Abstract
BackgroundTo determine the radiographic characteristics of wrists in idiopathic carpal tunnel syndrome patients, we compared the radiographic parameters of the wrists between carpal tunnel syndrome patients and non-symptomatic controls.MethodsWe evaluated radiographic parameters of 94 wrists of 62 idiopathic carpal tunnel syndrome patients and 94 asymptomatic wrists of 94 controls. Carpal tunnel syndrome was diagnosed by clinical findings and nerve conduction studies. The lack of symptoms was confirmed with the medical records and interviews for the controls. X-ray images of the postero-anterior and lateral views of the wrist were taken. Using the obtained X-ray images, the indices of radial inclination, volar tilt, ulnar variance, and transverse and antero-posterior diameters of the wrists were measured. Two raters independently performed the measurement. One rater measured without information of clinical symptoms. Inter-rater reliabilities for each parameter were evaluated by the intra-class correlation coefficients. The averages of the measurements of two raters were compared between the carpal tunnel syndrome patients and the controls.ResultsThe intra-class correlation coefficients were 0.58 for radial inclination, 0.77 for ulnar variance, 0.99 for transverse diameter, 0.60 for volar tilt, and 0.91 for antero-posterior diameter. Statistically significant correlations were found for all parameters (P < 0.01). The ulnar variance was significantly larger in the carpal tunnel syndrome patients compared to the controls (1.7 +/− 1.8 mm and 0.8 +/− 1.5 mm for the patients and controls, respectively P < 0.01). There were no significant differences in the other parameters.ConclusionsSignificant differences in the ulnar variance were observed between carpal tunnel syndrome patients and controls. This suggests that the imbalance of radioulnar bone length is one of the risk factors to develop carpal tunnel syndrome. The positive ulnar variance may be an index that needs attention to the development of carpal tunnel syndrome.Level of evidencelevel III, a case control study.
Highlights
To determine the radiographic characteristics of wrists in idiopathic carpal tunnel syndrome patients, we compared the radiographic parameters of the wrists between carpal tunnel syndrome patients and nonsymptomatic controls
It has been suggested that carpal tunnel narrowness is one of the risk factors, because idiopathic Carpal tunnel syndrome (CTS) develops at a high rate in women with a small carpal tunnel cross-sectional area [3]
There were no significant differences between CTS patients and controls for the age distribution and gender ratio
Summary
To determine the radiographic characteristics of wrists in idiopathic carpal tunnel syndrome patients, we compared the radiographic parameters of the wrists between carpal tunnel syndrome patients and nonsymptomatic controls. Carpal tunnel syndrome (CTS) is one of the most common peripheral neuropathies [1]. There are several etiologies of carpal tunnel syndrome including idiopathic, wrist trauma, oral contraceptives, pregnancy, arthritis, collagenvascular diseases, diabetes, hypothyroidism, and occupations or hobbies that involve repetitive motion of the wrist [2]. When considering the risk factors of median nerve compression in the carpal tunnel, it is necessary to consider the size of the carpal tunnel and the local factor narrowing the tunnel. It has been suggested that carpal tunnel narrowness is one of the risk factors, because idiopathic CTS develops at a high rate in women with a small carpal tunnel cross-sectional area [3]. There are two sites of median nerve compression, i.e., the proximal edge of the carpal tunnel and the narrowest portion at the hook of hamate. Because of the changes in thickness and rigidity between the proximal portion of the flexor retinaculum and the forearm facia, changes of fluid pressure in the carpal tunnel have been reported with wrist movement [4]
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