Association of Carpal Tunnel Syndrome in Diabetes Patient

Objective: The objective of our study was to determine Prevalence of carpel tunnel syndrome among diabetic patients and the significant association between carpel tunnel syndrome and diabetes mellitus. Materials and Methods: Study was conducted on 250 patients at Saveetha medical college and hospital. Study was conducted after getting proper ISE approval. Subjects were selected according to inclusion and exclusive criteria's. For every study subject after getting consent demographic information, past medical history of Diabetes such as type, duration, any associated complication (diabetic neuropathy, retinopathy, etc.), medication, and lifestyle modification were obtained via a self-reporting structured questionnaire and confirmed by the subject's medical record. For every subject, clinical tests such as Tinel's test and Phalen test were performed and nerve conduction study was used for diagnose carpal tunnel syndrome among the subjects who were showing positive clinical test. All data collected were entered into the standardized database and statistic analysis was calculated. Original Research Article Jaganath et al.; JPRI, 33(48A): 41-45, 2021; Article no.JPRI.75135 42 Results: After analysing the data collected on association between carpel tunnel syndrome and a diabetes patient. Conclusion: It implies that there is a significant relationship between carpal tunnel syndrome and

hospital. Study was conducted after getting proper ISE approval. Subjects were selected according to inclusion and exclusive criteria's. For every study subject after getting consent demographic information, past medical history of Diabetes such as type, duration, any associated complication (diabetic neuropathy, retinopathy, etc.), medication, and lifestyle modification were obtained via a self-reporting structured questionnaire and confirmed by the subject's medical record. For every subject, clinical tests such as Tinel's test and Phalen test were performed and nerve conduction study was used for diagnose carpal tunnel syndrome among the subjects who were showing positive clinical test. All data collected were entered into the standardized database and statistic analysis was calculated.
Original Research Article

INTRODUCTION
Carpal tunnel syndrome is defined as the entrapment of the median nerve in the carpal tunnel of the wrist. The onset of the disease usually starts as tingling and numbness or pain in the median nerve area and eventually leads to weakness and impaired hand function [1,2]. It is one of the most common peripheral neuropathies [3]. The incident and prevalence vary from 0.125%-1% and 5-16% depending upon the criteria used for the diagnosis [4].
In majority of patients, the exact cause and pathogenesis where not exactly known. Carpal tunnel syndrome and diabetic polyneuropathy are common condition in patients with type 1 and type 2 diabetic mellitus [4]. Experimental studies have shown a higher incidence of CTS in workers who are involved in high force and repetitive work compared to others [5,6,7,8].
Diabetic mellitus is a chronic metabolic disorder of carbohydrate, fat, and protein which result in state of hyperglycaemia which may lead to micro and/or macrovascular end organ damage. There are many types of diabetic but most common being type 1(Insulin dependent) and type 2(Non-Insulin dependent) diabetic of which latter is most commonly seen among people. Both of these types were found to be associated with or considered major risk factor for many of peripheral neuropathies [9].
Currently, the electro-diagnostic test is considered as Gold standard for diagnosis of carpal tunnel syndrome [10,11,12]. So far researchers through their studies have identified several factors that may contribute to the development of carpal tunnel syndrome which includes work condition [13,14], health condition, pregnancy, menopause [15,16], and personal factors such as female sex, hereditary, age, tobacco, caffeine and alcohol [17]. But the exact cause of carpal tunnel syndrome is unknown. In this study, we are trying to find out the prevalence of carpal tunnel syndrome among diabetic patients.

MATERIALS AND METHODS
The study was duly approved by The Institutional Ethics Committee, Saveetha medical college and hospital.

Study Design and Duration
A prospective observational study was conducted between Jan 2021 to May 2021 in the department of Orthopaedics, Saveetha medical college and hospital, Thandalam, Chennai, Tamil Nadu.

Inclusion Criteria
• Both male and female with confirmed diabetes, type 1 or type 2 attending diabetes OPD

Exclusion Criteria
• Patients below 13 years of age and above 60 years. • patients having secondary diabetes • Patients who are suffering from hypothyroidism, rheumatoid arthritis, joint deformities, fractures in the lower forearm, history of septic arthritis, occupational stress and other causes causing peripheral neuropathy including familial causes.

Data Collection
• For every subject, clinical tests such as Tinel's test and Phalen test were done • Nerve conduction study was performed for patient who was positive for above mentioned tests for diagnosing carpal tunnel syndrome. • All data collected were entered into the standardized database and statistic analysis was calculated.

Statistic Analysis
After collecting data from the patients, they are entered into the standardized database. The prevalence of carpel tunnel syndrome among diabetes patients, in the general population, is calculated using.
Assuming the Null hypothesis is true, which states that there is no association between carpel tunnel syndrome and a diabetes patient, chi-square (x 2 ) was calculated, The chi-square statistics 12.5334. The P-value is <0.0004. The test is significant at <0.05.
The chi-square statistic with Yates correction is 11.5392. The p-value is .000681. Significant at p < 0.05.
It implies that there is a significant associating carpel tunnel syndrome and a diabetes patient.

Chi-square (x 2 ) Calculation, [Table 2]
Assuming the Null hypothesis is true, which states that there is no association between carpel tunnel syndrome and a diabetes patient, chi-square (x 2 ) was calculated, The chi-square statistic is 20.2021. The p-value is < 0.00001. Significant at p < .05. The chisquare statistic with Yates correction is 17.6181.
The p-value is < 0.00001. Significant at p < .05. Since the P-value <0.05, the Null hypothesis is rejected.
It implies that there is a significant associating carpel tunnel syndrome and a diabetes patient with peripheral neuropathy.

RESULTS
This study was conducted to find out the prevalence of carpal tunnel syndrome among diabetes patients. In this study, we have included 250 study subjects out of which 83% of the population was above 45 years old. The prevalence of carpal tunnel syndrome among diabetes patients was 37.3% (table 1) out of which 22.2% was seen among female patients and rest, 15.1% was among male patients. Also in this study, we have shown that there is a significant association between carpal tunnel syndrome and diabetes patient with peripheral neuropathy and the incidence of CTS increases significantly after 5 years of diabetes.

DISCUSSION
After collection of data and statistic analysis it, we have found that the prevalence of carpal tunnel syndrome among diabetes is 37.3% and there is significant association between carpel tunnel syndrome among diabetes patients. The exact cause of carpal tunnel syndrome was not yet clearly understood but many studies have been undertaken to determine the prevalence of carpal tunnel syndrome [18,19]. The prevalence of carpal tunnel syndrome among the general population was about 2.7 per cent [16]. Many studies have shown that the prevalence of carpal tunnel syndrome is much higher in diabetes patients than that of the general population which shows that diabetes are an important risk factor for carpal tunnel syndrome [20,21,22]. There are also some studies that states there is no significant increase prevalence of carpel tunnel syndrome among diabetes patients.
As with most other short term studies, in this study also has some limitations such as, in our study we have only included a certain group of the population that may not represent the entire general population. In spite of these limitations in this study we have calculated the prevalence of CTS among diabetes patients, also we have shown that the incidence of CTS is more among diabetes patient with peripheral neuropathy and it increases with the duration of diabetes mellitus.

CONCLUSION
After analysing the data's collected we have show in this study the prevalence of carpel tunnel syndrome was 37.3% among diabetic. We also shown that there is significant association between carpel tunnel syndrome in diabetes patients, also we have shown that the incidence of CTS is more among diabetes patient with peripheral neuropathy and it increases with the duration of diabetes mellitus.

CONSENT
As per international standard or university standard, patients' written consent has been collected and preserved by the author(s).

ETHICAL APPROVAL
The study was duly approved by The Institutional Ethics Committee, Saveetha medical college and hospital.