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Incidence of Shoulder Impingement Syndrome Among Patients with Carpal Tunnel Syndrome: Epidemiological Study

Naglaa Hussein1*, Thochycovny Desmarets2, Richard Vilchez2

Aim of the work: Measure incidence of shoulder impingement syndrome (SIS) among carpal tunnel syndrome (CTS) patients and relationship with other risk factors.

Patients and Methods: This is a cross sectional study at outpatient setting, included 565 patients (210male and 355female) with clinical manifestation of CTS associated with shoulder pain.

Exclusion criteria: patients with manifestation suggestive of peripheral neuropathy, cervical radiculopathy or other neuromuscular disorder. Each patient was subjected to the following; detailed history, Pain score by visual analogue score, (VAS), neurological examination including Tinel’s sign and Phalen test, shoulder exam including Neer Impingement sign and Hawkins impingement sign, neck exam, Hemoglobin A1c level, nerve conduction study (NCS) for median, ulnar, Including the comparative techniques, electromyography of both upper extremities, MRI of shoulders if possible.

Results: Mean age was 48.2 y, majority was hard worker (56.8%), light worker (22.8%), house wives (16.8%) and house- keeping (3.5%). Only 161 patients (28.5%) had diabetes mellitus type II. Pain score was severe in 58.2%, moderate in 32.6% and mild in 3.7%, no pain in 5.5%. All studied patients (100%) had CTS confirmed by NCS. SIS was found on 380patients (67.25%). shoulder MRI was done for only 298 patients and all showed rotator cuff tendopathy. Significant incidence of SIS among diabetics (p 0.001). Significant incidence of MRI findings among diabetics (p 0.0001). Among diabetics 78.26% have both CTS and clinical impingement together, that is significantly higher than non-diabetics (p=0.0004). SIS had significantly high incidence among hard worker (p=0012). SIS was significantly correlated with prolonged distal median motor latency (right side p=0.011, left side p=0.023) and with prolonged peak median sensory latency (p=0.38 on right side and p=0.033 on left side). Pain score was significantly correlated with SIS (p=0.27) and MRI findings (p=0.031).

Conclusions: Significant high incidence of SIS among CTS patients This is higher among diabetic patients and manual worker. SIS significantly increases VAS among CTS patients and is significantly correlated with degree of CTS as reflected by median distal motor and peak sensory latency.