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Prevalence of Carpal Tunnel Syndrome in Pregnant Women: A Comparative Study
*Corresponding author: Dr. Arati Vinay Mahishale, Department of Obstetrics and Gynecology, Karnataka Lingayat Education Academy of Higher Education and Research, Institute of Physiotherapy, Nehru Nagar, Belgaum, 590010, India. mphysioarati@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Mahishale AV, Mahishale VV, Dudyal V, Doshi V. Prevalence of Carpal Tunnel Syndrome in Pregnant Women: A Comparative Study. J Health Allied Sci NU. 2025;15:559-63. doi: 10.25259/JHASNU_15_2025
Abstract
Objectives
Carpal tunnel syndrome (CTS) is a common condition that affects pregnant women due to hormonal changes, fluid retention, and increased pressure on the median nerve. Differences in lifestyle and healthcare access between rural and urban populations may influence the prevalence and severity of CTS. This study aims to address these disparities and provide a comparative analysis of CTS in pregnant women from these two populations. This study aims to compare the prevalence and symptom severity of Carpal tunnel syndrome (CTS) between rural and urban pregnant women and identify the associated risk factors.
Material and Methods
A cross-sectional survey involving 200 pregnant women (100 rural and 100 urban) was conducted. Data were collected using the Boston Carpal Tunnel Questionnaire (BCTQ) and clinical diagnostic criteria.
Results
The prevalence of CTS was higher in urban women (75.9%) than in rural women (24.1%), with significant associations observed with occupation, lifestyle, and comorbidities such as obesity.
Conclusion
This study underscores the importance of understanding the disparities in CTS prevalence between rural and urban pregnant women and highlights the crucial role of lifestyle and occupational factors in shaping these outcomes.
Keywords
Carpal Tunnel Syndrome
Median nerve entrapment
Pregnant Women
Rural
Urban
INTRODUCTION
Carpal Tunnel Syndrome (CTS) is the compression of the median nerve as it passes through the carpal tunnel, a narrow passageway at the base of the hand.[1] Several physiological changes associated with pregnancy increase the risk of CTS.[2] Pregnancy-related hormonal changes include a significant increase in progesterone and estrogen levels, which help alleviate ligamentous tension.[3] This may cause the carpal tunnel to grow in volume, increasing pressure on the median nerve.[3]
Fluid Retention: Fluid retention is a common side effect of pregnancy, particularly during the second and third trimesters of pregnancy. This extra fluid can accumulate around the wrists, resulting in swelling that puts more pressure on the median nerve inside the carpal tunnel.[3]
Weight gain is common in pregnancy. Heavier weight increases the risk of nerve compression by placing more strain on the carpal tunnel and other musculoskeletal structures. Although pregnancy is known to increase the incidence of CTS, lifestyle, occupational circumstances, and socioeconomic status can affect the prevalence and severity of CTS in rural and urban populations.[4]
Living expenses are typically greater in urban regions, which could result in disparities in access to preventive and medical care. Additionally, sedentary professions involving extended computer usage may be more common among urban women, thereby increasing their risk of developing CTS.[5,6] Rural women, on the other hand, could be subject to various risk factors because of their more physically demanding employment or everyday activities that require manual work.
Aspects of lifestyle: Because lifestyle choices include long workdays, tiring commutes, and reliance on cars, urban women frequently have high obesity rates, sedentary behaviour, and stress. These elements may contribute to the onset of CTS. However, because they work in agriculture or manual labour, rural women are more physically active.[7,8]
Healthcare Access: Generally, medical treatment and ergonomic solutions to prevent or manage CTS are more readily available in urban areas. This could indicate that metropolitan women are more likely to seek early treatment for CTS symptoms,[9] which could result in a higher diagnostic rate. Higher rates of untreated or severe CTS may result from delayed diagnosis or fewer preventive actions for rural women, who may have limited access to professional treatment. Because of these characteristics, pregnant women in rural and urban regions may have a significantly different prevalence of CTS and the risk factors that are linked to it. To shed light on population-specific trends and possible preventive measures,[10,11] this study aims to compare the prevalence and symptom severity of CTS between rural and urban pregnant women and identify associated risk factors.
MATERIAL AND METHODS
Study design and setting
A cross-sectional survey was conducted, where participants were recruited from antenatal clinics and community centers by convenience sampling to survey all pregnant women attending antenatal care (ANC). The recruitment process was designed to include a diverse sample of pregnant women from both urban and rural areas, ensuring that the findings were representative of the population. Pregnant women aged 18-40 years who were willing to provide informed consent were included in the study. Women with pre-existing conditions affecting the hand or wrist, a prior diagnosis of CTS, or neurological disorders were excluded. A sample size of 100 in each group (urban and rural) was determined based on common statistical standards for prevalence studies. A 95% confidence level was selected, corresponding to a Z-value of 1.96.
Procedure
The study was approved by the institutional review board (IRB) to ensure that ethical standards were met. Clinical examinination was done using Phalen’s test, Tinel’s sign, and nerve conduction studies for CTS diagnosis.[5,6] The Phalen’s test and Tinel’s sign demonstrate moderate inter-rater reliability, but their effectiveness depends on the consistency of test execution and the interpretation of patient-reported symptoms. The Boston Carpal Tunnel Questionnaire (BCTQ) was used to assess symptom severity and functional status. The BCTQ is commonly used to assess the symptoms and severity of CTS, a condition caused by compression of the median nerve in the wrist. The BCTQ typically has two main components: the Symptom Severity Scale (SSS), which measures the intensity of symptoms such as pain, numbness, tingling, and weakness, and the Functional Status Scale (FSS), which assesses how these symptoms impact daily activities such as driving, typing, or handling objects.[7]
RESULTS
Statistical analysis was performed using SPSS software. Chi-square tests were used to compare prevalence rates, while logistic regression was used to identify risk factors. Chi-square Tests: Understanding the distribution of conditions across different categorical groups. Logistic Regression: Determine which factors increase the likelihood of the condition and quantify the strength of these associations. Together, these analyses provided both a descriptive (chi-square) and predictive (logistic regression) understanding of the data.
The overall prevalence of CTS was 27%, indicating that a substantial proportion of the sample experienced this condition. Urban women have a higher prevalence (75.9%- 41 out of 54), which may reflect the greater presence of risk factors such as office work, sedentary behaviour, or stress. Rural women have a lower prevalence (24.1%- 13 out of 54), possibly due to different occupational and lifestyle factors, including more physically active jobs and less frequent use of computers or other repetitive tasks associated with CTS. Logistic regression analysis was performed to evaluate the factors influencing CTS in pregnant women. The following variables were analysed: obesity, sedentary lifestyle, and repetitive hand movements [Table 1].
| Characteristic | Urban women (n=100) | Rural women (n=100) | p-value |
|---|---|---|---|
| Age (Mean ± SD) | 28.5 ± 5.2 | 27.2 ± 5.8 | 0.14 |
| BMI (kg/m2) (Mean ± SD) | 27.4 ± 5.3 | 25.9 ± 5.0 | 0.06 |
| Obesity (BMI ≥ 30) | 40% | 30% | 0.12 |
| Parity (Primigravida) | 45% | 42% | 0.78 |
| Gravida (Mean ± SD) | 1.8 ± 0.8 | 1.7 ± 0.7 | 0.65 |
| Employment status | Employed: 65% | Employed: 35% | <0.001 |
| Education level | Higher education: 60% | Higher education: 30% | 0.003* |
| Sedentary lifestyle (< 30 min/day) | 55% | 40% | 0.05 |
| Repetitive hand movements (> 4 hours/day) | 50% | 30% | 0.02* |
| Hypertension history | 15% | 10% | 0.33 |
| Gestational diabetes | 12% | 8% | 0.40 |
| CTS symptoms (Mean ± SD) | 3.2 ± 1.0 | 2.5 ± 1.2 | 0.01* |
| Functional limitations (Mean ± SD) | 2.8 ± 1.1 | 2.2 ± 1.3 | 0.02* |
*p < 0.05 considered statistically significant. n represents sample size involved in the study. BMI: Body mass index, SD: Standard deviation, CTS: Carpal tunnel syndrome.
Demographic data: There was no significant difference in average age between urban and rural women (p = 0.14). Urban women tended to have a slightly higher BMI than rural women, but the difference was not statistically significant (p = 0.06). A higher proportion of urban women (40%) were obese than rural women (30%), but the difference was not statistically significant (p = 0.12). There was no significant difference in the proportion of primigravida (first-time pregnancies) between the groups (p = 0.78). No significant difference in the number of pregnancies was observed between the groups (p = 0.65). A significantly higher percentage of urban women (65%) were employed compared to rural women (35%) (p < 0.001). Urban women were more likely to have a higher education level (60%) than rural women (30%), with a statistically significant difference (p = 0.003). Urban women had a higher proportion (55%) with a sedentary lifestyle than rural women (40%), although the difference was marginally significant (p = 0.05). No significant difference in the prevalence of hypertension history between urban and rural women (p = 0.33). No significant difference in the prevalence of gestational diabetes (p = 0.40). SD: Standard deviation.
Risk factors
Obesity (defined as a BMI ≥ 30) was significantly associated with a higher likelihood of CTS (OR = 2.5, p = 0.003). Repetitive hand movements were also strongly associated (OR = 3.0, p = 0.001). A sedentary lifestyle was associated with a marginal increase (OR = 1.8, p = 0.05).
Symptom severity
The BCTQ scores indicated that urban women report higher symptom severity and functional limitations for CTS than rural women due to several factors. Urban women are more likely to have desk jobs involving repetitive hand movements, poor ergonomics, and prolonged sitting, which contributes to a higher risk and severity of CTS. Better access to healthcare in urban areas leads to earlier diagnosis and symptom reporting. By contrast, rural women may engage in more physically varied activities, have less access to healthcare, and may not report symptoms until they become more severe. Additionally, urban lifestyles often involve more sedentary behaviour and stress, which can exacerbate CTS symptoms.
A significantly higher percentage of urban women (50%) engaged in repetitive hand movements for more than 4 hours a day than rural women (30%) (p = 0.02). Urban women reported more severe CTS symptoms (mean score of 3.2) than rural women (mean score of 2.5), and the difference was statistically significant (p = 0.01). Urban women experienced more functional limitations (mean score of 2.8) than rural women (mean score of 2.2), with the difference being statistically significant (p = 0.02).
DISCUSSION
The findings indicate a higher prevalence of CTS among urban pregnant women, possibly attributable to lifestyle factors such as sedentary habits and increased obesity rates. In contrast, rural women, who often engaged in physical labour, exhibited lower CTS prevalence but reported delayed healthcare-seeking behaviour. Possible contributing factors to this higher prevalence in urban women might include urban environments that often have workplaces with higher concentrations of office jobs or technology-driven tasks (e.g., prolonged computer use, repetitive typing, or data entry), which are known to increase the risk of CTS. Poor ergonomic practices or a lack of proper workstation setup in office jobs can exacerbate the risk of CTS. Urban women may be more prone to sedentary lifestyles, which can increase the likelihood of developing musculoskeletal disorders, including CTS. Women in urban areas may have more access to healthcare and, therefore, may be more likely to be diagnosed with CTS than women in rural areas who may have limited access to healthcare resources.[1]
Among women in rural areas, the prevalence of CTS was 24.1%, which was lower than in urban women (75.9%). The lower prevalence of CTS in rural women could be attributed to several factors. Rural women may be engaged in different types of work, such as agriculture, farming, or manual labour, which may not involve the repetitive hand and wrist movements associated with urban office jobs. These activities may have a lower risk of developing CTS. Rural populations may have more physically active lifestyles (e.g., more outdoor work or less sedentary time), which can reduce the risk of musculoskeletal disorders such as CTS.[3,4] Rural women may have less access to healthcare or fewer opportunities for diagnosis, meaning that some cases of CTS may go undiagnosed or unreported. During pregnancy, there are significant hormonal fluctuations, particularly increases in progesterone and relaxin levels. These hormones play a role in fluid retention, which can lead to swelling and increased pressure on the median nerve in the wrist, the nerve primarily affected by CTS. This hormonal shift can lead to more pronounced symptoms of CTS, such as numbness, tingling, pain in the wrist, hand, and fingers, and weakness or difficulty gripping objects.[3]
Pregnancy also causes weight gain and changes in posture, which can exacerbate musculoskeletal strain. Increased body weight can put more pressure on the wrist joints, and changes in posture (such as a shift in the center of gravity due to a growing belly) may lead to poor ergonomics, which can aggravate CTS symptoms. CTS symptoms often worsen during pregnancy, especially during the second and third trimesters. Many pregnant women experience temporary CTS due to these changes, a condition known as gestational CTS. Fluid retention and increased pressure on the wrist may resolve after childbirth; however, for some women, CTS symptoms can persist.[3,4]
Hormonal and postural changes during pregnancy can contribute to the development or worsening of CTS. Hormonal changes, such as increased levels of relaxin and softened ligaments, including those in the wrist, can lead to instability and compression of the carpal tunnel. Additionally, fluid retention, particularly in the third trimester, causes swelling that further compresses the median nerve and worsens the symptoms of CTS. An increase in blood volume during pregnancy also contributes to swelling, which exacerbates the condition.[2,3]
In addition, ergonomic and postural changes during pregnancy play a crucial role in the development and exacerbation of CTS. As pregnancy progresses, the growing belly shifts the center of gravity forward, causing a woman to adjust her posture, often leading to an increase in lumbar lordosis and forward bending of the spine. These changes can cause misalignments in the shoulders, arms, and wrists, placing additional strain on the upper limbs. Altered posture can lead to poor wrist positioning, particularly when performing everyday activities, which can aggravate the compression of the median nerve in the carpal tunnel. Moreover, the added weight from the growing foetus puts additional pressure on the wrists and arms, particularly when standing or performing tasks that require lifting or holding objects. This increased pressure, combined with fluid retention causing swelling in the wrists and hands, can contribute to the narrowing of the carpal tunnel and the development of CTS symptoms.[11,12]
Limitation and future scope
While a cross-sectional study design provides valuable insights into the prevalence and symptom severity of CTS at a single point in time, it does not capture how symptoms may evolve over the course of pregnancy. Acknowledging this limitation, we suggest that future studies adopt a longitudinal design to better understand the progression of CTS symptoms during pregnancy. This approach would enable the tracking of changes in symptom severity, the identification of factors that influence symptom progression, and a more comprehensive understanding of the long-term impact of CTS on pregnant women.
CONCLUSION
This study emphasizes the significance of understanding the disparities in CTS prevalence between rural and urban pregnant women, as well as the substantial impact of lifestyle and occupational factors on these outcomes. The higher prevalence and symptom burden of CTS among urban pregnant women (75.9%) emphasises the need for tailored prevention and management strategies. These findings underscore the importance of targeted interventions that focus on early diagnosis and ergonomic education to mitigate the risk of CTS, particularly in urban settings.
Ethical approval
The study approved by the Institutional Review Board at Karnataka Lingayat Education Academy of Higher Education and Research Institute of Physiotherapy, number 716, dated 24th June 2024.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
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