Musculoskeletal problems in pregnancy

Incidence and Risk Factors for Pregnancy-Related de Quervain's Tenosynovitis in South Korea: A Population-Based Epidemiologic Study

Background

Although pregnant or lactating women have been recognized to be predisposed to de Quervain's tenosynovitis (DQT), there is a lack of epidemiologic evidence. The purpose of this study was to estimate the nationwide incidence of pregnancy-related DQT (PRDQT) and to analyze risk factors using the Korean National Health Insurance (NHI) database.

Methods

A retrospective epidemiologic study of pregnant women in South Korea from 2013 to 2017 was conducted using the NHI claims database. Using corresponding diagnostic codes, we identified women diagnosed with DQT during pregnancy or the postpartum period. We calculated the cumulative incidence and analyzed risk factors such as demographics, pregnancy type, delivery method, gestational complications, and comorbidities using multivariate logistic regression analysis.

Results

Between 2013 and 2017, 34,342 patients with PRDQT were identified among 1,601,501 pregnant women, representing a cumulative incidence of approximately 2.1%. Age ≥ 30 years, multiple gestation, cesarean delivery, hypertensive disorders in pregnancy, and underlying rheumatoid arthritis were all identified as significant risk factors for the occurrence of PRDQT, whereas diabetic disorders in pregnancy and underlying diabetes mellitus were not.

Conclusions

In South Korea, PRDQT was found to affect approximately 2.1 out of 100 pregnant women between 2013 and 2017. The incidence and risk factors identified in this study can be used for clinical consultations and prediction, as well as for development of national health policies.

The Brazilian Portuguese version of the Pregnancy Mobility Index: Cross-cultural adaptation and psychometric evaluation - a validation study

BACKGROUND

The Pregnancy Mobility Index (PMI) was developed to assess mobility in pregnant women in the Netherlands. At present, no similar questionnaire is available in Brazil.

OBJECTIVE

The present study aimed to translate, cross-culturally adapt, and evaluate the psychometric properties of a Brazilian PMI.

DESIGN AND SETTING

The present study was a validation study conducted at the Universidade Federal do Paraná and a public maternity ward in Curitiba, Brazil.

METHODS

Text translation and cross-cultural adaptation followed international guidelines. Construct validity, internal consistency, and inter- and intra-rater reliability tests included 97 women. The Pelvic Girdle Questionnaire, Multidimensional Pain Evaluation Scale, Schober's test, and lumbar spine range of motion assessment were administered on the first day. Intra-rater reliability (n = 19) was measured after 15 days. Exploratory factor analysis was performed, and the correlation matrix was analyzed using Pearson's coefficient.

RESULTS

Pregnant women (88%) understood the cultural adaptation process. The internal consistency was high (Cronbach's alpha > 0.90), construct validity was moderate, with significant correlation between lumbar spine range of motion (r = 0.283-0.369) and Schober's test (r = -0.314), and high correlation between the Multidimensional Pain Evaluation Scale (r = -0.650 and -0.499) and Pelvic Girdle Questionnaire (r = -0.737). Intra- and inter-rater reliabilities were excellent (intraclass correlation coefficient = 0.932 and 0.990, respectively).

CONCLUSION

The Brazilian version of the PMI was successfully translated with excellent reliability and moderate-to-high construct validity. It is an important tool for assessing mobility in pregnant women.

CLINICAL TRIAL

RBR-789tps (Validation study), https://ensaiosclinicos.gov.br/rg/RBR-789tps.

Gebelik Dönemindeki Potansiyel Kas-İskelet Sistemi Sorunları

Gebelik sırasında kadınlarda çeşitli fizyolojik ve anatomik değişiklikler meydana gelmektedir. Bu biyomekanik, hormonal ve vasküler değişiklikler gebelik ilerledikçe belirginleşmektedir. Kas-iskelet sistemi bu değişimlerden en çok etkilenen sistemlerden biridir. Gebelikle ilişkili kas-iskelet sistemi problemlerinin başında bel ağrısı gelmekte ve bunu sırt ağrısı, el-el bilek ağrısı ve kalça ağrısı takip etmektedir. Gebelikle ilişkili bu problemlerin çoğu gebelikten sonraki aylarda düzelmektedir. Ancak bazı gebelerde ciddi ağrı ve dizabiliteye neden olmaktadır. Bu nedenle, gebelik döneminde görülen kas-iskelet sistemi problemlerinin erken tanınması, koruyucu önlemlerin alınması ve bireysel tedavinin planlanması önemlidir. Bu yazıda, gebelik döneminde görülen kas-iskelet sistemi değişiklikleri, sık görülen patolojiler ve bu problemlerin tedavisi ile ilgili güncel literatürün gözden geçirilmesi amaçlanmaktadır.

The Main Changes in Pregnancy—Therapeutic Approach to Musculoskeletal Pain

Background and Objectives: During pregnancy, women undergo various physiological and anatomical changes that are accentuated as the pregnancy progresses, but return to their previous state a few weeks/months after the pregnancy. However, a targeted therapeutic approach is needed. Most of the time, during this period, these changes precipitate the appearance of pain, musculoskeletal pain being the most common. Pregnant women should avoid treating musculoskeletal pain with medication and should choose alternative and complementary methods. Exercise along with rest is the basis for treating chronic musculoskeletal pain. Side effects of physical therapy are rare and, in addition, it is not contraindicated in pregnant women. The benefits of this type of treatment in combating pain far outweigh the risks, being an easy way to improve quality of life. The objective of this article is to discuss the management of musculoskeletal pain during pregnancy, to identify the main musculoskeletal pain encountered in pregnant women along with drug treatment, and to expose the beneficial effects of alternative and complementary methods in combating pain. Materials and Methods: A literature search was conducted using medical databases, including PubMed, Google Scholar, and ScienceDirect, using the keywords “changes of pregnancy”, “musculoskeletal pain”, “pregnancy pain”, “pain management”, “pharmacological approach”, “alternative and complementary treatment” and specific sites. Information was collected from studies whose target population included pregnant women who complained of musculoskeletal pain during the 9 months of pregnancy; pregnant women with other pathologies that could increase their pain were not included in this review. Results: The articles related to the most common non-obstetric musculoskeletal pain in pregnancy along with pharmacological treatment options and alternative and complementary methods for musculoskeletal pain management during pregnancy were selected. Conclusions: The results were used to guide information towards the safest methods of therapy but also to raise awareness of the treatment criteria in order to compare the effectiveness of existing methods. Treatment must consider the implications for the mother and fetus, optimizing non-pharmacological therapeutic options.

Minimal-contact physical interventions for pregnant women with musculoskeletal disorders: a systematic review of randomised and non-randomised clinical trials

This review summarised minimal-contact physical interventions and their effects on pain, disability and quality of life in pregnant women with musculoskeletal disorders. Twelve bibliographic databases were systematically searched until December 31 2020. PEDro Scale was used for quality assessments. Narrative synthesis of 10 eligible studies was conducted. Education and multimodal home exercises plus handbooks/multimodal individual/group exercises; and self-management programmes improved pain intensity, sick leave and disability in pregnant women with lumbopelvic pain. Individual home-based progressive muscle relaxation exercises; unsupervised water exercises plus information using handbooks/videos/music; group multimodal exercises plus home exercises and information/education; and partner massage plus information using booklets/photographs reduced pain intensity in pregnant women with low back pain. Non-rigid/customised lumbopelvic belts plus information reduced pain intensity more significantly than rigid belts or stabilisation exercises plus information among pregnant women with pelvic girdle pain. Minimal contact interventions are effective and may be utilised during infectious disease pandemics.

A Systematic Review of Elective Laser Therapy during Pregnancy

Introduction: Currently, lasers are used to treat many diseases and their complications. However, the use of lasers in pregnant patients is still controversial. Methods: In this review, the application of lasers in the fields of urology, surgery, obstetrics, dermatology, and musculoskeletal disorders is evaluated. The following keywords were used to search through PubMed, Google Scholar, and Scopus: pregnancy, laser, urolithiasis, endovenous laser ablation (EVLA) or treatment, leg edema, varicose vein, venous insufficiencies, hair removal, pigmentation, telangiectasia, vascular lesions, Q switch laser, diode laser, holmium, holmium-YAG laser, erbium laser and Pulsed dye laser, low-level laser therapy, high-intensity laser therapy, pain, musculoskeletal disorders, twin to twin transfusion syndrome (TTTS), amnioreduction, and safety. Results: Totally, 147 articles were found, and their abstracts were evaluated; out of 53 articles extracted, 14 articles were about dermatology, 24 articles were about urology, 12 articles were about obstetrics and gynecology, 10 articles were about musculoskeletal disorders and three articles were related to surgery. Conclusion: Laser therapy can be used as a safe treatment for urolithiasis, skin diseases, TTTS and varicose veins of the lower extremities. However, the use of laser therapy for musculoskeletal disorders during pregnancy is not recommended due to lack of evidence, and also we cannot recommend endovenous ablation.

Musculoskeletal Considerations for Exercise and Sport: Before, During, and After Pregnancy

There is little written in the orthopaedic literature regarding common musculoskeletal problems that women encounter in relation to pregnancy and their clinical and surgical management. Exercise and other physical activity are generally recommended for most women before, during, and after pregnancy. Unfortunately, a variety of musculoskeletal issues may keep women from starting, continuing, or resuming a healthy exercise regimen throughout a notable portion of their reproductive years. Untreated and undertreated orthopaedic conditions in female athletes may therefore have further unintended negative effects on maternal and fetal health. This article reviews the existing literature on musculoskeletal health considerations before, during, and after pregnancy to provide practical information to orthopaedic surgeons who treat women of all ages and athletic abilities.

Community-based non-pharmacological interventions for improving pain, disability and quality of life in pregnant women with musculoskeletal conditions: protocol for a systematic review with meta-analyses

INTRODUCTION

Twenty five per cent of pregnant women with musculoskeletal pain have disabling symptoms that negatively influence quality of life. Studies have reported varying effects of non-pharmacological interventions including exercise, manipulation and pelvic belts for pregnant women with musculoskeletal problems. The overall effectiveness and acceptability of these interventions is uncertain due to lack of synthesised evidence. This protocol is for the first systematic review of community-based non-pharmacological interventions for improving pain, disability and quality of life in pregnant women with musculoskeletal conditions from studies published until August 2020.

METHODS AND ANALYSIS

A detailed search of PubMed, CINAHL, CENTRAL, Global Index Medicus, African Index Medicus, African Journal Online, Western Pacific Region Index Medicus, Latin American and Caribbean Centre on Health Science Information, Index Medicus for South-East Asia Region, IRIS (WHO digital publications), British Library for Development Studies and Google Scholar. Additional studies will be located from the reference list of identified studies and relevant systematic reviews. The databases will be searched from inception to August 2020. Appraisal of study quality will be performed with the Mixed Methods Appraisal Tool. Data will be synthesised using a mixed-studies synthesis design-the convergent synthesis. The description of interventions in all study designs will be summarised narratively. Meta-analyses will be used to statistically summarise the effectiveness of interventions in randomised controlled trials and the factors that influence these. Other quantitative studies will be summarised narratively to answer the objectives. Thematic synthesis will be used to summarise results of qualitative studies. The outcomes of interest include pain, disability and quality of life. This paper is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols 2015 guidelines.

ETHICS AND DISSEMINATION

Ethical clearance is not required. Findings will be presented at conferences and published in peer-reviewed journals.

PROSPERO REGISTRATION NUMBER

CRD42020189535.

Characteristics and Management of Pregnant Patients From a Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine Clinic

Context

Osteopathic manipulative medicine (OMM) is considered beneficial in the treatment of pregnant women, but few studies have outlined the presenting complaints and diagnoses that warrant consideration and utilization of osteopathic manipulative treatment (OMT) in this population.

Objective

To describe the characteristics of pregnant patients receiving OMM at a neuromusculoskeletal medicine (NMM)/OMM specialty outpatient clinic, for the purpose of identifying patients who would benefit from referral to NMM specialty clinics or to be considered for treatment by DOs in non-NMM specialty clinics.

Methods

Electronic health records were reviewed from a single clinic for a 3-year period from October 2015 through September 2018 for patient encounters involving patients with an International Classification of Diseases 10th Revision code for pregnancy. Data regarding patient demographics, payment methods, presenting complaints, treatment modalities, regions treated, and assessment diagnoses were collected and analyzed.

Results

Records showed 465 clinical encounters with 194 pregnant patients (mean [SD] number of encounters per patient, 2.4 [2.0]). The most common presenting complaints involved the back (371; 55.4%), hip and pelvis (99; 14.8%), neck (62; 9.3%), and head (54; 8.1%). The most common clinical assessments were lumbar and thoracic spine neuromusculoskeletal diagnoses (420; 53.0%). There were 2604 somatic dysfunction assessments documented; lumbar (409; 15.7%) and sacral (396; 15.2%) somatic dysfunction were most commonly assessed. There were 2518 OMT techniques documented, and muscle energy was most frequently used (406; 16.1%).

Conclusions

This data, which documents the most frequent presenting complaints of pregnant patients in an NMM/OMM clinic, may be used by clinicians to better understand the role of OMM as an obstetric adjunctive treatment approach and to identify conditions to investigate in future outcome studies.

Reproductive health counseling and contraceptive use in Mexican women with rheumatic diseases: a cross-sectional study

BACKGROUND

There is an overall increased risk of adverse pregnancy outcomes and maternal morbidity in patients with most autoimmune rheumatic diseases (ARD); outcomes are generally improved when the pregnancy is planned and the disease is in control.

OBJECTIVE

The objective of the present study was to describe the sexual and reproductive health characteristics and contraceptive use of Mexican women in childbearing age with ARD.

METHODS

We conducted an observational, cross-sectional, and descriptive study. All non-pregnant childbearing age women with an ARD were invited to participate. A self-administered questionnaire of ten items that included questions about sexuality, use of contraceptive methods, pregnancy desire, and contraceptional counseling was applied.

RESULTS

A total of 135 women were evaluated. The median age was 33 (25-39) years. Contraceptive use was referred by 49 (71%) of the patients that had sexual activity the last month, while 20 (28.9%) patients denied use. From the patients who had initiated sexual activity (N = 112), 41 (36.6%) did not use any contraceptive method, and 16 (14%) used a method classified as ineffective. The question about contraceptive counseling was answered by 112 patients. Eighty (70.4%) said they had received counseling from health-professional and 64 (57.1%) from their rheumatologist. A total of 57% of the women with teratogenic drugs did not employ a contraception method.

CONCLUSION

Contraceptive use and reproductive health counseling are suboptimal in Mexican women with ARD. A high proportion of women taking teratogenic drugs did not employ a highly effective contraceptive method. Strategies to improve reproductive and sexual health are necessary.

Musculoskeletal pain and symptoms in pregnancy: a descriptive study

Background

Pregnancy-induced hormonal and physiologic changes increase the risk of musculoskeletal problems in pregnancy. The purpose of this report is to provide a comprehensive look at the musculoskeletal pain and symptoms experienced during pregnancy.

Methods

A total of 184 women (mean age 30.9 ± 5.0 years) who gave birth in the obstetrics clinic of a tertiary hospital were included in the study. The participants who had given birth at 37-42 weeks of pregnancy (term pregnancy) and aged over 18 years were selected for participation. Basic demographic and clinical characteristics of the participants including age, body mass index, weight gained during pregnancy, education level, occupation, parity, sex of baby, and exercise habits were collected from the medical chart and face-to-face interviews. Musculoskeletal pain sites were defined as hand-wrist, elbow, shoulder, neck, back, low back, hip, knee, and ankle-foot in a diagram of the human body. The interviews with participants were performed to assess their musculoskeletal pain separately at each trimester follow-up visit.

Results

The most frequent musculoskeletal complaints during pregnancy were low back pain (n = 130, 70.7%), back pain (n = 80, 43.5%), hand-wrist (n = 61, 33.2%) and hip pain (n = 59, 32.1%). The participants experienced musculoskeletal pain most in the third trimester except for elbow, shoulder and neck pain compared with the first and second trimesters (p < 0.05).

Conclusions

The results of the study suggest that numerous musculoskeletal problems may complicate pregnancy especially in the third trimester.

Targeted drugs in spondyloarthritis during pregnancy and lactation

Spondyloarthritis (SpA) are a heterogeneous group of chronic inflammatory joint diseases that includes several clinical subgroups. SpA can affect women in the reproductive stage so pregnancy can influence the course of the disease and SpA can affect the maternal-fetal outcome. The treatment of SpA has changed dramatically in recent years and the use of targeted drugs is part of therapeutic armamentarium. The use of targeted drugs during pregnancy is controversial because the information available on safety during this period is still limited. Several cytokines have an important role in the normal development of pregnancy or other cytokines may play a role in certain maternal-fetal complications. Potentially targeted drugs can affect the function of these cytokines during pregnancy. The aim of this study is to review the interrelationship between SpA during pregnancy and lactation, the role of some cytokines during normal pregnancy and the development of maternal-fetal complications as well as to review recent information on targeted drugs during pregnancy and breastfeeding in these patients in order to maximize their use in these critical periods of life.

Pregnancy-related lumbopelvic pain: classification and diagnostics according to European guidelines and a review of literature

Lumbopelvic pain associated with pregnancy may originate from the lumbar spine, the pelvic girdle or may be mixed. According to European guidelines, individual subtypes of pain require different procedures, for which a detailed differential diagnosis is necessary. These ailments arouse a lot of controversy. The aim of the work was to present the current state of knowledge on the aforementioned ailments, including European guidelines and the latest trends in foreign literature. The diagnosis of lumbopelvic pain, with particular emphasis on the pathophysiology and methods of differentiation of both pain syndromes, was discussed. Lumbar spine pain is mainly related to the mechanical load caused by a pregnant uterus. In the case of pelvic girdle pain, the main cause is the disorder of optimal stability, which depends on the correct mechanisms of force and form closure. Pelvic girdle pain is characterized by other clinical symptoms and risk factors, it also often remains after pregnancy, having negative impact on the daily functioning of a woman even years after giving birth. Depending on the location (one or both sacroiliac joints, pubic symphysis), several types of this pain syndrome are distinguished. The worst prognosis is pelvic pain associated with the involvement of all three joints at the same time. Until now, this term has not been more widely used in the Polish-language literature. The complexity of chronic pain syndromes, in which the discomforts of the pregnancy period may develop, entails the necessity of early identifi cation and deliberate action. Knowledge of the etiopathogenesis of these ailments is a prerequisite for therapeutic success. Introduction of terminology popular in foreign literature will improve treatment of these diseases, adapting it to current standards and will also enable better exchange of experience between professionals. pelvic girdle pain, lumbar pain, pregnancy

Association between kinesiologic dysfunctions, lumbar disability and lumbopelvic pain in pregnancy

Abstract Introduction: Low back pain in pregnancy is highly prevalent and multifactorial. However, it is still nuclear if the back pain is associated with functional kinetic changes that occur during pregnancy. Objective: To evaluate the occurrence of low back pain in pregnancy and to investigate the association of low back pain disability with intensity, pain origin and kinesilogic dysfunction (range of motion of the lumbar spine, lumbar flexibility and trunk mobility). Methods: Women (n = 32) with gestational age equal or less than 20 weeks, assisted in one health centers on the coast of Paraná. Obstetric and historical lumbopelvic of pain, musculoskeletal discomfort, intensity lumbopelvic pain, low back disability, the source of pain through specific clinical trials, joint range of motion of the lumbar spine, the lumbar flexibility and general mobility of the trunk were evaluated. Results: The lumbar region was the most reported and higher frequency (p = 0.000) for the occurrence of musculoskeletal discomforts. The prevalence of lumbopelvic pain was 93.8%. Most reported the first episode after the 14th week of pregnancy (90%), on a daily frequency (63.3%), high intensity (50%), limiting the activities of daily living (50%) and generating low back disability (moderate to severe in 56.9%). Lumbar disability levels were significantly correlated to gestational age (r = 0.353), pain intensity (r = 0.402), positive results in clinical trials (except for the Lasègue test), range of motion for flexion (r = -0.280) and lumbar extension (r = -0.301), lumbar flexibility (r = -0.371) and general mobility trunk (r = 0.503). Conclusion: The greater gestational age, the greater intensity of pain, positivity in clinical trials, decreased range of motion, flexibility and lumbar trunk mobility constitute major lumbar disability.

Postpartum sacral insufficiency fractures

Postpartum sacral insufficiency fracture is an uncommon occurrence that is often under-diagnosed because its symptoms of low back, buttock and groin pains may initially be attributed to physiologic biomechanical changes caused by pregnancy or to intervertebral disc disease. We present a case of bilateral sacral insufficiency fractures in a 37-year-old postpartum woman with osteopenic bone mineral density confirmed by dual energy X-ray absorptiometry. The symptoms were initially suspected to be of discogenic cause, and the fractures were incidentally appreciated at the edge of a lumbar spine magnetic resonance image. Therefore, it is important to keep in mind this potential diagnosis when examining imaging studies of postpartum patients. For women who present other risk factors of osteoporosis, imaging of the entire sacrum should be part of the imaging studies. If sacral stress fractures are diagnosed, further evaluation for bone mineral density and underlying metabolic bone disease is recommended.