Carpel tunnel syndrome: A link with vitamin D and calcium

Abdul‑razzak,Khalid Khaleel; Kofahi,Raid Mohammed

doi:10.3892/br.2020.1322

Carpel tunnel syndrome: A link with vitamin D and calcium

Authors:
- Khalid Khaleel Abdul‑razzak
- Raid Mohammed Kofahi
View Affiliations

Affiliations: Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan, Department of Neuroscience, Faculty of Medicine, Jordan University of Science and Technology, Irbid‑22110, Jordan
Published online on: June 26, 2020 https://doi.org/10.3892/br.2020.1322
Article Number: 15

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Carpal tunnel syndrome (CTS) and vitamin D deficiency are two conditions that cause chronic pain and are thus associated with psychological issues as well. The aim of the present study was to evaluate vitamin D levels, daily calcium intake, musculoskeletal pain and psychological symptoms in patients with CTS. The study included 48 patients with CTS and age‑sex matched controls. Serum vitamin D levels were measured, and psychological symptoms were assessed using a Hospital Anxiety and Depression Scale. A Pain DETECT questionnaire was used to assess musculoskeletal pain (MSP) sites and severity. The results showed that vitamin D deficiency was considerably more prevalent in patients with CTS (95.8%) compared with controls (22.9%). Clinical anxiety (35.4 vs. 6.3%) and clinical depression (29.2 vs. 4.2%) were also more common in patients with CTS compared with controls. All the patients with CTS exhibited MSP, whereas none of the controls reported any MSP. Anxiety was significantly and inversely associated with vitamin D levels (r²=‑0.482; P<0.01), total daily calcium intake (r²=‑0.294: P<0.05), and positively associated with body mass index (BMI; r²=0.200; P≤0.05) and depression (r²=0.587; P<0.01). Depression was significantly and inversely associated with vitamin D levels (r²=‑0.269; P<0.01) and total daily calcium intake (r²=‑0.236; P<0.05). Logistic regression analysis showed that with every unit increase in serum vitamin D levels, the odds of CTS were decreased 1.22x. While a one‑unit increase in anxiety total score was associated with a 14% increase in the odds of having CTS after adjusting for different confounders. In conclusion, vitamin D deficiency, MSP and psychological symptoms are common in patients with CTS. Serum vitamin D levels and anxiety were significant independent predictors of CTS. Based on the results of the present study, it was shown that housewives had an equivalent chance of suffering from CTS morbidity as other high‑risk professions. Further studies are required to confirm if vitamin D supplementation could prevent the onset of CTS.

View Figures

View References

1	Ghasemi-Rad M, Nosair E, Vegh A, Mohammadi A, Akkad A, Lesha E, Mohammadi MH, Sayed D, Davarian A, Maleki-Miyandoab T and Hasan A: A handy review of carpal tunnel syndrome: From anatomy to diagnosis and treatment. World J Radiol. 6:284–300. 2014.PubMed/NCBI View Article : Google Scholar
2	Aroori S and Spence RA: Carpal tunnel syndrome. Ulster Med J. 77:6–17. 2008.PubMed/NCBI
3	Newington L, Harris EC and Walker-Bone K: Carpal tunnel syndrome and work. Best Pract Res Clin Rheumatol. 29:440–453. 2015.PubMed/NCBI View Article : Google Scholar
4	Tanik N, Balbaloğlu Ö, Ucar M, Sarp U, Atalay T, Çelikbilek A, Göçmen AY and Inan LE: Does vitamin D deficiency trigger carpal tunnel syndrome? J Back Musculoskelet Rehabil. 29:835–839. 2016.PubMed/NCBI View Article : Google Scholar
5	Nageeb RS, Shehta N, Nageeb GS and Omran AA: Body mass index and vitamin D level in carpal tunnel syndrome patients. Egypt J Neurol Psychiatr Neurosurg. 54(14)2018.PubMed/NCBI View Article : Google Scholar
6	Demiryurek BE and Gundogdu AA: The effect of vitamin D levels on pain in carpal tunnel syndrome. Orthop Traumatol Surg Res. 103:919–922. 2017.PubMed/NCBI View Article : Google Scholar
7	Edwards MH, Cole ZA, Harvey NC and Cooper C: The global epidemiology of vitamin D status. J Aging Res Clin Practice. 3:148–158. 2014.
8	Kim K, Gong HS, Kim J and Baek GH: Expression of vitamin D receptor in the subsynovial connective tissue in women with carpal tunnel syndrome. J Hand Surg Eur Vol. 43:290–295. 2018.PubMed/NCBI View Article : Google Scholar
9	Bonfiglioli R, Mattioli S, Spagnolo MR and Violante FS: Course of symptoms and median nerve conduction values in workers performing repetitive jobs at risk for carpal tunnel syndrome. Occup Med (Lond). 56:115–121. 2006.PubMed/NCBI View Article : Google Scholar
10	Tekeoglu I, Gulcu E, Sayin R, Besiroglu L and Yazmalar L: Sleep quality, depression and anxiety in carpal tunnel syndrome/Karpal tunel sendromunda uyku kalitesi ile depresyon ve anksiyete bulgulari. Turk J Phys Med Rehab. 102–107. 2008.
11	Jerosch-Herold C, Houghton J, Blake J, Shaikh A, Wilson EC and Shepstone L: Association of psychological distress, quality of life and costs with carpal tunnel syndrome severity: A cross-sectional analysis of the PALMS cohort. BMJ Open. 7(e017732)2017.PubMed/NCBI View Article : Google Scholar
12	Sieberg CB, Taras C, Gomaa A, Nickerson C, Wong C, Ward C, Baskozos G, Bennett DLH, Ramirez JD, Themistocleous AC, et al: Neuropathic pain drives anxiety behavior in mice, results consistent with anxiety levels in diabetic neuropathy patients. Pain Rep. 3(e651)2018.PubMed/NCBI View Article : Google Scholar
13	Abdul-Razzak KK, Mayyas FA and Al-Farras MI: Vitamin D as potential antidepressant in outpatients with musculoskeletal pain. Int J Clin Pharmacol Ther. 56:400–410. 2018.PubMed/NCBI View Article : Google Scholar
14	Abdul-Razzak KK, Almanasrah SO, Obeidat BA and Khasawneh AG: Vitamin D is a potential antidepressant in psychiatric outpatients. Int J Clin Pharmacol Ther. 56:585–596. 2018.PubMed/NCBI View Article : Google Scholar
15	Alkhatatbeh MJ, Abdul-Razzak KK, Khasawneh LQ and Saadeh NA: Prevalence of musculoskeletal pain in association with serum 25-hydroxyvitamin D concentrations in patients with type 2 diabetes mellitus. Biomed Rep. 8:571–577. 2018.PubMed/NCBI View Article : Google Scholar
16	McCabe PS, Pye SR, Mc Beth J, Lee DM, Tajar A, Bartfai G, Boonen S, Bouillon R, Casanueva F, Finn JD, et al: Low vitamin D and the risk of developing chronic widespread pain: Results from the European male ageing study. BMC Musculoskelet Disord. 17(32)2016.PubMed/NCBI View Article : Google Scholar
17	Alkhatatbeh MJ, Abdul-Razzak KK, Amara NA and Al-Jarrah M: Non-cardiac chest pain and anxiety: A possible link to vitamin D and calcium. J Clin Psychol Med Settings. 26:194–199. 2019.PubMed/NCBI View Article : Google Scholar
18	Abdul-Razzak KK, Alshogran OY, Altawalbeh SM, Al-Ghalayini IF, Al-Ghazo MA, Alazab RS, Halalsheh OM and Sahawneh FE: Overactive bladder and associated psychological symptoms: A possible link to vitamin D and calcium. Neurourol Urodyn. 38:1160–1167. 2019.PubMed/NCBI View Article : Google Scholar
19	Goodyear MD, Krleza-Jeric K and Lemmens T: The declaration of Helsinki. BMJ. 335:624–625. 2007.PubMed/NCBI View Article : Google Scholar
20	Freynhagen R, Baron R, Gockel U and Tölle TR: painDETECT: A new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin. 22:1911–1920. 2006.PubMed/NCBI View Article : Google Scholar
21	Axford J, Butt A, Heron C, Hammond J, Morgan J, Alavi A, Bolton J and Bland M: Prevalence of anxiety and depression in osteoarthritis: Use of the hospital anxiety and depression scale as a screening tool. Clin Rheumatol. 29:1277–1283. 2010.PubMed/NCBI View Article : Google Scholar
22	Rolfes SR, Pinna K and Whitney E: Understanding Normal and Clinical Nutrition. 9th edition. Cengage Learning, 2009.
23	Abdul-Razzak KK, Obeidat BA, Al-Farras MI and Dauod AS: Vitamin D and PTH status among adolescent and young females with severe dysmenorrhea. J Pediatr Adolesc Gynecol. 27:78–82. 2014.PubMed/NCBI View Article : Google Scholar
24	Gao X, Wilde PE, Lichtenstein AH and Tucker KL: Meeting adequate intake for dietary calcium without dairy foods in adolescents aged 9 to 18 years (National Health and Nutrition Examination Survey 2001-2002). J Am Diet Assoc. 106:1759–1765. 2006.PubMed/NCBI View Article : Google Scholar
25	Lima GA, Lima PD, Barros Mda G, Vardiero LP, Melo EF, Paranhos-Neto Fde P, Madeira M and Farias ML: Calcium intake: Good for the bones but bad for the heart? An analysis of clinical studies. Arch Endocrinol Metab. 60:252–263. 2016.PubMed/NCBI View Article : Google Scholar
26	Gürsoy AE, Bilgen HR, Dürüyen H, Altıntaş Ö, Kolukisa M and Asil T: The evaluation of vitamin D levels in patients with carpal tunnel syndrome. Neurol Sci. 37:1055–1061. 2016.PubMed/NCBI View Article : Google Scholar
27	Lee SH, Gong HS, Kim DH, Shin HS, Kim KM, Kim J and Baek GH: Evaluation of vitamin D levels in women with carpal tunnel syndrome. J Hand Surg Eur Vol. 41:643–647. 2016.PubMed/NCBI View Article : Google Scholar
28	AlJohri R, AlOkail M and Haq SH: Neuroprotective role of vitamin D in primary neuronal cortical culture. eNeurological Sci. 14:43–48. 2019.PubMed/NCBI View Article : Google Scholar
29	Shehab D, Al-Jarallah K, Mojiminiyi OA, Al Mohamedy H and Abdella NA: Does vitamin D deficiency play a role in peripheral neuropathy in type 2 diabetes? Diabet Med. 29:43–49. 2012.PubMed/NCBI View Article : Google Scholar
30	Celikbilek A, Gocmen AY, Tanik N, Borekci E, Adam M, Celikbilek M, Suher M and Delibas N: Decreased serum vitamin D levels are associated with diabetic peripheral neuropathy in a rural area of Turkey. Acta Neurol Belg. 115:47–52. 2015.PubMed/NCBI View Article : Google Scholar
31	Shipton EE and Shipton EA: Vitamin D deficiency and pain: Clinical evidence of low levels of vitamin D and supplementation in chronic pain states. Pain Ther. 4:67–87. 2015.PubMed/NCBI View Article : Google Scholar
32	Muir SW and Montero-Odasso M: Effect of vitamin D supplementation on muscle strength, gait and balance in older adults: A systematic review and meta-analysis. J Am Geriatr Soc. 59:2291–2300. 2011.PubMed/NCBI View Article : Google Scholar
33	Holick MF: Vitamin D: Evolutionary, physiological and health perspectives. Curr Drug Targets. 12:4–18. 2011.PubMed/NCBI View Article : Google Scholar
34	Torta R, Ieraci V and Zizzi F: A review of the emotional aspects of neuropathic pain: from comorbidity to co-pathogenesis. Pain Ther. 6 (Suppl 1):S11–S17. 2017.PubMed/NCBI View Article : Google Scholar
35	Turk DC, Audette J, Levy RM, Mackey SC and Stanos S: Assessment and treatment of psychosocial comorbidities in patients with neuropathic pain. Mayo Clin Proc. 85 (3 Suppl):S42:–S50. 2010.PubMed/NCBI View Article : Google Scholar
36	Shin YH, Yoon JO, Kim YK and Kim JK: Psychological status is associated with symptom severity in patients with carpal tunnel syndrome. J Hand Surg Am. 43:484.e1–484.e8. 2018.PubMed/NCBI View Article : Google Scholar
37	Castro M, Quarantini L, Daltro C, Pires-Caldas M, Koenen K, Kraychete D and Oliveira I: Comorbidade de sintomas ansiosos e depressivos em pacientes com dor crônica e o impacto sobre a qualidade de vida. Arch Clin Psychiatry (São Paulo). 38:126–129. 2011.
38	Werner RA: Evaluation of work-related carpal tunnel syndrome. J Occup Rehabil. 16:207–222. 2006.PubMed/NCBI View Article : Google Scholar
39	Chaurasia RN, Kawale SS, Pathak A, Mishra VN and Joshi D: Clinical evaluation and diagnostic utilities of different nerve conduction tests in 100 patients with carpal tunnel syndrome. J Neurosci Rural Pract. 8:575–580. 2017.PubMed/NCBI View Article : Google Scholar
40	Mattioli S, Baldasseroni A, Curti S, Cooke RM, Mandes A, Zanardi F, Farioli A, Buiatti E, Campo G and Violante FS: Incidence rates of surgically treated idiopathic carpal tunnel syndrome in blue- and white-collar workers and housewives in Tuscany, Italy. Occup Environ Med. 66:299–304. 2009.PubMed/NCBI View Article : Google Scholar
41	Abdalla SF: Neurophysiologic pattern and severity grading scale of carpal tunnel syndrome in sudanese patients. Archiv Med. 8(213)2017.
42	Sala E, Mattioli S, Violante FS and Apostoli P: Risk assessment of biomechanical load for the upper limbs in housework. Med Lav. 98:232–251. 2007.PubMed/NCBI(In Italian).
43	Kouyoumdjian JA, Morita MD, Rocha PR, Miranda RC and Gouveia GM: Body mass index and carpal tunnel syndrome. Arq Neuropsiquiatr. 58:252–256. 2000.PubMed/NCBI View Article : Google Scholar
44	Komurcu HF, Kilic S and Anlar O: Relationship of age, body mass index, wrist and waist circumferences to carpal tunnel syndrome severity. Neurol Med Chir (Tokyo). 54:395–400. 2014.PubMed/NCBI View Article : Google Scholar
45	Atalay NS, Sarsan A, Akkaya N, Yildiz N and Topuz O: The impact of disease severity in carpal tunnel syndrome on grip strength, pinch strength, fine motor skill and depression. J Phys Ther Sci. 23:115–118. 2011.
46	Nordstrom DL, Vierkant RA, DeStefano F and Layde PM: Risk factors for carpal tunnel syndrome in a general population. Occup Environ Med. 54:734–740. 1997.PubMed/NCBI View Article : Google Scholar