Pregnancy-related carpal tunnel syndrome (PRCTS) is the most common mononeuropathy during pregnancy.
Objective
to compare the efficacy of ultrasound (US)-guided steroid injection alone versus wiht splinting on symptom severity on PRCTS.
Methods
This retrospective cohort study included 37 pregnant women in their third trimester with PRCTS, treated with ultrasound-guided steroid injection of 4 mg dexamethasone into the median nerve (Group I, n = 15), volar splinting in a neutral position while sleeping and during the day whenever possible for at least ten weeks (Group S, n = 12), or both injection and splinting (Group I + S, n = 10). Patient data were collected from hospital records, and symptoms were assessed using the Boston Carpal Tunnel Symptom Questionnaire (BCTQ), the Douleur Neuropathique 4 (DN4) and the Numeric Rating Scale (NRS). Statistical analyses included Student's t-test, Mann-Whitney U test, Fisher's exact test, ANOVA, Kruskal-Wallis test, descriptive analyses, and power analyses.
Results
During the first month of intervention, group S had higher BCTQ scores than the other two groups (p < 0.001). In the postpartum period, the order of scores was Group S > Group I > Group I + S (p < 0.001). The effect size was significant with Partial eta squared = 0.369.
Conclusion
The combination of splinting and injection seems to be more effective in the short term period. But still, to validate our findings, Additional randomized controlled trials are recommended.
AfsharATabriziA. Pregnancy-related hand and wrist problems. Arch Bone Jt Surg2021; 9: 345–349.
2.
MeemsMTruijensSSpekV, et al.Prevalence, course, and determinants of carpal tunnel syndrome symptoms during pregnancy: a prospective study. BJOG2015; 122: 1112–1118.
3.
PaduaLDi PasqualeAPazzagliaC, et al.Systematic review of pregnancy-related carpal tunnel syndrome. Muscle Nerve2010; 42: 697–702.
4.
CîmpeanuMCRomanNGrigorescuS, et al.Management of “De Novo” carpal tunnel syndrome in pregnancy: a narrative review. J Pers Med2024 Feb 23; 14: 240.
5.
WrightCSmithBWrightS, et al.Who develops carpal tunnel syndrome during pregnancy: an analysis of obesity, gestational weight gain, and parity. Obstet Med2014; 7: 90–94.
6.
GöktürkŞGöktürkYKoçA,et al.Comparison of median nerve area measurement between MRI and electromyography in patients diagnosed with carpal tunnel syndrome. Adv Clin Exp Med. Published online September 3, 2024. doi:https://doi.org/10.17219/acem/187054
7.
MeemsMTruijensSEMSpekV, et al.Follow-up of pregnancy-related carpal tunnel syndrome symptoms at 12 months postpartum: a prospective study. Eur J Obstet Gynecol Reprod Biol2017; 211: 231–232.
8.
PazzagliaCCaliandroPAprileI, et al.Multicenter study on carpal tunnel syndrome and pregnancy incidence and natural course. Acta Neurochir Suppl2005; 92: 35–39.
9.
AbloveRHAbloveTS. Prevalence of carpal tunnel syndrome in pregnant women. WMJ2009; 108: 194–196.
10.
KarjalainenTVLusaVPageMJ, et al.Splinting for carpal tunnel syndrome. Cochrane Database Syst Rev2023; 2: CD010003. Published 2023 Feb 27.
11.
WalkerWCMetzlerMCifuDX,et al.Neutral wrist splinting in carpal tunnel syndrome: a comparison of night-only versus full-time wear instructions. Arch Phys Med Rehabil2000; 81: 424–429.
12.
MoghtaderiARMoghtaderiNLoghmaniA. Evaluating the effectiveness of local dexamethasone injection in pregnant women with carpal tunnel syndrome. J Res Med Sci2011 May; 16: 687–690.
13.
NiempoogSSanguanjitPWaitayawinyuT,et al.Local injection of dexamethasone for treating carpal tunnel syndrome in pregnancy. J Med Assoc Thai2007; 90: 2669–2676.
14.
SkovbjergBKHartig-AndreasenCSædderEA. Local anesthesia and steroid blockades for carpal tunnel syndrome in pregnancy. Ugeskr Laeger2021; 183: V12200932.
15.
WangJCLiaoKKLinKP, et al.Efficacy of combined ultrasound-guided steroid injection and splinting in patients with carpal tunnel syndrome: a randomized controlled trial. Arch Phys Med Rehabil2017; 98: 947–956.
16.
UcanHYagciIYilmazL, et al.Comparison of splinting, splinting plus local steroid injection and open carpal tunnel release outcomes in idiopathic carpal tunnel syndrome. Rheumatol Int2006; 27: 45–51.
17.
O’HaraMWMcCabeJE. Postpartum depression: current status and future directions. Annu Rev Clin Psychol2013; 9: 379–407.
18.
LevineDWSimmonsBPKorisMJ, et al.A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg (Am)1993; 75: 1585–1592.
19.
SezginMIncelNASerhanS, et al.Assessment of symptom severity and functional status in patients with carpal tunnel syndrome: reliability and functionality of the Turkish version of the Boston questionnaire. Disabil Rehabil2006; 28: 1281–1285.
20.
HawkerGAMianSKendzerskaT,et al.Measures of adult pain: visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care Res (Hoboken)2011; 63: S240–S252.
21.
BouhassiraD*, AttalNAlchaarH, et al.Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). PainMarch 2005; 114: 29–36.
22.
Unal-CevikISarioglu-AySEvcikD. A comparison of the DN4 and LANSS questionnaires in the assessment of neuropathic pain: validity and reliability of the turkish version of DN4. J Pain2010; 11: 1129–1135.
23.
CoxJLHoldenJMSagovskyR. Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry1987; 150: 782–786.
24.
BoranPWaqasAAşkanÖÖ, et al.Screening of postpartum depression among new mothers in Istanbul: a psychometric evaluation of the Turkish Edinburgh postnatal depression scale. BMC Res Notes2020; 13: 355. Published 2020 Jul 28.
25.
MondelliMRossiSMontiE, et al.Long-term follow-up of carpal tunnel syndrome during pregnancy: a cohort study and literature review. Electromyogr Clin Neurophysiol2007; 47: 259–271.
26.
SoadAManalYRagaE. An epidemiological study of carpal tunnel syndrome among pregnant women at al-wahda Hospital Derna. Int J Clin Obstet Gynaecol2020; 4.
27.
SchmidABElliottJMStrudwickMW, et al.Effect of splinting and exercise on intraneural edema of the median nerve in carpal tunnel syndrome–an MRI study to reveal therapeutic mechanisms. J Orthop Res2012; 30: 1343–1350.
28.
LiHXieWStrongJA,et al.Systemic antiinflammatory corticosteroid reduces mechanical pain behavior, sympathetic sprouting, and elevation of proinflammatory cytokines in a rat model of neuropathic pain. Anesthesiology2007; 107: 469–477.
29.
OliveiraGBernardesJMSantosE, et al.Carpal tunnel syndrome during the third trimester of pregnancy: prevalence and risk factors. Arch Gynecol Obstet2019; 300: 623–631.
30.
BurkeALMathiasJLDensonLA. Psychological functioning of people living with chronic pain: a meta-analytic review. Br J Clin Psychol2015; 54: 345–360.
31.
SteinAPearsonRMGoodmanSH, et al.Effects of perinatal mental disorders on the fetus and child. Lancet2014; 384: 1800–1819.
32.
Aşkın TuranSAydınŞ. Karpal tünel sendromu tedavisinde steroid enjeksiyonun uyku hijyeni üzerindeki etkisi [the effect of steroid injection treatment with carpal tunnel syndrome on sleep hygiene]. Agri2021; 33: 96–102.
33.
ErtemDHSirinTCYilmazI. Electrophysiological responsiveness and clinical outcomes of local corticosteroid injection in the treatment of carpal tunnel syndrome. Arq Neuropsiquiatr2019; 77: 638–645. Published 2019 Sep 23.
