Carpal Tunnel Syndrome in Military Aviators

Abstract Introduction The incidence of carpal tunnel syndrome (CTS) is increased in occupations exposed to repetitive motion, poor wrist posture, and vibration exposure. While all pilots are exposed to these factors, helicopter pilots are especially exposed to vibration. The study is to identify the incidence and risk factors for CTS in military aviators. Materials and Methods Clearance was obtained from Tripler Army Medical Center IRB. The Defense Medical Epidemiological Database was queried for all new cases of CTS from 2006 to 2015. Incidence rates (IRs) were determined for helicopter pilots, fixed-wing pilots, and nonpilot officers. Poisson regression analysis was used to calculate adjusted IR in order to control for demographic factors. Race was also taken into account, where pilots would classify themselves into a white or non-white race, defined by each individual. Race was assessed in the study to see if there were any differences in IR of CTS between white and non-white pilots. Results We identified 7,398 new cases of CTS among 2,319,352 person-years within the study period. Increasing age, female gender, and non-white race were significantly correlated with higher IR. Fixed-wing pilots demonstrated significantly lower adjusted IR than nonpilot officers in each age group. Helicopter pilots demonstrated higher IR than fixed-wing pilots in each age group. Helicopter pilots had lower incidence of CTS early in their career compared to nonpilot officers, but by age 40+, their IR ratio was significantly higher (1.21). Conclusion Analysis of the database indicates that fixed-wing pilot status is a protective factor against development of CTS among U.S. military officers. In contrast, helicopter pilots were found to be at an increased rate of CTS than their fixed-wing counterparts. Their incidence is comparable to their nonpilot officer peers early in their career, but is significantly increased at the senior level. Increasing age and female gender are risk factors in the military officer population as expected. Non-white race was found to increase risk in the military population, in contrast to reports of the civilian population.

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A Longitudinal Study of Predictors of Research-Defined Carpal Tunnel Syndrome in Industrial Workers: Findings at 17 Years

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2005.06.019 ◽

2005 ◽

Vol 30 (6) ◽

pp. 593-598 ◽

Cited By ~ 44

Author(s):

P. A. NATHAN ◽

J. A. ISTVAN ◽

K. D. MEADOWS

Keyword(s):

Risk Factors ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Relative Weight ◽

Female Gender ◽

Baseline Risk ◽

Industrial Workers ◽

Factors Associated ◽

Increased Risk ◽

Tunnel Syndrome

In 1984, we initiated a prospective study of factors associated with research-defined carpal tunnel syndrome (CTS) in 471 industrial workers. Medical history, lifestyle factors and job tasks were assessed by questionnaire and CTS case status was based on both symptoms and electrophysiologic findings. Participants were re-examined in 1989, 1994 to 1995 and 2001 to 2002. This study reports both baseline and aggregated risk factors associated with increased risk of CTS by 2001 to 2002 for 166 participants successfully re-examined after 17 years. In analyses of baseline risk factors, fewer repetitive tasks at work, female gender and greater relative weight were associated with any occurrence of CTS during follow-up. In analyses of aggregate risk factor scores through 1994 to 1995, only greater relative weight and female gender were associated with CTS in 2001 to 2002. Although obesity and gender are consistent predictors of CTS, workplace demands appear to bear an uncertain relationship to CTS. These findings are also discussed in relation to the possible differences between research-defined CTS and medically referred CTS.

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

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2007.novdec02 ◽

2007 ◽

Vol 12 (6) ◽

pp. 5-8 ◽

Cited By ~ 3

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.

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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

BMC Public Health ◽

10.1186/s12889-020-10137-1 ◽

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.

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

Occupational and Environmental Medicine ◽

10.1136/oemed-2013-102070 ◽

2014 ◽

Vol 71 (4) ◽

pp. 303.2-304 ◽

Cited By ~ 1

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

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

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/1541931213571504 ◽

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

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Risk factors in carpal tunnel syndrome

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(04)00046-4 ◽

2004 ◽

Author(s):

J GEOGHEGAN

Keyword(s):

Risk Factors ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Tunnel Syndrome

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The Most Important Risk Factors for Carpal Tunnel Syndrome

Journal of Zabol Medical School ◽

10.18502/jzms.v4i3.7821 ◽

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.

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

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/1541931213571202 ◽

2013 ◽

Vol 57 (1) ◽

pp. 911-914 ◽

Cited By ~ 2

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

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Síndrome do Túnel Cárpico: mais que movimentos repetitivos?

Revista Portuguesa de Saúde Ocupacional ◽

10.31252/rpso.15.02.2020 ◽

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.

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