High Prevalence Of Carpal Tunnel Syndrome Research Articles

When is it safe to operate after the failure of therapeutic steroid injections in carpal tunnel syndrome?

Carpal Tunnel Syndrome (CTS) is a multifactorial neuropathy caused by the compression of the median nerve due to its entrapment as it passes through the carpal tunnel in the wrist. It accounts for nearly 90% of neuropathies and usually presents as numbness, tingling, weakness, and pain. These symptoms are predominantly present in the thumb, second finger, third finger, and radial half of the hand's fourth finger. In the US, CTS has a prevalence of 50 per 1,000, which is similar to the prevalence in other developed countries.1 Overall, the prevalence of CTS in the general population in developed countries ranges from 3% to 6%, whereas the prevalence of CTS in developing countries like Pakistan has been reported to be from 10% to 15%.2 The management of mild to moderate CTS ranges from conservative management, including ultrasound therapy using the pulsed mode, wrist splinting, and tendon gliding exercises, to Neuro-mobilization.3 On the other hand, the management of moderate to severe CTS, which is unresponsive to the above-mentioned therapies comprises therapeutic steroid injections and surgical decompression of the median nerve. In many cases, surgical decompression is used as a last resort after the failure of therapeutic steroid injections. However, studies have shown that surgical decompression in these cases is associated with poor postoperative outcomes, including increased risk of pain and paresthesia.4 Furthermore, such cases are also associated with an increased risk of surgical site infections, non-infectious wound complications, and 1 year-reoperation. The risk of these complications is maximum when surgery is performed within 30 days of the last therapeutic steroid injection along with a high number of therapeutic steroid injections (infections 1.77%, non-infectious complications 1.12%, 1-year re-operation 2.09%), and is minimal when performed from 90 to 180 days of the last therapeutic steroid injection with a low number of therapeutic steroid injections (infections 1.19%, non-infectious complications 0.44%, 1-year re-operation 1.58%). Therefore, surgical decompression of the median nerve should be delayed for 90 to 180 days after the last therapeutic steroid injection, depending on the severity.5 There is a high prevalence of CTS in developing countries like Pakistan and therapeutic steroid injections are frequently prescribed as first-line treatment for moderate to severe CTS. ---Continue

Quantitative anatomical analysis of the carpal tunnel in women and men

PurposeThe main objective of this study was to identify anatomical differences between men and women in the absolute and relative size of the carpal tunnel (CT), its inner structures, and related external anatomical structures in order to shed light on the higher prevalence of CT syndrome (CTS) in women. Basic proceduresWe have dissected the forearms and hands of ten men and ten women and compared the cross-sectional area (CSA) of the CT between the two sexes. The size of the CT relative to the tendons passing through it, the median nerve (MN), and to hand and wrist size was also compared between men and women. Main findingsThe absolute CSAs of the CT and other parameters were larger in men than in women. The CSA of the CT relative to the length of the capitate bone was also larger in men. However, no significant differences were observed between men and women in the size of the CT relative to its inner structures. Principal conclusionsThe size of the inner structures of the CT are in proportion to that of the CT itself in both sexes. These findings suggest that the etiology of CTS seems to be primarily related to workload and personal traits.

Demographic and Occupational Risk Factors of Carpal Tunnel Syndrome among Dental students in their Final Year at King Abdulaziz University, Jeddah, Saudi Arabia

Carpal tunnel syndrome (CTS) is a common peripheral compression neuropathy that accounts for 90% of all entrapment neuropathies. Dentists typically have a higher prevalence of work-related musculoskeletal disorders including CTS. Currently, there is a lack of literature on CTS prevalence and risk factors among dentistry in Saudi Arabia. Our study was the first to examine the prevalence and the associated demographic and occupational factors of CTS among dental students. This cross-sectional study was conducted in the School of Dentistry at King Abdulaziz University. A total of 120 dental students in their final year were included. We used a validated self-administered questionnaire that included demographic data, work, medical history, and a modified Katz's hand diagram to assess the symptoms and occupational exposures. Descriptive statistics and logistic regression were applied using SPSS software version 16. The prevalence of CTS among dental students was 13.3%. It was higher in females 10% compared to male 3.3%. There was a significant relationship between the body mass index (P= 0.03) with underweight category by having a higher prevalence of CTS. The use of finger pinch grip showed an inverse association with CTS (P=0.04). Other risk factors were not significantly associated with CTS. The prevalence of CTS among dental students was higher than the general population. However, many previously identified risk factors showed no significant association with CTS adding to the controversy of the contributing risk factors of this disease among dentistry. Finger pinch grip showed inverse association which was contrary to published literature. Future studies may include exposure time for each occupational risk factor preferably in a prospective cohort.

Association between spinal stenosis and wild-type ATTR amyloidosis

Age-related cardiac amyloidosis results from deposits of wild-type tranthyretin amyloid (ATTRwt) in cardiac tissue. ATTR may play a role in carpal tunnel syndrome (CTS) and in spinal stenosis (SS), indicating or presaging systemic amyloidosis. We investigated consecutive patients undergoing surgery for SS for ATTR deposition in the resected ligamentum flavum (LF) and concomitant risk of cardiac amyloidosis. Each surgical specimen (LF) was stained with Congo red, and if positive, the amyloid deposits were typed by mass spectrometry. Patients with positive specimens underwent standard of care evaluation with fat pad aspirates, serum and urine protein electrophoresis with immunofixation, free light-chain assay, TTR gene sequencing and technetium 99 m-pyrophosphate-scintigraphy. In 2018–2019, 324 patients underwent surgery for SS and 43 patients (13%) had ATTR in the LF with wild-type TTR gene sequences. Two cases of ATTRwt cardiac amyloidosis were diagnosed and received treatment. In this large series, ATTRwt was identified in 13% of the patients undergoing laminectomy for SS. Patients with amyloid in the ligamentum flavum were older and had a higher prevalence of CTS, suggesting a systemic form of ATTR amyloidosis involving connective tissue. Further prospective study of patients with SS at risk for systemic amyloidosis is warranted.

P-NE003. Frequency of carpal tunnel syndrome in patients having diabetes mellitus with neuropathy in a tertiary care hospital

Introduction. Carpal tunnel syndrome (CTS) is one of the most frequent entrapment neuropathies of the upper limb. Carpal tunnel syndrome (CTS) and diabetic polyneuropathy (DPN) are common conditions in patients with diabetes and therefore frequently occur concomitantly. Diagnosis of CTS in patients with DPN is important, as therapeutic interventions directed toward relief of CTS may be effective irrespective of diffuse neuropathy. Methods. This study was a hospital based descriptive cross sectional study done in BIRDEM general hospital between July, 2015 and June, 2016, for a period of twelve months. The initial clinical diagnosis of DPN was made and was confirmed by doing nerve conduction study. After having informed written consents, a standard preformed questionnaire was filled up for each case. Results. A total of 354 cases were finally analyzed with 153 (43.2%) patients being symptomatic and among those 54 (58.7%) had electrophysiology proven CTS. It was observed that 26.0% of patients established as having DPN also had CTS. The frequency of CTS among those with symptoms was significantly higher than in asymptomatic participants. Majority (38.4%) of patients belonged to the age group of 51-60 years. The mean age was found to be 55.99 ± 9.25 years with a range from 28 to 80 years. Among all cases of electrophysiology proven CTS (92 patients), females (53.3%) numbered greater in comparison to males (46.7%). Study subjects with CTS had significantly higher BMI, higher fasting blood sugar and higher HbA1c in comparison to patients without CTS. The mean compound motor action potential was not significantly different between patients with and without CTS. Conclusion. Given the high prevalence of CTS in subjects with DPN, it is recommended that therapeutic decisions should be made carefully after nerve conduction study and proper diagnosis.

Abstract 124: The Relationship Between Carpal Tunnel Syndrome And Migraine Headache, A Diathesis?

Purpose: Compression of extra-cranial sensory nerves by surrounding tissues can provoke migraine headache pain (MH). We have demonstrated that at the occipital trigger site, the greater occipital nerve is surrounded by thickened trapezius fascia in 94% of patients1.This pathology is similar to that found in other nerve compression syndromes such as carpal tunnel syndrome (CTS). We hypothesized that MH surgery patients may have a higher prevalence of CTS than the general population. Methods: 108 migraine surgery patients who also have primary care with complete medical records at our institution were included in a retrospective chart review. Subjects with clinically certain diagnosis of CTS were identified and prevalence was compared to general population data. Results: Average age was 47.6 ±13.8 years (19-74). Prevalence of CTS was 13.8% (n=15). In the CTS group, eleven subjects presented with physician confirmed diagnosis of CTS that led to surgical release, one had EMG documented CTS and three had a physician confirmed diagnosis of CTS with no surgery to date. The prevalence of clinically certain CTS in the general population ranges from 3.8%2 to 7.8%3. Conclusion: CTS is significantly more prevalent in patients undergoing migraine surgery than the general population. (1.7- 3.5-fold). These remarkable findings warrant further exploration. We suspect that patients with nerve compression syndromes are more susceptible to development of this disease complex through shared pathogenesis, genetics and risk factors. This may have important clinical implications for evaluation of patients with CTS and/or MH. 1Gfrerer, L., Hansdorfer M., Ortiz R., Nealon K., Austen WG. Occipital neuralgia/ migraine: Intra- operative evidence for extracranial pathology. Paper presented at: American Society of Peripheral Nerve Meeting; Feb 1-3 2019; Palm Desert, CA. 2Atroshi, I., Gummesson, C., Johnsson, R., Ornstein, E., Ranstam, J., Rosen, I. Prevalence of carpal tunnel syndrome in a general population. JAMA 1999;282:153-158. 3Dale, A. M., Harris-Adamson, C., Rempel, D., et al. 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.

CARPAL TUNNEL SYNDROME AMONG SYMPTOMATIC SCHOOL TEACHERS ATTENDING UNIVERSITY HOSPITAL

Introduction: School teachers are prone to various occupational problems especially musculoskeletal disorders including carpal tunnel syndrome (CTS) which may cause sick leave, absenteeism and early retirement leading to decreased productivity at work. In developing countries, a paucity of researches was done in this field. Aim of work: To assess the prevalence and the risk factors of CTS among symptomatic school teachers in Menoufia, Egypt. Materials and methods: A cross-sectional study of symptomatic school teachers at the Physical Medicine, Rheumatology and Rehabilitation Department, Menoufia University Hospital from January to October 2018. A self-administered questionnaire including participants’ personal, occupational and pain information were used. Also, nerve conduction studies were done of both right and left median nerves including motor and sensory. Results: One hundred and eighty seven school teachers responded to the study. The prevalence of CTS was reported by 62% of symptomatic teacher. Both hands of CTS teachers had significantly higher mean latency and lower amplitude and nerve conduction velocity of motor and sensory nerve studies when compared to non CTS one. The severity of carpal tunnel syndrome in both hands of CTS teachers was mainly moderate grade. The CTS was significantly prevalent among female school teachers and primary or secondary level of school. A combination of risk factors: body mass index, school level, working duration, working hours per day and working computer hours per day; were found to be significantly associated with increasing CTS. Conclusion and recommendations: The symptomatic school teachers had high prevalence of CTS which is affecting their work and education system as a whole. An implement intervention programs is needed by the higher authorities to address this issue. An adequate care, ergonomic rules and exercise program have to be recommended so as to alleviate this disorder.

Keluhan Carpal Tunnel Syndrome pada Pekerja Sortasi Daun Tembakau (Studi di Gudang Restu I Koperasi Agrobisnis Tarutama Nusantara Jember)

Abstract Recruitment of labor in tobacco industry at Jember is high and there are still many utilize manual labor. Manual labor can increase complaints from workers.There are several MSDs listed in ILO, one of which is Carpal Tunnel Syndrome (CTS). CTS can cause pain and limit the function of the wrist and hand. Sorting work is one of the jobs with a high prevalence of CTS as it requires precision and accuracy. The purpose of this research was to analyze CTS complains on leaf sorting workers in Restu I warehouse of Agribusiness Tarutama Nusantara Cooperative.This was a descriptive research with quantitative approach. The results indicates that majority of leaf tobacco leaf workers (81,7%) in Restu I Warehouse experienced CTS complaint. Respondents with age more than 40 years are 3,609 times at risk of CTS complaint. Respondents with CTS complaint were more common at age more than 40 years, who had more nutritional status categories of overweight, who had a working period of more than 4 years as tobacco leaf sorting worker at Restu I Warehouse, who had medium risk work posture, and respondents who repeat movements of the wrist more than 30 times per minute. Keywords: MSDs, Carpal Tunnel Syndrome (CTS), Tobacco Leaf Sorting

Frequency of Carpal Tunnel Syndrome in Patients Having Diabetes Mellitus with Neuropathy in a Tertiary Care Hospital of Bangladesh

Background: Carpal tunnel syndrome (CTS) is one of the most frequent entrapment neuropathies of the upper limb. CTS and diabetic polyneuropathy (DPN) are common conditions in patients with diabetes and therefore frequently occur concomitantly. Diagnosis of CTS in patients with DPN is important, as therapeutic interventions directed toward relief of CTS may be effective irrespective of diffuse neuropathy.Methods: This study was a hospital based descriptive cross sectional study done in a tertiary care hospital, Dhaka between July, 2015 and June, 2016. The initial clinical diagnosis of diabetic peripheral neuropathy was made from history and examination. It was confirmed by doing nerve conduction study. After having informed written consents, a standard preformed questionnaire was filled up for each case. Collected data were checked, verified for consistency and edited for final results. Data cleaning, validation and analysis were performed using Statistical Package for the Social Sciences (Version 20.0).Results: A total of 354 cases were finally analyzed with 153 (43.2) patients being symptomatic for CTS and among those 54 (58.7%) had electrophysiology proven CTS. It was observed that 26.0% of patients established as having DPN also had CTS. The frequency of CTS among those with symptoms was significantly higher than in asymptomatic participants. The mean age was found to be 55.99 ± 9.25 years with a range from 28 to 80 years. Majority (38.4%) of patients belonged to the age group of 51-60 years. Among all cases of electrophysiology proven CTS (92 patients), females (53.3%) numbered greater in comparison to males (46.7%). One hundred and ninety two (54.2%) patients were housewives, 57 (16.1%) were garment workers, 45 (12.7%) patients were businessmen and 60 (16.9%) patients were service holders. Study subjects with CTS had significantly higher body mass index, higher fasting blood glucose and higher HemoglobinA1c in comparison to patients without CTS. Examination of upper limb sensory nerves showed that nerve conduction velocity was significantly decreased and distal latency was found to be significantly increased in patients with CTS on median nerve examination. The mean compound motor action potential was not significantly different between patients with and without CTS.Conclusion: Symptoms and signs of CTS are mostly masked by the symptoms of DPN and patients presenting with such symptoms in the upper limbs should be evaluated for CTS as a separate entity to DPN. The finding of a frequency of CTS of 26% in subjects with diabetes with varying degrees of DPN is remarkably high. Given the high prevalence of CTS in subjects with DPN, it is recommended that therapeutic decisions be made carefully after nerve conduction study and proper diagnosis.Birdem Med J 2018; 8(3): 240-245

Emphysematous Pyelonephritis: Experience of Managing 15 Consecutive Cases in a Tertiary Care Hospital of Bangladesh

Background: Carpal tunnel syndrome (CTS) is one of the most frequent entrapment neuropathies of the upper limb. CTS and diabetic polyneuropathy (DPN) are common conditions in patients with diabetes and therefore frequently occur concomitantly. Diagnosis of CTS in patients with DPN is important, as therapeutic interventions directed toward relief of CTS may be effective irrespective of diffuse neuropathy.Methods: This study was a hospital based descriptive cross sectional study done in a tertiary care hospital, Dhaka between July, 2015 and June, 2016. The initial clinical diagnosis of diabetic peripheral neuropathy was made from history and examination. It was confirmed by doing nerve conduction study. After having informed written consents, a standard preformed questionnaire was filled up for each case. Collected data were checked, verified for consistency and edited for final results. Data cleaning, validation and analysis were performed using Statistical Package for the Social Sciences (Version 20.0).Results: A total of 354 cases were finally analyzed with 153 (43.2) patients being symptomatic for CTS and among those 54 (58.7%) had electrophysiology proven CTS. It was observed that 26.0% of patients established as having DPN also had CTS. The frequency of CTS among those with symptoms was significantly higher than in asymptomatic participants. The mean age was found to be 55.99 ± 9.25 years with a range from 28 to 80 years. Majority (38.4%) of patients belonged to the age group of 51-60 years. Among all cases of electrophysiology proven CTS (92 patients), females (53.3%) numbered greater in comparison to males (46.7%). One hundred and ninety two (54.2%) patients were housewives, 57 (16.1%) were garment workers, 45 (12.7%) patients were businessmen and 60 (16.9%) patients were service holders. Study subjects with CTS had significantly higher body mass index, higher fasting blood glucose and higher HemoglobinA1c in comparison to patients without CTS. Examination of upper limb sensory nerves showed that nerve conduction velocity was significantly decreased and distal latency was found to be significantly increased in patients with CTS on median nerve examination. The mean compound motor action potential was not significantly different between patients with and without CTS.Conclusion: Symptoms and signs of CTS are mostly masked by the symptoms of DPN and patients presenting with such symptoms in the upper limbs should be evaluated for CTS as a separate entity to DPN. The finding of a frequency of CTS of 26% in subjects with diabetes with varying degrees of DPN is remarkably high. Given the high prevalence of CTS in subjects with DPN, it is recommended that therapeutic decisions be made carefully after nerve conduction study and proper diagnosis.Birdem Med J 2018; 8(3): 246-250

Estimation of Carpal Tunnel Syndrome (CTS) Prevalence in Adult Population in Western European Countries: A Systematic Review

Carpal Tunnel Syndrome or CTS has been recognized as an occupational disease in 9 out of 12 members countries of the EU as early as 2001. CTS is ranked 6th among the occupational diseases in Scandinavian countries and also outside EU. Increased prevalence of the disease is believed to have a link with several occupations where work involves exposure to high force and pressure and repetitive work using vibrating tools. Diabetic patients and pregnant women have a high prevalence rate of 30% and 20% consecutively. The aim of the study is to determine the prevalence of Carpal Tunnel Syndrome (CTS) in 27 member countries of Western European (EUR A) by identifying published papers with suitable data. This study used Preferred Reporting Items for Systematic Review and Meta Analysis (PRISMA) checklist for literature search, identification, data collection and evaluation of literatures to estimate prevalence of Carpal Tunnel Syndrome (CTS) in Adult Population in Western European Countries. Following the PRISMA protocol and guidelines for systematic review of quantitative literatures evaluation and tabulation of data was done. It has been confirmed through this study that Carpal Tunnel Syndrome remains as one of the most simple but frequently observed diseases among the adult population in this region. Despite high prevalence of CTS in this region any standard criteria for clinical diagnosis of this disease have not yet been established. There is also no consensus on whether CTS is a clinical or electro-physiologically diagnosed disease. But sufficient pathophysiological and epidemiological evidences are available for a causal relationship to be assumed between manual tasks and the occurrence of CTS. Industries can take actions to educate their workers about these work place safety practices to grow awareness against CTS. Furthermore, research to determine clear causal relation of CTS with occupation and to reach a consensus about the disease’s diagnostic criteria is needed.

Prevalence of Carpal Tunnel Syndrome in Diabetic Patients with and without Metabolic Syndrome

Background and Objectives : Carpal tunnel syndrome (CTS) is defined as the impaction of the median nerve in the carpal tunnel of the wrist. Metabolic disorders are closely associated with CTS; and metabolic syndrome (MS) is found to be more in patients with CTS. Metabolic syndrome is highly prevalent in patients with type 2 diabetes. This study was conducted to determine the prevalence of CTS in diabetic patients with and without metabolic syndrome. Material and Methods : In this cross-sectional study, 439 diabetic patients that participated in the study of risk factors for coronary artery disease in Kerman (KERCADRS) were enrolled. People with positive clinical symptoms for CTS and a positive Boston questionnaire, were referred to a neurologist for further diagnosis. For the diagnosis of metabolic syndrome, three criteria (ATPIII, IDF and new criteria in Kerman) were used. Also, electro-diagnostic tests were used for the diagnosis of CTS. Data were analyzed by independent t-test and chi square test in SPSS20. Results : The prevalence of CTS in diabetic patients was 24.23%. The prevalence of the disorder in male and female patients was 16.21% and 30.65%, respectively. The results showed that there is no significant difference in the prevalence of CTS in diabetic people with and without metabolic syndrome, in overall as well as sex subgroups. Discussion and Conclusion : The higher prevalence of CTS in diabetic patients in this study compared to other studies shows the lack of prevention and case finding in diabetic patients. Therefore, screening, educating and informing at risk people about the disease is necessary.

Examining the association between musculoskeletal injuries and carpal tunnel syndrome in manual laborers.

The association between musculoskeletal injuries and carpal tunnel syndrome (CTS) has not been investigated in a large, population-based study. Latino manual laborers were recruited as part of a study of work-related health conditions. Each had a clinical examination, completed a hand diagram, and had nerve conduction studies. A total of 512 individuals completed all testing. An association was found between rotator cuff syndrome and CTS, with an adjusted odds ratio of 2.25 (P = 0.01) for the right arm, 2.08 (P = 0.03) for the left arm, and 1.84 (P = 0.03) for all individuals. Associations between epicondylitis and CTS did not reach statistical significance. Individuals with rotator cuff syndrome have a higher prevalence of CTS. Further investigations will be needed to examine for causation and to determine if 1 condition typically occurs first and leads to the other. Muscle Nerve 54: 31-35, 2016.

The Prevalence of Carpal Tunnel Syndrome in Latino Poultry-Processing Workers and Other Latino Manual Workers

To determine the prevalence of carpal tunnel syndrome (CTS) in Latino poultry-processing workers. Symptoms and nerve conduction studies were used to prospectively assess 287 Latino poultry-processing workers and 226 Latinos in other manual-labor occupations. The prevalence of CTS was higher in poultry-processing (8.7%) compared with nonpoultry manual workers (4.0%; P < 0.0001). The adjusted odds ratio for the prevalence of CTS in poultry workers was 2.51 (95% confidence interval, 1.80-3.50) compared with nonpoultry workers. Within the poultry workers, those who performed packing, sanitation, and chilling had a trend toward less CTS than those who performed tasks requiring more repetitive and strenuous hand movements. Latino poultry-processing workers have a high prevalence of CTS, which likely results from the repetitive and strenuous nature of the work.

An Increased Frequency of Carpal Tunnel Syndrome in Sarcoidosis

Sarcoidosis is a systemic disease which affects the musculoskeletal system; however, its association with carpal tunnel syndrome (CTS) has been reported only rarely. In our study, we tried to determine the prevalence of CTS in our consecutive sarcoidosis patients based on their symptoms and nerve conduction study (NCS). Fiftysix patients (mean age: 45.2) who were followed up with the diagnosis of sarcoidosis at our center and who gave informed consent for NCS were included into the study. The patients were questionned for the presence of hand symptoms: paresthesia, pain, nocturnal paresthesia and/or pain, and, they underwent NCS. Ten (17.9 %) patients had recurrent paresthesia, 12 (21.4 %) had pain, and 8 (14.3 %) had nocturnal paresthesia and/or pain. The results of NCS showed that 41 % of the patients had findings compatible with CTS. Extrapulmonary involvement was significantly more frequent in these patients when compared to patients without CTS (p=0.04). Also, patients with CTS were older than the others and CTS-associated symptoms were more frequent in them although this was not significant (p&gt;0.05). In this study, by performing NCS we detected quite a high prevalence of CTS in our sarcoidosis patients. The fact that most of the patients were asymptomatic was interesting.

Carpal Tunnel Syndrome in Patients With Diabetic Polyneuropathy

Carpal tunnel syndrome (CTS) and diabetic polyneuropathy (DPN) are common conditions in patients with diabetes and therefore frequently occur concomitantly. Diagnosis of CTS in patients with DPN is important, as therapeutic interventions directed toward relief of CTS may be effective irrespective of diffuse neuropathy. The prevalence of clinical CTS and the most efficient electrodiagnostic discriminators of CTS from diffuse neuropathy are uncertain. A total of 478 subjects, including reference subjects (without diabetes and without neuropathy), nonneuropathic subjects with diabetes, and diabetic subjects with mild, moderate, and severe neuropathy, were evaluated in a cross-sectional design for clinical features of CTS. In the ascertainment of the cohort, a clinical stratification method was used to ensure a broad spectrum of neuropathy severity. All subjects underwent nerve conduction study determinations of median, ulnar, and sural nerve parameters. The prevalence of clinical CTS was 2% in the reference population, 14% in diabetic subjects without DPN, and 30% in those with DPN. Multiple linear regression analysis revealed that mean electrodiagnostic parameters are not significant predictors of clinical CTS in patients with diabetes. Generally, the parameters worsened with severity of neuropathy, but none reliably distinguished diabetic patients with and without CTS. Given the high prevalence of CTS in patients with DPN and that electrodiagnostic criteria cannot distinguish those with clinical CTS, it is recommended that therapeutic decisions for CTS be made independently of electrodiagnostic findings.

The effects of repeated mechanical trauma in the meat industry.

Meat handlers are more prone to traumatic hand lesions and wound infections than most other occupational groups. This paper deals with the carpal tunnel syndrome (CTS), which is thought to be a major occupationally related condition affecting thousands of workers engaged in repetitive hand motion tasks. The literature reveals a high prevalence of CTS among meat handlers. Additional epidemiological research is needed. Further, it is important to educate workers about the signs, symptoms, and causes of CTS.