Zespół cieśni nadgarstka

Zespół cieśni nadgarstka
Epidemiologia

Zespół cieśni nadgarstka (ZCN) jest najczęstszą neuropatią uciskową, stanowiącą około 90% wszystkich neuropatii obwodowych, z częstością występowania w populacji ogólnej na poziomie 1-5%, a roczną zapadalnością od 1 do 3 przypadków na 1000 osób. ZCN dotyka głównie kobiety (proporcja 3:1 do 10:1) w wieku 40-60 lat, z bimodalnym szczytem zachorowań w 50. i 75-84 roku życia. Czynniki ryzyka obejmują powtarzalne ruchy nadgarstka, używanie narzędzi wibracyjnych (zwiększające ryzyko 2-krotnie), otyłość (ryzyko podwaja się przy BMI >30), oraz choroby współistniejące, takie jak cukrzyca, niedoczynność tarczycy, RZS czy przewlekła niewydolność nerek. W populacjach pracowniczych prewalencja ZCN potwierdzonego elektrofizjologicznie wynosi od 5% do 21%, a zapadalność może sięgać 14,8 na 1000 osobolat, szczególnie w branżach przemysłowych i przetwórstwa żywności. Obustronne występowanie ZCN jest częste (do 70-80%), a czynniki predykcyjne obejmują obustronne objawy, osłabienie mięśni kłębu kciuka i wiek ≥45 lat.

Epidemiologia zespołu cieśni nadgarstka

Zespół cieśni nadgarstka (ZCN) jest najczęstszą neuropatią uciskową, stanowiącą około 90% wszystkich przypadków neuropatii obwodowych.¹² Schorzenie to powstaje wskutek ucisku nerwu pośrodkowego przechodzącego przez kanał nadgarstka, co prowadzi do charakterystycznych objawów, takich jak ból, drętwienie i osłabienie w obszarze unerwianym przez nerw pośrodkowy.³

Występowanie w populacji ogólnej

Częstość występowania ZCN w populacji ogólnej szacuje się na 1-5%.¹⁴ Niektóre badania podają wyższe wskaźniki, wskazując na rozpowszechnienie wynoszące od 2,7% do 5,8% wśród dorosłych.⁵ Roczna zapadalność w populacji ogólnej waha się od 1 do 3 przypadków na 1000 osób rocznie.⁴ W badaniach przeprowadzonych w Stanach Zjednoczonych odnotowano roczną zapadalność na poziomie 329 przypadków na 100 000 osobolat, a standaryzowana zapadalność wynosiła 276 przypadków na 100 000 osobolat.⁵ Inne badania wskazują na wyższe wskaźniki – 3,46 przypadków na 1000 osobolat.⁶

Dane dotyczące występowania ZCN w różnych krajach są zbliżone. Na przykład w Holandii roczna zapadalność wynosi około 2,5 przypadku na 1000 osób, a rozpowszechnienie w Wielkiej Brytanii wynosi 70-160 przypadków na 1000 osób.⁴ W badaniu przeprowadzonym w East Kent i Huddersfield (Wielka Brytania) roczne wskaźniki występowania (na 100 000) wynosiły 139,4 dla kobiet i 67,2 dla mężczyzn w East Kent oraz 83,2 dla kobiet i 48,0 dla mężczyzn w Huddersfield.⁷

Różnice demograficzne

Płeć: ZCN występuje znacznie częściej u kobiet niż u mężczyzn, z proporcją 3:1.¹ Niektóre źródła podają szerszy zakres tej proporcji – od 3:1 do 10:1.⁸ Wyższe ryzyko u kobiet może być związane z mniejszym przekrojem kanału nadgarstka oraz czynnikami hormonalnymi, takimi jak ciąża, stosowanie doustnych środków antykoncepcyjnych czy terapia estrogenowa.⁹¹⁰

Wiek: ZCN najczęściej występuje u osób w wieku 40-60 lat.¹¹¹ Szczytowy przedział wiekowy dla rozwoju ZCN to 45-60 lat, a tylko 10% pacjentów jest młodszych niż 31 lat.⁸ Schorzenie rzadko występuje u dzieci.¹¹² Interesującym jest fakt, że badania wykazują bimodalny rozkład wieku występowania ZCN, z pierwszym szczytem we wczesnych latach 50. i drugim szczytem w grupie wiekowej 75-84 lata.¹²¹³

Rasa: Istnieją pewne różnice rasowe w występowaniu ZCN. Osoby rasy białej prawdopodobnie mają najwyższe ryzyko rozwoju tego schorzenia, podczas gdy wśród niektórych grup rasowych (np. niebiałych mieszkańców Południowej Afryki) ZCN wydaje się być bardzo rzadki.⁸

Występowanie w populacjach pracowniczych

Częstość występowania ZCN potwierdzonego elektrofizjologicznie w populacjach pracowniczych jest generalnie wyższa niż w populacji ogólnej.¹⁴ Wśród pracowników przemysłu i przetwórstwa mięsnego prewalencja wynosi od 5% do 21%, podczas gdy w populacji ogólnej waha się od 1% do 5%.¹⁴

W wieloośrodkowym badaniu obejmującym głównie pracowników przemysłowych prewalencja ZCN wynosiła 7,8%, przy czym wyższe wskaźniki występowały wśród kobiet i w starszych kategoriach wiekowych.¹⁵ W tym samym badaniu zapadalność wynosiła 2,3 przypadku na 100 osobolat.¹⁶ Badania przeprowadzone w amerykańskiej populacji pracowników wykazały jeszcze wyższe wskaźniki – około 8%.⁹

Wskaźniki zapadalności na ZCN obliczone na podstawie dokumentacji odszkodowań pracowniczych w stanie Waszyngton wahały się od 0,8 do 14,8 na 1000 osobolat i różniły się w zależności od klasyfikacji przemysłowej i zawodowej.¹⁴

Czynniki ryzyka występowania ZCN

Ryzyko rozwoju ZCN jest związane z wieloma różnymi czynnikami epidemiologicznymi, w tym genetycznymi, medycznymi, społecznymi, zawodowymi i demograficznymi.⁴

Czynniki zawodowe: ZCN jest często związany z urazami spowodowanymi przeciążeniem wynikającym z powtarzalnych ruchów, zazwyczaj związanych z pracą.⁵ Osoby wykonujące powtarzalne czynności są narażone na ZCN, w tym:

pracownicy przemysłu odzieżowego
rzeźnicy
kasjerzy
pracownicy montażu elektronicznego
maszynistki
muzycy
pakowacze
gospodarze domowi/kucharze
stolarze³

Istnieją przekonujące dowody na to, że regularne, długotrwałe używanie ręcznych narzędzi wibracyjnych zwiększa ryzyko ZCN 2-krotnie.¹⁰ Branże o podwyższonym ryzyku ZCN to przetwórstwo żywności, budownictwo, branża kosmetyczna i produkcja.¹⁰ Warto zauważyć, że wiele badań wykazało, że korzystanie z klawiatury nie ma związku z ZCN, istnieje jednak związek między objawami mononeuropatii nerwu pośrodkowego w nadgarstku a używaniem prawostronnej myszy.¹⁰

Otyłość: Ryzyko rozwoju ZCN podwaja się u osób otyłych.¹ Badania wykazały, że każdorazowy wzrost BMI o jedną jednostkę powyżej 30 zwiększa ryzyko ZCN o 7%.⁹

Schorzenia współistniejące: Ryzyko ZCN zwiększają różne schorzenia, takie jak:

cukrzyca typu 1 i 2
niedoczynność tarczycy
reumatoidalne zapalenie stawów
zapalenie stawów, w tym choroba zwyrodnieniowa stawów
amyloidoza
przewlekła niewydolność nerek⁹¹⁰¹¹

Czynniki genetyczne: Pacjenci z obustronnym ZCN częściej mają dodatni wywiad rodzinny niż pacjenci z jednostronnym ZCN.¹⁰ W badaniu elektrofizjologicznym u pacjentów z ZCN w jednej ręce, przeciwległa bezobjawowa ręka wykazuje nieprawidłowości w badaniach przewodnictwa nerwowego w około 50% przypadków.⁹

Dwustronność ZCN

Obustronne występowanie ZCN jest częste – do 70% pacjentów ma obustronny ZCN.¹¹ W jednym z badań prewalencja obustronnego ZCN potwierdzonego elektrodiagnostycznie wynosiła 80,7%.¹⁷ Czynniki predykcyjne obustronnego ZCN obejmują obecność obustronnych objawów (AOR 6,7 [95% CI 3,1-14,3]), osłabienie mięśni kłębu kciuka (AOR 3,9 [95% CI 1,3-11,6]) i wiek ≥45 lat (AOR 2,5 [95% CI 1,3-4,6]).¹⁷

Trendy czasowe w występowaniu ZCN

Dane dotyczące trendów czasowych w występowaniu ZCN wskazują na zmiany w ciągu ostatnich dziesięcioleci.

Zmiany w częstości występowania ZCN

Badanie przeprowadzone w oparciu o Clinical Practice Research Datalink (CPRD) w Wielkiej Brytanii wykazało, że szacowana surowa prewalencja pacjentów z ZCN w brytyjskiej podstawowej opiece zdrowotnej wzrosła z 26,03 na 10 000 osobolat w 1993 roku (95% CI 25,10 do 27,00) do 36,08 na 10 000 osobolat (95% CI 35,45 do 36,72) w 2013 roku.¹⁸ Szczególnie widoczny wzrost odnotowano w latach 2000-2004, z roczną zmianą procentową wynoszącą 7,81.¹⁹

W badaniu przeprowadzonym w Korei Południowej w ciągu 10 lat średnie roczne występowanie ZCN wynosiło 360,26 na 100 000 osobolat, a średnia prewalencja – 556,24 na 100 000 osobolat. Prewalencja była znacznie wyższa wśród kobiet (848,41 na 100 000 osobolat) niż wśród mężczyzn (257,49 na 100 000 osobolat). Co ciekawe, roczna zapadalność na ZCN znacząco spadła w badanym okresie (wskaźnik częstości występowania [IRR] 0,979; 95% CI 0,972-0,985; p≤0,001), podczas gdy prewalencja istotnie wzrosła.²⁰²¹

We francuskim regionie Pays de la Loire roczne wskaźniki zapadalności na ZCN leczony chirurgicznie (SURG-CTS) zmniejszyły się z 3,35 do 2,98 na 1000 osobolat w ciągu 8-letniego okresu, z ogólną tendencją spadkową [-2,00%, 95% CI -3,07-(-0,91%), p≤0,001]. Natomiast roczny wskaźnik zapadalności na ZCN rozpoznany jako choroba zawodowa (OD-CTS) na 1000 osobolat zmniejszył się (z 1,52 do 1,01) między 2004 a 2007 rokiem, a następnie wzrósł po 2007 roku (z 1,45 do 2,34), z ogólnym przyrostem o 54% w okresie badania.²²

Zmiany w leczeniu chirurgicznym ZCN

Wskaźniki leczenia chirurgicznego ZCN również wykazywały zmiany w czasie. W badaniu brytyjskim CPRD zabiegi chirurgiczne z powodu ZCN zwiększały się do 2007 roku, a następnie wykazały statystycznie istotny spadek do poziomu z 2004 roku.¹⁹ Analiza Joinpoint sugerowała wzrost leczenia chirurgicznego ZCN między 1993 a 2007 rokiem (APC=2,55), a następnie tendencję spadkową między 2007 (95% CI 2004 do 2009) a końcem badania w 2013 roku (APC=-1,72).²³

W badaniu koreańskim odsetek pacjentów poddanych operacji był niski zarówno dla ZCN (12,0%), co autorzy tłumaczą szerokim zasięgiem populacji objętej koreańskim krajowym systemem ubezpieczeń i wysoce dostępną opieką medyczną dla obywateli Korei.²¹

ZCN jako choroba zawodowa

Zespół cieśni nadgarstka jest często uznawany za chorobę zawodową, szczególnie w kontekście wykonywania powtarzalnych czynności manualnych. Jest to druga najczęściej uznawana choroba zawodowa, zaraz po chorobach stożka rotatorów.²⁴

Kryteria uznania ZCN za chorobę zawodową

Aby ZCN został uznany za chorobę zawodową, muszą być spełnione określone kryteria. Na przykład, w niektórych systemach wymaga się, aby schorzenie wystąpiło po używaniu ręcznych narzędzi wibracyjnych lub wykonywaniu powtarzalnych ruchów zgięcia i wyprostu nadgarstka przez co najmniej 20 godzin tygodniowo, przez ponad połowę poprzednich 2 lat.²⁴

W Hiszpanii ZCN jest uznawany za najczęstszą chorobę zawodową związaną z przeciążeniem i jest uwzględniony w 4 specyficznych protokołach nadzoru nad zdrowiem zawodowym: ręczne przenoszenie ciężarów, powtarzalne ruchy, wymuszone pozycje i neuropatie.²⁵

Nadzór nad ZCN jako chorobą zawodową

Zespół cieśni nadgarstka podlega zgłoszeniu jako choroba zawodowa, jeśli jest zdiagnozowany przez lekarza i przypisany do działalności zawodowej danej osoby.²⁶ Pomimo istnienia programów zgłaszania chorób zawodowych w ponad połowie stanów USA, niedostateczne zgłaszanie jest powszechne.²⁷

Istnieją specjalne systemy nadzoru nad ZCN jako chorobą zawodową, takie jak program SENSOR (Sentinel Event Notification System for Occupational Risks), który ma na celu pomoc stanowym departamentom zdrowia w zwiększeniu zarówno zgłaszania chorób związanych z pracą przez personel medyczny, jak i działań profilaktycznych.²⁷

Pracodawcy mogą wdrażać programy nadzoru zdrowotnego w celu oceny i monitorowania pracowników narażonych na ryzyko rozwoju ZCN z powodu ich obowiązków zawodowych.²⁶ Nadzór zdrowotny obejmuje monitorowanie zdrowia pracowników w celu identyfikacji i zapobiegania zagrożeniom zdrowotnym związanym z pracą, w tym chorobom zawodowym, takim jak ZCN.²⁶

Metody screeningu i monitorowania ZCN

Istnieją różne metody screeningu i monitorowania ZCN w populacjach pracowniczych. W badaniach stosuje się różne procedury diagnostyczne, w tym:

Kwestionariusze objawów
Diagramy rąk (hand diagrams)
Badania elektrodiagnostyczne
Badania fizykalne²⁸²⁹

Rozwijane są również nowe technologie do screeningu ZCN, takie jak aplikacje mobilne. W jednym z badań opracowano aplikację na smartfony z wysoką zdolnością do screeningu ZCN, która mogła diagnozować ZCN z 94% czułością i 67% swoistością.³⁰³¹

Implikacje społeczno-ekonomiczne ZCN

ZCN może prowadzić do poważnych konsekwencji społecznych i ekonomicznych, szczególnie gdy nie jest odpowiednio leczony.

Wpływ na funkcjonowanie i jakość życia

Choć ZCN nie jest chorobą śmiertelną, nieleczony może prowadzić do całkowitego, nieodwracalnego uszkodzenia nerwu pośrodkowego, z konsekwentną ciężką utratą funkcji ręki.⁸ Badania wskazują, że co najmniej 20% pacjentów z ZCN nie reaguje dobrze na początkowe leczenie w podstawowej opiece zdrowotnej.¹⁸

Koszty społeczne i ekonomiczne

ZCN jest drugą najdłużej trwającą chorobą powodującą niepełnosprawność wśród głównych chorób i schorzeń powodujących niepełnosprawność we wszystkich prywatnych branżach, z średnim czasem nieobecności w pracy wynoszącym około 28 dni.³²

Wzrost zapadalności i prewalencji ZCN prawdopodobnie prowadzi do zwiększonego zapotrzebowania na usługi i kosztów dla gospodarki opieki zdrowotnej.²³ W samej Wielkiej Brytanii każdego roku wykonywanych jest dziesiątki tysięcy operacji uwolnienia kanału nadgarstka.³³

Perspektywy badawcze i przyszłe kierunki

Pomimo znaczącego postępu w zrozumieniu epidemiologii ZCN, istnieje wiele obszarów wymagających dalszych badań.

Luki w obecnej wiedzy

Badania wskazują na stosunkowo niewielką liczbę badań prospektywnych analizujących związki między czynnikami zawodowymi i pozazawodowymi a nowymi przypadkami ZCN.¹⁴ Stosunkowo niskie wskaźniki zapadalności na ZCN i trudności z ilościowym określeniem narażenia w miejscu pracy sprawiły, że badania przyczyn ZCN są dość trudne.¹⁴

Pomimo intensywnych badań, złożone mechanizmy patofizjologiczne ZCN nie są w pełni zrozumiałe. Podstawowa subkliniczna neuropatia może wskazywać na zwiększoną podatność na rozwój ZCN.³⁴

Przyszłe kierunki badań

Przyszłe badania nad ZCN mogą obejmować:

Wykorzystanie powiązanych krajowych rejestrów do zrozumienia czynników ryzyka
Badania nad możliwymi metodami screeningu
Ocenę diagnostyki i leczenia z szerszej perspektywy wykraczającej poza chirurgię, uwzględniającej dobrostan psychologiczny³⁴
Badania genetyczne identyfikujące geny predysponujące do rozwoju ZCN³³
Dokładniejsze badanie ZCN według płci, ze szczególnym uwzględnieniem pracownic³⁵

Badania pokazują, że chociaż ZCN związany z pracą jest częstszy niż ZCN niezwiązany z pracą, co najmniej jedna trzecia przypadków ZCN nie jest związana z pracą. Cechy charakterystyczne osób z ZCN niezwiązanym z pracą są podobne do tych z ZCN związanym z pracą, z wyjątkiem wieku powyżej 65 lat (gdy ludzie zazwyczaj nie pracują) i osób, które ogólnie nie wykonują prac wymagających dużej powtarzalności i siły.³⁶

Potrzebne są bardziej kompleksowe dane epidemiologiczne, obejmujące różne kraje i grupy populacyjne, aby lepiej zrozumieć globalny obraz występowania ZCN i opracować skuteczniejsze strategie profilaktyki i leczenia.

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Materiały źródłowe

#1 Carpal Tunnel Syndrome – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK448179/
Carpal tunnel syndrome (CTS) is the most prevalent focal mononeuropathy, constituting 90% of all neuropathy cases. […] The incidence of CTS in the general population ranges from 1% to 5%. CTS is more prevalent in females than males, with a 3:1 female-to-male ratio. The risk of developing CTS is doubled in individuals who are obese. […] CTS is uncommon in children and typically manifests in adults aged 40 to 60.
#2 Carpal Tunnel Syndrome | PM&R KnowledgeNow
https://now.aapmr.org/carpal-tunnel-syndrome/
Estimated prevalence of 3 to 6% of adults in the United States, with studies showing American workers at higher rates of 8%. […] Most frequent compressive focal mononeuropathy seen in clinical practice, accounting for 90% of all nerve entrapment neuropathies. […] In patients with nerve conduction study (NCS) evidence of CTS in one hand, the contralateral asymptomatic hand will show NCS abnormalities about 50% of the time. […] Known risk factors include obesity, with one-unit increase in BMI over 30 increased the risk of CTS by 7%. […] Female sex, (3:1) compared to males, with decreased cross-sectional area of carpal tunnel. […] Hormonal factors may play a role, as pregnancy, oral contraceptives, and estrogen therapy increase the risk. […] Arthritis and inflammatory diseases, including osteoarthritis, rheumatoid arthritis, and amyloidosis, are also risk factors.
#3
https://www.cdc.gov/Mmwr/preview/mmwrhtml/00001423.htm
Manifestations of carpal tunnel syndrome (CTS) include pain, numbness, and weakness in the median nerve distribution of the hand as a result of compression or irritation of the median nerve as it passes through the carpal tunnel in the wrist. […] Workers who perform repetitive tasks are at risk for CTS and include garment workers, butchers, grocery checkers, electronics assembly workers, typists, musicians, packers, housekeepers/cooks, and carpenters. […] However, no reliable data exist on the frequency of work-related CTS in the general working population. Surveillance of work-related CTS is limited because of inadequate training of health professionals and underreporting of recognized cases. […] The COHP survey indicates that although work-related CTS was commonly recognized by health-care providers, it was substantially underreported.
#4 Carpal Tunnel Syndrome: Practice Essentials, Pathophysiology, Epidemiology
https://emedicine.medscape.com/article/1243192-overview
The incidence of carpal tunnel syndrome is 1-3 cases per 1000 subjects per year; prevalence is approximately 50 cases per 1000 subjects in the general population. Incidence may rise as high as 150 cases per 1000 subjects per year, with prevalence rates greater than 500 cases per 1000 subjects in certain high-risk groups. […] A paucity of population-based studies of carpal tunnel syndrome (CTS) exists; however, the incidence and prevalence in developed countries seems similar to the United States (eg, incidence in the Netherlands is approximately 2.5 cases per 1000 subjects per year; prevalence in the United Kingdom is 70-160 cases per 1000 subjects). […] The risk of development of CTS appears to be associated, at least in part, with a number of different epidemiologic factors, including genetic, medical, social, vocational, avocational, and demographic.
#5 Carpal Tunnel Syndrome | AAFP
https://www.aafp.org/pubs/afp/issues/2011/0415/p952.html
Carpal tunnel syndrome is the most common entrapment neuropathy, affecting approximately 3 to 6 percent of adults in the general population. […] Carpal tunnel syndrome is the most common entrapment neuropathy, with a prevalence in the general adult population ranging from 2.7 to 5.8 percent. […] The mean annual crude incidence of carpal tunnel syndrome was found to be 329 cases per 100,000 person-years, and the standardized incidence was 276. […] Although the etiology is often unknown, certain conditions are commonly associated with carpal tunnel syndrome. […] Carpal tunnel syndrome is often associated with overuse-type injuries caused by repetitive motion, usually work-related.
#6
https://journals.lww.com/epidem/abstract/1998/05000/incidence_of_diagnosed_carpal_tunnel_syndrome_in_a.21.aspx
We sought to determine the incidence rate of carpal tunnel syndrome in the general population. […] Newly diagnosed probable or definite carpal tunnel syndrome (N = 309) occurred at a rate of 3.46 cases per 1,000 person-years (95% confidence interval = 3.073.84). […] The incidence rate in our study was 3.5 times higher than the rate 20 years ago in a Minnesota city. […] The rate difference probably results from a combination of reasons, including a true rise in incidence.
#7
https://chiro.org/Conditions/Clinical_Surveillance_of_Carpal_Tunnel.shtml
Objective: To study the demographic characteristics of patients with carpal tunnel syndrome and changes in incidence over time. […] Results: 6,245 new cases of neurophysiologically confirmed carpal tunnel syndrome were identified in Canterbury and 590 in Huddersfield. The average annual incidences (per 100,000) were 139.4 for women and 67.2 for men in East Kent, and 83.2 for women and 48.0 for men in Huddersfield. […] Between 1992 and 2001 there was an increase in the number of confirmed cases in East Kent but a decrease in their average severity. […] The disorder was consistently worse in the elderly, and more severe in men than in women in all age groups. […] The age distributions of unselected cases of carpal tunnel syndrome in both clinics differ markedly from that usually portrayed in surgical series.
#8 Carpal Tunnel Syndrome: Practice Essentials, Pathophysiology, Epidemiology
https://emedicine.medscape.com/article/1243192-overview
Carpal tunnel syndrome is not fatal, but it can lead to complete, irreversible median nerve damage, with consequent severe loss of hand function, if left untreated. […] Whites are probably at highest risk of developing carpal tunnel syndrome (CTS). The syndrome appears to be very rare in some racial groups (eg, nonwhite South Africans). […] The female-to-male ratio for carpal tunnel syndrome is 3-10:1. […] The peak age range for development of carpal tunnel syndrome (CTS) is 45-60 years. Only 10% of patients with CTS are younger than 31 years.
#9 Carpal Tunnel Syndrome | PM&R KnowledgeNow
https://now.aapmr.org/carpal-tunnel-syndrome/
Estimated prevalence of 3 to 6% of adults in the United States, with studies showing American workers at higher rates of 8%. […] Most frequent compressive focal mononeuropathy seen in clinical practice, accounting for 90% of all nerve entrapment neuropathies. […] In patients with nerve conduction study (NCS) evidence of CTS in one hand, the contralateral asymptomatic hand will show NCS abnormalities about 50% of the time. […] Known risk factors include obesity, with one-unit increase in BMI over 30 increased the risk of CTS by 7%. […] Female sex, (3:1) compared to males, with decreased cross-sectional area of carpal tunnel. […] Hormonal factors may play a role, as pregnancy, oral contraceptives, and estrogen therapy increase the risk. […] Arthritis and inflammatory diseases, including osteoarthritis, rheumatoid arthritis, and amyloidosis, are also risk factors.
#10 Carpal Tunnel Syndrome | PM&R KnowledgeNow
https://now.aapmr.org/carpal-tunnel-syndrome/
Metabolic conditions such as diabetes mellitus type 1 and 2, and hypothyroidism are known risk factors. […] Familial and congenital CTS, with bilateral CTS patients more likely to have a family history than patients with unilateral CTS. […] Environmental factors include prolonged or repeated wrist flexion/extension and high levels of hand force, with reasonable evidence that regular, prolonged use of hand-held vibratory tools increases the risk of CTS 2-fold. […] Food processing, construction, beauty industry, and manufacturing are occupations that have a higher incidence of CTS. […] Multiple studies have shown that keyboard use has no association with CTS; however, there is an association between median mononeuropathy symptoms at the wrist and use of a right-handed mouse.
#11
https://www.orthobullets.com/hand/6018/carpal-tunnel-syndrome
Carpal Tunnel Syndrome (CTS) is a common acquired compressive neuropathy of the median nerve that presents with symptoms of numbness and tingling in the median nerve distribution of the hand. […] Epidemiology: Incidence affects 0.1-10% of general population. […] Up to 70% of patients have bilateral carpal tunnel syndrome. […] Demographics: age manifests in adults aged 40-60 years old. […] Uncommon in children. […] Female:male 3:1 ratio. […] Risk factors include female sex, obesity, pregnancy, hypothyroidism, rheumatoid arthritis, trauma (acute CTS) – distal radius fractures or malunions, dislocation/or subluxation of the carpus, repetitive motion activities, acromegaly, advanced age, menopause, chronic renal failure, space-occupying lesion (e.g. ganglion cyst, neoplasm), use of oral contraceptives, congestive heart failure, diabetes, smoking, alcoholism, mucopolysaccharidosis (children), mucolipidosis. […] Diagnosis can be made purely based on history and physical examination and can be confirmed with EMG/NCS and ultrasound.
#12 Carpal tunnel syndrome | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/carpal-tunnel-syndrome-1?embed_domain=hackmd.io%252F%2540yipuafecsl2jsu8smr5njq%252Fbnjhjgjghjghjgh&lang=us
The prevalence of carpal tunnel syndrome is estimated to be ~5% (range 3-6%) of the global adult population, with a lifetime incidence of 10-16%, depending on occupational risk. […] Carpal tunnel syndrome is most common in the early 50s with a second peak in the 75-84 year age group. […] It is more common in women. […] Carpal tunnel syndrome is uncommon in children.
#13
https://chiro.org/Conditions/Clinical_Surveillance_of_Carpal_Tunnel.shtml
There was a significant increase in cases diagnosed between 1992 and 2001 in Canterbury, probably the result of increased ascertainment of milder cases. […] Carpal tunnel syndrome is often said to be increasing in incidence, and some population studies have endorsed this view, but there have been few reports of data collected in a similar way over a long period to document changes in incidence and diagnosis. […] The basic demographic data show the expected excess of female over male patients, but the ratio (2.07:1) is less than that reported elsewhere in Europe and markedly less than in Argentina or Korea. […] Both the Canterbury and the Huddersfield data clearly show a bimodal age distribution for carpal tunnel syndrome. […] The disorder tends to be more severe, and may even progress more rapidly, in the elderly.
#14 Prevalence and incidence of carpal tunnel syndrome in US working populations: pooled analysis of six prospective studies
https://pmc.ncbi.nlm.nih.gov/articles/PMC4042862/
Estimates of CTS prevalence and incidence vary widely in the literature. […] The prevalence of electrophysiologically confirmed CTS in working populations is generally higher than in the general population. […] Prevalent CTS among manufacturing and meat-packing workers has ranged from 5-21% while prevalence proportions in general populations range from 1-5%. […] Incidence rates of CTS calculated from Washington State workers compensation records ranged from 0.8-14.8 per 1000 person-years and varied by industrial and occupational classifications. […] Relatively few prospective studies have examined the relationships between work and non-work factors and new cases of incident CTS. […] The relatively low incidence rates of CTS and the difficulties experienced when quantifying workplace exposures has made investigations of CTS causation quite challenging.
#15 Prevalence and incidence of carpal tunnel syndrome in US working populations: pooled analysis of six prospective studies
https://pmc.ncbi.nlm.nih.gov/articles/PMC4042862/
In 2000, the US National Institute for Occupational Safety and Health (NIOSH) announced the availability of funding for prospective studies to evaluate the relationship between workplace factors and UEMSD, including CTS. […] The objectives of the present paper are to (i) describe the data available for establishing a common CTS case definition from six of the original consortium groups, (ii) describe the comparability of data elements across studies, and (iii) present the CTS prevalence and incidence rates for each study group and for the pooled cohort. […] The prevalence of CTS was 7.8% among the members of this pooled cohort of 4321 mostly industrial workers with higher proportions among females and older age categories. […] Incident CTS was observed among 5.8% of 3515 workers, who contributed any person time to the analysis resulting in an incidence rate of 2.3 per 100 person-years.
#16 Prevalence and incidence of carpal tunnel syndrome in US working populations: pooled analysis of six prospective studies
https://pmc.ncbi.nlm.nih.gov/articles/PMC4042862/
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. […] 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. […] 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.
#17 Prevalence and predictive factors for bilateral carpal tunnel syndrome by electrodiagnosis: A retrospective study | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0260578
Carpal tunnel syndrome (CTS) is the most common compressive neuropathy. […] The prevalence of bilateral CTS was 80.7%. […] The predictive factors for bilateral CTS were the presence of bilateral symptoms (AOR 6.7 [95%CI 3.1-14.3]), thenar muscle weakness (AOR 3.9 [95%CI 1.3-11.6]), and age 45 years (AOR 2.5 [95%CI 1.3-4.6]). […] The prevalence of bilateral CTS was in line with previous studies that documented 59-87%. […] The present study identified bilateral symptoms, thenar muscle weakness, age 45 years, duration of symptoms 90 days, BMI 30 kg/m2, and thenar muscle atrophy as associated with bilateral CTS, which is consistent with previous studies. […] The multivariate analysis revealed that patients with bilateral symptoms, thenar muscle weakness, and age 45 years had a greater probability of having bilateral CTS (OR 6.7, 3.9, and 2.5, respectively). […] The diagnostic accuracy of the model was considered adequate (AUC 0.76).
#18 The epidemiology, prognosis and management of carpal tunnel syndrome in primary care
https://keele-repository.worktribe.com/output/417174/the-epidemiology-prognosis-and-management-of-carpal-tunnel-syndrome-in-primary-care
Carpal tunnel syndrome (CTS) is a compression neuropathy of the median nerve. […] The aims of the studies presented in this thesis were to describe the epidemiology of CTS and to develop prognostic models to predict future likely outcomes in patients presenting with CTS in a primary care setting. […] The estimated crude prevalence of patients presenting with CTS in UK primary care (using data from the Clinical Practice Research Datalink – CPRD) increased from 26.03 per 10,000 person years in 1993 (95% CI 25.10 to 27.00) to 36.08 per 10,000 person years (95% CI 35.45 to 36.72) in 2013. […] In summary, patients with CTS presented in primary care with increasing frequency between 1993 and 2013. […] Assuming the CPRD population to be representative, at least 20% of patients presenting with CTS did not respond well to their initial management in primary care. […] However, the prognostic models developed in this thesis performed poorly. […] Therefore, patients with CTS can be initially managed in primary care using current guidance and should be routinely followed up and referred for surgery if they fail to experience initial satisfactory improvement.
#19 Trends in the prevalence, incidence and surgical management of carpal tunnel syndrome between 1993 and 2013: an observational analysis of UK primary care records | BMJ Open
https://bmjopen.bmj.com/content/8/6/e020166
Objectives To describe the prevalence, incidence and surgical management of carpal tunnel syndrome (CTS), between 1993 and 2013, as recorded in the Clinical Practice Research Datalink (CPRD). […] The prevalence of CTS increased over the study period, with a particular incline between 2000 and 2004 (annual percentage change 7.81). […] This study has demonstrated that the prevalence and incidence of CTS increased over the study period between 1993 and 2013. […] Rates of surgery for CTS also increased over the study period; however after 2007, the per cent of patients receiving surgery showed a statistically significant decline back to the rate seen in 2004. […] While the prevalence and incidence of CTS have increased over the study period 1993-2013, results show that episodes of surgery, increased until 2007 and declined thereafter.
#20 :: CIOS :: Clinics in Orthopedic Surgery
https://ecios.org/DOIx.php?id=10.4055/cios23281
Several nationwide, population-based studies have evaluated the epidemiology of CTS. However, these studies have several limitations including outdated data, short study duration, a focus on prevalence rather than incidence, and incomplete coverage of the entire population. […] The annual incidence of CTS (incidence rate ratio [IRR], 0.979; 95% CI, 0.9720.985; p0.001) and trigger finger (IRR, 0.976; 95% CI, 0.9670.985;p0.001) significantly decreased during the study period. […] The mean prevalence of CTS was 556.24 per 100,000 person-years, 848.41 per 100,000 person-years for women, and 257.49 per 100,000 person-years for men. During the same period, the total number of patients over the age of 20 years diagnosed with trigger finger was 493,634, of whom 80,736 were men and 412,898 were women. The mean prevalence of trigger finger was 112.16 per 100,000 person-years, 185.56 per 100,000 person-years for women, and 37.10 per 100,000 person-years for men.
#21 :: CIOS :: Clinics in Orthopedic Surgery
https://ecios.org/DOIx.php?id=10.4055/cios23281
The portion of patients who had surgery was low for both diseases: 12.0% for CTS and 5.5% for trigger finger. This could be explained by the wide coverage of the population by the Korean national insurance system and the highly accessible medical care of Korean citizens. […] In conclusion, during the past 10 years, the incidence of CTS and trigger finger significantly decreased, but the prevalence of both diseases significantly increased.
#22 Scandinavian Journal of Work, Environment & Health – Time trends in incidence and prevalence of carpal tunnel syndrome over eight…
https://www.sjweh.fi/article/3594
Time trends in incidence and prevalence of carpal tunnel syndrome over eight years according to multiple data sources: Pays de la Loire study […] The aim of this study was to describe time trends of incidence/prevalence of carpal tunnel syndrome (CTS), one of the most common musculoskeletal disorders, in a French region over an 8-year period. […] The annual incidence rates of SURG-CTS decreased from 3.35 to 2.98 per 1000 person-years over the 8-year period, with an overall declining trend [-2.00%, 95% confidence interval (95% CI) -3.07 -0.91%), P0.001]. The annual incidence rate of OD-CTS per 1000 person-years decreased (from 1.52 to 1.01) between 2004 and 2007 and increased after 2007 (from 1.45 to 2.34), with an overall gain of 54% during the study period. The prevalence rate of WRD-CTS decreased from 5.04 (95% CI 3.906.13) to 3.08 (95% CI 2.114.06) per 1000 employed person-years, with a non-significant trend between 2004 and 2011.
#23 Trends in the prevalence, incidence and surgical management of carpal tunnel syndrome between 1993 and 2013: an observational analysis of UK primary care records | BMJ Open
https://bmjopen.bmj.com/content/8/6/e020166
This study provides updated data observing the presenting primary care population. […] The Joinpoint analysis suggested an increase in surgical management of CTS between 1993 and 2007 (APC=2.55), followed by a reducing trend between 2007 (95% CI 2004 to 2009) and the end of the study in 2013 (APC=1.72). […] An increase in the incidence and prevalence of CTS is likely to lead to an increased demand on services and cost to the healthcare economy.
#24 Is carpal tunnel syndrome an occupational disease? | Epitact
https://epitact.co.uk/hand-wrist/carpal-tunnel-syndrome/occupational-disease
Carpal tunnel syndrome is the second condition admitted as an occupational disease (rotator cuff disease being on top of the list). Even if there are many aggravating factors, the progression of this condition can be slowed down by preventive actions. […] CTS is attributed as an occupational disease because it often occurs due to repetitive tasks and daily gestures at work. However, there are conditions for it to be considered as a work-related injury. Indeed, it has to occur after the use of hand-held powered vibrating tools or repeated wrist flexion and extension movements for at least 20 hours per week, over half of the preceding 2 years. […] The incidence of CTS among workers is higher in women than men and varies according to the occupational category and industry sector. […] Carpal tunnel syndrome is an occupational disease because it has risk factors directly related to work, especially manual and repetitive work duties. […] Some workers are more exposed to occupational diseases like carpal tunnel syndrome. […] Carpal tunnel syndrome is an occupational disease that could often be prevented. […] Is carpal tunnel an occupational disease? The answer is yes.
#25 Carpal Tunnel Syndrome | Hospital ClÃnic Barcelona
https://www.clinicbarcelona.org/en/assistance/diseases/carpal-tunnel-syndrome
Carpal Tunnel syndrome is the most common nerve compression and usually occurs between the ages of 40 and 60 years. In Europe, it affects between 1% and 7% of the population, with a higher incidence in women. It can affect the two hands (bilateral), although the dominant hand is usually the most affected. […] It is the most common occupational disease due to overuse, and in Spain it is included in 4 specific Occupational Health surveillance protocols: the manual handling of loads, repetitive movements, forced postures, and neuropathies.
#26 What is Carpal Tunnel Syndrome and what are your health and safety responsibilities? – THSP
https://www.thsp.co.uk/knowledge-hub/what-is-carpal-tunnel-syndrome-and-what-are-your-health-and-safety-responsibilities/
Carpal Tunnel Syndrome falls under the category of reportable occupational diseases if it is diagnosed by a doctor and is attributed to the individuals work activities. […] Employers may implement health surveillance programs to assess and monitor workers who are at risk of developing CTS due to their job duties. […] Health surveillance involves monitoring workers health to identify and prevent work-related health risks, including occupational diseases like CTS. […] Health surveillance programs for CTS should be tailored to the specific risks and needs of the workforce, taking into account factors such as the nature of the work, exposure levels, and individual risk factors. […] Compliance with regulatory requirements, such as RIDDOR reporting and health surveillance, is essential for ensuring the health and safety of workers at risk of CTS.
#27
https://www.cdc.gov/Mmwr/preview/mmwrhtml/00001423.htm
Even though more than half the states have reporting programs for occupational illnesses, underreporting is common. […] The SENSOR program aims to help state health departments increase both health-care-provider reporting of work-related illness and prevention efforts. […] Surveillance of work-related CTS, including the use of health-care-provider reports, can aid in identifying high-risk workplaces, occupations, and industries and in directing appropriate preventive measures.
#28
https://link.springer.com/article/10.1007/BF01076738
A variety of screening procedures for carpal tunnel syndrome (CTS) were applied among workers in a manufacturing plant, and results were compared. […] Cummings K, Maizlish N, Rudolph L, Dervin K, Ervin A. Occupational disease surveillance: Carpal tunnel syndrome. […] Katz JN, Larson MG, Fossel AH, Liang MH. Validation of a surveillance case definition of carpal tunnel syndrome.
#29
https://link.springer.com/article/10.1007/BF02331615
Four hundred and eleven workers from 4 different companies participated in a worksite screening program designed, in part, to estimate the prevalence of carpal tunnel syndrome (CTS). […] Analyses involved comparing hand diagram scores and non localized wrist/hand/finger symptoms with electrodiagnostic test results. […] Overall, our data suggest that hand diagrams are no better than using a questionnaire to determine if workers have experienced symptoms consistent with CTS in their wrists, hands or fingers without regard to localization. […] The choice of screening tool would depend on the goal of screening, in particular, whether it is more desirable to have slightly higher sensitivity or positive predictive value.
#30 JMIR mHealth and uHealth – A Screening Method Using Anomaly Detection on a Smartphone for Patients With Carpal Tunnel Syndrome: Diagnostic Case-Control Study
https://mhealth.jmir.org/2021/3/e26320
Carpal tunnel syndrome (CTS) is a medical condition caused by compression of the median nerve in the carpal tunnel due to aging or overuse of the hand. The prevalence of CTS is approximately 2% to 14%, and it affects more women than men. Since most patients with CTS are aged 40 years or older and the number of older people is increasing worldwide, the number of patients with CTS is expected to increase. […] Physical findings, such as the Tinel sign or Phalen test, may be used; however, their sensitivity and specificity are not high. Although a nerve conduction study (NCS) is considered useful for diagnosing CTS, the equipment is expensive and the process can be painful and long. […] In this study, we developed a smartphone app with a high ability to screen for CTS. The app could diagnose CTS with 94% sensitivity and 67% specificity and was almost equal to a tablet app in a previous study, which diagnosed CTS with 93% sensitivity and 73% specificity.
#31 JMIR mHealth and uHealth – A Screening Method Using Anomaly Detection on a Smartphone for Patients With Carpal Tunnel Syndrome: Diagnostic Case-Control Study
https://mhealth.jmir.org/2021/3/e26320
The results of the modified screening models suggest that thumb movement from directions 8 to 11 is different between the CTS and non-CTS groups, contributing to the diagnosis of CTS. […] We developed an app for screening patients with CTS that revealed the difficulty of thumb opposition for patients with CTS and could screen for CTS with high sensitivity and specificity.
#32 Epidemiology â GPnotebook
https://gpnotebook.com/pages/cardiovascular-medicine/carpal-tunnel-syndrome/epidemiology
Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy (around 90% of all entrapment neuropathies) (1). […] The reported prevalence according to population studies is around 5% while in the in the UK it is 7-16% (2). […] According to a UK General Practice Research Database study carried out in 2000 the incidence in males to be 88 per 100 000 and in females to be 193 per 100 000. […] CTS is more common in manual workers resulting in decrease productivity and time away from work (around 28 days – the second longest out of the major disabling diseases and illnesses in all private industries) (3).
#33 Molecular Genetics of Carpal Tunnel Syndrome â Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences
https://www.ndorms.ox.ac.uk/research/research-groups/Genetics-and-epidemiology-of-common-hand-conditions/current-studies/Molecular-Genetics-of-Carpal-Tunnel-Syndrome
Carpal tunnel syndrome (CTS) is a common condition of the hand that is caused by compression of the median nerve in the wrist. […] Tens of thousands of carpal tunnel release operations are performed in the UK each year. […] It is not known why some people develop CTS while others do not. Some people appear to be genetically predisposed to developing CTS, but there are also occupational and lifestyle factors that increase the risk of developing the condition. […] CTS is therefore likely to be what is called a complex disease, where several genetic and non-genetic factors interact to cause the disease. […] We believe that variations in some genes are likely to predispose some people to CTS, and the purpose of this study is to find out which genes are involved. These studies will help us to understand what causes CTS, and lead to the development of new treatments in the future, reducing the need for, and recurrence after surgery.
#34 Carpal tunnel syndrome | Nature Reviews Disease Primers
https://www.nature.com/articles/s41572-024-00521-1
Carpal tunnel syndrome (CTS) is the most common nerve entrapment disorder worldwide. The epidemiology and risk factors, including family burden, for developing CTS are multi-factorial. […] Despite much research, its intricate pathophysiological mechanism(s) are not fully understood. An underlying subclinical neuropathy may indicate an increased susceptibility to developing CTS. […] Health-care professionals should have increased awareness about CTS and all its implications. Future considerations of CTS include use of linked national registries to understand risk factors, explore possible screening methods, and evaluate diagnosis and treatment with a broader perspective beyond surgery, including psychological well-being. […] A large study using the UK Biobank, with a cohort of 500,000 participants, analysing the associations between CTS and female sex, raised BMI and three systemic diseases (diabetes, rheumatoid arthritis and hypothyroidism). […] A systematic review of prospective cohort studies that indicated a high likelihood of CTS related to specific work-related risk factors. […] A study with a large number of participants, analysing the epidemiological associations of CTS with anxiety and depression disorders.
#35 Sex-differences in the risk of carpal tunnel syndrome: results from a large Ontario, Canada worker cohort | BMC Musculoskeletal Disorders | Full Text
https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-024-08246-8
Carpal tunnel syndrome (CTS) is a prevalent cumulative strain injury associated with occupational risk factors such as vibration, repetitive and forceful wrist movements, and awkward wrist postures. This study aimed to identify Ontario workers at elevated risk for CTS and to explore sex differences in CTS risk among workers. […] A total of 3,224 CTS cases among females (f) and 2,992 cases among males (m) were identified in the cohort. […] The risk of CTS varied by occupation, industry, and sex in this large cohort. Workers engaged in highly repetitive and forceful manual work were at elevated CTS risk, highlighting the need to further understand and reduce ergonomic hazards among identified groups. Future studies should also explore CTS risk by sex, with a focus on female workers. […] The prevalence of CTS varies significantly, ranging from 0.6 to 61% among worker populations. These studies have found that around 50-90% of CTS cases are attributable to work, with higher attributable fractions among male workers.
#36 Characteristics of People with Work-Related Versus Non-Work Related Carpal Tunnel Syndrome: National Health Interview Survey, 2010 & 2015 – ACR Meeting Abstracts
https://acrabstracts.org/abstract/characteristics-of-people-with-work-related-versus-non-work-related-carpal-tunnel-syndrome-national-health-interview-survey-2010-2015/
While work-related CTS is more common than non work-related CTS, at least a third of CTS cases are non work-related. Characteristic of those with non work-related CTS are similar to those with work-related CTS. The exceptions are age over 65, when people typically are not working, and those who do not generally have high repetition forceful jobs. Although co-morbidities, such as arthritis and obesity did not increase the risk of reporting non work-related CTS, ever having smoked was an independent risk factor. This study supports the need to examine all causes of CTS and consider it as a potential upper extremity issue, regardless of work-status.