Carpal Tunnel Syndrome and Hand-Arm Vibration: A Swedish National Registry Case-Control Study

Prevalence and Risk Factors Associated With Carpal Tunnel Syndrome Among Sudanese Females: A Cross-Sectional Study

BACKGROUND

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy resulting from compression of the median nerve. This condition is more common in females than in males. The earlier the diagnosis, the better the prognosis and treatment outcomes.

MATERIAL AND METHODS

This is a cross-sectional hospital-based study conducted at Soba Teaching Hospital in obstetrics and gynecology outpatient clinic in Khartoum in the period from February 2022 to March 2022. A simple random sampling was applied, and an interview was conducted using a four-part questionnaire. The first part was based on socio-demographic data, the second was lifestyle, and the third and fourth were based on the Boston Carpal Tunnel Questionnaire (BCTQ). The data were analyzed using the statistical package for social sciences (SPSS) software, version 23 (IBM Corp., Armonk, NY) to find the correlation between the various variables.

RESULTS

A total of 113 women participated in the study (response rate=100%). The prevalence of CTS was found to be 5%. No significant association was found between lifestyle and medical history, e.g., obesity and oral contraceptives and CTS were p=0.167, 0.841 respectively. Conversely, there was a significant association between age and residency, with p=0.005 and 0.049, respectively.

CONCLUSIONS

The prevalence of CTS is increasing in Sudan. Therefore, it is essential to thoroughly assess patients for any symptoms related to hand pain by asking detailed questions during consultations. In addition, further studies covering more states are needed to better understand the regional variation in CTS prevalence.

Impact of Exposure to Hand-Held Vibrating Tools on Patient-Reported Outcome Measures after Open Carpal Tunnel Release: A Retrospective Cohort Study with Matched Controls

Objectives: Vibration exposure is a known risk factor for developing carpal tunnel syndrome (CTS), and insufficient outcomes for surgery for CTS have been reported after such exposure. We aim to investigate whether vibration exposure affects patient-reported outcomes following open carpal tunnel release. Methods: From a population surgically treated for CTS (n = 962), we identified patients who reported previous or present vibration exposure, had undergone preoperative electrophysiology testing and answered the Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) questionnaire before and at 12 months post-surgery (n = 23). We then matched the patients with controls based on age, sex, diabetes status, type of diabetes and smoking (n = 23). Results: Most of the patients included were men (17/23; 74% in each group) and had a mean age of 61 years. The preoperative electrophysiology results were slightly worse among vibration-exposed individuals, although the differences were not statistically significant. The QuickDASH scores did not differ between the two groups (preoperative QuickDASH scores in vibration-exposed individuals: median 45 [interquartile range; IQR 30-61]; non-exposed individuals: 43 [25-64], p = 0.68; postoperative 12 months QuickDASH score in vibration-exposed individuals: 20 [2-45]; non-exposed individuals: 14 [5-34], p = 0.87). Conclusions: When controlling for known confounders, vibration-exposed individuals can expect the same symptom relief following open carpal tunnel release as non-exposed individuals. Individual assessments and treatment of CTS are warranted if there is a history of vibration exposure.

Ponticulus posticus and skeletal malocclusion: A pilot study in a Southern Italian pre-orthodontic court

Purpose

Ponticulus posticus (PP) is a bony protrusion located between the posterior portion of the superior articular process and the posterolateral portion of a posterior arch of the atlas vertebrae in the cervical spine. The aim of this study is to verify the presence of different types of PP in a Southern Italian pre-orthodontic cohort to understand its correlation with skeletal class and maturity.

Methods

A case-control retrospective study was conducted, utilizing 212 latero-lateral telecranium radiographs to analyze skeletal maturity according to the cervical vertebral maturation method, the Angle's classification of malocclusion (I, II, or III), and the presence or absence of the PP, whether complete (c-PP) or partial (p-PP). A total of 212 lateral cephalograms were analyzed.

Results

Of the 72 male patients, 67 (93%) exhibited PP, and 116 (88%) were PP. The chi-square value was 0.001, while Cramer's V was 0.270, indicating a significant correlation between age groups and PP presence, and a very strong association overall. Out of the 41 complete PP cases, class I was notably more prevalent than classes II and III.

Conclusion

Orthodontists should carefully consider PP when assessing and treating individuals with or without skeletal discrepancies and dental anomalies.

Risk of hand and forearm conditions due to vibrating hand-held tools exposure: a retrospective cohort study from Sweden

OBJECTIVES

The occurrence of hand and forearm disorders related to vibration exposure, adjusted for relevant background factors, is scarcely reported. We analysed the prevalence of such conditions in a large population cohort, stratified by sex, and associations with exposure to vibrating hand-held tools.

DESIGN

This is a retrospective cohort study.

SETTING

Individuals in the Malmö Diet and Cancer Study cohort (MDCS; inclusion 1991-1996; followed until 2018) were asked, 'does your work involve working with vibrating hand-held tools?' (response: 'not at all', 'some' and 'much'). Data were cross-linked with national registers to identify treatment for carpal tunnel syndrome (CTS), ulnar nerve entrapment (UNE), Dupuytren's disease, trigger finger or first carpometacarpal joint (CMC-1) osteoarthritis (OA). Cox regression models, unadjusted and adjusted (age, sex, prevalent diabetes, smoking, hypertension and alcohol consumption), were performed to analyse the effects of reported vibration exposure.

PARTICIPANTS

Individuals in the MDCS who had answered the questionnaire on vibration exposure (14 342 out of the originally 30 446 individuals in MDCS) were included in the study.

RESULTS

In total, 12 220/14 342 individuals (76%) reported 'no' exposure, 1392/14 342 (9%) 'some' and 730/14 342 (5%) 'much' exposure to vibrating hand-held tools. In men, 'much' exposure was independently associated with CTS (HR 1.71 (95% CI 1.11 to 2.62)) and UNE (HR 2.42 (95% CI 1.15 to 5.07)). 'Some' exposure was independently associated with UNE in men (HR 2.10 (95% CI 1.12 to 3.95)). 'Much' exposure was independently associated with trigger finger in women (HR 2.73 (95% CI 1.49 to 4.99)). We found no effect of vibration exposure on Dupuytren's disease or CMC-1 OA. 'Much' vibration exposure predicted any hand and forearm diagnosis in men (HR 1.44 (95% CI 1.08 to 1.80)), but not in women.

CONCLUSIONS

Vibration exposure by hand-held tools increases the risk of developing CTS and UNE and any common hand and forearm conditions in men, whereas women only risk trigger finger and CMC-1 OA. Adjustment for relevant confounders in vibration exposure is crucial.

Carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is the most common nerve entrapment disorder worldwide. The epidemiology and risk factors, including family burden, for developing CTS are multi-factorial. Despite much research, its intricate pathophysiological mechanism(s) are not fully understood. An underlying subclinical neuropathy may indicate an increased susceptibility to developing CTS. Although surgery is often performed for CTS, clear international guidelines to indicate when to perform non-surgical or surgical treatment, based on stage and severity of CTS, remain to be elucidated. Neurophysiological examination, using electrophysiology or ultrasonography, performed in certain circumstances, should correlate with the history and findings in clinical examination of the person with CTS. History and clinical examination are particularly relevant globally owing to lack of other equipment. Various instruments are used to assess CTS and treatment outcomes as well as the effect of the disorder on quality of life. The surgical treatment options of CTS - open or endoscopic - offer an effective solution to mitigate functional impairments and pain. However, there are risks of post-operative persistent or recurrent symptoms, requiring meticulous diagnostic re-evaluation before any additional surgery. Health-care professionals should have increased awareness about CTS and all its implications. Future considerations of CTS include use of linked national registries to understand risk factors, explore possible screening methods, and evaluate diagnosis and treatment with a broader perspective beyond surgery, including psychological well-being.

Current Insights into Carpal Tunnel Syndrome: Clinical Strategies for Prevention and Treatment

BACKGROUND

Carpal tunnel syndrome (CTS) is a condition that is caused by medial nerve compression, resulting in symptoms such as numbness, tightness, or weakness in the hand.

OBJECTIVES

The aim of the study was to find out the genetic modulation, mechanism, available treatment, and recommendation for carpal tunnel syndrome at its specific stage.

METHODS

Almost 200 papers were searched for this review article, and 145 articles were selected. The literature was collected from different sources like Google scholar, PubMed, a directory of open-access journals, and science.gov by using keywords, such as treatment, risk factors, recommendation, and clinical features of carpal tunnel syndrome.

RESULTS

The most efficient non-surgical treatment is methylprednisolone acetate, which reduces inflammation by acting on the glucocorticoid receptor in conjunction with immunofilling. It has also been used successfully as a second-line drug for the treatment of patients with mild or moderate conditions in order to provide relief. New non-pharmacological options include laser therapy in acupuncture, transcutaneous electric nerve stimulation (TENS), and sham therapy. Modern treatments like TENS, laser therapy, splints, and injections of methylprednisolone acetate have been demonstrated to be helpful in sporadic situations. For patients with mild and moderate problems, more research should be conducted that includes the combination of these surgical and non-surgical treatments.

CONCLUSION

We propose a multifunctional panel construct and define standard data items for future research into carpal tunnel syndrome. A discussion on idiopathic carpal tunnel syndrome, risk factors, combination of therapies, using guidelines-based recommendations and treatment should be initiated.

High frequency of carpal tunnel syndrome and associated factors: A cross-sectional study in Peruvian workers from agro-export industry

Carpal tunnel syndrome (CTS) is a peripheral mononeuropathy caused by compression of the median nerve at the wrist and has been reported in workers who perform repetitive movements that involve actions of sustained grasping of vibrating objects. We carried out a cross-sectional analytical study in March 2018 to identify the factors associated with the CTS among workers of agro-export companies in Ica-Peru. CTS confirmation in our study was based on having at least 1 positive screening test (Tinel or Phalen) and a presumptive result of CTS by the Kamath and Stothard Questionnaire. We carried out 4 Poisson regression models to evaluate the factors associated with CTS based on epidemiological and statistical criteria. We enrolled 112 agro-export workers in production (42.0%), packing (35.7%), and administration (22.3%) working areas. The CTS frequency in Peruvian agro-export workers in production, packing, and administrative working area were 78.7%, 45.0%, and 28.0%, respectively. The bivariate analysis found a relationship between the CTS with age, female sex, sports practice, job seniority in the working area (year), and repetitive wrist movements (hours per day). In the multivariate analysis, only job seniority in the working area (year) and repetitive wrist movements maintained their association with CTS. Occupational factors are significantly associated with a high frequency of CTS, such as job seniority in the working area (year) and repetitive wrist movements in agro-export workers. Surveillance programs should be held to prevent, reduce, and monitor workers' health status.

Evaluation of neurological testing for hand-arm vibration syndrome

BACKGROUND

The neurological component of hand-arm vibration syndrome (HAVS) uses the Stockholm Workshop Scale sensorineural (SWS SN) stages for classification. Proximal compressive neuropathies are common in HAVS and the symptoms are similar to SN HAVS. The SWS may not be a valid staging tool if a patient has comorbid proximal compression neuropathy.

AIMS

To evaluate the prevalence of proximal compression neuropathy in patients presenting for HAVS assessment and examine the association between compressive neuropathies and SWS SN.

METHODS

A standardized assessment protocol was used to assess 431 patients for HAVS at St. Michael's Hospital, Toronto, Ontario. The prevalence of median and ulnar compressive neuropathies was determined. The association between proximal compression neuropathies and SWS SN stage (0/1 versus 2/3) was evaluated using Chi-square and Fisher's exact tests as well as multivariable logistic regression.

RESULTS

Most patients (79%) reported numbness and 20% had reduced sensory perception (SWS SN Stage 2/3). Almost half (45%) had median neuropathy at the wrist and 7% had ulnar neuropathy. There was no association between the SWS SN stage and median or ulnar neuropathy.

CONCLUSIONS

Two neurological lesions should be investigated in patients presenting for HAVS assessment: compressive neuropathy and digital neuropathy. The prevalence of compressive neuropathies is high in patients being assessed for HAVS and therefore nerve conduction studies (NCS) should be included in HAVS assessment protocols. Comorbid proximal neuropathy does not affect the SWS SN stage; therefore, NCS and SWS SN seem to be measuring different neurological outcomes in HAVS patients.

Ergonomic Evaluation of Young Agricultural Operators Using Handle Equipment Through Electromyography and Vibrations Analysis Between the Fingers

Background

Agricultural handle equipment is present on all production areas' farms. They are handy and portable; however, excessive use can lead to acute traumas or accidental injuries. Repetitive movements, awkward postures, and hand-arm vibrations predispose them to pain and work-related musculoskeletal disorders. The purpose of this study was to observe the interaction of handle equipment in terms of electromyographic activity and analyze the postural work-related alterations.

Materials and methods

Twenty male agricultural operators, mean age 24 ± 1.54 years, underwent the electromyographic analysis testing their muscular activities with a brushcutter, electric saw, and hedge trimmer in four different test conditions.

Results

The brushcutter proved to be the agricultural handle equipment with the higher mean frequency (3.37 ± 0.38 Hz) and root mean square (5.25 ± 1.24 ms^-2). Furthermore, the digital postural analysis showed a general asymmetry of the main arm and the respective side of the trunk. The head resulted right inclined in the anterior frontal plane by 5.7° ± 1.2°; the right scapula lower than the left in the posterior frontal plane (8.5° ± 1.8°), and a working trunk inclination of 34.15° ± 5.7°.

Conclusions

Vibrations of handle equipment and awkward working postures represent a risk for agricultural operators. Preventive measures are required to avoid young operators from experiencing musculoskeletal disorders all lifelong.

Occupational cold exposure and symptoms of carpal tunnel syndrome - a population-based study

BACKGROUND

Cold exposure is an underrecognized occupational hazard that may increase the risk of peripheral nerve entrapment. The aim of this study was to determine if self-reported occupational exposure to contact and ambient cooling was associated with symptoms of carpal tunnel syndrome (CTS).

METHODS

In this mainly cross-sectional study, surveys were conducted on a population-based sample of men and women between 18 and 70 years of age, living in northern Sweden. Cold exposure and presence of symptoms suggestive of CTS were subjectively reported. Associations between exposure and outcome were evaluated using logistic regression.

RESULTS

The study included 2,703 women and 2,314 men, with a median age of 60 years (interquartile range 19). Symptoms of CTS were reported by 453 (9.2%). Being highly occupationally exposed (almost always) to contact cooling of the hands was associated with reporting CTS (OR 3.20; 95% CI 1.62-6.33), as was ambient cooling (OR 2.00; 95% CI 1.03-3.88) and severe ambient cooling (OR 4.02 95% CI 2.09-7.71), after adjusting for age, gender, body mass index, current daily smoking, diabetes mellitus, joint disease, and hand-arm vibration exposure. The point estimates increased with longer daily exposure duration. For workers exposed to severe ambient cooling for more than half of their working hours, in addition to performing heavy manual handling every day, the OR for reporting CTS was 7.25 (95% CI 3.88-13.53), with a positive additive interaction effect (expressed as relative excess risk due to interaction) of 4.67.

CONCLUSIONS

Self-reported occupational exposure to contact and ambient cooling was associated with symptoms suggestive of CTS. There were statistically significant positive exposure-response patterns for time spent exposed to contact and ambient cooling at work in relation to reporting symptoms of CTS. Positive additive interaction effects between cold exposure and heavy manual handling were also found. Since there was important potential uncontrolled confounding regarding repetitive wrist movements and forceful gripping, the results need to be confirmed by other studies, preferably with longitudinal design and more detailed exposure assessment.