OBJECTIVE: To examine the relation between selected nonoccupational risk factors and surgery for carpal tunnel syndrome.
DESIGN: Case-control study using an administrative database.
PARTICIPANTS: Enrollees of New Jersey Medicine or Medicaid programs during 1989 to 1991.
MEASUREMENTS: The outcome of interest was open or endoscopic carpal tunnel release. We examined the relation between carpal tunnel release and diabetes mellitus, thyroid disease, inflammatory arthritis, hemodialysis, pregnancy, use of corticosteroids, and hormone replacement therapy.
MAIN RESULTS: In multivariate models, inflammatory arthritis was strongly associated with carpal tunnel release (odds ratio [OR] 2.9; 95% confidence interval [CI] 2.2, 3.8). However, corticosteroid use also appeared to be associated with a greater likelihood of undergoing carpal tunnel release, even in the absence of inflammatory arthritis (OR 1.6; 95% CI 1.2, 2.1). Diabetes had a weak but significant association with carpal tunnel release (OR 1.4; 95% CI 1.2, 1.8), as did hypothyroidism (OR 1.7; 95% CI 1.1, 2.8), although patients with hyperthyroidism did not have any change in risk. Women who underwent carpal tunnel release were almost twice as likely to be users of estrogen replacement therapy as controls (OR 1.8; 95% CI 1.0, 3.2).
CONCLUSIONS: Although inflammatory arthritis is the most important nonoccupational risk factor for carpal tunnel release, these data substantiate the increase in risk associated with diabetes and untreated hypothyroidism. Further investigation in detailed clinical studies will be necessary to confirm whether changes in corticosteroid use and hormone replacement therapy offer additional means of risk reduction for this common condition.
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This work was funded in part by National Institute of Health Multipurpose Arthritis Center Grant AR36308. Dr. Solomon is a recipient of a Physician Scientist Development Award from the Arthritis Foundation and American College of Rheumatology, and Dr. Katz is a recipient of an Investigator Award from the Arthritis Foundation.
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Solomon, D.H., Katz, J.N., Bohn, R. et al. Nonoccupational risk factors for carpal tunnel syndrome. J GEN INTERN MED 14, 310–314 (1999). https://doi.org/10.1046/j.1525-1497.1999.00340.x
- carpal tunnel syndrome
- risk factors
- thyroid disease
- diabetes mellitus