Clinical and Neurophysiological Evaluation of the Male Patients with Carpal Tunnel Syndrome with Regard to Relationship among Occupational Disease, Obesity and Smoking

Abstract

Objective: In this study, we aimed to investigate the relationship with the smoking, obesity, age, occupation and duration of occupation and carpal tunnel syndrome (CTS) in male patients with electrophysiologically diagnosed as having CTS.

Materials and Methods: 50 male patients with CTS were included into the study. Age, duration of the symptoms, dominant hand, occupation, duration of occupation, smoking status and body mass index (BMI) for all the patients were recorded. Boston Symptom Severity Scale (BSSS) and functional capacity score (FCS) was used for the assessment of the symptom severity. For the electrophysiological evaluation, sensory and motor conduction studies of bilateral median and ulnar nerves were performed.

Results: Mean age of the patients was 48.40±9.61 years. Distribution of the occupations were mostly included the workers of construction, textile, shoemaker and the cooks. The mean score of BSSS and FCS were 22.88±8.385 and 11.40±4.527, respectively. No statistically significant difference was found between the subjects with BMI <25 and BMI >25. CTS patients regarding the age, symptom duration, BSSS and FCS. Duration of the occupation and smoking status did not show any significant correlation with the disease severity.

Conclusion: CTS in males is specifically mostly seen in the workers of construction, textile, shoemaker and the cooks. Although we found no significant association between disease severity and obesity or smoking, studies on larger case series are necessary. To raise awareness of the patients about CTS and occupational disease is an important issue.

Keywords

• carpal tunnel syndrome
• male
• obesity
• occupitional diseases
• smoking

Karpal Tünel Sendromu Tanılı Erkek Olguların Klinik ve Elektrofizyolojik Bulgularının Meslek Hastalığı, Obezite ve Sigara Kullanımıyla İlişkisinin Değerlendirilmesi

Öz

Amaç: Bu çalışmada elektrofizyolojik olarak karpal tünel sendromu (KTS) tanısı almış erkek olgularda sigara kullanımı, obezite, yaş, meslek ve meslek süreleri ile KTS ilişkisinin araştırılmasını amaçladık.

Materyal ve Metot: Çalışmaya KTS tanısı konulan 50 erkek olgu dahil edildi. Hastaların yaşı, semptom süreleri, el dominansları, meslekleri ve meslek süreleri, sigara kullanımları ve vücut kitle indeksi (VKİ) kaydedildi. Semptom şiddeti Boston semptom şiddet skalası (BSŞS) ve fonksiyonel kapasite skorları (FKS) ile değerlendirildi. Elektrofizyolojik değerlendirmede bilateral ulnar median duysal ve motor sinir ileti incelemeleri çalışıldı.

Bulgular: Hastaların yaş ortalaması 48,40±9,61 yıldı. Mesleki dağılımları büyük oranda inşaat, tekstil, ayakkabı işçileri ve aşçılardan oluşturmaktaydı. BSŞS ortalaması 22,88±8,385 ve FKS 11,40±4,527 idi. VKİ <25 ile >25 üzeri olan KTS’lı hastaların yaş, semptom süresi, semptom şiddet ve FKS arasında istatistiksel olarak anlamlı fark saptanmadı. Meslek süreleri ve sigara kullanımıyla hastalık şiddeti arasında bir ilişki saptanmadı.

Sonuç: Erkek KTS özellikle tekstil, inşaat işçileri,ayakkabı üreticileri ve aşçılar gibi işçi sınıfında yüksek oranda görülür. Obezite dereceleri ve sigara kullanımıyla hastalık şiddeti arasında anlamlı ilişki saptamamakla birlikte daha büyük vaka serileri üzerinde çalışmak gereklidir. Çalışanların KTS ile ilgili bilinçlenmesi ve meslek hastalığı farkındalığının oluşturulması önemlidir.

Anahtar Kelimeler

• karpal tünel sendromu
• erkek
• meslek hatalıkları
• obesite
• sigara

Kaynakça

1. Burke DT, Burke MM, Stewart GW, Cambre A. Splinting for carpal tunnel syndrome: insearch of the optimal angle. Arch Phys Med Rehabil. 1994;75:1241-4.
2. Provinciali L, Giattini A, Splendiani G, LogulloF. Usefulness of hand rehabilitation after carpal tunnel surgery. Muscle Nerve. 2000;23:211-6.
3. Palmer KT, Harris EC, Coggon D. Carpal tunnel syndrome and its relation to occupation: a systematic literature review. Occup Med. 2007;7(1):57-66.
4. Pickering SA, Stevens A, Davis TR. Work practices and histopathological changes in the tenosynovium in carpal tunnel syndrome in men. Journal of Hand Surgery. 2004;29(4):325-8.
5. Watts AC, McEachan J, Carpal tunnel syndrome in men. Current Orthopaedics. 2006;20(4):294–298.
6. Shiri R, Pourmemari MH, Falah-Hassani K, Viikari-Juntura E. The effect of excess body mass on the risk of carpal tunnel syndrome: a meta-analysis of 58 studies. World Obesity. 2015;16(12):1094–1104.
7. Pourmemari MH, Juntura EV, Shiri R. Smoking and carpal tunnel syndrome: A meta-analysis. Muscle Nerve. 2014;49(3):345–350.
8. Sezgin M, Incel NA, Serhan S et al. Assessment of symptom severity and functional status in patients with carpal tunnel syndrome: reliability and functionality of the Turkish version of the Boston Questionnaire. Disabil Rehabil. 2006;28(20):1281-5.

9. Okutsu I, Ninomiya S, Hamanaka I, Kuroshima N, Inanami H. Measurement of pressure in the carpal canal before and after endoscopic management of carpal tunnel syndrome. The Journal of Bone and Joint. Surgery. 1989;71(5):679-683.
10. Silverstein BA, Fan ZJ, Bonauto DK, et al. The natural course of carpal tunnel syndrome in a working population. Scand J Work Environ Health. 2010;36(5):384–393.
11. Shiri R. A. square-shaped wrist as a predictor of carpal tunnel syndrome: A meta-analysis. Muscle Nerve. 2015;52(5):709-13.
12. Heilskov-Hansen T, Mikkelsen S, Svendsen SW, et al. Exposure-response relationships between movements and postures of the wrist and carpal tunnel syndrome among Male and female house painters: a retrospective cohort study. Occupational Environmental Medicine. 2016;73(6):401-8.
13. Bonfiglioli R, Mattioli S, Armostrong T, et al. Validation of the ACGIH TLV for hand activity in the OCTOPUS cohort: a two-year longitudinal study of carpal tunnel syndrome. Scand J Work Environ Health. 2013;39(2):155–163.
14. Nathan PA, Istvan JA, Meadows KD. A longitudinal study of predictors of research-defined carpal tunnel syndrome in industrial workers: findings at 17 years. Journal of Hand Surgery. 2005;30:593–598.
15. Fan ZJ, Harris‐Adamson C, Gerr F et al. Associations Between Workplace Factors and Carpal Tunnel Syndrome: A Multi-Site Cross Sectional Study .American Journal of Industrial Medicine. 2015;58:509–518.
16. 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 Section. 2000;83(1):23-32.
17. Jason TG, Scott DM Anthony JW, Alan LC. Occupational and Biopsychosocial Risk Factors for Carpal Tunnel Syndrome. Journal of Occupational and Environmental Medicine. 2014;56 (9):965-972.
18. Pourmemari MH, Heliövaara M, Viikari‐Juntura E, Shiri R. Carpal tunnel release: Lifetime prevalence, annual incidence, and risk factors. Muscle&Nerve. 2018;58(4) 497-502.
19. Nathan PA, Keniston RC, Lockwood RS, Meadows KD. Tobacco, Caffeine, Alcohol, and Carpal Tunnel Syndrome in American Industry: A Cross-Sectional Study of 1464 Workers. Journal of Occupational & Environmental Medicine. 1996;38(3):290-298.
20. Richardson JK, Jamieson SC. Cigarette smoking and ulnar mononeuropathy at the elbow. American Journal of Physical Medicine& Rehabilitation. 2004;83(9):730–734.