Pregnancy carpal tunnel syndrome symptoms
Carpal Tunnel and Pregnancy: What’s the Connection?
Carpal Tunnel and Pregnancy: What’s the Connection?Medically reviewed by Holly Ernst, PA-C — By Donna Christiano on June 4, 2018
Carpal tunnel syndrome and pregnancy
Carpal tunnel syndrome (CTS) is commonly seen in pregnancy. CTS occurs in 4 percent of the general population, but occurs in 31 to 62 percent of pregnant women, estimates a 2015 study.
Experts aren’t exactly sure what makes CTS so common during pregnancy, but they do think hormone-related swelling may be the culprit. Just as fluid retention in pregnancy can cause your ankles and fingers to swell, it can also cause swelling that leads to CTS.
Read on to learn more about CTS in pregnancy.
What are the symptoms of carpal tunnel syndrome in pregnancy?
Common symptoms of CTS in pregnancy include:
- numbness and tingling (almost like a pins-and-needles feeling) in fingers, wrists, and hands, which may worsen at night
- throbbing sensation in hands, wrists, and fingers
- swollen fingers
- trouble gripping objects and problems performing fine motor skills, such as buttoning a shirt or working the clasp on a necklace
One or both hands may be affected. A 2012 study found that almost 50 percent of pregnant participants with CTS had it in both hands.
Symptoms may worsen as the pregnancy progresses. One study found 40 percent of participants reported the onset of CTS symptoms after 30 weeks of pregnancy. This is when the most weight gain and fluid retention occurs.
What cause carpal tunnel syndrome?
CTS occurs when the median nerve becomes compressed as it passes through the carpal tunnel in the wrist. The median nerve runs from the neck, down the arm, and to the wrist. This nerve controls feeling in the fingers.
The carpal tunnel is a narrow passageway made up of tiny “carpal” bones and ligaments. When the tunnel is narrowed by swelling, the nerve is compressed. This leads to pain in the hand and numbness or burning in the fingers.
Median nerve diagram
[BODY MAP IMBED: /human-body-maps/median-nerve]
Are some pregnant women at an increased risk?
Some pregnant women are more prone to develop CTS than others.
Here are some risk factors of CTS:
Being overweight or obese before becoming pregnant
It’s unclear if weight causes CTS, but pregnant women who are overweight or obese receive diagnoses with the condition more frequently than pregnant women who aren’t overweight or obese.
Having pregnancy-related diabetes or hypertension
Gestational diabetes and gestational hypertensioncan both lead to fluid retention and subsequent swelling. This, in turn, can increase the risk of CTS.
High blood sugar levels can also cause inflammation, including of the carpal tunnel. This may further increase the risk of CTS.
Past pregnancies
Relaxin may be seen in higher amounts in subsequent pregnancies. This hormone helps the pelvis and cervix expand during pregnancy in preparation for childbirth. It can also cause inflammation in the carpal tunnel, squeezing the median nerve.
How is CTS diagnosed in pregnancy?
CTS is most often diagnosed based on your description of symptoms to your doctor.
Your doctor may also conduct a physical exam.
During the physical exam, your doctor may use electrodiagnostic tests to confirm the diagnosis, if needed. Electrodiagnostic tests use thin needles or electrodes (wires taped to the skin) to record and analyze signals your nerves send and receive. Damage to the median nerve can slow down or block these electrical signals.
Your doctor may also use Tinel’s sign to identify nerve damage. This test can be done as part of a physical exam, too. During the test, your doctor will lightly tap over the area with the affected nerve. If you feel a tingling sensation, this can indicate nerve damage.
Tinel’s sign and electrodiagnostic tests are safe for use during pregnancy.
How to treat carpal tunnel syndrome in pregnancy
Most doctors recommend treating CTS conservatively in pregnancy. This is because many people will experience relief in the weeks and months after giving birth. In one study, only 1 out of 6 participants who had CTS during pregnancy still had symptoms 12 months after delivery.
You’re more likely to continue to experience CTS after delivery if your CTS symptoms began earlier in your pregnancy or if your symptoms are severe.
The following treatments may be safely used during pregnancy:
- Use a splint. Look for a brace that keeps your wrist in a neutral (not bent) position. When symptoms tend to be worse, wearing a brace at night may be particularly beneficial. If it’s practical, you can wear it during the day as well.
- Reduce activities that cause your wrist to bend. This includes typing on a keyboard.
- Use cold therapy. Apply ice wrapped in a towel to your wrist for about 10 minutes, several times a day, to help decrease swelling. You might also try what’s called a “contrast bath”: Soak your wrist in cold water for about one minute, then in warm water for another minute. Keep alternating for five to six minutes. Repeat as often as practical.
- Rest. Whenever you feel pain or fatigue in your wrist, rest it for a bit, or switch to a different activity.
- Elevate your wrists whenever you can. You can use pillows to do so.
- Practice yoga. Results from one study found that practicing yoga can reduce pain and increase grip strength in people with CTS. More research is needed, though, especially to understand the benefits for pregnancy-related CTS.
- Get physical therapy. Myofascial release therapy may reduce CTS-related pain and increase hand function. This is a type of massage to reduce tightness and shortness in ligaments and muscles.
- Take pain relievers. Using acetaminophen (Tylenol) at any point in pregnancy is generally considered safe, as long as you don’t exceed 3,000 mg daily. Talk to your doctor if you have concerns. Avoid ibuprofen (Advil) during pregnancy unless it’s specifically approved to use by your doctor. Ibuprofen has been linked to low amniotic fluid and a number of other conditions.
Carpal tunnel syndrome and breastfeeding
Breastfeeding may be painful with CTS because you’ll need to use your wrist to hold your baby’s head and your breast in the proper position for nursing.
Try experimenting with different positions. Use pillows and blankets to prop, support, or brace when needed.
You may find that breastfeeding while lying on your side with the baby facing you works well. The “football hold” may also be easier on the wrist. With this position, you sit upright and place your baby on the side of your arm with your baby’s head close to your torso.
You may prefer hands-free nursing, where your baby feeds while in a sling worn close to your body.
If you’re having trouble breastfeeding or finding a position that’s comfortable for you and your baby, consider talking to a lactation consultant. They can help you learn comfortable positions and can help identify any problems that you or your baby are having with nursing.
What’s the outlook?
CTS is common during pregnancy. Simple measures like splinting and taking acetaminophen are standard therapies and usually bring relief.
Most people will see their symptoms resolve within 12 months after delivery.
However, it can take years in some cases. Talk to your doctor about ways to safely manage your symptoms.
Last medically reviewed on June 4, 2018
- Parenthood
- Pregnancy
- Pregnancy Health
How we reviewed this article:
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- Carlson H, et al. (2010). Current options for nonsurgical management of carpal tunnel syndrome. DOI:
10.2217/IJR.09.63 - Carpal Tunnel Fact Sheet [Fact Sheet]. (2017).
ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Carpal-Tunnel-Syndrome-Fact-Sheet - Carpal tunnel syndrome. (2016).
orthoinfo.aaos.org/en/diseases--conditions/carpal-tunnel-syndrome/ - Carpal tunnel syndrome during pregnancy [Fact sheet].
(2015).
uhs.nhs.uk/Media/Controlleddocuments/Patientinformation/Pregnancyandbirth/Carpal-tunnel-syndrome-during-pregnancy-patient-information.PDF - Daluiski A, et al. (2009). Carpal tunnel syndrome: Myths, facts, diagnosis, and treatment.
hss.edu/conditions_carpal-tunnel-syndrome-myths-facts-diagnosis-treatment.asp - Hamoda R. (2014). Effect of myofascial release on carpal tunnel syndrome during pregnancy.
scholar.cu.edu.eg/?q=reham_hamoda/publications/effect-myofascial-release-carpal-tunnel-syndrome-during-pregnancy - Hashempur MH, et al. (2015). Carpal tunnel syndrome in lactation: A challenging issue. DOI:
10.17795/whb-31414 - Khosrawi S, et al. (2012). The prevalence and severity of carpal tunnel syndrome during pregnancy. DOI:
10.4103/2277-9175.100143 - Meems M, et al. (2015). Prevalence, course and determinants of carpal tunnel syndrome symptoms during pregnancy: A prospective study.
DOI:
10.1111/1471-0528.13360 - Meems M, et al. (2017). Follow-up of pregnancy-related carpal tunnel syndrome symptoms at 12 months postpartum: A prospective study. DOI:
10.1016/j.ejogrb.2017.02.030 - Viera AJ. (2003). Management of carpal tunnel syndrome.
aafp.org/afp/2003/0715/p265.html - Wright C, et al. (2014). Who develops carpal tunnel syndrome during pregnancy: An analysis of obesity, gestational weight gain, and parity. DOI:
10.1177/1753495X14523407
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Medically reviewed by Holly Ernst, PA-C — By Donna Christiano on June 4, 2018
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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
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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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. Surgical intervention consists in excising the tissue that puts pressure on the median nerve.
