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Abstract

Hand and wrist disorders are common during pregnancy. Most of these problems develop during the third trimester when hormonal changes, fluid retention, and weight gain are maximum. This review study aimed to discuss pregnancy-related hand and wrist problems, and provide an overview of their pathology, clinical presentations, clinical examinations, and treatment options. Pregnancy-related carpal tunnel syndrome and De Quervain disease are among the most encountered disorders; however, neuralgic amyotrophy, pyogenic granuloma in hand, ligamentous laxity of the joints, arthralgia, and exacerbation of hand and wrist arthritis are among other reported disorders during pregnancy. Pregnancy-related hand and wrist problems may remain undertreated and reduce pregnant females' quality of life. Non-surgical treatments are usually effective for pregnancy-related hand and wrist problems. In general, pregnancy-related hand and wrist problems have a good prognosis and usually resolve after childbirth. Level of evidence: IV
)345(
COPYRIGHT 2021 © BY THE ARCHIVES OF BONE AND JOINT SURGERY
Arch Bone Jt Surg. 2021; 9(3): 345-349. Doi: 10.22038/abjs.2020.50995.2531 http://abjs.mums.ac.ir
the online version of this article
abjs.mums.ac.ir
Ahmadreza Afshar, MD1; Ali Tabrizi, MD1
Research performed at Department of Orthopedics, Imam Khomeini hospital, Urmia University of Medical Sciences, Urmia, Iran
Corresponding Author: Ali Tabrizi, Department of Orthopedics,
Imam Khomeini Hospital, Urmia University of Medical
Sciences, Urmia, Iran
Email: ali.tab.ms@gmail.com
SHORT COMMUNICATION
Received: 11 August 2020 Accepted: 24 August 2020
Pregnancy-related Hand and Wrist Problems
Abstract
Hand and wrist disorders are common during pregnancy. Most of these problems develop during the third trimester
when hormonal changes, uid retention, and weight gain are maximum. This review study aimed to discuss
pregnancy-related hand and wrist problems, and provide an overview of their pathology, clinical presentations, clinical
examinations, and treatment options. Pregnancy-related carpal tunnel syndrome and De Quervain disease are among
the most encountered disorders; however, neuralgic amyotrophy, pyogenic granuloma in hand, ligamentous laxity of
the joints, arthralgia, and exacerbation of hand and wrist arthritis are among other reported disorders during pregnancy.
Pregnancy-related hand and wrist problems may remain undertreated and reduce pregnant females’ quality of life. Non-
surgical treatments are usually effective for pregnancy-related hand and wrist problems. In general, pregnancy-related
hand and wrist problems have a good prognosis and usually resolve after childbirth.
Level of evidence: IV
Keywords: Neuralgic amyotrophy, Pregnancy-related carpal tunnel syndrome, Pregnancy-related De Quervain
disease, Pregnancy-related ligament laxity, Pyogenic granuloma
Introduction
Hand and wrist problems are common complaints
     
retention, and weight gain may exacerbate or
     
      

    


     

        
pregnancy. These problems were the third most common
      

        
reported that there were 125 (32.6%) asymptomatic
        

    
       
     

Pregnant patients with hand and wrist problems may
       
pregnancy-related hand and wrist problems and provide
an overview of pathology, clinic presentations, clinical
examinations, and treatment options of these conditions;
     

Pregnancy and nerve disorder of the hand and
wrist
Carpal tunnel syndrome
       
    
     
       

non-pregnant females. Moreover, eight (11%) patients
     

PREGNANCY-RELATED HAND
THE ARCHIVES OF BONE AND JOINT SURGERY. ABJS.MUMS.AC.IR
VOLUME 9. NUMBER 3. MAY 2021
)346(
    
symptoms persisted even after one year of treatment,
and approximately 30% of the patients still had the
symptoms after three years (6).
     
        
provide symptomatic relief of pregnancy-related CTS.
Steroid injection may provide temporary symptom
         
      
 
        
      
     

  


    

Neuralgic amyotrophy
    
       
       
    
 


nerve, long thoracic nerve, and axillary nerve are the most
commonly involved nerves. The least commonly involved


    
   
        

      
      
    
onset of symptoms when electromyography shows
chronic denervation and with early reinnervation
       
oral corticosteroid therapy has positive effects on pain
and may expedite recovery. Moreover, non-steroidal
     
        
pain, physical therapy is recommended to address the

Pregnancy and stenosing tenosynovitis in the
hand and wrist
      
      

       
       
      
       
         
  

     

The reported prevalence of CTS is higher in pregnancy,
       
        
      
are relatively mild compared to that in non-pregnant
 
     
        
    
       
of patients were reported to have self-reported CTS
      
        
       
    
        
third trimester (6).

similar to those in non-pregnant patients. The pregnant
 
        


        
     


         

    


  
  
avoided (5, 7).

       
       
hypertension and preeclampsia are more prone to
developing CTS. Patients with a higher pregravid body


and diabetes, increased maternal age, tenosynovitis, and
      



 
The severity of pregnancy-related CTS symptoms
       

pregnancy; however, electrophysiological changes
          
      
        
retention and hormonal changes, may delay complete
        

PREGNANCY-RELATED HAND
THE ARCHIVES OF BONE AND JOINT SURGERY. ABJS.MUMS.AC.IR
VOLUME 9. NUMBER 3. MAY 2021
)347(
        
has a higher rate of bilateral involvement in pregnant
       
disease is characterized by pain and tenderness over the


      
       
Histopathological examination of the tendon sheaths
revealed that myxoid degeneration was responsible
       
     
   
       





   
    
      
      













     
   

      
    
limitation (17).
Pregnancy and pyogenic granuloma in the hand

       
pregnancy and estrogen levels and the development
       


of this lesion. On rare occasions, the lesion may appear
         
       
       
      
       
is characterized by an exophytic, friable, red-to-yellow
        
      
       
      
   
      

 

of daily living of the pregnant females, it needs to be
       
   

Pregnancy and ligamentous and joint laxity in the
hand
   
     


  

        
        



    
         

  
       
       
      

      
      
      

their second baby (21).
        
      
      
     
lactation (22).
Regarding the preponderance of carpometacarpal
        

        
       

laxity and the development of CMC joint arthritis (23).
        




Pregnancy and small joint arthralgia and arthritis
in the hand
      

       
       
        
PREGNANCY-RELATED HAND
THE ARCHIVES OF BONE AND JOINT SURGERY. ABJS.MUMS.AC.IR
VOLUME 9. NUMBER 3. MAY 2021
)348(
Ahmadreza Afshar MD1
Ali Tabrizi MD1
1 Department of Orthopedics, Imam Khomeini Hospital,
Urmia University of Medical Sciences, Urmia, Iran
1.       
        

2.    
       
      

3. 
       

 
       
assessment of median nerve impairment in


5.          



6. 
A, Mondelli M. Systematic review of pregnancy-
     

7.        
      

 
       

9. 

   

References
10.        
     

11.       
       

12.     

13. 
        



2000;25(1):70-72
15.    
      
       

16.         
      
      
2002;26(1):23-25.
17.       
      

        
     


19. 


20. 
     
had arthralgia and exacerbation of arthritis, respectively,
in the small joints of hands. Arthralgia and arthritis

    
antibody were negative in all patients with arthritis. The
symptoms of arthralgia and arthritis of the small joints of
 


   
pregnancy in the development of small joint arthralgia

Summary
Hand and wrist problems may decrease pregnant
       
benign, self-limited, and temporary with expected


trimester of pregnancy, when the hormonal changes,
      
 
     
      
arthralgia, and exacerbation of arthritis in the hand
       
     
hand and wrist problems. In general, pregnancy-related
hand and wrist problems have a good prognosis and


   

PREGNANCY-RELATED HAND
THE ARCHIVES OF BONE AND JOINT SURGERY. ABJS.MUMS.AC.IR
VOLUME 9. NUMBER 3. MAY 2021
)349(



21.         
      

22.        
   


23.          
Delaronde S, et al. Relationship of relaxin hormone
     
     


   
       

... According to some authors, fluid retention during pregnancy and lactation contributed to the edematous state within the first dorsal compartment, increasing susceptibility to stenosing tenosynovitis of APL and EPB tendons. 12,13) Another hypothesis is that hormonal changes, particularly increased prolactin secretion during pregnancy and lactation, may contribute to the occurrence of DQT. 5,14) Changes in the secretion of estrogen and progesterone have also been proposed as possible hormonal contributors. ...
... 15) Another mechanical hypothesis is that postpartum infant care activities such as breastfeeding or milk feeding, lifting, and supporting infants in specific positions require continuous overexertion of the mothers' wrist, which may result in the development of DQT. 5,12,13) This study discovered that pregnant women aged ≥ 30 years were more prone to DQT than those aged < 30 years. Previous epidemiologic research on DQT in a young and active population using a large military personnel database indicated that age greater than 40 years was a major risk factor for DQT, with an adjusted rate ratio of 3.65 when compared to the age < 20-year group. ...
... The prevalence of neck pain has been reported to be associated with gender, with females having a higher prevalence than males (25). Pregnancy-induced biomechanical, hormonal, and vascular changes are likely to give rise to a wide variety of musculoskeletal problems (26)(27)(28). ...
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Objectives To investigate the characteristics of neck–shoulder pain (NSP) and explore the potentional relationship between the NSP and the individual and work organizational variables. Methods A cross-sectional study was performed in the tertiary general hospitals in Hunan Province, China between May 2019 and July 2019. A total of 2,030 healthcare workers were enrolled randomly in this study based on a three-stage stratified sampling method. The Neck Disability Index (NDI) was used to measure disability in subjects with neck pain. A self-administered questionnaire was used to assess the characteristics of individual and work organizational variables. The Mann–Whitney U test and the Kruskal–Wallis H test were applied to analyze the prevalence of pain intensity among groups. Multivariate linear regression analysis was performed to explore the potentional relationship between NSP and individual and work organizational variables using the NDI score as the dependent variable. Results 2,008 of 2,030 healthcare workers filled out the survey questionnaires online. In the past 12 months, 1,489 participants (74.2%) complained of pain in the cervical–shoulder region. NDI score increased by 0.10 for each year of age, with healthcare workers working in Obstetrics and Gynecology, and the Operating Room less likely to have NSP than those working in other departments. In contrast, female healthcare workers with a history of pregnancy were more likely to have NSP. In terms of organizational factors, workers who received concern from their supervisor about their health, who had the choice to change their shift status to off duty when they were not feeling well, or who were informed about WMSDs were less likely to have NSP. Conclusion The prevalence of NSP within the previous year was high in this population. Individual factors including history of neck–shoulder diseases, age, and history of pregnancy and organizational factors including being adequately informed regarding WMSDs, concern from supervisors about workers' health, and the ability of workers to change their shift status to off duty when they were not feeling well were shown to induce significant effects to NSP.
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Hand and wrist complaints can decrease the quality of life of pregnant women, which can occur or aggravate during pregnancy and advance to chronic state if left untreated. The purpose of this study was to describe hand and wrist complaints in relation to pregnancy and assess their significance in pregnancy. In a prospective cross-sectional study, 383 participants were randomly selected from among pregnant women on or over 28 weeks of gestation, attending the primary care maternal health clinic in a university hospital. The prevalence and severity of hand and wrist complaints were assessed using the Boston Carpal Tunnel Questionnaire (BCTQ). The symptomatic pregnant women were consulted by an orthopedist. The specific diagnoses of the patients were made based on patient history and physical examination. According to BCTQ scoring 258 (67.4 %) pregnant women were symptomatic. The diagnoses were as follows: asymptomatic 125 (32.6 %), nonspecific symptoms 138 (36 %), tendinitis 80 (20.9 %), carpal tunnel syndrome (CTS) 39 (10.2 %) and cubital syndrome 1 (0.3 %). There was no association noted between the diagnoses and numbers of pregnancies, occupational status, age, gestational weeks, weight gain or body mass index (BMI) (p > 0.05). The prevalence of hand and wrist complaints is high in pregnant women. All pregnant women should be investigated for hand and wrist complaints in routine antenatal checks to ensure good life quality during pregnancy and for avoiding these complaints advancing to chronic state. Further studies are needed to evaluate the effect of musculoskeletal systems disorders in pregnancy.
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Background: The female predominance in thumb carpometacarpal (CMC) joint arthritis has led to speculation that reproductive hormones or hypermobility are responsible. Evidence shows that patients with pathologic laxity have a higher rate of thumb CMC arthritis. Relaxin hormone increases laxity in the pelvic ligaments through upregulation of matrix metalloproteases (MMPs). It is thus a hormone of interest in the development of thumb CMC arthritis. Questions/purposes: Our goals were to identify demographic and hormonal factors associated with joint laxity in patients with CMC arthritis and to evaluate the relationship among serum relaxin, relaxin receptors, and MMPs in the anterior oblique ligament (AOL) of the thumb. We hypothesized that serum relaxin was correlated with joint laxity as well as with relaxin receptors and MMPs in the AOL. Methods: Forty-nine patients undergoing thumb CMC arthroplasty underwent laxity examination, blood draw, and AOL sampling. Ligaments were analyzed for relaxin receptor and MMPs 1 and 3 using quantitative reverse-transcriptase polymerase chain reaction. Results: Women demonstrated more joint laxity than men (p < 0.001). RNA analysis confirmed relaxin receptors in the AOL as well as MMPs 1 and 3. There was a significant correlation between serum relaxin and MMP-1 (p = 0.04). Detectable serum relaxin was negatively correlated with relaxin receptors in the AOL (p = 0.02). Conclusions: Further studies are needed to evaluate the role of laxity and sex hormones in thumb CMC arthritis. Clinical relevance: Relaxin hormone may play a role in the development of arthritis at the thumb CMC joint. Level of evidence: Level I, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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