It is easy to understand how Dr Romano's experience differs from ours, since his patient group is so different. Compared with our 297 patients, his 17 were more than 10 years older, on average, and his female population was only 6% vs the 77% in our study. All of his patients had physically demanding jobs with exposure to vibrating tools; only 9.8% of our patients were so occupied. His sample seems to have experienced a great deal of selection bias. If anything, his group resembles our 29 patients in the "industrial" job category: this was the only occupational group with exposure to vibrating tools, and only 17% were women. This was also the only job category with significant associations with CTS remaining after accounting for disease and obesity confounders. Osteoarthritis and gout composed most of the medical diseases in these patients.
Atcheson SG. Risk Factors for Carpal Tunnel Syndrome. Arch Intern Med. 1999;159(9):1009–1010. doi:https://doi.org/
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