Althea Medical Journal. 2017;4(2)
192 AMJ June 2017
Carpal Tunnel Syndrome Prevalence and Characteristics among
Administrative Staff at Dr.Hasan Sadikin General Hospital Bandung
Andrian,1 Nushrotul Lailiyya,2 Novitri3
1Faculty of Medicine Universitas Padjadjaran, 2Department of Neurology Faculty of Medicine,
Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, 3Department of Physical
Medicine and Rehabilitation Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin
General Hospital, Bandung
Abstract
Background: Carpal tunnel syndrome (CTS) is a neurologic disease affecting hands, which is closely related
to work, and is the most prevalent nerve compression disease. The incidence of CTS quite often occur in
people working with their hands, for instance the administrative staff, especially in a busy workplace such
as Dr.Hasan Sadikin General Hospital Bandung. CTS causes reduction in work productivity, and consequently
degrading family welfare and the quality of public service. For that very reason, the prevalence and
characteristics of CTS among administrative staff at Dr.HasanSadikin General Hospital Bandung needed to
be revealed.
Methods: This quantitative descriptive study involved 94 administrative staff in the Medical record
department of Dr. Hasan Sadikin General Hospital using the Carpal-tunnel.net questionnaire and further
examinations by neurologists. Variables involved in this study were the subject characteristics.
Results: Out of the 90 subjects, 22 stated having symptoms related to CTS (prevalence, 24.4%). On further
clinical examination, 3 were diagnosed of suffering from CTS (prevalence, 3.3%).
Conclusions: Carpal tunnel syndrome is found among the administrative staff at Dr. Hasan Sadikin General
Hospital Bandung and the prevalence is lower than in the general population. A further study is required to
reveal ther specific division in the hospital with the most prevalent CTS case.
Keywords: Administrative staff, carpal tunnel syndrome, Hasan Sadikin, prevalence
Correspondence: Tara Zhafira, Faculty of Medicine, Universitas Padjadjaran, Jalan Raya Bandung-Sumedang Km.21,
Jatinangor, Sumedang, Indonesia, Phone: +6281311349612 Email: tarazhafira@yahoo.com
Introduction
Carpal Tunnel Syndrome (CTS) is the most
prevalent median nerve disease, and also the
most prevalent nerve entrapment syndrome,
with the estimation that 3.8% of the world
population is affected.1 Risks for CTS are
related to work, and CTS is often ascribed as an
occupational disease.2,3 Administrative work,
especially in busy workplaces, is one of the
jobs with highest CTS occurrence, along with
other jobs such as secretarial, construction
work, and production.4
Aside from physical and functional loss,
people with CTS also suffer financial loss.
Furthermore, a study in Washington State
affirmed a significant financial loss is suffered
by people with CTS each year, and the study
underlined the significance of CTS prevention
in workplace.3,5,6 According to information from
the Human Resources Division of Dr. Hasan
Sadikin General Hospital Bandung, currently,
there are approximately 3000 administrative
staff working every day at Dr. Hasan Sadikin
General Hospital, and a study stated that 3.8%
of the general population are affected by CTS,
which means, approximately 114 out of 3000
administrative staff have CTS and the number
will increase if prevention is neglected.1,6
Prevention needs to be performed,
otherwise CTS will cause reduction in the
sufferer’s family well-being and downgrade
public service efforts.3 Nevertheless, not one
study has been conducted on CTS occurrence
and characteristics among the administrative
staff at Dr. Hasan Sadikin General Hospital
Bandung. Due to those reasons, this study was
conducted.
Methods
This study used the quantitative descriptive
AMJ. 2017;4(2):192–6
ISSN 2337-4330 || doi: http://dx.doi.org/10.15850/amj.v4n2.1077
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Althea Medical Journal. 2017;4(2)
method with cross sectional design. This
study was approved by Dr. Hasan Sadikin
General Hospital Bandung and the Health
Research Ethics Committee Faculty of
Medicine, Universitas Padjadjaran according
to Ethical Clearance Letter No. LB.04.01/A05/
EC/263/VII/2015. The study population was
all administrative staff working at Dr. Hasan
Sadikin General Hospital Bandung. Sample was
taken from all administrative staff working
in the Medical Record Division, which is one
of the busiest hand-involving administrative
jobs in the hospital, making it a high risk job
for CTS. There were 94 workers in the Medical
Record Division; however four workers were
inaccessible. Two of them were taking holiday,
one was sick, and the last one was unwilling
to participate in this study. This study was
conducted at all medical record offices and the
Department of Neurology, Dr. Hasan Sadikin
General Hospital Bandung in September–
December 2015.
The study was initiated by conducting
interviews and educating all medical record
administrative staff regarding CTS. Those
who stated having symptoms related to
CTS during the interview were reffered to a
further interviewed using the Carpal-tunnel.
net questionnaire. The questionnaire was a
validated self-administered questionnaire,
developed by Bland et al.7 to be used by people
with hands symptoms that were related to
CTS. The questionnaire was used as interview
material in this study with the author’s
consent.
The questionnaire contained questions
regarding the subject’s characteristics such as
gender, age, smoking history, computer use,
and handedness. Symptom characteristics,
such as presence of pain, numbness, tingling,
muscle weakness, persistency of symptom, and
bilateral symptom are also contained in the
questionnaire. The result of the questionnaire
was a probability score of the subject having
CTS.
It was suggested by the creator of the
questionnaire to use a cut-off point of 20%,
instead of 40% which was originally used
by the author, in this study, so the subjects
who scored over 20% were referred to
the Department of Neurology for further
examinations which consisted of history
taking and provocative tests. The provocative
tests comprised Phalen test, Tinnel test, carpal
compression test, and hand elevation test. The
examination was conducted by neurologists
and the positive result was established when
at least one provocative test was positive.
Furthermore, Phalen test was conducted by
asking the subject to bend both wrists so that
the dorsal part of the hands were in contact
with each other for 60 seconds, positive result
was established if the subject experienced
tingling or numbness in the part of the hand
innervated by the median nerve. Tinnel test
was conducted by performing percussion
over the carpal tunnel. Positive result was
established if the subject experienced tingling
in the part of the hand innervated by the
median nerve. Carpal compression test was
conducted by pressing the part of the hand
between thenar and hypothenar eminences
of the wrist for 30 seconds. Positive result
was established if the subject experienced
any CTS symptoms during the test. The hand
elevation test was conducted by requesting
the subject to lift both hands upright for 2
minutes. Positive result was established if
the subject experienced any CTS symptoms
during the test, which was later analyzed using
percentage to discover the prevalence.
Results
Out of 94 subjects included in this studyt only
90 subjects were accessible.
There was no significant difference in the
number of male and female subject in this study,
causing the gender variable proportional in
number. The numberof male subjects was
higher than the female. The higher proportion
of medical record administrative staff was less
than 40 years old , causing more staff members
were not in the high risk age for CTS, and this
may affect the result of CTS prevalence within
the staff (Table 1).
Twenty two staff members who stated
having hand symptoms were further
interviewed using the Carpal-tunnel.net
questionnaire. The rest of the subjects were
Andrian, Nushrotul Lailiyya, Novitri: Carpal Tunnel Syndrome Prevalence and Characteristics among
Administrative Staff at Dr.Hasan Sadikin General Hospital Bandung
Table 1 Distribution of Respondent’s
Characteristics
Variable Amount of Subjectn=90 (%)
Gender
Male 46 (51.1)
Female 44 (48.9)
Age (years old)
< 40 69 (77.7)
≥ 40 21 (22.3)
Althea Medical Journal. 2017;4(2)
194 AMJ June 2017
taken as negative subjects because CTS is
mainly a symptomatic disease, although a
study by Naseer et al.8 stated that CTS may be
asymptomatic.
Six males and sixteen females stated of
having a hand symptom, with fifteen out of
the twenty two subjects were below 40 years
in age, which is not a high risk age for CTS.
The bigger proportion of non-high risk age
subjects can be resulted from the initial bigger
proportion of non-high risk age subjects
before the interview was conducted (Table 2).
Most of the subjects experienced bilateral
symptoms. Nearly all subjects interviewed
had intermittent symptoms, leaving only one
subject with a persistent symptom.
The most prevalent symptoms experienced
by the subjects were tingling, pain during the
day, muscle weakness, pain during the night,
and numbness respectively. Those symptoms
are consistent with the symptoms described in
a previous study by Atroshi et al.1
After the second interview, there were
only three subjects with CTS probability score
above 20% and needed to be referred for
further examination (Table 3).
The examination by the neurologist verified
the three subjects referred for having CTS, and
it was concluded that the prevalence of CTS at
Dr. Hasan Sadikin General Hospital Bandung
was 3.3%.
All three subjects were diagnosed as having
bilateral CTS and had intermittent symptoms,
which is indicative for mild CTS.9 The main
symptom from the three positive subjects
was tingling. Two females were diagnosed as
having CTS. The three subjects with positive
CTS were over 40 years old (Table 4).
Discussions
The study discovered that 2 out of 3 subjects
Table 3 Symptom Distribution of
Respondent’s Symptoms Related to
CTS
Variable
Amount of
Subject/
Frequency
Bilaterality
Yes 13
No 9
Symptom persistency
Persistent 1
Intermittent 21
Symptom description
Pain during the day
Only right hand 5
Only left hand 2
Both hands 2
No pain during the day 13
Pain during the night
Only right hand 5
Only left hand 0
Both hands 2
No pain during the night 15
Numbness
Only right hand 3
Only left hand 2
Both hands 1
No numbness 16
Tingling
Only right hand 6
Only left hand 1
Both hands 12
No tingling 3
Muscle weakness
Only right hand 4
Only left hand 1
Both hands 2
No muscle weakness 15
Table 2 Characteristic Distribution of
Respondents with CTS-related
Symptoms
Variable Amount of Subject
Gender
Male 6
Female 16
Age (year)
< 40 15
≥ 40 7
with CTS were female, although the initial
portion of subject’s gender is proportional.1,10
This is consistent with other literatures stating
that CTS is more prevalent in women.1,6,10, 11
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Althea Medical Journal. 2017;4(2)
Andrian, Nushrotul Lailiyya, Novitri: Carpal Tunnel Syndrome Prevalence and Characteristics among
Administrative Staff at Dr.Hasan Sadikin General Hospital Bandung
Ninety four subjects in this study were
mostly under 40 years old, which is a non-high
risk age for CTS. This study discovered that
all positive subjects were above 40 years old,
although the initial proportion of subject’s age
was higher in the age below 40 years .
Three subjects examined by a neurologist
were all diagnosed as having bilateral CTS,
although one positive subject did not report
any symptom on the left hand, supporting the
study stating the presence of asymptomatic
CTS.8
A previous study by Atroshi et al.1 stated
that bilateral symptom commonly occurs in
CTS, it was supported by the finding of two
out of the three subjects having bilateral
symptoms and the diagnosis of all three
subjects as bilateral CTS in this study.1The
most prevalent symptom reported by positive
subjects was tingling, and this was consistent
with the previous study stated earlier.
The results showed the prevalence of CTS
among administrative staff at Dr. HasanSadikin
General Hospital Bandung was 3.3% (3 out of
90 subjects) which was close but lower than
the general world population prevalence
discovered by Atroshi et al.1 which is 3.8%.
The prevalence in this study may be lower due
to many factors. One important factor is age,
77% of all medical record administrative staff
were under 40 years old, making most of them
excluded from the high risk age for CTS.
Other factors causing difference in the
prevalence result may be the number of
subject, design, and method. The study
conducted by Atroshi et al.1 involved 2466
subjects, which was a lot more than this study,
causing the study to have a high variation in
the subject variable, besides the design of the
study conducted by Atroshi et al.1 was a case
control, giving the study the ability to compare
variables (between case and control), identify
risk factors, and a giving the study a greater
and broader case definition.
The study by Atroshi et al.1 was conducted
by sending mails to the subjects containing
inquiries about symptoms. Two months later,
the responders with and without symptoms
(as a control) were clinically examined
and underwent Nerve Conduction Studies
Table 4 Distribution of Respondent’s Characteristic, Symptom, & Physical Exam
Variable
Subject 1 Subject 2 Subject 3
Right Hand Left Hand Right Hand Left Hand Right Hand Left Hand
Examination
Tinnel + + + + + +
Phalen - + + - + +
Carpal compression + + + - + +
Hand elevation + + + - + +
Diagnosis Bilateral CTS Bilateral CTS Bilateral CTS
Symptom
Description
Pain during the day - - - - + -
Pain during the night - - - - + -
Numbness - - - - + -
Tingling + + + + + -
Muscle weakness - - - - - -
Bilateral symptom Yes Yes No
Persistency Intermittent Intermittent Intermittent
Subject
Characteristics
Gender Female Male Female
Age (year) 48 57 53
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196 AMJ June 2017
(NCS), which is a more sensitive and specific
examination for CTS than provocative tests.
In addition, the two months’ time given to the
respondents to fill in the inquiries gave them a
longer time for symptoms recall than a direct
interview.
The limited sample taken only from the
Medical Record Division was the limitation
of this study, as it might not cover all kinds
of administrative work in the hospital. In
addition, the amount of time needed to
complete the Carpal-tunnel.net questionnaire
(approximately 30 minutes) might affect the
answers of the subjects and bias the result
of this study. With the informed limitations
of this study, the researcher advises that
future studies should cover more or all
kinds of administrative work at Dr. Hasan
Sadikin General Hospital Bandung and it
recommends that a further study on revealing
the administration division with the highest
risk for CTS should be conducted. If the
further study would use the Carpal-tunnel.
net questionnaire, the interviewer should be
confident that the subjects are not answering
perfunctorily.
This study concluded that CTS occurs
among Dr. HasanSadikin General Hospital
Bandung administrative staff, and it amplifies
the evidence of other literatures regarding the
characteristics and epidemiology of CTS.
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