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

Pairwise association of upper extremity musculoskeletal conditions: large population investigation from PERSIAN cohort study

BACKGROUND

People with one area of upper extremity musculoskeletal conditions (UEMSCs) may have other. We aim to determine how frequent is the ipsilateral coexistence of common UEMSCs apparent on interview and examination.

METHODS

This is a large population cross-sectional study conducted as part of the PERSIAN cohort study int Mashhad University of Medical Sciences (MUMS). The study aimed to evaluate individuals for symptoms and signs of the following conditions: carpal tunnel syndrome (CTS), lateral epicondylitis (LE), trapeziometacarpal osteoarthritis (TMC OA), DeQuervain's tendinopathy, trigger digit (TD), ganglion cyst, and rotator cuff tendinopathy (RCT). The primary outcomes of the study are (1) to determine the side-specific relative risk of each UEMSC coexisting with the second condition, and (2) to identify predictive factors of each UEMSC using side-specific multivariate logistic regression analysis.

RESULTS

We conducted a study involving 4737 individuals from the staff of MUMS and found significant pairwise associations among UEMSCs on a side-specific basis. Women had more chance of having DeQuervain's disease (β = 6.3), CTS (β = 3.5), ganglion cyst (β = 2.5), TMC OA (β = 2.3), and RCT (β = 2.0). Each condition (dependent variable) was associated with others (predictors) as follows: CTS: RCT (β = 5.9), TMC OA (β = 4.7), TD (β = 2.9), and LE (β = 2.5).

TMC OA

LE (β = 6.4), TD (β = 5.4), RCT (β = 4.3), and CTS (β = 4.1). LE: RCT (β = 8.1), TMC OA (β = 6.4), and CTS (β = 2.5). DeQuervain's disease: TD (β = 13.6), RCT (β = 4.5), and LE (β = 3.8). TD: CTS (β = 8.8), ganglion cyst (β = 7.6), DeQuervain's disease (β = 5.7), and TMC OA (β = 4.3). RCT: LE (β = 5.8), TMC OA (β = 5.5), CTS (β = 5.2), and DeQuervain's disease (β = 4.3). Ganglion cyst: TD (β = 4.8).

CONCLUSION

Our study reports significant increased frequency of the UEMSCs among patients who already have one of the diseases, in a large sample size study. Level of Evidence Level II (Differential Diagnosis/Symptom Prevalence Study).

Women's wrist and elbow at work: analysis of acute injuries and cumulative trauma disorders to improve ergonomics in female-dominated activities

The aim of this study is to analyse women's wrist and elbow acute work injuries together with cumulative trauma disorders, such as carpal tunnel syndrome (CTS) and epicondylitis. Five years records (2015-2019) on women's wrist/elbow acute work injuries and CTS/epicondilytis, from Italian National Compensation Authority, were collected and pooled all together as 'dis-ac' (disorders + acute) events. A statistical analysis was performed in comparing the different female-dominated work sectors. Results showed that hairdressing/laundry sector was associated with the highest risk for wrist acute work injuries and cleaning for elbow while manufacturing for CTS and epicondylitis. Hairdressing/laundry and manufacturing were associated with the highest risk for dis-ac events (hairdressing: wrist dis-ac OR: 4.89; CI 95% 4.22-5.67; elbow dis-ac OR: 3.70; CI 95% 2.99-4.58; manufacturing: wrist dis-ac OR: 3.39; CI 95% 3.13-3.66; elbow dis-ac OR: 2.45; CI 95% 2.20-2.73). The relationship between acute injuries and cumulative trauma disorders is discussed to preserve women's safety and health in ergonomics.Practitioner Summary: Women's wrist and elbow acute work injuries and cumulative trauma disorders (carpal tunnel syndrome and epicondylitis) were analysed and studied all together (dis-ac events) in female-dominated activities. Hairdressing and manufacturing work sectors were associated with the highest risk, showing the need to safeguard the health and safety of female workers.

Risk factors for degenerative, symptomatic rotator cuff tears: a case-control study

BACKGROUND

Despite the considerable public health burden of rotator cuff tears, there is no consensus on risk factors associated with symptomatic rotator cuff tears. In this study, a large data source was used to identify factors associated with symptomatic rotator cuff tears. We defined cases of rotator cuff tears as those verified by imaging or operative reports and controls as symptomatic shoulders without rotator cuff tears as verified by imaging or operative reports.

METHODS

We performed a case-control study of patients with and without symptomatic rotator cuff tears by use of the Vanderbilt University Medical Center de-identified electronic medical record system, the Synthetic Derivative, with records on >2.5 million patients from 1998 to 2017. Cases and controls were confirmed by individual chart review and review of imaging and/or operative notes. A final set of 11 variables were analyzed as potential risk factors for cuff tears: age, sex, body mass index (BMI), race, smoking history, hypertension, depression/anxiety, dyslipidemia, carpal tunnel syndrome, overhead activity, and affected side. Multivariable logistic regression was used to estimate the association between predictor variables and the risk of having a rotator cuff tear.

RESULTS

A total of 2738 patients were selected from the Synthetic Derivative, which included 1731 patients with rotator cuff tears and 1007 patients without rotator cuff tears. Compared with individuals without tears, those with rotator cuff tears were more likely to be older (odds ratio [OR], 2.44; 95% confidence interval [CI], 2.12-2.89), to have a higher BMI (OR, 1.45; 95% CI, 1.24-1.69), to be of male sex (OR, 1.56; 95% CI, 1.32-1.85), and to have carpal tunnel syndrome (OR, 1.41; 95% CI, 1.03-1.93). Patients with rotator cuff tears were less likely to have left shoulder symptoms (OR, 0.68; 95% CI, 0.57-0.82) and to have depression/anxiety (OR, 0.77; 95% CI, 0.62-0.95) compared with the control group, which had symptomatic shoulder pain without rotator cuff tears.

CONCLUSIONS

In a large imaging and operative report-verified case-control study, we identified advancing age, male sex, higher BMI, and diagnosis of carpal tunnel syndrome as risk factors significantly associated with an increased risk of rotator cuff tears. Left shoulder symptoms and depression/anxiety were less likely to be associated with rotator cuff tears compared with symptomatic shoulders without rotator cuff tears. Contrary to some prior reports in the literature, smoking was not associated with rotator cuff tears.

Translation and validation of the Arabic version of the Boston carpal tunnel syndrome questionnaire

Objectives:

To translate and validate the Arabic version of the Boston carpal tunnel questionnaire (BCTQ-A).

Methods:

We recruited consecutive patients with carpal tunnel syndrome (CTS). Reliability was assessed with Cronbach α, reproducibility with intraclass correlation coefficients, construct validity with factor analysis, and responsiveness post carpal tunnel release (CTR) with the Wilcoxon signed-rank test.

Results:

In 134 patients, the mean total scores for the symptom severity scale (SSS) and functional status scale (FSS) were 32.0±8.4 (α=0.88, ICC=0.88) and 18.5±7.6 (α=0.87, ICC=0.89), respectively. As in the original Boston carpal tunnel questionnaire (BCTQ), a 3-factor model of the BCTQ-A best fitted the data. The BCTQ-A, SSS, and FSS scores were significantly lower post-CTR.

Conclusion:

The BCTQ-A is reliable, valid, reproducible, and responsive to interventions. The Arabic version can be now used with Arabic-speaking patients with CTS.

Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome

The Academy of Orthopaedic Physical Therapy and the Academy of Hand and Upper Extremity Physical Therapy have an ongoing effort to create evidence-based clinical practice guidelines (CPGs) for orthopaedic and sports physical therapy management and prevention of musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability and Health (ICF). This particular guideline focuses on hand pain and sensory deficits in carpal tunnel syndrome. J Orthop Sports Phys Ther 2019;49(5):CPG1-CPG85. doi:10.2519/jospt.2019.0301.

Factors Associated with Atraumatic Posterosuperior Rotator Cuff Tears

BACKGROUND

Certain metabolic factors have been proposed as risk factors for a posterosuperior rotator cuff tear. Although metabolic syndrome is of increasing concern in industrialized societies, little information exists regarding its association with posterosuperior rotator cuff tears. The purpose of this study was to determine the risk factors for an atraumatic posterosuperior rotator cuff tear, including metabolic factors and metabolic syndrome.

METHODS

This study involved 634 subjects (634 shoulders) drawn from a cohort of rural residents. Posterosuperior rotator cuff tear diagnoses were based on magnetic resonance imaging (MRI) findings. Logistic regression analysis was used to determine the odds ratios (ORs) and 95% confidence intervals (CIs) for various demographic, physical, and social factors, including age, sex, dominant-side involvement, body mass index (BMI), and participation in manual labor; the comorbidities of diabetes, hypertension, dyslipidemia, thyroid dysfunction, ipsilateral carpal tunnel syndrome, and metabolic syndrome; and the serum metabolic parameters of serum lipid profile, glycosylated hemoglobin A1c, and level of thyroid hormone. Two multivariable analyses were performed: the first excluded metabolic syndrome while including diabetes, hypertension, BMI, and hypo-high-density lipoproteinemia (hypo-HDLemia), and the second included metabolic syndrome while excluding the formerly included variables.

RESULTS

Age, BMI, waist circumference, dominant-side involvement, manual labor, diabetes, hypertension, metabolic syndrome, ipsilateral carpel tunnel syndrome, HDL (high-density lipoprotein), and hypo-HDLemia were significantly associated with posterosuperior rotator cuff tears in univariate analyses (p ≤ 0.035). In the first multivariable analysis, age (OR. 1.86 [95% CI, 1.47 to 2.35]), BMI (OR, 1.09 [95% CI, 1.02 to 1.18]), dominant-side involvement (OR, 2.04 [95% CI, 1.38 to 3.01]), manual labor (OR, 9.48 [95% CI, 5.13 to 17.51]), diabetes (OR, 3.38 [95% CI, 1.98 to 5.77]), and hypo-HDLemia (OR, 2.07 [95% CI, 1.30 to 3.29]) were significantly associated with posterosuperior rotator cuff tears (p ≤ 0.019). In the second multivariable analysis, age (OR, 1.85 [95% CI, 1.48 to 2.31]), dominant-side involvement (OR, 1.83 [95% CI, 1.26 to 2.67]), manual labor (OR, 7.71 [95% CI, 4.33 to 13.73]), and metabolic syndrome (OR, 1.98 [95% CI, 1.35 to 2.91]) were significantly associated with posterosuperior rotator cuff tears (p ≤ 0.002).

CONCLUSIONS

The metabolic factors of diabetes, BMI, hypo-HDLemia, and metabolic syndrome were significant independent factors associated with the development of posterosuperior rotator cuff tears.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.