• The study had a minimum of 30 subjects included.
  • Appropriate statistical analysis, emphasis on including logistic regression or multilinear regression in an attempt to control for other factors
  • The study was published in English.

Medical Conditions: diabetes, rheumatoid arthritis, thyroid disease, connective tissue disorders, vitamin B6 deficiency, pregnancy

Body Mass Index (BMI): Weight, Stature

• Gender

Wrist dimension/Anatomical size and shape of the carpal canal Age

General conditioning: strength, aerobic conditioning Genetics

Table 1 : Non-Biomechanical Risk Factors for CTDs

The search strategy included a MEDLINE search using the qualifier, 'etiology,' or 'epidemiology' with the medical subject headings of: carpal tunnel syndrome (CTS), median nerve injury, cumulative trauma disorders (CTDs), low back pain and repetitive strain disorders. If the study focused on age, gender, medical status, obesity, physical condition, anatomical variation or genetics, it was screened for the above criteria based upon the abstract. The articles selected are not meant to represent an exhaustive list but simply the studies with an adequate scientific basis.

There are many personal co-factors that have been related to the development of CTS and to a lesser extent all CTDs. Obesity (body mass index), square wrist configuration, small carpal canal area, diabetes as well as several other connective tissue disorders and poor general fitness have all been associated with higher prevalence of CTS. The ultimate mechanism of injury is probably ischemia so anything that influences the health of the vascular system may compromise the soft tissues, i.e. nerve, muscle and tendon. Several investigators have suggested that CTDs and specifically CTS are primarily a result of health habits and lifestyle and secondarily to the biomechanical stress. Of the numerous personal co-factors that have been reported, few have been quantified as to the strength of the association. In the instances where the relative risk has been determined, attempts at modeling disease based upon these factors have only explained a small percentage of the variance.

Systemic Disorders

Many systemic disorders place an individual at higher risk for the development of soft tissue injuries. Diabetes and rheumatoid arthritis are the most obvious risk factors affecting the development of overuse syndromes (Stevens et al. 1992; Albers et al. 1996; Atcheson et al. 1998). Rheumatoid arthritis patients as well as those with other connective tissue disorders are at higher risk for development of joint abnormalities as well as muscle and nerve injuries (Stevens



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