Clinical Practice Guidelines Antenatal Care — Module II
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- 7.14Carpal tunnel syndrome
- Incidence during pregnancy
- Factors influencing carpal tunnel syndrome
- Discussing carpal tunnel syndrome
- Practice summary: carpal tunnel syndrome
7.13ReferencesAlbert H, Godskesen M, Korsholm L et al (2006) Risk factors for developing pregnancy-related pelvic girdle pain. Acta Obstet Gynecol Scand 85: 539–44. Aslan E & Fynes M (2007) Symphysial pelvic dysfunction. Current Opinion in Obstetrics and Gynecology 19(2): 133-139. Bastiaanssen JM, de Bie RA, Bastiaenen CHG et al (2005) Etiology and prognosis of pregnancy-related pelvic girdle pain; design of a longitudinal study. BMC Public Health 5: 1–8. Biering K, Aagaard Nohr E, Olsen J et al (2010) Smoking and pregnancy-related pelvic pain. BJOG 117( 8): 1019–26. Bjelland E, Eskild A, Johansen R et al (2010) Pelvic girdle pain in pregnancy: the impact of parity. Am J Obstet Gynecol 203(2): 146.e1–e6. Depledge J, McNair P, Keal-Smith C et al (2005) Management of symphysis pubis dysfunction during pregnancy using exercise and pelvic support belts. Phys Ther 85(12): 1290–300. Eberhard-Gran M & Eskild A (2008) Diabetes mellitus and pelvic girdle syndrome in pregnancy – is there an association? Acta Obstet Gynecol Scand 87: 1015–19. Ee C, Manheimer E, Pirotta M et al (2008) Acupuncture for pelvic and back pain in pregnancy: a systematic review. Am J Obstet Gynaecol 198(3): 254–59. Eggen MH, Stuge B, Mowinckel P et al (2012) Can supervised group exercises including ergonomic advice reduce the prevalence and severity of low back pain and pelvic girdle pain in pregnancy? A randomized controlled trial. Phys Ther 92(6): 781–90. Ekdahl L & Petersson K (2010) Acupuncture treatment of pregnant women with low back and pelvic pain — an intervention study. Scand J Caring Sci 24: 175–82. Elden H, Hagberg H, Olsen MF et al (2008) Regression of pelvic girdle pain after delivery: follow-up of a randomised single blind controlled trial with different treatment modalities. Acta Obstet Gynecol Scand 87(2): 201–08. George JW, Skaggs CD, Thompson PA et al (2012) A randomized controlled trial comparing a multi-modal intervention and standard obstetrical care for low back and pelvic pain in pregnancy. Am J Obstet Gynecol 1: S360. Gutke A, Ostgaard H, Oberg B (2006) Pelvic girdle pain and lumbar pain in pregnancy: a cohort study of the consequences in terms of health and functioning. Spine 31(5): E149–55. Haugland KS, Rasmussen S, Daltveit AK (2006) Group intervention for women with pelvic girdle pain in pregnancy. A randomized controlled trial. Acta Obstet Gynecol Scand 85(11): 1320–26. Kanakaris NK, Roberts CS, Giannoudis PV (2011) Pregnancy-related pelvic girdle pain: an update. BMC Med 9: 15. Kovacs FM, Garcia E, Royuela A et al (2012) Prevalence and factors associated with low back pain and pelvic girdle pain during pregnancy: A multicenter study conducted in the Spanish national health service. Spine 37(17): 1516–33. Leadbetter R, Mawer D, Lindow S (2004) Symphysis pubis dysfunction: a review of the literature. J Maternal-Fetal Neonatal Med 16: 349–54. Morgren I (2005) Previous physical activity decreases the risk of low back pain and pelvic pain during pregnancy. Scand J Public Health 33: 300–06. Morgren I & Pohjanen A (2005) Low back pain and pelvic pain during pregnancy: prevalence and risk factors. Spine 30: 983–91. Pennick V & Young G (2007) Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Sys Rev 2007 Issue 2. Art. No.: CD001139. DOI: 10.1002/14651858.CD001139.pub2. Richards E, Van Kessel G, Virgara R et al (2012) Does antenatal physical therapy for pregnant women with low back pain or pelvic pain improve functional outcomes? A systematic review. Acta Obstet Gynecol Scand 91(9): 1038–45. Robinson H, Veierod M, Mengshoel A et al (2010) Pelvic girdle pain – associations between risk factors in early pregnancy and disability or pain intensity in late pregnancy: a prospective cohort study. BMC Musculoskeletal Dis 11(91): 1–12. Robinson H, Eskild A, Heiberg E et al (2006) Pelvic girdle pain in pregnancy: the impact on function. Acta Obstet Gynecol Scand 85:160–64. Stafne SN, Salvesen KA, Romundstad PR et al (2012) Does regular exercise during pregnancy influence lumbopelvic pain? A randomized controlled trial. Acta Obstet Gynecol Scand 91(5): 552–59. Stuge B, Hilde G, Vollestad N (2003) Physical therapy for pregnancy-related low back and pelvic pain: a systematic review. Acta Obstet Gynecol Scand 82(11): 983–90. Van de Pol G, Brummen J, Bruinse H et al (2007) Pregnancy related pelvic girdle pain in the Netherlands. Acta Obstet Gynecol Scand 86: 416–22. Vleeming A, Albert H, Ostgaard HC et al (2008) European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J 17: 794–819.
BackgroundCarpal tunnel syndrome results from compression of the median nerve within the carpal tunnel in the hand. It is characterised by tingling, burning pain, numbness and a swelling sensation in the hand that may impair sensory and motor function. Incidence during pregnancyDue to differences in methods of diagnosis between studies (eg neurophysiologically confirmed, clinically diagnosed, patient-reported), there is great variability in estimates of the incidence of pregnancy-related carpal tunnel syndrome; estimates range from approximately 2% to 72% (Eogan et al 2004; Finsen & Zeitlmann 2006; Baumann et al 2007; Mondelli et al 2007; Padua et al 2010). Factors influencing carpal tunnel syndromeIn non-pregnant populations, carpal tunnel syndrome has been reported to occur more frequently in occupations that involve repetitive activity, forceful work or vibration (Palmar et al 2007). In pregnancy, likely causes of carpal tunnel syndrome are hormonal changes (Ablove & Ablove 2009) and oedema (Pazzaglia et al 2005; Ablove & Ablove 2009). Carpal tunnel syndrome is more common in the third trimester (Shaafi et al 2006; Baumann et al 2007). Carpal tunnel syndrome is more common in women with gestational diabetes due to generalised slowing of nerve conduction (Ablove & Ablove 2009) but impaired median nerve conduction also occurs in pregnant women without gestational diabetes (Eogan et al 2004; Baumann et al 2007). Discussing carpal tunnel syndromeSummary of the evidenceThe recent evidence on interventions to treat carpal tunnel syndrome during pregnancy is limited to small case series studies (n=20–30) that found reduced symptoms associated with night splinting (Finsen & Zeitlmann 2006) or steroid (dexamethasone) injections (Niempoog et al 2007; Moghtaderi et al 2011). Activity modification, avoiding positions of extreme flexion or extension of the wrists and avoiding exposure to vibration have been suggested as adjuncts to splinting (Mabie 2005; Borg-Stein et al 2006; Ablove & Ablove 2009) but there is no evidence that these are effective for carpal tunnel syndrome. While carpal tunnel syndrome usually resolves after the birth (Pazzaglia et al 2005), persistence of symptoms has been reported in more than 50% of women after 1 year and in about 30% after 3 years (Padua et al 2010).
Advise women who are experiencing symptoms of carpal tunnel syndrome that the evidence to support either splinting or steroid injections is limited and symptoms may resolve after the birth. Practice summary: carpal tunnel syndrome
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