CARPAL TUNNEL SYNDROME IN PREGNANCY, A COMMON BUT NEGLECTED PROBLEM

Abstract

BACKGROUND: CTS is a condition in which the Median Nerve is compressed in the carpal tunnel at wrist and
is characterized by pain, tingling & numbers in the hand & Fingers, especially more at night. It is c/b pressure on
the Median Nerve in a tight/narrow “ CARPAL TUNNEL†at the wrist between carpal bones on one side & the
tough, 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 in
the 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 in
multiple centers of Khyber Pakhtoonkhwa.
MATERIALS AND METHOD: This descriptive study was conducted at Department of Orthopedics & Trauma
Saidu Teaching Hospital Swat, Department of Obstetrics and Gynecology Hayatabad Medical Complex
Peshawar, Department of Neurosurgery Gajju Khan Medical College Swabi and Department of Orthopedics and
Spine Surgery Ghurki Trust Teaching Hospital Lahore from 02-08-2014 to 01-12-2015. Five hundred and eighty
three (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 tunnel
surgery. Diagnosis of CTS was made by typical history, clinical tests which included Phalen’s test, Tinel's Sign
and direct compression of Median Nerve at carpal Tunnel. A written informed consent was taken from all the
patients 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 and
the 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%) were
Paramedical staff in health department, 2(0.34%) were lady doctors. 161 were in first trimester, 179 were in
second trimester and 243 were in third trimester. Out of 583 females 197(33.80%) were primigravida while
386(66.20%) were multigravida. Out of 583 females with wrist pain, 269(46.95%) had establish Carpal Tunnel
Syndrome. Among these 269 females, 21(7.81%) were in first trimester, 38 (14.13%) were in second trimester
and the rest 210(78.10%) were in third trimester. In 165(61.34%) females it was bilateral and in 104(38.66%) it
was unilateral. In unilateral cases right hand was involved in 71(68.27%) females while left hand was involved in
33(31.73%) females.
CONCLUSION: Carpal Tunnel Syndrome is a common condition in pregnancy which needs proper attention
and management.
KEY WORDS: Carpal Tunnel Syndrome, Pregnancy, Prevalence.