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Pregnancy in one of the most frequent physiological conditions associated with CTS. During 2000, the Italian CTS study group (participants: T.Carboni-San Benedetto del Tronto, S.Massi-San Giovanni Valdarno; M.Mondelli-Siena, A.Morini-Trento, D.Murasecco-Perugia, L.Padua-Roma, M.Romano-Palermo) studied the incidence of CTS in pregnancy in women enrolled in 7 Italian centers. CTS was diagnosed clinically in 62% and neurophysiologically in 43% of women. During 2001, 12 and 15 month follow-up evaluation was performed. The aims were to evaluate: 1) evolution of CTS after delivery and lactation; 2) predictive value of electrodiagnostic assessment and clinical picture at the time of the first diagnosis. An extensive and complete description of the study design was previously reported. Evolution was assessed on the following CTS severity measurements: SYMPT, FUNCT, PAIN, Hi-Ob and neurophysiologic class. Overall, at follow up, 20 of 37 women (54%) who presented clinical CTS at first evaluation had clinical CTS. All patient-oriented measurements showed significant improvement of CTS. Conversely, neurophysiologic findings did not differ between baseline and follow-up. Although CTS severity measurements improved at follow-up, more than half of women with CTS symptoms during pregnancy complained of CTS symptoms one year after delivery. Moreover, the onset of symptoms during pregnancy was the most predictive factor for untreated CTS evolution. All patient-oriented and clinical measurements showed that an earlier onset of symptoms was a negative prognostic factor. According to the neurophysiologic evolution, weight gain appeared predictive: an higher gain implied a lower probability of improvement at follow-up examination. |
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