10b - MSK and other conditions during childbearing year Flashcards
Hand Conditions in Pregnancy / Postpartum
1 Carpal Tunnel Syndrome
• Pregnancy
• Postpartum
2 De Quervain’s Tenosynovitis
• Postpartum
Carpal Tunnel related to Pregnancy causes
Carpal Tunnel of Pregnancy
• Predominantly related to increase in UL fluid retention in late pregnancy
Carpal Tunnel in the Puerperium
• Predominantly related to prolonged wrist flexion posture during breastfeeding
Tests for carpal tunnel
phalen’s
tinel’s
Carpal Tunnel – Treatment
Night splints
Oedema management (circulatory exercises, heat > massage > cold)
Carpal tunnel prognosis
Prognosis
– May worsen temporarily post birth if had IV fluids
– Tends to resolve within 2/52 of delivery
– Ave. Total duration = 2.36 months
Biggest concern carpal tunnel puerperium
Weakness and numbness > risk of dropping the baby
De Quervains Tenosynovitis – “BABY WRIST” caused by
Caused by impaired gliding of:
– Abductor pollicus longus (APL)
– Extensor pollicus brevis (EPB)
- repetitive lifting movements
Assessment of DeQuervain’s Tendonitis
Finkelstein Test
Conservative Management of DeQuervain’s
Ice Massage to Decrease Inflammation
- Splinting to immobilise thumb
- Taping to minimise wrist deviation movements
Abdominal Conditions in the Childbearing Year
1 Rectus Diastasis
2 Round Ligament Pain
Rectus Diastasis
Increased distance between bellies of rectus abdominus to allow for enlarging uterus
When does rectus siastasis occur?
2nd and 3rd trimester
Rectus Diastasis during pregnancy Is there anything we can do to minimise??
• No research to guide us!!
• The higher the tone / shorter mm length of
rectus abdominus the greater the linea
alba will need to stretch
• Sit-Ups during pregnancy are NOT advised
– Advice re in/out of bed via side-lying
• ??Tubigrip / Maternity belt to hold uterus in
toward spine rather than pull forward
Location of Round Ligament
– Extends from the lateral uterus to the labia majora
Round Ligament Structure
– Not true ligament – Fibromuscular band with mm fibres – Contains • Veins • Arteries • Lymphatics • Nerves
Round Ligament Function
– Supports growing uterus
– Maintains position of uterus during movement
Round Ligament Varicosities
- RLV are prominent veins within the round ligament.
- Often presents similarly to inguinal hernia
- Presents as an inguinal mass or “groin bulge” and mild discomfort.
nb If pain is predominant symptom thrombosis of RL vein or rupture
should be excluded.
Round Ligament Varicosities cause
– Progesterone dilatation of veins within the RL
– Increased blood volume of pregnancy
– Gravid uterus impingement of pelvic veins
Lower Limb Varicose Veins (LLVV) • Associated symptoms
– Pain+++ – Night cramps+++ – Numbness – Tingling – Legs feel heavy, ‘achy’ and “unsightly”
Lower Limb Varicose Veins (LLVV) Treatments during pregnancy…….
– Circulatory exercises, – avoid prolonged standing, – Leg elevation during the day. – Rest • Sleep on left side Inferior vena cava is on the right less pressure on IVC less pressure on saphenous Les venous congestio
Compression Stockings
Meralgia Paraesthetica
Painful, mononeuropathy of the Lateral Femoral Cutaneous nerve of the thigh (sensory)
Meralgia Paraesthetica
Symptoms
Presents as early as 25/40
• Purely sensory, very distinct cutaneous distribution
• Burning Paraesthesia
• Pain, pins and needles and
• Mild sensory loss to light touch and pin-prick
• In intense forms can be very debilitating
Treatmet Meralgia Paraesthetica
Fisher & Hanna (1987) found TENS along the course of the nn
to be highly successful, non-invasive and to carry no foetal risk
Posterior Tibial Nn Compression cause
• Oedema and swelling compression behind medial malleolus
Posterior Tibial Nn Compression • Symptoms:
• Symptoms:
– Paraesthesia over the sole of the foot
– Paraesthesia over the plantar aspect of the toes.
Posterior Tibial Nn Compression treatment
– Resting with legs in elevation
– Foot and ankle exercises
– Ice packs
Transient osteoporosis of Hip in Pregnancy symptoms
• Sudden, spontaneous onset of severe pain usually in unilateral groin, but can also be in
front of thigh, side of hip, or buttock.
• No history of accident / injury that would trigger pain
• Difficulty WB - Pt may have difficulty WB even with minimal pressure.
• Pain worsens with prolonged WB
– Patient often prefers to walk than stand still (good differential diagnosis tool for
comparing standard SIJ problems in pregnancy).
• Altered gait - Gradually worsening pain eventually preventing mobilisation completely
• Three phases of Transient Osteoporosis of the Hip in Pregnancy :
• Three phases of Transient Osteoporosis of the Hip in Pregnancy :
– 1- increasing pain with normal x rays
– 2- maximal pain with osteopaenia
– 3- regression of the symptoms and radiologic changes.
Meant duration of Transient Osteoporosis of the Hip in Pregnancy :
The mean duration is typically 6 to 8 months but can last up to & beyond 1 yr
If Hip Fractures due to ransient Osteoporosis of the Hip in Pregnancy :
will commonly need bilateral hip replacements.
When does Transient Osteoporosis of the Hip in Pregnancy present?
Usually presents in 3rd trimester (possibly earlier in multiple pregnancies
At risk: (however, may not have risk factors) transient osteoporosis of the hip
– Lean women
– 30-53 tears
Cause of transient osteoporosis of hip in pregnancy
• Unknown..... However: – Oestrogen associated with bone loss – Negative calcium balance in favour of the fetus • Suggested causes: – Viral infections – Marrow hypertrophy – Low bone density prior to pregnancy
Diagnosis transient osteoporosis hip
• Via bone scan or MRI (not usually performed until after pregnancy)
• During pregnancy: – “Gut feeling” based on history / symptoms during pregnancy – Pain on most ROM: in particular • Quadrant • Ends of range – Rule out other options of pain – Patients risk
Treatment of Transient Osteop of Hip
• Condition usually spontaneously resolves within 3 – 12 months of birth
• Management aims to
– Minimise loss of strength, ROM, etc
– Prevent stress facture and necrosis during period of osteoporosis.
Physiotherapy aims transient osteoporosis hip
BEST OPTION: Water based exercise to
• Maintain general strength
• Maintain ROM
- Maintain general health
- Improve circulation
- Minimise WB strain on hips
Progressively increase walking aids as needed to decrease strain on
bones
– Walking stick
– Crutches
– Frame
– Wheelchair
• Upper limb exercises for general health
