Excruciating carpal tunnel during pregnancy

Carpal tunnel syndrome and pregnancy go hand in hand | Your Pregnancy Matters

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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 Kumar

When 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.

Tips to Deal with Pregnancy Carpal Tunnel Syndrome

The carpal tunnel is quite literally a tunnel — a packed fibro-osseous tunnel — located on the palm side of the wrist. Normal pressures in this tunnel are 20-30 mmHg. The median nerve, which runs down the length of your arm, passes through the carpal tunnel to your palm side. The median nerve is responsible for controlling sensation and movement in the thumb and first three fingers.

When the median nerve becomes chronically compressed, this first will result in demyelination and eventually in axonal death, which will lead to tingling, numbness, and pain in the thumb, index, middle, and ring fingers. This is carpal tunnel syndrome.

Carpal tunnel syndrome occurs when there is swelling or a buildup of fluid in the wrist. It is often associated with professions that require repetitive movement of the wrist, or strong grips, such as computer workers, mechanics, assembly line workers, musicians, painters, and gardeners.

Since swelling and water retention are incredibly common during pregnancy, so are conditions like carpal tunnel syndrome, may occur as a result of swelling.

Not sure whether the symptoms you’re experiencing are due to CTS? These are the most common signs and symptoms of CTS, experienced in most cases from week 30 and on of pregnancy.

Tingling or numbness in part of the hand (thumb, index, middle, and ring fingers)
Throbbing or burning sensation in the hands, wrists, and fingers
Stiffness or cramping of hands, especially in the morning
Thumb weakness
Trouble gripping objects or performing tasks such as opening jars or buttoning a shirt.

CTS is usually worse in your dominant hand, and in more than half of pregnancy carpal tunnel syndrome cases, it occurs in both hands.

Some women are more likely to develop CTS during pregnancy than others. They include:

Women who were overweight or obese before pregnancy
Women carrying multiples
Women with gestational diabetes or gestational hypertension
Women who have experienced CTS in past pregnancies.

While carpal tunnel syndrome may cause a lot of discomfort, it is usually not a serious condition. In most cases, it resolves within 3 months after birth once swelling has subsided and hormone levels have returned to normal.

Between carpal tunnel syndrome and pregnancy in general, it can be difficult to get a good night's sleep. Normal daily tasks will suddenly seem impossible to accomplish due to the exhaustion, discomfort, and pain you’re experiencing.

We’re right there with you, mama-to-be! Here are a few things you can do that are safe during pregnancy for carpal tunnel relief.

Reduce your sodium intake

If you’re looking to reduce swelling in the body, the first place to start is by reducing your intake of salt. Sodium is quickly absorbed by cells, and it draws water in with it, causing water retention.

Cut down on the amount of salt you eat and increase your water intake and you’ll probably see a big difference quickly.

Wear a splint while you sleep and during the day if possible

While you sleep, you may not notice how your hands fold, flop, or get twisted into awkward positions until you wake up in pain. A splint will help to keep your hand in a neutral position so that you don’t end up putting pressure on your carpal tunnel.

Avoid repetitive motions

Find new ways to perform daily tasks that require repetitive motions by using your forearms or body weight to put power behind a movement, instead of using just your wrist. If your job requires a lot of typing, consider dictating instead.

Practice good posture

Your changing body can cause you to unknowingly sit, stand, and move in unnatural and awkward ways. Make sure that your neck and shoulders are not curved, causing added pressure on the median nerve.

These tried and true CTS treatments can help to ward away and keep away symptoms of pregnancy carpel tunnel.

Massage

You can perform massage on yourself, have your partner help you, or visit a professional massage therapist for pregnancy carpal tunnel relief.

Start from the inner fold of your elbow and work your way down toward your wrist. Use your thumb and apply firm pressure, moving in a circular motion all around your wrist, then work your way back up your arm again.

Exercise and stretching

Stretches are a great way to relieve CTS pain. Do them once an hour, especially if you have a profession that requires you to do repetitive motions or sustained positions with your hands.

Warm up. Make a firm fist with your hand, then stretch out your fingers as far apart as you can. Hold for 5 seconds and repeat 4 times.

Prayer stretch. Start with your palms together right in front of your chest. Lower your hands, keeping them together until you begin to feel a stretch. Hold the position for 20 seconds and repeat 3 times.

Traffic stop stretch. Hold your arm straight out in front of you with your palm facing out as if you were stopping traffic. Using your other hand, pull back on your fingers as if trying to bend them back toward your forearm. Hold for 15 seconds and repeat 3 times.

Physical therapy

If your CTS is affecting your daily functioning, it may be time to seek help from a doctor or physical therapist. A physical therapist will assess you, show you stretches and exercises to do, and will make sure that you’re doing them right.

Conservative treatment can include corticosteroid injection of the carpal syndrome. Surgical release of the carpal tunnel is a widely accepted treatment, particularly for fixed sensory loss, thenar weakness, or intolerable symptoms with no improvement after splinting and /or glucocorticoids.

Pain relievers

Avoid ibuprofen, as it has been linked to severe pregnancy complications. If you have any concerns or questions about what medications are safe to take during pregnancy, consult your doctor.

Carpal tunnel syndrome and breastfeeding

Breastfeeding is way more physically demanding than it looks. Most breastfeeding moms experience neck, shoulder, and back pain, and with carpal tunnel syndrome, it can get even worse.

Instead of holding your baby with your hands, experiment with different positions and prop your baby up using nursing pillows, couch pillows, and blankets and pillows to support yourself as well.

Try switching up how you position and hold your baby each time you breastfeed to avoid repeated and sustained postures that could put pressure on your wrist. Try nursing lying down with baby facing you.

If you’re really struggling, make an appointment with a lactation consultant. She can help you find positions that work for both you and your baby.

Takeaways

Carpal tunnel syndrome can be anything from mildly annoying to severely painful. To keep swelling down during pregnancy, eat a healthy diet with plenty of fruits and vegetables, whole grains, fatty fish, and low-fat dairy products. Avoid eating too much sodium, which can increase swelling and inflammation. Regular exercise and stretching are excellent ways to keep chronic pain and discomfort at bay.

If you are experiencing severe pain, visit your doctor as soon as possible.

Carpal tunnel syndrome in pregnant women

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.

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 and usually resolves spontaneously 2-3 weeks after deliveries .

How to deal with hand numbness in pregnant women?

A woman with carpal tunnel syndrome should avoid positions that cause pressure on her 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.

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 Crossbreeding feet and cross-legged position for prolonged sitting. It is better to rest with your legs up .

Proper Diet

Diet , rich in magnesium and vitamin B6, is useful 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 out minerals from the body, making it difficult to prevent carpal tunnel syndrome .

When should I consult a doctor?

Although hand numbness is a common disorder in pregnant women, sometimes home remedies to reduce symptoms do not help. When the pain gets worse, there are problems with normal functioning or holding objects in the hands, it is worth contacting to doctor . It may be that this will require an increase in vitamin intake or taking painkillers (pregnant women are better off avoiding self-diagnosis and treatment in this regard).

Sometimes it may be necessary to immobilize the wrist with special devices or visit a specialist, namely orthopedist , neurologist or physiotherapist .

Published in Pregnancy and Pregnancy Management Premium Clinic

Carpal tunnel syndrome - treatment, symptoms, causes, diagnosis

Karpal - this word comes from the Greek Karpos, which means "wrist". The wrist is surrounded by bundles of fibrous tissue, which normally performs a supporting function for the joint. The confined space between these fibrous bands of fibrous tissue and the bony structures of the wrist is called the carpal tunnel. The median nerve, which runs through the wrist, provides sensation to the thumb, index, and middle fingers. Any condition that causes swelling or repositioning of tissues in the wrist can compress and irritate the median nerve. Irritation of the median nerve, in such cases, results in tingling and numbness of the thumb, index, and middle fingers, a condition known as "carpal tunnel syndrome."

Causes of Carpal Tunnel Syndrome

Given the limited space of the carpal tunnel, any swelling in this area can put pressure on the median nerve, causing the symptoms of carpal tunnel syndrome. There are many different causes leading to the development of this syndrome, but often the exact cause cannot be determined. Some people initially have an anatomically narrower carpal tunnel, which makes them more at risk of developing carpal tunnel syndrome. It is believed that this tendency can be genetically determined, and if there are cases of this syndrome in the family, then the likelihood of pressure on the median nerve increases significantly. You are also more likely to develop carpal tunnel syndrome if you are overweight, smoke, or drink too much alcohol. The same risk factor is age - the older the person, the higher the likelihood of developing carpal tunnel syndrome. Women are more prone to this syndrome than men due to the narrower carpal tunnel. There is also a greater tendency to develop carpal tunnel syndrome if there was a wrist injury (rupture or sprain) or there are diseases such as:

diabetes mellitus

osteoarthritis

rheumatoid arthritis

hypothyroidism

It is possible that hormones play a role in the development of carpal tunnel syndrome, as some women develop the syndrome during pregnancy or menopause. Hormones produced during pregnancy can lead to fluid retention, which in turn can cause swelling in the wrist. It is noted that the performance of certain activities can lead to the development of this syndrome. People who do a lot of heavy manual work or repetitive wrist movements, such as on an assembly line or working with their hands in cold temperatures, are also at greater risk of developing carpal tunnel syndrome. But the probability increases significantly if the load is combined with the presence of systemic diseases.

Symptoms of carpal tunnel syndrome

Patients with carpal tunnel syndrome initially feel numbness and tingling in the hand along the median nerve innervation (thumb, index, middle, and part of the fourth fingers). These sensations are often more pronounced at night and may even lead to awakening from sleep. The reason for the worsening of symptoms at night may be due to the flexed position of the wrist during sleep and / or the accumulation of fluid around the wrist and hand while it is in a horizontal position. Carpal tunnel syndrome may be a temporary condition that resolves completely on its own, or symptoms may persist and progress.

As the syndrome progresses, patients may develop a burning sensation and/or spasms and hand weakness. Decreased grip strength can cause objects to fall out of the hand frequently. Sometimes sharp shooting pains can also be felt in the forearm. Chronic carpal tunnel syndrome can also lead to muscle atrophy in the hand, especially the muscles at the base of the thumb on the palmar surface.

Diagnosis

Carpal tunnel syndrome can be diagnosed based on the symptoms and characteristic areas of numbness in the hand. But at the same time, it is often necessary to exclude other possible causes of symptoms that mimic carpal tunnel syndrome. It could be neck, shoulder or elbow problems. The doctor examines the wrist to detect swelling, local temperature increase, tenderness, and discoloration. Sometimes pressing on the front of the wrist can produce a tingling sensation in the hand and is called the Tinel sign, which is characteristic of carpal tunnel syndrome. Symptoms can also be reproduced from time to time with forward flexion of the wrist (called the Phalen symptom). The final diagnosis can be made with ENMG. As a rule, with carpal tunnel syndrome, there is a slowdown in the conduction of a nerve impulse after the nerve passes through the wrist.

Testing of limb muscles, an electromyogram, is sometimes done to rule out or detect other conditions that may mimic carpal tunnel syndrome.

Laboratory tests may be performed in order to diagnose conditions associated with carpal tunnel. These tests include thyroid hormone testing, complete blood counts, blood sugar levels, etc. An x-ray of the hand may also be ordered to check for bony changes (abnormalities in the bones and joints of the wrist). MRI is necessary in cases where it is necessary to visualize changes in ligaments, cartilage.

Treatments for carpal tunnel syndrome

The choice of treatment for carpal tunnel syndrome depends on the severity of the symptoms and the underlying disease that may be causing the symptoms.

In the first stage, treatment usually includes rest, immobilization of the wrist in a brace, and sometimes local cold. If the patient's profession is associated with a load on the wrist, then it is necessary to change activities for a while. In addition, it is possible to improve the ergonomics of the workplace, for example, you can adjust the computer keyboard and chair height and optimize the load on the hands. These measures, along with occasional periods of rest and wrist stretching, can actually prevent the symptoms of carpal tunnel syndrome, which are caused by repetitive excessive motion of the wrist, from developing. If there are systemic diseases or injuries, then individual treatment of these diseases is carried out. In case of fractures, orthopedic correction (gypsum, orthosis) may be required. Overweight patients should be advised to reduce weight. In rheumatoid arthritis, specific treatment of the inflammatory autoimmune process is carried out. Swelling of the wrist, which may be associated with pregnancy, disappears after the birth of the child.

Medications

Several types of medications can be used to treat carpal tunnel syndrome. Vitamin B6 (pyridoxine) is often prescribed in the treatment of carpal tunnel syndrome, and although the mechanism of therapeutic action is not entirely clear, nevertheless, many doctors note a certain effect of using this drug. Non-steroidal anti-inflammatory drugs may also be helpful in reducing inflammation and reducing pain. But these drugs have side effects and therefore it is necessary to take this into account when prescribing them. Corticosteroids may also be used. They can be given orally or by injection into the affected wrist joint. Corticosteroids can lead to a rapid improvement in symptoms, but the side effects of these drugs prevent their use for a long time and in the presence of certain conditions (for example, in diabetes mellitus, their use may lead to a worsening of the condition). They should also not be used in the presence of infections. In addition to drug treatment, physiotherapy and acupuncture also provide a certain therapeutic effect. Most patients with carpal tunnel syndrome can be treated with conservative therapy. But sometimes chronic pressure on the median nerve can lead to permanent numbness and weakness. In order to avoid serious and permanent nerve and muscle damage, surgical treatment may be recommended in such cases.
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