August 2016 BabiesWhat are the best products for you and your baby? From travel systems to sterilisers, find out all you need to know from our Mumsnet Best reviews. I have rheumatoid arthritis and am also after a long haul 27 weeks pregnant. My symptoms have been mostly under control by taking prednisilone before and during my pregnancy. I've noticed that in the last few weeks, that I'm becoming increasingly stiffer and am finding it difficult to walk more than 30 minutes without my ankle becoming swollen and painful. I'm seeing anabolic steroids multiple sclerosis rheumatologist tomorrow who has said he'll give me a steroid injection which should help. I just wondered if anyone had any experience of this in pregnancy and what effect, if steroid injections for arthritis during pregnancy, this would have on the baby?
Safe Medications During Pregnancy
Most of the medical treatments for carpal tunnel syndrome CTS have focused on suppressing the inflammatory process. An injection of dexamethasone acetate might provide the necessary cellular and humoral mediators to induce a healing cascade. Dexamethasone is a water-soluble steroid which is safe to be used in the third trimester, especially as a local treatment. The aim of this study was to evaluate the effectiveness of 4 mg dexamethasone acetate injection to treat carpal tunnel syndrome in pregnancy period.
Twenty pregnant women with CTS were recruited using strict inclusion and exclusion criteria. All the patients had been injected with 4 mg of dexamethasone acetate and 0. Pain intensity based on visual analog scale or VAS and electro physiologic parameters of median nerve transcarpal median sensory nerve conduction velocity SNCV , distal motor latency DML and distal sensory latency DSL were recorded before and 3 weeks after the injection.
The average pain scores before and 3 weeks after the dexamethasone acetate injection was 8. In addition, transcarpal SNCV of median nerve was After dexamethasone acetate injection, pain intensity and electrophysiological parameters were significantly improved. This study offered encouraging results for an alternative minimally invasive treatment for CTS in pregnant women.
In cases where the patient does not respond well to the conservative treatment or there are progressive symptoms such as severe atrophy of thenar muscles and an impaired conduction velocity of median nerve, surgical treatment would be considered. Previous studies have offered encouraging results for treating refractory lateral epicondylitis and recurrent temporomandibular joint dislocation with dexamethasone acetate injection.
This study did not consider electro diagnosis test for diagnosis of carpal tunnel syndrome and also assessing the effectiveness of treatment by steroid injection. This study tried to analyze steroid injection as a treatment and assess its effectiveness using electro diagnosis test in patients with CTS who were waiting for a surgical operation or were not willing to undertake it. Twenty pregnant patients in the third trimester referred to electromyography clinics in Isfahan University of Medical Sciences for evaluation of CTS who were selected using simple sampling method.
Diagnosis was made clinically based on the presence of sings and symptoms of CTS and confirmed electrophysiologically as well. The subjects had at least one of the following electrophysiologic findings:. Furthermore, in the singed extremity, electromyographic examination was made on muscles innervated by roots C 5 to T1.
In addition, examination of the radial, ulnar and median nerves was undertaken to exclude subjects such as polyneuropathy, radiculopathy and other entrapment neuropathies.
Other excluding criteria included diabetes, thyroid disease, uremia and vascular collagen disease such as rheumatoid arthritis and trauma to the wrist. Electrophysiologic excluding criteria included:. Four mg dexamethasone acetate was mixed with 0. If the patient felt paresthesia during the injection in the median nerve route, the needle was dragged back and then injection was made with a little change in the needle's position. The severity of the pain in each patient based on VAS before and 3 weeks after injection was recorded.
All the statistical analysis, including age, sex and severity of the pain were analyzed using Software SPSS Friedman test and Mann-Whitney test alo were used for analysis of the data. All the twenty pregnant patients consented to participate and recruited in the study.
The mean age of all the participants was 30 SD: Using visual analog scale VAS , the average pain score before dexamethasone acetate injection was 8. Besides, there was a statistically significant difference in electro diagnosis results before and after the intervention.
Transcarpal SNCV of median nerve was Moreover, DML of median nerve was 5. Furthermore, DSL of median nerve showed a statistical significant improvement from 4. None of the patients experienced any significant complications or pain exacerbation. According to the findings, after the injection of dexamethasone, the severity of pain was significantly reduced. The electrophysiological parameters of nerve conduction velocity and sensory and motor median nerve latency improved somehow as well.
No special complication occurred in the patients. It seemed that the dexamethasone acetate could lead to improve regenerative process by commencing the inflammatory-reparative process.
Some studies have mentioned that the improvement caused by corticosteroid injection into the wrist, was made through bleeding at the side of injection; however, the histological evidence have not yet supported this claim.
These studies showed that blood injection into the connective tissue activated specific mediators and mitogenic agents. Also, the mediators may activate the ligament inflammation repairing cascade. It is not clear whether the inflammatory response made, is caused by dexamethasone acetate or local stimulation of blood metabolites or by cell mediated factors in the blood. The findings showed a faster and more stable improvement in the test group compared to the control group.
Therefore, the fibroblastic hyperplasia and vascular formation hypothesis should be more taken into account. The importance of this fact for patients, who waited for the surgical operation or were not willing to undertake it, was not negligible. In brief it seems that dexamethasone acetate injection has fewer complications than other corticosteroids injection.
Generally, this study showed that injection of dexamethasone acetate in carpal tunnel region could be used as an alternative method for treatment of carpal tunnel syndrome in pregnancy, with the least complications. ARM was the main investigator, designed the study, and wrote the paper. NM helped in designing the study and patient recruitment, AL contributed to the design of study, analysis of the data and helped in writing the final manuscript.
All authors have read and approved the content of the manuscript. National Center for Biotechnology Information , U. J Res Med Sci.
Received Jan 11; Accepted Apr This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. This article has been cited by other articles in PMC.
Dexamethasone acetate injection, Carpal tunnel syndrome, Pain intensity, Electro physiologic parameters. The subjects had at least one of the following electrophysiologic findings: Severe cases of disease, including proximal sensory latency if more than 5.
All the tests in questions were conducted at the same surface skin temperature of hand at All the stages and the methods of the study were explained for the patients and a written informed consent was taken. For evaluation of the severity of pain, the visual analog scale VAS was used. Results All the twenty pregnant patients consented to participate and recruited in the study. Discussion According to the findings, after the injection of dexamethasone, the severity of pain was significantly reduced.
Footnotes Conflict of Interests Authors have no conflict of interests. Prevalence of carpal tunnel syndrome in pregnant women. Systematic review of pregnancy related carpal tunnel syndrome. Current concepts in carpal tunnel syndrome: Eur J Orthop Surg Traumatol. Neuromuscular disorders in pregnancy. Risk factors for carpal tunnel syndrome in a general population. Clinical study of cervical myeloradiculopathy with carpal tunnel syndrome, double crush syndrome.
Lack of scientific evidence for the treatment of lateral epicondylitis of the elbow. J Bone Joint Surg Br. Prevention and treatment of elbow and shoulder injuries in the tennis player. Local injection of dexamethasone for the treatment of carpal tunnel syndrome in pregnancy. J Med Assoc Thai. Determination of sensitive electrophysiologic parameters at follow- up of different steroid treatments of carpal tunnel syndrome.
Sensitivity of median sensory nerve conduction tests in digital branches for the diagnosis of carpal tunnel syndrome. Am J phys Med Rehabil. J Am Acad Orthop Surg. Cell-matrix response in tendon injury. Int J Clin Pract. The effects of platelet-derived growth factor-BB on healing of the rabbit medial collateral ligament.