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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

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.

Carpal tunnel syndrome and pregnancy

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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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Swelling during pregnancy

Need more information?

Carpal tunnel syndrome - MyDr.com.au

Carpal tunnel syndrome is a progressive and painful condition where the median nerve is compressed as it passes through the carpal tunnel.

Carpal tunnel syndrome

Carpal tunnel syndrome is a disorder of the hand caused by pressure on the median nerve as it runs through the wrist.

Carpal tunnel syndrome - Better Health Channel

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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.

Why fingers hurt during pregnancy: reasons for what to do
Complaints that fingers hurt during pregnancy appear in a large number of women in the "position". The situation is associated with the restructuring of the female body to meet the needs of the embryo, creating the most comfortable conditions for intrauterine development. In the process of adaptation, hormonal changes begin, the load on all parts of the body increases.

Why do my fingers hurt during pregnancy?
The smallest joints are located on the fingers, and during pregnancy they are affected by a lack of many nutrients. So, a lack of calcium, together with an excess of the hormone relaxin, leads to pain in the area of the hands. Often this situation occurs after sleep, when the hands become somewhat swollen.
As the fetus grows, the load on the body gradually increases, so the pain syndrome is more often observed in the later stages, from the second or third trimester. A set of body weight by a woman and the appearance of an edematous reaction provokes squeezing of the tubes with nerves connecting the hand to the fingers. Thus, the functionality of the nerve endings is disrupted, there is a feeling that the fingers hurt during pregnancy.

In addition to pain, other symptoms may be observed:

there may be some weakness when the fingers are bent;

trembling and slight tingling;

numbness of the hand or fingers;

"shooting" pain from the elbow joint to the hand.

Less often, the joints in the hands hurt due to the development of pathological processes. In this case, diseases such as osteochondrosis, osteomalacia, arthrosis or arthritis can be diagnosed, which affect the condition of the bones and lead to pinching of the nerve processes.
Fingers can also hurt as a result of various sprains or previous injuries. Cardiovascular abnormalities provoke aching pain syndrome only in the left hand. Pathology manifests itself after a strong emotional stress or stress. In this case, you will need to consult a cardiologist to make an accurate diagnosis.

When answering the question why fingers hurt during pregnancy, one should proceed from the fact that gestation is accompanied, first of all, with a colossal burden on the female body. Therefore, this kind of pain does not require special treatment, while after the birth of a child, all systems return to normal on their own.

What should I do if my hands hurt during pregnancy?
At the stage of 9 months of gestation, doctors rarely prescribe any medications. If the hands hurt as a result of the formation of a pathology or a serious illness, sparing safe medicines can be used.
Most often, complex treatment is used to compensate for the lack of vitamins D, B6 and calcium. In chronic diseases, non-steroidal anti-inflammatory drugs, hormones and salicylates are used.

To reduce pain in the fingers, under the influence of a physiological factor, it is necessary to slightly change the daily lifestyle:

daily diet should include a lot of fermented milk products and fiber;

try not to gain excess body weight during pregnancy;

monotonous manual work should be kept to a minimum;

avoid lifting heavy weights, so as not to provoke sensations of pain in the joints;

to refuse from bad habits.

To relieve pain from the fingers, you need to use special exercises that will improve blood flow and restore the cartilaginous structure of the joints. When performing gymnastics, sudden movements and straining should be avoided, all exercises are carried out in a slow rhythm.
Folk methods of external use with the use of medicinal herbs will help reduce pain.
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