The relationship between body mass index and the diagnosis of carpal tunnel syndrome.
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Body Mass Index↗
Biomedical subjects
K D Meadows
Publications and source records attributed to K D Meadows.
Predictive value of nerve conduction measurements at the carpal tunnel.
We compared the predictive values of three measurements of sensory conduction of the median nerve at the carpal tunnel (maximum latency difference [MLD], 8-cm latency [S8], and 14-cm latency [S14]) in 2334 hands of industrial workers, workers' compensation patients, and students. The MLD was determined by the centimetric technique. The MLD was the most sensitive and efficient measurement for predicting carpal tunnel syndrome (CTS). An MLD > or = 0.40 ms correctly identified 86.3% of 753 hands with CTS. The MLD correlated best with CTS and with the primary diagnostic category (CAT). MLD was the second factor selected in stepwise regression analysis for CAT (numbness was first and S8 was third). The MLD was the most important factor for predicting persistent or de novo CTS in a 5-year follow-up of 630 hands. Thus, the MLD was the most reliable nerve conduction study measurement for predicting current or future CTS in these subjects' hands.
Adult↗
Rehabilitation of carpal tunnel surgery patients using a short surgical incision and an early program of physical therapy.
One goal of surgery for carpal tunnel syndrome is to return the patient to work or full-time activities in the shortest possible period of time. The authors evaluated the effectiveness of two incisions, a short incision less than 2.5 cm and an incision greater than 2.5 cm, both combined with a program of active postoperative hand-therapy in a group of 216 patients (293 release). When compared to other techniques with or without active physical therapy, our combined program achieved as short a median return-to-work interval as any other method, both for workers' compensation patients (21 days) and for private/Medicare/welfare patients (10 days). The operating time averaged 7 minutes, and postoperative complications were few. The findings suggest that early hand therapy is more important than the short incision for minimizing the interval for regaining normal function and for decreasing the time-loss cost.
Adolescent↗
Validation of occupational hand use categories.
As part of a study of the etiology of carpal tunnel syndrome in industry, we developed a measure of occupational hand use activities, "Occupational Hand Use" (OHU), using 471 workers from four industries. This categorization has five categories based primarily upon observed relative force and secondarily upon observed relative repetitions. Because the validity of this OHU categorization has been questioned, we devised a study to validate this variable by demonstrating its reliability. Using discriminant analysis, we show that the OHU categorization accurately reflects the subjective impressions of other industrial workers (605 workers from four other industries in the United States and Japan). Within each validation industry, 68 to 88% of all workers were classified precisely to the correct OHU category, and an additional 10 to 25% were classified to within one OHU category, for a hit or near-miss rate of 87 to 98%. The major classification error was due to some workers overestimating the repetitiousness of their jobs. An equation for calculating OHU from subjective or objective data is provided.
Adult↗
Cumulative trauma disorders of the upper extremities.
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Arm↗
Simple decompression of the ulnar nerve: an alternative to anterior transposition.
Anterior transposition and/or medial epicondylectomy are often considered procedures of choice for ulnar neuropathy at the elbow. Much experience suggests simple decompression to be a comparably effective alternative which involves less trauma, morbidity, and rehabilitation time. The post-operative clinical and electrophysiological results of 52 cases of simple decompression (41 patients) are summarized. Excellent or good clinical results were found in 75% of the nerves. Mean ulnar motor conduction velocities were significantly improved post-operatively, although nerve conduction parameters did not consistently correlate with clinical outcome. The average return-to-work time was 5.1 weeks. The advantages of simple decompression make it the procedure of choice for most cases of ulnar neuropathy.
Adult↗
Longitudinal study of median nerve sensory conduction in industry: relationship to age, gender, hand dominance, occupational hand use, and clinical diagnosis.
As part of a longitudinal study of the cause of carpal tunnel syndrome in industry, we evaluated sensory conduction of the median nerve in relation to age, gender, hand dominance, occupational hand use, and clinical diagnosis. The original 1984 study group consisted of 942 hands of 471 industrial workers, and the follow-up study group in 1989 consisted of 630 hands of 316 (67%) of these same workers. The palmar segmental stimulation technique was employed, and slowing was defined as a maximum latency difference of 0.4 msec or more after adjustment for temperature variation. There was no significant change in the prevalence of slowing between 1984 and 1989 (23% in 1984, 22% in 1989), and slowing was still strongly correlated with increased age but not with gender. Slowing continued to be more prevalent in the dominant hand. Slowing was no longer correlated in any fashion with occupational hand use. The prevalence of probable carpal tunnel syndrome was still strongly correlated with the degree of slowing. Age and hand dominance were more important than any job-related factor in the prediction of slowing after 5 years.
Adolescent↗
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.
As part of a longitudinal study of the etiology of carpal tunnel syndrome in industry, we evaluated weight and body mass index (BMI) as risk factors for slowing of sensory conduction of the median nerve. Using nerve conduction studies, we evaluated 858 hands of 429 industrial workers in 1984 and reevaluated 630 hands of 316 of these same workers in 1989. Weight and BMI were strongly and positively correlated with the maximum latency difference (MLD). In 1984 and 1989 the risk for abnormal nerve conduction averaged 3.5-fold and 4.1-fold greater, respectively, in the obese workers than in the slender workers. In stepwise regression analysis for 1989 MLD based on 1984 factors, the BMI was the number one factor selected, followed by age, wrist depth/width ratio, hand dominance, and exercise level. None of three 1984 job-related factors (occupational hand use, duration of employment, or industry) was an independent predictor of 1989 MLD. This study suggests that individual characteristics, not job-related factors, are the primary determinants of slowing of sensory conduction of the median nerve and carpal tunnel syndrome.
Adult↗
Location of impaired sensory conduction of the median nerve in carpal tunnel syndrome.
Sensory conduction of the median nerve at the carpal tunnel for eight consecutive 1 cm segments of the nerve was evaluated in 217 hands of 153 of our patients with carpal tunnel syndrome. Impairment was found to be highly focal and often confined to a single 1 cm segment of the nerve. The section of the nerve at or just distal to the distal margin of the carpal tunnel was affected most frequently, the section within the tunnel was affected less often, and the section proximal to the tunnel at the level of the mid-carpal and radio-carpal joints was affected least. The greatest contrast between frequencies of slowing at adjacent segments occurred at the proximal and distal margins of the carpal tunnel. The distribution of the nerve impairment was similar between the sexes; however, among the men the segment affected most frequently was located 1 cm distal to the segment affected most frequently among the women. The general pattern of slowing which we found does not substantiate some commonly-held opinions about the aetiology of carpal tunnel syndrome.
Adult↗
Comparison of sensory latencies of the median nerve at the carpal tunnel among juveniles and adults.
Five hundred and ninety-three juveniles and adults were studied to determine if there was an age-related trend in the occurrence of sensory nerve conduction latencies of the median nerve at the carpal tunnel. Latencies were found to increase with increasing age in both the dominant and nondominant hands of the subjects. A significant and positive correlation was found between the latencies of both hands, indicating that an increased value in one hand is likely to be associated with an increased value in the other. Among the adults, the latencies were found to be consistently greater for the dominant hand.
Adolescent↗
Relationship of age and sex to sensory conduction of the median nerve at the carpal tunnel and association of slowed conduction with symptoms.
A cross-sectional study of 471 randomly selected employees from 4 industries was performed to assess the prevalence of slowing of sensory conduction of the median nerve at the carpal tunnel as well as the effect of age and sex on slowing. The association between slowed conduction and symptoms of carpal tunnel syndrome (CTS) was also evaluated. Slowing was identified in 17% of the subjects and in 11% of the hands. The prevalence and the severity of slowing increased with increasing age of the subjects. Slowed conduction occurred more often among the women in the study, but this was shown to be an effect of age and not of sex. Slowing occurred six times more often in hands with symptoms of CTS than in those not reporting symptoms.
Adult↗
Occupation as a risk factor for impaired sensory conduction of the median nerve at the carpal tunnel.
471 industrial employees from 27 occupations in four industries were surveyed to evaluate the role of occupational hand activity as a risk factor for slowing of sensory conduction of the median nerve at the carpal tunnel. After age-adjusting the latency values, slowing of the sensory fibres of the median nerve was found in 39% of the subjects and in 26% of the hands. No consistent association was found between the type and the level of occupational hand activity and the prevalence or the severity of slowing. In addition, the prevalence of bilateral slowing of conduction of the median nerve was not associated with bimanual occupational hand activity, and the length of employment of the subjects in the current industry did not influence the occurrence of impaired sensory conduction of the median nerve at the carpal tunnel.
Carpal Tunnel Syndrome↗
Sensory segmental latency values of the median nerve for a population of normal individuals.
Seventy hands of 38 individuals without carpal tunnel syndrome (CTS) were compared with 54 hands of 30 age- and sex-matched patients with a clinical diagnosis of CTS. The comparison was performed in order to determine the limits for normal-usual values for sensory nerve conduction latency values of the median nerve in the area of the wrist, using the segmental stimulation technique in 1 cm increments described by Kimura. Kimura has recognized 0.5msec as the criterion for abnormality. In this study the segmental latency value of 0.4msec was also found to fall outside the range of normal-usual values. Although 0.5msec provides a higher degree of specificity (97%), its sensitivity is limited (54%). By contrast, 0.4msec provides an enhanced sensitivity (81%) while maintaining what we feel is an acceptable amount of specificity (81%). Although the predictive accuracy of 0.4msec (77%) is less than that of 0.5msec (93%), both values have merit in confirming CTS. With 0.5msec the clinician can be assured that relatively few normal individuals will be included in the CTS group; however, use of this value may result in a high number of false negative results. In contrast, 0.4msec affords the clinician the increased sensitivity needed to make a diagnosis of CTS in those cases where the conduction deficit is subtle and highly localized; but associated with its use is the possibility of false positive results. In both cases, a thorough history and clinical examination are necessary to ensure correct interpretation of the nerve conduction study results.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Ulna-minus variance and Kienböck's disease.
A 29-year-old woman meat wrapper with long-standing bilateral carpal tunnel syndrome had an incidental finding of severe unilateral ulna-minus variance caused by a childhood injury. Despite the strenuousness of the patient's occupation and the severity of the abnormality, there was no clinical or radiologic evidence of lunatomalacia (kienböck's disease) on the affected side, indicating that there is not necessarily a direct causal relationship between ulna-minus variance and lunatomalacia.
Adult↗
Neuromusculoskeletal conditions of the upper extremity: are they due to repetitive occupational trauma?
The significance of neuromusculoskeletal conditions in the workplace is the subject of much discussion among occupational medicine professionals. There are differing philosophies as to what constitutes appropriate diagnostic criteria for identification of these conditions. The traditional diagnostic model requires the presence of objective pathology. An emerging symptom-based model accepts that symptoms by themselves can constitute a diagnostic entity. The extent to which these conditions are considered to be associated with occupational activity depends greatly upon which of the two models is employed. This chapter presents an overview of each diagnostic model and a discussion of the impact each has on the prevalence of identified conditions and the manner in which the various diagnostic requirements can affect treatment, prevention, and disability rating protocols.
Arm↗