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2 PB
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Department of Anthropology, Jagiellonian University, Krakow, Poland
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Department of Anatomy, Jagiellonian University, Krakow, Poland
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University Hospital, Jagiellonian University Medical College, Krakow, Poland
Address for correspondence: M. Koziej, MD, Department of Anatomy, Jagiellonian University, ul. Kopernika 12, 31–034 Kraków, Poland,
tel/fax: +48 12 42 29 51, e-mail: mateusz.koziej@gmail.com
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M. Trybus et al., Hand anthropometry in carpal tunnel syndrome
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Folia Morphol., 2019, Vol. 78, No. 1
60.7 ± 11.5 years (range: 36–81 years). The mean age any CTS occurrence in either gender (p > 0.05). A total
for the control group was 51.4 ± 10.3 years (range: of 66.7% of all patients with CTS and 70% of healthy
31–68 years). The patients in the control group were volunteers were found to be physically active.
significantly younger in both sexes (p < 0.05). None of There was no significant difference in the length
the measured hand parameters were correlated with of digits I–V between groups and genders (p > 0.05).
age in a particular group or in either gender (p > 0.05). The same results were obtained in the functional
Participants’ places of residence (urban vs. rural) length of digits I–V (p > 0.05). Statistical comparison
and physical activity did not statistically determine revealed differences in the width of proximal phalan-
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Figure 1. Anthropometric measurements performed in this study; L1-L5 — length of the digits; W1-W5 — width of the digits; F1-F5 — func-
tional length of digits; C1-C5 — circumference of the proximal phalanges; L6 — length without fingers; L7 — hand length; W6 — hand width
in the metacarpus; H1 — palm thickness; H2 — height of hypothenar; H3 — height of thenar; C6 — circumference through fingers; C7 —
palm circumference; C8 — hand circumference; C9 — wrist circumference; W7 — wrist width; H4 — wrist thickness.
ges I-V in females between patients with CTS and the Total hand length, as well as the palm length
control group, where mean value was higher in the without fingers was not statistically different between
CTS group (Table 3, p < 0.001). In females, means of groups and genders (Table 4, p > 0.05). Measure-
circumferences of proximal fingers were significantly ments of the width of the metacarpus, thickness of
higher in the CTS group (Table 3, p < 0.001). No sig- hand, the height of the thenar and the height of the
nificant differences were recorded in males (Table 3). thenar eminence did not shown statistical differences
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M. Trybus et al., Hand anthropometry in carpal tunnel syndrome
in analysed groups and genders (p > 0.05). Statistical puted shape and digit indexes, as well as hand length/
analysis has shown that narrower wrists occur in pa- height ratios and hand length/upper limb ratios have
tients with CTS when compared to the control group, not shown any significant differences between the
both in males and females (p = 0.02 and p = 0.004, control and CTS groups in either gender (p > 0.05).
respectively). Mean value of the height (depth) The BMI of females with CTS was significantly
of the wrist was significantly higher in the female CTS higher than in females form the control group (29.8 ±
group (p = 0.03), with a similar trend in the male CTS ± 5.0 vs. 25.7 ± 5.3 kg/m2; p < 0.001). The males’
group (p = 0.08). BMI was similar in both groups (27.9 ± 4.0 vs. 25.7 ±
Measurement of the circumference of the wrist ± 2.6 kg/m2; p > 0.05). Based on the World Health
has shown that females with CTS have a higher mean Organisation classification of BMI, we have observed
value than the control group (Table 4, p < 0.001), that almost 90.0% of females with diagnosed CTS
but we could not observe the same finding in males have an elevated BMI, wherein 54.5% of females
(p > 0.05). Mean values of hand circumference mea- were considered overweight and 33.3% considered
sured in the finger area were higher in CTS group than obese. In the control group, overweight and obesity
in the control group of women (Table 4, p = 0.007). status was observed in 31.0% and 17.2% of cases,
However, the circumference of the palm and hand respectively. In the male CTS group, 46.7% and 26.7%
(with the thumb adducted) were similar in both of patients were considered overweight and obese,
groups (Table 4, both p > 0.05). No differences in respectively. It is important to note, that 72.7% of
mentioned parameters were found in males between the males in the control group were also considered
the CTS group and control group. overweight. No statistical significance differences
We have noted that the mean value of the body were recorded in the percentage of overweight and
height of the females with CTS (158.9 ± 4.6 cm) was obese individuals between CTS and control group
significantly lower than in the control group (162 ± (p > 0.05).
± 5.5 cm; p = 0.025). We could not observe the same
finding in males. There were no statistically significant DISCUSSION
differences in length of the arm, forearm and the total The aim of this study was to evaluate the hy-
length of the upper limb between analysed groups pothesis that the CTS is related to hand morphom-
and genders (Table 5, p > 0.05). etry. Factors not directly related to anthropometric
Correlation coincidences were analysed between measurements was also considered in this study and
the width of each proximal phalange, the width of the included: age, BMI, place of residence and daily phys-
hand in metacarpal area and body weight (Table 6). ical activity to find potential links to CTS occurrence.
In the female control group there were significant Previous authors have stated that CTS is more
correlations between body weight and each finger common in people above 40 years old, and that risk
width (except thumb) as well as metacarpal width increases with age [18, 31, 34]. This is why our control
(p < 0.001; r = 0.35–0.57). In the CTS group such group consisted mainly of mature individuals (Table 2)
correlation was observed for both sexes, but for the to best match patients in the CTS group. Other fac-
metacarpal width only (p < 0.001; r = 0.56–0.71; tors in addition to age are equally important. Phys-
Table 6). Correlation coincidences were also analysed ical factors such as repeatable pressure, systematic
between circumferences within the hand, palm and bending or torsion of the hand with the wrist during
body weight (Table 6) and significant correlations with work activity, using vibrating tools, some everyday
the individual fingers circumferences occurred only in activities, as well as hand trauma can lead to CTS
the female control group (p < 0.001, r = 0.46–0.63). [4, 13, 22, 23, 33]. In addition, individual factors such
Furthermore, all remaining measured circumferences as gender, pregnancy, endocrine disorders, diabetes
were correlated with body weight in both groups and or connective tissue disorders could indirectly and
genders (Table 6, p < 0.05). directly influence CTS manifestation [17, 26]. Two
Calculated indexes are presented in the Table 7. other medical factors predisposing to this condition,
The wrist index was calculated in every group and such as rheumatoid arthritis and kidney failure can
the value was statistically higher in both males and be also included in that list [5].
females from CTS group compared with the control As aforementioned, it is well known that CTS is
group (p = 0.01 and p < 0.001, respectively). Com- more frequent in women [3]. In our patient study
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Folia Morphol., 2019, Vol. 78, No. 1
Table 6. Association between proximal phalanges and hand circumferences and body weight, as well as, width of proximal phalan-
ges, hand and body weight
Males Females
CTS (20 hands) Control (22 hands) CTS (51 hands) Control (58 hands)
r p r p r p r p
Association between proximal phalanges width and hand width in the metacarpus and body weight
I 0.15 NS 0.30 NS 0.06 NS 0.16 NS
II –0.01 NS –0.02 NS 0.02 NS 0.57 < 0.001
III 0.29 NS –0.11 NS 0.05 NS 0.35 0.012
IV 0.10 NS 0.05 NS –0.02 NS 0.56 < 0.001
V 0.33 NS –0.03 NS 0.10 NS 0.51 < 0.001
Hand width in the metacarpus 0.64 0.002 0.71 < 0.001 0.56 < 0.001 0.57 < 0.001
Association between circumferences and body weight
I 0.19 NS 0.33 NS 0.03 NS 0.62 < 0.001
II -0.07 NS 0.37 NS 0.12 NS 0.63 < 0.001
III 0.27 NS 0.20 NS 0.15 NS 0.46 < 0.001
IV 0.05 NS 0.35 NS -0.05 NS 0.59 < 0.001
V 0.10 NS 0.32 NS 0.01 NS 0.49 < 0.001
Palm circumference 0.53 0.014 0.75 < 0.001 0.40 0.002 0.59 < 0.001
Hand circumference 0.74 < 0.001 0.79 < 0.001 0.49 < 0.001 0.63 < 0.001
Circumference through fingers 0.73 < 0.001 0.47 0.033 0.42 < 0.001 0.56 < 0.001
Wrist circumference 0.70 < 0.001 0.74 < 0.001 0.61 < 0.001 0.80 < 0.001
I–V — proximal phalanges; NS — non-significant; CTS — carpal tunnel syndrome
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M. Trybus et al., Hand anthropometry in carpal tunnel syndrome
group, females were far more prevalent than males, CTS is related to body fat content [4, 7, 11]. Increased
accounting for 70% of all patients. This prevalence fat mass within the carpal tunnel and hydrostatic
may be related to an increased predisposition of fe- pressure in obese people can be an indirect factor
males to being overweight, especially in the peri- and in elevated morbidity in CTS [34]. Other indexes did
postmenopausal periods [21]. It can be also related not demonstrate any significant difference between
to hormone level fluctuations [16]. Oestrogen recep- patients with CTS and volunteers.
tors are located in the central and peripheral nervous Interestingly, our study shows that in CTS patients,
systems and one of its relevant actions is neuron thenar eminence dimensions were similar to the val-
proliferation and regeneration [12, 28]. At the per- ues obtained in the control group. Previous studies
imenopausal age, oestrogen levels are reduced and indicated that severe CTS is often accompanied by
can influence the medial nerve and other structures thenar eminence muscles atrophy caused by com-
located in the carpal tunnel [16]. With respect to body pression of the motor branch of the median nerve [6].
height, females with CTS were significantly shorter In the current study, patients were not categorised
than control subjects. This result is dependent on by the severity of symptoms as it was presented in
the selection of the control group. However, Chiotis previous publications [4]. It may be the reason why
et al. [5] reported similar findings. They examined the averaged measurements for all subjects of our
only women and revealed that females with CTS had study did not show muscle atrophy.
a smaller average body height as well as a higher BMI Higher values of the wrist index are character-
than the control group. Moreover, Mondelli et al. [25] istic of people with CTS, concerning both men and
have shown that in clinical practice, the cut-off values women. There is no evident explanation about link
for many anthropometric measurements have limited between wrist structure and its predisposition to CTS
value as tools for the diagnosis of CTS. occurrence in current literature [4, 9]. Some authors
We haven’t noticed any significant differences have shown dependence between the wrist index
between the CTS patients and control individuals in and CTS (odds ratio: 1.35, p < 0.001) [4, 14, 30].
the lengths and functional lengths of digits as well as Kouyoumdjian et al. [19, 20] indicates that higher
total hand length and palm length without fingers. values of the wrist ratio is an increased risk factor
Moreover, no relation was found between CTS oc- of CTS occurrence. It is suggested that values of the
currence in both genders and height measurements wrist ratio can be related with changes in the canal,
of the hand. Research conducted by Hlebs et al. [10] such as static and dynamic changes between the
showed that people with CTS have shorter third digits wrist ligaments or nerves. It is believed that a stronger
than healthy volunteers, but our study did not repli- association with CTS is observable for the wrist ratio
cate the same dependence. (depth to width ratio) than for direct dimensions such
A completely different situation is observed with as circumference or width, which suggests that the
width measurements and circumferences of the hand. shape of wrist is more significant than its dimensions
It has been shown that the widths of the proximal [24]. Moreover, some authors suggest that CTS emer-
phalanges in females are significantly different be- gence is connected with nerve conduction velocity
tween CTS patients and healthy volunteers. Higher along the medial nerve, which in turn is connected
mean values of width measurement of the proximal with age, body height and BMI [8].
phalanges were observed in females with CTS. On Kamolz et al. [15] implement wrist classification
the other hand, no such differences between CTS according to its shape with two main types: rec-
and healthy subjects were recorded in males. It may tangular and square. For the former, the mean val-
be due to the fact that width measurements are ue of the wrist ratio is 0.65 and for the latter, it is
dependent on body weight. Females at the perimen- above 0.70. Patients with wide wrists with a square
opausal age tend to have increased weight and BMI shape may have slower nerve impulse speed along
which may consequently favour the manifestation of the sensory and motor fibres in the canal [5]. The
CTS [12, 28]. In our research, females with CTS have critical value of the wrist index which may lead to
significantly higher BMI values, with almost 90% hav- a decrease in conduction velocity is 0.7 (square shape).
ing a BMI above 25.0 kg/m2. A similar tendency was Our research demonstrates values of 0.8 and 0.74,
found in other studies, wherein people with CTS had respectively for males and females of our CTS group,
elevated BMI values. Hence, it is reasonable to say that which indicates a mainly square shape of the wrist.
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Folia Morphol., 2019, Vol. 78, No. 1
Moreover, such a shape may directly translate into the syndrome. Coll Antropol. 2014; 38(1): 219–226, indexed in
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