Awareness and Knowledge of Carpal Tunnel Syndrome among Adult Saudi Population

: Introductions: The median nerve's occasional or persistent compression or entrapment in the carpal tunnel from the wrist to the hand causes carpal tunnel syndrome (CTS). The main symptoms are pain, tingling, swelling, and loss of grip strength and function in the thumb, index finger, middle finger, and thumb of thumb. This study examined Saudi adults' awareness and understanding of Carpal Tunnel Syndrome and its link with demographics and chronic conditions. Material and Methods: This cross-sectional study examined adults' knowledge, attitudes, and practices regarding carpal tunnel syndrome from 2021 to 2022 in different Saudi Arabian regions. This study used a researcher-created questionnaire. In the awareness category, general public questions included CTS clinical aspects, etiology, and effects on daily life. Practice questions covered CTS preventive and chronic diseases. Volunteers were selected following informed consent. Result: 420 participants aged 34.8 ± 13.49 years. 280 (66.6%) were male, 140 (33.3%) females. 38 (9.04%) were non-Saudi workers, while 384 were Saudis. 235 (55.9%) individuals knew about wrist CTS and 161 (38.3%) about pain. 157 (37.3%) individuals experienced thumb tingling or numbness, while 117 and 142 agreed that CTS may produce thumb weakness (27.8%) and hand grip (35.2%). The older age group reported more thumb numbness or tingling than the other groups, although there was no statistical difference (p= 0.09). CTS was not associated with chronic disease; however, diabetes was the main comorbidity in all age groups (44; 45.3%), especially in the middle age group (21; 60%). 5.4% had CTS. CTS was rare during pregnancy (0.7%), however all age groups agreed that it could influence their employment and social life (p= 0.014 and < 0.00001). The average knowledge score was 43.3 ± 40.5, whereas the awareness score was 50.1 ± 44.2. These findings indicate that Saudis were aware of CTS clinical symptoms. Conclusion: The study examined Saudi adults' awareness and understanding of CTS and estimated the association between CTS and demographics and chronic conditions. The study found that adult CTS awareness and knowledge were sufficient and associated with age and quality of life. CTS awareness campaigns may lower risk and raise knowledge of prevention and treatment. People who work with discomfort or use computers for long periods of time without breaks are more prone to develop CTS. Larger research is needed to understand how physical exercise causes CTS.

hand specialists.CTS continues to be an enigma and can be disabling. 1Carpal tunnel syndrome (CTS) is caused by intermittent or persistent compression or entrapment of the median nerve as it travels from the wrist to the hand through the carpal tunnel.The median nerve goes, with nine extrinsic digital flexors, through the tunnel limited by the carpal bones and transverse ligament, which is related to the scaphoid, trapezoid, and hamate.Anatomically, the cross section of the carpal tunnel narrows 2.0 to 2.5 cm distal to the entrance. 2Patients with CTS have an excessively high intracarpal tunnel pressure that peaks at this level. 3ain, tingling, and swelling of the thumb, index finger, middle finger, and thumb of thumb, as well as a loss in grip strength and function of the affected hand, are the most prominent symptoms. 4,5Typically, they begin gradually and overnight.The discomfort can lengthen the arm.Weak muscle strength is possible, and the subcutaneous tissue may disappear with time. 4S is one of the most prevalent entrapment neuropathies affecting the upper limb and has a major impact on everyday activities and job. 6The presence of sensory symptoms like paraesthesia or dysaesthesia, with or without pain, followed by a loss of sensation and weakening in a median nerve-innervated area, are what make it distinctive. 7Although the research on its frequency differs greatly, it is estimated that 8.0% of individuals in the general population, especially those between the ages of 30 and 60, have CTS. 1,8Additionally, women are two to three times more likely to have the condition than men are, particularly around the menopause. 9,10In Mexico, there are about 99 cases of CTS per 100,000 people per year, with a prevalence of about 3.4% in women and 0.6% in males. 11Compared to the 5% prevalence in the United States, the prevalence of CTS in the United Kingdom (UK) is 7-16%. 12,13It is estimated that 17.5% of the general population in Iran has chronic thoracic syndrome based on physical tests; hence, CTS has a significant incidence in Iran. 14Due to hormonal fluctuations, women are more susceptible than men to develop CTS. 15   A higher incidence of CTS is linked to personal variables such advanced age, female gender, a higher BMI, and smoking. 16Hand bending and twisting, working with vibratory equipment, and using one's hands in the same way on a regular basis are all examples of occupational risk factors. 17Patients who suffer from systemic disorders such as hypothyroidism, diabetes mellitus, rheumatoid arthritis, and high blood pressure are at an increased risk of developing CTS. 18[21] The Phalen's and Tinel's tests, as well as a comprehensive patient history and physical examination, are mostly used to make diagnoses. 22The gold standard for identifying and assessing the severity of CTS is electrodiagnosis. 23The severity of the condition determines the course of treatment.Conservative treatment for mild to severe cases, such as splinting, laser therapy, and local corticosteroid injections, can be beneficial. 24But some people who are treated conservatively or who have severe or recurring symptoms will need surgery in the long run. 25Surgery to open up the carpal tunnel can take up to a year to heal. 25 It is crucial to assess public knowledge of CTS and its risk factors in order to encourage people to seek medical attention and healthcare as soon as possible.As a result, the ideal medical care plan can be established.In spite of this, the Kingdom of Saudi Arabia offers virtually little study.Hence this study was aimed to assess the awareness and knowledge about Carpal Tunnel Syndrome among adult population in Saudi Arabia and to identify the correlation between Carpal Tunnel Syndrome and other demographic characteristics and chronic diseases.

Study Design:
This cross-sectional study was design to assess the knowledge, attitudes and practice toward awareness of Carpal tunnel syndrome among adults in different region of Saudi Arabia populations from 2021 to 2022.A researcher-made questionnaire was developed for this study.Questions related to CTS clinical features while in the awareness category causes of CTS and effect of CTS on daily life activities were asked from the general population.The practice category involved questions related to CTS prevention techniques and associated with chronic diseases.The participants were volunteers and were selected after an informed consent was taken.The study was approved by the ethical committee.
Inclusion Criteria: Both male and female with Age more than 18 years were included in this study Exclusion Criteria: Age less than 18 years and lack of consent were excluded excluded in this study

Sample Size:
The sample size used in this study was determined using the following formula, with a significance level of p>0.05: n = NZ 2 P (1-P) / (D 2 + Z 2 P (1-P).Taking into account the expected rate of non-response, the total estimated sample size was 420.

Data Collection Tools and Instruments:
A validated pre-tested questionnaire was used for data collection.The questionnaire included questions about sociodemographic factors, knowledge about clinical features, awareness about causes, prevention, effect on their daily activities, relationship with pregnancy and relationship with chronic diseases of Carpal Tunnel Syndrome among adult population.All question were categorized as yes or no or I don't know based on the responses from the participants.

Data Analysis:
The Statistical Package for the Social Science (SPSS) version 25 was used to code the data, enter the data, and analyze the data.Employing both descriptive statistics (such as mean, standard deviation, and percentage), as well as inferential statistics (comparing independent groups and analysis of variation).The chi-square test was used to investigate whether or not there was a correlation between socio-demographic factors and the categories of awareness and knowledge.We used the Kruskal-Wallis test to analyzed the comparison of awareness, knowledge and prevalence.A p-value <0.05 was considered statistically significant.

Result:
For this study, we classified our questionnaire into three major categories; knowledge, awareness and practice.In the knowledge category, we recruited questions related to CTS clinical features while in the awareness category causes of CTS were asked from the general population.The practice category involved questions related to CTS prevention techniques while the relationship between CTS and its association with chronic diseases was discussed.In the end, we discussed the opinion of the general population related to the effect of CTS on daily life activities.

Socio-Demographic Information:
This survey was conducted to evaluate the awareness and knowledge of carpal tunnel syndrome among the adult Saudi population.We appreciated voluntary participation from all occupations.We recruited 420 participants with a mean age of 34.8 ± 13.49 years.Among these 280 (66.6%) were male while 140 (33.3%)were female.Total of 38    We observed that the middle age group of this study had more awareness about the CTS causes and preventions but no statistical differences were found between groups when they associated trauma and tumor to the bone with CTS, using a splint sitting posture to avoid CTS-related discomfort (p= 0.46, 0.23, 0.43, and 0.36).This statistical insignificance indicated that people had less awareness of the medical conditions and treatment modalities.(Tables 3 and 4).people of all age groups agreed that CTS may affect their job experience and social life (p= 0.014 and < 0.00001) (Table 5).

Mean score of Knowledge and Awareness:
When comparing the mean scores, we observed that both genders had a similar mean score of knowledge and prevalence (75.06 ± 34.9 vs 75.3 ± 34.1) with a significant p-value of the Kruskal-Wallis Test (0.0072).
Comparing the mean scores separately we observed that males had higher knowledge scores than awareness (97.6 ± 36.08 vs 95.2 ± 33.5, p= 0.06) whereas females had higher awareness than knowledge 52.5 ± 10.9 vs 55.3 ± 20.4, p= 0.038.Comparing mean scores on the behalf of education levels illiterate participants and college students had high knowledge scores ( 3 ± 0 and 99.6 ± 36.4 respectively) while school participants and higher education levels had more awareness levels (21.6 ± and 31.9 ± 12.94 respectively).The overall mean score of knowledge among all participants was noted as 43.3 ± 40.5 while the awareness score was observed as 50.1 ± 44.2.These results show that the Saudi population had high awareness of than clinical features of CTS (Table 7).  4 According to the sample's age distribution, 49.5% of participants were between the ages of 18 and 30.The majority of participants (97.3%) were Saudi citizens. 4The research revealed a link between gender and CTS. 10,27,28The existence of differences in wrist anthropometrics between males and females is one of the hypotheses put out to explain this association. 29,30 In this study we reported 235 (55.9%) participants had information about CTS in the wrist, and 161 (38.3%) knew about pain.Studies conducted in Saudi Arabia and India reported 26.7% and 27.5% participants were had information about CTS respectively 4,33 and which is approximately half of our study.When comparing the awareness of pain, weakness in the thumb muscle, loss of hand grip, muscular wasting, and changes in pain intensity, significant differences were found (p=0.005,0.0019, 0.000093, 0.002888, and 0.00042).However, there was no statistically significant difference between the groups (p=0.09).We noticed that the older age group provided more information on numbness or tingling in the thumb than the other groups (30.9% 14.4% and 20.5%).According to Devi RG et al., the primary clinical sign of CTS is tingling and numbness in the thumb, index, and middle finger.The second most frequently reported clinical feature of CTS is wrist pain, followed by a gradual decline in hand grip strength. 34A recent study in the Saudi population found that those who work with patents for more than eight hours experience greater hand pain and symptoms. 35dditionally, past studies showed that CTS was more likely to develop in dentists who put in long hours of labor. 36,37mputer taping was reported as a contributing factor by a total of 143  4,38 Although there was no conclusive evidence linking chronic diseases to CTS, diabetes was the most common comorbidity across all age categories (44; 45.3%).Prevalence of CTS during pregnancy was very low (0.7%), although individuals across all age groups concur that CTS may have an impact on their social and professional lives (p=0.014 and 0.00001).The overall mean knowledge score was recorded as 43.3 40.5, and there was no statistically significant difference between any of the groups (p=0.99).A cross-sectional study discovered that women's domestic tasks were probably contributing factors to CTS, whereas an earlier study could not find evidence of this association. 39,40Only 98 (23.3%) knew about the treatment options.
According to Raman et al Kuwait's study, which revealed that CTS was substantially associated with female gender, gender, nationality, status, education level, and occupation did not correlate with awareness level. 41In this investigation, we found that both sexes had a comparable mean score of knowledge and prevalence, and the Kruskal-Wallis test revealed that this difference was statistically significant (0.0072).By examining each group's scores independently, we were able to determine that males had higher levels of knowledge than awareness, whereas females had higher levels of awareness than knowledge.According to these findings, the Saudi population exhibited a high level of awareness regarding the clinical characteristics of CTS.
We suggest that future research should consist of a large-scale survey, as well as clinical trials that involve the application of egronomic alteration, and an assessment of the degree to which the risk can be reduced.There is a need for interventional studies that look into the treatment and preventative measures that may be taken with this population.In addition, educational workshops and public awareness campaigns should be carried out as primary prophylactic measures against this illness.In addition to teaching the general public on the risks, healthcare professionals and the general public.

Conclusion:
The aim of the study was to identify the awareness and knowledge of CTS among adult population in Saudi Arabia, and to estimate correlation between Carpal Tunnel Syndrome and other demographic characteristics and chronic diseases.The study concluded that the awareness and knowledge of CTS among adult population was sufficient and significant association between awareness, knowledge of CTS and the age, affect of quality of life.Improving the awareness campaign about CTS may potentially reduce the risk and increases the knowledge about the prevention and treatments.CTS is more likely to develop in people who regularly work with pain, such as those who use computers for long periods of time without breaks and those who work with pain.Largerscale studies are needed to investigate and explain the role that physical activity plays in the onset of CTS.

Table 2
disclosed the prevalence of knowledge about the clinical features of CTS among general population.

Table 6 :
The relation between chronic diseases and CTS