280,000 Missed Carpal Tunnel Cases?

Data from a new study, “Prospective Evaluation of the Incidence and Persistence of Gestational Carpal Tunnel Syndrome”, presented at the 2019 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) in Las Vegas, Nevada, provided information that gestational carpal tunnel syndrome persists after pregnancy more frequently than originally thought.

Gestational carpal tunnel syndrome can cause pain, numbness, and tingling in the hand and arm. The cause isn’t clear, but it has been hypothesized that fluid retention, weight gain, and hormones are contributing factors.

“Conventional medical wisdom has been that gestational carpal tunnel syndrome simply goes away after pregnancy, and for many women this is true,” said lead author, Philip E. Blazar, M.D., Chief, Hand and Upper Extremity Service at Brigham and Women’s Hospital in Boston, Massachusetts.

“However, in our practice this wasn’t always the case, and it warranted additional analysis to help educate physicians, advise patients with persistent carpal tunnel syndrome (CTS) and continue research in this field.”

In this study, Blazar and colleagues sought to determine how long it takes for gestational carpal syndrome to dissipate after childbirth and how commonly symptoms persist. To do so, they prospectively administered a survey, Boston Carpal Tunnel Questionnaire (BCTQ) to 368 women in their trimester of pregnancy with gestational carpal tunnel syndrome. These women had no prior history of carpal tunnel syndrome.

The women were then asked to complete additional surveys at two to six weeks, three months, six months, twelve months postpartum or until symptoms were resolved or they underwent surgical treatment.

According to the data collected, approximately 28% of previously asymptomatic patients will have gestational carpal tunnel syndrome in their third trimester. About 84.8% will have symptom resolution by six weeks postpartum, but for women who still experienced symptoms at three months postpartum, the symptoms persisted and worsened over time.

One month after delivery, 15.2% (n=10), of patients still had persistent symptoms of carpal tunnel syndrome. Demographic and comorbid conditions that can increase the risk of developing gestational carpal tunnel syndrome include non-Caucasian, higher BMI, history of smoking and preeclampsia.

Blazar told OTW, “The conventional wisdom in the Orthopaedic hand surgery and Obstetrical communities has been that essentially all of these patients get better after delivery. I was taught by my mentors that this problem resolved quickly after delivery. We found that while that was true for the majority of patients, a minority (7 percent in our study) had persistent symptoms for longer than 3 months postpartum. And there are almost 4 million babies born annually in the US.”

Seven percent of four million is, incidentally, 280,000 cases.

He added that the next questions he is interested in exploring about this condition are:

• Is this true for all populations of pregnant women?
• Is the presence of symptoms during pregnancy indicative of symptoms a decade or two later when women are in their 50s and 60s? (Women in their 50s and 60s have the highest rate of carpal tunnel surgery)
• What are the benefits or downsides to surgically addressing carpal tunnel earlier in life for this population?