Fibromyalgia and hand diseases: A case-control study

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Fibromyalgia and hand diseases: A case-control study

Abstract

Background: Fibromyalgia is a chronic disorder characterized by widespread pain, fatigue, and other systemic symptoms. While fibromyalgia is associated with generalized musculoskeletal complaints, little is known about its relationship with specific hand disorders that impact function and quality of life.

Purpose: To determine whether fibromyalgia is associated with an increased prevalence of hand diseases-including carpal tunnel syndrome, De Quervain’s tenosynovitis, trigger finger, tendinitis, and hand osteoarthritis-and to assess healthcare utilization patterns and surgical intervention.

Study design: Retrospective, population-based, matched case-control study.

Methods: We used electronic health records from Leumit Health Services, an Israeli healthcare provider serving 750,000 enrollees. The study included adults aged 18-90 diagnosed with fibromyalgia between 2002 and 2023, confirmed by board-certified rheumatologists using the 2010 ACR criteria. Controls were matched 5:1 by age, sex, and enrollment year. Hand diseases were diagnosed using ICD-9 codes, which were confirmed by repeated documentation. Surgical interventions and hand-related healthcare utilization were extracted from administrative records. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression, with significance determined by p < 0.05 and Benjamini-Hochberg correction.

Results: The study included 9232 fibromyalgia patients and 46,160 controls (mean age 47.6 years; 86.8% female). Fibromyalgia was significantly associated with increased odds of carpal tunnel syndrome (OR 2.98 [2.80-3.16]), trigger finger (OR 1.77), De Quervain’s tenosynovitis (OR 1.96), tendinitis (OR 2.16), and hand osteoarthritis (OR 2.99) (all p < 0.001). Fibromyalgia patients also had higher healthcare utilization and surgical procedure rates, including carpal tunnel release (OR 2.57) and trigger finger repair (OR 2.98).

Conclusions: Fibromyalgia is associated with a significantly higher prevalence of hand diseases and related surgical interventions. These findings support the need for early screening and multidisciplinary management of hand pathology in fibromyalgia patients to improve outcomes and prevent disability.

Keywords: Carpal tunnel syndrome; Case-control study; Fibromyalgia; Hand diseases; Healthcare utilization.

The impact of a hand therapy screening and management clinic for patients referred for surgical opinion in an Australian public hospital

Abstract

Study design: Retrospective cohort study.

Purpose: To measure the impact of initial treatment by a hand therapist of people referred to a hand surgeon for common hand conditions.

Methods: This retrospective cohort study included 224 patients with Carpal Tunnel Syndrome, Trigger Finger/Thumb, de Quervain’s tenosynovitis, and trapeziometacarpal osteoarthrosis. All were invited to attend for assessment and non-operative treatment and were followed up for at least one year. Between groups comparisons for who attended (N = 164) and those who did not (N = 60) were conducted.

Results: 40.8% of the non-operative treatment group and 65% of the no treatment group underwent surgery, which was statistically significant (p = 0.02). Univariate analysis found that the variable “attending non-operative treatment” was able to predict those who did not have surgery (p = 0.02). Multivariate analysis using logistic regression also showed that this was the only significant predictor of not progressing to surgery (p = 0.001).

Conclusions: Assessment and treatment by a non-operative provider were associated with a decrease in the rate of operative treatment. Prospective, randomized studies could help determine if this observed difference is related to the treatment approach.

Keywords: Carpal tunnel syndrome; Extended scope practitioner; Trapeziometacarpal osteoarthrosis; Trigger finger; Trigger thumb; de Quervain’s tenosynovitis.

The impact of a hand therapy screening on patients referred for surgical opinion

Fibromyalgia Hand Pain

Fibromyalgia is a condition that typically involves widespread pain. This diagnosis can have many different manifestations. The condition is generally considered to be centered around a heightened sensitivity of the nervous system, especially in the brain.

Many people with fibromyalgia experience multiple symptoms including:
  • Tiredness
  • Trouble sleeping
  • Anxiety
  • Depression
  • Arthritic conditions
  • Gastrointestinal conditions
One symptom that most people have in common is generalized pain. This pain can affect many parts of the body, including any part of the arm.

Causes

While the cause of fibromyalgia is not yet fully understood, many theories about the condition include its onset being triggered by different stressors. These triggers may include mental stress, having family members with the condition, and other general medical health problems.

Signs and Symptoms

The main symptom leading to a diagnosis of fibromyalgia is widespread pain. While all-over pain is common, the pain can also be more localized. It can vary in location of the body and may be occasional or constant.
Other symptoms, such as numbness and tingling with fibromyalgia, may be confused with nerve conditions that affect the arms and hands. Often, the numbness and tingling of fibromyalgia is not to the same degree as we see with other nerve conditions in the arm. It also does not always follow the typical patterns of a nerve in the limb.
Therefore, a careful sensory exam is needed to help find the actual cause of hand numbness or tingling. Special nerve testing (EMG/NCV) can help to clarify the causes of the symptoms in the elbow, forearm, or hand and can help determine whether the symptoms are coming from a nerve problem.
There are no common tests, such as x-rays or blood studies, to diagnose fibromyalgia hand pain or the disease in general. The diagnosis is made primarily by physical examination and a review of all body symptoms (generalized pain, headaches, anxiety, depression, sleep problems, mental fogginess, abdominal problems, etc.).
The diagnosis can be confusing because people with fibromyalgia can also have other conditions in the arm which are unrelated to the fibromyalgia diagnosis, such as carpal tunnel syndrome.

Treatment

There are no surgical treatments for fibromyalgia hand pain or arm pain, but other conditions present at the same time may benefit from surgical treatment.
Arthritis specialists (rheumatologists) may assist with the diagnosis and management of fibromyalgia. They may recommend medications, activity/exercises changes, and other treatments to help with the symptoms of fibromyalgia.

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