Differences in risk factors for neurophysiologically confirmed carpal tunnel syndrome and illness with similar symptoms but normal median nerve function: a case–control study

BMC Musculoskeletal Disorders

Keith T Palmer¹  Cyrus Cooper¹  Richard Van der Star²  Cathy Linaker¹  E Clare Harris¹  Georgia Ntani¹  David Coggon¹ 

[1] MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK;Department of Clinical Neurophysiology, Wessex Neurological Centre, Southampton General Hospital, Southampton, UK

关键词: Upper limb disorders;    Somatising tendency;    Psychosocial;    Occupation;    Vibration;    Obesity;    Case–control;    Nerve conduction;    Carpal tunnel syndrome;   

Others  :  1129965
DOI  :  10.1186/1471-2474-14-240

 received in 2012-12-18, accepted in 2013-08-09,  发布年份 2013

【 摘 要 】

Background

To explore whether risk factors for neurophysiologically confirmed carpal tunnel syndrome (CTS) differ from those for sensory symptoms with normal median nerve conduction, and to test the validity and practical utility of a proposed definition for impaired median nerve conduction, we carried out a case–control study of patients referred for investigation of suspected CTS.

Methods

We compared 475 patients with neurophysiological abnormality (NP+ve) according to the definition, 409 patients investigated for CTS but classed as negative on neurophysiological testing (NP-ve), and 799 controls. Exposures to risk factors were ascertained by self-administered questionnaire. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated by logistic regression.

Results

NP+ve disease was associated with obesity, use of vibratory tools, repetitive movement of the wrist or fingers, poor mental health and workplace psychosocial stressors. NP-ve illness was also related to poor mental health and occupational psychosocial stressors, but differed from NP+ve disease in showing associations also with prolonged use of computer keyboards and tendency to somatise, and no relation to obesity. In direct comparison of NP+ve and NP-ve patients (the latter being taken as the reference category), the most notable differences were for obesity (OR 2.7, 95 % CI 1.9-3.9), somatising tendency (OR 0.6, 95% CI 0.4-0.9), diabetes (OR 1.6, 95% CI 0.9-3.1) and work with vibratory tools (OR 1.4, 95% CI 0.9-2.2).

Conclusions

When viewed in the context of earlier research, our findings suggest that obesity, diabetes, use of hand-held vibratory tools, and repeated forceful movements of the wrist and hand are causes of impaired median nerve function. In addition, sensory symptoms in the hand, whether from identifiable pathology or non-specific in origin, may be rendered more prominent and distressing by hand activity, low mood, tendency to somatise, and psychosocial stressors at work. These differences in associations with risk factors support the validity of our definition of impaired median nerve conduction.

【 授权许可】

   
2013 Coggon et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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