Carpal tunnel first trimester
Carpal tunnel syndrome and pregnancy
Carpal tunnel syndrome and pregnancy | Pregnancy Birth and Baby beginning of content6-minute read
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Key facts
- Carpal tunnel syndrome is a condition that occurs when swelling in your wrist presses on a nerve and causes pain in your hand.
- It’s common in pregnancy and usually goes away after your baby is born.
- It can cause pain, numbness and tingling in your thumb, index finger and middle finger. It can also cause weakness in your hand and pain going up your arm.
- You can modify your daily activities to reduce your pain.
- See a physiotherapist or occupational therapist to learn exercises and get a special wrist splint fitted to help relieve pain.
What is carpal tunnel syndrome?
Carpal tunnel syndrome is a condition that occurs as a result of swelling around the nerves of your wrist. It can cause numbness, tingling or pain in one or both of your hands.
If you are pregnant, you’re particularly susceptible to the disorder. Up to 5 out of every 10 people who are pregnant develop carpal tunnel syndrome.
What causes carpal tunnel syndrome?
The carpal tunnel is a passage in your wrist that contains tendons and a nerve, called the median nerve, that run through the base of your hand. The carpal tunnel can swell and press against this sensitive nerve, causing pain.
While pregnancy is one cause, other common causes include arthritis or repetitive hand movements, which may occur in some jobs. Visit this healthdirect page for information about carpal tunnel syndrome unrelated to pregnancy.
How does pregnancy cause carpal tunnel syndrome?
When you are pregnant, your hormones cause fluid to build up in your body, which can cause swelling. This can lead to swelling within the carpal tunnel.
The condition is more common in the third trimester, but it can also happen in the first and second trimesters or after you give birth. In most cases, symptoms will go away after your baby is born.
What are the symptoms of carpal tunnel syndrome?
Common symptoms of carpal tunnel syndrome include:
- pain, numbness, tingling, or weakness of your hand
- difficulty with hand coordination
- pain spreading to your arm or shoulder
You will probably feel the symptoms most in your thumb, index finger and middle finger. Symptoms can get worse at night.
The intensity of symptoms can vary from mild irritation or occasional soreness, to severe pain. Symptoms may stop you from sleeping or make it difficult to perform regular tasks such as working, getting dressed, cooking or caring for your baby.
Things that may make your symptoms worse include:
- repeating the same hand movements frequently
- keeping your hands in the same position for an extended time
- supporting your weight with straightened arms
Swelling may be a sign of high blood pressure in pregnancy. If your hands or feet are more swollen than usual, speak to your doctor or midwife.
What can I do to relieve carpal tunnel syndrome?
You may find that your pain is reduced by the following:
- Keep your hands elevated as much as you can.
- Keep your wrists in a neutral position (not bent forwards or backwards), as much as you can.
- Maintain good posture in your arms and wrists while working at a desk and take breaks every 20 minutes.
- Sleep on the side of your less affected hand.
- Put an ice pack on your wrist or run cold water over your hand.
Here are some things you should avoid:
- Avoid any repeated movements that make your pain worse.
- Avoid lifting heavy objects.
- Avoid tasks where you do the same movement repeatedly.
- Don’t bend your wrist as far as it can go.
Here are some things you can do to relieve general swelling in your body:
- Lie down whenever you can, with your feet elevated.
- Cut down on salt in foods.
- Elevate your legs when you’re sitting down.
- Wear compression socks or stockings.
Are there any treatments for carpal tunnel syndrome?
Treatment options include physiotherapy or occupational therapy. This may involve fitting you with a splint to keep your wrist in the best position to reduce strain. The splint must be adjusted to fit your wrist in order to be protective and supportive. You should wear your splint at night to keep your wrist in the right position while you’re asleep.
Your therapist will be able to tell you how best to protect your wrist at home, including exercises and resting positions.
You can try fluid drainage massage to reduce the swelling in your hand. You can do this by lifting your arm up and using your other hand to sweep gently along your skin from your fingers towards your shoulder. Be careful not to sweep the other way.
There are other treatments available for carpal tunnel syndrome, such as a cortisone injection into your wrist or even surgery.
Will I still have pain after my baby is born?
Carpal tunnel syndrome tends to ease, and often disappears, after birth. If you still have pain after your baby is born, you may need to change the way you use your wrist. This might affect how you use your hand to hold and care for your baby, including how you feed your baby.
Speak to your physiotherapist, occupational therapist or lactation consultant for strategies and tips on how to minimise strain on your wrist while holding your newborn. It’s a good idea to continue using your splint, if you have one.
Sources:
Royal Women’s Hospital (Pregnancy-related carpal tunnel syndrome), Australian Government Department of Health (Carpal tunnel syndrome), Western Australia Department of Health (Carpal tunnel syndrome), Western Sydney local Heath District (Fact Sheet Carpal Tunnel Syndrome)Learn more here about the development and quality assurance of healthdirect content.
Last reviewed: June 2022
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- Physiotherapy advice after pregnancy
- Swelling during pregnancy
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Carpal tunnel syndrome and pregnancy go hand in hand | Your Pregnancy Matters
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MedBlog
Your Pregnancy Matters
October 20, 2020
Your Pregnancy Matters
Robyn Horsager-Boehrer, M. D. Obstetrics and Gynecology
Approximately 31% to 62% of pregnant patients have carpal tunnel syndrome.Swelling – everywhere – is one of the most common symptoms of pregnancy. Patients often notice extra puffiness in their face, legs, and feet. But for some women, swelling manifests inside the wrist, resulting in carpal tunnel syndrome (CTS).
Approximately 4% of adults in the general population have carpal tunnel syndrome, but 31% to 62% of pregnant patients have it. Many patients notice symptoms after 30 weeks' gestation.
During pregnancy, your blood volume doubles. That extra fluid increases pressure and swelling in the blood vessels throughout your body. In tight spaces such as the carpal tunnel area of the wrist – through which nine tendons and one nerve pass – the swelling can compress the median nerve, which runs to the hand.
The median nerve gives sensation to the palm-side surface of thumb, index, and middle fingers, and half the ring finger. It's also responsible for helping to move the muscles in the hand that bend your fingers.
Nerve compression can cause pain, tingling, and numbness in the wrist and hand, which may increase when you're trying to sleep. Pregnancy may be the first time CTS symptoms arise or the last straw that causes a woman to see her doctor for ongoing symptoms.
The good news is that pregnancy-safe treatment is available, and symptoms typically subside for many patients after the baby arrives.
I've invited my colleague, Rupali Kumar, M.D., from UT Southwestern's Physical Medicine and Rehabilitation (PM&R) team to discuss CTS symptoms and treatment options.
Carpal tunnel symptoms in pregnancy
Dr. Rupali KumarWhen the median nerve is compressed during pregnancy, symptoms present as they would in any patient:
● Numbness and tingling
● Burning sensation
● Pain in the wrist or hand
At the onset of CTS, symptoms may come and go. But when numbness or weakness occurs frequently or constantly, that's a potential sign of nerve damage.
In severe cases, patients may have weakened grip strength or decreased finger dexterity. For example, you might have trouble picking up small objects with your fingers, opening jars, or buttoning clothes.
Related reading: 5 weird pregnancy symptoms you might not know about
Diagnosing carpal tunnel in pregnancy
We often can diagnose CTS by talking with you about your symptoms and medical history. If your symptoms are severe, we may recommend an electrodiagnostic study (EMG) to confirm the diagnosis and measure nerve function in the arm, wrist, and hand. An EMG can tell us whether you have nerve damage, how severe it is, and whether it might be reversible with intervention.
The doctor will attach small electrode stickers to your hand and arm in different places and apply low levels of electrical stimulation to gauge the nerve activity. The doctor may also insert a fine acupuncture-like needle in certain areas of the arm and hand to test muscle electrical activity. The study can be a little uncomfortable, but should not cause lasting pain.
Pregnancy-safe treatment options
With CTS, it's best to start with the most conservative therapies. That's especially true in pregnancy. Here is a list of carpal tunnel treatment options that are safe for pregnancy, from least to most invasive.
Splinting
The first-line treatment is to immobilize the wrist in a neutral position to limit the range of flexion or extension. We use a neutral wrist splint with a metal bar inside that prevents the wrist from moving up, down, or side-to-side but allows the fingers to move.
Splinting gives the median nerve a break and can help alleviate swelling, which can allow mild to moderate nerve damage to heal. However, it's tough to wear a splint all day and do everyday activities. Your doctor may recommend wearing it while sleeping and as much as you can during the day.
Occupational therapy
Hand and wrist therapy can sometimes help relieve symptoms and prevent further nerve damage. A PM&R doctor or occupational therapist can create a personalized plan for you.
Therapy may include wrist and finger range of motion and strengthening movements, massage, and nerve gliding techniques. We may also recommend desensitization to decrease nerve pain, including alternating hot and cold water baths.
Medication
Topical numbing agents can relieve symptoms, but these ointments won't get to the root of the problem. Some patients may benefit from pain relief injections, which include a combination of steroids and a local anesthetic injected around the median nerve under ultrasound guidance.
However, if there are other therapies to try, we typically avoid prescribing steroids during pregnancy to avoid side effects.
Check with your Ob/Gyn before using any over-the-counter or prescribed topical medications. Our PM&R doctors will consult with your Ob/Gyn prior to recommending medication during pregnancy.
Surgery, in severe cases
Carpal tunnel release surgery is reserved for severe cases. In this procedure, a surgeon will cut the ligament that presses on the carpal tunnel, making more room for the median nerve and tendons. This usually improves function and pain.
Generally, we recommend waiting until after pregnancy to have surgeries that are not urgent. If wrist pain or hand weakness severely limits your daily function, talk with your Ob/Gyn about the risks and benefits of having carpal tunnel surgery prior to delivery.
When will symptoms improve?
After delivery, your fluid levels and the extra pressure in your blood vessels will decrease. As such, your symptoms will likely improve or resolve.
That being said, new mothers use their hands and wrists nearly constantly. Lifting, changing, and feeding the new baby may lead to worsened or new hand and wrist symptoms.
Let your Ob/Gyn know as soon as symptoms begin. If we catch carpal tunnel early enough, we can start conservative treatments to reduce the risk of nerve damage or lingering symptoms.
After pregnancy, keep an eye on your wrist health. You'll be lifting your baby a lot and making repetitive motions, which can lead to tendinopathies related to overuse.
Even if your new aches and pains don't seem overtly pregnancy-related, let your Ob/Gyn know. Pregnancy does strange things to the body, and your provider can help you find relief from painful or annoying symptoms.
To visit with an Ob/Gyn, call 214-645-8300 or request an appointment online.
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How to diagnose carpal tunnel syndrome
How to diagnose carpal tunnel syndrome - advice from a neurologistRecord 24/7
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How to Diagnose Carpal Tunnel Syndrome (Carpal Tunnel Syndrome) : Carpal Tunnel Syndrome (Carpal Tunnel Syndrome) is a neurological disorder that causes prolonged pain and numbness in the fingers. Primary diagnosis of carpal tunnel syndrome (carpal tunnel syndrome) will require electroneuromyography (ENMG) and subsequent consultation with a neurologist. As an additional examination, the doctor may prescribe:
- Wrist MRI,
- Nerve conduction study.
Which doctor treats carpal tunnel syndrome (carpal tunnel syndrome): If you have symptoms of carpal tunnel syndrome (carpal tunnel syndrome), you should first consult a neurologist, based on the results of the initial examination, the doctor may prescribe an additional consultation with an orthopedic traumatologist.
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Carpal tunnel syndrome is caused by pressure on the median nerve. The carpal tunnel is a narrow passage surrounded by bones and ligaments. When it is compressed, the median nerve is pinched, as a result of which the palm becomes numb, loses functionality, and a tingling sensation occurs. The syndrome appears due to prolonged stress on the hand, the anatomical features of the wrist, as well as other health problems. In the conditions of modern medicine, the problem can be successfully diagnosed and treated.
Carpal tunnel symptoms
Tingling and numbness. In the initial stages, the symptoms appear in the fingers. The sensations are comparable to light electric shocks. Further, they extend to the wrist and the entire arm as a whole. Warming up the hands helps to relieve discomfort for a while, but after a while it returns again.
Weakness. Carpal tunnel syndrome results in a pinched thumb muscle. Because of this, the hand becomes noticeably weaker.
Which doctor diagnoses carpal tunnel syndrome
It is necessary to consult a neurologist in case of any manifestations of the disease. Medical attention is especially important if you are unable to sleep properly or cope with daily tasks due to pain. If the problem is not treated, it leads to irreversible damage to the muscles and nerves.
Causes
Carpal tunnel syndrome is caused by pressure on the median nerve, which runs from the forearm to the hand and controls the movement of the thumb, index, middle and ring fingers. nine0004
There are several factors that contribute to the onset of the disease. These include fractures/dislocations of the wrist, as well as swelling and inflammation caused by rheumatoid arthritis. In most cases, the disease occurs due to a number of reasons, which can be diagnosed only after a detailed examination.
Risk factors
Factors that increase the risk of damage to the median nerve are not direct causes of the disease. They only contribute to its rapid development. These include:
Anatomical features of the upper limbs. Carpal tunnel deformity can occur due to fractures, dislocations, or arthritis. As a result, the median nerve is pinched.
Pos. The problem is more common among women. This is due to the anatomy of the carpal tunnel, the lumen of which is much narrower than in men.
Chronic diseases. Diabetes, kidney/liver failure, and thyroid disorders greatly increase the chance of median nerve injury. Also, risk factors include diseases associated with serious metabolic disorders. nine0004
Inflammation. Rheumatoid arthritis and other inflammatory diseases irritate the lining of the carpal tendons, resulting in the development of the syndrome.
Medicines. Numerous studies have proven a link between carpal tunnel syndrome and the use of anastrozole, a drug used to treat breast cancer.
Obesity. Excess weight, which has arisen as a result of metabolic disorders, has a negative effect on the joints as a whole. nine0004
Fluid stagnation. Excess fluid in the body increases pressure in the carpal tunnel, irritating the median nerve. This is usually experienced by women during pregnancy or menopause.
The disease often develops due to the specific working conditions of a person. For example, carpal tunnel syndrome often affects people working with vibration tools. Wrist overload occurs due to prolonged repeated bending of the hand in production, while driving a car, and so on. nine0004
There is also an opinion that office workers often face a similar problem. Prolonged use of a computer mouse, writing instruments, and electronic gadgets can lead to wrist pain.
Diagnosis of carpal tunnel syndrome
To make a diagnosis, a neurologist will perform a complete neurological examination:
- Identify symptoms. First of all, the doctor will check the sensitivity of the fingers and establish the localization of numbness / tingling. He will also ask you about what factors contribute to the pain in the hand. It can occur due to long driving, lifting heavy objects, and so on. nine0013
- Visual inspection. The neurologist will ask you to bend your wrist in different positions, and also perform light taps and pressure on the nerve.
- MRI of the wrist joint. This type of study will help to exclude / confirm the fact of injury. It is impossible to diagnose carpal tunnel syndrome directly with the help of tomography, but it will be possible to assess the places of compression of the median nerve, which makes it possible to establish the localization of damage. nine0022 Electromyography. This is a method for assessing the functional state of peripheral nerves. During the study, certain parts of the muscles are exposed to small electrodes. They send weak discharges that cause muscle contraction. As a result, the doctor easily determines spasmodic places that compress the median nerve.
- Nerve conduction study. This is another form of electromyography in which weak electrical signals are sent through the median nerve. During the study, the specialist monitors the deceleration of electrical impulses, indicating the presence of carpal tunnel syndrome. nine0013
Treatment
The treating neurologist will determine the best treatment based on:
- age
- general health and medical history
- neglect situation
- drug tolerance.
Treatment may include:
- splinting of the arm. This keeps the wrist immobile and eases pressure on the nerve inside the tunnel
- anti-inflammatory drugs. Reduce swelling
- surgery. Relieves nerve compression in the carpal tunnel
- workplace changes. Changing the position of the computer keyboard or other ergonomic changes relieve symptoms
- exercises. Stretching and strengthening exercises relieve tension and improve condition
Author: Bogatov Nikita Dmitrievich
Specialization: Manual therapy, Osteopath
Where does the reception: MRI Center and Clinic Riorit, Clinic Intentro
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Where does the reception: MC Riorit
Levina Ekaterina Olegovna
Specialization: Neurologist
Medical experience: since 1998
Where does the appointment: Clinic Dr. Pelya
Obukhov Andrey Vasilyevich
Specialization: Neurologist, Manual Therapy, Osteopath
Medical experience: from 1995 years old
Place of admission: Clinic of Dr. Pel, Medical Center Express
Revtovich Anton Arkadyevich
Specialization: Neurologist
Medical experience: since 2010
Where does the appointment: Clinic of Dr. Pel, Clinic for Bioacoustic Correction on Moskovskaya
References:
- Bogov, A.A. Carpal tunnel syndrome / A.A. Bogov, R.F. Masgutov, I.G. Khannanova, A.R. Gallyamov, R.I. Mullin, V.G. Topyrkin, I.F. Akhtyamov // Practical medicine. - 2014. - V. 4-2, No. 80. - S. 35-40. nine0013
- Gnezditsky, V.V. Vegetative evoked potentials of the brain: basics of the method, clinical application / V.V. Gnezditsky, A.V. Chatskaya, O.S. Korepin - M: 2017. -111 p.
- Nikolaev, S. G. Workshop on clinical electroneuromyography / S. G. Nikolaev - Ivanovo, 2003. - 264 p.
- Savitskaya, N.G. Electroneuromyography in the diagnosis of carpal tunnel syndrome / N.G. Savitskaya, E.V. Pavlov, N.I. Shcherbakova, D.S. Yankevich // Annals of Clinical and Experimental Neurology. - 2011. - V. 5, No. 2. - S. 40-44. nine0013
- Vershinin, A.V. The method of surgical treatment of carpal tunnel syndrome using / A.V. Vershinin, A.O. Gushcha, S.O. Arestov, D.M. Nizametdinova // Annals of Clinical and Experimental Neurology. - 2017. - T. 11, No. 3. - S. 41-47.
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Pregnant carpal tunnel syndrome
02/26/2020
At the end of the second trimester of pregnancy many women suffer from hand numbness. Around the 26th week there is tingling, numbness and pain in the fingers, sometimes extending to the shoulder. This is carpal tunnel syndrome, which in pregnant women is associated with hormonal changes and water retention in the body. nine0004
As a result of stagnant fluid, compression of the nerves in the wrist reaches the fingers. The symptoms are worse especially at night. The pain can be so severe that it can wake the woman up or prevent her from getting a good night's sleep. Although carpal tunnel syndrome is a problem, it usually resolves spontaneously 2-3 weeks after delivery .
How to deal with hand numbness in pregnant women?
A woman with carpal tunnel syndrome should avoid a position that causes pressure on the arm. Sometimes symptoms come from shaking the numb limb or placing it below the heart line (eg on the knee) or loosely lowering the arm (also during sleep).
People who have symptoms of carpal tunnel syndrome should stop tasks that require repeating the same finger and hand movements. They include working on a computer (writing, graphic design), working on a production line, as well as embroidery, crocheting, or even peeling fruits and vegetables. nine0004
If it is not possible to completely eliminate these responsibilities, you should schedule frequent breaks. When working on a computer, you can take care of special pillows and ergonomic keyboards that will facilitate the correct positioning of the hand. The position of our body is also important for proper circulation. Avoid crossing legs and cross-legged position when sitting for a long time. It is better to rest with legs up .
Proper diet
Diet , rich in magnesium and vitamin B6, is helpful in preventing and relieving symptoms of carpal tunnel syndrome. It is worth taking care of a variety of dishes based on poultry, fish, potatoes and milk. Other sources of vitamin B6 include nuts, beans, soybeans, avocados, sunflower seeds, eggs, and bananas. Magnesium deficiency can be supplemented by such foods: parsley, pumpkin seeds, dill, dark chocolate, buckwheat or cocoa.
A woman should also reduce her intake of salt, coffee and tea (not to mention smoking and alcohol!). They flush minerals out of the body, making it difficult to prevent carpal tunnel syndrome .