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Association Between Manual Loading and Newly Developed Carpal Tunnel Syndrome in Subjects With Physical Disabilities: A Follow-Up Study

  • Yen-Nung Lin
    Affiliations
    Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

    Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan

    Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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  • Chun-Chieh Chiu
    Affiliations
    Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

    Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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  • Shih-Wei Huang
    Affiliations
    Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taiwan
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  • Wen-Yen Hsu
    Affiliations
    Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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  • Tsan-Hon Liou
    Affiliations
    Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan

    Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taiwan
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  • Yi-Wen Chen
    Affiliations
    Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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  • Kwang-Hwa Chang
    Correspondence
    Corresponding author Kwang-Hwa Chang, MD, Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, 111 Xinglong Rd, Section 3, Taipei 11696, Taiwan.
    Affiliations
    Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

    Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan

    Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
    Search for articles by this author
Published:March 09, 2017DOI:https://doi.org/10.1016/j.apmr.2017.02.008

      Highlights

      • Persons with physical disability frequently develop new carpal tunnel syndrome (CTS).
      • Leg lean tissue percentage is negatively related to the risk of developing new CTS.
      • Subjects with a leg lean tissue percentage <12% are at risk of developing CTS.

      Abstract

      Objective

      To identify the association between body composition and newly developed carpal tunnel syndrome (CTS) and to search for the best probabilistic cutoff value of associated factors to predict subjects with physical disabilities developing new CTS.

      Design

      Longitudinal.

      Setting

      University-affiliated medical center.

      Participants

      Subjects with physical disabilities (N=47; mean age ± SD, 42.1±7.7y).

      Interventions

      Not applicable.

      Main Outcome Measures

      Median and ulnar sensory nerve conduction velocity (SNCV) were measured at the initial and follow-up tests (interval >2y). Total and regional body composition were measured with dual-energy x-ray absorptiometry at the initial test. Leg lean tissue percentage was calculated to delineate each participant's manual loading degree during locomotion. Leg lean tissue percentage is the lean tissue mass of both legs divided by body weight.

      Results

      Based on median SNCV changes, we divided all participants into 3 groups: subjects with bilateral CTS (median SNCV value <45m/s plus a normative ulnar SNCV value >37.8m/s) in the initial test (n=10), subjects with newly developed CTS in the follow-up test (n=8), and subjects without additional CTS in the follow-up test (n=27). Eight of 35 subjects not having bilateral CTS initially developed new CTS (8.8% per year; mean follow-up period, 2.6y). Leg lean tissue percentage was associated with the probability of newly developed CTS (adjusted odds ratio, .64; P<.05). Subjects with a leg lean tissue percentage >12% were less likely to have developed new CTS at the follow-up test (sensitivity, .75; specificity, .85; area under the curve, .88; P<.005).

      Conclusions

      Leg lean tissue percentage may be useful for early identification of developing new CTS in subjects with physical disabilities. Therefore, a preventive program for those subjects at risk can start early.

      Keywords

      List of abbreviations:

      BMI (body mass index), CTS (carpal tunnel syndrome), DXA (dual-energy x-ray absorptiometry), LTM (lean tissue mass), ROC (receiver operating characteristic), SNCV (sensory nerve conduction velocity)
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