Carpal tunnel syndrome and hormone replacement therapy.

ObjectiveCarpal tunnel syndrome (CTS) is the most common compressive focal mononeuropathy, and the increased incidence in postmenopausal and pregnant women suggests its association with oestrogen. The objective of this study is to evaluate the relationship between hormone replacement therapy (HRT) and the occurrence of CTS.DesignPopulation-based case-control study.SettingNationwide health insurance programme operated by the government with a near 100% coverage rate.ParticipantsWe identified women ≥45 years old in the Health Insurance Research Database of Taiwan, which contains data on a representative sample of one million enrollees. After exclusion of those who were diagnosed with CTS before the prescription of HRT, a total of 118 309 participants were included and followed up for 15 years starting from 1 January 1996. Both HRT and occurrence of CTS were identified using the insurance claims.Main outcome measuresWe identified incident patients of CTS and evaluated the association between HRT and CTS by calculating the OR.ResultsOf the 4535 participants who developed CTS during the study period, 2334 (51.5%) were HRT recipients. In participants without CTS, the proportion of HRT recipients was 28.1%, yielding an OR of 2.72 with a 95% CI of 2.56 to 2.88. After adjustment for age, diabetes, rheumatoid arthritis, hypothyroidism, gout and obesity, the OR of CTS associated with HRT was 2.04 (95% CI 1.91 to 2.17). While HRT, diabetes, rheumatoid arthritis and gout had similar effects on CTS across all age groups, hypothyroidism and obesity had different effects on different groups.ConclusionThis study observed a positive association between HRT and CTS, independent of age, diabetes, rheumatoid arthritis, hypothyroidism, gout and obesity. While the ORs of CTS associated with HRT were similar across age groups, those associated with hypothyroidism and obesity were not, indicating effect modifications by age.

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Carpal tunnel syndrome in mucopolysaccharidosis type I Hurler-Scheie/Scheie and effect of enzyme replacement therapy

Molecular Genetics and Metabolism ◽

10.1016/j.ymgme.2018.12.101 ◽

2019 ◽

Vol 126 (2) ◽

pp. S46-S47

Author(s):

James E. Davison ◽

Laura Guilder ◽

Maureen A. Cleary ◽

Matthew Pitt ◽

Benan Dala-Ali ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Enzyme Replacement Therapy ◽

Replacement Therapy ◽

Carpal Tunnel ◽

Type I ◽

Mucopolysaccharidosis Type ◽

Mucopolysaccharidosis Type I ◽

Enzyme Replacement ◽

Tunnel Syndrome

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DYNAMICS OF CLINICAL AND ELECTROPHYSIOLOGICAL CHARACTERISTICS OF CARPAL TUNNEL SYNDROME IN CHILDREN WITH MUCOPOLYSACCHARIDOSES AGAINST THE BACKGROUND OF ENZYME-REPLACEMENT THERAPY

Российский педиатрический журнал ◽

10.18821/1560-9561-2018-21-3-152-156 ◽

2019 ◽

Vol 21 (3) ◽

pp. 152-156

Author(s):

Liliya L. Osipova ◽

L. M. Kuzenkova ◽

A. L. Kurenkov ◽

T. V. Podkletnova ◽

L. S. Namazova-Baranova ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Enzyme Replacement Therapy ◽

Replacement Therapy ◽

Median Nerve ◽

Carpal Tunnel ◽

Clinical Symptoms ◽

Clinical Manifestations ◽

Enzyme Replacement ◽

Tunnel Syndrome ◽

The Impact

Introduction. Mucopolysaccharidoses are the most common cause of the carpal tunnel syndrome in children. Enzyme-replacement therapy, which is available in clinical practice within last 10-15 years for mucopolysaccharidoses I, II and VI demonstrated the efficacy regarding somatic symptoms of the diseases, however, the impact of this new pathogenetic treatment on neuropathy of median nerve, arising from compression in the carpal tunnel, is poorly described. Objective. To study the dynamics of clinical and electrophysiological characteristics of carpal tunnel syndrome in children with mucopolysaccharidoses during enzyme-replacement therapy. Materials and methods. 18 children with mucopolysaccharidoses I, II and VI, received enzyme-replacement therapy, are included in the study. Dynamics of clinical symptoms of the carpal tunnel syndrome and EMG indices of median nerve testing are described against the background of enzyme-replacement therapy. Results. Objective and subjective clinical manifestations of the carpal tunnel syndrome persisted or appeared in children, receiving enzyme-replacement therapy for 21±12 months. However, there were no statistically significant changes in EMG-characteristics of median nerves testing during enzyme-replacement therapy in children with mucopolysaccharidoses Conclusion. Enzyme-replacement therapy in children with mucopolysaccharidoses I, II and VI may suspend and/or delay progressive damage of median nerves in the carpal canal, thus indicating prevention and slowing down in glycosaminoglycans storage in the carpal tunnel.

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Risk Factors in Carpal Tunnel Syndrome

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2004.02.009 ◽

2004 ◽

Vol 29 (4) ◽

pp. 315-320 ◽

Cited By ~ 168

Author(s):

J. M. GEOGHEGAN ◽

D. I. CLARK ◽

L. C. BAINBRIDGE ◽

C. SMITH ◽

R. HUBBARD

Keyword(s):

Risk Factors ◽

General Practice ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Hormone Replacement ◽

Oral Contraceptive Pill ◽

General Practice Research Database ◽

Practice Research ◽

Research Database ◽

Tunnel Syndrome

We have undertaken a large case–control study using the UK General Practice Research Database to quantify the relative contributions of the common risk factors for carpal tunnel syndrome (CTS) in the community. Cases were patients with a diagnosis of CTS and, for each, four controls were individually matched by age, sex and general practice. Our dataset included 3,391 cases, of which 2,444 (72%) were women, with a mean age at diagnosis of 46 (range 16–96) years. Multivariate analysis showed that the risk factors associated with CTS were previous wrist fracture (OR = 2.29), rheumatoid arthritis (OR = 2.23), osteoarthritis of the wrist and carpus (OR = 1.89), obesity (OR = 2.06), diabetes (OR = 1.51), and the use of insulin (OR = 1.52), sulphonylureas (OR = 1.45), metformin (OR = 1.20) and thyroxine (OR = 1.36). Smoking, hormone replacement therapy, the combined oral contraceptive pill and oral corticosteroids were not associated with CTS. The results were similar when cases were restricted to those who had undergone carpal tunnel decompression.

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Aromatase Inhibitor–Induced Carpal Tunnel Syndrome: Results From the ATAC Trial

Journal of Clinical Oncology ◽

10.1200/jco.2009.22.0236 ◽

2009 ◽

Vol 27 (30) ◽

pp. 4961-4965 ◽

Cited By ~ 52

Author(s):

Ivana Sestak ◽

Francisco Sapunar ◽

Jack Cuzick

Keyword(s):

Breast Cancer ◽

Carpal Tunnel Syndrome ◽

Postmenopausal Women ◽

Early Breast Cancer ◽

Carpal Tunnel ◽

Hormone Replacement ◽

Moderate Intensity ◽

Tunnel Syndrome ◽

Treatment Medication

Purpose Carpal tunnel syndrome (CTS) is a condition in which the median nerve is compressed, leading to pain and muscle weakness in the fingers and hand. Aromatase inhibitors lead to profound estrogen suppression and may be expected to increase the risk of CTS in postmenopausal women receiving adjuvant therapy for early breast cancer. Patients and Methods The current analyses were based on the 100-month median follow-up data in postmenopausal women in the two monotherapy arms (anastrozole, n = 3,092; tamoxifen, n = 3,094). Here, we investigate the natural history of patients who presented with CTS during adjuvant treatment for breast cancer and the relative importance of a range of known risk factors for CTS. Results After 100 months of follow-up, 80 cases (2.6%) of CTS were reported in the anastrozole arm, compared with 23 cases (0.7%) in the tamoxifen arm (P < .0001). The majority of CTS cases were reported as mild to moderate intensity and occurred early. None of the women stopped treatment medication as a result of CTS. CTS was significantly increased for women who used prior hormone replacement therapy (P = .007) or received prior chemotherapy (P = .01). Those who were 60 years of age or older at entry were at lower risk of CTS compared with their counterparts (P = .002). Conclusion Although the use of anastrozole is associated with a greater incidence of CTS, it is rare, and most cases were of mild to moderate intensity and short duration. CTS has little impact on the overall risk-to-benefit ratio for the use of anastrozole in postmenopausal women with early breast cancer.

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