The prevalence of hand pain in Ibadan--implications for the carpal tunnel syndrome.

Hand pain or brachialgia paraesthetica nocturna (BPN) is a series of symptoms described as "waking up at night due to unpleasant sensations in the fingers" (Dekrom et al, 1992). Usually, these symptoms form the first rungs up the ladder leading up to the carpal tunnel syndrome (CTS) (Skandalakis et al, 1992), and thus are used as part of the diagnostic criteria for the disorder. We describe the results of a questionnaire survey of 422 patients attending two major hospitals in Ibadan, Nigeria for complaints unrelated to hand pathology. Questions related to the bio-data (including type of occupation), general health status, past medical and/or surgical history, and finally hand symptoms of the patients. For a patient to be positive for BPN, the hand symptoms had to correspond to the cutaneous distribution of the median nerve. Positive cases formed 12.75% of all interviewees in one hospital and 19.59% of respondents in the other, with females forming the bulk of those affected. This figure is somewhat higher than the ones previously reported. From earlier work on the predictive value of BPN for the carpal tunnel syndrome we conservatively estimate that between 20% and 38% of individuals in our study group will suffer from CTS. The relationship of heavy hand-use to BPN was a negative one as most sufferers of BPN were light hand-users. However, individual occupations requiring highly repetitive flexion-extension wrist movements recorded many BPN cases. No BPN case was confirmed when the patients presented in hospital, indicating that more awareness of the symptoms and signs of this disorder needs to be created among doctors and the general public. Also, we believe that more investigations, particularly among the general population, are needed to be able to define the prevalence of this condition more accurately.