Hand and wrist complaints in pregnancy.

PURPOSE: Hand and wrist complaints can decrease the quality of life of pregnant women, which can occur or aggravate during pregnancy and advance to chronic state if left untreated. The purpose of this study was to describe hand and wrist complaints in relation to pregnancy and assess their significance in pregnancy. METHODS: In a prospective cross-sectional study, 383 participants were randomly selected from among pregnant women on or over 28 weeks of gestation, attending the primary care maternal health clinic in a university hospital. The prevalence and severity of hand and wrist complaints were assessed using the Boston Carpal Tunnel Questionnaire (BCTQ). The symptomatic pregnant women were consulted by an orthopedist. The specific diagnoses of the patients were made based on patient history and physical examination. RESULTS: According to BCTQ scoring 258 (67.4 %) pregnant women were symptomatic. The diagnoses were as follows: asymptomatic 125 (32.6 %), nonspecific symptoms 138 (36 %), tendinitis 80 (20.9 %), carpal tunnel syndrome (CTS) 39 (10.2 %) and cubital syndrome 1 (0.3 %). There was no association noted between the diagnoses and numbers of pregnancies, occupational status, age, gestational weeks, weight gain or body mass index (BMI) (p > 0.05). CONCLUSION: The prevalence of hand and wrist complaints is high in pregnant women. All pregnant women should be investigated for hand and wrist complaints in routine antenatal checks to ensure good life quality during pregnancy and for avoiding these complaints advancing to chronic state. Further studies are needed to evaluate the effect of musculoskeletal systems disorders in pregnancy.

Difficulty in Clinical Evaluation of Radial Nerve Injury due to Multiple Trauma to the Humerus, Wrist, and Hand.

Radial nerve damage is frequently encountered in humeral fractures. The radial nerve is primarily damaged when the humerus gets fractured, while secondary damage maybe due to post-traumatic manipulations and surgical exploration. High impact traumatic nerve injury, serious neuropathic pain, lack of response to therapeutic interventions, and indifference to the Tinel test are indications for surgical intervention. Since most humeral fracture-induced low impact radial nerve injuries resolve spontaneously, conservative therapy is preferred. We present a patient with humeral fracture-associated radial nerve injury, accompanied with digital amputation and flexor tendon avulsion on the same arm. These injuries required immediate surgery, thus rendering the clinical evaluation of the radial nerve impossible. We would like to highlight and discuss the inherent difficulties associated with multiple trauma of the upper arm.

Increased pulse wave velocity and carotid intima-media thickness in patients with carpal tunnel syndrome.

INTRODUCTION: Carpal tunnel syndrome (CTS) is associated with cardiovascular risk factors. The aim of our study was to determine whether carotid intima-media thickness (CIMT) and carotid-femoral pulse wave velocity (cf-PWV), as surrogates of cardiovascular disease and arterial stiffness, are increased in patients with carpal tunnel syndrome. METHODS: Forty patients with CTS and 40 gender- and age-matched controls underwent cf-PWV assessment, CIMT measurement, and nerve conduction study. RESULTS: CIMT and cf-PWV were increased significantly in patients with CTS. They correlated positively with median sensory and motor nerve distal latency. Whereas both CIMT and PWV related to CTS, only CIMT independently predicted CTS. CONCLUSIONS: There is both increased pulse wave velocity and CIMT and a positive correlation between these parameters and median nerve sensory distal latency in patients with CTS. CTS appears to be associated with arterial stiffness and atherosclerotic burden, but the underlying mechanisms require further study.