Effectiveness of prevention exercises protocol among office workers with symptoms of carpal tunnel syndrome.

OBJECTIVES: Carpal tunnel syndrome (CTS) is common among office workers and limits functional hand ability and the ability to work. Carpal tunnel syndrome prevention programs implementation are still insufficient among office workers. In view of the fact that physical activity is the best method of preventing musculoskeletal complaints the aim of the study was to evaluate the effectiveness of prevention exercises protocol for hand and wrist pain among office workers. MATERIAL AND METHODS: Study group consists form 62 office workers, reporting complaints of hand and wrist pain. Exercise group it was 49 subjects who performed the exercise protocol and the non-exercise group consisted of 13 subjects. An exercises program, consisting of 7 exercises. The program was planned for daily routine during 8 weeks. The effectiveness of the exercise program was assessed by physical parameters (hand grip and pinch grip strength, force of forearm muscles) and questionnaires (Visual Analog Scale pain scale, Carpal Tunnel Syndrome Symptom Severity Scale, and Carpal Tunnel Syndrome Functional Status Scale functional hand assessment questionnaires) were performed. Assessment was performed before and after the intervention. RESULTS: Statistical analysis of the data showed significant changes in the value of measured hand grip of the right hand (Z = -2.85, p < 0.01). For pinch grip, changes were significant for both the right (Z = -2.12, p < 0.05) and the left hands (Z = -2.35, p < 0.05). Functional performance improved significantly in bought groups. There was no statistically significant change in the intensity of experienced pain. CONCLUSIONS: The results of the study indicate that performing a preventive exercise program regularly has an effect on increasing forearm muscle strength in a group of office workers. Office workers with symptoms of CTS who exercised regularly had higher results in hand grip and pincer grip strength. Exercises do not affect the level of pain complaints, which may indicate a more complex etiology of pain perception in this study group. Int J Occup Med Environ Health. 2024;37(1):45-57.

Device to relate the superficial temperature of the forearm and the muscular conditioning of the flexor muscle for prevention of carpal tunnel syndrome in E-sports.

Currently, various labor and competitive sectors use computing devices as the primary development tool, one of them being e-sports or electronic sports. Constant use of the computer involves repetitive use of the fingers' superficial and deep flexor muscles, which causes the median nerve to squeeze and irritate in the carpal tunnel space causing carpal tunnel syndrome (CTS). There are methods that can minimize stress on the hands and wrists through muscle conditioning. However, there are no quantifiable indicators of the conditioning performed. Therefore, this work aims to develop a device capable of conditioning the flexor muscles and indicate in a quantifiable way the conditioning carried out as prevention of carpal tunnel syndrome. After the analysis of these data, a direct relationship between the surface temperature of the forearm and the muscular conditioning of the flexors is observed. The temperature variation during conditioning is greatest in the distal forearm with a range of [32.76-34.38]°. Post-conditioning temperature retention is greater in the distal forearm over time.

Women's wrist and elbow at work: analysis of acute injuries and cumulative trauma disorders to improve ergonomics in female-dominated activities.

The aim of this study is to analyse women's wrist and elbow acute work injuries together with cumulative trauma disorders, such as carpal tunnel syndrome (CTS) and epicondylitis. Five years records (2015-2019) on women's wrist/elbow acute work injuries and CTS/epicondilytis, from Italian National Compensation Authority, were collected and pooled all together as 'dis-ac' (disorders + acute) events. A statistical analysis was performed in comparing the different female-dominated work sectors. Results showed that hairdressing/laundry sector was associated with the highest risk for wrist acute work injuries and cleaning for elbow while manufacturing for CTS and epicondylitis. Hairdressing/laundry and manufacturing were associated with the highest risk for dis-ac events (hairdressing: wrist dis-ac OR: 4.89; CI 95% 4.22-5.67; elbow dis-ac OR: 3.70; CI 95% 2.99-4.58; manufacturing: wrist dis-ac OR: 3.39; CI 95% 3.13-3.66; elbow dis-ac OR: 2.45; CI 95% 2.20-2.73). The relationship between acute injuries and cumulative trauma disorders is discussed to preserve women's safety and health in ergonomics.Practitioner Summary: Women's wrist and elbow acute work injuries and cumulative trauma disorders (carpal tunnel syndrome and epicondylitis) were analysed and studied all together (dis-ac events) in female-dominated activities. Hairdressing and manufacturing work sectors were associated with the highest risk, showing the need to safeguard the health and safety of female workers.

Strategies for the prevention of carpal tunnel syndrome in the workplace: A systematic review.

Carpal Tunnel Syndrome (CTS) is one of the most frequently occurring musculoskeletal disorders of the upper limbs. Strategies for preventing CTS in the workplace include interventions such as ergonomics, education, exercise, physical therapy, and occupational health. The purpose of this study was to provide a general overview based on the review of scientific literature regarding strategies used for preventing CTS in working populations. From September to October 2018, the MEDLINE, PUBMED, EMBASE and SCOPUS (1990 to December 2017) databases were searched for evidence. The risk of bias assessment in the selected papers was evaluated using the criteria recommended by The Cochrane Handbook and the methodological quality of the included studies was evaluated using Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. A total of 11 studies were included in the present review. A total of 1,061 subjects participated in the studies. The quality of the included studies was limited in three studies, appropriate in three studies, good in three studies, and strong in two studies. The overall results suggest a mixed level of evidence of the effect of applying strategies for preventing CTS in the workplace. The bias assessment was primarily due to incomplete result data, selective reporting of results, and blinding. In this review, interventions focused on the modification or change of accessories (keyboard, mouse, wrist rest, and the overall workstation), education in ergonomics, exercise, and physical therapies, among others, were analyzed. The findings of this review show different possibilities when choosing an intervention strategy for the workplace. However, it was challenging to analyze each of the papers owing to the heterogeneity of the studies included.

Ergonomics and musculoskeletal disorders in neurosurgery: a systematic review.

BACKGROUND: Work-related musculoskeletal disorders (WMSDs) are a growing and probably undervalued concern for neurosurgeons and spine surgeons, as they can impact their quality of life and career length. This systematic review aims to ascertain this association and to search for preventive measures. METHODS: We conducted a PRISMA-P-based review on ergonomics and WMSDs in neurosurgery over the last 15 years. Twelve original articles were included, of which 6 focused on spine surgery ergonomics, 5 cranio-facial surgery (mainly endoscopic), and one on both domains. RESULTS: We found a huge methodological and content diversity among studies with 5 surveys, 3 cross-sectional studies, 2 retrospective cohorts, and 2 technical notes. Spine surgeons have sustained neck flexion and neglect their posture during surgery. In a survey, low back pain was found in 62% of surgeons, 31% of them with a diagnosed lumbar disc herniation, and 23% of surgery rate. Pain in the neck (59%), shoulder (49%), finger (31%), and wrist (25%) are more frequent than in the general population. Carpal tunnel syndrome showed a linear relationship with increasing cumulative hours of spine surgery practice. Among cranial procedures, endoscopy was also significantly related to shoulder pain while pineal region surgery received some attempts to optimize ergonomics. CONCLUSIONS: Ergonomics in neurosurgery remains underreported and lack attention from surgeons and authorities. Improvements shall target postural ergonomics, equipment design, weekly schedule adaptation, and exercise.

Case-Control Study of Ultrasound Evaluation of Acute Median Nerve Response to Upper Extremity Circuit Training in Spinal Cord Injury.

OBJECTIVE: Individuals with spinal cord injury (SCI) often present signs and symptoms of median nerve (MN) pathology. Preclinical signs identification of MN pathology might facilitate early intervention to prevent or delay carpal tunnel syndrome in SCI. We assessed if ultrasound parameters changed in response to upper extremity (UE) circuit training exercise in individuals with paraplegia and able-bodied individuals. DESIGN: Case-control study. PARTICIPANTS: Adults (N=32) with paraplegia (n=16) and age- and sex-matched able-bodied controls (n=16). INTERVENTION: Circuit training exercise. MAIN OUTCOME MEASURES: MN ultrasound evaluation at the pisiform and radius before and after UE exercise. Ultrasound parameters included cross-sectional area (CSA), and gray scale (GS). Data presented as mean ± SD. RESULTS: Pre-exercise CSAs were larger in SCI at the radius (12.0±2.9 vs 9.0±2.1; P=.003), but not the pisiform (9.8±3.1 vs 9.1±1.7; P=.431). There were no statistical differences in MN response to exercise between groups (all P≥.293). Across participants, CSA changes were inversely associated with their pre-exercise values at the pisiform (r=-0.648; P<.001) and the radius (r=-0.366; P=.043). Participants with pre-exercise CSA values ≥10.00 mm2 at the pisiform responded to exercise with decreases in CSA (mean change ± SD, -2.0±1.5; P=.002) and GS (-2.8±6.2; P=.029). Participants with pre-exercise CSA ≤9.99 mm2 at the pisiform responded to exercise with no change in CSA (mean change ± SD, 0.7±2.5; P=.002) and increased GS (3.2±7.2; P=.029). CONCLUSIONS: CSA exercise response was more strongly related to pre-exercise MN values than presence or absence of SCI.

Theoretical impact of simulated workplace-based primary prevention of carpal tunnel syndrome in a French region.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy in the working-age population. The reduction of CTS incidence in the workforce is a priority for policy makers due to the human, social and economic costs. To assess the theoretical impact of workplace-based primary interventions designed to reduce exposure to personal and/or work-related risk factors for CTS. METHODS: Surgical CTS were assessed using regional hospital discharge records for persons aged 20-59 in 2009. Using work-related attributable fractions (AFEs), we estimated the number of work-related CTS (WR-CTS) in high-risk jobs. We simulated three theoretical scenarios of workplace-based primary prevention for jobs at risk: a mono-component work-centered intervention reducing the incidence of WR-CTS arbitrarily by 10% (10%-WI), and multicomponent global interventions reducing the incidence of all surgical CTS by 5% and 10% by targeting personal and work risk factors. RESULTS: A limited proportion of CTS were work-related in the region's population. WR-CTS were concentrated in nine jobs at high risk of CTS, amounting to 1603 [1137-2212] CTS, of which 906 [450-1522] were WR-CTS. The 10%-WI, 5%-GI and 10%-GI hypothetically prevented 90 [46-153], 81 [58-111] and 159 [114-223] CTS, respectively. The 10%-GI had the greatest impact regardless of the job. The impact of the 10%-WI interventions was high only in jobs at highest risk and AFEs (e.g. food industry jobs). The 10%-WI and 5%-GI had a similar impact for moderate-risk jobs (e.g. healthcare jobs). CONCLUSION: The impact of simulated workplace-based interventions suggests that prevention efforts to reduce exposure to work-related risk factors should focus on high-risk jobs. Reducing CTS rates will also require integrated strategies to reduce personal risk factors, particularly in jobs with low levels of work-related risk of CTS.

Does routine carpal tunnel release during fixation of distal radius fractures improve outcomes?

OBJECTIVE: This case-control study was designed to test the hypothesis whether carpal tunnel release (CTR) during fixation of distal radius 23-C2 AO fractures improves outcomes. METHODS: Thirty-five consecutive patients who sustained distal radius fractures of the dominant hand participated in this study. Patients were allocated into two groups: (a) The ORIF + CTR (16 patients (11 males and 5 females)); (b) the ORIF and NOT CTR 19 patients (12 males and 7 females). Patient assessment included visual analogic scale of pain (VAS), the subjective Mayo Wrist Score (MWS), electromyograms (EMG) at 3 month and 6 months from the day of injury and complications. All patients had the same physiotherapy treatment algorithm following surgery. Patient follow up took place at 1 month, 3, 6, and 12 months. RESULTS: A the T12 month follow up point the VAS average was 0.8 (range 0-3) in ORIF + CTR group compared to 1.2 (range 0-3) in the ORIF and NOT CTR. The MWS average was 98.7 (range 95-100) in ORIF + CTR group versus 97.6 (range 95-100) in ORIF no CTR group. There was no statistical significance (p > 0.5) between the two groups during the follow up period. Patients in the sixth month of ORIF + CTR had no suffering of the median nerve, while 31.58% of patients in ORIF and no CTR found to have carpal tunnel syndrome. CONCLUSIONS: Routine release of the transverse carpal ligament at the time of fracture fixation may reduce the incidence of postoperative median nerve dysfunction.

Carpal spasm in a girl as initial presentation of celiac disease: a case report.

BACKGROUND: Celiac disease is an immune-mediated disorder elicited by ingestion of gluten in genetically susceptible persons. This disorder is characterized by specific histological changes of the small intestine mucosa resulting in malabsorption. This case was written up as it was an unusual and dramatic presentation of celiac disease. CASE PRESENTATION: We report the case of a 3-year-old Albanian girl who presented at our clinic with carpal spasms and hand paresthesia. A physical examination at admission revealed a relatively good general condition and body weight of 10.5 kg (10 percentile). Carpal spasms and paresthesias of her extremities were present. Neuromuscular irritability was demonstrated by positive Chvostek and Trousseau signs. Blood tests showed severe hypocalcemia with a total serum calcium of 1.2 mmol/L (normal range 2.12 to 2.55 mmol/L), ionized calcium of 0.87 (normal range 1.11 to 1.30 mmol/L), and 24-hour urine calcium excretion of 9.16 mmol (normal range female <6.2 mmol/day). Among other tests, screening for celiac disease was performed: antigliadin immunoglobulin A, anti-tissue transglutaminase, and anti-endomysial immunoglobulin A antibodies were positive. A duodenal biopsy revealed lymphocyte infiltration, crypt hyperplasia, and villous atrophy compatible with celiac disease grade IIIb according to the Marsh classification. Following the diagnosis of celiac disease, human leukocyte antigen typing was performed, giving a definite diagnosis of celiac disease. She was started on a gluten-free diet. Due to failure to follow a gluten-free diet, episodes of carpal spasms appeared again. Unfortunately, at the age of 7 years she presents with delayed psychophysical development. CONCLUSIONS: Although hypocalcemia is a common finding in celiac disease, hypocalcemic carpal spasm is a rare initial manifestation of the disease. Therefore, the possibility of celiac disease should be considered in patients with repeated carpal spasms that seem unduly difficult to treat. This should be evaluated even in the absence of gastrointestinal symptoms since hypocalcemia and its manifestation may present as initial symptoms of celiac disease even in young children.

Prevalence of low back pain and carpal tunnel syndrome among dental practitioners in Dakshina Kannada and Coorg District.

CONTEXT: Dental practitioners who usually have to work for long durations in a particular fixed posture are more prone to musculoskeletal disorders (MSDs), particularly those involving the hand and wrist and also of the lower back. AIMS: To study the prevalence of carpal tunnel syndrome (CTS) and low back pain (LBP) among dental practitioners and to correlate the symptoms with the duration of practice. SUBJECTS AND METHODS: A closed-end questionnaire was distributed to 100 dental practitioners from Dakshina Kannada and Coorg districts of Karnataka, India. STATISTICAL ANALYSIS USED: Analyses were carried out using Chi-square test and Fisher's exact test. RESULTS: The study found that 86% of the total population of dentists practicing for more than 5 years showed symptoms of CTS and 54.0% experienced LBP. CONCLUSION: Symptoms of MSDs related to hands, wrists, and low back is widely prevalent among the dentists, which severely impact their work efficiency. Precautionary measures early in the clinical practice such as proper ergonomics in the operating field and few strengthening exercises as described in this study can reduce the onset and progression of the symptoms.

Síndrome do túnel do carpo na esfera trabalhista / Carpal tunnel syndrome in labor field

Contexto: As doenças do sistema musculoesquelético continuam a figurar entre as maiores causas de incapacidade e absenteísmo na população de trabalhadores em geral. O impacto dessas afecções reflete-se em número considerável de reclamações e processos trabalhistas. O perito médico e o médico do trabalho precisam estar familiarizados com essas doenças e seus fatores de risco para que os primeiros possam realizar uma avaliação isenta e embasar seus laudos tecnicamente, e os segundos, atuar na sua prevenção e em diagnóstico precoces. Objetivos: Realizar revisão bibliográfica para estabelecer o "estado da arte" do conhecimento médico acerca da síndrome do túnel do carpo, voltado para as práticas de Medicina do Trabalho e Perícias Médicas. Métodos: Levantamento bibliográfico dos últimos cinco anos referente aos aspectos clínicos da STC, com especial ênfase à sua epidemiologia, fisiopatologia, principais diagnósticos diferenciais, tratamento e prognóstico, assim como dos chamados riscos ocupacionais. Para contextualização do tema no universo médico pericial trabalhista, enquadramento de deficiências e prognóstico de retorno ao trabalho, foram selecionadas publicações de fontes nacionais e internacionais. Resultados: Pela Cochrane, foram apresentados 28 artigos por meio das buscas, dos quais 7 foram selecionados e 21 descartados; e, pela PubMed, foram apresentados 39 artigos, dos quais 11 foram selecionados e 28 descartados. Conclusões: A síndrome do túnel do carpo, mononeuropatia compressiva mais comum dos membros superiores, apresenta características peculiares quanto à sua etiologia e ao seu prognóstico, que devem ser bem conhecidos pelo médico perito e pelo médico do trabalho, o qual pode agir na prevenção e no diagnóstico precoce da doença.

Context: The musculoskeletal system diseases remain among the major causes of disability and absenteeism in the population of general workers . The impact of these diseases is reflected in a considerable number of complaints and labor proceedings. The medical expert and occupational physician need to be familiar with these diseases and their risk factors so that the former can carry out a free evaluation and provide technical support to their reports, whereas the latter can act in their early prevention and diagnosis. Objectives: To perform a literature review to establish the "state-of-the-art" of medical knowledge about carpal tunnel syndrome, directed to the practices of Occupational Medicine and Medical Expertise. Methods: Bibliographic survey of the last five years with regard to the clinical aspects of the carpal tunnel syndrome, with special emphasis on its epidemiology, pathophysiology, main differential diagnosis, treatment and prognosis, as well as so-called "occupational hazards". Publications from national and international sources were selected to contextualize the theme in the labor expertise medical universe, in the disability framing, and in the work return prognosis. Results: Cochrane presented 28 articles through searches, of which 7 were selected and 21 were removed. PubMed displayed 39 articles, of which 11 were selected and 28 were removed. Conclusions: Carpal tunnel syndrome, the most common compression mononeuropathy of the upper limbs, has peculiar characteristics as to its etiology and prognosis that should be well-known by the Medical Expert and the Occupational Physician, who can act in the prevention and early diagnosis of such disease.

Experiences with preventing carpal tunnel syndrome in an automotive plant.

OBJECTIVES: Carpal tunnel syndrome (CTS) is a common occupational disease. The aim was to assess the effect of preventive measures in automotive assembly workers. MATERIAL AND METHODS: The analysis summarizes data from annual crosssectional studies. The 7-year analysis of data was based on medical records obtained from an occupational physician and inspections carried out at the workplace where targeted preventive measures were introduced, including better ergonomic arrangement of the workplace, technical adjustments facilitating the work, preventive nerve conduction studies (NCS) testing of the median nerve once a year, switching of workers and their targeted rotation within the workplace. The NCS testing of median nerve conduction at the wrist was the basic objective method for assessment of the prevalence and severity of CTS. Over the study period, the sample comprised 1804 workers at risk for repetitive overuse of the upper extremities, of whom 281 were females with a mean age of 38.5 years and 1523 were males with a mean age of 31.4 years. RESULTS: Over the study period, a total of 13 cases of CTS were recognized as an occupational disease in the plant, 8 of which occurred within the first 2 years from the initiation of production. Introduction of preventive measures decreased the prevalence of median neuropathy from 18.3% of examined extremities in 2011 to 10.5% in 2013 (p = 0.003). In early 2014, the production pace increased and this was accompanied by a rise in abnormal NCS findings to 16.9%. Over the study period, the rate of sensorimotor neuropathy decreased in favor of merely sensory neuropathies, which have been most frequent since 2013. The percentage of employees whose contracts were terminated due to median neuropathy decreased steadily from 5.5% to 0.4%. CONCLUSIONS: Targeted prevention of work-related CTS is effective as evidenced by the decrease in the prevalence of median neuropathy detected by NCS. Int J Occup Med Environ Health 2017;30(1):45-54.

Estudio sobre la influencia del diámetro de apertura en la fuerza ejercida por cada dedo / A study on the influence of grip span on the strength exerted by each finger

RESUMEN Objetivo Estudiar el efecto de mantener un mismo diámetro de apertura en los dedos sobre la fuerza actuante de éstos en un agarre de fuerza. Métodos Se condujo un experimento con 30 participantes (15 hombres y 15 mujeres) quienes realizaron el gesto de aprehensión en un dispositivo diseñado para mantener constante la apertura para todos los dedos en 4 diámetros diferentes. Resultados Se muestra evidencia que en un rango de accionamiento entre 0-75% de la apertura funcional, los dedos índice, corazón y anular ejercen una fuerza significativamente igual si el diámetro de apertura se mantiene constante. Conclusiones Este hallazgo permitiría reducir la exposición de los operarios de herramientas de corte a factores de riesgo de síndrome del conducto carpiano (SCC). Se sugiere que en el diseño de herramientas, la distancia de apertura para todos los dedos debe mantenerse constante durante el gesto de aprehensión.(AU)

ABSTRACT Objective To study the effect of maintaining the same grip span between the thumb and exerting fingers, on the acting force of these in a power grip. Methods We conducted an experiment with 30 participants (15 men and 15 women) who made the gesture of apprehension in a device designed to maintain constant grip span to all fingers in 4 different diameters. Results In the range between 0-75 percent of functional grip span of the fingers, the index, middle and ring finger exert a force significantly equal when the aperture diameter is maintained constant. Conclusions These findings would reduce exposure to risk factors for carpal canal syndrome (CTS) in cutting activities, by controlling risk factors like strength. We suggest that on the design of tools, the opening distance for all the fingers must remain constant during the act of apprehension.(AU)

Do exposure limits for hand-transmitted vibration prevent carpal tunnel syndrome?

BACKGROUND: An apparently high frequency of carpal tunnel syndrome (CTS) among shipyard workers undergoing health surveillance because of exposure to hand-transmitted vibration (HTV) prompted concerns that current regulatory limits on exposure might not protect adequately against the disorder. AIMS: To explore whether within regulatory limits, higher exposures to HTV predispose to CTS. METHODS: As part of a retrospective audit, we compared duration and current intensity of exposure to HTV in cases with new-onset CTS and controls matched for age. Conditional logistic regression was used to quantify associations, which were summarized by odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: There were 23 cases and 55 controls. After adjustment for body mass index and previous diagnosis of diabetes, no clear associations were observed either with duration of exposure to HTV or with current intensity of exposure. Risk was non-significantly elevated in men with ≥30 years' exposure to HTV (OR 1.6), but in the highest category of current exposure [8-h energy-equivalent frequency-weighted acceleration (A8) ≥ 4.0 m/s(2)], risk was lower than that in the reference category (A8 < 2.5 m/s(2)). Moreover, there was a significantly reduced risk of CTS in men with a previous diagnosis of hand-arm vibration syndrome (HAVS) (OR 0.2, 95% CI 0.1-0.9). CONCLUSIONS: We found no evidence that below the current limit for A(8) of 5 m/s(2), higher exposures to HTV predispose to CTS. However, care should be taken not to overlook the possibility of treatable CTS when workers with diagnosed HAVS present with new or worsening sensory symptoms in the hand.

The surveillance of occupational diseases in Italy: the MALPROF system.

BACKGROUND: Occupational diseases data can guide efforts to improve worker's health and safety. AIMS: To describe MALPROF, the Italian system for surveillance of work-related diseases collected by the subregional Department of Prevention. METHODS: The MALPROF system started in 1999 with contributions from Lombardy and Tuscany and spread in the following years to collect contributions from 14 out of the 20 Italian regions. MALPROF data were explored to follow-up work-related diseases and to detect emerging occupational health risks by calculating proportional reporting ratio (PRR), as in pharmacosurveillance. It classified work-related diseases according to economic sector and job activity in which the exposure occurred. Occupational physicians of the Italian National Health Service evaluate the possible causal relationship with occupational exposures and store the data in a centralized database. RESULTS: From 1999 to 2012, the MALPROF system collected about 112000 cases of workers' diseases. In 2010, more than 13000 cases of occupational diseases were reported. The most frequently reported diseases were hearing loss (n = 4378, 32%), spine disorders (n = 2394, 17%) and carpal tunnel syndrome (n = 1560, 11%). The PRR calculated for cervical disc herniation, a disease whose occupational origin has to be studied, in 1999-2010 was 2.47 [95% confidence interval (CI) 1.76-3.47] for drivers and 36.64 (95% CI 22.03-60.93) for air transport workers. CONCLUSIONS: MALPROF is a sensitive system for identifying possible associations between occupational risks and diseases, it can contribute to the development of preventive measures, to evaluate the effectiveness of preventive interventions and to stimulate research on new occupational risks and diseases.

The effect of excess body mass on the risk of carpal tunnel syndrome: a meta-analysis of 58 studies.

We aimed to estimate the effects of overweight and obesity on carpal tunnel syndrome (CTS), and to assess whether sex modifies the associations. Literature searches were conducted in PubMed, Embase, Web of Science, Scopus, Google Scholar and ResearchGate databases from 1953 to February 2015. Fifty-eight studies consisting of 1,379,372 individuals qualified for a meta-analysis. We used a random-effects meta-analysis, assessed heterogeneity and publication bias, and performed sensitivity analyses. Overweight increased the risk of CTS or carpal tunnel release 1.5-fold (pooled confounder-adjusted odds ratio [OR] = 1.47, 95% CI 1.37-1.57, N = 1,279,546) and obesity twofold (adjusted OR = 2.02, 95% CI 1.92-2.13, N = 1,362,207). Each one-unit increase in body mass index increased the risk of CTS by 7.4% (adjusted OR = 1.074, 95% CI 1.071-1.077, N = 1,258,578). Overweight and obesity had stronger effects on carpal tunnel release than CTS. The associations did not differ between men and women, and they were independent of study design. Moreover, the associations were not due to bias or confounding. Excess body mass markedly increases the risk of CTS. As the prevalence of overweight and obesity is increasing globally, overweight-related CTS is expected to increase. Future studies should investigate whether a square-shaped wrist and exposure to physical workload factors potentiate the adverse effect of obesity on the median nerve.

In the Clinic. Carpal Tunnel Syndrome.

This issue provides a clinical overview of carpal tunnel syndrome, focusing on screening and prevention, diagnosis, and treatment. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

Carpal tunnel syndrome and computer exposure at work in two large complementary cohorts.

OBJECTIVES: The boom in computer use and concurrent high rates in musculoskeletal complaints and carpal tunnel syndrome (CTS) among users have led to a controversy about a possible link. Most studies have used cross-sectional designs and shown no association. The present study used longitudinal data from two large complementary cohorts to evaluate a possible relationship between CTS and the performance of computer work. SETTINGS AND PARTICIPANTS: The Cosali cohort is a representative sample of a French working population that evaluated CTS using standardised clinical examinations and assessed self-reported computer use. The PrediCTS cohort study enrolled newly hired clerical, service and construction workers in several industries in the USA, evaluated CTS using symptoms and nerve conduction studies (NCS), and estimated exposures to computer work using a job exposure matrix. PRIMARY AND SECONDARY OUTCOME MEASURES: During a follow-up of 3-5 years, the association between new cases of CTS and computer work was calculated using logistic regression models adjusting for sex, age, obesity and relevant associated disorders. RESULTS: In the Cosali study, 1551 workers (41.8%) completed follow-up physical examinations; 36 (2.3%) participants were diagnosed with CTS. In the PrediCTS study, 711 workers (64.2%) completed follow-up evaluations, whereas 31 (4.3%) had new cases of CTS. The adjusted OR for the group with the highest exposure to computer use was 0.39 (0.17; 0.89) in the Cosali cohort and 0.16 (0.05; 0.59) in the PrediCTS cohort. CONCLUSIONS: Data from two large cohorts in two different countries showed no association between computer work and new cases of CTS among workers in diverse jobs with varying job exposures. CTS is far more common among workers in non-computer related jobs; prevention efforts and work-related compensation programmes should focus on workers performing forceful hand exertion.

The Extended Flexor Carpi Radialis Approach for Concurrent Carpal Tunnel Release and Volar Plate Osteosynthesis for Distal Radius Fracture.

PURPOSE: To determine the relative benefits of an extended flexor carpi radialis (FCR) (eFCR) approach with prophylactic carpal tunnel release at the time of volar plate osteosynthesis for distal radius fracture via a single incision into the traditional volar Henry (VH) approach. METHODS: This was a prospective cohort comparison of preoperative and postoperative median nerve function of 27 patients (15 eFCR and 12 VH) with unilateral, isolated distal radius fractures requiring open reduction internal fixation without preoperative acute carpal tunnel syndrome. Patients were operated on via either the eFCR or VH approach. The validated Levine-Katz Carpal Tunnel Questionnaire (symptom and functional severity scores) was administered and Semmes-Weinstein monofilament and 2-point discrimination testing were conducted preoperatively and at 6 weeks and 3 months postoperatively. Grip and pinch strength were measured at 6 weeks and 3 months. The groups were comparable in terms of age, sex, and fracture type and displacement. RESULTS: Comparing across groups, there were no statistically significant differences in any outcome measured preoperatively or postoperatively. The eFCR and VH groups demonstrated significant improvement in functional severity scores, symptom severity, and grip strength. The symptom severity score improved to statistical significance at 6 weeks in the eFCR group and at 3 months in the VH group. CONCLUSIONS: In this small comparative study, the eFCR approach was found to be safe and efficacious. There was no increased surgical morbidity, which suggests that this technique can be used safely for all patients undergoing volar plating and not just in cases of concurrent carpal tunnel syndrome. It allows easier retraction of carpal tunnel contents; therefore, it is our preferred approach.