Risk factors for carpal tunnel syndrome in a general population

Exploring Musculoskeletal Complaints in a Needle Manufacturing Industry: A Cross-Sectional Study

Musculoskeletal disorders (MSD) encompass a variety of conditions affecting muscles, joints, and nerves. In Portugal, MSDs are the most prevalent occupational health problem in companies. Based on the relevance of work-related MSD (WMSD), this study aims to assess the prevalence of MSD complaints in a needle manufacturing industry in Northern Portugal, following a cross-sectional approach. Thus, 526 workers from five departments (i.e., operator, tuning, maintenance, administration, and logistics) answered a sociodemographic questionnaire and the Nordic Musculoskeletal Questionnaire (NMQ). Within the last 12 months, females exhibited a higher frequency of complaints than males across all body parts except for ankles/feet. The body parts eliciting the most percentage of complaints for both genders include the lower back (54.2%), neck (42.2%), shoulders (39.0%), ankles/feet (38.2%), and wrists/hands (35.7%). No significant association was found between Body Mass Index (BMI) and body part complaints. Tuners reported the highest complaint rate, with occupations as substantial predictors of complaints in certain body parts. Likewise, complaints tend to increase with age. The findings advocate for ergonomic interventions that are gender-, age-, and job-sensitive.

Current Insights into Carpal Tunnel Syndrome: Clinical Strategies for Prevention and Treatment

BACKGROUND

Carpal tunnel syndrome (CTS) is a condition that is caused by medial nerve compression, resulting in symptoms such as numbness, tightness, or weakness in the hand.

OBJECTIVES

The aim of the study was to find out the genetic modulation, mechanism, available treatment, and recommendation for carpal tunnel syndrome at its specific stage.

METHODS

Almost 200 papers were searched for this review article, and 145 articles were selected. The literature was collected from different sources like Google scholar, PubMed, a directory of open-access journals, and science.gov by using keywords, such as treatment, risk factors, recommendation, and clinical features of carpal tunnel syndrome.

RESULTS

The most efficient non-surgical treatment is methylprednisolone acetate, which reduces inflammation by acting on the glucocorticoid receptor in conjunction with immunofilling. It has also been used successfully as a second-line drug for the treatment of patients with mild or moderate conditions in order to provide relief. New non-pharmacological options include laser therapy in acupuncture, transcutaneous electric nerve stimulation (TENS), and sham therapy. Modern treatments like TENS, laser therapy, splints, and injections of methylprednisolone acetate have been demonstrated to be helpful in sporadic situations. For patients with mild and moderate problems, more research should be conducted that includes the combination of these surgical and non-surgical treatments.

CONCLUSION

We propose a multifunctional panel construct and define standard data items for future research into carpal tunnel syndrome. A discussion on idiopathic carpal tunnel syndrome, risk factors, combination of therapies, using guidelines-based recommendations and treatment should be initiated.

The Effect of Body Mass Index on Open Carpal Tunnel Release Recovery

Purpose

The purpose of this study was to determine whether a relationship exists between body mass index (BMI), specifically obesity, and surgical outcomes for open carpal tunnel release. Obesity is correlated with increased incidence of carpal tunnel syndrome; however, the effect of obesity on after release recovery has not been examined.

Methods

This study used a retrospective review of patient charts (n = 142). BMI was calculated based on height and weight measurements, and patients were grouped based on their BMI into the following categories: healthy BMI (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), obesity class one (30-34.9 kg/m2) (OB1), obesity class (2 35-39.9 kg/m2) (OB2), or obesity class three (40+ kg/m2) (OB3). Data were then complied on surgical outcomes by assessing preoperative pain, postoperative pain at 2 and 6 weeks, postoperative joint stiffness, wound healing time, and infection status. Data were analyzed using chi-square analyses and multivariable logistic regression to assess the differences in treatment outcomes while controlling for possible confounding variables.

Results

Age at the time of release was found to be inversely correlated with BMI. Healthy BMI patients (n = 19) underwent release at an average age of 59.1 years, whereas OB3 (n = 30) underwent release at an average age of 46.9 years. The odds of improvement in pain were significantly lower in all three obesity groups when compared with healthy BMI at both 2 and 6 weeks after operation.

Conclusions

Our results indicate that obesity may be positively correlated with earlier incidence of carpal tunnel syndrome requiring surgical intervention. These data also indicate the increased rates of postoperative complications in obese patients, particularly patients with OB3. Patients with OB3 need to understand these risks before undergoing open release. Further study should examine the impact of type 2 diabetes on carpal tunnel release recovery.

Clinical relevance

The information included in this study may be used to guide surgeons and patients when considering the effect and potential improvement in outcomes that may come from addressing patient BMI before open carpal tunnel surgery.

An Integrated Review of Carpal Tunnel Syndrome: New Insights to an Old Problem

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.

Intraoperative Nerve Conduction Studies During Open Carpal Tunnel Release: A Pilot Study

Background

Operative management of carpal tunnel syndrome (CTS) involves release of the transverse carpal ligament (TCL) and often the volar antebrachial fascia (VAF). Evidence of a difference between TCL and TCL+VAF release is limited. We conducted a pilot study to measure changes of intraoperative nerve conduction velocity (NCV) after CTS surgery and compared outcomes of variable degrees of decompression.

Methods

Patients aged 18 to 65 years diagnosed with idiopathic CTS that failed to respond to conservative management were included in this study. Patients were excluded if they had prior surgical release, diabetes, acute CTS, trauma, or cervical spine radiculopathy. Outcomes included motor and sensory amplitude and latency. Electrodes were placed on the skin intraoperatively along the abductor pollicis brevis, index finger, and forearm. Outcome data were recorded at baseline, after TCL release, and after TCL+VAF release. Data were compared using a single-tail t test.

Results

A total of 10 patients were included in this study. There were no significant changes in mean motor or sensory amplitude and latency from baseline to TCL release, TCL to VAF release, or from baseline to TCL+VAF release measured intraoperatively.

Conclusions

This pilot study shows there is no immediate detectable difference in NCV following release of TCL or TCL+VAF. This suggests that NCV may not be useful for assessing intraoperative improvement. We highlight the need for future research in the form of case-control studies to determine the utility of intraoperative NCV. These studies should be conducted with larger numbers of patients and involve multiple hand specialists.

Evaluation of occupational and non-occupational risk factors associated with carpal tunnel syndrome in dentists

BACKGROUND

Musculoskeletal disorders are very prevalent among dentists. Of these disorders, carpal tunnel syndrome (CTS) is notable.

OBJECTIVE

The aim of this study was to investigate the relationship between the occupational and non-occupational risk factors and CTS among dentists.

METHODS

It is a cross-sectional study. We evaluated 106 dentists from dental schools in Tehran. We collected data by a general questionnaire, a hand diagram, and physical examination. A nerve conduction velocity (NCV) test was used to confirm the diagnosis of CTS. The analysis was performed using an independent T-test and logistic regressions on SPSS software.

RESULTS

The prevalence of CTS among dentists was 17.9%. Significant risk factors of CTS included: vibration exposure greater than two hours per day (OR: 2.5), a wrist diameter ratio of greater than 0.7 (OR: 10.14), and female sex (OR: 13.38).

CONCLUSIONS

Exposure to the hand-arm vibration should be considered as an occupational risk factor for CTS in dentists. Female dentists should take more preventive measures.

Relationship Between Obesity and Severity of Carpal Tunnel Syndrome in Tanzania

Background: Carpal tunnel syndrome (CTS) is the most common focal mononeuropathy in the general population, and obesity is one of its established independent risk factors The prevalence of obesity in CTS patients and its association with CTS severity are yet to be fully studied among Tanzanians. In this study, we determined the frequency of obesity in patients with CTS and its relationship with the electrophysiological severity of CTS in a Tanzanian private tertiary level hospital. Methods: This is a retrospective observational and analytical study of patients referred for electrodiagnostic (EDX) evaluation of suspected CTS at the clinical neurophysiology laboratory of the Aga Khan Hospital, Dar es Salaam, Tanzania. All EDX studies done for CTS indications between August 1, 2017, and December 31, 2019, were reviewed. The frequency of CTS patients with obesity (body mass index >30 kg/m²) and overweight (25.0-29.9 kg/m²) was determined. Next, we explored the relationship between obesity and the electrophysiologic severity of CTS. Results: One-hundred nine hands were studied. The prevalence of obesity was 50.5% and overweight was 31.2%. Females were significantly more obese than males (P = 0.001). Many of the EDX parameters that defined CTS, including prolonged median nerve sensory and distal motor latencies as well as sensory conduction velocity, were significantly more abnormal in the obese when compared to the nonobese patients. On univariate analysis, severe CTS (stage 5) was commoner among nonobese patients (P = 0.031), while moderate CTS (stage3) was more prevalent among obese patients (P < 0.001). Multivariate regression analysis, however, revealed no effect of obesity on CTS severity (P = 0.490). Conclusion: Obesity and overweight are prevalent among this cohort with CTS, but did not predict severe CTS. The use of other indices of adiposity may show a trend.

Carpel tunnel syndrome: A link with vitamin D and calcium

Carpal tunnel syndrome (CTS) and vitamin D deficiency are two conditions that cause chronic pain and are thus associated with psychological issues as well. The aim of the present study was to evaluate vitamin D levels, daily calcium intake, musculoskeletal pain and psychological symptoms in patients with CTS. The study included 48 patients with CTS and age-sex matched controls. Serum vitamin D levels were measured, and psychological symptoms were assessed using a Hospital Anxiety and Depression Scale. A Pain DETECT questionnaire was used to assess musculoskeletal pain (MSP) sites and severity. The results showed that vitamin D deficiency was considerably more prevalent in patients with CTS (95.8%) compared with controls (22.9%). Clinical anxiety (35.4 vs. 6.3%) and clinical depression (29.2 vs. 4.2%) were also more common in patients with CTS compared with controls. All the patients with CTS exhibited MSP, whereas none of the controls reported any MSP. Anxiety was significantly and inversely associated with vitamin D levels (r²=-0.482; P<0.01), total daily calcium intake (r²=-0.294: P<0.05), and positively associated with body mass index (BMI; r²=0.200; P≤0.05) and depression (r²=0.587; P<0.01). Depression was significantly and inversely associated with vitamin D levels (r²=-0.269; P<0.01) and total daily calcium intake (r²=-0.236; P<0.05). Logistic regression analysis showed that with every unit increase in serum vitamin D levels, the odds of CTS were decreased 1.22x. While a one-unit increase in anxiety total score was associated with a 14% increase in the odds of having CTS after adjusting for different confounders. In conclusion, vitamin D deficiency, MSP and psychological symptoms are common in patients with CTS. Serum vitamin D levels and anxiety were significant independent predictors of CTS. Based on the results of the present study, it was shown that housewives had an equivalent chance of suffering from CTS morbidity as other high-risk professions. Further studies are required to confirm if vitamin D supplementation could prevent the onset of CTS.

Prevalence and Risk Factors of Carpal Tunnel Syndrome in Japanese Aged 50 to 89 Years

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy worldwide, but there are few reports investigating its prevalence using subjects diagnosed by both clinical symptoms and nerve conduction studies (NCSs) in a population-based cohort. This study aimed to determine the epidemiology of CTS diagnosed by sensory disturbance findings and NCSs using a randomly sampled resident population. Methods: Subjects aged between 50 and 89 years were randomly sampled from the basic resident registry of a rural Japanese town. Subjects indicating a history of CTS surgery in a written questionnaire were classified as having past CTS. Subjects with both sensory disturbance of the median nerve area and delays in NCSs were diagnosed as having present CTS. Subjects with past or present CTS were judged as affected with CTS. We calculated the prevalence of CTS and investigated for possible risk factors. Results: Seventeen subjects (14 female and 3 male) were affected with CTS among 379 enrolled subjects. Adjusting these results to Japanese population values, the weighted prevalence of CTS was 4.7% (female: 7.2%, male: 1.8%) in the Japanese population aged 50 to 89 years. Statistically significant positive correlations were found between CTS and female, higher BMI, rheumatoid arthritis, and trigger digit. In females affected with CTS, third metacarpal length was significantly shorter than in those without CTS. Conclusions: This epidemiological study clarified the prevalence of CTS among Japanese seniors as 4.7%. Female, higher BMI, rheumatoid arthritis, trigger digit, and shorter third metacarpal length in females were risk factors for CTS.

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

Objective

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

Methods

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

Results

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

Conclusions

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

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

Background

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

Methods

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

Results

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

Conclusions

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

Physical Exposures, Work Tasks, and OSHA-10 Training Among Temporary and Payroll Construction Workers

OBJECTIVE

We characterize and compare the self-reported physical exposures, work tasks, and OSHA-10 training in a non-probabilistic sample of temporary and payroll construction workers.

METHODS

In June 2016, a total of 250 payroll and temporary general laborers employed at Florida construction sites completed a survey at the job site as part of the falls reported among minority employees (FRAME) study.

RESULTS

Workers employed through temp agencies (57.1%) were significantly more likely to report moving or lifting materials more than 100 pounds than payroll workers (38.5%; P < 0.01). Temporary construction workers with 10-hour OSHA training (22.2%) spent significantly less time with intense hand use/awkward hand posture than temporary workers without 10-hour OSHA training (46.9%; P = 0.048).

CONCLUSIONS

Temp construction workers with OSHA 10-hour training reported less hazardous physical postures than workers without the same training.

Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome

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.

Preferences in Sleep Position Correlate With Nighttime Paresthesias in Healthy People Without Carpal Tunnel Syndrome

BACKGROUND

Carpal tunnel syndrome has been associated with sleep position preferences. The aim of this study is to assess self-reported nocturnal paresthesias and sleeping position in participants with and without carpal tunnel syndrome diagnosis to further clinical knowledge for preventive and therapeutic interventions.

METHODS

A cross-sectional survey study of 396 participants was performed in young adults, healthy volunteers, and a patient population. Participants were surveyed on risk factors for carpal tunnel syndrome, nocturnal paresthesias, and sleep preferences. Binary logistic regression analysis was performed comparing participants with rare and frequent nocturnal paresthesias. Subanalyses for participants without carpal tunnel syndrome under and over 21 years of age were performed on all factors significantly associated with subclinical compression neuropathy in the overall population.

RESULTS

Thirty-three percent of the study population experienced nocturnal paresthesias at least weekly. Increased body mass index ( P < .001) and sleeping with the wrist flexed ( P = .030) were associated with a higher frequency of nocturnal paresthesias. Side sleeping was associated with less frequent nocturnal symptoms ( P = .003). In participants without carpal tunnel syndrome, subgroup analysis illustrated a relationship between nocturnal paresthesias and wrist position. In participants with carpal tunnel syndrome, sleeping on the side had a significantly reduced frequency of nocturnal paresthesias.

CONCLUSION

This study illustrates nocturnal paresthesias in people without history of carpal tunnel syndrome including people younger than previously reported. In healthy patients with upper extremity subclinical compression neuropathy, sleep position modification may be a useful intervention to reduce the frequency of nocturnal symptoms prior to developing carpal tunnel syndrome.

Sonographic Measurement of Cross-sectional Area of the Median Nerve in Academic Dentists Without Symptoms or Signs of Carpal Tunnel Syndrome

The objective was to evaluate the distribution of the cross-sectional area (CSA) and flattening ratio (FR) of the median nerve (MN) in asymptomatic academic dentists using ultrasonography (US). Fifty academic dentists underwent US of the MN in transverse section at the pisiform bone level and the CSA (mm2) and FR were measured bilaterally. A CSA of <10 mm2 was considered normal. Paired t-test showed no statistical significance between either hand for CSA and FR ( P> .05). Two independent t-tests showed significant statistical differences ( P= .023) between males and females in the right dominant hand for CSA. Linear correlation analysis showed no significant correlation between CSA and FR for number of years of experience or number of working hours per day in either hand ( P>.05). The CSA was abnormal in the right dominant hand in 20 (40%) of the subjects. These male academic dentists were at increased risk of having an enlarged MN without symptoms.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Hypercholesterolemia Is Associated with the Subjective Evaluation of Postoperative Outcomes in Patients with Idiopathic Carpal Tunnel Syndrome Who Undergo Surgery: A Multivariate Analysis

BACKGROUND

Carpal tunnel syndrome is a compression neuropathy of the median nerve at the wrist; its symptoms include neuropathic pain and sensory and motor disturbance distributed by the median nerve. Carpal tunnel syndrome and hypercholesterolemia have similar backgrounds, but the effect of these similarities on postoperative outcomes has not been reported. Using multivariate analysis, the authors analyzed the relationship between prognostic factors, including the presence of hypercholesterolemia, and subjective postoperative outcomes of patients with idiopathic carpal tunnel syndrome.

METHODS

Of 168 hands with carpal tunnel syndrome that were treated surgically, 141 that were followed up and assessed 1 year postoperatively or thereafter were included. The mean postoperative follow-up period was 40.8 months. Surgery was performed through a small palmar skin incision under local anesthesia. The outcomes were postoperative symptoms, including pain and numbness, and overall Kelly assessment.

RESULTS

Preoperative numbness and pain resolved and alleviated in 94 of 141 hands and was diminished in 59 of 64 hands. Univariate analysis showed that postoperative numbness and Kelly assessment were significantly associated with hypercholesterolemia. Multivariate analysis showed that postoperative numbness was significantly associated with smoking and hypercholesterolemia, and Kelly assessment was significantly associated with smoking (adjusted OR, 3.3; 95 percent CI, 1.1 to 10; p = 0.04) and hypercholesterolemia (adjusted OR, 2.9; 95 percent CI, 1.4 to 6.3; p = 0.01).

CONCLUSION

Hypercholesterolemia, usually a systemic condition in sites other than the hand, is associated with the subjective evaluation of postoperative symptoms in patients with idiopathic carpal tunnel syndrome.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Risk, III.

Effect of metabolic syndrome on the outcome of corticosteroid injection for carpal tunnel syndrome

Diffuse peripheral nerve impairment is common in metabolic syndrome: in patients with metabolic syndrome and carpal tunnel syndrome this might affect the outcome of treatment by local corticosteroid injection. A total of 55 consecutive patients with carpal tunnel syndrome and metabolic syndrome treated with corticosteroid injection (10 mg triamcinolone acetonide) were age and sex matched with 55 control patients without metabolic syndrome. Grip strength, perception of touch with Semmes-Weinstein monofilaments and Boston Carpal Tunnel Questionnaires were assessed at the baseline and at 6, 12 and 24 weeks follow-up. The two groups had similar pre-operative grip strength and Boston Carpal Tunnel Questionnaire scores. The Boston Carpal Tunnel Questionnaire symptom and function scores of the metabolic syndrome group were significantly greater than the control group at 12 and 24 weeks follow-up. Except for significantly greater grip strength at the 12-week follow-up in the control group, there were no significant differences in grip strength between the groups. Semmes-Weinstein monofilament sensory index for the control group was significantly greater than that of the metabolic syndrome group throughout the 24-week follow-up. After 24 weeks, five patients (13%) in the control group and 13 patients (27%) in the metabolic syndrome group had had carpal tunnel surgery. Patients with metabolic syndrome are at risk for poor functional outcome and failure of treatment after corticosteroid injection for carpal tunnel syndrome.

LEVEL OF EVIDENCE

Treatment benefits III.

Risk Factors in Carpal Tunnel Syndrome

We have undertaken a large case–control study using the UK General Practice Research Database to quantify the relative contributions of the common risk factors for carpal tunnel syndrome (CTS) in the community. Cases were patients with a diagnosis of CTS and, for each, four controls were individually matched by age, sex and general practice. Our dataset included 3,391 cases, of which 2,444 (72%) were women, with a mean age at diagnosis of 46 (range 16–96) years. Multivariate analysis showed that the risk factors associated with CTS were previous wrist fracture (OR = 2.29), rheumatoid arthritis (OR = 2.23), osteoarthritis of the wrist and carpus (OR = 1.89), obesity (OR = 2.06), diabetes (OR = 1.51), and the use of insulin (OR = 1.52), sulphonylureas (OR = 1.45), metformin (OR = 1.20) and thyroxine (OR = 1.36). Smoking, hormone replacement therapy, the combined oral contraceptive pill and oral corticosteroids were not associated with CTS. The results were similar when cases were restricted to those who had undergone carpal tunnel decompression.

Carpal Tunnel Syndrome in Obstructive Sleep Apnea Patients

Introduction

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity. It is usually associated with the compression of the median nerve in the median groove. Because the main symptoms of CTS pain and numbness worsen at night, sleep disorders in CTS patients and the impact of preferred sleeping position on CTS development have been formerly studied. However, to the best of our knowledge, this is the first study assessing the frequency of CTS in obstructive sleep apnea (OSA) patients. This study aimed to determine the frequency of CTS in OSA patients and evaluate the causative relation between the two diseases.

Methods

Records of individuals who were admitted to our sleep laboratory were retrospectively scanned. Eighty patients who were diagnosed with OSA and did not have comorbidities that might cause OSA (e.g., diabetes mellitus, hypothyroiditis, rheumatic diseases, and cervical radiculopathy) were included in the study along with 80 healthy controls who matched for age, sex, and BMI of OSA patients. To maintain observer blindness, patients were not questioned regarding their symptoms or the clinical data that would be used in the study. All participants underwent nerve conduction studies. Those who were diagnosed with CTS were questioned regarding CTS symptoms and the preferred sleeping position. Subsequently, patients were given the Boston CTS questionnaire.

Results

CTS frequency in OSA patients was found to be 27.5%. There was no significant relation between preferred sleeping position or being a manual worker and having CTS.

Conclusion

CTS frequency in OSA patients is significantly higher than that in healthy individuals. In contrast to previous studies that have been performed in the absence of polysomnographic and electrophysiological data, in our study biomechanical factors were not associated with CTS presence. Therefore, we conclude that intermittent hypoxemia is the main etiological factor for CTS in OSA patients. Inflammation may be a common factor for etiopathogenesis for both diseases, but this hypothesis needs further investigation.

Peripheral neuropathies

Peripheral neuropathies are diseases of the peripheral nervous system that can be divided into mononeuropathies, multifocal neuropathies, and polyneuropathies. Symptoms usually include numbness and paresthesia. These symptoms are often accompanied by weakness and can be painful. Polyneuropathies can be divided into axonal and demyelinating forms, which is important for diagnostic reasons. Most peripheral neuropathies develop over months or years, but some are rapidly progressive. Some patients only suffer from mild, unilateral, slowly progressive tingling in the fingers due to median nerve compression in the wrist (carpal tunnel syndrome), while other patients can be tetraplegic, with respiratory insufficiency within 1-2 days due to Guillain-Barré syndrome. Carpal tunnel syndrome, with a prevalence of 5% and incidence of 1-2 per 1000 person-years, is the most common mononeuropathy. Population-based data for chronic polyneuropathy are relatively scarce. Prevalence is estimated at 1% and increases to 7% in persons over 65 years of age. Incidence is approximately 1 per 1000 person-years. Immune-mediated polyneuropathies like Guillain-Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy are rare diseases, with an annual incidence of approximately 1-2 and 0.2-0.5 per 100 000 persons respectively. Most peripheral neuropathies are more prevalent in older adults and in men, except for carpal tunnel syndrome, which is more common in women. Diabetes is a common cause of peripheral neuropathy and is associated with both mono- and polyneuropathies. Among the group of chronic polyneuropathies, in about 20-25% no direct cause can be found. These are slowly progressive axonal polyneuropathies.

Effects of Metabolic Syndrome on the Outcome of Carpal Tunnel Release: A Matched Case-Control Study

PURPOSE

To compare outcomes of carpal tunnel release in patients with or without metabolic syndrome.

METHODS

In a prospective consecutive series, 35 patients with metabolic syndrome and surgically treated carpal tunnel syndrome (CTS) were age- and sex- matched with 37 control patients without metabolic syndrome. Grip, pinch strength, perception of touch with Semmes-Weinstein monofilament, and Boston Carpal Tunnel Questionnaires (BCTQ) were assessed preoperatively and at 3, 6, and 12 months postoperatively.

RESULTS

Patients with metabolic syndrome had more severe electrophysiologic grade of CTS than those without metabolic syndrome, but the 2 groups had similar preoperative grip/pinch strength and BCTQ scores. The BCTQ symptom score for the metabolic syndrome group was significantly greater than that of the control group at 3 months, and the BCTQ function score of the metabolic syndrome group was significantly greater than that of the control group at 3 and 6 months' follow-up. However, there was no significant difference in BCTQ symptom or functional scores between groups at 12 months' follow-up. There was no significant difference in grip strength between groups through 12 months' follow-up whereas the pinch strength of the control group was significantly greater than that of the metabolic syndrome group at 12 months' follow-up. Semmes-Weinstein monofilament test results were significantly greater in the control group than in the metabolic syndrome group at 3 and 6 months' follow-up but were similar at 12 months.

CONCLUSIONS

Patients with CTS and metabolic syndrome have delayed functional recovery after carpal tunnel release, but noteworthy improvements in symptom severity and hand function are similar to those in patients without metabolic syndrome 1 year after surgery.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic II.

Anthropometric measurements as a screening test for carpal tunnel syndrome: receiver operating characteristic curves and accuracy

OBJECTIVE

To identify optimal cutoff values for body, hand, and wrist measurements in order to correctly identify individuals with carpal tunnel syndrome (CTS), using receiver operating characteristic (ROC) curves.

METHODS

We enrolled patients with CTS and control subjects at a 1:2 ratio, regardless of age and sex. The diagnosis of CTS was based on clinical findings and delayed distal conduction velocity of the median nerve. The anthropometric measurements included weight, height, waist circumference, hip circumferences, wrist depth/width, third digit length, and palm length/width. Obesity indicators and hand/wrist ratios were calculated. Area under the ROC curve (AUC), sensitivity, specificity, and likelihood ratios were calculated separately according to sex. To assess the role of multiple anthropometric measurements, we fit multivariable logistic regression models including age, wrist ratio, shape index, body mass index, and waist-to-hip ratio.

RESULTS

The study group comprised 1,117 subjects (250 female patients and 474 female controls; 120 male patients and 273 male controls). In women, the accuracy of all anthropometric measures was low (AUC ≤0.64). In men, the accuracy of the hand ratio, shape index, and wrist-to-palm ratio was moderate (AUC = 0.75). The estimates from the multivariable models confirmed the well-known associations between the selected variables and the risk of CTS, but the use of multiple predictors did not dramatically improve the diagnostic performance observed for single anthropometric indexes.

CONCLUSION

In clinical practice, the cutoff values for many anthropometric measurements have limited value as tools for the diagnosis of CTS.

Carpal tunnel syndrome and prediabetes: is there a true association?

BACKGROUND

Carpal tunnel syndrome (CTS) is probably associated with diabetes mellitus, but its link to prediabetes (PD) is unknown.

OBJECTIVE

To determine prevalence of PD and others risk factors in CTS.

METHODS

A cross-sectional study including 115 idiopathic CTS patients and 115 age-, gender-and body mass index (BMI)-matched controls was performed. Clinical, laboratory and neurophysiological evaluations were conducted in all subjects to confirm CTS diagnosis. CTS severity was graded on a standardized neurophysiological scale. PD was defined using strict criteria.

RESULTS

The prevalence of PD was similar in CTS and control groups (27% vs. 21.7%, respectively P=0.44). Nocturnal symptoms (91.3%) and moderate CTS (58.3%) were most frequently observed in CTS patients. In logistic regression analysis, PD was significantly correlated with age (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.01-1.09; P=0.006) and BMI (OR 1.08. 95% CI 1.01-1.16; P=0.026), but not with CTS (OR 0.82, 95% CI 0.43-1.53; P=0.537). CTS patients with PD had a significantly higher mean age compared to those without PD (53.8±10.2 vs. 49.5±8.6 years, respectively P=0.027). The frequency of age >60 years was significantly higher in CTS with PD than in CTS without PD (29.0% vs. 8.3%, respectively P=0.04) as was BMI >30kg/m(2) (64.5% vs. 33.3%, respectively P=0.03). No significant differences were observed between the two CTS groups with respect to gender, BMI, symptoms, and neurophysiological severity of CTS.

CONCLUSIONS

Our findings indicated that CTS is not associated with PD, but that PD is closely linked to age and overweight.

Carpal tunnel syndrome and work

Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome, and it frequently presents in working-aged adults. Its mild form causes 'nuisance' symptoms including dysaesthesia and nocturnal waking. At its most severe, CTS can significantly impair motor function and weaken pinch grip. This review discusses the anatomy of the carpal tunnel and the clinical presentation of the syndrome as well as the classification and diagnosis of the condition. CTS has a profile of well-established risk factors including individual factors and predisposing co-morbidities, which are briefly discussed. There is a growing body of evidence for an association between CTS and various occupational factors, which is also explored. Management of CTS, conservative and surgical, is described. Finally, the issue of safe return to work post carpal tunnel release surgery and the lack of evidence-based guidelines are discussed.

Associations between workplace factors and carpal tunnel syndrome: A multi-site cross sectional study

BACKGROUND

Few large epidemiologic studies have used rigorous case criteria, individual-level exposure measurements, and appropriate control for confounders to examine associations between workplace psychosocial and biomechanical factors and carpal tunnel syndrome (CTS).

METHODS

Pooling data from five independent research studies, we assessed associations between prevalent CTS and personal, work psychosocial, and biomechanical factors while adjusting for confounders using multivariable logistic regression.

RESULTS

Prevalent CTS was associated with personal factors of older age, obesity, female sex, medical conditions, previous distal upper extremity disorders, workplace measures of peak forceful hand activity, a composite measure of force and repetition (ACGIH Threshold Limit Value for Hand Activity Level), and hand vibration.

CONCLUSIONS

In this cross-sectional analysis of production and service workers, CTS prevalence was associated with workplace and biomechanical factors. The findings were similar to those from a prospective analysis of the same cohort with differences that may be due to recall bias and other factors.

Waist circumference and waist-to-hip ratio in carpal tunnel syndrome: a case-control study

BACKGROUND

The association between carpal tunnel syndrome (CTS) and high body mass index (BMI) and some hand measures is well known. No study has been specifically focused on waist circumference (WC) and waist-to-hip-ratio (WHR). The aim of this prospective case-control study is to evaluate the association between CTS and WC, WHR and other body and hand anthropometric measures.

METHODS

We consecutively enrolled one "idiopathic" CTS case for two controls in 3 outpatient electromyography labs. The main anthropometric measures were BMI, WC, WHR, wrist ratio (WR) and hand ratio (HR). We performed univariate and multivariate analyses.

RESULTS

Female cases and controls were 250 and 474 and male cases and controls were 120 and 273, respectively. At univariate analysis there were differences in many anthropometric measures between cases and controls. At multivariate logistic regression analyses high BMI, WC and WHR and abnormal HR and WR were independent risk factors for CTS. Crossing two categories between BMI, WC and WHR, the overweight subjects, especially females, were at risk only if they had very high WC or high WHR. The risk increased if they were obese.

CONCLUSIONS

High WC/WHR doubles the risk of CTS, the risk further increased if overweight/obese subjects have also very high WC or high WHR. The obese subjects were always at risk regardless of WC and WHR values. Metabolic causes of this association with CTS were hypothesised. BMI is not the only and most powerful body predictor of "idiopathic" CTS, but also WHR and WC should be considered. These measures may not be interchangeable and it may be desirable to consider the utility of their joint use.

Differences in risk factors for neurophysiologically confirmed carpal tunnel syndrome and illness with similar symptoms but normal median nerve function: a case-control study

BACKGROUND

To explore whether risk factors for neurophysiologically confirmed carpal tunnel syndrome (CTS) differ from those for sensory symptoms with normal median nerve conduction, and to test the validity and practical utility of a proposed definition for impaired median nerve conduction, we carried out a case-control study of patients referred for investigation of suspected CTS.

METHODS

We compared 475 patients with neurophysiological abnormality (NP+ve) according to the definition, 409 patients investigated for CTS but classed as negative on neurophysiological testing (NP-ve), and 799 controls. Exposures to risk factors were ascertained by self-administered questionnaire. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated by logistic regression.

RESULTS

NP+ve disease was associated with obesity, use of vibratory tools, repetitive movement of the wrist or fingers, poor mental health and workplace psychosocial stressors. NP-ve illness was also related to poor mental health and occupational psychosocial stressors, but differed from NP+ve disease in showing associations also with prolonged use of computer keyboards and tendency to somatise, and no relation to obesity. In direct comparison of NP+ve and NP-ve patients (the latter being taken as the reference category), the most notable differences were for obesity (OR 2.7, 95 % CI 1.9-3.9), somatising tendency (OR 0.6, 95% CI 0.4-0.9), diabetes (OR 1.6, 95% CI 0.9-3.1) and work with vibratory tools (OR 1.4, 95% CI 0.9-2.2).

CONCLUSIONS

When viewed in the context of earlier research, our findings suggest that obesity, diabetes, use of hand-held vibratory tools, and repeated forceful movements of the wrist and hand are causes of impaired median nerve function. In addition, sensory symptoms in the hand, whether from identifiable pathology or non-specific in origin, may be rendered more prominent and distressing by hand activity, low mood, tendency to somatise, and psychosocial stressors at work. These differences in associations with risk factors support the validity of our definition of impaired median nerve conduction.

Carpal tunnel syndrome among ewe dairy farmers in Sardinia, Italy

BACKGROUND

The region of Sardinia, Italy is known internationally for the production of cheeses made from ewe's milk. Although the use of automated milking equipment is available in ewe dairy operations, traditional hand milking is still performed on many ewe farms. The purpose of this study was to evaluate the prevalence of carpal tunnel syndrome (CTS) among farmers that manually milk ewes.

METHODS

Worker demographics, upper limb symptoms, and electrophysiologic studies were obtained on 76 ewe farmers recruited from a random sample of 109 in northern Sardinia. Characteristic hand symptoms and electrophysiologic studies were used in the case definition of CTS.

RESULTS

Of the 76 farmers evaluated, 42 (55.3%) fit the case definition of CTS in at least one hand. Assuming that all non-respondents did not have CTS, the CTS prevalence ratio would have been 38.5% (42/109) among the randomized sample of ewe farmers.

CONCLUSIONS

These findings suggest that CTS is a significant occupational health issue for ewe farmers that continue the traditional methods of manual milking. The recent trend in automated ewe milking machines may help reduce the prevalence of CTS among the next generation of Italian ewe farmers.

Association of dental practice as a risk factor in the development of carpal tunnel syndrome

STATEMENT OF PROBLEM

Carpal tunnel syndrome (CTS) is an important cause of work disability. There is controversy over the relation between carpal tunnel syndrome and occupation. The aim of this study was to assess the relationship between the time-span of practicing dentistry and the role of dominant hands in the development of carpal tunnel syndrome.

MATERIALS AND METHOD

In this descriptive cross sectional study, 40 dentists and dental students (15 women and 25 men) undertook the electroneuro-diagnostic test in both hands by an electromyogram (EMG) and they were also evaluated in terms of self- reported clinical symptoms.

RESULTS

17.5% of participants were diagnosed to have decreased nerve conduction velocity while10% had reported clinical symptoms of CTS. Both dominant and non-dominant hands were involved. Within cases who were diagnosed as having median nerve neuropathy, 87.5% worked more than 20 hours per week. 57% had 17-23 years of dental practice experience and 14.2% of cases had10-16 years of practice in dentistry.

CONCLUSION

The high rate of CTS symptoms, in both dominant and non-dominant hand among dental practitioners with more years of dental practice, indicates a prequisite for particular attention, then sufficient education on the major risk factors causing this problem. Early diagnosis of these symptoms may improve the future management of the disease.

Prevalence and incidence of carpal tunnel syndrome in US working populations: pooled analysis of six prospective studies

OBJECTIVES

Most studies of carpal tunnel syndrome (CTS) incidence and prevalence among workers have been limited by small sample sizes or restricted to a small subset of jobs. We established a common CTS case definition and then pooled CTS prevalence and incidence data across six prospective studies of musculoskeletal outcomes to measure CTS frequency and allow better studies of etiology.

METHODS

Six research groups collected prospective data at > 50 workplaces including symptoms characteristic of CTS and electrodiagnostic studies (EDS) of the median and ulnar nerves across the dominant wrist. While study designs and the timing of data collection varied across groups, we were able to create a common CTS case definition incorporating both symptoms and EDS results from data that were collected in all studies.

RESULTS

At the time of enrollment, 7.8% of 4321 subjects met our case definition and were considered prevalent cases of CTS. During 8833 person-years of follow-up, an additional 204 subjects met the CTS case definition for an overall incidence rate of 2.3 CTS cases per 100 person-years.

CONCLUSIONS

Both prevalent and incident CTS were common in data pooled across multiple studies and sites. The large number of incident cases in this prospective study provides adequate power for future exposure-response analyses to identify work- and non-work-related risk factors for CTS. The prospective nature allows determination of the temporal relations necessary for causal inference.

Minimally invasive ultrasound-guided carpal tunnel release: a cadaver study

BACKGROUND

Carpal tunnel syndrome is a common condition frequently requiring surgical intervention. We describe a new minimally invasive surgical technique for carpal tunnel release utilizing ultrasound (US) visualization.

METHODS

The technique was performed on 20 fresh frozen cadaver specimens. A surgical metallic probe with a "U"-shaped trough and upward curved distal tip was precisely positioned in the carpal tunnel with US guidance followed by division of the flexor retinaculum (FR) with a "V"-shaped scalpel.

RESULTS

Complete division of the FR was confirmed by US. Dissection performed on the specimens confirmed complete release of FR and absence of neurovascular injury. The distance from the division of the FR to these structures, the "safety margins," was measured.

CONCLUSIONS

This new technique for carpal tunnel release appears to combine the safety and efficacy of open carpal tunnel surgery with the advantages of the minimally invasive techniques.

Pictorial essay: Role of ultrasound in failed carpal tunnel decompression

USG has been used for the diagnosis of carpal tunnel syndrome. Scarring and incomplete decompression are the main causes for persistence or recurrence of symptoms. We performed a retrospective study to assess the role of ultrasound in failed carpal tunnel decompression. Of 422 USG studies of the wrist performed at our center over the last 5 years, 14 were for failed carpal tunnel decompression. Scarring was noted in three patients, incomplete decompression in two patients, synovitis in one patient, and an anomalous muscle belly in one patient. No abnormality was detected in seven patients. We present a pictorial review of USG findings in failed carpal tunnel decompression.

Surface electromyography features in manual workers affected by carpal tunnel syndrome

INTRODUCTION

Alterations in surface electromyographic (sEMG) signals of the abductor pollicis brevis muscle were evaluated in 24 non-manual workers and 40 manual workers (25 asymptomatic and 15 reporting CTS symptoms).

METHODS

The initial value (IV) and the normalized rate of change (NRC) of average rectified value (ARV), mean frequency of the power spectrum (MNF), and muscle fiber conduction velocity (MFCV) were calculated during contractions at 20% and 50% of maximal voluntary contraction (MVC). Neuromuscular efficiency (NME) and kurtosis of the sEMG amplitude distribution were estimated.

RESULTS

With respect to controls, manual workers showed higher NME, lower ARV IV, and reduced myoelectric manifestations of fatigue (lower MNF NRC for both contraction levels, and lower MFCV NRC at 50% MVC). Kurtosis at 20% MVC showed higher values in symptomatic manual workers than in the other two groups.

CONCLUSIONS

Kurtosis seems to be a promising parameter for use in monitoring individuals who develop CTS.

PREVALENCE OF CARPAL TUNNEL SYNDROME IN WORKERS FROM A FISHNET FACTORY IN THAILAND

We determined the prevalence of carpal tunnel syndrome (CTS) at a fishnet factory in order to discern the possible associated risk factors at this type of workplace. The 662 workers were interviewed then physically examined. The prevalence of CTS was 14.5%, which is significantly higher than in the general population. Workers directly involved in the production of fishnets had a significantly higher risk of CTS than the factory's office workers or housemaids (odds ratio = 1.84; range, 1.03–3.29; 95% CI, p = 0.049). There was no association between the length of employment in the factory with CTS (odds ratio = 1.13; range, 0.77–1.66; 95% CI, p = 0.591). Our results confirm that factory jobs with repetitive hyperflexing and twisting of the wrists are at risk of CTS.

Carpal tunnel syndrome and metabolic syndrome co-occurrence

We aimed to evaluate the relation between the severity of carpal tunnel syndrome and metabolic syndrome. One hundred and fifty patients who had a clinical and electrophysiologically confirmed diagnosis of carpal tunnel syndrome (CTS), were included in this study. The patients were divided into two groups (with or without metabolic syndrome) according to the criteria of National Cholesterol Education Program. Eighty one (73.5 %) of the patients with CTS had metabolic syndrome. The patients with metabolic syndrome the severity of CTS was found 22.2 % had mild CTS, 56.8 % had moderate CTS, and 21 % had severe CTS. The patients without metabolic syndrome the severity of CTS was found 44.9 % had mild CTS, 40.6 % had moderate CTS, and 14.5 % had severe CTS. The severity of CTS between both groups was found to be statistically significant (p = 0.0009). While a correlation was found between the severity of CTS and high level of LDL with the presence of metabolic syndrome (correlation coefficient 0.209). In conclusion metabolic syndrome that appears to be a risk factor for CTS. At the same time, the presence of metabolic syndrome increases the severity of the disease.

The Strain Index (SI) and Threshold Limit Value (TLV) for Hand Activity Level (HAL): risk of carpal tunnel syndrome (CTS) in a prospective cohort

A cohort of 536 workers was enrolled from 10 diverse manufacturing facilities and was followed monthly for six years. Job physical exposures were individually measured. Worker demographics, medical history, psychosocial factors, current musculoskeletal disorders (MSDs) and nerve conduction studies (NCS) were obtained. Point and lifetime prevalence of carpal tunnel syndrome (CTS) at baseline (symptoms + abnormal NCS) were 10.3% and 19.8%. During follow-up, there were 35 new CTS cases (left, right or both hands). Factors predicting development of CTS included: job physical exposure (American conference of governmental industrial hygienists Threshold Limit Value (ACGIH TLV) for Hand Activity Level (HAL) and the Strain Index (SI)), age, BMI, other MSDs, inflammatory arthritis, gardening outside of work and feelings of depression. In the adjusted models, the TLV for HAL and the SI were both significant per unit increase in exposure with hazard ratios (HR) increasing up to a maximum of 5.4 (p = 0.05) and 5.3 (p = 0.03), respectively; however, similar to other reports, both suggested lower risk at higher exposures. Data suggest that the TLV for HAL and the SI are useful metrics for estimating exposure to biomechanical stressors.

PRACTITIONER SUMMARY

This study was conducted to determine how well the TLV for HAL and the SI predict risk of CTS using a prospective cohort design with survival analysis. Both the TLV for HAL and the SI were found to predict risk of CTS when adjusted for relevant covariates.

Socioeconomic deprivation and the epidemiology of carpal tunnel syndrome

Deprivation has been recognized as a major determinant of health and is associated with several musculoskeletal conditions. This study examines the effect of deprivation on the incidence of carpal tunnel syndrome using a regional prospective audit database. Over a 6 year period there were 1564 patients diagnosed with CTS with an annual incidence of 72/100,000 population. There was a significant difference in population incidence of CTS from the most deprived (81/100,000) to the least deprived (62/100,000) (p = 0.003). Functional impairment was higher in the most deprived group compared with the least (DASH 56 vs 48, p = 0.001). The most deprived group exhibited the greatest exposure to occupation vibration (42.7%), and had the greatest risk of bilateral disease (OR = 2.33, p < 0.001). We report an association between socioeconomic deprivation and carpal tunnel syndrome, with the disease being more likely to be bilateral and have a poorer DASH score in the most deprived patients.

Subclinical carpal tunnel syndrome in patients with acute stroke

BACKGROUND

Stroke is the first cause of morbidity all around the world. Entrapment neuropathies are a known complication of stroke. The objective of this study is to assess the frequency of subclinical carpal tunnel syndrome in the healthy and paretic hands of stroke patients.

METHODS

The authors performed nerve conduction study in the first three days after admission in 39 stroke patients without subclinical carpal tunnel syndrome and 30 days after admission. Electrophysiological studies were done in both paretic and non-paretic hands. Both ulnar and median nerves were studied.

RESULTS

After one month we found subclinical carpal tunnel syndrome in 16 paretic hands and 13 healthy hands. We did not find any difference in the frequency of carpal tunnel syndrome in two sides.

CONCLUSION

The authors suggest that simultaneous different mechanisms may act in inducing carpal tunnel syndrome in both hands of hemiparetic patients.

Preferred sleep position on the side is associated with carpal tunnel syndrome

BACKGROUND

Although carpal tunnel syndrome is the most common compressive neuropathy, there is no comprehensive theory of its etiology. Because of the prevalence of night symptoms, we are interested in the role of sleep position in the causation of carpal tunnel syndrome.

METHODS

We performed a case-control study comparing the prevalence of preferred sleep position in 68 cases and 138 controls. Analysis was stratified by age and gender and controlled for body mass index.

RESULTS

We found a strong and significant association between a preference for sleeping on the side and the presence of carpal tunnel syndrome in men and in women less than 60 years of age. Body mass index was associated with carpal tunnel syndrome in women but not men.

CONCLUSIONS

Our findings of a strong association between the presence of carpal tunnel syndrome and preferred sleeping on the side suggest a comprehensive unifying theory of causation.

Evaluating the effectiveness of local dexamethasone injection in pregnant women with carpal tunnel syndrome

BACKGROUND

Most of the medical treatments for carpal tunnel syndrome (CTS) have focused on suppressing the inflammatory process. An injection of dexamethasone acetate might provide the necessary cellular and humoral mediators to induce a healing cascade. Dexamethasone is a water-soluble steroid which is safe to be used in the third trimester, especially as a local treatment. The aim of this study was to evaluate the effectiveness of 4 mg dexamethasone acetate injection to treat carpal tunnel syndrome in pregnancy period.

METHODS

Twenty pregnant women with CTS were recruited using strict inclusion and exclusion criteria. All the patients had been injected with 4 mg of dexamethasone acetate and 0.5 ml lidocaine 1% under the carpal tunnel. Pain intensity (based on visual analog scale or VAS) and electro physiologic parameters of median nerve (transcarpal median sensory nerve conduction velocity (SNCV), distal motor latency (DML) and distal sensory latency (DSL) were recorded before and 3 weeks after the injection.

RESULTS

The average pain scores before and 3 weeks after the dexamethasone acetate injection was 8.70 ± 0.92 and 4.30 ± 0.76 respectively (p < 0.005). In addition, transcarpal SNCV of median nerve was 33.7 ± 6.3 m/s and 24.5 ± 6.8 m/s (p = 0.001); DML of median nerve was 5.16 ± 1.04 ms and 4.70 ± 0.53 ms (p = 0.001) and DSL of median nerve was 4.84 ± 0.77 ms and 4.2 ± 0.6 ms (p = 0.001), respectively.

CONCLUSIONS

After dexamethasone acetate injection, pain intensity and electrophysiological parameters were significantly improved. This study offered encouraging results for an alternative minimally invasive treatment for CTS in pregnant women.

Associations of cardiovascular risk factors, carotid intima-media thickness and manifest atherosclerotic vascular disease with carpal tunnel syndrome

BACKGROUND

The role of atherosclerosis in carpal tunnel syndrome (CTS) has not previously been addressed in population studies. The aim of this study was to investigate the associations of cardiovascular risk factors, carotid artery intima-media thickness (IMT), and clinical atherosclerotic diseases with CTS.

METHODS

In this cross sectional study, the target population consisted of subjects aged 30 or over who had participated in the national Finnish Health Survey in 2000-2001. Of the 7977 eligible subjects, 6254 (78.4%) were included in our study. Carotid IMT was measured in a sub-sample of subjects aged 45 to 74 (N=1353).

RESULTS

Obesity (adjusted odds ratio (OR) 2.4, 95% confidence interval (CI) 1.1-5.4), high LDL cholesterol (OR 3.8, 95% CI 1.6-9.1 for >190 vs. <129 mg/dL), high triglycerides (OR 2.7, 95% CI 1.2-6.1 for >200 vs. <150 mg/dL), hypertension (OR 3.4, 95% CI 1.6-7.4) and cardiac arrhythmia (OR 10.2, 95% CI 2.7-38.4) were associated with CTS in subjects aged 30-44. In the age group of 60 years or over, coronary artery disease (OR 1.9, 95% CI 1.1-3.5), valvular heart disease (OR 2.3, 95% CI 1.0-5.0) and carotid IMT (1.4, 95% CI 0.9-2.1 for each 0.23 mm increase) were associated with CTS. Carotid IMT was associated with CTS only in subjects with hypertension or clinical atherosclerotic vascular disease, or in those who were exposed to physical workload factors.

CONCLUSIONS

Our findings suggest an association between CTS and cardiovascular risk factors in young people, and carotid IMT and clinical atherosclerotic vascular disease in older people. CTS may either be a manifestation of atherosclerosis, or both conditions may share similar risk factors.