Effect of Treatment with an Aldosereductase Inhibitor on Symptomatic Carpal Tunnel Syndrome in Type 2 Diabetes

AbstractBackgroundWe aimed to examine evidence for a causal effect of overall and abdominal adiposity on carpal tunnel syndrome (CTS) using two-sample Mendelian randomization (MR).MethodsThe exposure included genetic instruments comprising independent variants associated with body mass index (BMI) (n=322,154), a proxy for overall adiposity, and waist-hip ratio adjusted for BMI (WHRadjBMI) (n=210,082), a proxy for abdominal adiposity. Associations of these variants with CTS were obtained from a genome-wide association study (GWAS) conducted in UK Biobank (12,312 CTS cases / 389,344 controls). Causal effects were estimated using inverse-variance weighted regression and conventional MR sensitivity analyses were conducted to assess for horizontal pleiotropy. In follow-up analyses we determined whether type 2 diabetes (T2D) or hyperlipidemia mediated the observed effects.ResultsA 1-standard deviation (SD, ∼4.7kg/m2) increase in genetically instrumented BMI increased the risk of CTS (OR 1.73, 95% CI 1.48-2.02, p=2.68e-12), with consistent effects across sensitivity analyses. This effect translates to an absolute increase of 17 CTS cases per 1000 person years amongst US working populations [95% CI 11.0-23.5]. Univariable MR was consistent with a causal effect of T2D (OR 1.08, 95% CI 1.03-1.11, p=5.20e-05), and the effect of BMI was partially attenuated (OR 1.53, 95% CI 1.38-1.68, p=2.85e-08) when controlling for T2D liability in multivariable MR. In contrast, no effect was observed of WHRadjBMI on CTS (OR 1.03, 95% CI 0.74-1.33, p=0.83).ConclusionThese data support a causal effect of overall adiposity on susceptibility to CTS that is only partially mediated through T2D, suggesting that efforts to reduce obesity may mitigate the population burden of CTS.Key messages- A one-standard deviation increase in body mass index, a proxy for overall adiposity, increased risk of carpal tunnel by 73%. In contrast, no effect of waist-to-hip ratio adjusted for BMI, a proxy for abdominal adiposity, was observed on risk of carpal tunnel syndrome.- The effects of BMI on carpal tunnel syndrome risk were partially attenuated when accounting for mediation through type 2 diabetes, suggesting that the majority of the causal effect operates independently of diabetes risk.- These data suggest that efforts to reduce rates of obesity could reduce the incidence of carpal tunnel syndrome.

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THU0525 Effect of local insulin injection in the treatment of mild to moderate carpal tunnel syndrome in patients with type 2 diabetes mellitus

10.1136/annrheumdis-2018-eular.5695 ◽

2018 ◽

Author(s):

A.H. Ismail ◽

S.R. Kamel ◽

H.A. Sadek ◽

O.A. Sayed

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Insulin Injection ◽

Tunnel Syndrome

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Obesity, Type 2 Diabetes, and the Risk of Carpal Tunnel Syndrome: A Two-Sample Mendelian Randomization Study

Frontiers in Genetics ◽

10.3389/fgene.2021.688849 ◽

2021 ◽

Vol 12 ◽

Author(s):

Jiarui Mi ◽

Zhengye Liu

Keyword(s):

Type 2 Diabetes ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Mendelian Randomization ◽

Causal Effect ◽

The Body ◽

Genome Wide Association Studies ◽

Increased Risk ◽

Tunnel Syndrome

Some previous observational studies have reported an increased risk of carpal tunnel syndrome (CTS) in patients with obesity or type 2 diabetes (T2D), which was however, not observed in some other studies. In this study we performed a two-sample Mendelian randomization to assess the causal effect of obesity, T2D on the risk of CTS. Single nucleotide polymorphisms associated with the body mass index (BMI) and T2D were extracted from genome-wide association studies. Summary-level results of CTS were available through FinnGen repository. Univariable Mendelian randomization (MR) with inverse-variance-weighted method indicated a positive correlation of BMI with CTS risk [odds ratio (OR) 1.66, 95% confidence interval (CI), 1.39–1.97]. Genetically proxied T2D also significantly increased the risk of CTS [OR 1.17, 95% CI (1.07–1.29)]. The causal effect of BMI and T2D on CTS remained consistent after adjusting for each other with multivariable MR. Our mediation analysis indicated that 34.4% of BMI’s effect of CTS was mediated by T2D. We also assessed the effects of several BMI and glycemic related traits on CTS. Waist circumference and arm fat-free mass were also causally associated with CTS. However, the associations disappeared after adjusting for the effect of BMI. Our findings indicate that obesity and T2D are independent risk factors of CTS.

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Type 2 diabetes seems not to be a risk factor for the carpal tunnel syndrome: a case control study

BMC Musculoskeletal Disorders ◽

10.1186/1471-2474-15-346 ◽

2014 ◽

Vol 15 (1) ◽

Cited By ~ 9

Author(s):

Steven H Hendriks ◽

Peter R van Dijk ◽

Klaas H Groenier ◽

Peter Houpt ◽

Henk JG Bilo ◽

...

Keyword(s):

Type 2 Diabetes ◽

Risk Factor ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Case Control Study ◽

Case Control ◽

Tunnel Syndrome ◽

Control Study

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Surgical treatment results of carpal tunnel syndrome in patients with and without type 2 diabetes mellitus

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1412675m ◽

2014 ◽

Vol 142 (11-12) ◽

pp. 675-679 ◽

Cited By ~ 3

Author(s):

Melih Malkoc ◽

Özgür Korkmaz ◽

Ismail Oltulu ◽

Ali Seker ◽

Ferhat Say ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Functional Status ◽

Carpal Tunnel ◽

Symptom Severity ◽

Severity Score ◽

Type 2 Dm ◽

Status Score ◽

Symptom Severity Score ◽

Tunnel Syndrome

Introduction. Carpal tunnel syndrome (CTS) is the most commonly seen peripheral nerve compression syndrome and CTS surgery is the most common surgery done for peripheral nerve compression syndromes. Type 2 diabetes mellitus (DM) is a systemic disease with a component of peripheral neuropathy. Objective. We aimed to investigate the effects of type 2 DM on functional results in type 2 DM patients who underwent carpal tunnel surgery. Methods. The study included 39 patients with carpal tunnel syndrome which was confirmed by electromyography. Twenty-one patients did not have DM, 18 patients had type 2 DM that were treated for DM and had regulated blood glucose levels. Assessments were done with the Boston scale. All operations were done by the same surgical team using the same surgical technique. Functional and symptomatic scores between the two groups were compared with the Mann-Whitney U test which is the non-parametric version of the Student?s t test, and 95% confidence interval p<0.05, which is considered as statistically significant. Results. In patients with type 2 DM, preoperative mean Symptom Severity Score was 3.6?0.35 (2.9 to 4.2) in the last control mean Symptom Severity Score was 1.2?0.16 (1.0-1.7), and preoperative mean functional status score was 3.3?0.56 (2.3 to 4.5) and in the last control mean functional status score was 1.3?0.36 (1.0 to 2.4). The patients without DM, preoperative mean Symptom Severity Score was 3.5?0.45 (2.8 to 4.2) in the last control mean Symptom Severity Score was 1.2?0.19 (1.0 to 1.6), and preoperative functional status score was 3.2?0.47 (2.4 to 4.6) in the last control mean functional status score was 1.3?0.35 (1.0 to 2.5). There was no statistically significant difference between the two groups. Conclusion. Type 2 DM patients with regulated blood glucose levels can be operated without additional procedure during and after surgery for carpal tunnel syndrome like in carpal tunnel syndrome patients without DM.

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Carpal tunnel syndrome in type 2 diabetic patients

Diabetes Research and Clinical Practice ◽

10.1016/s0168-8227(00)80913-4 ◽

2000 ◽

Vol 50 ◽

pp. 268

Author(s):

Sami Bashi ◽

Adnan Awada ◽

Mohammed Al-Jumaah ◽

L.P Hefernan ◽

Salem AlSuwaidan

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Tunnel Syndrome ◽

Type 2 Diabetic

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THE EFFECT OF TREATMENT ON MEDIAN NERVE CONDUCTION IN PATIENTS WITH THE CARPAL TUNNEL SYNDROME

Rheumatology ◽

10.1093/rheumatology/6.4.137 ◽

1961 ◽

Vol 6 (4) ◽

pp. 137-155

Author(s):

H. V. GOODMAN ◽

R. W. GILLIATT

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Nerve Conduction ◽

Tunnel Syndrome ◽

Effect Of Treatment

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Clinical Update: Assessing Maximum Medical Improvement in Carpal Tunnel Syndrome

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2003.julaug02 ◽

2003 ◽

Vol 8 (4) ◽

pp. 4-5

Author(s):

Christopher R. Brigham ◽

James B. Talmage

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Proper Time ◽

Carpal Tunnel Release ◽

Hand Function ◽

Factors Affecting ◽

Early Results ◽

Medical Evaluation ◽

Nerve Recovery ◽

Tunnel Syndrome

Abstract Permanent impairment cannot be assessed until the patient is at maximum medical improvement (MMI), but the proper time to test following carpal tunnel release often is not clear. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) states: “Factors affecting nerve recovery in compression lesions include nerve fiber pathology, level of injury, duration of injury, and status of end organs,” but age is not prognostic. The AMA Guides clarifies: “High axonotmesis lesions may take 1 to 2 years for maximum recovery, whereas even lesions at the wrist may take 6 to 9 months for maximal recovery of nerve function.” The authors review 3 studies that followed patients’ long-term recovery of hand function after open carpal tunnel release surgery and found that estimates of MMI ranged from 25 weeks to 24 months (for “significant improvement”) to 18 to 24 months. The authors suggest that if the early results of surgery suggest a patient's improvement in the activities of daily living (ADL) and an examination shows few or no symptoms, the result can be assessed early. If major symptoms and ADL problems persist, the examiner should wait at least 6 to 12 months, until symptoms appear to stop improving. A patient with carpal tunnel syndrome who declines a release can be rated for impairment, and, as appropriate, the physician may wish to make a written note of this in the medical evaluation report.

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