julie Bodin
- Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, University of Angers, CHU Angers, University of Rennes, Inserm, Ehesp, F-49000, Angers, France
| | - Audrey Petit
- Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, University of Angers, CHU Angers, University of Rennes, Inserm, Ehesp, F-49000, Angers, France
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