Comment on “Evaluating the Association Between Obesity and Development of Trigger Finger and Carpal Tunnel Syndrome”

To the Editor:

The publication on “Evaluating the Association Between Obesity and Development of Trigger Finger and Carpal Tunnel Syndrome”¹ is interesting. In this study, the researchers used a retrospective chart review method, which has notable limitations. The data may be inadequate or lacking specific aspects, such as the real onset of symptoms before diagnosis, which may affect the accuracy of age measurement at the time of diagnosis. The classification of body mass index (BMI) groups based on only two standard criteria (BMI ≥ 30 and BMI 18.5–24.9) may overlook the effects of different levels of body weight and obstruct the potential differences in the overweight but not obese group, such as the BMI 25–29.9 group, which may also be a risk group.

Statistically, the use of a multivariate linear regression model has the advantage of adjusting for the effects of many confounding factors, but it is limited by model assumptions, such as the linearity of the relationship between BMI variables and age at diagnosis, which may not always be true. Furthermore, selecting variables such as “smoking,” “type 1 diabetes,” and “hypertension” as accelerators or delayers of illness development without accounting for smoking intensity or level of disease control may be insufficient for the analysis. Furthermore, the sample size (n = 259) stratified by distinct conditions may be insufficient for subgroup analysis, yielding erroneous and generalizable conclusions.

The topic “Which factors might be the real co-cause between BMI and the age of onset of carpal tunnel syndrome or trigger finger, such as hand-use behavior, occupational history, or genetic factors?” could spark debate and contribute to future research. Furthermore, it should be addressed whether the BMI measurement at the time of diagnosis matches the body weight at the time of disease beginning, as well as “Does diabetes or hypertension control affect the duration of the disease?” These are fascinating questions that deserve additional investigation.

The study found that those with a BMI ≥ 30 had an earlier diagnostic age of 6.4 years, including smoking and type 1 diabetes, which accelerated the beginning of the disease. These findings may be attributed to “chronic inflammation and metabolic disorders” as key accelerators. However, the study indicated that patients with hypertension experienced a 6-year delay in the development of the disease compared to those without hypertension, which is an inconsistent and suspicious finding. It could be the result of using anti-inflammatory medicines to manage blood pressure or a statistical error. To have a thorough understanding of this subject, additional study and investigation are required.

Conflicts of Interest

No benefits in any form have been received or will be received related directly to this article.