Ultrasound criteria for carpal tunnel syndrome (CTS) may vary in different populations. To determine the ultrasonographic criteria for CTS in a Malaysian population and compare its usefulness with nerve conduction studies (NCS), we studied patients clinically diagnosed with CTS and normal controls by ultrasonography. All patients also underwent standard NCS. Median nerve Cross-Sectional Area (CSA) and Flattening Ratio (FR) at 3 different levels – proximal to tunnel inlet, at tunnel inlet and tunnel outlet were measured. Receiver operator characteristic (ROC) analyses were used to calculate the optimal discriminatory threshold values for CTS. Of 54 CTS hands, NCS was positive in 85.2%. Median nerve CSA at all 3 levels, were signifi cantly greater in CTS hands.FR was signifi cantly greater at tunnel inlet. A CSA threshold of 0.1 cm2 proximal to and at tunnel inlet had sensitivities of 70.4% and 63% and specifi cities of 85.2% and 88.5 % respectively. CSA at tunnel outlet had lower specifi city. If CSA of 2 levels (viz. proximal to or at tunnel inlet) were considered together, sensitivity and specifi city improved to 81.5% and 83.3%. Qualitative loss of fascicular discrimination of the nerve proximal to the inlet had sensitivity and specifi city of 77.8% and 96.3%. The most useful ultrasonographic parameter was median nerve CSA either proximal to or at tunnel inlet. However, the sensitivities were lower compared to NCS. Qualitative appearance of the median nerve is a useful adjunct to diagnosis. In conclusion, ultrasonography play an important complementary role to NCS in the diagnosis of CTS.

INTRODUCTIONFoot pain is a common problem, especially in women, and studies have shown that it is related to footwear. This study was conducted to establish the prevalence of nontraumatic foot pain and its contributing factors in young working Malaysian women in an urban setting.

METHODSThe survey was conducted on a group of working women (age range 21-40 years) selected using convenience sampling. Data on foot problems was collected through an investigator-directed questionnaire and during clinical inspection of the foot.

RESULTSA total of 400 women, with a mean age of 29.4 years, were recruited. Half (n = 200) of the women had experienced recurrent nontraumatic foot pain in the past one year. Subjective assessments of foot pain using the Numeric Intensity Scale gave an average score of 4.89 ± 1.78 (range 2-10), with most episodes occurring at the heel. There was no statistically significant association between foot pain and age, ethnicity or body mass index. However, there was a higher incidence of foot pain in women wearing high-heeled footwear than those wearing non-high-heeled footwear (p = 0.027, odds ratio 1.591).

CONCLUSIONNontraumatic foot pain is common among young working women in our society. More than half (68.4%) of the women with foot pain in our study attributed the pain to footwear. Wearing high-heeled shoes to work was a significant contributing factor. Increased public awareness on the importance of proper footwear may help to reduce the prevalence of nontraumatic foot pain in working women.

Adult ; Age Factors ; Cross-Sectional Studies ; Developing Countries ; Female ; Foot ; Humans ; Pain ; epidemiology ; etiology ; physiopathology ; Pain Measurement ; Prevalence ; Risk Factors ; Shoes ; Singapore ; Urban Population ; Women, Working ; statistics & numerical data ; Young Adult