Tunnel Syndrome In Pregnancy Research Articles

Comparison of ultrasonographic parameters in the diagnosis of carpal tunnel syndrome in pregnancy

Comparison of ultrasonographic parameters in the diagnosis of carpal tunnel syndrome in pregnancy

Management of "De Novo" Carpal Tunnel Syndrome in Pregnancy: A Narrative Review.

Carpal tunnel syndrome is a common entrapment neuropathy that can occur in the upper limbs during pregnancy. However, it is often undervalued and underdiagnosed because the symptoms can be mistaken for regular changes during pregnancy. Delay or absence of diagnosis and treatment can lead to permanent nerve damage, which can affect a woman's quality of life during and after pregnancy. Although the treatment protocols are well established for carpal tunnel syndrome in patients from the general population, there is a different situation among pregnant and postpartum women that requires a preventive and personalized approach to manage this pathology. Unfortunately, the range of available treatment options is limited due to the pregnant woman's physiological status and influenced by the high possibility of the complete resolution of this pathology in the postpartum period without any treatment. To limit the possibility of unfavorable evolution of this syndrome during pregnancy, an early diagnosis and personalized approach are mandatory in each case involving a multidisciplinary team of general practitioners, obstetricians, hand surgeons, rehabilitation physicians, physiotherapists, and occupational therapists.

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

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.

Carpal Tunnel Syndrome and Meralgia Paresthetica in Pregnancy.

Carpal tunnel syndrome and meralgia paresthetica are 2 common neuropathies complicating pregnancy. Each of these causes significant discomfort but can be diagnosed and treated safely during pregnancy. This article outlines the existing literature diagnosis, treatment, and prognosis of carpal tunnel syndrome and meralgia paresthetica, specifically looking at the implications during pregnancy. The aim is to provide a reference for physicians diagnosing and treating neuropathies in pregnant patients. Existing literature on neuropathies during pregnancy, clinical presentation, and treatment options for both carpal tunnel syndrome and meralgia paresthetica was reviewed through a MEDLINE and PubMed search. Referenced articles were reviewed and used as primary source materials as appropriate. Carpal tunnel syndrome affects individuals of all ages and sexes but is more prevalent in women, particularly during pregnancy. Meralgia paresthetica can occur in various circumstances but is most commonly associated with prolonged second stage in lithotomy position. Multiple clinical signs and neurologic tests are useful to establish the diagnosis of either neuropathy. Effective treatment for carpal tunnel syndrome includes wrist splints, steroid and lidocaine injections, and release surgery. Optimal treatment of meralgia paresthetica remains controversial but includes nerve block injections and active release techniques. Neuropathies are common in pregnancy and can result in significant impairment. Accurate diagnosis is possible during pregnancy and can usually be accomplished with bedside neurologic tests. Treatment options can be safely considered during pregnancy and can result in symptomatic improvement and reduction in chronic symptoms.

Effect of Conservative Treatment on Alleviation of Symptoms in 36 cases of Carpal Tunnel Syndrome in Pregnancy: A Prospective Study

Background: Carpal Tunnel Syndrome (CTS) is the most common upper extremity compression neuropathy which is a common entrapment neuropathy seen in pregnant women.Objective: The purpose of the present study was to assess presentation and severity of various symptoms among women with CTS in pregnancy and to see the effect of conservative management protocols in alleviation of symptoms of the disease and restoration of functional capability of the affected hands.Methodology: This interventional study was included 36 pregnant women attended in the Outpatient Department of Physical Medicine and Rehabilitation Specialist in the Hi-Tech Multicare Hospital, Dhaka during the period from January 2015 to January 2016 for a period of one year and one month. Detail history was taken and examined physically by a specialist in physical medicine to ascertain the clinical diagnosis. Out of 48 referred cases, 42 pregnant women were identified clinically as CTS cases based on symptoms and signs. However, 2 cases were not enrolled because of severe form of pain and referred to other hospital for admission and 6 patient dropped out. Therefore, 36 cases with CTS symptoms included in this study. All the patients were given conservative treatment (Wrist splint, Exercise and activity modification) for 8 weeks. All patients were followed up at 4 weeks interval. Treatment outcome were measured by Boston carpal tunnel questionnaire (BCTQ).Result: The mean age of the patients is 30±3.5 years. 26 (78%) patients mild to moderate type of CTS symptoms showed improvement in conservative management. Before treatment the mean symptoms severity scale (SSS) of BCTQ) was 2.32±0.4 and for functional status scale (FSS) was it was 1.99±0.43. After treatment for SSS 1.86±0.47 and for FSS 1.53±0.42. And in SSS the p value<.05 and in FSS p value is <.05 which was statistically significant.Conclusion: In conclusion conservative management protocols are sufficient enough in alleviation of symptoms of the disease and is effective for the restoration of functional capability of the affected hand or hands.Journal of National Institute of Neurosciences Bangladesh, 2018;4(2): 101-107

Treatment of Carpal Tunnel Syndrome in pregnancy with Polarized Polychromatic Non-coherent Light (Bioptron Light): A Preliminary, Prospective, Open Clinical Trial.

The aim of this trial was to assess the efficacy of polarized polychromatic noncoherent light (Bioptron light) in the treatment of Carpal Tunnel Syndrome (CTS) in pregnancy. An uncontrolled experimental study was conducted in pregnant patients with CTS who visited our clinic from January 2006 to January 2010. Bioptron light (480-3400 nm; 95% polarization; 40 mW/cm2; and 2.4 J/cm2) was administered perpendicular to the carpal tunnel area. The irradiation time for each session was 6 min at an operating distance of 5-10 cm from the carpal tunnel area, twice each day, five days per week for 2 weeks. Pain and paraesthesia using a visual analogue scale (VAS) and finger pinch strength were evaluated at the end of treatment (week 2) and 1-month (week 6) after the end of treatment. The Student'sttest was used and p values < 0.05 were accepted as statistically significant. 46 patients participated in the study. The mean age of subjects was 27.6 years (range 22-37). The patient population had a mean duration of CTS of 2.3 months (range 1-4). All patients were in the third trimester. Pain and paraesthesia decreased at the end of treatment and at the 1-month follow-up, whereas the finger pinch strength increased at the end of treatment and at the 1-month follow-up. In conclusion, the results of the present study suggest that Bioptron light is a reliable, safe, and effective treatment option in pregnant patients with CTS. Controlled clinical trials are needed to establish the absolute and relative effectiveness of this intervention.

Risk Factors of Carpal Tunnel Syndrome in Pregnancy.

Risk Factors of Carpal Tunnel Syndrome in Pregnancy.

Comparison Efficacy of Triamcinolone and Wrist Splint in Severe Carpal Tunnel Syndrome in Pregnancy

Introduction: Carpal tunnel syndrome (CTS) is entrapment of median nerve in carpal tunnel of the wrist. The main aim of this study was to compare the effectiveness of steroid injection and wrist splint in severe carpal tunnel syndrome in pregnancy. The cases were selected among pregnant women who referred to OB and GYN clinic in Yasuj city in South- west of Iran. Materials and methods: This study is a randomized clinical trial which was accomplished from December 2010 to June 2012 at S. Mofateh Clinic on 28 pregnant women. Standard electrodiagnostic techniques were performed on the women who had clinical symptoms of CTS in their hands, with positive Tinel and/or Phalen tests, for rule in/or out of CTS. The patients with severe CTS were randomly divided in 2 groups including triamcinolone injection (40 mg) and wrist splint in night for 6 weeks. Electrophysiologic parameters of median and ulnar nerves were recorded before and 2 months after the steroid injection and wrist splint. In cases of observing changes from severe to lower stages of the disease in electrodiagnostic studies, treatment was considered successful and otherwise failed. Results: Effectiveness of triamcinolone injection and wrist splint were 85. 7% and 90. 9%, respectively. There was no significant difference between treatments by steroid injection and wrist splint (p=0. 157). Also no correlation was observed between severe carpal tunnel syndrome and number of pregnancy. Conclusion: Triamcinolone injection or wrist splint are effective methods for treatment of severe CTS in pregnancy and therefore recommended instead of carpal tunnel release surgery.

Evaluation of pathological carpal tunnel syndrome in pregnancy

Evaluation of pathological carpal tunnel syndrome in pregnancy

A review of carpal tunnel syndrome in pregnancy

Carpal tunnel syndrome (CTS) during pregnancy is common and distressing, however, the syndrome can be simply treated if diagnosed early. The purpose of this article is to revise the anatomy and pathology of CTS in pregnancy, enabling the midwife to diagnose the condition and instigate early treatment in the antenatal clinic. The current international literature on CTS in pregnancy is reviewed and key points are set out in the text.

Carpal tunnel syndrome in pregnancy: multiperspective follow-up of untreated cases.

In a follow-up of carpal tunnel syndrome (CTS) after pregnancy, the Italian CTS Study Group prospectively studied 63 pregnant women with multiple measurements of CTS symptoms. Fifty-four percent of women with CTS symptoms during pregnancy had symptoms 1 year later. Patients with onset of CTS symptoms early during pregnancy are less likely to improve after delivery.

Symptoms and neurophysiological picture of carpal tunnel syndrome in pregnancy

Objective: To evaluate the incidence of carpal tunnel syndrome (CTS) in pregnancy through a validated and multiperspective assessment of CTS. Methods: During 2000, the Italian CTS study group focussed on the occurrence of CTS in women during the final stages of pregnancy, enrolled in 7 Italian centers. In addition to the physician-centered and neurophysiologic traditional evaluations, we used a validated patient-oriented measurement to obtain more comprehensive and consistent data for severity of symptoms and functional impairment. Results: In our study, CTS was clinically diagnosed in more than half of women (62%). Neurophysiological evaluation provided diagnosis of CTS in around half of women (43% were positive in one hand at least). Our study provides evidence, reported here for the first time, of a correlation between edema and neurophysiological picture. Similarly, our study provides a correlation between validated patient-oriented measurement and edema. Moreover, a significant correlation between a negative trend (subjectively assessed) and smoking and alcohol consumption was observed. Conclusions: Our observations confirm that the edema of the tissues in the carpal tunnel could induce a mechanical compression of the nerve. Moreover, our data suggest that smoking and alcohol consumption have a negative role in the evolution of the syndrome probably due to impairment of the microcirculation.

The management of carpal tunnel syndrome in pregnancy

Objectives: To determine the prevalence of carpal tunnel syndrome (CTS) after delivery and its relationship to individual factors.Study design: A cohort of 46 pregnant women, aged 15–48 years, who had suffered from CTS during pregnancy and who had delivered at Aydin Maternity Hospital, Turkey was selected. They had been followed up through pregnancy and 12 months postpartum and filled out a qu estionnaire. The data were analysed statistically.Results: Follow up showed that CTS at 6 and 12 months post partum was reported by 10.9% and 4.3% of the women, respectively. The difference in prevalence of CTS between young women and older women was statistically significant (P= 0.005). The history of diabetes mellitus and infant birth weight were similar in the two groups. However, patient weight gain during pregnancy increased the risk of CTS (P= 0.000). On the other hand, there was no difference in the number of previous pregnancies between women with CTS and without CTS during pregnancy (P= 0.210). Furthermore, affected and unaffected groups required Caesarean section in nine and 248 patients during pregnancy, respectively.Conclusion: These results indicate that, in most pregnant patients with CTS, the symptoms are present in both hands and are first noted during the third trimester. The majority of patients with CTS obtain spontaneous relief in the immediate postpartum period.

Carpal tunnel syndrome in pregnancy: Frequency, severity, and prognosis

Objective: To determine the frequency, severity, prognosis, and patterns of carpal tunnel syndrome (CTS) in pregnancy. Design: Descriptive retrospective chart review using the Rochester Epidemiology Project medical record diagnostic indexing system to identify patients with new CTS occurring during pregnancy from 1987 to 1992 at our institution. Setting: Obstetrical practice, where two thirds of pregnant women in the county receive primary obstetrical care. Patients: Women pregnant during 1987 to 1992 who had a new diagnosis of CTS. Women with pregnancies at other dates or women who had CTS with onset before or after pregnancy were excluded. Outcome Measures: Age, underlying medical problems, gestation interval, weight gain, number of pregnancies, presenting symptoms, onset and duration of symptoms before diagnosis, trimester of CTS diagnosis, treatment and response, and results of electrophysiologic studies are described. Results: Of 10,873 pregnant patients receiving antenatal care for 14,579 pregnancies, 50 (.34%) fulfilled the inclusion criteria. Their mean age was 30.5 ± 4.0yrs. Twelve patients (24%) were primigravid. Mean weight gain was 12.1 ± 5.7kg. CTS was diagnosed most frequently during the third trimester ( n = 25, 50%). Symptom onset, when recorded, occurred with even distribution during each trimester: first, n = 11 (32%); second, n = 11 (32%); third, n = 12 (35%). For 37 patients in whom symptom duration was recorded, duration before diagnosis was 9.3 ± 9.0 weeks. Paresthesia (88%) was most often bilateral (68%), and 67% of patients had pain. The Tinel sign was present over the median nerve at the wrist in 95%. Only nine patients had nerve conduction studies performed. During pregnancy, 37 women were treated nonsurgically with wrist orthoses, steroid injections, or both. Of treated patients for whom follow-up data were available, 25 of 26 improved, and 4 of 26 required surgery. Thirteen women had no treatment during pregnancy; three underwent surgery in the postpartum period. All 7 women in whom conservative treatment failed who underwent surgery had resolution of symptoms. Conclusion: These results represent the frequency and patterns of clinically significant CTS in a large population of pregnant women. CTS severe enough to warrant treatment occurs infrequently in pregnancy and generally resolves spontaneously postpartum or responds to conservative treatment.

Carpal tunnel syndrome in pregnancy: indications for early surgery

The incidence of carpal tunnel syndrome is increased during pregnancy. The common conventional therapeutic approach is conservative, as symptoms usually abate after delivery. We describe our experience with 65 hands (50 patients), who were treated initially by a conservative approach and later, when required, surgically. We found that all patients who (i) had either started having CTS symptoms during the first two trimesters or had previous history of CTS symptoms; and (ii) had both a positive Phalen test within less than 30 seconds and abnormal two point discrimination at the finger tips (> 6 mm), were eventually operated upon, either during or after pregnancy, as conservative measures failed. We therefore recommend consideration of an early surgical approach in patients fulfilling these criteria.

Carpal Tunnel Syndrome in Pregnancy and Lactation

A retrospective study of 40 women with carpal tunnel syndrome developing in pregnancy and 18 women with carpal tunnel syndrome in the puerperium was undertaken. All the cases that developed in pregnancy occurred in the third trimester and resolved within two weeks of delivery. Those cases developing in the puerperium affected women who had breast-fed their infants and their symptoms lasted a mean of 5.8 months. These patients were older and more likely to be primiparous than if the condition occurred in pregnancy. All the pregnant women and none of the lactating women had symptoms of peripheral oedema. Spontaneous resolution with a good response to conservative measures occurred in both groups; only three cases were treated surgically. Residual clinical evidence of median nerve damage was present in 40% of all cases. Carpal tunnel syndrome which develops in pregnancy appears to be a separate clinical entity to that developing in the puerperium.

Carpal tunnel syndrome in pregnancy and lactation

A retrospective study of 40 women with carpal tunnel syndrome developing in pregnancy and 18 women with carpal tunnel syndrome in the puerperium was undertaken. All the cases that developed in pregnancy occurred in the third trimester and resolved within two weeks of delivery. Those cases developing in the puerperium affected women who had breast-fed their infants and their symptoms lasted a mean of 5.8 months. These patients were older and more likely to be primiparous than if the condition occurred in pregnancy. All the pregnant women and none of the lactating women had symptoms of peripheral oedema. Spontaneous resolution with a good response to conservative measures occurred in both groups; only three cases were treated surgically. Residual clinical evidence of median nerve damage was present in 40% of all cases. Carpal tunnel syndrome which develops in pregnancy appears to be a separate clinical entity to that developing in the puerperium.

Carpal Tunnel Syndrome in Pregnancy

In this prospective study, 56 women (2.3%) of 2,358 (47% nulliparous and 53% multiparous) delivered during a 12-month period at the Department of Obstetrics and Gynecology, Malmo General Hospital, had symptoms of carpal tunnel syndrome during pregnancy. All (33 nulliparous and 23 multiparous women) were examined, at the outpatient's maternity care unit and within 4-5 weeks from the time of debut of symptoms, by a specialist in hand surgery. At that time the most common symptoms were paresthesia and nocturnal pain. Twenty-nine had signs of reduced sensibility and 14 of them had a positive two-point discrimination test. All had generalized edema. Conservative treatment with splinting of the wrist at night made 46 out of 56 symptom-free. Of the remaining 10 women, 3 had to be operated on, whereas 7 received only conservative treatment, as the expected time for parturition was very close. One of them had to be operated on after delivery. In conclusion, carpal tunnel syndrome during pregnancy is most common in primiparas with generalized edema. Conservative treatment is sufficient for symptom relief in most women (80%) but a few cases need operative intervention to abolish the severe pain and to avoid disturbances of hand function.

Carpal tunnel syndrome in pregnancy. A prospective study.

In this prospective study, 56 women (2.3%) of 2,358 (47% nulliparous and 53% multiparous) delivered during a 12-month period at the Department of Obstetrics and Gynecology, Malmö General Hospital, had symptoms of carpal tunnel syndrome during pregnancy. All (33 nulliparous and 23 multiparous women) were examined, at the outpatient's maternity care unit and within 4-5 weeks from the time of debut of symptoms, by a specialist in hand surgery. At that time the most common symptoms were paresthesia and nocturnal pain. Twenty-nine had signs of reduced sensibility and 14 of them had a positive two-point discrimination test. All had generalized edema. Conservative treatment with splinting of the wrist at night made 46 out of 56 symptom-free. Of the remaining 10 women, 3 had to be operated on, whereas 7 received only conservative treatment, as the expected time for parturition was very close. One of them had to be operated on after delivery. In conclusion, carpal tunnel syndrome during pregnancy is most common in primiparas with generalized edema. Conservative treatment is sufficient for symptom relief in most women (80%) but a few cases need operative intervention to abolish the severe pain and to avoid disturbances of hand function.

Carpal tunnel syndrome in pregnancy

Carpal tunnel syndrome in pregnancy