Observed Differences between Males and Females in Surgically Treated Carpal Tunnel Syndrome Among Non-manual Workers: A Sensitivity Analysis of Findings from a Large Population Study

Abstract

ObjectivesWe aimed at assessing whether differences among males and females in carpal tunnel syndrome (CTS) epidemiology might be attributable to segregation with respect to occupational biomechanical exposures or differential access to care by sex.MethodsWe analysed surgically treated cases of CTS occurring among non-manual workers in Tuscany between 1997 and 2000. We conducted a Monte Carlo simulation to estimate the difference in occupational biomechanical exposures between males and females necessary to explain the observed incidence rate ratios. We also accounted for the sex-specific probability of receiving surgery after the diagnosis of CTS, as women were reported to be more likely to undergo surgery in a subset of our study population. We quantified the hypothetical biomechanical overload through the hand activity level (HAL) metric proposed by the American Conference of Governmental Industrial Hygienists. To quantify the effect of HAL on CTS risk, we assumed a prior distribution based on findings from two large cohort studies of industrial workers.ResultsAfter adjustment for the probability of receiving surgery, women showed a 4-fold incidence of CTS as compared with men. To explain this association among non-manual workers, women should have an average value of HAL at least 5 points higher.ConclusionsOur analysis does not support the hypothesis that the difference in CTS incidence between males and females is entirely attributable to occupational risk factors or to differential access to surgery. The causal pathway between sex and CTS might include more determinants such as hormonal factors, anthropometric characteristics, and non-occupational exposure to biomechanical overload (e.g. household tasks).

Carpal tunnel syndrome in cardiac amyloidosis: implications for early diagnosis and prognostic role across the spectrum of aetiologies

“…Remarkably, the gender ratio usually observed for CTS (F:M 2:1) was not found in our study population and the percentage of men who had received surgery for CTS (11.8%) was actually higher than in females (8.4%). This finding strongly supports the hypothesis that most cases of CTS among ATTR patients are attributable to the disease and are not idiopathic.…”

“…In a recent study, the lifetime prevalence of carpal tunnel release in the general population was estimated to be as high as 3.1% . The descriptive epidemiology of CTS has constant features over time and across countries, incidence being much higher among females (with a ratio of at least 2:1) and strongly age‐related, with a characteristic peak of incidence in females aged between 40 and 60 years . CTS arises from a complex pathological process that can be determined by both occupational and personal factors.…”

“…1 The descriptive epidemiology of CTS has constant features over time and across countries, incidence being much higher among females (with a ratio of at least 2:1) and strongly age-related, with a characteristic peak of incidence in females aged between 40 and 60 years. 2,3 CTS arises from a complex pathological process that can be determined by both occupational and personal factors. Well known personal determinants of CTS include both modifiable and non-modifiable risk factors and, among them, apart from age and sex, the most studied is obesity.…”

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“…Mechanical loading seems to be a significant factor in the pathogenesis of de Quervain's disease. Nevertheless, a large population study [26] reported that women had four times more CTS than did men. The causes of diseases are most likely more complicated than simple sex differences, the combined effects of hormonal changes, and mechanical loading.…”

“…Hormonal changes are associated with musculoskeletal diseases. [27,28] A direct effect of estrogen antagonist (aromatase-inhibitor [AI]) therapy was reported [26] to induce a musculoskeletal syndrome characterized by tenosynovial change and post-treatment intra-articular fluid. [29] AI treatment is associated with a higher prevalence of CTS and trigger finger.…”