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Pregnancy: Carpal Tunnel Syndrome | Kaiser Permanente

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Overview

Tingling, numbness, and pain in the hands are common during pregnancy, especially in the last trimester. These problems are usually caused by carpal tunnel syndrome, and they usually go away after pregnancy.

Carpal tunnel syndrome is a specific group of symptoms that can include tingling, numbness, weakness, or pain in the fingers, thumb, hand, and occasionally in the arm. These symptoms occur when there is pressure on the median nerve within the wrist.

The carpal tunnel is a small space or "tunnel" in the wrist formed by the wrist bones (carpal bones) and a ligament (transverse carpal ligament). The median nerve and several tendons pass through the carpal tunnel from the forearm to the hand. The median nerve controls some movements of the thumb, and this nerve supplies feeling to most of the thumb and to the index finger, middle finger, and part of the ring finger.

Carpal tunnel syndrome occurs when a combination of health conditions and activities puts pressure on the median nerve as it passes through the carpal tunnel in your wrist. Anything that decreases the amount of space in the carpal tunnel, increases the amount of tissue in the tunnel, or increases the sensitivity of the median nerve can lead to carpal tunnel syndrome.

The swelling that is common in pregnancy can crowd structures in the tunnel and lead to carpal tunnel syndrome, especially when combined with forceful or repetitive hand and finger movement or the use of vibrating equipment.

If your symptoms are not severe, expect your health professional to recommend nonsurgical treatment to see whether symptoms improve. Nonsurgical treatment includes:

• Changing or avoiding activities that may be causing symptoms, and taking frequent breaks from repetitive tasks.
• Wearing a wrist splint to keep your wrist straight, usually just at night. See an illustration of a wrist splint.
• Doing exercises to stretch and strengthen the muscles in the hand and arm.
• Learning ways to protect your joints as you go through your daily activities.

Unless carpal tunnel symptoms become intolerable, a pregnant woman should delay surgery until after childbirth. After delivery, symptoms often disappear without treatment when pregnancy-related fluid buildup is relieved.

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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. nine0005

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. nine0005

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. nine0005

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. nine0005

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. nine0005

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. nine0005

Pain in the pubic region during pregnancy

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The pubic bone is one of the three bones that make up the pelvic bone. Two pubic bones, forming the pubic articulation (symphysis), form the anterior wall of the pelvis. The pubic bone in women with a regular physique has the form of a roller about the thickness of the thumb, which is curved and forms a pubic eminence. This bone hangs in a kind of arch over the entrance to the vagina. nine0005

The main cause of pain in the pubic bone is the divergence and increased mobility of the pubic symphysis. To refer to pathological changes in the pubic symphysis of the pelvis during pregnancy and after childbirth, the following terms are used: symphysiopathy, symphysitis, arthropathy of pregnant women, divergence and rupture of the pubic symphysis, dysfunction of the pubic symphysis. The most commonly used terms are "symphysitis" or "symphysiopathy".

So, symphysiopathy is a disease associated with a pronounced softening of the pubic joint under the influence of the hormone relaxin, which is produced during pregnancy. The process of softening the interosseous joints is natural, it helps the child to pass more easily through the bone pelvis during childbirth. The diagnosis of "symphysiopathy" is made when severe pain appears, the pubic joint swells, greatly stretches, becomes mobile, and the pubic bones diverge excessively. One of the striking, characteristic symptoms of this pathology is that it is impossible to raise the leg in the prone position. In addition to acute pain in the pubis, there are difficulties when walking up the stairs, it becomes difficult to turn from side to side on the bed and get up from the sofa, and the gait changes and becomes like a "duck". According to most doctors, the cause of symphysiopathy is a lack of calcium, an increased concentration of the hormone relaxin, and increased physical activity on the bones of the pelvic region. In addition, the development of symphysiopathy can be provoked by a serious sports injury or a fracture of the pelvic bones. nine0005

At what stage of pregnancy do they occur?

The disease begins gradually or suddenly during pregnancy, childbirth or after childbirth. Most often, women begin to feel pain in the area of ​​the pubic joint in the third trimester of pregnancy. This is due to the fact that the places of adhesions of the pubic bones, their ligaments and cartilage, soften under the influence of the hormone relaxin. This hormone of pregnancy naturally softens the bony joints, which is necessary to facilitate the passage of the child's bone pelvis and birth canal at the time of childbirth. nine0005

Some women begin to complain of pain in the pelvic bones some time after giving birth. This may be the result of traumatic childbirth (imposition of obstetrical forceps, shoulder dystocia, excessive separation of the hips during childbirth, etc.) or physical exertion (lifting a heavy baby stroller up the stairs, prolonged motion sickness in the arms of a well-fed baby, etc.). It is recommended to limit physical activity, wear an orthopedic bandage, consult a traumatologist. Complaints usually recur after the next pregnancy. In a small proportion of patients, pain persists for a long time. nine0005

When can this be considered the norm, and when not?

Obstetricians-gynecologists do not consider a slight soreness of the pubic joint to be a pathology, but if the pain is acute, restricting the movements of the pregnant woman, accompanied by edema, then we can talk about pathology. Pain can be quite strong and especially manifest itself while walking, turning the body to the right and left in a sitting position and even lying down. In this case, you need to urgently consult a doctor and undergo an ultrasound diagnosis (ultrasound) to determine the size of the divergence of the pubic bones. Magnetic resonance imaging (MRI) is also used, which allows assessing the state of the symphysis, the state of the bone tissue, as well as soft tissues. nine0005

With ultrasound, the degree of divergence (diastasis) of the pubic bones is determined. The severity of the clinical picture largely depends on the degree of divergence of the pubic bones, and therefore there are three degrees of divergence of the pubic branches: in the first degree - by 6-9 mm, in the second - by 10-20 mm, in the third - more than 20 mm. The severity of the symptoms of the disease varies from mild discomfort to unbearable pain.

How can pain be relieved? nine0003

There are some recommendations that will help reduce bone pain during pregnancy, if the cause of its occurrence is the divergence of the pubic bones. Be sure to wear a bandage, especially in later pregnancy. The bandage takes on most of the load, thereby releasing pressure from the pubic joint. Limitation of heavy physical exertion is indicated for any manifestations of pain, lying down more often, walking less and being in a sitting position for no longer than 30-40 minutes. In severe cases, before and sometimes after childbirth, a woman may be shown strict bed rest. Moreover, the bed should not be hard and flat. nine0005

Since the appearance of symphysiopathy is associated not only with a large production of the hormone relaxin, but also with a lack of calcium in the body, the expectant mother is prescribed calcium preparations and complex vitamins for pregnant women, which contain all the necessary vitamins and trace elements in the right amount and proportions. There is evidence that pain is reduced during acupuncture and physiotherapy.

In especially severe cases of symphysiopathy, the pregnant woman is hospitalized. nine0005

What is the danger of this condition?

The occurrence of symphysiopathy is due to several reasons. This is a lack of calcium in the body of the future mother, and an excess amount of the hormone relaxin, and the individual structural features of the woman's body, and possible hereditary or acquired problems of the musculoskeletal system.

With an unexpressed clinical picture of the disease, with an expansion of the pubic fissure up to 10 mm, normal pelvic sizes, a small fetus, childbirth can be carried out through the birth canal, avoiding the use of physical force, such as the Christeller maneuver. With a pronounced stretching of the pubic symphysis, pain syndrome, especially with anatomical narrowing of the pelvis, a large fetus, there is a danger of rupture of the pubic symphysis, and the method of choice in this case is caesarean section. This is due to the fact that during natural delivery, the bones can disperse even more and the woman subsequently will not be able to walk at all.

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