Prevalence and risk factors of self-reported wrist and hand symptoms and clinically confirmed carpal tunnel syndrome among office workers in China: a cross-sectional study

Aesthetic and Functional Outcomes of Open Carpal Tunnel Release and Thread Carpal Tunnel Release: A Randomized Clinical Trial

Background and Objectives  Surgical techniques for carpal tunnel release (CTR) have gradually become less invasive. No substantial evidence supports replacing the open carpal tunnel release (OCTR) with novel minimally invasive approaches. Thread carpal tunnel release (TCTR) is a new minimally invasive CTR method associated with promising results. This study aimed to compare the aesthetic and functional outcomes of OCTR with TCTR. Materials and Methods  This study was a randomized clinical trial conducted in a hospital in Tehran, Iran, in 2022. Patients were randomized to OCTR and TCTR groups through simple randomization. Data such as demographics, nerve conduction study, electromyography, pain, and sensory evaluation by monofilament test were recorded in patients at baseline and after 3 months. Aesthetic evaluation was conducted by assessing the scar length and patients' satisfaction 3 months after the surgery. Results  Twenty patients (10 in each group) entered the final analysis. Nerve conduction study, electromyography, and sensory evaluation were similar between groups 3 months after the operation. The TCTR group had lower postsurgical pain ( p  < 0.001) and lower scar length ( p  < 0.001) compared to the OCTR group. Overall satisfaction was not statistically different between TCTR and OCTR. Conclusion  The TCTR method is safe in patients with CTS, and its efficacy is similar to OCTR. It can be a good alternative for OCTR, with a better aesthetic outcome.

Effectiveness of prevention exercises protocol among office workers with symptoms of carpal tunnel syndrome

OBJECTIVES

Carpal tunnel syndrome (CTS) is common among office workers and limits functional hand ability and the ability to work. Carpal tunnel syndrome prevention programs implementation are still insufficient among office workers. In view of the fact that physical activity is the best method of preventing musculoskeletal complaints the aim of the study was to evaluate the effectiveness of prevention exercises protocol for hand and wrist pain among office workers.

MATERIAL AND METHODS

Study group consists form 62 office workers, reporting complaints of hand and wrist pain. Exercise group it was 49 subjects who performed the exercise protocol and the non-exercise group consisted of 13 subjects. An exercises program, consisting of 7 exercises. The program was planned for daily routine during 8 weeks. The effectiveness of the exercise program was assessed by physical parameters (hand grip and pinch grip strength, force of forearm muscles) and questionnaires (Visual Analog Scale pain scale, Carpal Tunnel Syndrome Symptom Severity Scale, and Carpal Tunnel Syndrome Functional Status Scale functional hand assessment questionnaires) were performed. Assessment was performed before and after the intervention.

RESULTS

Statistical analysis of the data showed significant changes in the value of measured hand grip of the right hand (Z = -2.85, p < 0.01). For pinch grip, changes were significant for both the right (Z = -2.12, p < 0.05) and the left hands (Z = -2.35, p < 0.05). Functional performance improved significantly in bought groups. There was no statistically significant change in the intensity of experienced pain.

CONCLUSIONS

The results of the study indicate that performing a preventive exercise program regularly has an effect on increasing forearm muscle strength in a group of office workers. Office workers with symptoms of CTS who exercised regularly had higher results in hand grip and pincer grip strength. Exercises do not affect the level of pain complaints, which may indicate a more complex etiology of pain perception in this study group. Int J Occup Med Environ Health. 2024;37(1):45-57.

Carpal tunnel syndrome and nerve conduction studies in fibromyalgia patients

INTRODUCTION

The aim of this study is to evaluate ENMG results of female patients with Fibromyalgia Syndrome (FMS) with a preliminary diagnosis of carpal tunnel syndrome (CTS) and to examine whether there are differences in ENMG results compared to control group.

MATERIAL AND METHODS

Ethical approval was obtained for this study on 30.12.2022 with number E. Kurul-2022-20/32 and recorded retrospectively between January 2021 and January 2023. 201 female patients who were diagnosed with FMS in Physical Therapy and Rehabilitation polyclinic and who were requested to have ENMG testing with a preliminary diagnosis of CTS were included in study as patient group. 201 patients were ıncluded as control group.

RESULTS

While the number of patients with right CTS was 39 (25.49%) in the FMS group, the number of patients with right CTS was 38 (24.20%) in control group. While the number of patients with left CTS was 34 (25%) in the FMS group, number of patients with left CTS in the control group was 36 (24.65%). When we analyzed a total of 592 ENMG results in our study, we found a high normal ENMG rate of 75%.

CONCLUSION

We found that there was no difference between the FMS and the control group in terms of compatibility between the pre-diagnosis and electroneurophysiological diagnosis in the ENMG results requested with the pre-diagnosis of CTS in our study. The ENMG examination should be requested for right patient in right indication, by first evaluating the patient well.

External wrist ratio is not a proxy for internal carpal tunnel shape: Implications for evaluating carpal tunnel syndrome risk

Carpal tunnel syndrome (CTS) is highly prevalent, resulting in decreased function and increased need for costly healthcare services. External wrist ratio (depth/width >0.70) is a strong predictor of the development of CTS and has been suggested to be a proxy for internal carpal tunnel (CT) shape. Conversely, sonography can more directly evaluate CT shape. The purpose of our study was to explore the relationship between wrist ratio and sonographic CT measurements to (1) evaluate the reliability of sonographic CT measurements and (2) explore how external wrist measures relate to anthropometric features of the CT. We used sonographic imaging on a sample of healthy participants (n = 226) to measure CT cross-sectional area, depth, width, and depth/width ratio. We conducted exploratory correlation and regression analyses to identify relationships of these measures with external wrist ratio. Reliability for dominant and nondominant sonographic CT measures ranged from good to excellent (0.79-0.95). Despite a moderate correlation between CT width and depth and their external wrist counterparts (0.33-0.41, p < 0.001), wrist ratio and CT ratio demonstrated weak to no correlation (dominant: r = 0.12, p = 0.053; nondominant: r = 0.20, p = 0.002) and the mean CT ratio was far lower than the mean wrist ratio (0.45 vs. 0.71 bilaterally). Supporting this, we observed several key differences in the relationship between external wrist measures compared to corresponding CT measures. Additionally, regression analyses combining participant factors and CT measurements produced models accounting for less than 15% of the variability in external wrist ratio (linear models) or correctly predicting less than 68% of wrist ratio-based risk categorization (logistic models). Overall, among healthy young adults, wrist shape is not an adequate proxy for CT shape.

Occupational and non-occupational risk factors correlating with the severity of clinical manifestations of carpal tunnel syndrome and related work disability among workers who work with a computer

The contribution of certain occupational and personal factors to the development of carpal tunnel syndrome (CTS) is still uncertain. We investigated which specific occupational and non-occupational factors correlate with the level of clinical manifestations and work disability related to CTS. The study included 190 workers who work with a computer and have diagnosed CTS (100 men, 90 women, aged 20-65 years). Subjective experience of CTS-related impairments was assessed with the Symptom Severity Scale (SSS) and the Functional Status Scale (FSS) of the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). The objective, neural impairments were tested with electrodiagnostics (EDX), whereas CTS-related work disability data were collected from medical records. We found a high inter-correlation between BCTQ, EDX, and work disability data. These also showed high correlations with certain occupational factors (duration of computer-working in months and hours spent daily in computer-working, certain ergonomic, microclimatic, and other occupational conditions) and non-occupational factors (demographic and lifestyle factors: nutritional status, diet, smoking, alcohol consumption, and physical activity). Despite its limitations, our study has identified occupational and non-occupational risk factors that can aggravate CTS and work disability, but which can also be improved with workplace and lifestyle preventive and corrective measures. More research is needed, though, to establish the possible causal relationships and the independent influence of each of those risk factors.

Central Sensitization in Patients with Chronic Pain Secondary to Carpal Tunnel Syndrome and Determinants

Purpose

Central sensitization (CS) is commonly seen in chronic pain disorders, including neuropathic pain. However, there exist inconsistencies concerning the presence of CS in chronic pain secondary to carpal tunnel syndrome (CTS). CS and neuropathic pain manifestations in CTS remain not well established. Therefore, this study aims to investigate the CS and pain profiles in patients with CTS and to explore the potential determinants associated with CS.

Patients and Methods

Patients with suspected CTS symptoms lasting 3 months or above and healthy controls were enrolled. History, physical examinations, and nerve conduction studies were employed to confirm the diagnosis and severity of median nerve dysfunction. The central sensitization inventory (CSI) was used to screen CS. Other outcomes included neuropathic pain, CTS-specific symptom severity and functions, emotion, and health-related quality of life. Between-group comparisons were conducted in terms of the CS presence. Logistic regression analysis was performed to identify determinants associated with CS.

Results

Over 60% of participants with CTS were found with clinical CS, significantly higher than that in the control group. More than 70% of the CTS participants were identified to have possible or very likely neuropathic pain components. In addition, one-fourth of CTS cases had depression or anxiety. Anxiety was associated with an increased risk of developing CS in CTS (adjusted OR=1.31, 95% CI 1.08-1.59), whereas higher self-perceived general health rating was negatively associated with the presence of CS (adjusted OR=0.92, 95% CI 0.88-0.97) in the multivariate adjusted regression model.

Conclusion

CS is prevalent in patients with CTS. Predominant neuropathic pain characteristics were uncovered in CTS patients as well as comorbid psychological distress. Significant association was found between anxiety and CS presence. Self-perceived general health was inversely related to CS. Further research is warranted to explore the mechanisms of anxiety and central pain processing in painful entrapment neuropathy.

Sex differences in wrist strength: a systematic review

Sex differences in strength have been attributed to differences in body anthropometrics and composition; these factors are often ignored when generating workplace guidelines. These differences directly impact the upper extremity, leaving female workers exposed to injury risk. The wide range of tools and techniques for measuring upper extremity strength presents a challenge to ergonomists and work task designers; collating outcomes to provide a clear outlook of differences between males and females is essential and the purpose of this work. Four online databases were searched (PROSPERO ID: CRD42022339023) with a focus on articles assessing sex differences in wrist strength. A total of 2,378 articles were screened for relevancy; 25 full-text articles were included in this systematic review. Articles examined movement pairs (ulnar/radial deviation, pronation/supination, and flexion/extension), as well as contraction types (isometric and isokinetic) to observe sex differences in wrist strength. Across all articles, females produced ∼60-65% of male flexion/extension strength, ∼55-60% pronation/supination strength, and ∼60-70% ulnar/radial deviation strength. Overall, females presented lower strength-producing abilities than males, but when considering strength relative to body mass, male-female differences were less pronounced and occasionally females surpassed male strength metrics; typically, this occurred during flexion/extension, particularly in isokinetic contractions. This review has identified a scarcity of articles examining ulnar/radial deviation, pronation/supination, as well as isokinetic contractions; these are needed to supplement workplace exposure guidelines.

Awareness of Carpal Tunnel Syndrome Among the Middle-Aged Population in Riyadh, Saudi Arabia

Background Carpal tunnel syndrome (CTS), a common and often underdiagnosed condition, imposes a significant burden on individuals, particularly in middle-aged populations. This study aims to assess the awareness and prevalence of CTS among middle-aged residents in Riyadh, highlighting the crucial need for targeted educational initiatives to address knowledge gaps. Methodology A cross-sectional study design was employed to capture a snapshot of CTS awareness and prevalence among the middle-aged population in Riyadh, Saudi Arabia. Participants aged 40-60 residing in Riyadh were included. A self-reported questionnaire gathered data on demographics, CTS diagnosis, and awareness levels regarding symptoms, risk factors, treatment, and the impact of CTS. Statistical analysis included descriptive statistics and Chi-squared tests. Results We collected 415 valid responses to the questionnaire. The demographic profile revealed a balanced gender distribution, with 48.4% (n=201) males and 51.6% (n=214) females, and a majority (66.5%; n=276) within the 40-50 age range. A substantial 87.2% (n=362) reported no prior CTS diagnosis. Neuroimaging studies were infrequently conducted at 15.9% (n=66). Participants exhibited significant knowledge gaps, notably in the awareness of CTS diagnosis 66.3% (n=275) uncertainty, symptoms 55.4% (n=230) lack of knowledge, and risk factors 54.7% (n=227) lack of awareness. The results indicated uncertainty regarding the relationship between CTS and diabetes 63.9% (n=265) and knowledge gaps on anesthesia methods for CTS operations 64.1% (n=294). The association between age and CTS diagnosis was significant (p-value 0.004), while awareness did not significantly vary with gender or age. Conclusion This study unveils a substantial lack of awareness about CTS among the middle-aged population in Riyadh, emphasizing the need for targeted educational interventions. The prevalence of CTS remains underreported, with a notable gap in understanding symptoms, risk factors, and available treatments; the findings underscore the vital importance of targeted educational programs designed to raise public awareness, bridge information gaps, and empower individuals to make informed decisions about their hand health.

Carpal tunnel syndrome and its associated factors among computer user bankers in South Gondar Zone, Northwest Ethiopia, 2021: a cross sectional study

INTRODUCTION

The use of information devices like computers is skyrocketed in recent years, leading injuries. Carpal Tunnel Syndrome is a leading cause of upper extremity MSDs specially to banking workers. Hence, this paper was intended to highlight its magnitude associated factors in the study area.

METHODS AND MATERIALS

Institutional based cross-sectional study was conducted from September 13, 2021 to October 09, 2021. A total of 422 private and government owned computer user bankers were participated. Simple random sampling technique was used to select the study participants. Data were collected using Durkan's compression test, flexion and compression test, Phalen's test, and Tinel's test. Multivariable logistic regression model was used to investigate the relationship between predictors and Carpal Tunnel Syndrome. P-value less than 0.05 was considered to declare as a significant and Adjusted Odds Ration for strength association between risk factors and Carpal Tunnel Syndrome.

RESULT

Among 422 participants, the annual prevalence of CTS was 11.7%. Being smoker [AOR: 4.2; 95% CI: 1.76-10.26], having > 5-year work experience [AOR: 7.98; 95% CI: 3.7-17.33], movement repetition [AOR: 3.9; 95% CI: 1.66-9.4] and lack of ergonomics training [AOR: 5.2; 95% CI: 2.8-9.5] were independently associated risk factors to Carpal Tunnel Syndrome.

CONCLUSION

Carpal Tunnel Syndrome was high (11.7%) among bankers in this study area. Carpal Tunnel Syndrome was predicted by smoking, length of employment, movement repetition, and not received ergonomics training. Therefore, fore the banking industry, it would be better to maintain strict follow-up and provision of ergonomics training.

A Pilot Study In to the Effects of Cervical Manual Therapy Plus Conventional Physical Therapy on Clinical Outcomes and Electrodiagnostic Findings in People With Carpal Tunnel Syndrome

Background

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy that has a significant impact on patients' quality of life. Current physical therapy treatment options show limited effects or low-quality evidence, especially in the long term. To date, there has been little research to look at the effects of treating the cervical spine on decreasing symptoms distally to the carpal tunnel. This study aimed to evaluate the effects of cervical manual therapy plus conventional physical therapy on patients with carpal tunnel syndrome.

Methods

This pilot pretest/posttest and six-month follow-up clinical study included 15 adult patients with CTS. For two weeks, each patient received 10 sessions of supervised intervention treatment. The efficacy of the therapies was assessed at baseline (T0), immediately after treatment (T1), and six months after treatment (T2). The visual analog scale (VAS), a symptom severity scale, the functional capacity scale of the Boston Carpal Tunnel Questionnaire (BCTQ), the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, median nerve motor distal latency (mMDL), and median sensory nerve conduction velocity (mSNCV) were outcome measures.

Results

There were significant improvements in all measures between the baseline values at T0 and those recorded immediately after the treatment at T1 or six months later at T2 (p<.05).

Conclusion

This pilot study indicates that cervical manual therapy plus conventional physical therapy applied for two weeks improves clinical outcomes and electrodiagnostic findings in people with CTS.

Meta-analysis of the prevalence of Carpal Tunnel Syndrome (CTS) among dental health care personnel

Background: Carpal Tunnel Syndrome (CTS) is one such common disorder among dental health care personnel caused due to the entrapment neuropathy of the median nerve in the carpal tunnel. We aimed to evaluate the pooled estimates of the CTS among dental healthcare personnel. Methods: We systematically reviewed the existing literature from six databases till January 1 ^st, 2022. Studies reported in English along with the prevalence of CTS or where prevalence could be calculated were included. Independent screening of title and abstracts, and the full text was done by two examiners. Information collected was authors, year of publication, geographic location, type of dental healthcare personnel, sample size, distribution of age, sex, CTS, method of diagnosis, and risk of bias. The random effect model was used to estimate the pooled estimates. Results: Thirty-seven studies yielded 38 estimates. A total of 17,152 dental health care personnel were included of which 2717 had CTS. The overall pooled prevalence of CTS among the included studies was 15%, with a high heterogeneity. Meta-analysis showed no significant difference in the pooled estimates of CTS between male and female dental healthcare personnel (OR: 0.73; 95% CI: 0.52 -1.02; I ²= 69.71). The pooled estimates among the dentist and dental auxiliaries were 20% and 10%, respectively. The pooled prevalence of CTS with self-reported measures, clinical examination and NCS were 21%, 13% and 8% respectively. Meta-regression showed that the prevalence estimates were significantly associated with publication year (coefficient: 0.006; 95% CI= 0.002-0.01). Conclusion: One out of seven dental health care personnel may be affected by CTS. No significant difference was seen in the prevalence of CTS between male and female dental healthcare personnel.

Remote working during the COVID-19 pandemic: Computer-related musculoskeletal symptoms in university staff

BACKGROUND

The COVID-19 pandemic resulted in mandatory remote working for workers in many sectors, including education.

OBJECTIVE

This study aimed to investigate the physical characteristics of workspaces, computer use, and prevalence, associated factors, and reported impact of computer-related musculoskeletal symptoms (MSS) among university staff during the COVID-19 pandemic.

METHODS

A cross-sectional study of staff in a university in Ireland was conducted in March 2021. An anonymous online survey of computer use, work practices and 3-month prevalence and the reported impact of computer-related MSS (modified Nordic Musculoskeletal Questionnaire) was conducted. Data analysis involved descriptive statistics and relationships were tested using chi-squared analysis.

RESULTS

The analysis included 1045 responses. The majority (63%) worked solely from home, used a laptop more frequently than a desktop computer, and worked a greater number of hours. Almost half (48%) did not have a dedicated home workspace. More respondents reported their university workspace (72%) was more comfortable than their home workspace (51.2%) (p < 0.0001). Prevalence of computer-related MSS was 83% : neck (62%), shoulder (57%), lower back (47%). Laptop-related MSS was reported more frequently (82%) than desktop-related MSS (65%) (p < 0.05). Computer-related MSS was associated with workspace, equipment at home, laptop use, female gender, and righthandedness (p < 0.05). A reduction in non-work-related activities (35%), work activities (18%) and seeking medical attention (24%) was reported.

CONCLUSION

The prevalence of computer-related MSS was high and associated with remote working. Further studies that aim to mitigate the risks of computer-related MSS in those working remotely or in hybrid models are required.

Acupuncture for carpal tunnel syndrome: A systematic review and meta-analysis of randomized controlled trials

Background

The evidence for the effectiveness of acupuncture for patients with carpal tunnel syndrome (CTS) is insufficient. Therefore, this systematic review and meta-analysis aimed to evaluate the effectiveness of acupuncture on CTS through a comprehensive literature search.

Methods

English and Chinese databases were searched from their inceptions until 27 October 2022 to collect randomized controlled trials (RCTs) that investigated the effect of acupuncture on CTS. Two reviewers independently selected studies that met the eligibility criteria, extracted the required data, assessed the risk of bias using version 2 of the Cochrane risk-of-bias tool for randomized trials (ROB 2), and evaluated the quality of reporting for acupuncture interventions using the Revised Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA). The primary outcomes were symptom severity and functional status, while secondary outcomes included pain intensity, responder rate, and electrophysiological parameters. Review Manager software (version 5.4.1) was used for data analysis. The certainty of the evidence was rated with GRADEpro (version 3.6) software.

Results

We included 16 RCTs with a total of 1,025 subjects. The overall risk of bias was rated as low in one RCT, some concerns in 14, and high in one. Compared with night splints, acupuncture alone was more effective in relieving pain, but there were no differences in symptom severity and functional status. Acupuncture alone had no advantage over medicine in improving symptom severity and electrophysiological parameters. As an adjunctive treatment, acupuncture might benefit CTS in terms of symptom severity, functional status, pain intensity, and electrophysiological parameters, and it was superior to medicine in improving the above outcomes. Few acupuncture-related adverse events were reported. The above evidence had a low or very low degree of certainty.

Conclusion

Acupuncture as an adjunctive treatment may be effective for patients with CTS. Additionally, more rigorous studies with objective outcomes are needed to investigate the effect of acupuncture in contrast with sham acupuncture or other active treatments.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=329925, identifier CRD42022329925.

Diacutaneous Fibrolysis Intervention in Patients with Mild to Moderate Carpal Tunnel Syndrome May Avoid Severe Cases in Elderly: A Randomized Controlled Trial

BACKGROUND

Carpal Tunnel Syndrome (CTS) mainly affects adults of working age. The prevalence of severe cases is higher in elderly patients (>65 years old). Clinical guidelines recommend conservative treatment as the best option in the initial stages of CTS to avoid severe cases. Diacutaneous Fibrolysis (DF) has demonstrated to improve nerve conduction studies and mechanosensitivity. The main purpose was to quantify changes in the cross-sectional area (CSA) of the median nerve, transversal carpal ligament (TCL) thickness, numbness intensity, and the subjective assessment of clinical change after DF treatment in patients with CTS.

METHODS

a double-blind, randomized, placebo-controlled trial was designed. A number of 44 patients (60 wrists) with CTS were randomized to the DF group or the sham group. CSA and TCL thickness variables were registered by ultrasound. Clinical variables were assessed by the visual analogue scale and GROC scale. SPSS version 24.0 for MAC was used for statistical analysis. The group by time interaction between groups was analyzed using two-way repeated measures analysis of variance.

RESULTS

The DF group reduced CSA with a mean of 0.45 mm² (IC 95% 0.05 to 0.86) and TCL thickness with a mean reduction of 0.4 mm (IC 95% 0.6 to 2.1) compared to the sham group (p < 0.01, p < 0,03, respectively). Additionally, the DF group decreased the numbness intensity with a mean reduction of 3.47 (IC 95% 2.50 to 4.44, p < 0.01) and showed a statistically significant improvement on the GROC scale (p < 0.01).

CONCLUSIONS

DF treatment may significantly reduce CSA and TCL thickness, numbness intensity, and improved clinical perspective. DF applied in patients with mild to moderate CTS may prevent the progression of the disease as they age.

Digital rehabilitation for hand and wrist pain: a single-arm prospective longitudinal cohort study

Supplemental Digital Content is Available in the Text.

This study supports that a fully remote digital care program is feasible and able to promote high patient engagement in the telerehabilitation of patients with wrist and hand pain.

Introduction:

Wrist and hand represent the third most common body part in work-related injuries, being associated with long-term absenteeism. Telerehabilitation can promote access to treatment, patient adherence, and engagement, while reducing health care–related costs.

Objective:

Report the results of a fully remote digital care program (DCP) for wrist and hand pain (WP).

Methods:

A single-arm interventional study was conducted on individuals with WP applying for a DCP. Primary outcome was the mean change in the Numerical Pain Rating Scale after 8 weeks (considering a minimum clinically important change of 30%). Secondary outcomes were: disability (Quick Disabilities of the Arm, Shoulder, and Hand questionnaire), analgesic intake, surgery intention, mental health (patient health questionnaire [PHQ-9] and generalized anxiety disorder [GAD-7]), fear-avoidance beliefs (FABQ-PA), work productivity and activity impairment, and engagement.

Results:

From 189 individuals starting the DCP, 149 (78.8%) completed the intervention. A significant pain improvement was observed (51.3% reduction (2.26, 95% CI 1.73; 2.78)) and 70.4% of participants surpassing minimum clinically important change. This change correlated with improvements in disability (52.1%), FABQ-PA (32.2%), and activities impairment recovery (65.4%). Improvements were also observed in other domains: surgery intent (76.1%), mental health (67.0% in anxiety and 72.7% in depression), and overall productivity losses (68.2%). Analgesic intake decreased from 22.5% to 7.1%. Mean patient satisfaction score was 8.5/10.0 (SD 1.8).

Conclusions:

These findings support the feasibility and utility of a fully remote DCP for patients with WP. Clinically significant improvements were observed in all health-related and productivity-related outcomes, alongside very high patient adherence rates and satisfaction. This study strengthens that management of WP is possible through a remote DCP, decreasing access barriers and potentially easing health care expenditure.

Musculoskeletal disorders in video gamers - a systematic review

Background

Video gaming is a recreational activity with yearly increasing popularity. It is mostly a sedentary behavior combined with repetitive movements of the upper limbs. If performed excessively, these movements may promote strain injuries and a sedentary lifestyle is one of the contributing factors to musculoskeletal disorders. Therefore, a systematic review was conducted to evaluate if video gaming negatively affects the musculoskeletal system of video gamers.

Methods

PubMed, Web of Science and The Cochrane Library were systematically searched in order to identify relevant peer reviewed original articles in English published between 2000 and 2021. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was used for the analysis. Studies were included when they contained investigations of changes of the musculoskeletal system due to video gaming in healthy individuals. Studies with participants older than 60 years or solely psychological, social or cardiovascular outcomes were excluded. An adapted version of the Newcastle–Ottawa Scale was used for the risk of bias analysis.

Results

Sixteen observational studies involving a total of 62,987 participants met the inclusion criteria. A majority (11) of the studies reported statistical negative musculoskeletal changes due to video game playtime. Four studies did not report changes and one study found no effect of video game playtime on the musculoskeletal system. Out of the eleven studies, which demonstrated a negative impact of video game playtime on the musculoskeletal system, the most reported painful body parts were the neck (n = 4), shoulder (n = 4) and back (n = 3). Ten studies reported odds ratios (OR) for the dependence of the appearance of musculoskeletal disorders on video game playtime. In eight studies OR were significantly increased (1.3—5.2).

Conclusion

Eleven out of twelve studies demonstrated a negative impact of video game playtime on the musculoskeletal system. In particular, excessive video game playtimes (> 3 h/day) seemed to be a predictor for the appearance of musculoskeletal disorders. Due to their great popularity across multiple generations, specific and tailored prevention and health promotion programs for video gamers need to be developed to counteract this important public health issue.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05614-0.

Optimization of Carpal Tunnel Syndrome Using WALANT Method

As surgical management of carpal tunnel release (CTR) becomes ever more common, extensive research has emerged to optimize the contextualization of this procedure. In particular, CTR under the wide-awake, local-anesthesia, no-tourniquet (WALANT) technique has emerged as a cost-effective, safe, and straightforward option for the millions who undergo this procedure worldwide. CTR under WALANT is associated with considerable cost savings and workflow efficiencies; it can be safely and effectively executed in an outpatient clinic under field sterility with less use of resources and production of waste, and it has consistently demonstrated standard or better post-operative pain control and satisfaction among patients. In this review of the literature, we describe the current findings on CTR using the WALANT technique.

Surgically Treated Carpal Tunnel Syndrome and Ulnar Nerve Entrapment at the Elbow in Different Occupations and their Effect on Surgical Outcome

OBJECTIVE

We investigated whether certain occupations were over-represented among surgically treated carpal tunnel syndrome and ulnar entrapment at the elbow, and if manual occupation affected surgical outcome.

METHODS

We included 9030 patients operated for CTS and 1269 for UNE registered in the Swedish National Quality Register for Hand Surgery (HAKIR) 2010-2016. Occupational data was retrieved from Statistics Sweden. Outcome was assessed using the QuickDASH questionnaire.

RESULTS

In patients operated for CTS, there were more assistant nurses, attendants/care providers/personal assistants, nannies/student assistants, carpenters/bricklayers/construction workers, cleaners, nurses, and vehicle mechanics than in the general population. In the UNE population, assistant nurses and attendants/care providers/personal assistants were over-represented. Manual workers with CTS scored the preoperative QuickDASH higher than non-manual workers.

CONCLUSIONS

Manual workers are overrepresented among surgically treated CTS and UNE. Manual workers with CTS have more symptoms preoperatively than non-manual workers.

Effectiveness of therapeutic ultrasound for the treatment of carpal tunnel syndrome (the USTINCTS trial): study protocol for a three-arm, prospective, multicentre, randomised controlled trial

INTRODUCTION

There has no consensus on optimal management of carpal tunnel syndrome (CTS), the most common compression neuropathy. Conservative therapy is generally accepted as first-line intervention. Therapeutic ultrasound has been widely reported to be treatment beneficial in nerve regeneration and conduction, and further accelerate compression recovery. The purpose of this study is to investigate the effectiveness of therapeutic ultrasound for CTS treatment.

METHODS AND ANALYSIS

This study protocol entails a three-arm, prospective, multicentre, randomised controlled trial. 162 eligible adult participants diagnosed with mild to moderate CTS by using criteria developed from a consensus survey by the UK Primary Care Rheumatology Society will be assigned to either (1) therapeutic ultrasound, (2) night splint or (3) therapeutic ultrasound +night splint (combined) group. Primary outcome will be difference in Symptom Severity Scale of Boston Carpal Tunnel Questionnaire (BCTQ-SSS) at 6-week between night splint and therapeutic ultrasound +night splint groups. Secondary outcomes include Functional Status Scale of BCTQ, sleep questionnaire for interrupted sleep, EuroQol-5D for general health, Hospital Anxiety and Depression Scale for mental status, Work Limitations Questionnaire-25 for functional limitations at work, Global Rating of Change for treatment success and recurrence rate, physical examination, electrophysiological and ultrasound parameters. Intention-to-treat analyses will be used.

ETHICS AND DISSEMINATION

Ethics committees of all clinical centres have approved this study. The leading centre is Shanghai Sixth People's Hospital, whose approval number is 2021-152. New versions with appropriate amendments will be submitted to the committee for further approval. Final results will be published in peer-reviewed journals and presented at local, national and international conferences.

TRIAL REGISTRATION NUMBER

ChiCTR2100050701.

Prevalence and risk factors for self-reported symptoms of carpal tunnel syndrome among hospital office workers: a cross-sectional study

OBJECTIVES

We aimed to determine the prevalence of self-reported symptoms of carpal tunnel syndrome (CTS) and associated risk factors among hospital office workers.

MATERIAL AND METHODS

This cross-sectional study was carried out between May and August 2021 with office workers actively working in a hospital in Izmir, Turkey. The Boston Carpal Tunnel Syndrome Questionnaire was used to evaluate the severity of self-reported CTS symptoms and their effect on the functional status of the participants.

RESULTS

The study included 151 people, 68.2% of whom were women. The CTS symptoms were reported by 74.1% of the participants, the majority of whom (73.2%) were women. These reported symptoms were mild in 43%, moderate in 24.5%, severe in 5.3%, and very severe in 1.3%. Significant differences were found between those with and without CTS symptoms regarding the age, body-mass index, a previous diagnosis of CTS, daily work hours, using a wrist-supported mousepad, and perceived workload (p < 0.05).

CONCLUSION

It was found that the CTS symptoms of office workers in the hospital were associated with occupational characteristics as well as individual factors. These risk factors should be taken into account while planning for future preventive and interventional measures in workplaces.

Acupuncture and related therapies for carpal tunnel syndrome: A protocol for systematic review and Bayesian network meta-analysis

BACKGROUND

Carpal tunnel syndrome (CTS) is the most common peripheral nerve compression syndrome of the upper limb. Plenty of studies showed the effects of acupuncture therapy on relieving pain and improving functional status for CTS patients. Diverse types of acupuncture therapies have been used in the treatment for CTS, but their relative treatment effects are poorly understood. This study will evaluate the effects of different acupuncture and related therapies for CTS by conducting a systematic review and Bayesian network meta-analysis (NMA).

METHODS

We will search randomized controlled trials (RCTs) of acupuncture and related therapies for CTS in MEDLINE (via PubMed), EMBASE, Web of Science, Cochrane Library, Chinese Biomedical Database, China National Knowledge Infrastructure, VIP Database, Wanfang Database, WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, Chinese Clinical Trial Register, and OpenGrey from inception to November 2021. Then, we will select eligible studies, extract data, and conduct risk of bias assessment using the Cochrane tool. Pairwise meta-analysis and Bayesian NMA will be performed in Stata 15.1 software and Aggregate Data Drug Information System 1.16.8 software. We will assess the quality of the evidence using the Confidence in Network Meta-Analysis application.

RESULTS

In this study, the treatment effects and safety of different acupuncture and related therapies for CTS will be evaluated.

CONCLUSION

This study will provide evidence for choosing the optimal acupuncture and related therapies in the treatment for CTS.