Individual risk factors for carpal tunnel syndrome: an evaluation of body mass index, wrist index and hand anthropometric measurements

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Abstract

In this study we aimed to identify the role of the body mass index (BMI), wrist index and hand anthropometric measures as risk factors for carpal tunnel syndrome (CTS) in both genders. Based on clinical and electrophysiologic diagnostic criteria, 154 female and 44 male CTS patients, as well as 150 female and 44 male age-matched control subjects, were selected. BMI, wrist index, hand shape index, digit index and hand length/height ratio were compared between the CTS patients and the control subjects for each gender separately. Mean BMI was found to be a significant risk factor for CTS in both genders. The wrist index was found to be higher in female (P<0.001) and in male (P=0.034) CTS groups than in the respective control groups. Logistic regression analysis revealed the wrist index to be an independent risk factor in females, but not in males. Shape and digit indices were significantly higher in female CTS patients than in corresponding control subjects, and regression analysis showed the shape and digit indices to be independent risk factors for CTS. In the male CTS group, the shape and digit indices did not significantly differ from their controls. Differences in the hand length/height ratio were not statistically significant in female and male CTS patients compared to their controls and it was not found to be an independent risk factor for CTS.

Our study confirmed BMI as an independent risk factor for CTS in both genders. Hand and wrist anthropometrics were found to be independent risk factors for CTS in females, but not in males.

Introduction

Carpal tunnel syndrome (CTS), an entrapment of the median nerve at the wrist, is the most commonly encountered neuropathy causing disability [1], [2], [3]. There has been much debate over the last few decades as to whether it is an occupationally caused or personally attributed syndrome that plays a major role in the development of CTS and in the prevention of the condition [2], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14]. Many physical factors such as repetitive stress, repetitive bending or twisting of the hands and wrist at work, the use of vibrating tools and physical injury have been noted as occupational risk factors for CTS [15], [16], [17], [18], [19]. Personal risk factors associated with CTS are female gender, age, race, pregnancy and various medical conditions including thyroid disease, diabetes, amyloidosis and connective tissue disorders [2], [11], [12], [13], [20], [21], [22]. Recently the genetic component of CTS has been explored in a twin study [23]. Despite some contradicting data, obesity and squarer wrists and hands have been identified as individual risk factors associated with an increased risk of CTS in the last two decades [21], [24], [25], [26]. The role of hand anthropometrics in the development of CTS has been given less attention [27].

Most of the previous studies of individual risk factors for CTS have been limited in scope as they primarily addressed the relationship between CTS and risk factors among only female, or both genders, allocated into the same group without a gender-matching comparison. Equally, the relatively small sample sizes, some of them with the absence of a control population, and the consideration of some individual risk factors while ignoring other individual risk effects have limited the application of many investigations.

In this prospective study we aimed to determine the role of the body mass index (BMI), wrist index and hand anthropometric measurements in the development of CTS and their relationship to CTS severity in both genders.

Section snippets

Materials and methods

From March 2000 to June 2002, 150 female and 44 male right-handed patients who had a clinical and electrophysiologically confirmed diagnosis of CTS, and 154 female and 44 male age-matched right-handed, healthy control subjects who had no symptoms of CTS, no obvious systemic disease, and no abnormality on the median and ulnar nerve conduction parameters, were included in our study. The control subjects were recruited from the relatives of patients or those accompanying them, or from volunteers

Results

Of 154 females, 18 had right CTS, 12 had left CTS and 124 had bilateral CTS. Of 44 males, 2 had right CTS, 2 had left CTS and 40 had bilateral CTS.

When the defining parameters were compared by sex between the 150 normal female and 44 normal male controls, the means of the height (160.90±5.94 for females; 172.61±8.07 for males, P<0.001) and shape indices (42.307±2.685 for females; 44.932±3.892 for males P<0.001) were found to be significantly higher in males than in females. However, digit index

Discussion

Although our study was not concerned specifically with the definition of the anthropometric measures in a normal male and female population, in agreement with the literature, our findings show differences in some hand anthropometric measurements between males and females. In addition to this, the sensitivity and specificity of BMI for determining obesity were reported differently for men and women [31], [32]. Thus, it is proper to evaluate individual risks for CTS independently for both genders

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