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Journal ArticleDOI

Prevalence and incidence of carpal tunnel syndrome in US working populations: pooled analysis of six prospective studies

TL;DR: A common CTS case definition was established incorporating both symptoms and EDS results from data that were collected in all studies, and both prevalent and incident CTS were common in data pooled across multiple studies and sites.
Abstract: Objectives Most studies of carpal tunnel syndrome (CTS) incidence and prevalence among workers have been limited by small sample sizes or restricted to a small subset of jobs. We established a common CTS case definition and then pooled CTS prevalence and incidence data across six prospective studies of musculoskeletal outcomes to measure CTS frequency and allow better studies of etiology. Methods Six research groups collected prospective data at >50 workplaces including symptoms characteristic of CTS and electrodiagnostic studies (EDS) of the median and ulnar nerves across the dominant wrist. While study designs and the timing of data collection varied across groups, we were able to create a common CTS case definition incorporating both symptoms and EDS results from data that were collected in all studies. Results At the time of enrollment, 7.8% of 4321 subjects met our case definition and were considered prevalent cases of CTS. During 8833 person-years of follow-up, an additional 204 subjects met the CTS case definition for an overall incidence rate of 2.3 CTS cases per 100 person-years. Conclusions Both prevalent and incident CTS were common in data pooled across multiple studies and sites. The large number of incident cases in this prospective study provides adequate power for future exposure–response analyses to identify work- and non-work-related risk factors for CTS. The prospective nature allows determination of the temporal relations necessary for causal inference.

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Citations
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Journal ArticleDOI
TL;DR: Measures of exposure to forceful hand exertion were associated with incident CTS after controlling for important covariates, and these findings may influence the design of workplace safety programmes for preventing work-related CTS.
Abstract: Background Between 2001 and 2010, five research groups conducted coordinated prospective studies of carpal tunnel syndrome (CTS) incidence among US workers from various industries and collected detailed subject-level exposure information with follow-up of symptoms, electrophysiological measures and job changes. Objective This analysis examined the associations between workplace biomechanical factors and incidence of dominant-hand CTS, adjusting for personal risk factors. Methods 2474 participants, without CTS or possible polyneuropathy at enrolment, were followed up to 6.5 years (5102 person-years). Individual workplace exposure measures of the dominant hand were collected for each task and included force, repetition, duty cycle and posture. Task exposures were combined across the workweek using time-weighted averaging to estimate job-level exposures. CTS case-criteria were based on symptoms and results of electrophysiological testing. HRs were estimated using Cox proportional hazard models. Results After adjustment for covariates, analyst (HR=2.17; 95% CI 1.38 to 3.43) and worker (HR=2.08; 95% CI 1.31 to 3.39) estimated peak hand force, forceful repetition rate (HR=1.84; 95% CI 1.19 to 2.86) and per cent time spent (eg, duty cycle) in forceful hand exertions (HR=2.05; 95% CI 1.34 to 3.15) were associated with increased risk of incident CTS. Associations were not observed between total hand repetition rate, per cent duration of all hand exertions, or wrist posture and incident CTS. Conclusions In this prospective multicentre study of production and service workers, measures of exposure to forceful hand exertion were associated with incident CTS after controlling for important covariates. These findings may influence the design of workplace safety programmes for preventing work-related CTS.

139 citations

Journal ArticleDOI
TL;DR: There is sufficient evidence to propose a new paradigm for the diagnosis of CTS that incorporates US, based on similar sensitivity and specificity to NC studies but higher patient acceptability, lower cost and additional capability to assess carpal tunnel anatomy and guide injection.
Abstract: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, affecting 9% of women, and it is responsible for significant morbidity and occupational absence. Clinical assessment is used for initial diagnosis and nerve conduction (NC) studies are currently the principal test used to confirm the diagnosis. Sensitivity of NC studies is >85% and specificity is >95%. There is now good evidence that US can be used as an alternative to NC studies to diagnose CTS. US can assess the anatomy of the median nerve and also identify pathology of the surrounding structures that may compress the nerve. Median nerve enlargement (cross-sectional area ≥10 mm(2) at the level of the pisiform bone or tunnel inlet) is the most commonly used parameter to diagnose CTS on US, and sensitivity has been reported to be as high as 97.9% using this parameter. US may also be used to guide therapeutic corticosteroid injection into the carpal tunnel--thus avoiding median nerve injury--and to objectively monitor the response to treatment. There is now sufficient evidence to propose a new paradigm for the diagnosis of CTS that incorporates US. US is proposed as the initial diagnostic test in CTS based on similar sensitivity and specificity to NC studies but higher patient acceptability, lower cost and additional capability to assess carpal tunnel anatomy and guide injection.

101 citations

Journal ArticleDOI
TL;DR: Personal factors associated with an increased risk of developing carpal tunnel syndrome were BMI, age and being a woman, while social support was protective in the pooled cohort.
Abstract: Background Between 2001 and 2010, six research groups conducted coordinated multiyear, prospective studies of carpal tunnel syndrome (CTS) incidence in US workers from various industries and collected detailed subject-level exposure information with follow-up symptom, physical examination, electrophysiological measures and job changes. Objective This analysis of the pooled cohort examined the incidence of dominant-hand CTS in relation to demographic characteristics and estimated associations with occupational psychosocial factors and years worked, adjusting for confounding by personal risk factors. Methods 3515 participants, without baseline CTS, were followed-up to 7 years. Case criteria included symptoms and an electrodiagnostic study consistent with CTS. Adjusted HRs were estimated in Cox proportional hazard models. Workplace biomechanical factors were collected but not evaluated in this analysis. Results Women were at elevated risk for CTS (HR=1.30; 95% CI 0.98 to 1.72), and the incidence of CTS increased linearly with both age and body mass index (BMI) over most of the observed range. High job strain increased risk (HR=1.86; 95% CI 1.11 to 3.14), and social support was protective (HR=0.54; 95% CI 0.31 to 0.95). There was an inverse relationship with years worked among recent hires with the highest incidence in the first 3.5 years of work (HR=3.08; 95% CI 1.55 to 6.12). Conclusions Personal factors associated with an increased risk of developing CTS were BMI, age and being a woman. Workplace risk factors were high job strain, while social support was protective. The inverse relationship between CTS incidence and years worked among recent hires suggests the presence of a healthy worker survivor effect in the cohort.

94 citations

Journal ArticleDOI
TL;DR: The prevalence of cubital tunnel syndrome in the general population may be higher than that reported previously when compared with previous estimates of disease burden, and the active surveillance technique used in this study may account for the higher reported prevalence.
Abstract: Background Although cubital tunnel syndrome is the second most common peripheral mononeuropathy (after carpal tunnel syndrome) encountered in clinical practice, its prevalence in the population is unknown. The objective of this study was to evaluate the prevalence of cubital tunnel syndrome in the general population. Methods We surveyed a cohort of adult residents of the St. Louis metropolitan area to assess for the severity and localization of hand symptoms using the Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SSS) and the Katz hand diagram. We identified subjects who met our case definitions for cubital tunnel syndrome and carpal tunnel syndrome: self-reported hand symptoms associated with a BCTQ-SSS score of >2 and localization of symptoms to the ulnar nerve or median nerve distributions. Results Of 1,001 individuals who participated in the cross-sectional survey, 75% were women and 79% of the cohort was white; the mean age (and standard deviation) was 46 ± 15.7 years. Using a more sensitive case definition (lax criteria), we identified 59 subjects (5.9%) with cubital tunnel syndrome and 68 subjects (6.8%) with carpal tunnel syndrome. Using a more specific case definition (strict criteria), we identified 18 subjects (1.8%) with cubital tunnel syndrome and 27 subjects (2.7%) with carpal tunnel syndrome. Conclusions The prevalence of cubital tunnel syndrome in the general population may be higher than that reported previously. When compared with previous estimates of disease burden, the active surveillance technique used in this study may account for the higher reported prevalence. This finding suggests that a proportion of symptomatic subjects may not self-identify and may not seek medical treatment. Clinical relevance This baseline estimate of prevalence for cubital tunnel syndrome provides a valuable reference for future diagnostic and prognostic study research and for the development of clinical practice guidelines.

85 citations

Journal ArticleDOI
TL;DR: Pain ratings varied widely, however less variability was seen in pain location, with immediate paraspinal region being the most common area of LBP.
Abstract: Low Back Pain (LBP) is a common and costly problem, with variation in prevalence. Epidemiological reports of rating of pain intensity and location within the low back area are rare. The objective is to describe LBP in a large, multi-center, occupational cohort detailing both point and 1-month period prevalence of LBP by location and intensity measures at baseline. In this cross-sectional report from a prospective cohort study, 828 participants were workers enrolled from 30 facilities performing a variety of manual material handling tasks. All participants underwent a structured interview detailing pain rating and location. Symptoms in the lower extremities, demographic and other data were collected. Body mass indices were measured. Outcomes are pain rating (0–10) in five defined lumbar back areas (i) LBP in the past month and (ii) LBP on the day of enrollment. Pain ratings were reported on a 0–10 scale and subsequently collapsed with ratings of 1–3, 4–6 and 7–10 classified as low, medium and high respectively. 172 (20.8%) and 364 (44.0%) of the 828 participants reported pain on the day of enrollment or within the past month, respectively. The most common area of LBP was in the immediate paraspinal area with 130 (75.6%) participants with point prevalence LBP and 278 (77.4%) with 1-month period prevalence reported having LBP in the immediate paraspinal area. Among those 364 reporting 1-month period prevalence pain, ratings varied widely with 116 (31.9%) reporting ratings classified as low, 170 (46.7%) medium and 78 (21.4%) providing high pain ratings in any location. Among the 278 reporting 1-month period prevalence pain in the immediate paraspinal area, 89 (32.0%) reported ratings classified as low, 129 (46.4%), medium and 60 (21.6%) high pain ratings. Pain ratings varied widely, however less variability was seen in pain location, with immediate paraspinal region being the most common. Variations may suggest different etiological factors related to LBP. Aggregation of different locations of pain or different intensities of pain into one binary classification of LBP may result in loss of information which may potentially be useful in prevention or treatment of LBP.

63 citations


Cites background from "Prevalence and incidence of carpal ..."

  • ...While younger and healthier than the general population, this dataset is similar to other occupational cohorts in age and proportion of chronic diseases such as diabetes mellitus, thyroid disease, smoking, body mass index [27-32,65-70]....

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References
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Journal ArticleDOI
14 Jul 1999-JAMA
TL;DR: About 1 in 5 symptomatic subjects would be expected to have CTS based on clinical examination and electrophysiologic testing, which indicates symptoms of pain, numbness, and tingling in the hands are common in the general population.
Abstract: Context Carpal tunnel syndrome (CTS) is a cause of pain, numbness, and tingling in the hands and is an important cause of work disability. Although high prevalence rates of CTS in certain occupations have been reported, little is known about its prevalence in the general population. Objective To estimate the prevalence of CTS in a general population. Design General health mail survey sent in February 1997, inquiring about symptoms of pain, numbness, and tingling in any part of the body, followed 2 months later by clinical examination and nerve conduction testing of responders reporting symptoms in the median nerve distribution in the hands, as well as of a sample of those not reporting these symptoms (controls). Setting A region in southern Sweden with a population of 170,000. Participants A sex- and age-stratified sample of 3000 subjects (age range, 25-74 years) was randomly selected from the general population register and sent the survey, with a response rate of 83% (n=2466; 46% men). Of the symptomatic responders, 81% underwent clinical examination. Main Outcome Measures Population prevalence rates, calculated as the number of symptomatic responders diagnosed on examination as having clinically certain CTS and/or electrophysiological median neuropathy divided by the total number of responders. Results Of the 2466 responders, 354 reported pain, numbness, and/or tingling in the median nerve distribution in the hands (prevalence, 14.4%; 95% confidence interval [CI], 13.0%-15.8%). On clinical examination, 94 symptomatic subjects were diagnosed as having clinically certain CTS (prevalence, 3.8%; 95% CI, 3.1%-4.6%). Nerve conduction testing showed median neuropathy at the carpal tunnel in 120 symptomatic subjects (prevalence, 4.9%; 95% CI, 4.1%-5.8%). Sixty-six symptomatic subjects had clinically and electrophysiologically confirmed CTS (prevalence, 2.7%; 95% CI, 2.1%-3.4%). Of 125 control subjects clinically examined, electrophysiological median neuropathy was found in 23 (18.4%; 95% CI, 12.0%-26.3%). Conclusion Symptoms of pain, numbness, and tingling in the hands are common in the general population. Based on our data, 1 in 5 symptomatic subjects would be expected to have CTS based on clinical examination and electrophysiologic testing.

1,698 citations


"Prevalence and incidence of carpal ..." refers background in this paper

  • ...Yet lower prevalence proportions between 3–11% were found for studies with case definitions requiring both symptoms and nerve conduction abnormalities (8, 12), similar to the 7....

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Book
01 Jan 1983
TL;DR: This book provides a comprehensive review of most peripheral nerve and muscle diseases, including specific techniques and locations for performing each test, and is of value to neurologists and physiatrists who are interested in neuromuscular disorders and noninvasive electrodiagnostic methods.
Abstract: With each subsequent edition, Dr. Kimura has built upon his extensive experience teaching electromyography (EMG) around the world and has transferred his knowledge to the book. It is intended for clinicians who perform electrodiagnostic procedures as an extension of their clinical examination, and will be of value to neurologists and physiatrists who are interested in neuromuscular disorders and noninvasive electrodiagnostic methods, particularly those practicing electromyography (EMG). The book provides a comprehensive review of most peripheral nerve and muscle diseases, including specific techniques and locations for performing each test.New to this edition:intra-operative monitoringstudies for the pediatric and geriatric populationsdata analysis and reporting, which should help facilitate daily practice

1,503 citations

Journal Article
01 Oct 2004-Harefuah
TL;DR: The purpose of the operation is to relieve the pressure in the carpal tunnel by dissecting the transverse ligament, which can be done in an open approach, endoscopic approach or limited invasive approach.
Abstract: Carpal tunnel syndrome is the most common peripheral nerve compression syndrome. Compression of the median nerve in the carpal tunnel, disrupts the blood-nerve barrier causing edema, inflammation and fibrosis of its surrounding connective tissues. In the next stage of the syndrome there is a disruption of the myelin coverage of the nerve followed by damage to the axons. Most carpal tunnel syndromes are idiopathic. Other causes include intrinsic factors (which cause pressure within the tunnel), extrinsic factors (which cause pressure from outside the tunnel) and overuse/exertional factors. Patients usually report numbness and pain of the palmar aspect of their 1st, 2nd, 3rd and radial half of their 4th finger, night pain and gradual worsening of their symptoms. At a later stage, weakness and atrophy of the thenar muscles appears. The physical examination may show a decrease in sensibility, positive provocative tests and a decrease in thenar strength. The typical finding in the nerve conduction tests is a prolonged latency period. The conservative treatment for carpal tunnel syndrome includes ergonomic modifications, anti inflammatory medications and splintage and less frequently, special exercise and therapeutic ultrasound. The indications for operative treatment are failure of conservative treatment or severe carpal tunnel syndrome. The purpose of the operation is to relieve the pressure in the carpal tunnel by dissecting the transverse ligament. The operation can be done in an open approach, endoscopic approach or limited invasive approach.

1,134 citations


"Prevalence and incidence of carpal ..." refers methods in this paper

  • ...All study groups followed recommended electrodiagnostic testing protocols (10)....

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Journal Article
TL;DR: The classic symptoms of CTS include nocturnal pain associated with tingling and numbness in the distribution of median nerve in the hand and surgery is the only treatment that provides cure in moderate to severe cases.
Abstract: Carpal tunnel syndrome is one of the most common peripheral neuropathies. It affects mainly middle aged women. In the majority of patients the exact cause and pathogenesis of CTS is unclear. Although several occupations have been linked to increased incidence and prevalence of CTS the evidence is not clear. Occupational CTS is uncommon and it is essential to exclude all other causes particularly the intrinsic factors such as obesity before attributing it to occupation. The risk of CTS is high in occupations involving exposure to high pressure, high force, repetitive work, and vibrating tools. The classic symptoms of CTS include nocturnal pain associated with tingling and numbness in the distribution of median nerve in the hand. There are several physical examination tests that will help in the diagnosis of CTS but none of these tests are diagnostic on their own. The gold standard test is nerve conduction studies. However, they are also associated with false positive and false negative results. The diagnosis of CTS should be based on history, physical examination and results of electrophysiological studies. The patient with mild symptoms of CTS can be managed with conservative treatment, particularly local injection of steroids. However, in moderate to severe cases, surgery is the only treatment that provides cure. The basic principle of surgery is to increase the volume of the carpal tunnel by dividing transverse carpal ligament to release the pressure on the median nerve. Apart from early recovery and return to work there is no significant difference in terms of early and late complications and long-term pain relief between endoscopic and open carpal tunnel surgery.

614 citations

Journal ArticleDOI
TL;DR: H/A and N/S MSS and MSD were common among computer users and gender, prior history of H/A pain, prior computer use, and children at home were associated with either H-A MSS or MSD.
Abstract: Background A prospective study of computer users was performed to determine the occurrence of and evaluate risk factors for neck or shoulder (N/S) and hand or arm (H/A) musculoskeletal symptoms (MSS) and disorders (MSD). Methods Individuals (n = 632) newly hired into jobs requiring ≥ 15 hr/week of computer use were followed for up to 3 years. At study entry, workstation dimensions and worker postures were measured and medical and psychosocial risk factors were assessed. Daily diaries were used to document work practices and incident MSS. Those reporting MSS were examined for specific MSD. Incidence rates of MSS and MSD were estimated with survival analysis. Cox regression models were used to evaluate associations between participant characteristics at entry and MSS and MSD. Results The annual incidence of N/S MSS was 58 cases/100 person-years and of N/S MSD was 35 cases/100 person-years. The most common N/S MSD was somatic pain syndrome. The annual incidence of H/A MSS was 39 cases/100 person-years and of H/A MSD was 21 cases/100 person-years. The most common H/A disorder was deQuervain's tendonitis. Forty-six percent of N/S and 32% of H/A MSS occurred during the first month of follow-up. Gender, age, ethnicity, and prior history of N/S pain were associated with N/S MSS and MSD. Gender, prior history of H/A pain, prior computer use, and children at home were associated with either H/A MSS or MSD. Conclusions H/A and N/S MSS and MSD were common among computer users. More than 50% of computer users reported MSS during the first year after starting a new job. Am. J. Ind. Med. 41:221–235, 2002. © 2002 Wiley-Liss, Inc.

570 citations


"Prevalence and incidence of carpal ..." refers methods in this paper

  • ...2013;39(5):495–505. doi:10.5271/sjweh.3351 Prevalence and incidence of carpal tunnel syndrome in US working populations: pooled analysis of six prospective studies by Ann Marie Dale, PhD,1 Carisa Harris-Adamson, PhD,2 David Rempel, MD,3 Fred Gerr, MD,4 Kurt...

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  • ...Letz R, Gerr F. Covariates of human peripheral nerve function: I. Nerve conduction velocity and amplitude....

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  • ...Gerr F, Marcus M, Ensor C, Kleinbaum D, Cohen S, Edwards A, et al. A prospective study of computer users: I. Study design and incidence of musculoskeletal symptoms and disorders....

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  • ...Washington University School of Medicine Digital Commons@Becker OHS Faculty Publications Occupational Health and Safety 2013 Prevalence and incidence of carpal tunnel syndrome in US working populations: pooled analysis of six prospective studies Ann Marie Dale Washington University School of Medicine in St. Louis C. Harris-Adamson Samuel Merritt University David Rempel University of California at San Francisco F. Gerr University of Iowa K. Hegmann University of Utah See next page for additional authors Follow this and additional works at: https://digitalcommons.wustl.edu/ohs_facpubs Recommended Citation Dale, Ann Marie; Harris-Adamson, C.; Rempel, David; Gerr, F.; Hegmann, K.; Silverstein, B.; Burt, S.; Garg, A.; Kapellusch, J.; Merlino, L.; Thiese, M. S.; Eisen, E. A.; and Evanoff, Bradley A., "Prevalence and incidence of carpal tunnel syndrome in US working populations: pooled analysis of six prospective studies"....

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  • ...Kapellusch J, Garg A, Bao S, Silverstein B, Burt S, Dale A, Evanoff B, Gerr F, Harris-Adamson C, Hegmann K, Merlino L, Rempel D. Pooling Job Physical Exposure Data from Multiple Sites in a Study of Carpal Tunnel Syndrome....

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