Q for Dr Bland - CTS-pregnancy-water intake
Hi.
Im working in a team of terapeutic massage therapists in Sweden and we have focused on patients that are pregnant and/or newly become mothers.
We have several patients with the diagnosis CTS and I have 2 Q's that I have tried to find out more about but find it hard to find info about in Sweden and on the web, so I thought that maybe you could help me.
1. Some Dr's in Sweden advice pregnant patients with CTS to be restrictiv with there water intake, so that they dont drink "to much water" ( ei 1 glas/hr) and because of this increase the swelling and in the long run increase there CTS.
I know that you argue that there is little evidence that support "systemic fluid retention should increase the pressure in the carpal tunnel", but say for the argument that so is the case, could then this increase the swelling and in the long run increase there CTS.
I have tried to find evidence for or against this but I can not find any info i books or on the web that scientificaly adresses this, do you have any facts around this. Pregnant + CTS + drink water = can increase CTS.
2. I have read that you suggest that the "balance of oestrogen and progestogen does have something to do with the pathophysiology of CTS", were can I find more info about this?
Kind regards and thank you
John Carrier, Sweden
You are basically right - there is little or no real evidence one way or the other regarding the mechanism of CTS in pregnancy. So far as I can tell from reading the scientific literature 'someone' many years ago guessed that CTS in pregnancy might be a result of water retention and everyone since has simply accepted that guess as an established scientific fact. The idea of restricting water intake suggested by your doctors is just the converse of that - a simplistic assumption that if there is too much water in the body then drinking less might reduce that. I say simplistic becasue the human body is very good at regulating the amount of water in it through the agency of the kidneys and in general restricting water intake moderately will just result in a lower urine output.
Most of the evidence relating CTS to hormonal status is circumstantial - the very fact that CTS is commoner in women for a start and has a large peak in incidence just after the menopause - but there are biochemical studies which show a higher density of progestogen receptors in the connective tissues of the wrist in CTS sufferers and CTS is a well known side effect of drugs which manipulate female hormone levels such as Exemestane. At present I know of no single summary article which discusses all these issues concisely I'm afraid - you have to read each topic separatey and piece together the jigsaw yourself. JB