Carpal Tunnel Syndrome in Pregnancy
Department of Orthopaedic Surgery, Thomas Jefferson University, 1015 Walnut Street Curtis Buliding, Suite 810, Philadelphia, PA 19107, USA. Orthopedic Clinics of North America
(Impact Factor: 1.25).
10/2012; 43(4):515-20. DOI: 10.1016/j.ocl.2012.07.020
During pregnancy, hormonal fluctuations, fluid shifts, and musculoskeletal changes predispose women to carpal tunnel syndrome. While the clinical presentation is similar to other patients, the history obtained must include information regarding the pregnancy itself. Currently, the indication for electrodiagnostic testing is not clearly defined. Given that symptoms often improve with conservative treatment and abate after delivery, EMG/NCV testing can often be avoided. However, if symptoms are severe or persist, carpal tunnel release is indicated and is considered a safe procedure for both mother and fetus.
Available from: Tim J von Oertzen
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ABSTRACT: Neurological conditions during pregnancy can be pregnancy related or can be caused by exacerbation of pre-existing neurological disorders. Knowledge of pre-existing epilepsy or myasthenia gravis in women of childbearing age requires preconception counselling by neurologist and planned pregnancy. Possible adverse effects of medication on the foetus should be balanced with the risk of uncontrolled symptoms. Interdisciplinary management before, during and after pregnancy is recommended. New acute neurological symptoms in pregnant or postpartum women should lead to an urgent neurological review. Patients need a thorough diagnostic evaluation that targets a range of serious pathological conditions that are either unique to (e.g. eclampsia) or arise more frequently (e.g. cerebral venous thrombosis) in this population. Most of these conditions are infrequent and require a specialized and multidisciplinary management. Treatment is challenging due to risks to the unborn child.
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ABSTRACT: Epidemiology of the carpal tunnel syndrome (CTS) during pregnancy remains to be fully elucidated. The purpose of the following study is to determine occurrence of that complication in a population of pregnant women. So far the literature in Polish lacks information that might enable adequate diagnosis and proper therapy.
The study included 301 women who delivered at term (between 37 and 41 weeks of pregnancy) at the Gynecological and Obstetrical University Hospital in Poznań. An original questionnaire about CTS symptoms was prepared for the purpose of the study The tool included questions about general health, current and previous pregnancies, CTS symptoms, as well as the Boston Carpal Tunnel Questionnaire (BCTQ), modified for the purpose of the study. The original BCTQ includes questions about symptoms frequency during the last 2 weeks, while in our modified BCTQ we asked about symptoms during the whole pregnancy The respondents filled in the questionnaire with the help of a physician. A part of the research group underwent Phalen sign evaluation.
Ninety-eight patients (32.6%) reported occurrence of at least one CTS symptom during pregnancy and 22 patients (22.4%) had similar symptoms in previous pregnancies. Only 3 patients had received any form of therapy The number of patients with CTS symptoms who reported extremities edema was significantly higher than in the group without CTS symptoms (26.3% vs. 6.1%; p < 0.05). The frequency of occurrence of diabetes and pregnancy induced hypertension was similar in both groups. The results of the first part of the modified BCTQ (symptom severity) were significantly higher in the CTS group as compared to non-CTS group (2.1 +/- 0.8 vs. 1.0 +/- 0.1; p < 0.05). The results of the second part of the modified BCTQ (impairment of daily life activities) were similar (1.7 +/- 0.8 vs. 1.0 +/- 0.1; p < 0.05). Out of 74 patients with CTS symptoms who underwent Phalen sign examination, 50% had positive Phalen sign. Patients with positive Phalen sign had significantly higher scores for both parts of the modified BCTQ.
CTS symptoms are quite common during pregnancy (32% in the study group). However symptom intensity remains rather moderate. Some of the patients had those symptoms during previous pregnancies. Although the frequency of CTS symptoms is quite high in the population of pregnant women, only few have any form of treatment. Early detection of CTS symptoms in pregnant women is very important, because it allows introduction of conservative treatment, which is successful in most cases.
Available from: Maarten van son
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The HAPPY study is a large prospective longitudinal cohort study in which pregnant women (N ≈ 2,500) are followed during the entire pregnancy and the whole first year postpartum. The study collects a substantial amount of psychological and physiological data investigating all kinds of determinants that might interfere with general well-being during pregnancy and postpartum, with special attention to the effect of maternal mood, pregnancy-related somatic symptoms (including nausea and vomiting (NVP) and carpal tunnel syndrome (CTS) symptoms), thyroid function, and human chorionic gonadotropin (HCG) on pregnancy outcome of mother and foetus.
During pregnancy, participants receive questionnaires at 12, 22 and 32 weeks of gestation. Apart from a previous obstetric history, demographic features, distress symptoms, and pregnancy-related somatic symptoms are assessed. Furthermore, obstetrical data of the obstetric record form and ultrasound data are collected during pregnancy. At 12 and 30 weeks, thyroid function is assessed by blood analysis of thyroid stimulating hormone (TSH), free thyroxine (FT4) and thyroid peroxidase antibodies (TPO-Ab), as well as HCG. Also, depression is assessed with special focus on the two key symptoms: depressed mood and anhedonia. After childbirth, cord blood, neonatal heel screening results and all obstetrical data with regard to start of labour, mode of delivery and complications are collected. Moreover, mothers receive questionnaires at one week, six weeks, four, eight, and twelve months postpartum, to investigate recovery after pregnancy and delivery, including postpartum mood changes, emotional distress, feeding and development of the newborn.
The key strength of this large prospective cohort study is the holistic (multifactorial) approach on perinatal well-being combined with a longitudinal design with measurements during all trimesters of pregnancy and the whole first year postpartum, taking into account two physiological possible markers of complaints and symptoms throughout gestation: thyroid function and HCG. The HAPPY study is among the first to investigate within one design physiological and psychological aspects of NVP and CTS symptoms during pregnancy. Finally, the concept of anhedonia and depressed mood as two distinct aspects of depression and its possible relation on obstetric outcome, breastfeeding, and postpartum well-being will be studied.
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