Pregnancy and Carpal Tunnel Syndrome

 For many women, sporting a baby bump comes with an unexpected surprise-symptoms of carpal tunnel syndrome! A recent article has estimated that more than 20% of pregnant women get carpal tunnel syndrome, which is compression of a nerve where it lies in a small tunnel, at the level of the wrist. It's usually diagnosed in the third trimester.

So the first question is, "Why is this happening?" Well with pregnancy, hormonal changes may be a contributor but more likely it's due to an overall increase in fluid volume. Since the carpal tunnel is normally a tight space, the extra fluid constricts the contents of the tunnel even more, placing pressure on the median nerve. Gestational diabetes can also play a role by slowing the speed at which the nerve transmits signals. The symptoms that result are pain in the wrist or hand and pins and needles sensations, particularly in the thumb and first three fingers.

The second question is "What can be done about it?" Luckily, most cases resolve between the fourth and sixth weeks after delivery, when most of the residual swelling has dissipated. In the meantime, wearing wrist splints or braces is recommended, especially while sleeping. The proper splint for carpal tunnel syndrome should keep the wrist in a straight position while allowing you to move your fingers and thumb. The splint or brace should extend approximately two-thirds up the length of your forearm. Using a flexible gel cold pack can also help to decrease the pain associated with carpal tunnel syndrome. Place the cold pack in a pillowcase to protect your skin. Wrap it around your wrist and hand for 8-10 minutes. This can be done several times a day.

If symptoms persists longer than one or two months after the baby is born, it may be because it has become a mechanical problem. The hands and arms of new moms get quite a workout, from lifting the newborn to diaper and clothing changes. When combined with the pressure placed on the nerve from the increased swelling during pregnancy, the new workload and awkward wrist positions when holding the baby can keep the cycle going. At this point, you should discuss your options with your doctor. A nerve conduction study, which is highly sensitive in detecting carpal tunnel syndrome, and an electromyography test is the likely next step in evaluating the problem. Further treatment decisions can be made based on the results of these two tests. Many cases of pregnancy-related carpal tunnel syndrome respond to conservative treatment, including gentle exercises, techniques to reduce pain and inflammation, and modifying daily activities.

Jessica Karge and Kathleen Papi-Baker are both occupational therapists and certified hand therapists, with over 40 years of clinical experience. Their company, Treat Yourself Therapy, LLC develops do-it-yourself therapy programs for common conditions, including tennis elbow, golfer's elbow, carpal tunnel syndrome, and thumb arthritis.


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