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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%.


INTRODUCTION:
(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 carpal tunnel syndrome (3).
Carpal tunnel syndrome (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 is vary according to the severity. Hypoesthesia involve 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 is differ from each population to other. in the Netherlands 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 carpal tunnel syndrome (6). Women are considerably more prone to this disorder in a ratio of 3:1 to about 10:1(4). CTS are bilateral in up to 87% of patients clinically and approximate 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 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 carpal tunnel syndrome among adult population at Almjma'ah City including the prevalence of CTS, the understanding of clinical features, etiology, management, and prevention and its effect in social life. Study Planned duration: the timetable of study has been created to collect data from sample population in a period not rather than 6 months from May to Oct. 2018. Inclusion Criteria: 1. Age >18.

2.
Non-Saudi population End Point and Outcomes 1. Primary end point awareness of carpal tunnel syndrome among adult population. 2. Secondary outcomes were population understanding of clinical features, causes, prevention and management of CTS and its relationship with chronic disease. Also, its prevalence among adult Saudi people in almjmaah city.

Measurement
• A structured questionnaire has been designed to measure the following variables: • the prevalence of carpal tunnel syndrome among Saudi population in almjmaah 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, Marital status. prevalence of carpal Tunnel Syndrome, clinical features, causes, prevention and management of disease will have analyzed through percentages and other statistical commands. Also, chi square test will have done to fixed the CTS and chronic disease relationship.

RESULTS:
There are 386 participants volunteered in CTS study from almjmaah population. The prevalence of CTS is 14% of the participants reported that they had CTS which equal 54 person while 86% they have not which equal 332 illustrated on (figure 1). The Females are more than Males (57.6% to 42.4%) in the study. While Youth are more participating involve study (43.1%), category (40-60) represent 40.7%, and a few participants from overage (16.2%). And nearly over two third of participants are married. Illustrated In (Table 1)  About one third (30.1%) of the sample are think that clinical features can happen with carpal Tunnel Syndrome is " Pain in wrist ", and 26.8% of the sample are think that clinical features can happen with carpal Tunnel Syndrome is " Tingling and numbness in thumb, index and middle finger ", and 8.4% of the sample are thought that the symptom can happen with carpal Tunnel Syndrome 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 carpal Tunnel Syndrome is " Muscle wasting in the hand ", and 10.3% of the sample are thought that clinical features can happen with carpal Tunnel Syndrome is " Changing of pain intensity while moving the wrist". . Illustrated In (Table 2) Exactly one third (33.8%) of the sample are think that the causes lead to carpal Tunnel Syndrome is "Trauma ", while 29.1% of the sample are think that " Repeated physical activities like using computer and taping", is the cause. Also, 21.4% of the sample think that the causes lead to carpal Tunnel Syndrome is " wrist fracture or dislocation", and 9.5% of the sample thought that the leading cause of carpal Tunnel Syndrome is " Arthritis ", and 6.2% of the sample think that the causes lead to carpal Tunnel Syndrome is " Tumor of bone ". table and chart below shown that. Illustrated In (Table 3).
29.7% of participants reported that they thought that oral analgesics is a method of treat CTS, 23.8% thought it could be treat by splint & 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).     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)