Occupational risk factors of carpal tunnel syndrome (CTS) are popular current research targets, with main emphasis put on wrist posture and dynamics. In this study, we do not intend to pinpoint individual occupations, but aim to identify high risk wrist postures and actions which may occur across various occupations. It is hoped that prevention can thus be instituted in a general population by directing at the particular causative wrist actions rather than exclusively targeting isolated occupations. We performed a case-control study with 166 cases and 111 controls recruited from different hospitals in Hong Kong in 2004. All cases and controls completed the survey on their general health condition, smoking status, wrist posture and motion as well as psychosocial status at the time of diagnosis of CTS. Frequent flexion OR = 4.436 (95% CI: 1.833-10.734), frequent extension OR = 2.691 (95% CI: 1.106-6.547) of the wrist were found to be associated with CTS. Frequent sustained forceful motion of the wrist OR = 2.588 (95% CI: 1.144-5.851) was also found to be associated with CTS. Neutral wrist position and repetitive wrist motion were not associated with CTS. Adjustment was made for age, sex, BMI, smoking and psychosocial stress. Our study confirms that frequent flexion, extension and sustained force of the wrist increase the risk of developing CTS.

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Introduction: Coronary angiography-derived index of microvascular resistance (caIMR) is a index that quantifies coronary microvascular dysfunction (CMD), which obviates the need of wire manipulation compared to index of microvascular resistance (IMR). In patients with ischemia with non-obstructive coronary arteries (INOCA), CMD plays a key role and is associated with development of heart failure (HF). The significance of global CMD, reflected by the average of caIMR values obtained in the three coronary arteries was however not fully known. The aim of this study was to evaluate the association between HF related outcomes (HFRO) and global CMD in INOCA patients based on caIMR. Methods: Patients with clinical myocardial ischemia and without ≥50% diameter stenosis in any coronary arteries on coronary angiography were included. For every patient, the global-caIMR value was calculated by averaging caIMR values measured in the three major coronary arteries, and it reflects the extent of global CMD. Based on IMR threshold, patients were stratified into high-global-caIMR group (global-caIMR≥25U) and low-global-caIMR group (global-caIMR<25U). The primary endpoint was HFRO, defined by a composite of HF related hospitalization and outpatient diuretic intensification. Results: Among 325 patients included (mean age 63.4±11.0; male 57.2%), 105 and 220 patients were stratified into the high- and low-global-caIMR groups respectively. The rate of HFRO at 3 years was higher in the high-global-caIMR group compared to low-global-caIMR group (19.0% vs. 8.2%; P=0.004). In multivariable analysis adjusted for age, gender, Charlson Comorbidity Index and baseline HF, global-caIMR≥25U was associated with a higher risk of HFRO at 3 years (subdistribution hazard ratio [sHR], 2.65; 95% confidence interval [CI], 1.39-5.06; P=0.003). With the same multivariable adjustment, every 1U increase in global-caIMR was associated with an increased risk of HFRO at 3 years (sHR, 1.07; 95% CI, 1.05-1.09; P<0.001). Similar trends were observed at 5 years of follow-up. Conclusions: Global CMD, reflected by increased global-caIMR, was associated with a higher risk of HFRO at 3 and 5 years in INOCA patients. This study provides clinical data that support real-world application of caIMR.