Hormone replacement therapy in women and risk of carpal tunnel syndrome: a systematic review and metaanalysis

Abstract

Background Carpal tunnel syndrome (CTS) is the most common entrapment mononeuropathy. Menopausal status and/or estrogen level may play a role in CTS. The evidence regarding the association between hormone replacement therapy (HRT) in postmenopausal women and CTS is still conflicting. This meta-analysis aimed to investigate the association between carpal tunnel syndrome (CTS) and women using hormone replacement therapy (HRT). Methods A search was conducted in the PubMed/Medline, Scopus, Embase, and Cochrane databases, from their inception through July 2022. Studies which reported on the association between any type of HRT use and the risk of developing CTS in postmenopausal women compared to a control group were included. Studies which did not include a control group were excluded. Of the 1573 articles extracted from database searches, seven studies involving 270,764 women were included of which 10,746 had CTS. The association between CTS and HRT use was evaluated using the pooled odds ratio (OR) with a 95% confidence interval (CI) under random-effects modelling. Risk of bias in each study was assessed using the Newcastle–Ottawa Scale (NOS) and version 2 of the Cochrane tool for assessing risk of bias in randomized trials (RoB 2). Results HRT use showed no statistically significant association with a higher risk of CTS with pooled odds ratio (OR) 1.49, 95% confidence interval (CI) 0.99–2.23, and p = 0.06, although high heterogeneity among the studies was observed (I2 97.0%, Q-test p-value < 0.001). Subgroup analysis of groups in non-randomized controlled studies showed a significantly increased risk of CTS, while groups in randomized controlled studies showed a decreased risk of CTS (pooled OR 1.87, 95% CI 1.24–2.83 versus pooled OR 0.79, 95% CI 0.69–0.92, respectively) with the p-value of group difference < 0.001. The risk of bias in most of the included studies was estimated to be low. Conclusions This meta-analysis supports the safety of using HRT in postmenopausal women with potential risk factors for CTS. Level of evidence I, Prognosis. Registration: INPLASY (202280018).

Severe Carpal Tunnel Syndrome in a Pediatric Patient With a History of Congenital Adrenal Hyperplasia

“… 5 , 6 It has been postulated that inflammation of the TCL and tenosynovial tissue within the carpal tunnel can cause CTS. 7 , 8 Toesca et al 3 found high concentrations of estrogen and progesterone receptors in samples of the TCL and synovial tissue from CTS patients, suggesting the carpal tunnel to be a major target for hormonal action. 7 Patients with CAH who are obese and noncompliant will have elevated estrogen in addition to hyperandrogenism secondary to the aromatization of androgens by adipose tissue.…”

“…Elevated levels of estrogen are also associated with elevated levels of TNF-α, IL-6, and C-reactive protein, which is an acute phase reactant. 7 Maurizio et al 8 , 10 studied the synovial fluid of patients with rheumatoid arthritis and determined that increased estrogen concentrations enhance proinflammatory cytokine secretion and favor the development of immuno-mediated synovitis. Elevated levels of these cytokines can result in cellular proliferation, increased capillary permeability, and edematous changes followed by fibrosis, which can contribute to the development of CTS.…”