Clinical Update: Understanding Causation: An Example Using Carpal Tunnel Syndrome

2007 ◽  
Vol 12 (6) ◽  
pp. 5-8 ◽  
Author(s):  
J. Mark Melhorn
Keyword(s):  
Risk Factors ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Legal Responsibility ◽  
Medical Evidence ◽  
Anatomic Structure ◽  
Legal Professionals ◽  
Compensation Systems ◽  
Tunnel Syndrome ◽  
Four Levels

Abstract Medical evidence is drawn from observation, is multifactorial, and relies on the laws of probability rather than a single cause, but, in law, finding causation between a wrongful act and harm is essential to the attribution of legal responsibility. These different perspectives often result in dissatisfaction for litigants, uncertainty for judges, and friction between health care and legal professionals. Carpal tunnel syndrome (CTS) provides an example: Popular notions suggest that CTS results from occupational arm or hand use, but medical factors range from congenital or acquired anatomic structure, age, sex, and body mass index, and perhaps also involving hormonal disorders, diabetes, pregnancy, and others. The law separately considers two separate components of causation: cause in fact (a cause-and-effect relationship exists) and proximate or legal cause (two events are so closely related that liability can be attached to the first event). Workers’ compensation systems are a genuine, no-fault form of insurance, and evaluators should be aware of the relevant thresholds and legal definitions for the jurisdiction in which they provide an opinion. The AMA Guides to the Evaluation of Permanent Impairment contains a large number of specific references and outlines the methodology to evaluate CTS, including both occupational and nonoccupational risk factors and assigning one of four levels of evidence that supports the conclusion.

scholarly journals Prevalence and risk factors of self-reported wrist and hand symptoms and clinically confirmed carpal tunnel syndrome among office workers in China: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Beibei Feng ◽  
Kedi Chen ◽  
Xiaoxia Zhu ◽  
Wing-Yuk Ip ◽  
Lars L. Andersen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Computer Use ◽  
Office Workers ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Work Related ◽  
Tunnel Syndrome ◽  
Hand Symptoms

Abstract Background Carpal tunnel syndrome (CTS) is a common cause of pain, numbness and tingling in the wrist and hand region and is associated with repetitive wrist and hand use in office workers. However, scarce knowledge exists about the epidemiology of clinically confirmed CTS among Chinese office workers. This study aimed to investigate the prevalence of wrist/hand symptoms and CTS in office workers in China and to identify associated risk factors. Methods A cross-sectional survey was carried out in a metropolitan city in China involving 969 respondents (aged 17–49 years) from 30 workplaces. A questionnaire was distributed to each participant to collect their demographic, work-related physical and psychosocial factors, and wrist and hand symptoms. The wrist and hand pain/numbness symptoms were marked on a body chart and the nature and intensity of symptoms, nocturnal symptoms, as well as aggravating activities were also recorded. Clinically confirmed CTS cases were screened based on the history, Phalen’s test, Tinel Sign and skin sensation testing among symptomatic respondents. Logistic regression was employed to estimate the odds ratio (OR) and 95% confidence interval (95% CI) for the occurrence of self-reported wrist and hand symptoms and clinically confirmed CTS. Results The clinically confirmed CTS prevalence was 9.6%. The prevalence of wrist and hand symptoms were 22 and 15%, respectively. Frequently working in pain was associated with higher odds of CTS. Multivariate modelling adjusted for age and gender showed that prolonged computer use time and working without breaks were associated with presence of wrist/hand symptoms (adjusted ORs: 1.11 (95% CI 1.02–1.22) and 1.88 (95% CI 1.12–3.14)). Educational level was inversely associated with CTS and smoking was associated with wrist/hand complaints (adjusted OR: 2.20 (95% CI 1.19–4.07)). Conclusions The prevalence of work-related clinically confirmed CTS symptoms among young office workers in China is high. Frequently working in pain is closely associated with clinically confirmed CTS. Intense computer use and no breaks at work are associated with wrist and hand symptoms.

Personal and workplace psychosocial risk factors for carpal tunnel syndrome: a pooled study cohort: author response

2014 ◽  
Vol 71 (4) ◽  
pp. 303.2-304 ◽  
Author(s):  
Carisa Harris-Adamson ◽  
Ellen Christoph Eisen ◽  
Ann Marie Dale ◽  
Bradley Evanoff ◽  
Kurt T Hegmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Psychosocial Risk Factors ◽  
Psychosocial Risk ◽  
Author Response ◽  
Study Cohort ◽  
Tunnel Syndrome

The impact of gender on personal, health and workplace psychosocial risk factors for carpal tunnel syndrome

2013 ◽  
Vol 57 (1) ◽  
pp. 2167-2170
Author(s):  
Carisa Harris-Adamson ◽  
Ellen A Eisen ◽  
Ann Marie Dale ◽  
Bradley Evanoff ◽  
Kurt T. Hegmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Psychosocial Risk Factors ◽  
Psychosocial Risk ◽  
Personal Health ◽  
Tunnel Syndrome ◽  
The Impact

The Most Important Risk Factors for Carpal Tunnel Syndrome

2021 ◽  
Author(s):  
Ali Asghar Sharifi
Keyword(s):  
Risk Factors ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Clinical Symptoms ◽  
Normal Subjects ◽  
Shape Index ◽  
Mean Values ◽  
Tunnel Syndrome ◽  
Independent Risk Factors ◽  
Hand Length

Background: The aim of this study was to determine the risk factors for carpal tunnel syndrome and its relationship with the severity of the disease. Methods: A total of 131 patients with clinical symptoms of CTS and 131 normal subjects were enrolled, of whom 121 were female both in the CTS cases and the controls. All cases were electro diagnostically confirmed and assigned to three severity groups. BMI, wrist ratio, shape index, digit index and hand length/height ratio were measured in all participants. Mean values for each item were compared between cases and controls and severity subgroups. A logistic regression analysis was performed to determine independent CTS risk factors. Results: The mean values of BMI, wrist ratio and shape index were significantly higher in all CTS patients and females compared to controls, whereas in males only BMI and wrist ratio were higher. The patients in the mild severity subgroup had a significantly lower age and wrist ratio. BMI, wrist ratio and shape index were found to be independent risk factors of CTS development in all patients and females. Conclusion: Our study showed BMI, wrist ratio and shape index as independent risk factors for CTS. These findings are important anatomically and clinically and these are the risk factors of anatomical malfunction of the wrist in CTS.

The Impact of Gender on Personal, Health and Workplace Psychosocial Risk Factors for Carpal Tunnel Syndrome

2013 ◽  
Vol 57 (1) ◽  
pp. 911-914 ◽  
Author(s):  
Carisa Harris-Adamson ◽  
Ellen A Eisen ◽  
Ann Marie Dale ◽  
Bradley Evanoff ◽  
Kurt T. Hegmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Psychosocial Risk Factors ◽  
Psychosocial Risk ◽  
Personal Health ◽  
Tunnel Syndrome ◽  
The Impact

Síndrome do Túnel Cárpico: mais que movimentos repetitivos?

2020 ◽  
Vol 9 ◽  
pp. 15-30
Author(s):  
Diana Costa
Keyword(s):  
Risk Factors ◽  
Insulin Resistance ◽  
Metabolic Syndrome ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Cochrane Central Register ◽  
Case Control Studies ◽  
Painful Condition ◽  
Repetitive Movements ◽  
Tunnel Syndrome

INTRODUCTION/ FRAMEWORK/ OBJECTIVES Carpal tunnel syndrome (CTS) is a progressively painful condition of the wrist and hands, caused by compression of the median nerve, at the level of the carpal tunnel, on the anterior side of the wrist. There are several known risk factors, such as repetitive movements, loads, vibrations, diabetes or pregnancy, but some authors consider that in 50% of cases the etiology is idiopathic. This review aims to visualize CTS in addition to repetitive movements, seeking to provide a different perspective when relating it to inappropriate lifestyles, such as metabolic syndrome or insulin resistance. METHODS It is an integrative bibliographic review in the EBSCO databases: CINAHL Plus, Nursing & Allied Health Collection, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effects (DARE), MedicLatina; MEDLINE, PUBMED and RCAAP, held in January 2020, considering what is described in the literature regarding carpal tunnel syndrome and insulin resistance or metabolic syndrome. RESULTS/DISCUSSION We found cross-sectional and case-control studies, in which CTS is associated with changes in glycemic metabolism (between 50 to 75% of cases), or manifestations at the insulin level, including changes in fasting insulin or HOMA-IR. CONCLUSIONS Approaching the link between idiopathic CTS as an indicator of an inadequate lifestyle (marked by metabolic syndrome or insulin resistance) represents a first step towards early approaches in individuals with tendinopathies. It is proposed that professionals study possible insulin resistance as a suspect of all workers with idiopathic tendinopathies, requiring an effort from the entire multidisciplinary team. More than stretching, massages, anti-inflammatory drugs and muscle relaxers, it is necessary not to look at CTS as just “a fist”, but as a system that acts (repetitively) in synergy with inappropriate lifestyles, resulting from exposure to more risk factors beyond the most obvious.

scholarly journals Personal, biomechanical, psychosocial, and organizational risk factors for carpal tunnel syndrome

Pain ◽  
2020 ◽  
Vol 161 (4) ◽  
pp. 749-757 ◽  
Author(s):  
Yves Roquelaure ◽  
Ronan Garlantézec ◽  
Bradley A. Evanoff ◽  
Alexis Descatha ◽  
Jean-Baptiste Fassier ◽  
...  
Keyword(s):  
Risk Factors ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Organizational Risk ◽  
Tunnel Syndrome

Radiographic Predictors of Delayed Carpal Tunnel Syndrome After Distal Radius Fracture in the Elderly

Hand ◽  
2020 ◽  
pp. 155894472096387
Author(s):  
Kevin H. Kim ◽  
Bryan Duell ◽  
Swapna Munnangi ◽  
Mitchell Long ◽  
Elizabeth Morrison
Keyword(s):  
Risk Factors ◽  
Decision Making ◽  
Carpal Tunnel Syndrome ◽  
Distal Radius Fracture ◽  
Carpal Tunnel ◽  
Nonoperative Management ◽  
Significant Risk ◽  
The Elderly ◽  
Control Group ◽  
Tunnel Syndrome

Background Delayed-onset carpal tunnel syndrome (DCTS) can develop weeks and months after distal radius fracture (DRFx). A better understanding of the risk factors of DCTS can guide surgeon’s decision making regarding the management of DRFx and also provides another discussion point to be had with elderly patients when discussing outcomes of nonoperative management. Methods We reviewed 216 nonoperatively managed DRFx between June 2015 and January 2019 at a single level 1 trauma center and senior author’s office. We identified 26 patients who developed DCTS at a minimum of 6 weeks after DRFx, which constituted our case group. The remaining 190 patients served as the control group (non–carpal tunnel syndrome [CTS]). Differences between case and control group were evaluated through univariate and multivariate analyses. Results The prevalence of DCTS among nonoperatively managed DRFx was 12%. In univariate analysis, volar tilt (VT) and teardrop angle (TDA) were significant independent predictors of development of DCTS. Multivariate logistic regression analysis determined that the odds of developing CTS increased by 12% and 24% for each degree of decrease in VT and TDA, respectively. No other significant risk factors were identified. Conclusions Decreasing VT and TDA are the most significant risk factors associated with DCTS in nonoperatively managed DRFx. These are simple and reliable radiographic measurements that provide significant prognostic value. These parameters can be used to guide surgeon decision making regarding management of DRFx in the elderly while aiding patient expectations and outcomes following nonoperative management of DRFx.

PREVALENCE OF CARPAL TUNNEL SYNDROME IN WORKERS FROM A FISHNET FACTORY IN THAILAND

Hand Surgery ◽  
2005 ◽  
Vol 10 (01) ◽  
pp. 67-70 ◽  
Author(s):  
Surut Jianmongkol ◽  
Weerachai Kosuwon ◽  
Ekamol Thumroj ◽  
Sermsak Sumanont
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Carpal Tunnel Syndrome ◽  
General Population ◽  
Carpal Tunnel ◽  
Odds Ratio ◽  
Office Workers ◽  
Tunnel Syndrome ◽  
Associated Risk Factors

We determined the prevalence of carpal tunnel syndrome (CTS) at a fishnet factory in order to discern the possible associated risk factors at this type of workplace. The 662 workers were interviewed then physically examined. The prevalence of CTS was 14.5%, which is significantly higher than in the general population. Workers directly involved in the production of fishnets had a significantly higher risk of CTS than the factory's office workers or housemaids (odds ratio = 1.84; range, 1.03–3.29; 95% CI, p = 0.049). There was no association between the length of employment in the factory with CTS (odds ratio = 1.13; range, 0.77–1.66; 95% CI, p = 0.591). Our results confirm that factory jobs with repetitive hyperflexing and twisting of the wrists are at risk of CTS.

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