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INTRODUCTION

NEARLY ALL WOMEN HAVE MUSCULOSKELETAL complaints at some point during their pregnancy, including a significant portion with severe pain and/or disabling symptoms.1,2 Unfortunately, women in this population may be counseled by well-intentioned family, friends, and care providers that their pain symptoms are a “normal” part of pregnancy and the postpartum period. Minimization of pain during pregnancy may lead to a delay in diagnosis of musculoskeletal pathology, or worse, a total lack of care. Consequently, this vulnerable patient population faces the potential for increased morbidity, development of chronic disease, decreased quality of life during pregnancy, and potential disability. The presence of severe pain during pregnancy may also lead women to refrain from future pregnancies due to fear-avoidance behaviors.3

There are a myriad of pathophysiologic diagnoses involving the neurologic and musculoskeletal systems that affect pregnant and postpartum women (Table 38–1). Although not covered in this chapter, it is important to also consider gynecologic, gastroenterologic, infectious, rheumatologic, and oncologic diagnoses since these can also present with neurologic and musculoskeletal symptoms. Pregnancy and lactation necessitate judicious use of imaging and medications. Conservative management including physical therapy and complementary medicine treatments that are typically viewed as benign must also be carefully considered and adjusted to reduce risk of harm to the mother and her child.

Table 38–1Differential Diagnosis of Neurologic and Musculoskeletal Injuries by Pain Presentation

Rehabilitation ...

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