Carpal tunnel syndrome and the associated symptoms
Carpal tunnel syndrome (CTS) is a condition in which the median nerve is compressed due to the narrow path or tunnel at the wrist where the nerve travels down the arm into the hand. This pressure on the wrist causes the fingers and thumb to feel numb, tingly and at times almost unable to move. This syndrome, denoted by ICD-9-D 354.0, is one of the most frequent diagnoses in the entire orthopedic region.
According to the American Academy of Orthopedic Surgeons (AAOS), more than 3 million patients visit their doctors every year for relief of carpal tunnel symptoms. According to the PearlDiver Patient Records Database (PRD), carpal tunnel syndrome is not only a major diagnosis within the hand and wrist region of orthopedics but is among the top ten diagnoses in the entire orthopedic sector.
Carpal tunnel syndrome can occur to patients of any age. However, it is more common among patients 45 or older who represent 60% of the population. The condition occurs more commonly in women than in men by a ratio of 3:1. Among younger patients, men between the ages of 20 and 45 occasionally develop the syndrome as a result of stressful activity involving the hand and wrist.
Past studies have indicated that carpal tunnel syndrome can be brought on by simple day- to- day activities, such as typing or driving a car, that cause pressure on the median nerve and restrict blood flow to the hand.
Other conditions, such as diabetes, rheumatoid arthritis, smoking, obesity, and osteoarthritis—as well as pain in shoulder—are also significant contributing factors for carpal tunnel syndrome. While most patients who get CTS acquire it through daily activity, researchers are aware that other comorbidities also have a role in CTS.
First Symptom: Diabetes
The link between carpal tunnel syndrome and diabetes is well established. Several studies have found a number of causative links between the physiological effects of diabetes (restricted blood flow, for example) and the onset of CTS. So, while practitioners have noticed the link for years, using the PearlDiver database we are able to quantify the correlation. Six percent of the patients in the PearlDiver Patient Records Database who have carpal tunnel syndrome also have diabetes. PearlDiver researchers conducted two studies looking at the link between diabetes and carpal tunnel. The first study looked at the simple incidence rates and it found that 5%–6 % of the patients with diabetes were later diagnosed with CTS. The second study tried to discover how many carpal tunnel syndrome patients later developed diabetes. Almost 7% of the patients had carpal tunnel syndrome before becoming diabetic. Table 1 below shows the results of the two studies done with the PRD database on carpal tunnel syndrome and diabetes.
Table 1: Diabetes Mellitus With CTS, Before and After
Source: PearlDiver Patient Records Database January 2004 – June, 2007
Since diabetes is more common among an aging population, especially medicare patients, the percentage of patients shown in the database who had CTS before and after might be low as the database does not include MEDPAR data. These results are based on patients 65 and under in the PRD database.
Second Symptom: Rheumatoid Arthritis
Rheumatoid arthritis (RA) is also a common associated diagnosis with carpal tunnel syndrome. Rheumatoid arthritis in the wrist causes swelling of the wrist joint itself or of the tendons which run through the carpal tunnel. When RA is not well controlled it may lead to the formation of pannus, which consists of large amounts of inflamed tissue that grows out from the wrist and compresses the median nerve. The joint inflammation, itself, may damage adjacent structures, leading to compression of certain nerves. PearlDiver researchers conducted a study similar to the one on the diabetes patients, where they found a similar set of results. A range of 5.5% to 6% of patients who had CTS went on to develop rheumatoid arthritis later. Slightly over 5% of patients who had rheumatoid arthritis later developed CTS. Overall, 3.7% of the patients who have CTS also have RA. Table 2 shows the comparison of RA with CTS before and after.
Table 2: Rheumatoid Arthritis with CTS, Before and After
Source: PearlDiver Patient Records Database January 2004 – June, 2007
Third Symptom: Osteoarthritis
As was the case with rheumatoid arthritis, osteoarthritis (OA) is also an associated diagnosis with carpal tunnel syndrome. Almost 27 million patients in the U.S. have OA according to The National Arthritis Data Workgroup. Sixty percent of the OA patients are females—two-thirds of these patients also have CTS. With increased age comes more arthritis in the hand and knee areas. PearlDiver researchers discovered that 20% of patients who have osteoarthritis have also been diagnosed with CTS. Osteoarthritis plays a very big role in developing carpal tunnel syndrome.
Table 3 shows the number of patients with osteoarthritis and CTS and the timing of their diagnoses.
Table 3: Osteoarthritis with CTS, Before and After
Source: PearlDiver Patient Records Database January 2004 – June, 2007
Fourth and Fifth Symptoms: Obesity and Smoking
Obesity and smoking are two criteria considered when dealing with medical-related problems. Carpal tunnel is no exception. Smoking is considered to be a major risk factor in causing carpal tunnel syndrome, perhaps because the nerves around the carpal tunnels are being deprived of oxygen. The data revealed that 10% of the patients who smoked were diagnosed with CTS, while 13% of patients suffering from obesity also experience CTS.
Other Symptoms
Other symptoms relating to carpal tunnel syndrome include shoulder joint pain. About 3% of patients who had shoulder joint pain (ICD-9-D-719.41) were later diagnosed with CTS. Over a million patients in the PearlDiver Patient Records Database were diagnosed for pain in shoulder joint and over 36,000 of those later were diagnosed with carpal tunnel syndrome.Out of that million and more patients who were diagnosed with shoulder joint pain, almost 4% or over 38,000 distinct patients, had diabetes. Out of those 38,000 patients, almost 10% were diagnosed with carpal tunnel syndrome later in their life.
Other medical conditions that relate to carpal tunnel syndrome are tumors, amyloidosis (metabolic disorder), bone enlargement caused by overproduction of growth hormone (acromegaly), pregnancy (may cause swelling of the extremities), tendon inflammation, uremia (condition in which the kidneys do not filter the blood sufficiently), and wrist fracture. All of these are high risks for the development of carpal tunnel syndrome.
Conclusion
A longitudinal study of all the patients with diabetes, shoulder joint pain, arthritis, and the other comorbidities mentioned above revealed that 7.2% of patients diagnosed with CTS had one or more of the other medical problems. Diabetes, smoking, and arthritis were the leading factors associated with CTS. It appears from the data that the percentage of patients age 40 and older diagnosed with CTS has been increasing year after year and will continue to increase with these many comorbidities attached with CTS