Subclinical incidence of carpal tunnel syndrome during third trimester of pregnancy

Clinical and electrophysiological features were studied in 52 cases of carpal tunnel syndrome (CTS) associated with 30 pregnancies. The duration of symptoms was less than 3 months before electrodiagnosis was performed. This study revealed a higher incidence of persistent, painful diurnal symptoms in pregnancy-related CTS (PRCTS) than in idiopathic CTS. PRCTS usually occurs for the first time (de novo) (24/30 cases), in primigravidas (15 cases) as well as multigravidas. The onset of symptoms was in the first or second trimester in 11 women, the third trimester in 12 women, or the post-partum period in seven women. Nerve conduction studies demonstrated evidence of an acute median nerve lesion at the wrist with motor and/or sensory conduction blocks in 20/30 women and severe denervation signs in five women.

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Carpal Tunnel Syndrome in Pregnancy and Lactation

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681_90_90057-b ◽

1990 ◽

Vol 15 (1) ◽

pp. 93-95

Author(s):

J. S. WAND

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Clinical Evidence ◽

Third Trimester ◽

Lactating Women ◽

Separate Clinical Entity ◽

Pregnancy And Lactation ◽

Tunnel Syndrome ◽

Breast Fed ◽

In Pregnancy

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.

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CARPAL TUNNEL SYNDROME IN PREGNANCY, A COMMON BUT NEGLECTED PROBLEM

Journal of Saidu Medical College, Swat ◽

10.52206/jsmc.2016.6.1.743-747 ◽

1969 ◽

Vol 6 (1) ◽

pp. 743-747

Author(s):

WAQAR ALAM ◽

DILAWAR KHAN ◽

UZMA BEGUM ◽

RIAZ UR REHMAN ◽

ASHFAQ AHMED

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Teaching Hospital ◽

Carpal Tunnel ◽

Health Department ◽

First Trimester ◽

Wrist Fracture ◽

Third Trimester ◽

Tunnel Syndrome ◽

In Pregnancy

BACKGROUND: CTS is a condition in which the Median Nerve is compressed in the carpal tunnel at wrist andis characterized by pain, tingling & numbers in the hand & Fingers, especially more at night. It is c/b pressure onthe Median Nerve in a tight/narrow “ CARPAL TUNNEL” at the wrist between carpal bones on one side & thetough, non elastic “ transverse carpal ligament” on the other side. Risk factors can be previous wrist fracture, Rh,Arthritis, Hypothyroidism & pregnancy. In pregnancy, the signs & symptoms of CTS are aggravated especially inthe last trimester and are more severe at night and decrease or disappear after pregnancy.It’s a common & neglected Neuropathy of the Median Nerve in pregnancy & is said to be caused by tissue edema& swelling during increased fluid retension during pregnancy.OBJECTIVE: To know the prevalence of Carpal Tunnel Syndrome in Pregnancy in patients seen as outpatient inmultiple centers of Khyber Pakhtoonkhwa.MATERIALS AND METHOD: This descriptive study was conducted at Department of Orthopedics & TraumaSaidu Teaching Hospital Swat, Department of Obstetrics and Gynecology Hayatabad Medical ComplexPeshawar, Department of Neurosurgery Gajju Khan Medical College Swabi and Department of Orthopedics andSpine Surgery Ghurki Trust Teaching Hospital Lahore from 02-08-2014 to 01-12-2015. Five hundred and eightythree (583) pregnant females were included in the study. All these women visited Orthopedics OPD and OB &GYN OPD. Exclusion criteria in this study were previous wrist fracture, pre-pregnancy CTS and carpal tunnelsurgery. Diagnosis of CTS was made by typical history, clinical tests which included Phalen’s test, Tinel's Signand direct compression of Median Nerve at carpal Tunnel. A written informed consent was taken from all thepatients fulfilling the criteria. Patient’ s data was recorded in the Proforma and analyzed in SPSS version 17.Results were presented as graphs and tables.RESULTS: In this study 583 female pregnant patients were enrolled. Their ages ranged from 19 to 43 years andthe mean age was 31.27 years. The majority of our patients were housewives i.e. 514(88.17%) were housewives.Amongst the rest 37(6.35%) were school teachers, 9(1.54%) were computer operator, 21(3.60%) wereParamedical staff in health department, 2(0.34%) were lady doctors. 161 were in first trimester, 179 were insecond trimester and 243 were in third trimester. Out of 583 females 197(33.80%) were primigravida while386(66.20%) were multigravida. Out of 583 females with wrist pain, 269(46.95%) had establish Carpal TunnelSyndrome. Among these 269 females, 21(7.81%) were in first trimester, 38 (14.13%) were in second trimesterand the rest 210(78.10%) were in third trimester. In 165(61.34%) females it was bilateral and in 104(38.66%) itwas unilateral. In unilateral cases right hand was involved in 71(68.27%) females while left hand was involved in33(31.73%) females.CONCLUSION: Carpal Tunnel Syndrome is a common condition in pregnancy which needs proper attentionand management.KEY WORDS: Carpal Tunnel Syndrome, Pregnancy, Prevalence.

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Clinical Update: Assessing Maximum Medical Improvement in Carpal Tunnel Syndrome

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2003.julaug02 ◽

2003 ◽

Vol 8 (4) ◽

pp. 4-5

Author(s):

Christopher R. Brigham ◽

James B. Talmage

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Proper Time ◽

Carpal Tunnel Release ◽

Hand Function ◽

Factors Affecting ◽

Early Results ◽

Medical Evaluation ◽

Nerve Recovery ◽

Tunnel Syndrome

Abstract Permanent impairment cannot be assessed until the patient is at maximum medical improvement (MMI), but the proper time to test following carpal tunnel release often is not clear. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) states: “Factors affecting nerve recovery in compression lesions include nerve fiber pathology, level of injury, duration of injury, and status of end organs,” but age is not prognostic. The AMA Guides clarifies: “High axonotmesis lesions may take 1 to 2 years for maximum recovery, whereas even lesions at the wrist may take 6 to 9 months for maximal recovery of nerve function.” The authors review 3 studies that followed patients’ long-term recovery of hand function after open carpal tunnel release surgery and found that estimates of MMI ranged from 25 weeks to 24 months (for “significant improvement”) to 18 to 24 months. The authors suggest that if the early results of surgery suggest a patient's improvement in the activities of daily living (ADL) and an examination shows few or no symptoms, the result can be assessed early. If major symptoms and ADL problems persist, the examiner should wait at least 6 to 12 months, until symptoms appear to stop improving. A patient with carpal tunnel syndrome who declines a release can be rated for impairment, and, as appropriate, the physician may wish to make a written note of this in the medical evaluation report.

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Clinical Update: Understanding Causation: An Example Using Carpal Tunnel Syndrome

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2007.novdec02 ◽

2007 ◽

Vol 12 (6) ◽

pp. 5-8 ◽

Cited By ~ 3

Author(s):

J. Mark Melhorn

Keyword(s):

Risk Factors ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Legal Responsibility ◽

Medical Evidence ◽

Anatomic Structure ◽

Legal Professionals ◽

Compensation Systems ◽

Tunnel Syndrome ◽

Four Levels

Abstract Medical evidence is drawn from observation, is multifactorial, and relies on the laws of probability rather than a single cause, but, in law, finding causation between a wrongful act and harm is essential to the attribution of legal responsibility. These different perspectives often result in dissatisfaction for litigants, uncertainty for judges, and friction between health care and legal professionals. Carpal tunnel syndrome (CTS) provides an example: Popular notions suggest that CTS results from occupational arm or hand use, but medical factors range from congenital or acquired anatomic structure, age, sex, and body mass index, and perhaps also involving hormonal disorders, diabetes, pregnancy, and others. The law separately considers two separate components of causation: cause in fact (a cause-and-effect relationship exists) and proximate or legal cause (two events are so closely related that liability can be attached to the first event). Workers’ compensation systems are a genuine, no-fault form of insurance, and evaluators should be aware of the relevant thresholds and legal definitions for the jurisdiction in which they provide an opinion. The AMA Guides to the Evaluation of Permanent Impairment contains a large number of specific references and outlines the methodology to evaluate CTS, including both occupational and nonoccupational risk factors and assigning one of four levels of evidence that supports the conclusion.

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