The Clinical Neurological Manifestations of Patients Diagnosed with Carpal Tunnel Syndrome

1. INTRODUCTION

A group of symptoms caused by compression of the median nerve at the carpal tunnel is known as carpal tunnel syndrome (CTS). Pain, numbness, or tingling on the anterior surface of the index, middle, or radial half of the ring finger are signs of compression of the median nerve. It is frequently linked to hand grip weakness or nighttime symptoms, including numbness and pain in the hands or arms [1].

The pathophysiological mechanism linked to CTS is the median nerve entrapment in the wrist, which causes compression of the nerve, resulting in paresthesia, numbness, and hand muscle weakness that can be diagnosed by the nerve conduction study [2].

The disease is very common in the general population; at a point, the morbidity is rising with the advancement of modern life. Since CTS is a common illness, research on its etiology is crucial to improving the quality of life among patients. Individual characteristics such as age, sex, diabetes, hypothyroidism, obesity, tobacco, injury, and occupational factors are among the risk factors. However, the majority of the studies were conducted on western societies [3]. A multifactorial etiology has been suggested by the association between CTS and occupational i.e., repetitive and forceful work such as gripping and vibrations [4].

The links between CTS and work-related psychological aspects at work are still unclear, despite an increasing number of studies on occupational stress [5,6]. Because of increased exposure to repetitive movements and a lack of recovery time, lean production systems and the corresponding new work organization systems are thought to intensify work pace and job demand and, as a result, increase the risk of musculoskeletal disorders. Some epidemiological studies indicate associations between a higher risk of CTS and the characteristics of the workplace [7]. Despite the available evidence of high certainty about work-related physical risk factors for CTS, there still might be a lack of awareness in clinical care for prevention [4].

The current study aims to assess the neurological manifestations of CTS and their association with demographic and clinical features.

2. MATERIALS AND METHODS

3. RESULTS

Table 1 shows the sociodemographic characteristics of the study participants, the age group between 35 and 44 years old comprises 54% of the total achieved sample. According to the findings of the present study, females were affected by CTS when compared to males (91% female and 9% male). In addition, the majority of the patients were married (69%), a quarter of the total sample was illiterate, and eight patients completed secondary school. In terms of occupation, which may have a significant impact on the prevalence of the disease, the majority of the participants were housewives, and the proportion of the patients who retired from jobs was only 1%, besides patients who were employed comprised 34% of the total sample.

TABLE 1: Sociodemographic characteristics of the study participants

Table 2 describes the clinical characteristics of the participants, the proportion of the patients who never consumed alcohol was 99%, however, 18% of them were smokers. The majority of the patients had the disease for more than 1 year, which is 71%, and the rest have it for <1 year. Regarding the side that was affected by the neurological symptoms, right arm symptoms were doubled when compared to the left side, while patients who had symptoms on both arms had. Patients who have not been diagnosed with other chronic diseases were nearly twice as many as those with other chronic diseases (65% vs. 35%, respectively). Type 2 diabetes mellitus was the most prevalent chronic disease besides CTS (11%), while only 2% of them had hypertension and gout disease. Finally, ten patients (10%) of the total sample were living with more than five comorbidities.

TABLE 2: Clinical characteristics among the participants

Table 3 shows the neurological clinical symptoms among the patients. Seventy-seven percent of the patients had pain in their wrists at night, besides tingling and numbness, which accounted for 78% of the total sample. Morning symptoms also comprised 72% of the participants, particularly tingling and numbness. In addition, more than half of the patients 54% reported tingling and numbness when grasping something.

TABLE 3: Prevalence of neurological symptoms among the patients

Regarding specific areas of the symptoms, only 4 percent complained of tingling and numbness in the little finger, and neck pain was presented in 22%.

In Table 4, a statistically significant relationship was found between the occurrence of tingling and numbness in the morning and the patients’ occupation at P = 0.05. To exemplify, this symptom was reported among 100% of patients who were self-employed and more than 80% of housewife patients who work repetitively handy work at home. Moreover, all the patients who were retired from their jobs complained of the same symptoms.

TABLE 4: Association between patients’ occupation and the CTS symptom

Table 5 illustrates a statistically highly significant association between the clinical features of the participants and the CTS symptoms. For example, 82% of the patients who had the disease for more than 1 year presented with tingling and numbness in the morning when compared to those who had a history of <1 year which only 48% complained with this symptom at P = 0.001.

TABLE 5: Association clinical features of the patients and the CTS symptom

Tingling and numbness at night were found among those who had other chronic diseases by almost 91%. Patients with rheumatoid arthritis (RA), HTN, and comorbidity (more than five diseases) presented without tingling and numbness in the morning P = 0.016.

Table 6 discloses the level of CTS symptoms among the patients, by which it has being found that 100% of the study sample presented with severe levels of CTS symptoms.

TABLE 6: The level of CTS symptoms among the study sample

4. DISCUSSION

In the current study, most of the CTS were female and they were doing housekeeping in terms of occupation. This is totally in line with the finding of a study by Hong et al., 2022 in China, by which female comprises the majority of the cases when compared to males (72 females and 2 males). Among the 72 females, 29 were housekeepers and 18 were farmers. In another study that aimed to explore the characteristics of CTS patients, it has being found that 63% of the cases are female and 37% – male [8].

In our study, the proportion of the right side wrist affected with CTS was 55%, the left side – 29%, and both wrists – 16%, but these results are noticed in other studies differently. For instance, Hong et al. found only 30% were affected with the right side, 15% – left wrist, and 55% having CTS in both wrists [8].

In the current study, a significant relationship was observed between the occupations and the occurrences of CTS. Similarly, in several studies, the role of occupations was examined among workers and concluded with the significant effects of occupation on the prevalence of CTS [9]–[11]

In this study, moreover, there is a great impact of patients’ clinical data on the intensity and variation of the neurological symptoms, For example, the duration of the disease, the affected side of CTS, and the patients’ other chronic diseases had a critical impact on the symptoms, patients with type 2 diabetes mellitus presented with severe neurological symptoms, especially tingling and numbness. The results of a case–control study were in line with our study presenting an association between diabetes mellitus and CTS symptoms [12]. In addition, a study of the assessment of the incidence and severity of CTS among RA patients found the same curtailment impact of RA on the incidence and symptoms of CTS [7], [12].

In our study, the level of CTS symptom intensity was analyzed by the perceived CTS questionnaire. Following the scoring, the study sample presented with severe CTS symptoms and no one was found with mild symptoms. To discuss this finding, no studies were found clearly with the same results. However, there is a substantial amount of literature highlighting the causes of the severity of CTS symptoms including, nerve injury, duration of the disease, side of the arm, occupation, and other comorbidities [13]–[16].

5. CONCLUSION

The study discovered that patients with CTS mainly experience neurological symptoms that interfere with their daily activities. Tingling and numbness at night were the most common symptoms among the patients. Several factors can aggregate the symptoms, including the duration of the disease and other comorbidities and their occupation.

6. ACKNOWLEDGMENT

It is acknowledged to all patients involved in this study.

7. ETHICAL CONSIDERATIONS

This study was approved by the Scientific Committee of the Basic Sciences Department at College of Nursing. Then, Ethical approval was guaranteed from the Ethical Committee for the Medical Colleges at University of Sulaimani. In addition, patients were informed about the objectives of the study and their independent participation. They also provided consent to the current study.

8. CONFLICTS OF INTERESTS

The author declared that they have no conflicts of interest.

9. FUNDING

No financial support was provided for the study.