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Pregnancy Induced Thumb And Wrist Pain

by Louise McQuaid

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23

October

Pregnancy induced thumb tendonitis and Carpal Tunnel Syndrome cane make it difficult to care for your baby

Why Now?

Hormone changes during pregnancy change how tendons and ligaments stretch and react to movement. This is obviously a good thing for pushing out a baby but not so good for thumbs and wrists. They can suffer as a result of this change and develop conditions which linger on after delivery.

The most common conditions are called Carpal Tunnel Syndrome (CTS) and De-Quervain's tendonitis.

Carpal Tunnel Syndrome

If you have tingling, numb and painful hands during pregnancy, it's likely to be caused by (CTS).  

CTS is common in pregnancy. It happens when there is a build-up of fluid (oedema) in the tissues in your wrist. This swelling squeezes a nerve, called the median nerve, that runs down to your hand and fingers, causing tingling and numbness. You may also find your grip is weaker and it's harder to move your fingers. 

CTS usually happens in your second trimester or third trimester. If you have CTS in one pregnancy, you are likely to have it in later pregnancies. CTS can also continue, or develop, in the days after the birth of your baby. 

CTS will be worse in your dominant hand and in the first and middle fingers, though it may affect your whole hand. It may be particularly painful when you wake up in the morning, because your hands have been curled up at night. 

You're more likely to develop CTS if your family has a history of it, and if you've had any problems with your back, neck or shoulders. The median nerve passes the top of your ribcage before travelling down your arm. So a previous problem in this area, such as a broken collar bone or whiplash injury, increases your likelihood of having CTS.

If you gain too much weight in pregnancy you're more likely to develop CTS.

Signs and symptoms:

• Pins and needles in the fingers that buzz when you rest 
  
• Numbness in the fingers making it hard to feel seat belt buckles, or nappy tags
  
• Achy hands that can wake you up at night and make it difficult to night feed
  
• Difficulty finding a comfortable position to nurse the baby
  
• Pain and symptoms get worse if spoon feeding the baby in a high chair
  

De-Quervain's Tendonitis

In De Quervain's tenosynovitis, the covering of the tendons on the thumb side of the wrist becomes inflamed or swollen, restricting the tendons' movement. The result is discomfort and pain at the base of the thumb and wrist every time you turn your wrist, grasp anything or make a fist.

It is suspected that retention of fluid during pregnancy initially causes this problem, and symptoms generally start quite mild. It is frequently aggravated by activities of infant care and housework causing it to linger and, often, make it worse. In some cases it can be so painful that hand movements are restricted.

Improvement usually occurs with conservative management, and it is best to see a Hand Therapist early on to commence treatment. It is rare for this condition to require surgical or other medical management.

Signs and symptoms:

• Pain, tenderness and swelling at base of the thumb and wrist .
  
• Pain that may radiate up your forearm and is worse changing nappies.
  
• Pain when you turn your wrist, grasp or make a fist which can lead to difficulties with picking up your baby, or holding your baby to settle.
  
• Difficulties picking up objects where thumb pressure is required e.g. picking up a plate of food or even peeling the tags on nappies.
  
• Folding a pram, bathing the baby and cooking e.g. peeling, stirring hurt 
  

What Mums say about these problems

Leanne McGill, Newry

I had tendonitis in my thumb and wrist from the way I fed the twins when I switched to bottles at five months. I had to wear a brace at night for 18 months before it finally healed. It would have healed faster if I could have worn the brace all day, but there was no way I could hold and change two infants like that and I had no help. I refused cortisone shots though. That might have helped. I went to see a Hand Therapist and I wish I went sooner. I had dry needling to kick start healing which had just stopped. My problem was getting worse because I was caring for babies that were growing and getting heavier.

Sharon Foster, Hilltown

I had pregnancy induced carpal tunnel in my right hand. I bought a brace to sleep in, I was supposed to wear it during the day but it drove me nuts. I had no feeling in my hand, which was super annoying as I am right handed- plus I couldn't grip anything at all including a pen. And because I couldn't feel my hand I couldn't even use nail clippers, I had no strength in my hand. After about 3 weeks I went to Hand therapist and got partial feeling in my hand but not my fingertips. I was honestly afraid I would never get full feeling back! But by 6 weeks my hand was pretty much back to normal. It was really a strange feeling!

Megan Harvey, Newcastle

I was diagnosed by my doctor with carpal tunnel and she gave me the braces. But then when I went to see a Hand therapist and when I explained my symptoms, she said it was tendonitis - not carpal tunnel. The pain was mostly in my forearm and I could not lift my wrists or do fine work - it definitely was worsened by use! Fortunately, she taped them up a certain way to basically not let them fall down even when the muscle was relaxed, she also told me to take some supplement - I can't remember which, maybe a B vitamin? - and that did the trick. I think it maybe came back once (while I was still pregnant) but was gone even before their birth! 

What can I do about it?

Rest

This is the most effective treatment but is nearly impossible with a baby. Try to avoid using your hands and wrists when you can, even if it means letting the house work slide for a short while.

Support the wrist

This is often recommended, to immobilise your thumb/wrist, and help rest your tendons or to reduce carpal tunnel pressure on the median nerve. Depending on your condition the type of splint needed is different so avoid buying one online or at the chemist. It is best to see a Hand therapist and have one made for you or at least get advice before purchasing one.

Modify your activities

• Avoid repetitive movements such as scrubbing the shower or using sustained positions such as nursing a baby in the same position each time.
  
• Carry things with a shoulder bag or over your forearms, not your hands
  
• Avoid over-gripping when opening jars or feeding bottles to wash them
  

Feeding position

• After your baby is born, try to use pillows to take the baby's weight off your hands when feeding or cuddling.
  
• Do not use your hand to support your baby's head; use your forearm instead.
  
• Alter your breast feeding position and try lying down to feed the baby 
  
• Try holding a feeding bottle by letting it rest in your palm rather than grasping it
  
• Stretch your wrists and arms before feeding and after feeding especially during the night
  

Housework and daily activities

Ask for help with food preparation, especially when using knives, etc. Remember you can buy pre-cut, pre-washed fruits and vegetables.

When brushing your teeth or your hair, try to move from your elbow instead of from your wrist.

Massage

Gentle massage might help ease some of the pain and reduce swelling. Use the heel of your unaffected hand to gently rub the upper half of your forearm where the muscles are. You can do this as often as you need.

If massage helps, ask your support person to do this for you, to help rest your hands.

Contrast bathing

If you have swelling this technique is very effective. Set up two bowls; fill one with very warm (NOT scalding) water and one with iced water. Bathe your hand/wrist in warm water for about 1 minute, then in cold water for about 30 seconds. Alternate between the two bowls for three minutes and finish with the cold water.

Pain relief medications

Check with your pharmacist or doctor about pain relief. If you are pregnant or breastfeeding or have a medical condition talk to your pharmacist or doctor before taking any medication, even herbal remedies.

Exercises

Try the following hand exercises, but do NOT continue if symptoms become worse:

• Hold your fingers stretched out as far as possible for a few seconds and then relax.
  
• Make a fist and then straighten out your fingers.
  
• Move your hands slowly up and down, from side to side, and round in a circle.
  
• A Hand therapist can prescribe further exercise (strengthening and mobility, nerve and tendon glides). 

At Hand Kinetics we use these and other treatments using therapeutic Ultrasound and Dry needling if required.

For More Information

Please contact Hand Kinetics to speak to our Principal Hand Therapist if you think you have one of these conditions.

There are many other conditions affecting the hand and wrist caused by changes in pregnancy hormones that have not been talked about here.

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Hands hurt during pregnancy

Carpal tunnel syndrome: characteristic symptoms

Pain occurs, as already mentioned, due to compression of the median nerve, so the most innervation is carried out not by the median nerve, but by the outgoing branches of the ulnar nerve), wrist, palmar surface of the hand.

The period characteristic for the manifestation of this disease, when the wrist of the left hand most often hurts, is the 3rd trimester of pregnancy.

The nature of the discomfort is determined by the fact that the hands and wrists hurt, swell and go numb during pregnancy, sometimes trembling of the fingers may be present.

In addition to the above, vasoconstriction, increased sensitivity of the hands to cold, and pallor of the skin are added. Most often, the disease manifests itself at night, but symptoms can also be observed during the day.

If pain occurs in the little finger or on the back of the hand, then this indicates the presence of another disease, since these parts of the hand have a different innervation.

Often the syndrome resolves after labor. A woman's normal, prenatal metabolism is restored. . However, if the disease persists, then you need to contact a hematologist (nephrologist, neuropathologist, cardiologist) to prescribe drug therapy. Physiotherapy also helps to avoid the frequent occurrence of pain.

If the situation does not improve, then surgical treatment must be applied.

Cause of pain

So, why do hands hurt during pregnancy? As a rule, during this period, a woman begins to gain weight, which is the physiological norm for this condition. However, after weight gain, edema may appear, indicating a violation of the water-salt metabolism in the body. Here, a woman may complain that her joints of the hands hurt during pregnancy. Along with the violation of water-salt metabolism, there is a decrease in blood flow.

Innervation changes due to nerve compression. Due to the current situation, the nerve cannot conduct nerve impulses normally, and this, in turn, leads to a lack of impulses in the wrist and hand area.

Most often, women who suffer from kidney and heart problems, as well as overweight, rheumatic diseases, and fractures in the area of ​​the hands suffer from diseases. Pregnant women also have reduced immunity, so most often they have exacerbated chronic diseases.

The hands are the most painful, since everything has to be done with the hands. In addition to numbness, pain, in the hands there may be sensations such as: hand tremor; the appearance of heaviness in the hands; feeling of weakness in the fingers; itching in the palms.

Many women are forced to remove jewelry from their fingers and hands due to severe discomfort and pain.

How to get rid of the disease

If you are still overtaken by this disease, first you need to adjust your lifestyle and diet.

Taking into account the fact that the body of a pregnant woman is undergoing restructuring, she needs the so-called "building materials". These include vitamins (especially vitamins K, B12, B6, C, E - they are all involved in hematopoiesis). Therefore, you should eat meat products (poultry), vegetables (peppers, onions, tomatoes, cucumbers), fruits (oranges, lemons, apples, bananas, kiwi), berries (blueberries, raspberries, strawberries), also legumes, dairy products. Flour products and foods rich in starch should be excluded from the diet.

After adjusting the diet, physical activity should be put in order. So, if you are busy with one thing, during which the woman does not particularly move, you need to periodically perform exercises for the hands: shake, make circular movements with the hands, squeeze and unclench your fingers several times, bringing them into a fist.

If possible, try to avoid unnecessary stress on the hands (lean less on the hands, use special splints during a night's sleep). Do not forget that some pain sensations are a sign of the presence of severe or chronic diseases, so you need to tell your doctor about these sensations, who observes you throughout your pregnancy. Compliance with all these rules will help you reduce pain, or even completely get rid of them. And also spend your difficult, but very happy nine months in a good mood.

Did you know that your joints soften during pregnancy?

Nausea, urinary incontinence and swollen legs. The body of a pregnant woman goes through a lot. But do you know why you get Pelvic Girdle Pain (PGP) and what you can do to prevent it?

During pregnancy, the female body is transformed. Hormones cause a series of changes in the body, preparing and allowing the child to endure.
One of these hormones is called relaxin. His job is to soften the joints, ligaments and connective tissue so that the pelvis becomes more flexible.

What we call Pelvic Girdle Pain (PGP) is necessary to allow the baby to pass through the birth canal.
For some pregnant women, increased joint mobility can lead to pain in the pelvis, hips, knees, and lower back.
Joint pain may appear early in pregnancy as relaxin is released when a woman becomes pregnant. But women with arthritis get better during pregnancy.

A condition where pain makes it difficult to walk, work, and participate in daily activities is called symptomatic PGP. In the last trimester of pregnancy, about 15% of Norwegian women experience pelvic pain, and PGP is the most common cause of disability in pregnant women.

Is there anything you can do to prevent this?
In order to support the joints and avoid excessive stress on them, the muscles of the abdomen, back and legs must work rationally. In order to prevent painful PGP, the work of the transverse abdominis muscle is especially important in the early stages of pregnancy, according to the Health Department.

You don't have to attend heavy gymnastics to develop these muscles. Here is a simple exercise you can do at home:
- Get on all fours if your pelvis can handle it. Pull your navel inward without moving your lower back. Hold for a few seconds, then relax. Repeat this exercise ten times, three times a day. But don't feel guilty if you didn't complete your task. You can always try again tomorrow!
- You can also do the same exercise while sitting in a chair: put one hand on the lower part of your stomach and the other on the lower back. Pull your navel inward and hold for a few seconds before relaxing. Make sure your lower back doesn't move.

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