CARPAL TUNNEL SYNDROME IN PREGNANCY, A COMMON BUT NEGLECTED PROBLEM

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.