Increased Risk of Carpal Tunnel Syndrome in People With Spinal Cord Injury: A Nationwide Longitudinal Follow-Up Study

  • Yi-Hsiang Chiu
    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei
    Search for articles by this author
  • Kuo-Cheng Yeh
    Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan
    Search for articles by this author
  • Shin-Liang Pan
    Corresponding author Shin-Liang Pan, MD, PhD, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City 100, Taiwan. Tel.: 886-2-23123456 ext. 67749.
    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei

    Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan
    Search for articles by this author
Published:August 20, 2021DOI:



      To investigate the long-term risk of carpal tunnel syndrome (CTS) in people with spinal cord injury (SCI).


      Retrospective cohort study.


      Taiwan's Longitudinal Health Insurance Database 2005, containing data about 1 million people randomly sampled from among those registered in the National Health Insurance Program as of 2005.


      The SCI group consisted of 1681 subjects with SCI, and the comparison group comprised 6724 propensity score-matched subjects without SCI (N=8405). The variables included in propensity-score matching were age, sex, comorbid conditions, and socioeconomic status.


      Not applicable.

      Main Outcome Measures

      The occurrence of newly diagnosed CTS, defined by at least 1 hospital discharge or 2 outpatient visits with a diagnosis of CTS.


      The incidence density of CTS in the SCI group was 7.55 per 1000 person-years (95% confidence interval [CI], 6.03-9.33), and in the comparison group, 4.61 per 1000 person-years (95% CI, 4.08-5.19). The hazard ratio (HR) of CTS for the SCI group was therefore 1.59 (95% CI, 1.24-2.03). Additionally, the HR of CTS for the cervical-SCI subgroup, 1.90 (95% CI, 1.21-2.97) was considerably higher than that of its noncervical counterpart, 1.47 (95% CI, 1.09-1.98).


      People with both cervical and noncervical SCI have an increased risk of developing CTS, as compared with those without SCI. Moreover, the CTS risk appears to be higher for individuals with cervical SCI than their noncervical SCI counterparts.


      List of abbreviations:

      CI (confidence interval), CTS (carpal tunnel syndrome), COPD (chronic obstructive pulmonary disease), HR (hazard ratio), ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification), LHID2005 (Longitudinal Health Insurance Database 2005), NHI (National Health Insurance), NT$ (New Taiwan dollar), SCI (spinal cord injury)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Wipperman J
        • Goerl K
        Carpal tunnel syndrome: diagnosis and management.
        Am Fam Physician. 2016; 94: 993-999
        • Gellman H
        • Chandler DR
        • Petrasek J
        • Sie I
        • Adkins R
        • Waters RL
        Carpal tunnel syndrome in paraplegic patients.
        J Bone Joint Surg Am. 1988; 70: 517-519
        • Aljure J
        • Eltorai I
        • Bradley WE
        • Lin JE
        • Johnson B
        Carpal tunnel syndrome in paraplegic patients.
        Spinal Cord. 1985; 23: 182-186
        • Akbar M
        • Penzkofer S
        • Weber MA
        • Bruckner T
        • Winterstein M
        • Jung M
        Prevalence of carpal tunnel syndrome and wrist osteoarthritis in long-term paraplegic patients compared with controls.
        J Hand Surg Eur Vol. 2014; 39: 132-138
        • Asheghan M
        • Hollisaz MT
        • Taheri T
        • Kazemi H
        • Aghda AK
        The prevalence of carpal tunnel syndrome among long-term manual wheelchair users with spinal cord injury: a cross-sectional study.
        J Spinal Cord Med. 2016; 39: 265-271
        • Kentar Y
        • Zastrow R
        • Bradley H
        • et al.
        Prevalence of upper extremity pain in a population of people with paraplegia.
        Spinal Cord. 2018; 56: 695-703
        • Hsieh C-Y
        • Su C-C
        • Shao S-C
        • et al.
        Taiwan's National Health Insurance Research Database: past and future.
        Clinical Epidemiol. 2019; 11: 349-358
        • Polykandriotis E
        • Premm W
        • Horch RE
        Carpal tunnel syndrome in young adults—an ultrasonographic and neurophysiological study.
        Minim Invasive Neurosurg. 2007; 50: 328-334
        • Stang P
        • Lydick E
        • Silberman C
        • Kempel A
        • Keating ET
        The prevalence of COPD: using smoking rates to estimate disease frequency in the general population.
        Chest. 2000; 117 (354S-59S)
        • Jenkins PJ
        • Watts AC
        • Duckworth AD
        • McEachan JE
        Socioeconomic deprivation and the epidemiology of carpal tunnel syndrome.
        J Hand Surg Eur Vol. 2012; 37: 123-129
        • Johnson NA
        • Darwin O
        • Chasiouras D
        • Selby A
        • Bainbridge C
        The effect of social deprivation on the incidence rate of carpal and cubital tunnel syndrome surgery.
        J Hand Surg Eur Vol. 2020; 46: 265-269
        • Mondelli M
        • Giannini F
        • Giacchi M
        Carpal tunnel syndrome incidence in a general population.
        Neurology. 2002; 58: 289
        • Liu CY
        • Hung YT
        • Chuang YL
        • Chen YJ
        • Weng WS
        • Liu JS
        Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey.
        J Health Manag. 2006; 4: 1-22
        • Rosenbaum PR
        • Rubin DB
        The central role of the propensity score in observational studies for causal effects.
        Biometrika. 1983; 70: 41-55
      1. Performing a 1: N case-control match on propensity score. In: Parsons LS, ed. Proceedings of the 29th Annual SAS Users Group International Conference; 2004 May 9–12; Montreal, Canada; SAS Institute; 2004.

        • Tonelli M
        • Wiebe N
        • Fortin M
        • et al.
        Methods for identifying 30 chronic conditions: application to administrative data.
        BMC Med Inform Decis Mak. 2015; 15: 31
        • Yang YW
        • Chen YH
        • Wang KH
        • Wang CY
        • Lin HW
        Risk of herpes zoster among patients with chronic obstructive pulmonary disease: a population-based study.
        CMAJ. 2011; 183: E275-E280
        • Normand SLT
        • Landrum MB
        • Guadagnoli E
        • et al.
        Validating recommendations for coronary angiography following acute myocardial infarction in the elderly: a matched analysis using propensity scores.
        J Clin Epidemiol. 2001; 54: 387-398
        • Padua L
        • Coraci D
        • Erra C
        • et al.
        Carpal tunnel syndrome: clinical features, diagnosis, and management.
        Lancet Neurol. 2016; 15: 1273-1284
        • Pallaver A
        • Schibli S
        • Fridén J
        Surgical intervention for carpal tunnel syndrome in individuals with spinal cord injuries-patient characteristics, diagnostic considerations, and treatment outcomes.
        Spinal Cord Ser Cases. 2021; 7: 9
        • Shiri R
        • Pourmemari M
        • Falah-Hassani K
        • Viikari-Juntura E
        The effect of excess body mass on the risk of carpal tunnel syndrome: a meta-analysis of 58 studies.
        Obes Rev. 2015; 16: 1094-1104
        • Becker J
        • Nora DB
        • Gomes I
        • et al.
        An evaluation of gender, obesity, age and diabetes mellitus as risk factors for carpal tunnel syndrome.
        Clin Neurophysiol. 2002; 113: 1429-1434
        • Lam N
        • Thurston A
        Association of obesity, gender, age and occupation with carpal tunnel syndrome.
        Aust N Z J Surg. 1998; 68: 190-193
        • Pourmemari M
        • Shiri R
        Diabetes as a risk factor for carpal tunnel syndrome: a systematic review and meta-analysis.
        Diabetic Medicine. 2016; 33: 10-16
        • Shiri R
        Hypothyroidism and carpal tunnel syndrome: a meta-analysis.
        Muscle Nerve. 2014; 50: 879-883
        • van Dijk MA
        • Reitsma JB
        • Fischer JC
        • Sanders GT
        Indications for requesting laboratory tests for concurrent diseases in patients with carpal tunnel syndrome: a systematic review.
        Clin Chem. 2003; 49: 1437-1444
        • Ozge A
        • Atiş S
        • Sevim S
        Subclinical peripheral neuropathy associated with chronic obstructive pulmonary disease.
        Electromyogr Clin Neurophysiol. 2001; 41: 185-191
        • Kozak A
        • Schedlbauer G
        • Wirth T
        • Euler U
        • Westermann C
        • Nienhaus A
        Association between work-related biomechanical risk factors and the occurrence of carpal tunnel syndrome: an overview of systematic reviews and a meta-analysis of current research.
        BMC Musculoskelet Disord. 2015; 16: 231
        • Boninger ML
        • Cooper RA
        • Baldwin MA
        • Shimada SD
        • Koontz A
        Wheelchair pushrim kinetics: body weight and median nerve function.
        Arch Phys Med Rehabil. 1999; 80: 910-915
        • Hogaboom NS
        • Diehl JA
        • Oyster ML
        • Koontz AM
        • Boninger ML
        Ultrasonographic median nerve changes after repeated wheelchair transfers in persons with paraplegia: relationship with subject characteristics and transfer skills.
        PM R. 2016; 8: 305-313
        • Werner RA
        • Franzblau A
        • Albers JW
        • Armstrong TJ
        Median mononeuropathy among active workers: are there differences between symptomatic and asymptomatic workers?.
        Am J Ind Med. 1998; 33: 374-378
        • Palmer KT
        Carpal tunnel syndrome: the role of occupational factors.
        Best Pract Res Clin Rheumatol. 2011; 25: 15-29
        • Luchetti R
        • Schoenhuber R
        • De Cicco G
        • Alfarano M
        • Deluca S
        • Landi A
        Carpal-tunnel pressure.
        Acta Orthop Scand. 1989; 60: 397-399
        • Amirfeyz R
        • Gozzard C
        • Leslie IJ
        Hand elevation test for assessment of carpal tunnel syndrome.
        J Hand Surg Eur Vol. 2005; 30: 361-364
        • Ehler E
        Median nerve ultrasonography in carpal tunnel syndrome.
        Clin Neurophysiol Pract. 2017; 2: 186-187
        • Adams MM
        • Hicks AL
        Spasticity after spinal cord injury.
        Spinal Cord. 2005; 43: 577-586
        • Hara Y
        Dorsal wrist joint pain in tetraplegic patients during and after rehabilitation.
        J Rehabil Med. 2003; 35: 57-61
        • Rempel DM
        • Keir PJ
        • Bach JM
        Effect of wrist posture on carpal tunnel pressure while typing.
        J Orthop Res. 2008; 26: 1269-1273
        • Giersiepen K
        • Eberle A
        • Pohlabeln H
        Gender differences in carpal tunnel syndrome? Occupational and non-occupational risk factors in a population-based case-control study.
        Ann Epidemiol. 2000; 10: 481
        • Wu CY
        • Chen YJ
        • Ho HJ
        • et al.
        Association between nucleoside analogues and risk of hepatitis B virus-related hepatocellular carcinoma recurrence following liver resection.
        JAMA. 2012; 308: 1906-1913
        • Boninger ML
        • Koontz AM
        • Sisto SA
        • et al.
        Pushrim biomechanics and injury prevention in spinal cord injury: recommendations based on CULP-SCI investigations.
        J Rehabil Res Dev. 2005; 42: 9-19