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Yamamoto M, Curley J, Hirata H. Trends in Open vs. Endoscopic Carpal Tunnel Release: A Comprehensive Survey in Japan. J Clin Med 2022; 11:jcm11174966. [PMID: 36078895 PMCID: PMC9456605 DOI: 10.3390/jcm11174966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 01/17/2023] Open
Abstract
We analyzed trends in open and endoscopic carpal tunnel release (CTR) from 2014 to 2019 using the National Database of Health Insurance Claims and Specific Health Checkups in Japan (NDB). Japan has a universal health insurance system and more than 95% of all claims are searchable in the NDB open data repository. The results revealed that nearly 40,000 CTRs were performed annually in Japan, and open CTR was performed almost 4 times more often than endoscopic CTR. The crude annual incidence of CTR in the general population among people 20 years of age or older was 32.2 per 100,000. The incidence of open CTR peaked in the 80–84 age range for both males and females. The incidence of endoscopic CTR peaked at 80–84 years in females and at 75–79 years in males. There was a mild correlation coefficient between the endoscopic CTRs and the number of hand surgery specialists by prefecture per population (r = 0.32, p = 0.04). However, the number of hand surgeons per capita by region and open CTR per capita was not correlated (r = 0.06, p = 0.67). There were about twice as many outpatient as inpatient surgeries, reflecting a trend toward ambulatory treatment.
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Fiat F, Merghes PE, Scurtu AD, Almajan Guta B, Dehelean CA, Varan N, Bernad E. The Main Changes in Pregnancy—Therapeutic Approach to Musculoskeletal Pain. Medicina (B Aires) 2022; 58:medicina58081115. [PMID: 36013582 PMCID: PMC9414568 DOI: 10.3390/medicina58081115] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/27/2022] [Accepted: 08/15/2022] [Indexed: 11/30/2022] Open
Abstract
Background and Objectives: During pregnancy, women undergo various physiological and anatomical changes that are accentuated as the pregnancy progresses, but return to their previous state a few weeks/months after the pregnancy. However, a targeted therapeutic approach is needed. Most of the time, during this period, these changes precipitate the appearance of pain, musculoskeletal pain being the most common. Pregnant women should avoid treating musculoskeletal pain with medication and should choose alternative and complementary methods. Exercise along with rest is the basis for treating chronic musculoskeletal pain. Side effects of physical therapy are rare and, in addition, it is not contraindicated in pregnant women. The benefits of this type of treatment in combating pain far outweigh the risks, being an easy way to improve quality of life. The objective of this article is to discuss the management of musculoskeletal pain during pregnancy, to identify the main musculoskeletal pain encountered in pregnant women along with drug treatment, and to expose the beneficial effects of alternative and complementary methods in combating pain. Materials and Methods: A literature search was conducted using medical databases, including PubMed, Google Scholar, and ScienceDirect, using the keywords “changes of pregnancy”, “musculoskeletal pain”, “pregnancy pain”, “pain management”, “pharmacological approach”, “alternative and complementary treatment” and specific sites. Information was collected from studies whose target population included pregnant women who complained of musculoskeletal pain during the 9 months of pregnancy; pregnant women with other pathologies that could increase their pain were not included in this review. Results: The articles related to the most common non-obstetric musculoskeletal pain in pregnancy along with pharmacological treatment options and alternative and complementary methods for musculoskeletal pain management during pregnancy were selected. Conclusions: The results were used to guide information towards the safest methods of therapy but also to raise awareness of the treatment criteria in order to compare the effectiveness of existing methods. Treatment must consider the implications for the mother and fetus, optimizing non-pharmacological therapeutic options.
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Affiliation(s)
- Felicia Fiat
- Department of Obstetrics-Gynecology II, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Petru Eugen Merghes
- Department of Physical Education and Sport, Banat’s University of Agricultural Sciences and Veterinary Medicine “King Mihai I of Romania” from Timisoara, Calea Aradului 119, 300645 Timisoara, Romania
| | - Alexandra Denisa Scurtu
- Department of Toxicology and Drug Industry, Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Research Centre for Pharmaco-Toxicological Evaluation, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Correspondence: (A.D.S.); (B.A.G.)
| | - Bogdan Almajan Guta
- Department of Physical Therapy and Special Motor Skills, Faculty of Physical Education and Sport, West University of Timisoara, Vasile Parvan Boulevard, No. 4, 300223 Timisoara, Romania
- Correspondence: (A.D.S.); (B.A.G.)
| | - Cristina Adriana Dehelean
- Department of Toxicology and Drug Industry, Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Research Centre for Pharmaco-Toxicological Evaluation, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Narcis Varan
- Department of Physical Education and Sport, Banat’s University of Agricultural Sciences and Veterinary Medicine “King Mihai I of Romania” from Timisoara, Calea Aradului 119, 300645 Timisoara, Romania
| | - Elena Bernad
- Department of Obstetrics-Gynecology II, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
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Stjernbrandt A, Vihlborg P, Wahlström V, Wahlström J, Lewis C. Occupational cold exposure and symptoms of carpal tunnel syndrome - a population-based study. BMC Musculoskelet Disord 2022; 23:596. [PMID: 35725430 PMCID: PMC9210706 DOI: 10.1186/s12891-022-05555-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cold exposure is an underrecognized occupational hazard that may increase the risk of peripheral nerve entrapment. The aim of this study was to determine if self-reported occupational exposure to contact and ambient cooling was associated with symptoms of carpal tunnel syndrome (CTS). METHODS In this mainly cross-sectional study, surveys were conducted on a population-based sample of men and women between 18 and 70 years of age, living in northern Sweden. Cold exposure and presence of symptoms suggestive of CTS were subjectively reported. Associations between exposure and outcome were evaluated using logistic regression. RESULTS The study included 2,703 women and 2,314 men, with a median age of 60 years (interquartile range 19). Symptoms of CTS were reported by 453 (9.2%). Being highly occupationally exposed (almost always) to contact cooling of the hands was associated with reporting CTS (OR 3.20; 95% CI 1.62-6.33), as was ambient cooling (OR 2.00; 95% CI 1.03-3.88) and severe ambient cooling (OR 4.02 95% CI 2.09-7.71), after adjusting for age, gender, body mass index, current daily smoking, diabetes mellitus, joint disease, and hand-arm vibration exposure. The point estimates increased with longer daily exposure duration. For workers exposed to severe ambient cooling for more than half of their working hours, in addition to performing heavy manual handling every day, the OR for reporting CTS was 7.25 (95% CI 3.88-13.53), with a positive additive interaction effect (expressed as relative excess risk due to interaction) of 4.67. CONCLUSIONS Self-reported occupational exposure to contact and ambient cooling was associated with symptoms suggestive of CTS. There were statistically significant positive exposure-response patterns for time spent exposed to contact and ambient cooling at work in relation to reporting symptoms of CTS. Positive additive interaction effects between cold exposure and heavy manual handling were also found. Since there was important potential uncontrolled confounding regarding repetitive wrist movements and forceful gripping, the results need to be confirmed by other studies, preferably with longitudinal design and more detailed exposure assessment.
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Affiliation(s)
- Albin Stjernbrandt
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, 901 87, Umeå, Sweden.
| | - Per Vihlborg
- Department of Geriatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Viktoria Wahlström
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, 901 87, Umeå, Sweden
| | - Jens Wahlström
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, 901 87, Umeå, Sweden
| | - Charlotte Lewis
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, 901 87, Umeå, Sweden
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Tamminga SJ, Kuijer PPFM, Badarin K, Alfonso JH, Amaro J, Curti S, Canu IG, Mattioli S, Mehlum IS, Rempel D, Roquelaure Y, Visser S, van der Molen HF. Towards harmonisation of case definitions for eight work-related musculoskeletal disorders - an international multi-disciplinary Delphi study. BMC Musculoskelet Disord 2021; 22:1018. [PMID: 34863143 PMCID: PMC8645098 DOI: 10.1186/s12891-021-04871-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background International consensus is needed on case definitions of work-related musculoskeletal disorders and diseases (MSDs) for use in epidemiological research. We aim to: 1) study what information is needed for the case definition of work-related low back pain (LBP), lumbosacral radicular syndrome (LRS), subacromial pain syndrome (SAPS), carpal tunnel syndrome (CTS), lateral and medial elbow tendinopathy, and knee and hip osteoarthritis, and to 2) seek consensus among occupational health professionals/researchers regarding the case definitions of these work-related MSDs. Methods A two-round Delphi study was conducted with occupational health professionals/researchers from 24 countries. Definition of work-related MSDs were composed of a case definition with work exposures. Round 1 included 32 case definitions and round 2, 60 case definitions. After two rounds, consensus required 75% of the panellists to rate a case definition including work exposures ≥7 points on a 9-point rating scale (completely disagree/completely agree). Results Fifty-eight panellists completed both rounds (response rate 90%). Forty-five (70%) panellists thought that for LBP a case definition can be based on symptoms only. Consensus was only reached for work-related medial elbow tendinopathy, while the lowest agreement was found for knee osteoarthritis. Where consensus was not reached, this was – except for LBP - related to physical examination and imaging rather than disagreement on key symptoms. Conclusion Consensus on case definitions was reached only for work-related medial elbow tendinopathy. Epidemiological research would benefit from harmonized case definitions for all MSDs including imaging and physical examination for LRS, SAPS, CTS, lateral elbow tendinopathy and hip and knee osteoarthritis. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04871-9.
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Affiliation(s)
- Sietske J Tamminga
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands.
| | - P Paul F M Kuijer
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Kathryn Badarin
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jose Hernán Alfonso
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
| | - Joana Amaro
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal
| | - Stefania Curti
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Irina Guseva Canu
- Department of Occupational and Environmental Health, Center of Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Stefano Mattioli
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Ingrid S Mehlum
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - David Rempel
- Division of Occupational and Environmental Medicine, University of California, San Francisco, USA
| | - Yves Roquelaure
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-49000, Angers, France
| | - Steven Visser
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Henk F van der Molen
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
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Bahrami E, Parvaresh M, Fattahi A, Farzan A, Kazemi F. Clinical Presentation of Foramen Magnum Meningioma Masqueraded by Carpal Tunnel Syndrome: A Report of 2 Cases. JBJS Case Connect 2021; 11:01709767-202112000-00043. [PMID: 34735377 DOI: 10.2106/jbjs.cc.20.00374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Meningioma is the second most common intracranial tumor. We present 2 cases of foramen magnum meningioma (FMM) that was first operated on with the diagnosis of carpal tunnel syndrome (CTS). CONCLUSION During the diagnostic assessment of CTS and recalcitrant CTS, a more proximal etiology of nerve compression should be considered, including FMM. If a more proximal cause of nerve dysfunction is suspected, cervical spine magnetic resonance imaging may be beneficial to evaluate a patient for spinal etiology.
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Affiliation(s)
- Eshagh Bahrami
- Department of Neurosurgery, Iran University of Medical Sciences, Tehran, Iran
| | - Mansour Parvaresh
- Department of Neurosurgery, Iran University of Medical Sciences, Tehran, Iran
| | - Arash Fattahi
- Department of Neurosurgery, Iran University of Medical Sciences, Tehran, Iran
| | - Abdolnaser Farzan
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Foad Kazemi
- Department of Neurosurgery, Iran University of Medical Sciences, Tehran, Iran
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Personal, biomechanical, psychosocial, and organizational risk factors for carpal tunnel syndrome: a structural equation modeling approach. Pain 2021; 161:749-757. [PMID: 31815912 DOI: 10.1097/j.pain.0000000000001766] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This longitudinal study aimed at exploring the direct and indirect relationships between organizational, psychosocial, biomechanical, and personal factors and carpal tunnel syndrome (CTS) in French workers. Between 2002 and 2005, 3710 workers were included in the Cosali cohort. Between 2007 and 2010, 1611 workers were re-examined using the same standardized clinical protocol. Subjects free from CTS at baseline were studied (804 men and 563 women). We used structural equation models to examine the relationships between incident CTS cases and organizational (machine-paced work or work pace dependent on customers' demand), psychosocial (job strain model), biomechanical (Borg's rating perceived exertion, wrist bending, pinching, and hand-transmitted vibrations), and personal factors at baseline. Symptomatic CTS risk was directly increased by biomechanical factors (standardized coefficient = 0.19, P = 0.011), female gender (0.25, P < 0.001), and age (0.15, P = 0.042). No psychosocial factors had a direct impact on CTS, but decision authority and skill discretion had an indirect impact by influencing biomechanical exposure. Exposure to machine-paced work had an indirect impact on increasing CTS, either by raising biomechanical exposure (0.19, P < 0.001) or by lowering decision authority (-0.18, P < 0.001) and skill discretion (-0.20, P < 0.001), which in turn increased biomechanical exposure. Similar complex relationships were observed between risk factors and CTS defined by a more strict case definition. Biomechanical exposure had a direct impact on CTS, while organizational factors and psychosocial factors had an indirect impact on CTS. The findings support conceptual models linking work organization to CTS.
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van der Molen HF, Visser S, Alfonso JH, Curti S, Mattioli S, Rempel D, Roquelaure Y, Kuijer PPFM, Tamminga SJ. Diagnostic criteria for musculoskeletal disorders for use in occupational healthcare or research: a scoping review of consensus- and synthesised-based case definitions. BMC Musculoskelet Disord 2021; 22:169. [PMID: 33573616 PMCID: PMC7879660 DOI: 10.1186/s12891-021-04031-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/28/2021] [Indexed: 12/19/2022] Open
Abstract
Background The aim of this study was to identify case definitions of diagnostic criteria for specific musculoskeletal disorders (MSDs) for use in occupational healthcare, surveillance or research. Methods A scoping review was performed in Medline and Web of Science from 2000 to 2020 by an international team of researchers and clinicians, using the Arksey and O’Malley framework to identify case definitions based on expert consensus or a synthesis of the literature. Seven MSDs were considered: non-specific low back pain (LBP), lumbosacral radicular syndrome (LRS), subacromial pain syndrome (SAPS), carpal tunnel syndrome (CTS), lateral or medial elbow tendinopathy, and knee and hip osteoarthritis (OA). Case definitions for occupational healthcare or research were charted according to symptoms, signs and instrumental assessment of signs, and if reported, on work-related exposure criteria. Results In total, 2404 studies were identified of which 39 were included. Fifteen studies (38%) reported on non-specific LBP, followed by knee OA (n = 8;21%) and CTS (n = 8;21%). For non-specific LBP, studies agreed in general on which symptoms (i.e., pain in lower back) and signs (i.e., absence of red flags) constituted a case definition while for the other MSDs considerable heterogeneity was found. Only two studies (5%), describing case definitions for LBP, CTS, and SAPS and lateral and medial elbow tendinopathy respectively, included work-related exposure criteria in their clinical assessment. Conclusion We found that studies on non-specific LBP agreed in general on which symptoms and signs constitute a case definition, while considerable heterogeneity was found for the other MSDs. For prevention of work-related MSDs, these MSD case definitions should preferably include work-related exposure criteria. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04031-z.
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Affiliation(s)
- Henk F van der Molen
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Steven Visser
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jose Hernán Alfonso
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
| | - Stefania Curti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Stefano Mattioli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - David Rempel
- Division of Occupational and Environmental Medicine, University of California, San Francisco, USA
| | - Yves Roquelaure
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, F-49000, Angers, France
| | - P Paul F M Kuijer
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Sietske J Tamminga
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
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Burton CL, Chen Y, Chesterton LS, van der Windt DA. Trends in the prevalence, incidence and surgical management of carpal tunnel syndrome between 1993 and 2013: an observational analysis of UK primary care records. BMJ Open 2018; 8:e020166. [PMID: 29921681 PMCID: PMC6020969 DOI: 10.1136/bmjopen-2017-020166] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 04/24/2018] [Accepted: 05/14/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To describe the prevalence, incidence and surgical management of carpal tunnel syndrome (CTS), between 1993 and 2013, as recorded in the Clinical Practice Research Datalink (CPRD). DESIGN We completed a series of cross-sectional epidemiological analyses to observe trends over time. SETTING Primary care data collected between 1993 and 2013, stored in the CPRD. POPULATION Individuals aged ≥18 years were selected. Prevalent and incident episodes of CTS and episodes of surgical intervention were identified using a list of preidentified Read codes. ANALYSIS We defined incident episodes as those with no preceding diagnostic code for CTS in the past 2 years of data. Episodes of surgery were expressed as a percentage of the prevalent population during the same calendar year. Joinpoint regression was used to determine significant changes in the underlying trend. RESULTS The prevalence of CTS increased over the study period, with a particular incline between 2000 and 2004 (annual percentage change 7.81). The female-to-male prevalence ratio reduced over time from 2.74 in 1993 to 1.93 in 2013. The median age of females and males with CTS were noted to increase from 49 and 53 years, respectively in 1993 to 54 and 59 years, respectively in 2013. Incidence was also noted to increase over time. After an initial increase between 1993 and 2007, the percentage of prevalent patients with a coded surgical episode began to decrease after 2007 to 27.41% in 2013 (annual percentage change -1.7). CONCLUSION This study has demonstrated that the prevalence and incidence of CTS increased over the study period between 1993 and 2013. Rates of surgery for CTS also increased over the study period; however after 2007, the per cent of patients receiving surgery showed a statistically significant decline back to the rate seen in 2004.
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Affiliation(s)
- Claire L Burton
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK
| | - Ying Chen
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK
| | - Linda S Chesterton
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK
| | - Danielle A van der Windt
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK
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El-Helaly M, Balkhy HH, Vallenius L. Carpal tunnel syndrome among laboratory technicians in relation to personal and ergonomic factors at work. J Occup Health 2017; 59:513-520. [PMID: 28855446 PMCID: PMC5721273 DOI: 10.1539/joh.16-0279-oa] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Work-related carpal tunnel syndrome (CTS) has been reported in different occupations, including laboratory technicians, so this study was carried out to determine the prevalence and the associated personal and ergonomic factors for CTS among laboratory technicians. METHODS A cross-sectional study was conducted among 279 laboratory technicians at King Fahd Hospital, Saudi Arabia, who filled in a self-administered questionnaire, including questions regarding their demographic criteria, occupational history, job tasks, workplace tools, ergonomic factors at work, and symptoms suggestive of CTS. Physical examinations and electrodiagnostic studies were carried out for those who had symptoms suggestive of CTS to confirm the diagnosis. Univariate and multivariate analysis were performed for both personal and physical factors in association with confirmed CTS among laboratory technicians. RESULTS The prevalence of CTS among the laboratory technicians was 9.7% (27/279). The following were the statistically significant risk factors for CTS among them: gender (all cases of CTS were female, P=0.00), arm/hand exertion (OR: 7.96; 95% CI: 1.84-34.33), pipetting (OR: 7.27; 95% CI: 3.15-16.78), repetitive tasks (OR: 4.60; 95% CI: 1.39-15.70), using unadjustable chairs or desks (OR: 3.35; 95% CI: 1.23-9.15), and working with a biosafety cabinet (OR: 2.49; 95% CI: 1.11-5.59). CTS cases had significant longer work duration (17.9 ± 5.6 years) than CTS non-case (11.5 ± 7.4 yeas) with low OR (1.108). CONCLUSION This study demonstrates some personal and ergonomic factors associated with CTS among the laboratory technicians, including female gender, arm/hand exertion, pipetting, repetitive tasks, working with a biosafety cabinet, and an unadjusted workstation.
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Affiliation(s)
- Mohamed El-Helaly
- Department of Infection Prevention and Control, King Abdulaziz Medical City.,Community Medicine Department, Faculty of Medicine, Mansoura University
| | - Hanan H Balkhy
- Department of Infection Prevention and Control, King Abdulaziz Medical City
| | - Laura Vallenius
- Department of Infection Prevention and Control, King Abdulaziz Medical City
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An TW, Evanoff BA, Boyer MI, Osei DA. The Prevalence of Cubital Tunnel Syndrome: A Cross-Sectional Study in a U.S. Metropolitan Cohort. J Bone Joint Surg Am 2017; 99:408-416. [PMID: 28244912 PMCID: PMC5324036 DOI: 10.2106/jbjs.15.01162] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although cubital tunnel syndrome is the second most common peripheral mononeuropathy (after carpal tunnel syndrome) encountered in clinical practice, its prevalence in the population is unknown. The objective of this study was to evaluate the prevalence of cubital tunnel syndrome in the general population. METHODS We surveyed a cohort of adult residents of the St. Louis metropolitan area to assess for the severity and localization of hand symptoms using the Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SSS) and the Katz hand diagram. We identified subjects who met our case definitions for cubital tunnel syndrome and carpal tunnel syndrome: self-reported hand symptoms associated with a BCTQ-SSS score of >2 and localization of symptoms to the ulnar nerve or median nerve distributions. RESULTS Of 1,001 individuals who participated in the cross-sectional survey, 75% were women and 79% of the cohort was white; the mean age (and standard deviation) was 46 ± 15.7 years. Using a more sensitive case definition (lax criteria), we identified 59 subjects (5.9%) with cubital tunnel syndrome and 68 subjects (6.8%) with carpal tunnel syndrome. Using a more specific case definition (strict criteria), we identified 18 subjects (1.8%) with cubital tunnel syndrome and 27 subjects (2.7%) with carpal tunnel syndrome. CONCLUSIONS The prevalence of cubital tunnel syndrome in the general population may be higher than that reported previously. When compared with previous estimates of disease burden, the active surveillance technique used in this study may account for the higher reported prevalence. This finding suggests that a proportion of symptomatic subjects may not self-identify and may not seek medical treatment. CLINICAL RELEVANCE This baseline estimate of prevalence for cubital tunnel syndrome provides a valuable reference for future diagnostic and prognostic study research and for the development of clinical practice guidelines.
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Affiliation(s)
- Tonya W. An
- Division of General Medical Sciences (B.A.E.), Department of Orthopedic Surgery (M.I.B. and D.A.O.), School of Medicine (T.W.A.), and Institute of Clinical and Translational Sciences (B.A.E. and D.A.O.), Washington University, St. Louis, Missouri
| | - Bradley A. Evanoff
- Division of General Medical Sciences (B.A.E.), Department of Orthopedic Surgery (M.I.B. and D.A.O.), School of Medicine (T.W.A.), and Institute of Clinical and Translational Sciences (B.A.E. and D.A.O.), Washington University, St. Louis, Missouri
| | - Martin I. Boyer
- Division of General Medical Sciences (B.A.E.), Department of Orthopedic Surgery (M.I.B. and D.A.O.), School of Medicine (T.W.A.), and Institute of Clinical and Translational Sciences (B.A.E. and D.A.O.), Washington University, St. Louis, Missouri
| | - Daniel A. Osei
- Division of General Medical Sciences (B.A.E.), Department of Orthopedic Surgery (M.I.B. and D.A.O.), School of Medicine (T.W.A.), and Institute of Clinical and Translational Sciences (B.A.E. and D.A.O.), Washington University, St. Louis, Missouri,E-mail address for D.A. Osei:
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Bonfiglioli R, Mattioli S, Violante FS. Occupational mononeuropathies in industry. HANDBOOK OF CLINICAL NEUROLOGY 2015; 131:411-26. [PMID: 26563800 DOI: 10.1016/b978-0-444-62627-1.00021-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Peripheral nerve injuries have the potential to cause significant disability and can be commonly associated with recreational and occupational activities. Acute nerve injuries are mainly related to violent trauma, while repeated mechanical trauma due to external forces or repetitive motions can produce chronic nerve compression injury. This chapter will present a narrative review of the existing evidence of the association between peripheral compressive nerve disorders and work-related risk factors. Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy in the general population and in working populations employed in manual repetitive and forceful activities. The work-relatedness of CTS is essentially based on epidemiologic evidence and the results of experimental studies showing the capability of repetitive wrist extreme postures, associated with hand-wrist forceful exertions, to increase the pressure inside the carpal tunnel and to compress the median nerve. Assembly industry, food processing and packaging, hand-arm vibrating tools, and jobs involving high-repetition, high-force tasks put workers at risk for CTS. Less strong evidence exists of the association between ulnar elbow neuropathy and manual tasks or repetitive stretch on squatting and peroneal nerve neuropathy at the fibular head. Very few reports are available about the association between occupation and other compressive peripheral nerve injuries.
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Affiliation(s)
- Roberta Bonfiglioli
- Occupational Health Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Stefano Mattioli
- Occupational Health Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Francesco S Violante
- Occupational Health Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Mediouni Z, Bodin J, Dale AM, Herquelot E, Carton M, Leclerc A, Fouquet N, Dumontier C, Roquelaure Y, Evanoff BA, Descatha A. Carpal tunnel syndrome and computer exposure at work in two large complementary cohorts. BMJ Open 2015; 5:e008156. [PMID: 26353869 PMCID: PMC4567686 DOI: 10.1136/bmjopen-2015-008156] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The boom in computer use and concurrent high rates in musculoskeletal complaints and carpal tunnel syndrome (CTS) among users have led to a controversy about a possible link. Most studies have used cross-sectional designs and shown no association. The present study used longitudinal data from two large complementary cohorts to evaluate a possible relationship between CTS and the performance of computer work. SETTINGS AND PARTICIPANTS The Cosali cohort is a representative sample of a French working population that evaluated CTS using standardised clinical examinations and assessed self-reported computer use. The PrediCTS cohort study enrolled newly hired clerical, service and construction workers in several industries in the USA, evaluated CTS using symptoms and nerve conduction studies (NCS), and estimated exposures to computer work using a job exposure matrix. PRIMARY AND SECONDARY OUTCOME MEASURES During a follow-up of 3-5 years, the association between new cases of CTS and computer work was calculated using logistic regression models adjusting for sex, age, obesity and relevant associated disorders. RESULTS In the Cosali study, 1551 workers (41.8%) completed follow-up physical examinations; 36 (2.3%) participants were diagnosed with CTS. In the PrediCTS study, 711 workers (64.2%) completed follow-up evaluations, whereas 31 (4.3%) had new cases of CTS. The adjusted OR for the group with the highest exposure to computer use was 0.39 (0.17; 0.89) in the Cosali cohort and 0.16 (0.05; 0.59) in the PrediCTS cohort. CONCLUSIONS Data from two large cohorts in two different countries showed no association between computer work and new cases of CTS among workers in diverse jobs with varying job exposures. CTS is far more common among workers in non-computer related jobs; prevention efforts and work-related compensation programmes should focus on workers performing forceful hand exertion.
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Affiliation(s)
- Z Mediouni
- Inserm, Population-Based Epidemiological Cohorts Unit, UMS 011, Villejuif, France
- Versailles St-Quentin University, UMS 011, Villejuif, France
- AP-HP, Occupational Health Unit/EMS (Samu92), University hospital of West suburb of Paris, Poincaré site, Garches, France
| | - J Bodin
- Laboratory of Ergonomics and Epidemiology in Occupational Health (LEEST), LUNAM University, University of Angers, Angers, France
| | - A M Dale
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - E Herquelot
- Inserm, Population-Based Epidemiological Cohorts Unit, UMS 011, Villejuif, France
- Versailles St-Quentin University, UMS 011, Villejuif, France
| | - M Carton
- Inserm, Population-Based Epidemiological Cohorts Unit, UMS 011, Villejuif, France
- Versailles St-Quentin University, UMS 011, Villejuif, France
| | - A Leclerc
- Inserm, Population-Based Epidemiological Cohorts Unit, UMS 011, Villejuif, France
- Versailles St-Quentin University, UMS 011, Villejuif, France
- Inserm, UMR-S VIMA, Villejuif, France
| | - N Fouquet
- Laboratory of Ergonomics and Epidemiology in Occupational Health (LEEST), LUNAM University, University of Angers, Angers, France
- Department of Occupational Health, French Institute for Public Health Surveillance, Saint-Maurice, France
| | - C Dumontier
- Hand Center, Clinique les eaux claires, ZAC Moudong Sud, Baie Mahault, France
| | - Y Roquelaure
- Laboratory of Ergonomics and Epidemiology in Occupational Health (LEEST), LUNAM University, University of Angers, Angers, France
- CHU Angers, Angers, France
| | - B A Evanoff
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - A Descatha
- Inserm, Population-Based Epidemiological Cohorts Unit, UMS 011, Villejuif, France
- Versailles St-Quentin University, UMS 011, Villejuif, France
- AP-HP, Occupational Health Unit/EMS (Samu92), University hospital of West suburb of Paris, Poincaré site, Garches, France
- Inserm, UMR-S VIMA, Villejuif, France
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Fan ZJ, Harris-Adamson C, Gerr F, Eisen EA, Hegmann KT, Bao S, Silverstein B, Evanoff B, Dale AM, Thiese MS, Garg A, Kapellusch J, Burt S, Merlino L, Rempel D. Associations between workplace factors and carpal tunnel syndrome: A multi-site cross sectional study. Am J Ind Med 2015; 58:509-18. [PMID: 25778111 DOI: 10.1002/ajim.22443] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2015] [Indexed: 11/07/2022]
Abstract
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.
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Affiliation(s)
- Z. Joyce Fan
- Washington Traffic Safety Commission; Olympia Washington
| | - Carisa Harris-Adamson
- Department of Environmental Health Sciences; University of California Berkeley; Berkeley California
- Department of Physical Therapy; Samuel Merritt University; Oakland California
| | - Fred Gerr
- Department of Occupational and Environmental Health; College of Public Health; University of Iowa; Iowa City Iowa
| | - Ellen A. Eisen
- Department of Environmental Health Sciences; University of California Berkeley; Berkeley California
| | - Kurt T. Hegmann
- Rocky Mountain Center for Occupational and Environmental Health (RMCOEH); University of Utah; Salt Lake City Utah
| | - Stephen Bao
- Safety and Health Assessment and Research for Prevention (SHARP) Program; Washington State Department of Labor and Industries; Olympia Washington
| | - Barbara Silverstein
- Safety and Health Assessment and Research for Prevention (SHARP) Program; Washington State Department of Labor and Industries; Olympia Washington
| | - Bradley Evanoff
- Division of General Medical Science; Washington University School of Medicine; Saint Louis Missouri
| | - Ann Marie Dale
- Division of General Medical Science; Washington University School of Medicine; Saint Louis Missouri
| | - Matthew S. Thiese
- Rocky Mountain Center for Occupational and Environmental Health (RMCOEH); University of Utah; Salt Lake City Utah
| | - Arun Garg
- Center for Ergonomics; University of Wisconsin-Milwaukee; Milwaukee Wisconsin
| | - Jay Kapellusch
- Center for Ergonomics; University of Wisconsin-Milwaukee; Milwaukee Wisconsin
| | - Susan Burt
- National Institute for Occupational Safety and Health (NIOSH); Cincinnati Ohio
| | - Linda Merlino
- Department of Occupational and Environmental Health; College of Public Health; University of Iowa; Iowa City Iowa
| | - David Rempel
- Division of Occupational and Environmental Medicine; University of California at San Francisco; San Francisco California
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Petit A, Ha C, Bodin J, Rigouin P, Descatha A, Brunet R, Goldberg M, Roquelaure Y. Risk factors for carpal tunnel syndrome related to the work organization: a prospective surveillance study in a large working population. APPLIED ERGONOMICS 2015; 47:1-10. [PMID: 25479968 DOI: 10.1016/j.apergo.2014.08.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 06/25/2014] [Accepted: 08/04/2014] [Indexed: 06/04/2023]
Abstract
The study aimed to determine the risk factors for incident carpal tunnel syndrome (CTS) in a large working population, with a special focus on factors related to work organization. In 2002-2005, 3710 workers were assessed and, in 2007-2010, 1611 were re-examined. At baseline all completed a self-administered questionnaire about personal/medical factors and work exposure. CTS symptoms and physical examination signs were assessed by a standardized medical examination at baseline and follow-up. The risk of "symptomatic CTS" was higher for women (OR = 2.9 [1.7-5.2]) and increased linearly with age (OR = 1.04 [1.00-1.07] for 1-year increment). Two work organizational factors remained in the multivariate risk model after adjustment for the personal/medical and biomechanical factors: payment on a piecework basis (OR = 2.0, 95% CI 1.1-3.5) and work pace dependent on automatic rate (OR = 1.9, 95% CI 0.9-4.1). Several factors related to work organization were associated with incident CTS after adjustment for potential confounders.
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Affiliation(s)
- Audrey Petit
- LUNAM Université, Université d'Angers, Laboratoire d'ergonomie et d'épidémiologie en santé au travail (LEEST), Angers, France.
| | - Catherine Ha
- Département santé travail, Institut de veille sanitaire (DST-InVS), Saint-Maurice, France
| | - Julie Bodin
- LUNAM Université, Université d'Angers, Laboratoire d'ergonomie et d'épidémiologie en santé au travail (LEEST), Angers, France
| | - Pascal Rigouin
- LUNAM Université, Université d'Angers, Laboratoire d'ergonomie et d'épidémiologie en santé au travail (LEEST), Angers, France
| | - Alexis Descatha
- INSERM, Université de Versailles St-Quentin, UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France
| | - René Brunet
- LUNAM Université, Université d'Angers, Laboratoire d'ergonomie et d'épidémiologie en santé au travail (LEEST), Angers, France
| | - Marcel Goldberg
- INSERM, Université de Versailles St-Quentin, UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France
| | - Yves Roquelaure
- LUNAM Université, Université d'Angers, Laboratoire d'ergonomie et d'épidémiologie en santé au travail (LEEST), Angers, France
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15
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Musculoskeletal problems in pregnancy. Rheumatol Int 2014; 35:581-7. [DOI: 10.1007/s00296-014-3135-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 09/12/2014] [Indexed: 10/24/2022]
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Thiese MS, Gerr F, Hegmann KT, Harris-Adamson C, Dale AM, Evanoff B, Eisen EA, Kapellusch J, Garg A, Burt S, Bao S, Silverstein B, Merlino L, Rempel D. Effects of varying case definition on carpal tunnel syndrome prevalence estimates in a pooled cohort. Arch Phys Med Rehabil 2014; 95:2320-6. [PMID: 25175160 DOI: 10.1016/j.apmr.2014.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 08/02/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To analyze differences in carpal tunnel syndrome (CTS) prevalence using a combination of electrodiagnostic studies (EDSs) and symptoms using EDS criteria varied across a range of cutpoints and compared with symptoms in both ≥1 and ≥2 median nerve-served digits. DESIGN Pooled data from 5 prospective cohorts. SETTING Hand-intensive industrial settings, including manufacturing, assembly, production, service, construction, and health care. PARTICIPANTS Employed, working-age participants who are able to provide consent and undergo EDS testing (N=3130). INTERVENTIONS None. MAIN OUTCOME MEASURES CTS prevalence was estimated while varying the thresholds for median sensory latency, median motor latency, and transcarpal delta latency difference. EDS criteria examined included the following: median sensory latency of 3.3 to 4.1 milliseconds, median motor latency of 4.1 to 4.9 milliseconds, and median-ulnar sensory difference of 0.4 to 1.2 milliseconds. EDS criteria were combined with symptoms in ≥1 or ≥2 median nerve-served digits. EDS criteria from other published studies were applied to allow for comparison. RESULTS CTS prevalence ranged from 6.3% to 11.7%. CTS prevalence estimates changed most per millisecond of sensory latency compared with motor latency or transcarpal delta. CTS prevalence decreased by 0.9% to 2.0% if the criteria required symptoms in 2 digits instead of 1. CONCLUSIONS There are meaningful differences in CTS prevalence when different EDS criteria are applied. The digital sensory latency criteria result in the largest variance in prevalence.
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Affiliation(s)
- Matthew S Thiese
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, Salt Lake City, UT.
| | - Fred Gerr
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, IA
| | - Kurt T Hegmann
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, Salt Lake City, UT
| | | | - Ann Marie Dale
- Division of General Medical Science, Washington University School of Medicine, Saint Louis, MO
| | - Bradley Evanoff
- Division of General Medical Science, Washington University School of Medicine, Saint Louis, MO
| | - Ellen A Eisen
- Department of Environmental Health Sciences, University of California Berkeley, Berkeley, CA
| | - Jay Kapellusch
- Center for Ergonomics, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - Arun Garg
- Center for Ergonomics, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - Susan Burt
- National Institute for Occupational Safety and Health, Cincinnati, OH
| | - Stephen Bao
- Safety and Health Assessment and Research for Prevention Program, Washington State Department of Labor and Industries, Olympia, WA
| | - Barbara Silverstein
- Safety and Health Assessment and Research for Prevention Program, Washington State Department of Labor and Industries, Olympia, WA
| | - Linda Merlino
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, IA
| | - David Rempel
- Division of Occupational and Environmental Medicine, University of California at San Francisco, San Francisco, CA
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Violante FS, Bonfiglioli R, Hagberg M, Rempel D. Carpal tunnel syndrome diagnosis in occupational epidemiological studies. Occup Environ Med 2014; 71:591. [PMID: 24879372 DOI: 10.1136/oemed-2013-102061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- F S Violante
- Department of Medical and Surgical Science, Occupational Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - R Bonfiglioli
- Department of Medical and Surgical Science, Occupational Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - M Hagberg
- Department of Public Health and Community Medicine, Occupational and Environmental Medicine, University of Gothenburg (UGOT), Gothenburg, Sweden
| | - D Rempel
- Division of Occupational and Environmental Medicine, University of California, San Francisco, USA
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Ntani G, Palmer KT, Linaker C, Harris EC, Van der Star R, Cooper C, Coggon D. Symptoms, signs and nerve conduction velocities in patients with suspected carpal tunnel syndrome. BMC Musculoskelet Disord 2013; 14:242. [PMID: 23947775 PMCID: PMC3765787 DOI: 10.1186/1471-2474-14-242] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 08/09/2013] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND To inform the clinical management of patients with suspected carpal tunnel syndrome (CTS) and case definition for CTS in epidemiological research, we explored the relation of symptoms and signs to sensory nerve conduction (SNC) measurements. METHODS Patients aged 20-64 years who were referred to a neurophysiology service for investigation of suspected CTS, completed a symptom questionnaire (including hand diagrams) and physical examination (including Tinel's and Phalen's tests). Differences in SNC velocity between the little and index finger were compared according to the anatomical distribution of symptoms in the hand and findings on physical examination. RESULTS Analysis was based on 1806 hands in 908 patients (response rate 73%). In hands with numbness or tingling but negative on both Tinel's and Phalen's tests, the mean difference in SNC velocities was no higher than in hands with no numbness or tingling. The largest differences in SNC velocities occurred in hands with extensive numbness or tingling in the median nerve sensory distribution and both Tinel's and Phalen's tests positive (mean 13.8, 95% confidence interval (CI) 12.6-15.0 m/s). Hand pain and thumb weakness were unrelated to SNC velocity. CONCLUSIONS Our findings suggest that in the absence of other objective evidence of median nerve dysfunction, there is little value in referring patients of working age with suspected CTS for nerve conduction studies if they are negative on both Tinel's and Phalen's tests. Alternative case definitions for CTS in epidemiological research are proposed according to the extent of diagnostic information available and the relative importance of sensitivity and specificity.
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Affiliation(s)
- Georgia Ntani
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK.
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Luckhaupt SE, Dahlhamer JM, Ward BW, Sweeney MH, Sestito JP, Calvert GM. Prevalence and work-relatedness of carpal tunnel syndrome in the working population, United States, 2010 National Health Interview Survey. Am J Ind Med 2013; 56:615-24. [PMID: 22495886 DOI: 10.1002/ajim.22048] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2012] [Indexed: 11/09/2022]
Abstract
BACKGROUND Patterns of prevalence and work-relatedness of carpal tunnel syndrome (CTS) among workers offer clues about risk factors and targets for prevention. METHODS Data from an occupational health supplement to the 2010 National Health Interview Survey were used to estimate the prevalence of self-reported clinician-diagnosed CTS overall and by demographic characteristics. The proportion of these cases self-reported to have been attributed to work by clinicians was also examined overall and by demographic characteristics. In addition, the distribution of industry and occupation (I&O) categories to which work-related cases of CTS were attributed was compared to the distribution of I&O categories of employment among current/recent workers. RESULTS Data were available for 27,157 adults, including 17,524 current/recent workers. The overall lifetime prevalence of clinician-diagnosed CTS among current/recent workers was 6.7%. The 12-month prevalence was 3.1%, representing approximately 4.8 million workers with current CTS; 67.1% of these cases were attributed to work by clinicians, with overrepresentation of certain I&O categories. CONCLUSIONS CTS affected almost 5 million U.S. workers in 2010, with prevalence varying by demographic characteristics and I&O.
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Affiliation(s)
- Sara E Luckhaupt
- Division of Surveillance, Hazard Evaluations and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH 45226, USA.
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Dale AM, Harris-Adamson C, Rempel D, Gerr F, Hegmann K, Silverstein B, Burt S, Garg A, Kapellusch J, Merlino L, Thiese MS, Eisen EA, Evanoff B. Prevalence and incidence of carpal tunnel syndrome in US working populations: pooled analysis of six prospective studies. Scand J Work Environ Health 2013; 39:495-505. [PMID: 23423472 DOI: 10.5271/sjweh.3351] [Citation(s) in RCA: 203] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
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.
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Affiliation(s)
- Ann Marie Dale
- Division of General Medical Science, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8005, St Louis, MO 63110, USA.
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Natural history and predictors of long-term pain and function among workers with hand symptoms. Arch Phys Med Rehabil 2013; 94:1293-9. [PMID: 23416766 DOI: 10.1016/j.apmr.2013.01.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 01/29/2013] [Accepted: 01/29/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate predictors of hand symptoms and functional impairment after 3 years of follow-up among workers with different types of hand symptoms including carpal tunnel syndrome (CTS). Functional status and job limitations were also analyzed as key secondary objectives. DESIGN Cohort design of 3 years duration. SETTING Working population-based study. PARTICIPANTS Newly employed workers without a preexisting diagnosis of CTS (N=1107). Subjects were categorized into 4 groups at baseline examination: no hand symptoms, any hand symptoms but not CTS (recurring symptoms in hands, wrist, or fingers without neuropathic symptoms), any hand symptoms of CTS (neuropathic symptoms in the fingers and normal nerve conduction study), or confirmed CTS (CTS symptoms and abnormal nerve conduction study). Among workers with hand pain at baseline, subject and job characteristics were assessed as prognostic factors for outcomes, using bivariate and multivariate regression models. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The primary outcome assessed by questionnaire at 3 years was "severe hand pain" in the past 30 days. RESULTS At baseline, 155 workers (17.5% of 888 followed workers) reported hand symptoms, of which 21 had confirmed CTS. Presence of hand pain at baseline was a strong predictor of future hand pain and job impairment. Subjects with confirmed CTS at baseline were more likely than workers with other hand pain to report severe hand pain (adjusted prevalence ratios 1.98 [95% confidence interval 1.11-3.52]) and functional status impairment (adjusted prevalence ratios 3.37 [95% confidence interval 1.01-11.29]). Among subjects meeting our case definition for CTS at baseline, only 4 (19.1%) reported seeing a physician in the 3-year period. CONCLUSIONS Hand symptoms persisted among many workers after 3-year follow-up, especially among those with CTS, yet few symptomatic workers had seen a physician.
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Organizational and psychosocial risk factors for carpal tunnel syndrome: a cross-sectional study of French workers. Int Arch Occup Environ Health 2013; 87:147-54. [DOI: 10.1007/s00420-013-0846-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 01/11/2013] [Indexed: 10/27/2022]
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Meta-Analysis on the Performance of Sonography for the Diagnosis of Carpal Tunnel Syndrome. Semin Arthritis Rheum 2012; 41:914-22. [DOI: 10.1016/j.semarthrit.2011.11.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Revised: 11/11/2011] [Accepted: 11/15/2011] [Indexed: 11/19/2022]
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