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Beyond Body Mass Index: Appendicular Lean Mass Index-Defined Sarcopenia and Carpal Tunnel Syndrome-A Cross-Sectional
1Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Introduction/Aims:
Obesity is a well-established risk factor for carpal tunnel syndrome (CTS), but body mass index (BMI) does not distinguish adiposity from skeletal muscle mass. The role of sarcopenia in CTS has received little attention. Sarcopenia may increase nerve vulnerability to compression. We examined whether appendicular lean mass index (ALMI) and ALMI-defined sarcopenia are associated with CTS independent of BMI.
Methods:
We retrospectively analyzed 193 consecutive patients aged 50 years or older who underwent carpal tunnel release by a single surgeon at a tertiary center over 4 years. Controls were 5665 age-matched participants from the 2022-2023 Korea National Health and Nutrition Examination Survey. ALMI-defined sarcopenia was compared between groups. Multivariable logistic regression was applied to examine the association between ALMI-defined sarcopenia and CTS, adjusting for BMI.
Results:
Compared with controls, CTS patients exhibited a higher prevalence of sarcopenia in both men and women (p < 0.05). The association with sarcopenia was significant across most age and sex subgroups, whereas obesity was more evident in younger age groups (50-69 years). In multivariable models, sarcopenia showed a stronger association with CTS (OR 2.41, 95% CI 1.79-3.22) compared with BMI (OR 1.05, 95% CI 1.01-1.10).
Discussion:
In this case-control study, both obesity and ALMI-based sarcopenia were associated with CTS, with sarcopenia showing a stronger association. These findings suggest an association between reduced muscle mass and CTS independent of BMI. Muscle mass assessment alongside BMI may help clinicians identify at-risk patients who might otherwise be overlooked by conventional obesity metrics.
