Ultrasonography for carpal tunnel syndrome in pregnancy: a prospective cross-sectional study

Abstract

Confirmation of carpal tunnel syndrome (CTS) diagnosis with sonographic measurement of the median nerve cross sectional area (MN-CSA) is increasing in popularity. We aimed to analyse the ultrasonography (USG) values of MN-CSA in pregnant women with and without CTS symptoms. MN-CSAs of third trimester pregnant women were measured with USG and they were asked about the presence of CTS symptoms. Symptomatic participants were assigned to the CTS group and remaining participants were assigned to the Control group. The groups were compared according to MN-CSA. Twenty-five participants were grouped in CTS group and the remaining 64 participants were grouped in Control group. The MN-CSA was higher in the CTS group (9.44 ± 2.68) than in the Control group (7.20 ± 1.99), p = .00004. Obstetricians can use USG measurement of MN-CSA to confirm CTS diagnosis and consequently can offer conservative management, which is the widely accepted treatment modality in this cohort. Impact statement What is already known on this subject? CTS is the most common mononeuropathy of pregnancy, with up to 62% prevalence rates. The American Association of Neuromuscular & Electrodiagnostic Medicine practice guideline for the diagnosis of CTS recommends sonographic measurement of median nerve swelling at the carpal tunnel inlet as an accurate diagnostic test (Level A). What do the results of this study add? We found that a simple sonographic measurement of median nerve cross sectional area (MN-CSA) at the wrist appears to be a convenient method to confirm clinical CTS diagnosis in pregnant women. This study offers to use USG to confirm clinical CTS diagnosis in third trimester pregnant women before delivery. What are the implications of these findings for clinical practice and/or further research? This study will help to raise awareness of obstetricians about CTS during pregnancy. USG can be an effective first-line confirmatory test for CTS diagnosis in the pregnant population, but further research is necessary to determine a clear cut-off value for MN-CSA. We advise obstetricians to use sonographic measurement of MN-CSA in pregnant women with typical CTS symptoms, which will increase uniformity for consensus development. Obstetricians can offer advice for conservative management of CTS during pregnancy, which is the widely accepted treatment in this cohort.