Is essential tremor a risk factor for carpal tunnel syndrome? A prospective study excluding the most common comorbid conditions

Year 2024, , 325 - 330, 30.09.2024

İdris Kocatürk , Fatih Uğur

https://doi.org/10.38053/acmj.1537182

Abstract

Aims: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity, resulting from compression of the median nerve. Tremor, a rhythmic and involuntary movement of any part of the body, is the most common movement disorder, affecting millions of people worldwide. There is limited research on the coexistence of CTS and ET (essential tremor).
Methods: This prospective study included patients aged 18-65 who presented to the neurology outpatient clinic and were diagnosed with ET. Participants supplied informed consent, a sociodemographic form, and the Fahn-Tolosa-Marin Clinical Tremor Rating Scale (FTM TRS). Patients were evaluated for the presence and severity of CTS with electromyography (EMG). The EMG data were categorized as normal, mild, moderate, and severe CTS.
Results: In the study, the average age of the 50 ET patients was 56.0 (35.0-64.0) years. The gender distribution comprised 22 (44.0%) males and 28 (56.0%) females. The following tremor locations were reported: 41 (82.0%) in both upper extremities, 3 (6.0%) in the right upper extremity, 2 (4.0%) in the left upper extremity, 1 (2.0%) in both upper extremities, head tremor, and voice, and 3 (6.0%) in both upper extremities and head tremor. A high prevalence of CTS was detected in ET patients (46%). Additionally, a positive correlation was found between CTS in ET patients, long disease duration, and female gender. No significant relationship was found between FTM TRS Part A, Part B, Part C, total scores, and median sensory and motor nerve amplitude and velocity values in ETS patients.
Conclusion: CTS is more common in patients with ET. This suggests that ET may be a risk factor for CTS, independent of other factors. Early diagnosis and treatment of CTS in patients with ET is important to improve their quality of life.

Keywords

Essential tremor, carpal tunnel syndrome, Fahn-Tolosa-Marin Clinical Tremor Rating Scale

Ethical Statement

KASTAMONU UNİVERSİTY

Project Number

2023-KAEK-52

References

• Boyd CJ, Singh NP, Robin JX, Sharma S. Compression neuropathies of the upper extremity: a review. Surgeries. 2021. 2(3): 320-334.
• Genova A, Dix O, Saefan A, Thakur M, Hassan A. Carpal tunnel syndrome: a review of literature. Cureus. 2020. 12(3).
• Werner RA Andary M. Electrodiagnostic evaluation of carpal tunnel syndrome. Muscle & nerve 2011.44(4):597-607.
• Han SW, Cheon KY, Kim JY, Baik JS. Carpal tunnel syndrome in patients with tremor dominant parkinson’s disease. PLoS One 2015.10(6):e0130779.
• Geoghegan J, Clark DI, Bainbridge LC, Smith C, Hubbard R. Risk factors in carpal tunnel syndrome. J Hand Surg Br. 2004. 29(4): 315-320.
• Loizon M, Laurencin C, Vial C, Danaila T, Thobois S. High incidence of carpal tunnel syndrome after deep brain stimulation in Parkinson’s disease. J Neurol. 2016. 263: 2416-2418.
• Elias WJ, Shah BB. Tremor. Jama 2014. 311(9):948-954.
• Thenganatt MA, Jankovic J. The relationship between essential tremor and Parkinson’s disease. Parkinsonism & related disorders. 2016. 22: S162-S165.
• Fekete R, Jankovic J. Revisiting the relationship between essential tremor and Parkinson’s disease. Movement Disorders. 2011. 26(3): 391-398.
• Yang SN, Kang HJ, Yoon JS, Won SJ, Seo WK, Koh SB. Is median nerve enlargement at the wrist associated with tremor in Parkinson disease? J Ultrasound Med. 2014. 33(12): 2079-2083.
• Yucel A, Yilmaz O, Babaoglu S, Acar M, Degirmenci B. Sonographic findings of the median nerve and prevalence of carpal tunnel syndrome in patients with Parkinson’s disease. Eur J Radiol. 2008. 67(3):546-550.
• Eliaçık S. What is going on in the peripheral nerves of the upper extremity in young essential tremor patients? J Res Administration. 2024. 6(1).
• Lee HL, Kim JS, Kim H, et al. Ultrasonography and electrophysiological study of median nerve in patients with essential tremor. Plos one. 2019. 14(4):e0215750.
• Padua L, Coraci D, Erra C, et al. Carpal tunnel syndrome: clinical features, diagnosis, and management. The Lancet Neurol. 2016. 15(12): 1273-1284.
• Louis ED, DG Machado. Tremor-related quality of life: a comparison of essential tremor vs. áParkinson’s disease patients. Parkinsonism & related disorders. 2015. 21(7): 729-735.
• Li K, Evans PJ, Seitz WH Jr, Li ZM. Carpal tunnel syndrome impairs sustained precision pinch performance. Clin Neurophysiol 2015.126(1):194-201.
• Smid A, Pauwels RWJ, Elting JWJ, et al. A novel accelerometry method to perioperatively quantify essential tremor based on Fahn–Tolosa–Marin Criteria. J Clin Med. 2023. 12(13):4235.
• Fahn S, Tolosa, E, Marin, C,Jankovic, J. Parkinson’s disease and movement disorders. Clinical rating scale for tremor. 1993:271-280.
• Jablecki C, Andary MT., Floeter MK, et al. Practice parameter: electrodiagnostic studies in carpal tunnel syndrome [RETIRED] report of the American association of electrodiagnostic medicine, American academy of neurology, and the American academy of physical medicine and rehabilitation. Neurology. 2002. 58(11): 1589-1592.
• Islam, MN, Chowdhury MSJH., Chowdhury MT, et al. Identification of common risk factors associated with carpal tunnel syndrome. Bangladesh J Neuroscience. 2013. 29(2): 70-78.
• Afshar A, Tabrizi A, Tajbakhsh M, Navaeifar N. Subjective outcomes of carpal tunnel release in patients with diabetes and patients without diabetes. Journal of Hand and Microsur. 2020. 12(03):183-188.
• Sanjari E, Raeisi Shahraki H, G Khachatryan L, Mohammadian-Hafshejani A. Investigating the association between diabetes and carpal tunnel syndrome: a systematic review and meta-analysis approach. Plos one. 2024.19(4):e0299442.
• Duyff RF, Van den Bosch J, Laman DM, van Loon BJ, Linssen WH. Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study. Journal of Neurology, Neurosurgery Psychiatry. 2000. 68(6):750-755.
• Oktayoglu P, Nas K, Kilinç F, Tasdemir N, Bozkurt M, Yildiz I. Assessment of the presence of carpal tunnel syndrome in patients with diabetes mellitus, hypothyroidism and acromegaly. Journal of clinical and diagnostic research: JCDR. 2015. 9(6):OC14.
• Lam N Thurston A. Association of obesity, gender, age and occupation with carpal tunnel syndrome. Australian and New Zealand journal of surgery. 1998. 68(3): 190-193.
• Cazares-Manríquez MA, Wilson, CC, Vardasca, R, et al. A review of carpal tunnel syndrome and its association with age, body mass index, cardiovascular risk factors, hand dominance, and sex. Applied Sciences. 2020. 10(10): 3488.
• Bland JD. The relationship of obesity, age, and carpal tunnel syndrome: more complex than was thought? Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine. 2005. 32(4): 527-532.
• Louis ED, JJ Ferreira. How common is the most common adult movement disorder? Update on the worldwide prevalence of essential tremor. Movement Disorders. 2010. 25(5):534-541.
• McDiarmid M, Oliver M, Ruser J, Gucer P. Male and female rate differences in carpal tunnel syndrome injuries: personal attributes or job tasks? Environmental research. 2000. 83(1): 23-32.
• Mattioli S, Baldasseroni A, Curti S, et al. Incidence rates of surgically treated idiopathic carpal tunnel syndrome in blue-and white-collar workers and housewives in Tuscany, Italy. Occupational environmental Med. 2009. 66(5): 299-304.
• Elble RJ. What is essential tremor? Current neurology and neuroscience reports. 2013. 13:1-8.
• Nutt JG, Wooten GF. Diagnosis and initial management of Parkinson’s disease. New Engl J Med. 2005. 353(10): 1021-1027.
• Welton T, Cardoso F, Carr JA, et al. Essential tremor. Nature reviews Disease primers. 2021. 7(1):83.
• Deng X, Chau PL, Chiu SY, Leung KP, Hu Y, Ip WY. Neural plasticity secondary to carpal tunnel syndrome: a pseudo-continuous arterial spin labeling study. Neural Regen Res 2021. 16(1): 158-165.
• Yu JY, Rajagopal A, Syrkin-Nikolau J, et al. Transcutaneous afferent patterned stimulation therapy reduces hand tremor for one hour in essential tremor patients. Frontiers in Neurosci. 2020. 14: 530300.