Pregnancy may predispose women to carpal tunnel syndrome (CTS) due to fluid retention and hormonal changes. Symptoms typically present in the first two trimesters and resolve within 1-2 weeks of delivery. Conservative treatment is usually effective, with 82% of pregnant patients finding relief with night splints alone. Electrodiagnostic testing is generally avoided unless symptoms are severe. Surgery is recommended if conservative care fails or testing shows significant nerve compression. The goal is to keep patients comfortable until delivery, after which symptoms typically resolve.

1. CTS following distal
radius fractures
Prepared by Dr Madan Mohan
Based on Orthop Clin N Am 43 (2012) 459–465

2. • The time for onset of CTS after distal radius fracture
can vary from a few hours to many years
• Gross deformity of the wrist following distal radius
fractures should be expeditiously reduced to mitigate
the risk of median nerve injury.
• Acute CTS presenting with painful paraesthesias in the
hand requires urgent decompression and fixation of
the fracture

3. • Prophylactic release of the carpal tunnel during
fracture fixation is not recommended unless the
patient has a prior history of CTS or is demonstrating
active median nerve paraesthesias preoperatively.
• If a concomitant CTR is to be performed, it should be
performed through a separate incision or through a
radial-sided hybrid FCR approach.

4. Delayed presentation of CTS
following a healed distal radius
fracture is best treated as an
idiopathic CTS, including evaluation
with electrodiagnostic testing

5. CTS in Pregnancy
Prepared by Dr Madan Mohan
Based on Orthop Clin N Am 43 (2012) 515–520

6. •Fluid changes, hormonal fluctuations, and increased
weight gain all stress the muscular system and
predispose patients to a plethora of orthopedic
issues.
•Greater than 70% of pregnant women report back
pain during the course of their pregnancy, making it
the number one musculoskeletal condition in the
peripartum period.
•The next most common musculoskeletal condition is
CTS

7. • The true cause of pregnancy-related CTS is unknown.
• It is thought to be multifactorial, with median nerve
compression resulting as a consequence of normal
physiologic changes of pregnancy.
• Increased fluid volume, uterine pressure on the
inferior vena cava, progesterone-mediated hyperemia,
and fluid retention lead to generalized edema during
pregnancy

8. •Specifically, pregnant patients with hand swelling
that prevents them from wearing their rings
have an increased incidence of carpal tunnel
symptoms.
•In addition, patients who have gestational
hypertension and preeclampsia have a higher
incidence of CTS

9. • It has also been shown that patients nursing their infants
postpartum have increased development of CTS.
• These patients often have symptom relief with cessation of
nursing.
• However, the cause of this phenomenon is unknown.
• CTS related to nursing maybe secondary to new repetitive
hand positions, but it could also be the result of residual
fluid and hormonal changes associated with pregnancy

10. • There is a known association between altered glucose
metabolism, such as that in diabetes, and the development
of CTS.
• Impaired fasting glucose levels and increased insulin
resistance are independent risk factors for the
development of CTS and, more specifically, for the
development of bilateral disease

11. Pregnancy may predispose women
to nerve hypersensitivity.

12. Diagnosis
•When obtaining the history, it is important to discern
the onset of symptoms.
•Pregnant patients presenting in their first 2
trimesters characteristically have more acute, rapidly
progressing symptoms for which conservative
treatment often fails.

13. •The indication for electrodiagnostic studies in a
pregnant patient is not clearly defined
•Given that surgery is not frequently considered
during pregnancy and that symptoms frequently
abate after delivery, electrodiagnostic testing
can often be avoided.
•However, severe symptoms such as constant
numbness, thenar weakness, and/or thenar
atrophy require prompt attention

14. Treatment
Wand reported that 95% of pregnant
patients with CTS had resolution of
their symptoms within 2 weeks of
delivery and the remainder within 1
month

15. •The goal is to keep patients comfortable as they
progress through their pregnancy and to use
surgical decompression for patients not
responding to conservative care or those with
significant nerve compression on
electrodiagnostic studies
•With conservative care, patients with pregnancy-
related CTS have a 3 to 4 times greater
probability of improving compared with
nonpregnant patients with CTS
•In fact, 82% of pregnant patients have good
relief of symptoms using night-time splints alone

16. • Steroid injections are most beneficial in patients with
mild to moderate carpal tunnel disease (sensory
latency >3.5 ms and distal motor latency >4.2 ms,
both <6 ms)
• When conservative management fails or patients
demonstrate significant electrodiagnostic changes,
surgical release of the transverse carpal ligament is
recommended