Awareness of carpal tunnel syndrome among adult population of Al Majmaah city, Saudi Arabia, 2018-2019.

BACKGROUND: Due to the lack of data and studies concerning about measurement of population awareness about carpal tunnel syndrome (CTS) in Al Majmaah city, this study aims at determining the level of population awareness among Al Majmaah adult population in Saudi Arabia. AIMS: To study the awareness of CTS among adult population in Al Majmaah city, Saudi Arabia, and to estimate the overall prevalence of CTS. In addition, to look for the relationship between CTS and chronic disease.
MATERIALS AND METHODS: In this cross-sectional study, 386 individuals were covered, both males and females in the targeted areas. A standardized questionnaire was used to cover 11 different aspects concerning CTS. SPSS package was used to analyze the data collected from the sample.
RESULTS: The result of scoring system shows that 54 of participants (14.0%) have CTS. Approximately, 30% of them are thought that the main symptom is pain in wrist. However, 26.7% think that tingling and numbness in fingers is the main manifestation. The most causes that population think that leads to the CTS are trauma, repeated hand physical activities such as using computer, taping, and wrist fracture or dislocation by 33.8%, 29.1%, and 21.4% respectively. There is relationship between patients who had chronic diseases and CTS [sig = 0.000]. CTS cause a strong effect on social life by 79.01% of participant though that CTS could affect patient sleep and job performance.
CONCLUSION: The awareness of community was sufficient among adult population in Al Majmaah city, and the prevalence of CTS is 14%. Copyright:

Introduction

Carpal Tunnel Syndrome (CTS) is entrapment of median nerve during passing the wrist within carpal bone.[1] The median nerve passes, with nine extrinsic digital flexors, through the tunnel bound by the carpal bones and transverse ligament, which is attached to the scaphoid, trapezoid, and hamate. Anatomically the carpal tunnel narrows in cross section at 2.0 to 2.5 cm distal to the entrance.[2] An abnormally high intracarpal tunnel pressure also peaks at this level in patients with CTS.[3]

CTS is the most common entrapment mononeuropathy. Symptoms of CTS include paresthesias (numbness, tingling, and burning) involving the median nerve distribution (first 3 digits and median half of 4th finger) along with a deep aching pain in the hand and wrist.[4] These symptoms are intermittent and typically worse at night where the patient is awakened from sleep and relieves the discomfort by vigorously shaking the hand (Flick sign). The diagnosis and physical examination findings in CTS vary according to the severity. Hypoesthesia involves the first three digits and the radial half of the fourth digit and wasting of thenar muscles may be seen in severe cases of CTS.

The prevalence of disease differs from population to population. In the Netherlands, it is 0.6% for men and 5.8% for women.[5] A more recent study has concluded that approximately 2.7% of the population has both clinically and electrophysiologically documented CTS.[6] Women are considerably more prone to this disorder in a ratio of 3:1 to about 10:1(4). CTS is bilateral in up to 87% of patients clinically and approximately 50% through neurophysiologic testing.[7] Certain conditions such as diabetes mellitus, amyloidosis, hypothyroidism, and rheumatoid arthritis can predispose to CTS.[5] Obesity and pregnancy are also risk factors for CTS.[8] Electrodiagnostic studies are an important electrophysiologic extension of the history and physical in diagnosing CTS with high degree of sensitivity and specificity. Nerve conduction studies and electromyography (EMG) can determine the presence and the severity of median neuropathy at the wrist.[4] Carpal tunnel decompression also benefits patients with advanced thenar atrophy and sensory deficits[9] and those with underlying peripheral neuropathy.[10]

Materials and Methods

Study design and end points

Survey used a structured questionnaire created for a study objectives awareness of CTS among adult population at Al Majmaah city including the prevalence of CTS; the understanding of clinical features, etiology, management, and prevention; and its effect in social life.

Inclusion criteria:

Age >18

Both gender

Saudi population.

Exclusion criteria:

Age <18

Non-Saudi population

End point and outcomes

Primary end point awareness of CTS among adult population

Secondary outcomes were population understanding of clinical features, causes, prevention, and management of CTS and its relationship with chronic disease. In addition, its prevalence among adult Saudi people in Al Majmaah city.

Measurement

A structured questionnaire has been designed to measure the following variables:

The prevalence of CTS among Saudi population in Al Majmaah city

Understanding of clinical features, causes, prevention, and management options in percentages (%)

Fixed and measure the relationship between CTS and chronic disease.

Analysis

All the demographic and 11 variables of a structured questionnaire to gather information of 386 participants should be entered to Statistical Software and processing with SPSS program. Variables are gender, age, and marital status. The Prevalence of CTS, clinical features, causes, prevention, and management of disease will have analyzed through percentages and other statistical commands. In addition, Chi-square test was done to fix the CTS and chronic disease relationship.

Results

There are 386 participants volunteered in CTS study from Al Majmaah population. The prevalence of CTS is 14% of the participants reported that they had CTS, illustrated in Figure 1.

Figure 1

Percentage of sample who suffer from CTS

Demographic variables

The females are more than males (57.6% to 42.4%) in the study, whereas youth are more participating involve study (43.1%), category (40–60) represents 40.7%, and a few participants from overage (16.2%). Approximately, over two-third of participants are married. Illustrated in Table 1.

Table 1

Socio-demographic data gender, age, and marital status

	Frequency	Percentage
Gender
Male	164	42.4
Female	222	57.6
Age
18-39	166	43.1
40-60	157	40.7
>60	63	16.2
Marital Status
Married	268	69.5
Single	118	30.5
Total	386	100.0

Approximately, one-third (30.1%) of the sample thought that clinical features can happen with CTS is “Pain in wrist,” and 26.8% of the sample are think that clinical features can happen with CTS is “Tingling and numbness in thumb, index and middle finger,” and 8.4% of the sample are thought that the symptom can happen with CTS is “Weakness affecting the thumb muscle,” and 11.6% of the sample think that the manifestation is “Decreased overall hand grip,” and 12.7% of the sample are think that clinical features can happen with CTS is “Muscle wasting in the hand,” and 10.3% of the sample are thought that clinical features can happen with CTS is “Changing of pain intensity while moving the wrist.” Illustrated in Table 2.

Table 2

Frequency and percent for population knowledge about clinical features of Carpal tunnel syndrome

	Frequency	Percentage
Pain in wrist	239	30.1%
Tingling and numbness in thumb, index, and middle finger	213	26.8%
Weakness affecting the thumb muscle	67	8.4%
Decreased overall hand grip	92	11.6%
Muscle wasting in the hand	101	12.7%
Changing of pain intensity while moving the wrist	82	10.3%
Total	794	100.0%

Exactly one-third (33.8%) of the sample are think that the causes lead to CTS is “Trauma,” whereas 29.1% of the sample are think that “Repeated physical activities like using computer and taping,” is the cause. In addition, 21.4% of the sample think that the causes lead to CTS is “wrist fracture or dislocation,” and 9.5% of the sample thought that the leading cause of CST is “Arthritis,” and 6.2% of the sample think that the causes lead to CTS is “Tumor of bone.” Table and chart below shown that. Illustrated in Table 3.

Table 3

Awareness of causes lead to CTS

	Frequency	Percentage
Trauma	196	33.8%
Repeated physical activities like using computer and taping	169	29.1%
Wrist fracture or dislocation	124	21.4%
Arthritis	55	9.5%
Tumor of bone	36	6.2%
Total	580	100.0%

Approximately, 29.7% of participants reported that they thought that oral analgesics is a method of treating CTS, 23.8% thought it could be treated by splint and surgical intervention, 13.4% thought that the treatment is by NSAID, and only 9.3% of participants were thought CTS could be treat by steroid injection. The results are shown in the following graphs, and Illustrated In [Figure 2].

Figure 2

Frequency and percent of population awareness of treatment of CTS

The table showed that 25.6% of the sample used to prevent CTS “Avoid repetitive movement,” and 15.2% from the sample used to Prevent CTS “Keep your wrist straight while at rest,” and 25.2% from the sample used to Prevent CTS “Wear splint while sleeping,” and 25.3% from the sample used to Prevent CTS are “Avoid Fall or direct impact,” and 8.7% from the sample used to Prevent CTS are “Stay warm”.. Illustrated in Table 4.

Table 4

Frequency and percent for population awareness of prevention of CTS

	Frequency	Percentage
Avoid repetitive movement	170	25.6%
Keep your wrist straight while at rest	101	15.2%
Wear splint while sleeping	167	25.2%
Avoid fall or direct impact	168	25.3%
Stay warm	58	8.7%
Total	664	100.0%

29.5% of the participant had chronic diseases which equal to 114 persons more than half (57.7%) of the affected had “Diabetes Mellitus,” and 32.5% of the affected had “Hypothyroidism,” and 9.6% of the affected had “Rheumatoid Arthritis,” and there is no any “Amyloidosis” Illustrated in Table 5 and Figure 3.

Table 5

The relation between chronic disease and CTS

Chronic diseases present		CTS present
		Yes	No
Yes	N	34	80
	%	28.8	67.8
No	N	6	217
	%	2.6	95.6

Figure 3

Frequency and percent of chronic disease

79.01% of participant's people thought that CTS could affect patient sleep, 84.97% of them thought could affect patient job performance, and 70.4% they thought affected social life. Following table and chart shown that illustrated in Table 6.

Table 6

Frequency and percent of population awareness of CTS effect

		Frequency	Percentage
Thinking of CTS affect patient sleep	Yes	305	79.01
	No	81	20.99
Thinking of CTS affect patient job performance	Yes	328	84.97
	No	58	15.03
Thinking of CTS affected social life	Yes	272	70.4
	No	114	29.6
Total		386	100.0

Discussion

There are number of studies discussed the awareness of Carpel Tunnel Syndrome among different types of populations. In this study, the population awareness of CTS is sufficient, which is reflected by their knowledge about the disease. In details, their knowledge about clinical features of CTS is 30.1% of them said that pain in the wrist is one of manifestation and 26.8% know that the tingling and numbness in finger is one of symptom. In addition, their knowledge about causes is 33.8%, 29.1%, and 21.4% said that trauma, repetitive hand activity, and wrist fracture or dislocation is the cause respectively. In addition, their knowledge about treatment is 29.7% people reported that oral analgesics is a method of treating and 23.8% of population said it could be treat by splint and surgical intervention.

In this study, the adult population has good awareness which is different than study done in India which reflect that approximately 72% of the population were unaware about CTS, and the people were then asked whether they knew that the previously mentioned symptoms were actually symptoms of CTS, and approximately 76.5% of the people were unaware about the symptoms being those of CTS. People were also asked if they were affected by CTS, and approximately 85 people out of the 102 people answered that they suffer from CTS, most people answered on the basis of experiencing the causative symptoms while a few (7 people) agreed to being affected and to be undergoing medication for the same. It was then asked what method of medication people take and most people opted for methods without drugs (e.g., rotating of wrists).

In this study, the prevalence of the CTS is slightly high, which is 14% of people in Al Majmaah city suffer from CTS. There is significant relationship between CTS and the chronic disease, especially diabetes mellitus and hypothyroidism.

CTS cause a strong impacting on social life for 79.01% of participants thought that CTS could affect patient sleep, 84.97% of them thought could affect patient job performance, and 70.4% they thought affected social life.

Conclusion

The aim of the study was to study the awareness of CTS among adult population in Al Majmaah city, Saudi Arabia, and to estimate the overall prevalence of CTS. The results show that the awareness of community population was sufficient among population and show that the prevalence of CTS is 14% it is nearly equal the international population prevalence. In addition, the study shows there is a strong relationship between CTS and chronic disease. In addition, those populations think the CTS can affect the quality of life.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.