The reported incidence of pregnancy-related carpal tunnel syndrome (PRCTS) ranges from 08% to 70%, and little is known of its natural history We systematically reviewed the reported incidence of PRCTS and evaluated its natural history We identified 214 studies that fulfilled our selection criteria Six publications fulfilled the inclusion criteria Five fulfilled the incidence criteria, 3 fulfilled the natural history criteria, and 2 of the 6 publications satisfied both The reported incidence of neurophysiologically confirmed PRCTS ranged from 7% to 43%, whereas the incidence of clinically diagnosed PRCTS ranged from 31% to 62% Symptoms persisted in more than 50% of the patients after 1 year and in about 30% after 3 years Our review suggests that variations in the reported incidence of PRCTS largely depend on the methods used to detect this syndrome Our data also suggest that symptoms persist in a substantial number of patients 1 or more years after delivery

Systematic review of pregnancy-related carpal tunnel syndrome

Low back pain is a common musculoskeletal symptom in pregnancy that can present as lumbar pain or pelvic girdle pain, with significant physical and psychosocial implications. Pelvic girdle pain is more prevalent and results in greater disability than lumbar pain. It is possible to distinguish between these two conditions from a detailed history based on the site of the pain, its intensity, disability and pain provocation tests. Management of low back pain in pregnancy is conservative, with physical exercise for lumbar pain and minimising activities that exacerbate pain, analgesics and bed rest for pelvic girdle pain, as well as avoiding abduction beyond the pain-free zone in labour. There is evidence that stabilising exercises in patients with pelvic girdle pain postpartum have a beneficial effect. Other treatment modalities that have been shown to be safe and effective include pelvic belts, transcutaneous electrical nerve stimulation, spinal manipulative therapy, acupuncture and complementary therapy with yoga. Other orthopaedic complications in pregnancy such as carpal tunnel syndrome, pubic symphysis rupture, transient osteoporosis and osteonecrosis are usually self-limiting with a satisfactory outcome. However, a lack of awareness and failure to recognise these complications can result in long-term morbidity. Knowledge of the preoperative diagnostic investigations, surgical approaches and intraoperative positioning of the mother to avoid gravid uterus compression is vital in orthopaedic emergencies such as lumbar disc herniation, cauda equina syndrome, fractures and acute compartment syndrome of the lower limb to ensure a safe maternal and fetal outcome and to prevent serious disability. Pregnancy is not contraindicated in women with pre-existing orthopaedic complications such as kyphoscoliosis and total hip arthroplasty as there is no evidence to suggest increased maternal or fetal risks.

https://pmj.bmj.com/content/postgradmedj/early/2014/06/05/postgradmedj-2013-132377.full.pdf

Musculoskeletal symptoms and orthopaedic complications in pregnancy: pathophysiology, diagnostic approaches and modern management

Background: Carpal tunnel syndrome (CTS) is entrapment of median nerve in carpal tunnel of the wrist. The prevalence of CTS related to pregnancy and non-pregnancy is unknown in some countries such as Iran. The main aim of this study was to determine the prevalence of CTS in women of Boyerahmad Township located in South-West part of Iran. Methods: This cross-sectional descriptive analytic study was done since February 2010 to January 2011 in Obstetrics and Gynecology clinics in 2656 non-pregnant and 1508 pregnant women. The women that had clinical symptoms of CTS performed standard electro diagnostic techniques for rule in or rule out of CTS. Results: The prevalence of CTS in pregnant and non- pregnant women was 3.4and 2 .3 percent respectively. The prevalence of CTS in all women was 2.7%. Overall, 51 pregnant women had CTS that 59.4% had mild, 18.8 % had moderate and 21.9% had severe CTS. Sixty-one non-pregnant women had CTS that 73.6 %had mild, 20.8 %t had moderate and 5.6 % had severe CTS. Conclusion: Although the prevalence of CTS in Iranian pregnancy is higher than non-pregnancy women conservative treatment is safe and more effective.

/pdf/prevalence-and-severity-of-carpal-tunnel-syndrome-in-women-2tci4oeke5.pdf

Prevalence and Severity of Carpal Tunnel Syndrome in Women

OBJECTIVE : To evaluate the median nerve (MN) in pregnant women with carpal tunnel syndrome (CTS) by using ultrasound elastography. PATIENTS AND METHODS: 30 wrists of 20 pregnant women with CTS and 25 wrists of 14 healthy control pregnant women were evaluated by ultrasound and ultrasound elastography (UE). The MN in the patients' wrist was imaged to mea - sure the cross-sectional area and longitudinally to calculate the elasticity value (EV) at four dif - ferent locations (proximal carpal tunnel (CT) at the level of the pisiform, distal CT at the level of the hamate, middle of the CT and forearm at one centimeter above the CT). Clinical classification was performed according to a historic and ob - jective scale of CTS. In the healthy pregnant women and pregnant women with CTS, MN area and EV were analyzed statistically by comparing with parity and clinical grade. RESULTS: There was a statistically significant difference for MN area between the patient and control groups ( p = 0.001). A positive relation - ship was found between parity in pregnancy and clinical grade of the CTS ( p = 0.035, Pearson's correlation coefficient = 0.386). Although MN elasticity for both groups was nearly the same in the proximal region of the CT, these values were decreased in the middle of the CT. MN elasticity values were smaller in the distal region of CT, and it was statistically significant in pregnant women with CTS ( p = 0.02). CONCLUSIONS: Ultrasound elastography, which is a non-invasive, inexpensive and a favorable di - agnosis technique, may be useful in the diagnosis of CTS, especially in conditions in which an inva - sive procedure would be problem, as in pregnancy.

/pdf/ultrasound-elastographic-evaluation-of-the-median-nerve-in-3lecuqkd1n.pdf

Ultrasound elastographic evaluation of the median nerve in pregnant women with carpal tunnel syndrome

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.

/pdf/treatment-of-carpal-tunnel-syndrome-in-pregnancy-with-3tgim17v9j.pdf

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

Background: Carpal tunnel syndrome (CTS) is the most common compression neuropathy of median nerve, which can occur or aggravate during pregnancy and sometimes needs surgery. Since early diagnosis leads to simpler and less risky treatments, this study evaluated the frequency and severity of CTS in pregnancy. Materials and Methods: In this descriptive cross-sectional study, 100 pregnant women who came to gynecology clinic of university hospitals were randomly selected. At first, they were asked for presence of clinical symptoms, and then clinical tests including Phalen and Tinel were conducted to diagnose CTS. Then, electrodiagnostic studies including sensory and motor distal latencies of median nerve were measured and compared with those of ulnar nerve, and then, nerve conduction velocity of median nerve across wrist was evaluated. Results: Among the studied pregnant women, 19% had CTS, out of whom 47.5% were bilateral and 26.3% had severe CTS. The prevalence in the first, second, and third trimesters were 11%, 26%, and 63%, respectively, and 42% were asymptomatic. Sensitivity and specificity of clinical signs as compared with electrodiagnostic findings were 52% and 23%, respectively. Conclusions: The prevalence of CTS is relatively high in pregnant women. The prevalence and severity of CTS increase and the rate of asymptomatic cases reduces with the age of pregnancy. Clinical examination and history taking could not diagnose all cases, and their sensitivity and specificity are much less than electrodiagnostic tests. Therefore, it is recommended that electrodiagnostic studies be conducted in pregnant women during the third trimester.

The prevalence and severity of carpal tunnel syndrome during pregnancy

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The prevalence and severity of carpal tunnel syndrome during pregnancy