Carpal tunnel syndrome is particularly common in women who are pregnant. Some studies estimate that as many as 50% of pregnant women will experience carpal tunnel syndrome. The true incidence is still unknown, but experts agree that it is very common, second only to lower back/pelvic pain during pregnancy (Smith et. al 1998).
Carpal tunnel is characterized by nerve symptoms in the hands, wrists, and forearms. The affected nerve is the median nerve and it travels through the narrow passage in the wrist called the carpal tunnel. The median nerve innervates the palm side of the wrist and hand, with branches going to:
- The palm side of the thumb
- Index finger
- Long finger
- Part of the ring finger
Symptoms of carpal tunnel syndrome can include numbness, tingling, throbbing, pain, and weakness in the hands, wrists and forearms. The symptoms can occur in both hands, but the dominant hand is usually most affected. Carpal tunnel syndrome symptoms most commonly present in the third trimester.
The exact cause of carpal tunnel syndrome during pregnancy is still unknown. It is believed to be multifactorial and associated with the many changes which occur during pregnancy. During the approximate 40 weeks of pregnancy there are:
- Musculoskeletal changes
- Hormonal changes
- Blood volume changes
- Glucose sensitivity changes
- Weight changes
- Fluid retention changes
- Etc.
The combination of these changes can not only affect the available space in the already narrow passageway that is the carpal tunnel, but also the median nerve’s sensitivity to compression. Fluid retention or edema in the hand, is the most linked to the development of carpal tunnel syndrome during pregnancy. A practical sign for edema in the wrist and hands is not being able to wear a previously comfortable ring on your ring finger while pregnant. In fact, pregnant patients with enough swelling in their hands to prevent them from wearing their rings, are at increased risk of developing carpal tunnel syndrome (Osterman et. al 2012).
Diagnosis and Treatment:
Pregnancy related carpal tunnel syndrome is diagnosed in the office by manual clinical exams which often reproduce the symptoms. The need for further testing is assessed on an individual basis. Since most cases resolve after pregnancy, electrodiagnostic testing can often be avoided.
Non-invasive, conservative treatments are the first line of defense. One or a combination of the following treatment options is used here in the office:
- Soft-tissue manual adhesion release to allow the median nerve to floss through the carpal tunnel with less irritation
- Therapeutic exercises – for the hands, forearms and wrists
- Nighttime neutral wrist splint – to minimize anatomic pressure on the median nerve
- Activity modification recommendations – identifying and modifying aggravating activities
- Nutritional recommendations – a low salt diet, etc.
It’s important to note that most cases of pregnancy related carpal tunnel syndrome resolve after pregnancy. Therefore, invasive treatments like surgery are reserved for only a small percentage of cases. Other treatment options for the rare, non-responsive cases which need to be referred out, include (Turgut 2001 et. al):
- Anti-inflammatory medications
- Diuretic
- Injection therapy
- Surgical intervention
Pregnancy related carpal tunnel syndrome responds well to non-invasive treatments for managing symptoms during the pregnancy. It is believed that most cases resolve fully after pregnancy without the need for more invasive treatments, such as carpal tunnel release surgery. In the small minority of cases in which surgery is required, outcomes are generally good. Some women may require continuation of care for carpal tunnel syndrome after the pregnancy. The static postures and repetitive movements associated with holding, carrying, and feeding the baby may be why some women have a more prolonged recovery.
It is important to monitor carpal tunnel syndrome for progression of symptoms as these may be signs of the need for further testing or more invasive treatments.
©CenterForMusculoskeletalFunction2018
References
Courts, R. B. (1995). Splinting for Symptoms of Carpal Tunnel Syndrome during Pregnancy. Journal of Hand Therapy, 8(1), 31-34. doi:10.1016/s0894-1130(12)80154-2
Lazaro, R. P., & Eagan, T. (2017). Concurrent musculoskeletal and soft tissue pain in the upper extremity can affect the treatment and prognosis of carpal tunnel syndrome: redefining a common condition. Journal of Pain Research, Volume 10, 2497-2502. doi:10.2147/jpr.s142153
Osterman, M., Ilyas, A. M., & Matzon, J. L. (2012). Carpal Tunnel Syndrome in Pregnancy. Orthopedic Clinics of North America, 43(4), 515-520. doi:10.1016/j.ocl.2012.07.020
Stolp-Smith, K. A., Pascoe, M. K., & Ogburn, P. L. (1998). Carpal tunnel syndrome in pregnancy: Frequency, severity, and prognosis. Archives of Physical Medicine and Rehabilitation, 79(10), 1285-1287. doi:10.1016/s0003-9993(98)90276-3
Turgut, F., Cetinsahin, M., Turgut, M., & Bolukbasi, O. (2001). The management of carpal tunnel syndrome in pregnancy. Journal of Clinical Neuroscience, 8(4), 332-334.
Wand, J. S. (1989). The Natural History of Carpal Tunnel Syndrome in Lactation. Journal of the Royal Society of Medicine, 82(6), 349-350. doi:10.1177/014107688908200612
