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

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

carpal tunnel syndrome, nerve conduction, case–control, obesity, vibration, occupation, psychosocial, somatising tendency, upper limb disorders
240
Coggon, D.
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Ntani, G.
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Harris, E.C.
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Linaker, C.
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Van der Star, R.
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Cooper, C.
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Palmer, K.T.
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Coggon, D.
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Ntani, G.
9b009e0a-5ab2-4c6e-a9fd-15a601e92be5
Harris, E.C.
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Linaker, C.
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Van der Star, R.
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Cooper, C.
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Palmer, K.T.
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Coggon, D., Ntani, G., Harris, E.C., Linaker, C., Van der Star, R., Cooper, C. and Palmer, K.T. (2013) 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, 14, 240. (doi:10.1186/1471-2474-14-240). (PMID:23947720)

Record type: Article

Abstract

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.

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Published date: 15 August 2013
Keywords: carpal tunnel syndrome, nerve conduction, case–control, obesity, vibration, occupation, psychosocial, somatising tendency, upper limb disorders
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 359304
URI: http://eprints.soton.ac.uk/id/eprint/359304
PURE UUID: f334364a-cda7-44e3-ba9e-d22aeef62ec1
ORCID for D. Coggon: ORCID iD orcid.org/0000-0003-1930-3987
ORCID for E.C. Harris: ORCID iD orcid.org/0000-0001-8037-566X
ORCID for C. Linaker: ORCID iD orcid.org/0000-0003-1091-9283
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 28 Oct 2013 10:12
Last modified: 18 Feb 2021 16:48

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Contributors

Author: D. Coggon ORCID iD
Author: G. Ntani
Author: E.C. Harris ORCID iD
Author: C. Linaker ORCID iD
Author: R. Van der Star
Author: C. Cooper ORCID iD
Author: K.T. Palmer

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