Nonoccupational risk factors for carpal tunnel syndrome.
OBJECTIVE
To examine the relation between selected nonoccupational risk factors and surgery for carpal tunnel syndrome.


METHODS
Case-control study using an administrative database.


METHODS
Enrollees of New Jersey Medicare or Medicaid programs during 1989 to 1991.


METHODS
The outcome of interest was open or endoscopic carpal tunnel release. We examined the relation between carpal tunnel release and diabetes mellitus, thyroid disease, inflammatory arthritis, hemodialysis, pregnancy, use of corticosteroids, and hormone replacement therapy.


RESULTS
In multivariate models, inflammatory arthritis was strongly associated with carpal tunnel release (odds ratio [OR] 2.9; 95% confidence interval [CI] 2.2, 3.8). However, corticosteroid use also appeared to be associated with a greater likelihood of undergoing carpal tunnel release, even in the absence of inflammatory arthritis (OR 1.6; 95% CI 1.2, 2.1). Diabetes had a weak but significant association with carpal tunnel release (OR 1.4; 95% CI 1.2, 1.8), as did hypothyroidism (OR 1.7; 95% CI 1.1, 2.8), although patients with hyperthyroidism did not have any change in risk. Women who underwent carpal tunnel release were almost twice as likely to be users of estrogen replacement therapy as controls (OR 1.8; 95% CI 1.0, 3.2).


CONCLUSIONS
Although inflammatory arthritis is the most important nonoccupational risk factor for carpal tunnel release, these data substantiate the increase in risk associated with diabetes and untreated hypothyroidism. Further investigation in detailed clinical studies will be necessary to confirm whether changes in corticosteroid use and hormone replacement therapy offer additional means of risk reduction for this common condition.
Solomon
D H
DH
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. 02115, USA.
Katz
J N
JN
Bohn
R
R
Mogun
H
H
Avorn
J
J
D017677:Age Distribution; D000368:Aged; D002349:Carpal Tunnel Syndrome / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D016022:Case-Control Studies; D016001:Confidence Intervals; D015986:Confounding Factors, Epidemiologic; D048909:Diabetes Complications; D015914:Estrogen Replacement Therapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009784:Occupational Diseases; D010003:Osteoarthritis / Q000150:complications; D011247:Pregnancy; D012042:Registries; D012307:Risk Factors; D017678:Sex Distribution; D013959:Thyroid Diseases / Q000150:complications; D014481:United States / Q000453:epidemiology