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|NI FEATURE: THE EDITORIAL DEBATE IV-- PROS AND CONS
|Year : 2018 | Volume
| Issue : 3 | Page : 673
Carpal tunnel syndrome: The precipitating risk factors
Gopal Krishnan, Dhananjaya I Bhat, B Indira Devi
Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangaluru, Karnataka, India
|Date of Web Publication||15-May-2018|
Dr. B Indira Devi
Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Hosur Road, Bangaluru, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Krishnan G, Bhat DI, Devi B I. Carpal tunnel syndrome: The precipitating risk factors. Neurol India 2018;66:673
We appreciate the researchers, Sharief et al., in undertaking a study to determine the risk factors that were prevalent in a group of patients who were diagnosed with carpal tunnel syndrome (CTS). They also attempt to find the correlation between the severity of the disease and how it affects the day-to-day functioning.
Sharief et al., have confirmed the greater prevalence of known risk factors such as obesity and female gender in this condition. Obesity, which is more common in women, further compromises the relatively smaller cross-sectional area of the proximal carpal tunnel in female subjects, leading to a higher prevalence of the condition in this gender. However, the fact that the female-to-male ratio in this study was just under two, makes us wonder if a large proportion of women in this population is remaining underdiagnosed. We must also keep in mind that although many studies implicate obesity as a risk factor, a nested case-control protocol in a classical twins study showed only genetic predisposition for the condition and excluded a higher body mass index as an independent risk factor.
Work related conditions are also known to predispose to CTS, though, in this study, only 8% of the hundred patients had moderate or severe risk factors. A large meta-analysis has shown that there is a high quality evidence for the prevalence of risk factors such as repetitive or forceful movements, and that a combination of such movements precipitated carpal tunnel syndrome. Interestingly, no excessive risk was found during computer usage.
Unsurprisingly, the severity of the symptoms correlated with functional impairment in the current study by Sharief et al. How much of these symptoms are alleviated by treatment was not designed to be addressed.
To answer the question of whether or not risk reduction aided by an early diagnosis made by nurse administrators can prevent further progression of carpal tunnel syndrome and avoid invasive treatment in high risk groups, it is obvious that a different design of prospective, interventional study is required. We do agree that using objective and validated severity scales such as the ones being used here are useful in research and in high-volume clinical settings. Current evidence favours surgical treatment over splinting and other non-invasive modalities in relieving symptoms. There is also no solid evidence that treating the predisposing factors like obesity, hypothyroidism, diabetes etc., leads to symptom resolution.
| » References|| |
Sharief F, Kanmani j, Kumar S. A study to assess risk factors, symptom severity, and functional status among patients with carpel tunnel syndrome. Neurol India 2018;66:743-6. [Full text]
Hakim AJ, Cherkas L, El Zayat S, MacGregor AJ, Spector TD. The genetic contribution to carpal tunnel syndrome in women: a twin study. Arthritis Rheum. 2002;47:275-9.
Kozak A, Schedlbauer G, Wirth T, Euler U, Westermann C, Nienhaus A. Association between work-related biomechanical risk factors and the occurrence of carpal tunnel syndrome: An overview of systematic reviews and a meta-analysis of current research. BMC Musculoskelet Disord 2015;16:231.
Verdugo RJ, Salinas RA, Castillo JL, Cea JG. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev. 2008;4:CD001552.