Independent Risk Factor For Carpal Tunnel Syndrome Research Articles

Prevalence and Predictors of Carpal Tunnel Syndrome Symptoms Among Teachers in Riyadh: A Cross-Sectional Study.

Background Carpal tunnel syndrome (CTS) is a musculoskeletal disorder (MSD) afflicting the upper limbs with a prevalence of approximately14.4% in the general population. Previous studies have noted the increasing prevalence of MSDs among teachers but have not investigated in depth the prevalence and predictors of CTS symptoms in this population. The aim of this study was to help fill this gap in the literature by investigating teachers working in Riyadh, Saudi Arabia. Methods We conducted this cross-sectional study in Riyadh using an online survey. We distributed the Boston carpal tunnel questionnaire (BCTQ) to schoolteachers in the city through the social media applications Twitter, WhatsApp, and Telegram. We assessed the respondents' symptoms using Univariate association analyses with a Wilcoxon rank sum test for the continuous variables and Fisher's exact test and Pearson's chi-squared test for the categorical variables. We assessed the independent risk factors for CTS by constructing multivariate binary logistic regression models and expressed the results using the odds ratio (OR) and 95% confidence intervals (95% CIs), with p < 0.05 indicating statistical significance. Results The sample for this study included 490 teachers. Among them, the prevalence of moderate to severe CTS symptoms was 40.0%, and self-reported CTS was 9.1%. The teachers who were female, relatively old, left-handed, retired, and spent significant time using a pen, keyboard, and/or blackboard were more likely than those who were male, relatively young, right-handed, and did not spend significant time using a pen, keyboard, and/or blackboard to self-report CTS and exhibit moderate to severe symptoms. Conclusions We found a relatively high percentage (40.0%) of CTS symptoms among teachers working in Riyadh. This finding suggests that any sign of CTS symptoms should be checked to ensure early diagnosis and treatment, which contribute to positive outcomes, particularly given the recent increase in such risk factors for CTS as diabetes, hypothyroidism, and high BMI in populations worldwide.

Weight-Related and Personal Risk Factors of Carpal Tunnel Syndrome in the Northern Finland Birth Cohort 1966.

Background: Excess body mass is a risk factor for carpal tunnel syndrome (CTS), but the mechanisms of this are unclear. This study aimed to evaluate the association between CTS and personal risk factors of body mass index (BMI), waist circumference and waist-to-hip ratio (WHR). Methods: The study sample consisted of the Northern Finland Birth Cohort 1966 (n = 9246). At the age of 31 in 1997 and at the age of 46 in 2012, the participants underwent a clinical examination. Cohort A consisted of complete cases with a follow-up from 1997 to 2012 (n = 4701), and Cohort B was followed up from 2012 to 2018 (n = 4548). The data on diagnosed CTS were provided by the Care Register for Health Care until the end of 2018. Results: After an adjustment for confounding factors, BMI was associated with CTS among women (hazard ratio (HR) 1.47, 95% Cl 0.98–2.20 for overweight women and HR 2.22, 95% Cl 1.29–3.83 for obese women) and among both sexes combined (HR 1.35 95% Cl 0.96–1.90 for overweight and HR 1.98 95% Cl 1.22–3.22 for obese participants). Neither waist circumference nor WHR was associated with CTS. Conclusions: BMI is an independent risk factor for CTS and is more relevant for estimating the increased risk of CTS due to excess body mass than waist circumference or WHR.

Relationship of BMI and wrist joint index with carpal tunnel syndrome in manual laborers

Objective: To evaluate the severity of median nerve damage in patients with carpal tunnel syndrome (CTS) , and to analyze its relationship with body mass index (BMI) and wrist joint index. Methods: From May 2016 to January 2017, 23 patients with mild CTS (mild group) and 35 patients with moderate to severe CTS (moderate to severe group) were enrolled in this study. And 22 healthy volunteers matched for sex and age were selected as control group. The neuroelectrophysiological monitor was used to measure the median nerve movement and sensory nerve conduction in the subjects. The BMI and wrist joint index were calculated. The relationship of neuroelectrophysiological parameters with BMI and wrist joint index was analyzed in the CTS patients. Results: Compared with the control group, the mild group and the moderate to severe group had significantly higher wrist joint index, significantly longer distal motor latency (DML) of the median nerve, and significantly lower sensory nerve conduction velocity (SNCV) and sensory nerve action potential (SNAP) amplitude of the finger 1-wrist and finger 3-wrist (P<0.01) ; the moderate to severe group had significantly higher BMI and significantly lower composite muscle action potential (CMAP) amplitude (P<0.01) . The wrist joint index and BMI were positively correlated with DML of the median nerve and negatively correlated with SCV and SNAP amplitude of the finger 1-wrist and finger 3-wrist (all P<0.05) . The patients with a wrist joint index of >0.73 had a significantly higher risk of CTS than those with a wrist joint index of <0.73 (odd ratio=30.67, 95% confidence interval: 3.79-248.36) . Conclusion: A wrist joint index of >0.73 is an independent risk factor for CTS in manual laborers. CTS should be prevented in the manual laborers with high wrist joint index and BMI.

High wrist ratio is a risk factor for carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is the most common upper extremity entrapment neuropathy and various risk factors have been implicated in the etiology. In this study, we aimed to determine whether anthropometric measurements are independent risk factors for CTS. Patients with symptoms of CTS (n = 27) and asymptomatic controls (n = 27) were enrolled following electrophysiological confirmation. Body mass index (BMI) was recorded and anthropometric measurements of the hand were made by a digital caliper. BMI, wrist width, wrist depth, palm length, hand width, wrist ratio, wrist/palm ratio, and wrist/hand ratio were significantly higher in the CTS group. BMI, wrist ratio, wrist/palm ratio, and wrist/hand ratio were independent variables in the logistic regression analysis; wrist ratio was the only significant predictor of CTS. Patients with a wrist ratio higher than 0.69 were 8.2 times more likely to have CTS. This study suggests that wrist ratio may be considered as an independent risk factor for CTS. Clin. Anat. 31:698-701, 2018. © 2018 Wiley Periodicals, Inc.

Acute carpal tunnel syndrome caused by thrombosed persistent median artery associated with bifurcated median nerve in a pregnant woman

Carpal tunnel syndrome (CTS) is a common form of peripheral nerve entrapment, which is observed due to compression of the median nerve at the level of the carpal tunnel in...

Exposure-Response Relationships for Force and Repetition, and CTS

Carpal tunnel syndrome (CTS), though widely investigated, remains a troubling and costly disease for both employers and workers. Recent studies have consistently shown that combinations of force and repetition are occupational risk factors for CTS. However, it remains unclear which of these two factors is primarily responsible for the increase in risk. This study uses pooled prospective data to compare exposure-response relationships for peak force and several measures of repetition, including the integrated measure of peak force and hand activity level, the ACGIH TLV for HAL. Results suggest that peak force acts as an independent risk factor for CTS, while repetition is only a risk factor if the exertions are “forceful”. Thus, it appears that applied hand/wrist force is the dominant occupational physical exposure risk factor for CTS.

Waist circumference and waist-to-hip ratio in carpal tunnel syndrome: A case–control study

BackgroundThe association between carpal tunnel syndrome (CTS) and high body mass index (BMI) and some hand measures is well known. No study has been specifically focused on waist circumference (WC) and waist-to-hip-ratio (WHR). The aim of this prospective case–control study is to evaluate the association between CTS and WC, WHR and other body and hand anthropometric measures. MethodsWe consecutively enrolled one “idiopathic” CTS case for two controls in 3 outpatient electromyography labs. The main anthropometric measures were BMI, WC, WHR, wrist ratio (WR) and hand ratio (HR). We performed univariate and multivariate analyses. ResultsFemale cases and controls were 250 and 474 and male cases and controls were 120 and 273, respectively. At univariate analysis there were differences in many anthropometric measures between cases and controls. At multivariate logistic regression analyses high BMI, WC and WHR and abnormal HR and WR were independent risk factors for CTS. Crossing two categories between BMI, WC and WHR, the overweight subjects, especially females, were at risk only if they had very high WC or high WHR. The risk increased if they were obese. ConclusionsHigh WC/WHR doubles the risk of CTS, the risk further increased if overweight/obese subjects have also very high WC or high WHR. The obese subjects were always at risk regardless of WC and WHR values. Metabolic causes of this association with CTS were hypothesised. BMI is not the only and most powerful body predictor of “idiopathic” CTS, but also WHR and WC should be considered. These measures may not be interchangeable and it may be desirable to consider the utility of their joint use.

Incidence of Carpal Tunnel Syndrome in the US Military Population

Carpal tunnel syndrome (CTS) is a common disease. Its epidemiology has been evaluated previously, mostly in regional populations or in working groups, with an incidence between 1.5 and 3.5 per 1,000 person-years. We studied this diagnosis in the US military population, with the hypothesis that this young population would have a lower incidence of CTS than previously reported in general populations. The Defense Medical Epidemiology Database notes all medical encounters for all US military personnel and maintains the number of all personnel on active duty each year. We queried the database using the International Classification of Diseases, ninth revision, code 354.0 (CTS) and analyzed the personnel presenting for initial visits for the years 1998-2006. Multivariate Poisson analysis was performed, controlling for rank, gender, age, and race. The raw incidence of CTS in the US military was 3.98 per 1,000 person-years, in a population of 12,298,088 person-years. Females had a significantly higher incidence of CTS than males, with an adjusted incidence rate ratio of 3.29. CTS incidence increased by age, with the age group > or = 40 years having a significantly higher incidence. Additionally, military rank was found to be an independent risk factor for CTS, with rates higher in senior officer and enlisted groups. This suggests that occupational requirements have an effect on CTS within the military. We showed a comparable incidence of CTS between the US military and general population, with a significantly higher female cohort with a diagnosis of CTS. Increased age and advanced rank were risk factors for CTS.

An evaluation of gender, body mass index, wrist circumference and wrist ratio as independent risk factors for carpal tunnel syndrome

The aim of this study was to evaluate the role of gender, body mass index (BMI), wrist ratio (WR) and wrist circumference as independent risk factors for carpal tunnel syndrome (CTS) and to analyze the strength of association of these factors. We have undertaken a case-control study in 128 CTS patients and 109 controls. Based on clinical and electrophysiologic criteria, 109 female and 19 male CTS patients as well as 62 female and 47 male control subjects were selected from patients and their relatives referred to our hospital. In total, 179 hands with CTS in three groups of severity (mild, moderate and severe) were examined. Height, weight, BMI, wrist width, depth, circumference and ratio were measured in all patients and control group. Mean values of different risk factors for CTS group and controls were measured. A logistic regression analysis was conducted to evaluate odds ratio of different risk factors. The mean values for BMI and WR were greater in CTS patients than in the subject group. Thirty-four, 89 and 57 patients had mild, moderate and severe CTS, respectively. Mean age, BMI, wrist circumference and ratio were not statistically significant in the three groups. Female gender, increased BMI and increased WR had odds ratio of 9.95, 1.75 and 1.12, respectively. Our study confirms that female gender, obesity and square wrists are independent risk factors for CTS.

The relationship of obesity, age, and carpal tunnel syndrome: More complex than was thought?

Previous reports have shown that obesity is a risk factor for carpal tunnel syndrome (CTS). This study was performed to investigate whether this could be confirmed in a large, existing cohort of patients and to explore the interaction between age and body mass index (BMI) as risk factors. Demographic and clinical data were collected from 6096 patients referred to a subregional neurophysiology service for diagnosis of possible CTS. Patients presenting with their second CTS and those with diabetes or thyroid disease were excluded. Subjects in whom nerve conduction studies (NCS) confirmed CTS were compared with those having normal NCS. After exclusions, there were 4166 patients for analysis of whom 11 had incomplete data. A total of 2408 of 4155 proved to have definite neurophysiological evidence of CTS. Of these patients, 1150 were over the age of 63 years. Univariate and multivariate analyses demonstrated that increased BMI is a significant independent risk factor for CTS in patients under the age of 63 years, but is less important in older patients. Patients over the age of 63 years have a different pattern of risk factors for CTS than younger patients. This suggests that CTS in the elderly population may have different underlying pathogenetic mechanisms.

A Longitudinal Study of Industrial and Clerical Workers: Incidence of Carpal Tunnel Syndrome and Assessment of Risk Factors

This study followed workers over an extended period of time to identify factors which may influence the onset of Carpal Tunnel Syndrome (CTS). The purpose was to evaluate incidence of CTS and to create a predictive model of factors that play a role in the development of CTS. This prospective study followed 432 industrial and clerical workers over 5.4 years. Incident cases were defined as workers who had no prior history of CTS at baseline testing and were diagnosed with CTS during the follow-up period or at the follow-up screening. On the basis of logistic regression, significant predictors for CTS include baseline median-ulnar peak latency difference, a history of wrist/hand/finger tendonitis, a history of numbness, tingling, burning, and/or pain in the hand, and work above the action level of the peak force and hand activity level threshold limit value. This longitudinal study supports findings from previous cross-sectional studies identifying both work related ergonomic stressors and physical factors as independent risk factors for CTS.

Individual risk factors for carpal tunnel syndrome: an evaluation of body mass index, wrist index and hand anthropometric measurements.

In this study we aimed to identify the role of the body mass index (BMI), wrist index and hand anthropometric measures as risk factors for carpal tunnel syndrome (CTS) in both genders. Based on clinical and electrophysiologic diagnostic criteria, 154 female and 44 male CTS patients, as well as 150 female and 44 male age-matched control subjects, were selected. BMI, wrist index, hand shape index, digit index and hand length/height ratio were compared between the CTS patients and the control subjects for each gender separately. Mean BMI was found to be a significant risk factor for CTS in both genders. The wrist index was found to be higher in female (P < 0.001) and in male (P = 0.034) CTS groups than in the respective control groups. Logistic regression analysis revealed the wrist index to be an independent risk factor in females, but not in males. Shape and digit indices were significantly higher in female CTS patients than in corresponding control subjects, and regression analysis showed the shape and digit indices to be independent risk factors for CTS. In the male CTS group, the shape and digit indices did not significantly differ from their controls. Differences in the hand length/height ratio were not statistically significant in female and male CTS patients compared to their controls and it was not found to be an independent risk factor for CTS. Our study confirmed BMI as an independent risk factor for CTS in both genders. Hand and wrist anthropometrics were found to be independent risk factors for CTS in females, but not in males.

An evaluation of gender, obesity, age and diabetes mellitus as risk factors for carpal tunnel syndrome.

The aim of this study is to identify gender, high body mass index (BMI), age and diabetes mellitus (DM) as independent risk factors (RF) for carpal tunnel syndrome (CTS) and to analyse the strength of association of these factors, both globally and in individual subgroups. We performed a case-control study with 791 CTS cases and 981 controls. Patients were selected from those referred to nerve conduction studies and electromyography in 3 university hospitals and two private services. We calculated the odds ratio between the two groups to analyse the RF. Possible sources of bias were studied using stratified and multivariate analyses. The mean BMI and age were greater in the case group than in the control. Female gender, BMI>30, age of 41-60 years and DM were significantly more frequent in the case group. Males tend to have a more severe CTS and DM was a significant RF for bilateral lesions. Stratified analysis showed female gender, obesity and age of 41-60 years as independent RF. DM, when stratified by BMI category, was not significantly associated with CTS. Our study confirms that female gender, obesity and age are independent RF for CTS. DM may be a weak RF, especially among women.

Points: Drugs in developing countries

Carpal tunnel syndrome (CTS) is a common form of peripheral nerve entrapment, which is observed due to compression of the median nerve at the level of the carpal tunnel in the wrist. Bifid median nerve and persistent median artery association are rare, and they may be independent risk factors for CTS. These rare entities are usually asymptomatic, but in cases of acute thrombosis or dilatation of the persistent median artery, acute findings can be seen. We report a case of acute CTS due to thrombosis of a persistent median artery and associated bifurcated median nerve during pregnancy.