To review our practice of requesting nerve root blocks, to see how effective our therapeutic blocks are and how many of our diagnostic blocks confirm clinical suspicion and help decision making.

Retrospective cohort analysis

120 fluoroscopically guided nerve root blocks were performed between 20/08/2008 and 29/12/2008. There were 100 patients who had pain diary data available, 42 males (mean age 52.02 range 20-76) 58 females (mean age 60.03, range 22-88).

We recorded: clinical diagnosis, reason for block, result of block on a 10 point visual analogue pain diary on days 0, 2, 14 and at review. A successful block was defined as an improvement of at least 2 points. For the diagnostic blocks we also recorded whether the block result influenced surgical decision making.

Block methods will be illustrated in diagram. Results will be displayed graphically and in text. 18 blocks were cervical (1 purely diagnostic, 6 therapeutic, and 10 mixed, 1 data unavailable). 71 blocks were lumbar (1 purely diagnostic, 28 purely therapeutic, and 37 mixed, 5 data unavailable). 28% of all blocks were successful immediately (2 unavailable data) and 22% at two weeks (1 unavailable data). By 3 months the success rate for therapeutic blocks was 26%. Of the blocks done for diagnostic reasons, 86% influenced a clinical decision at the next outpatient appointment.

Our results justify the continuance of this service. Increased care should be taken that patients' outcome data is collected.

Background: Relatively little is known about the risk factors for carpal tunnel syndrome (CTS) in the community. Previous studies have generally assessed smaller numbers of patients in specialist clinics, or in particular occupations. Therefore, we have performed a case-control study using the West Midlands General Practice Research Database.

Methods: Our cases were all patients with a recorded diagnosis of CTS; four controls per case were individually matched by age, sex and general practice. Information on constitutional, hormonal and musculoskeletal factors was extracted and analysed by conditional logistic regression.

Results: Our dataset included 3,391 cases; 2,444 (72%) were female, mean age at diagnosis was 45.8 years: and 13,564 matched controls. Multivariate analysis showed that the risk factors associated with CTS were previous wrist fracture (OR = 2.29, 95% CI: 1.67–3.12), rheumatoid arthritis (OR = 2.23, 95% CI: 1.57–3.17), osteoarthritis (OR = 1.89, 95% CI: 1.65–2.17), BMI (BMI 30–40, OR = 2.06, 95% CI: 1.79–2.38), diabetes (OR = 1.51, 95% CI: 1.24–1.84), the use of insulin (OR = 1.52, 95% CI: 1.06–2.18), sulphonylureas (OR = 1.45, 95% CI: 1.07–1.97), metformin (OR = 1.20, 95% CI: 0.84–1.72) and thyroxine (OR = 1.36, 95% CI: 1.08–1.70). Smoking habit, hormone replacement therapy, the combined oral contraceptive pill and oral corticosteroids were not associated with CTS.

Conclusions: Rheumatoid arthritis, wrist fracture, osteoarthritis, and an increased Body Mass Index were the most important risk factors for CTS that we identiþed. The combined oral contraceptive, hormone replacement therapy, prednisolone and smoking are not associated with CTS.

Background: Presently the aetiology of this common condition remains unclear. Previous research suggests that diabetes or epilepsy might increase the prevalence of the condition, but the evidence is inconsistent.

Methods: Our cases were all patients diagnosed with Dupuytren’s Disease, with two controls per case individually matched by age, sex, and general practice. Information on all diagnoses of diabetes and diabetic medication, and epilepsy and anti-epileptics was extracted. All analysis was adjusted for consulting behaviour to reduce ascertainment bias.

Results: There were 821 cases (1,642 controls), 588 (72%) of which were males. Mean age at diagnosis was 62 years. Prevalence = 0.2%. Diabetes was significantly associated with Dupuytren’s (OR 1.82). Insulin use was strongly associated with Dupuytren’s (OR = 4.33), as was metformin (OR = 3.67); the association was also present for sulphonlyureas (OR = 1.89). There was no association with epilepsy and Dupuytren’s (OR = 1.05). None of the treatments for epilepsy were associated with Dupuytren’s disease.

Conclusion:Diabetes is a significant risk factor for Dupuytren’s Disease. There is an increased risk for treated diabetes rather than diet controlled diabetes. Epilepsy and anti-epileptic medication are not associated with Dupuytren’s Disease. Ascertainment bias may explain the association observed in previous studies.