Probable Carpal Tunnel Syndrome Research Articles

ASSESSING CARPAL TUNNEL SYNDROME AMONG ADMINISTRATIVE STAFF OF A HIGHER LEARNING INSTITUTION: A PRELIMINARY STUDY

Background: Repeated hand and wrist movements increase the risk of carpal tunnel syndrome (CTS). The administrative staff is one of the high-risk classes that repeatedly involve the execution of identical tasks.
 Objective: This preliminary study was conducted to determine the prevalence of CTS among administrative staff and identify the socio-demographic and occupational risk factors for this syndrome.
 Methods: Descriptive cross-sectional study design was conducted amongst administrative staff at one of the higher learning institutions in Pahang, Malaysia. A total of 61 respondents were conveniently sampled according to the inclusion criteria. Respondents were required to undergo three tests (Phallen’s test, Thinel’s test, Durkan’s test) to identify probable CTS and answer questionnaires (socio-demographic background, occupational risk factors, and Boston Carpal Tunnel Syndrome Questionnaire). Data were analyzed using SPSS, and a Chi-square test was used to identify risk factors for CTS.
 Results: The average age for respondents was 31.72 (+5.38). The majority of respondents were female (70.5%), with a bachelor’s degree background and below (91.2%), and never used ergonomic tools (68.9%). The prevalence of probable CTS was 16.5% (n=10). There is no statistically significant finding between socio-demographic and occupational risk factors with probable CTS (p >.05).
 Conclusion: The data from this preliminary study revealed no association between the use of computers at work and probable CTS in a higher learning institution. Although the findings are not significant, this study can be used as a baseline for a future longitudinal study for nurses and other healthcare professionals to encourage good occupational and environmental health.

Carpal Tunnel Syndrome: The Role of Occupational Factors Among 906 Workers

BackgroundCarpal tunnel syndrome (CTS) is common in the industrial setting. However,there is a controversy about the sole role of occupational ergonomic hazards in CTS.ObjectivesThis study was conducted among assembling workers of a detergent factory and computer users with the aims of A) determination of CTS prevalence and B) evaluation of personal risk factors and level of exposure to occupational risk factors via Quick Exposure Check (QEC).Materials and MethodsIn this descriptive cross-sectional study, 906 cases (332 assembling workers and 574 computer workers) were enrolled. CTS was assessed by symptoms on the Katz hand diagram and physical examination. QEC technique was applied to evaluate physical exposure to the risk factors.ResultsAccording to this study, the prevalence of probable CTS was 14% in men and 8.9% in women; the rate of probable CTS was significantly higher in assembly workers than in computer users (P < 0.001). Mean age and work duration in the probable CTS group was statistically higher than in non-CTS group. But both groups were in the same range (fewer than 30, P = 0.024, 0.004); BMI in the probable CTS group was slightly lower than in non CTS group, but BMI in both groups were in the normal range. Wrist ratio > 0.7 correlated with increased risk of probable CTS (P < 0.001) Prevalence of probable CTS was significantly higher in third and fourth levels of QEC (P < 0.001).ConclusionsAlthough this article had limitations, our findings suggest that the level of occupational exposure is an indicator of CTS development.

Medical and non‐medical correlates of carpal tunnel syndrome in a Taiwan cohort of one million

Carpal tunnel syndrome (CTS), with unclear etiology, is the most common entrapment neuropathy. Its occurrence is related to lots of medical and non-medical conditions with uncertain causality. With a large population, we characterized selected demographical and clinical factors to add more information on CTS-correlated factors and new insight into future CTS prevention. A national insurance claim dataset of one million enrollees in Taiwan was used to identify 15 802 patients with CTS and 31 604 randomly selected controls, during a period of 7 years starting 1 January 2000. Statistical association with CTS was determined for five sociodemographic and nine medical factors. Patients were predominantly women (65.6% vs. 47.7% in the control group) and older (40 and above, 62.6% vs. 36.2%). Rheumatoid arthritis was found to be the most significant comorbidity associated with CTS, followed by gout, hypertension, diabetes, obesity, uremia, and acromegaly. For younger group age ≤39, the association of these comorbidities was stronger, and hypothyroidism and vitamin B(6) deficiency were additional comorbidities. Aging appears to reduce the relative impact of the diseases commonly associated with CTS as the possible risk factors. Identification of the CTS correlates in younger group would be of greater value in timely detection and treatment for these diseases. Correcting these disorders may aid in removing possible causes of CTS. This is the first report on the effect of aging on probable CTS risk factors. How factors associated with aging contribute to the development of CTS remains to be determined.

Physical work load factors and carpal tunnel syndrome: a population-based study

Objective:Carpal tunnel syndrome (CTS) is the most common nerve entrapment syndrome. Studies on selected occupational populations suggest an association of CTS with forceful repetitive work and vibration. Only few population-based...

Review of Different Electrodiagnostic Studies in Mild Carpal Tunnel Syndrome

Aims The objective of this study was to evaluate different sensory electrodiagnostic tests in mild carpal tunnel syndrome (CTS). Methods Forty-seven patients (45 females and 2 males) with a total of 65 hands who attended the electrodiagnosis laboratory with the complaints of paresthesia, tingling, and pain in the median nerve distribution area for at least 1 month, at least 3 times/wk were included in the study. Patients with a history of CTS surgery, decreased ulnar sensory nerve action potential amplitude (<12 μV), increased ulnar sensory nerve onset latency (>3.7 ms), increased median motor distal latency (>4.2 ms), polyneuropathy and/or radiculopathy, pacemaker users, and pregnant women were excluded from the study. Electrodiagnostic studies including median and ulnar motor nerve conduction velocities; median sensory nerve conduction velocity (SNCV) of the first, second, and third digit to wrist (D1-W, D2-W, and D3-W) and palm to wrist; sensory median-radial latency difference (MRD) from the thumb; sensory median-ulnar latency difference (MUD) across the wrist over 8-cm segment; and sensory median-ulnar latency difference (MUDF) from the fourth digit were performed. Results Median SNCV of D1-W was found pathologic in all patients, MRD in 92.3%, MUDF in 92%, median SNCV of D2-W in 81.5%, MUD in 78.5%, and median SNCV of palm to wrist in 55.62%. In the case where a second test including median SNCV of D1-W, MUDF, or MRD is conducted with median SNCV of D3-W, 100%, 98%, and 97% of patients, respectively, having mild CTS could be diagnosed electrodiagnostically. Conclusions For the electrophysiologic diagnosis of patients with probable mild CTS, adding median SNCV of D1-W, MUDF, MRD, and median SNCV of D3-W study could be suggested to increase the accuracy of the diagnosis.

Clinical features of 1039 patients with neurophysiological diagnosis of carpal tunnel syndrome

Purpose: To describe the clinical features of patients with a neurophysiologic diagnosis of carpal tunnel syndrome (CTS) in the state of Rio Grande do Sul, Brazil. Methods: We prospectively studied 1039 patients with a neurophysiologic diagnosis of CTS in southern Brazil. All patients completed a clinicoepidemiological questionnaire which included a drawing of the arm and hand, in which they were asked to paint the areas in which paresthesia and pain occurred. In part of the sample, we also investigated the presence of clinical signs such as Tinel's, Phalen, and tenar atrophy. The diagnosis of CTS was performed using a predetermined neurophysiological protocol. Results: A total of 1528 hands were diagnosed with CTS. The severity of CTS was mild in 42% of cases, moderate in 18% and severe in 40%. Patients had a mean age of 48.3 ± 12.4 years old, and a ratio of 5.6 females to 1 male was observed. Symptoms restricted to the hand and wrist was observed in 51.8% of cases with paresthesia and in 18.5% of cases with pain. In 92.5% of the partially affected hands, paresthesia was present in at least one of the first three fingers, while pain affected the three first fingers in 78.8% of these hands. Pain with a distribution which did not involve the hand occurred in 18.5% of cases, while paresthesia without involvement of the hand occurred in only 1.9%. Distribution of symptoms, according to Katz's hand diagram, showed a classic pattern in 12.6% of affected hands, a pattern classified as probable CTS in 66.3%, and an unlikely CTS pattern in 4.1%. Tinel's and Phalen's sign were observed in 34.2 and 56.3% of the hands, respectively. Conclusion: The clinical presentation of CTS is pleomorphic, ranging from the absence of symptoms to very severe cases. This variation probably is dependent on coexistent diseases, such as tendinitis and fibromyalgia, as well as on subjective aspects of the patients.

Evaluation and Treatment of Carpal Tunnel Syndrome Reviewed

These authors review the evidence for and provide clinical recommendations regarding diagnostic strategies and treatments for carpal tunnel syndrome (CTS). History- and examination-based diagnostic methods have limited sensitivity and specificity. Nonetheless, to identify probable CTS, the authors favor using history, facilitated by a hand-pain diagram, and examination, including sensory and motor testing and provocative maneuvers. They recommend treating probable CTS conservatively, with neutral wrist splinting, which alleviates symptoms in …

COMPARISON BETWEEN A QUANTITATIVE CLINICAL SCALE AND NEUROPHYSIOLOGICAL EVALUATION IN CARPAL TUNNEL SYNDROME

Background: Carpal Tunnel Syndrome (CTS) is one of the most frequent cause of pain and paresthesias in the upper extremities. Neurophysiological studies allow to confirm diagnosis based on clinical evaluation.Aim of the study: to investigate if the score of the Simovic and Weinberg Clinical Scale (SWCS) for CTS correlates to the neurophysiological severity assessment proposed by Padua.Material and methods: 65 consecutive patients with suspected CTS were examinated. 54 were females (mean age, 54.5; range, 23–83). Body mass index (BMI), wrist circumference, and symptoms duration were also calculated for each patient. The SWCS was administered to all patients before neurophysiological evaluation. The scale consists of 11 items (8 anamnestic and 3 clinical), which have a different impact on the total score (maximum 30/30). Diagnosis of CTS using SWCS can be probable (9–30/30), possible (7–8/30), or unlikely (1–6/30). CTS were classified using neurophysiological criteria according to Padua into six severity groups (from negative to extreme).Results: CTS severity according to Padua's criteria was related to higher scores in SWCS. No correlation was found comparing BMI and symptoms duration with clinical and neurophysiological severity. Wrist circumference was also not significant. There was no diagnosis of unlikely‐CTS at SWCS, but on the contrary 15 patients with probable CTS had no pathological findings at electrophysiological evaluation.Comment: Clinical severity assessed using SWCS correlates with neurophysiological severity. Irritative symptoms are easily recognized by the SWCS, even if there is no neurophysiological correlate. The use of a sensitive scale as SWCS allows to avoid useless neurophysiological studies if the diagnosis of CTS is unlikely.

Terminal latency index in the carpal tunnel syndrome.

Our retrospective study assessed the validity of the median motor terminal latency index (m-TLI) in evaluation of carpal tunnel syndrome (CTS). In patients deemed most likely to have CTS, the mean m-TLI was markedly reduced at 0.25 while the controls had a mean m-TLI of 0.44. The m-TLI was abnormal in all of the "probable CTS" hands and in none of the control hands. The m-TLI is a sensitive adjunctive electrophysiologic measure for the presence of CTS.

Assessment of the carpal tunnel outcome instrument in patients with nerve-compression symptoms

The outcome movement in medicine has encouraged the development of patient-answered questionnaires as measures of well-being. A disease-specific questionnaire for carpal tunnel syndrome (CTS) was introduced by Levine et al. in 1993. We evaluated this questionnaire in 156 consecutive new patients presenting with pain, numbness, or tingling of the upper extremity. Of these, 114 correctly filled out the carpal tunnel outcome instrument. In addition, these patients completed the self-administered hand diagram developed by Katz and Stirrat for the diagnosis of CTS. The 114 patients were classified according to their hand diagram as classic or probable CTS (n = 47), possible CTS (n = 31), and unlikely CTS (n = 36). The mean symptom severity score in patients classified as classic or probable CTS was significantly higher than the mean score in patients classified as possible or unlikely CTS (p < .01). The mean scores of items regarding sensory symptoms were significantly higher in patients with classic or probable CTS compared to patients with possible or unlikely CTS (p < .0001). The scores were similar for CTS and non-CTS patients on the functional status subscale.

Slowing of sensory conduction of the median nerve and carpal tunnel syndrome in Japanese and American industrial workers

As part of a continuing study of the causes of carpal tunnel syndrome (CTS) in industry, we measured sensory conduction of the median nerve in 101 Japanese furniture factory workers. We used the maximum latency difference (MLD) with a critical value of ⩾0.40 msec to indicate abnormal slowing of nerve conduction. The prevalence of slowing in the Japanese workers was 17.8%, while the prevalence of probable CTS (based on symptoms only) was 2.5%, and the prevalence of definite CTS (probable CTS confirmed by slowing) was 2.0%. The most important factor predicting the MLD was the body mass index. The MLD was the most important factor predicting probable CTS. The prevalence of slowing in the Japanese workers was not significantly different from the prevalence of slowing in 316 American workers from four industries (22.0%), but the prevalences of probable CTS and definite CTS were much lower in the Japanese. The meaning of these findings is discussed.

Comparison of a digital electroneurometer and standard nerve conduction studies for the measurement of median nerve sensory latency

The purpose of this study was to determine the validity of measuring median nerve distal sensory latency with a portable digital electroneurometer. The results from the digital electroneurometer were compared to standard nerve conduction studies in 51 subjects (40 asymptomatic hands and 12 hands with probable carpal tunnel syndrome). There was a high correlation (r=0.92) between the latencies obtained from the electroneurometer and the onset latencies measured by standard nerve conduction studies. The mean difference between distal sensory latencies for matched pairs of latency measurements was 0.09 (+/-0.21) ms. The use of the digital electroneurometer for obtaining distal sensory latencies proved to be objective and valid. The electroneurometer would be useful in a variety of occupational and clinical settings for screening of peripheral neuropathy where standard nerve conduction equipment may be unavailable or impractical.

Correlation studies of velocity, amplitude, and duration in median nerves

Nerve conduction velocity is the parameter most often attended to when performing nerve conduction studies, but amplitude and duration of the nerve potentials should also provide important information about the status of the nerve examined. This study compared the results of amplitude and duration measurement to nerve conduction velocity to determine whether or not the various parameters correlated. Using standard techniques, median nerve motor and sensory conduction studies were performed on 390 unselected patients. The results were analyzed and correlation statistics calculated between the parameters of velocity, duration, and amplitude. Amplitude and duration of evoked potential correlated relatively poorly with conduction velocity (r2 = 0.26). Sensory and motor fibers were often affected differently in cases with probable carpal tunnel syndrome (CTS). Proximal motor conduction velocity correlated best with distal evoked potential amplitude (r2 = 0.27) in the CTS cases. The use of residual latency appeared to add little helpful diagnostic information. It was concluded that different parameters measure different physiologic processes that are to a considerable degree independent of each other.