Incidence and Reappraisal of Known Risk Factors Associated with Carpal Tunnel Syndrome: A Nationwide, 11-Year, Population-Based Study in South Korea

The Impact of Social Media for Hand Surgeons: A Prevalence and Correlation Study With Online and Academic Reputations

Purpose

This study examines the influence of social media use among orthopedic and plastic-trained hand surgeons on patient-reported ratings online and academic productivity.

Methods

The American Society of Surgery of the Hand directory was queried for actively practicing orthopedic and plastic surgeons with a hand surgery fellowship. Each name was searched on various social media platforms. Average ratings, number of reviews, and number of comments were collected from Healthgrades, Google reviews, and Vitals. H-index was searched on Scopus. A summated social media presence score was calculated to identify the top 20% of social media users in each cohort.

Results

A total of 97 orthopedic and 102 plastic surgeons were included. Overall, plastic surgeons were more active on social media compared to orthopedic surgeons. There was a positive association between having active profiles and Healthgrades ratings. When looking within the subgroups, the top 20% of social media orthopedic users were found to have a significantly higher mean Healthgrades rating and a mean number of comments than the rest of the cohort. On Vitals, the top 20% of social media users had higher mean ratings compared to the remaining 80%. The top 20% of plastics social media users had a significantly higher average Healthgrades rating compared to the rest of the plastics group. On Google reviews, the top 20% also had higher mean ratings, as well as mean number of ratings, compared to the rest of the cohort. Plastic surgeons with a Twitter/X account had a significantly higher h-index than plastic surgeons without a Twitter/X account (14.5 vs 9.2, P < .05).

Conclusions

Social media involvement is positively associated with surgeon ratings and the number of reviews and comments on physician rating websites. Using web-based marketing tools is still rare in hand surgery, especially among orthopedic surgeons.

Type of study/level of evidence

Economic/decision analysis IV.

Causal relationship between hypothyroidism and peripheral neuropathy: a Mendelian randomization study of European ancestry

Background

Metabolic disorders are significant risk factors for peripheral neuropathy (PN) diseases. However, current clinical observational studies cannot fully determine the causal relationships between hypothyroidism (HT) and PN diseases.

Methods

We performed univariate Mendelian randomization (MR) analyses using single nucleotide polymorphisms (SNPs) associated with hypothyroidism and two diseases clinically presented as HT (autoimmune thyroid disease and benign neoplasm of the pituitary gland and craniopharyngeal duct) as instrumental variables. We selected eight peripheral neuropathy diseases (diabetic neuropathy, nerve root/plexus disorder, carpal tunnel syndrome, polyneuropathies, sciatica with lumbago, trigeminal neuralgia, postherpetic neuralgia, small fiber neuropathy) as outcomes. Genetic data were sourced from authoritative genome-wide association study (GWAS) datasets. We primarily used the inverse variance-weighted (IVW) method and conducted a comprehensive sensitivity analysis to ensure robustness.

Results

The IVW results indicated that HT was significantly associated with an increased risk of diabetic peripheral neuropathy (OR = 1.22, p = 6.49E-05). HT was also significantly linked to nerve root/plexus disorder (OR = 1.04, p = 6.43E-06) and carpal tunnel syndrome (OR = 1.04, p = 0.004), but appeared to be a potential protective factor for polyneuropathies (OR = 0.93, p = 0.0009). Additionally, autoimmune thyroid disease (AITD) was identified as a potential risk factor for carpal tunnel syndrome (OR = 13.79, p = 0.006) and a protective factor for polyneuropathies (OR = 0.0011; p = 4.44E-5).

Conclusions

This study provides genetic evidence supporting potential causal links between hypothyroidism and various peripheral neuropathy diseases.

Epidemiology of Carpal Tunnel Syndrome and Trigger Finger in South Korea: A Nationwide Population-Based Study

Background

Carpal tunnel syndrome (CTS) and trigger finger are representative pathologic conditions of the hand. Although several studies have evaluated the epidemiology of these diseases as nationwide population-based research, they had several limitations including old data and short study period.

Methods

We conducted a retrospective cohort study of patients aged ≥ 20 years diagnosed with CTS or trigger finger between 2009 and 2019 using the Korean Health Insurance Review and Assessment Service database. The annual incidence of these diseases was standardized based on age and sex. The proportion of patients who received corticosteroid injections or surgery within 1 year of their diagnoses was calculated annually.

Results

The mean annual incidence of CTS was 360.26 per 100,000 person-years and that of trigger finger was 63.09 per 100,000 person-years. The annual incidence of CTS (incidence rate ratio [IRR], 0.979; 95% confidence interval [CI], 0.972-0.985; p < 0.001) and trigger finger (IRR, 0.976; 95% CI, 0.967-0.985; p < 0.001) significantly decreased. The proportion of patients who received corticosteroid injections for CTS significantly increased (relative risk [RR], 1.025; 95% CI, 1.020-1.031; p < 0.001), while the number of surgeries significantly decreased (RR, 0.949; 95% CI, 0.940-0.957; p < 0.001). The proportion of patients who received corticosteroid injections for trigger finger significantly increased (RR, 1.021; 95% CI, 1.009-1.033; p < 0.001), while the number of surgeries did not change significantly (RR, 1.006; 95% CI, 0.988-1.023; p = 0.523).

Conclusions

In the past 10 years, the incidence of CTS and trigger finger decreased. The portion of patients who received corticosteroid injections increased for both diseases, but the portion of patients who had surgery decreased for CTS within 1 year after diagnosis. This study provides insight into the epidemiology of these diseases in an Asian population and may inform estimates of healthcare costs.

Risk of carpal tunnel syndrome among patients with osteoarthritis: a US population-based study

BACKGROUND

Carpal tunnel syndrome (CTS), an entrapment neuropathy caused by pressure of the median nerve, is a progressive condition that can lead to a decreased quality of life. Studies suggest an association between CTS and arthritis; however, previous studies examining osteoarthritis (OA) and CTS are limited in number, scope and study design. This study estimated the incidence and risk of CTS among patients with OA, both overall and by specific joints, in a large population-based cohort in the United States.

METHODS

Patients from the Optum claims database aged ≥ 45 years and diagnosed with OA between January 1, 2018, and December 31, 2022, were eligible for the OA cohort. The non-OA cohort included those without a diagnosis of OA at the index date and no history of OA for 12 months pre-index. Baseline characteristics were balanced using propensity score matching. The risk of CTS in the OA and non-OA cohort were evaluated using incidence rates and adjusted hazard ratios that were estimated using Cox regression.

RESULTS

After applying the inclusion/exclusion criteria, 3,610,240 of the 6,023,384 adults with a diagnosis of OA remained in the OA cohort. After propensity-score matching, each cohort included 1,033,439 individuals. The incidence rates for CTS per 1000 person-years were 7.35 (95% confidence interval [CI] 7.21-7.49) in the OA cohort and 1.44 (95% CI 1.38-1.50) in the non-OA cohort. The risk of developing CTS in patients with OA was ~ 4 times that of patients without (hazard ratio = 3.80; 95% CI 3.54-4.07). This increased risk was found across all OA joint types, with OA of the hand/wrist having the highest risk for CTS. Additionally, multiple OA joints presented a higher risk compared with a single affected joint.

CONCLUSIONS

OA increases the risk of CTS, but this is not limited to patients with hand/wrist OA, suggesting a systemic impact of OA on CTS. While the risk appears highest for patients with hand/wrist OA, patients with more distant affected joints like knee or hip also have an increased risk of CTS.

Association of carpal tunnel syndrome risk factors with treatment modality selection focusing on corticosteroid injection and surgery: A nationwide population-based study

Several studies have revealed the risk factors for carpal tunnel syndrome (CTS). However, no studies have evaluated the influence of these risk factors on the selection of treatment modalities for CTS. This study aimed to determine the influence of CTS risk factors on the selection of CTS treatment modalities with a focus on corticosteroid injection (CI) and surgery. We conducted a retrospective cohort study of patients aged ≥20 years with newly diagnosed CTS in the Korean health insurance review and assessment service between 2010 and 2019. We evaluated the demographic information, the existence of CTS risk factors, and the applied treatment modalities for CTS, including CI and operation. The CTS risk factors include age, sex, diabetes mellitus, osteoarthritis of the hand or wrist, rheumatoid arthritis, hypothyroidism, gout, chronic kidney disease (CKD) on dialysis, antiestrogen or aromatase inhibitor medication, and a history of distal radius fracture (DRF). Multivariable logistic regression analyses were conducted. Age over 80 years was the most significantly associated factor for the selection of CI in CTS (odd ratio [OR], 2.149; 95% confidence interval [CI], 2.092 to 2.209; P < .001). Among underlying diseases or medications, CKD on dialysis (OR, 4.001; 95% CI, 3.819-4.193; P < .001) was the most significant associated factor for the selection of operation for CTS, followed by a history of DRF (OR, 1.803; 95% CI, 1.749-1.860; P < .001). Old age was the most significantly related factor for selecting CI. Among underlying diseases or medications, CKD on dialysis and the history of DRF were the most significantly related factors for selecting operative treatment. For these patients, clinicians should proactively consider an operation to reduce the long-term discomfort and economic burdens.

Khachatryan L, Mohammadian-Hafshejani A. Investigating the association between diabetes and carpal tunnel syndrome: A systematic review and meta-analysis approach

INTRODUCTION

In recent years, several studies have reported on the relationship between diabetes and carpal tunnel syndrome (CTS). However, due to their contradictory results, a systematic review and meta-analysis were conducted to investigate this subject.

METHODS

This study is a systematic review and meta-analysis of studies published in ISI Web of Science, Scopus, PubMed, Cochrane, Google Scholar, and Embase databases. Heterogeneity in the studies included in the meta-analysis was evaluated using statistical tests such as the Chi-square test, I2, and forest plots. Publication bias was assessed using Begg's and Egger's tests.

RESULTS

This investigation analyzed data from 42 studies conducted between 1985 and 2022, with a total of 3,377,816 participants. The meta-analysis demonstrated that the odds ratio (OR) of CTS in participants with a history of diabetes compared to those without was 1.90 (95% CI: 1.64-2.21; P-value < 0.001). Given that publication bias was observed in this study (Begg's test P-value = 0.01), the modified OR was calculated with consideration of missed studies, which was 1.68 (95% CI: 1.45-1.94; P-value < 0.001).

CONCLUSION

The results of this study suggest that diabetic patients have 90% higher odds of developing CTS compared to non-diabetic individuals, which is statistically significant.

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.

The Incidence of Carpal Tunnel Syndrome Diagnosis Increases after Arthroscopic Shoulder Surgery

Purpose

Arthroscopic shoulder surgery has been identified as a potential risk factor for carpal tunnel syndrome (CTS). The purposes of this study were as follows: to (1) examine the percentage of patients who underwent arthroscopic shoulder procedures and later developed ipsilateral CTS within 1 year of the procedure, (2) determine the percentage of those patients with CTS who subsequently underwent an injection or release, and (3) examine comorbidities associated with developing CTS after surgery.

Methods

Patients who underwent arthroscopic rotator cuff repair (RCR), labral repair, or biceps tenodesis were retrospectively identified in a national database. Within 1 year, we compared the rates of ipsilateral CTS diagnoses versus the contralateral side. The rates of comorbidities between those who did and did not develop CTS were also compared.

Results

Within 1 year, arthroscopic RCR patients (1.47% vs 1.00%; odds ratio [OR], 1.48; P < .001) and arthroscopic labral repair patients (0.76% vs 0.52%; OR, 1.47; P < .001) had a significantly higher rate of ipsilateral carpal tunnel diagnosis versus contralateral side diagnosis. Arthroscopic RCR patients were also significantly more likely to have ipsilateral carpal tunnel injection (0.16% vs 0.11%; OR, 1.45; P < .001) and release (0.46% vs 0.37%; OR, 1.24; P < .001). Patients who had an ipsilateral carpal tunnel diagnosis following arthroscopic RCR and labral repair were both significantly older (both P < .001), a higher percentage of women (both P<.001), and more likely to have had a preoperative nerve block (both P < .05). Both cohorts had significantly higher mean Elixhauser comorbidity Index (P < .001) and more comorbidities.

Conclusions

This study demonstrated a significantly higher incidence of operative side CTS within 1 year following arthroscopic RCR and labral repairs. Arthroscopic RCR was also demonstrated to result in significantly higher rates of injections and carpal tunnel release. The cohort that developed ipsilateral CTS was older, had higher percentage of women, and had more comorbidities.

Type of study/level of evidence

Prognostic III.

[Post-traumatic pain mononeuropathies]

Neuropathic pain syndrome (NPS) caused by peripheral nerve (PN) injury is a serious clinical problem due to its prevalence, complexity of pathogenesis, significant impact on the quality of life of patients. The issues of epidemiology, pathogenesis and treatment of patients with NBS with PN injury are considered. Modern possibilities of invasive treatment of such patients are discussed.

Assessment of L-carnitine effectiveness on carpal tunnel syndrome

Background: Carpal tunnel syndrome (CTS) is the most prevalent entrapment neuropathy. Due to the results of recent studies about the protective effects of L-carnitine on nerves, this study was conducted to evaluate the effects L-carnitine on CTS improvement in terms of patient's function, electrodiagnostic study (EDX), and median nerve sonography. Methods: In this double-blind, randomized, controlled trial, patients with CTS were selected based on the inclusion and exclusion criteria, and then, divided into two groups of placebo and L-carnitine at a dose of 500 mg twice daily for 6 weeks. They were assessed at baseline, and 4 and 6 weeks later using Boston Carpal Tunnel Questionnaire (BCTQ)‎, median nerve conduction study (EDX), and sonography. Results: There was no statistically significant difference between the intervention and control groups in terms of BCTQ‎ scores, electrodiagnostic findings, and sonographic indexes. Although based on the results of the repeated measures test of the intervention and control groups separately, there was a statistically significant difference in some electrodiagnostic criteria and BCTQ‎ scores. These indexes improved after the intervention. Conclusion: The effectiveness of L-carnitine on mild to moderate CTS improvement cannot be approve based on the findings of this study and more studies and systematic reviews are required in this regard.

Biomarkers and Disease Trajectories Influencing Women's Health: Results from the UK Biobank Cohort

Women's health is important for society. Despite the known biological and sex-related factors influencing the risk of diseases among women, the network of the full spectrum of diseases in women is underexplored. This study aimed to systematically examine the women-specific temporal pattern (trajectory) of the disease network, including the role of baseline physical examination indexes, and blood and urine biomarkers. In the UK Biobank study, 502,650 participants entered the cohort from 2006 to 2010, and were followed up until 2019 to identify disease incidence via linkage to the patient registers. For those diseases with increased risk among women, conditional logistic regression models were used to estimate odds ratios (ORs), and the binomial test of direction was further used to build disease trajectories. Among 301 diseases, 82 diseases in women had ORs > 1.2 and p < 0.00017 when compared to men, involving mainly diseases in the endocrine, skeletal and digestive systems. Diseases with the highest ORs included breast diseases, osteoporosis, hyperthyroidism, and deformity of the toes. The biomarker and disease trajectories suggested estradiol as a risk predictor for breast cancer, while a high percentage of reticulocyte, body mass index and waist circumference were associated with an increased risk of upper-limb neuropathy. In addition, the risk of cholelithiasis was increased in women diagnosed with dyspepsia and diaphragmatic hernia. In conclusion, women are at an increased risk of endocrine, skeletal and digestive diseases. The biomarker and disease trajectories in women suggested key pathways to a range of adverse outcomes downstream, which may shed light on promising targets for early detection and prevention of these diseases.

Supplementary Information

The online version contains supplementary material available at 10.1007/s43657-022-00054-1.

Effects of Benign Joint Hypermobility Syndrome on the Clinical Characteristics of Carpal Tunnel Syndrome in Females

Background and Purpose

The study aim was to determine the effects of benign joint hypermobility syndrome (BJHS) on symptom severity and functional capacity in females with carpal tunnel syndrome (CTS) based on the findings of physical examinations.

Methods

One hundred female patients diagnosed with bilateral CTS in electrophysiological testing were included in this study. The participants were evaluated for BJHS using the Brighton 1998 criteria, and divided into two groups: one consisting of 56 CTS patients with BJHS, and the other comprising 44 CTS patients without BJHS. Tinel’s, Phalen’s, and reverse Phalen’s tests were applied to all patients, and the severity and functional capacity of CTS were evaluated using the Boston Carpal Tunnel Syndrome Questionnaire.

Results

Symptom severity and functional capacity varied significantly between the two groups in the right hand (p=0.037 and p=0.039, respectively) and in the left hand (p=0.016 and p=0.029). The hypermobile group yielded more positive results on the right side during Tinel’s, Phalen’s, and reverse Phalen’s tests (p=0.032, p=0.032, and p=0.018, respectively).

Conclusions

Hypermobility in females exacerbated the symptoms of CTS and led to a further reduction of functional capacity. Therefore, hypermobility should be tested and an intense exercise program should be implemented in BJHS patients, especially in females with CTS.

Utility of shear wave elastography and high-definition color for diagnosing carpal tunnel syndrome

OBJECTIVE

The diagnostic values of measuring median nerve (MN) stiffness and vascularity with shear wave elastography (SWE) and high-definition (HD) color were investigated in carpal tunnel syndrome (CTS).

METHODS

Seventy patients (123 wrists) with CTS and thirty-five healthy volunteers (70 wrists) were enrolled. Based on nerve conduction studies (NCS), the patients were subdivided into NCS-negative, mild-to-moderate, and severe CTS groups. MN and abductor pollicis brevis (APB) SWE and MN HD color were performed on a longitudinal plane.

RESULTS

The mild-to-moderate and severe CTS groups showed increased MN stiffness at the wrist and MN stiffness ratio (wrist-to forearm) compared with the control (p < 0.001). The NCS-negative CTS group showed increased MN stiffness at the wrist (p = 0.022) and MN stiffness ratio (p = 0.032) compared with the control. The severe CTS group showed increased MN stiffness at the wrist compared with the mild-to-moderate CTS group (p = 0.034). The cutoff-values in diagnosing NCS-confirmed CTS were 50.12 kPa for MN stiffness at the wrist, 1.91 for MN stiffness ratio, and grade 1 for HD color.

CONCLUSIONS

SWE and HD color are good supportive tools in diagnosing and assessing severity in CTS.

SIGNIFICANCE

SWE and HD color demonstrated that MN in CTS was associated with increased stiffness and hypervascularity.