Participants diagnosed with CuTS were recruited from the outpatient service of hand surgery department. The diagnosis of carpal tunnel syndrome was made using a combination of clinical assessment and nerve conduction studies. Clinical assessment included a history of initial presence with intermittent paresthesias, numbness, and tingling in the small finger and ulnar half of the ring finger . According to the guidelines of the American Association of Electrodiagnostic Medicine , all patients were performed the nerve conduction studies. Confirmatory criteria included: (1) motor nerve conduction velocity (MNCV) across the elbow of less than 50 m/s, (2) an MNCV difference of greater than 10 m/s between the elbow segment and the forearm segment, (3) a decrease of the compound muscle action potential (CMAP) amplitude from below the elbow to above the elbow greater than 20%, suggesting a conduction block. Electrodiagnostic studies were performed by a specialist technician using a Dantec Keypoint Portable Nerve Conduction/EMG machine (Dantec Dynamics, Bristol, Bristol, UK) and reported by a consultant neurophysiologist. The specific process is shown in Figure 1.
Patients were selected based on one of the following criteria: (1) patients with subjective symptoms, no matter intrinsic muscle atrophy; (2) electrodiagnostic evidence support; and (3) age older than 18 years. Patients with one of the following criteria were excluded: (1) age < 18, (2) patients cannot provide written informed consent, (3) patients with other neuropathy, which was confirmed by electrophysiologically, (4) patients who had undergone previous treatments, such as splinting, steroid injection or CuTS release surgery, (4) a previous clinical diagnosis of anxiety, depression and other psychiatric disorder, (5) pregnant and lactating women.
Demographics and clinical evaluation
In this study, A self-administered questionnaire consisting of two parts was used. The first part included patients’ demographic data (age, gender, educational level, marital status, job status and socioeconomic status). The second part included patients’ clinic data (hypertension, hypertension, tobacco use, alcohol use, history of cancer, duration of symptoms). Age was determined as older = more than 50 years old and younger = less than 50 years old. Educational level was registered as university degree, Primary and middle degree and illiterate degree. Marital status was coded as married, single, widow, and divorced. Job status was registered as employed and unemployed. The socioeconomic status was recorded from the total number of the family income; it was determined as high = earning more than 10,000 RMB, medium = earning 50,001 to 10,000 RMB per year, or low = earning 1 to 5000 RMB per year. Duration of symptoms was determined as long= more than 2 years, short = less than 2 years.
CuTS patients were asked to complete a Quick Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire to assess the hand function (0= no disability, and 100= total disability) [10, 11]. Based on the modified McGowan grade, all CuTS patients were classified into 4 groups. Grade I: Subjective symptoms, no abnormal objective findings; Grade IIa: Good intrinsic strength (4/5), no detectable muscle atrophy; Grade IIb: Fair intrinsic strength (3/5), detectable muscle atrophy; Grade III Profound sensory and motor disturbances with marked intrinsic atrophy.
We used the Hospital Anxiety and Depression Scale to assess depression and anxiety symptoms. The Hospital Anxiety and Depression scale contain two scores: an anxiety subscale (HADS‐A) and a depression subscale (HADS‐D). Each subscale concludes seven questions. Scores of 11 or higher are indicative of a probable disorder, 8 to 10 points are possible cases, and 7 or less points mean no case. We classified individuals as being depressed or anxious (present cases, ≥8 points) or nondepressed/nonanxious (absent case, ≤7 points).
Statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS, version 25, Chicago, IL) for windows. The main study outcomes were the prevalence of anxiety and depression in CuTS patients and factors associated with anxiety and depression. A p < 0.05 was considered to be statistically significant. Then multiple logistic regression (Backword-Wald) was carried out to identify the variables that were independently associated with anxiety and depression among persons with CuTS. Results of logistic regression are expressed as odds ratios with 95% confidence interval (CI).