Carpal tunnel syndrome in pregnancy and lactation

Abstract

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.

Carpal Tunnel Syndrome in Lactation: A Challenging Issue

“…On the other hand, in some women symptoms of CTS begin in the puerperium and some authors believe that it is a separate clinical entity to that developing in pregnancy. In contrast to carpal tunnel syndrome of pregnancy, car-pal tunnel syndrome of lactation is not associated with pre-eclampsia or peripheral edema (10).…”

“…In another study carried out by Wand (10), the number of surgical decompressions for lactating mothers reported to be 2 (11%) out of 18 cases. Rapid relief of symptoms in 100% of patients has been reported following surgery (9,10). In a study which was originally performed on pregnancy-induced CTS, with a watchful follow-up during lactation, the surgery warranted if the symptoms persisted more than 2 years after delivery (18).…”

“…Splinting is a safe option that does not interfere with breastfeeding. In a study on 18 lactating women, splints worn mainly at night, ranked as the second efficient treatment with 86% symptomatic relief (10). A postal survey on CTS in lactation, investigated 27 women, of whom 26% were advised by their family physician to wear splint.…”

Neuromuscular disorders in pregnancy

“…85,123,130 Usually, symptoms of CTS greatly improve after delivery and do not require surgical intervention. 40,123,129 However, there are conflicting data on the postpartum course. The study by Turgut et al of 46 women with CTS during pregnancy revealed that 40% still complained of CTS symptoms at…”

“…85 Pregnant women with CTS are more likely to be nulliparous, over 30 years of age, in the last trimester of pregnancy, and have pregnancies complicated by hand or generalized edema. 40,129 The increased incidence of CTS during pregnancy may be due to fluid retention exerting pressure on the median nerve. 123 Other mechanisms have been proposed.…”