Lifetime risk of symptomatic carpal tunnel syndrome in Type 1 diabetes

Singh, Ranveer; Gamble, Greg; Cundy, Tim

doi:10.1111/j.1464-5491.2005.01487.x

Cited by 80 publications

(60 citation statements)

References 35 publications

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“…Although in most cases, the cause of this localized pressure elevation is unknown.For such cases of idiopathic CTS, clinical studies [13] and clinical observation suggest that the pressure elevations are first intermittent, resulting in transient symptoms, only later becoming continuous and resulting in neurophysiological changes consistent with demyelination. To explain this clinical picture, microtrauma has been commonly implicated as an etiological factor [12], as well physiological abnormalities, especially diabetes mellitus [3,27,30].…”

Section: Introductionmentioning

confidence: 99%

Dextrose-Induced Subsynovial Connective Tissue Fibrosis in the Rabbit Carpal Tunnel: A Potential Model to Study Carpal Tunnel Syndrome?

Oh¹,

Ettema²,

Zhao³

et al. 2007

Hand (New York, N,Y.)

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In this pilot study, hypertonic dextrose solution was used to induce fibrosis of the subsynovial connective tissue (SSCT) and create an animal model of potential use in the study of carpal tunnel syndrome (CTS). The SSCT of the carpal tunnel in 15 New Zealand white rabbits were injected with 0.05 ml of 10% dextrose solution in 1 paw and 0.05 ml of saline in the contralateral paw, to serve as a control. The animals were killed at 1, 2, 4, 8, or 12 weeks. While the saline side showed minimal changes at any time period, the hypertonic dextrose side showed progressive noninflammatory SSCT fibrosis, with vascular proliferation and thickening of collagen bundles. Demyelination of the median nerve developed at 12 weeks after the injection on the dextrose side. These findings are similar to the progression of pathology noted in humans with CTS.

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Section: Introductionmentioning

confidence: 99%

Dextrose-Induced Subsynovial Connective Tissue Fibrosis in the Rabbit Carpal Tunnel: A Potential Model to Study Carpal Tunnel Syndrome?

Oh¹,

Ettema²,

Zhao³

et al. 2007

Hand (New York, N,Y.)

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“…The prevalence increases with the duration of diabetes [55]. Those who had developed CTS had had diabetes longer than those who had not yet developed CTS.…”

Section: Pregnancy and Sleep Positionmentioning

confidence: 93%

“…Those who had developed CTS had had diabetes longer than those who had not yet developed CTS. The calculated lifetime risk of CTS was 50% after 44 years and 85% after 54 years of having type 1 diabetes [55]. Becker et al [4] showed that while diabetes may be a significant risk factor for CTS in women, diabetes only appears to be a risk factor for CTS when combined with BMI.…”

Section: Pregnancy and Sleep Positionmentioning

confidence: 99%

Epidemiologic Associations of Carpal Tunnel Syndrome and Sleep Position: Is there a Case for Causation?

McCabe

Uebele

Pihur

et al. 2007

Hand (New York, N,Y.)

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Introduction Carpal tunnel syndrome (CTS) is thought to be due to compression of the median nerve in the carpal tunnel. It is known that carpal tunnel pressures are elevated in wrist postures of flexion and extension and in those patients with CTS. Classic symptoms of CTS include night waking with pain, tingling, and numbness. These classic symptoms stimulated our interest in the relationship of sleep to the development of CTS. Method We reviewed the literature surrounding the epidemiology of CTS and the literature regarding sleep disturbances. Through careful distillation of these studies and a process of reasoning, we have developed a hypothesis for a causal mechanism of CTS.Results Epidemiologically, it has been shown that CTS is associated with age, gender, increased body mass index (BMI), diabetes, pregnancy, and is more common in some populations. The same associations noted above for CTS are strongly associated with sleep disturbances. Sleep disturbances due to age, gender, BMI, pregnancy, and population variations are all associated with sleeping in the lateral position supporting the hypothesis that a common causative mechanism of CTS is sleeping in a lateral position. Discussion We believe that the epidemiologic associations with CTS act through a common causative mechanism, increased sleeping in the lateral position which puts the wrist at increased risk of flexion or extension, compressing the median nerve in the carpal tunnel. This hypothesis is simple and explains the connection between a previously unconnected group of epidemiologic associations. This realization has real clinical significance in that it focuses our attention on the early disorder when it is completely reversible. It clarifies previously confused clinical circumstances, creates research questions that can be tested, and it invites us to change our clinical perspective in this most common form of nerve compression.

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“…However, the clinical condition generally is recognised on the basis of diabetes (high blood glucose levels) occurring in mainly younger and thinner people in the absence of other precipitating causes (WHO, 1999). (Singh et al, 2005) No; there was no demonstrable effect of glycaemic control on the incidence of carpel tunnel syndrome (Singh et al, 2005) Yes; there was a higher prevalence in patients with Type 1 diabetes mellitus than in control subjects (Pavlovic et al, 2007) No; there was no evidence to relate diabetic hand to metabolic control (Pavlovic et al, 2007) …”

Section: Definition Of Type 1 Diabetes Mellitusmentioning

confidence: 99%

Development and validation of a cost–utility model for Type 1 diabetes mellitus

et al. 2015

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A simple cost-utility model was developed to evaluate new interventions for Type 1 diabetes mellitus by assessing the association between the interventions' effects on mean glycated haemoglobin and long-term complications and the risk of hypoglycaemic events. High-quality, recently reported data specific to people with Type 1 diabetes mellitus were identified by a systematic review. Methods: Through a systematic review, we identified complications associated with Type 1 DM and data describing the long-term incidence of these complications. An individual patient simulation model was developed and included the following complications: cardiovascular disease, peripheral neuropathy, microalbuminuria, end-stage renal disease, proliferative retinopathy, ketoacidosis, cataract, and adverse birth outcomes. Risk equations were developed from published cumulative incidence data and hazard ratios for the effect of glycated haemoglobin, age, and duration of diabetes. We validated the model by comparing model predictions with observed outcomes from studies used to build the model (internal validation) and from other published data (external validation). We performed illustrative analyses for typical patient cohorts and a hypothetical intervention.Results: Model predictions were within 2% of expected values in the internal validation and within 8% of observed values in the external validation (percentages represent absolute differences in the cumulative incidence). Conclusions:The model utilised high-quality, recent data specific to people with Type 1 DM. In the model validation, results deviated less than 8% from expected values.

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Lifetime risk of symptomatic carpal tunnel syndrome in Type 1 diabetes

Abstract: The lifetime risk of developing symptomatic CTS with Type 1 diabetes is high, and is related to age and duration of diabetes, but not to the development of microvascular complications.

Cited by 80 publications

References 35 publications

Dextrose-Induced Subsynovial Connective Tissue Fibrosis in the Rabbit Carpal Tunnel: A Potential Model to Study Carpal Tunnel Syndrome?

Dextrose-Induced Subsynovial Connective Tissue Fibrosis in the Rabbit Carpal Tunnel: A Potential Model to Study Carpal Tunnel Syndrome?

Epidemiologic Associations of Carpal Tunnel Syndrome and Sleep Position: Is there a Case for Causation?

Development and validation of a cost–utility model for Type 1 diabetes mellitus

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