Association between wrist ratio and carpal tunnel syndrome: Effect modification by body mass index
Corresponding Author
Matthew S. Thiese PhD, MSPH
Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, Utah, 84108 USA
Correspondence to: M. S. Thiese; e-mail: [email protected].Search for more papers by this authorAndrew Merryweather PhD
Department of Mechanical Engineering, University of Utah, Salt Lake City, Utah, USA
Search for more papers by this authorAlzina Koric MPP
Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, Utah, 84108 USA
Search for more papers by this authorUlrike Ott PhD, MSPH
Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, Utah, 84108 USA
Search for more papers by this authorEric M. Wood MD, MPH
Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, Utah, 84108 USA
Search for more papers by this authorJay Kapellusch PhD
Center for Ergonomics, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
Search for more papers by this authorJames Foster MD
Center for Ergonomics, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
Search for more papers by this authorArun Garg PhD
Center for Ergonomics, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
Search for more papers by this authorGwen Deckow-Schaefer MS, OTR/L
Encore Unlimited LLC, Stevens Point, Wisconsin, USA
Search for more papers by this authorRichard Kendall DO
Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA
Search for more papers by this authorDavid L. Drury MD, MPH
Allina Health Clinics, Minneapolis, Minnesota, USA
Search for more papers by this authorJacqueline Wertsch MD
Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
Search for more papers by this authorKurt T. Hegmann MD, MPH
Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, Utah, 84108 USA
Search for more papers by this authorThe Wistah Study Team
Search for more papers by this authorCorresponding Author
Matthew S. Thiese PhD, MSPH
Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, Utah, 84108 USA
Correspondence to: M. S. Thiese; e-mail: [email protected].Search for more papers by this authorAndrew Merryweather PhD
Department of Mechanical Engineering, University of Utah, Salt Lake City, Utah, USA
Search for more papers by this authorAlzina Koric MPP
Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, Utah, 84108 USA
Search for more papers by this authorUlrike Ott PhD, MSPH
Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, Utah, 84108 USA
Search for more papers by this authorEric M. Wood MD, MPH
Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, Utah, 84108 USA
Search for more papers by this authorJay Kapellusch PhD
Center for Ergonomics, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
Search for more papers by this authorJames Foster MD
Center for Ergonomics, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
Search for more papers by this authorArun Garg PhD
Center for Ergonomics, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
Search for more papers by this authorGwen Deckow-Schaefer MS, OTR/L
Encore Unlimited LLC, Stevens Point, Wisconsin, USA
Search for more papers by this authorRichard Kendall DO
Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA
Search for more papers by this authorDavid L. Drury MD, MPH
Allina Health Clinics, Minneapolis, Minnesota, USA
Search for more papers by this authorJacqueline Wertsch MD
Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
Search for more papers by this authorKurt T. Hegmann MD, MPH
Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, Utah, 84108 USA
Search for more papers by this authorThe Wistah Study Team
Search for more papers by this authorFunding: This work was funded in part by grants from the National Institute for Occupational Safety and Health (U 01 OH007917-01; 3TC42OH008414).
Conflicts of Interest: None of the authors have any conflicts of interest to disclose.
ABSTRACT
Introduction
Previous studies have reported higher wrist ratios (WR) related to carpal tunnel syndrome (CTS) but have not assessed effect modification by obesity and may have inadequately controlled for confounders.
Methods
Baseline data of a multicenter prospective cohort study were analyzed. CTS was defined by nerve conduction study (NCS) criteria and symptoms.
Results
Among the 1,206 participants, a square-shaped wrist was associated with CTS after controlling for confounders (prevalence ratio = 2.27; 95% confidence interval [95% CI], 1.33–3.86). Body mass index (BMI) was a strong effect modifier on the relationship between WR and both CTS and abnormal NCS results, with normal weight strata of rectangular versus square wrists = 8.18 (95% CI, 1.63–49.96) and 7.12 (95% CI, 2.19–23.16), respectively.
Discussion
A square wrist is significantly associated with CTS after controlling for confounders. Effect modification by high BMI masked the eightfold magnitude adjusted relationship seen between WR and CTS among normal weight participants. Muscle Nerve 56: 1047–1053, 2017
Supporting Information
Additional supporting information may be found in the online version of this article
| Filename | Description |
|---|---|
| mus25692-sup-0001-suppinfot1.docx12.7 KB | Supporting Information Table 1 |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
REFERENCES
- 1 Day CS, Makhni EC, Mejia E, Lage DE, Rozental TD. Carpal and cubital tunnel syndrome: who gets surgery? Clin Orthop Relat Res 2010; 468(7): 1796–1803.
- 2 Roh YH, Chung MS, Baek GH, Lee YH, Rhee SH, Gong HS. Incidence of clinically diagnosed and surgically treated carpal tunnel syndrome in Korea. J Hand Surg 2010; 35(9): 1410–1417.
- 3 Nora DB, Becker J, Ehlers JA, Gomes I. Clinical features of 1039 patients with neurophysiological diagnosis of carpal tunnel syndrome. Clin Neurol Neurosurg 2004; 107(1): 64–69.
- 4 Phalen GS. The carpal-tunnel syndrome. J Bone Joint Surg 1966; 48(2): 211–228.
- 5 Werner RA, Gell N, Franzblau A, Armstrong TJ. Prolonged median sensory latency as a predictor of future carpal tunnel syndrome. Muscle Nerve 2001; 24(11): 1462–1467.
- 6 Werner RA, Franzblau A, Albers JW, Buchele H, Armstrong TJ. Use of screening nerve conduction studies for predicting future carpal tunnel syndrome. Occup Environ Med 1997; 54(2): 96–100.
- 7 Redmond MD, Rivner MH. False positive electrodiagnostic tests in carpal tunnel syndrome. Muscle Nerve 1988; 11(5): 511–518.
- 8 Gelberman RH, Hergenroeder PT, Hargens AR, Lundborg GN, Akeson WH. The carpal tunnel syndrome. A study of carpal canal pressures. J Bone Joint Surg Am 1981; 63(3): 380–383.
- 9 Chroni E, Paschalis C, Arvaniti C, Zotou K, Nikolakopoulou A, Papapetropoulos T. Carpal tunnel syndrome and hand configuration. Muscle Nerve 2001; 24(12): 1607–1611.
- 10 Kamolz LP, Beck H, Haslik W, Högler R, Rab M, Schrögendorfer KF, Frey M. Carpal tunnel syndrome: a question of hand and wrist configurations? J Hand Surg 2003; 28: 69.
- 11 Werner R, Armstrong T, Bir C, Aylard M. Intracarpal canal pressures: the role of finger, hand, wrist and forearm position. Clin Biomech 1997; 12(1): 44–51.
- 12 Hand, wrist, and forearm disorders. In: KT Hegmann, editor. Occupational medicine practice guidelines. Evaluation and management of common health problems and functional recovery in workers, 3rd ed. Elk Grove Village, IL: American College of Occupational and Environmental Medicine; 2011. p 571–927.
- 13 Aboonq MS. Pathophysiology of carpal tunnel syndrome. Neurosciences 2015; 20(1): 4.
- 14 Salaffi F, De Angelis R, Grassi W. Prevalence of musculoskeletal conditions in an Italian population sample: results of a regional community-based study. I. The MAPPING study. Clin Exp Rheumatol 2005; 23(6): 819–828.
- 15 Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I. Prevalence of carpal tunnel syndrome in a general population. JAMA 1999; 282(2): 153–158.
- 16 Nathan PA, Keniston RC, Meadows KD, Lockwood RS. The relationship between body mass index and the diagnosis of carpal tunnel syndrome. Muscle Nerve 1994; 17(12): 1491–1493.
- 17 Shiri R, Varonen H, Heliovaara M, Viikari-Juntura E. Hand dominance in upper extremity musculoskeletal disorders. J Rheumatol 2007; 34(5): 1076–1082.
- 18 Thiese MS, Gerr F, Hegmann KT, Harris-Adamson C, Dale AM, Evanoff B, Eisen EA, Kapellusch J, Garg A, Burt S, Bao S. Effects of varying case definition on carpal tunnel syndrome prevalence estimates in a pooled cohort. Arch Phys Med Rehabil 2014; 95(12): 2320–2326.
- 19 Silverstein BA, Fan ZJ, Bonauto DK, Bao S, Smith CK, Howard N, Viikari-Juntura E. The natural course of carpal tunnel syndrome in a working population. Scand J Work Environ Health 2010; 36(5): 384–393.
- 20 Luckhaupt SE, Dahlhamer JM, Ward BW, Sweeney MH, Sestito JP, Calvert GM. Prevalence and work relatedness of carpal tunnel syndrome in the working population, United States, 2010 National Health Interview Survey. Am J Ind Med 2013; 56(6): 615–624.
- 21 Dale AM, Harris-Adamson C, Rempel D, Gerr F, Hegmann K, Silverstein B, Burt S, Garg A, Kapellusch J, Merlino L, Thiese MS. Prevalence and incidence of carpal tunnel syndrome in US working populations: pooled analysis of six prospective studies. Scand J Work Environ Health 2013; 39(5): 495–505.
- 22 Gelfman R, Melton LJ 3rd, Yawn BP, Wollan PC, Amadio PC, Stevens JC. Long-term trends in carpal tunnel syndrome. Neurology 2009; 72(1): 33–41.
- 23 Mondelli M, Giannini F, Giacchi M. Carpal tunnel syndrome incidence in a general population. Neurology 2002; 58(2): 289–294.
- 24 Harris-Adamson C, Eisen EA, Dale AM, Evanoff B, Hegmann KT, Thiese MS, Kapellusch JM, Garg A, Burt S, Bao S, Silverstein B. Personal and workplace psychosocial risk factors for carpal tunnel syndrome: a pooled study cohort. Occup Environ Med 2013; 70(8): 529–537.
- 25 Farmer JE, Davis TR. Carpal tunnel syndrome: a case-control study evaluating its relationship with body mass index and hand and wrist measurements. J Hand Surg Eur 2008; 33(4): 445–448.
- 26 Gordon C, Johnson EW, Gatens PF, Ashton JJ. Wrist ratio correlation with carpal tunnel syndrome in industry. Am J Phys Med Rehabil 1988; 67(6): 270–272.
- 27 Johnson EW, Gatens T, Poindexter D, Bowers D. Wrist dimensions: correlation with median sensory latencies. Arch Phys Med Rehabil 1983; 64(11): 556–557.
- 28 Nathan PA, Keniston RC. Carpal tunnel syndrome and its relation to general physical condition. Hand Clinics 1993; 9(2): 253–261.
- 29 Radecki P. A gender specific wrist ratio and the likelihood of a median nerve abnormality at the carpal tunnel. Am J Phys Med Rehabil 1994; 73(3): 157–162.
- 30 Chiotis K, Dimisianos N, Rigopoulou A, Chrysanthopoulou A, Chroni E. Role of anthropometric characteristics in idiopathic carpal tunnel syndrome. Arch Phys Med Rehabil 2013; 94(4): 737–744.
- 31 Sharifi-Mollayousefi A, Yazdchi-Marandi M, Ayramlou H, Heidari P, Salavati A, Zarrintan S. Assessment of body mass index and hand anthropometric measurements as independent risk factors for carpal tunnel syndrome. Folia Morphol 2008; 67(1): 36–42.
- 32 Sposato RC, Riley MW, Ballard JL, Stentz TL, Glismann CL. Wrist squareness and median nerve impairment. J Occup Environ Med 1995; 37(9): 1122–1126.
- 33 Kamolz LP, Beck H, Haslik W, Högler R, Rab M, Schrögendorfer KF, Frey M. Carpal tunnel syndrome: a question of hand and wrist configurations? J Hand Surg Br 2004; 29(4): 321–324.
- 34 Stetson DS, Albers JW, Silverstein BA, Wolfe RA. Effects of age, sex, and anthropometric factors on nerve conduction measures. Muscle Nerve 1992; 15(10): 1095–1104.
- 35 Boz C, Ozmenoglu M, Altunayoglu V, Velioglu S, Alioglu Z. Individual risk factors for carpal tunnel syndrome: an evaluation of body mass index, wrist index and hand anthropometric measurements. Clin Neurol Neurosurg 2004; 106(4): 294–299.
- 36 Chroni E, Paschalis C, Arvaniti C, Zotou K, Nikolakopoulou A, Papapetropoulos T. Carpal tunnel syndrome and hand configuration. Muscle Nerve 2001; 24(12): 1607–1611.
- 37 Moghtaderi A, Izadi S, Sharafadinzadeh N. An evaluation of gender, body mass index, wrist circumference, and wrist ratio as independent risk factors for carpal tunnel syndrome. Acta Neurol Scand 2005; 112(6): 375–379.
- 38 Garg A, Hegmann KT, Wertsch JJ, Kapellusch J, Thiese MS, Bloswick D, Merryweather A, Sesek R, Deckow-Schaefer G, Foster J, Wood E. The WISTAH hand study: a prospective cohort study of distal upper extremity musculoskeletal disorders. BMC Musculoskelet Disord 2012; 13(1): 90.
- 39 Werner RA, Albers JW, Franzblau A, Armstrong TJ. The relationship between body mass index and the diagnosis of carpal tunnel syndrome. Muscle Nerve 1994; 17(6): 632–636.
- 40 Hegmann KT, Thiese MS, Kapellusch J, Merryweather AS, Bao S, Silverstein B, Wood EM, Kendall R, Wertsch J, Foster J, Garg A. Association between cardiovascular risk factors and carpal tunnel syndrome in pooled occupational cohorts. J Occup Environ Med 2016; 58(1): 87–93.
- 41 Lim PG, Tan S, Ahmad TS. The role of wrist anthropometric measurement in idiopathic carpal tunnel syndrome. J Hand Surg Eur 2008; 33(5): 645–647.
- 42 Shiri R. A square-shaped wrist as a predictor of carpal tunnel syndrome: a meta-analysis. Muscle Nerve 2015; 52(5): 709–713.
- 43 Becker J, Nora DB, Gomes I, Stringari FF, Seitensus R, Panosso JS, Ehlers JA. An evaluation of gender, obesity, age, and diabetes mellitus as risk factors for carpal tunnel syndrome. Clin Neurophysiol 2002; 113(9): 1429–1434.
- 44 Lam N, Thurston A. Association of obesity, gender, age, and occupation with carpal tunnel syndrome. Aust NZJ Surg 1998; 68(3): 190–193.
- 45 Kouyoumdjian JA, Morita MDPA, Rocha PRF, Miranda RC, Gouveia G. Body mass index and carpal tunnel syndrome. Arq Neuropsiquiatr 2000; 58(2A): 252–256.
- 46 Nathan PA, Keniston RC, Myers LD, Meadows KD. Obesity as a risk factor for slowing of sensory conduction of the median nerve in industry: a cross-sectional and longitudinal study involving 429 workers. J Occup Environ Med 1992; 34(4): 379–383.
- 47 Mondelli M, Aprile I, Ballerini M, Ginanneschi F, Reale F, Romano C, Rossi S, Padua L. Sex differences in carpal tunnel syndrome: comparison of surgical and nonsurgical populations. Eur J Neurol 2005; 12(12): 976–983.
- 48 Coggon D, Ntani G, Harris EC, Linaker C, Van der Star R, Cooper C, Palmer KT. Differences in risk factors for neurophysiologically confirmed carpal tunnel syndrome and illness with similar symptoms but normal median nerve function: a case–control study. BMC Musculoskelet Disord 2013; 14(1): 240.
- 49 Crossman MW, Gilbert CA, Travlos A, Craig KD, Eisen A. Nonneurologic hand pain versus carpal tunnel syndrome: do psychological measures differentiate? Am J Phys Med Rehabil 2001; 80(2): 100–107.
Citing Literature
