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Relationship of Ultrasonographic Physiologic Changes to Personal Factors and Psychosocial Stressors in the Development and Diagnosis of Carpal Tunnel Syndrome

Roll, Shawn C.

Abstract Details

2011, Doctor of Philosophy, Ohio State University, Allied Medical Professions.

Carpal tunnel syndrome (CTS) is diagnosed in nearly 12,000 workers every year and may occur in up to 6% of the population. CTS limits individual functional performance and can be costly for employees and employers due to medical expenses and lost productivity. While psychosocial, physical, and personal stressors have all been identified as potential risk factors for carpal tunnel syndrome, little research has been conducted to evaluate the interrelationships and combined effects of each of these factors to identify the most salient stressors. Additionally, due to a lack of efficient and cost-effective technology, few research studies have investigated acute physiologic changes in the upper extremity and median nerve due to such stressors. Instead, studies measure secondary, often chronic, changes in the nerve conduction of symptomatic individuals. In order to move toward interventional techniques that effectively reduce salient risk factors for carpal tunnel syndrome, relationships between risk factors should be better understood and novel tools and methodologies could be investigated to study acute physiologic changes.

Together, a systematic review of literature and a cohort study provided evidence to support the use of sonography as a screening tool for CTS. Standardized methods and measures identified in the systematic review were used to obtain the sensitivity and specificity of sonographic measurements compared to electrodiagnostic testing (EDX). Cross-sectional area (CSA) of the median nerve within the carpal tunnel had the highest diagnostic accuracy and multiple additional sonographic measures showed high correlation to EDX. Utilizing these measures an exploratory binary logistic regression indicated that CSA of the median nerve as measured by sonography combined with body mass index and level of education could predict the presence of subjective complaints of discomfort or decreased functional tolerances, typical of median nerve pathology.

The preliminary regression analysis in this study provided guidance in completion of further research to understand the constellation of physical, psychosocial, and personal factors that contribute to CTS. These studies were limited by a small sample size, recruitment of subjects from a convenient sample, and some limitations in the measurement techniques. The combined effects of all of these factors, as they relate to physiological changes, require continued research within larger, longitudinal studies.

The effective prevention or remediation of median nerve pathology in the working population is reliant upon understanding the relationship of these factors to physiological changes over time. Refinement of sonographic measurements and techniques is required to identify valid and precise physiologic measures. Further research is needed to combat work-related musculoskeletal disorders, such as CTS, by determining the impact of comprehensive, multidisciplinary interventions. Comprehensive interventions may mediate an individual’s stress through the culture and values of the organization, psychosocial demands and job control, work styles and workstation positioning, and individual coping mechanisms and cognitive processing.

Kevin Evans, PhD (Advisor)
Jane Case-Smith, EdD (Committee Member)
Carolyn Sommerich, PhD (Committee Member)
Miriam Freimer, MD (Committee Member)
201 p.

Recommended Citations

Citations

  • Roll, S. C. (2011). Relationship of Ultrasonographic Physiologic Changes to Personal Factors and Psychosocial Stressors in the Development and Diagnosis of Carpal Tunnel Syndrome [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1305654432

    APA Style (7th edition)

  • Roll, Shawn. Relationship of Ultrasonographic Physiologic Changes to Personal Factors and Psychosocial Stressors in the Development and Diagnosis of Carpal Tunnel Syndrome. 2011. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1305654432.

    MLA Style (8th edition)

  • Roll, Shawn. "Relationship of Ultrasonographic Physiologic Changes to Personal Factors and Psychosocial Stressors in the Development and Diagnosis of Carpal Tunnel Syndrome." Doctoral dissertation, Ohio State University, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=osu1305654432

    Chicago Manual of Style (17th edition)