Rate Of Carpal Tunnel Syndrome Research Articles

Nerve Conduction Studies and Measurement of Median Nerve Cross-Sectional Area in Patients Newly Diagnosed with Hypothyroidism

Aim: This study aimed to investigate the rate of carpal tunnel syndrome (CTS) and polyneuropathy in patients with new-diagnosed hypothyroidism and the relationship between median nerve conduction and the cross-sectional area of the median nerve by ultrasonography. Material and Methods: It was a prospective, cross-sectional and case-control study. This study included thirty-five new-diagnosed hypothyroidism cases and thirty-five healthy controls. Bilateral sensory and motor nerve potentials were noted in the lower and upper extremities. The cross-sectional area of the median nerve was examined at the entrance of the CT with the axial plan by ultrasonography. The relationship between the cross-sectional areas of the median nerve and nerve conduction parameters was investigated. Results: CTS was determined electrophysiologically in 8 (22.9%) patients. The control group had no CTS. There was no significant electrophysiological finding to support polyneuropathy in the patients. The cross-sectional areas of the median nerve were higher in the patient group but did not reach statistically significant (p>0.05). There was a positive correlation between the right and left cross-sectional area of median nerves and body mass index (BMI) (p<0.05). Conclusion: The rate of CTS is high in patients with newly diagnosed hypothyroidism. There is a positive correlation between cross-sectional nerve areas and BMI. There was no significant correlation between nerve conductions and median nerve ultrasonographic cross-sectional areas.

Abstract 10257: Diagnostic Yield of Screening and Associated Factors for Transthyretin Cardiac Amyloidosis in Severe Aortic Stenosis

Introduction: Transthyretin cardiac amyloidosis (ATTR-CA) has been associated with severe aortic stenosis (AS), with some studies finding up to 20% of patients who undergo transcatheter aortic replacement (TAVR) have ATTR-CA. New therapies for ATTR-CA have brought significant interest in identifying patients at high risk for this disease. The purpose of this study was to prospectively evaluate the yield of universal testing for ATTR-CA in older patients with severe AS. Methods: All patients ≥ 70 years with severe, native, and degenerative AS seen in valve clinic for evaluation of TAVR were referred for technetium-99m pyrophosphate cardiac scintigraphy (PYP scan). Diagnosis was made via a combination of planar grade, heart to contralateral lung ratio, and single positron emission computed tomography/computed tomography. Patients with a positive PYP scan were referred for appropriate laboratory testing to rule out AL amyloidosis. Clinical and echocardiographic factors were correlated with the PYP result. Results: Over a 12-month period, 787 patients with severe AS were screened of which 543 met the inclusion criteria. Of these patients, 298 underwent a PYP scan with 232 not undergoing the scan for logistical and scheduling issues during the pandemic. The positivity rate was 4.3% (13/298). Patients with a positive PYP scan had higher rates of carpal tunnel syndrome (54% vs 14%, p <0.001), abnormal global longitudinal strain (> -18%) (100% vs 69%, p=0.044), low stroke volume index (≤35 ml/m 2 ) (92% vs 42%, p<0.001), thick intraventricular septum ≥ 1.1 cm (100% vs 79%, p=0.07), and abnormal left ventricular mass index (83% vs 46%, p=0.010). Conclusions: The prevalence of ATTR-CA in severe AS is lower than cited in previous studies, likely due to the expanded indication for TAVR. A multiparametric diagnostic algorithm or risk score for ATTR-CA in AS could enhance the yield of screening, reduce cost and unnecessary radiation, and result in more rapid treatment of amyloidosis.

Carpal tunnel syndrome and tenosynovitis in women with breast cancer associated with hormone therapy: A multi-institutional analysis using a clinical data warehouse.

The study aims to evaluate the characteristics, treatments, and incidence rates of carpal tunnel syndrome (CTS) and tenosynovitis in women with breast cancer, according to the hormone therapy used. We retrospectively reviewed women with breast cancer identified from the clinical data warehouse of the six hospitals in Korea, from January 2015 to August 2020. Among them, patients with CTS or tenosynovitis were reviewed in terms of disease status and treatments. A total of 101 patients among a population of 15,504 met the study inclusion criteria, so their clinical data were analyzed. Aromatase inhibitor (AI) users frequently needed oral medication for CTS, and developed severe CTS which frequently required surgery. AI users presented with a higher incidence of CTS (1.3%) than patients without hormone therapy (0.4%), and tenosynovitis occurred at a higher rate in AI users (2.3%) compared to the tamoxifen (1.1%) and no hormone groups (0.5%). More than half of the CTS and tenosynovitis occurred within 12 months after hormone commencement. The incidence and disease characteristics of CTS and tenosynovitis differed among the groups depending on the type of hormone therapy received. Our findings will help clinicians understand clinical courses and treatments for CTS and tenosynovitis in breast cancer patients.

The effect of ergonomic educational intervention on the exacerbation rate of carpal tunnel syndrome (CTS) among employees of governmental banks

Introduction: Carpal tunnel syndrome (CTS) is the most common peripheral nerve compressive neuropathy. Some occupational factors influence the development of this syndrome, such as frequent and prolonged work with hands and fingers. The purpose of this study was to evaluate the symptoms and functional status of CTS and to evaluate the effect of ergonomic educational intervention on the exacerbation rate of CTS among employees of governmental banks.
 Materials and Methods: This descriptive-analytical study was conducted in the state banks of Torbat Heydariyeh. Symptoms severity and functional status of Carpal Tunnel Syndrome were assessed using Boston Questionnaire. The wrist ratio was measured with a caliper. Data were analyzed by SPSS 23 software using Wilcoxon and Chi-square tests.
 Results: The results showed that staff with wrist dimensions greater than 0.7 (square wrist) had more severe CTS symptoms and functional status. Also, there was a significant relationship between the dominant hand and CTS symptoms. (p<0.0001). Results of comparing the severity of symptoms and functional status of carpal tunnel syndrome in the two groups before and after the intervention show that the percentage of the severity of symptoms of severe and moderate carpal tunnel syndrome in the post-intervention group was significantly lower than before; (Z= -3.317, p<0.0001).
 Conclusion: The results show that the severity of symptoms, functional status of carpal tunnel syndrome among bank employees at three levels of mild, moderate, and severely decreased significantly after ergonomic intervention. Ergonomics training intervention is an easy, low-cost, and practical method that can be used as an effective program to improve the symptoms of people with carpal tunnel syndrome in banks.

What Is the Infection Rate of Carpal Tunnel Syndrome and Trigger Finger Release Performed Under Wide-Awake Anesthesia?

High infection rates have been reported in hand procedures using the wide-awake local anesthesia no tourniquet (WALANT) method, causing some to question the validity of this approach. However, little evidence exists surrounding the direct use of WALANT compared with monitored anesthetic care (MAC). This study was conducted to directly compare the postoperative infection rates of carpal tunnel syndrome (CTS) and trigger finger (TF) release surgeries performed under WALANT and MAC. A retrospective study comparing postoperative infection rates between patients undergoing CTS and TR releases was conducted. Our primary outcome measure was postoperative infection. Our secondary outcome was postoperative complications. Comparative statistics were used to compare means of infection between the groups. A total of 526 patients underwent CTS release (255 with WALANT and 271 with MAC), and 129 patients underwent TF release (64 with WALANT and 65 with MAC). Patients undergoing WALANT and MAC were statistically comparable in terms of sex, smoking status, diabetes, and American Society of Anesthesiologists physical status classification. In patients undergoing CTS release, there were no infections with WALANT and 6 infections (2.2%) with MAC. In patients undergoing TF release, there were no infections in either group. There were similar rates of complications in patients undergoing WALANT and MAC for CTS and TF releases. There was no increased risk of infection with WALANT compared with MAC in CTS or TR surgeries. These surgeries can be safely conducted with lidocaine and epinephrine without a concern for increased risk of infections or complications.

Rates of Carpal Tunnel Syndrome in a State Workers' Compensation Information System, by Industry and Occupation - California, 2007-2014.

Carpal tunnel syndrome (CTS) occurs when the median nerve becomes compressed as it passes through the wrist within the carpal tunnel, resulting in pain, tingling, weakness, or numbness in the hand or the wrist. Occupational risk factors for CTS include engaging in work activities that require forceful, repetitive tasks, prolonged use of the hands or wrists in an awkward posture, or vibration (1). To assess trends and identify high-risk industries and occupations for CTS, the California Department of Public Health (CDPH) analyzed California workers' compensation claims for CTS by industry (2007-2014) and occupation (2014) and calculated rates per full-time equivalent (FTE) worker. During 2007-2014, a total of 139,336 CTS cases were reported (incidence=6.3 cases per 10,000 FTE) in California workers; the rate among women (8.2) was 3.3 times higher than that among men (2.5). Industries with the highest rates of CTS were textile, fabric finishing, and coating mills (44.9), apparel accessories and other apparel manufacturing (43.1), and animal slaughtering and processing (39.8). Industries with high rates of CTS should consider implementing intervention measures, including ergonomic evaluations and development of tools and instruments that require less repetition and force and that correct awkward postures.

Systematic review and pooled analysis of the rate of carpal tunnel syndrome after prophylactic carpal tunnel release in patients with a distal radius fracture

The aim of this study was to determine the rate of carpal tunnel syndrome (CTS) in patients with a volar plated distal radius fracture (DRF), with or without prophylactic carpal tunnel release (CTR). The PubMed database was searched for studies reporting on CTS in patients with a DRF fixed by a volar plate. Selected patients were those who underwent prophylactic CTR versus patients who did not. Pooled rates of CTS were calculated using inverse — variance weighting assuming a random effects model. Tests for heterogeneity were applied. In this study, 172 patients in the CTR group and 1839 patients in the non-CTR group were included. The pooled rate for CTS in the CTR group was 28.1% (95% CI: 11.8% to 48.2%) while it was 4.4% (95% CI: 3.1% to 6.0%) in the non-CTR group. CTR is of no prophylactic value for postoperative CTS in volar plated DRF patients.

The incidence of carpal tunnel syndrome in patients with rheumatoid arthritis.

To assess the incidence rate of carpal tunnel syndrome (CTS) in patients with rheumatoid arthritis (RA) and investigate the correlations between CTS and disease activity and duration in patients with RA. This retrospective cohort study was conducted to assess the incidence rate of CTS in 1070 patients with RA who had visited our rheumatism center between March 2001 and May 2013, and had participated in follow-up at least once over a 5-year period. We also investigated duration of RA and C-reactive protein (CRP) levels at time of CTS occurrence to identify correlations between CTS occurrence and duration of RA, and disease activity of RA. The cumulative incidence for 12years of CTS in patients with RA was 6.8% (12/176), and 37 cases of CTS occurred in 1070 patients with RA. The incidence rate of CTS in patients with RA was found to be 4.18 per 1000 person-years (37 in 8849 person-years). There was no statistically significant correlation between CTS occurrence and duration of RA, and no positive correlation between CTS occurrence and CRP levels. Our incidence rate of CTS in patients with RA was similar to the incidence rate of CTS in the general population (0.3-5.0 per 1000 person-years). CTS occurrence did not correlate with duration of RA and had no positive correlation with disease activity of RA.

Incidence of carpal tunnel syndrome in adult patients with mitochondrial disease.

Symmetrical polyneuropathy is a common feature of mitochondrial disease. Both axonal and demyelinating types are described, with Schwann cell abnormalities demonstrated on nerve biopsy. Some authors have also suggested an increased incidence of entrapment neuropathy. We identified 738 adult patients with proven mitochondrial disease seen in our centre in the past 25 years. One-hundred sixty seven of these patients had undergone nerve conduction studies as part of their routine clinical care, and the results of these studies were reviewed. We found an incidence rate of carpal tunnel syndrome (CTS) of 50.7 per 100,000 person-years; 32.5 per 100,000 person-years for men and 65.3 per 100,000 person-years for women. One other patient had evidence of ulnar neuropathy at the elbow. The incidence of CTS in mitochondrial disease is similar to published rates for the UK general population. We found no evidence that mitochondrial disease per se increases the risk of entrapment neuropathy. We suggest that the pathophysiological mechanisms for the development of polyneuropathy in mitochondrial disease are quite distinct from the pathophysiology of CTS. Furthermore, it is essential that patients with mitochondrial disease who present with upper limb paraesthesia be referred for neurophysiological testing, so that treatableCTS is not missed.

Evaluation of Upper Extremity Nerve Conduction Velocities and the Relationship Between Fibromyalgia and Carpal Tunnel Syndrome

We undertook this study to evaluate upper extremity nerve conduction velocities (NCVs) in fibromyalgia syndrome (FS) and the relationship of the electrophysiological findings between carpal tunnel syndrome (CTS) and FS. Sixty three right-handed female patients diagnosed with FS and 52 right-handed age- and gender-matched healthy controls were enrolled in the study. Conduction studies of the median and ulnar nerves and median nerve F-wave latencies were assessed in both upper extremities using standard methods. CTS was diagnosed electrophysiologically if the median nerve sensory NCV was decreased and/or motor distal latency (DL) was prolonged. CTS was detected electrophysiologically in 26 (20.63%) of 126 extremities of 63 patients and in three (2.82%) of 104 extremities of 52 individuals of the control group. Statistically significant differences were detected between groups with respect to rate of carpal tunnel syndrome (p <0.05). There were no differences between results of NCVs of patients in FS group and healthy controls except the prolongation of the right median nerve motor DL (p = 0.019), decrease of the sensory NCV (p = 0.003) in the right median nerve, in the left median nerve (p = 0.011) and in the left ulnar nerve (p = 0.015). We determined an increased rate of CTS and decreased NCVs in the upper extremities in patients with FS. We should consider that complaints of paresthesia and pain in hands, increasing especially at nights, observed in FS may mask that CTS can be an associated illness.

Incidence of Carpal Tunnel Syndrome Among Automobile Assembly Workers and Assessment of Risk Factors

This study defined the incidence rate of carpal tunnel syndrome (CTS) among active assembly workers and evaluated risk factors. This study followed 189 automobile assembly workers over 1 year. Incident cases were defined as workers who had no current or prior history of CTS and were subsequently diagnosed with CTS by means of active surveillance during the study. The estimated annual incidence rate ranged from 1% to 10%, depending on the case definition. Significant predictors for CTS include a higher baseline median-ulnar peak latency difference, history of wrist/hand/finger tendonitis, history of diabetes, nonneutral wrist and elbow postures, and a lower self-reported social support. This is similar to other prospective studies that demonstrate both ergonomic and medical history are independent risk factors for development of CTS.

Commentary: severe carpal tunnel syndrome

There is a general perception in the United States that the rate of carpal tunnel syndrome (CTS) is increasing. Although carpal tunnel release is one of the most commonly performed surgeries in this country, it is still unclear whether there is an epidemic of this disease. Several studies have estimated the prevalence of CTS in the general population (prevalence identifies current existing cases and incidence points to new cases). The prevalence of CTS (confirmed clinically and electrodiagnostically) from a region in Sweden was estimated at 2.7% (95% confidence interval, 2.1% to 3.4%).1 In the U.S., the prevalence of CTS estimated from a regional health care system was 3.7% (95% confidence interval, 0.9% to 4.7%).2 By using the population register at Maastricht, the Netherlands, deKrom et al3 estimated the prevalence at 5.8% (95% confidence interval, 3.5% to 8.1%). Because all these surveys were not based on national samples using strict survey methodology, the prevalence estimates were only extrapolated estimates of the general population. The consistency in the data presented by these 3 studies, however, provided a reasonably valid estimate of CTS prevalence. One of the reasons that the prevalence of CTS is so difficult to establish lies in the lack of a confirmatory study for this disease; provocative tests are notoriously inaccurate, and false-positive and negative findings in electrodiagnostic studies do occur, depending on the prevalence of CTS in the study sample and the cut-off criteria used in the studies.

Active epidemiological surveillance of musculoskeletal disorders in a shoe factory

Aims: (1) To evaluate an active method of surveillance of musculoskeletal disorders (MSDs). (2) To compare different criteria for deciding whether or not a work situation could be considered at...

ENDOSCOPIC PLASTIC SURGERY

This article discusses three of the most popular endoscopic procedures in plastic surgery. Brow lift, transaxillary breast augmentation, and abdominoplasty are all cosmetic procedures with a high demand on inconspicuous scars; however, many investigators are working on reconstructive endoscopically assisted procedures. The treatment of many facial fractures involving the upper third of the facial skeleton usually requires long bicoronal incisions similar to the incisions used in the traditional brow lift. Attempts are under way to use endoscopically assisted minimal-access techniques to reduce and fixate these fractures. Many flaps used in plastic surgery require long scars for harvest, as in the case of the latissimus dorsi muscle flap. A relatively long incision on the back is needed to gain access to the muscle so that it can be elevated from structures superficial and deep to it. Although it is unpopular, investigators have reported harvesting latissimus dorsi muscle flaps through fairly small incisions with the assistance of balloon dissectors and endoscopes. In the field of hand surgery, carpal tunnel release surgery has had more than one method proposed to transect the carpal ligament using endoscopes and special instrumentation. Although some reported series claim excellent results, many hand surgeons are reluctant to use endoscopes because of associated complications and a high recurrence rate of carpal tunnel syndrome. Plastic surgery has special demands that emphasize aesthetics in cosmetic and reconstructive procedures. Although the lack of natural optical cavities has slowed the incorporation of endoscopic surgery in the specialty, surgically created cavities are used to allow for minimal access incisions. The future of plastic surgery will include an ever-increasing number of endoscopically assisted procedures. Cosmetic and reconstructive procedures will benefit from this new technology.

How Solid Is the Flesh?

How Solid Is the Flesh?

Incidence of Diagnosed Carpal Tunnel Syndrome in a General Population

We sought to determine the incidence rate of carpal tunnel syndrome in the general population. Using three different case definitions, we conducted a prospective study to ascertain by medical record review all cases of incident disease in a defined population during a 2-year period. Newly diagnosed probable or definite carpal tunnel syndrome (N = 309) occurred at a rate of 3.46 cases per 1,000 person-years (95% confidence interval = 3.07-3.84). The incidence rate in our study was 3.5 times higher than the rate 20 years ago in a Minnesota city. The rate difference probably results from a combination of reasons, including a true rise in incidence.

Carpal tunnel syndrome and occupation in U.S. Navy enlisted personnel.

The objectives of this study were to (a) describe demographic factors associated with high rates of carpal tunnel syndrome (CTS), cubital tunnel syndrome, and other neuritis of the arm and hand, and (2) identify the high-risk occupations associated with these disorders in the Navy. Computerized records of first hospitalizations of all active-duty Navy-enlisted personnel were searched for all cases of CTS, cubital tunnel syndrome, and other neuritis of the arm and hand (ICD-9 CM codes 354.0-354.9) during 1980-1988. There were 1039 first hospitalizations (including 493 cases of CTS) for all neuritis of the arm and hand in 4095708 person-years in men and 186 first hospitalizations (including 90 cases of CTS) in 365668 person-years in women. Incidence rates of hospitalized cases with CTS rose with age for both sexes. Rates in white women were approximately three times those in white men (p < .0001), but rates in black women were not significantly different from those in black men. Rates of cubital tunnel syndrome also increased with age in both sexes and were higher in white women than white men (p < .05). Occupations with significantly high standardized incidence ratios (p < .05) for CTS in men included aviation-support equipment technician, engineman, hull-maintenance technician, boatswain's mate, and machinist's mate. In women, occupations with significantly high standardized incidence ratios included boatswain's mate, engineman, hospital corpsman, ocean-systems technician, and personnelman. Several occupations for each sex had significantly high standardized incidence ratios for cubital tunnel syndrome, with high rates in hospital corpsmen of both sexes (p < .05). Gender and race differences according to occupation did not account for the occupations at highest risk. Further research is needed to determine the extent to which CTS and related disorders could be prevented by modifying the motions currently performed in occupations with the highest standardized incidence ratios.

A stress-strength interference model for predicting CTD probabilities

A model for predicting the incidence rate of carpal tunnel syndrome (CTS) for a given job, was developed using known biomechanical data, mechanical properties of human tendons and reliability engineering techniques to simplify the problem. In addition, time-dependent stress-strength interference theory was used to quantify the stress on the tendons during a job cycle, based on wrist position and grip strength and to estimate the tendon failure rate (or CTS incidence) for a given job. Higher failure probabilities were predicted for greater wrist deviations, for higher grasp forces, for females as compared to males, for wrist extension as compared to wrist flexion, and for two-fingered pinches as compared to four-fingered grasps. The predictions closely matched previously reported CTS incidence rates for a poultry thigh boning task.

Risk factors for median mononeuropathy of the wrist in postpoliomyelitis patients

There is evidence that chronic cane, crutch, and wheelchair users are at increased risk for developing pain and functional compromise of the wrist and hand. This investigation examined the prevalence and risk factors for median mononeuropathy at the wrist in the postpoliomyelitis population. The medical records of 148 consecutive patients with histories of poliomyelitis were reviewed. Forty-nine percent of this cohort had complaints of wrist pain. The prevalence rate of carpal tunnel syndrome was 22% (n = 33). Age, sex, duration of disability, and work history did not significantly influence the relative risk of developing this disorder. However, the relative risk of developing this compression neuropathy at the wrist by using the combination of a cane and/or a crutch and a wheelchair was 4.86 (95% confidence interval 2.35-10.06). The high risk associated with chronic cane, crutch, and wheelchair use shows the need for developing preventive strategies.