A Review of Carpal Tunnel Syndrome and Its Association with Age, Body Mass Index, Cardiovascular Risk Factors, Hand Dominance, and Sex

Risk factors, associations, and high-risk patient profiles for nocturnal pain in carpal tunnel syndrome: implications for patient care

INTRODUCTION

Carpal tunnel syndrome results from chronic compression of the median nerve, causing pain and paresthesia, especially at night. The impact of these symptoms on patients includes disrupted sleep patterns and a desire to alleviate discomfort through hand movements. Our study aims to investigate risk factors, associations, and high-risk patient profiles associated with these nocturnal manifestations in carpal tunnel syndrome.

METHODOLOGY

Utilizing a retrospective case-control design, our study comprises 681 patients with carpal tunnel syndrome, including 581 with nocturnal symptoms and 90 without. Data were obtained through personalized phone calls and health records, covering health profiles, medical comorbidities, perioperative variables, and selected outcomes.

RESULTS

Analyzing 591 patients with night symptoms revealed significant differences compared to the non-night symptoms group. The night symptoms group exhibited a lower mean age (51.3 vs. 56.6 years, p = 0.001), higher prevalence of diabetes (30.1% vs. 45.6%, p = 0.003), and paresthesia (98.5% vs. 81.1%, p < 0.001). In addition, the night symptoms group reported a higher incidence of disabling pain (89.2% vs. 70.0%, p < 0.001), weak hand grip (80.5% vs. 62.2%, p < 0.001), and night splints use (37.7% vs. 24.4%, p < 0.001). Preoperatively, the night symptoms group exhibited slightly higher intraoperative anxiety (40.9% vs. 30.0%, p = 0.12) and a slightly longer recovery time (1.7 vs. 1.4 months, p = 0.22), with no significant difference in pain relief scores (8.1 vs. 7.7, p = 0.16).

CONCLUSION

Patients with night symptoms show increased likelihood of comorbidities (diabetes, and renal, conditions), along with a propensity for disabling symptoms and paresthesia. Although they experience slightly longer recovery times, they demonstrate improved pain relief scores.

LEVEL OF EVIDENCE III

Case-Control Study.

Khachatryan L, Mohammadian-Hafshejani A. Investigating the association between diabetes and carpal tunnel syndrome: A systematic review and meta-analysis approach

INTRODUCTION

In recent years, several studies have reported on the relationship between diabetes and carpal tunnel syndrome (CTS). However, due to their contradictory results, a systematic review and meta-analysis were conducted to investigate this subject.

METHODS

This study is a systematic review and meta-analysis of studies published in ISI Web of Science, Scopus, PubMed, Cochrane, Google Scholar, and Embase databases. Heterogeneity in the studies included in the meta-analysis was evaluated using statistical tests such as the Chi-square test, I2, and forest plots. Publication bias was assessed using Begg's and Egger's tests.

RESULTS

This investigation analyzed data from 42 studies conducted between 1985 and 2022, with a total of 3,377,816 participants. The meta-analysis demonstrated that the odds ratio (OR) of CTS in participants with a history of diabetes compared to those without was 1.90 (95% CI: 1.64-2.21; P-value < 0.001). Given that publication bias was observed in this study (Begg's test P-value = 0.01), the modified OR was calculated with consideration of missed studies, which was 1.68 (95% CI: 1.45-1.94; P-value < 0.001).

CONCLUSION

The results of this study suggest that diabetic patients have 90% higher odds of developing CTS compared to non-diabetic individuals, which is statistically significant.

Occupational and non-occupational risk factors correlating with the severity of clinical manifestations of carpal tunnel syndrome and related work disability among workers who work with a computer

The contribution of certain occupational and personal factors to the development of carpal tunnel syndrome (CTS) is still uncertain. We investigated which specific occupational and non-occupational factors correlate with the level of clinical manifestations and work disability related to CTS. The study included 190 workers who work with a computer and have diagnosed CTS (100 men, 90 women, aged 20-65 years). Subjective experience of CTS-related impairments was assessed with the Symptom Severity Scale (SSS) and the Functional Status Scale (FSS) of the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). The objective, neural impairments were tested with electrodiagnostics (EDX), whereas CTS-related work disability data were collected from medical records. We found a high inter-correlation between BCTQ, EDX, and work disability data. These also showed high correlations with certain occupational factors (duration of computer-working in months and hours spent daily in computer-working, certain ergonomic, microclimatic, and other occupational conditions) and non-occupational factors (demographic and lifestyle factors: nutritional status, diet, smoking, alcohol consumption, and physical activity). Despite its limitations, our study has identified occupational and non-occupational risk factors that can aggravate CTS and work disability, but which can also be improved with workplace and lifestyle preventive and corrective measures. More research is needed, though, to establish the possible causal relationships and the independent influence of each of those risk factors.

Awareness of Carpal Tunnel Syndrome Among the Middle-Aged Population in Riyadh, Saudi Arabia

Background Carpal tunnel syndrome (CTS), a common and often underdiagnosed condition, imposes a significant burden on individuals, particularly in middle-aged populations. This study aims to assess the awareness and prevalence of CTS among middle-aged residents in Riyadh, highlighting the crucial need for targeted educational initiatives to address knowledge gaps. Methodology A cross-sectional study design was employed to capture a snapshot of CTS awareness and prevalence among the middle-aged population in Riyadh, Saudi Arabia. Participants aged 40-60 residing in Riyadh were included. A self-reported questionnaire gathered data on demographics, CTS diagnosis, and awareness levels regarding symptoms, risk factors, treatment, and the impact of CTS. Statistical analysis included descriptive statistics and Chi-squared tests. Results We collected 415 valid responses to the questionnaire. The demographic profile revealed a balanced gender distribution, with 48.4% (n=201) males and 51.6% (n=214) females, and a majority (66.5%; n=276) within the 40-50 age range. A substantial 87.2% (n=362) reported no prior CTS diagnosis. Neuroimaging studies were infrequently conducted at 15.9% (n=66). Participants exhibited significant knowledge gaps, notably in the awareness of CTS diagnosis 66.3% (n=275) uncertainty, symptoms 55.4% (n=230) lack of knowledge, and risk factors 54.7% (n=227) lack of awareness. The results indicated uncertainty regarding the relationship between CTS and diabetes 63.9% (n=265) and knowledge gaps on anesthesia methods for CTS operations 64.1% (n=294). The association between age and CTS diagnosis was significant (p-value 0.004), while awareness did not significantly vary with gender or age. Conclusion This study unveils a substantial lack of awareness about CTS among the middle-aged population in Riyadh, emphasizing the need for targeted educational interventions. The prevalence of CTS remains underreported, with a notable gap in understanding symptoms, risk factors, and available treatments; the findings underscore the vital importance of targeted educational programs designed to raise public awareness, bridge information gaps, and empower individuals to make informed decisions about their hand health.

The Mini-Incision Technique Versus Conventional Open Approach for Carpal Tunnel Release: A Retrospective, Comparative Cohort Study

Background and objective Open carpal tunnel release (OCTR) is the gold standard technique for treating carpal tunnel syndrome (CTS). While mini-incision carpal tunnel release (MCTR) has been introduced as an alternative approach, there have been some concerns over its effectiveness and risks. In light of this, the aim of the study was to compare the long-standing clinical outcomes after MCTR with those following OCTR. Methods We employed a retrospective cohort design for this study. Patients were classified into two surgery groups, followed up for two years, and compared in terms of the following variables: duration of symptoms; pinch strength; grip strength; 2-point discrimination; visual analog scale (VAS) score; Levine symptom score; Levine function score; quick disabilities of the arm, shoulder, and hand (QuickDASH) score; wound pain; and pillar pain. Results The study included data regarding 120 patients, 71.66% of whom were females. The MCTR and OCTR groups were similar in terms of age, sex, duration of symptoms, and certain other aspects at baseline. The operation duration (15.15 ±2.20 vs. 25.01 ±2.15 minutes, p<0.01) and incision length (11.425 ±1.56 vs. 20.35 ±2.43 mm, p<0.01) were significantly shorter in the MCTR group compared to the OCTR group. Wound pain and pillar pain were not documented in the MCTR group at three and six months. The OCTR group had pillar pain in 25% of the patients till two years postoperatively. Conclusion Based on our findings, we propose that MCTR is superior to OCTR. The mini-incision technique has the advantages of small incision and scar, low pain, and faster recovery. Moreover, the technique was also found to be safe with no major complications or recurrence of symptoms. Further randomized control trials may help to re-evaluate the technique and validate our findings.

Bilateral Idiopathic Carpal Tunnel Syndrome: Clinical-Functional Characterization and Efficacy of Two Combined Postoperative Physiotherapeutic Treatments

OBJECTIVE

To evaluate the efficacy of combined association instrument myofascial mobilization (IASTM) and stretching in patients with idiopathic bilateral carpal tunnel syndrome (CTS) operated on one hand and to analyze the response of the operated (OH) and non-operated (NH) hand according to the sequence of therapies. Research on these parameters has not yet been found in the literature.

METHODS

Randomized controlled crossover study with 43 participants using the objective and subjective outcome variables. Patients were randomly assigned to two groups: starting with stretching followed by IASTM and starting with IASTM followed by stretching. Then patients underwent surgery on the hand with more severe involvement and physical therapy rehabilitation was started 30 days after for a period of 4 weeks. After the 1-week interval the participants who started with stretching were referred to IASTM and vice versa, following the same previous patterns. The outpatient reassessments took place at 3 to 6 months. Crossover ANOVA and effect sizes were used as analysis methods.

RESULTS

Time was the most significant outcome for all variables both during therapies and at 6-month follow-up. Regarding response to the combined therapies between OH and NH, there were differences for both OH and NH, with the greatest impact on NH for the palmar grip and VAS variables. The treatment sequences were significant for pain on the NH and mental SF-12, suggesting that starting with IASTM followed by stretching had a superior outcome for these outcomes.

CONCLUSION

The combination of IASTM with stretching, used in the postoperative period of bilateral idiopathic CTS, proved to be supplementary, with significant results and large effect sizes for most of the outcomes assessed, both during the time of application of the therapies and in the 6-month follow-up for both hands, and may constitute a viable therapeutic alternative for this population.

Evaluation of Functional and Symptomatic Outcomes After Vitamin D3 Administration in Carpal Tunnel Syndrome With Hypovitaminosis D

BACKGROUND

Vitamin D deficiency is now recognized as an independent risk factor and is involved in the pathogenesis of carpal tunnel syndrome (CTS). The purpose of this study was to evaluate the effects of vitamin D3 supplementation on functional and symptomatic outcomes in CTS patients with vitamin D deficiency.

METHODS

This was a prospective, single-arm study with a pretreatment or posttreatment quasi-experimental design. Carpal tunnel syndrome patients with vitamin D deficiency were treated with vitamin D3 (60 000 IU/week) plus standard treatment for a period of 3 months. Carpal tunnel syndrome-related pain and functional and symptomatic outcomes were assessed at baseline and at 3 months posttreatment using the Visual Analogue Scale (VAS) and the Boston Carpal Tunnel Questionnaire, respectively, along with serum vitamin D.

RESULTS

A total of 42 patients were analyzed. At 3 months posttreatment, there was a significant reduction in the severity of pain (VAS score) from baseline (Z = -5.71, P < .001). Similarly, the functional and symptomatic outcomes (Boston symptoms severity scale [SSS] and Boston functional status scale [FSS] score) at 3 months posttreatment significantly improved in comparison with baseline (Boston SSS: Z = -5.66, P < .001; Boston FSS: Z = -5.68, P < .001).

CONCLUSIONS

Vitamin D3 supplementation was associated with improvement in functional and symptomatic outcomes and CTS-related pain in CTS with vitamin deficiency. However, further robust randomized controlled trials are warranted to validate the results.

Independent risk factors of carpal tunnel syndrome: Assessment of body mass index, hand, wrist and finger anthropometric measurements

BACKGROUND: The most prevalent neuropathy in the upper extremity is carpal tunnel syndrome (CTS). A variety of related risk factors such as biomechanical exposures, body mass index (BMI), sex and hand shape are reported to be related to CTS. OBJECTIVE: We aimed to identify the role of BMI, hand, wrist and finger anthropometric dimensions in the development of CTS, and to compare these measured variables between control and CTS participants. METHODS: A cross-sectional, case control study (n = 240, CTS = 120, controls = 120) with participants recruited from a convenience sample diagnosed with CTS and referred for anthropometric measurements. The control participants were matched by age and sex. The body height, weight, hand width, hand length, wrist depth, wrist width, wrist circumference, and finger length were measured. Hand, wrist and finger indices, hand to height ratio, and BMI were calculated. Mean values of all dimensions were compared between cases and controls, and the role of independent risk factors were determined by logistic regression analysis. RESULTS: The mean BMI, age, weight, sex and height were not significant between the two groups. Among the measured dimensions and calculated indices the significantly different variables between two groups were the wrist width, wrist depth, wrist circumference, hand index, hand to height index, and wrist index. Regression analysis showed that the wrist index (β=-1.7, p = 0.0001), wrist depth (β=0.25, p = 0.0001) and wrist width (β=0.21, p = 0.0001) were the strongest factors in CTS development in the sample. CONCLUSION: Wrist parameters have a strong role in predicting the development of CTS, while BMI was not confirmed as an independent risk factor.

Carpal Tunnel Syndrome and Hand-Arm Vibration: A Swedish National Registry Case-Control Study

OBJECTIVE

To investigate the increased risk for carpal tunnel syndrome (CTS) in men and women with hand-arm vibration (HAV) exposure.

DESIGN

Case-control study of CTS where 4396 cases was obtained from National Outpatient Register between 2005 through 2016. Cases were matched to controls and exposure was estimated using a job exposure matrix.

RESULTS

Exposure to HAV increased the risk of CTS with an OR of 1.61 (95% CI 1.46-1.77). The risk was highest in men <30 years of age and among women <30 years no increased risk was observed. The risk increased with a mean year exposure above 2.5 m/s2 to OR 1.84 (95% CI 1.38-2.46).

CONCLUSIONS

HAV exposure increase the risk of CTS in both genders, with highest risk increase in younger men. This emphasize identification of HAV exposure in patients with CTS.

Personal factors associated with carpal tunnel syndrome (CTS): a case-control study

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.

Association between carpal tunnel syndrome and trigger finger: a clinical and electrophysiological study

Background

Carpal tunnel syndrome is a prevalent mononeuropathy. Trigger finger is a flexor stenosing tenosynovitis. The aim of the study was to assess the concomitant occurrence of carpal tunnel syndrome and trigger finger in the same hand among patients presented with idiopathic carpal tunnel syndrome or idiopathic trigger finger. The study included 110 hands (75 patients) presented with carpal tunnel syndrome or trigger finger and 60 asymptomatic hands (46 apparently healthy individuals). Clinical assessment and neurophysiological evaluation were done.

Results

Regarding the presenting clinical complaints, there were 76 hands (69.1%) from 48 patients (64.0%) presented with idiopathic carpal tunnel syndrome. There 34 hands (30.9%) from 27 patients (36.0%) presented with idiopathic trigger finger. Classification of the patients into three groups depending on the final diagnosis: (I) carpal tunnel syndrome group, 57 hands (51.8%) with only carpal tunnel syndrome from 36 patients (48.0%); (II) trigger finger group, 25 hands (22.7%) with only trigger finger from 22 patients (29.3%); and (III) carpal tunnel syndrome with trigger finger group, 28 hands (25.5%) with both conditions from 24 patients (32.0%); and among them, seven patients had contralateral hand carpal tunnel syndrome only. The duration of complaints among the carpal tunnel syndrome with trigger finger group was significantly shorter than that in the other two groups. There were statistically significantly higher values of patient global assessment of hand symptoms and effect of hand symptoms on function and quality of life among the carpal tunnel syndrome with trigger finger group versus the other two groups. There was no statistically significant difference between the carpal tunnel syndrome with trigger finger group versus the carpal tunnel syndrome group regarding different classes of the Padua neurophysiological classification scale. The most common digit to have trigger finger was the middle finger in 19 hands (35.8%).

Conclusions

The concurrent presentation of idiopathic carpal tunnel syndrome and idiopathic trigger finger in the same hand is common. Each of them could be associated with the other one. The symptoms of one of them usually predominate the patient’s complaints. The identification of this association is essential for proper diagnosis and comprehensive management of patients presented with these conditions.

Assessment of carpal tunnel syndrome via ultrasonography among hospital workers: a screening study

Background

Carpal tunnel syndrome is a reasonably common disorder among working individuals. It may also be a cause of functional impairment. The aim of the study was to screen for the presence of carpal tunnel syndrome among hospital workers by non-invasive ultrasound.

Results

The prevalence of carpal tunnel syndrome diagnosed by ultrasound among hospital workers was 21.5%. Age and Boston carpal tunnel questionnaire scale were positively correlated to median nerve cross sectional area.

Conclusions

Ultrasound can be used as a non-invasive and convenient method for screening for carpal tunnel syndrome.

The effects of vitamin D supplementation in carpal tunnel syndrome treatment outcomes: a systematic review

PURPOSE

Vitamin D deficiency is related to carpal tunnel syndrome symptoms. Correcting vitamin D levels by supplementation was supposed to improve carpel tunnel symptoms, though there is a lack of aggregated data about treatment outcomes. This study aimed to examine whether vitamin D supplementation could improve the treatment outcomes in carpal tunnel syndrome patients.

METHODS

A comprehensive search of the PubMed, Cochrane Library, Scopus, and Web of Science databases for articles on vitamin D and carpel tunnel syndrome from January 2000 to March 2021 was performed. The article screening and data extraction were performed by two investigators independently with blinding to decisions on selected studies. All included studies had assessed the quality of evidence using the Methodological Index for Non-Randomized Studies (MINORS) scoring system.

RESULTS

We retrieved four studies that met the eligibility criteria. The treatment outcomes were evaluated by visual analog scale (124 wrists), functional scores (176 patients), muscle strength (84 patients), and nerve conduction velocity (216 wrists). After vitamin D supplementation, two studies reported improved pain scores and nerve conduction velocity, and three studies showed enhancement of functional status.

CONCLUSION

Vitamin D administration could offer favorable outcomes in pain improvement, better functional status, and increased sensory conduction velocity in carpal tunnel syndrome. However, there is to date no recommendations concerning a standardized dose or duration of vitamin D administration in carpal tunnel syndrome; prescribing vitamin D at the usual appropriate dose is suggested as an additional treatment in patients with mild to moderate carpel tunnel symptoms.

LEVEL OF EVIDENCE

Level IV, therapeutic study.

Machine learning-based approach for disease severity classification of carpal tunnel syndrome

Identifying the severity of carpal tunnel syndrome (CTS) is essential to providing appropriate therapeutic interventions. We developed and validated machine-learning (ML) models for classifying CTS severity. Here, 1037 CTS hands with 11 variables each were retrospectively analyzed. CTS was confirmed using electrodiagnosis, and its severity was classified into three grades: mild, moderate, and severe. The dataset was randomly split into a training (70%) and test (30%) set. A total of 507 mild, 276 moderate, and 254 severe CTS hands were included. Extreme gradient boosting (XGB) showed the highest external validation accuracy in the multi-class classification at 76.6% (95% confidence interval [CI] 71.2–81.5). XGB also had an optimal model training accuracy of 76.1%. Random forest (RF) and k-nearest neighbors had the second-highest external validation accuracy of 75.6% (95% CI 70.0–80.5). For the RF and XGB models, the numeric rating scale of pain was the most important variable, and body mass index was the second most important. The one-versus-rest classification yielded improved external validation accuracies for each severity grade compared with the multi-class classification (mild, 83.6%; moderate, 78.8%; severe, 90.9%). The CTS severity classification based on the ML model was validated and is readily applicable to aiding clinical evaluations.

Infrared thermal imaging monitoring on hands when performing repetitive tasks: An experimental study

The monitoring of infrared thermal images is reported to analyze changes in skin temperature in the hand fingers when repetitive work is performed to know which finger has a greater risk of injury, besides, the recovery time is analyzed regarding the initial temperature and its relationship with age, sex, weight, height if practice sports, and Body Mass Index (BMI) per individual. For the above, an experimental test was carried out for 10 minutes on a repetitive operation that takes place in the telecommunications industry and 39 subjects participated in which an infrared thermal image of the dorsal and palmar part of both hands was taken in periods of 5 minutes after the 10-minute test has elapsed. The results show that none of the participants recovered their initial temperature after 10 minutes of the experimental test. In addition, it was found that there is a relationship between skin temperature and sex, and that age influences the recovery of temperature. On the other hand, the thumb, index, and middle fingers have a higher risk of injury in the analyzed task. It is concluded that performing repetitive work with all the fingers of the hand does not show that all they have the same risk of injury, besides that, not all the variables studied affect the recovery of temperature and its behavior.

New and Emerging Risk Factors in Occupational Health

Workplace health and safety is constantly evolving both in developed and developing countries. Under the tumultuous development of technology, working environments are changing, leading to the onset of new occupational hazards and unprecedented risk conditions deriving from the new ways of organizing work. At the same time, progress in medical science, with the knowledge in the fields of genetics, metabolomics, big data, and smart technologies, makes it possible to promptly identify and treat risk conditions that would have escaped notice in the past. Personalized occupational medicine represents the frontier of prevention in the workplace, from the perspective of total worker health and the sustainability of resources. The contributions to this Special Issue range from chemical, physical, and biological to psychosocial risks, and from the search for new ways to control long-known risks, such as mercury toxicity, to observations of the most frequent pathologies in the workplace in the last twenty years, such as repetitive trauma diseases, immunodeficiency transmitted as a result of biological injuries, and violence and psychological trauma in the workplace. New insights are needed in occupational health and safety practice to address the new challenges in this field.