Clinical, Physical, and Neurophysiological Impairments Associated With Decreased Function in Women With Carpal Tunnel Syndrome

Abstract

[ research report ] C arpal tunnel syndrome (CTS) is a disorder characterized by compres sion of the median nerve at the carpal tunnel, often as a result of repetitive activities. 40The clinical presentation of CTS includes motor and sensory deficits in the median nerve distribution and numbness, which may be worse during the night. 31 Women are most often afflicted with CTS, with a reported annual incidence of 139 per 100 000 females, compared to 67 cases per 100 000 males.6 CTS can result in considerable pain, loss of function, and disability. The societal burden of CTS is substantial, and it has been reported that individuals with CTS exhibit loss in productivity and monetary income. 22 Although CTS is primarily considered a peripheral neuropathy, increasing evidence is showing that musculoskeletal disorders and sensitization mechanisms are related in this condition. 16 Previous studies have demonstrated the presence of widespread pressure pain hypersen-T T STUDY DESIGN: Cross-sectional study. T T OBJECTIVE:To examine the associations between clinical (pain), physical (cervical range of motion [ROM] and pinch grip force), and neurophysiological (pressure pain thresholds) outcomes and self-reported function and disability in women with carpal tunnel syndrome (CTS). T T BACKGROUND:The association of physical and physiological variables with self-rated function and disability in patients with CTS has not been fully determined. A better understanding of the association between potentially modifiable risk factors, such as limited cervical ROM, could assist clinicians in optimizing therapeutic programs for this group of patients. T T METHODS:One hundred fifty-four women with CTS were recruited. Demographic information and data on duration of symptoms, pain intensity, depression, cervical ROM, pinch grip force, and pressure pain thresholds over the neck, hand, and leg were collected. Self-reported function and disability were measured with the functional status subscale of the Boston Carpal Tunnel Questionnaire. Correlation and regression analyses were performed to determine associations between variables. T T RESULTS:There were significant positive correlations between the functional status subscale score and pain intensity (r = 0.36, P<.001), depression (r = 0.32, P<.001), and duration of symptoms (r = 0.23, P = .005). Significant negative correlations were also observed between the functional status subscale score and pinch grip force of the index finger (r = -0.25, P = .002) and little finger (r = -0.28, P<.001), ROM in cervical flexion (r = -0.22, P = .003) and lateral flexion away from the side of CTS (r = -0.24, P = .002) and toward the side of CTS (r = -0.16, P = .045), and pressure pain threshold over C5-6 (r = -0.34, P<.001), the carpal tunnel (r = -0.35, P<.001), and the tibialis anterior muscle (r = -0.26, P<.001).Stepwise regression analyses revealed that pain intensity, thumb and little finger pinch grip force, severity of depression, and cervical ROM in lateral flexion away from the side of CTS expla...

Direct and Indirect Effects of Function in Associated Variables Such as Depression and Severity on Pain Intensity in Women with Carpal Tunnel Syndrome

“…A potential association between the intensity of pain and self‐reported function in patients with neuropathic pain was previously reported by Seventer et al . Therefore, it seems clear that nociceptive pain has an effect on function in individuals with chronic pain including CTS . Some studies showed that the intensity of pain was a predictor of worse function in a variety of pain conditions, including low back pain or sciatica .…”

“…Nunez et al observed that two psychological variables, that is, misinterpretation of nociception and depression, were associated with the intensity of pain in different hand pain conditions, including CTS . Another study reported that the intensity of pain and depression were associated with hand function in women with CTS . These studies would support a potential relationship between the intensity of hand pain, function and depression, among other variables; however, all these studies included an analysis without considering potential direct and indirect interactions between these variables.…”

Factors affecting symptoms and functionality of patients with carpal tunnel syndrome: a retrospective study

“…Most of the women were at the age of menopause. Fernández-de-Las-Peñas C et al found that a number of factors were associated with function in women with CTS 10 ) . The effect of female psychology on the progress of healing after carpal tunnel surgery should be examined in future research.…”

“…Women are reported to be more at risk of CTS than men, probably due to their culturally mandated gender-related duties at home. Hormonal changes that occur at menopause may also be associated with CTS 4 , 9 , 10 ) . Other factors associated with a poor prognosis following surgery are older age, an extended history of CTS, and prolonged or absent sensation or motor response 2 , 11 ) .…”

Mathematical Modeling for Neuropathic Pain: Bayesian Linear Regression and Self-Organizing Maps Applied to Carpal Tunnel Syndrome

“…Previous studies reported associations between pain intensity and function with psychological (e.g., depressive levels), psychophysical (i.e., pressure pain sensitivity), and physical (lower pinch tip grip force) outcomes in a sample of women with CTS [8][9][10]. Previous studies used linear regression analyses to determine the associations between the dependent variable(s) and independent variables.…”