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Wahlström Jens - One of the best experts on this subject based on the ideXlab platform.
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Occupational biomechanical risk factors for surgically treated Ulnar Nerve Entrapment in a prospective study of male construction workers
'Scandinavian Journal of Work Environment and Health', 2019Co-Authors: Jackson, Jennie A, Olsson David, Punnett Laura, Burdorf Alex, Järvholm Bengt, Wahlström JensAbstract:Objectives: The aim of this study was to determine the association between occupational biomechanical exposures and occurrence of surgically treated Ulnar Nerve Entrapment (UNE). Methods: A cohort of 229 689 male construction workers who participated in a national occupational health surveillance program (1971–1993) were examined prospectively over a 13-year case ascertainment period (2001–2013) for surgically treated UNE. Job title (construction trade), smoking status, height, weight and age were recorded on examination. Job titles were merged into occupational groups of workers performing similar work tasks and having similar training. Occupational biomechanical exposure estimates were assigned to each occupational group with a job exposure matrix (JEM) developed for the study. Negative binomial models were used to assess the relative risks for each biomechanical exposure and the sums of highly correlated biomechanical exposures. Surgical treatment of UNE was determined via a linkage with the Swedish Hospital Outpatient Surgery Register. Results: There were 555 cases of surgically treated UNE within the cohort. Workers exposed to forceful hand-grip factors had a 1.4-fold higher relative risk (95% CI 1.18–1.63) of undergoing surgical treatment for UNE compared to unexposed workers. Occupational groups comprising workers exposed to forceful hand-grip work showed the highest risks for UNE and included concrete workers, floor layers, ground preparatory workers, rock blasters, and sheet-metal workers. Conclusion: Forceful hand-grip work increases the risk for surgically treated Ulnar Nerve Entrapment
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Biomechanical risk factors for surgically treated Ulnar Nerve Entrapment in a cohort of Swedish male construction workers
Department of Public Health Erasmus MC Rotterdam The Netherlands., 2018Co-Authors: Jackson Jennie, Olsson David, Punnett Laura, Burdorf Alex, Järvholm Bengt, Wahlström JensAbstract:Background: The literature on occupational risk factors for Ulnar Nerve Entrapment (UNE), also called cubital tunnel syndrome is sparse. Objectives: The aim was study the association between occupational biomechanical exposures and UNE. Methods: The occurrence of UNE was examined prospectively in a cohort of 229 689 Swedish male construction workers who participated in a nation-wide occupational health surveillance program between 1971 and 1996. UNE case status was defined on the basis of a surgical release of Ulnar Nerve Entrapment; case data were obtained from a national outpatient database for a 13 year observation period (2001-2013). Individual risk factors considered were smoking status, BMI and age. Biomechanical exposure estimates were assigned at the occupational group level using a job exposure matrix developed specifically for the study and included 10 ergonomic (force/posture/repetition) and 2 hand-arm vibration exposure parameters determined a priori to be relevant to UNE. Relative risks (RR) for all biomechanical factors were modelled using negative binomial regression analyses and adjusted for age, smoking habits and BMI. Results: There were 555 cases of surgically treated UNE in the cohort and the average annual incidence was 19.2 cases per 100,000 person-years. Smoking status (ever vs. never smoker RR=1.28, 95% CI=1.07-1.54) and BMI (≥25 kg/m2 vs. < 25 kg/m2 RR=1.60 , 95% CI=1.34-1.91) were associated with increased risk of UNE. Increased grip force (RR=1.54, 95% CI =1.24-1.92), hand-Arm-vibration (RR=1.35, 95% CI=1.07-1.71) upper extremity load (RR=1.63, 95% CI=1.30-1.92), and increased frequency of hand tool use (RR =1.37, 95% CI=1.09-1.71), elbow flexion and extension (RR=1.36, 95% CI=1.10-1.68), and static work (RR=1.36, 95% CI=1.12-1.65) were also associated with increased risk of UNE. Discussion and Conclusions: Our findings demonstrate that multiple biomechanical factors were associated with increased risk of UNE. Many of the identified risk factors involved elevated hand grip force (grip force, upper extremity load, and frequency of hand tool use and hand-arm vibration) which may indicate it is a key etiological aspect of UNE
Wahlstrom J. - One of the best experts on this subject based on the ideXlab platform.
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Occupational biomechanical risk factors for surgically treated Ulnar Nerve Entrapment in a prospective study of male construction workers
'Scandinavian Journal of Work Environment and Health', 2019Co-Authors: Jackson J.a., Olsson D., Punnett L., Burdorf A., Järvholm B., Wahlstrom J.Abstract:Objectives The aim of this study was to determine the association between occupational biomechanical exposures and occurrence of surgically treated Ulnar Nerve Entrapment (UNE). Methods A cohort of 229 689 male construction workers who participated in a national occupational health surveillance program (1971–1993) we
Martijn J A Malessy - One of the best experts on this subject based on the ideXlab platform.
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anterior subcutaneous transposition for persistent Ulnar neuropathy after neurolysis
Neurosurgical Focus, 2017Co-Authors: Jort A N Van Gent, Mirjam Datema, Justus L Groen, Willem Pondaag, Job L A Eekhof, Martijn J A MalessyAbstract:OBJECTIVE Little is known about optimal treatment if neurolysis for Ulnar Nerve Entrapment at the elbow fails. The authors evaluated the clinical outcome of patients who underwent anterior subcutaneous transposition after failure of neurolysis of Ulnar Nerve Entrapment (ASTAFNUE). METHODS A consecutive series of patients who underwent ASTAFNUE performed by a single surgeon between 2009 and 2014 was analyzed retrospectively. Preoperative and postoperative complaints in the following 3 clinical modalities were compared: pain and/or tingling, weakness, and numbness. Six-point satisfaction scores were determined on the basis of data from systematic telephonic surveys. RESULTS Twenty-six patients were included. The median age was 56 years (range 22-79 years). The median duration of complaints before ASTAFNUE was 23 months (range 8-78 months). The median interval between neurolysis and ASTAFNUE was 11 months (range 5-34 months). At presentation, 88% of the patients were experiencing pain and/or tingling, 46% had weakness, and 50% had numbness of the fourth and fifth fingers. Pain and/or tingling improved in 35%, motor function in 23%, and sensory disturbances in 19% of all the patients. Improvement in at least 1 of the 3 clinical modalities was found in 58%. However, a deterioration in 1 of the 3 modalities was noted in 46% of the patients. On the patient-satisfaction scale, 62% reported a good or excellent outcome. Patients with a good/excellent outcome were a median of 11 years younger than patients with a fair/poor outcome. No other factor was significantly related to satisfaction score. CONCLUSIONS A majority of the patients were satisfied after ASTAFNUE, even though their symptoms only partly resolved or even deteriorated. Older age is a risk factor for a poor outcome. Other factors that affect outcome might play a role, but they remain unidentified. One of these factors might be earlier surgical intervention. The modest results of ASTAFNUE should be mentioned when counseling patients after failure of neurolysis of Ulnar Nerve Entrapment to manage their expectations. Patients, especially those who are elderly, might even consider not undergoing a secondary procedure. A randomized trial that includes a conservative treatment group and groups undergoing one of the several possible surgical procedures is needed to find the definitive answer for this clinical problem.
Michael S. Cartwright - One of the best experts on this subject based on the ideXlab platform.
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Ultrasonographic measurements in cubital tunnel syndrome.
Muscle & nerve, 2007Co-Authors: Joon Shik Yoon, Suk-joo Hong, Byung Jo Kim, Sei Joo Kim, Jae Min Kim, Francis O. Walker, Kyu Hun Sim, Michael S. CartwrightAbstract:The cubital tunnel is the most common site of Ulnar Nerve Entrapment. Previous ultrasound studies have demonstrated enlargement of the Ulnar Nerve in cubital tunnel syndrome but did not report on the cubital tunnel itself. Twenty-two individuals with cubital tunnel syndrome were evaluated with Nerve conduction studies and ultrasound. The ultrasound measurement that most strongly correlated with conduction velocity was the ratio of Ulnar Nerve to cubital tunnel cross-sectional area with the elbow flexed. Measurement of this ratio may improve the diagnostic accuracy of ultrasound in cubital tunnel syndrome, although further investigation is needed.
Hulkkonen Sina - One of the best experts on this subject based on the ideXlab platform.
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Work-related risk factors for Ulnar Nerve Entrapment in the Northern Finland Birth Cohort of 1966
'Springer Science and Business Media LLC', 2021Co-Authors: Miettinen Laura, Auvinen Juha, Miettunen Jouko, Karppinen Jaro, Ryhänen Jorma, Shiri Rahman, Hulkkonen SinaAbstract:Ulnar Nerve Entrapment (UNE) is the second most common Entrapment neuropathy in the upper extremity. The aetiology of UNE is multifactorial and is still not fully understood. The aim of the study was to identify occupational risk factors for UNE and to determine whether smoking modifies the effects of work-related factors on UNE. The study population consisted of the Northern Finland Birth Cohort of 1966 (NFBC1966). In total, 6325 individuals active in working life participated at baseline in 1997. Occupational risk factors were evaluated by a questionnaire at baseline. The data on hospitalizations due to UNE were obtained from the Care Register for Health Care between 1997 and 2018. The incidence rate of hospitalization due to UNE was 47.6 cases per 100,000 person-years. After adjusting for confounders, entrepreneurs (Hazard ratio (HR)=3.68, 95% CI 1.20-11.27), smokers (HR=2.51, 95% CI 1.43-4.41), workers exposed to temperature changes (HR=1.72, 95% CI 1.00-2.93), workers with physically demanding jobs (HR=3.02, 95% CI 1.39-6.58), and workers exposed to hand vibration (HR=1.94, 95% CI 1.00-3.77) were at an increased risk of hospitalization for UNE. Exposure to work requiring arm elevation increased the risk of hospitalization due to UNE among smokers (HR=2.62, 95% CI 1.13-6.07), but not among non-smokers. Work-related exposure to vibration and temperature changes, and physically demanding work increase the risk of hospitalization for UNE. Smoking may potentiate the adverse effects of work-related factors on UNE.Peer reviewe
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Smoking is associated with Ulnar Nerve Entrapment : a birth cohort study
'Springer Science and Business Media LLC', 2019Co-Authors: Hulkkonen Sina, Auvinen Juha, Miettunen Jouko, Karppinen Jaro, Ryhänen JormaAbstract:Ulnar Nerve Entrapment is the second most common compression neuropathy of the upper extremity. It has been associated with smoking in cross-sectional studies. Our aim was to study whether smoking is associated with Ulnar Nerve Entrapment. The study population consisted of the Northern Finland Birth Cohort 1966 participants, who attended the 31-year follow-up in 1997 (N = 8,716). Information on smoking, body mass index (BMI), long-term illnesses, and socio-economic status were recorded at baseline in 1997. Data on hospitalizations due to Ulnar Nerve Entrapment neuropathies was obtained from the Care Register for Health Care, 1997-2016. Hazard ratios (HR) with 95% confidence intervals (CI) and population attributable risk (PAR) were calculated adjusted for gender, BMI and socio-economic status. 66 patients were diagnosed with Ulnar Nerve Entrapment in the follow-up 1997-2016. Before the age of 31 years, smoking 10 pack years with more than five-folded (HR = 5.61, 95% CI = 2.80-11.23) risk for Ulnar Nerve Entrapment compared to non-smokers in the adjusted analyses. Adjusted PAR for smoking (reference of no smoking) was 53.6%. In our study, smoking associated with increased risk for Ulnar Nerve Entrapment, accounting for considerable proportion of increased risk.Peer reviewe
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Incidence and risk factors of carpal tunnel syndrome and Ulnar and radial Entrapment neuropathies in the Finnish population
'University of Helsinki Libraries', 2019Co-Authors: Hulkkonen SinaAbstract:Entrapment neuropathies of the upper extremity, including carpal tunnel syndrome (CTS) and Ulnar and radial neuropathies are common in the general population. The most common of these is CTS, the prevalence of which can be up to 5%. These neuropathies cause loss of hand function, disability, sick leaves and high health care costs. Up to two thirds of diagnosed cases are treated surgically. However, their aetiology is multifactorial and is still not fully understood. This study evaluated the incidence rate and the proportion of surgically treated cases of CTS, Ulnar Nerve Entrapment (UNE) and radial neuropathies in the Finnish population, based on data from the Care Register for Health Care on hospitalizations in specialist care, 2007–2016. The risk factors for CTS and UNE were studied in the Northern Finland Birth Cohort 1966 (NFBC1966), whose participants attended a clinical examination in 1997 and gave their written informed consent (N = 8 719). For CTS, occupational exposures were studied in a sub-population of NFBC1966 participants who worked at least three days a week at study baseline in 1997at the age of 31. In the Finnish population, the crude incidence rates (95% confidence interval, CI) per 100 000 person-years between 2007 and 2017 among women and men were 196.5 (194.8–198.2) and 104.8 (103.6–106.0) for CTS, 25.8 (25.2–26.4) and 36.0 (35.2–36.7) for UNE, and 5.7 (5.4–6.0) and 8.5 (8.2–8.9) for radial Entrapment neuropathies. Of these, CTS was operated in 62.6% of women and 61.3% of men, UNE in 43.2% of women and 47.2% of men, and radial Nerve Entrapment in 11.4% of women and 7.7% of men. CTS was more common among women (women : men risk ratio, RR = 1.4), whereas UNE and radial neuropathies were more common among men (men : women RR = 1.4 and 1.5, respectively). In NFBC1966, overweight or obesity, history of regular smoking, and the socio-economic status of farmers or manual workers increased the risk of CTS over follow-up (1997–2016). Of the self-reported occupational exposures, vibration to the hands was associated with double the risk of CTS. Smoking ten or less pack-years before the age of 31 increased the risk of UNE two-fold and smoking more than ten pack-years over five-fold over follow-up. Overweight or obesity, socioeconomic status, or gender did not increase the risk of UNE in the adjusted analyses. Successful prevention of CTS, UNE and radial neuropathies requires better recognition of their risk factors. This study established several risk factors for CTS, and revealed smoking as the most important risk factor for UNE. Keywords: carpal tunnel syndrome, Ulnar Nerve Entrapment, Entrapment neuropathy, risk, factors, register study, cohort studyYläraajan hermopinteet, kuten rannekanavaoireyhtymä ja kyynär- ja värttinähermon pinteet, ovat yleisiä väestössä. Niistä yleisin on rannekanavaoireyhtymä, jonka esiintyvyys on noin 5%. Yläraajan hermopinteet aiheuttavat toiminnanvajausta, sairauslomia ja merkittäviä terveydenhuollon kustannuksia. Hermopinteet vaativat noin kahdessa kolmesta tapauksesta leikkaushoitoa. Tässä väitöskirjatutkimuksessa selvitettiin rannekanavaoireyhtymän ja kyynär- ja värttinähermon pinteiden ilmaantuvuutta ja leikkaushoidon osuutta suomalaisessa väestössä vuosina 2007-2016 Hoitoilmoitustietorekisterin tietoihin perustuen. Rannekanavaoireyhtymän ja kyynärhermon pinteiden riskitekijöitä tutkittiin Pohjois-Suomen syntymäkohortissa 1966 (N=8719). Potilaiden tiedot ja suostumus oli kerätty kliinisessä tutkimuksessa vuonna 1997. Rannekanavaoireyhtymän työaltisteita tutkittiin henkilöillä, jotka kävivät palkkatyössä vähintään kolmena päivänä viikossa. Suomalaisessa väestössä vuosina 2007-2016 rannekanavaoireyhtymän ilmaantuvuus (95% luottamusväli) sataatuhatta henkilövuotta kohti oli naisilla 196,5 (194.8-198.1), kyynärhermon pinteiden 25,8 (25,2-26,4) ja värttinähermon pinteiden 5,7 (5,4-6,0). Miehillä vastaavat luvut olivat 104,8 (103,6-106,0), 36,0 (35,2-36,7) ja 8,5 (8,2-8,9). Leikkauksella hoidettujen tapausten osuus naisilla rannekanavaoireyhtymäryhmässä oli 62,6%, kyynärhermon pinneryhmässä 43,2% ja värttinähermon pinneryhmässä 11,4 %. Vastaavat luvut miehillä olivat 61,3%, 47,2% ja 7,7%. Rannekanaoireyhtymä oli yleisempi naisilla (naiset : miehet, riskisuhde 1.4), mutta kyynär- ja värttinähermon pinteet olivat yleisempiä miehillä (miehet : naiset, riskisuhde 1.4 ja 1.5). Pohjois-Suomen syntymäkohortissa 1966 ylipaino, säännöllinen tupakointi, maatalousyrittäjyys tai ruumiillinen työ lisäsivät sekä naisten että miesten riskiä sairastua rannekanavaoireyhtymään seuranta-aikana (1997-2016). Työaltisteista tärkein rannekanavaoireyhtymän riskitekijä oli käsiin kohdistuva tärinä. Tupakointi ennen 31 ikävuotta lisäsi kyynärhermopinteen riskiä: korkeintaan kymmenen askivuoden tupakointi yli kaksinkertaisti ja yli kymmenen askivuoden tupakointi yli viisinkertaisti seuranta-aikana todetun riskin. Ylipaino, sosioekonominen asema tai sukupuoli eivät lisänneet kyynärhermopinteen riskiä. Jotta rannekanavaoireyhtymää ja kyynär- ja värttinähermon pinteitä voitaisiin ehkäistä, niiden riskitekijät tulisi tunnistaa paremmin. Tässä väitöskirjatutkimuksessa löydettiin useita rannekanaoireyhtymän riskitekijöitä. Kyynärhermopinteiden riskitekijöistä tupakointi oli merkittävin. Asiasanat: rannekanavaoireyhtymä, kyynärhermon pinne, hermopinteet, riskitekijät, rekisteritutkimus, kohorttitutkimu
