Association between wrist ratio and carpal tunnel syndrome: Effect modification by body mass index

Thiese, Matthew S.; Koric, Alzina; Ott, Ulrike; Wood, Eric M.; Kapellusch, Jay; Foster, James C.; Garg, Arun; Deckow-Schaefer, Gwen; Tomich, Suzanna; Kendall, Richard; Drury, David L.; Wertsch, Jacqueline J.; Hegmann, Kurt T.

doi:10.1002/mus.25692

Cited by 13 publications

(10 citation statements)

References 39 publications

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“…Anthropometric evaluations are also methods that have been studied over the past years and the relationship between hand structural features and CTS (6,11,22–26). According to these studies, we can predict pathophysiological changes in the carpal tunnel in terms of slower capillary circulation, hypoxia of nerve fibres, oedema and increased pressure inside the carpal tunnel, and consequently reduced median nerve conductivity.…”

Section: Discussionmentioning

confidence: 99%

Can the First Web Space Angle Be Predictive of Carpal Tunnel Syndrome?

Uz¹,

Umay²,

Gündoğdu³

et al. 2019

ijph

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Background: Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy in the upper limb. Although more objective methods for assessment have been reported in literature, there is a lack of evidence concerning the best methods for assessment of CTS. This study aimed to investigate whether there was a difference in the first web space in patients with different severities of CTS in relation to healthy controls as easy screen method. Methods: This prospective controlled trial was conducted on 126 patients at the Physical Medicine and Rehabilitation Clinic, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, University of Health Science, Ankara, Turkey, from January 2016 to January 2018. Hand grip and pinch strength of patients were determined. Also, first web angle were measured by goniometer. Patients were divided into 3 CTS groups as electrophysiologically: "mild: group 1", "moderate: group 2" and "severe: group 3". Patient and healthy groups were compared in terms of the evaluation parameters. Comparisons were also made between these groups. Results: There was significant reduction in hand strengths and first web angle in patient groups compared to healthy groups (P<0.05). Moreover, the first web angle was significantly different between the CTS groups (P= 0.001). The cut-off value for CTS was <38.5º. Conclusion: The possibility of CTS can be evaluated by measuring the first web space angle with a simple goniometer as a easy and in-expensive method in outpatient clinics.

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Section: Discussionmentioning

confidence: 99%

Can the First Web Space Angle Be Predictive of Carpal Tunnel Syndrome?

Uz¹,

Umay²,

Gündoğdu³

et al. 2019

ijph

View full text Add to dashboard Cite

show abstract

“…This cross‐sectional study by Thiese et al . has some weaknesses that are of concern, and the findings from their study may fan the flames of what has been an effort by some orthopedic surgeons to debunk work‐related CTS .…”

mentioning

confidence: 94%

“…None of the articles cited by Thiese et al . in support of an association between wrist ratio and CTS are better quality, prospective cohort studies.…”

mentioning

confidence: 98%

“…Normally, an editorial discusses the background of reasonable work, its scientific merits, and then the context of its findings. The main point in the study by Thiese et al . in this issue of the journal, regarding the association between wrist ratio and carpal tunnel syndrome (CTS) and its effect modification by obesity, is almost totally beside the point in the larger context.…”

mentioning

confidence: 99%

“…A major confounding factor is that, although obesity is clearly linked to CTS, it may also be associated with wrist ratio and other anthropometric measures of the wrist. Thiese et al . used a large occupational cohort to tease‐out the relationship between wrist ratio and CTS occurrence, and found support for this only among normal‐weight workers and not for obese workers.…”

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confidence: 99%

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Work‐related carpal tunnel syndrome: What's important?

Franklin¹,

Gray

2017

Muscle and Nerve

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Normally, an editorial discusses the background of reasonable work, its scientific merits, and then the context of its findings. The main point in the study by Thiese et al. 1 in this issue of the journal, regarding the association between wrist ratio and carpal tunnel syndrome (CTS) and its effect modification by obesity, is almost totally beside the point in the larger context. Focusing on an arbitrary measure of wrist anthropometrics redirects focus from higher risk occupational factors, obfuscating useful and potentially preventable measures, in favor of creating "diagnostic" cut-points of debatable value. So, let us turn things around a bit and start from that context.The National Institute of Occupational Safety and Health, in 2000, funded a consortium of 6 centers to track more than 3,500 workers across regions of the USA to try to determine, prospectively, risk factors for work-related upper extremity musculoskeletal disorders (WRUEMSKs). 2 The main purpose of these studies was to clarify, after years of heated debate, 3 the relative contribution of various types of common physical work exposures and the risk of incident WRUEMSKs. Being a prospective cohort study, it promised to offer some of the most valid information to date, at least indirectly offering a clearer window into the causation of these disorders. In general, these studies were carefully done and, in spite of some heterogeneity in how each center conducted the studies, common case definitions of some of the WRUEMSKs, including CTS, were implemented across the 6 centers. 2 The consortium CTS case definition included both typical symptoms and signs, and nerve conduction studies. This is a key point: a proper case definition of CTS for research purposes requires appropriate symptoms and signs and electrodiagnostic studies (EDX). 4 This may be particularly critical for CTS cases in the workers' compensation policy arena. Outcomes of various surgical procedures tend to be much worse in workers' compensation than in non-workers' compensation populations. 5 Harris et al. included 10 studies of CTS, with the compensation patients experiencing a >4-fold increase in unsatisfactory outcomes compared with the non-compensation patients. 5 In addition, 47% of hand surgeons reported in a national survey that, if CTS symptoms are typical and there is a positive response to steroid injection, there is no need to conduct EDX before performing CTS surgery. 6 These types of results regarding poorer outcomes of CTS surgery in workers' compensation, and attitudes of orthopedic surgeons, has led the Industrial Insurance Medical Advisory Committee of the Washington State Department of Labor and Industries to mandate EDX in combination with appropriate symptoms and signs for CTS before authorizing surgical decompression for work-related CTS. 7 Greater specificity is warranted when a normally effective CTS decompression procedure is considered in an injured worker population.Thus, in workers' compensation systems, abnormal EDX findings alone are not sufficient to co...

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Review of Symptoms and Signs for Working Adults with Median Nerve Entrapment

Melhorn¹,

Hegmann²

2019

AMA Guides® Newsletter

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Physicians often must evaluate patients who present with symptoms in a median nerve distribution and typically diagnose carpal tunnel syndrome (CTS), but an accurate diagnosis is critical to determine causation and to define possible impairment. CTS is a constellation of symptoms and signs that result from mononeuropathy of the median nerve in the carpal tunnel; symptoms typically include tingling and/or numbness, dysesthesias, and/or pain in the radial palm and palmar aspect of the thumb, index, middle, and perhaps ring fingers. The American Academy of Orthopaedic Surgeons suggests use of the CTS-6 scoring aid (shown in a table) as a clinical aid for diagnosing CTS. Electrodiagnostic testing, nerve conduction studies in particular, are considered the gold standard for diagnosis of CTS, but research suggests that the definitions of relevant sensory and assignment of CTS are sensitive to threshold changes from a latency of, eg, >4.4 msec vs >4.5 msec. Other factors to consider include whether there are effects from the known association between wrist ratio and CTS and assessing the benefits of neuromuscular ultrasound to diagnose CTS. Nocturnal paresthesias and paresthesias while holding onto an object were sensitive indicators of the presence of CTS but use of the Phalen and Hoffmann-Tinel signs has significant potential to be unreliable.

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Association between wrist ratio and carpal tunnel syndrome: Effect modification by body mass index

Abstract: A square wrist is significantly associated with CTS after controlling for confounders. Effect modification by high BMI masked the eightfold magnitude adjusted relationship seen between WR and CTS among normal weight participants. Muscle Nerve 56: 1047-1053, 2017.

Cited by 13 publications

References 39 publications

Can the First Web Space Angle Be Predictive of Carpal Tunnel Syndrome?

Can the First Web Space Angle Be Predictive of Carpal Tunnel Syndrome?

Work‐related carpal tunnel syndrome: What's important?

Review of Symptoms and Signs for Working Adults with Median Nerve Entrapment

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