Carpal tunnel syndrome and manual milking: nerve conduction studies in 43 cases

Abstract

-From 1989 to 2004 consecutive patients had electrodiagnosis of carpal tunnel syndrome (CTS); from these 43 cases (1.38%) were associated to manual milking; mean age was 44.9 years and 88.4% were male. The mean time in the milking profession was 247 months; the mean daily milking time was 146 minutes; symptoms referred at electrodiagnostic consultation had lasted on average 34 months, 83% were bilateral. The median sensory nerve conduction study was abnormal in 75.6% to the right and 66.7% to the left hand. The median nerve motor distal latency (MDL) was abnormal in 92.1% to the right and in 80.0% to the left hand. There were no differences between right and left for all electrophysiological parameters. In CTS related to manual milking most cases were men, with the MDL more affected than the sensory distal latencies and the electrophysiological abnormalities were found to be symmetric. Manual milking could be a natural model for occupational CTS. In contrast to idiopathic CTS, there was a greater involvement of motor fascicles; this finding is remarkable for CTS.KEY WORDS: carpal tunnel syndrome, median nerve, compressive neuropathy, manual milking. Síndrome do túnel do carpo e ordenha: estudo de condução nervosa em 43 casos RESUMO -No período de 1989 a 2004 foram diagnosticados por meio de eletroneuromiografia 3125 casos consecutivos de Síndrome do túnel do carpo (STC) e destes, 43(1,38%) estavam associados com ordenha; a média de idade foi 44,9 anos e 88,4% eram do sexo masculino. O tempo médio de atividade profissional era 247 meses; o tempo médio de ordenha diária era 146 minutos; a sintomatologia referida na consulta eletrodiagnóstica tinha em média 34 meses de duração e 83% a referiam bilateralmente. O estudo da condução senstiva do nervo mediano estava anormal em 75,6% na mão direita e em 66,7% da mão esquerda. A latência distal motora (LDM) do nervo mediano estava anormal em 92,1% à direita e em 80% à esquerda. Não havia diferença significante dos parâmetros eletrofisiológicos entre os lados direito e esquerdo. Na STC associada a ordenha, a maioria dos casos é de homens, a LDM está mais afetada que as latências distais sensitivas e as anormalidades eletrofisiológicas são simétricas. A ordenha poderia ser considerada um modelo para STC ocupacional e diferente da STC idiopática, há maior envolvimento dos fascícu-los motores. PALAVRAS-CHAVE: síndrome do túnel do carpo, nervo mediano, neuropatia compressiva, ordenha.

Carpal tunnel syndrome in manual tea harvesters

“…These electrophysiological and clinical findings suggest extensive fascicular involvement within the median nerve in contrast to idiopathic CTS. [1][2][3] There were statistically significant positive correlations between the clinical stages of the patients and the age, working duration and duration of symptoms in our study. A statistically significant positive correlation was also present between the neurophysiologic grades of the patients and the duration of symptoms in our study (Table II).…”

“…The results of this study showed that employment duration and work produced per year were weak but significant risk factors for CTS development in carpet workers. Kouyoumdjian et al [1] investigated the relation between CTS and manual milking and found that manual milking represents a major and very specific risk factor mainly in countries where milking machines are not yet in common use. The authors have stated that manual milking requires powerful and repetitive use of finger flexor muscles and concluded that manual milking could be a natural model for occupational CTS.…”

“…[1] It is also a part of the cumulative trauma disorders. [2] Although many clinical risk factors are associated with the syndrome, epidemiologic studies have identified that several combinations of work factors, individual factors, and psychosocial factors are also related to CTS.…”

“…Several studies about occupational factors and CTS are present in the literature. [1,[5][6][7][8][9][10] Among the occupational factors having a role in the CTS etiology, manual tea harvesting has not yet been investigated. Clinical and neurophysiological evaluation of CTS among manual tea harvesters, and results of open carpal tunnel release as surgical treatment were investigated in this study.…”

Evaluation of the Prevalence of Hand and Wrist Complaints and ganglions in Welders

“…KTS'yi diğer median nöropatilerden, servikal kök ve brakiyal pleksus lezyonlarından ayırabilmek için, median sinir ve KT anatomisinin iyi bilinmesi gerekir. Hastalıkla ilişkilendirilen risk faktörlerinden birisi de kümülatif travmaya neden olabilen bir işte çalışıyor olmaktır (1). Toplumda %1 civarında tahmin edilen KTS sıklığı tekrarlayıcı el ve el bilek hareketlerine neden olan meslek kollarında %5 'e kadar çıkmaktadır (2).…”