Assessment of the Relationship between Vitamin D Deficiency and Carpal Tunnel Syndrome

Abstract

ABSTRACT

Purpose: Although there is substantial evidence that vitamin D deficiency is associated with many health problems such as diabetes, infections, autoimmune diseases, cancer and cardiovascular diseases, very few studies have examined the association with Carpal Tunnel Syndrome (CTS) and other peripheral mononeuropathies work is available. We investigated whether vitamin D deficiency is associated with CTS.

Materials and Methods: 241 patients with clinically diagnosed CTS were evaluated.  The files of these patients were retrospectively reviewed. Electro neurophysiological (ENMG) evaluation was performed for all patients in terms of CTS. Vitamin D levels were assessed by 25-hydroxy-cholalciferol (25(OH)D) levels.

Results: In 13 of 241 patients (5.4%) severe, in 46 patients (19.1%) moderate and 32 of them (13.3%) mild level of CTS was detected. The 25(OH)D vitamin level in patients with and without carpal tunnel syndrome did not differ significantly (p=0.118).

Conclusion: In our study, we did not find a significant relationship between KTS levels and vitamin D levels. Although there are many studies related to vitamin D levels, there are very few studies that have investigated the relationship with CTS. More studies are needed to understand the potential role of vitamin D in the pathogenesis of CTS.

 

Keywords

• Carpal tunnel syndrome,vitamin D,neuropathy

Vitamin D Eksikliği ve Karpal Tünel Sendromu Arasındaki İlişkinin Değerlendirilmesi

Abstract

ÖZ

Amaç: Vitamin D eksikliğinin diyabet, infeksiyonlar, otoimmün hastalıklar, kanser ve kardiyovasküler hastalıklar gibi pek çok sağlık sorunu ile ilişkili olduğu yönünde önemli kanıtlar bulunmasına rağmen Karpal Tünel Sendromu (KTS) ve diğer periferik mononöropatiler ile ilişkisini inceleyen çok az çalışma mevcuttur. Bu çalışmamızda vitamin D eksikliğinin KTS ile ilişkili olup olmadığını araştırdık.

Araçlar ve Yöntem: Klinik olarak KTS ön tanısı konmuş 241 hasta değerlendirildi. Bu hastaların dosyaları retrospektif olarak incelendi. Tüm hastaların KTS açısından elektronörofizyolojik (ENMG) değerlendirmesi yapıldı. Vitamin D düzeyleri 25-hidroksi-kolekalsiferol ( 25(OH)D ) düzeyine bakılarak değerlendirildi.

Bulgular: 241 hastanın 13’ünde ( %5.4) ağır, 46’sında ( %19.1) orta ve 32’sinde ( %13.3) hafif KTS saptandı. Karpal tünel sendromu olan ve olmayan grupta 25(OH)D vitamin değeri anlamlı (p=0.118) farklılık göstermedi.

Sonuç: Çalışmamızda KTS ve derecesi ile vitamin D düzeyleri arasında anlamlı bir ilişki bulmadık. Vitamin D düzeyi ile ilgili birçok alanda çalışma olduğunu görsek de, KTS ile ilişkini inceleyen çok az sayıda çalışma vardır. Vitamin D düzeyinin KTS patogenezindeki potansiyel rolünü anlayabilmek için daha çok çalışmaya ihtiyaç vardır.

Keywords

• Karpal tünel sendromu,vitamin D,nöropatİ

References

1. KAYNAKÇA:1. Sucher BM, Schreiber AL. Carpal tunnel syndrome diagnosis. Phys Med Rehabil Clin N Am 2014;25:229-247.
2. 2. Kaymak B, Özçakar L. Karpal tünel sendromu. Hacettepe Tıp Dergisi 2007;38:141–146.
3. 3. LeBlanc KE, Cestia W. Carpal tunnel syndrome. Am Fam Physician 2011;83(8):952–958.
4. 4. Kouyoumdjian JA, Zanetta DM, Motita MP. Evaluation of age, body mass index, and wrist index as risk factors for carpal tunnel syndrome severity. Muscle Nerve 2002;25:93-97.
5. 5. Bland JDP. Do nerve conduction studies predict the outcome of carpal tunnel decompression?. Muscle Nerve 2001;24:935-940.
6. 6. Özdemir G, Demir R, Özel L, et al. The effect of steroid injection by novel method in carpal tunnel syndrome on pain severity and electrophysiological findings. Dicle Med J 2014;41:277-281.
7. 7. Öngen B, Kabaroğlu C, Parıldar Z. D Vitamini’nin Biyokimyasal ve Laboratuvar Değerlendirmesi. Ege Üniversitesi Tıp Fakültesi, Türk Klinik Biyokimya Dergisi 2008;6:23-31.
8. 8. Heath KM, Elovic EP. Vitamin D Deficiency: Implications in the Rehabilitation Setting. Am J PhysMedRehabil 2006;85:916-923.

9. 9. Mitri J, Muraru MD, Pittas AG. Vitamin D and type 2 diabetes: a systematic review. Eur J Clin Nutr 2011;65:1005-1015.
10. 10. Cannell JJ, Vieth R, Umhau JC, et al. Epidemic influenza and vitamin D. Epidemiol Infect 2006;134:1129-1140.
11. 11. Yap KS, Northcott M, Hoi AB, et al. Association of low vitamin D with high disease activity in an Australian systemic lupus erythematosus cohort. Lupus Sci Med 2015;2:000064.
12. 12. Schöttker B, Haug U, Schomburg L, et al. Strong associations of 25-hydroxyvitamin D concentrations with all-cause, cardiovascular, cancer, and respiratory disease mortality in a large cohort study. Am J Clin Nutr 2013;97:782-793.
13. 13. Chen S, Glenn DJ, Ni W, et al. Expression of the vitamin D receptor is increased in the hypertrophic heart. Hypertension 2008;52:1106–1112.
14. 14. Oh YM, Ma TZ, Kwak YG, et al. Proteomic evaluation to identify biomarkers for carpal tunnel syndrome: a comparative serum analysis. Connect Tissue Res 2013;54:76–81.
15. 15. Lee SH, Gong HS, Kim DH, et al. Evaluation of vitamin D levels in women with carpal tunnel syndrome. J Hand Surg Eur 2016;41:643–647.
16. 16. Jablecki CK, Andary MT, Floeter MK, et al. Practice parameter: Electrodiagnostic studies in carpal tunnel syndrome: Report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation. Neurology 2002;58:1589-1592. 17. Erkal MZ, Wilde J, Bilgin Y, et al. High prevalence of vitamin D deficiency, secondary hyperparathyroidism and generalized bone pain in Turkish immigrants in Germany: identification of risk factors. Osteoporos Int 2006;17(8):1133-1140.
17. 18. Arabi A, El Rassi R, El-Hajj Fuleihan G. Hypovitaminosis D in developing countries-prevalence, risk factors and outcomes. Nat Rev Endocrinol 2010;6(10):550-561.
18. 19. Açıkgöz B, Sümer M. Carpal tunnel syndrome. Türk Nöroşirurji Dergisi 2000;10(1):79–84.
19. 20. Wion D, MacGrogan D, Neveu I, et al. 1, 25-Dihydroxyvitamin D3 is a potent inducer of nerve growth factor synthesis. J Neurosci Res 1991;28:110–114.
20. 21. Brewer LD, Thibault V, Chen KC, et al. Vitamin D hormone confers neuroprotection in parallel with downregulation of L-type calcium channel expression in hippocampal neurons. J Neurosci. 2001;21:98–108.
21. 22. Smith MP, Fletcher-Turner A, Yurek DM, et al. Calcitriol protection against dopamine loss induced by intracerebroventricular administration of 6-hydroxydopamine. Neurochem Res 2006;31:533–539.
22. 23. Garcion E, Nataf S, Berod A, et al. 1, 25-Dihydroxyvitamin D 3 inhibits the expression of inducible nitric oxide synthase in rat central nervous system during experimental allergic encephalomyelitis. Brain Res Mol Brain Res 1997;45:255–267.
23. 24. Skalli S, Muller M, Pradines S, et al. Vitamin D deficiency and peripheral diabetic neuropathy. Eur J Intern Med 2012;23:67–68.
24. 25. Putz Z, Martos T, Ne´meth N, Ko¨rei AE, Va´gi OE, Kempler MS, Kempler P Is there an association between diabetic neuropathy and low vitamin D levels? Curr Diab Rep 2014;14(10):537.
25. 26. Soderstrom LH, Johnson SP, Diaz VA, Mainous AG 3rd Association between vitamin D and diabetic neuropathy in a nationally representative sample: results from 2001–2004 NHANES. Diabet Med 2012;29(1):50–55.
26. 27. Atherton K, Berry DJ, Parsons T, Macfarlane GJ, Power C, Hyppo¨nen E. Vitamin D and chronic widespread pain in a white middle-aged British population: evidence from a crosssectional population survey. Ann Rheum Dis. 2009;68(6):817–822.
27. 28. Lee P, Chen R. Vitamin D as an analgesic for patients with type 2 diabetes and neuropathic pain. Arch Int Med 2008;168:771–772.
28. 29. Wepner F, Scheuer R, Schuetz-Wieser B, Machacek P, Pieler-Bruha E, Cross HS, Hahne J, Friedrich M. Effects of vitamin D on patients with fibromyalgia syndrome: a randomized placebo-controlled trial. Pain. 2014;155(2):261-268.
29. 30. Schreuder F, Bernsen RM, van der Wouden JC. Vitamin D supplementation for nonspecific musculoskeletal pain in non-Western immigrants: a randomized controlled trial. Ann Fam Med. 2012;10(6):547–555.
30. 31. Agmon-Levin N, Kivity S, Tzioufas AG, et al. Low levels of vitamin-D are associated with neuropathy and lymphoma among patients with Sjogren’s syndrome. J Autoimmun 2012;39:234–239.
31. 32. Gursoy A E, Bilgen H R, Duruyen H, et al. The evaluation of vitamin D levels in patients with carpal tunnel syndrome. Neurol Sci. 2016; Mar 3. [Epub ahead of print] DOI 10.1007/s10072-016-2530-0.
32. 33. Hovaguimian, A. & Gibbons, C.H. Curr Pain Headache Rep 2011;15:193. https://doi.org/10.1007/s11916-011-0181-7.
33. 34. Tanik N, Balbaloglu O , Ucar M, et al. Does vitamin D deficiency trigger carpal tunnel syndrome?. J Back Musculoskelet Rehabil 2016;Mar 31. [Epub ahead of print] DOI: 10.3233/BMR-160696.
34. 35. Demiryurek BE, Gundogdu AA. The Effect of Vitamin D Levels on Pain In Carpal Tunnel Syndrome. Orthopaedics and Traumatology: Surgery and Research 2017;S1877-0568(17)30142-1.