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Table 5 Case Definitions for Musculoskeletal Disorders

From: The WISTAH hand study: A prospective cohort study of distal upper extremity musculoskeletal disorders

Disease criteria for case Exclusions & Right Censor Conditions
Carpal Tunnel Syndrome: Exclude from Consideration if:
Case if meets: (1 + 2 + 3 + 4) OR 5 · had both tingling/numbness and an abnormal nerve study at baseline (met the prevalence case definition, hand specific1)
1. Numbness/Tingling (N/T) in 2 or more median nerve served digits (thumb, index, middle finger and/or ring finger) for ≥25% of days and/or nights on at least 2 consecutive monthly followups (from monthly follow-up interview). Note: N/T at baseline counts as one of two consecutive followups).  
  · has evidence of systemic neuropathy (determined by JJW, censor for all CTS analyses)
  · had prior Carpal Tunnel Release surgery (hand specific1)
  · had prior diagnosis of CTS by a Physician (hand specific1)
2. Abnormal nerve conduction study consistent with median mononeuropathy at the wrist (from baseline, or semiannual NCS) that was independently interpreted by a blinded, board certified physical medicine and rehabilitation physician (JW).  
  · had prior injection for CTS (hand specific)
  · has amputation of second or third digits at MCP or PIP in either hand (censor for all CTS analyses)
  Right Censor if:
3. Time difference between + (positive) NCS and consecutive N/T followups must occur within 6-months) · becomes CTS incident case (hand specific1)
4. Automatically a case if has surgery for CTS, provided the surgery cause is said to be “work-related” or “unsure”) and review by physician (KTH) suggests CTS. · leaves the study permanently (non-case)
Lateral Epicondylalgia: Exclude from Consideration if: all exclusions are hand specific 1
Case if meets: (1 + 2 + 3) OR 4  
1) Lateral elbow pain on interview present for ≥ 25% of days since last follow-up (from monthly follow-up interview). · met the case definition at baseline
  · had prior lateral elbow surgery
  · had prior elbow surgery of unknown type
2) “Pain” upon palpation of 1 or more of 6 lateral tender points (from monthly follow-up physical exam). · had prior diagnosis of lateral epicondylalgia
  · had prior treatment for lateral epicondylalgia
3) Automatically a case if have surgery or injection for lateral epicondylalgia, provided the surgery cause is said to be “work-related” or “unsure”) and review by physician (KTH) suggests lateral epicondylalgia.  
  · had prior radial nerve pain
  Right Censor if:
  · becomes Lateral Epicondylalgia incident case (hand specific1)
  · suffers an elbow injury (i.e. accident, fall, etc..) (hand specific1, non-case)
  · permanently leaves the study (non-case)
Medial Epicondylalgia: Exclude from Consideration if: all exclusions are hand specific 1
Case if meets: (1 + 2 + 3) OR 4  
1) Medial elbow pain on interview present for ≥ 25% of days since last follow-up (from monthly follow-up interview). · met the case definition at baseline
  · had prior medial elbow surgery
  · had prior elbow surgery of unknown type
2) “Pain” upon palpation of 1 or more of 2 medial tender points (from monthly follow-up physical exam). · had prior ulnar neuropathy or cubital tunnel surgery, OR clinical impression of ulnar neuropathy.
3) Automatically a case if have surgery or injection for medial epi, provided the surgery cause is said to be “work-related” or “unsure” and review by physician (KTH) suggests medial epicondylalgia. · had prior diagnosis of medial epicondylalgia
  · had prior treatment of medial epicondylalgia
  Right Censor if:
  · becomes medial epicondylalgia incident case (hand specific1)
  · suffers an elbow injury (i.e. accident, fall, etc..) (hand specific1, non-case)
  · permanently leaves the study (non-case)
deQuervain’s Tenosynovitis: Exclude from Consideration if: all exclusions are hand specific1
Case if meets: (1 + 2 + 3 + 4) OR 5  
1. Radial wrist pain for ≥ 25% of days since last follow-up (from monthly follow-up interview). · met the case definition at baseline
  · had prior deQuervain’s surgery
  · had prior deQuervain’s treatment (injection)
2. 1st extensor compartment tenderness (from monthly follow-up physical exam).  
  · had prior deQuervain’s diagnosis
3. Positive Finkelstein test (active) (from monthly follow-up physical exam). · has CMC/Wrist/MCP arthritis at baseline (or prior)
4. Automatically a case if have surgery or injection for deQuervain’s, provided the cause is said to be “work-related” or “unsure” and review by physician (KTH) suggests deQuervain’s. Right Censor if:
  · becomes deQuervain’s incident case (hand specific1)
  · suffers a wrist injury (i.e. accident, fall, etc..) (hand specific1, non-case)
  · develops CMC/Wrist/MCP arthritis (hand specific1, non-case)
  · permanently leaves the study (non-case)
Extensor Tendinosis (compartments 2-6) Exclude from Consideration if: all exclusions are hand specific 1
Case if meets: (1 + 2 + 3 + 4) OR 5  
1. Dorsal wrist pain for ≥ 25% of days since last follow-up. · met the case definition at baseline
  · had prior wrist extensor tendinosis surgery
2. 2-6 extensor compartment tenderness.  
  · had prior wrist extensor tendinosis treatment (injection)
3. Positive resisted wrist extension  
  · had wrist arthritis at baseline (or prior)
4. Automatically a case if have surgery or injection for extensor tendinosis, provided the cause is said to be “work-related” or “unsure” and review by physician (KTH) suggests extensor tendinosis. Right Censor if:
  · becomes wrist extensor tendinosis incident case (hand specific1)
  · suffers a wrist injury (i.e. accident, fall, etc..) (hand specific1, non-case)
  · develops wrist arthritis (hand specific1, non-case)
  · permanently leaves the study (non-case)
Digital Flexor Tendinosis Exclude from Consideration if: all
Case if meets: (1 + 2 + 3 + 4) OR 5 exclusions are hand specific 1
1. Volar wrist pain – from Hand Pain Diagram · met the case definition at baseline
  · had prior flexor tendinosis surgery
2. Digital flexor tendon tenderness (from monthly follow-up physical exam).  
  · had prior flexor tendinosis treatment (injection)
3. No numbness/tingling in digits 1-4 (from monthly follow-up interview).  
  · had wrist arthritis at baseline (or prior)
  Right Censor if:
4. Automatically a case if have surgery or injection for digital flexor tendinosis, provided the cause is said to be “work-related” or “unsure” and review by physician (KTH) suggests digital flexor tendinosis  
  · becomes flexor tendinosis incident case (hand specific1)
  · suffers a wrist injury (i.e. accident, fall, etc..) (hand specific1, non-case)
  · develops wrist arthritis (hand specific1, non-case)
  · permanently leaves the study (non-case)
Trigger Finger/Trigger Thumb Exclude from Consideration if: all exclusions are hand specific 1
Case if meets: (1 + 3) OR (2 + 3) OR 4  
1. Pain in the finger (from both monthly follow-up physical exam and interview) AND Focal tenderness over A-1 pulley · met the case definition at baseline
  · had prior trigger finger/thumb
  · had prior finger/hand surgery
2. Demonstrated triggering (from monthly follow-up physical exam OR monthly interview). · had prior treatment for trigger finger/thumb (injection)
  · had MCP/finger OA at baseline
3. Automatically a case if have surgery or injection for trigger finger, provided the cause is said to be “work-related” or “unsure” and review by physician (KTH) suggests trigger finger. Right Censor if:
  · becomes trigger finger/thumb incident case (hand specific1)
  · suffers a hand/finger injury (i.e. accident, fall, etc..) (hand specific1, non-case)
  · permanently leaves the study (non-case)
Non-Specific Pain Exclude from Consideration if: all exclusions are hand specific 1
Case if meets: (1 + 3) OR (2 + 3)  
1) Pain in DUE with intensity ≥ 6 for ≥ 25% of days since last follow-up that is NOT associated with a specific disorder. · met the case definition for non-specific pain at baseline
  · met the case definition for any specific disorders at baseline
2) Pain in DUE of any intensity AND taking medication for pain.  
3) a. Carpal Tunnel Syndrome
  b. Lateral Epicondylalgia
  c. Medial Epicondylalgia
  d. deQuervain’s
  e. Extensor Tendinosis
  f. Digital Flexor Tendinosis
  g. Trigger Finger/Trigger Thumb
  Right Censor if:
  · becomes a non-specific pain incident case (hand specific1)
  · becomes an incident case for ANY specific disorder
  a. Carpal Tunnel Syndrome
  b. Lateral Epicondylalgia
  c. Medial Epicondylalgia
  d. deQuervain’s
  e. Extensor Tendinosis
  f. Digital Flexor Tendinosis
  g. Trigger Finger/Trigger Thumb
  · suffers a DUE injury (i.e. accident, fall, etc..) (hand specific1, non-case)
  · permanently leaves the study (non-case)
Aggregate Disorders Exclusions from Consideration:
Case if meets: 1 · Subjects are excluded from becoming a case under specific disorders based on the specific exclusion criteria above. Note: Subjects may still be eligible to become an aggregate disorder case despite being ineligible under certain disorders. (e.g. a subject that is excluded from becoming a case for trigger finger/trigger thumb, DeQuervain’s, and lateral and medial epicondylalgia, may still become a case for CTS, extensor, or digital flexor tendinosis, and is therefore still eligible to become a case for aggregate disorders.)
2. Meets any of the following case definitions as defined above:  
a. Carpal Tunnel Syndrome  
b. Lateral Epicondylalgia  
c. Medial Epicondylalgia  
d. deQuervain’s  
e. Extensor Tendinosis  
f. Digital Flexor Tendinosis  
g. Trigger Finger/Trigger Thumb  
Note: person level based on development of any of above disorders in either hand.  
  · If a subject is not eligible to become a case
  for any of the 7 specific disorders listed to the left, the subject is excluded from aggregate disorders
  Right Censor if:
  · becomes aggregate disorder incident case (hand specific1)
  · suffers a hand/wrist/elbow injury (i.e. accident, fall, etc..) (hand specific1, non-case)
  · permanently leaves the study (non-case)
  1. 1hand specific, out for person level analyses, out for dominant hand if dominant hand affected.