J Menopausal Med.  2016 Aug;22(2):80-86. 10.6118/jmm.2016.22.2.80.

Correlation between Female Sex Hormones and Electrodiagnostic Parameters and Clinical Function in Post-menopausal Women with Idiopathic Carpal Tunnel Syndrome

• Mohammadi
• Naseri M
• Namazi H
• Ashraf MJ
• Ashraf A

• KMID: 2365463
• DOI: http://doi.org/10.6118/jmm.2016.22.2.80

Abstract

OBJECTIVES
To investigate the role of sex-hormonal changes in idiopathic carpal tunnel syndrome (CTS) among post-menopausal women through measuring estrogen receptor (ER) expression in their transverse carpal ligament (TCL) and serum estrogen level, as well as determine the correlation between these factors and electrodiagnostic parameters and Boston score.
METHODS
Biopsy samples of TCL were collected from 12 postmenopausal women who had undergone surgery for severe idiopathic CTS; control specimens were collected from 10 postmenopausal women without CTS who had undergone surgery for the other hand pathologies. To determine the distributions of ER in TCL, histological and immunohistochemical examinations were performed. Serum estrogen level was also measured. Electrodiagnosis and Boston questionnaire were used for CTS severity and determination of the patients' function.
RESULTS
ER expression in TCL and serum estrogen level were not significantly different in the case group compared to the control group (P = 0.79 and P = 0.88, respectively). Also, there was no correlation between ER expression or serum estrogen level and electrodiagnostic parameters or Boston score.
CONCLUSIONS
Sex hormones cannot still be considered as the etiology of idiopathic CTS in postmenopausal women. The role of other factors such as wrist ratio and narrower outlet in females compared to the males should be considered along with hormonal changes.

Keyword

Carpal tunnel syndrome; Electrodiagnosis; Estrogen; Receptors

MeSH Terms

Biopsy
Carpal Tunnel Syndrome*
Electrodiagnosis
Estrogens
Female*
Gonadal Steroid Hormones*
Hand
Humans
Ligaments
Male
Pathology
Wrist
Estrogens
Gonadal Steroid Hormones

Reference

1. Hashempur MH, Homayouni K, Ashraf A, Salehi A, Taghizadeh M, Heydari M. Effect of Linum usitatissimum L. (linseed) oil on mild and moderate carpal tunnel syndrome: a randomized, double-blind, placebo-controlled clinical trial. Daru. 2014; 22:43.

2. de Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F. Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol. 1992; 45:373–376.

3. Kim JK, Hann HJ, Kim MJ, Kim JS. The expression of estrogen receptors in the tenosynovium of postmenopausal women with idiopathic carpal tunnel syndrome. J Orthop Res. 2010; 28:1469–1474.

4. Toesca A, Pagnotta A, Zumbo A, Sadun R. Estrogen and progesterone receptors in carpal tunnel syndrome. Cell Biol Int. 2008; 32:75–79.

5. Sharifi-Mollayousefi A, Yazdchi-Marandi M, Ayramlou H, Heidari P, Salavati A, Zarrintan S, et al. Assessment of body mass index and hand anthropometric measurements as independent risk factors for carpal tunnel syndrome. Folia Morphol (Warsz). 2008; 67:36–42.

6. Geoghegan JM, Clark DI, Bainbridge LC, Smith C, Hubbard R. Risk factors in carpal tunnel syndrome. J Hand Surg Br. 2004; 29:315–320.

7. de Krom MC, Kester AD, Knipschild PG, Spaans F. Risk factors for carpal tunnel syndrome. Am J Epidemiol. 1990; 132:1102–1110.

8. Ashraf A, Daghaghzadeh A, Naseri M, Nasiri A, Fakheri M. A study of interpolation method in diagnosis of carpal tunnel syndrome. Ann Indian Acad Neurol. 2013; 16:623–626.

9. Lue YJ, Wu YY, Liu YF, Lin GT, Lu YM. Confirmatory factor analysis of the Boston carpal tunnel questionnaire. J Occup Rehabil. 2015; 25:717–724.

10. Werner RA, Andary M. Electrodiagnostic evaluation of carpal tunnel syndrome. Muscle Nerve. 2011; 44:597–607.

11. Rezazadeh A, Bakhtiary AH, Samaei A, Moghimi J. Validity and reliability of the Persian Boston questionnaire in Iranian patients with carpal tunnel syndrome. Koomesh. 2014; 15:138–145.

12. Kaplan Y, Kurt SG, Karaer H. Carpal tunnel syndrome in postmenopausal women. J Neurol Sci. 2008; 270:77–81.

13. Ferry S, Hannaford P, Warskyj M, Lewis M, Croft P. Carpal tunnel syndrome: a nested case-control study of risk factors in women. Am J Epidemiol. 2000; 151:566–574.

14. Dieck GS, Kelsey JL. An epidemiologic study of the carpal tunnel syndrome in an adult female population. Prev Med. 1985; 14:63–69.

15. Liu SH, al-Shaikh R, Panossian V, Yang RS, Nelson SD, Soleiman N, et al. Primary immunolocalization of estrogen and progesterone target cells in the human anterior cruciate ligament. J Orthop Res. 1996; 14:526–533.

16. Liu SH, Al-Shaikh RA, Panossian V, Finerman GA, Lane JM. Estrogen affects the cellular metabolism of the anterior cruciate ligament. A potential explanation for female athletic injury. Am J Sports Med. 1997; 25:704–709.

17. Yu WD, Panossian V, Hatch JD, Liu SH, Finerman GA. Combined effects of estrogen and progesterone on the anterior cruciate ligament. Clin Orthop Relat Res. 2001; 268–281.

18. Cvoro A, Tatomer D, Tee MK, Zogovic T, Harris HA, Leitman DC. Selective estrogen receptor-beta agonists repress transcription of proinflammatory genes. J Immunol. 2008; 180:630–636.

19. Pfeilschifter J, Koditz R, Pfohl M, Schatz H. Changes in proinflammatory cytokine activity after menopause. Endocr Rev. 2002; 23:90–119.

20. Tsujii M, Hirata H, Morita A, Uchida A. Palmar bowing of the flexor retinaculum on wrist MRI correlates with subjective reports of pain in carpal tunnel syndrome. J Magn Reson Imaging. 2009; 29:1102–1105.

21. Boz C, Ozmenoglu M, Altunayoglu V, Velioglu S, Alioglu Z. Individual risk factors for carpal tunnel syndrome: an evaluation of body mass index, wrist index and hand anthropometric measurements. Clin Neurol Neurosurg. 2004; 106:294–299.

22. Gelmers HJ. Primary carpal tunnel stenosis as a cause of entrapment of the median nerve. Acta Neurochir (Wien). 1981; 55:317–320.