Carpal Tunnel Syndrome In Women Research Articles

To Study the Impact of Wrist Splints and Nerve Tendon Gliding Exercises on Carpal Tunnel Syndrome in Women who Work at Computers and in Women Who Do Not

Background: To study the difference between the effects of wrist splint and nerve tendon gliding exercises forcarpal tunnel syndrome in women with computer desk job and the difference between the effects of wrist splintand nerve tendon gliding exercises in non computer desk job women with carpal tunnel syndrome.Methods: 34 Females objects with symptomatic carpal tunnel syndrome were selected randomly with age groupbetween 25-30 years with due consideration to inclusion and exclusion criteria. In this study 34 subjects areselected. They were randomly divided into two groups using lottery method. In group A (Non Computer deskjob women) wrist splint& Exercises was given. In group B (Computer desk job women) Nerve tendon glidingtechnique & exercises was done for 6 weeks. The beneficial effect of gliding exercises may be the mobilization ofthe nerve directly or facilitation of venous return or oedema dispersal. The pressure in the carpal tunnel is lowestin neutral wrist flexion extension range, with the pressure rising significantly as the wrist is moved into flexion orextension. Splint with the wrist in a neutral position, at night and during the day is used for starting 3 weeks andany at night during rest of period. Analyzing scores after 6 weeks the mean and SD values for pre and post FSSSores of group A were 27 &21. 64 and 1.36 & 1.80 respectively.Conclusion: The study showed that there was decrease in the pain and improvement in the functional abilitystatistically in carpal tunnel syndrome women with computer desk job by performing nerve and tendon glidingexercises and wrist splinting for both the groups for a period of 6weeks. This concluded that there was equalimprovement in pain in both the groups but the functional ability is more improved after the nerve and tendongliding exercises in group B. Therefore this study is rejecting the null hypothesis and accepts the alternatehypothesis.

Sex-related differences in carpal arch morphology.

The purpose of this study was to investigate the sex-based differences in the carpal arch morphology. Carpal arch morphology was quantified using palmar bowing and area of the arch formed by the transverse carpal ligament. The carpal arch was imaged at the distal and proximal tunnel levels using ultrasonography in 20 healthy young adults (10 women and 10 men). It was found that females had a smaller carpal arch height compared to men at both distal and proximal levels (p<0.05) and smaller carpal arch width only at the proximal level (p<0.05) but not distally. Palmar bowing index, the carpal arch height to width ratio, was significantly smaller in females at the distal level (p<0.05) but not at the proximal level. Carpal arch cross-sectional area normalized to the wrist cross-sectional area was found to be significantly smaller in females at both tunnel levels compared to men (p<0.05). This study demonstrates that females have a smaller carpal arch compared to men with a reduced palmar bowing distally and a smaller arch area at both tunnel levels. The findings help explain the higher incidence of carpal tunnel syndrome in women as a smaller carpal arch makes the median nerve more vulnerable to compression neuropathy.

Biaxial quantification of deep layer transverse carpal ligament elastic properties by sex and region

BackgroundThe transverse carpal ligament is a major component of the carpal tunnel and is an important structure in the etiology of carpal tunnel syndrome. The current study aimed to quantify biaxial elastic moduli of the transverse carpal ligament and compare differences between sex and region (Radial and Ulnar). MethodsBiaxial testing of radial and ulnar samples from twenty-two (thirteen male, nine female) human fresh frozen cadaveric transverse carpal ligaments was performed. Elastic moduli and stiffness were calculated and compared. FindingsBiaxial elastic moduli of the transverse carpal ligament ranged from 0.76MPa to 3.38MPa, varying based on region (radial and ulnar), testing direction (medial-lateral and proximal-distal) and sex. Biaxial elastic moduli were significantly larger in the medial-lateral direction than the proximal-distal direction (P<0.001). Moduli were significantly larger ulnarly than radially (P=0.001). No significant differences due to gender were noted. InterpretationThe regional variations in biaxial elastic moduli of the transverse carpal ligament may help improve non-invasive treatment methods for carpal tunnel syndrome, specifically manipulative therapy. The smaller biaxial elastic moduli found in the radial region suggests that manipulative therapy should be focused on the radial aspect of the transverse carpal ligament. The trend where female transverse carpal ligaments had larger stiffness in the ulnar location than males suggests that that the increased prevalence of carpal tunnel syndrome in women may be related to an increased stiffness of the transverse carpal ligament, however further work is warranted to evaluate this trend.

Carpal tunnel syndrome in women working in tea agriculture.

OBJECTIVE:The aim of this cross-sectional study was to determine the frequency of carpal tunnel syndrome (CTS) among women using tea leaf scissors and compare it with normal population.METHODS:Two hundred hands of 100 women using tea leaf scissors (tea leaf scissors group) and 112 hands of 56 healthy women (control group) were clinically and electrophysiologically evaluated for CTS. Women using tea leaf scissors were evaluated with visual analog scale (VAS) for pain and Boston Carpal Tunnel Syndrome Questionnaire for symptoms and functional status.RESULTS:Carpal tunnel syndrome was diagnosed bilaterally in 62 (62%) and unilaterally in 7 (7%) women using tea leaf scissors, whereas 2 (3.57%) bilateral and 6 (10.71%) unilateral cases of CTS was diagnosed in controls. The differences in demographic factors were not statistically significant. In women with CTS using tea leaf scissors, mean symptom severity, functional status, and VAS scores were 2.73±0.60, 2.42±0.71 and 5.19±1.84, respectively. There was statistically significant difference in the frequency of CTS between women using tea leaf scissors and the control group and the risk of having CTS among women using tea leaf scissors was approximately 12 times greater (p<0.001).CONCLUSION:In tea agriculture, working with repetitive flexions and extensions of the wrist highly increases the risk of developing CTS.

Anatomical Differences in the Shape of the Male and Female Carpal Tunnels

Objective: The purpose of this study was to examine the relationship between the dimensions of the carpal tunnel and sex. Study Design: Basic science. Background: Women have a higher incidence of carpal tunnel syndrome than men, and understanding anatomic factors that may predispose women to developing carpal tunnel syndrome may be informative clinically. Using ultrasound, others have shown that a “squarer” carpal tunnel is associated with carpal tunnel syndrome. Methods and Measures: In this study, we measured cross-sectional area, width, and depth of the carpal tunnels from 8 female and 9 male cadavers in transverse sections made through the carpal tunnel. Results: No significant differences were found between the age, weight, body mass index, or radius-derived stature of the female and male cadavers. The cross-sectional area of the female carpal tunnels (1.34 ± 0.16 cm2) was significantly less (P < 0.01) than the area of the male carpal tunnels (1.66 ± 0.21 cm2). The depth of the carpal tunnel was not significantly different between the sexes, but the average width of the female carpal tunnel (2.04 ± 0.14 cm) was significantly shorter (P < 0.01) than the average width of the male carpal tunnel (2.33 ± 0.15 cm). Conclusions: The depth-to-width ratio of the carpal tunnel was significantly greater (P < 0.05) in the females (0.50 ± 0.07) than in the males (0.43 ± 0.07). Thus, the “squarer” carpal tunnels of females may contribute to the higher incidence of carpal tunnel syndrome in women.

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

Although carpal tunnel syndrome is the most common compressive neuropathy, there is no comprehensive theory of its etiology. Because of the prevalence of night symptoms, we are interested in the role of sleep position in the causation of carpal tunnel syndrome. We performed a case-control study comparing the prevalence of preferred sleep position in 68 cases and 138 controls. Analysis was stratified by age and gender and controlled for body mass index. We found a strong and significant association between a preference for sleeping on the side and the presence of carpal tunnel syndrome in men and in women less than 60years of age. Body mass index was associated with carpal tunnel syndrome in women but not men. Our findings of a strong association between the presence of carpal tunnel syndrome and preferred sleeping on the side suggest a comprehensive unifying theory of causation.

CLINICAL EVALUATION OF ELECTRODIAGNOSTICALLY VERIFIED CARPAL TUNNEL SYNDROME

Background. The aim of the research was a clinical evaluation of a group of people with confirmed carpal tunnel syndrome and setting of useful instructions for daily use. Methods. Prospective study includes 70 potential patients suffering from carpal tunnel syndrome. By using electrodiagnostics, the diagnosis could be confirmed with only 30 patients that were checked up. These were clinically evaluated on the following criteria: anamnesis, Katz-hand diagram, symptoms and signs. Results. The study found a higher percentage of carpal tunnel syndrome in women. The difference between women and men in this respect is statistically significant (p < 0.05). In most cases, both hand are afflicted or, in the case of just one hand, usually the dominant one (20 patients [66.6%]). At an average, the problems lasted for 1184 days. The average age was 51.13 years. 22 people (73.3%) had coincident problems with the neck and shoulder. Typical symptoms were tingling, pain and awakening. In 66% (33 hands) disturbed sensory functions were registered: hypo sensibility 52%, hyper sensibility 14%. The first place of the provocative diagnostically tests takes Phalen (72% – 36 arms) followed by Tinel (70% – 35 arms), reverse Phalen 54% and tethered median nerve stress test 46%. The Katz diagram is not of a mentionable diagnostic value according to our experience. Conclusions. The typical carpal tunnel syndrome can be clinically identified by a precise test performance, observation and with help of anamnesis. For the confirmation of the diagnosis and planning of the treatment the electrodiagnostic test is used.

The genetic contribution to carpal tunnel syndrome in women: a twin study.

To assess the relative genetic and environmental contribution to carpal tunnel syndrome (CTS) using a classic twin study of monozygotic (MZ) and dizygotic (DZ) twins. The study group comprised unselected female twin pairs, between 20 and 80 years of age, from the St Thomas' UK Adult Twin Registry. Individuals completed a questionnaire that included details on potential risk factors for CTS. The diagnosis of CTS was made using a standardized hand pain diagram and validated criteria. The genetic contribution to CTS was assessed using variance component and regression methods, the heritability was adjusted for environmental confounders. The role of individual risk factors was assessed by a nested case-control study. An overall prevalence of 14.2% for CTS was found in a population of 4,488 females, comprising 867 MZ and 970 DZ twin pairs, and 814 singletons. The concordance for CTS was significantly higher in MZ compared with DZ twins (case-wise concordance values of 0.35 and 0.24 respectively, with a significantly increased MZ:DZ ratio of 1.48; P = 0.03). Modeling produced a heritability estimate of 0.46 (95% CI 0.34-0.58) that was essentially unchanged after adjustment for environmental risk factors including age, body mass index, physical activities, and hormonal/reproductive factors. No major influence of any individual risk factor was seen in the case-control analysis of 520 cases and 3,154 controls, apart from a modest association with menopausal status with an increased risk of 1.53 and 1.43 in the peri and postmenopausal groups. There was no overall effect of age or body mass index. This is the first study to explore the genetic component of CTS. Our data show that up to half of the liability to CTS in women is genetically determined, and this appears to be the single strongest risk factor, with only minor contributions from known environmental factors. Further studies should focus on genetic mechanisms that may lead to tests for susceptibility and detection of those at risk of developing CTS.

Symptoms and neurophysiological picture of carpal tunnel syndrome in pregnancy

Objective: To evaluate the incidence of carpal tunnel syndrome (CTS) in pregnancy through a validated and multiperspective assessment of CTS. Methods: During 2000, the Italian CTS study group focussed on the occurrence of CTS in women during the final stages of pregnancy, enrolled in 7 Italian centers. In addition to the physician-centered and neurophysiologic traditional evaluations, we used a validated patient-oriented measurement to obtain more comprehensive and consistent data for severity of symptoms and functional impairment. Results: In our study, CTS was clinically diagnosed in more than half of women (62%). Neurophysiological evaluation provided diagnosis of CTS in around half of women (43% were positive in one hand at least). Our study provides evidence, reported here for the first time, of a correlation between edema and neurophysiological picture. Similarly, our study provides a correlation between validated patient-oriented measurement and edema. Moreover, a significant correlation between a negative trend (subjectively assessed) and smoking and alcohol consumption was observed. Conclusions: Our observations confirm that the edema of the tissues in the carpal tunnel could induce a mechanical compression of the nerve. Moreover, our data suggest that smoking and alcohol consumption have a negative role in the evolution of the syndrome probably due to impairment of the microcirculation.

Carpal tunnel syndrome in women undergoing reduction mammaplasty.

Women with mammary hypertrophy who present for reduction mammaplasty have several well-described musculoskeletal complaints, but a high prevalence of carpal tunnel syndrome has not been reported. We identified 151 patients from a plastic surgery practice who underwent reduction mammaplasty from 1994 to 1996. To this group we added a convenience sample of 64 women volunteers with relatively smaller breasts (brassiere cup size B or smaller). We questioned the entire group about specific symptoms and examined them using standard provocative tests. Carpal tunnel syndrome was defined as the coexistence of symptoms and at least two physical examination findings. We examined its association with breast size, age, race, and body mass index. Stepwise logistic regression was used to determine which physical characteristics were predictive of the condition. Carpal tunnel syndrome was found in 30 patients (19.9 percent) (95 percent confidence interval, 13.8 to 27.1) and in none of the women in the convenience sample. Breast size and, to a lesser degree, body mass index were found to be highly significant predictors of carpal tunnel syndrome. After controlling for breast size, race was also significant. Breast size displayed an independent risk ratio of 6.67 when comparing the upper quartile of size to the lower quartiles. There is a markedly higher prevalence of carpal tunnel syndrome in women who present for reduction mammaplasty than in those with smaller breasts. Breast size was a significant predictor of carpal tunnel syndrome.

Carpal Tunnel Syndrome in Women Undergoing Reduction Mammaplasty

Women with mammary hypertrophy who present for reduction mammaplasty have several well-described musculoskeletal complaints, but a high prevalence of carpal tunnel syndrome has not been reported. We identified 151 patients from a plastic surgery practice who underwent reduction mammaplasty from 1994 to 1996. To this group we added a convenience sample of 64 women volunteers with relatively smaller breasts (brassiere cup size B or smaller). We questioned the entire group about specific symptoms and examined them using standard provocative tests. Carpal tunnel syndrome was defined as the coexistence of symptoms and at least two physical examination findings. We examined its association with breast size, age, race, and body mass index. Stepwise logistic regression was used to determine which physical characteristics were predictive of the condition. Carpal tunnel syndrome was found in 30 patients (19.9 percent) (95 percent confidence interval, 13.8 to 27.1) and in none of the women in the convenience sample. Breast size and, to a lesser degree, body mass index were found to be highly significant predictors of carpal tunnel syndrome. After controlling for breast size, race was also significant. Breast size displayed an independent risk ratio of 6.67 when comparing the upper quartile of size to the lower quartiles. There is a markedly higher prevalence of carpal tunnel syndrome in women who present for reduction mammaplasty than in those with smaller breasts. Breast size was a significant predictor of carpal tunnel syndrome. (Plast. Reconstr. Surg. 105: 1314, 2000.)

Work practice and histopathological changes in the tenosynovium and flexor retinaculum in carpal tunnel syndrome in women

Work practice and histopathological changes in the tenosynovium and flexor retinaculum in carpal tunnel syndrome in women

Carpal tunnel syndrome: a nested case-control study of risk factors in women.

Risk factors for the development of carpal tunnel syndrome in women were studied by means of a nested case-control analysis of a prospective cohort study of the health effects of oral contraception in British women. A total of 1,264 women who had a diagnosis of carpal tunnel syndrome reported by their general practitioner between 1968 and 1993 were compared with 1,264 age-matched control women who did not have this diagnosis. The syndrome was associated in older women with some hormonal factors, notably past use of oral contraception (adjusted odds ratio in women aged 40 years and over = 1.38, 95 percent confidence interval: 1.08, 1.76) and more generally with obesity (adjusted odds ratio = 1.68, 95 percent confidence interval: 1.29, 2.18). However, the strongest link was with a previous history of another musculoskeletal complaint for which consultation had been sought (adjusted odds ratio = 1.98, 95 percent confidence interval: 1.61, 2.42). Previous findings of a higher risk in women with diabetes and myxoedema were confirmed, but these contribute only a small proportion of all cases in women. There was no link with psychologic problems or nonmusculoskeletal pain complaints. The previously described increased incidence of carpal tunnel syndrome in women may be partly due to hormonal factors, but is also related to an underlying propensity to musculoskeletal problems and their higher overall frequency in women.

Work practices and histopathological changes in the tenosynovium and flexor retinaculum in carpal tunnel syndrome in women

We studied 58 women of employable age with the carpal tunnel syndrome in order to determine whether the histological appearances of the carpal tunnel, tenosynovium and flexor retinaculum are influenced by work practices. Age, body mass index and the duration of symptoms did not correlate with the extent of oedema or fibrosis within the tenosynovium. The incidence of abnormality on histological examination of the tenosynovium was the same in employed and unemployed patients (p = 1.0), and was not influenced by the level of repetition (p = 0.89) or force (p = 0.29) of work. Myxoid degeneration within the flexor retinaculum was, however, more common in women undertaking ‘high-force’ work. Apart from this finding, the results suggest that work practices do not affect tenosynovial thickening, fibrosis or oedema in patients with carpal tunnel syndrome.

Work practices and histopathological changes in the tenosynovium and flexor retinaculum in carpal tunnel syndrome in women

We studied 58 women of employable age with the carpal tunnel syndrome in order to determine whether the histological appearances of the carpal tunnel, tenosynovium and flexor retinaculum are influenced by work practices. Age, body mass index and the duration of symptoms did not correlate with the extent of oedema or fibrosis within the tenosynovium. The incidence of abnormality on histological examination of the tenosynovium was the same in employed and unemployed patients (p = 1.0), and was not influenced by the level of repetition (p = 0.89) or force (p = 0.29) of work. Myxoid degeneration within the flexor retinaculum was, however, more common in women undertaking 'high-force' work. Apart from this finding, the results suggest that work practices do not affect tenosynovial thickening, fibrosis or oedema in patients with carpal tunnel syndrome.

Prevalence and incidence of carpal tunnel syndrome in a meat packing plant.

OBJECTIVES: To determine prevalence and incidence of carpal tunnel syndrome (CTS) in a modern meat packing plant. The secondary objective was to explore the relation between ethnicity and CTS. METHODS:...

Carpal tunnel syndrome: what is attributable to work? The Montreal study.

OBJECTIVE: To estimate the fraction of carpal tunnel syndrome (CTS) that is attributable to work in the total adult population of the island of Montreal. METHODS: The population consisted of...

Evidence for Work-Related Musculoskeletal Disorders

Evidence for Work-Related Musculoskeletal Disorders

Epidemiology of Carpal Tunnel Syndrome in Women of Childbearing Age. Findings in a Large Cohort Study

There are few epidemiological data in the scientific literature about the carpal tunnel syndrome. This paper describes the characteristics of the 154 women referred to hospital for management of this condition among the 17,032 taking part in the Oxford-Family Planning Association contraceptive study. Standardized first referral rates for carpal tunnel syndrome doubled as age increased from 25-29 to 50 or more, tripled as smoking increased from zero to 25 or more cigarettes per day, doubled as total duration of oral contraceptive use increased from zero to ten years or more and doubled as Quetelet's obesity index (weight(g)/height(cm)2) increased from up to 1.99 to 2.6 or more. All these trends were statistically significant. Carpal tunnel syndrome was also found to be positively associated with a history of menstrual disorders, gastrointestinal tract symptoms and various orthopaedic conditions. The findings on cigarette smoking are of particular interest but require confirmation or refutation in another study before firm conclusions can be drawn.