Abstract
ObjectiveTo study the diagnostic properties of hand/wrist and body measures according to validated clinical and electrophysiological carpal tunnel syndrome (CTS) severity scales.MethodsWe performed a prospective case-control study. For each case, two controls were enrolled. Two five-stage clinical and electrophysiological scales were used to evaluate CTS severity. Anthropometric measurements were collected and obesity indicators and hand/wrist ratios were calculated. Area under the receiver operating characteristic curves (AUC), sensitivity, specificity, and likelihood ratios were calculated separately by gender.ResultsWe consecutively enrolled 370 cases and 747 controls. The wrist-palm ratio, waist-hip-height ratio and waist-stature ratio showed the highest proportion of cases with abnormal values in the severe stages of CTS for clinical and electrophysiological severity scales in both genders. Accuracy tended to increase with CTS severity for females and males. In severe stage, most of the indexes presented moderate accuracy in both genders. Among subjects with severe CTS, the wrist-palm ratio presented the highest AUC for hand measures in the clinical and electrophysiological severity scales both in females (AUC 0.83 and 0.76, respectively) and males (AUC 0.91 and 0.82, respectively). Among subjects with severe CTS, the waist-stature ratio showed the highest AUC for body measures in the clinical and electrophysiological severity scales both in females (AUC 0.78 and 0.77, respectively) and males (AUC 0.84 and 0.76, respectively). The results of waist-hip-height ratio AUC were similar.ConclusionsWrist-palm ratio, waist-hip-height ratio and waist-stature ratio could contribute to support the diagnostic hypothesis of severe CTS that however has to be confirmed by nerve conduction study.
Highlights
Accuracy tended to increase with carpal tunnel syndrome (CTS) severity for females and males
Among subjects with severe CTS, the wrist-palm ratio presented the highest areas under the receiver operating characteristic (ROC) curves (AUC) for hand measures in the clinical and electrophysiological severity scales both in females (AUC 0.83 and 0.76, respectively) and males (AUC 0.91 and 0.82, respectively)
Among subjects with severe CTS, the waist-stature ratio showed the highest AUC for body measures in the clinical and electrophysiological severity scales both in females (AUC 0.78 and 0.77, respectively) and males (AUC 0.84 and 0.76, respectively)
Summary
Several epidemiological studies have investigated the association between anthropometric characteristics and the risk of carpal tunnel syndrome (CTS), the most common peripheral A mononeuropathy [1,2,3,4,5]. large body of literature supports a causal association between overweight or obesity and CTS [6,7,8,9,10,11,12,13,14,15,16]. As anthropometric measures can be collected alongside symptoms and signs during clinical examinations, they could be proposed as a screening tool to detect subjects at risk of CTS. To explore this hypothesis, we previously tried to verify the existence of optimal cutoff values for anthropometric measurements to identify individuals with CTS. We analyzed several anthropometric indexes using receiver operating characteristic (ROC) curves and we found that all the studied variables were clearly associated with CTS [25]. Due to the high proportion of false positive and false negative test results, we did not recommend the use of anthropometric characteristics as screening tools for CTS [25]. Our previous analysis was based solely on the presence or absence of CTS, ignoring the clinical or electrophysiological severity of the disease
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