Awareness of Cubital Tunnel Syndrome among Adult Population of Almajmaah City, Saudi Arabia (2018-2019)
Saleh Khalaf M Almaymoni*, Khaled Khalaf M Almaymuni, Yazeed Saad R Alsubaie, Mohammed Abdullah Hazizi, Abdulrahman Mohamed Y Alyousef, Abdulaziz Khalaf M Almaymuni, Yousef Mohammed Y Alyousef, Fahad Abdulaah M Alotaibi, Mohammed Khalaf M Almaymuni, Fahad Mohammed Y Alyousef and Osama Abdullah Hazizi
Background: Due to the lack of data and studies concerning about measurement of population awareness about cubital tunnel syndrome in almjmaah city, this study aims at determining the level of population awareness among almjmaah adult population in Saudi Arabia and measure the prevalence of CuTS in Almjmaah city. Cubital Tunnel Syndrome is a disease that involves pressure or stretching of the ulnar nerve, which can cause numbness or tingling in the ring and small fingers, pain in the forearm, and/or weakness in the hand. The ulnar nerve runs in a groove on the inner side of the elbow.
Aims: To study the awareness of cubital tunnel syndrome (CuTS) among adult population in Almjmaah city, Saudi Arabia, and to estimate the overall prevalence of CuTS. In addition to determine its effect on social life.
Methods: 384 respondents of Almajmaah were participated (45.4% are male and 54.6% female, nearly half are youth aged range between (18-39)). The intervention includes measurement of understanding the clinical features could happen, causes, prevention and management of CuTS. A standardized questionnaire was used to cover 11 different aspects concerning CuTS. SPSS package was used to analyze the data collected from the sample.
Results: The present study has a huge sample size survey gained a rich information through a structured questionnaire by researchers, follow-up duration of mean of year (2018- 2019). 16 of participants (4.1%) have cubital Tunnel Syndrome. One third of them are thought that the main symptom is Pain in elbow. On the other hand, one quarter think that Tingling and numbness in ring and little fingers is the main manifestation. The most causes that population think that’s it leads to the Cubital tunnel syndrome are Trauma, repeated hand physical activities like lifting heavy weights, and wrist fracture or dislocation respectively.
Conclusion: The study shows that the awareness of community was sufficient among adult population and shows that the prevalence of cubital Tunnel Syndrome (CuTS) is 4.1% it is nearly below the international population prevalence. Also, the study shows that population think that the CuTS can affect the quality of life.
Cubital tunnel syndrome, Ulnar neuropathy, Tunnel syndrome, Ulnar nerve, Prevalence of cubital tunnel syndrome
(CuTS) is entrapment of the ulnar nerve at the level of the elbow as it passes behind the medial epicondyle of the humerus this happened usually by repetitive or prolonged compression, traction, or ischemia of the ulnar nerve as it courses through the cubital tunnel via activities involving repetitive or prolonged elbow flexion, trauma, fibro muscular compression from the triceps, and compression from osteophytes, ganglia, lipomas, and cysts . Excessive cubitus valgus deformity similar to the ‘abducted ulnohumeral lesion’ described by Fryette, et al. has also been considered as a potential cause of CuTS [2,3], as well as diabetes mellitus which makes the nerve more vulnerable to compression. This may occur secondary to a micro vascular injury in the nerve causing local ischemia or by interfering with the innate metabolism of the nerve. There is evidence of damage to axonal transport in the nerve. Diabetes may increase the risk of damage in a manner similar to mechanical double crush which lead to CuTS .
The major risk factors for cubital tunnel syndrome were obesity and holding a tool in a constant position, performing a repetitive task . Cubital tunnel syndrome (CuTS) is second only to carpal tunnel syndrome as the most frequently diagnosed peripheral neuropathy of the upper extremities it is associated with pain, numbness, and weakness in the hand [1,6]. Affected individuals frequently have impairment of work and the vocational activities . Left untreated, permanent hand disability may occur Common conservative medical intervention focuses primarily on nerve gliding exercises, patient education, rest, non-steroid anti-inflammatory drugs (NSAIDs), activity modification, splint immobilization, bracing, and ergonomic changes, but manual therapy, specifically joint manipulation, has rarely been included in the plan of care for CuTS, Cubital tunnel release operation is the best option the ligament "roof" of the cubital tunnel is cut and divided . This increases the size of the tunnel and decreases pressure on the nerve [1,6,9].
The prevalence of disease is differ from each population to other. in U.S. Metropolitan a study was done shows that Of 1,001 individuals who participated in the cross-sectional survey, 75% were women and 79% of the cohort was white; the mean age (and standard deviation) was 46 ± 15.7 years. Using a more sensitive case definition (lax criteria), we identified 59 subjects (5.9%) with cubital tunnel syndrome .
Materials and Methods
Study design, and end points
Survey has been used a structured questionnaire created for a study objectives awareness of cubital tunnel syndrome among adult population at Almjma’ah City including the prevalence of CuTS, the understanding of clinical features, etiology, management, and prevention and its effect in social life.
Study planned duration: the timetable of study has been created to collect data from sample population in a period not rather than 6 months from Sep 2018 to Mar 2019.
1. Age >18.
2. Both genders.
3. Saudi population.
1. Age <18.
2. Non-Saudi population
End point and outcomes
1. Primary end point awareness of cubital tunnel syndrome among adult population.
2. Secondary outcomes were population understanding of clinical features, causes, prevention and management of CuTS. Also, its prevalence among adult Saudi people in almjmaah city.
1. A structured questionnaire has been designed to measure the following variables.
2. The prevalence of cubital tunnel syndrome among Saudi population in almjmaah city.
3. Understanding of clinical features, causes, prevention and management options in percentages (%).
All the demographic and 11 variables of a structured questionnaire to gather information of 384 participants should be entered to Statistical Software and processing with SPSS Program. Variables are Gender, Age, and Marital status. Prevalence of cubital Tunnel Syndrome, clinical features, causes, prevention and management of disease will have analyzed through percentages.
There are 384 participants volunteered in CuTS study from almjmaah population. The prevalence of CuTS is 4.1% of the participants reported that they had CuTS which equal 16 person while 95.9% they have not which equal 368 illustrated in Figure 1.
Figure 1: Percentage of sample who suffers from CuTS.
The Females are more than Males (54.6% to 45.4%) in the study. While Youth are more participating involves study (45.1%), category (40-60) represents 38.7% and a few participants from overage (16.2%). And nearly over two third of participants are married. Illustrated in Table 1 and Figure 2.
Figure 2: Percentage of gender.
Table 1: Socio-demographic Data gender, age, and marital status.
27.8% of the sample are think that clinical features can happen with cubital Tunnel Syndrome is "Pain in the elbow", and 22.4% of the sample are think that clinical features can happen with cubital Tunnel Syndrome is "Tingling and numbness in ring and little fingers ", and 8.9% of the sample are thought that the symptom can happen with cubital Tunnel Syndrome is "Weakness affecting the ring and little fingers muscle ", and 10.9% of the sample think that the manifestation is " Decreased overall hand grip", and 13.2% of the sample are think that clinical features can happen with cubital Tunnel Syndrome is " Muscle wasting in the hand", and 9.8% of the sample are thought that clinical features can happen with cubital Tunnel Syndrome is " Decreased ability to pinch the thumb and little finger" and 6.9% of the sample are think that clinical features can happen with cubital Tunnel Claw-like deformity of the hand (Table 2).
|Pain in the elbow||195||27.80%|
|Tingling and numbness in ring and little fingers||157||22.40%|
|Weakness affecting the ring and little fingers||63||8.90%|
|Decreased overall hand grip||77||10.90%|
|Muscle wasting in the hand||92||13.20%|
|Decreased ability to pinch the thumb and little finger||68||9.80%|
|Claw-like deformity of the hand||49||6.90%|
Table 2: Frequency and percent for population knowledge about clinical features of CuTS.
one third (30.8%) of the sample are think that the causes lead to cubital Tunnel Syndrome is “Trauma ", while 28.1% of the sample are think that " Repeated physical activities like lifting heavy weights ", is the cause. Also, 22.4% of the sample thinks that the causes lead to cubital Tunnel Syndrome is "elbow fracture or dislocation", and 10.5% of the sample thought that the leading cause of cubital Tunnel Syndrome is "Arthritis", and 8.2% of the sample think that the causes lead to cubital Tunnel Syndrome is "Tumor of bone". Table and chart below showed that (Table 3).
|Repeated physical activities like lifting heavy weights||183||28.10%|
|Elbow fracture or dislocation||146||22.40%|
|Tumor of bone||54||8.20%|
Table 3: Awareness of causes leading to CuTS.
31.24% of participants reported that they thought that oral analgesics is a method of treat CuTS, 24.35% thought it could be treat by splint , 22.83% thought it could be treat by Surgical intervention, 12.40% thought that the treatment is by NSAID, and only 9.18% of participants were thought CuTS could be treat by Steroid Injection. The results are shown in the following graphs, and. Illustrated In Table 4 and Figure 3.
Table 4: Awareness of method of treating CuTS.
Figure 3: Percentage of population awareness of CuTS treatment.
The table showed that 25.7% from the sample used to Prevent CuTS " Avoid repetitive movement ", and 14.5% from the sample used to Prevent CuTS “Keeping the elbow straight while at rest.", and 24.5% from the sample used to CuTS " Wear splint while sleeping. ", and 26.6% from the sample used to Prevent CuTS are “Avoid Fall or direct impact", and 8.7% from the sample used to Prevent CuTS are “Avoid leaning on elbow while driving” (Table 5).
|Avoid repetitive movement||171||25.70%|
|Keep your elbow straight while at rest||92||14.50%|
|Wear splint while sleeping||156||24.50%|
|Avoid Fall or direct impact||169||26.60%|
|Avoid leaning on elbow while driving||55||8.70%|
Table 5: Frequency and percent for population awareness of prevention of CuTS.
75.7% of participants people thought that CuTS could affect patient sleep, 82.03% of them thought could affect patient job performance, and 67.4% they thought affected social life. Following table and chart shown that illustrated in Table 6.
|Thinking of CuTS affect patient sleep||Yes||291||75.7|
|Thinking of CuTS affect patient job performance||Yes||315||82.03|
|Thinking of CTuS affected social life||Yes||259||67.4|
Table 6:Frequency and percent of population awareness of CuTS effects.
There are few studies discussed the Cubital Tunnel Syndrome prevelance among different types of populations. But In this study, we searched both the prevelance and the awareness of CuTS in the population, the awareness of CuTS is sufficient which is reflected by their knowledge about the disease. In details, their knowledge about clinical features of CuTS is 27.8% of them said that pain in the elbow is one of manifestation and 22.4% know that the tingling and numbness in ring and little fingers is one of symptom. In addition, their knowledge about causes is 30.8%, 28.1% and 22,4% said that Trauma, repetitive hand activity and elbow fracture or dislocation is the cause respectively. In addition, their knowledge about treatment is 31.24% people reported that oral analgesics is a method of treat and 24.35% of population said it could be treat by splint & 22.83% by Surgical intervention.
In this study, the prevalence of the CuTS is slightly lower the developed countries which is 4.1% of people in almjmaah city suffer from CuTS while on USA there is a cross sectional cohort study was done to study the prevalence of CuTS it showed of 1,001 individuals who participated in the cross-sectional survey, 75% were women and 79% of the cohort was white; the mean age (and standard deviation) was 46 ± 15.7 years. Using a more sensitive case definition (lax criteria), we identified 59 subjects (5.9%) with cubital tunnel syndrome
Cubital Tunnel Syndrome cause a strong impacting on social life for 75.7 % of participants people thought that CuTS could affect patient sleep, 82.03% of them thought could affect patient job performance, and 67.4% they thought affected social life.
The aim of the study was to study the awareness of cubital tunnel syndrome (CuTS) among adult population in Almjmaah city, Saudi Arabia, and to estimate the overall prevalence of CuTS. I have not found any research that discusses people's awareness of upper neuropathy. We need a lot of work to raise people's awareness of this disease to prevent it but the results show that the awareness of community population was sufficient and show that the prevalence of cubital Tunnel Syndrome (CuTS) is 4.1% it is nearly lower than international population prevalence. Also, the study shows that population think the CTS can affect the quality of life.
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Saleh Khalaf M Almaymoni*, Khaled Khalaf M Almaymuni, Yazeed Saad R Alsubaie, Mohammed Abdullah Hazizi, Abdulrahman Mohamed Y Alyousef, Abdulaziz Khalaf M Almaymuni, Yousef Mohammed Y Alyousef, Fahad Abdulaah M Alotaibi, Mohammed Khalaf M Almaymuni, Fahad Mohammed Y Alyousef and Osama Abdullah HaziziMedical College, Majmaah, Saudi Arabia
Citation: Saleh Khalaf M Almaymoni, Fahad Mohammed Y Alyousef, Mohammed Khalaf M Almaymuni, Fahad Abdulaah M Alotaibi, Yousef Mohammed Y Alyousef, Abdulaziz Khalaf M Almaymuni, Abdulrahman Mohamed Y Alyousef, Mohammed Abdullah Hazizi, Yazeed Saad R Alsubaie, Khaled Khalaf M Almaymuni, Osama Abdullah Hazizi, Awareness of Cubital Tunnel Syndrome among Adult Population of Almajmaah City, Saudi Arabia (2018-2019), J Res Med Dent Sci, 2019, 7(6):54-58.
Received: 15-Oct-2019 Accepted: 14-Nov-2019