Cases Of Carpal Tunnel Syndrome Research Articles

Impact of Work Organizational Factors on Carpal Tunnel Syndrome and Epicondylitis.

The aim of this study was to identify relationships between work organizational variables (job rotation, overtime work, having a second job, and work pacing) (These work organizational variables and their relationships with biomechanical and psychosocial exposures were studied previously and published in a separate paper.) and health outcome measures [carpal tunnel syndrome (CTS), lateral and medial epicondylitis (LEPI/MEPI)]. Using a pooled baseline cohort of 1834 subjects, the relationships were studied using logistic regression models. Varied degrees of associations between the work organizational and outcomes variables were found. Job rotation was significantly associated with being a CTS case [odds ratio (OR) = 1.23, 95% confidence interval (95% CI): 1.00 to 1.50]. Overtime work was significantly associated with lower LEPI prevalence (OR = 0.48, 95% CI: 0.28 to 0.84). No statistically significant associations were found between having a second job and different work pacing and any of the three health outcome measures. Work organizational variables were only partially associated with the studied health outcomes.

Electrophysiological Grading to Assess the Severity of Carpal Tunnel Syndrome in Symptomatic Diabetic Patients

Background: Carpal tunnel syndrome (CTS) is the most frequent compressive focal mononeuropathy found in clinical practice. Patients mostly experience pain, paresthesia, and less commonly, weakness in the median nerve distribution which badly affects dexterity and grip. Common risk factors include repetitive wrist movements, metabolic and degenerative diseases, connective tissue disease and pregnancy. Nerve conduction study is one of the most sensitive and specific tools to diagnose CTS. This study was aimed to grade the CTS cases according to the severity based on electrophysiological findings and explore its association with clinical presentation of diabetic patients had nerve conduction study at BIRDEM General Hospital. Materials and Methods: This observational study was done in the electro diagnostic clinic of Neurology department, BIRDEM during the period Sept 2015 to Feb 2016. The study included 100 hands of 84 patients suffering from CTS consecutively attending the clinic. All the patients were interviewed and clinically examined. Demographic data including age, gender, occupation, affected hand and hand dominance along with duration of disease were recorded. Patients were graded according to clinical history and objective findings and again based on the Canterbury NCS Severity Scale.
 Results: Of these 84 diabetic patients presenting with impression of CTS 96% were females. Mean age of the study subjects was 49.6±10.1 (28-85). Most of the female patients were housewives. Clinical grading of CTS was as follows: mild symptoms in 54.76%, moderate symptoms in 23.8% and severe symptoms in 28.58% patients. According to The Canterbury NCS Severity Scale out of total 100 hands,3.5% had Grade 2 (Mild ) 30.5%had Grade 3 (Moderate) ,29.4 % had Grade 4 (Severe), 34.1% had Grade 5 (Very severe) disease. Only 2 patients had Grade 6 (extremely severe) lesion. Of the study subjects 22 (26.19%) had bilateral and rest (73.81%) had unilateral disease.
 Conclusion: Data demonstrated female preponderance of the diabetic CTS cases of middle age. Proportional graded deterioration of electrophysiological parameters along with the clinical severity grades highlights the fact that NCS provide additional and independent objective evidence in the diagnosis and severity assessment of CTS and plausibly has important role in prioritizing treatment plan.
 Bangladesh Journal of Neuroscience 2016; Vol. 32 (2): 98-105

Biomechanical and psychosocial exposures are independent risk factors for carpal tunnel syndrome: assessment of confounding using causal diagrams

BackgroundBetween 2001 and 2010, six research groups conducted coordinated prospective studies of carpal tunnel syndrome (CTS) incidence among US workers from various industries to estimate exposure–response relationships.ObjectiveThis analysis examined the...

Carpal tunnel syndrome and manual work: the OCTOPUS cohort, results of a ten-year longitudinal study.

The American Conference of Governmental Industrial Hygienists (ACGIH) proposed a method to assess the hand, wrist and forearm biomechanical overload based on exertions frequency (hand-activity level) and force use (normalized peak force). We applied the ACGIH threshold limit value (TLV)® method to a large occupational cohort to assess its ability to predict carpal tunnel syndrome (CTS) onset. A cohort of industrial and service workers was followed-up between 2000 and 2011. We investigated the incidence of CTS symptoms and CTS confirmed by nerve conduction studies (NCS). We then classified exposure with respect to action limit (AL) and TLV. Cox regression models including age, gender, body mass index, and presence of predisposing pathologies were conducted to estimate hazard ratios (HR) of CTS and population attributable fractions. We analyzed data from 3131 workers [females, N=2032 (65%); mean age at baseline 39.3, standard deviation (SD) 9.4 years]. We observed 431 incident cases of CTS symptoms in 8000 person-years and 126 cases of CTS confirmed by NCS in 8883 person-years. The ACGIH TLV® method predicted both CTS symptoms [HR between AL and TLV 2.18, 95% confidence interval (95% CI) 1.86-2.56; above TLV 2.07, 95% CI 1.52-2.81] and CTS confirmed by NCS (HR between AL and TLV 1.93, 95% CI 1.38-2.71; above TLV 1.95, 95% CI 1.27-3.00). About one third of CTS cases were attributable to exposure levels above the AL. The ACGIH TLV® method predicted the risk of CTS, but the dose-response was flat above the AL; a fine-tuning of the proposed thresholds should be considered.

Predictors of the patient-centered outcomes of surgical carpal tunnel release - a prospective cohort study.

BackgroundCarpal tunnel syndrome (CTS) causes a substantial burden of disease in society. While CTS can be resolved by surgical carpal tunnel release, it still remains unclear as to what degree outcomes depend on patients’ characteristics. This study assesses patient-centered outcomes after surgical carpal tunnel release in a large outpatient clinic in Germany.MethodsPatients with CTS were recruited prospectively between August 1st and December 31st, 2013. We assessed socio-demographic and psychological factors as well as nerve conduction velocities at baseline (before the surgery) and at three and six months after surgery. We analyzed the improvement of patient-centered outcomes (symptoms and function of the affected hand as well as measures of well-being and subjective quality of life) at the two follow-up time points and investigated if socio-demographic characteristics and CTS-related variables predict the success of the surgery with respect to nerve conduction velocities and patient-centered outcomes by means of analysis of covariance (ANCOVA). Factors influencing the duration of sick leave were investigated by means of Cox regression.ResultsThe study sample consisted of 71 CTS cases. Surgical carpal tunnel release generally improved nerve conduction velocity and patient-centered outcomes. Regarding the former, the improvement was proportional to the severity score at baseline. The presence of muscular atrophy in the thenar area at baseline displayed medium size effects for the patient-centered outcomes. Other socio-demographic characteristics and CTS-related variables did not have a strong predictive effect on the improvement of nerve conduction velocity and patient-centered outcomes.ConclusionsThere is a significant improvement of clinical and subjective outcomes after CTS surgery in the outpatient sector. The improvement is largely independent of socio-demographic and clinical characteristics of the patients.

Idiopathic Carpal Tunnel Syndrome in Childhood: Two Case Reports

Background/Purpose: Carpal tunnel syndrome (CTS) is the most common compression neuropathy in adults. In literature, there are very few cases reported of CTS at an early age. Most children described were suffering from a symptomatic CTS caused by a disorder such as mucopolysaccharidosis (MPS), Mucolipidosis (ML) or a hereditary neuropathy with liability to pressure palsies (HNPP). We describe two cases of idiopathic CTS concerning a 3.5- and 5-year-old girl.

Long-term symptomatic, functional, and work outcomes of carpal tunnel syndrome among construction workers.

The long-term outcomes of carpal tunnel syndrome (CTS) including symptoms, functional status, work disability, and economic impact are unknown. We conducted a retrospective study of 234 active construction workers with medical claims for CTS and 249 workers without CTS claims; non-cases were matched on age, trade, and insurance eligibility. We conducted telephone interviews with cases and non-cases and collected administrative data on work hours. Compared to non-cases, CTS cases were more likely to report recurrent hand symptoms, decreased work productivity/quality, decreased performance of physical work demands, and greater functional limitations. Surgical cases showed larger improvements on multiple outcomes than non-surgical cases. Minimal differences in paid work hours were seen between cases and non-cases in the years preceding and following CTS claims. Persistent symptoms and functional impairments were present several years after CTS diagnosis. Long-term functional limitations shown by this and other studies indicate the need for improved prevention and treatment.

An analysis of the predisposition factors for carpal tunnel syndrome

Objective To explore the predisposition factors for carpal tunnel syndrome (CTS). Methods From February 2005 to December 2014, 93 cases of CTS were treated with carpal tunnel release. There were 23 males and 70 females. Patient age ranged from 22 to 84 years, with an average of 56.7 years. Involvement of the left wrist was seen in 49 cases, of the right wrist in 53 cases, and of both wrists in 9 cases. Factors related to the occurrence and severity of the syndrome were investigated. Results Gender difference in the incidence of severe CTS was statistically significant. Preoperative duration was also significantly longer in patients with severe CTS than in patients with moderate CTS. Patient age, work time, labor intensity, occupation, and hand dominance did not significantly affect the incidence of CTS. Conclusion The incidence of severe CTS is related to gender, being much higher in women than men. Severe CTS patients tend to have longer symptom durations. Key words: Carpal tunnel syndrome; Incidence; Etiology analysis

Clinical analysis of the correlation between preoperative severity and duration of symptoms and the outcomes of carpal tunnel decompression

Objective To investigate the relationship between the severity and duration of preoperative symptoms and the outcomes of carpal tunnel release in patients with carpal tunnel syndrome. Methods Forty patients of carpal tunnel syndrome treated from January 2013 to June 2014 were divided into two groups, namely symptom severity group and symptom duration group, based on the severity and duration of the symptoms. Postoperative recovery of these patients was assessed using carpal tunnel syndrome evaluation criteria after standard carpal tunnel release. The excellent and good recovery rate in each group was calculated. The distribution of excellent and good recovery was analyzed. Results In symptom severity groups the excellent and good recovery rate was 95.83% in the moderate group and 92.31% in the severe group. The difference was not statistically significant(P>0.05). However distribution of the recovery was quite different, showing more excellent recovery in the moderate group and more good recovery in the severe group. In symptom duration groups the recovery rates were not significantly different(P>0.05). Functional recovery of opposition was the best, followed by sensory recovery. Grip strength recovery was the poorest. Conclusion Preoperative duration of the symptoms does not affect the surgical outcomes in carpal tunnel syndrome patients. Surgical release can greatly improve functions in both moderate and severe carpal tunnel syndrome cases although better recovery is seen in moderate cases. Thumb opposition recovers the best, while grip strength recovery is the poorest. Key words: Carpal tunnel syndrome; Treatment outcome; Symptom duration; Symptom severity

Carpal Tunnel Syndrome Associated with Oral Bisphosphonates. A Population-Based Cohort Study

BackgroundBisphosphonates are widely used to prevent osteoporotic fractures. Some severe musculoskeletal reactions have been described with this medication; among them, some cases of carpal tunnel syndrome. Thus, the aim of this study was to explore whether bisphosphonates may be associated with this syndrome.MethodsA cohort study was conducted to compare exposed to unexposed women; the exposed group was that composed of women having received at least one prescription of an oral bisphosphonate. For the purpose, we used information from The Health Improvement Network (THIN) database. The outcome of interest was defined as those women diagnosed with carpal tunnel syndrome. A survival analysis was performed; the Cox proportional hazard model was used to calculate hazard ratios and 95% confidence intervals, and to adjust for identified confounding variables.ResultsOut of a sample of 59,475 women older than 51 years, 19,825 were treated with bisphosphonates during the period studied. No differences in age distribution or mean follow-up time were observed between the two groups in comparison. Overall, there were 572 women diagnosed with carpal tunnel syndrome, 242 (1.2%) in the group exposed to bisphosphonates, and 330 (0.8%) in the unexposed. An adjusted hazard ratio of developing carpal tunnel syndrome of 1.38 (95%CI, 1.15–1.64) was found for women exposed to bisphosphonates; no significant changes in the hazard ratios were found when considering different levels of bisphosphonate exposure.ConclusionsAn increased risk of carpal tunnel syndrome is associated with the use of bisphosphonates in postmenopausal women.

Posture and Loading in the Pathomechanics of Carpal Tunnel Syndrome: A Review.

Carpal tunnel syndrome is a neuropathy of the median nerve at the wrist, and represents the most common peripheral neuropathy. It has long been an issue in the workplace because of healthcare costs and loss of productivity. The two main pathomechanisms of carpal tunnel syndrome include increased hydrostatic pressure within the carpal tunnel (carpal tunnel pressure) and contact stress (or impingement). As most cases of carpal tunnel syndrome in the workplace are labelled "idiopathic", a clear understanding of the physical parameters that may act as pathomechanisms is critical for its prevention. The aim of this review is to examine and quantify the influence of posture and loading factors on the increase of carpal tunnel pressure and median nerve contact stress. Forearm, wrist, and finger postures, as well as fingertip force have significant effects on carpal tunnel pressure. Contact stress on the median nerve is mainly a product of wrist posture and musculotendinous loading. Anatomical and musculoskeletal sources have been proposed to explain these effects. This critical review provides an improved understanding of pathomechanisms and etiology underlying carpal tunnel syndrome.

Correlation between median nerve conduction studies and ultrasonography in cases of carpal tunnel syndrome

Background Nerve conduction studies (NCS) have long been the only objective measure used to confirm the diagnosis of carpal tunnel syndrome (CTS), localize median nerve abnormalities, and exclude alternative diagnosis. Ultrasonography (US) can give information about the contents of carpal tunnel (CT) as well as aid in assessing the size of the median nerve (MN). Aim The aim of this study was to detect the relation between median NCS and cross-sectional area (CSA) of the MN measured using US in different grades of CTS. Patients and methods This study was a case–control, age-group matched, cross-sectional one. It included 60 wrists of 30 patients diagnosed with CTS and 60 wrists from 30 controls. Candidates were subjected to clinical assessment, median NCS, and measurement of CSA using US. Results There was a significant positive correlation between CSA of the MN at CT inlet and both motor and sensory responses latencies (r=0.638, P Conclusion US is highly correlated to NCS results in CTS. CSA of the MN at CT inlet measured using ultrasonography can be used as a screening tool for detection as well as discrimination of severe cases of CTS.

The role of median nerve terminal latency index in the diagnosis of carpal tunnel syndrome in comparison with other electrodiagnostic parameters.

Background:Carpal tunnel syndrome (CTS) considers the most common compression neuropathy, which nerve conduction studies (NCSs) used for its detection routinely and universally. This study was performed to determine the value of the median TLI and other NCS variables and to investigate their sensitivity and specificity in the diagnosis of CTS.Materials and Methods:The study was carried out among 100 hands of healthy volunteers and 50 hands of patients who had a positive history of paresthesia and numbness in upper extremities. Information including age, gender, and result of sensory and motor nerve conduction velocity (MNCV), peak latency difference of median and ulnar nerves of fourth digit (M4-U4 peak latency difference), and TLI were recorded for analysis. Sensitivity and specificity of electro diagnostic parameters in the diagnosis of CTS was investigated.Results:Normal range of the median nerve TLI was 0.43 ± 0.077. There was no significant difference between two groups for MNCV means (P = 0. 45). Distal sensory latency and distal motor latency (DML) of median nerve and fourth digit median-ulnar peak latency differences (PM4-PU4) for CTS group was significantly higher (P < 0.001) and mean for sensory nerve conduction velocity was significantly higher in control group (P < 0.001). The most sensitive electrophysiological finding in CTS patients was median TLI (82%), but the most specific one was DML (98%).Conclusion:Although in early stages of CTS, we usually expect only abnormalities in the sensory studies, but TLI may better demonstrate the effect on median nerve motor fiber even in mild cases of CTS.

Carpal tunnel syndrome and computer exposure at work in two large complementary cohorts

ObjectivesThe 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...

Carpal tunnel syndrome secondary to Masson's tumour

We present a case of a Masson's tumour causing carpal tunnel syndrome. Space occupying lesions should be considered as a differential in refractory cases of carpal tunnel syndrome, especially those in whom the symptoms are dynamic. Once radiological investigation confirms such a diagnosis, we advocate surgical excision, as malignancy can only be excluded via histological examination.

Ultrasound assessment of the median nerve: a biomarker that can help in setting a treat to target approach tailored for carpal tunnel syndrome patients.

Ultrasonography (US) is a valuable tool for confirming the diagnosis of carpal tunnel syndrome (CTS) as it enables the detection of changes in the median nerve shape and rule out anatomic variants as well as space-occupying lesions such as ganglion cysts or tenosynovitis. This work was carried out aiming at: 1. Ultrasonography assessment of the median nerve and its neurovascular blood-flow in CTS patients before and after management. 2. Verify the possibility of using baseline US parameters as a biomarker to predict likely outcomes and frame a treatment plan for CTS patients.233 CTS subjects diagnosed based on clinical and electrophysiological (NCS) testing were included in this work. US measures at the tunnel inlet included: cross sectional area, flattening ratio and neural Power Doppler (PD) signals. Patients who had severe NCS outcomes or neurological deficit were referred for open surgical decompression; the remaining patients were given the choice of either conservative or surgical management. The main outcome variable was improvement >70% in CTS symptoms. Assessments were carried out at baseline, 1-week, 1-month and 6-months post treatment. Results revealed an inverse relation between the neural vasculature and CTS severity defined by NCS (r = − 0.648). In CTS cases treated conservatively, the US measures started to improve within 1-week, whereas in the surgically treated cohort there was an initial phase of post-operative nerve measures increase, before settling at 1-month time of follow-up. The risk of poor outcomes was significantly higher (RR 3.3) in patients with high median nerve flattening ratio. This risk was most marked in the cohort with nerve flattening associated with longer duration of illness (RR 4.3) and low PD signal (RR 4.1). The results revealed that in addition to the diagnostic value of US in CTS, the detection of increased median nerve neuro-vasculature has a good prognostic value as an indicator of early median nerve affection.

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.

Carpal tunnel syndrome in females – an experience from Al-Hasa, Eastern Province, Saudi Arabia

Introduction: Carpal tunnel syndrome (CTS) is an entrapment neuropathy that involves the median nerve at the carpal tunnel of the wrist. When the median nerve is compressed, the clinical presentation of CTS starts to appear, such as numbness, tingling in the thumb, index, middle and part of the fourth finger. Objectives: To study CTS among females in Al-Hasa, Saudi Arabia, in relation to specific medical conditions. Materials and methods: A descriptive retrospective study was conducted on 115 women over a 14-year period from December 2000 to January 2014. Statistical analysis was carried out using IBM SPSS Statistics version 21 (IBM Corporation, Armonk, NY, USA) with the mean, median and standard deviation. A P -value of less than 0.05 was considered significant. Results: The majority of CTS cases were seen among patients with diabetes mellitus (68.70%) followed by those with hypertension (15.4%). Conclusions: The prevalence of CTS is relatively high among woman with diabetes mellitus. Middle-aged women have a higher risk of developing the syndrome. The performance of daily activities was mostly unaffected in our studied population, which was consistent with previously published data. Patients with CTS should control their weight and blood sugar levels to lower their susceptibility of having CTS. Acknowledgements: We would like to acknowledge Dr Sayed Ibrahim, Assistant Professor of Biostatistics, Department of Family Medicine, College of Medicine, King Faisal University, for help and support with statistical analysis.

Personal and workplace factors and median nerve function in a pooled study of 2396 US workers.

Evaluate associations between personal and workplace factors and median nerve conduction latency at the wrist. Baseline data on workplace psychosocial and physical exposures were pooled from four prospective studies of production and service workers (N = 2396). During the follow-up period, electrophysiologic measures of median nerve function were collected at regular intervals. Significant adjusted associations were observed between age, body mass index, sex, peak hand force, duration of forceful hand exertions, Threshold Limit Value for Hand Activity Limit, forceful repetition rate, wrist extension, and decision latitude on median nerve latencies. Occupational and nonoccupational factors have adverse effects on median nerve function. Measuring median nerve function eliminates possible reporting bias that may affect symptom-based carpal tunnel syndrome case definitions. These results suggest that previously observed associations between carpal tunnel syndrome and occupational factors are not the result of such reporting bias.

Exposure-response relationships for the ACGIH threshold limit value for hand-activity level: results from a pooled data study of carpal tunnel syndrome.

This paper aimed to quantify exposure-response relationships between the American Conference of Governmental Industrial Hygienists' (ACGIH) threshold limit value (TLV) for hand-activity level (HAL) and incidence of carpal tunnel syndrome (CTS). Manufacturing and service workers previously studied by six research institutions had their data combined and re-analyzed. CTS cases were defined by symptoms and abnormal nerve conduction. Hazard ratios (HR) were calculated using proportional hazards regression after adjusting for age, gender, body mass index, and CTS predisposing conditions. The longitudinal study comprised 2751 incident-eligible workers, followed prospectively for up to 6.4 years and contributing 6243 person-years of data. Associations were found between CTS and TLV for HAL both as a continuous variable [HR 1.32 per unit, 95% confidence interval (95% CI) 1.11-1.57] and when categorized using the ACGIH action limit (AL) and TLV. Those between the AL and TLV and above the TLV had HR of 1.7 (95% CI 1.2-2.5) and 1.5 (95% CI 1.0-2.1), respectively. As independent variables (in the same adjusted model) the HR for peak force (PF) and HAL were 1.14 per unit (95% CI 1.05-1.25), and 1.04 per unit (95% CI 0.93-1.15), respectively. Those with exposures above the AL were at increased risk of CTS, but there was no further increase in risk for workers above the TLV. This suggests that the current AL may not be sufficiently protective of workers. Combinations of PF and HAL are useful for predicting risk of CTS.