Poster 142: Bilateral Efficacy of Local Corticosteroid Injection in a Primagravid Patient With Asymmetric Temporal Development of Carpal Tunnel Syndrome in the 2 Hands

Abstract

Setting: Academic medical center. Patient: A 35-year-old woman in the third trimester of her first pregnancy. Case Description: The patient had no significant medical history. Chief complaint was pain in her right hand and arm significant at all times of day, sufficiently severe to make getting to sleep difficult. She also noted numbness in the first 3 fingers of the right hand. Exam was consistent with right carpal tunnel syndrome (CTS). Splinting did not significantly decrease pain. The patient opted against a trial of oral medications, however, she did allow a local steroid and anesthetic injection. Assessment/Results: She noted immediate and complete relief of pain and numbness, and had ability to fall asleep that night and subsequently without difficulty. Some weeks later, she presented with similar symptoms in her left hand. Exam was consistent with CTS. A steroid and local anesthetic injection was performed. Again, the patient noted immediate relief of pain and numbness and the ability to fall asleep without difficulty. A healthy baby was delivered at term without complication. Mother and baby are doing well. There has been no recurrence of CTS symptoms. Discussion: Pregnancy increases the risk of developing CTS through an incompletely understood mechanism. Local steroid injection often has efficacy for a few months in CTS—long enough to last until parturition, when the symptoms of CTS typically resolve. Our case not only illustrates the utility of local steroid injection in CTS in pregnancy, but also raises the interesting question of why the CTS developed in an asymmetric temporal fashion in the 2 hands. Conclusions: Local corticosteroid injection is safe and effective in CTS in pregnancy. A full understanding of how and why pregnancy so frequently induces often de novo CTS may lead to a better understanding of the pathogenesis of CTS, and merits further study.